Sara Abdallah

Effect of morphine on breathlessness and exercise endurance in advanced COPD: a randomised crossover trial

The objective of the present study was to evaluate the effect of morphine on exertional breathlessness and exercise endurance in advanced chronic obstructive pulmonary disease (COPD). In a randomised crossover trial, we compared the acute effect of immediate-release oral morphine versus placebo on physiological and perceptual responses during constant-load cardiopulmonary cycle exercise testing (CPET) in 20 adults with advanced COPD and chronic breathlessness syndrome. Compared with placebo, morphine reduced exertional breathlessness at isotime by 1.2±0.4 Borg units and increased exercise endurance time by 2.5±0.9 min (both p≤0.014). During exercise at isotime, morphine decreased ventilation by 1.3±0.5 L·min−1 and breathing frequency by 2.0±0.9 breaths·min−1 (both p≤0.041). Compared with placebo, morphine decreased exertional breathlessness at isotime by ≥1 Borg unit in 11 participants (responders) and by <1 Borg unit in nine participants (non-responders). Baseline participant characteristics, including pulmonary function and cardiorespiratory fitness, were similar between responders and non-responders. A higher percentage of responders versus non-responders stopped incremental CPET due to intolerable breathlessness: 82 versus 33% (p=0.028). Immediate-release oral morphine improved exertional breathlessness and exercise endurance in some, but not all, adults with advanced COPD. The locus of symptom-limitation on laboratory-based CPET may help to identify patients most likely to benefit from morphine. Immediate-release oral morphine decreased exertional breathlessness and improved exercise endurance in advanced COPD http://ow.ly/mrHQ30dS2qS

Abdominal Binding Improves Neuromuscular Efficiency of the Human Diaphragm during Exercise

We tested the hypothesis that elastic binding of the abdomen (AB) would enhance neuromuscular efficiency of the human diaphragm during exercise. Twelve healthy non-obese men aged 24.8 ± 1.7 years (mean ± SE) completed a symptom-limited constant-load cycle endurance exercise test at 85% of their peak incremental power output with diaphragmatic electromyography (EMGdi) and respiratory pressure measurements under two randomly assigned conditions: unbound control (CTRL) and AB sufficient to increase end-expiratory gastric pressure (Pga,ee) by 5–8 cmH2O at rest. By design, AB increased Pga,ee by 6.6 ± 0.6 cmH2O at rest. Compared to CTRL, AB significantly increased the transdiaphragmatic pressure swing-to-EMGdi ratio by 85–95% during exercise, reflecting enhanced neuromuscular efficiency of the diaphragm. By contrast, AB had no effect on spirometric parameters at rest, exercise endurance time or an effect on cardiac, metabolic, ventilatory, breathing pattern, dynamic operating lung volume, and perceptual responses during exercise. In conclusion, AB was associated with isolated and acute improvements in neuromuscular efficiency of the diaphragm during exercise in healthy men. The implications of our results are that AB may be an effective means of enhancing neuromuscular efficiency of the diaphragm in clinical populations with diaphragmatic weakness/dysfunction.

Effect of Vaporized Cannabis on Exertional Breathlessness and Exercise Endurance in Advanced Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial

Rationale: A series of studies conducted approximately 40 years ago demonstrated an acute bronchodilator effect of smoked cannabis in healthy adults and adults with asthma. However, the acute effects of vaporized cannabis on airway function in adults with advanced chronic obstructive pulmonary disease (COPD) remain unknown. Objectives: To test the hypothesis that inhaled vaporized cannabis would alleviate exertional breathlessness and improve exercise endurance by enhancing static and dynamic airway function in COPD. Methods: In a randomized controlled trial of 16 adults with advanced COPD (forced expiratory volume in 1 second [FEV1], mean ± SD: 36 ± 11% predicted), we compared the acute effect of 35 mg of inhaled vaporized cannabis (18.2% &Dgr;9‐tetrahydrocannabinol, <0.1% cannabidiol) versus 35 mg of a placebo control cannabis (CTRL; 0.33% &Dgr;9‐tetrahydrocannabinol, <0.99% cannabidiol) on physiological and perceptual responses during cardiopulmonary cycle endurance exercise testing; spirometry and impulse oscillometry at rest; and cognitive function, psychoactivity, and mood. Results: Compared with CTRL, cannabis had no effect on breathlessness intensity ratings during exercise at isotime (cannabis, 2.7 ± 1.2 Borg units vs. CTRL, 2.6 ± 1.3 Borg units); exercise endurance time (cannabis, 3.8 ± 1.9 min vs. CTRL, 4.2 ± 1.9 min); cardiac, metabolic, gas exchange, ventilatory, breathing pattern, and/or operating lung volume parameters at rest and during exercise; spirometry and impulse oscillometry‐derived pulmonary function test parameters at rest; and cognitive function, psychoactivity, and mood. Conclusions: Single‐dose inhalation of vaporized cannabis had no clinically meaningful positive or negative effect on airway function, exertional breathlessness, and exercise endurance in adults with advanced COPD. Clinical trial registered with www.clinicaltrials.gov (NCT03060993).

Opioids for breathlessness: Psychological and neural factors influencing variability in response

Effective management of distressing bodily symptoms (such as pain and breathlessness) is an important clinical goal. However, extensive variability exists in both symptom perception and treatment response. One theory for understanding variability in bodily perception is the ‘Bayesian Brian Hypothesis’, whereby symptoms may result from the combination of sensory inputs and prior expectations. In light of this theory, we explored the relationships between opioid responsiveness, behavioural/physiological symptom modulators and brain activity during anticipation of breathlessness. Methods We utilised two existing opioid datasets to investigate the relationship between opioid efficacy and physiological/behavioural qualities, employing hierarchical cluster analyses in: 1) a clinical study in chronic obstructive pulmonary disease, and 2) a functional magnetic resonance brain imaging study of breathlessness in healthy volunteers. We also investigated how opioid efficacy relates to anticipatory brain activity using linear regression in the healthy volunteers. Results Consistent across both datasets, diminished opioid efficacy was more closely associated with negative affect than with other physiological and behavioural properties. Furthermore, in healthy individuals, brain activity in the anterior cingulate and ventromedial prefrontal cortices during anticipation of breathlessness were inversely correlated with opioid effectiveness. Conclusion Diminished opioid efficacy for relief of breathlessness may be associated with high negative affective qualities, and was correlated with the magnitude of brain activity during anticipation of breathlessness. Clinical implications Negative affect and symptom expectations may influence perceptual systems to become less responsive to opioid therapy.

Does wearing clothing made of a synthetic “cooling” fabric improve indoor cycle exercise endurance in trained athletes?

This randomized, double‐blind, crossover study examined the effects of a clothing ensemble made of a synthetic fabric promoted as having superior cooling properties (COOL) on exercise performance and its physiological and perceptual determinants during cycle exercise in ambient laboratory conditions that mimic environmental conditions of indoor training/sporting facilities. Twenty athletes (15 men:5 women) aged 25.8 ± 1.2 years (mean ± SEM) with a maximal rate of O2 consumption of 63.7 ± 1.5 mL·kg−1·min−1 completed cycle exercise testing at 85% of their maximal incremental power output to exhaustion while wearing an ensemble consisting of a fitted long‐sleeved shirt and full trousers made of either COOL or a synthetic control fabric (CTRL). Exercise endurance time was not different under COOL versus CTRL conditions: 12.38 ± 0.98 versus 11.75 ± 1.10 min, respectively (P > 0.05). Similarly, COOL had no effect on detailed thermoregulatory (skin and esophageal temperatures), cardiometabolic, ventilatory, and perceptual responses to exercise (all P > 0.05). In conclusion, clothing made of a synthetic fabric with purported “cooling” properties did not improve high‐intensity cycle exercise endurance in trained athletes under ambient laboratory conditions that mimic the environmental conditions of indoor training/sporting facilities.