Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. ERS Task Force on Standardization of Clinical Exercise Testing. European Respiratory Society

Background: Nintedanib is approved for the treatment of idiopathic pulmonary fibrosis (IPF) and has been shown to slow disease progression by reducing annual lung function decline. Objective: To evaluate the results of a large cohort of IPF patients treated with nintedanib within a compassionate use program (CUP) in Germany (9 centers). Methods: Patients (≥40 years) were required to have a confirmed diagnosis of IPF, a forced vital capacity (FVC) ≥50% predicted (pred.) and a carbon monoxide diffusing capacity (DLCO) 30-79% pred. and not to be eligible for pirfenidone treatment. Clinical data, pulmonary function tests and adverse events were recorded up to July 2015. Results: Sixty-two patients (48 male/14 female) with moderate IPF (FVC 64 ± 17% pred. and DLCO 40 ± 10% pred.) were treated with nintedanib. 77% of patients switched from pirfenidone (mean treatment duration 14 ± 2 months) mostly due to disease progression (mean decline in FVC 7.4 ± 3% pred. in the 6 months prior to nintedanib intake). Initiation of nintedanib treatment occurred 69 ± 29 months after IPF diagnosis, and mean treatment duration was 8 ± 4 months. Most patients (63%) stabilized 6 months after treatment start (mean FVC decline 3 ± 1 vs. -17 ± 2% in patients with disease progression; p < 0.01). The most common adverse events were diarrhea (63%) and weight loss (50%). Dose reduction occurred in 34% of cases and treatment discontinuation in 10%. Conclusion: Nintedanib treatment was generally well tolerated and was associated with FVC stabilization in the majority of IPF patients in this CUP setting where most patients were not treatment naïve. Our data are in agreement with the previously published data.

Section: Methodsmentioning

confidence: 99%

Insights from the German Compassionate Use Program of Nintedanib for the Treatment of Idiopathic Pulmonary Fibrosis

Bonella

Kreuter²,

Hagmeyer³

et al. 2016

“…Pulse oximetry identifies exercise-induced hypoxemia [2], while monitoring of ventilation and pulmonary gas exchange allows the best evaluation of aerobic capacity as well as factors limiting exercise tolerance [25,26]. HR measurements allow the determination of maximal effort during the test and enable recommendations on exercise intensities - both for everyday activities as well as for sports.…”

Section: Routine Monitoring and Evaluation Of Exercise-related Symptomsmentioning

confidence: 99%

“…In general, the gold standard exercise test for assessing aerobic exercise capacity is an incremental exercise test to measure peak oxygen uptake (V ∙ O 2 peak ) on either the treadmill or cycle ergometer [24,25,26]. Progressive incremental protocols, continuously incremental (ramp) protocols and protocols in which each stage lasts 1 min are very efficient in providing exercise responses in a short amount of time (within 8-12 min) [24,27].…”

Section: Introductionmentioning

confidence: 99%

Statement on Exercise Testing in Cystic Fibrosis

Hebestreit

Arets²,

Aurora³

et al. 2015

138

227

This statement summarizes the information available on specific exercise test protocols and outcome parameters used in patients with cystic fibrosis (CF) and provides expert consensus recommendations for protocol and performance of exercise tests and basic interpretation of results for clinicians. The conclusions were reached employing consensus meetings and a wide-band Delphi process. Although data on utility are currently limited, standardized exercise testing provides detailed information on physiological health, allows screening for exercise-related adverse reactions and enables exercise counselling. The Godfrey Cycle Ergometer Protocol with monitoring of oxygen saturation and ventilatory gas exchange is recommended for exercise testing in people 10 years and older. Cycle ergometry only with pulse oximetry using the Godfrey protocol or treadmill exercise with pulse oximetry - preferably with measurement of gas exchange - are second best options. Peak oxygen uptake, if assessed, and maximal work rate should be reported as the primary measure of exercise capacity. The final statement was reviewed by the European Cystic Fibrosis society and revised based on the comments received. The document was endorsed by the European Respiratory Society.

“…The AT demarcates the upper limit of a range of exercise intensities that can be accomplished almost entirely aerobically.Whereas essentially, WRs below the AT can be sustained indefinitely, a progressive increase in WR above the AT is associated with a progressive decrease in exercise tolerance [14]. In normal individuals, the AT occurs at about 50–60% V O 2max predicted in sedentary individuals, with a wide range of normal values extending from 35 to 80% [15]. …”

Section: Respiratory Gas Exchange Parametersmentioning

confidence: 99%

Exercise Tolerance Measurements in Pulmonary Vascular Diseases and Chronic Heart Failure

Piepoli

2009

The hallmark symptoms of heart failure are dyspnoea and fatigue during exercise. In recent years, the physiologic response to progressive exercise using direct measures of ventilation and gas exchange, commonly termed the ‘cardiopulmonary exercise test’ (CPET), has evolved into an important clinical tool in the management of patients with heart failure. CPET provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ system in isolation. The noninvasive, dynamic physiologic overview permits the evaluation of both submaximal and peak exercise responses providing the physician with relevant information for clinical decision making. The use of CPET in the management of chronic heart failure patients is increasing, with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are better predicted by indices of exercise tolerance than by resting measurements.