Inhaled Fentanyl Citrate Improves Exercise Endurance During High-Intensity Constant Work Rate Cycle Exercise in Chronic Obstructive Pulmonary Disease

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Inhaled Fentanyl Citrate Improves Exercise Endurance During High-Intensity Constant Work Rate Cycle Exercise in Chronic Obstructive Pulmonary Disease Dennis Jensen, PhD, Abdullah Alsuhail, MD, Raymond Viola, MD, Deborah J. Dudgeon, MD, Katherine A. Webb, MSc, Denis E. O’Donnell, MD Journal of Pain and Symptom Management Volume 43, Issue 4, Pages 706-719 (April 2012) DOI: 10.1016/j.jpainsymman.2011.05.007 Copyright © 2012 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 1 Mean±SEM ratings (modified 10-point Borg scale) of the intensity and unpleasantness of perceived dyspnea and the intensity of perceived leg discomfort during constant work rate cycle exercise at 75% of maximal work rate after inhalation of fentanyl citrate (50mcg) or placebo. The rate of increase in dyspnea intensity (1.2±0.3 vs. 2.9±0.8 Borg units/minute, P=0.03) and unpleasantness ratings (0.5±0.2 vs. 2.9±1.3 Borg units/minute, P=0.06) between isotime and peak exercise was less after inhaled fentanyl citrate vs. placebo (refer also to Fig. 2). SEM=standard error of the mean. Journal of Pain and Symptom Management 2012 43, 706-719DOI: (10.1016/j.jpainsymman.2011.05.007) Copyright © 2012 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 2 Individual subject and mean postdose differences in EET, Isotime ICdyn, and the increase in exertional dyspnea intensity and unpleasantness ratings between isotime and peak exercise after single-dose inhalation of nebulized fentanyl citrate (50mcg) vs. placebo. †P≤0.01; ∗P<0.05; ‡P=0.06. Isotime ICdyn=dynamic inspiratory capacity at isotime; Bu=Borg units; EET=exercise endurance time. Journal of Pain and Symptom Management 2012 43, 706-719DOI: (10.1016/j.jpainsymman.2011.05.007) Copyright © 2012 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 3 Ventilatory, breathing pattern and operating lung volume responses (mean±SEM) to constant work rate cycle exercise at 75% of Wmax after inhalation of nebulized fentanyl citrate (50mcg) or placebo. ∗P<0.05 fentanyl citrate vs. placebo. SEM=standard error of the mean; TLC=total lung capacity; Wmax=maximum incremental cycle work rate. Journal of Pain and Symptom Management 2012 43, 706-719DOI: (10.1016/j.jpainsymman.2011.05.007) Copyright © 2012 U.S. Cancer Pain Relief Committee Terms and Conditions