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Kominami K, Noda K, Minagawa N, Yonezawa K, Ueda M, Kobayashi Y, Murata M, Akino M. Detection of dynamic lung hyperinflation using cardiopulmonary exercise testing and respiratory function in patients with stable cardiac disease: a multicenter, cross-sectional study. BMC Sports Sci Med Rehabil 2024; 16:84. [PMID: 38622661 PMCID: PMC11020655 DOI: 10.1186/s13102-024-00871-z] [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: 09/12/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Many patients with heart disease potentially have comorbid chronic obstructive pulmonary disease (COPD); however, there are not enough opportunities for screening, and the qualitative differentiation of shortness of breath (SOB) has not been well established. We investigated the detection rate of SOB based on a visual and qualitative dynamic lung hyperinflation (DLH) detection index during cardiopulmonary exercise testing (CPET) and assessed potential differences in respiratory function between groups. METHODS We recruited 534 patients with heart disease or patients who underwent simultaneous CPET and spirometry (369 males, 67.0 ± 12.9 years) to scrutinize physical functions. The difference between inspiratory and expiratory tidal volume was calculated (TV E-I) from the breath-by-breath data. Patients were grouped into convex (decreased TV E-I) and non-convex (unchanged or increased TV E-I) groups based on their TV E-I values after the start of exercise. RESULTS Among the recruited patients, 129 (24.2%) were categorized in the convex group. There was no difference in clinical characteristics between the two groups. The Borg scale scores at the end of the CPET showed no difference. VE/VCO2 slope, its Y-intercept, and minimum VE/VCO2 showed no significant difference between the groups. In the convex group, FEV1.0/FVC was significantly lower compared to that in the non-convex group (69.4 ± 13.1 vs. 75.0 ± 9.0%). Moreover, significant correlations were observed between FEV1.0/FVC and Y-intercept (r=-0.343), as well as between the difference between minimum VE/VCO2 and VE/VCO2 slope (r=-0.478). CONCLUSIONS The convex group showed decreased respiratory function, suggesting a potential airway obstruction during exercise. A combined assessment of the TV E-I and Y-intercept of the VE/VCO2 slope or the difference between the minimum VE/VCO2 and VE/VCO2 slopes could potentially detect COPD or airway obstruction.
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Affiliation(s)
- Kazuyuki Kominami
- Department of Rehabilitation, Sanseikai Kitano Hospital, 6-30, 1-chome, Kitano 1-jyo, Kiyota-ku, 004-0861, Sapporo, Hokkaido, Japan.
| | - Kazuki Noda
- Department of Rehabilitation, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Nanaho Minagawa
- Sinfuwakai Asabu Heart and Cardiac Rehabilitation Clinic, Sapporo, Hokkaido, Japan
| | - Kazuya Yonezawa
- Department of Cardiovascular Medicine, National Hospital Organization Hakodate Hospital, Hakodate, Hokkaido, Japan
| | - Masanori Ueda
- Department of Clinical Laboratory, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Yasuyuki Kobayashi
- Department of Clinical Laboratory, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Masatoshi Akino
- Department of Internal Medicine, Sapporo Kiyota Hospital, Sapporo, Hokkaido, Japan
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Kominami K, Noda K, Minagawa N, Yonezawa K, Akino M. The concept of detection of dynamic lung hyperinflation using cardiopulmonary exercise testing. Medicine (Baltimore) 2023; 102:e33356. [PMID: 36961157 PMCID: PMC10036017 DOI: 10.1097/md.0000000000033356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/03/2023] [Indexed: 03/25/2023] Open
Abstract
Dynamic lung hyperinflation (DLH) caused by air trapping, which increases residual air volume, is a common cause of shortness of breath on exertion in chronic obstructive pulmonary disease (COPD). DLH is commonly evaluated by measuring the decrease in maximal inspiratory volume during exercise, or using the hyperventilation method. However, only few facilities perform these methods, and testing opportunities are limited. Therefore, we investigated the possibility of visually and qualitatively detecting DLH using data from a cardiopulmonary exercise test (CPET). Four men who underwent symptom-limiting CPET were included in this study, including a male patient in his 60s with confirmed COPD, a 50s male long-term smoker, and 2 healthy men in their 20s and 70s, respectively. We calculated the difference between the inspiratory tidal volume (TV I) and expiratory tidal volume (TV E) per breath (TV E-I) from the breath-by-breath data of each CPET and plotted it against the time axis. No decrease in TV E-I was observed in either of the healthy men. However, in the patient with COPD and long-term smoker, TV E-I began to decrease immediately after the initiation of exercise. These results indicate that DLH can be visually detected using CPET data. However, this study was a validation of a limited number of cases, and a comparison with existing evaluation methods and verification of disease specificity are required.
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Affiliation(s)
- Kazuyuki Kominami
- Department of Rehabilitation, Sanseikai Kitano Hospital, Sapporo, Hokkaido, Japan
| | - Kazuki Noda
- Department of Rehabilitation, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Nanaho Minagawa
- Cardiac Rehabilitation Center, Caress-Sapporo Hokko Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Kazuya Yonezawa
- Department of Cardiovascular Medicine, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Masatoshi Akino
- Department of Orthopedics, Sapporo Kiyota Orthopedic Hospital, Sapporo, Hokkaido, Japan
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Chen CC, Lin CH, Hao WR, Chiu CC, Fang YA, Liu JC, Sung LC. Association between chronic obstructive pulmonary disease and ventricular arrhythmia: a nationwide population-based cohort study. NPJ Prim Care Respir Med 2021; 31:8. [PMID: 33580036 PMCID: PMC7880986 DOI: 10.1038/s41533-021-00221-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
The ventricular arrhythmia (VA)-chronic obstructive pulmonary disease (COPD) association and related risk factors remain unclear. Using 2001-2012 data from National Health Insurance Research Database, we retrospectively reviewed 71,838 patients diagnosed as having COPD and 71,838 age- and sex-matched controls. After adjustments for comorbidities, medication, urbanization level, and monthly income, patients with COPD had higher incidence rates of VA than did the controls (adjusted hazard ratio [aHR] [95% confidence interval (CI)]: 1.45 [1.25-1.68]). More hospitalization or emergency visits because of acute COPD exacerbation (aHRs [95% CIs] for first, second, and third visits: 1.28 [1.08-1.50], 1.75 [1.32-2.32], and 1.88 [1.46-2.41], respectively) and asthma-COPD overlap (aHR [95% CI]: 1.49 [1.25-1.79]) were associated with high VA risk in patients with COPD. In the multivariate analysis, heart failure (aHR [95% CI]: 2.37 [1.79-3.14]), diabetes (aHR [95% CI]:1.64 [1.29-2.08]), age ≥75 (aHR [95% CI]: 2.48 [1.68-3.67]), male (aHR [95% CI]: 1.69[1.34-2.12]), and class III antiarrhythmic drug use (aHR [95% CI]: 2.49 [1.88-3.28]) are the most significant risk factors of new onset of VA in patients with COPD.
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Affiliation(s)
- Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Hsin Lin
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Rui Hao
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Ann Fang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan. .,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Li-Chin Sung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan. .,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Ogino T, Mase K, Murakami S, Domen K. Work of breathing during arm bracing in normal male subjects. ACTA ACUST UNITED AC 2020; 56:65-69. [PMID: 33274260 PMCID: PMC7690311 DOI: 10.29390/cjrt-2020-012] [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: 11/16/2022]
Abstract
Objective Although chronic obstructive pulmonary disease patients get relief from their dyspnea by arm bracing, the mechanics of this effect are unknown. This study aimed to investigate the mechanisms by which arm bracing affects dyspnea by measuring the work of breathing (WOB) in the arm bracing posture. Methods Six normal male subjects were studied in two standing postures: erect and with their arms braced. For the arm bracing posture, the subjects leaned forward with their arms stretched and rested their hands on a platform. Respiratory frequency was set at 20 tidal breaths/min with the use of a metronome, and tidal volume was set at 1 L by observing the lung volume on a monitor. All the subjects randomly adopted the two postures, and a preset respiratory pattern was measured for 30 s in each posture. Lung volume and flow rate were measured using a hot-wire flowmeter. Esophageal pressure was measured using a 12-cm balloon catheter. The WOB was estimated using modified Campbell diagrams. Results Lung volume increased and inspiratory resistive WOB decreased, while inspiratory elastic WOB increased significantly with arm bracing compared with that of the erect posture (P < 0.05). Conclusion Arm bracing posture increases the chest wall expansion thereby increasing the end-expiratory lung volume and decreasing the inspiratory resistive WOB among healthy individuals.
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Affiliation(s)
- Tomoyuki Ogino
- Department of Rehabilitation, Hyogo College of Medicine Sasayama Medical Center, Sasayama, Hyogo, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Higashinada, Kobe, Hyogo, Japan
| | - Shigefumi Murakami
- Department of Rehabilitation, Hyogo College of Medicine Sasayama Medical Center, Sasayama, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Akimoto K, Hirai K, Matsunaga T, Kaneko K, Mikuni H, Kawahara T, Uno T, Fujiwara A, Miyata Y, Ohta S, Homma T, Inoue H, Yamaguchi F, Kusumoto S, Suzuki S, Tanaka A, Sagara H. The Relationship Between the "Adherence Starts with Knowledge-20" Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2020; 15:3201-3211. [PMID: 33311977 PMCID: PMC7726831 DOI: 10.2147/copd.s280464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Inhaler therapy is the mainstay of chronic obstructive pulmonary disease (COPD) management. Poor adherence causes disease exacerbation and affects patient mortality. Although the Adherence Starts with Knowledge-20 (ASK-20) questionnaire is a reliable tool for assessing medication adherence, the relationship between the ASK-20 and clinical factors in patients with COPD remains unknown. We investigated the relationship between the ASK-20 and clinical factors, and assessed real-world inhaler therapy use. Patients and Methods A multicenter, cross-sectional study of outpatients with COPD undergoing inhaler treatment who completed the ASK-20 questionnaire was performed. We investigated COPD-related health status using the COPD Assessment Test (CAT), psychological status using the Hospital Anxiety and Depression Scale (HADS-anxiety and HADS-depression), respiratory function, patient satisfaction levels, and real-world inhaler therapy use. Results Of the total 319 patients, 87% were male with a median age of 74 years. Most patients had mild or moderate COPD, according to Global Initiative for Chronic Obstructive Lung Disease stage. The total ASK-20 scores correlated significantly with the CAT, HADS-anxiety, and HADS-depression scores (r = 0.27, 0.33, and 0.29, respectively, p < 0.01). Multivariable analysis showed that CAT and HADS-anxiety scores had an independent and significant impact on the ASK-20 scores [β, standardized regression coefficient: 0.18 (95% CI, 0.03–0.35; p = 0.02), and 0.29 (95% CI, 0.17–0.42; p < 0.01), respectively]; however, the ASK-20 scores were not correlated with age, sex, body mass index, cohabitation, modified Medical Research Council Dyspnea Scale score, pulmonary function, disease duration, number of COPD exacerbations per year, comorbidities, inhaler numbers, nor inhaler components. Conclusion The ASK-20 scores in patients with COPD were significantly associated with CAT and HADS scores. In Japan, Respimat was prescribed to younger patients and patients with lower CAT scores. The ASK-20, a simple evaluation method, is useful for identifying clinical factors affecting adherence in patients with COPD.
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Affiliation(s)
- Kaho Akimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kuniaki Hirai
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Matsunaga
- Division of Allergology and Respiratory Medicine, Department of Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Keisuke Kaneko
- Department of Pulmonary Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Hatsuko Mikuni
- Department of Respiratory Medicine, Asahi General Hospital, Chiba, Japan
| | - Tomoko Kawahara
- Department of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan
| | - Tomoki Uno
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akiko Fujiwara
- Department of Respiratory, Odawara Municipal Hospital, Kanagawa, Japan
| | - Yoshito Miyata
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shin Ohta
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tetsuya Homma
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hideki Inoue
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Sojiro Kusumoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shintaro Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Tanaka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Tsujimura Y, Hiramatsu T, Kojima E, Tabira K. Effect of pulmonary rehabilitation with assistive use of short-acting β2 agonist in COPD patients using long-acting bronchodilators. Physiother Theory Pract 2019; 37:719-728. [PMID: 31294667 DOI: 10.1080/09593985.2019.1641866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Assistive use of short-acting β2 agonists (SABAs) reportedly improves exercise tolerance, activities of daily living, and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). However, the effect of SABA on physical activity (PA) is unclear.Objective: This study aimed to determine whether assistive use of SABA increases PA and whether additional pulmonary rehabilitation (PR) can aid further improvement.Methods: Twelve outpatients with COPD and dyspnea during daily activities despite regular use of long-acting bronchodilators were enrolled. This study comprised a 2-week pre-intervention investigation, a 12-week investigation of SABA effects, and an 8-week investigation of the additional effects of PR. Assistive use of SABA was allowed up to 4 times per day after the pre-intervention period. PA was measured for 14 consecutive days using an accelerometer sensor. Dyspnea, exercise tolerance, and HRQOL were evaluated at entry, at 4 and 12 weeks after initiating SABA use, and after completing PR.Results: Assistive use of SABA improved breathlessness during daily activities and increased PA (p < .001). PA and HRQOL were also improved following PR (p < .001 and p = .013, respectively).Conclusions: Combined therapy of SABA and PR can increase PA and HRQOL in COPD patients.
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Affiliation(s)
- Yasuhiko Tsujimura
- Hiramatsu Clinic of Internal and Respiratory Medicine, Komaki, Japan.,Division of Health Science, Graduate School of Health Science, Kio University, Nara, Japan
| | - Tetsuo Hiramatsu
- Hiramatsu Clinic of Internal and Respiratory Medicine, Komaki, Japan
| | - Eiji Kojima
- Department of Respiratory Medicine, Komaki City Hospital, Komaki, Japan
| | - Kazuyuki Tabira
- Division of Health Science, Graduate School of Health Science, Kio University, Nara, Japan
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Kawachi S, Fujimoto K. Efficacy of tiotropium and olodaterol combination therapy on dynamic lung hyperinflation evaluated by hyperventilation in COPD: an open-label, comparative before and after treatment study. Int J Chron Obstruct Pulmon Dis 2019; 14:1167-1176. [PMID: 31213796 PMCID: PMC6551445 DOI: 10.2147/copd.s201106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/10/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Dynamic lung hyperinflation (DLH) following metronome-paced incremental hyperventilation (MPIH) was reported to be useful for assessment of pathophysiological impairment in patients with chronic obstructive pulmonary disease (COPD), and the effects of tiotropium and olodaterol on DLH following MPIH have not been reported. Methods: Treatment consisted of administration of tiotropium/olodaterol 5/5 μg inhalation solution (2.5/2.5 μg per actuation) using a soft-mist inhaler once a day. We compared outcomes before and after 8 weeks of treatment. The primary outcome was defined as a decrease in inspiratory capacity (IC) from rest by MPIH, which is an index of DLH. The secondary outcomes were COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), and 6-min walking distance (6MWD). In addition, we investigated whether there were correlations between changes with treatment in DLH and FEV1, 6MWD, and dyspnea. Results: Thirty-three of the 38 registered patients completed this study. Most of these 33 patients had mild to moderate COPD. Decreasing IC by MPIH was significantly reduced by treatment for 8 weeks, with a mean change of about −0.11 to −0.13 mL (P <0.05). In addition, CAT score, FEV1, and 6MWD improved with treatment (P <0.05). There were no significant correlations between changes in DLH, FEV1, 6MWD, or dyspnea with treatment. Conclusions: The results of this study showed that the combination of tiotropium and olodaterol is effective for improvement of DLH following hyperventilation. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/j1pN5vQuhyc
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Affiliation(s)
- Shohei Kawachi
- Department of Biomedical Laboratory Science, Graduate School of Medicine, Shinshu University, Nagano 390-8621, Japan
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto 390-8621, Japan
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Mannée D, Vis E, Hoekstra-Kuik A, van der Maten J, van 't Hul AJ, van Helvoort H. Is the Metronome-Paced Tachypnea Test (MPT) Ready for Clinical Use? Accuracy of the MPT in a Prospective and Clinical Study. Respiration 2019; 97:569-575. [PMID: 30870858 DOI: 10.1159/000496290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A simple technique to measure dynamic hyperinflation (DH) in patients with chronic obstructive pulmonary disease (COPD) is the metronome-paced tachypnea test (MPT). Earlier studies show conflicting results about the accuracy of the MPT compared to cardiopulmonary exercise testing (CPET). OBJECTIVES The focus was to investigate the diagnostic accuracy of MPT to detect DH in a prospective and clinical study. METHODS COPD patients were included; all underwent spirometry, CPET, and MPT. DH (ΔIC) was calculated as the difference in % between inspiratory capacity (IC) at the start and end of the test divided by IC at the start. A subject was identified as a hyperinflator, if ΔIC (% of ICrest) was smaller than -10.2 and -11.1% in CPET and MPT, respectively. With these values, sensitivity and specificity were calculated. Bland-Altman plots were made of ΔIC (% of ICrest). RESULTS In the prospective and clinical study, 107 and 48 patients were included, respectively. Sensitivity of the MPT was 85% in both studies. The specificities were 33 and 27%, respectively. In the prospective study, B = +2.6%, L = 30.6, and -25.6%. In the clinical study, B = +0.8%, L = 31.0, and -29.1%. CONCLUSION MPT seems to be a good replacement for CPET in group studies. The mean amount of DH was not different between CPET and MPT. On an individual level, MPT cannot be used to identify hyperinflators; it should be kept in mind that MPT overdiagnoses DH. The amount of DH should not be interchanged between CPET and MPT.
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Affiliation(s)
- Denise Mannée
- Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands,
| | - Esther Vis
- Pulmonary Diseases, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | | | - Jan van der Maten
- Pulmonary Diseases, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Alex Jan van 't Hul
- Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hanneke van Helvoort
- Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
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Hirano T, Matsunaga K, Hamada K, Uehara S, Suetake R, Yamaji Y, Oishi K, Asami M, Edakuni N, Ogawa H, Ichinose M. Combination of assist use of short-acting beta-2 agonists inhalation and guidance based on patient-specific restrictions in daily behavior: Impact on physical activity of Japanese patients with chronic obstructive pulmonary disease. Respir Investig 2019; 57:133-139. [PMID: 30612948 DOI: 10.1016/j.resinv.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assist use of inhaled short-acting beta 2 agonists (SABAs) is reportedly effective for preventing shortness of breath on exertion in chronic obstructive pulmonary disease (COPD) patients. However, it is unclear what strategy would be useful for improving physical activity in such patients. The aim is to investigate the effects of assisted use of SABA (procaterol) on physical activity in Japanese COPD patients targeting patient-specific restrictions in daily behavior. METHODS Fourteen patients with stable COPD (age: 72.1±1.5, %FEV1: 55.6±4.5%) were asked to inhale 20 μg of procaterol 15 minutes before patient-specific daily physical activity that had been identified as limited by a questionnaire and document their usage in a diary. Physical activity was measured using a triaxial accelerometer and the results were collected every month for 2 months. In the first month, a clinician assessed whether inhalation of SABA was appropriate based on a usage diary and coached patients to conduct adequate assist use of SABA for limited physical activity. RESULTS The strategy significantly improved the physical activity level, assessed using the values of the metabolic equivalents (METs) multiplied by physical activity endurance, at ≥3.0 METs (p<0.05), and physical activity endurance at ≥2.5 and ≥3.0 METs, (p<0.05, p<0.05, respectively). The degree of improvement of physical activity level was significantly positively correlated with the baseline %FVC and %FEV1 (p<0.05, p<0.05, respectively). CONCLUSIONS Assist use of SABA targeting patient-specific restrictions, particularly when better lung function is still preserved, could be a useful approach for improving physical activity in patients with COPD.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan.
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Sho Uehara
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Ryo Suetake
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Yoshikazu Yamaji
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Keiji Oishi
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Japan
| | - Maki Asami
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Nobutaka Edakuni
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kawachi S, Fujimoto K. Usefulness of a Newly Developed Spirometer to Measure Dynamic Lung Hyperinflation following Incremental Hyperventilation in Patients with Chronic Obstructive Pulmonary Disease. Intern Med 2019; 58:39-46. [PMID: 30101930 PMCID: PMC6367078 DOI: 10.2169/internalmedicine.1212-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/31/2018] [Indexed: 11/06/2022] Open
Abstract
Objective This study was performed to determine the usefulness of a newly developed spirometer for the quantitative assessment of dynamic lung hyperinflation (DLH) following incremental hyperventilation in chronic obstructive pulmonary disease (COPD). Methods The subjects were 54 patients with COPD and 25 healthy volunteers. Each subject was asked to hyperventilate for 30 seconds with stepwise increments starting at the resting respiration rate and increasing to respiratory rates of 20, 30, and finally 40 breaths/min while using a newly developed spirometer. The relationship between the observed inspiratory capacity (IC) reduction following incremental hyperventilation as an index of DLH and spirometry or the 6-minute walking distance was examined. Results The IC did not decrease significantly from the resting IC, even when the respiratory rate was increased, in the healthy volunteer group. However, in the COPD patient group, the IC decreased with increases in the respiratory rate. Significant correlations were found between all IC parameters and the severity of COPD. A significant negative correlation was also found between the decreased IC and the 6-minute walking distance. Conclusion These findings suggest that the quantitative assessment of DLH following incremental hyperventilation using the newly developed spirometer may be useful for the assessment of pathophysiological impairment in patients with COPD.
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Affiliation(s)
- Shohei Kawachi
- Department of Biomedical Laboratory Science, Graduate School of Medicine, Shinshu University, Japan
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Japan
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Fujimoto K, Yamazaki H, Ura M, Kitaguchi Y. Efficacy of tiotropium and indacaterol monotherapy and their combination on dynamic lung hyperinflation in COPD: a random open-label crossover study. Int J Chron Obstruct Pulmon Dis 2017; 12:3195-3201. [PMID: 29138547 PMCID: PMC5679691 DOI: 10.2147/copd.s149054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The difference in efficacy of long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) for dynamic lung hyperinflation (DLH) in COPD is unclear. The purpose of this study was to elucidate the difference in efficacy of LAMA and LABA alone and the combination thereof for DLH. SUBJECTS AND METHODS Thirty stable patients were enrolled and randomly divided into two groups following baseline measurements. One group was treated with 5 μg tiotropium (Respimat inhaler) for 4 weeks following a 4-week treatment with 150 μg indacaterol, while the other group was treated with indacaterol for 4 weeks following a 4-week treatment with tiotropium. For both groups, these treatments were followed by a combination of the two drugs for 4 weeks. Pulmonary function tests, including DLH evaluated by metronome-paced incremental hyperventilation and exercise tolerance evaluated by the shuttle-walk test, were performed at the end of each treatment period. RESULTS In total, 23 patients completed this study. Both tiotropium and indacaterol alone significantly increased forced expiratory volume in 1 second, exercise tolerance, and improved health status. Tiotropium significantly improved DLH, but indacaterol did not. The combination therapy resulted in further improvements in lung function and exercise tolerance, but not in DLH. CONCLUSION The efficacy of tiotropium in inhibiting DLH following metronome-paced incremental hyperventilation may be superior to that of 150 μg indacaterol, although the effects on airflow obstruction were the same, and the combination therapy showed further improvement in airflow obstruction, but not in DLH.
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Affiliation(s)
- Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, School of Health Sciences
| | - Haruna Yamazaki
- Department of Biomedical Laboratory Science, Graduate School of Medicine
| | - Midori Ura
- Department of Biomedical Laboratory Science, Graduate School of Medicine
| | - Yoshiaki Kitaguchi
- First Department of Internal Medicine, School of Medicine, Shinshu University, Matsumoto, Japan
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Burioka N, Nakamoto S, Amisaki T, Horie T, Shimizu E. A Modified Method for Examining the Walking Pattern and Pace of COPD Patients in a 6-min Walk Test Before and After the Inhalation of Procaterol. Intern Med 2017; 56:1949-1955. [PMID: 28768962 PMCID: PMC5577068 DOI: 10.2169/internalmedicine.56.7961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective The 6-min walk test (6MWT) is a simple test that is used to examine the exercise tolerance and outcomes in patients with chronic obstructive pulmonary disease (COPD). Although the 6MWT is useful for assessing exercise tolerance, it is difficult to evaluate time-dependent parameters such as the walking pattern. A modified 6MWT has been devised to assess the walking pattern by calculating the number of steps per second (NSPS). This study was performed to investigate walking pattern of COPD patients in the modified 6MWT before and after a single inhalation of the short-acting β2-agonist procaterol. Methods Nine male COPD patients participated in this study. The 6MWT was performed before and after the inhalation of procaterol hydrochloride. A digital video recording of the 6MWT was made. After the 6MWT, the number of steps walked by the subject in each 5-s period was counted manually with a hand counter while viewing the walking test on the video monitor. Results After the inhalation of procaterol, the 6-min walking distance increased significantly in comparison to baseline (p<0.01). The mean NSPS was also significantly increased after the inhalation of procaterol in comparison to baseline (p<0.01). The walking pattern was displayed on a graph of time versus NSPS, and the walking pace was shown by a graph of time versus cumulative steps. Conclusion The analysis of the COPD patients' walking test performance and their walking pattern and pace in the 6MWT may help to evaluate the effects of drug treatment.
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Affiliation(s)
- Naoto Burioka
- Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Japan
| | - Sachiko Nakamoto
- Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Japan
| | - Takashi Amisaki
- Department of Biological Regulation, School of Health Science, Tottori University Faculty of Medicine, Japan
| | - Takuya Horie
- Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Japan
| | - Eiji Shimizu
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Japan
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Ushiki A, Nozawa S, Yasuo M, Urushihata K, Yamamoto H, Hanaoka M, Fujimoto K. Associations between the distance covered in the incremental shuttle walk test and lung function and health status in patients with chronic obstructive pulmonary disease. Respir Investig 2016; 55:33-38. [PMID: 28012491 DOI: 10.1016/j.resinv.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Field walk tests such as the incremental shuttle walk test (ISWT) are simple tests for assessing the degree of disability in individuals with chronic obstructive pulmonary disease (COPD). In the present study, the correlations between exercise performance in the ISWT, lung function, and health status were examined in patients with COPD of varying severities. METHODS A retrospective examination of 277 COPD patients was performed using the ISWT and lung function tests along with assessment of health status using St. George׳s Respiratory Questionnaire (SGRQ). In addition, we assessed the correlations between the walking distance, lung function parameters, and SGRQ scores. RESULTS ISWT distances were poorly correlated with lung function parameters and SGRQ scores in mild COPD patients. In contrast, ISWT distances were significantly correlated with pulmonary function parameters, such as vital capacity (%predicted) and forced expiratory volume in one second, and SGRQ scores in moderate and severe COPD patients. CONCLUSIONS The ISWT is more independent of health status and pulmonary function in patients with mild COPD compared to moderate or severe cases. Therefore, the exercise capacity of patients with mild COPD should be estimated by the ISWT.
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Affiliation(s)
- Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Shuhei Nozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Kazuhisa Urushihata
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
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Klooster K, ten Hacken NHT, Hartman JE, Sciurba FC, Kerstjens HAM, Slebos DJ. Determining the Role of Dynamic Hyperinflation in Patients with Severe Chronic Obstructive Pulmonary Disease. Respiration 2015; 90:306-13. [PMID: 26352833 DOI: 10.1159/000439056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dynamic hyperinflation due to increased respiratory frequency during exercise is associated with limitations in exercise capacity in patients with moderately severe chronic obstructive pulmonary disease (COPD). OBJECTIVES The present study assessed whether the manually paced tachypnea (MPT) test, sitting at rest, induces dynamic hyperinflation correlating with exercise capacity in patients with very severe COPD. METHODS Dynamic hyperinflation was induced by the MPT test, using a breathing frequency of 40/min for 1 min. Dynamic hyperinflation was defined as a 'change' in inspiratory capacity (IC) before and directly after the MPT test. At baseline, static hyperinflation by body plethysmography was measured, as well as the 6-min walking test and spirometry. RESULTS We studied 74 patients with severe COPD (age 59 ± 9 years, FEV1 28 ± 10% predicted). All patients tolerated the MPT test well. It induced a significant decrease in IC: -0.65 ± 0.33 liters, p < 0.001, correlating with the 6-min walking distance (rho = -0.246, p = 0.034). Static hyperinflation [IC/total lung capacity (TLC)] at baseline correlated stronger with the 6-min walking distance (r = 0.582, p < 0.001). Multiple regression analysis showed that IC/TLC, but not dynamic hyperinflation, was the only independent predictor of walking distance. CONCLUSIONS In patients with very severe COPD, dynamic hyperinflation measurement by the MPT test is feasible and contributes less importantly to exercise performance than static hyperinflation.
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Affiliation(s)
- Karin Klooster
- Research Institute for Asthma and COPD, University Medical Center Groningen, Department of Pulmonary Diseases, University of Groningen, Groningen, The Netherlands
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Nozoe M, Mase K, Tsutou A. Regional chest wall volume changes during various breathing maneuvers in normal men. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2015; 14:12-8. [PMID: 25792893 DOI: 10.1298/jjpta.vol14_002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 09/01/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the regional chest wall volume changes during various breathing maneuvers in normal men with an optical reflectance system (OR), which tracks reflective markers in three dimensions. METHODS Chest wall volume was measured by the OR system [VL(CW)], and lung volume was measured by hot wire spirometry [VL(SP)] in 15 healthy men during quiet breathing (QB), during breathing at a rate of 50 tidal breaths/min paced using a metronome (MT: metronome-paced tachypnea), and during a maximal forced inspiratory and expiratory maneuver (MFIE maneuver). RESULTS There were few discrepancies between VL(CW) and VL(SP) for QB and MT. In the MFIE maneuver, however VL(CW) was often underestimated compared with VL(SP), particularly during forced maximal expiration, because of pulmonary rib cage volume changes. Furthermore, the regional chest wall volume changes were affected by breathing maneuver alternation. In the pulmonary and abdominal rib cage, inspiratory reserve volume was larger than expiratory reserve volume, respectively, and in the abdomen, expiratory reserve volume was larger than inspiratory reserve volume. CONCLUSION Alternation of breathing maneuvers affects regional chest wall volume changes.
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Affiliation(s)
- Masafumi Nozoe
- Department of Rehabilitation, Hyogo College of Medicine Sasayama Medical Center Kurooka 5, Sasayama, Hyogo, 669-2321 Japan ; Division of Preventive Health Sciences, Department of Community Health Sciences, Faculty of Health Sciences, Kobe University Graduate School of Health Sciences
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University
| | - Akimitsu Tsutou
- Division of Preventive Health Sciences, Department of Community Health Sciences, Faculty of Health Sciences, Kobe University Graduate School of Health Sciences
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Nakagawa M, Hattori N, Haruta Y, Sugiyama A, Iwamoto H, Ishikawa N, Fujitaka K, Murai H, Tanaka J, Kohno N. Effect of increasing respiratory rate on airway resistance and reactance in COPD patients. Respirology 2014; 20:87-94. [DOI: 10.1111/resp.12387] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 04/17/2014] [Accepted: 07/15/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Misa Nakagawa
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Yoshinori Haruta
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Aya Sugiyama
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Nobuhisa Ishikawa
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Hiroshi Murai
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Junko Tanaka
- Department of Epidemiology; Infectious Disease Control and Prevention; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - Nobuoki Kohno
- Department of Molecular and Internal Medicine; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
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17
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Kitaguchi Y, Fujimoto K, Hanaoka M, Honda T, Hotta J, Hirayama J. Pulmonary function impairment in patients with combined pulmonary fibrosis and emphysema with and without airflow obstruction. Int J Chron Obstruct Pulmon Dis 2014; 9:805-11. [PMID: 25114520 PMCID: PMC4122579 DOI: 10.2147/copd.s65621] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The syndrome of combined pulmonary fibrosis and emphysema (CPFE) is a recently described entity associating upper-lobe emphysema and lower-lobe fibrosis. We sought to evaluate differences in pulmonary function between CPFE patients with and without airflow obstruction. SUBJECTS AND METHODS Thirty-one CPFE patients were divided into two groups according to the presence or absence of irreversible airflow obstruction based on spirometry (forced expiratory volume in 1 second/forced vital capacity <70% following inhalation of a β2-agonist) as follows: CPFE patients with airflow obstruction (CPFE OB(+) group, n=11), and CPFE patients without airflow obstruction (CPFE OB(-) group, n=20). Pulmonary function, including respiratory impedance evaluated using impulse oscillometry and dynamic hyperinflation following metronome-paced incremental hyperventilation, was retrospectively analyzed in comparison with that observed in 49 chronic obstructive pulmonary disease (COPD) patients (n=49). RESULTS In imaging findings, low-attenuation-area scores on chest high-resolution computed tomography, representing the degree of emphysema, were significantly lower in the CPFE OB(-) group than in the CPFE OB(+) and COPD groups. In contrast, the severity of pulmonary fibrosis was greater in the CPFE OB(-) group than in the CPFE OB(+) group. In pulmonary function, lung hyperinflation was not apparent in the CPFE OB(-) group. Impairment of diffusion capacity was severe in both the CPFE OB(-) and CPFE OB(+) groups. Impulse oscillometry showed that respiratory resistance was not apparent in the CPFE OB(-) group compared with the COPD group, and that easy collapsibility of small airways during expiration of tidal breath was not apparent in the CPFE OB(+) group compared with the COPD group. Dynamic hyperinflation following metronome-paced incremental hyperventilation was significantly greater in the COPD group than in the CPFE OB(-) group, and also tended to be greater in the CPFE OB(+) group than in the CPFE OB(-) group. CONCLUSION The mechanisms underlying impairment of physiological function may differ among CPFE OB(+) patients, CPFE OB(-) patients, and COPD patients. CPFE is a heterogeneous disease, and may have distinct phenotypes physiologically and radiologically.
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Affiliation(s)
- Yoshiaki Kitaguchi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Internal Medicine, Okaya City Hospital, Okaya, Japan
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takayuki Honda
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Junichi Hotta
- Department of Internal Medicine, Okaya City Hospital, Okaya, Japan
| | - Jiro Hirayama
- Department of Internal Medicine, Okaya City Hospital, Okaya, Japan
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Perez T, Garcia G, Roche N, Bautin N, Chambellan A, Chaouat A, Court-Fortune I, Delclaux B, Guenard H, Jebrak G, Orvoen-Frija E, Terrioux P. Société de pneumologie de langue française. Recommandation pour la pratique clinique. Prise en charge de la BPCO. Mise à jour 2012. Exploration fonctionnelle respiratoire. Texte long. Rev Mal Respir 2014; 31:263-94. [DOI: 10.1016/j.rmr.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Calligaro GL, Raine RI, Bateman ME, Bateman ED, Cooper CB. Comparing dynamic hyperinflation and associated dyspnea induced by metronome-paced tachypnea versus incremental exercise. COPD 2013; 11:105-12. [PMID: 24152211 DOI: 10.3109/15412555.2013.841669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dynamic hyperinflation (DH) during exercise is associated with both dyspnea and exercise limitation in COPD. Metronome-paced tachypnoea (MPT) is a simple alternative for studying DH. We compared MPT with exercise testing (XT) as methods of provoking DH, and assessed their relationship with dyspnea. We studied 24 patients with moderate COPD (FEV1 59 ± 9% predicted) after inhalation of ipratropium/salbutamol combination or placebo in a double-blind, crossover design. Inspiratory capacity (IC) was measured at baseline and after 30 seconds of MPT with breathing frequencies (fR) of 20, 30 and 40 breaths/min and metronome-defined I:E ratios of 1:1 and 1:2, in random sequence, followed by incremental cycle ergometry with interval determinations of IC. DH was defined as a decline in IC from baseline (∆IC) for both methods. Dyspnea was assessed using a Borg CR-10 scale. ∆IC during MPT was greater with higher fR and I:E ratio of 1:1 versus 1:2, and less when patients were treated with bronchodilator rather than placebo (P = 0.032). DH occurred during 19 (40%) XTs, and during 35 (73%) tests using MPT. Eleven of 18 (61%) non-congruent XTs (where DH occurred on MPT but not XT) terminated before fR of 40 breaths/min was reached. Although greater during XT, the intensity of dyspnea bore no relationship to DH during either MPT and XT. MPT at 40 breaths/min and I:E of 1:1 elicits the greatest ∆IC, and is a more sensitive method for demonstrating DH. The relationship between DH and dyspnea is complex and not determined by DH alone.
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Affiliation(s)
- Gregory L Calligaro
- 1Department of Medicine, University of Cape Town and University of Cape Town Lung Institute , Cape Town , South Africa
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Cooper CB, Calligaro GL, Quinn MM, Eshaghian P, Coskun F, Abrazado M, Bateman ED, Raine RI. Determinants of dynamic hyperinflation during metronome-paced tachypnea in COPD and normal subjects. Respir Physiol Neurobiol 2013; 190:76-80. [PMID: 23994176 DOI: 10.1016/j.resp.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/15/2013] [Accepted: 08/01/2013] [Indexed: 11/19/2022]
Abstract
In COPD, dynamic hyperinflation (DH) occurs during exercise and during metronome-paced tachypnea (MPT). We investigated the relationship of DH with breathing pattern and ventilation (V˙E) in COPD and normal subjects (NS). In 35 subjects with moderate COPD and 17 younger healthy volunteers we measured inspiratory capacity (IC), breathing frequency (fR), expiratory time (TE), ventilation (V˙E) and end-tidal carbon dioxide tension (PETCO2) at baseline and after 30s of MPT at 40breaths/min with metronome-defined I:E ratios of 1:1 and 1:2. A reduction in IC (ΔIC) was taken to indicate DH. In COPD subjects, DH correlated with TE but not with V˙E or PETCO2, and was best predicted by total lung capacity. NS also showed DH (although less than in COPD), which correlated with PETCO2 but not with fR, TE or V˙E. We conclude that MPT evokes DH in both NS and patients with COPD. TE is the most important determinant of DH during MPT in patients with COPD.
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Affiliation(s)
- C B Cooper
- Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA.
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21
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Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators. Respir Med 2012; 107:394-400. [PMID: 23245993 DOI: 10.1016/j.rmed.2012.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/21/2012] [Accepted: 11/24/2012] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to clarify the additive efficacy of short-acting β(2)-agonists (SABA) or muscarinic antagonists (SAMA) on dynamic hyperinflation and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) who had been treated with long-acting bronchodilators. Thirty-two patients with stable COPD who had been treated with long-acting bronchodilators, including long-acting muscarinic antagonists (LAMA), were examined by pulmonary function tests, dynamic hyperinflation evaluated by the method of step-wise metronome-paced incremental hyperventilation, and the incremental shuttle walking test before and after inhalation of SABA or SAMA. The additive efficacy of the two drugs was analyzed. Inhalation of SABA and SAMA improved airflow limitation and dynamic hyperinflation in stable COPD patients who had been treated with LAMA. Inhalation of SABA decreased respiratory resistance and the difference in respiratory resistance at 5 Hz and 20 Hz. On the whole, the additive efficacy of SABA on airflow limitation and dynamic hyperinflation was superior to that of SAMA. Furthermore, inhalation of SABA resulted in relief of breathlessness during exercise and significant improvement in exercise capacity. Inhalation of SABA resulted in significant improvement in exercise tolerance, which may have been due to improvement in dynamic hyperinflation. Single use of SABA before exercise, in addition to regular treatment with LAMA, may therefore be useful in stable COPD patients.
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Lahaije AJMC, Willems LM, van Hees HWH, Dekhuijzen PNR, van Helvoort HAC, Heijdra YF. Diagnostic accuracy of metronome-paced tachypnea to detect dynamic hyperinflation. Clin Physiol Funct Imaging 2012; 33:62-9. [DOI: 10.1111/j.1475-097x.2012.01164.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 07/17/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Anke J. M. C. Lahaije
- Radboud University Nijmegen Medical Centre; of Pulmonary Diseases; Nijmegen; The Netherlands
| | - Laura M. Willems
- Radboud University Nijmegen Medical Centre; of Pulmonary Diseases; Nijmegen; The Netherlands
| | | | | | | | - Yvonne F. Heijdra
- Radboud University Nijmegen Medical Centre; of Pulmonary Diseases; Nijmegen; The Netherlands
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In Vivo Computed Tomography as a Research Tool to Investigate Asthma and COPD: Where Do We Stand? J Allergy (Cairo) 2012; 2012:972479. [PMID: 22287977 PMCID: PMC3263629 DOI: 10.1155/2012/972479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 09/16/2011] [Indexed: 01/15/2023] Open
Abstract
Computed tomography (CT) is a clinical tool widely used to assess and followup asthma and chonic obstructive pulmonary disease (COPD) in humans. Strong efforts have been made the last decade to improve this technique as a quantitative research tool. Using semiautomatic softwares, quantification of airway wall thickness, lumen area, and bronchial wall density are available from large to intermediate conductive airways. Skeletonization of the bronchial tree can be built to assess its three-dimensional geometry. Lung parenchyma density can be analysed as a surrogate of small airway disease and emphysema. Since resident cells involve airway wall and lung parenchyma abnormalities, CT provides an accurate and reliable research tool to assess their role in vivo. This litterature review highlights the most recent advances made to assess asthma and COPD with CT, and also their drawbacks and the place of CT in clarifying the complex physiopathology of both diseases.
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Fujimoto K, Kitaguchi Y, Kanda S, Urushihata K, Hanaoka M, Kubo K. Comparison of efficacy of long-acting bronchodilators in emphysema dominant and emphysema nondominant chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011; 6:219-27. [PMID: 21660299 PMCID: PMC3107698 DOI: 10.2147/copd.s18461] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to clarify the association between morphological phenotypes according to the predominance of emphysema and efficacy of long-acting muscarinic antagonist and β(2) agonist bronchodilators in patients with chronic obstructive pulmonary disease (COPD). METHODS Seventy-two patients with stable COPD treated with tiotropium (n = 41) or salmeterol (n = 31) were evaluated for pulmonary function, dynamic hyperinflation following metronome-paced incremental hyperventilation, six-minute walking distance, and St George's Respiratory Questionnaire (SGRQ) before and 2-3 months following treatment with tiotropium or salmeterol. They were then visually divided into an emphysema dominant phenotype (n = 25 in the tiotropium-treated group and n = 22 in the salmeterol-treated group) and an emphysema nondominant phenotype on high-resolution computed tomography, and the efficacy of the two drugs in each phenotype was retrospectively analyzed. RESULTS Tiotropium significantly improved airflow limitation, oxygenation, and respiratory impedance in both the emphysema dominant and emphysema nondominant phenotypes, and improved dynamic hyperinflation, exercise capacity, and SGRQ in the emphysema dominant phenotype but not in the emphysema nondominant phenotype. Salmeterol significantly improved total score for SGRQ in the emphysema phenotype, but no significant effects on other parameters were found for either of the phenotypes. CONCLUSION These findings suggest that tiotropium is more effective than salmeterol for airflow limitation regardless of emphysema dominance, and also can improve dynamic hyperinflation in the emphysema dominant phenotype, which results in further improvement of exercise capacity and health-related quality of life.
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Affiliation(s)
- Keisaku Fujimoto
- Department of Biomedical Laboratory Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
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Perez T, Guenard H. Comment mesurer et suivre la distension pulmonaire au cours de la BPCO. Rev Mal Respir 2009; 26:381-93; quiz 478, 482. [DOI: 10.1016/s0761-8425(09)74043-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weigt SS, Abrazado M, Kleerup EC, Tashkin DP, Cooper CB. Time course and degree of hyperinflation with metronome-paced tachypnea in COPD patients. COPD 2009; 5:298-304. [PMID: 18972278 DOI: 10.1080/15412550802363428] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In COPD patients, tachypnea should increase (dynamic) hyperinflation by shortening expiratory time. We developed a method to evaluate the time course and degree of dynamic hyperinflation during metronome-paced tachypnea. Fourteen patients with stable COPD (FEV(1) 43 +/- 13% predicted) were studied. Inspiratory capacity (IC) was measured breathing through a flow transducer. Subjects paced their respiratory rate (f(R)) at 20/min, 30/min and 40/min for 60-second periods in response to audible tones generated by a computer. IC measurements were obtained at baseline and after 30 and 60 seconds at each f(R). End-tidal carbon dioxide was monitored and f(R) was allowed to return to baseline between periods of tachypnea. Tachypnea produced reductions in IC of 200 +/- 240 ml, 380 +/- 330 ml and 540 +/- 300 ml after 30 seconds at 20/min, 30/min and 40/min, respectively. IC reduction at 60 seconds was similar to 30 seconds for each f(R). In patients with moderate-to-severe COPD, the dynamic hyperinflation induced by metronome-paced tachypnea was shown to occur rapidly and be complete by 30 seconds for a given f(R). Controlled increments in f(R) produced stepwise increases in dynamic hyperinflation. This standardized method could be a useful and easier method of assessing dynamic hyperinflation in COPD patients before and after therapeutic interventions.
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Affiliation(s)
- S Samuel Weigt
- Exercise Physiology Research Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA.
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Abstract
PURPOSE OF REVIEW To discuss three emerging areas of research triggering new hypotheses for mechanisms of dyspnea. RECENT FINDINGS There has been an emphasis on the importance of lung volumes in evaluating symptoms and lung function in patients with chronic obstructive pulmonary disease. Dyspnea intensity seems to more closely correlate with measures of hyperinflation than airflow limitation, highlighting the importance of neuromechanical dissociation in the development of dyspnea. Inhaled furosemide has demonstrated a beneficial effect in laboratory-induced dyspnea, and the sensation of air hunger has been ameliorated by this therapy, possibly via activation of pulmonary stretch receptors. There appear to be distinct affective and sensory components of dyspnea, and the affective dimension may be modifiable, although this has not been fully studied. SUMMARY Dyspnea in chronic obstructive pulmonary disease is clearly related to hyperinflation, and lung volumes are valuable for characterizing disease. It remains unclear whether a limitation in tidal volume due to dynamic hyperinflation is the key factor in exertional dyspnea in this disease. Research of inhaled furosemide demonstrates the importance of afferent sensory input in modifying dyspnea, and deserves further study. The contributions of the affective and sensory components of dyspnea remain unclear, but should be studied further.
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