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Home-based Neuromuscular Electrical Stimulation as an Add-on to Pulmonary Rehabilitation Does Not Provide Further Benefits in Patients With Chronic Obstructive Pulmonary Disease: A Multicenter Randomized Trial. Arch Phys Med Rehabil 2018; 99:1462-1470. [DOI: 10.1016/j.apmr.2018.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/18/2022]
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202
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Puente Maestú L, García de Pedro J, Benedetti PA. El futuro de las pruebas de esfuerzo. Arch Bronconeumol 2018; 54:405-406. [DOI: 10.1016/j.arbres.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
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Lloyd M, Skelton DA, Mead GE, Williams B, van Wijck F. Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis. Brain Behav 2018; 8:e01000. [PMID: 29920979 PMCID: PMC6043697 DOI: 10.1002/brb3.1000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors. METHODS Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework. RESULTS Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%. CONCLUSIONS Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings.
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Affiliation(s)
- Megan Lloyd
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Dawn A. Skelton
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Gillian E. Mead
- Geriatric MedicineDivision of Health SciencesCentre for Clinical Brain SciencesThe University of Edinburgh, and the Royal InfirmaryEdinburghUK
| | - Brian Williams
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
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Gonçalves I, Guimarães M, van Zeller M, Menezes F, Moita J, Simão P. Clinical and molecular markers in COPD. Pulmonology 2018; 24:250-259. [DOI: 10.1016/j.pulmoe.2018.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/09/2018] [Indexed: 11/15/2022] Open
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Zeng Y, Jiang F, Chen Y, Chen P, Cai S. Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review. Int J Chron Obstruct Pulmon Dis 2018; 13:2013-2023. [PMID: 29983556 PMCID: PMC6027710 DOI: 10.2147/copd.s167098] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Skeletal muscle dysfunction leads to reduction in activity in patients with COPD. As an essential part of the management of COPD, pulmonary rehabilitation (PR) alleviates dyspnea and fatigue, improves exercise tolerance and health-related quality of life, and reduces hospital admissions and mortality for COPD patients. Exercise is the key component of PR, which is composed of exercise assessment and training therapy. To evaluate PR’s application in clinical practice, this article summarizes the common methods of exercise measurement and exercise training for patients with COPD. Exercise assessments should calculate patients’ symptoms, endurance, strength, and health-related quality of life. After calculation, detailed exercise therapies should be developed, which may involve endurance, strength, and respiratory training. The detailed exercise training of each modality is mentioned in this review. Although various methods and therapies of PR have been used in COPD patients, developing an individualized exercise training prescription is the target. More studies are warranted to support the evidence and examine the effects of long-term benefits of exercise training for patients with COPD in each stage.
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Affiliation(s)
- Yuqin Zeng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China, .,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China, .,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan 410011, China,
| | - Fen Jiang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China, .,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China, .,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan 410011, China,
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China, .,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China, .,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan 410011, China,
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China, .,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China, .,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan 410011, China,
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China, .,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China, .,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, Hunan 410011, China,
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Beaumont M, Mialon P, Couturaud F. Breathlessness measurement should be standardised for the level of exertion. Eur Respir J 2018; 51:51/5/1800820. [PMID: 29848577 DOI: 10.1183/13993003.00820-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Marc Beaumont
- Pulmonary Rehabilitation unit, Morlaix Hospital Centre, European University of Occidental Brittany, Morlaix, France
| | - Philippe Mialon
- Pulmonary Physiology unit, EA 2438, European University of Occidental Brittany, University Brest Centre, Brest, France
| | - Francis Couturaud
- Dept of Internal Medicine and Chest Diseases, EA3878 (G.E.T.B.O.), CIC INSERM 0502, University Hospital of Brest, European University of Occidental Brittany, Brest, France
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Ekström M, Elmberg V, Lindow T, Wollmer P. Breathlessness measurement should be standardised for the level of exertion. Eur Respir J 2018; 51:51/5/1800486. [DOI: 10.1183/13993003.00486-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 11/05/2022]
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Herer B, Chinet T. Acute exacerbation of COPD during pulmonary rehabilitation: outcomes and risk prediction. Int J Chron Obstruct Pulmon Dis 2018; 13:1767-1774. [PMID: 29881266 PMCID: PMC5985797 DOI: 10.2147/copd.s163472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was performed to examine acute exacerbation of COPD (AECOPD) during pulmonary rehabilitation (PR) and the usefulness of multidimensional indices (MIs) to predict AECOPD at enrolment in PR. Patients and methods A 4-week PR program (PRP) was implemented for 125 consecutive patients with COPD. At baseline and PRP completion, we recorded the FEV1, 6-minute walk test, peak work rate at cardiopulmonary testing, modified Medical Research Council score, and COPD Assessment Test (CAT) score. The risk of AECOPDs at baseline was assessed using the body mass index, airway obstruction, dyspnea, Exercise capacity (BODE), dyspnea, obstruction, smoking, exacerbation (DOSE), and score to predict short-term risk of COPD exacerbations (SCOPEX) MIs. Results Thirty-two episodes of AECOPD occurred. The COPD status was worse in patients with than without AECOPD at baseline (lower FEV1, 6-minute walk test, and peak work rate; higher modified Medical Research Council and CAT scores). The sensitivities of the BODE, DOSE, and SCOPEX MIs to predict the occurrence of AECOPD during PRP were 78.1%, 21.9%, and 84.4%, and the specificities were 73.6%, 87.1%, and 51.6%, respectively. Conclusion The BODE and SCOPEX MIs help to predict the exacerbation risk during PR.
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Affiliation(s)
- Bertrand Herer
- Pulmonary Rehabilitation Unit, Pulmonary Department, Centre Hospitalier De Bligny, Briis sous Forges, France
| | - Thierry Chinet
- Pneumology Unit, Hôpital A. Paré, Boulogne-Billancourt, France
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209
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Abstract
Cardiopulmonary exercise testing (CPET) in hyperoxia and hypoxia has several applications, stemming from characterization of abnormal physiological response profiles associated with exercise intolerance. As altered oxygenation can impact the performance of gas-concentration and flow sensors and pulmonary gas exchange algorithms, integrated CPET system function requires validation under these conditions. Also, as oxygenation status can influence peak [Formula: see text]o2, care should be taken in the selection of work-rate incrementation rates when CPET performance is to be compared with normobaria at sea level. CPET has been used to evaluate the effects of supplemental O2 on exercise intolerance in chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, and cystic fibrosis at sea level. However, identification of those CPET indices likely to be predictive of supplemental O2 outcomes for exercise tolerance at altitude in such patients is lacking. CPET performance with supplemental O2 in respiratory patients residing at high altitudes is also poorly studied. Finally, CPET has the potential to give physiological and clinical information about acute and chronic mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. It may also translate high-altitude acclimatization and adaptive processes in healthy individuals into intensive care medical practice.
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210
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The Link between Reduced Inspiratory Capacity and Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2018; 14:S30-S39. [PMID: 28398073 DOI: 10.1513/annalsats.201610-834fr] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Low inspiratory capacity (IC), chronic dyspnea, and reduced exercise capacity are inextricably linked and are independent predictors of increased mortality in chronic obstructive pulmonary disease. It is no surprise, therefore, that a major goal of management is to improve IC by reducing lung hyperinflation to improve respiratory symptoms and health-related quality of life. The negative effects of lung hyperinflation on respiratory muscle and cardiocirculatory function during exercise are now well established. Moreover, there is growing appreciation that a key mechanism of exertional dyspnea in chronic obstructive pulmonary disease is critical mechanical constraints on tidal volume expansion during exercise when resting IC is reduced. Further evidence for the importance of lung hyperinflation comes from multiple studies, which have reported the clinical benefits of therapeutic interventions that reduce lung hyperinflation and increase IC. A reduced IC in obstructive pulmonary disease is further eroded by exercise and contributes to ventilatory limitation and dyspnea. It is an important outcome for both clinical and research studies.
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211
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Ward SA. Open-circuit respirometry: real-time, laboratory-based systems. Eur J Appl Physiol 2018; 118:875-898. [PMID: 29728765 DOI: 10.1007/s00421-018-3860-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Abstract
This review explores the conceptual and technological factors integral to the development of laboratory-based, automated real-time open-circuit mixing-chamber and breath-by-breath (B × B) gas-exchange systems, together with considerations of assumptions and limitations. Advances in sensor technology, signal analysis, and digital computation led to the emergence of these technologies in the mid-20th century, at a time when investigators were beginning to recognise the interpretational advantages of nonsteady-state physiological-system interrogation in understanding the aetiology of exercise (in)tolerance in health, sport, and disease. Key milestones include the 'Auchincloss' description of an off-line system to estimate alveolar O2 uptake B × B during exercise. This was followed by the first descriptions of real-time automated O2 uptake and CO2 output B × B measurement by Beaver and colleagues and by Linnarsson and Lindborg, and mixing-chamber measurement by Wilmore and colleagues. Challenges to both approaches soon emerged: e.g., the influence of mixing-chamber washout kinetics on mixed-expired gas concentration determination, and B × B alignment of gas-concentration signals with respired flow. The challenging algorithmic and technical refinements required for gas-exchange estimation at the alveolar level have also been extensively explored. In conclusion, while the technology (both hardware and software) underpinning real-time automated gas-exchange measurement has progressively advanced, there are still concerns regarding accuracy especially under the challenging conditions of changing metabolic rate.
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Affiliation(s)
- Susan A Ward
- Human Bio-Energetics Research Centre, Crickhowell, Wales, NP8 1AT, UK.
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212
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Ichinose M, Minakata Y, Motegi T, Ueki J, Gon Y, Seki T, Anzai T, Nakamura S, Hirata K. Efficacy of tiotropium/olodaterol on lung volume, exercise capacity, and physical activity. Int J Chron Obstruct Pulmon Dis 2018; 13:1407-1419. [PMID: 29750027 PMCID: PMC5936008 DOI: 10.2147/copd.s166023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose This study evaluated the efficacy of tiotropium/olodaterol vs tiotropium on lung function, exercise capacity, and physical activity in patients with COPD. Patients and methods A total of 184 patients aged ≥40 years with COPD (Global Initiative for Chronic Obstructive Lung Disease stage II-IV) received tiotropium/olodaterol for 6 weeks, then tiotropium for 6 weeks, or vice versa. The primary endpoint was inspiratory capacity (IC) at peak post-dose. Results Adjusted mean IC after 6-week treatment was 1.990 L with tiotropium/olodaterol vs 1.875 L with tiotropium (difference: 115 mL; 95% CI: 77, 153; p<0.0001). Forced expiratory volume in 1 s (difference: 105 mL; 95% CI: 88, 123), forced vital capacity (difference: 163 mL; 95% CI: 130, 197), and slow vital capacity (difference: 134 mL; 95% CI: 91, 176) improved with tiotropium/olodaterol (all p<0.0001). Adjusted mean 6-min walk distance was similar between treatments in the overall population but was significantly increased with tiotropium/olodaterol in the subgroup with Global Initiative for Chronic Obstructive Lung Disease stage III/IV at baseline (difference: 18.1 m; 95% CI: 2.3, 33.9; p=0.0254). In a post hoc analysis, tiotropium/olodaterol improved the values for ≥2.0 metabolic equivalents (difference: 5.0 min; 95% CI: 0.4, 9.7; p=0.0337). Conclusion Tiotropium/olodaterol significantly improved IC compared with tiotropium and potentially enhanced the exercise capacity in COPD patients. A slight improvement in physical activity of relatively more than moderate intensity was also seen with tiotropium/olodaterol.
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Affiliation(s)
- Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai
| | - Yoshiaki Minakata
- Department of Respiratory Medicine, National Hospital Organization Wakayama Hospital, Wakayama
| | - Takashi Motegi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo
| | - Jun Ueki
- Clinical Research Unit of Respiratory Pathophysiology, Juntendo University Graduate School of Health Care and Nursing, Chiba
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine
| | - Tetsuo Seki
- Medical Division, Nippon Boehringer Ingelheim Co., Ltd
| | - Tatsuhiko Anzai
- Clinical Information Division Data Science Center, Statistics Analysis Department 1, EPS Corporation, Tokyo
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213
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Miki K, Tsujino K, Edahiro R, Kitada S, Miki M, Yoshimura K, Kagawa H, Oshitani Y, Ohara Y, Hosono Y, Kurebe H, Maekura R. Exercise tolerance and balance of inspiratory-to-expiratory muscle strength in relation to breathing timing in patients with chronic obstructive pulmonary disease. J Breath Res 2018; 12:036008. [PMID: 29321341 DOI: 10.1088/1752-7163/aaa6db] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
RATIONALE Little is known about the applicability of respiratory muscle training based on exertional pathophysiological conditions in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the relationship between breathing timing and exertional responses, as well as whether exertional changes in the inspiratory duty cycle (Ti/Ttot) affect pathophysiological conditions, including respiratory muscles. METHODS Forty-five stable COPD patients (mean age: 71.2 years, severe and very severe COPD: 80%) were evaluated based on exertional cardiopulmonary function and respiratory muscle strength. To compare exertional responses and the balance of inspiratory-to-expiratory muscle strength, the patients were divided into two groups according to whether the Ti/Ttot increased (Ti/Ttot-increased group: resting Ti/Ttot ≤ peak Ti/Ttot, n = 21) or decreased during exercise (Ti/Ttot-decreased group: resting Ti/Ttot > peak Ti/Ttot, n = 24). RESULTS At peak exercise, the Ti/Ttot was positively correlated with minute ventilation ([Formula: see text] E), and oxygen uptake ([Formula: see text]) in all patients. No significant differences were seen in breathing frequency, tidal volume, or [Formula: see text] E at peak exercise between the two groups. Compared with the Ti/Ttot-increased group, the Ti/Ttot-decreased group had significantly lower mean values of [Formula: see text] and ΔFO2 (the inspired minus expired oxygen concentration) at peak exercise, and significantly higher mean values of the absolute ratio of maximal inspiratory pressure/maximal expiratory pressure. CONCLUSIONS The exertional change of breathing timing affected exercise tolerance and the balance of inspiratory-to-expiratory muscle strength; this finding might be helpful in making the contradictory choice of managing COPD patients with inspiratory or expiratory muscle training.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
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Arena R, Ozemek C, Laddu-Patel D, Myers J. Refining the Risk Prediction of Cardiorespiratory Fitness With Network Analysis. Circ Res 2018; 122:804-806. [DOI: 10.1161/circresaha.118.312849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ross Arena
- From the Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (R.A., C.O., D.L.-P.); Division of Cardiology, VA Palo Alto Healthcare System, CA (J.M.); and Stanford University, CA (J.M.)
| | - Cemal Ozemek
- From the Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (R.A., C.O., D.L.-P.); Division of Cardiology, VA Palo Alto Healthcare System, CA (J.M.); and Stanford University, CA (J.M.)
| | - Deepika Laddu-Patel
- From the Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (R.A., C.O., D.L.-P.); Division of Cardiology, VA Palo Alto Healthcare System, CA (J.M.); and Stanford University, CA (J.M.)
| | - Jonathan Myers
- From the Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (R.A., C.O., D.L.-P.); Division of Cardiology, VA Palo Alto Healthcare System, CA (J.M.); and Stanford University, CA (J.M.)
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215
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Medrinal C, Prieur G, Combret Y, Quesada AR, Debeaumont D, Bonnevie T, Gravier FE, Dupuis Lozeron E, Quieffin J, Contal O, Lamia B. Functional Electrical Stimulation-A New Therapeutic Approach to Enhance Exercise Intensity in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Crossover Trial. Arch Phys Med Rehabil 2018. [PMID: 29524398 DOI: 10.1016/j.apmr.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake (V˙o2) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD). DESIGN A randomized, single-blind, placebo-controlled crossover trial. SETTING Pulmonary rehabilitation department. PARTICIPANTS Consecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program. INTERVENTION Two consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling. MAIN OUTCOME MEASURES The primary outcome was mean V˙o2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions. RESULTS FES-cycling increased the physiological response more than the placebo, with a greater V˙o2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9-64.3mL/min) (P=.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05-2.9mmol/L]; P=.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition. CONCLUSIONS FES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.
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Affiliation(s)
- Clément Medrinal
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France.
| | - Guillaume Prieur
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Yann Combret
- Institute for Experimental Research, Pulmonology, ORL & Dermatology, Catholic University of Louvain, Brussels, Belgium; Physiotherapy Department, Le Havre Hospital, Montivilliers, France
| | | | - David Debeaumont
- Exercise and Respiratory Physiology Department, Bois Guillaume Hospital, Rouen University Hospital, Rouen Cedex, France
| | - Tristan Bonnevie
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; ADIR Association, Bois Guillaume, France
| | | | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Quieffin
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Olivier Contal
- University of Applied Sciences and Arts of Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Bouchra Lamia
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France; Intensive Care Unit, Respiratory Department, Rouen University Hospital, Rouen, France
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Abstract
The aim of this study was to examine the role of explicit and implicit attitudes in the improvement of exercise capacity during a 5-week pulmonary rehabilitation (PR). A total of 105 patients performed walking tests at baseline and at the end of PR. Change between performances was computed at the end of PR, and Minimal-Clinically-Important-Difference (MCID) were used to categorize patients as responders (i.e. change above MCID, N = 54) or non-responders (i.e. change below MCID, N = 51). At baseline, implicit attitudes were measured through a physical activity versus sedentary behavior Implicit Association Test; explicit attitudes toward physical activity and sedentary behavior were measured by questionnaires. Only implicit attitudes significantly differed between the two groups (p = .015), responders displaying implicit attitudes significantly more in favor of physical activity (M = .91, SD = .54) than non-responders (M = .60, SD = .71) at baseline. Measuring implicit attitudes in PR could help to accurately estimate patients' motivation, and design more individualized rehabilitation programs.
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217
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Levett D, Jack S, Swart M, Carlisle J, Wilson J, Snowden C, Riley M, Danjoux G, Ward S, Older P, Grocott M. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth 2018; 120:484-500. [DOI: 10.1016/j.bja.2017.10.020] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/20/2017] [Accepted: 10/22/2017] [Indexed: 01/09/2023] Open
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218
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Degani-Costa LH, O'Donnell DE, Webb K, Aranda LC, Carlstron JP, Cesar TDS, Plachi F, Berton DC, Neder JA, Nery LE. A Simplified Approach to Select Exercise Endurance Intensity for Interventional Studies in COPD. COPD 2018; 15:139-147. [PMID: 29485343 DOI: 10.1080/15412555.2018.1428944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Time to exercise limitation (Tlim) in response to constant work rate (CWR) is sensitive to interventions in chronic obstructive pulmonary disease (COPD). This is particularly true when the pre-intervention test lasts between 3 and 8 min (Tlim3'-8'). There is, however, no simple method to select a work rate which is consistently associated with Tlim3'-8' across the spectrum of COPD severity. We assessed 59 GOLD stages II-IV patients who initially cycled to Tlim at 75% peak. In case of short (<3 min, low-endurance) or long (>8 min, high-endurance) tests, patients exercised after 60 min at 50% or 90%, respectively (CWR50%⇐75%⇒90%). Critical mechanical constraints and limiting dyspnea at 75% were reached within the desired timeframe in 27 "mid-endurance" patients (46%). Increasing work rate intensity to 90% hastened the mechanical-ventilatory responses leading to Tlim3'-8' in 23/26 (88%) "high-endurance" patients; conversely, decreasing exercise intensity to 50% slowed those responses leading to Tlim3'-8' in 5/6 (83%) "high-endurance" patients. Repeating the tests at higher (60%) or lower (80%) intensities fail to consistently produce Tlim3'-8' in "low-" and "high-endurance", respectively (p > 0.05). Compared to a fixed work rate at 75%, CWR50%⇐75%⇒90% significantly decreased Tlim's coefficient of variation; consequently, the required N to detect 100 s or 33% improvement in Tlim decreased from 82 to 26 and 41 to 14, respectively. This simplified approach to individualized work rate adjustment (CWR50%⇐75%⇒90%) might allow greater sensitivity in evaluating interventional efficacy in improving respiratory mechanics and exercise tolerance while simultaneously reducing sample size requirements in patients with COPD.
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Affiliation(s)
- Luiza H Degani-Costa
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Denis E O'Donnell
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Katherine Webb
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Liliane C Aranda
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Júlio P Carlstron
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Tamires da Silva Cesar
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Franciele Plachi
- c Division of Respirology , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Danilo C Berton
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada.,c Division of Respirology , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - J Alberto Neder
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Luiz E Nery
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
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Porszasz J, Carraro N, Cao R, Gore A, Ma S, Jiang T, Maltais F, Ferguson GT, O'Donnell DE, Shaikh A, Rossiter HB, Casaburi R. Effect of tiotropium on spontaneous expiratory flow-volume curves during exercise in GOLD 1-2 COPD. Respir Physiol Neurobiol 2018; 251:8-15. [PMID: 29438808 DOI: 10.1016/j.resp.2018.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/12/2018] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Abstract
This substudy of a large, randomized, controlled trial (NCT01072396) examined tiotropium (18 μg qd) effects on dynamic hyperinflation during constant work rate treadmill exercise. Areas-under-the-spontaneous expiratory flow-volume (SEFV)-curves were compared in 20 COPD patients and 16 age-matched untreated controls, using rectangular area ratio (RAR) between peak intrabreath and end-expiratory flow. Seven patients exhibited SEFV curve concavity with RAR ≤ 0.5 (RARlow) in ≥1 test without tiotropium; (mean ± SD FEV1: 1.60 ± 0.59 L; 63.4 ± 14.0%predicted). In RARlow patients, tiotropium increased end-exercise inspiratory capacity (IC, 2.10 ± 0.05 vs. 1.89 ± 0.05 L, tiotropium vs. placebo; p = 0.045) and RAR (0.57 ± 0.02 vs. 0.53 ± 0.02; p < 0.001). Patients without SEFV curve concavity with RAR > 0.5 (n = 13; RARhigh), had higher screening FEV1 (2.15 ± 0.47 L; 79.6 ± 10.1%predicted) versus RARlow patients and no difference in end-exercise IC and RAR between tiotropium and placebo (IC: 2.24 ± 0.03 vs. 2.17 ± 0.03 L; RAR: 0.63 ± 0.005 vs. 0.62 ± 0.005). RAR and%predicted IC at peak exercise were positively correlated in RARlow patients (R2 = 0.43, p = 0.0002). Tiotropium increased exercise RAR in GOLD 1-2 patients with SEFV curve concavity.
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Affiliation(s)
- Janos Porszasz
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
| | - Nicolò Carraro
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Robert Cao
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
| | - Ashwani Gore
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Shuyi Ma
- Center for Infectious Disease Research, Seattle, WA, USA.
| | - Thomas Jiang
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA.
| | - Denis E O'Donnell
- Department of Medicine, Queen's University & Kingston General Hospital, Kingston, ON, Canada.
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Faculty of Biological Sciences, University of Leeds, Leeds, UK.
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
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220
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Weatherald J, Sattler C, Garcia G, Laveneziana P. Ventilatory response to exercise in cardiopulmonary disease: the role of chemosensitivity and dead space. Eur Respir J 2018; 51:51/2/1700860. [PMID: 29437936 DOI: 10.1183/13993003.00860-2017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 11/11/2017] [Indexed: 12/30/2022]
Abstract
The lungs and heart are irrevocably linked in their oxygen (O2) and carbon dioxide (CO2) transport functions. Functional impairment of the lungs often affects heart function and vice versa The steepness with which ventilation (V'E) rises with respect to CO2 production (V'CO2 ) (i.e. the V'E/V'CO2 slope) is a measure of ventilatory efficiency and can be used to identify an abnormal ventilatory response to exercise. The V'E/V'CO2 slope is a prognostic marker in several chronic cardiopulmonary diseases independent of other exercise-related variables such as peak O2 uptake (V'O2 ). The V'E/V'CO2 slope is determined by two factors: 1) the arterial CO2 partial pressure (PaCO2 ) during exercise and 2) the fraction of the tidal volume (VT) that goes to dead space (VD) (i.e. the physiological dead space ratio (VD/VT)). An altered PaCO2 set-point and chemosensitivity are present in many cardiopulmonary diseases, which influence V'E/V'CO2 by affecting PaCO2 Increased ventilation-perfusion heterogeneity, causing inefficient gas exchange, also contributes to the abnormal V'E/V'CO2 observed in cardiopulmonary diseases by increasing VD/VT During cardiopulmonary exercise testing, the PaCO2 during exercise is often not measured and VD/VT is only estimated by taking into account the end-tidal CO2 partial pressure (PETCO2 ); however, PaCO2 is not accurately estimated from PETCO2 in patients with cardiopulmonary disease. Measuring arterial gases (PaO2 and PaCO2 ) before and during exercise provides information on the real (and not "estimated") VD/VT coupled with a true measure of gas exchange efficiency such as the difference between alveolar and arterial O2 partial pressure and the difference between arterial and end-tidal CO2 partial pressure during exercise.
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Affiliation(s)
- Jason Weatherald
- Dept of Medicine, Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.,Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Caroline Sattler
- Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Gilles Garcia
- Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Pneumologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,These authors contributed equally to this work and are both last authors
| | - Pierantonio Laveneziana
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France .,Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Dépt "R3S", Pôle PRAGUES, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.,These authors contributed equally to this work and are both last authors
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221
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Di Marco F, Sotgiu G, Santus P, O’Donnell DE, Beeh KM, Dore S, Roggi MA, Giuliani L, Blasi F, Centanni S. Long-acting bronchodilators improve exercise capacity in COPD patients: a systematic review and meta-analysis. Respir Res 2018; 19:18. [PMID: 29368604 PMCID: PMC5784692 DOI: 10.1186/s12931-018-0721-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background We carried out a systematic review and meta-analysis with the aim to evaluate the efficacy of longacting bronchodilators on exercise capacity in COPD patients. Methods The endpoints were the efficacy of long-acting bronchodilators (altogether, and by single classes) vs. placebo in modifying endurance time (ET), inspiratory capacity (IC) and dyspnea during exercise, taking into consideration the outcomes according to different patients’ inclusion criteria and exercise methodology. Results Twenty-two studies were deemed eligible for analysis. Weighted mean increase in ET resulted of 67 s (95% CI ranges from 55 to 79). For isotime IC and dyspnea during exercise, weighted improvements were 195 ml (162–229), and − 0.41 units (− 0.56 to − 0.27), respectively. The increase in trough IC was 157 ml (138–175). We found a trend in favour of LAMA compared to LABA in terms of ET. In the 11 studies which reported a value of functional residual capacity > 120% as inclusion criterion, weighted mean increase in endurance time was 94 s (65 to 123); however we did not find any significant correlation between ET and mean trough IC (P: 0.593). The improvement of ET in the 5 studies using walking as exercise methodology resulted of 58 s (− 4 to 121). Conclusions Long-acting bronchodilators improve exercise capacity in COPD. The main effect of long-acting bronchodilators seems to be a increase of basal IC rather than a modification of dynamic hyperinflation during exercise. The efficacy in terms of endurance time seems higher in studies which enrolled patients with hyperinflation, with a similar efficacy on walking or cycling.
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Affiliation(s)
- Fabiano Di Marco
- Respiratory Unit, Ospedale San Paolo, Department of Health Science, Università degli Studi di Milano, Via A. di Rudinì, 8-20142 Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Pierachille Santus
- Department of Biomedical And Clinical Sciences (DIBIC), University of Milan, Milan, Italy
- Respiratory Unit, “Luigi Sacco” University Hospital; ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Denis E. O’Donnell
- Division of Respiratory and Critical Care Medicine, Respiratory Investigation Unit, Queen’s University and Kingston General Hospital, Kingston, ON Canada
| | | | - Simone Dore
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Lisa Giuliani
- Respiratory Unit, Ospedale San Paolo, Department of Health Science, Università degli Studi di Milano, Via A. di Rudinì, 8-20142 Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinic, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, Ospedale San Paolo, Department of Health Science, Università degli Studi di Milano, Via A. di Rudinì, 8-20142 Milan, Italy
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222
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High Oxygen Delivery to Preserve Exercise Capacity in Patients with Idiopathic Pulmonary Fibrosis Treated with Nintedanib. Methodology of the HOPE-IPF Study. Ann Am Thorac Soc 2018; 13:1640-7. [PMID: 27348402 DOI: 10.1513/annalsats.201604-267oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Pulmonary rehabilitation improves dyspnea and exercise capacity in idiopathic pulmonary fibrosis (IPF); however, it is unknown whether breathing high amounts of oxygen during exercise training leads to further benefits. OBJECTIVES Herein, we describe the design of the High Oxygen Delivery to Preserve Exercise Capacity in IPF Patients Treated with Nintedanib study (the HOPE-IPF study). The primary objective of this study is to determine the physiological and perceptual impact of breathing high levels of oxygen during exercise training in patients with IPF who are receiving antifibrotic therapy. METHODS HOPE-IPF is a two-arm double-blind multicenter randomized placebo-controlled trial of 88 patients with IPF treated with nintedanib. Patients will undergo 8 weeks of three times weekly aerobic cycle exercise training, breathing a hyperoxic gas mixture with a constant fraction of 60% inhaled oxygen, or breathing up to 40% oxygen as required to maintain an oxygen saturation level of at least 88%. MEASUREMENTS AND MAIN RESULTS End points will be assessed at baseline, postintervention (Week 8), and follow-up (Week 26). The primary analysis will compare the between-group baseline with post-training change in endurance time during constant work rate cycle exercise tests. Additional analyses will evaluate the impact of training with high oxygen delivery on 6-minute walk distance, dyspnea, physical activity, and quality of life. CONCLUSIONS The HOPE-IPF study will lead to a comprehensive understanding of IPF exercise physiology, with the potential to change clinical practice by indicating the need for increased delivery of supplemental oxygen during pulmonary rehabilitation in patients with IPF. Clinical trial registered with www.clinicaltrials.gov (NCT02551068).
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223
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Lee AL, Dolmage TE, Rhim M, Goldstein RS, Brooks D. The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People With COPD. Chest 2017; 153:1134-1141. [PMID: 29253555 DOI: 10.1016/j.chest.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/23/2017] [Accepted: 12/01/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In people with COPD, dyspnea is the primary symptom limiting exercise tolerance. One approach to reducing dyspnea during exercise is through music listening. A constant speed endurance test reflects a high-intensity aerobic exercise training session, but whether listening to music affects endurance time is unknown. This study aimed to determine the effects of listening to music during a constant speed endurance test in COPD. METHODS Participants with COPD completed two endurance walk tests, one with and one without listening to self-selected music throughout the test. The primary outcome was the difference in endurance time between the two conditions. Heart rate, percutaneous oxygen saturation, dyspnea, and rate of perceived exertion were measured before and after each test. RESULTS Nineteen participants (mean [SD]: age, 71 [8] years; FEV1, 47 [19] % predicted) completed the study. Endurance time was greater (1.10 [95% CI, 0.41-1.78] min) while listening to music (7.0 [3.1] min) than without (5.9 [2.6] min), and reduced end-test dyspnea (1.0 [95% CI, -2.80 to -1.80] units) (with music, 4.6 [1.7] units; vs without music, 5.6 [1.4] units, respectively). There was not a significant difference in heart rate, percutaneous oxygen saturation, or leg fatigue. There were no adverse events under either condition. CONCLUSIONS In COPD, dyspnea was less while listening to music and was accompanied by an increased tolerance of high-intensity exercise demonstrated by greater endurance time. Practically, the effect was modest but may represent an aid for exercise training of these patients. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry; No. ACTRN12617001217392.
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Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - Thomas E Dolmage
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Respiratory Diagnostic and Evaluation Services, West Park Healthcare Centre, Toronto, ON, Canada
| | - Matthew Rhim
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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224
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Agustí A, Celli B. Natural history of COPD: gaps and opportunities. ERJ Open Res 2017; 3:00117-2017. [PMID: 29255718 PMCID: PMC5731770 DOI: 10.1183/23120541.00117-2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/13/2017] [Indexed: 02/04/2023] Open
Abstract
Understanding the natural history of a disease is as important as knowing its cause(s) for effective disease prevention and treatment. Yet, our current understanding of the natural history of chronic obstructive pulmonary disease (COPD) is incomplete and often controversial. This article discusses the current gaps, and hence opportunities for research, in this field. In particular, it discusses the following six specific questions. 1) Is COPD a “single” disease? 2) Is COPD “only” a lung disease? 3) When does COPD begin or what is “early” COPD? 4) How does COPD “progress”? 5) How do we assess disease “severity”? 6) Can COPD be prevented (beyond smoking cessation) or its course be modified once detected? A new review series starts in ERJ Open Research: “Gaps in our understanding of COPD”http://ow.ly/CFSD30gpXs8
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Affiliation(s)
- Alvar Agustí
- Respiratory Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain
| | - Bartolomé Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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225
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Mancuso M, McFarland R, Klopstock T, Hirano M. International Workshop:: Outcome measures and clinical trial readiness in primary mitochondrial myopathies in children and adults. Consensus recommendations. 16-18 November 2016, Rome, Italy. Neuromuscul Disord 2017; 27:1126-1137. [PMID: 29074296 PMCID: PMC6094160 DOI: 10.1016/j.nmd.2017.08.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Michelangelo Mancuso
- Department of Experimental and Clinical Medicine, Neurological Institute, University of Pisa, Italy.
| | - Robert McFarland
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Department of Physiology and Functional Genomics NE1 3BZ, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Klopstock
- Friedrich-Baur-Institut an der Neurologischen Klinik und Poliklinik, LMU München, Ziemssenstr. 1a, 80336 München, Federal Republic of Germany
| | - Michio Hirano
- Department of Neurology, H. Houston Merritt Neuromuscular Research Center, Columbia University Medical Center, New York, NY, USA
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226
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Machado FVC, Bisca GW, Morita AA, Rodrigues A, Probst VS, Furlanetto KC, Pitta F, Hernandes NA. Agreement of different reference equations to classify patients with COPD as having reduced or preserved 6MWD. Pulmonology 2017; 24:S2173-5115(17)30151-3. [PMID: 29191775 DOI: 10.1016/j.rppnen.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/22/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interpretation of the six-minute walk distance (6MWD) is enhanced by using recommended reference equations. Whenever possible, the choice of equation should be region-specific. A potential problem is that different equations for the 6MWD may have been developed for the same population, and it may be complicated to choose the most suitable. OBJECTIVE To verify the agreement of different reference equations in classifying patients with Chronic Obstructive Pulmonary Disease (COPD) as having reduced or preserved 6MWD. METHODS 159 patients with COPD performed the six-minute walk test according to international standardization. They were classified as having reduced 6MWD if it was below the lower limit of normal. Five Brazilian equations (Iwama; Britto1; Britto2; Dourado; Soares) and the two non-Brazilian equations most cited worldwide (Troosters; Enright) were used. The agreement for patients classified as reduced or preserved 6MWD was verified by Cohen's Kappa (pair-to-pair) analysis. The proportion of patients classified as having reduced walked distance was compared by the Chi-squared test. RESULTS Agreement between equations varied largely in classifying subjects as having reduced or preserved 6MWD (Kappa: 0.10-0.82). Brazilian equations with the highest agreement were Iwama, Britto1 and Britto2 (Kappa>0.75). The proportion of patients classified as having reduced 6MWD was statistically similar only between equations in which the agreement was higher than 0.70. CONCLUSION Even reference equations from the same country vary considerably in the classification of reduced or preserved 6MWD, and it is recommended that the region-specific ones be used as they give with higher agreement for similar and comparable interpretation of the patients' functional exercise capacity.
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Affiliation(s)
- F V C Machado
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - G W Bisca
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil; Centro Universitário Filadélfia (UniFil), Av. Juscelino Kubitscheck, 1626, 86020-000 Londrina, Paraná, Brazil
| | - A A Morita
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - A Rodrigues
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - V S Probst
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - K C Furlanetto
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil; Research Centre in Health Sciences (CPCS), University of Northern Paraná (UNOPAR), Londrina, Paraná, Brazil
| | - F Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - N A Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil.
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227
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Kovacs G, Herve P, Barbera JA, Chaouat A, Chemla D, Condliffe R, Garcia G, Grünig E, Howard L, Humbert M, Lau E, Laveneziana P, Lewis GD, Naeije R, Peacock A, Rosenkranz S, Saggar R, Ulrich S, Vizza D, Vonk Noordegraaf A, Olschewski H. An official European Respiratory Society statement: pulmonary haemodynamics during exercise. Eur Respir J 2017; 50:50/5/1700578. [DOI: 10.1183/13993003.00578-2017] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/08/2017] [Indexed: 01/18/2023]
Abstract
There is growing recognition of the clinical importance of pulmonary haemodynamics during exercise, but several questions remain to be elucidated. The goal of this statement is to assess the scientific evidence in this field in order to provide a basis for future recommendations.Right heart catheterisation is the gold standard method to assess pulmonary haemodynamics at rest and during exercise. Exercise echocardiography and cardiopulmonary exercise testing represent non-invasive tools with evolving clinical applications. The term “exercise pulmonary hypertension” may be the most adequate to describe an abnormal pulmonary haemodynamic response characterised by an excessive pulmonary arterial pressure (PAP) increase in relation to flow during exercise. Exercise pulmonary hypertension may be defined as the presence of resting mean PAP <25 mmHg and mean PAP >30 mmHg during exercise with total pulmonary resistance >3 Wood units. Exercise pulmonary hypertension represents the haemodynamic appearance of early pulmonary vascular disease, left heart disease, lung disease or a combination of these conditions. Exercise pulmonary hypertension is associated with the presence of a modest elevation of resting mean PAP and requires clinical follow-up, particularly if risk factors for pulmonary hypertension are present. There is a lack of robust clinical evidence on targeted medical therapy for exercise pulmonary hypertension.
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228
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Vitacca M, Kaymaz D, Lanini B, Vagheggini G, Ergün P, Gigliotti F, Ambrosino N, Paneroni M. Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support: A randomized controlled trial. Respirology 2017; 23:182-189. [PMID: 28940820 DOI: 10.1111/resp.13181] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. METHODS All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone. Outcome measures were 6MWD (primary outcome), incremental and endurance cycle ergometer exercise time, respiratory muscle function, quality of life by the Maugeri Respiratory Failure questionnaire (MRF-28), dyspnoea (Medical Research Council scale) and leg fatigue at rest. RESULTS Forty-two patients completed the study. Following training, no significant difference in 6MWD changes were found between groups. Improvement in endurance time was significantly greater in the NIV group compared with the non-NIV training group (754 ± 973 vs 51 ± 406 s, P = 0.0271); dyspnoea improved in both groups, while respiratory muscle function and leg fatigue improved only in the NIV ET group. MRF-28 improved only in the group training without NIV. CONCLUSION In CRF patients on long-term NIV and long-term oxygen therapy (LTOT), the addition of NIV to ET sessions resulted in an improvement in endurance time, but not in 6MWD.
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Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
| | - Dicle Kaymaz
- Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Barbara Lanini
- Respiratory Unit, Fondazione Don Gnocchi IRCCS, Florence, Italy
| | | | - Pınar Ergün
- Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Nicolino Ambrosino
- Pulmonary and Respiratory Medicine Department, Medical Faculty Sebelas Maret University, Solo, Indonesia
| | - Mara Paneroni
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
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Watz H, Troosters T, Beeh KM, Garcia-Aymerich J, Paggiaro P, Molins E, Notari M, Zapata A, Jarreta D, Garcia Gil E. ACTIVATE: the effect of aclidinium/formoterol on hyperinflation, exercise capacity, and physical activity in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2545-2558. [PMID: 28883722 PMCID: PMC5574699 DOI: 10.2147/copd.s143488] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Phase IV, 8-week, randomized, double-blind, placebo-controlled ACTIVATE study (NCT02424344) evaluated the effect of aclidinium/formoterol (AB/FF) 400/12 μg twice daily on lung hyperinflation, exercise capacity, and physical activity in patients with moderate-to-severe COPD. Patients received AB/FF (n=134) or placebo (n=133) (1:1) via the Genuair™/Pressair® dry powder inhaler for 8 weeks. From Weeks 5 to 8, all patients participated in behavioral intervention (BI; daily messages providing step goals). The primary end point was trough functional residual capacity (FRC) at Week 4. Exercise endurance time and physical activity were assessed at Week 4 (pharmacotherapy only) and at Week 8 (8 weeks of pharmacotherapy plus 4 weeks of BI). Other end points included post-dose FRC, residual volume, and inspiratory capacity (IC) at rest and during exercise. After 4 weeks, trough FRC improved with AB/FF versus placebo but did not reach significance (125 mL; P=0.0690). However, post-dose FRC, residual volume, and IC at rest improved significantly with AB/FF at Week 4 versus placebo (all P<0.0001). AB/FF significantly improved exercise endurance time and IC at isotime versus placebo at Week 4 (P<0.01 and P<0.0001, respectively) and Week 8 (P<0.05 and P<0.0001, respectively). AB/FF achieved higher step counts (P<0.01) with fewer inactive patients (P<0.0001) at Week 4 versus placebo. Following BI, AB/FF maintained improvements in physical activity at Week 8 and nonsignificant improvements were observed with placebo. AB/FF 400/12 μg demonstrated improvements in lung hyperinflation, exercise capacity, and physical activity versus placebo that were maintained following the addition of BI. A 4-week period of BI might be too short to augment the improvements of physical activity observed with AB/FF.
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Affiliation(s)
- Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Pulmonary Rehabilitation and Respiratory Division, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Kai M Beeh
- insaf Respiratory Research Institute GmbH, Wiesbaden, Germany
| | - Judith Garcia-Aymerich
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | | | - Massimo Notari
- A. Menarini Farmaceutica Internazionale S.R.L., Firenze, Italy
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Prieur G, Medrinal C, Combret Y, Quesada AR, Prieur F, Quieffin J, Borel JC, Reychler G. Effect of high-flow nasal therapy during acute aerobic exercise in patients with chronic obstructive pulmonary disease after exacerbation: protocol for a randomised, controlled, cross-over trial. BMJ Open Respir Res 2017; 4:e000191. [PMID: 29071072 PMCID: PMC5647475 DOI: 10.1136/bmjresp-2017-000191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/13/2017] [Accepted: 07/12/2017] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Early pulmonary rehabilitation is recommended after a severe exacerbation of chronic obstructive pulmonary disease (COPD). However, this is difficult to implement, particularly for exercise training. High-flow nasal therapy (HFNT) may reduce the work of breathing and dyspnoea and may improve exercise tolerance. METHODS AND ANALYSIS This is a single-centre, prospective, controlled, randomised, cross-over study. Eligible patients will have a diagnosis of COPD (postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio of <0.7). Two constant work rate exercise tests at 80% of the peak work rate will be carried out on two consecutive days with and without HFNT. The primary outcome will be the difference in endurance time between the two conditions. Secondary outcomes will be the change in muscle oxygenation during exercise, dyspnoea and muscle fatigue, respiratory muscle strength after exercise, respiratory rate, cardiac frequency, transcutaneous CO2 pressure and pulsed O2 saturation. Nineteen patients will be included. Data will be analysed as intention to treat by a blinded statistician. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Ethics Committees Nord-Ouest III, Caen, France (N° ID RCB: 2016-A01325-46). The study will begin in April 2017 for a duration of 2 years. The results of the trial will be presented at national and international meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03058081.
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Affiliation(s)
- Guillaume Prieur
- Pulmonology Department and Pulmonary Rehabilitation Department, Groupe Hospitalier du Havre, Montivilliers, France
| | - Clement Medrinal
- Normandie UnivRouen France Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Pulmonology Department Groupe Hospitalier du Havre, Montivilliers, France
| | - Yann Combret
- Physiotherapy Department, Groupe Hospitalier du Havre, Montivilliers, France.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie Université Catholique de Louvain, 1200 Brussels, Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Fabrice Prieur
- Université Paris Saclay, Orsay Cedex, France.,CIAMS Université d'Orléans, Orléans, France
| | - Jean Quieffin
- Pulmonology Department, Groupe Hospitalier du Havre, Montivilliers, France
| | | | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, 1200 Brussels, Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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231
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Schaeffer MR, Molgat-Seon Y, Ryerson CJ, Guenette JA. Supplemental oxygen and dypsnoea in interstitial lung disease: absence of evidence is not evidence of absence. Eur Respir Rev 2017; 26:26/145/170033. [PMID: 28794145 DOI: 10.1183/16000617.0033-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/25/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Michele R Schaeffer
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.,Dept of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Yannick Molgat-Seon
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.,Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada .,Dept of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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232
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Calzetta L, Ora J, Cavalli F, Rogliani P, O'Donnell DE, Cazzola M. Impact of LABA/LAMA combination on exercise endurance and lung hyperinflation in COPD: A pair-wise and network meta-analysis. Respir Med 2017; 129:189-198. [DOI: 10.1016/j.rmed.2017.06.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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233
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Karlsson SL, Backer V, Godtfredsen NS. Oral prednisolone for 4 days does not increase exercise tolerance in men with COPD. Chron Respir Dis 2017; 15:220-222. [PMID: 28718320 PMCID: PMC5958466 DOI: 10.1177/1479972317721929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
One of the primary objectives in management of chronic obstructive pulmonary disease (COPD) is preventing decrease in lung function and reducing the annual number of acute exacerbations of COPD (AECOPD). An oral course of systemic corticosteroids is a commonly used treatment in AECOPD. We hypothesize that this treatment also increases exercise performance and decreases muscle fatigue. In a randomized double-blinded, parallel, placebo-controlled trial, we investigated 14 men (8 on prednisolone 37.5 mg vs. 6 on placebo) with severe and very severe COPD. For 5 consecutive days, the patients performed a submaximal endurance test measuring time to exhaustion (TTE, primary endpoint), spirometry, maximal inspiratory and expiratory pressure and maximal isometric contraction of the quadriceps femoris muscle (maximum voluntary contraction (MVC)). At visits 2, 3 and 4, a fatigue protocol was carried out after 40 minutes of cycling at 40% of maximal effort. No differences between groups were found for TTE, lung function or maximal inspiratory or expiratory pressure, however, patients on prednisolone showed significant increased MVC: median 5.15 [3.35; 9.15] against placebo: −2 [−5.57; 3.95] (p = 0.03). This finding indicates an impact of corticosteroids on muscle groups being exposed to submaximal endurance.
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Affiliation(s)
- S L Karlsson
- 1 Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - V Backer
- 2 Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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234
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Mazzuco A, Medeiros WM, Souza ASD, Alencar MCN, Neder JA, Borghi-Silva A. Are heart rate dynamics in the transition from rest to submaximal exercise related to maximal cardiorespiratory responses in COPD? Braz J Phys Ther 2017; 21:251-258. [PMID: 28558953 PMCID: PMC5537469 DOI: 10.1016/j.bjpt.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Poor exercise capacity is an important negative prognostic marker in patients with chronic obstructive pulmonary disease (COPD). Heart rate variability (HRV) responses can indicate alterations in cardiac autonomic control. Nevertheless, it remains unclear whether these abnormalities are related to cardiorespiratory responses to exercise in these patients. OBJECTIVE To evaluate whether HRV at rest and submaximal exercise are related to impaired cardiopulmonary responses to exercise in COPD patients. METHODS Fifteen men (66.2±8.7 years) with COPD (FEV1: 55.1±19.2%) were assessed. The R-R interval (RRi) data collection was performed at rest (stand position) and during the six-minute walk test (6MWT). All patients performed a symptom-limited cardiopulmonary exercise test on a cycle ergometer. The HRV changes from rest to submaximal exercise (Δ rest-6MWT) were calculated. RESULTS We found significant correlations between low frequency (LF) and high frequency (HF) Δ rest-6MWT with Δ oxyhemoglobin saturation by pulse oximetry (r=-0.64 and r=0.65, respectively; p<0.05), minute ventilation/carbon dioxide output relationship from beginning to peak exercise (r=-0.52 and r=0.53, p<0.05), and exercise ventilatory power (r=0.52 and r=-0.53, p<0.05). Interestingly, there was a strong positive correlation (r=0.82, p<0.05) between six-minute walk distance (6MWD) and Δ LF/HF from rest to exercise. CONCLUSION HRV analysis in the transition from rest to submaximal exercise is associated with exercise ventilatory and hemodynamic abnormalities in COPD patients. Rehabilitative strategies to improve HRV responses may provide an important tool to clinical practice in these patients.
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Affiliation(s)
- Adriana Mazzuco
- Laboratório de Fisioterapia Cardiopulmonar (LACAP), Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Wladimir Musetti Medeiros
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício (SEFICE), Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Aline Soares de Souza
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício (SEFICE), Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Maria Clara Noman Alencar
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício (SEFICE), Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - José Alberto Neder
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício (SEFICE), Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Audrey Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar (LACAP), Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
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van Geffen WH, Klooster K, Hartman JE, Ten Hacken NHT, Kerstjens HAM, Wolf RFE, Slebos DJ. Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment. Respiration 2017. [PMID: 28637047 DOI: 10.1159/000477258] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. OBJECTIVE To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. METHODS HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (<1 mm), 5 points for each medium-sized lesion (1-5 mm), and 10 points for each large lesion (>5 mm). RESULTS The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score <12 did not rule out the occurrence of pneumothorax. CONCLUSION A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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237
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Schaeffer MR, Ryerson CJ, Ramsook AH, Molgat-Seon Y, Wilkie S, Dhillon SS, Mitchell RA, Sheel AW, Khalil N, Camp PG, Guenette JA. Effects of hyperoxia on dyspnoea and exercise endurance in fibrotic interstitial lung disease. Eur Respir J 2017; 49:49/5/1602494. [DOI: 10.1183/13993003.02494-2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/11/2017] [Indexed: 11/05/2022]
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238
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Functional Tests in Chronic Obstructive Pulmonary Disease, Part 2: Measurement Properties. Ann Am Thorac Soc 2017; 14:785-794. [DOI: 10.1513/annalsats.201609-734as] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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239
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Cambios en la respuesta ventilatoria al esfuerzo en deportistas entrenados: efectos beneficiosos sobre la fisiología respiratoria más allá del rendimiento cardiovascular. Arch Bronconeumol 2017; 53:237-244. [DOI: 10.1016/j.arbres.2016.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 11/24/2022]
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240
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Benson AP, Bowen TS, Ferguson C, Murgatroyd SR, Rossiter HB. Data collection, handling, and fitting strategies to optimize accuracy and precision of oxygen uptake kinetics estimation from breath-by-breath measurements. J Appl Physiol (1985) 2017; 123:227-242. [PMID: 28450551 DOI: 10.1152/japplphysiol.00988.2016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/20/2017] [Accepted: 04/19/2017] [Indexed: 11/22/2022] Open
Abstract
Phase 2 pulmonary oxygen uptake kinetics (ϕ2 τV̇o2P) reflect muscle oxygen consumption dynamics and are sensitive to changes in state of training or health. This study identified an unbiased method for data collection, handling, and fitting to optimize V̇o2P kinetics estimation. A validated computational model of V̇o2P kinetics and a Monte Carlo approach simulated 2 × 105 moderate-intensity transitions using a distribution of metabolic and circulatory parameters spanning normal health. Effects of averaging (interpolation, binning, stacking, or separate fitting of up to 10 transitions) and fitting procedures (biexponential fitting, or ϕ2 isolation by time removal, statistical, or derivative methods followed by monoexponential fitting) on accuracy and precision of V̇o2P kinetics estimation were assessed. The optimal strategy to maximize accuracy and precision of τV̇o2P estimation was 1-s interpolation of 4 bouts, ensemble averaged, with the first 20 s of exercise data removed. Contradictory to previous advice, we found optimal fitting procedures removed no more than 20 s of ϕ1 data. Averaging method was less critical: interpolation, binning, and stacking gave similar results, each with greater accuracy compared with analyzing repeated bouts separately. The optimal procedure resulted in ϕ2 τV̇o2P estimates for transitions from an unloaded or loaded baseline that averaged 1.97 ± 2.08 and 1.04 ± 2.30 s from true, but were within 2 s of true in only 47-62% of simulations. Optimized 95% confidence intervals for τV̇o2P ranged from 4.08 to 4.51 s, suggesting a minimally important difference of ~5 s to determine significant changes in τV̇o2P during interventional and comparative studies.NEW & NOTEWORTHY We identified an unbiased method to maximize accuracy and precision of oxygen uptake kinetics (τV̇o2P) estimation. The optimum number of bouts to average was four; interpolation, bin, and stacking averaging methods gave similar results. Contradictory to previous advice, we found that optimal fitting procedures removed no more than 20 s of phase 1 data. Our data suggest a minimally important difference of ~5 s to determine significant changes in τV̇o2P during interventional and comparative studies.
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Affiliation(s)
- Alan P Benson
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom; .,Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom
| | - T Scott Bowen
- Heart Centre, University of Leipzig, Leipzig, Germany
| | - Carrie Ferguson
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom.,Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom
| | - Scott R Murgatroyd
- Neurosciences Intensive Care Unit, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom; and
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.,School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
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Laveneziana P, Agostoni P. Exertional dyspnoea in cardiorespiratory disorders: the clinical use of cardiopulmonary exercise testing. Eur Respir Rev 2017; 25:227-9. [PMID: 27581822 PMCID: PMC9487217 DOI: 10.1183/16000617.0044-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 12/04/2022] Open
Abstract
Is 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 [1–7]. A series of articles on exertional dyspnoea in cardiorespiratory disorders begins in the European Respiratory Reviewhttp://ow.ly/fLT0300uHgw
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Affiliation(s)
- Pierantonio Laveneziana
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département "R3S", Pôle PRAGUES), Paris, France
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Dept of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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242
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O'Donnell DE, Elbehairy AF, Faisal A, Webb KA, Neder JA, Mahler DA. Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing. Eur Respir Rev 2017; 25:333-47. [PMID: 27581832 DOI: 10.1183/16000617.0054-2016] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/01/2016] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Denis E O'Donnell
- Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Amany F Elbehairy
- Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada Dept of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azmy Faisal
- Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada Faculty of Physical Education for Men, Alexandria University, Alexandria, Egypt
| | - Katherine A Webb
- Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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Miki K, Maekura R, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Kagawa H, Oshitani Y, Satomi A, Nishida K, Sawa N, Inoue K. Pulmonary rehabilitation for COPD improves exercise time rather than exercise tolerance: effects and mechanisms. Int J Chron Obstruct Pulmon Dis 2017; 12:1061-1070. [PMID: 28435239 PMCID: PMC5388245 DOI: 10.2147/copd.s131061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND COPD patients undergoing pulmonary rehabilitation (PR) show various responses. The purpose of this study was to investigate the possible mechanisms and predictors of the response to PR in COPD patients. METHODS Thirty-six stable COPD patients underwent PR including a 4-week high-intensity exercise training program, and they were evaluated by cardiopulmonary exercise testing. All patients (mean age 69 years, severe and very severe COPD 94%) were classified into four groups by whether the exercise time (Tex) or the peak oxygen uptake [Formula: see text] increased after PR: two factors increased (both the Tex and the peak [Formula: see text] increased); two factors decreased; time only increased (the Tex increased, but the peak [Formula: see text] economized); and [Formula: see text] only increased (the Tex decreased, but the peak [Formula: see text] increased). Within all patients, the relationships between baseline variables and the post-to-pre-change ratio of the time-slope, Tex/(peak minus resting [Formula: see text]), were investigated. RESULTS Compared with the two factors increased group (n=11), in the time only increased group (n=18), the mean differences from pre-PR at peak exercise in 1) minute ventilation [Formula: see text] (P=0.004), [Formula: see text] (P<0.0001), and carbon dioxide output [Formula: see text] (P<0.0001) were lower, 2) [Formula: see text]/ [Formula: see text] (P=0.034) and [Formula: see text]/ [Formula: see text] (P=0.006) were higher, and 3) the dead space/tidal volume ratio (VD/VT) and the dyspnea level were similar. After PR, there was no significant difference in the ratio of the observed peak heart rate (HR) to the predicted peak HR (220 - age [years]) between the two groups. A significant negative correlation with the baseline time-slope (r=-0.496, P=0.002) and a positive correlation with the baseline body mass index (BMI) (r=0.496, P=0.002) were obtained. CONCLUSIONS PR in COPD patients improves Tex rather than exercise tolerance, economizing oxygen requirements, resulting in reduced ventilatory requirements without cardiac loads followed by reduced exertional dyspnea. In addition, the time-slope and BMI could be used to predict PR responses beforehand.
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Affiliation(s)
| | | | | | | | | | - Hiroshi Yamamoto
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
| | - Toshiko Kawabe
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
| | | | | | | | | | | | - Kimiko Inoue
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
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O'Donnell DE, Casaburi R, Frith P, Kirsten A, De Sousa D, Hamilton A, Xue W, Maltais F. Effects of combined tiotropium/olodaterol on inspiratory capacity and exercise endurance in COPD. Eur Respir J 2017; 49:1601348. [PMID: 28424359 PMCID: PMC5898947 DOI: 10.1183/13993003.01348-2016] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/14/2016] [Indexed: 11/05/2022]
Abstract
Two replicate, double-blind, 6-week, incomplete-crossover studies (MORACTO 1 and 2) assessed the effects of tiotropium/olodaterol on inspiratory capacity and exercise endurance time in patients with moderate to severe chronic obstructive pulmonary disease.For each patient, four of five treatments were administered once daily for 6 weeks, with a 21-day washout between treatments: tiotropium/olodaterol 2.5/5 µg or 5/5 µg, tiotropium 5 µg, olodaterol 5 µg or placebo, all via the Respimat inhaler. Primary outcomes were inspiratory capacity prior to exercise and exercise endurance time during constant work-rate cycle ergometry to symptom limitation at 75% of peak incremental work rate after 6 weeks (2 h post-dose).295 and 291 patients were treated in MORACTO 1 and 2, respectively. Tiotropium/olodaterol 2.5/5 and 5/5 µg provided significant improvements in inspiratory capacity versus placebo and monotherapies (p<0.0001), and significant improvements in exercise endurance time versus placebo (p<0.0001). Intensity of breathing discomfort was reduced following both doses of tiotropium/olodaterol versus placebo (p<0.0001).Once-daily tiotropium/olodaterol yielded improvements in lung hyperinflation versus placebo and statistically significant improvements versus monotherapies. Tiotropium/olodaterol also showed improvements in dyspnoea and exercise tolerance versus placebo but not consistently versus monotherapies.
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Affiliation(s)
- Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Peter Frith
- Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Anne Kirsten
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | | | | | - Wenqiong Xue
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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245
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Neder JA, Berton DC, Arbex FF, Alencar MC, Rocha A, Sperandio PA, Palange P, O'Donnell DE. Physiological and clinical relevance of exercise ventilatory efficiency in COPD. Eur Respir J 2017; 49:49/3/1602036. [PMID: 28275174 DOI: 10.1183/13993003.02036-2016] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
Exercise ventilation (V'E) relative to carbon dioxide output (V'CO2 ) is particularly relevant to patients limited by the respiratory system, e.g. those with chronic obstructive pulmonary disease (COPD). High V'E-V'CO2 (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV1). Establishing an association between high V'E-V'CO2 and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV1 impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase V'E-V'CO2 In fact, a high V'E-V'CO2 has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high V'E-V'CO2 has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the V'E-V'CO2 relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.
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Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Danilo C Berton
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada.,Division of Respiratory Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flavio F Arbex
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Clara Alencar
- Division of Cardiology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alcides Rocha
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paolo Palange
- Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Denis E O'Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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Maddocks M, Nolan CM, Man WDC. Simple functional tests in COPD: stand up and be counted! Eur Respir J 2017; 49:49/3/1700104. [PMID: 28254769 DOI: 10.1183/13993003.00104-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/24/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Claire M Nolan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK.,Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, Harefield, UK
| | - William D-C Man
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK .,Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, Harefield, UK
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O'Donnell DE, Elbehairy AF, Berton DC, Domnik NJ, Neder JA. Advances in the Evaluation of Respiratory Pathophysiology during Exercise in Chronic Lung Diseases. Front Physiol 2017; 8:82. [PMID: 28275353 PMCID: PMC5319975 DOI: 10.3389/fphys.2017.00082] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
Dyspnea and exercise limitation are among the most common symptoms experienced by patients with various chronic lung diseases and are linked to poor quality of life. Our understanding of the source and nature of perceived respiratory discomfort and exercise intolerance in chronic lung diseases has increased substantially in recent years. These new mechanistic insights are the primary focus of the current review. Cardiopulmonary exercise testing (CPET) provides a unique opportunity to objectively evaluate the ability of the respiratory system to respond to imposed incremental physiological stress. In addition to measuring aerobic capacity and quantifying an individual's cardiac and ventilatory reserves, we have expanded the role of CPET to include evaluation of symptom intensity, together with a simple "non-invasive" assessment of relevant ventilatory control parameters and dynamic respiratory mechanics during standardized incremental tests to tolerance. This review explores the application of the new advances in the clinical evaluation of the pathophysiology of exercise intolerance in chronic obstructive pulmonary disease (COPD), chronic asthma, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). We hope to demonstrate how this novel approach to CPET interpretation, which includes a quantification of activity-related dyspnea and evaluation of its underlying mechanisms, enhances our ability to meaningfully intervene to improve quality of life in these pathologically-distinct conditions.
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Affiliation(s)
- Denis E. O'Donnell
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
| | - Amany F. Elbehairy
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
- Department of Chest Diseases, Faculty of Medicine, Alexandria UniversityAlexandria, Egypt
| | - Danilo C. Berton
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
| | - Nicolle J. Domnik
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
| | - J. Alberto Neder
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
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248
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Bonini M, Fiorenzano G. Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing. Eur Respir Rev 2017; 26:26/143/160099. [DOI: 10.1183/16000617.0099-2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/01/2016] [Indexed: 01/08/2023] Open
Abstract
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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249
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Humbert M, Dinh-Xuan AT, Reeves EL, Broadhead MG, Bullen NJ. The ambition of the European Respiratory Journal continues: chapter 5. Eur Respir J 2017; 49:49/1/1602393. [PMID: 28049182 DOI: 10.1183/13993003.02393-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Marc Humbert
- Univ. Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France .,Service de Pneumologie, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Anh Tuan Dinh-Xuan
- Service de Physiologie, Paris Descartes University EA 2511, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elin L Reeves
- European Respiratory Society Publications Office, Sheffield, UK
| | | | - Neil J Bullen
- European Respiratory Society Publications Office, Sheffield, UK
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