Efficacy and safety of nitrate supplementation on exercise tolerance in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Medicine (Baltimore). 2022 Jan 14;101(2):e28578. doi: 10.1097/MD.0000000000028578.

Abstract

Background: Exercise intolerance was prevalent in people with chronic obstructive pulmonary disease (COPD) and had a detrimental effect on the quality of life. We aimed to evaluate the efficacy and safety of nitrate supplementation in exercise tolerance of people with COPD.

Methods: We searched medical databases including Cochrane Library, EMBASE, and PubMed from inception to October 2020 for randomized control trials in treating COPD with nitrate supplementation.

Results: Nine trials were identified. Compared with placebo, nitrate supplementation has no significant effect on the following variables: exercise endurance time (standard mean difference [SMD]: 0.06; 95% confidence interval [CI]: -0.39 to 0.52; P = .79), exercise capacity (SMD: 0.30; 95% CI: -0.21 to 0.80; P = .25), oxygen consumption (SMD: -0.04; 95% CI: -0.33 to 0.25; P = .80), resting systolic blood pressure (MD: -2.84; 95% CI: -8.46 to 2.78; P = .32), systolic blood pressure after exercise (MD: -4.66; 95% CI -15.66 to 6.34; P = .41), resting diastolic blood pressure (MD: 0.89; 95% CI: -4.41 to 6.19; P = .74), diastolic blood pressure after exercise (MD: -0.21; 95% CI: -5.51 to 5.10; P = .94), heart rate (MD: -2.52; 95% CI: -7.76 to 2.73; P = .35), and arterial oxygen saturation (MD: -0.44; 95% CI: -2.38 to 1.49; P = .65). No severe adverse effects from nitrate supplementation were reported in the included trails.

Conclusion: Current evidence suggests that nitrate supplementation may be safe but ineffective for improving exercise tolerance in people with COPD.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Dietary Supplements*
  • Exercise Tolerance*
  • Humans
  • Nitrates / administration & dosage*
  • Oxygen Saturation
  • Pulmonary Disease, Chronic Obstructive* / drug therapy

Substances

  • Nitrates