Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Puente-Maestu, Luís; Palange, Paolo; Casaburi, Richard; Laveneziana, Pierantonio; Maltais, François; Neder, J. Alberto; O’Donnell, Denis E.; Onorati, Paolo; Pórszász, János; Rabinovich, Roberto; Rossiter, Harry B.; Singh, Sally; Troosters, Thierry; Ward, Susan A.

doi:10.1183/13993003.00745-2015

Cited by 320 publications

(345 citation statements)

References 310 publications

(464 reference statements)

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“…For the purpose of evaluating the efficacy of various interventions in relieving activity-related dyspnoea in clinical or research settings, a constant work rate exercise protocol set at a fixed fraction of a pre-established peak work rate (e.g. 60-80%) is preferable [104]. This is justified on the grounds that any beneficial changes in lung mechanics and dyspnoea are more readily translated into increases in time to exercise intolerance (endurance) than changes in maximal exercise capacity [105].…”

Section: Evaluation Of Therapeutic Interventions Using Cpetmentioning

confidence: 99%

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: Evaluation Of Therapeutic Interventions Using Cpetmentioning

confidence: 99%

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

et al. 2016

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“…Though somewhat less popular, the visual analogue scale (VAS) is another dyspnoea-measuring instrument with proven construct validity used during CPET. Both the VAS and Borg scale have been shown to provide similar scores during CPET, and to be reliable and reproducible over time in healthy subjects, and in patients with chronic respiratory diseases undergoing CPET [9]. The advantage of using the Borg or VAS scales in individual patients is the possibility of reliably comparing "intensity of exertional dyspnoea" at the same level of exercise activity (standardised work-rate or oxygen consumption or ventilation during CPET) between subjects, and before and after a pharmacological and/or nonpharmacological treatment [9].…”

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confidence: 98%

“…The advantage of using the Borg or VAS scales in individual patients is the possibility of reliably comparing "intensity of exertional dyspnoea" at the same level of exercise activity (standardised work-rate or oxygen consumption or ventilation during CPET) between subjects, and before and after a pharmacological and/or nonpharmacological treatment [9]. Studies in cardiopulmonary diseases have shown that during CPET, there is a close correlation between the magnitude (and duration) of respiratory effort (measured by tidal oesophageal pressure relative to maximum) and the intensity of dyspnoea (measured by the Borg scale), and that pharmacological manipulations able to reduce the magnitude (and duration) of respiratory effort are clearly and consistently associated with reduced dyspnoea intensity [1,9].…”

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confidence: 99%

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

Laveneziana

Agostoni

2016

Eur Respir Rev

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@ERSpublicationsA series of articles on exertional dyspnoea in cardiorespiratory disorders begins in the European Respiratory Review http://ow.ly/fLT0300uHgwIs dyspnoea worth documenting and accurately assessing? The answer is undoubtedly yes, for at least the following reasons. 1) Activity-related dyspnoea is usually the earliest and most troublesome complaint for which patients with cardiopulmonary diseases seek medical attention. 2) This symptom progresses relentlessly as the underlying disease advances, leading invariably to avoidance of activity with consequent skeletal muscle deconditioning and an impoverished quality of life. 3) It is estimated that up to a quarter of the general population and half of severely ill patients are affected by it. 4) Dyspnoea is also an important predictor of quality of life, exercise tolerance and mortality in various conditions. In patients with chronic obstructive pulmonary disease (COPD), it has been shown to be a better predictor of mortality than forced expiratory volume in 1 s. In patients with heart disease referred for clinical exercise testing, it is a better predictor of mortality than angina. 5) Dyspnoea is also associated with decreased functional status and worse psychological health in older individuals living at home. 6) It is also a factor in the low adherence to exercise training programmes in sedentary adults and in patients with COPD. 7) The effective management of exertional dyspnoea remains a major challenge for caregivers and modern treatment strategies that are based on attempts to reverse the underlying chronic condition are only partially successful [1][2][3][4][5][6][7].The perception of dyspnoea involves the integration of afferent and efferent inputs at a cortical level and is modulated by affective, emotional and behavioural components. The recent statements of the American Thoracic Society (ATS) [8] and European Respiratory Society [1] have underlined the multidimensional nature of dyspnoea which comprises three major dimensions: 1) the sensory-perceptual domain, 2) the affective distress and 3) the symptom impact or burden.Dyspnoea is a complex, multifaceted and highly personalised sensory experience, the source and mechanisms of which are incompletely understood: there is no unique central or peripheral source of this symptom. The definition given by the latest ATS statement ("a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity") highlights the importance of the

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“…A typical protocol for constant work rate testing is instead to start with a 1-3 min warm-up, followed by a workload brusquely increased to a high percentage (usually 75-80%) of that patient's maximal work rate [61]. The constant work test is generally continued to a symptom-limited maximum, and is mainly used for monitoring disease evolution over time and determining responses to pharmacological and nonpharmacological therapeutic interventions [62].…”

Section: The Role Of Cardiopulmonary Exercise Test In Ildsmentioning

confidence: 99%

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Bonini

Fiorenzano

2017

Eur Respir Rev

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Interstitial lung diseases (ILDs) represent a heterogeneous group of pathologies characterised by alveolar and interstitial damage, pulmonary inflammation (usually associated with fibrosis), decreased lung function and impaired gas exchange, which can be attributed to either a known or an unknown aetiology. Dyspnoea is one of the most common and disabling symptoms in patients with ILD, significantly impacting quality of life. The mechanisms causing dyspnoea are complex and not yet fully understood. However, it is recognised that dyspnoea occurs when there is an imbalance between the central respiratory efferent drive and the response of the respiratory musculature. The respiratory derangement observed in ILD patients at rest is even more evident during exercise. Pathophysiological mechanisms responsible for exertional dyspnoea and reduced exercise tolerance include altered respiratory mechanics, impaired gas exchange, cardiovascular abnormalities and peripheral muscle dysfunction.This review describes the respiratory physiology of ILD, both at rest and during exercise, and aims to provide comprehensive and updated evidence on the clinical utility of the cardiopulmonary exercise test in the assessment and management of these pathological entities. In addition, the role of exercise training and pulmonary rehabilitation programmes in the ILD population is addressed.

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Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Cited by 320 publications

References 310 publications

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

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

Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

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