A Combined Pulmonary Function and Emphysema Score Prognostic Index for Staging in Chronic Obstructive Pulmonary Disease

Boutou, Afroditi; Nair, Arjun; Douraghi-Zadeh, Dariush; Sandhu, Ranbir S.; Hansell, David M.; Wells, Adrian; Polkey, Michael I.; Hopkinson, Nicholas S

doi:10.1371/journal.pone.0111109

Cited by 9 publications

(9 citation statements)

References 36 publications

(51 reference statements)

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“…Additional research is warranted to investigate the structural correlates of increased VD in mild COPD, e.g. microvascular disease [84], early emphysema [32,85,86], ventilation distribution heterogeneity [27,86]. Regardless of the mechanism(s), high V′E/V′CO 2 nadir is linked to earlier attainment of critical dynamic mechanical constraints: inspiratory reserve volume becomes critically reduced.…”

Section: Ventilatory Efficiency and Exercise Intolerancementioning

confidence: 99%

Physiological and clinical relevance of exercise ventilatory efficiency in COPD

et al. 2017

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Exercise ventilation (') relative to carbon dioxide output (' ) is particularly relevant to patients limited by the respiratory system, those with chronic obstructive pulmonary disease (COPD). High'-' (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV). Establishing an association between high '-' and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase '-' In fact, a high '-' has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high '-' has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the '-' relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.

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Section: Ventilatory Efficiency and Exercise Intolerancementioning

confidence: 99%

Physiological and clinical relevance of exercise ventilatory efficiency in COPD

et al. 2017

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“…Several studies have shown that an increased V D /V Tphys , partially due to emphysema [21,23,25,28,96,97], constitutes an important correlate of a high V′ E /V′ CO 2 . As discussed later, this is particularly true in patients who are not severely compromised from the mechanical standpoint, i.e.…”

Section: Structural and Functional Determinants Of V′ E /V′ Co 2 In Copdmentioning

confidence: 99%

Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications

et al. 2021

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There is well established evidence that the minute ventilation (V′E)/carbon dioxide output (V′CO2) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V′E/V′CO2 reflects an enlarged physiological dead space (“wasted” ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V′E/V′CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V′E/V′CO2 is valuable to ascertain a role for the “lungs” in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V′E/V′CO2. A high V′E/V′CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V′E/V′CO2 should be valued in the clinical management of patients with COPD.

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“…However, no studies on the clinical impact of the ESI have been published. FEV 1 and other spirometric variables such as FEV 1 /FVC have been shown to correlate with all-cause mortality in several previous studies and are currently the principal spirometric measures used when establishing severity of airflow obstruction [4][5][6][7][8]. Since ESI is not dependent on reference values or any additional equipment beyond that needed for conducting spirometry, it could be easily implemented in a clinical setting alongside other currently used spirometric parameters such as FEV 1 .…”

Section: Introductionmentioning

confidence: 99%