1
|
Bitos K, Furian M, Mayer L, Schneider SR, Buenzli S, Mademilov MZ, Sheraliev UU, Marazhapov NH, Abdraeva AK, Aidaralieva SD, Muratbekova AM, Sooronbaev TM, Ulrich S, Bloch KE. Effect of High-Flow Oxygen on Exercise Performance in COPD Patients. Randomized Trial. Front Med (Lausanne) 2021; 7:595450. [PMID: 33693009 PMCID: PMC7938234 DOI: 10.3389/fmed.2020.595450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background: High-flow oxygen therapy (HFOT) provides oxygen-enriched, humidified, and heated air at high flow rates via nasal cannula. It could be an alternative to low-flow oxygen therapy (LFOT) which is commonly used by patients with chronic obstructive pulmonary disease (COPD) during exercise training. Research Question: We evaluated the hypothesis that HFOT improves exercise endurance in COPD patients compared to LFOT. Methods: Patients with stable COPD, FEV1 40–80% predicted, resting pulse oximetry (SpO2) ≥92%, performed two constant-load cycling exercise tests to exhaustion at 75% of maximal work rate on two different days, using LFOT (3 L/min) and HFOT (60 L/min, FiO2 0.45) in randomized order according to a crossover design. Primary outcome was exercise endurance time, further outcomes were SpO2, breath rate and dyspnea. Results: In 79 randomized patients, mean ± SD age 58 ± 9 y, FEV1 63 ± 9% predicted, GOLD grades 2-3, resting PaO2 9.4 ± 1.0 kPa, intention-to-treat analysis revealed an endurance time of 688 ± 463 s with LFOT and 773 ± 471 s with HFOT, mean difference 85 s (95% CI: 7 to 164, P = 0.034), relative increase of 13% (95% CI: 1 to 28). At isotime, patients had lower respiratory rate and higher SpO2 with HFOT. At end-exercise, SpO2 was higher by 2% (95% CI: 2 to 2), and Borg CR10 dyspnea scores were lower by 0.8 points (95% CI: 0.3 to 1.2) compared to LFOT. Interpretation: In mildly hypoxemic patients with COPD, HFOT improved endurance time in association with higher arterial oxygen saturation, reduced respiratory rate and less dyspnea compared to LFOT. Therefore, HFOT is promising for enhancing exercise performance in COPD. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03955770.
Collapse
Affiliation(s)
- Konstantinos Bitos
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Michael Furian
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Laura Mayer
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Simon R Schneider
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Simone Buenzli
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Maamed Z Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ulan U Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nuridin H Marazhapov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ainura K Abdraeva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Shoira D Aidaralieva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Aybermet M Muratbekova
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Talant M Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Silvia Ulrich
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| |
Collapse
|
2
|
Miles M, Rodrigues A, Tajali S, Xiong Y, Orchanian-Cheff A, Reid WD, Rozenberg D. Muscle and cerebral oxygenation during cycling in chronic obstructive pulmonary disease: A scoping review. Chron Respir Dis 2021; 18:1479973121993494. [PMID: 33605155 PMCID: PMC7897842 DOI: 10.1177/1479973121993494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To synthesize evidence for prefrontal cortex (PFC), quadriceps, and respiratory muscle oxygenation using near-infrared spectroscopy (NIRS) during cycling in individuals with chronic obstructive pulmonary disease (COPD). A scoping review was performed searching databases (inception-August 2020): Ovid MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, CINAHL, SPORTDiscus and Pedro. The search focused on COPD, cycling, and NIRS outcomes. 29 studies (541 COPD participants) were included. Compared to healthy individuals (8 studies), COPD patients at lower cycling workloads had more rapid increases in vastus lateralis (VL) deoxygenated hemoglobin (HHb); lower increases in VL total hemoglobin (tHb) and blood flow; and lower muscle tissue saturation (StO2). Heliox and bronchodilators were associated with smaller and slower increases in VL HHb. Heliox increased VL and intercostal blood flow compared to room air and supplemental oxygen in COPD patients (1 study). PFC oxygenated hemoglobin (O2Hb) increased in COPD individuals during cycling in 5 of 8 studies. Individuals with COPD and heart failure demonstrated worse VL and PFC NIRS outcomes compared to patients with only COPD-higher or more rapid increase in VL HHb and no change or decrease in PFC O2Hb. Individuals with COPD present with a mismatch between muscle oxygen delivery and utilization, characterized by more rapid increase in VL HHb, lower muscle O2Hb and lower muscle StO2. PFC O2Hb increases or tends to increase in individuals with COPD during exercise, but this relationship warrants further investigation. NIRS can be used to identify key deoxygenation thresholds during exercise to inform PFC and muscle oxygenation.
Collapse
Affiliation(s)
- Melissa Miles
- Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Antenor Rodrigues
- Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Shirin Tajali
- Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Yijun Xiong
- Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, 7989University Health Network, Toronto, Ontario, Canada
| | - W Darlene Reid
- Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,KITE - Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Department of Medicine, Division of Respirology, 7938University of Toronto, University Health Network, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Manifield J, Chynkiamis N, Alexiou C, Megaritis D, Hume E, Barry G, Vogiatzis I. Acute thoracoabdominal and hemodynamic responses to tapered flow resistive loading in healthy adults. Respir Physiol Neurobiol 2021; 286:103617. [PMID: 33454351 DOI: 10.1016/j.resp.2021.103617] [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: 11/10/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/17/2022]
Abstract
We investigated the acute physiological responses of tapered flow resistive loading (TFRL) at 30, 50 and 70 % maximal inspiratory pressure (PImax) in 12 healthy adults to determine an optimal resistive load. Increased end-inspiratory rib cage and decreased end-expiratory abdominal volumes equally contributed to the expansion of thoracoabdominal tidal volume (captured by optoelectronic plethysmography). A significant decrease in end-expiratory thoracoabdominal volume was observed from 30 to 50 % PImax, from 30 to 70 % PImax, and from 50 to 70 % PImax. Cardiac output (recorded by cardio-impedance) increased from rest by 30 % across the three loading trials. Borg dyspnoea increased from 2.36 ± 0.20 at 30 % PImax, to 3.45 ± 0.21 at 50 % PImax, and 4.91 ± 0.25 at 70 % PImax. End-tidal CO2 decreased from rest during 30, 50 and 70 %PImax (26.23 ± 0.59, 25.87 ± 1.02 and 24.30 ± 0.82 mmHg, respectively). Optimal intensity for TFRL is at 50 % PImax to maximise global respiratory muscle and cardiovascular loading whilst minimising hyperventilation and breathlessness.
Collapse
Affiliation(s)
- James Manifield
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK.
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Charikleia Alexiou
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| |
Collapse
|
4
|
Barberan-Garcia A, Munoz PA, Gimeno-Santos E, Burgos F, Torralba Y, Gistau C, Roca J, Rodriguez DA. Training-induced changes on quadriceps muscle oxygenation measured by near-infrared spectroscopy in healthy subjects and in chronic obstructive pulmonary disease patients. Clin Physiol Funct Imaging 2019; 39:284-290. [PMID: 31012529 DOI: 10.1111/cpf.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 04/15/2019] [Indexed: 12/23/2022]
Abstract
AIM We hypothesize that training-induced changes in muscle oxygen saturation (StO2 ) assessed by near-infrared spectroscopy (NIRS) during constant work rate cycling exercise (CWRE) may be a useful marker of the effects of training at 'vastus medialis' of the quadriceps in patients with chronic obstructive pulmonary disease (COPD). METHODS Incremental exercise [peak oxygen uptake (VO2 )] and CWRE at 70% pretraining peak VO2 , before and after 8-w training, were done in 10 healthy age-matched subjects (H) [80% men, 65(11) years, FEV1 105(14)%] and 16 COPD patients [94% men, 70(5) years, FEV1 46(11) %] encompassing the entire spectrum of disease severity, recruited in the outpatient clinics. NIRS was used to assess StO2 in the 'vastus medialis' of the left quadriceps. RESULTS Pretraining CWRE decreased StO2 (P<0·05) and generated marked StO2 rebound (P<0·001) after unloading in the two groups. After training, VO2 peak increased in H [253(204) ml min-1 ] (P<0·01) and in COPD [180(183) ml·min-1 ] (P = 0·01) and blood lactate fell [-4·4 (2·7) and -1·6(2·3) mmol·m-1 ] (P<0·05 each). Training generated a further fall in StO2 during CWRE [-10(12)% and -10(10)%, P<0·05] and increased StO2 rebound after unloading [8(7)% and 5(9)%, P<0·05] in both groups. CONCLUSION Endurance training further decreased StO2 during CWRE, similarly in both groups, likely due to training-induced enhancement of muscle O2 transfer and utilization. Training-induced StO2 fall during CWRE may be useful individual marker for non-invasive assessment of enhanced muscle aerobic post-training function.
Collapse
Affiliation(s)
- Anael Barberan-Garcia
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Phillip A Munoz
- Respiratory Investigation Unit, Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Elena Gimeno-Santos
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Felip Burgos
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Yolanda Torralba
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Concepción Gistau
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Josep Roca
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Diego A Rodriguez
- Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES (ISCIII), Barcelona, Spain
| |
Collapse
|
5
|
Ribeiro F, Oueslati F, Saey D, Lépine PA, Chambah S, Coats V, Maltais F. Cardiorespiratory and Muscle Oxygenation Responses to Isokinetic Exercise in Chronic Obstructive Pulmonary Disease. Med Sci Sports Exerc 2018; 51:841-849. [PMID: 30531487 DOI: 10.1249/mss.0000000000001856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to describe cardiorespiratory, quadriceps oxygenation, and muscle fatigue responses during a one-legged quadriceps isokinetic endurance exercise in chronic obstructive pulmonary disease (COPD) and control subjects. METHODS Fourteen patients with COPD and 14 control subjects performed a cardiopulmonary cycling exercise test to exhaustion to assess peak oxygen consumption (V˙O2peak), minute ventilation (V˙Epeak), and heart rate (HRpeak). They also performed a quadriceps isokinetic endurance exercise consisting in 30 maximal knee extensions at 90°·s with continuous monitoring of expired gases, cardiac output, and oxygenation of the quadriceps by near-infrared spectroscopy. Total muscle work and fatigue index were also quantified. RESULTS The total muscle work developed during the quadriceps isokinetic endurance exercise was 2.25 ± 0.57 kJ in COPD and 3.12 ± 0.60 kJ in controls, P < 0.001. In absolute terms, there were no between-group differences in V˙O2, V˙E, cardiac output, and HR at the end of quadriceps isokinetic endurance exercise. However, V˙E and HR reported that a fraction of their respective peak values during cardiopulmonary cycling exercise test were higher in COPD (V˙E/V˙Epeak, 69% ± 3%; HR/HRpeak, 82% ± 15%) compared with controls (V˙E/V˙Epeak, 45% ± 2%; HR/HRpeak, 71% ± 13%), all P < 0.05. During quadriceps isokinetic endurance exercise, quadriceps deoxyhemoglobin increased by 47% ± 31% in patients versus 33% ± 41% in controls (P < 0.05 from rest values) with a significant between-group differences (P = 0.025). The fatigue index during the quadriceps exercise was higher in COPD compared with controls. CONCLUSIONS Although one-legged quadriceps isokinetic endurance exercise resulted in substantial central cardiorespiratory demands in COPD, this exercise was nevertheless associated with muscle overload as evidenced by muscle deoxygenation and higher muscle fatigue index in COPD compared with controls. These findings may have implications of the design of exercise training programs in COPD.
Collapse
Affiliation(s)
- Fernanda Ribeiro
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, CANADA
| | | | | | | | | | | | | |
Collapse
|
6
|
Curtis KJ, O’Brien KA, Tanner RJ, Polkey JI, Minnion M, Feelisch M, Polkey MI, Edwards LM, Hopkinson NS. Acute Dietary Nitrate Supplementation and Exercise Performance in COPD: A Double-Blind, Placebo-Controlled, Randomised Controlled Pilot Study. PLoS One 2015; 10:e0144504. [PMID: 26698120 PMCID: PMC4689520 DOI: 10.1371/journal.pone.0144504] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/18/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dietary nitrate supplementation can enhance exercise performance in healthy people, but it is not clear if it is beneficial in COPD. We investigated the hypotheses that acute nitrate dosing would improve exercise performance and reduce the oxygen cost of submaximal exercise in people with COPD. METHODS We performed a double-blind, placebo-controlled, cross-over single dose study. Subjects were randomised to consume either nitrate-rich beetroot juice (containing 12.9 mmoles nitrate) or placebo (nitrate-depleted beetroot juice) 3 hours prior to endurance cycle ergometry, performed at 70% of maximal workload assessed by a prior incremental exercise test. After a minimum washout period of 7 days the protocol was repeated with the crossover beverage. RESULTS 21 subjects successfully completed the study (age 68 ± 7 years; BMI 25.2 ± 5.5 kg/m2; FEV1 percentage predicted 50.1 ± 21.6%; peak VO2 18.0 ± 5.9 ml/min/kg). Resting diastolic blood pressure fell significantly with nitrate supplementation compared to placebo (-7 ± 8 mmHg nitrate vs. -1 ± 8 mmHg placebo; p = 0.008). Median endurance time did not differ significantly; nitrate 5.65 (3.90-10.40) minutes vs. placebo 6.40 (4.01-9.67) minutes (p = 0.50). However, isotime oxygen consumption (VO2) was lower following nitrate supplementation (16.6 ± 6.0 ml/min/kg nitrate vs. 17.2 ± 6.0 ml/min/kg placebo; p = 0.043), and consequently nitrate supplementation caused a significant lowering of the amplitude of the VO2-percentage isotime curve. CONCLUSIONS Acute administration of oral nitrate did not enhance endurance exercise performance; however the observation that beetroot juice caused reduced oxygen consumption at isotime suggests that further investigation of this treatment approach is warranted, perhaps targeting a more hypoxic phenotype. TRIAL REGISTRATION ISRCTN Registry ISRCTN66099139.
Collapse
Affiliation(s)
- Katrina J. Curtis
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Katie A. O’Brien
- Centre of Human & Aerospace Physiological Sciences, King’s College London, London, United Kingdom
| | - Rebecca J. Tanner
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Juliet I. Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Magdalena Minnion
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, and Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, and Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom
| | - Michael I. Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Lindsay M. Edwards
- Centre of Human & Aerospace Physiological Sciences, King’s College London, London, United Kingdom
| | - Nicholas S. Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
- * E-mail:
| |
Collapse
|
7
|
Gloeckl R, Heinzelmann I, Matthaei M, Seeberg S, Damisch T, Jerrentrup A, Kenn K. Benefits of an oxygen reservoir cannula versus a conventional nasal cannula during exercise in hypoxemic COPD patients: a crossover trial. Respiration 2014; 88:399-405. [PMID: 25323335 DOI: 10.1159/000368165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Oxymizer® is a special nasal cannula that provides a higher luminal diameter in combination with an incorporated oxygen (O2) reservoir. It is assumed that a higher O2 concentration can be delivered breath by breath in order to increase oxygenation. OBJECTIVE We aimed to investigate the effects of the Oxymizer on endurance time in comparison to a conventional nasal cannula (CNC). METHODS Forty-three patients with severe chronic obstructive pulmonary disease (COPD, age 60 ± 9 years, FEV1 37 ± 16% pred.) and indications for LTOT were recruited during pulmonary rehabilitation for this cross-over study. After an initial maximal incremental cycle test, all patients performed 4 cycling endurance time tests at 70% of their peak work rate (twice with the Oxymizer and twice with a CNC, in reverse order). RESULTS The endurance time was significantly higher when patients cycled while using the Oxymizer in comparison to while using the CNC [858 ± 754 vs. 766 ± 652 s; between-group difference 92 s (95% confidence interval 32-152), p < 0.001]. In addition to a longer cycling duration, O2 saturation at isotime was significantly higher with the Oxymizer (93.5 ± 5.4 vs. 90.4 ± 5.3%; p = 0.027). Furthermore, there was a positive correlation (r = 0.427, p = 0.002) between the O2 flow rate and improvements in the constant work rate test, showing greater improvements in favor of the Oxymizer in patients with a higher demand for O2 (≥ 4 liters/min). CONCLUSION We show that O2 delivery via the Oxymizer is superior to a CNC with regard to endurance capacity and oxygenation during exercise in patients with severe COPD. It seems that patients with a higher demand for O2 (≥ 4 liters/min), in particular, may benefit more from the use of the Oxymizer.
Collapse
Affiliation(s)
- Rainer Gloeckl
- Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | | | | | | | | | | | | |
Collapse
|
8
|
Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, Dekhuijzen PNR, Franssen F, Gayan-Ramirez G, Gea J, Gosker HR, Gosselink R, Hayot M, Hussain SNA, Janssens W, Polkey MI, Roca J, Saey D, Schols AMWJ, Spruit MA, Steiner M, Taivassalo T, Troosters T, Vogiatzis I, Wagner PD. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189:e15-62. [PMID: 24787074 DOI: 10.1164/rccm.201402-0373st] [Citation(s) in RCA: 700] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. PURPOSE The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. METHODS An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. RESULTS We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. CONCLUSIONS Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem. Strategies for early detection and specific treatments for this condition are also needed.
Collapse
|
9
|
Cissik JM. The Effects of Chronic Obstructive Pulmonary Disease. Strength Cond J 2013. [DOI: 10.1519/ssc.0b013e31829776b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Hamaoka T, McCully KK, Niwayama M, Chance B. The use of muscle near-infrared spectroscopy in sport, health and medical sciences: recent developments. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4591-604. [PMID: 22006908 DOI: 10.1098/rsta.2011.0298] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Near-infrared spectroscopy (NIRS) has been shown to be one of the tools that can measure oxygenation in muscle and other tissues in vivo. This review paper highlights the progress, specifically in this decade, that has been made for evaluating skeletal muscle oxygenation and oxidative energy metabolism in sport, health and clinical sciences. Development of NIRS technologies has focused on improving quantification of the signal using multiple wavelengths to solve for absorption and scattering coefficients, multiple pathlengths to correct for the influence of superficial skin and fat, and time-resolved and phase-modulated light sources to determine optical pathlengths. In addition, advances in optical imaging with multiple source and detector pairs as well as portability using small wireless detectors have expanded the usefulness of the devices. NIRS measurements have provided information on oxidative metabolism in various athletes during localized exercise and whole-body exercise, as well as training-induced adaptations. Furthermore, NIRS technology has been used in the study of a number of chronic health conditions. Future developments of NIRS technology will include enhancing signal quantification. In addition, advances in NIRS imaging and portability promise to transform how measurements of oxygen utilization are obtained in the future.
Collapse
Affiliation(s)
- Takafumi Hamaoka
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan.
| | | | | | | |
Collapse
|