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Neder JA, Santyr G, Zanette B, Kirby M, Pourafkari M, James MD, Vincent SG, Ferguson C, Wang CY, Domnik NJ, Phillips DB, Porszasz J, Stringer WW, O'Donnell DE. Beyond Spirometry: Linking Wasted Ventilation to Exertional Dyspnea in the Initial Stages of COPD. COPD 2024; 21:2301549. [PMID: 38348843 DOI: 10.1080/15412555.2023.2301549] [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: 10/15/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024]
Abstract
Exertional dyspnea, a key complaint of patients with chronic obstructive pulmonary disease (COPD), ultimately reflects an increased inspiratory neural drive to breathe. In non-hypoxemic patients with largely preserved lung mechanics - as those in the initial stages of the disease - the heightened inspiratory neural drive is strongly associated with an exaggerated ventilatory response to metabolic demand. Several lines of evidence indicate that the so-called excess ventilation (high ventilation-CO2 output relationship) primarily reflects poor gas exchange efficiency, namely increased physiological dead space. Pulmonary function tests estimating the extension of the wasted ventilation and selected cardiopulmonary exercise testing variables can, therefore, shed unique light on the genesis of patients' out-of-proportion dyspnea. After a succinct overview of the basis of gas exchange efficiency in health and inefficiency in COPD, we discuss how wasted ventilation translates into exertional dyspnea in individual patients. We then outline what is currently known about the structural basis of wasted ventilation in "minor/trivial" COPD vis-à-vis the contribution of emphysema versus a potential impairment in lung perfusion across non-emphysematous lung. After summarizing some unanswered questions on the field, we propose that functional imaging be amalgamated with pulmonary function tests beyond spirometry to improve our understanding of this deeply neglected cause of exertional dyspnea. Advances in the field will depend on our ability to develop robust platforms for deeply phenotyping (structurally and functionally), the dyspneic patients showing unordinary high wasted ventilation despite relatively preserved FEV1.
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Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Giles Santyr
- Translational Medicine Department, Faculty of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada
| | - Brandon Zanette
- Translational Medicine Department, Faculty of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada
| | - Miranda Kirby
- Department of Physics, Faculty of Science, Toronto Metropolitan University, Toronto, Canada
| | - Marina Pourafkari
- Department of Radiology and Diagnostic Imaging, Kingston Health Sciences Centre, Kingston, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Carrie Ferguson
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - Chu-Yi Wang
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
| | - Devin B Phillips
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Janos Porszasz
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - William W Stringer
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
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Panza L, Piamonti D, Palange P. Pulmonary gas exchange and ventilatory efficiency during exercise in health and diseases. Expert Rev Respir Med 2024:1-13. [PMID: 38912849 DOI: 10.1080/17476348.2024.2370447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) is nowadays used to study the exercise response in healthy subjects and in disease. Ventilatory efficiency is one of the main determinants in exercise tolerance, and its main variables are a useful tool to guide pathophysiologists toward specific diagnostic pathways, providing prognostic information and improving disease management, treatment, and outcomes. AREAS COVERED This review will be based on today's available scientific evidence, describing the main physiological determinants of ventilatory efficiency at rest and during exercise, and focusing also on how CPET variables are modified in specific diseases, leading to the possibility of early diagnosis and management. EXPERT OPINION Growing knowledge on CPET interpretation and a wider use of this clinical tool is expected in order to offer more precise diagnostic and prognostic information to patients and clinicians, helping in the management of therapeutic decisions. Future research could be able to identify new and more simple markers of ventilatory efficiency, and to individuate new interventions for the improvement of symptoms, such as exertional dyspnea.
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Affiliation(s)
- Luigi Panza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Daniel Piamonti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Knöpfel G, Baty F, Uhl F, Kern L, Brutsche M. Quantification of breathing irregularity for the diagnosis of dysfunctional breathing using proportional tidal volume variation: a cross-sectional, retrospective real-world study. BMJ Open 2024; 14:e083401. [PMID: 38885986 PMCID: PMC11184190 DOI: 10.1136/bmjopen-2023-083401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To develop a statistical approach that provides a quantitative index measuring the magnitude of the irregularity of the breathing response to exercise for the diagnosis of dysfunctional breathing. DESIGN Cross-sectional, retrospective, real-world study. SETTING Single-centre study. PARTICIPANTS A population of 209 patients investigated with cardiopulmonary exercise testing in our institution for unexplained or disproportionate exertional dyspnoea between January and July 2022. PRIMARY AND SECONDARY OUTCOME MEASURES A novel statistical approach providing a quantitative index-proportional tidal volume variation (PTVV)-was developed to measure the magnitude of the irregularity of the breathing response to exercise. RESULTS PTVV provided a reliable statistical readout for the objective assessment of DB with a prediction accuracy of 78% (95% CI: 72 to 83%). The prevalence of DB in the investigated population was high with more than half of the patients affected by moderate-to-severe DB. CONCLUSIONS PTVV can easily be implemented in the clinical routine. Our study suggests a possible further simplification for the diagnosis of DB with two objective criteria including PTVV and one single criterion for hyperventilation.
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Affiliation(s)
- Georg Knöpfel
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
| | - Florent Baty
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
- University of Basel, Basel, Switzerland
| | - Friedrich Uhl
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
| | - Lukas Kern
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
| | - Martin Brutsche
- Pulmonary Medicine, Cantonal Hospital St. Gallen, Sankt Gallen, Switzerland
- University of Basel, Basel, Switzerland
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Silva RN, Goulart CDL, de Oliveira CR, Mendes RG, Arena R, Myers J, Borghi-Silva A. Respiratory muscle strength can improve the prognostic assessment in COPD. Sci Rep 2024; 14:12360. [PMID: 38811574 PMCID: PMC11137089 DOI: 10.1038/s41598-024-54264-w] [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: 09/24/2023] [Accepted: 02/10/2024] [Indexed: 05/31/2024] Open
Abstract
Impaired lung function, respiratory muscle weakness and exercise intolerance are present in COPD and contribute to poor prognosis. However, the contribution of the combination of these manifestations to define prognosis in COPD is still unknown. This study aimed to define cut-off points for both inspiratory and expiratory muscle strength (MIP and MEP, respectively) for mortality prediction over 42-months in patients with COPD, and to investigate its combination with other noninvasive established prognostic measures (FEV1, V̇O2peak and 6MWD) to improve risk identification. Patients with COPD performed pulmonary function, respiratory muscle strength, six-minute walk and cardiopulmonary exercise tests, and were followed over 42 months to analyze all-cause mortality. A total of 79 patients were included. The sample was mostly (91.1%) comprised of severe (n = 37) and very severe (n = 34) COPD, and 43 (54%) patients died during the follow-up period. Cut-points of ≤ 55 and ≤ 80 cmH2O for MIP and MEP, respectively, were associated with increased risk of death (log-rank p = 0.0001 for both MIP and MEP) in 42 months. Furthermore, MIP and MEP substantially improved the mortality risk assessment when combined with FEV1 (log-ranks p = 0.006 for MIP and p < 0.001 for MEP), V̇O2peak (log-rank: p < 0.001 for both MIP and MEP) and 6MWD (log-ranks: p = 0.005 for MIP; p = 0.015 for MEP). Thus, patients severely affected by COPD presenting MIP ≤ 55 and/or MEP ≤ 80 cmH2O are at increased risk of mortality. Furthermore, MIP and MEP substantially improve the mortality risk assessment when combined with FEV1, V̇O2peak and 6MWD in patients with COPD.
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Affiliation(s)
- Rebeca Nunes Silva
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Cássia da Luz Goulart
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Claudio R de Oliveira
- Department of Medicine, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Renata Gonçalves Mendes
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Veterans Affairs Palo Alto HealthCare System, Stanford University, Palo Alto, CA, USA
| | - Audrey Borghi-Silva
- Department of Physiotherapy, Cardiopulmonary Physiotherapy Laboratory (LACAP), Federal University of São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil.
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Rushwan A, Stefanou D, Tariq J, Drosos P, Chaudhuri N, Milton R, Tcherveniakov P, Papagiannopoulos K, Brunelli A. Increased minute ventilation-to-carbon dioxide slope during cardiopulmonary exercise test is associated with poor postoperative outcome following lung cancer resection. Eur J Cardiothorac Surg 2024; 65:ezad337. [PMID: 37812232 DOI: 10.1093/ejcts/ezad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Ventilatory efficiency [minute ventilation-to-carbon dioxide output slope (VE/VCO2 slope)] can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections. METHODS Retrospective, single-centre analysis on all patients undergoing lung resection for cancer (April 2014-August 2022) and with a preoperative cardiopulmonary exercise test. VE/VCO2 slope >40 was chosen as high-risk threshold. Logistic regression analysis was used to test the association of VE/VCO2 slope and several patient- and surgery-related factors with 90-day mortality. RESULTS A total of 552 patients were included (374 lobectomies, 81 segmentectomies, 55 pneumonectomies and 42 wedge resections). Seventy-four percent were minimally invasive procedures. Cardiopulmonary morbidity was 32%, in-hospital/30-day mortality 6.9% and 90-day mortality 8.9%. A total of 137 patients (25%) had a slope of >40. These patients were older (72 vs 70 years, P = 0.012), had more frequently coronary artery disease (17% vs 10%, P = 0.028), lower carbon monoxide lung diffusion capacity (57% vs 68%, P < 0.001), lower body mass index (25.4 vs 27.0 kg/m2, P = 0.001) and lower peak VO2 (14.9 vs 17.0 ml/kg/min, P < 0.001) than those with a lower slope. The cardiopulmonary morbidity among patients with a slope of >40 was 40% vs 29% in those with lower slope (P = 0.019). Ninety-day mortality was 15% vs 6.7% (P = 0.002). The 90-day mortality of elderly patients with slope >40 was 21% vs 7.8% (P = 0.001). After adjusting for peak VO2 value, extent of operation and other patient-related variables in a logistic regression analysis, VE/VCO2 slope retained a significant association with 90-day mortality. CONCLUSIONS VE/VCO2 slope was strongly associated with morbidity and mortality following lung resection and should be included in the functional algorithm to assess fitness for surgery.
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Affiliation(s)
- Amr Rushwan
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Demetrios Stefanou
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Javeria Tariq
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Polivious Drosos
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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Xu L, Chen G, Zhang L, He A, Li Y. Lixisenatide ameliorated lipopolysaccharide (LPS)-induced expression of mucin and inflammation in bronchial epithelial cells. J Biochem Mol Toxicol 2024; 38:e23618. [PMID: 38229325 DOI: 10.1002/jbt.23618] [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: 04/29/2023] [Revised: 10/19/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) induces serious social and economic burdens due to its high disability and mortality, the pathogenesis of which is highly involved with inflammation, oxidative stress (OS), and mechanism of mucin 5AC (MUC5AC) secretion. Lixisenatide is a selective glucagon-like peptide 1 receptor agonist recently reported to have anti-inflammatory properties. Our study will focus on the potential impact of lixisenatide on lipopolysaccharide (LPS)-induced mucin secretion and inflammation in 16 human bronchial epithelial (16HBE) cells to check its potential function in COPD. 16HBE cells were treated with LPS, with or without lixisenatide (10 and 20 nM) for 1 day. Remarkably declined cell viability, enhanced lactate dehydrogenase release, activated OS, and elevated release of inflammatory cytokines were observed in LPS-treated 16HBE cells, accompanied by the activation of nuclear factor-κB signaling, all of which were signally reversed by lixisenatide. Moreover, elevated expression and release of MUC5AC were observed in LPS-treated 16HBE cells but were markedly repressed by lixisenatide. Furthermore, the repressed nuclear factor erythroid 2-related factor 2 (Nrf2) level in LPS-treated 16HBE cells was notably rescued by lixisenatide. Lastly, following the knockdown of Nrf2, the protective function of lixisenatide on LPS-triggered MUC5AC release in 16HBE cells was significantly abrogated. Collectively, lixisenatide ameliorated LPS-induced expression of mucin and inflammation in bronchial epithelial cells by regulating Nrf2.
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Affiliation(s)
- Leiming Xu
- Department of Emergency, Binhai People's Hospital, Yancheng, Jiangsu Province, China
| | - Guoping Chen
- Department of Respiratory and Critical Care, Binhai People's Hospital, Yancheng, Jiangsu Province, China
| | - Leiming Zhang
- Department of Infectious Disease, Binhai People's Hospital, Yancheng, Jiangsu Province, China
| | - Aifeng He
- Department of Respiratory and Critical Care, Binhai People's Hospital, Yancheng, Jiangsu Province, China
| | - Yong Li
- Department of Critical Care Medicine, Binhai People's Hospital, Yancheng, Jiangsu Province, China
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Muller PDT. Ventilatory efficiency (η⩒E) of the exercise: A detailed method report. MethodsX 2023; 11:102412. [PMID: 37860042 PMCID: PMC10582470 DOI: 10.1016/j.mex.2023.102412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Ventilatory efficiency is a combination of the ventilatory-metabolic response stemming from non-invasive analysis of cardiopulmonary exercise testing. Despite being a recognized marker in exercise physiology, this measure presents considerable limitations, including the imprecise designation of "efficiency", broadly recognized, and recently denominated as "excess ventilation". Herein we present a detailed method, with substantial improvements, and new physiological insights, in order to better define the true ventilatory efficiency of the exercise, according to recommendations for physical/physiological processes.•"Ventilatory efficiency" of the exercise is a remarkable physiological index.•Several limitations are currently debated.•We report a new ventilatory efficiency index that match with recommendations.
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Affiliation(s)
- Paulo de Tarso Muller
- Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Laboratory of Respiratory Pathophysiology (LAFIR), Campo Grande MS, Mato Grosso do Sul, Brazil
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Brawner CA, Lazar MH. Cardiopulmonary exercise testing criteria for advanced therapies in patients with heart failure. Heart Fail Rev 2023; 28:1297-1306. [PMID: 37644366 DOI: 10.1007/s10741-023-10337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Many cardiology associations endorse the role of the cardiopulmonary exercise test (CPET) to define the severity of impairment of functional capacity in individuals with heart failure with reduced ejection fraction (HFrEF) and when evaluating the need for advanced therapies for these patients. The focus of the CPET within the cardiology community has been on peak volume of oxygen uptake (VO2). However, several CPET variables are associated with outcomes in individuals with and without chronic disease and can inform clinical decisions in individuals with HFrEF. In this manuscript, we will review the normal cardiopulmonary response to a graded exercise test and review current guideline recommendations relative to CPET in patients with HFrEF.
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Affiliation(s)
- Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, 6525 Second Ave., Detroit, MI, 48202, USA.
| | - Michael H Lazar
- Division of Pulmonary & Critical Care Medicine, Henry Ford Hospital, 2799 West Grand Blvd Suite K17, Detroit, MI, 48202, USA
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Gentili F, Calcagni G, Cantarutti N, Manno EC, Cafiero G, Tranchita E, Salvati A, Palma P, Giordano U, Drago F, Turchetta A. Cardiopulmonary Exercise Testing in Children and Young Adolescents after a Multisystem Inflammatory Syndrome: Physical Deconditioning or Residual Pathology? J Clin Med 2023; 12:jcm12062375. [PMID: 36983374 PMCID: PMC10057515 DOI: 10.3390/jcm12062375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that imposes a long-term follow-up. The purpose of our pilot study is to evaluate the usefulness of the cardiopulmonary stress test (CPET) in the follow-up after MIS-C. All patients admitted for MIS-C in our hospital in the 12 months preceding the date of observation were considered for inclusion in the study. Pre-existing cardio-respiratory diseases and/or the lack of collaboration were the exclusion criteria. At enrolment, each subject passed a cardiological examination, rest ECG, echocardiogram, 24 h Holter-ECG, blood tests, and a CPET complete of spirometry. A total of 20 patients met the inclusion criteria (11.76 ± 3.29 years, 13 male). In contrast to the normality of all second-level investigations, CPET showed lower-than-expected peakVO2 and peak-oxygen-pulse values (50% of cases) and higher-than-expected VE/VCO2-slope values (95% of cases). A statistically significant inverse correlation was observed between P-reactive-protein values at admission and peakVO2/kg values (p = 0.034), uric acid values at admission, and peakVO2 (p = 0.011) or peak-oxygen-pulse expressed as a percentage of predicted (p = 0.021), NT-proBNP values at admission and peakVO2 expressed as a percentage of predicted (p = 0.046). After MIS-C (4-12 months) relevant anomalies can be observed at CPET, which can be a valuable tool in the follow-up after this condition.
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Affiliation(s)
- Federica Gentili
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Giulio Calcagni
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Nicoletta Cantarutti
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Emma Concetta Manno
- Complex Unit of Clinical Immunology and Vaccinology, Clinical Area of University Hospital Pediatrics, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Giulia Cafiero
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Eliana Tranchita
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Annamaria Salvati
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Paolo Palma
- Complex Unit of Clinical Immunology and Vaccinology, Clinical Area of University Hospital Pediatrics, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Ugo Giordano
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Fabrizio Drago
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
| | - Attilio Turchetta
- Complex Unit of Cardiology S. Paolo, Palidoro, Santa Marinella and Arrhythmology, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, L.go S. Onofrio 4, 00165 Rome, Italy
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Orlandi R, Rinaldo RF, Mazzucco A, Baccelli A, Mondoni M, Marchetti F, Zagaria M, Cefalo J, Leporati A, Montoli M, Ghilardi G, Baisi A, Centanni S. Early outcomes of “low-risk” patients undergoing lung resection assessed by cardiopulmonary exercise testing: Single-institution experience. Front Surg 2023; 10:1130919. [PMID: 37009610 PMCID: PMC10062454 DOI: 10.3389/fsurg.2023.1130919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveCardiopulmonary exercise testing (CPET) is currently recommended for all patients undergoing lung resection with either respiratory comorbidities or functional limitations. The main parameter evaluated is oxygen consumption at peak (VO2peak). Patients with VO2peak above 20 ml/kg/min are classified as low risk surgical candidates. The aims of this study were to evaluate postoperative outcomes of low-risk patients, and to compare their outcomes with those of patients without pulmonary impairment at respiratory function testing.MethodsRetrospective monocentric observational study was designed, evaluating outcomes of patients undergoing lung resection at San Paolo University Hospital, Milan, Italy, between January 2016 and November 2021, preoperatively assessed by CPET, according to 2009 ERS/ESTS guidelines. All low-risk patients undergoing any extent surgical lung resection for pulmonary nodules were enrolled. Postoperative major cardiopulmonary complications or death, occurring within 30 days from surgery, were assessed. A case-control study was nested, matching 1:1 for type of surgery the cohort population with control patients without functional respiratory impairment consecutively undergoing surgery at the same centre in the study period.ResultsA total of 80 patients were enrolled: 40 subjects were preoperatively assessed by CPET and deemed at low risk, whereas 40 subjects represented the control group. Among the first, 4 patients (10%) developed major cardiopulmonary complications, and 1 patient (2.5%) died within 30 days from surgery. In the control group, 2 patients (5%) developed complications and none of the patients (0%) died. The differences in morbidity and mortality rates did not reach statistically significance. Instead, age, weight, BMI, smoking history, COPD incidence, surgical approach, FEV1, Tiffenau, DLCO and length of hospital stay resulted significantly different between the two groups. At a case-by-case analysis, CPET revealed a pathological pattern in each complicated patient, in spite of VO2peak above target for safe surgery.ConclusionsPostoperative outcomes of low-risk patients undergoing lung resections are comparable to those of patients without any pulmonary functional impairment; nonetheless the formers represent a dramatically different category of individuals from the latter and may harbour few patients with worse outcomes. CPET variables overall interpretation may add to the VO2peak in identifying higher risk patients, even in this subgroup.
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Affiliation(s)
- Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy
- Correspondence: Riccardo Orlandi
| | - Rocco Francesco Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Baccelli
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Marchetti
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariapia Zagaria
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Jacopo Cefalo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea Leporati
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Montoli
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giorgio Ghilardi
- General Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessandro Baisi
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
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11
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Commentaries on Viewpoint: Lung mechanical constraints: the Achilles heel of excess exertional ventilation for prognosis assessment? J Appl Physiol (1985) 2023; 134:383-384. [PMID: 36745690 DOI: 10.1152/japplphysiol.00753.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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12
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Müller PDT, Chiappa GR, Laveneziana P, Ewert R, Neder JA. Lung mechanical constraints: the Achilles' heel of excess exertional ventilation for prognosis assessment? J Appl Physiol (1985) 2023; 134:378-382. [PMID: 36227163 DOI: 10.1152/japplphysiol.00059.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Paulo de Tarso Müller
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Campo Grande, Brazil
| | - Gaspar Rogério Chiappa
- Graduate Program in Human Movement and Rehabilitation of Evangelical Universitary of Goiás, Goiania, Brazil
| | - Pierantonio Laveneziana
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - José Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada
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13
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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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14
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Paneroni M, Vitacca M, Comini L, Salvi B, Saleri M, Schena F, Venturelli M. Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study. Eur J Appl Physiol 2022; 122:2403-2416. [PMID: 35951129 DOI: 10.1007/s00421-022-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient's characteristics, comparing severe patients with COPD to patients without CRF (COPD group). METHODS This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion. RESULTS CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD -1.5 ± 2.4 vs COPD -1.1 ± 1.2% baseline kJ-1, p = 0.5819), in the potentiated resting twitch force (CRF-COPD -2.8 ± 4.7 vs COPD -2.0 ± 3.3% baseline kJ-1, p = 0.7481) and in the maximal voluntary activation (CRF-COPD -0.1 ± 3.9 vs COPD -0.9 ± 1.2 -2.0 ± 3.3% baseline kJ-1, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found. CONCLUSION Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction.
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Affiliation(s)
- Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy.
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Lumezzane, 25065, Brescia, Italy
| | - Beatrice Salvi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy
| | - Manuela Saleri
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Science, Section of Movement Science, University of Verona, 37134, Verona, Italy
| | - Massimo Venturelli
- Department of Neuroscience, Biomedicine, and Movement Science, Section of Movement Science, University of Verona, 37134, Verona, Italy.,Department of Internal Medicine Section of Geriatrics, University of Utah, Salt Lake City, UT, 84132, USA
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15
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Stickland MK, Neder JA, Guenette JA, O'Donnell DE, Jensen D. Using Cardiopulmonary Exercise Testing to Understand Dyspnea and Exercise Intolerance in Respiratory Disease. Chest 2022; 161:1505-1516. [PMID: 35065052 DOI: 10.1016/j.chest.2022.01.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/01/2021] [Accepted: 01/11/2022] [Indexed: 01/02/2023] Open
Abstract
A cardiopulmonary exercise test (CPET) is ideally suited to quantify exercise tolerance and evaluate the pathophysiological mechanism(s) of dyspnea and exercise limitation in people with chronic respiratory disease. Although there are several statements on CPET and many outstanding resources detailing the cardiorespiratory and perceptual responses to exercise, limited information is available to support the health care provider in conducting a practical CPET evaluation. This article provides the health care provider with practical and timely information on how to use CPET data to understand dyspnea and exercise intolerance in people with chronic respiratory diseases. Information on CPET protocol, as well as how to evaluate maximal patient effort, peak rate of oxygen consumption, ventilatory demand, pulmonary gas exchange, ventilatory reserve, operating lung volumes, and exertional dyspnea, is presented. Two case examples are also described to highlight how these parameters are evaluated to provide a clinical interpretation of CPET data.
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Affiliation(s)
- 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.
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, The University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
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16
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Gonzalez-Garcia M, Aguirre-Franco CE, Vargas-Ramirez L, Barrero M, Torres-Duque CA. Effect of pulmonary hypertension on exercise capacity and gas exchange in patients with chronic obstructive pulmonary disease living at high altitude. Chron Respir Dis 2022; 19:14799731221104095. [PMID: 35603864 PMCID: PMC9127868 DOI: 10.1177/14799731221104095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is associated with decreased exercise tolerance in chronic obstructive pulmonary disease (COPD) patients, but in the altitude the response to exercise in those patients is unknown. Our objective was to compare exercise capacity, gas exchange and ventilatory alterations between COPD patients with PH (COPD-PH) and without PH (COPD-nonPH) residents at high altitude (2640 m). Methods: One hundred thirty-two COPD-nonPH, 82 COPD-PH, and 47 controls were included. Dyspnea by Borg scale, oxygen consumption (VO2), work rate (WR), ventilatory equivalents (VE/VCO2), dead space to tidal volume ratio (VD/VT), alveolar-arterial oxygen tension gradient (AaPO2), and arterial-end-tidal carbon dioxide pressure gradient (Pa-ETCO2) were measurement during a cardiopulmonary exercise test. For comparison of variables between groups, Kruskal-Wallis or one-way ANOVA tests were used, and stepwise regression analysis to test the association between PH and exercise capacity. Results: All COPD patients had a lower exercise capacity and higher PaCO2, A-aPO2 and VD/VT than controls. The VO2 % predicted (61.3 ± 20.6 vs 75.3 ± 17.9; p < 0.001) and WR % predicted (65.3 ± 17.9 vs 75.3 ± 17.9; p < 0.001) were lower in COPD-PH than in COPD-nonPH. At peak exercise, dyspnea was higher in COPD-PH (p = 0.011). During exercise, in COPD-PH, the PaO2 was lower (p < 0.001), and AaPO2 (p < 0.001), Pa-ETCO2 (p = 0.033), VE/VCO2 (p = 0.019), and VD/VT (p = 0.007) were higher than in COPD-nonPH. In the multivariate analysis, PH was significantly associated with lower peak VO2 and WR (p < 0.001). Conclusion: In COPD patients residing at high altitude, the presence of PH was an independent factor related to the exercise capacity. Also, in COPD-PH patients there were more dyspnea and alterations in gas exchange during the exercise than in those without PH.
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Affiliation(s)
- Mauricio Gonzalez-Garcia
- Pulmonary Function Testing Laboratory, Fundación Neumológica Colombiana, Bogotá, Colombia
- Faculty of Medicine, Universidad de la Sabana, Chía, Colombia
- Faculty of Medicine, Sports Medicine Group, Universidad El Bosque, Bogotá, Colombia
| | - Carlos Eduardo Aguirre-Franco
- Pulmonary Function Testing Laboratory, Fundación Neumológica Colombiana, Bogotá, Colombia
- Faculty of Medicine, Universidad de la Sabana, Chía, Colombia
| | - Leslie Vargas-Ramirez
- Pulmonary Function Testing Laboratory, Fundación Neumológica Colombiana, Bogotá, Colombia
- Instituto Neumológico del Oriente, Bucaramanga, Colombia
| | - Margarita Barrero
- Pulmonary Function Testing Laboratory, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Pulmonary Function Testing Laboratory, Fundación Neumológica Colombiana, Bogotá, Colombia
- Faculty of Medicine, Universidad de la Sabana, Chía, Colombia
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He J, Fu J, Zhao W, Ren C, Liu P, Chen L, Li D, Zhou L, Tang L, Liu X, Ye S, Liu X, Ma Y, Zhang Y, Ma X, Zhang L, Zhang G, Li N, Fan D. Exercise Physiology Impairments of Patients With Amyotrophic Lateral Sclerosis: Cardiopulmonary Exercise Testing Findings. Front Physiol 2022; 13:792660. [PMID: 35370778 PMCID: PMC8967153 DOI: 10.3389/fphys.2022.792660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective In amyotrophic lateral sclerosis (ALS), progressive weakness significantly limits the ability to exercise. However, measurements of the impaired exercise function and their practical value to assess disease progression in ALS are scarce. Cardiopulmonary exercise testing (CPET) is a non-invasive accurate method used to comprehensively quantify exercise physiology in a variety of diseases. This study aimed to evaluate the clinical value of CPET and to explore its association with disease severity and prognosis prediction in ALS. Methods A total of 319 participants were enrolled in this 3-year prospective study. After strict quality control, 109 patients with ALS and 150 age- and sex-matched healthy controls were included with comprehensive clinical assessment and follow-ups. The incremental ramp protocol for symptom-limited CPET was applied in both groups. The exercise physiology during peak effort exercise was systematically measured, including the overall aerobic capacity of exercise (VO2 peak) and the respective capacity of the exercise-involved organs [cardiac response (heart rate peak—HR peak), ventilatory efficiency (VE/VCO2 slope), breathing economy (VE/VO2 peak), and other relevant parameters]. Disease severity and progression were evaluated using recognized scales. Survival was monitored with regular follow-ups every 6 months. Results Decreased exercise capacity (VO2 peak < 16 ml/kg/min) occurred more frequently in patients with ALS than in controls (44.95% vs. 9.33%, p < 0.01). In patients with ALS, the average VO2 peak (16.16 ± 5.43 ml/kg/min) and HR peak [135 (112–153) bpm] were significantly lower (p < 0.01) than in controls [22.26 ± 7.09 ml/kg/min; 148 (135–164) bpm], but the VE/VCO2 slope was significantly higher [28.05 (25.03–32.16) vs. 26.72 (24.37–29.58); p = 0.03]. In patients with ALS, the VO2 peak and HR peak were significantly correlated with disease severity and progression scores (p < 0.05). Survival analyses revealed the VO2 peak and HR peak as protective indicators while the VE/VO2 peak as a detrimental indicator for the prognostic prediction in ALS (HR = 0.839, p = 0.001; HR = 0.967, p < 0.001; HR = 1.137, p = 0.028, respectively). Conclusion Our prospective study quantified the significantly decreased exercise capacity in ALS through non-invasive CPET. The impaired VO2 peak and HR peak closely correlated with disease severity and independently predicted a worse prognosis. Our findings identified the clinical value of CPET as an objective indicator of disease progression in ALS.
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Affiliation(s)
- Ji He
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Wei Zhao
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Chuan Ren
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Ping Liu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dan Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lequn Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaolu Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yan Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xinran Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Gaoqi Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Nan Li
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- *Correspondence: Dongsheng Fan,
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18
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Hyrylä VV, Rissanen APE, Peltonen JE, Koponen AS, Tikkanen HO, Tarvainen MP. Altered Expiratory Flow Dynamics at Peak Exercise in Adult Men With Well-Controlled Type 1 Diabetes. Front Physiol 2022; 13:836814. [PMID: 35250637 PMCID: PMC8894884 DOI: 10.3389/fphys.2022.836814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Type 1 diabetes may, in time, cause lung dysfunction including airflow limitation. We hypothesized that ventilatory flow morphology during a cardiopulmonary exercise test (CPET) would be altered in adult men with well-controlled type 1 diabetes. Thirteen men with type 1 diabetes [glycated hemoglobin A1c 59 (9) mmol/mol or 7.5 (0.8)%, duration of diabetes 12 (9) years, and age 33.9 (6.6) years] without diagnosed diabetes-related complications and 13 healthy male controls [age 37.2 (8.6) years] underwent CPET on a cycle ergometer (40 W increments every 3 min until volitional fatigue). We used a principal component analysis based method to quantify ventilatory flow dynamics throughout the CPET protocol. Last minute of each increment, peak exercise, and recovery were examined using linear mixed models, which accounted for relative peak oxygen uptake and minute ventilation. The type 1 diabetes participants had lower expiratory peak flow (P = 0.008) and attenuated slope from expiration onset to expiratory peak flow (P = 0.012) at peak exercise when compared with the healthy controls. Instead, during submaximal exercise and recovery, the type 1 diabetes participants possessed similar ventilatory flow dynamics to that of the healthy controls. In conclusion, men with relatively well-controlled type 1 diabetes and without clinical evidence of diabetes-related complications exhibited attenuated expiratory flow at peak exercise independently of peak oxygen uptake and minute ventilation. This study demonstrates that acute exercise reveals alterations in ventilatory function in men with type 1 diabetes but not until peak exercise.
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Affiliation(s)
- Vesa V. Hyrylä
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- *Correspondence: Vesa V. Hyrylä,
| | - Antti-Pekka E. Rissanen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland
- HULA—Helsinki Sports and Exercise Medicine Clinic, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Juha E. Peltonen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland
- HULA—Helsinki Sports and Exercise Medicine Clinic, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Anne S. Koponen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - Heikki O. Tikkanen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland
- School of Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Mika P. Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
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19
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Miyazaki A, Miki K, Maekura R, Tsujino K, Hashimoto H, Miki M, Yanagi H, Koba T, Nii T, Matsuki T, Kida H. Increased Oxygen Extraction by Pulmonary Rehabilitation Improves Exercise Tolerance and Ventilatory Efficiency in Advanced Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11040963. [PMID: 35207235 PMCID: PMC8878603 DOI: 10.3390/jcm11040963] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background: In cardiopulmonary exercise testing (CPET), oxygen uptake (V’O2) is calculated using the product of minute ventilation (V’E) and the difference between inspiratory and expiratory O2 concentrations (ΔFO2). However, little is known about the response of ΔFO2 to pulmonary rehabilitation (PR). The aim of the present study was (1) to investigate whether PR increases peak V’O2, based on whether ΔFO2 or V’E at peak exercise increase after PR, and (2) to investigate whether an improvement in ΔFO2 correlates with an improvement in ventilatory efficiency. Methods: A total of 38 patients with severe and very severe COPD, whose PR responses were evaluated by CPET, were retrospectively analyzed. Results: After PR, peak V’O2 was increased in 14 patients. The difference in ΔFO2 at peak exercise following PR correlated with the difference in peak V’O2 (r = 0.4884, p = 0.0019), the difference in V’E/V’CO2-nadir (r = −0.7057, p < 0.0001), and the difference in V’E–V’CO2 slope (r = −0.4578, p = 0.0039), but it did not correlate with the difference in peak V’E. Conclusions: The increased O2 extraction following PR correlated with improved exercise tolerance and ventilatory efficiency. In advanced COPD patients, a new strategy for improving O2 extraction ability might be effective in those in whom ventilatory ability can be only minimally increased.
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Affiliation(s)
- Akito Miyazaki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
- Correspondence: ; Tel.: +81-6-6853-2001
| | - Ryoji Maekura
- Graduate School of Health Care Sciences, Jikei Institute, Osaka 532-0003, Japan;
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Hisako Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Mari Miki
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto 772-8503, Japan;
| | - Hiromi Yanagi
- Department of Clinical Examination, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan;
| | - Taro Koba
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Takuro Nii
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
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20
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Laveneziana P, Palange P. Ventilatory efficiency and its clinical and prognostic value in adults with cystic fibrosis. Eur Respir Rev 2021; 30:30/162/200395. [PMID: 34853094 DOI: 10.1183/16000617.0395-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/08/2021] [Indexed: 11/05/2022] Open
Abstract
Cystic fibrosis, due to the absence or abnormal function of the cystic fibrosis transmembrane conductance regulator, is the most common life-limiting autosomal recessive genetic disorder among the Caucasian population. The lungs are particularly affected due to thick and tenacious mucus causing parenchymal anomalies ranging from bronchiectasis, progressive airflow limitation, respiratory infections, lung destruction and ultimately respiratory failure. Despite the remarkable advances in treatment that have greatly improved survival, most patients experience progressive exercise curtailment, with the consequence that a growing number of patients with cystic fibrosis will be referred for exercise-based evaluations in the forthcoming years. Cardiopulmonary exercise testing, in particular, is a useful tool to assess the mechanisms of exercise intolerance in individual patients that may have treatment and prognostic implications. In this review, we will focus on ventilatory efficiency and its clinical and prognostic value in adults with cystic fibrosis.
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Affiliation(s)
- Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Paolo Palange
- Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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21
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Jesus JP, Gomes M, Dias-Gonçalves A, Correia JM, Pezarat-Correia P, Mendonca GV. Effects of surgical masks on the responses to constant work-rate cycling performed at different intensity domains. Clin Physiol Funct Imaging 2021; 42:43-52. [PMID: 34753208 PMCID: PMC8646879 DOI: 10.1111/cpf.12734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
We aimed at examining the impact of wearing surgical face masks on exercise performance. Thirty-two healthy adults (16 males and 16 females) completed a graded exercise test to measure peak oxygen uptake (VO2peak ) and the ventilatory threshold (VT). Then, on separate days, all participants performed resting and standardized protocols (moderate intensity: 25% infra-VT; severe intensity: 25% supra-VT) on two different conditions (with and without a surgical mask). The use of masks reduced both VO2 and minute ventilation during moderate and severe exercise (p < 0.0001), and this effect was particularly pronounced during severe exercise. Time to exhaustion was also shortened by ~10% on the face mask condition (p = 0.014). In contrast, neither heart rate nor the respiratory exchange ratio was affected by masking. The submaximal VO2 was similar between the two epochs of analysis obtained during moderate cycling (i.e. 3-6 min vs. 7-10 min) and this occurred similarly between conditions. In conclusion, the impact of the surgical masks on exercise capacity is particularly pronounced during severe exercise performed at constant work rate. Ultimately, this may implicate a considerable impairment of structured or even unstructured strenuous physical activity. Clinical Trials registration number: NCT04963049.
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Affiliation(s)
- João P Jesus
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Miguel Gomes
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - André Dias-Gonçalves
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Joana M Correia
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Pedro Pezarat-Correia
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Goncalo V Mendonca
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
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22
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Neder JA, Berton DC, Phillips DB, O'Donnell DE. Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications. Eur Respir Rev 2021; 30:30/161/200190. [PMID: 34526312 PMCID: PMC9489189 DOI: 10.1183/16000617.0190-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023] Open
Abstract
There is well established evidence that the minute ventilation (V′E)/carbon dioxide output (V′CO2) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V′E/V′CO2 reflects an enlarged physiological dead space (“wasted” ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V′E/V′CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V′E/V′CO2 is valuable to ascertain a role for the “lungs” in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V′E/V′CO2. A high V′E/V′CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V′E/V′CO2 should be valued in the clinical management of patients with COPD. The minute ventilation/carbon dioxide production relationship is relevant to a number of patient-related outcomes in COPD. Minute ventilation/carbon dioxide production, therefore, should be valued in the clinical management of these patients.https://bit.ly/3df2upH
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Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Danilo C Berton
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada.,Division of Respiratory Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Devin B Phillips
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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23
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Caviedes I. Ventilatory inefficiency: a key physiopathological mechanism increasing dyspnea and reducing exercise capacity in chronic obstructive pulmonary disease. J Thorac Dis 2021; 13:4614-4617. [PMID: 34422386 PMCID: PMC8339755 DOI: 10.21037/jtd-21-834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Iván Caviedes
- Servicio de Enfermedades Respiratorias, Clínica Alemana de Santiago, Chile.,Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
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24
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Miki K, Tsujino K, Maekuara R, Matsuki T, Miki M, Hashimoto H, Kagawa H, Kawasaki T, Kuge T, Kida H. Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease. Front Physiol 2021; 12:703977. [PMID: 34393822 PMCID: PMC8355815 DOI: 10.3389/fphys.2021.703977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/18/2021] [Indexed: 12/28/2022] Open
Abstract
Aims: In contrast to cardiovascular disease, low rather than high ventilatory inefficiency, evaluated by the minute ventilation-carbon dioxide output (V'E-V'CO2)-slope, has been recognized as being related to greater disease severity in chronic obstructive pulmonary disease (COPD). To better care for patients with cardiopulmonary disease, understanding the physiological correlation between ventilatory inefficiency and exercise limitation is necessary, but remains inadequate. Given that oxygen uptake (V'O2) evaluated by cardiopulmonary exercise testing (CPET) depends on both the ventilatory capability and oxygen extraction, i.e., the difference between inspiratory and expiratory oxygen concentration (ΔFO2), the aim of this study was to investigate the correlations between V'E-V'CO2-slope and the ΔFO2 during exercise and their physiological implications in patients with COPD. Methods: A total of 156 COPD patients (mean age, 70.9 ± 7.2 years) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV and 16 controls underwent CPET with blood gas analysis. Results: With the progression of COPD, mechanical ventilatory constraints together with a slower respiratory frequency led to exertional respiratory acidosis. In GOLD IV cases, (1) decrease in the dependence of reduced peak V'O2 on V'E led to an increase in its dependence on peak ΔFO2 during exercise; and (2) the ΔFO2-V'CO2-slope became steeper, correlating with the severity of exertional respiratory acidosis (r = 0.6359, p < 0.0001). No significant differences in peak exercise ΔFO2 or V'E-V'CO2-slope were observed among the various GOLD stages. In all subjects, including controls, peak exercise ΔFO2 had the strongest correlation with the V'E-V'CO2-slope (r = −0.8835, p < 0.0001) and correlated well with body mass index (r = 0.3871, p < 0.0001), although it did not correlate with the heart rate-V'CO2-relationship and V'E. Conclusions: Ventilatory efficiency related to CO2 clearance might depend on exertional oxygen extraction in the body. Measuring ΔFO2 might be a key component for identifying ventilatory inefficiency and oxygen availability. Increasing ΔFO2 would help to improve ventilatory inefficiency and exercise tolerance separately from cardiac and ventilatory capability in COPD patients.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Ryoji Maekuara
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hisako Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takahiro Kawasaki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Tomoki Kuge
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
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25
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Broadman J, Jensen D. Effect of induced acute metabolic alkalosis on the V̇ E/V̇CO 2 response to exercise in healthy adults. Respir Physiol Neurobiol 2021; 294:103740. [PMID: 34256173 DOI: 10.1016/j.resp.2021.103740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
We tested the hypothesis that increasing the respiratory control systems' arterial PCO2 equilibrium point via induced acute metabolic alkalosis by ingestion of sodium bicarbonate (NaHCO3, 0.3 g/kg) would decrease the ventilatory equivalent for CO2 (V̇E/V̇CO2) at its lowest point ("nadir") during constant-load cycle exercise testing performed at 80 % of peak power output in 18 healthy young adults. Compared to the sodium chloride (4 g) control condition, ingestion of NaHCO3: increased arterialized venous pH, HCO3- and PCO2 at rest by 0.05 ± 0.01 units (mean ± SE), 6.4 ± 0.4 mEq/L and 4.3 ± 0.7 mmHg, respectively (all p < 0.0001); and decreased the V̇E/V̇CO2 nadir during exercise by 9.4 % (p < 0.0001) secondary to a 4.7 ± 1.8 L/min decrease in V̇E (p = 0.019). In conclusion, induced acute metabolic alkalosis by ingestion of NaHCO3 decreased the V̇E/V̇CO2 response to strenuous exercise in healthy adults.
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Affiliation(s)
- Joshua Broadman
- 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; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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26
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Gonzalez-Garcia M, Barrero M, Maldonado D. Exercise Capacity, Ventilatory Response, and Gas Exchange in COPD Patients With Mild to Severe Obstruction Residing at High Altitude. Front Physiol 2021; 12:668144. [PMID: 34220533 PMCID: PMC8249805 DOI: 10.3389/fphys.2021.668144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Exercise intolerance, desaturation, and dyspnea are common features in patients with chronic obstructive pulmonary disease (COPD). At altitude, the barometric pressure (BP) decreases, and therefore the inspired oxygen pressure and the partial pressure of arterial oxygen (PaO2) also decrease in healthy subjects and even more in patients with COPD. Most of the studies evaluating ventilation and arterial blood gas (ABG) during exercise in COPD patients have been conducted at sea level and in small populations of people ascending to high altitudes. Our objective was to compare exercise capacity, gas exchange, ventilatory alterations, and symptoms in COPD patients at the altitude of Bogotá (2,640 m), of all degrees of severity. Methods Measurement during a cardiopulmonary exercise test of oxygen consumption (VO2), minute ventilation (VE), tidal volume (VT), heart rate (HR), ventilatory equivalents of CO2 (VE/VCO2), inspiratory capacity (IC), end-tidal carbon dioxide tension (PETCO2), and ABG. For the comparison of the variables between the control subjects and the patients according to the GOLD stages, the non-parametric Kruskal–Wallis test or the one-way analysis of variance test was used. Results Eighty-one controls and 525 patients with COPD aged 67.5 ± 9.1 years were included. Compared with controls, COPD patients had lower VO2 and VE (p < 0.001) and higher VE/VCO2 (p = 0.001), A-aPO2, and VD/VT (p < 0.001). In COPD patients, PaO2 and saturation decreased, and delta IC (p = 0.004) and VT/IC increased (p = 0.002). These alterations were also seen in mild COPD and progressed with increasing severity of the obstruction. Conclusion The main findings of this study in COPD patients residing at high altitude were a progressive decrease in exercise capacity, increased dyspnea, dynamic hyperinflation, restrictive mechanical constraints, and gas exchange abnormalities during exercise, across GOLD stages 1–4. In patients with mild COPD, there were also lower exercise capacity and gas exchange alterations, with significant differences from controls. Compared with studies at sea level, because of the lower inspired oxygen pressure and the compensatory increase in ventilation, hypoxemia at rest and during exercise was more severe; PaCO2 and PETCO2 were lower; and VE/VO2 was higher.
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Affiliation(s)
- Mauricio Gonzalez-Garcia
- Pulmonary Function Testing Laboratory, Fundación Neumologica Colombiana, Bogotá, Colombia.,Faculty of Medicine, Universidad de La Sabana, Bogotá, Colombia
| | - Margarita Barrero
- Pulmonary Function Testing Laboratory, Fundación Neumologica Colombiana, Bogotá, Colombia
| | - Dario Maldonado
- Pulmonary Function Testing Laboratory, Fundación Neumologica Colombiana, Bogotá, Colombia
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27
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Nahmias O, Ritter O, Sagawa Y, Roux P, Degano B, Soumagne T. Ventilatory adaptation during eccentric cycling in patients with severe COPD: Potential implications for exercise training. Respir Physiol Neurobiol 2021; 292:103706. [PMID: 34062283 DOI: 10.1016/j.resp.2021.103706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Eccentric (ECC) cycling is viewed as an alternative to concentric (CON) cycling for exercise training in patients with severe COPD as it induces a much lower ventilatory demand for a given mechanical load than CON cycling. However, a more hyperpneic breathing pattern (i.e., higher fB and lower tidal volume (VT)) during ECC than during CON has been reported in healthy subjects. RESEARCH QUESTION Do patients with severe COPD develop a more hyperpneic breathing pattern during ECC than during CON cycling, and is it associated with differences in dynamic hyperinflation, ventilatory efficiency and cardiometabolic adaptation? METHODS Fourteen patients with severe COPD performed incremental CON and ECC cardiopulmonary exercise tests (CPET). Several physiological parameters including VT, fB, inspiratory capacity (IC) and oxygen consumption (V̇O2) were recorded at each workload increment during CPET. RESULTS At the highest identical minute ventilation (V̇E) achieved during ECC and CON (28.6 ± 4.6 L.min-1), VT was lower (1010 ± 218 vs. 1100 ± 233 mL; p = 0.02), fB was higher (29.0 ± 5.1 vs. 27.0 ± 5.5 min-1; p = 0.03), IC(% baseline) was lower (84 ± 10 vs. 78 ± 9; p < 0.01) and markers of ventilatory efficiency were poorer during ECC than during CON. Similar results were found at the highest identical V̇O2 achieved during ECC and CON. CONCLUSION The finding of a more hyperpneic ventilatory pattern during ECC cycling together with a lower IC and a poorer ventilatory efficiency suggests that ECC exercise training should be decided with caution in patients with severe COPD.
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Affiliation(s)
- Olympe Nahmias
- Department of Respiratory Physiology, University Hospital of Besançon, Besançon, France; Department of Physical Medicine and Rehabilitation, University Hospital of Besançon, Besançon, France
| | - Ophélie Ritter
- Department of Respiratory Physiology, University Hospital of Besançon, Besançon, France
| | - Yoshimasa Sagawa
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France; Clinical Investigation Center, INSERM CIC 1431, University Hospital of Besançon, Besançon, France
| | - Pauline Roux
- Department of Respiratory Physiology, University Hospital of Besançon, Besançon, France
| | - Bruno Degano
- Department of Respiratory Medicine, University Hospital of Grenoble Alpes, Grenoble, France; HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Thibaud Soumagne
- Department of Respiratory Physiology, University Hospital of Besançon, Besançon, France.
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Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084207. [PMID: 33921105 PMCID: PMC8071399 DOI: 10.3390/ijerph18084207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = -435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, -8.5 L/min, BF10 = 25), respiratory rate (RR, -3.3 breaths/min, BF10 = 2), heart rate (HR, -13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, -183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, -3.8 L/min, BF10 = 1.1) and compared to CG in VE (-8.3 L/min, BF10 = 3.6), VCO2 (-215.9 L/min, BF10 = 3.0), EqCO2 (-3.7 L/min, BF10 = 1.1) and HR (-12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (-4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.
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29
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Ward SA. Ventilation/carbon dioxide output relationships during exercise in health. Eur Respir Rev 2021; 30:30/160/200160. [PMID: 33853883 PMCID: PMC9488729 DOI: 10.1183/16000617.0160-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/22/2020] [Indexed: 11/27/2022] Open
Abstract
“Ventilatory efficiency” is widely used in cardiopulmonary exercise testing to make inferences regarding the normality (or otherwise) of the arterial CO2 tension (PaCO2) and physiological dead-space fraction of the breath (VD/VT) responses to rapid-incremental (or ramp) exercise. It is quantified as: 1) the slope of the linear region of the relationship between ventilation (V′E) and pulmonary CO2 output (V′CO2); and/or 2) the ventilatory equivalent for CO2 at the lactate threshold (V′E/V′CO2) or its minimum value (V′E/V′CO2min), which occurs soon after but before respiratory compensation. Although these indices are normally numerically similar, they are not equally robust. That is, high values for V′E/V′CO2 and V′E/V′CO2min provide a rigorous index of an elevated VD/VT when PaCO2 is known (or can be assumed) to be regulated. In contrast, a high V′E–V′CO2 slope on its own does not, as account has also to be taken of the associated normally positive and small V′E intercept. Interpretation is complicated by factors such as: the extent to which PaCO2 is actually regulated during rapid-incremental exercise (as is the case for steady-state moderate exercise); and whether V′E/V′CO2 or V′E/V′CO2min provide accurate reflections of the true asymptotic value of V′E/V′CO2, to which the V′E–V′CO2 slope approximates at very high work rates. The efficiency of CO2 clearance at the lungs in exercise is estimated from the relationship between ventilation and CO2 elimination rate. It is compromised in lung and cardiovascular disease, stressing breathing and shortness of breath, and therefore impairing exercise capacity.https://bit.ly/3gYY866
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Affiliation(s)
- Susan A Ward
- Human Bio-Energetics Research Centre, Crickhowell, Powys, UK
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30
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Dorelli G, Braggio M, Gabbiani D, Busti F, Caminati M, Senna G, Girelli D, Laveneziana P, Ferrari M, Sartori G, Dalle Carbonare L, Crisafulli E. Importance of Cardiopulmonary Exercise Testing amongst Subjects Recovering from COVID-19. Diagnostics (Basel) 2021; 11:diagnostics11030507. [PMID: 33809260 PMCID: PMC7998697 DOI: 10.3390/diagnostics11030507] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/20/2021] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Abstract
The cardiopulmonary exercise test (CPET) provides an objective assessment of ventilatory limitation, related to the exercise minute ventilation (VE) coupled to carbon dioxide output (VCO2) (VE/VCO2); high values of VE/VCO2 slope define an exercise ventilatory inefficiency (EVin). In subjects recovered from hospitalised COVID-19, we explored the methodology of CPET in order to evaluate the presence of cardiopulmonary alterations. Our prospective study (RESPICOVID) has been proposed to evaluate pulmonary damage’s clinical impact in post-COVID subjects. In a subgroup of subjects (RESPICOVID2) without baseline confounders, we performed the CPET. According to the VE/VCO2 slope, subjects were divided into having EVin and exercise ventilatory efficiency (EVef). Data concerning general variables, hospitalisation, lung function, and gas-analysis were also collected. The RESPICOVID2 enrolled 28 subjects, of whom 8 (29%) had EVin. As compared to subjects with EVef, subjects with EVin showed a reduction in heart rate (HR) recovery. VE/VCO2 slope was inversely correlated with HR recovery; this correlation was confirmed in a subgroup of older, non-smoking male subjects, regardless of the presence of arterial hypertension. More than one-fourth of subjects recovered from hospitalised COVID-19 have EVin. The relationship between EVin and HR recovery may represent a novel hallmark of post-COVID cardiopulmonary alterations.
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Affiliation(s)
- Gianluigi Dorelli
- School of Medicine in Sports and Exercise, University of Verona, 37134 Verona, Italy; (G.D.); (M.B.); (M.F.); (L.D.C.)
| | - Michele Braggio
- School of Medicine in Sports and Exercise, University of Verona, 37134 Verona, Italy; (G.D.); (M.B.); (M.F.); (L.D.C.)
| | - Daniele Gabbiani
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (D.G.); (F.B.); (D.G.); (G.S.)
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (D.G.); (F.B.); (D.G.); (G.S.)
| | - Marco Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Gianenrico Senna
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (D.G.); (F.B.); (D.G.); (G.S.)
| | - Pierantonio Laveneziana
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l’Exercice et de la Dyspnée du Département Médico-Universitaire «APPROCHES», 75013 Paris, France;
| | - Marcello Ferrari
- School of Medicine in Sports and Exercise, University of Verona, 37134 Verona, Italy; (G.D.); (M.B.); (M.F.); (L.D.C.)
| | - Giulia Sartori
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (D.G.); (F.B.); (D.G.); (G.S.)
- Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy
| | - Luca Dalle Carbonare
- School of Medicine in Sports and Exercise, University of Verona, 37134 Verona, Italy; (G.D.); (M.B.); (M.F.); (L.D.C.)
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (D.G.); (F.B.); (D.G.); (G.S.)
| | - Ernesto Crisafulli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy; (D.G.); (F.B.); (D.G.); (G.S.)
- Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy
- Correspondence:
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Motor Pathophysiology Related to Dyspnea in COPD Evaluated by Cardiopulmonary Exercise Testing. Diagnostics (Basel) 2021; 11:diagnostics11020364. [PMID: 33670051 PMCID: PMC7926713 DOI: 10.3390/diagnostics11020364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD), exertional dyspnea, which increases with the disease’s progression, reduces exercise tolerance and limits physical activity, leading to a worsening prognosis. It is necessary to understand the diverse mechanisms of dyspnea and take appropriate measures to reduce exertional dyspnea, as COPD is a systemic disease with various comorbidities. A treatment focusing on the motor pathophysiology related to dyspnea may lead to improvements such as reducing dynamic lung hyperinflation, respiratory and metabolic acidosis, and eventually exertional dyspnea. However, without cardiopulmonary exercise testing (CPET), it may be difficult to understand the pathophysiological conditions during exercise. CPET facilitates understanding of the gas exchange and transport associated with respiration-circulation and even crosstalk with muscles, which is sometimes challenging, and provides information on COPD treatment strategies. For respiratory medicine department staff, CPET can play a significant role when treating patients with diseases that cause exertional dyspnea. This article outlines the advantages of using CPET to evaluate exertional dyspnea in patients with COPD.
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Berton DC, Mendes NBS, Olivo-Neto P, Benedetto IG, Gazzana MB. Pulmonology approach in the investigation of chronic unexplained dyspnea. ACTA ACUST UNITED AC 2021; 47:e20200406. [PMID: 33567064 PMCID: PMC7889318 DOI: 10.36416/1806-3756/e20200406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022]
Abstract
Chronic unexplained dyspnea and exercise intolerance represent common, distressing symptoms in outpatients. Clinical history taking and physical examination are the mainstays for diagnostic evaluation. However, the cause of dyspnea may remain elusive even after comprehensive diagnostic evaluation-basic laboratory analyses; chest imaging; pulmonary function testing; and cardiac testing. At that point (and frequently before), patients are usually referred to a pulmonologist, who is expected to be the main physician to solve this conundrum. In this context, cardiopulmonary exercise testing (CPET), to assess physiological and sensory responses from rest to peak exercise, provides a unique opportunity to unmask the mechanisms of the underlying dyspnea and their interactions with a broad spectrum of disorders. However, CPET is underused in clinical practice, possibly due to operational issues (equipment costs, limited availability, and poor remuneration) and limited medical education regarding the method. To counter the latter shortcoming, we aspire to provide a pragmatic strategy for interpreting CPET results. Clustering findings of exercise response allows the characterization of patterns that permit the clinician to narrow the list of possible diagnoses rather than pinpointing a specific etiology. We present a proposal for a diagnostic workup and some illustrative cases assessed by CPET. Given that airway hyperresponsiveness and pulmonary vascular disorders, which are within the purview of pulmonology, are common causes of chronic unexplained dyspnea, we also aim to describe the role of bronchial challenge tests and the diagnostic reasoning for investigating the pulmonary circulation in this context.
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Affiliation(s)
- Danilo Cortozi Berton
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia, Hospital de Clinicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Nathalia Branco Schweitzer Mendes
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia, Hospital de Clinicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Pedro Olivo-Neto
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia, Hospital de Clinicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Igor Gorski Benedetto
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia, Hospital de Clinicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia e Cirurgia Torácica, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
| | - Marcelo Basso Gazzana
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia, Hospital de Clinicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Serviço de Pneumologia e Cirurgia Torácica, Hospital Moinhos de Vento, Porto Alegre (RS) Brasil
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Dos Santos PB, Simões RP, Goulart CDL, Roscani MG, Marinho RS, Camargo PF, Arbex RF, Casale G, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance. Int J Chron Obstruct Pulmon Dis 2021; 16:203-214. [PMID: 33568904 PMCID: PMC7868200 DOI: 10.2147/copd.s285812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness. Methods The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Results Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e' ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: -0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: -0.62; p: 0.001) in the CHF+COPD group. Conclusion Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil.,Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Minas Gerais, Brazil
| | - Cássia da L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Patrícia Faria Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Guilherme Casale
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Cláudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
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Abstract
Lung function testing has undisputed value in the comprehensive assessment and individualized management of chronic obstructive pulmonary disease, a pathologic condition in which a functional abnormality, poorly reversible expiratory airway obstruction, is at the core of its definition. After an overview of the physiologic underpinnings of the disease, the authors outline the role of lung function testing in this disease, including diagnosis, assessment of severity, and indication for and responses to pharmacologic and nonpharmacologic interventions. They discuss the current controversies surrounding test interpretation with these purposes in mind and provide balanced recommendations to optimize their usefulness in different clinical scenarios.
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35
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Manco A, Pisi R, Aiello M, Tzani P, Frizzelli A, Fantin A, Alfieri V, Bertorelli G, Chetta A. Small airway dysfunction predicts excess ventilation and dynamic hyperinflation during exercise in patients with COPD. RESPIRATORY MEDICINE: X 2020. [DOI: 10.1016/j.yrmex.2020.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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36
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Dyspnea Postpulmonary Embolism. Chest 2020; 158:1780-1781. [DOI: 10.1016/j.chest.2020.05.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 11/24/2022] Open
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37
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Caviedes I, Soto R, Herth F. The determination of ventilatory inefficiency at rest in COPD: the expected parameter. Eur Respir J 2020; 56:56/4/2002947. [PMID: 33004441 DOI: 10.1183/13993003.02947-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Iván Caviedes
- Servicio de Enfermedades Respiratorias, Clínica Alemana de Santiago, Santiago, Chile .,Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Rodrigo Soto
- Servicio de Enfermedades Respiratorias, Clínica Alemana de Santiago, Santiago, Chile.,Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Felix Herth
- Thoraxklinik Heidelberg at Heidelberg University, Dept of Pneumology and Critical Care Medicine, Heidelberg, Germany
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Yamamoto Y, Miki K, Matsuki T, Fukushima K, Oshitani Y, Kagawa H, Tsujino K, Yoshimura K, Miki M, Kida H. Evaluation of Exertional Ventilatory Parameters Using Oscillometry in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1697-1711. [PMID: 32764915 PMCID: PMC7367741 DOI: 10.2147/copd.s260735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Oscillometry is a tool to measure respiratory impedance that requires minimal patients’ effort. In patients with chronic obstructive pulmonary disease (COPD), the correlation of respiratory impedance at rest with exertional ventilatory parameters, including exercise tolerance, has scarcely been reported. In addition, the utility of oscillometric parameters might differ between the inspiratory and expiratory phases due to airflow obstruction during expiration, but the hypothesis had not been validated. The aim of the present study was to investigate whether oscillometric parameters are associated with exertional ventilatory parameters in patients with COPD. Methods Fifty-five subjects with COPD who attended clinics at the National Hospital Organization Osaka Toneyama Medical Center performed spirometry, oscillometry, and cardiopulmonary exercise testing (CPET) within 2 weeks. The correlations between parameters of spirometry, oscillometry, and CPET were analyzed using Spearman’s rank correlation coefficient, univariate, and multivariate analyses. Results Respiratory reactance had better correlations with the CPET parameters than respiratory resistance. Moreover, inspiratory reactance at rest correlated with the CPET parameters stronger than expiratory reactance. In particular, inspiratory resonant frequency (Fres-ins) correlated with peak oxygen uptake (rS=−0.549, p<0.01) and dead space to tidal volume ratio at peak exercise (rS=0.677, p<0.01) and the best predicted expiratory tidal volume (VT ex) at peak exercise of all the oscillometric parameters (rS=−0.679, p<0.01). However, the correlation between Fres-ins and VT ex at peak exercise became weak in subjects with severe and very severe COPD during exercise. Conclusion Measurement of respiratory reactance is useful for the effortless evaluation of not only exertional ventilatory parameters but exercise tolerance in patients with COPD. The correlation of respiratory impedance with exertional ventilatory parameters can become weak in patients with advanced COPD; thus, the measurement of oscillometry might not be appropriate for evaluating exertional ventilatory parameters of patients with advanced COPD.
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Affiliation(s)
- Yuji Yamamoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kiyoharu Fukushima
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
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Marillier M, Bernard AC, Gass R, Berton DC, Verges S, O'Donnell DE, Neder JA. Are the “critical” inspiratory constraints actually decisive to limit exercise tolerance in COPD? ERJ Open Res 2020; 6:00178-2020. [PMID: 32832523 PMCID: PMC7430139 DOI: 10.1183/23120541.00178-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/21/2020] [Indexed: 11/16/2022] Open
Abstract
Exercise intolerance is characteristically multi-factorial in patients with chronic obstructive pulmonary disease (COPD) [1]. At least in symptomatic patients with moderate-to-severe airflow limitation, higher operating lung volumes assume a relevant role in decreasing patients’ tolerance to sustain “prolonged” exercise. As a consequence of the dynamic increase in the end-expiratory lung volume, tidal volume (VT) occurs close to total lung capacity (TLC), thereby reducing the room for further lung–chest wall expansion. The combination of low dynamic lung compliance and a severely reduced inspiratory reserve volume causes a mismatch between a growing respiratory neural drive and the resulting lung–chest wall displacement [2]. It has been postulated that such critical inspiratory constraints (CIC) lead to a plateau in VT, and a concomitant increase in dyspnoea as a function of ventilation (V′E) [3]. Accordingly, patients change their perception of the uncomfortable respiratory sensations from “laboured breathing” to “insufficient inspiration”, prompting early exercise termination [4]. The concept of critical inspiratory constraints is key to the modern understanding of exercise pathophysiology in patients with moderate-to-severe COPDhttps://bit.ly/2A6bCxD
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40
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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: 37] [Impact Index Per Article: 9.3] [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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Srinathan S. Is ventilatory efficiency the next new thing in prehabilitation? J Thorac Cardiovasc Surg 2020; 159:e323-e324. [DOI: 10.1016/j.jtcvs.2019.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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42
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Neder JA. Ventilatory demand-capacity imbalance during incremental exercise in COPD: an in silico perspective. Eur Respir J 2020; 56:13993003.00495-2020. [PMID: 32341112 DOI: 10.1183/13993003.00495-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/14/2020] [Indexed: 11/05/2022]
Affiliation(s)
- J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Division of Respirology, Dept of Medicine, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
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43
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Neder JA, Berton DC, Marillier M, Bernard AC, de Torres JP, O'Donnell DE. Resting V′E/V′CO2 adds to inspiratory capacity to predict the burden of exertional dyspnoea in COPD. Eur Respir J 2020; 56:13993003.02434-2019. [DOI: 10.1183/13993003.02434-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/24/2020] [Indexed: 01/06/2023]
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Rinaldo RF, Mondoni M, Comandini S, Lombardo P, Vigo B, Terraneo S, Santus P, Carugo S, Centanni S, Di Marco F. The role of phenotype on ventilation and exercise capacity in patients affected by COPD: a retrospective study. Multidiscip Respir Med 2020; 15:476. [PMID: 32153779 PMCID: PMC7037504 DOI: 10.4081/mrm.2020.476] [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: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 01/09/2023] Open
Abstract
Background The idea of phenotype in chronic obstructive pulmonary disease (COPD) has evolved in the last decades, and the importance of peculiar treatment strategies has now been acknowledged. Although dyspnea and exercise limitation are hallmarks of COPD, this aspect has never been fully explored in literature in terms of disease phenotype. The aim of the present study was to explore the relevance of clinical COPD phenotypes on exercise ventilation and maximal capacity. Methods In this observational cohort retrospective study we analyzed the data of 50 COPD patients who underwent cardiopulmonary exercise test, categorized as emphysematous (n=29), and non-emphysematous (n=21) according to a previously validated model. Results We found a significant difference in terms of VE/VCO2 slope (median values 32.4 vs 28.0, p=0.015) and VE/VCO2 ratio at nadir (median values 37 vs. 33, p=0.004), which resulted higher in emphysematous patients, who also presented lower PETCO2 values (median values 32.6 vs 35.6, p=0.008). In a subgroup of 31 tests which met the maximality criteria, emphysematous patients presented a significantly lower work rate at peak (median value 51 vs 72% predicted, p=0.016), and showed a lower peak oxygen consumption, although at the limit of significance (median values of 63 vs 85 % predicted, p=0.051). Conclusions This study extends our knowledge about the characterization of the COPD phenotypical expression of disease, showing that patients affected by emphysema are more prone to ventilatory inefficiency during exercise, and that this is likely to be an important cause of their overall reduced exercise capacity.
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Affiliation(s)
- Rocco F Rinaldo
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan
| | - Michele Mondoni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan
| | - Sofia Comandini
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo
| | - Pietro Lombardo
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan
| | - Beatrice Vigo
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan
| | - Silvia Terraneo
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Luigi Sacco University Hospital, Milan
| | - Stefano Carugo
- Department of Health Sciences, University of Milan, Cardiology Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo
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Vonbank K, Marzluf B, Knötig M, Funk GC. Agreement between Cardiopulmonary Exercise Test and Modified 6-Min Walk Test in Determining Oxygen Uptake in COPD Patients with Different Severity Stages. Respiration 2020; 99:225-230. [PMID: 32008003 DOI: 10.1159/000505856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In moderate-to-severe chronic obstructive pulmonary disease (COPD) patients the 6-min walk test (6MWT) is often exhaustive and correlates with the incremental cycle cardiopulmonary exercise test (CPET). OBJECTIVES The aim of this study was to assess the agreement between oxygen uptake (VO2) measured during the 6MWT by portable equipment and incremental cycle exercise in COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) I-IV. METHODS A total of 30 patients with COPD GOLD I-IV (14 patients GOLD stage I and II and 16 patients GOLD stage III and IV) underwent a 6MWT and an incremental CPET. Breath-by-breath analysis for VO2, carbon dioxide output (VCO2), and minute ventilation (VE) were measured during each test. Blood gas analysis and lactate measurements were performed before, during, and after the test. RESULTS VO2 in COPD patients GOLD stage I and II was 16.2 ± 4.2 mL/kg/min measured by 6MWT and 20.5 ± 7.0 mL/kg/min measured by CPET as compared to GOLD stage III and IV (11.2 ± 3.7 mL/kg/min measured by 6MWT and 15.5 ± 4.3 mL/kg/min measured by CPET). No significant correlation in VO2 measurements could be found between both tests in COPD GOLD I and II (r = 0.17), whereas the VO2 significantly correlated in patients with COPD stage III and IV (r = 0.7). CONCLUSIONS A significant relationship between VO2 measured by 6MWT and CPET could only be found in patients with more severe COPD but not in milder stages. 6MWT and CPET provide different VO2 measurements in COPD patients. The two methods cannot be used interchangeably.
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Affiliation(s)
- Karin Vonbank
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria,
| | - Beatrice Marzluf
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria
| | - Monika Knötig
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Physiological and perceptual responses to exercise according to locus of symptom limitation in COPD. Respir Physiol Neurobiol 2019; 273:103322. [PMID: 31629879 DOI: 10.1016/j.resp.2019.103322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/12/2019] [Accepted: 10/14/2019] [Indexed: 01/28/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease, with pulmonary and extra-pulmonary factors contributing to exercise intolerance. The primary self-reported exercise-limiting symptom may reflect the primary pathophysiological factor contributing to exercise intolerance. We compared physiological and perceptual responses at the symptom-limited peak of incremental cardiopulmonary cycle exercise testing between people with COPD reporting breathlessness (B, n = 34), leg discomfort (LD, n = 16), or a combination of B and LD (BOTH, n = 42) as their main exercise-limiting symptom(s). Despite similarly impaired health status, symptomology and peak exercise capacity, the B group had greater restrictive constraints on tidal volume expansion at end-exercise and was more likely to report unpleasant qualities of exertional breathlessness than LD and BOTH groups. In conclusion, reporting breathlessness as the primary exercise-limiting symptom indicated the presence of distinct lung pathophysiology and symptom perception during exercise in people with COPD.
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Perrotta F, Cennamo A, Cerqua FS, Stefanelli F, Bianco A, Musella S, Rispoli M, Salvi R, Meoli I. Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer. ACTA ACUST UNITED AC 2019; 45:e20180132. [PMID: 31618297 PMCID: PMC7447542 DOI: 10.1590/1806-3713/e20180132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. METHODS We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. RESULTS There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). CONCLUSIONS Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.
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Affiliation(s)
- Fabio Perrotta
- . Dipartimento di Medicina e Scienze della Salute V. Tiberio, Università degli Studi del Molise, Campobasso, Italia
| | - Antonio Cennamo
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | - Francesco Saverio Cerqua
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | | | - Andrea Bianco
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | | | - Marco Rispoli
- . Dipartimento di Anestesia and Unità di Terapia Intensiva. A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Rosario Salvi
- . Dipartimento di Chirurgia Toracica. A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Ilemando Meoli
- . Divisione di Pneumologia, Ospedale Monaldi, Napoli, Italia
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Neder JA, Berton DC, Marillier M, Bernard AC, O.Donnell DE. The role of evaluating inspiratory constraints and ventilatory inefficiency in the investigation of dyspnea of unclear etiology. Respir Med 2019; 158:6-13. [DOI: 10.1016/j.rmed.2019.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022]
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Kampouras A, Hatziagorou E, Avramidou V, Georgopoulou V, Kirvassilis F, Hebestreit H, Tsanakas J. Ventilation efficiency to exercise in patients with cystic fibrosis. Pediatr Pulmonol 2019; 54:1584-1590. [PMID: 31276310 DOI: 10.1002/ppul.24438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Exercise ventilation efficiency index in cardiopulmonary exercise testing (CPET) is elevated in patients with heart failure providing useful information on disease progression and prognosis. Few data, however, exist for ventilation efficiency index among cystic fibrosis (CF) patients. AIMS To assess ventilation efficiency index (ΔVE/ΔVCO2 or V'E/V'CO2 slope) and intercept of ventilation (VE-intercept) in CF patients with mild, moderate, and severe cystic fibrosis (CF) lung disease. To assess possible correlations with ventilation inhomogeneity and structural damages as seen on high resolution computed tomography (HRCT). METHODS CF patients with mild (FEV1 > 80%, n = 47), moderate (60% < FEV1 < 80%, n = 21), and severe (FEV1 < 60%, n = 9) lung disease, mean age 14.9 years participated. Peak oxygen uptake (VO2 peak), pulmonary ventilation at peak exercise (VE), respiratory equivalent ratios for oxygen and carbon dioxide at peak exercise (VE/VO2 , VE/VCO2 ), end-tidal CO2 (PetCO2 ), and ΔVE/ΔVCO2 , ΔVE/ΔVO2 in a maximal CPET along with spirometry and multiple breath washout indices were examined. HRCT scans were performed and scored using Bhalla score. RESULTS Mean ΔVE/ΔVCO2 showed no significant differences among the three groups (P = .503). Mean VEint discriminated significantly among the different groups (p 2 < 0.001). Ventilation efficiency index did not correlate either with LCI or Bhalla score. However, VE together with ΔVE/ΔVCO2 slope could predict Bhalla score (r 2 = 0.869, P = .006). CONCLUSION No significant differences were found regarding ΔVE/ΔVCO2 slope levels between the three groups. Ventilation intercept (VEint ) was elevated significantly as disease progresses reflecting increased dead space ventilation. CF patients retain their ventilation efficiency to exercise even as lung function deteriorates by adopting a higher respiratory rate along with increased dead space ventilation.
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Affiliation(s)
- Asterios Kampouras
- Pediatric Pulmonology and Cystic Fibrosis Unit, Aristotle University of Thessaloniki School of Health Sciences, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Elpis Hatziagorou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Aristotle University of Thessaloniki School of Health Sciences, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Avramidou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Aristotle University of Thessaloniki School of Health Sciences, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Georgopoulou
- Radiology Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Fotis Kirvassilis
- Pediatric Pulmonology and Cystic Fibrosis Unit, Aristotle University of Thessaloniki School of Health Sciences, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - John Tsanakas
- Pediatric Pulmonology and Cystic Fibrosis Unit, Aristotle University of Thessaloniki School of Health Sciences, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
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50
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Neder JA, Berton DC, O'Donnell DE. Why we should never ignore an "isolated" low lung diffusing capacity. ACTA ACUST UNITED AC 2019; 45:e20190241. [PMID: 31508675 PMCID: PMC6733732 DOI: 10.1590/1806-3713/e20190241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- José Alberto Neder
- . Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology and Sleep Medicine, Kingston Health Science Center & Queen's University, Kingston (ON) Canada
| | - Danilo Cortozi Berton
- . Unidade de Fisiologia Pulmonar, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Denis E O'Donnell
- . Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology and Sleep Medicine, Kingston Health Science Center & Queen's University, Kingston (ON) Canada
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