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Effects of Cardioselective β-blockers on Dynamic Hyperinflation in COPD

Primary Purpose

Chronic Obstructive Pulmonary Disease

Status
Completed
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Bisoprolol
Placebo
Sponsored by
Laval University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Obstructive Pulmonary Disease focused on measuring chronic obstructive pulmonary disease, exercise, dynamic hyperinflation, cardioselective beta blockers

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • age: >50 years old;
  • cigarette exposure: >10 pack-year;
  • moderate-to-severe COPD (Forced expiratory volume in one second/Forced vital capacity (FEV1/FVC) <70%; FEV1 between 30 to 80% predicted).

Exclusion Criteria:

  • previous bronchospasm induced by beta-blockers;
  • respiratory exacerbation in the previous 8 weeks;
  • long-term oxygen therapy or arterial oxygen saturation <85% at rest;
  • known coronary artery disease with persistent symptoms or persistent myocardial ischemia on cardiac imaging;
  • left ventricular ejection fraction <40%;
  • current treatment with oral corticosteroids;
  • intrinsic musculoskeletal abnormality precluding exercise testing;
  • medical condition for which the patient is currently treated with beta-blockers.

Sites / Locations

  • Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Bisoprolol

Sugar pill

Arm Description

Outcomes

Primary Outcome Measures

Dynamic hyperinflation
Dynamic hyperinflation assessed during a cycle endurance test

Secondary Outcome Measures

Exercise tolerance
Exercise time during cycle endurance test
Respiratory symptoms during exercise
Borg dyspnea and leg fatigue (0 to 10 scale)
Resting lung function
Standard pulmonary function tests

Full Information

First Posted
November 24, 2010
Last Updated
June 22, 2011
Sponsor
Laval University
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1. Study Identification

Unique Protocol Identification Number
NCT01273298
Brief Title
Effects of Cardioselective β-blockers on Dynamic Hyperinflation in COPD
Official Title
Effects of Cardioselective Beta-blockers on Dynamic Hyperinflation in Moderate-to-severe Chronic Obstructive Pulmonary Disease (COPD)
Study Type
Interventional

2. Study Status

Record Verification Date
November 2010
Overall Recruitment Status
Completed
Study Start Date
June 2008 (undefined)
Primary Completion Date
September 2010 (Actual)
Study Completion Date
October 2010 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Laval University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Patients with chronic obstructive pulmonary disease (COPD) are at greater risk of suffering from diseases for which beta-blockers may be indicated and effective. Clinicians remain hesitant to administer beta-blockers to COPD patients for fear of adverse effects on lung function. However, cardioselective beta-blockers therapy led to a non-significant worsening of resting expiratory flow limitation measured by the forced expiratory volume in one second (FEV1) as compared to placebo. But, the FEV1 appears to be a crude estimate bronchial obstruction in COPD. Importantly, the effects of cardioselective beta-blockers on dynamic hyperinflation, a subtle marker of bronchial obstruction, remain unknown. Thus, a prospective placebo-controlled study assessing the effects of short-term cardioselective beta-blocker therapy on dynamic hyperinflation in patients with moderate-to-severe COPD is needed.
Detailed Description
Beta-blockers are indicated in the management of numerous medical conditions including angina pectoris, myocardial infarction, hypertension, congestive heart failure, cardiac arrhythmia, systemic hypertension, as well as to reduce complications in the perioperative period. Patients with chronic obstructive pulmonary disease (COPD) are at greater risk of such conditions and may therefore benefit from the use of beta-blockers. Despite clear evidence of their effectiveness, clinicians are often hesitant to administer beta-blockers in COPD patients for fear of adverse effects on lung function. Indeed, the pathophysiologic hallmark of COPD is expiratory flow limitation. Because beta-adrenergic receptors participate to bronchial dilatation, review articles and practice guidelines traditionally listed asthma and COPD as relative contraindications to beta-blocker use, citing cases of acute bronchospasm occurring during beta-blocker exposure. However, cardioselective betablockers have over 20 times more affinity for beta-1 receptors as for beta-2 receptors, and theoretically should have significantly less risk for bronchoconstriction. Cardioselective beta-blockers include atenolol, metoprolol, bisoprolol and acebutolol. A recent Cochrane analysis documented the safety of cardioselective beta-blockers in COPD. Indeed, single doses of cardioselective beta-blockers as well as treatment of longer duration ranging from 2 days to 12 weeks led to a non-significant worsening in lung function compared to placebo. Expiratory flow limitation is commonly assessed by forced expiratory volume in one second (FEV1). However, the FEV1 appears to be a crude estimate bronchial obstruction in COPD. Indeed, the relationship between the physiologic impairment, as traditionally measured by FEV1, and the characteristic symptom of COPD is not straightforward. Dyspnea appears to be more related to dynamic hyperinflation occurring during exercise than to FEV1 measured at rest. Lung hyperinflation is defined as an abnormal increase in the volume of air remaining in the lungs at the end of spontaneous expiration. For example, bronchodilators, which generally have minimal effect on FEV1 in COPD, work by improving dynamic airway function, allowing improved lung emptying with each breath. This allows the patient to achieve the required alveolar ventilation during rest and exercise at a lower operating lung volume and thus at a lower oxygen cost of breathing. Exercise can proceed for a longer duration before the mechanical limitation to ventilation is reached. Changes in dynamic hyperinflation are thus representative of subtle changes in bronchial obstruction. Importantly, the effects of cardioselective beta-blockers on dynamic hyperinflation, a subtle marker of bronchial obstruction, remain unknown. The aim of this prospective, randomized, double blind and crossover study is to assess the effects of short-term cardioselective beta-blocker therapy on dynamic hyperinflation and on exercise tolerance and symptoms in patients with moderate-to-severe COPD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Obstructive Pulmonary Disease
Keywords
chronic obstructive pulmonary disease, exercise, dynamic hyperinflation, cardioselective beta blockers

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
27 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bisoprolol
Arm Type
Experimental
Arm Title
Sugar pill
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Bisoprolol
Other Intervention Name(s)
Monocor (02241148)
Intervention Description
Patients will be assigned to bisoprolol per os or matching placebo per os daily for 14 days. Bisoprolol will be initiated at a dose of 2.5mg daily for the first two days then up-titrated to 5mg daily for two other days. And finally, bisoprolol will be up-titrated to 10mg daily for the remaining 10 days.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Sugar pill
Intervention Description
Patients will be assigned to bisoprolol per os or matching placebo per os daily for 14 days. Bisoprolol will be initiated at a dose of 2.5mg daily for the first two days then up-titrated to 5mg daily for two other days. And finally, bisoprolol will be up-titrated to 10mg daily for the remaining 10 days.
Primary Outcome Measure Information:
Title
Dynamic hyperinflation
Description
Dynamic hyperinflation assessed during a cycle endurance test
Time Frame
14 days
Secondary Outcome Measure Information:
Title
Exercise tolerance
Description
Exercise time during cycle endurance test
Time Frame
14 days
Title
Respiratory symptoms during exercise
Description
Borg dyspnea and leg fatigue (0 to 10 scale)
Time Frame
14 days
Title
Resting lung function
Description
Standard pulmonary function tests
Time Frame
14 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: age: >50 years old; cigarette exposure: >10 pack-year; moderate-to-severe COPD (Forced expiratory volume in one second/Forced vital capacity (FEV1/FVC) <70%; FEV1 between 30 to 80% predicted). Exclusion Criteria: previous bronchospasm induced by beta-blockers; respiratory exacerbation in the previous 8 weeks; long-term oxygen therapy or arterial oxygen saturation <85% at rest; known coronary artery disease with persistent symptoms or persistent myocardial ischemia on cardiac imaging; left ventricular ejection fraction <40%; current treatment with oral corticosteroids; intrinsic musculoskeletal abnormality precluding exercise testing; medical condition for which the patient is currently treated with beta-blockers.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steeve Provencher, MD, M.Sc
Organizational Affiliation
Laval University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ)
City
Québec
State/Province
Quebec
ZIP/Postal Code
G1V 4G5
Country
Canada

12. IPD Sharing Statement

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Effects of Cardioselective β-blockers on Dynamic Hyperinflation in COPD

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