Pathogenesis of hyperinflation in chronic obstructive pulmonary disease

Gagnon, Philippe; Guenette, Jordan A.; Langer, Daniël; Laviolette, Louis; Mainguy, Vincent; Maltais, François; Ribeiro, Fernanda; Saey, Didier

doi:10.2147/copd.s38934

Cited by 89 publications

(74 citation statements)

References 198 publications

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“…Hyperinflation is related to a reduced exercise capacity leading to limited daily activities of the affected patients, a meaningful factor for a decreased quality of life [15,16,17]. Patients with severe hyperinflation are appropriate candidates for BLVR [4,14].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with severe hyperinflation are appropriate candidates for BLVR [4,14]. It is known that with increasing severity of the disease and worsening airflow, there is also an increase in hyperinflation [15,18]. It can be expected that patients with very severe COPD, as indicated by limited airflow, are patients who will benefit from BLVR therapy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Low-FEV<sub>1</sub> Patients

Darwiche¹,

Karpf-Wissel²,

Eisenmann³

et al. 2016

Respiration

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Background: Bronchoscopic lung volume reduction (BLVR) with valves has been shown to improve lung function, exercise capacity, and quality of life in patients with emphysema, but only few patients with forced expiratory volume in 1 s (FEV₁) ≤20% predicted have been included in former studies. Although the procedure can be performed safely, pneumothorax is a frequent complication, which can be critical for these very severely diseased patients. Objectives: The aim of the study was to assess the safety of BLVR in patients with a very advanced stage of emphysema, as indicated by FEV₁ ≤20% predicted. Patients and Methods: Patients in whom BLVR was performed between January 2013 and August 2015 were included in this analysis if their baseline predicted FEV₁ was ≤20%. BLVR, performed only if collateral ventilation was absent, achieved complete occlusion of the target lobe. All patients were closely monitored and were not discharged before the fourth day after BLVR. Results: Twenty patients with FEV₁ ≤20% predicted were included in the analysis. Lung volume reduction was achieved in 65% of the cases. Pneumothorax occurred in 4 cases (20%). No patient died. Lung function and exercise tolerance improved after 1 and 3 months, respectively. Conclusions: BLVR with valves can be safely performed in patients with FEV₁ ≤20% predicted when close postprocedural monitoring is provided. Improvement in lung function and exercise capacity can be achieved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Low-FEV<sub>1</sub> Patients

Darwiche¹,

Karpf-Wissel²,

Eisenmann³

et al. 2016

Respiration

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show abstract

“…As a result, these patients display substantial heterogeneity in airways resistance and conductance, pulmonary gas trapping, resting (static) lung hyperinflation, and integrity of the alveolar–capillary gas exchange interface 33. Recent evidence has also shown that dynamic hyperinflation (during exercise) occurs in many patients with mild COPD, independently of whether patients have resting hyperinflation 34. Understanding the structure–function relationships in the lungs and airways may assist understanding of exercise limitations in COPD.…”

Section: Exercise Abnormalities In Copdmentioning

confidence: 99%

Activity restriction in mild COPD: a challenging clinical problem

O’Donnell¹,

Gebke²

2014

COPD

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Dyspnea, exercise intolerance, and activity restriction are already apparent in mild chronic obstructive pulmonary disease (COPD). However, patients may not seek medical help until their symptoms become troublesome and persistent and significant respiratory impairment is already present; as a consequence, further sustained physical inactivity may contribute to disease progression. Ventilatory and gas exchange impairment, cardiac dysfunction, and skeletal muscle dysfunction are present to a variable degree in patients with mild COPD, and collectively may contribute to exercise intolerance. As such, there is increasing interest in evaluating exercise tolerance and physical activity in symptomatic patients with COPD who have mild airway obstruction, as defined by spirometry. Simple questionnaires, eg, the modified British Medical Research Council dyspnea scale and the COPD Assessment Test, or exercise tests, eg, the 6-minute or incremental and endurance exercise tests can be used to assess exercise performance and functional status. Pedometers and accelerometers are used to evaluate physical activity, and endurance tests (cycle or treadmill) using constant work rate protocols are used to assess the effects of interventions such as pulmonary rehabilitation. In addition, alternative outcome measurements, such as tests of small airway dysfunction and laboratory-based exercise tests, are used to measure the extent of physiological impairment in individuals with persistent dyspnea. This review describes the mechanisms of exercise limitation in patients with mild COPD and the interventions that can potentially improve exercise tolerance. Also discussed are the benefits of pulmonary rehabilitation and the potential role of pharmacologic treatment in symptomatic patients with mild COPD.

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“…Resistance of respiratory tract in patients with COPD is 5-15 times higher in comparison with such of healthy persons. Hyperinflation also contributes to reducing the contractile properties of respiratory muscles [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Functional Condition of Respiratory Muscles of Patients With a Complicated Bronchial Asthma Pathology and Chronic Obstructive Pulmonary Diseases

Feschenko

Nazarenko

2017

EUREKA: Health Sciences

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The aim of the research was to study the functional state of respiratory muscles and neuro-respiratory drive in patients with a combined pathology of bronchial asthma and chronic obstructive pulmonary disease. The functional condition of the respiratory muscles and the tone of the respiratory centre were determined with the help of a device for occlusion spirometry. Also, the patient was observed with a spirometry, a general plethysmography of the body. Materials and methods. 140 patients with combined broncho-obstructive pathology, 34 patients with asthma and 17 patients with COPD were examined. Spirometry, general plethysmography of the body and occlusion spirometry were provided for all patients. Results show a decrease in muscle strength of breath in all categories of patients with broncho-obstructive diseases, especially expressed in patients with bronchial asthma and asthma-COPD intersection. The muscle strength of breath was maintained with a significant increase in COPD patients compared with those with bronchial asthma. With increasing broncho-obstruction in patients with asthma-COPD intersection, there was a progressive and reliable decrease in muscle strength for breath and expiration, as well as a tendency to increase neuron respiratory drive. In patients with asthma-COPD intersection with more expressed symptoms revealed a significant and reliable weakening of muscle strength for breath and increased neuro-respiratory drive. During the work were obtained reliable links of the parameters of respiratory muscle strength not only with the parameters of pulmonary volume and bronchial patency, but also with the degree of neutrophilic inflammation in this category of patients. Conclusions The obtained data on failure of the functional state of the respiratory muscles and the neuro-respiratory drive can be used in the development of rehabilitation programs for the management of patients with combined broncho-obstructive pathology.

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Pathogenesis of hyperinflation in chronic obstructive pulmonary disease

Cited by 89 publications

References 198 publications

Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Low-FEV<sub>1</sub> Patients

Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Low-FEV<sub>1</sub> Patients

Activity restriction in mild COPD: a challenging clinical problem

Evaluation of Functional Condition of Respiratory Muscles of Patients With a Complicated Bronchial Asthma Pathology and Chronic Obstructive Pulmonary Diseases

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