A decreased inspiratory capacity (IC)/total lung capacity (TLC) ratio is associated with dynamic hyperinflation and decreased exercise capacity. The present authors hypothesised that static (low IC/TLC) and dynamic hyperinflation impair cardiac function as assessed by oxygen pulse at rest and during cardiopulmonary exercise testing (CPET). Lung function, body mass index, hand grip strength and CPET parameters were measured (oxygen uptake (mL x kg(-1) x min(-1)) and oxygen pulse (mL x beat(-1))) in 87 chronic obstructive pulmonary disease (COPD) patients (American Thoracic Society/European Respiratory Society/Global Initiative for Chronic Obstructive Lung Disease stage 3-4) and 46 controls. The patients were divided into those with IC/TLC > 25% or < or = 25%. The IC/TLC ratio at rest and at peak exercise was associated significantly with oxygen pulse. Patients with IC/TLC < or = 25% (n = 45) had significantly lower exercise capacity, peak oxygen pulse, peak minus baseline oxygen pulse, peak IC, peak IC/TLC ratio and % change from baseline to peak IC/TLC ratio compared with patients with IC/TLC > 25% and controls. During CPET, the oxygen pulse was lower at iso-work in patients with IC/TLC < or = 25% than in those with IC/TLC > 25%. Resting hyperinflation (inspiratory capacity/total lung capacity) is associated with lower oxygen pulse, peak exercise inspiratory capacity/total lung capacity and exercise capacity in patients with severe chronic obstructive pulmonary disease. The present results support an interaction between hyperinflation and decreased cardiac function that may contribute to exercise limitation in these patients.

BackgroundThe relationship between serum biomarkers and clinical expressions of COPD is limited. We planned to further describe this association using markers of inflammation and injury and repair.MethodsWe studied lung function, comorbidities, exercise tolerance, BODE index, and quality of life in 253 COPD patients and recorded mortality over three years. Serum levels of Interleukins 6,8 and16, tumor necrosis factor alpha (TNF α) [inflammatory panel], vascular endothelial growth factor (VEGF), and matrix metalloproteinase 9 (MMP-9) [injury and repair panel] and pulmonary and activation-regulated chemokine (PARC/CCL-18) and monocyte chemotactic protein 1 (MCP-1/CCL2) [chemoattractant panel] were measured. We related the pattern of the biomarker levels to minimal clinically important differences (MCID) using a novel visualization method [ObServed Clinical Association Results (OSCAR) plot].ResultsLevels of the inflammatory markers IL-6, TNF α were higher and those of injury and repair lower (p < 0.01) with more advanced disease (GOLD 1 vs. 4). Using the OSCAR plot, we found that patients in the highest quartile of inflammatory and lowest quartile of injury and repair biomarkers level were more clinically compromised and had higher mortality (p < 0.05).ConclusionsIn COPD, serum biomarkers of inflammation and repair are distinctly associated with important clinical parameters and survival.

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The study suggests that bosentan treatment results in the improvement of different kinds of surrogate markers independently of their specificity to reflect functional capacity, quality of life and myocardial stress. It is concluded that the combined use of these different markers may be an alternative endpoint for future short duration clinical trials.

Background. Comprehensive exercise training (CET) is an efficient strategy to decrease dyspnea perception in chronic obstructive pulmonary disease (COPD) and may result in significant improvement in ventilatory muscles function. Our aim was to evaluate the effects of general exercise training on dyspnea perception and on respiratory muscles strength in COPD patients. Methods. Consecutive COPD patients were enrolled to complete a CET programme. The patients underwent a routine that included a global warm up, upper and lower limbs endurance exercise as well as stretching and relaxation. Before and after the CET programme, patients completed maximal inspiratory (PImax) and expiratory (PEmax) pressures measurements, maximal incremental test, endurance test, and 6-min walk distance (6MWD). Results. 71 patients (52 male). Mean age 67.6±8.6 years, FEV1 (%) 44.2±16.2 and Mahler dyspnea scale 6.4±1.8. The results before and after the exercise programme were: PImax 64.7±22.9 vs. 75.5±23.7 cmH2O (p=0.001), PEmax 110.8±28.1 vs. 120.4±28.1 cmH2O (p=0.004), 6MWD 510.6±90.3 vs. 528.2±99.7 metres (p=0.88), time of incremental test 672±135 vs. 856±226 sec (p&lt;0.0001). Compared with the pre exercise programme, we observed a significant reduction on Borg dyspnea scale (6.1±2.8 to 3.6±2.3, p&lt;0.0001) as well as a longer test time (504±218 to 1.038±841, p&lt;0.0001) at the end of the endurance test after CET programme. Improvement of PImax correlated negatively with dyspnea perception at iso-time during the endurance test (r= -0.33, p=0.03). Conclusions. Our results confirm that CET is associated with significant improvement in PImax, PEmax and provide evidence demonstrating that CET reduces dyspnea perception in patients with COPD.

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Handgrip is associated with impaired heart function at rest and during exercise in COPD patients even adjusting for muscle mass differences. Lower handgrip may be a marker of impaired cardiac function in COPD patients.