Exercise limitation is a hallmark of chronic obstructive pulmonary disease (COPD) and countering this is a major therapeutic goal. Chapter 1 considers the factors contributing to exercise intolerance with particular reference to the respective roles of ventilatory limitation and skeletal muscle dysfunction. A review of the strategies studied or currently used to counter exercise limitation then follows. Chapter 2 describes the methodology of the assessments of exercise limitation used in this thesis, along with an evaluation of other currently available techniques. Chapter 3 describes how different means of body composition evaluation can effect the functional conclusions made from the data obtained. Assessment of peak exercise capacity related to muscle mass was found to be underestimated by anthropometry in comparison to air displacement plethysmography or bioelectrical impedance. It is concluded that inter-method differences in estimation of fat-free mass are large enough to require that a single methodology of assessment is used for comparative evaluations. Chapter 4 describes a trial of creatine supplementation, both in isolation and in combination with exercise training. Muscle mass, strength and endurance, and health status were all enhanced by creatine, with or without exercise training. Whole body exercise capacity, when examined by field and laboratory tests, was not affected. It is concluded that creatine may be a potentially useful ergogenic agent for use in COPD patients. Chapter 5 describes a crossover study of formoterol, a long acting bronchodilator, in advanced COPD patients with poor spirometric response to bronchodilation. Formoterol is shown to decrease exercise induced dynamic hyperinflation and breathlessness during activities. An equivocal effect on exercise tolerance is demonstrated. This study supports the rational for the use of long acting bronchodilators in symptomatically limited COPD patients, largely irrespective of individuals lung function response to bronchodilator. Chapter 6 considers the implications of the work performed and suggests lines of investigation for future research.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:761838 |
| Date | January 2004 |
| Creators | Fuld, Jonathan Paul |
| Publisher | University of Glasgow |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://theses.gla.ac.uk/39037/ |
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