Patterns of dynamic hyperinflation during exercise and recovery in patients with severe chronic obstructive pulmonary disease

Abstract

Background: Not all patients with severe chronic obstructive pulmonary disease (COPD) progressively hyperinflate during symptom limited exercise. The pattern of change in chest wall volumes (Vcw) was investigated in patients with severe COPD who progressively hyperinflate during exercise and those who do not. Methods: Twenty patients with forced expiratory volume in 1 second (FEV 1 ) 35 (2)% predicted were studied during a ramp incremental cycling test to the limit of tolerance (Wpeak). Changes in Vcw at the end of expiration (EEVcw), end of inspiration (EIVcw), and at total lung capacity (TLCVcw) were computed by optoelectronic plethysmography (OEP) during exercise and recovery. Results: Two significantly different patterns of change in EEVcw were observed during exercise. Twelve patients had a progressive significant increase in EEVcw during exercise (early hyperinflators, EH) amounting to 750 (90) ml at Wpeak. In contrast, in all eight remaining patients EEVcw remained unchanged up to 66% Wpeak but increased significantly by 210 (80) ml at Wpeak (late hyperinflators, LH). Although at the limit of tolerance the increase in EEVcw was significantly greater in EH, both groups reached similar Wpeak and breathed with a tidal EIVcw that closely approached TLCVcw (EIVcw/TLCVcw 93 (1)% and 93 (3)%, respectively). EEVcw was increased by 254 (130) ml above baseline 3 minutes after exercise only in EH. Conclusions: Patients with severe COPD exhibit two patterns during exercise: early and late hyperinflation. In those who hyperinflate early, it may take several minutes before the hyperinflation is fully reversed after termination of exercise.

Effects of dynamic hyperinflation on exercise capacity and quality of life in stable COPD patients

“…Recent studies have demonstrated that the extent and pattern of DH development during cycle ergometer exercise in COPD patients are highly variable, some patients presenting with dramatic DH whereas others avoiding or delaying DH development . Our study also observed the similar phenomenon.…”

Breathing pattern and chest wall volumes during exercise in patients with cystic fibrosis, pulmonary fibrosis and COPD before and after lung transplantation

“…During exercise it increases both in the rib cage and in the abdomen, but it is limited by dynamic hyperinflation of the chest wall. This is located in the rib cage 13 22. In our waiting list patients, 3 out of 21 showed an euvolumic pattern13—that is, a decrease of EE chest wall volume during exercise.…”

An assessment of pulmonary function testing and ventilatory kinematics by optoelectronic plethysmography

“…Volumes measured by OEP demonstrated a strong correlation with volumes measured by spirometry testing during quiet breathing and during the vital capacity manoeuver (Cala et al, 1996). OEP has also been validated for intensive care patients, infants and patients with chronic obstructive pulmonary disease (Aliverti et al, 2001b;Dellaca et al, 2010;Vogiatzis et al, 2005). As well, OEP has also been validated on subjects in the prone and supine positions.…”

“…Lastly, OEP has been validated during exercise for both men and women and in subjects with chronic obstructive pulmonary disease (Aliverti et al. , 2009, 2004; Vogiatzis et al. , 2005).…”

“…The term ÔkinematicsÕ refers to the motion or displacement. Over the past 10 years, OEP has been utilized in research settings for a variety of patient populations (Aliverti et al, 2000(Aliverti et al, , 2001b(Aliverti et al, , 2004Bastianini et al, 2009;Dellaca et al, 2010;Vogiatzis et al, 2005).…”