RESUMO
BACKGROUND: This study assessed the clinical effects of a ventilatory assist (VA) device in addition to supplemental O2 (VA+O2) on exercise endurance in subjects with severe to very severe COPD managed with long-term oxygen therapy (LTOT). METHODS: This was a crossover clinical feasibility study of the effects of VA+O2 in subjects with severe to very severe COPD managed with LTOT (N = 15). At visit 1, physiologic measures were obtained, and subjects were tested on the cycle ergometer with VA. Peak work rate and flow for continuous supplemental O2/VA+O2 were established. At visit 2, subjects exercised at a constant work rate of 80% peak work rate to maximum endurance after allocation to VA+O2 or O2. Cardiorespiratory variables, work rate, and dyspnea were included to define potential clinical benefits of VA+O2. Data were analyzed using a linear mixed model. RESULTS: Fifteen subjects with COPD (mean ± SD, age 67.9 ± 9.0 y, FEV1 0.89 ± 0.35 observed) completed the study. Exercise duration in minutes was significantly longer with VA+O2 versus O2 (least squares mean [standard error], 12.0 [2.0] vs 6.2 [2.0], P = .01). VA+O2 versus O2 was also associated with significantly greater isotime improvements in Borg dyspnea scores (3.6 [0.5] vs 5.7 [0.5], P < .001), SpO2 (96.9 [0.9] vs 91.4 [0.9], P < .001), leg fatigue scores (3.8 [0.6] vs 5.2 [0.6], P = .008), and breathing frequency (22.8 [0.9] vs 25.8 [0.9] breaths/min, P = .01). There were no differences in heart rate. CONCLUSIONS: In symptomatic subjects with severe to very severe COPD, VA+O2 significantly increased exercise time and improved dyspnea, SpO2 , breathing frequency, and leg fatigue versus O2 alone.
RESUMO
BACKGROUND: The AERx Pain Management System (Aradigm Corporation, Hayward, CA) is a novel pulmonary delivery system for the systemic administration of morphine. The authors compared the relative analgesic efficacy and safety of the AERx Pain Management System with those of placebo and intravenous morphine in an orthopedic postsurgical pain model. METHODS: Eighty-nine male and female PS-1 to PS-3 patients underwent standardized bunionectomy surgery and received multiple doses of inhaled or intravenous placebo, inhaled morphine (one inhalation [2.2 mg] or three inhalations [6.6 mg]), or intravenous morphine (4 mg) in a blinded fashion. Open-label rescue morphine (2 mg) was also available as needed. Pain intensity, pain relief, and time to pain relief were measured after the first dose. Global evaluation, morphine consumption, vital signs, and adverse events were monitored for 8 h after treatment. Blinded study personnel performed all treatment administrations and pain assessments. RESULTS: Three inhalations of morphine and 4 mg intravenous morphine provided comparable single- and multiple-dose analgesia. One inhalation of morphine was statistically indistinguishable from placebo. Three inhalations of morphine and 4 mg intravenous morphine both consistently demonstrated significantly greater analgesic efficacy than did placebo and one inhalation of morphine. CONCLUSIONS: Comparable analgesic efficacy was demonstrated between a carefully matched dose of inhaled and intravenous morphine in a postsurgical pain model.