The aim of this interventional, randomized, double-blind, monocentric, cross-over study is to quantify the possible deleterious effect on the cardiac autonomic nervous system control of two long-acting anticholinergic bronchodilatators (tiotropium and glycopyrronium) and one beta-2 agonist long-acting bronchodilatator (indacaterol ) in patients with mild COPD.
This is a cross-over study with randomization in terms of 4 treatments: two long-acting muscarinic antagonists (tiotropium and glycopyrronium), one long-acting beta-adrenoceptor agonist(indacaterol) and placebo. Each subject will pass 4 experimental random sessions, separated by at least 48 hours given the pharmacokinetic properties of the drugs tested. During each of the 4 sessions, blood pressure will be measured. Drugs inhaled by the patient will be prepared and administered by the nurse according to the randomization schedule. Patients and investigators will be blinded regarding the administered drug/placebo (anonymized inhaler). After 15 minutes (at rest, at neutral temperature), patients will have continuous measurement of blood pressure and heart rate (by a sphygmomanometer) (1) in supine position and (2) after a passive tilt test on a tilt test table. A flow-volume loop (BDV) will be performed after the tilt table test (measurement of Forced expiratory volume in 1 second (FEV1) and FVC).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
42
Centre Hospitalier Régional Universitaire
Besançon, France
Low-frequency (LF)/High-frequency (HF) ratio in supine position during a tilt table test after bronchodilators inhalation
For each patient, the LF/HF ratio after inhalation of an active drug (indacaterol or glycopyrronium or tiotropium) will be compared to LF / HF ratio measured after inhalation of a placebo.
Time frame: 10 minutes
Slope of baroreflex in supine position
Drugs vs placebo
Time frame: 10 minutes
LF / HF ratio derived from the spectral analysis of R-R intervals measured after verticalisation during a tilt table test
Drugs vs placebo
Time frame: 10 minutes
Total spectral power during a tilt table tes
Drugs vs placebo
Time frame: 20 minutes
Value of HF (gross value then normalized according to the average R-R interval) during a tilt table tes
Drugs vs placebo
Time frame: 20 minutes
RMSSD (Root Mean Square of the Successive Differences) index during a tilt table test
Drugs vs placebo
Time frame: 20 minutes
Variability in blood pressure during a tilt table test
Drugs vs placebo
Time frame: 20 minutes
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inhalation