CHEST Guidelines-A-Randomized-Controlled-Trial-of-Angiotensin-Conve

A-Randomized-Controlled-Trial-of-Angiotensin-Conve

Pdf Summary

This randomized controlled trial investigated the efficacy of using the angiotensin-converting enzyme (ACE) inhibitor fosinopril in improving skeletal muscle function in patients with Chronic Obstructive Pulmonary Disease (COPD) suffering from quadriceps weakness. The study involved 80 individuals, predominantly male, with severe COPD characterized by reduced quadriceps strength and was aimed at observing changes in quadriceps endurance and exercise performance over a 3-month period.<br /><br />The study found that while the treatment with fosinopril effectively reduced systolic blood pressure and serum ACE activity compared to placebo, there was no significant impact on the primary outcomes of quadriceps endurance or muscle atrophy signaling. Furthermore, no improvements were noted in secondary measures like quadriceps maximum voluntary contraction (QMVC), mid-thigh cross-sectional area (MTCSA), or incremental shuttle walk distance (ISWD). Interestingly, both the treatment and placebo groups exhibited improvements in QMVC, with the placebo group experiencing a more considerable increase.<br /><br />The trial highlighted that despite the theoretical basis for using ACE inhibitors to potentially improve muscle function by inhibiting ACE-related pathways that cause muscle loss, they did not lead to measurable benefits in muscle function or exercise capacity in COPD patients with existing quadriceps weakness.<br /><br />This suggests that ACE inhibitors like fosinopril alone may not be effective in targeting muscle dysfunction in COPD, especially in the absence of an exercise regimen which could potentially yield different results. The study concludes that while ACE inhibition can affect BP and systemic ACE activity, its standalone impact on skeletal muscles within this patient cohort remains unsupported, suggesting future research should incorporate pharmacotherapy in conjunction with physical rehabilitation efforts.

Keywords

randomized controlled trial

ACE inhibitor

fosinopril

skeletal muscle function

COPD

quadriceps weakness

systolic blood pressure

muscle atrophy

exercise capacity

physical rehabilitation