Abnormal patterns of response to incremental CPET

Neder, J. Alberto; Berton, Danilo Cortozi; Rocha, Alcides; Arbex, Flávio; Alencar, Maria Clara; Degani-Costa, Luiza Helena; Ferreira, Eloara Vieira Machado; Ramos, Roberta Pulcheri; O’Donnell, Denis E.

doi:10.1183/2312508x.10011017

Cited by 17 publications

(44 citation statements)

References 70 publications

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“…A recent publication confirmed the specificity of high V′ E /V′ CO 2 in defining elevation in V D /V T (as opposed to ventilatory control-mediated alteration in arterial carbon dioxide tension) [150]. Inadequate oxygen exchange can be detected by reductions in P aO 2 or, less directly, by fall in S pO 2 assessed by pulse oximetry [3].…”

Section: Infection Control Considerationsmentioning

confidence: 91%

“…Indications for CPET in chronic lung disease include the following. 1) Evaluation of "out-of-proportion" (to resting functional impairment) exertional dyspnoea and limited exercise tolerance [3]. 2) Preoperative evaluation (e.g.…”

Section: Exercise Testingmentioning

confidence: 99%

“…Defining cardiovascular limitation to exercise relies on a number of interrelated variables. A low slope or terminal flattening of the V′ O 2 over work rate relationship or flattening of oxygen pulse may be diagnostic [3]. Pulmonary vascular causes of cardiovascular limitation may yield a high V′ E /V′ CO 2 slope in addition to those abnormalities.…”

Section: Infection Control Considerationsmentioning

confidence: 99%

“…Cardiopulmonary exercise testing (CPET) is useful in the assessment of subjects with chronic lung conditions as it may help to: 1) recognise physiological factors limiting exercise (with or without the presence of psychogenic limiting factors); 2) identify these factors as potential therapeutic targets; 3) allow quantification of the level of impairment; 4) assess the effects of an intervention; and 5) provide prognostic information [1][2][3][4][5][6][7]. Furthermore, CPET is a common procedure in research.…”

Section: Introductionmentioning

confidence: 99%

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ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

et al. 2019

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The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.

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Section: Infection Control Considerationsmentioning

confidence: 91%

Section: Exercise Testingmentioning

confidence: 99%

Section: Infection Control Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

et al. 2019

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“…Investigating exercise intolerance Dyspnoea as a cause of exercise intolerance In respirology practice, CPET is now more commonly requested as part of the work-up for unexplained or disproportionate exertional dyspnoea [5][6][7][8][9][10][11][12][13]. As discussed elsewhere in this Monograph [14], the test is more suited to describing patterns of dysfunction, as different clusters of abnormalities overlap across specific diseases. CPET fundamentally aims to shorten the list of differential diagnoses that could explain a patient's symptoms; in some circumstances, it also helps guide further investigations.…”

Section: Introductionmentioning

confidence: 99%

Preface

Bals¹

Clinical Exercise Testing

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CPET is one of the most useful and informative diagnostic approaches in pulmonary medicine. It offers deep insight into the cardiopulmonary network and generates data that can be used in diagnosis, staging and outcome prediction in multiple lung diseases. In the hands of an experienced investigator, exercise testing looks easy and elegant. For the patient, exercise testing focuses on relevant outcomes, such as exercise capacity and dyspnoea. It also has the benefit of being noninvasive. However, for novices in this area, the large amount of information generated and the task of interpreting this data can cause a sense of reluctance. The data that result from exercise testing differ in complexity, ranging from simple one-figure measurements to graphical displays of time curves requiring sophisticated interpretation of. As a result, a comprehensive summary of the methodology of CPET is urgently needed to ensure its more frequent use in clinical practice. This ERS Monograph is therefore timely as it provides the reader with a broad and detailed overview of the various CPET applications. The initial chapters summarise the technologies and standard techniques used. They are followed by sections about individual disease areas and a chapter on lung transplantation. Self-assessment cases have also been included in this book, a first for the ERS Monograph book series. We hope that our readers like this new feature and will find it useful. The Guest Editors Paolo Palange, Pierantonio Laveneziana, J. Alberto Neder and Susan A. Ward have worked very hard on topic selection and to integrate these aspects into a book that summarises current knowledge. Together with the authors, they have produced a practice-guideline publication that comprises both background information and hands-on application. I am sure this comprehensive review will be useful in the clinical practice of a broad range of respiratory physicians, and will improve patient care.

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