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Nir V, Bentur L, Zucker-Toledano M, Gur M, Adler Z, Hanna M, Toukan Y, Masarweh K, Hakim F, Bar-Yoseph R. Functional capacity and quality of life in patients with vascular ring. Pediatr Pulmonol 2022; 57:2946-2953. [PMID: 35971243 DOI: 10.1002/ppul.26112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vascular rings are congenital anomalies of the aortic arch that compress the trachea and esophagus and may require corrective surgery. Data about the long-term effects of vascular rings are scarce. We aimed to evaluate the long-term cardiorespiratory, exercise capacity, and quality of life of vascular ring patients. METHODS A single center prospective study evaluating spirometry, echocardiography, six-minute walk test (6MWT), cardiopulmonary exercise testing (CPET), and quality of life questionnaire (SF36) in patients with a diagnosis of vascular ring, with or without corrective surgery. RESULTS Twenty-seven patients participated (11.9 ± 6 years, 52% males). The most common diagnosis was double aortic arch (16 patients, 59%). Nineteen patients had corrective surgery (O) and 8 did not (NO). Pulmonary function tests were within normal range in both groups (FEV1 % predicted O = 87.6 ± 16.5, NO = 83 ± 10.8%). However, 11/27 had abnormal FEV1 , 5 had abnormal FVC, and 13 (48%) had flattening of the expiratory curve. 6MWD and oxygen uptake were similarly mildly reduced in both groups; (6MWD O = 80.1 ± 10.7% predicted, NO = 74.1 ± 10.9% and oxygen uptake O = 78.5 ± 23.2% predicted, NO = 73.4 ± 14.3%). Peak O2 pulse (V̇O2 /HR% predicted) was mildly reduced in the NO group (O = 88.4 ± 17.3%, NO = 75.8 ± 16.2%). Echocardiogram and SF36 scores were normal in all patients. CONCLUSIONS Long-term evaluation of patients born with vascular rings revealed mild pulmonary impairment, reduction in 6MWD, and oxygen uptake. The NO group had also mild reduced peak O2 pulse. Larger, long-term studies assessing functional parameters in operated and non-operated patients are needed to assess disease/surgery limitation in patients with vascular rings. Clinical trial registration number: NCT04781738.
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Affiliation(s)
- Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Merav Zucker-Toledano
- Pediatric Cardiology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Zvi Adler
- Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel.,Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Kamal Masarweh
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Reuveny R, Vilozni D, Dagan A, Ashkenazi M, Velner A, Segel MJ. The role of inspiratory capacity and tidal flow in diagnosing exercise ventilatory limitation in Cystic Fibrosis. Respir Med 2021; 192:106713. [PMID: 35033964 DOI: 10.1016/j.rmed.2021.106713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Exercise ventilatory limitation conventionally defined by reduced breathing reserve (BR) may underestimate the effect of lung disease on exercise capacity in patients with mild to moderate obstructive lung diseases. OBJECTIVE To investigate whether ventilatory limitation may be present despite a normal BR in Cystic Fibrosis (CF). METHODS Twenty adult CF patients (age 16-58y) with a wide range of pulmonary obstruction severity completed a symptom-limited incremental exercise test on a cycle ergometer. Operating lung volumes were derived from inspiratory capacity (IC) measurement during exercise and exercise tidal flow volume loop analysis. RESULTS six patients had a severe airway obstruction (FEV1<45% predicted) and conventional evidence of ventilatory limitation (low BR). Fourteen patients had mild to moderate-severe airway obstructive (FEV1 46-103% predicted), and a normal BR [12-62 L/min, BR% (17-40)]. However, dynamic respiratory mechanics demonstrated that even CF patients with mild to moderate-severe lung disease had clear evidence of ventilatory limitation during exercise. IC was decreased by (median) 580 ml (range 90-1180 ml) during exercise, indicating dynamic hyperinflation. Inspiratory reserve volume at peak exercise was 445 ml (241-1350 ml) indicating mechanical constraint on the respiratory system. The exercise tidal flow met or exceeded the expiratory boundary of the maximal flow volume loop over 72% of the expiratory volume (range 40-90%), indicating expiratory flow limitation. CONCLUSION Reduced BR as a sole criterion underestimates ventilatory limitation during exercise in mild to moderate-severe CF patients. Assessment of dynamic respiratory mechanics during exercise revealed ventilatory limitation, present even in patients with mild obstruction.
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Affiliation(s)
- Ronen Reuveny
- Pulmonary Institute, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Daphna Vilozni
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; National CF Center, Paediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
| | - Adi Dagan
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; National CF Center, Paediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
| | - Moshe Ashkenazi
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; National CF Center, Paediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
| | - Ariela Velner
- Pulmonary Institute, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
| | - Michael J Segel
- Pulmonary Institute, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Nir V, Bentur L, Tal G, Gur M, Gut G, Ilivitzki A, Zucker-Toledano M, Hanna M, Toukan Y, Bar-Yoseph R. Comprehensive cardiopulmonary assessment in α mannosidosis. Pediatr Pulmonol 2020; 55:2348-2353. [PMID: 32445542 DOI: 10.1002/ppul.24864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION α Mannosidosis is an extremely rare, progressive, and complex lysosomal storage disease, characterized by mental retardation, hearing impairment, coarse facial features, skeletal abnormalities, and pulmonary involvement. While bone marrow transplantation has been the only therapeutic option to date, nowadays new treatment options are being explored, which may affect pulmonary and exercise capacity. AIM AND METHODS To assess cardiopulmonary involvement in patients with α mannosidosis by pulmonary function tests, cardiopulmonary exercise testing, and low irradiation chest computed tomography (CT). RESULTS Five patients aged 11 to 28 years were followed in our Respiratory-Metabolic Clinic. All five had pulmonary symptoms and received inhaled therapy. Three patients underwent bone marrow transplantation. Parenchymal lung disease was evident in 3/5 chest CT tests. Pulmonary function tests were abnormal in all patients and showed obstructive/restrictive impairment with air trapping. All five patients showed reduced peak oxygen uptake (median 23.1; range 20.4-32.2 mL/minute/kg, median %predicted 62; range %predicted 59-79). CONCLUSIONS Pulmonary involvement is a known complication in this rare disease. Comprehensive cardiopulmonary evaluation is feasible among these patients and may help in assessing disease progression and response to new treatment modalities.
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Affiliation(s)
- Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Galit Tal
- Metabolic Clinic, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Anat Ilivitzki
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Radiology, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Merav Zucker-Toledano
- Pediatric Cardiology, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Quon BS, Ramsook AH, Dhillon SS, Mitchell RA, Boyle KG, Wilcox PG, Guenette JA. Short-term effects of Lumacaftor/Ivacaftor (Orkambi™) on exertional symptoms, exercise performance, and ventilatory responses in adults with cystic fibrosis. Respir Res 2020; 21:135. [PMID: 32487229 PMCID: PMC7268353 DOI: 10.1186/s12931-020-01406-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Lumacaftor/ivacaftor (LUM/IVA) modestly improves lung function following 1 month of treatment but it is unknown if this translates into improvements in exercise endurance and exertional symptoms. METHODS Adult CF participants completed a symptom-limited constant load cycling test with simultaneous assessments of dyspnea and leg discomfort ratings pre- and 1 month post-initiation of LUM/IVA. RESULTS Endurance time, exertional dyspnea and leg discomfort ratings at submaximal exercise did not change significantly. There was a significant inverse correlation between changes in leg discomfort and endurance time (r = - 0.88; p = 0.009) following 1-month of LUM/IVA. CONCLUSIONS Overall, 1-month of LUM/IVA did not increase endurance time or modify exertional dyspnea or leg discomfort ratings. However, individuals who experienced a reduction in leg discomfort following LUM/IVA had an improvement in endurance time. Future studies with a larger sample size are needed to verify these findings and to assess the long-term effects of LUM/IVA on exercise outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02821130. Registered July 1, 2016.
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Affiliation(s)
- Bradley S Quon
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Andrew H Ramsook
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Satvir S Dhillon
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Reid A Mitchell
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kyle G Boyle
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Pearce G Wilcox
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jordan A Guenette
- Clinician-Scientist, UBC Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, #166 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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5
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Bar-Yoseph R, Ilivitzki A, Cooper DM, Gur M, Mainzer G, Hakim F, Livnat G, Schnapp Z, Shalloufeh G, Zucker-Toledano M, Subar Y, Bentur L. Exercise capacity in patients with cystic fibrosis vs. non-cystic fibrosis bronchiectasis. PLoS One 2019; 14:e0217491. [PMID: 31194748 PMCID: PMC6563963 DOI: 10.1371/journal.pone.0217491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background Bronchiectasis is associated with morbidity, low exercise capacity and poor quality of life. There is a paucity of data on exercise capacity using cardiopulmonary exercise test (CPET) in non-cystic fibrosis (CF) bronchiectasis. Our aim was to compare exercise capacity using CPET in CF and non-CF bronchiectasis patients. Methods Cross-sectional retrospective/prospective controlled study assessing CPET using cycle ergometer. Exercise parameters and computed tomography (CT) findings were compared. Results: Hundred two patients with bronchiectasis and 88 controls were evaluated; 49 CF (age 19.7 ± 9.7 y/o, FEV1%predicted 70.9 ± 20.5%) and 53 non-CF (18.6 ± 10.6 y/o, FEV1%predicted 68.7 ± 21.5%). Peak oxygen uptake (peak V˙O2) was similar and relatively preserved in both groups (CF 1915.5±702.0; non-CF 1740±568; control 2111.0±748.3 mL/min). Breathing limitation was found in the two groups vs. control; low breathing reserve (49% in CF; 43% non-CF; 5% control) and increased V˙E/V˙CO2 (CF 31.4±4.1, non-CF 31.7±4.1 and control 27.2 ± 2.8). Oxygen pulse was lower in the non-CF; whereas a linear relationship between peak V˙O2 vs. FEV1 and vs. FVC was found only for CF. CT score correlated with V˙E/V˙CO2 and negatively correlated with V˙O2/kg and post exercise oxygen saturation (SpO2). Conclusions CPET parameters may differ between CF and non-CF bronchiectasis. However, normal exercise capacity may be found unrelated to the etiology of the bronchiectasis. Anatomical changes in CT are associated with functional finding of increased V˙E/V˙CO2 and decreased SpO2. Larger longitudinal studies including cardiac assessment are needed to better study exercise capacity in different etiologies of non-CF bronchiectasis. Trial registration ClinicalTrials.gov, registration number: NCT03147651.
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Affiliation(s)
- Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
- * E-mail:
| | - Anat Ilivitzki
- Pediatric Radiology unit, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Dan M. Cooper
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California Irvine, Irvine, CA, United States of America
- University of California Irvine Institute for Clinical and Translational Science, Irvine, CA, United States of America
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Gur Mainzer
- Pediatric Cardiology, The Baruch Padeh Medical Center, Poriya, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Galit Livnat
- The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Pediatric pulmonology unit, Carmel Medical Center, Haifa, Israel
| | - Zeev Schnapp
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - George Shalloufeh
- Department of Pediatrics A, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Merav Zucker-Toledano
- Pediatric Cardiology, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yael Subar
- The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
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Ward N, Stiller K, Holland AE. Exercise as a therapeutic intervention for people with cystic fibrosis. Expert Rev Respir Med 2019; 13:449-458. [PMID: 30902029 DOI: 10.1080/17476348.2019.1598861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The complex multisystem nature of cystic fibrosis (CF) commonly results in reduced exercise tolerance, which is independently associated with poor clinical outcomes. Exercise is routinely recommended as part of the therapeutic regimen in CF to improve both respiratory and non-respiratory impairments. Areas covered: This article summarises the most recent evidence regarding the use of exercise as a therapeutic intervention in CF and discusses some of the practical considerations for exercise prescription in this setting. Clinical trials in progress and future research priorities are outlined. Expert opinion: On the balance of available evidence, exercise is likely to assist in improving physical fitness and health-related quality of life (HRQOL) and may be associated with a slower rate of decline in respiratory function in CF. Limitations to current studies include small sample sizes, study durations insufficient to achieve a training effect and difficulty distinguishing the effects of exercise training from that of other interventions implemented as part of a package of care. Larger, multi-centred trials are required to clarify the role of exercise in CF in improving physical fitness, respiratory function, HRQOL, as a substitute for traditional airway clearance techniques and in the management of common CF-related comorbidities.
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Affiliation(s)
- Nathan Ward
- a Physiotherapy , Royal Adelaide Hospital , Adelaide , SA , Australia.,b Physiotherapy , La Trobe University , Melbourne , Vic , Australia
| | - Kathy Stiller
- c Allied Health , Central Adelaide Local Health Network , Adelaide , SA , Australia
| | - Anne E Holland
- d La Trobe University and Alfred Health , Melbourne , Vic , Australia
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7
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Cao Y, Ichikawa Y, Sasaki Y, Ogawa T, Hiroyama T, Enomoto Y, Fujii N, Nishiyasu T. Expiratory flow limitation under moderate hypobaric hypoxia does not influence ventilatory responses during incremental running in endurance runners. Physiol Rep 2019; 7:e13996. [PMID: 30714335 PMCID: PMC6360241 DOI: 10.14814/phy2.13996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/12/2019] [Indexed: 11/24/2022] Open
Abstract
We tested whether expiratory flow limitation (EFL) occurs in endurance athletes in a moderately hypobaric hypoxic environment equivalent to 2500 m above sea level and, if so, whether EFL inhibits peak ventilation ( V ˙ Epeak ), thereby exacerbating the hypoxia-induced reduction in peak oxygen uptake ( V ˙ O2peak ). Seventeen young male endurance runners performed incremental exhaustive running on separate days under hypobaric hypoxic (560 mmHg) and normobaric normoxic (760 mmHg) conditions. Oxygen uptake ( V ˙ O2 ), minute ventilation ( V ˙ E), arterial O2 saturation (SpO2 ), and operating lung volume were measured throughout the incremental exercise. Among the runners tested, 35% exhibited EFL (EFL group, n = 6) in the hypobaric hypoxic condition, whereas the rest did not (Non-EFL group, n = 11). There were no differences between the EFL and Non-EFL groups for V ˙ Epeak and V ˙ O2peak under either condition. Percent changes in V ˙ Epeak (4 ± 4 vs. 2 ± 4%) and V ˙ O2peak (-18 ± 6 vs. -16 ± 6%) from normobaric normoxia to hypobaric hypoxia also did not differ between the EFL and Non-EFL groups (all P > 0.05). No differences in maximal running velocity, SpO2 , or operating lung volume were detected between the two groups under either condition. These results suggest that under the moderate hypobaric hypoxia (2500 m above sea level) frequently used for high-attitude training, ~35% of endurance athletes may exhibit EFL, but their ventilatory and metabolic responses during maximal exercise are similar to those who do not exhibit EFL.
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Affiliation(s)
- Yinhang Cao
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
| | - Yuhei Ichikawa
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
| | - Yosuke Sasaki
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
- Faculty of EconomicsNiigata Sangyo UniversityKashiwazakiJapan
| | - Takeshi Ogawa
- Department of Physical EducationOsaka Kyoiku UniversityOsakaJapan
| | - Tsutomu Hiroyama
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
| | - Yasushi Enomoto
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
| | - Naoto Fujii
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
| | - Takeshi Nishiyasu
- Faculty of Health and Sport SciencesUniversity of TsukubaIbarakiJapan
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8
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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9
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Overall and differentiated sensory responses to cardiopulmonary exercise test in patients with cystic fibrosis: kinetics and ability to predict peak oxygen uptake. Eur J Appl Physiol 2018; 118:2007-2019. [DOI: 10.1007/s00421-018-3923-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/22/2018] [Indexed: 12/20/2022]
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10
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Peripheral muscle abnormalities in cystic fibrosis: Etiology, clinical implications and response to therapeutic interventions. J Cyst Fibros 2017; 16:538-552. [DOI: 10.1016/j.jcf.2017.02.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 12/14/2022]
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11
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Washino S, Kanehisa H, Yoshitake Y. Neck inspiratory muscle activation patterns during well-controlled inspiration. Eur J Appl Physiol 2017; 117:2085-2097. [PMID: 28823081 DOI: 10.1007/s00421-017-3699-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Surprisingly, the activation characteristics of the neck inspiratory muscles as a function of key inspiratory mechanical parameters have yet to be demonstrated experimentally under well-controlled conditions. This study aimed to elucidate the muscle activation patterns of the neck inspiratory muscles by strictly controlling flow rate and lung volume. METHODS Thirteen healthy subjects matched their inspiratory flow rate at approximately 20-100% of peak flow rate (PFR) as steady as possible during inspiration. Amplitude of surface electromyogram (EMG) of the sternocleidomastoid (SCM) and scalene were calculated for every increase in %PFR over a duration corresponding to an increase in lung volume by 10% of forced vital capacity (FVC), as well as for every 5% increment of FVC over a point corresponding to an increase in flow rate by 20%PFR to determine the %PFR-EMG and %FVC-EMG relations, respectively. RESULTS Regression analyses showed that EMGs of the neck inspiratory muscles exponentially increased with increase in %PFR and their associated variables which reflect recruitment onset when increasing flow rate increased with increasing %FVC. In %FVC-EMG relation, a linear regression analysis showed positive slope at all %PFR and positive y-intercept at 80% PFR. CONCLUSIONS The main new finding is that the neck inspiratory muscle activities increase with flow rate as well as lung volume. The positive y-intercept of the %FVC-EMG relation at higher %PFR indicates that the neck inspiratory muscles are always activated even when lung volume level is low, implying that SCM is not necessarily an "accessory" muscle as described in previous observations.
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Affiliation(s)
- Sohei Washino
- Graduate School of Physical Education, National Institute of Fitness and Sports in Kanoya, 1 Shiromizu, Kanoya, Kagoshima, 8912393, Japan
| | - Hiroaki Kanehisa
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, 1 Shiromizu, Kanoya, Kagoshima, 8912393, Japan
| | - Yasuhide Yoshitake
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, 1 Shiromizu, Kanoya, Kagoshima, 8912393, Japan.
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Quon BS, Wilkie SS, Ramsook AH, Schaeffer MR, Puyat JH, Wilcox PG, Guenette JA. Qualitative dimensions of exertional dyspnea in adults with cystic fibrosis. J Appl Physiol (1985) 2016; 121:449-56. [PMID: 27311438 DOI: 10.1152/japplphysiol.00391.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/15/2016] [Indexed: 11/22/2022] Open
Abstract
No studies of cystic fibrosis (CF) have systematically characterized the evolution of the qualitative dimensions of exertional dyspnea. Adults with CF (n = 25) and control individuals matched for sex, age, and body mass index (n = 25) underwent cardiopulmonary cycle exercise testing with a detailed evaluation of ventilatory and dyspnea responses. The qualitative dimensions of dyspnea were examined during each exercise stage by having subjects select phrases that best described their breathing (i.e., "work/effort," "unsatisfied inspiration," and "unsatisfied expiration"). Subjects also selected phrases that described the quality of their breathing at peak exercise using an established 15-item questionnaire, which was then clustered into different categories. Subjects with CF had greater ventilatory requirements, higher end-inspiratory and end-expiratory lung volumes (% total lung capacity), and an earlier inflection/plateau in tidal volume during exercise compared with control subjects. Increased work/effort was the dominant qualitative descriptor in both groups throughout exercise. Unsatisfied inspiration was selected by 48% of subjects with CF and 40% of controls at some point during exercise. The onset of unsatisfied inspiration in these subjects occurred at a significantly lower relative exercise intensity in subjects with CF vs. controls (72 ± 21 vs. 94 ± 11% Wmax, P < 0.01). Chest tightness was the only qualitative descriptor cluster that was selected more frequently by subjects with CF vs. controls (36 vs. 0%, respectively, P < 0.05) at peak exercise. Therapeutic interventions that reduce ventilatory requirements and improve lung volumes may delay the onset of distressing sensations such as unsatisfied inspiration and chest tightness in adults with CF.
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Affiliation(s)
- Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, 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; and
| | - 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; and
| | - Joseph H Puyat
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pearce G Wilcox
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, 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; and
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