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Neder JA, Phillips DB, O'Donnell DE, Dempsey JA. Excess ventilation and exertional dyspnoea in heart failure and pulmonary hypertension. Eur Respir J 2022; 60:13993003.00144-2022. [PMID: 35618273 DOI: 10.1183/13993003.00144-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 01/11/2023]
Abstract
Increased ventilation relative to metabolic demands, indicating alveolar hyperventilation and/or increased physiological dead space (excess ventilation), is a key cause of exertional dyspnoea. Excess ventilation has assumed a prominent role in the functional assessment of patients with heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction, pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). We herein provide the key pieces of information to the caring physician to 1) gain unique insights into the seeds of patients' shortness of breath and 2) develop a rationale for therapeutically lessening excess ventilation to mitigate this distressing symptom. Reduced bulk oxygen transfer induced by cardiac output limitation and/or right ventricle-pulmonary arterial uncoupling increase neurochemical afferent stimulation and (largely chemo-) receptor sensitivity, leading to alveolar hyperventilation in HFrEF, PAH and small-vessel, distal CTEPH. As such, interventions geared to improve central haemodynamics and/or reduce chemosensitivity have been particularly effective in lessening their excess ventilation. In contrast, 1) high filling pressures in HFpEF and 2) impaired lung perfusion leading to ventilation/perfusion mismatch in proximal CTEPH conspire to increase physiological dead space. Accordingly, 1) decreasing pulmonary capillary pressures and 2) mechanically unclogging larger pulmonary vessels (pulmonary endarterectomy and balloon pulmonary angioplasty) have been associated with larger decrements in excess ventilation. Exercise training has a strong beneficial effect across diseases. Addressing some major unanswered questions on the link of excess ventilation with exertional dyspnoea under the modulating influence of pharmacological and nonpharmacological interventions might prove instrumental to alleviate the devastating consequences of these prevalent diseases.
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Affiliation(s)
- J Alberto Neder
- Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Devin B Phillips
- Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Denis E O'Donnell
- Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, Dept of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Melliti W, Kammoun R, Masmoudi D, Ahmaidi S, Masmoudi K, Alassery F, Hamam H, Chlif M. Effect of Six-Minute Walk Test and Incremental Exercise on Inspiratory Capacity, Ventilatory Constraints, Breathlessness and Exercise Performance in Sedentary Male Smokers without Airway Obstruction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312665. [PMID: 34886390 PMCID: PMC8657380 DOI: 10.3390/ijerph182312665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
We investigated physiological responses and exercise capacity in sedentary young smokers during sub-maximal and maximal test and its impact on dyspnea and exercise intolerance. Fifty sedentary male smokers and non-smokers (age: 24 ± 1 years., weight: 71 ± 9 kg, height: 177.3 ± 4.8 cm, body mass index: 22.6 ± 2.5 kg/m2) underwent two visits with pulmonary function tests, breathing pattern, and inspiratory capacity measurement at rest and during sub-maximal and maximal exercise. Smokers show reduced exercise capacity during six minutes walk test (6-MWT) with decreased walked distance (p < 0.001) and inspiratory capacity (p < 0.05). During cardiopulmonary exercise test (CPET), smokers had higher minute ventilation VE for a given submaximal intensity (p < 0.05) and lower minute ventilation at maximal exercise (p < 0.001). End expiratory lung volume was significantly lower in sedentary smokers at rest (p < 0.05), at ventilatory threshold during exercise (p < 0.05), but not during peak exercise. End inspiratory lung volume was significantly lower in smokers at rest (p < 0.05) and ventilatory threshold (p < 0.05). Cigarette smoking alters lung function during submaximal and maximal exercise. This alteration is manifested by the development of dynamic hyperinflation contributing to exercise capacity limitation.
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Affiliation(s)
- Wassim Melliti
- Research Unit: Education, Motor Skills, Sport and Health (EM2S), UR15JS01, High Institute of Sport and Physical Education, University of Sfax, Sfax BP 3000, Tunisia;
- Research Unit Respiratory Pathology in Southern Tunisia, Pulmonology Department CHU Hedi Chaker, Sfax 3000, Tunisia
| | - Rim Kammoun
- Physiology and Functional Exploration Service, University Hospital Habib Bourguiba, Sfax 3000, Tunisia; (R.K.); (D.M.); (K.M.)
| | - Donies Masmoudi
- Physiology and Functional Exploration Service, University Hospital Habib Bourguiba, Sfax 3000, Tunisia; (R.K.); (D.M.); (K.M.)
| | - Said Ahmaidi
- EA 3300 “APS and Motor Patterns: Adaptations-Rehabilitation”, Picardie Jules Verne University, 80025 Amiens, France;
| | - Kaouthar Masmoudi
- Physiology and Functional Exploration Service, University Hospital Habib Bourguiba, Sfax 3000, Tunisia; (R.K.); (D.M.); (K.M.)
| | - Fawaz Alassery
- Department of Computer Engineering, College of Computers and Information Technology, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia;
| | - Habib Hamam
- Department of Electrical Engineering, Faculty of Engineering, Moncton University, Moncton, NB E1A 3E9, Canada;
| | - Mehdi Chlif
- EA 3300 “APS and Motor Patterns: Adaptations-Rehabilitation”, Picardie Jules Verne University, 80025 Amiens, France;
- National Center of Medicine and Science in Sports (NCMSS), Tunisian Research Laboratory Sports Performance Optimization, Ave Med Ali Akid, El Menzah, Tunis 263, Tunisia
- Correspondence: ; Tel.: +216-22-27-22-80
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de Almeida GC, Pereira MC, Moreira MM, Souza JRM, Paschoal IA. Lung function and stress echocardiography in pulmonary arterial hypertension: a cross-sectional study. SAO PAULO MED J 2021; 139:505-510. [PMID: 34378739 PMCID: PMC9632527 DOI: 10.1590/1516-3180.2021.0045.r1.0604221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals. OBJECTIVE To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients. DESIGN AND SETTING Single-center prospective study conducted in a Brazilian university hospital. METHODS We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables. RESULTS The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia. CONCLUSIONS The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.
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Affiliation(s)
| | - Mônica Corso Pereira
- MD, PhD. Professor, Discipline of Pulmonology, Department of Internal Medicine, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Marcos Mello Moreira
- PT, PhD. Physiotherapist, Discipline of Pulmonology, Department of Internal Medicine, and Professor of Postgraduate Program on Surgical Sciences, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas (SP), Brazil.
| | - José Roberto Matos Souza
- MD, PhD. Professor, Discipline of Cardiology, Department of Internal Medicine, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Ilma Aparecida Paschoal
- MD, PhD. Full Professor, Discipline of Pulmonology, Department of Internal Medicine, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Campinas (SP), Brazil.
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Laveneziana P, Humbert M, Godinas L, Joureau B, Malrin R, Straus C, Jaïs X, Sitbon O, Simonneau G, Similowski T, Garcia G. Inspiratory muscle function, dynamic hyperinflation and exertional dyspnoea in pulmonary arterial hypertension. Eur Respir J 2016; 45:1495-8. [PMID: 25931490 DOI: 10.1183/09031936.00153214] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pierantonio Laveneziana
- Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Paris, France AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France Both authors contributed equally
| | - Marc Humbert
- Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France AP-HP, Hôpital Universitaire de Bicêtre, Service de Pneumologie et Soins Intensifs Thoraciques, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France Both authors contributed equally
| | - Laurent Godinas
- AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Barbara Joureau
- Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Roxane Malrin
- AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Christian Straus
- Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Paris, France
| | - Xavier Jaïs
- Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France AP-HP, Hôpital Universitaire de Bicêtre, Service de Pneumologie et Soins Intensifs Thoraciques, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France AP-HP, Hôpital Universitaire de Bicêtre, Service de Pneumologie et Soins Intensifs Thoraciques, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France
| | - Gérald Simonneau
- Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France AP-HP, Hôpital Universitaire de Bicêtre, Service de Pneumologie et Soins Intensifs Thoraciques, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France Both authors contributed equally
| | - Gilles Garcia
- AP-HP, Hôpital Universitaire de Bicêtre, Service d'Explorations Fonctionnelles Respiratoires, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU TORINO "Thorax Innovation", Le Kremlin-Bicêtre, France Univ. Paris-Sud 11, Faculté de médecine, Le Kremlin-Bicêtre, France INSERM U999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France Both authors contributed equally
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