PracticeUpdate Conference Series: ERS 2018

Targeted LungDenervationLinked to Improvement in Symptoms of COPD Patients with COPD suffer fewer respiratory-related problems when treated with targeted lung denervation. F irst results with targeted lung dener- vation (TLD) in patients with chronic obstructive pulmonary disease nerves interrupts their normal function. The airways then relax and widen, mucus production is decreased, and airway wall inflammation decreases as well.

Dr. Slebos noted that there was a trend toward better lung function and improved quality of life in patients who received treatment, which will significantly impact healthcare costs for these patients. He also explained that the number of patients requiring hospitalization for respiratory complications decreased by over 50% in the first year in patients receiving TLD treatment compared with those in the sham arm. TLD involves passing a catheter through a bronchoscope into the lungs. Radiofrequency energy to the airway

(COPD) have shown significantly reduced symptoms and good tolerability, reports the AIRFLOW 2 phase II clinical trial. Dirk-Jan Slebos, MD, PhD, of the University Medical Centre Groningen in The Netherlands, explained that a group of COPD patients on aggressive medical therapy has exhibited significantly reduced chronic respiratory symptoms, including disease exacerbations, shortness of breath, infections, and hospitalizations.

AIRFLOW-2 is taking place in several centers in six European countries. Patients are randomized to either TLD or a sham procedure under general anesthesia. The sham procedure also involves inserting the bronchoscope and catheter, but the radiofrequency electrical change is not delivered. TLD targets the cholinergic pathway. Anticholinergic drugs, which are often

Nitrate SupplementationEnhances Pulmonary Rehabilitation inPatientsWithCOPD Supplementation of the diet with nitrate improves pulmonary rehabilitation and exercise endurance time in patients with COPD.

I n patients with chronic obstructive pulmonary disease (COPD), dietary nitrate supplementation reduces the oxygen cost of peak exercise and raises exercise endurance time via improved skel- etal muscle blood flow and efficiency of energy metabolism and thus has the potential to augment the effect of exercise training. This conclusion, based on results of a multicenter, double-blind, placebo-controlled, parallel group comparison, was presented at ERS 2018. Matthew Pavitt, MBBS, PhD, of the Royal Brompton & Harefield National Health Service Trust in Harefield, UK, and colleagues set out to determine whether adjunctive dietary nitrate supplementation enhances the effects of pulmonary rehabilitation and exercise endurance time in stable COPD. They hypothesized that dietary nitrate supplemen- tation would enhance the gains in incremental shuttle walk test in the context of pulmonary reha- bilitation in patients with COPD versus placebo. The effect of 140 mL (12.9 mmol) of nitrate-rich beetroot juice was compared with that of matched placebo, nitrate-depleted beetroot juice. Patients consumed one of these beverages 3 hours before attending pulmonary rehabilitation sessions only (n=122).

The pulmonary rehabilitation program consisted of twice-weekly strength and endurance training over 8 weeks and education. Primary outcomes included change in distance on the incremental shuttle walk test and exercise endurance time via the endurance shuttle walk test, assessed 3 h after ingesting nitrate-rich or nitrate-depleted beetroot juice. A total of 166 patients were recruited, and 122 com- pleted the full protocol (female, 40%; age, 76 ± 11 years; body mass index, 27± 7 kg/m 2 ; forced expir- atory volume in 1 s, percent predicted 49% ± 18%; baseline distance of 284.9 ± 152.8 m on the incre- mental shuttle walk test). Nitrate supplementation increased distance on the incremental shuttle walk test significantly: nitrate- rich beetroot juice 60 m versus placebo 30 m (95% CI 10, 40), P = .008. A total of 20 patients (female 40%, age 67.6 ± 8.5 years, body mass index 25.2 ± 4.7 kg/m 2 , forced expiratory volume in 1 s percent predicted 27% ± 8.1%) completed the incremental shuttle walk test. Nitrate supplementation increased exercise endurance time significantly: beetroot juice 194.6 s (89.1–1200.0 s) versus placebo 159.1 s (78.6–785.0 s).

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PRACTICEUPDATE CONFERENCE SERIES • ERS 2018