Abstract\nBackground: This study evaluated the effects of aclidinium bromide, a long-acting muscarinic antagonist indicated\nfor maintenance treatment of chronic obstructive pulmonary disease (COPD), on exercise endurance, dyspnea, lung\nhyperinflation, and physical activity.\nMethods: In this randomized, double-blind, crossover study, patients with stable COPD and moderate-to-severe\nairflow limitation received aclidinium 400 ?g twice daily or placebo via Genuair�®/Pressair�®a for 3 weeks (2-week\nwashout between treatment periods). The primary endpoint was change from baseline to Week 3 in endurance\ntime, measured by constant work rate cycle ergometry testing at 75% peak incremental work rate. Changes from\nbaseline in intensity of exertional dyspnea (Borg CR10 Scale�®) and trough inspiratory capacity were secondary\nendpoints. Additional endpoints included changes from baseline in other spirometric, plethysmographic, and physical\nactivity (assessed by objective accelerometer measurement) parameters. Efficacy endpoints were analyzed using an\nanalysis of covariance model.\nResults: In total, 112 patients were randomized and treated (mean age 60.3 years; mean post-bronchodilator\nforced expiratory volume in 1 s 1.7 L [56.7% predicted]; mean endurance time 485.7 s). After 3 weeks, endurance\ntime was significantly increased with aclidinium versus placebo (treatment difference 58.5 s; p < 0.05). At Week 3,\naclidinium significantly reduced dyspnea intensity at isotime during exercise (treatment difference ?0.63; p < 0.05)\nand improved trough inspiratory capacity (treatment difference 78 mL; p < 0.05) versus placebo. Significant\nimprovements in spirometric, plethysmographic, and some physical activity parameters were observed with aclidinium\nversus placebo.\nConclusions: These results suggest that aclidinium significantly improves exercise endurance, exertional dyspnea,\nhyperinflation, and physical activity in patients with COPD.
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