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Molgat-Seon Y, Sawatzky MAT, Dominelli PB, Kirby M, Guenette JA, Bourbeau J, Tan WC, Sheel AW. Dysanapsis is not associated with exertional dyspnoea in healthy male and female never-smokers aged 40 years and older. Appl Physiol Nutr Metab 2024; 49:223-235. [PMID: 37847929 DOI: 10.1139/apnm-2023-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
In healthy adults, airway-to-lung (i.e., dysanapsis) ratio is lower and dyspnoea during exercise at a given minute ventilation (V̇E) is higher in females than in males. We investigated the relationship between dysanapsis and sex on exertional dyspnoea in healthy adults. We hypothesized that females would have a smaller airway-to-lung ratio than males and that exertional dyspnoea would be associated with airway-to-lung ratio in males and females. We analyzed data from n = 100 healthy never-smokers aged ≥40 years enrolled in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study who underwent pulmonary function testing, a chest computed tomography scan, and cardiopulmonary exercise testing. The luminal area of the trachea, right main bronchus, left main bronchus, right upper lobe, bronchus intermedius, left upper lobe, and left lower lobe were 22%-37% smaller (all p < 0.001) and the airway-to-lung ratio (i.e., average large conducting airway diameter relative to total lung capacity) was lower in females than in males (0.609 ± 0.070 vs. 0.674 ± 0.082; p < 0.001). During exercise, there was a significant effect of V̇E, sex, and their interaction on dyspnoea (all p < 0.05), indicating that dyspnoea increased as a function of V̇E to a greater extent in females than in males. However, after adjusting for age and total lung capacity, there were no significant associations between airway-to-lung ratio and measures of exertional dyspnoea, regardless of sex (all r < 0.34; all p > 0.05). Our findings suggest that sex differences in airway size do not contribute to sex differences in exertional dyspnoea.
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Affiliation(s)
- Yannick Molgat-Seon
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Mathieu A T Sawatzky
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Paolo B Dominelli
- Department of KinesiologyUniversity of Waterloo, Waterloo, ON N2 L3G1, Canada
| | - Miranda Kirby
- Department of PhysicsToronto Metropolitan University, Toronto, ON M5 B2K3, Canada
| | - Jordan A Guenette
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
- Department of Physical TherapyThe University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Jean Bourbeau
- Department of MedicineMcGill University, Montreal, QC H4A 3J1, Canada
| | - Wan C Tan
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - A William Sheel
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, BC V6T 1Z1, Canada
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2
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Johnson MJ, Pitel L, Currow DC, Forbes C, Soyiri I, Robinson L. Breathlessness limiting exertion in very old adults: findings from the Newcastle 85+ study. Age Ageing 2023; 52:afad155. [PMID: 37658750 PMCID: PMC10474592 DOI: 10.1093/ageing/afad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/09/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Long-term breathlessness is more common with age. However, in the oldest old (>85 years), little is known about the prevalence, or impact of breathlessness. We estimated breathlessness limiting exertion prevalence and explored (i) associated characteristics; and (ii) whether breathlessness limiting exertion explains clinical and social/functional outcomes. METHODS Health and socio-demographic characteristics were extracted from the Newcastle 85+ Study cohort. Phase 1 (baseline) and follow-up data (18 months, Phase 2; 36 months, Phase 3; 60 months, Phase 4 after baseline) were examined using descriptive statistics and cross-sectional regression models. RESULTS Eight hundred seventeen participants provided baseline breathlessness data (38.2% men; mean 84.5 years; SD 0.4). The proportions with any limitation of exertion, or severe limitation by breathlessness were 23% (95% confidence intervals (CIs) 20-25%) and 9% (95%CIs 7-11%) at baseline; 20% (16-25%) and 5% (3-8%) at Phase 4. Having more co-morbidities (odds ratio (OR) 1.34, 1.18-1.54; P < 0.001), or self-reported respiratory (OR 1.88, 1.25-2.82; P = 0.003) or cardiovascular disease (OR 2.38, 1.58-3.58; P < 0.001) were associated with breathlessness limiting exertion. Breathlessness severely limiting exertion was associated with poorer self-rated health (OR 0.50, 029-0.86; P = 0.012), depression (beta-coefficient 0.11, P = 0.001), increased primary care contacts (beta-co-efficient 0.13, P = 0.001) and number of nights in hospital (OR 1.81; 1.02-3.20; P = 0.042). CONCLUSIONS Breathlessness limiting exertion appears to become less prevalent over time due to death or withdrawal of participants with cardio-respiratory illness. Breathlessness severely limiting exertion had a wide range of service utilisation and wellbeing impacts.
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Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lukas Pitel
- Hull Health Trials Unit, Hull York Medical School, University of Hull, Hull, UK
| | - David C Currow
- Department of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Cynthia Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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3
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MacAskill W, Hoffman B, Johnson MA, Sharpe GR, Rands J, Wotherspoon SE, Gevorkov Y, Kolbe‐Alexander TL, Mills DE. The effects of age on dyspnea and respiratory mechanical and neural responses to exercise in healthy men. Physiol Rep 2023; 11:e15794. [PMID: 37604647 PMCID: PMC10442526 DOI: 10.14814/phy2.15794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga ) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro-transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end-expiration, Pga expiratory tidal swings, and the gastric pressure-time product (PTPga ) at absolute and relative minute ventilation were higher (p < 0.05) for older compared to younger men. There were no differences in EMG responses between older and younger men. Younger men were more likely to report shallow breathing (p = 0.005) than older men. Our findings showed younger and older men had similar respiratory neuromuscular activation patterns and reported different dyspnea descriptors, and that older men had greater expiratory muscle pressure generation during exercise. Greater expiratory muscle pressures in older men may be due to compensatory mechanisms designed to offset increasing airway resistance due to aging. These results may have implications for exercise-induced expiratory muscle fatigue in older men.
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Affiliation(s)
- William MacAskill
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
- Rural Clinical SchoolGriffith UniversityToowoombaQueenslandAustralia
| | - Ben Hoffman
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
| | - Michael A. Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamshireUK
| | - Graham R. Sharpe
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamshireUK
| | - Joshua Rands
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
| | | | - Yaroslav Gevorkov
- Institute of Vision Systems, Hamburg University of TechnologyHamburgGermany
| | - Tracy L. Kolbe‐Alexander
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Research Unit for Exercise Science and Sports Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Dean E. Mills
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
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Hegendörfer E, Degryse JM. Breathlessness in older adults: What we know and what we still need to know. J Am Geriatr Soc 2023. [PMID: 36929105 DOI: 10.1111/jgs.18326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/18/2023]
Abstract
Breathlessness is common among older adults, but it is often hidden as "normal aging "or considered narrowly as a symptom of cardio-respiratory diseases. Studies on breathlessness in older adults are mostly focused on specific diseases, whereas older adults are characterized by multimorbidity and multi-system age-related impairments. This article aims to provide an overview of what is known so far on breathlessness in the general population of older adults and identify areas for further research. Research shows that breathlessness in older adults is a multifactorial geriatric condition, crossing the borders of system-based impairments and diseases, and a valuable independent prognostic indicator for adverse outcomes. Further research needs to investigate (1) the multi-factorial mechanisms of breathlessness in community-dwelling older adults including the role of respiratory sarcopenia; (2) the influence of affective and cognitive changes of older age on the perception and report of breathlessness; (3) the best way to assess and use breathlessness for risk prediction of adverse outcomes in general geriatric assessments; and (4) the most appropriate multi-modal rehabilitation interventions and their outcomes. Clinicians need to shift their approach to dyspnea from a disease symptom to a multifactorial geriatric condition that should be proactively searched for, as it identifies higher risk for adverse outcomes, and can be addressed with evidence-based interventions that can improve the quality of life and may reduce the risk of adverse outcomes in older adults.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Leuven, Belgium.,Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Leuven, Belgium
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5
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Azevedo IG, da Câmara SMA, Maciel ACC, Vieira ER, Espinoza CFL, Pichún SMM, Viana EDSR, Sousa SLDO. Relationship between inspiratory muscle strength and balance in women: A cross-sectional study. PLoS One 2023; 18:e0280465. [PMID: 36791078 PMCID: PMC9931101 DOI: 10.1371/journal.pone.0280465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/31/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND There is scarce evidence on changes at the functional level associated with the respiratory area in women. This study aims to analyse the relationship between inspiratory muscle strength and balance in women. MATERIAL AND METHODS In this cross-sectional observational study, the sample consisted of groups according to the results obtained in the balance test. Inspiratory muscle weakness was defined as maximum inspiratory pressure (MIP) ≤ 80% of the predictive value. MIP was carried out using through a mouthpiece, with an electronic manometer. Logistic regression model was used to examine if MIP predicts balance. RESULTS 159 women participated in the study. Approximately 20% of them achieved balance ≤ 2 seconds and 18% presented MIP≤80%. MIP was associated with the time achieved in the one-leg support test. Subjects with MIP ≤ 80% of the predictive value show 3 times more risk of having a lower performance in the balance test (OR = 3.26). CONCLUSIONS Inspiratory muscle weakness is associated with deficient balance in this sample. It shows the need for multidimensional assessment and rehabilitation strategies for patients identified as having MIP weakness and/or balance disorders.
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Affiliation(s)
- Ingrid Guerra Azevedo
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco UCT, La Araucanía, Temuco, Chile
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
| | - Saionara M. A. da Câmara
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
| | - Alvaro C. C. Maciel
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
| | - Edgar R. Vieira
- Department of Physical Therapy, Florida International University, Miami, Florida, United States of America
| | - Camila F. L. Espinoza
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco UCT, La Araucanía, Temuco, Chile
| | - Sebastián M. M. Pichún
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco UCT, La Araucanía, Temuco, Chile
| | - Elizabel de S. R. Viana
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
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6
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Nicolò A, Sacchetti M. Differential control of respiratory frequency and tidal volume during exercise. Eur J Appl Physiol 2023; 123:215-242. [PMID: 36326866 DOI: 10.1007/s00421-022-05077-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
The lack of a testable model explaining how ventilation is regulated in different exercise conditions has been repeatedly acknowledged in the field of exercise physiology. Yet, this issue contrasts with the abundance of insightful findings produced over the last century and calls for the adoption of new integrative perspectives. In this review, we provide a methodological approach supporting the importance of producing a set of evidence by evaluating different studies together-especially those conducted in 'real' exercise conditions-instead of single studies separately. We show how the collective assessment of findings from three domains and three levels of observation support the development of a simple model of ventilatory control which proves to be effective in different exercise protocols, populations and experimental interventions. The main feature of the model is the differential control of respiratory frequency (fR) and tidal volume (VT); fR is primarily modulated by central command (especially during high-intensity exercise) and muscle afferent feedback (especially during moderate exercise) whereas VT by metabolic inputs. Furthermore, VT appears to be fine-tuned based on fR levels to match alveolar ventilation with metabolic requirements in different intensity domains, and even at a breath-by-breath level. This model reconciles the classical neuro-humoral theory with apparently contrasting findings by leveraging on the emerging control properties of the behavioural (i.e. fR) and metabolic (i.e. VT) components of minute ventilation. The integrative approach presented is expected to help in the design and interpretation of future studies on the control of fR and VT during exercise.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135, Rome, Italy.
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135, Rome, Italy
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7
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van Ommen AMLN, Canto ED, Cramer MJ, Rutten FH, Onland-Moret NC, Ruijter HMD. Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions. BMC Med 2022; 20:496. [PMID: 36575484 PMCID: PMC9795723 DOI: 10.1186/s12916-022-02650-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022] Open
Abstract
Diastolic dysfunction of the left ventricle (LVDD) is equally common in elderly women and men. LVDD is a condition that can remain latent for a long time but is also held responsible for elevated left ventricular filling pressures and high pulmonary pressures that may result in (exercise-induced) shortness of breath. This symptom is the hallmark of heart failure with preserved ejection fraction (HFpEF) which is predominantly found in women as compared to men within the HF spectrum. Given the mechanistic role of LVDD in the development of HFpEF, we review risk factors and mechanisms that may be responsible for this sex-specific progression of LVDD towards HFpEF from an epidemiological point-of-view and propose future research directions.
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Affiliation(s)
- A M L N van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - E Dal Canto
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - F H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - H M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
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8
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Bhammar DM, Balmain BN, Babb TG, Bernhardt V. Sex differences in the ventilatory responses to exercise in mild-moderate obesity. Exp Physiol 2022; 107:965-977. [PMID: 35771362 PMCID: PMC9357174 DOI: 10.1113/ep090309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of the study? What are the sex differences in ventilatory responses during exercise in adults with obesity. What is the main finding and its importance? Tidal volume and expiratory flows are lower in females when compared with males at higher levels of ventilation despite small increases in end-expiratory lung volumes. Since dyspnea on exertion is a frequent complaint, particularly in females with obesity, careful attention should be paid to unpleasant respiratory symptoms and mechanical ventilatory constraints before prescribing exercise. ABSTRACT Obesity is associated with altered ventilatory responses, which may be exacerbated in females due to the functional consequences of sex-related morphological differences in the respiratory system. This study examined sex differences in ventilatory responses during exercise in adults with obesity. Healthy adults with obesity (n = 73; 48 females) underwent pulmonary function testing, underwater weighing, magnetic resonance imaging, a graded exercise test to exhaustion, and two constant work rate exercise tests; one at a fixed work rate (60W for females and 105W for males) and one at a relative intensity (50% of peak oxygen uptake, V̇O2peak ). Metabolic, respiratory, and perceptual responses were assessed during exercise. Compared with males, females used a smaller proportion of their ventilatory capacity at peak exercise (69.13 ± 14.49 vs. 77.41 ± 17.06 % maximum voluntary ventilation, P = 0.0374). Females also utilized a smaller proportion of their forced vital capacity (FVC) at peak exercise (tidal volume: 48.51±9.29 vs. 54.12±10.43 %FVC, P = 0.0218). End-expiratory lung volumes were 2-4% higher in females compared with males during exercise (P<0.05), while end-inspiratory lung volumes were similar. Since the males were initiating inspiration from a lower lung volume, they experienced greater expiratory flow limitation during exercise. Ratings of perceived breathlessness during exercise were similar between females and males at comparable levels of ventilation. In summary, sex differences in the manifestations of obestity-related mechanical ventilatory constraints were observed. Since dyspnea on exertion is a common complaint in patients with obesity, particularly in females, exercise prescriptions should be tailored with the goal of minimizing unpleasant respiratory sensations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dharini M Bhammar
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA.,Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA
| | - Vipa Bernhardt
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA.,Department of Health & Human Performance, Texas A&M University - Commerce, Commerce, TX, USA
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9
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Dominelli PB, Molgat-Seon Y. Sex, gender and the pulmonary physiology of exercise. Eur Respir Rev 2022; 31:31/163/210074. [PMID: 35022254 PMCID: PMC9488949 DOI: 10.1183/16000617.0074-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023] Open
Abstract
In this review, we detail how the pulmonary system's response to exercise is impacted by both sex and gender in healthy humans across the lifespan. First, the rationale for why sex and gender differences should be considered is explored, and then anatomical differences are highlighted, namely that females typically have smaller lungs and airways than males. Thereafter, we describe how these anatomical differences can impact functional aspects such as respiratory muscle energetics and activation, mechanical ventilatory constraints, diaphragm fatigue, and pulmonary gas exchange in healthy adults and children. Finally, we detail how gender can impact the pulmonary response to exercise. Biological sex can influence the pulmonary response to exercise in healthy individuals across the lifespanhttps://bit.ly/3ejMDrv
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Affiliation(s)
| | - Yannick Molgat-Seon
- Dept of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB, Canada.,Centre for Heart and Lung Innovation, Providence Health Care Research Institute, St Paul's Hospital, Vancouver, BC, Canada
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10
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Weavil JC, Thurston TS, Hureau TJ, Gifford JR, Aminizadeh S, Wan HY, Jenkinson RH, Amann M. Impact of aging on the work of breathing during exercise in healthy men. J Appl Physiol (1985) 2022; 132:689-698. [PMID: 35085030 PMCID: PMC8896992 DOI: 10.1152/japplphysiol.00443.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the impact of aging on the elastic and resistive components of the work of breathing (Wb) during locomotor exercise at a given 1) ventilatory rate, 2) metabolic rate, and 3) operating lung volume. Eight healthy younger (25 ± 4 yr) and 8 older (72 ± 6 yr) participants performed incremental bicycle exercise, from which retrospective analyses identified similar ventilatory rates (approximately 40, 70, and 100 L·min-1), similar metabolic rates (V̇o2: approximately 1.2, 1.6, and 1.9 L·min-1), and similar lung volumes [inspiratory and expiratory reserve volumes (IRV/ERV: approximately 25/34%, 16/33%, and 13-34% of vital capacity]. Wb at each level was quantified by integrating the averaged esophageal pressure-volume loop, which was then partitioned into elastic and resistive components of inspiratory and expiratory work using the modified Campbell diagram. IRV was smaller in the older participants during exercise at ventilations of 70 and 100 L·min-1 and during exercise at the three metabolic rates (P < 0.05). Mainly because of a greater inspiratory elastic and resistive Wb in the older group (P < 0.05), total Wb was augmented by 40%-50% during exercise at matched ventilatory and matched metabolic rates. When examined during exercise evoking similar lung volumes, total Wb was not different between the groups (P = 0.86). Taken together, although aging exaggerates total Wb during locomotor exercise at a given ventilatory or a given metabolic rate, this difference is abolished during exercise at a given operating lung volume. These findings highlight the significance of operating lung volume in determining the age-related difference in Wb during locomotor exercise.NEW & NOTEWORTHY This study evaluated the impact of aging on the work of breathing (Wb) during locomotor exercise evoking similar ventilatory rates, metabolic rates, and operating lung volumes in young and older individuals. Mainly because of a greater inspiratory elastic and resistive Wb in older participants, total Wb was higher during exercise at any given ventilatory and metabolic rate with aging. However, this age-related difference was abolished during exercise evoking similar operating lung volumes in both age groups. These findings highlight the significance of lung volumes in determining the age-related difference in total Wb.
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Affiliation(s)
- Joshua C. Weavil
- 1Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah,2Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Taylor S. Thurston
- 2Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Thomas J. Hureau
- 2Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jayson R. Gifford
- 1Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah,2Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Soheil Aminizadeh
- 3Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hsuan-Yu Wan
- 4Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | | | - Markus Amann
- 1Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah,2Department of Internal Medicine, University of Utah, Salt Lake City, Utah,4Department of Anesthesiology, University of Utah, Salt Lake City, Utah
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Rossman MJ, Petrics G, Klansky A, Craig K, Irvin CG, Haverkamp HC. Exercise-induced Bronchodilation Equalizes Exercise Ventilatory Mechanics despite Variable Baseline Airway Function in Asthma. Med Sci Sports Exerc 2022; 54:258-266. [PMID: 34559730 PMCID: PMC8892975 DOI: 10.1249/mss.0000000000002793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We quantified the magnitude of exercise-induced bronchodilation in adult asthmatics under conditions of narrowed and dilated airways. We then assessed the effect of the bronchodilation on ventilatory capacity and the extent of ventilatory limitation during exercise. METHODS Eleven asthmatics completed three exercise bouts on a cycle ergometer. Exercise was preceded by no treatment (trialCON), inhaled β2 agonist (trialBD), or a eucapnic voluntary hyperpnea challenge (trialBC). Maximal expiratory flow-volume maneuvers (MEFV) were performed before and within 40 s of exercise cessation. Exercise tidal flow-volume loops were placed within the preexercise and postexercise MEFV curve and used to determine expiratory flow limitation and maximum ventilatory capacity (V˙ECap). RESULTS Preexercise airway function was different among the trials (forced expiratory volume 1 s during trialCON, trialBD, and trialBC = 3.3 ± 0.8 L, 3.8 ± 0.8 L, and 2.9 ± 0.8 L, respectively; P < 0.05). Maximal expired airflow increased with exercise during all three trials, but the increase was greatest during trialBC (delta forced expiratory volume 1 s during trialCON, trialBD, and trialBC = +12.2% ± 13.1%, +5.2% ± 5.7%, +28.1% ± 15.7%). Thus, the extent of expiratory flow limitation decreased, and V˙ECap increased, when the postexercise MEFV curve was used. During trialCON and trialBC, actual exercise ventilation exceeded V˙ECap calculated with the preexercise MEFV curve in seven and nine subjects, respectively. CONCLUSIONS These findings demonstrate the critical importance of exercise bronchodilation in the asthmatic with narrowed airways. Of clinical relevance, the results also highlight the importance of assessing airway function during or immediately after exercise in asthmatic persons; otherwise, mechanical limitations to exercise ventilation will be overestimated.
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Affiliation(s)
- Matthew J Rossman
- Department of Integrative Physiology, University of Colorado-Boulder, Boulder, CO
| | - Greg Petrics
- Department of Environmental and Health Sciences, Northern Vermont University-Johnson, Johnson, VT
| | - Andrew Klansky
- Department of Environmental and Health Sciences, Northern Vermont University-Johnson, Johnson, VT
| | - Kasie Craig
- Department of Environmental and Health Sciences, Northern Vermont University-Johnson, Johnson, VT
| | - Charles G Irvin
- Departments of Medicine and Biophysics Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT
| | - Hans Christian Haverkamp
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University-Spokane Health Sciences, Spokane, WA
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12
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Schaeffer MR, Guenette JA, Jensen D. Impact of ageing and pregnancy on the minute ventilation/carbon dioxide production response to exercise. Eur Respir Rev 2021; 30:30/161/200225. [PMID: 34289982 PMCID: PMC9488679 DOI: 10.1183/16000617.0225-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022] Open
Abstract
Ventilatory efficiency can be evaluated using the relationship between minute ventilation (V′E) and the rate of CO2 production (V′CO2). In accordance with the modified alveolar ventilation equation, this relationship is determined by changes in dead space volume (VD) and/or the arterial CO2 tension (PaCO2) equilibrium point. In this review, we summarise the physiological factors that may account for normative ageing and pregnancy induced increases in V′E/V′CO2 during exercise. Evidence suggests that age-related increases in VD and pregnancy-related decreases in the PaCO2 equilibrium point are mechanistically linked to the increased V′E/V′CO2 during exercise. Importantly, the resultant increase in V′E/V′CO2 (ratio or slope), with normal ageing or pregnancy, remains below the critical threshold for prognostic indication in cardiopulmonary disease, is not associated with increased risk of adverse health outcomes, and does not affect the respiratory system's ability to fulfil its primary role of eliminating CO2 and maintaining arterial oxygen saturation during exercise. The minute ventilation/carbon dioxide production response to exercise is elevated with advancing age and in healthy pregnancy due to increased dead space and lowering of the arterial partial pressure of carbon dioxide equilibrium point, respectively.https://bit.ly/2GJXm0o
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Affiliation(s)
- Michele R Schaeffer
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,Dept of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada .,Dept of Physical Therapy, The University of British Columbia, Vancouver, Canada.,School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Dennis Jensen
- Dept of Kinesiology and Physical Education, McGill University, Montréal, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montréal, Canada.,Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Canada
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13
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Collins SÉ, Phillips DB, Brotto AR, Rampuri ZH, Stickland MK. Ventilatory efficiency in athletes, asthma and obesity. Eur Respir Rev 2021; 30:30/161/200206. [PMID: 34289980 DOI: 10.1183/16000617.0206-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/16/2020] [Indexed: 11/05/2022] Open
Abstract
During submaximal exercise, minute ventilation (V' E) increases in proportion to metabolic rate (i.e. carbon dioxide production (V' CO2 )) to maintain arterial blood gas homeostasis. The ratio V' E/V' CO2 , commonly termed ventilatory efficiency, is a useful tool to evaluate exercise responses in healthy individuals and patients with chronic disease. Emerging research has shown abnormal ventilatory responses to exercise (either elevated or blunted V' E/V' CO2 ) in some chronic respiratory and cardiovascular conditions. This review will briefly provide an overview of the physiology of ventilatory efficiency, before describing the ventilatory responses to exercise in healthy trained endurance athletes, patients with asthma, and patients with obesity. During submaximal exercise, the V' E/V' CO2 response is generally normal in endurance-trained individuals, patients with asthma and patients with obesity. However, in endurance-trained individuals, asthmatics who demonstrate exercise induced-bronchoconstriction, and morbidly obese individuals, the V' E/V' CO2 can be blunted at maximal exercise, likely because of mechanical ventilatory constraint.
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Affiliation(s)
- Sophie É Collins
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University, Kingston, Canada
| | - Andrew R Brotto
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Zahrah H Rampuri
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, Canada
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14
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Archiza B, Leahy MG, Kipp S, Sheel AW. An integrative approach to the pulmonary physiology of exercise: when does biological sex matter? Eur J Appl Physiol 2021; 121:2377-2391. [PMID: 33903937 DOI: 10.1007/s00421-021-04690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada.
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - Shalaya Kipp
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
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15
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Multidimensional breathlessness response to exercise: Impact of COPD and healthy ageing. Respir Physiol Neurobiol 2021; 287:103619. [PMID: 33497795 DOI: 10.1016/j.resp.2021.103619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
This study compared the multidimensional breathlessness response to incremental cardiopulmonary cycle exercise testing (CPET) in people with chronic obstructive pulmonary disease (COPD; n = 14, aged 69 ± 9 years, forced expiratory volume in 1-sec = 54 ± 16 % predicted) and healthy older (OA) (n = 35, aged 68 ± 5 years) and younger (YA) (n = 19, aged 28 ± 8 years) adults. Participants performed CPET and successively rated overall breathlessness intensity, unsatisfied inspiration, breathing too shallow, work/effort of breathing, and breathlessness-related unpleasantness, fear, and anxiety using the 0-10 Borg scale. At any given percent predicted peak minute ventilation, people with COPD rated all breathlessness sensations higher than OA and YAs, who were similar. Most between group differences disappeared when examined in relation to inspiratory reserve volume, except people with COPD reported higher levels of unsatisfied inspiration and breathing too shallow (vs YA), and breathlessness-related fear and anxiety (vs OA and YAs). Multidimensional ratings of breathlessness sensations during CPET provides further insight into differences in exertional symptom perceptions among people with COPD and without COPD.
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16
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Lewthwaite H, Elsewify O, Niro F, Bourbeau J, Guenette JA, Maltais F, Marciniuk DD, O'Donnell DE, Smith BM, Stickland MK, Tan WC, Jensen D. Normative Cardiopulmonary Exercise Test Responses at the Ventilatory Threshold in Canadian Adults 40 to 80 Years of Age. Chest 2020; 159:1922-1933. [PMID: 33217419 DOI: 10.1016/j.chest.2020.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Physiologic and symptom responses at the ventilatory threshold (Tvent) during incremental cardiopulmonary exercise testing (CPET) can provide important prognostic information. RESEARCH QUESTION This study aimed to develop an updated normative reference set for physiologic and symptom responses at Tvent during cycle CPET (primary aim) and to evaluate previously recommended reference equations from a 1985 study for predicting Tvent responses (secondary aim). STUDY DESIGN AND METHODS Participants were adults 40 to 80 years of age who were free of clinically relevant disease from the Canadian Cohort Obstructive Lung Disease. Rate of oxygen consumption (V˙O2) at Tvent was identified by two independent raters; physiologic and symptom responses corresponding to V˙O2 at Tvent were identified by linear interpolation. Reference ranges (5th-95th percentiles) for responses at Tvent were calculated according to participant sex and age for 29 and eight variables, respectively. Prediction models were developed for nine variables (oxygen pulse, V˙O2, rate of CO2 production, minute ventilation, tidal volume, inspiratory capacity, end-inspiratory lung volume [in liters and as percentage of total lung capacity], and end-expiratory lung volume) using quantile regression, estimating the 5th (lower limit of normal), 50th (normal), and 95th (upper limit of normal) percentiles based on readily available participant characteristics. The two one-sided test of equivalence for paired samples evaluated the measured and 1985-predicted V˙O2 at Tvent for equivalence. RESULTS Reference ranges and equations were developed based on 96 participants (49% men) with a mean ± SD age of 63 ± 9 years. Mean V˙O2 at Tvent was 50% of measured V˙O2 peak; the normal range was 33% to 66%. The 1985 reference equations overpredicted V˙O2 at Tvent: mean difference in men, -0.17 L/min (95% CI, -0.25 to -0.09 L/min); mean difference in women, -0.19 L/min (95% CI, -0.27 to -0.12 L/min). INTERPRETATION A contemporary reference set of CPET responses at Tvent from Canadian adults 40 to 80 years of age is presented that differs from the previously recommended and often used reference set from 1985. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00920348; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Hayley Lewthwaite
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal; UniSA: Allied Health and Human Performance, Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, SA, Australia.
| | - Omar Elsewify
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal
| | - Frank Niro
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal
| | - Jean Bourbeau
- Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Vancouver, BC; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, QC
| | - Darcy D Marciniuk
- Respiratory Research Centre and Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology, Kingston Health Science Center & Queen's University, Kingston, ON, Canada
| | - Benjamin M Smith
- Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Vancouver, BC
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal; Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal
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17
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Multidimensional breathlessness assessment during cardiopulmonary exercise testing in healthy adults. Eur J Appl Physiol 2020; 121:499-511. [PMID: 33141262 DOI: 10.1007/s00421-020-04537-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study explored if healthy adults could discriminate between different breathlessness dimensions when rated immediately one after another (successively) during symptom-limited incremental cardiopulmonary cycle exercise testing (CPET) using multiple single-item rating scales. METHODS Fifteen apparently healthy adults (60% male) aged 22 ± 2 years performed six incremental cycle CPETs separated by ≥ 48 h. During each CPET (at rest, every 2-min and at end exercise), participants rated different breathlessness sensations using the 0-10 modified Borg scale using one of six assessment protocols, randomized for order: (1) 'BREATHLESSALL' = breathlessness sensory intensity (SI), breathlessness unpleasantness (UN), work/effort of breathing (SQW/E), and unsatisfied inspiration (SQUI) assessed; (2) SI and UN assessed; and (3-6) SI, UN, SQW/E, and SQUI each assessed alone. Physiological responses to CPET were also evaluated. RESULTS Physiological and breathlessness responses to CPET were comparable across the six protocols, with the exception of SI rated lower at the highest submaximal power output (220 ± 56 watts) during the BREATHLESSALL protocol (0-10 Borg units 4.2 ± 1.7) compared to SI + UN (5.2 ± 2.1, p = 0.03) and SI alone (5.1 ± 1.9, p = 0.04) protocols. Ratings of SI and SQW/E were not significantly different when assessed in the same protocol, and were significantly higher than UN and SQUI, which were comparable. CONCLUSION In healthy younger adults, use of two separate single-item rating scales to assess breathlessness during CPET is feasible and enables the distinct sensory intensity and affective dimensions of exertional breathlessness to be assessed.
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18
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Domnik NJ, Walsted ES, Langer D. Clinical Utility of Measuring Inspiratory Neural Drive During Cardiopulmonary Exercise Testing (CPET). Front Med (Lausanne) 2020; 7:483. [PMID: 33043023 PMCID: PMC7530180 DOI: 10.3389/fmed.2020.00483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) has traditionally included ventilatory and metabolic measurements alongside electrocardiographic characterization; however, research increasingly acknowledges the utility of also measuring inspiratory neural drive (IND) through its surrogate measure of diaphragmatic electromyography (EMGdi). While true IND also encompasses the activation of non-diaphragmatic respiratory muscles, the current review focuses on diaphragmatic measurements, providing information about additional inspiratory muscle groups for context where appropriate. Evaluation of IND provides mechanistic insight into the origins of dyspnea and exercise limitation across pathologies; yields valuable information reflecting the integration of diverse mechanical, chemical, locomotor, and metabolic afferent signals; and can help assess the efficacy of therapeutic interventions. Further, IND measurement during the physiologic stress of exercise is uniquely poised to reveal the underpinnings of physiologic limitations masked during resting and unloaded breathing, with important information provided not only at peak exercise, but throughout exercise protocols. As our understanding of IND presentation across varying conditions continues to grow and methods for its measurement become more accessible, the translation of these principles into clinical settings is a logical next step in facilitating appropriate and nuanced management tailored to each individual's unique physiology. This review provides an overview of the current state of understanding of IND measurement during CPET: its origins, known patterns of behavior and links with dyspnea in health and major respiratory diseases, and the possibility of expanding this approach to applications beyond exercise.
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Affiliation(s)
| | - Emil S. Walsted
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Daniel Langer
- Research Group for Rehabilitation in Internal Disorders, Respiratory Rehabilitation and Respiratory Division, Department of Rehabilitation Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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19
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Milne KM, Domnik NJ, Phillips DB, James MD, Vincent SG, Neder JA, O'Donnell DE. Evaluation of Dynamic Respiratory Mechanical Abnormalities During Conventional CPET. Front Med (Lausanne) 2020; 7:548. [PMID: 33072774 PMCID: PMC7533639 DOI: 10.3389/fmed.2020.00548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/31/2020] [Indexed: 12/21/2022] Open
Abstract
Assessment of the ventilatory response to exercise is important in evaluating mechanisms of dyspnea and exercise intolerance in chronic cardiopulmonary diseases. The characteristic mechanical derangements that occur during exercise in chronic respiratory conditions have previously been determined in seminal studies using esophageal catheter pressure-derived measurements. In this brief review, we examine the emerging role and clinical utility of conventional assessment of dynamic respiratory mechanics during exercise testing. Thus, we provide a physiologic rationale for measuring operating lung volumes, breathing pattern, and flow-volume loops during exercise. We consider standardization of inspiratory capacity-derived measurements and their practical implementation in clinical laboratories. We examine the evidence that this iterative approach allows greater refinement in evaluation of ventilatory limitation during exercise than traditional assessments of breathing reserve. We appraise the available data on the reproducibility and responsiveness of this methodology. In particular, we review inspiratory capacity measurement and derived operating lung volumes during exercise. We demonstrate, using recent published data, how systematic evaluation of dynamic mechanical constraints, together with breathing pattern analysis, can provide valuable insights into the nature and extent of physiological impairment contributing to exercise intolerance in individuals with common chronic obstructive and restrictive respiratory disorders.
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Affiliation(s)
- Kathryn M Milne
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada.,Clinician Investigator Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre & Queen's University, Kingston, ON, Canada
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20
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Phillips DB, Collins SÉ, Stickland MK. Measurement and Interpretation of Exercise Ventilatory Efficiency. Front Physiol 2020; 11:659. [PMID: 32714201 PMCID: PMC7344219 DOI: 10.3389/fphys.2020.00659] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) is a method for evaluating pulmonary and cardiocirculatory abnormalities, dyspnea, and exercise tolerance in healthy individuals and patients with chronic conditions. During exercise, ventilation (V˙E) increases in proportion to metabolic demand [i.e., carbon dioxide production (V˙CO2)] to maintain arterial blood gas and acid-base balance. The response of V˙E relative to V˙CO2 (V˙E/V˙CO2) is commonly termed ventilatory efficiency and is becoming a common physiological tool, in conjunction with other key variables such as operating lung volumes, to evaluate exercise responses in patients with chronic conditions. A growing body of research has shown that the V˙E/V˙CO2 response to exercise is elevated in conditions such as chronic heart failure (CHF), pulmonary hypertension (PH), interstitial lung disease (ILD), and chronic obstructive pulmonary disease (COPD). Importantly, this potentiated V˙E/V˙CO2 response contributes to dyspnea and exercise intolerance. The clinical significance of ventilatory inefficiency is demonstrated by findings showing that the elevated V˙E/V˙CO2 response to exercise is an independent predictor of mortality in patients with CHF, PH, and COPD. In this article, the underlying physiology, measurement, and interpretation of exercise ventilatory efficiency during CPET are reviewed. Additionally, exercise ventilatory efficiency in varying disease states is briefly discussed.
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Affiliation(s)
- Devin B Phillips
- Clinical Physiology Laboratory, Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Sophie É Collins
- Clinical Physiology Laboratory, Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Clinical Physiology Laboratory, Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
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21
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Boyle KG, Mitchell RA, Ramsook AH, Schaeffer MR, Koehle MS, Sheel AW, Guenette JA. The effect of diaphragm fatigue on the multidimensional components of dyspnoea and diaphragm electromyography during exercise in healthy males. J Physiol 2020; 598:3223-3237. [DOI: 10.1113/jp279755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/11/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kyle G. Boyle
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Reid A. Mitchell
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Andrew H. Ramsook
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Michele R. Schaeffer
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Michael S. Koehle
- School of Kinesiology Faculty of Education University of British Columbia Vancouver Canada
- Department of Family Practice Faculty of Medicine University of British Columbia Vancouver Canada
| | - A. William Sheel
- School of Kinesiology Faculty of Education University of British Columbia Vancouver Canada
| | - Jordan A. Guenette
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
- School of Kinesiology Faculty of Education University of British Columbia Vancouver Canada
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22
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Dominelli PB, Molgat-Seon Y, Sheel AW. Sex Differences in the Pulmonary System Influence the Integrative Response to Exercise. Exerc Sport Sci Rev 2020; 47:142-150. [PMID: 30817330 DOI: 10.1249/jes.0000000000000188] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Healthy women have proportionally smaller lungs and airways compared with height-matched men. These anatomical sex-based differences result in greater mechanical ventilatory constraints and may influence the integrative response to exercise. Our review will examine this hypothesis in healthy humans in the context of dynamic whole-body exercise.
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Affiliation(s)
- Paolo B Dominelli
- Department of Anesthesia, Mayo Clinic, Rochester, MN.,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Yannick Molgat-Seon
- Centre for Heart and Lung Innovation, St. Paul's Hospital.,Department of Physical Therapy, Faculty of Medicine, and
| | - A William Sheel
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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23
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Molgat-Seon Y, Ramsook AH, Peters CM, Schaeffer MR, Dominelli PB, Romer LM, Road JD, Guenette JA, Sheel AW. Manipulation of mechanical ventilatory constraint during moderate intensity exercise does not influence dyspnoea in healthy older men and women. J Physiol 2019; 597:1383-1399. [PMID: 30578651 DOI: 10.1113/jp277476] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/17/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The perceived intensity of exertional breathlessness (i.e. dyspnoea) is higher in older women than in older men, possibly as a result of sex-differences in respiratory system morphology. During exercise at a given absolute intensity or minute ventilation, older women have a greater degree of mechanical ventilatory constraint (i.e. work of breathing and expiratory flow limitation) than their male counterparts, which may lead to a greater perceived intensity of dyspnoea. Using a single-blind randomized study design, we experimentally manipulated the magnitude of mechanical ventilatory constraint during moderate-intensity exercise at ventilatory threshold in healthy older men and women. We found that changes in the magnitude of mechanical ventilatory constraint within the physiological range had no effect on dyspnoea in healthy older adults. When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. ABSTRACT We aimed to determine the effect of manipulating mechanical ventilatory constraint during submaximal exercise on dyspnoea in older men and women. Eighteen healthy subjects (aged 60-80 years; nine men and nine women) completed two days of testing. On day 1, subjects were assessed for pulmonary function and performed a maximal incremental cycle exercise test. On day 2, subjects performed three 6-min bouts of cycling at ventilatory threshold, in a single-blind randomized manner, while breathing: (i) normoxic helium-oxygen (HEL) to reduce the work of breathing (Wb ) and alleviate expiratory flow limitation (EFL); (ii) through an inspiratory resistance (RES) of ∼5 cmH2 O L-1 s-1 to increase Wb ; and (iii) ambient air as a control (CON). Oesophageal pressure, diaphragm electromyography, and sensory responses (category-ratio 10 Borg scale) were monitored throughout exercise. During the HEL condition, there was a significant decrease in Wb (men: -21 ± 6%, women: -17 ± 10%) relative to CON (both P < 0.01). Moreover, if EFL was present during CON (four men and five women), it was alleviated during HEL. Conversely, during the RES condition, Wb (men: 42 ± 19%, women: 50 ± 16%) significantly increased relative to CON (both P < 0.01). There was no main effect of sex on Wb (P = 0.59). Across conditions, women reported significantly higher dyspnoea intensity than men (2.9 ± 0.9 vs. 1.9 ± 0.8 Borg scale units, P < 0.05). Despite significant differences in the degree of mechanical ventilatory constraint between conditions, the intensity of dyspnoea was unaffected, independent of sex (P = 0.46). When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea.
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Affiliation(s)
- Yannick Molgat-Seon
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carli M Peters
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Paolo B Dominelli
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada.,Mayo Clinic, Rochester, MN, USA
| | - Lee M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, Uxbridge, UK.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UK
| | - Jeremy D Road
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jordan A Guenette
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - A William Sheel
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
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Welch JF, Archiza B, Guenette JA, West CR, Sheel AW. Effect of diaphragm fatigue on subsequent exercise tolerance in healthy men and women. J Appl Physiol (1985) 2018; 125:1987-1996. [PMID: 30307818 DOI: 10.1152/japplphysiol.00630.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Women are more resistant to diaphragmatic fatigue (DF) and experience an attenuated inspiratory muscle metaboreflex relative to men. The effects of such sex-based differences on whole body exercise tolerance are yet to be examined. It was hypothesized that DF induced prior to exercise would cause less of a reduction in subsequent exercise time in women compared to men. Healthy men ( n = 9, age = 24 ± 3 yr) and women ( n = 9, age = 24 ± 3 yr) completed a maximal incremental cycle test on day 1. On day 2, subjects performed isocapnic inspiratory pressure-threshold loading (PTL) to task failure followed by a constant load submaximal time-to-exhaustion (TTE) exercise test at 85% of the predetermined peak work rate. On day 3, subjects performed the same exercise test without prior induced DF. Days 2 and 3 were randomized and counterbalanced. Magnetic stimulation of the phrenic nerve roots was used to nonvolitionally assess DF by measurement of transdiaphragmatic twitch pressure ( Pdi,tw). A similar degree of DF was produced in both sexes following PTL [ Pdi,tw (% change from baseline): M = -24.6 ± 7.8%, W = -23.1 ± 5.4%; P = 0.54)]. There was a significant reduction in TTE with prior induced DF compared with the control condition in both men (10.9 ± 3.5 min vs. 13.0 ± 3.2 min, P = 0.05) and women (10.1 ± 2.4 min vs. 12.2 ± 3.3 min, P = 0.03) that did not differ in magnitude between the sexes (M = -15.8 ± 19.5%, W = -14.5 ± 19.2%, P = 0.89). In conclusion, DF negatively and equally impairs exercise tolerance independent of sex. NEW & NOTEWORTHY Women are more resistant to diaphragmatic fatigue (DF) relative to men. The effect of DF on exercise tolerance is currently being debated. Our findings show that DF negatively and equally affects exercise tolerance in healthy men and women. Mechanisms beyond the inspiratory muscle metaboreflex (e.g., dyspnea, central fatigue, breathing pattern) may explain the absence of a sex-based difference.
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Affiliation(s)
- Joseph F Welch
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Bruno Archiza
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada.,Department of Physical Therapy, Federal University of Sao Carlos , Sao Carlos , Brazil
| | - Jordan A Guenette
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada.,Department of Physical Therapy, University of British Columbia , Vancouver, British Columbia , Canada.,Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia and St. Paul's Hospital , Vancouver, British Columbia , Canada
| | - Christopher R West
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada.,International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia , Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
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Molgat-Seon Y, Peters CM, Sheel AW. Sex-differences in the human respiratory system and their impact on resting pulmonary function and the integrative response to exercise. CURRENT OPINION IN PHYSIOLOGY 2018. [DOI: 10.1016/j.cophys.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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26
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Rehder-Santos P, Minatel V, Ribeiro BA, Ducatti R, de Moura-Tonello SCG, Roscani MG, da Silva Reis M, Silva E, Catai AM. Age is the main factor related to expiratory flow limitation during constant load exercise. Clinics (Sao Paulo) 2018; 73:e439. [PMID: 30379226 PMCID: PMC6201139 DOI: 10.6061/clinics/2018/e439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/06/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the interaction among the determinants of expiratory flow limitation (EFL), peak oxygen uptake (VO2peak), dysanapsis ratio (DR) and age during cycling at different intensities in young and middle-aged men. METHODS Twenty-two (11 young and 11 middle-aged) men were assessed. Pulmonary function tests (DR), cardiopulmonary exercise tests (VO2peak) and two constant load tests (CLTs) at 75% (moderate intensity) and 125% (high intensity) of the gas exchange threshold were performed to assess EFL. EFL was classified using the percentage of EFL determined from both CLTs (mild: 5%-30%, moderate: 30%-50%, severe: >50%). RESULTS Only the middle-aged group displayed EFL at both exercise intensities (p<0.05). However, the number of participants with EFL and the percentage of EFL were only associated with age during high-intensity exercise. CONCLUSIONS There was no interaction between the determinants. However, age was the only factor that was related to the presence of EFL during exercise in the age groups studied.
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Affiliation(s)
- Patricia Rehder-Santos
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Vinicius Minatel
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Bruno Araújo Ribeiro
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Richard Ducatti
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Silvia Cristina Garcia de Moura-Tonello
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Meliza Goi Roscani
- Departamento de Medicina, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Michel da Silva Reis
- Grupo de Pesquisa em Avaliacao e Reabilitacao Cardiorrespiratoria (GECARE), Departamento Fisioterapia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Ester Silva
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Aparecida Maria Catai
- Laboratorio de Fisioterapia Cardiovascular, Nucleo de Pesquisas em Exercicio Fisico, Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
- *Corresponding author. E-mail:
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MOLGAT-SEON YANNICK, DOMINELLI PAOLOB, RAMSOOK ANDREWH, SCHAEFFER MICHELER, ROMER LEEM, ROAD JEREMYD, GUENETTE JORDANA, SHEEL AWILLIAM. Effects of Age and Sex on Inspiratory Muscle Activation Patterns during Exercise. Med Sci Sports Exerc 2018; 50:1882-1891. [DOI: 10.1249/mss.0000000000001648] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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28
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Ekström M, Bornefalk-Hermansson A, Wysham N, Currow DC, MacIntyre N. Spirometric Volumes and Breathlessness across Levels of Airflow Limitation: The COPDGene Study. Am J Respir Crit Care Med 2018; 198:678-681. [PMID: 29702011 DOI: 10.1164/rccm.201803-0594le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Magnus Ekström
- Lund UniversityLund, Sweden.,University of Technology SydneyUltimo, New South Wales, Australia
| | | | | | - David C Currow
- University of Technology SydneyUltimo, New South Wales, Australia
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Smith JR, Cross TJ, Van Iterson EH, Johnson BD, Olson TP. Resistive and elastic work of breathing in older and younger adults during exercise. J Appl Physiol (1985) 2018; 125:190-197. [PMID: 29672228 DOI: 10.1152/japplphysiol.01105.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is unknown whether the greater total work of breathing (WOB) with aging is due to greater elastic and/or resistive WOB. We hypothesized that older compared with younger adults would exhibit a greater total WOB at matched ventilations (V̇e) during graded exercise, secondary to greater inspiratory resistive and elastic as well as expiratory resistive WOB. Older (OA: 60 ± 8 yr; n = 9) and younger (YA: 38 ± 7 yr; n = 9) adults performed an incremental cycling test to volitional fatigue. Esophageal pressure, inspiratory (IRV) and expiratory reserve volumes (ERV), expiratory flow limitation (EFL), and ventilatory variables were measured at matched V̇e (i.e., 25, 50, and 75 l/min) during exercise. The inspiratory resistive and elastic as well as expiratory resistive WOB were quantified using the Otis method. At V̇e of 75 l/min, older adults had greater %EFL and larger tidal volumes to inspiratory capacity but smaller relative IRV ( P ≤ 0.03) than younger adults. Older compared with younger adults had greater total WOB at V̇E of 50 and 75 l/min (OA: 90 ± 43 vs. YA: 49 ± 21 J/min; P < 0.04 for both). At V̇e of 75 l/min, older adults had greater inspiratory elastic and resistive WOB (OA: 44 ± 27 vs. YA: 24 ± 22 and OA: 23 ± 15 vs. YA: 11 ± 3 J/min, respectively, P < 0.03 for both) and expiratory resistive WOB (OA: 23 ± 19 vs. YA: 14 ± 9 J/min, P = 0.02) than younger adults. These data demonstrate that aging-induced pulmonary alterations result in greater inspiratory elastic and resistive as well as expiratory resistive WOB, which may have implications for the integrated response during exercise. NEW & NOTEWORTHY Aging-induced changes to the pulmonary system result in increased work of breathing (WOB) during exercise. However, it is not known whether this higher WOB with aging is due to differences in elastic and/or resistive WOB. Herein, we demonstrate that older adults exhibited greater inspiratory elastic and resistive as well as expiratory resistive WOB during exercise.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Troy J Cross
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Erik H Van Iterson
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
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Ekström M, Sundh J, Schiöler L, Lindberg E, Rosengren A, Bergström G, Angerås O, Hedner J, Brandberg J, Bake B, Torén K. Absolute lung size and the sex difference in breathlessness in the general population. PLoS One 2018; 13:e0190876. [PMID: 29304074 PMCID: PMC5755925 DOI: 10.1371/journal.pone.0190876] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background Breathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes. Methods Cross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spirometry and diffusing capacity (n = 1,013; 49% women). Breathlessness was measured using the modified Medical Research Council (mMRC) scale and analyzed using ordinal logistic regression adjusting for age, pack-years of smoking, body mass index, chronic airway limitation, asthma, chronic bronchitis, depression and anxiety in all models. Results Breathlessness was twice as common in women as in men; adjusted odds ratio (OR) 2.20 (95% confidence interval, 1.32−3.66). Lower absolute lung volumes were associated with increased breathlessness prevalence in both men and women. The sex difference in breathlessness was unchanged when adjusting for lung function in %predicted, but disappeared when controlling for absolute values of total lung capacity (OR 1.12; 0.59−2.15), inspiratory capacity (OR 1.26; 0.68−2.35), forced vital capacity (OR 0.84; 0.42−1.66), forced expiratory volume in one second (OR 0.70; 0.36−1.35) or lung diffusing capacity (OR 1.07; 0.58−1.97). Conclusion In the general population, the markedly higher prevalence of breathlessness in women is related to their smaller absolute lung volumes.
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Grants
- The main funding body of The Swedish CArdioPulmonary bioImage Study (SCAPIS) was the Swedish Heart and Lung Foundation. The study was also funded by the Knut and Alice Wallenberg Foundation, the Swedish Research Council (VR), VINNOVA and the Swedish Council for Working Life, Health, and Welfare (FORTE). In addition, there was support from the Sahlgrenska University Hospital, and grants from the Swedish state under the agreement concerning research and education of doctors in Western Sweden and from the Sahlgrenska Academy at University of Gothenburg. ME was supported by unrestricted grants from The Swedish Society of Medicine, the Swedish Respiratory Society, the Swedish Heart-Lung Foundation, the Scientific Committee of Blekinge County Council, and the Wera and Emil Cornell Foundation.
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Affiliation(s)
- Magnus Ekström
- Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Linus Schiöler
- Section of Occupational and environmental medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Annika Rosengren
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Göran Bergström
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Hedner
- Department of Internal Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Department of Respiratory Medicine and Allergology, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and environmental medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Molgat-Seon Y, Dominelli PB, Ramsook AH, Schaeffer MR, Molgat Sereacki S, Foster GE, Romer LM, Road JD, Guenette JA, Sheel AW. The effects of age and sex on mechanical ventilatory constraint and dyspnea during exercise in healthy humans. J Appl Physiol (1985) 2017; 124:1092-1106. [PMID: 29357513 DOI: 10.1152/japplphysiol.00608.2017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We examined the effects of age, sex, and their interaction on mechanical ventilatory constraint and dyspnea during exercise in 22 older (age = 68 ± 1 yr; n = 12 women) and 22 younger (age = 25 ± 1 y, n = 11 women) subjects. During submaximal exercise, older subjects had higher end-inspiratory (EILV) and end-expiratory (EELV) lung volumes than younger subjects (both P < 0.05). During maximal exercise, older subjects had similar EILV ( P > 0.05) but higher EELV than younger subjects ( P < 0.05). No sex differences in EILV or EELV were observed. We noted that women had a higher work of breathing (Wb) for a given minute ventilation (V̇e) ≥65 l/min than men ( P < 0.05) and older subjects had a higher Wb for a given V̇e ≥60 l/min ( P < 0.05). No sex or age differences in Wb were present at any submaximal relative V̇e. At absolute exercise intensities, older women experienced expiratory flow limitation (EFL) more frequently than older men ( P < 0.05), and older subjects were more likely to experience EFL than younger subjects ( P < 0.05). At relative exercise intensities, women and older individuals experienced EFL more frequently than men and younger individuals, respectively (both P < 0.05). There were significant effects of age, sex, and their interaction on dyspnea intensity during exercise at absolute, but not relative, intensities (all P < 0.05). Across subjects, dyspnea at 80 W was significantly correlated with indexes of mechanical ventilatory constraint (all P < 0.05). Collectively, our findings suggest age and sex have significant impacts on Wb, operating lung volumes, EFL, and dyspnea during exercise. Moreover, it appears that mechanical ventilatory constraint may partially explain sex differences in exertional dyspnea in older individuals. NEW & NOTEWORTHY We found that age and sex have a significant effect on mechanical ventilatory constraint and the perception of dyspnea during exercise. We also observed that the perception of exertional dyspnea is associated with indexes of mechanical ventilatory constraint. Collectively, our results suggest that the combined influences of age and biological sex on mechanical ventilatory constraint during exercise contributes, in part, to the increased perception of dyspnea during exercise in older women.
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Affiliation(s)
- Yannick Molgat-Seon
- School of Kinesiology, University of British Columbia , Vancouver , Canada.,Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia , Vancouver , Canada
| | - Andrew H Ramsook
- Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - Michele R Schaeffer
- Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - Stéfan Molgat Sereacki
- Division of Family Medicine, Faculty of Medicine, University of British Columbia , Vancouver , Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia , Kelowna , Canada
| | - Lee M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Jeremy D Road
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia , Vancouver , Canada
| | - Jordan A Guenette
- Centre for Heart and Lung Innovation, St. Paul's Hospital , Vancouver , Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver , Canada
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Expiratory flow limitation and operating lung volumes during exercise in older and younger adults. Respir Physiol Neurobiol 2017; 240:26-31. [DOI: 10.1016/j.resp.2016.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/14/2016] [Accepted: 12/07/2016] [Indexed: 11/21/2022]
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Ekström M, Schiöler L, Grønseth R, Johannessen A, Svanes C, Leynaert B, Jarvis D, Gislason T, Demoly P, Probst-Hensch N, Pin I, Corsico A, Forsberg B, Heinrich J, Nowak D, Raherison-Semjen C, Dharmage SC, Trucco G, Urrutia I, Martinez-Moratalla Rovira J, Sánchez-Ramos JL, Janson C, Torén K. Absolute values of lung function explain the sex difference in breathlessness in the general population. Eur Respir J 2017; 49:49/5/1602047. [DOI: 10.1183/13993003.02047-2016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/29/2017] [Indexed: 11/05/2022]
Abstract
Activity-related breathlessness is twice as common among females as males in the general population and is associated with adverse health outcomes. We tested whether this sex difference is explained by the lower absolute forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) in females.This was a cross-sectional analysis of 3250 subjects (51% female) aged 38−67 years across 13 countries in the population-based third European Community Respiratory Health Survey. Activity-related breathlessness was measured using the modified Medical Research Council (mMRC) scale. Associations with mMRC were analysed using ordered logistic regression clustering on centre, adjusting for post-bronchodilator spirometry, body mass index, pack-years smoking, cardiopulmonary diseases, depression and level of exercise.Activity-related breathlessness (mMRC ≥1) was twice as common in females (27%) as in males (14%) (odds ratio (OR) 2.21, 95% CI 1.79−2.72). The sex difference was not reduced when controlling for FEV1 % predicted (OR 2.33), but disappeared when controlling for absolute FEV1 (OR 0.89, 95% CI 0.69−1.14). Absolute FEV1 explained 98−100% of the sex difference adjusting for confounders. The effect was similar within males and females, when using FVC instead of FEV1 and in healthy never-smokers.The markedly more severe activity-related breathlessness among females in the general population is explained by their smaller spirometric lung volumes.
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O'Donnell DE, Elbehairy AF, Berton DC, Domnik NJ, Neder JA. Advances in the Evaluation of Respiratory Pathophysiology during Exercise in Chronic Lung Diseases. Front Physiol 2017; 8:82. [PMID: 28275353 PMCID: PMC5319975 DOI: 10.3389/fphys.2017.00082] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
Dyspnea and exercise limitation are among the most common symptoms experienced by patients with various chronic lung diseases and are linked to poor quality of life. Our understanding of the source and nature of perceived respiratory discomfort and exercise intolerance in chronic lung diseases has increased substantially in recent years. These new mechanistic insights are the primary focus of the current review. Cardiopulmonary exercise testing (CPET) provides a unique opportunity to objectively evaluate the ability of the respiratory system to respond to imposed incremental physiological stress. In addition to measuring aerobic capacity and quantifying an individual's cardiac and ventilatory reserves, we have expanded the role of CPET to include evaluation of symptom intensity, together with a simple "non-invasive" assessment of relevant ventilatory control parameters and dynamic respiratory mechanics during standardized incremental tests to tolerance. This review explores the application of the new advances in the clinical evaluation of the pathophysiology of exercise intolerance in chronic obstructive pulmonary disease (COPD), chronic asthma, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). We hope to demonstrate how this novel approach to CPET interpretation, which includes a quantification of activity-related dyspnea and evaluation of its underlying mechanisms, enhances our ability to meaningfully intervene to improve quality of life in these pathologically-distinct conditions.
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Affiliation(s)
- Denis E. O'Donnell
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
| | - Amany F. Elbehairy
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
- Department of Chest Diseases, Faculty of Medicine, Alexandria UniversityAlexandria, Egypt
| | - Danilo C. Berton
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
| | - Nicolle J. Domnik
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
| | - J. Alberto Neder
- Division of Respiratory Medicine, Department of Medicine, Queen's University and Kingston General HospitalKingston, ON, Canada
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Roman MA, Rossiter HB, Casaburi R. Exercise, ageing and the lung. Eur Respir J 2016; 48:1471-1486. [PMID: 27799391 DOI: 10.1183/13993003.00347-2016] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023]
Abstract
This review provides a pulmonary-focused description of the age-associated changes in the integrative physiology of exercise, including how declining lung function plays a role in promoting multimorbidity in the elderly through limitation of physical function. We outline the ageing of physiological systems supporting endurance activity: 1) coupling of muscle metabolism to mechanical power output; 2) gas transport between muscle capillary and mitochondria; 3) matching of muscle blood flow to its requirement; 4) oxygen and carbon dioxide carrying capacity of the blood; 5) cardiac output; 6) pulmonary vascular function; 7) pulmonary oxygen transport; 8) control of ventilation; and 9) pulmonary mechanics and respiratory muscle function. Deterioration in function occurs in many of these systems in healthy ageing. Between the ages of 25 and 80 years pulmonary function and aerobic capacity each decline by ∼40%. While the predominant factor limiting exercise in the elderly likely resides within the function of the muscles of ambulation, muscle function is (at least partially) rescued by exercise training. The age-associated decline in pulmonary function, however, is not recovered by training. Thus, loss in pulmonary function may lead to ventilatory limitation in exercise in the active elderly, limiting the ability to accrue the health benefits of physical activity into senescence.
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Affiliation(s)
- Michael A Roman
- Division of Respiratory Medicine, Rockyview Hospital, University of Calgary, Calgary, AB, Canada
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA.,Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Chlif M, Keochkerian D, Temfemo A, Choquet D, Ahmaidi S. Inspiratory muscle performance in endurance-trained elderly males during incremental exercise. Respir Physiol Neurobiol 2016; 228:61-8. [PMID: 26994757 DOI: 10.1016/j.resp.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 03/13/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to compare the inspiratory muscle performance during an incremental exercise of twelve fit old endurance-trained athletes (OT) with that of fit young athletes (YT) and healthy age-matched controls (OC). The tension-time index (TT0.1) was determined according to the equation TT0.1=P0.1/PImax×ti/ttot, where P0.1 is the mouth occlusion pressure, PImax the maximal inspiratory pressure and ti/ttot the duty cycle. For a given VCO2, OT group displayed P0.1, P0.1/PImax ratio, TT0.1 and effective impedance of the respiratory muscle values which were lower than OC group and higher than YT group. At maximal exercise, P0.1/PImax ratio and TT0.1 was still lower in the OT group than OC group and higher than YT group. This study showed lower inspiratory muscle performance attested by a higher (TT0.1) during exercise in the OT group than YT group, but appeared to be less marked in elderly men having performed lifelong endurance training compared with sedentary elderly subjects.
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Affiliation(s)
- Mehdi Chlif
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France; Tunisian Research Laboratory Sport Performance Optimization, National Center of Medicine and Science in Sports (CNMSS), Bp263, Ave Med Ali Akid, 1004 El, Menzah, Tunis, Tunisia.
| | - David Keochkerian
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France
| | - Abdou Temfemo
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France
| | - Dominique Choquet
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France; Department of Cardiac Rehabilitation, Corbie's hospital, F-80800 Corbie, France
| | - Said Ahmaidi
- EA 3300 "APS and Motor Patterns, Adaptations-Rehabilitation,", Picardie Jules Verne University, Sport Science Department, F-80025 Amiens Cedex, France
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Johnson MJ, Bland JM, Gahbauer EA, Ekström M, Sinnarajah A, Gill TM, Currow DC. Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors. J Am Geriatr Soc 2016; 64:73-80. [PMID: 26782854 PMCID: PMC4719155 DOI: 10.1111/jgs.13865] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate relationships between age, clinical characteristics, and breathlessness sufficient to have people spend at least half a day a month in bed or to cut down on their usual activities (restricting breathlessness) during the last year of life. DESIGN Secondary data analysis. SETTING General community. PARTICIPANTS Nondisabled persons aged 70 and older (N=754). MEASUREMENTS Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was percentage of months with restricting breathlessness reported during the last year of life. RESULTS Data regarding breathlessness were available for 548 of 589 (93.0%) participants who died (mean age 86.7, range 71-106; 38.8% male) between enrollment (March 1998 to October 1999) and June 2013; 311 of these (56.8%) reported restricting breathlessness at some point during the last year of life, but none reported it every month. Frequency increased in the months closer to death, irrespective of cause. Restricting breathlessness was associated with anxiety (0.25 percentage points greater in months with breathlessness per percentage point months reported anxiety, 95% confidence interval (CI)=0.16-0.34, P<.001), depression (0.14, 95% CI=0.05-0.24, P=.003), and mobility problems (0.07, 0.03-0.1, P<.001). Percentage months of restricting breathlessness was greater if chronic lung disease was noted at the most-recent comprehensive assessment (6.62 percentage points, 95% CI=4.31-8.94, P<.001), heart failure (3.34 percentage points, 95% CI=0.71-5.97, P=.01), and ex-smoker status (3.01 percentage points, 95% CI=0.94-5.07, P=.004) but decreased with older age (-0.19 percentage points, 95% CI=-0.37 to -0.02, P=.03). CONCLUSION Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis.
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Affiliation(s)
| | | | - Evelyne A. Gahbauer
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Magnus Ekström
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Aynharan Sinnarajah
- Palliative & End of Life Care, Alberta Health Services (AHS) - Calgary Zone, Canada
| | - Thomas M. Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - David C. Currow
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia
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Sheel AW, Dominelli PB, Molgat-Seon Y. Revisiting dysanapsis: sex-based differences in airways and the mechanics of breathing during exercise. Exp Physiol 2015; 101:213-8. [PMID: 26440369 DOI: 10.1113/ep085366] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/25/2015] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review focuses on sex-based differences in the anatomy of the respiratory system, which manifest in mechanical ventilatory constraints and potentially alter the integrative response to exercise. What advances does it highlight? Recent evidence indicates that women have smaller conducting airways than men, even when matched for lung size. Consequently, women are more likely to experience mechanical ventilatory constraints to exercise hyperpnoea. Furthermore, at a given ventilation, women have a higher work and oxygen cost of breathing, both of which may lead to differences in the whole-body integrative response to dynamic exercise. Our understanding of the human ventilatory response to exercise is largely based on a historical body of literature focused primarily on male rather than female research subjects. In recent years, important sex-based differences in the anatomy of the human respiratory system have been identified; for a given lung size, women appear to have smaller-diameter conducting airways than men. The presence of such inherent differences in the tracheobronchial tree greatly affects the mechanics of airflow generation, especially during conditions of high ventilation rates, such as exercise. Data from a growing number of studies suggest that women may be more susceptible to respiratory system limitations during exercise than their male counterparts. Specifically, women are more likely to experience expiratory flow limitation and exercise-induced arterial hypoxaemia and have a higher metabolic cost of breathing for a given ventilation. Collectively, the available evidence suggests that sex differences in the ventilatory response to exercise are present and may have important ramifications for the integrated response to exercise; however, several fundamental questions remain unanswered.
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Affiliation(s)
- A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yannick Molgat-Seon
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Adult survivors of preterm birth. What spirometry conceals, exercise tests reveal. Ann Am Thorac Soc 2015; 11:1606-7. [PMID: 25549025 DOI: 10.1513/annalsats.201410-479ed] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cory JM, Schaeffer MR, Wilkie SS, Ramsook AH, Puyat JH, Arbour B, Basran R, Lam M, Les C, MacDonald B, Jensen D, Guenette JA. Sex differences in the intensity and qualitative dimensions of exertional dyspnea in physically active young adults. J Appl Physiol (1985) 2015; 119:998-1006. [PMID: 26338458 DOI: 10.1152/japplphysiol.00520.2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023] Open
Abstract
Understanding sex differences in the qualitative dimensions of exertional dyspnea may provide insight into why women are more affected by this symptom than men. This study explored the evolution of the qualitative dimensions of dyspnea in 70 healthy, young, physically active adults (35 M and 35 F). Participants rated the intensity of their breathing discomfort (Borg 0-10 scale) and selected phrases that best described their breathing from a standardized list (work/effort, unsatisfied inspiration, and unsatisfied expiration) throughout each stage of a symptom-limited incremental-cycle exercise test. Following exercise, participants selected phrases that described their breathing at maximal exercise from a list of 15 standardized phrases. Intensity of breathing discomfort was significantly higher in women for a given ventilation, but differences disappeared when ventilation was expressed as a percentage of maximum voluntary ventilation. The dominant qualitative descriptor in both sexes throughout exercise was increased work/effort of breathing. At peak exercise, women were significantly more likely to select the following phrases: "my breathing feels shallow," "I cannot get enough air in," "I cannot take a deep breath in," and "my breath does not go in all the way." Women adopted a more rapid and shallow breathing pattern and had significantly higher end-inspiratory lung volumes relative to total lung capacity throughout exercise relative to men. These findings suggest that men and women do not differ in their perceived quality of dyspnea during submaximal exercise, but subjective differences appear at maximal exercise and may be related, at least in part, to underlying sex differences in breathing patterns and operating lung volumes during exercise.
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Affiliation(s)
- Julia M Cory
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina S Wilkie
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph H Puyat
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Brandon Arbour
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robbi Basran
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Lam
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Les
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin MacDonald
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada;
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O'Donnell DE, Neder JA, Elbehairy AF. Physiological impairment in mild COPD. Respirology 2015; 21:211-23. [PMID: 26333038 DOI: 10.1111/resp.12619] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/03/2015] [Accepted: 07/22/2015] [Indexed: 11/28/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common and often progressive inflammatory disease of the airways, alveoli and microvasculature that is both preventable and treatable. It is well established that smokers with mild airway obstruction, as spirometrically defined, represent the vast majority of patients with COPD, yet this population has not been extensively studied. An insidious preclinical course means that mild COPD is both underdiagnosed and undertreated. In this context, recent studies have confirmed that even patients with mild COPD can have extensive physiological impairment, which contributes to poor perceived health status compared with non-smoking healthy controls. This review describes the heterogeneous pathophysiology that can exist in COPD patients with only mild airway obstruction on spirometry. It exposes the compensatory adaptations that develop in such patients to ensure that the respiratory system fulfils its primary task of maintaining adequate pulmonary gas exchange for the prevailing metabolic demand. It demonstrates that adaptations such as increased inspiratory neural drive to the diaphragm due to combined effects of increased mechanical loading and chemostimulation underscore the increased dyspnoea and exercise intolerance in this population. Finally, based on available evidence, we present what we believe is a sound physiological rationale for earlier diagnosis in this population.
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Affiliation(s)
- Denis E O'Donnell
- Department of Medicine, Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - J Alberto Neder
- Department of Medicine, Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Amany F Elbehairy
- Department of Medicine, Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.,Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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43
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Faisal A, Webb KA, Guenette JA, Jensen D, Neder JA, O’Donnell DE. Effect of age-related ventilatory inefficiency on respiratory sensation during exercise. Respir Physiol Neurobiol 2015; 205:129-39. [DOI: 10.1016/j.resp.2014.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/19/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
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Jolley CJ, Luo YM, Steier J, Rafferty GF, Polkey MI, Moxham J. Neural respiratory drive and breathlessness in COPD. Eur Respir J 2014; 45:355-64. [PMID: 25323229 DOI: 10.1183/09031936.00063014] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to test the hypothesis that neural respiratory drive, measured using diaphragm electromyogram (EMGdi) activity expressed as a percentage of maximum (EMGdi%max), is closely related to breathlessness in chronic obstructive pulmonary disease. We also investigated whether neuroventilatory uncoupling contributes significantly to breathlessness intensity over an awareness of levels of neural respiratory drive alone. EMGdi and ventilation were measured continuously during incremental cycle and treadmill exercise in 12 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s±sd was 38.7±14.5 % pred). EMGdi was expressed both as EMGdi%max and relative to tidal volume expressed as a percentage of predicted vital capacity to quantify neuroventilatory uncoupling. EMGdi%max was closely related to Borg breathlessness in both cycle (r=0.98, p=0.0001) and treadmill exercise (r=0.94, p=0.005), this relationship being similar to that between neuroventilatory uncoupling and breathlessness (cycling r=0.94, p=0.005; treadmill r=0.91, p=0.01). The relationship between breathlessness and ventilation was poor when expansion of tidal volume became limited. In chronic obstructive pulmonary disease the intensity of exertional breathlessness is closely related to EMGdi%max. These data suggest that breathlessness in chronic obstructive pulmonary disease can be largely explained by an awareness of levels of neural respiratory drive, rather than the degree of neuroventilatory uncoupling. EMGdi%max could provide a useful physiological biomarker for breathlessness in chronic obstructive pulmonary disease.
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Affiliation(s)
- Caroline J Jolley
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK.
| | - Yuanming M Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical College, Guangzhou, China
| | - Joerg Steier
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK. Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gerrard F Rafferty
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - John Moxham
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK
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Sheikh K, Paulin GA, Svenningsen S, Kirby M, Paterson NAM, McCormack DG, Parraga G. Pulmonary ventilation defects in older never-smokers. J Appl Physiol (1985) 2014; 117:297-306. [PMID: 24903918 DOI: 10.1152/japplphysiol.00046.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hyperpolarized (3)He MRI previously revealed spatially persistent ventilation defects in healthy, older compared with healthy, younger never-smokers. To understand better the physiological consequences and potential relevance of (3)He MRI ventilation defects, we evaluated (3)He-MRI ventilation-defect percent (VDP) and the effect of deep inspiration (DI) and salbutamol on VDP in older never-smokers. To identify the potential determinants of ventilation defects in these subjects, we evaluated dyspnea, pulmonary function, and cardiopulmonary exercise test (CPET) measurements, as well as occupational and second-hand smoke exposure. Fifty-two never-smokers (71 ± 6 yr) with no history of chronic respiratory disease were evaluated. During a single visit, pulmonary function tests, CPET, and (3)He MRI were performed and the Burden of Obstructive Lung Disease questionnaire administered. For eight of 52 subjects, there was spirometry evidence of airflow limitation (Global Initiative for Chronic Obstructive Lung Disease-Unclassified, I, and II), and occupational exposure was reported in 13 of 52 subjects. In 13 of 52 (25%) subjects, there were no ventilation defects and in 39 of 52 (75%) subjects, ventilation defects were observed. For those subjects with ventilation defects, six of 39 showed a VDP response to DI/salbutamol. Ventilation heterogeneity and VDP were significantly greater, and forced expiratory volume in 1 s (FEV1)/forced vital capacity was significantly lower (P < 0.05) for subjects with ventilation defects with a response to DI/salbutamol than subjects with ventilation defects without a response to DI/salbutamol and subjects without ventilation defects. In a step-wise, forward multivariate model, FEV1, inspiratory capacity, and airway resistance significantly predicted VDP (R(2) = 0.45, P < 0.001). In conclusion, most never-smokers had normal spirometry and peripheral ventilation defects not reversed by DI/salbutamol; such ventilation defects were likely related to irreversible airway narrowing/collapse but not to dyspnea and decreased exercise capacity.
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Affiliation(s)
- Khadija Sheikh
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Gregory A Paulin
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Sarah Svenningsen
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Miranda Kirby
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Nigel A M Paterson
- Division of Respirology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - David G McCormack
- Division of Respirology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Grace Parraga
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada;
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Geriatric dyspnea: doing worse, feeling better. Ageing Res Rev 2014; 15:94-9. [PMID: 24675044 DOI: 10.1016/j.arr.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/04/2014] [Accepted: 03/13/2014] [Indexed: 01/03/2023]
Abstract
Older age is associated with a decline in physical fitness and reduced efficiency of the respiratory system. Paradoxically, it is also related to reduced report of dyspnea, that is, the experience of difficult and uncomfortable breathing. Reduced symptom reporting contributes to misdiagnosis or late diagnosis of underlying disease, suboptimal treatment, faster disease progression, shorter life expectancy, lower quality of life for patients, and considerably increased costs for the health care system in an aging society. However, pathways in the complex relationship between dyspnea and age are not well explored yet. We propose a model on geriatric dyspnea that integrates physiological, neurological, psychological and social pathways which link older age with dyspnea perception and expression. We suggest that the seemingly paradox of reduction of dyspnea in older age, despite physiological decline, can be solved by taking age-related changes on these multiple levels into account. In identifying these variables, the Geriatric Dyspnea Model highlights risk factors for reduced dyspnea perception and report in older age and pathways for intervention.
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Laveneziana P, Guenette JA, Webb KA, O’Donnell DE. New physiological insights into dyspnea and exercise intolerance in chronic obstructive pulmonary disease patients. Expert Rev Respir Med 2014; 6:651-62. [DOI: 10.1586/ers.12.70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schaeffer MR, Mendonca CT, Levangie MC, Andersen RE, Taivassalo T, Jensen D. Physiological mechanisms of sex differences in exertional dyspnoea: role of neural respiratory motor drive. Exp Physiol 2013; 99:427-41. [DOI: 10.1113/expphysiol.2013.074880] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michele R. Schaeffer
- Clinical Exercise & Respiratory Physiology Laboratory; Department of Kinesiology & Physical Education; McGill University; Montreal Quebec Canada
| | - Cassandra T. Mendonca
- Clinical Exercise & Respiratory Physiology Laboratory; Department of Kinesiology & Physical Education; McGill University; Montreal Quebec Canada
| | - Marc C. Levangie
- Clinical Exercise & Respiratory Physiology Laboratory; Department of Kinesiology & Physical Education; McGill University; Montreal Quebec Canada
| | - Ross E. Andersen
- Clinical Exercise & Respiratory Physiology Laboratory; Department of Kinesiology & Physical Education; McGill University; Montreal Quebec Canada
| | - Tanja Taivassalo
- Clinical Exercise & Respiratory Physiology Laboratory; Department of Kinesiology & Physical Education; McGill University; Montreal Quebec Canada
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory; Department of Kinesiology & Physical Education; McGill University; Montreal Quebec Canada
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50
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Aguilaniu B, Tercé G, Wallaert B. Exploration fonctionnelle à l’exercice (EFX) et dyspnée inattendue. Rev Mal Respir 2013; 30:856-67. [DOI: 10.1016/j.rmr.2013.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/25/2013] [Indexed: 11/15/2022]
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