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Extra pulmonary boosting in chronic obstructive pulmonary disease: leverage of piracetam as an adjunctive therapy on respiratory and neuropsychiatric functions in patients with chronic obstructive pulmonary disease

Background Promotion of central control of respiration might contribute in minimization of chronic obstructive lung disease disability. Objectives Our study was done to evaluate the effect of oral supplementation of piracetam tablets in low dose (400 mg twice daily) versus high dose (1200 mg twice daily) in patients with chronic obstructive pulmonary disease grade IV with type II respiratory failure, on respiratory parameters (spirometric, respiratory muscle strength, and diaphragmatic echographic measurements; velocity and excursion), in addition to neuropsychiatric parameters (cognitive functions and brain changes with MRI). Patients and methods This randomized controlled study was conducted on 126 patients who were subjected to oral piracetam and classified into group A (42 patients received 800 mg daily for 3 months), group B (44 patients received 2400 mg daily for 3 months) for 3 months, and group C (40 patients) as a control group. Pulmonary evaluation, by spirometry and respiratory muscle study by Pimax, Pemax, Sniff test, and diaphragmatic echography, was conducted in addition to neuropsychiatric evaluation by Alzheimer disease 8 cognitive score assessment and brain MRI. Results Total pulmonary fractional functional progress of piracetam was higher in group B (28.12%) than group A (23.27%) and the control group (5.68%). On the contrary, neuropsychiatric fractional functional progress was higher in group B (29.11%) than group A (15.7%), and lastly, the control group (<1%). Conclusion Oral piracetam demonstrated enhanced spirometric parameters and improved cognition with low dose, but with high dose, it enhanced both spirometric and respiratory muscle strength and cognitive parameters with brain MRI and apparent diffusion coefficient changes.