PT  - JOURNAL ARTICLE
AU  - Bruno Baldi
AU  - Suzana Pimenta
AU  - André Albuquerque
AU  - Ronaldo Kairalla
AU  - Milena Suesada
AU  - Vanessa Pavezi
AU  - Fabiane Polisel
AU  - Carlos Carvalho
TI  - Impact of bronchodilator on pulmonary function and exercise tolerance in LAM
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p2137
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p2137.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p2137.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Rationale: Reduced exercise capacity in LAM patients is still slightly understood. As many patients have airflow obstruction and dynamic hyperinflation (DH) (abstract 4576, ATS 2010), bronchodilator (Bd) might be a plausible option.Objective: To evaluate the improvement with inhaled salbutamol in resting airflow obstruction, exercise tolerance and reversal of DH.Methods: 37 LAM patients (mean age 41±10 years; FEV1 79±24%pred; DLCO 68±24%pred) performed incremental CPET (incCPET) on cycle; decrease ≥ 10% in IC defined DH. So, a randomized double-blind crossover study (inhaled salbutamol x placebo) was done. After each intervention, they performed lung function (PFT) and endurance CPET (endCPET) (75% max work-rate). Exercise duration, Borg scale and IC were compared at isotime in endCPET after Bd and placebo.Results: 19 patients (51%) showed DH in incCPET, with max work-rate lower in DH group (93 × 115W, p=0.16) and higher values in Borg dyspnea (7 x 5, p=0.02). Compared to non-DH, DH group had lower DLCO (56 x 81%pred, p=0.001), lower FEV1 (76 x 89%pred, p=0.002) and greater RV/TLC (0.43 x 0.29, p<0.001). In general, Bd increased FEV1 (2.39 to 2.46L, p<0.001), with no effects on exercise duration (325 x 329s, p=0.75), delta IC (-0.22 x -0.22L, p=0.99) or Borg dyspnea (5 x 5, p=0.99). In DH group, Bd reduced RV/TLC (p=0.006) and Borg dyspnea (-1 x 1, p=0.003) more significantly, with no effects in the variation of duration (4 x 2, p=0.82) and of IC during CPET (60 x 60 mL, p=0.99).Conclusion: DH during exercise is frequent in LAM and is associated with resting airflow obstruction, reduced exercise capacity and higher breathlessness. Short-term Bd may exert a potential beneficial effect in DH patients.