• Resp Care · Jul 2010

    Randomized Controlled Trial

    Adjuncts to physical training of patients with severe COPD: oxygen or noninvasive ventilation?

    • Audrey Borghi-Silva, Renata Gonçalves Mendes, Andreza Cristina Toledo, Malosá Sampaio Luciana Maria LM, Tatiane Patrocínio da Silva, Luciana Noemi Kunikushita, Dutra de Souza Hugo Celso HC, Tânia F Salvini, and Dirceu Costa.
    • Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, Washington Luis, Km 235 São Carlos, São Paulo 13565-905, Brazil. audrey@ufscar.br
    • Resp Care. 2010 Jul 1; 55 (7): 885-94.

    BackgroundPrevious studies have shown positive effects from noninvasive ventilation (NIV) or supplemental oxygen on exercise capacity in patients with COPD. However, the best adjunct for promoting physiologic adaptations to physical training in patients with severe COPD remains to be investigated.MethodsTwenty-eight patients (mean +/- SD age 68 +/- 7 y) with stable COPD (FEV(1) 34 +/- 9% of predicted) undergoing an exercise training program were randomized to either NIV (n = 14) or supplemental oxygen (n = 14) during group training to maintain peripheral oxygen saturation (S(pO2)) >/= 90%. Physical training consisted of treadmill walking (at 70% of maximal speed) 3 times a week, for 6 weeks. Patients were assessed at baseline and after 6 weeks. Assessments included physiological adaptations during incremental exercise testing (ratio of lactate concentration to walk speed, oxygen uptake [V (O2)], and dyspnea), exercise tolerance during 6-min walk test, leg fatigue, maximum inspiratory pressure, and health-related quality of life.ResultsTwo patients in each group dropped out due to COPD exacerbations and lack of exercise program adherence, and 24 completed the training program. Both groups improved 6-min walk distance, symptoms, and health-related quality of life. However, there were significant differences between the NIV and supplemental-oxygen groups in lactate/speed ratio (33% vs -4%), maximum inspiratory pressure (80% vs 23%), 6-min walk distance (122 m vs 47 m), and leg fatigue (25% vs 11%). In addition, changes in S(pO2)/speed, V (O2), and dyspnea were greater with NIV than with supplemental-oxygen.ConclusionsNIV alone is better than supplemental oxygen alone in promoting beneficial physiologic adaptations to physical exercise in patients with severe COPD.

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