Dyspnea Clinical Trial
— CODExOfficial title:
Measurement of Exertional Dyspnea in the Primary Care Setting in Patients With COPD, Phase III: Sensitivity of the Step Test to Detect Improvement in Dyspnea Following Bronchodilation in Patients With COPD
During the previous phases of the project (Phase I and II), two new field tests have been designed and validated for an integration in a primary care setting in Chronic Obstructive Pulmonary Disease (COPD). These new field tests are 3-min paced-walk test (3MPWT) and 3-min paced step test (3MPST). If the validity and sensitivity of the TM3 could be highlighted, particularly by the reduction of dyspnea level following bronchodilatation, Phase II highlight that the 3MPST does not allow to detect this decrease of dyspnea after bronchodilatation. The use of too high step rates could explain these results through a hypothesis relative to neuromechanical coupling of dyspnea. The main objective of this trial is to follow the investigations on the sensitivity of 3MPST to detect the effects of pharmacological intervention on the exertional dyspnea in COPD patient. The hypothesis of this work is that the use of lower step rates cadences could allow to detect an improvement of exertional dyspnea following treatment-induced bronchodilatation, contrary to higher step rates.
Status | Recruiting |
Enrollment | 40 |
Est. completion date | July 2014 |
Est. primary completion date | July 2014 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 50 Years to 80 Years |
Eligibility |
Inclusion Criteria: - age higher than 50 years old - smoking history = 10 packs/year - post-bronchodilator FEV1 between 30 and 80% of the predicted value and FEV1/FVC lesser than 70% as assessed in previous pulmonary function test (corresponding to GOLD stages II and III) Exclusion Criteria: - respiratory exacerbation within the preceding 6 weeks - asthmatic condition - significant O2 desaturation (SaO2 < 85%) at rest or during exercise - presence of another pathology that could influence exercise tolerance or may prevent the realization of the step test - subject having a pacemaker |
Intervention Model: Single Group Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Diagnostic
Country | Name | City | State |
---|---|---|---|
Canada | Montreal Chest Institute - McGill University | Montréal | Quebec |
Canada | Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval | Québec | Quebec |
Lead Sponsor | Collaborator |
---|---|
Laval University | Université de Montréal |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Symptom perception | Patients will be asked to score their dyspnea and leg discomfort perception using a 10-point Borg scale. | change from baseline in Borg Scale at 3 min of exercise | No |
Secondary | Cardiac and ventilatory outcomes | Metabolic, cardiac and ventilatory parameters will be measured using a metabolic cart. Principal outcomes will be oxygen uptake (VO2), carbon dioxide output (VCO2), ventilation (VE), breathing frequency (BF), tidal volume (Vt) and heart rate (HR). | Change from baseline at 3 minutes of exercise | No |
Secondary | Inspiratory capacity | Inspiratory capacity will be measured at rest and at the end of the 3-min step test (immediately following the assessment of dyspnea at 3 minutes). | Change from baseline at the end of the exercise. | No |
Secondary | Respiratory pressures and diaphragm EMG | Tidal excursion in pleural pressure will be measured using an oesophageal balloon-catheter system that will be positioned using standardized technique (n=40). Gastric and transdiaphragmatic pressures as well as the diaphragm electromyogram will be recorded in the 20 subjects studied at McGill University using a multipair esophageal electrode-balloon catheter. | Change from baseline at 1, 2 and 3 minutes of exercise | No |
Secondary | Pulmonary function | Pulmonary function will be measured by spirometry and plethysmography in the initial visit. In the subsequent visits, pulmonary function will be evaluated by spirometry before and 60-min after the nebulization of either placebo or bronchodilator. | At baseline and 60-min after the nebulization of either placebo and bronchodilator | No |
Secondary | Maximal oxygen consumption | Exercise capacity will be directly assessed following an incremental cycle exercise test. The exercise capacity was defined as the maximal oxygen consumption (VO2 peak, ml/kg/min) by direct measurements of gas exchanges. | Change from baseline at 1, 2 and 3 minutes of exercise | No |
Secondary | Maximal inspiratory pressure (PImax) | The maximum inspiratory pressure (PImax) will be measured during a sniff manoeuvre. These measurements will allow to construct the ratio of respiratory effort (tidal Pes/PImax) to thoracic displacement (VT/predicted VC), an index of neuromechanical coupling | Change from baseline after 3 minutes of exercise | No |
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