Effects of acute dual bronchodilator treatment (tiotropium + olodaterol) on cardiopulmonary interactions in hyperinflated patients with COPD

We investigated whether lower operating lung volumes after inhaled bronchodilators are associated with beneficial effects on central (stroke volume and cardiac output) and peripheral (skeletal muscle blood flow) hemodynamic responses to exercise in COPD. In a double-blind, single-dose and placebo-controlled study, 20 patients with moderate-to-severe COPD (12 males, 69.4 ± 13.2yrs, FEV 1 = 47 ± 12%, and FRC=154 ± 31% pred) performed, at least 48 hrs apart, high intensity (75% peak work rate) exercise tests after tiotropium+olodaterol Respimat TM (TIO-OLO) or placebo. Impedance cardiography and near-infrared spectroscopy (using the indocyanine green dye) assessed central and peripheral hemodynamics, respectively. TIO-OLO significantly improved resting lung function, operating lung volumes, and exercise tolerance compared to placebo (p Similar results were found in a post-hoc analysis in which patients showing larger lung deflation with TIO-OLO were contrasted with their counterparts (p>0.05). The beneficial effects of TIO-OLO fixed combination on resting and operating lung volumes (i.e., lung deflation) did not translate into enhanced central or peripheral hemodynamics in hyperinflated patients with moderate to severe COPD.