Exercise ventilatory inefficiency in mild to end-stage COPD

Neder, J. Alberto; Arbex, Flávio; Alencar, Maria Clara; O'Donnell, Conor; Cory, Julia; Webb, Kathy; O’Donnell, Denis E.

doi:10.1183/09031936.00135514

Cited by 129 publications

(167 citation statements)

References 37 publications

(94 reference statements)

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“…Increased stimulation of central and peripheral chemoreceptors in COPD occurs as a result of: 1) alveolar ventilation/perfusion (V′A/Q′) abnormalities (decreased ventilatory efficiency, high V′A/Q′ lung units and increased physiological dead space) [18][19][20]; 2) critical arterial oxygen (O 2 ) desaturation (low V′A/Q′ lung units and reduced systemic mixed venous O 2 in the blood) [21,22]; and 3) increased acid-base disturbances (e.g. early metabolic acidosis) due to deconditioning [23,24].…”

Section: Increased Reflex Chemostimulationmentioning

confidence: 99%

“…In other words, the V′E/V′CO 2 nadir equals the slope plus intercept [95]. As discussed in the following section of this review, COPD severity strongly influences the different metrics of ventilatory inefficiency (nadir, slope and intercept) [19,96,97].…”

Section: Cpet Interpretation: Panel Displaysmentioning

confidence: 99%

“…Thus, relatively preserved mechanical reserves during the early phases of exercise allows increased physiological dead space to be readily translated into a higher V′E-V′CO 2 relationship in patients with mild COPD, i.e. higher V′E/V′CO 2 nadir and steeper V′E-V′CO 2 slope compared with healthy controls (figure 6) [19].…”

Section: Increasing Exertional Dyspnoea With Disease Progressionmentioning

confidence: 99%

“…Inspiratory neural drive is substantially greater at lower exercise intensities than in patients with milder COPD reflecting worsening pulmonary gas exchange and mechanical constraints, in various combinations ( figure 1) [17, 19,37]. Increased drive in more advanced COPD is compounded in many patients by negative effects of low ventilatory thresholds (and metabolic acidosis) secondary to deconditioning and, in some cases, critical arterial O 2 desaturation (arterial O 2 tension <60 mmHg or <8 kPa).…”

Section: Increasing Exertional Dyspnoea With Disease Progressionmentioning

confidence: 99%

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Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

et al. 2016

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Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET. @ERSpublications Measurement of symptom intensity, ventilatory control and mechanics during exercise exposes mechanisms of dyspnoea

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Section: Increased Reflex Chemostimulationmentioning

confidence: 99%

Section: Cpet Interpretation: Panel Displaysmentioning

confidence: 99%

Section: Increasing Exertional Dyspnoea With Disease Progressionmentioning

confidence: 99%

Section: Increasing Exertional Dyspnoea With Disease Progressionmentioning

confidence: 99%

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Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

et al. 2016

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“…Accordingly, those patients whose main cause We also analyzed the correlation of COPD severity index (BODE index) with CPET parameter. Along with COPD progression, there are inappropriate consequences on the exercise parameter (31). In this study BODE index was inversely correlated with peak-V O 2 , WR and breathingreserve.…”

Section: Discussionmentioning

confidence: 68%

Correlation of cardiopulmonary exercise testing parameters with quality of life in stable COPD patients

Mirdamadi¹,

Rahimi²,

Safavi³

et al. 2016

J. Thorac. Dis.

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Background: The precise head to head relationships between Cardio-pulmonary exercise testing (CPET) parameters and patients' daily symptoms/activities and the disease social/emotional impact are less well defined. In this study, the correlation of COPD daily symptoms and quality of life [assessed by St. George's Respiratory Questionnaire (SGRQ)] and COPD severity index (BODE-index) with CPET parameters were investigated. Methods: Symptom-limited CPET was performed in 37 consecutive COPD (GOLD I-III) subjects during non-exacerbation phase. The SGRQ was also completed by each patient. Results: SGRQ-score correlated negatively with FEV1 (r=−0.49, P<0.01), predicted maximal workrate (%WR-max) (r=−0.44, P<0.01), V'O 2 /WR (r=−0.52, P<0.01) and breathing reserve (r=−0.50, P<0.01). However it did not correlate with Peak-V'O 2 % predicted (r=−0.27, P=0.10). In 20 (54.1%) subjects in which leg fatigue was the main cause for stopping the test, Peak-V'O 2 , %WR-max, HR-Reserve and Breathing reserve were higher (P=0.04, <0.01, 0.04 and <0.01 respectively) than the others. There was also a significant correlation between BODE-index and ∆VO 2 /∆WR (r=−0.64, P<0.001) and breathing-reserve (r=−0.38, P=0.018). Conclusions: The observed relationships between CPET parameter and daily subjective complaints in COPD were not strong. Those who discontinued the CPET because of leg fatigue were in the earlier stages of COPD. Significant negative correlation between ∆VO 2 /∆WR and BODE-index suggests that along with COPD progression, regardless of negative past history, other comorbidities such as cardiac/musculoskeletal problems should be sought. Although more difficult to use than other tools such as COPD Assessment Test (CAT) or COPD Clinical Questionnaire (CCQ) during routine daily practice (6), the St. George's Respiratory Questionnaire (SGRQ) is one of the most widely used self-complete measures in research for assessing patients' symptoms, activities and quality of life (7,8). Along with this subjective measurement, functional capacity in COPD could be measured by objective tools such as cardio-pulmonary exercise testing (CPET) or 6-min walk distance (6MWD) (9-11). Considering the fact that at rest physiologic variable such as pulmonary diffusing capacity for carbon monoxide (DLCO), body mass index (BMI) or even forced expiratory volume in one second (FEV1) could not solely predict exercise intolerance, CPET has been proposed as the gold standard for evaluating the exercise intolerance in patients with pulmonary diseases, including COPD (12). But the precise head to head comparisons of CPET variable with patients' daily symptoms/activities and the disease social/ emotional impact are less well defined. In one study among 129 COPD subjects with GOLD stage II and III, there was at best a weak correlation between Peak-V'O 2 (maximum oxygen uptake) % predicted and some sub-domains of health status (13). While in another study Peak-V'O 2 was to some extent a predictor of physical function (r 2 increased by 0.109) and health-related ...

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Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

Guazzi

Wilhelm

Halle

et al. 2022

European J of Heart Fail

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Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype‐specific treatments.

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Exercise ventilatory inefficiency in mild to end-stage COPD

Cited by 129 publications

References 37 publications

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

Correlation of cardiopulmonary exercise testing parameters with quality of life in stable COPD patients

Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

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