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Dolmage TE, Majd S, Bradding P, Singh SJ, Green RH, Evans RA. Dynamic hyperinflation in patients with severe asthma compared to healthy adults. Pulmonology 2024; 30:78-81. [PMID: 37567815 DOI: 10.1016/j.pulmoe.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Affiliation(s)
- T E Dolmage
- Respiratory Diagnostics & Evaluation Services, West Park Healthcare Centre, Toronto, ON, Canada
| | - S Majd
- Centre for Exercise Rehabilitation Science, Leicester National Institute for Health Research Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - P Bradding
- Centre for Exercise Rehabilitation Science, Leicester National Institute for Health Research Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, Thoracic Surgery and Allergy, Glenfield Hospital, Leicester, UK
| | - S J Singh
- Centre for Exercise Rehabilitation Science, Leicester National Institute for Health Research Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, Thoracic Surgery and Allergy, Glenfield Hospital, Leicester, UK
| | - R H Green
- Centre for Exercise Rehabilitation Science, Leicester National Institute for Health Research Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK; Department of Respiratory Medicine, Thoracic Surgery and Allergy, Glenfield Hospital, Leicester, UK
| | - R A Evans
- Centre for Exercise Rehabilitation Science, Leicester National Institute for Health Research Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, Thoracic Surgery and Allergy, Glenfield Hospital, Leicester, UK.
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Fumat R, Dupuis M, Mallah S, Heluain V, Favard F, Simonneau Y, Dusselier M, Barthes R, Pontier S, Collot S, Plat G, Egenod T, Guibert N. Impact of bronchoscopic lung volume reduction with endobronchial valves on dynamic hyperinflation: Results from the PIERCE study. Respirology 2023; 28:525-532. [PMID: 36889358 DOI: 10.1111/resp.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Dynamic hyperinflation (DH) is a major marker of exertional dyspnoea in severe emphysema. We hypothesized that bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs) decreases DH. METHODS In this prospective bi-centre study from both Toulouse and Limoges Hospitals, we assessed DH during an incremental cycle ergometry before and 3 months after EBVs treatment. The primary objective was to observe the change in inspiratory capacity (IC) at isotime. Target lobe volume reduction (TLVR) and changes in residual volume (RV), forced expiratory volume in one-second (FEV1 ), mMRC, 6 minutes walking distance (6MWD), BODE and other dynamic measures like tele-expiratory volume (EELV) were also analysed. RESULTS Thirty-nine patients were included, of whom thirty-eight presented DH. IC and EELV at isotime significantly improved (+214 mL, p = 0.004; -713 mL, p ˂ 0.001, respectively). Mean changes were +177 mL for FEV1 (+19%, p < 0.001), -600 mL for RV (p < 0.0001), +33 m for 6MWD (p < 0.0001), respectively. Patients who responded on RV (>430 mL decrease) and FEV1 (>12% gain) had better improvements compared to non-responders (+368 mL vs. +2 mL; +398 mL vs. -40 mL IC isotime, respectively). On the opposite, in patients who responded on DH (>200 mL IC isotime increase), changes in TLV (-1216 mL vs. -576 mL), FEV1 (+261 mL vs. +101 mL), FVC (+496 mL vs. +128 mL) and RV (-805 mL vs. -418 mL) were greater compared to non-responders. CONCLUSIONS DH decreases after EBVs treatment, and this improvement is correlated with static changes.
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Affiliation(s)
- Romane Fumat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Marion Dupuis
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Siham Mallah
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Valentin Heluain
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Florent Favard
- Pulmonology Department, Dupuytren University Hospital, Limoges, France
| | - Yannick Simonneau
- Pulmonology Department, Dupuytren University Hospital, Limoges, France
| | | | - Romain Barthes
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Sandrine Pontier
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Samia Collot
- Radiology Department, Rangueil University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Thomas Egenod
- Pulmonology Department, Dupuytren University Hospital, Limoges, France
| | - Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France.,Paul Sabatier Toulouse University III, Toulouse, France
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Hill K, Dolmage TE. Take a Deep Breath: More Support for Noninvasive Ventilation During Exercise in People With COPD. Chest 2021; 160:1991-1992. [PMID: 34872659 DOI: 10.1016/j.chest.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kylie Hill
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Institute for Respiratory Health, Perth, WA, Australia.
| | - Thomas E Dolmage
- Department of Respiratory Medicine and Respiratory Diagnostic & Evaluation Services, West Park Healthcare Centre, Toronto, ON, Canada
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Pianosi PT. Flow limitation and dysanapsis in children and adolescents with exertional dyspnea. Respir Physiol Neurobiol 2018; 252-253:58-63. [PMID: 29588200 DOI: 10.1016/j.resp.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/05/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
The consequence of dysanapsis, quantitated by dysanapsis ratio (DR), on expiratory flow limitation (EFL) during exercise in pediatric subjects was examined. EFL occurred in 80 (56%) subjects from an enriched sample of children and adolescents tested during investigation of exertional dyspnea. DR was lower in subjects with vs without EFL during exercise: (0.055 ± 0.015 vs 0.067 ± 0.017, p < 0.001), and lower ratio correlated with greater extent of EFL (r = -0.64, p < 0.001). EFL was seen more often in boys: 67% vs 46% (p = 0.01), as girls had higher DR (0.063 ± 0.016 vs 0.056 ± 0.018, p = 0.007). Lower FEV1 (95 ± 17 vs 102 ± 15%predicted, p < 0.005) and FEF50 (3.47 ± 1.28 vs 4.08 ± 1.20 L s-1, p = 0.002) distinguished those with vs without EFL. Inspiratory capacity rose (IC) steadily, as work increased among those with EFL, whereas it fell to back resting levels after an initial rise in subjects without EFL. Low DR predicts EFL in pediatric subjects. Adjusting operating lung volume during exercise can mitigate EFL but this strategy may contribute to exertional dyspnea.
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Affiliation(s)
- Paolo T Pianosi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
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Beaumont M, Mialon P, Le Ber C, Le Mevel P, Péran L, Meurisse O, Morelot-Panzini C, Dion A, Couturaud F. Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial. Eur Respir J 2018; 51:51/1/1701107. [PMID: 29371379 DOI: 10.1183/13993003.01107-2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/29/2017] [Indexed: 01/24/2023]
Abstract
The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMT versus PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (PImax), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase of PImax after IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement of PImax in the IMT group.
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Affiliation(s)
- Marc Beaumont
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, EA3878, European University of Occidental Brittany, Morlaix, France
| | - Philippe Mialon
- Pulmonary Physiology Unit, EA2438, European University of Occidental Brittany, University Brest Centre, Brest, France
| | - Catherine Le Ber
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, EA3878, European University of Occidental Brittany, Morlaix, France
| | - Patricia Le Mevel
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, EA3878, European University of Occidental Brittany, Morlaix, France
| | - Loïc Péran
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, EA3878, European University of Occidental Brittany, Morlaix, France
| | - Olivier Meurisse
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, EA3878, European University of Occidental Brittany, Morlaix, France
| | | | - Angelina Dion
- INSERM CIC 1412, University Hospital of Brest, Brest, France
| | - Francis Couturaud
- Dept of Internal Medicine and Chest Diseases, EA3878 (GETBO), CIC INSERM 1412, University Hospital of Brest, European University of Occidental Brittany, Brest, France
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Alves GRT, Marchiori E, Irion KL, Teixeira PJZ, Berton DC, Rubin AS, Hochhegger B. The effects of dynamic hyperinflation on CT emphysema measurements in patients with COPD. Eur J Radiol 2014; 83:2255-2259. [PMID: 25271068 DOI: 10.1016/j.ejrad.2014.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/20/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Dynamic hyperinflation (DH) significantly affects dyspnea and intolerance to exercise in patients with chronic obstructive pulmonary disease (COPD). Quantitative computed tomography (QCT) of the chest is the modality of choice for quantification of the extent of anatomical lung damage in patients with COPD. The purpose of this article is to assess the effects of DH on QCT measurements. METHODS The study sample comprised patients with Global initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV COPD referred for chest CT. We examined differences in total lung volume (TLV), emphysema volume (EV), and emphysema index (EI) determined by QCT before and after DH induction by metronome-paced tachypnea (MPT). Initial (resting) and post-MPT CT examinations were performed with the same parameters. RESULTS Images from 66 CT scans (33 patients) were evaluated. EV and EI, but not TLV, increased significantly (p<0.0001) after DH induction. CONCLUSION QCT showed significant increases in EV and EI after MPT-induced DH in patients with GOLD stages III and IV COPD. For longitudinal assessment of patients with COPD using QCT, we recommend the application of a pre-examination rest period, as DH could mimic disease progression. QCT studies of the effects of DH-preventive therapy before exercise could expand our knowledge of effective measures to delay DH-related progression of COPD.
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Affiliation(s)
| | - Edson Marchiori
- Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro, Brazil
| | | | | | | | - Adalberto Sperb Rubin
- Pulmonology Department, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Bruno Hochhegger
- Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro, Brazil
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Langer D, Ciavaglia CE, Neder JA, Webb KA, O'Donnell DE. Lung hyperinflation in chronic obstructive pulmonary disease: mechanisms, clinical implications and treatment. Expert Rev Respir Med 2014; 8:731-49. [PMID: 25159007 DOI: 10.1586/17476348.2014.949676] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung hyperinflation is highly prevalent in patients with chronic obstructive pulmonary disease and occurs across the continuum of the disease. A growing body of evidence suggests that lung hyperinflation contributes to dyspnea and activity limitation in chronic obstructive pulmonary disease and is an important independent risk factor for mortality. In this review, we will summarize the recent literature on pathogenesis and clinical implications of lung hyperinflation. We will outline the contribution of lung hyperinflation to exercise limitation and discuss its impact on symptoms and physical activity. Finally, we will examine the physiological rationale and efficacy of selected pharmacological and non-pharmacological 'lung deflating' interventions aimed at improving symptoms and physical functioning.
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Affiliation(s)
- Daniel Langer
- Respiratory Investigation Unit, Queen's University & Kingston General Hospital, 102 Stuart Street, Kingston, ON K7L 2V6, Canada
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Gagnon P, Guenette JA, Langer D, Laviolette L, Mainguy V, Maltais F, Ribeiro F, Saey D. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:187-201. [PMID: 24600216 PMCID: PMC3933347 DOI: 10.2147/copd.s38934] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterized by airflow limitation that is not fully reversible. In a significant proportion of patients with COPD, reduced lung elastic recoil combined with expiratory flow limitation leads to lung hyperinflation during the course of the disease. Development of hyperinflation during the course of COPD is insidious. Dynamic hyperinflation is highly prevalent in the advanced stages of COPD, and new evidence suggests that it also occurs in many patients with mild disease, independently of the presence of resting hyperinflation. Hyperinflation is clinically relevant for patients with COPD mainly because it contributes to dyspnea, exercise intolerance, skeletal muscle limitations, morbidity, and reduced physical activity levels associated with the disease. Various pharmacological and nonpharmacological interventions have been shown to reduce hyperinflation and delay the onset of ventilatory limitation in patients with COPD. The aim of this review is to address the more recent literature regarding the pathogenesis, assessment, and management of both static and dynamic lung hyperinflation in patients with COPD. We also address the influence of biological sex and obesity and new developments in our understanding of hyperinflation in patients with mild COPD and its evolution during progression of the disease.
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Affiliation(s)
- Philippe Gagnon
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada ; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Langer
- Department of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Louis Laviolette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - François Maltais
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Fernanda Ribeiro
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Didier Saey
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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