Effect of Ketoconazole on Breathlessness

Beta-endorphins are naturally occurring narcotic substances (like morphine) that are released
by the brain under stressful conditions, such as exercise and when breathing through a
resistive load (a tube containing fine wire mesh). In one study of 8 patients with coronary
artery disease, ketoconazole, an oral medication used to treat fungal infections, was
administered (1,200 mg at 12 midnight and 600 mg at 6 am) and increased blood levels of
beta-endorphins five fold. In a recent study performed at Dartmouth-Hitchcock Medical Center,
we found that ketoconazole increased blood levels of beta-endorphins in all eight patients
with chronic obstructive pulmonary disease (COPD). Mean values increased by 2.5 times at four
hours compared with baseline values (p = 0.0078). Based on this significant response, we
propose to study the effect of ketoconazole on patients' perception of breathlessness induced
by resistive breathing loads in a randomized clinical trial. The hypothesis of the study is
that ketoconazole will reduce ratings of breathlessness as mediated by the increased levels
of beta-endorphins.

Inclusion Criteria:

- 50 years of age or older;

- diagnosis of COPD;

- current or former smoker of at least 10 pack-years;

- post-bronchodilator FEV1 greater than or equal to 30% predicted and less than or equal
to 80% predicted; post-bronchodilator ratio < 70%

Exclusion Criteria:

- any concomitant disease that might interfere with study procedures;

- use of a drug that may cause a possible drug interaction with ketoconazole