{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:41:17Z","timestamp":1792410077588,"version":"4.4.0"},"reference-count":27,"publisher":"European Respiratory Society (ERS)","issue":"5","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","award":["SLS-998585 and SLS-971611"],"award-info":[{"award-number":["SLS-998585 and SLS-971611"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009745","name":"Emil och Wera Cornells Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009745","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2025-07761"],"award-info":[{"award-number":["2025-07761"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["20200295"],"award-info":[{"award-number":["20200295"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>\n                      Breathlessness is a leading cause of disability and reduced quality of life in COPD. Inhaled\n                      <jats:sc>l<\/jats:sc>\n                      -menthol may reduce breathlessness but data on its effect on exertional breathlessness is limited. We aimed to evaluate the effect of inhaled\n                      <jats:sc>l<\/jats:sc>\n                      -menthol on exertional breathlessness and exercise capacity in patients with COPD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a double-blinded, randomised (ratio 1:1), crossover trial (RCT) of\n                      <jats:sc>l<\/jats:sc>\n                      -menthol inhalation\n                      <jats:italic>versus<\/jats:italic>\n                      placebo. 20 participants with COPD performed two constant-load cycle cardiopulmonary exercise tests (CPET) to exhaustion, with either\n                      <jats:sc>l<\/jats:sc>\n                      -menthol or placebo (strawberry) scented patch in the mask in randomised order. The primary outcome was the difference in breathlessness intensity (Borg 0\u201310 scale) at isotime. Secondary outcomes were change in breathlessness unpleasantness and leg fatigue at isotime, exercise endurance time (EET), exertional physiological responses and multidimensional breathlessness (MDP).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with placebo, inhaled\n                      <jats:sc>l<\/jats:sc>\n                      -menthol reduced breathlessness intensity at isotime (mean difference \u22120.8, 95% CI \u22121.6\u20130.0; p=0.042), corresponding to a moderate effect size (Cohen's d=\u2009\u22120.49). Isotime breathlessness unpleasantness (\u22120.7, \u22121.7\u20130.3) and emotional response score was lower with L\n                      <jats:sc>-menthol<\/jats:sc>\n                      (\u22122.2, \u22124.4\u20130.0). Leg discomfort (\u22120.5, \u22121.3\u20130.2) was numerically lower, EET was longer (0.9\u2005min, \u22120.7\u20132.5) and physiological responses were unchanged.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Inhalation of\n                      <jats:sc>l<\/jats:sc>\n                      -menthol reduced the intensity and emotional response of exertional breathlessness and increased the EET compared with placebo in patients with COPD. The unchanged physiological responses support a central brain effect and\n                      <jats:sc>l<\/jats:sc>\n                      -menthol might be a promising new treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.00495-2026","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:50:25Z","timestamp":1784825425000},"page":"00495-2026","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of l-menthol on breathlessness and exercise endurance in COPD: a randomised crossover trial"],"prefix":"10.1183","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1863-2033","authenticated-orcid":false,"given":"Jacob","family":"Sandberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6237-9082","authenticated-orcid":false,"given":"Henrik","family":"Mosen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-5113","authenticated-orcid":false,"given":"Magnus","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Jesperson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1434-5715","authenticated-orcid":false,"given":"Zainab","family":"Ahmadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026101903501757000_12.5.00495-2026.1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201111-2042ST"},{"key":"2026101903501757000_12.5.00495-2026.2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02107-2019"},{"key":"2026101903501757000_12.5.00495-2026.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2023-002029"},{"key":"2026101903501757000_12.5.00495-2026.4","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.5.1434"},{"key":"2026101903501757000_12.5.00495-2026.5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jpainsymman.2019.09.021","article-title":"Breathlessness, anxiety, depression, and function-the BAD-F study: a cross-sectional and population prevalence study in adults","volume":"59","author":"Currow","year":"2020","journal-title":"J Pain Symptom Manage"},{"key":"2026101903501757000_12.5.00495-2026.6","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209908"},{"key":"2026101903501757000_12.5.00495-2026.7","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.01164-2025"},{"key":"2026101903501757000_12.5.00495-2026.8","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.chest.2025.03.002","article-title":"Inhaled menthol for dyspnea relief during cycle exercise in COPD: a randomized trial","volume":"168","author":"Schaeffer","year":"2025","journal-title":"Chest"},{"key":"2026101903501757000_12.5.00495-2026.9","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/j.chest.2019.12.028","article-title":"Effect of olfactory stimulation by l-menthol on laboratory-induced dyspnea in COPD","volume":"157","author":"Kanezaki","year":"2020","journal-title":"Chest"},{"key":"2026101903501757000_12.5.00495-2026.10","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01823-2016"},{"key":"2026101903501757000_12.5.00495-2026.11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/SPC.0000000000000449","article-title":"Updates in opioid and nonopioid treatment for chronic breathlessness","volume":"13","author":"Abdallah","year":"2019","journal-title":"Curr Opin Support Palliat Care"},{"key":"2026101903501757000_12.5.00495-2026.12","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02453-2022"},{"key":"2026101903501757000_12.5.00495-2026.13","doi-asserted-by":"crossref","first-page":"5587","DOI":"10.3390\/jcm12175587","article-title":"L-menthol olfactory stimulation reduced dyspnea sensation during the 6\u2005min walk test in patients with chronic breathlessness syndrome: a pilot study","volume":"12","author":"Sato","year":"2023","journal-title":"J Clin Med"},{"key":"2026101903501757000_12.5.00495-2026.14","first-page":"100482","article-title":"Effect of menthol on dyspnea during exercise in individuals with COPD","volume":"7","author":"Smondack","year":"2025","journal-title":"Arch Rehabil Res Clin Transl"},{"key":"2026101903501757000_12.5.00495-2026.15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1513\/AnnalsATS.202305-394OC","article-title":"Normative reference equations for breathlessness intensity during incremental cardiopulmonary cycle exercise testing","volume":"21","author":"Ekstr\u00f6m","year":"2024","journal-title":"Ann Am Thorac Soc"},{"key":"2026101903501757000_12.5.00495-2026.16","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.chest.2022.01.021","article-title":"Using cardiopulmonary exercise testing to understand dyspnea and exercise intolerance in respiratory disease","volume":"161","author":"Stickland","year":"2022","journal-title":"Chest"},{"key":"2026101903501757000_12.5.00495-2026.17","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/S0140-6736(25)00672-5","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials","volume":"405","author":"Hopewell","year":"2025","journal-title":"Lancet"},{"key":"2026101903501757000_12.5.00495-2026.18","unstructured":"Global Initiative for Chronic Obstructive Lung Disease, 2025 GOLD Report. 2024: https:\/\/goldcopd.org\/2025-gold-report\/."},{"key":"2026101903501757000_12.5.00495-2026.19","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05402"},{"key":"2026101903501757000_12.5.00495-2026.20","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00102509"},{"key":"2026101903501757000_12.5.00495-2026.21","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1513\/AnnalsATS.202305-480OC","article-title":"Validation of constant work rate cycling endurance time for use in chronic obstructive pulmonary disease clinical trials","volume":"21","author":"Casaburi","year":"2024","journal-title":"Ann Am Thorac Soc"},{"key":"2026101903501757000_12.5.00495-2026.22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1781"},{"key":"2026101903501757000_12.5.00495-2026.23","unstructured":"Cohen J . Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York, Routledge, 1988."},{"key":"2026101903501757000_12.5.00495-2026.24","doi-asserted-by":"publisher","DOI":"10.1080\/00031305.2016.1154108"},{"key":"2026101903501757000_12.5.00495-2026.25","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.congress-2025.PA1668"},{"key":"2026101903501757000_12.5.00495-2026.26","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01235-2017"},{"key":"2026101903501757000_12.5.00495-2026.27","first-page":"e1","article-title":"The effect of inhaled menthol on upper airway resistance in humans: a randomized controlled crossover study","volume":"20","author":"Pereira","year":"2013","journal-title":"Can Respir J"}],"container-title":["ERJ Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/23120541.00495-2026","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:50:27Z","timestamp":1792407027000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/23120541.00495-2026"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10,19]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1183\/23120541.00495-2026"],"URL":"https:\/\/doi.org\/10.1183\/23120541.00495-2026","relation":{},"ISSN":["2312-0541"],"issn-type":[{"value":"2312-0541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}