Orthopnea and Tidal Expiratory Flow Limitation in Patients With Stable COPD

Eltayara, L; Ghezzo, Heberto; Milic–Emili, J.

doi:10.1378/chest.119.1.99

Cited by 38 publications

(25 citation statements)

References 19 publications

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“…In contrast, EFL measured with the NEP technique is a much better predictor of chronic dyspnoea than FEV1 in COPD patients [25]. Furthermore, it is also shown that there is a high prevalence of orthopnoea in these patients [42].…”

Section: Clinical Applicationsmentioning

confidence: 95%

See 1 more Smart Citation

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

European Respiratory Journal

221

168

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Fashions in ideas, like clothes, come and go. From approximately 1950From approximately -1980, physiological research was seen as the key discipline in understanding lung disease and was at the cutting edge of pulmonary science. Subsequently, its importance has been down played amid a widely accepted but unfounded assumption that we now have a perfect working understanding of the physiological behaviour of the respiratory system in health and disease. Although it seems improbable that completely new disciplines within respiratory physiology will emerge with fundamentally different ways of describing the mechanical or gas exchanging function of the lung, advances in computing and new observations in disease have highlighted previously unsuspected physiological abnormalities that have changed the way we view lung disease and the interface between disordered lung mechanics, symptomatology and disability. This is especially true for the two related physiological concepts of expiratory flow limitation and dynamic hyperinflation, which are now being taken from the physiological laboratory to the bedside with dramatic effect. Each arises from well-established theoretical and practical observations first made 40 yrs ago and now adapted to a range of settings, particularly in the field of obstructive lung disease. This review focuses on how these conditions are defined and assessed and what evidence there is that they might be important in lung disease.

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Section: Clinical Applicationsmentioning

confidence: 95%

“…Indeed, 48% of COPD patients were EFL as compared with 15% of stable asthmatics at comparable FEV1 values [22,25,[42][43][44]. In contrast with COPD patients, most asthmatics do not exhibit EFL during resting breathing seated and/or supine [28,[42][43][44][45][46].…”

Section: Clinical Applicationsmentioning

confidence: 98%

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

European Respiratory Journal

221

168

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“…EFL may occur during tidal breathing at rest in COPD patients and has been found in more than 50% of the patients with moderate-to-severe-to-very-severe airway obstruction [6, 14, 19, 28]. Despite this general picture, changes in conventional indices of airway obstruction such as FEV 1 , PEF, and FEV 1 /FVC derived from maximal flow/volume curve are not useful to predict EFL, and special techniques must be adopted to accurately detect EFL in these patients [7].…”

Section: Clinical Aspectsmentioning

confidence: 99%

Expiratory Flow Limitation Definition, Mechanisms, Methods, and Significance

Tantucci

2013

Pulmonary Medicine

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When expiratory flow is maximal during tidal breathing and cannot be increased unless operative lung volumes move towards total lung capacity, tidal expiratory flow limitation (EFL) is said to occur. EFL represents a severe mechanical constraint caused by different mechanisms and observed in different conditions, but it is more relevant in terms of prevalence and negative consequences in obstructive lung diseases and particularly in chronic obstructive pulmonary disease (COPD). Although in COPD patients EFL more commonly develops during exercise, in more advanced disorder it can be present at rest, before in supine position, and then in seated-sitting position. In any circumstances EFL predisposes to pulmonary dynamic hyperinflation and its unfavorable effects such as increased elastic work of breathing, inspiratory muscles dysfunction, and progressive neuroventilatory dissociation, leading to reduced exercise tolerance, marked breathlessness during effort, and severe chronic dyspnea.

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“…DH also compromises efficiency of the inspiratory pump, as muscle fibers foreshorten and the inspiratory geometry becomes less conducive to force generation (46). It is no surprise, then, that dyspnea correlates strongly with DH (47)(48)(49). Independently of associated DH, AP of itself may cause dyssynchronous ventilation, impaired triggering, and less effective inspiratory pressures, with attendant consequences for ventilation efficiency and comfort (40,50).…”

Section: Consequences Of Apmentioning

confidence: 99%

Dynamic Hyperinflation and Auto–Positive End-Expiratory Pressure

Marini

2011

Am J Respir Crit Care Med

121

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Auto-positive end-expiratory pressure (auto-PEEP; AP) and dynamic hyperinflation (DH) may affect hemodynamics, predispose to barotrauma, increase work of breathing, cause dyspnea, disrupt patient-ventilator synchrony, confuse monitoring of hemodynamics and respiratory system mechanics, and interfere with the effectiveness of pressure-regulated ventilation. Although basic knowledge regarding the clinical physiology and management of AP during mechanical ventilation has evolved impressively over the 30 years since DH and AP were first brought to clinical attention, novel and clinically relevant characteristics of this complex phenomenon continue to be described. This discussion reviews some of the more important aspects of AP that bear on the care of the ventilated patient with critical illness.

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Orthopnea and Tidal Expiratory Flow Limitation in Patients With Stable COPD

Cited by 38 publications

References 19 publications

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Expiratory Flow Limitation Definition, Mechanisms, Methods, and Significance

Dynamic Hyperinflation and Auto–Positive End-Expiratory Pressure

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