Dynamic Hyperinflation Correlates with Exertional Oxygen Desaturation in Patients with Chronic Obstructive Pulmonary Disease

Zafar, Muhammad Ahsan; Tsuang, Wayne; Lach, Laura; Eschenbacher, William L.; Panos, Ralph J.

doi:10.1007/s00408-012-9443-3

Cited by 28 publications

(25 citation statements)

References 25 publications

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“…Desaturation during exercise (ED) in COPD can be a predictive factor of mortality (47). The main pathophysiological factors are ventilation-perfusion mismatch and drop of mixed venous oxygen saturation related desaturation during exercise in COPD (47).…”

Section: Correlation Between Desaturation During Exercise and Dynamicmentioning

confidence: 99%

“…The main pathophysiological factors are ventilation-perfusion mismatch and drop of mixed venous oxygen saturation related desaturation during exercise in COPD (47). A higher value of diffusion capacity (DLCO) and resting oxygen saturation mostly do not predict desaturation during exercise.…”

Section: Correlation Between Desaturation During Exercise and Dynamicmentioning

confidence: 99%

“…Dynamic hyperinflation has a correlation with lower oxygen and increased exhaled CO 2 content (47). These processes have a correlation with higher ventilationperfusion mismatch and lower mixed venous oxygen content, and they lead to dynamic hyperinflation related oxygen uptake increment in the respiratory muscles (47).…”

Section: Correlation Between Desaturation During Exercise and Dynamicmentioning

confidence: 99%

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Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

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Expiratory flow limitation can develop in parallel with the progression of COPD, and as a consequence, dynamic hyperinflation and lung mechanical abnormalities can develop. Dynamic hyperinflation can cause increased breathlessness and reduction in exercise tolerance. Achievement of critical inspiratory reserve volume is one of the main factors in exercise intolerance. Obesity has specific lung mechanical effects. There is also a difference concerning gender and dyspnoea. Increased nerve activity is characteristic in hyperinflation. Bronchodilator therapy, lung volume reduction surgery, endurance training at submaximal intensity, and heliox or oxygen breathing can decrease the degree of dynamic hyperinflation.Keywords: COPD, dyspnoea, expiratory flow limitation, dynamic hyperinflation, lung mechanics, exercise toleranceOne of the main symptoms in chronic obstructive pulmonary disease (COPD) is dyspnoea, and initially it is manifested during exercise and later at rest with the progression of the disease. Dyspnoea leads to exercise intolerance in parallel with physical inactivity, and as a consequence, disability may develop (28). The main causes of exercise intolerance may be lung mechanical abnormalities and patient's deconditioning (28). Dyspnoea is characterised by an increase in the following factors: respiratory work/ effort ratio, breathing load, end-expiratory lung volume (EELV) related dynamic hyperinflation, intrinsic positive end-expiratory pressure (PEEP) related elastic effort, and neurological sensation (Fig. 1) (28). Dyspnoea manifestation is often associated with dynamic hyperinflation (DH) in patients with COPD from moderate to severe obstruction (26,28,29,35,42). The discrepancy between respiratory centre induced respiratory muscle work and muscle load, and capacity related lung volume changes lead to neuromechanical dissociation (Fig. 2). The consequence of this process is the development of dynamic hyperinflation as a cause of chronic and exertional dyspnoea (28).

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Section: Correlation Between Desaturation During Exercise and Dynamicmentioning

confidence: 99%

Section: Correlation Between Desaturation During Exercise and Dynamicmentioning

confidence: 99%

Section: Correlation Between Desaturation During Exercise and Dynamicmentioning

confidence: 99%

See 1 more Smart Citation

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

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“…Accordingly, dynamic hyperinflation can be defined as a decline in the IC greater than zero. 20 The cardiovascular response of the exercise was expressed by the following parameters: oxygen pulse (O 2 pulse), V O 2 efficiency slope (OUES), and heart rate recovery (HRR). O 2 pulse (in mL/beats/min) was calculated by dividing instantaneous V O 2 by the heart rate 18 and was recorded at the peak of exercise.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Fat-Free Mass Depletion Is Associated With Poor Exercise Capacity Irrespective of Dynamic Hyperinflation in COPD Patients

et al. 2013

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BACKGROUND:In patients with COPD, we investigated the effect of the fat-free mass (FFM) on maximal exercise capacity and the relationship with changes in operational lung volumes during exercise. METHODS: In a cross-sectional study 57 patients (16 females; age 65 ؎ 8 y) were consecutively assessed by resting lung function, symptom-limited cardiopulmonary exercise test, and body composition by means of bioelectrical impedance analysis to measure the FFM index (FFMI; in kilograms per square meter). RESULTS: Patients were categorized as depleted (n ‫؍‬ 14) or nondepleted (n ‫؍‬ 43) according to FFMI. No significant difference in gender, age, and resting lung function was found between depleted and nondepleted patients. When compared with nondepleted COPD patients, the depleted COPD patients had a significantly lower O 2 uptake at the peak of exercise and at anaerobic threshold as well as at peak oxygen pulse, oxygen uptake efficiency slope (OUES), and heart rate recovery (HRR) (P < .05 for all comparisons), but similar inspiratory capacity/total lung capacity at the peak of exercise. Moreover, they also reported significantly higher leg fatigue (P < .05), but not dyspnea on exertion. In all patients, significant correlations (P < .01) were found between FFMI and peak oxygen pulse, OUES, HRR, and leg fatigue. CONCLUSIONS: This study shows that FFM depletion plays a part in the reduction of exercise capacity in COPD patients, regardless of dynamic hyperinflation, and is strictly associated with poor cardiovascular response to exercise and to leg fatigue, but not with dyspnea.

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“…Zafar et al [22] recently found a strong correlation between DH and oxygen desaturation during a 6-min walking test, corroborating the evidence that DH contributes directly to the worsening of COPD signs and symptoms. Other authors have reported that DH-preventive medication improved dyspnea scores and quality of life parameters in patients with COPD [23].…”

Section: Discussionmentioning

confidence: 67%

The effects of dynamic hyperinflation on CT emphysema measurements in patients with COPD

Alves

Marchiori

Irion

et al. 2014

European Journal of Radiology

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Dynamic Hyperinflation Correlates with Exertional Oxygen Desaturation in Patients with Chronic Obstructive Pulmonary Disease

Abstract: Routine pulmonary function test results and clinical variables did not correlate with ED in patients with stable COPD. Dynamic hyperinflation strongly correlates with exertional desaturation and could be a reason for this desaturation.

Cited by 28 publications

References 25 publications

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Fat-Free Mass Depletion Is Associated With Poor Exercise Capacity Irrespective of Dynamic Hyperinflation in COPD Patients

The effects of dynamic hyperinflation on CT emphysema measurements in patients with COPD

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