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Matsuyama E, Miyata J, Terai H, Miyazaki N, Iwasaki T, Nagashima K, Watase M, Sunata K, Namkoong H, Asakura T, Masaki K, Chubachi S, Ohgino K, Kawada I, Minami K, Hagiwara R, Ueda S, Yoshiyama T, Kokuto H, Kusumoto T, Oashi A, Miyawaki M, Saito F, Tani T, Ishioka K, Takahashi S, Nakamura M, Ishii M, Sato Y, Fukunaga K. Chronic obstructive pulmonary disease, asthma, and mechanical ventilation are risk factors for dyspnea in patients with long COVID: A Japanese nationwide cohort study. Respir Investig 2024; 62:1094-1101. [PMID: 39342666 DOI: 10.1016/j.resinv.2024.09.009] [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: 07/24/2024] [Revised: 09/15/2024] [Accepted: 09/22/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Patients often experience multiple prolonged symptoms following acute coronavirus disease 2019 (COVID-19) recovery, defined as long coronavirus disease (COVID). Patients with long COVID may experience dyspnea during acute and post-acute phases. Therefore, this study aimed to identify specific risk factors for dyspnea in patients with long COVID. METHODS Hospitalized patients with COVID-19, aged ≥18 years, were enrolled in this multicenter cohort study conducted at 26 medical institutions across Japan. Clinical data during hospitalization and patient-reported outcomes after discharge at the 3, 6, and 12-month follow-ups were retrieved from medical records and paper-based or smartphone application-based questionnaires, respectively. RESULTS Generalized linear mixed model (GLMM) analysis of prolonged dyspnea at each time point during follow-up showed that this symptom was associated with chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.31-5.74), asthma (OR, 2.21; 95%CI, 1.17-4.16), and ventilator management (OR, 3.10; 95%CI, 1.65-5.83). In addition, patients with COPD (44.4%) and ventilator management (25.0%) were more frequently associated with delayed dyspnea onset. The generalized estimating equations analysis results with multiple imputed datasets, conducted as a sensitivity analysis, confirmed the adjusted GLMM analysis results. CONCLUSIONS Prolonged dyspnea was associated with COPD, asthma, and severe infection that required mechanical ventilation in the Japanese population with long COVID. Further investigation is needed to clarify its mechanism and develop prophylactic and therapeutic strategies for dyspnea in patients with long COVID.
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Affiliation(s)
- Emiko Matsuyama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Jun Miyata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan.
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan; Keio Cancer Center, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Toshiki Iwasaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan; Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, 5-1, Higashigaoka 2-chome, Meguro-ku, Tokyo, 152-8902, Japan
| | - Keeya Sunata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan; Department of Infectious Diseases, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan; Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, 9-1, Shirokane 5-chome, Minato-ku, Tokyo, 108-8642, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Keiko Ohgino
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan; Research Centers and Institutes, Health Center, Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Kazuhiro Minami
- Department of Internal Medicine, Saitama Medical Center, 4-9-3 Kita-Urawa, Urawa-ku, Saitama-shi, Saitama, 330-0074, Japan
| | - Rie Hagiwara
- Department of Internal Medicine, Saitama Medical Center, 4-9-3 Kita-Urawa, Urawa-ku, Saitama-shi, Saitama, 330-0074, Japan
| | - Soichiro Ueda
- Department of Internal Medicine, Saitama Medical Center, 4-9-3 Kita-Urawa, Urawa-ku, Saitama-shi, Saitama, 330-0074, Japan
| | - Takashi Yoshiyama
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 1-24, Matsuyama 3-chome, Kiyose-shi, Tokyo, 204-8522, Japan
| | - Hiroyuki Kokuto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 1-24, Matsuyama 3-chome, Kiyose-shi, Tokyo, 204-8522, Japan
| | - Tatsuya Kusumoto
- Department of Pulmonary Medicine, Eiju General Hospital, 3-16, Higashi-Ueno 2-chome, Taito-ku, Tokyo, 110-8645, Japan
| | - Ayano Oashi
- Department of Pulmonary Medicine, Eiju General Hospital, 3-16, Higashi-Ueno 2-chome, Taito-ku, Tokyo, 110-8645, Japan
| | - Masayoshi Miyawaki
- Department of Pulmonary Medicine, Eiju General Hospital, 3-16, Higashi-Ueno 2-chome, Taito-ku, Tokyo, 110-8645, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, 3-16, Higashi-Ueno 2-chome, Taito-ku, Tokyo, 110-8645, Japan
| | - Tetsuo Tani
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 4-17, Mita 1-chome, Minato-ku, Tokyo, 108-0073, Japan
| | - Kota Ishioka
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 4-17, Mita 1-chome, Minato-ku, Tokyo, 108-0073, Japan
| | - Saeko Takahashi
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 4-17, Mita 1-chome, Minato-ku, Tokyo, 108-0073, Japan
| | - Morio Nakamura
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, 4-17, Mita 1-chome, Minato-ku, Tokyo, 108-0073, Japan; Department of Pulmonary Medicine, National Hospital Organization Kanagawa Hospital, 666-1 Ochiai, Hadano, Kanagawa, 257-8585, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicin, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-0016, Japan
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Ekström M, Li PZ, Lewthwaite H, Bourbeau J, Tan WC, Jensen D. Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiologic Responses in Chronic Airflow Limitation. Chest 2024; 166:81-94. [PMID: 38423279 DOI: 10.1016/j.chest.2024.02.034] [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] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. RESEARCH QUESTION How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiologic responses in people with chronic airflow limitation (CAL)? STUDY DESIGN AND METHODS An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output, rate of oxygen uptake, and minute ventilation at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy people; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated. RESULTS We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40-89 years); FEV1/FVC, 57.3% ± 8.2%; FEV1, 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak rate of oxygen uptake < lower limit of normal) was present in 26%. Relative to peak power output, rate of oxygen uptake, and minute ventilation, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiologic abnormalities during CPET. INTERPRETATION Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness.
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Affiliation(s)
- Magnus Ekström
- Division of Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada.
| | - Pei Zhi Li
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada
| | - Hayley Lewthwaite
- Centre of Research Excellence Treatable Traits, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jean Bourbeau
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, 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
| | - Wan C Tan
- Department of Medicine, University of British Columbia Centre for Heart Lung Innovation, Vancouver, BC, 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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Blanco Loures J, Guimarães Assis M, Pereira HLA, Mancuzo EV, Parreira VF. Perception of patients with interstitial lung diseases submitted to inspiratory muscle training. Physiother Theory Pract 2024; 40:1317-1325. [PMID: 36326066 DOI: 10.1080/09593985.2022.2141598] [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: 03/16/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although inspiratory muscle training reduces dyspnea in patients with chronic respiratory diseases, it was not yet evaluated in a sample composed exclusively of patients with interstitial lung diseases. OBJECTIVE To discuss the perception of patients with interstitial lung diseases about inspiratory muscle training intervention. METHODS This is a qualitative study. Data were collected using semi-structured interviews, transcribed, and analyzed by thematic analysis. RESULTS Fourteen patients (64 ± 7 years) with interstitial lung disease were interviewed. Average participation in the inspiratory muscle training program was 90% (range, 66-100%). Three themes were elaborated: 1) dyspnea and other symptoms in daily life (e.g. "I could not carry out a bag; I was very uncomfortable"); 2) less symptom and greater performance (e.g. "I wash and change my clothes, house cleaning, do everything without feeling anything"); and 3) IMT: a time dedicated to my health (e.g. "For me it was great because I saw my evolution every day"). CONCLUSION Patients noticed improvements in symptoms and performance related to daily activities. Despite initial difficulties, patients continued training as planned.
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Affiliation(s)
- Jéssica Blanco Loures
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcella Guimarães Assis
- Department of Occupacional Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Eliane Viana Mancuzo
- Department of Medical Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Bondarenko J, Dal Corso S, Dillon MP, Singh S, Miller BR, Kein C, Holland AE, Jones AW. Clinically important changes and adverse events with centre-based or home-based pulmonary rehabilitation in chronic respiratory disease: A systematic review and meta-analysis. Chron Respir Dis 2024; 21:14799731241277808. [PMID: 39187265 PMCID: PMC11348370 DOI: 10.1177/14799731241277808] [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: 04/08/2024] [Revised: 07/06/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Objectives: To determine the proportion of people who achieve minimal clinically important differences (MCID) with centre-based or home-based pulmonary rehabilitation and to synthesise data on adverse events.Methods: Cochrane reviews and electronic databases were searched to identify randomised trials comparing centre-based to home-based pulmonary rehabilitation, or either model to usual care, in people with chronic respiratory disease. Primary outcomes were the proportion of participants achieving MCIDs in exercise capacity and disease-specific quality of life. Secondary outcomes were symptoms and adverse events. Cochrane Risk of Bias 1.0 and GRADE were used to assess the risk of bias and certainty of evidence respectively.Results: Forty-nine trials were eligible. Compared to usual care, a higher proportion of pulmonary rehabilitation participants achieved the MCID for exercise capacity (6MWT: 47% vs 20%, p = 0.11), dyspnoea (43% vs 29%, p = 0.0001), fatigue (48% vs 27%, p = 0.0002) and emotional function (37% vs 25%, p = 0.02), with all of these between group differences statistically significant except for exercise capacity. There were no differences between centre-based and home-based pulmonary rehabilitation in the proportion of participants who achieved MCIDs (34%- 58% across studies). Ninety percent of trials reported no adverse events. Certainty of evidence was low-to- moderate with all outcomes except for CRQ-mastery (centre-based vs home-based pulmonary rehabilitation, or pulmonary rehabilitation vs usual care in COPD), ESWT (pulmonary rehabilitation vs usual care in COPD) and 6MWT (pulmonary rehabilitation vs usual care in bronchiectasis) where evidence was very uncertain.Discussion: Clinically meaningful outcomes are achieved by similar proportions of participants in centre-based and home-based pulmonary rehabilitation, with few adverse events. Reporting of trial outcomes according to MCIDs is necessary for informed decision making regarding pulmonary rehabilitation models.
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Affiliation(s)
- Janet Bondarenko
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
| | - Simone Dal Corso
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
| | - Michael P Dillon
- Department of Physiotherapy, Podiatry, Prosthetics and orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Sally Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Belinda R Miller
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Caroline Kein
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia
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Ekström M, Li PZ, Lewthwaite H, Bourbeau J, Tan WC, Schiöler L, Brotto A, Stickland MK, Jensen D. Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing. Ann Am Thorac Soc 2024; 21:56-67. [PMID: 37708387 PMCID: PMC10867914 DOI: 10.1513/annalsats.202305-394oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023] Open
Abstract
Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0-10 category ratio) response in men and women aged ⩾40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged ⩾40 years undergoing symptom-limited incremental cycle CPET (10 W/min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories <5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0-10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression. Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (n = 86) of healthy Canadian adults. Results: We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42-91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m2. Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81-0.92, C statistic for women = 0.81-0.96). Conclusions: Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.
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Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Hayley Lewthwaite
- Centre of Research Excellence in Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, New Lambton, New South Wales, Australia
- UniSA: Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Jean Bourbeau
- Montreal Chest Institute and
- Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, McGill University Health Center Research Institute, and
| | - Wan C. Tan
- Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and
| | - Andrew Brotto
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dennis Jensen
- Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, McGill University Health Center Research Institute, and
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Québec, Canada
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Gustafsson D, Elmberg V, Schiöler L, Jensen D, Ekström M. The modified Medical Research Council scale misclassifies exertional breathlessness among people referred for exercise testing. ERJ Open Res 2023; 9:00592-2023. [PMID: 38152083 PMCID: PMC10752288 DOI: 10.1183/23120541.00592-2023] [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: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023] Open
Abstract
Background Exertional breathlessness is a major symptom in cardiorespiratory disease and is often assessed using the modified Medical Research Council (mMRC) questionnaire. The mMRC might underestimate exertional breathlessness in people with impaired exercise capacity who have reduced their physical activity to avoid the symptom. We aimed to evaluate the ability of mMRC to detect abnormally high exertional breathlessness or abnormally low exercise capacity during incremental cycle exercise testing (IET). Methods A secondary analysis of data from a randomised controlled trial of outpatients aged 18 years or older referred for IET was carried out. Participants completed the mMRC before IET. Abnormally high exertional breathlessness was defined as a breathlessness (Borg 0-10) intensity response more than the upper limit of normal. Abnormally low exercise capacity was defined using published reference equations. The sensitivity, specificity, accuracy and discriminative ability of each mMRC rating to detect each outcomewas calculated. Results 92 participants were included; the mean age was 59 years, 61% were male, and 64% and 15% had mMRC 1 and ≥2, respectively. An mMRC ≥2 had the highest accuracy (71%) to detect abnormally high exertional breathlessness, with a specificity of 93% but a sensitivity of only 28%, failing to identify 72% of people with abnormally high exertional breathlessness. The accuracy, specificity and sensitivity for abnormally low exercise capacity was 64%, 88% and 19%, respectively. Conclusion Among people referred for clinical exercise testing, the mMRC dyspnoea scale misclassified exertional breathlessness and exercise capacity assessed using cycle IET, with substantial underdetection. A mMRC dyspnoea rating of 0-1 does not preclude the presence of abnormally high exertional breathlessness or abnormally low exercise capacity.
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Affiliation(s)
- David Gustafsson
- Department of Respiratory Medicine, Allergology and Palliative Medicine, Institution for Clinical Sciences in Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology, Blekinge Hospital, Karlskrona, Sweden
| | - Viktor Elmberg
- Department of Respiratory Medicine, Allergology and Palliative Medicine, Institution for Clinical Sciences in Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology, Blekinge Hospital, Karlskrona, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - 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
| | - Magnus Ekström
- Department of Respiratory Medicine, Allergology and Palliative Medicine, Institution for Clinical Sciences in Lund, Lund University, Lund, Sweden
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Hanada M, Tanaka T, Kozu R, Ishimatsu Y, Sakamoto N, Orchanian-Cheff A, Rozenberg D, Reid WD. The interplay of physical and cognitive function in rehabilitation of interstitial lung disease patients: a narrative review. J Thorac Dis 2023; 15:4503-4521. [PMID: 37691666 PMCID: PMC10482628 DOI: 10.21037/jtd-23-209] [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: 02/12/2023] [Accepted: 07/04/2023] [Indexed: 09/12/2023]
Abstract
Background and Objective Interstitial lung disease (ILD) encompasses several diverse pulmonary pathologies that result in abnormal diffuse parenchymal changes. When prescribing rehabilitation, several additional factors need to be considered as a result of aging, polypharmacy, and comorbidities manifested in ILD patients. This review aims to discuss issues related to frailty, skeletal muscle and cognitive function that limit physical activities in ILD patients. It will also highlight exercise training and propose complementary strategies for pulmonary rehabilitation. Methods A literature search was performed in MEDLINE, CINAHL (inception to October 19th, 2022) using search terms based on concepts of: idiopathic pulmonary fibrosis or interstitial lung disease; frailty; muscular atrophy; skeletal muscle dysfunction; cognitive dysfunction; sleep quality; sleep disorders; anxiety disorders; or depressive disorders. After eligible texts were screened, additional references were included from references cited in the screened articles. Key Content and Findings Frailty and skeletal muscle dysfunction are common in ILD. Weight loss, exhaustion, and anti-fibrotic medications can impact frailty, whereas physical inactivity, aging, corticosteroids and hypoxemia can contribute to sarcopenia (loss of muscle mass and function). Frailty is associated with worse clinical status, exercise intolerance, skeletal muscle dysfunction, and decreased quality of life in ILD. Sarcopenia appears to influence wellbeing and can potentially affect overall physical conditioning, cognitive function and the progression of ILD. Optimal assessment tools and effective strategies to prevent and counter frailty and sarcopenia need to be determined in ILD patients. Even though cognitive impairment is evident in ILD, its prevalence and underlying neurobiological model of contributing factors (i.e., inflammation, disease severity, cardiopulmonary status) requires further investigation. How ILD affects cognitive interference, motor control and consequently physical daily activities is not well defined. Strategies such as pulmonary rehabilitation, which primarily focuses on strength and aerobic conditioning have demonstrated improvements in ILD patient outcomes. Future incorporation of interval training and the integration of motor learning could improve transfer of rehabilitation strategies to daily activities. Conclusions Numerous underlying etiologies of ILD contribute to frailty, skeletal muscle and cognitive function, but their respective neurobiologic mechanisms require further investigation. Exercise training increases physical measures, but complementary approaches may improve their applicability to improve daily activities.
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Affiliation(s)
- Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takako Tanaka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
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Vézina FA, Bouchard PA, Breton-Gagnon É, Dion G, Viglino D, Roy P, Bilodeau L, Provencher S, Denault MH, Saey D, Lellouche F, Maltais F. Automated O 2 Titration Alone or With High-Flow Nasal Cannula During Walking Exercise in Chronic Lung Diseases. Respir Care 2023; 69:respcare.10810. [PMID: 37491073 PMCID: PMC10753602 DOI: 10.4187/respcare.10810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Exercise-induced O2 desaturation contributes to dyspnea and exercise intolerance in various respiratory diseases. This study assessed whether automated O2 titration was superior to fixed-flow O2 to improve exertional dyspnea and walking exercise endurance. We also aimed at evaluating possible additive effects of high-flow nasal cannula coupled with automated O2 titration on these outcomes. METHODS Subjects with chronic respiratory diseases and exercise-induced desaturation performed a 3-min constant-speed shuttle test (CSST) and an endurance shuttle walking test (ESWT) with either (1) fixed-flow O2, (2) automated O2 titration targeting an SpO2 of 94% (± 2%), and (3) automated O2 titration + high-flow nasal cannula according to a randomized sequence. The main outcome was Borg dyspnea score at the end of the 3-min CSST. Secondary outcomes included endurance time and dyspnea during ESWT and oxygenation status during exercise. RESULTS Ten subjects with COPD, 10 with interstitial lung disease, 5 with pulmonary hypertension, and 3 with cystic fibrosis completed the study. Compared to fixed-flow O2, automated O2 titration did not reduce dyspnea at the end of the 3-min CSST. Endurance time during the ESWT was prolonged with automated O2 titration (mean difference 298 [95% CI 205-391] s, P < .001), and dyspnea at isotime was reduced. No further improvement was noted when high-flow nasal cannula was added to automated O2 titration. Compared to fixed-flow O2, O2 flows were higher with automated O2 titration, resulting in better oxygenation. CONCLUSIONS Automated O2 titration was superior to fixed-flow O2 to alleviate dyspnea and improve exercise endurance during the ESWT in subjects with a variety of chronic respiratory diseases. Adding high-flow nasal cannula to automated O2 titration provided no further benefits.
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Affiliation(s)
- Felix-Antoine Vézina
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec City, Québec, Canada
| | - Pierre-Alexandre Bouchard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Émilie Breton-Gagnon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Geneviève Dion
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Damien Viglino
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; and Université Grenoble Alpes, Laboratoire Hypoxie-Physiopathologie HP2 INSERM U1300, Grenoble, France
| | - Pascalin Roy
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Lara Bilodeau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Marie-Hélène Denault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Didier Saey
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - François Lellouche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada.
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9
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Zaki S, Moiz JA, Mujaddadi A, Ali MS, Talwar D. Does inspiratory muscle training provide additional benefits during pulmonary rehabilitation in people with interstitial lung disease? A randomized control trial. Physiother Theory Pract 2023; 39:518-528. [PMID: 35001815 DOI: 10.1080/09593985.2021.2024311] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Interstitial lung disease (ILD) encompasses a diverse group of chronic lung conditions which is often characterized by inspiratory muscle weakness (IMW). Despite the potential importance of inspiratory muscle dysfunction in ILD, the effect of inspiratory muscle training (IMT) added to pulmonary rehabilitation (PR) in ILD largely remains unknown. OBJECTIVE The primary objective of the present study was to evaluate the benefits of IMT added to PR on inspiratory muscle strength and secondary objectives were to assess its effects on functional capacity, health-related quality of life (HRQoL), pulmonary function test (PFT) and dyspnea in ILD along with IMW. METHODS Fifty-one participants were randomly allocated into two groups; PR + IMT (n = 26) or PR alone (n = 25). The primary outcome [maximal inspiratory pressure (PImax)] and secondary outcomes [6-min walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), PFT and modified Medical Research Council dyspnea scale (mMRC)] were evaluated before and after the 8-weeks intervention. Independent t-test or Mann Whitney-U test was applied for between-group comparisons while for within-group comparison Wilcoxon's Sign Rank test or paired t test was performed. RESULTS At the end of 8 weeks exercise intervention inspiratory muscle strength (PImax + 11.10 cm H2O, p< .001), functional capacity (6MWD, + 47.90 m, p= .001), HRQoL (SGRQ-total - 4 points, p= .038) and dyspnea (mMRC dyspnea scale, -1.27, p< .001) improved significantly in PR+IMT group alone. CONCLUSION Inclusion of IMT to PR may have superior benefits as compared to PR alone in ILD accompanied with IMW.
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Affiliation(s)
- Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Okhla, New Delhi, 110025, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Okhla, New Delhi, 110025, India
| | - Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Okhla, New Delhi, 110025, India
| | - Mir Shad Ali
- Department of Pulmonary Rehabilitation, Metro Centre for Respiratory Diseases, Metro Hospital and Multispeciality Institute, Noida, Uttar Pradesh, 201301, India
| | - Deepak Talwar
- Department of Pulmonology Allergy Sleep and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Hospital and Multispeciality Institute, Noida, Uttar Pradesh, 201301, India
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10
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Sharshar R, Zaki O, Younes R, AbdElla A. Role of pulmonary function tests and computed tomography volumetric quantitative analysis in assessment of idiopathic pulmonary fibrosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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11
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Hun Kim S, Beom Shin Y, Shin MJ, Hui Hong C, Huh S, Yoo W, Lee K. Effects of walking with a portable oxygen concentrator on muscle oxygenation while performing normal or pursed-lip breathing in patients with interstitial lung disease: a randomized crossover trial. Ther Adv Respir Dis 2023; 17:17534666231186732. [PMID: 37462163 DOI: 10.1177/17534666231186732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND In patients with interstitial lung disease (ILD), decreased oxygen saturation (SpO2) reduces physical performance and causes exertional dyspnea. Portable oxygen concentrator (POC) and pursed-lip breathing (PLB) have the potential to improve these parameters in ILD patients. OBJECTIVE To evaluate the effects of PLB while using a POC during walking in ILD patients. DESIGN Prospective, randomized crossover trial. METHODS We compared two breathing techniques. Participants not trained in PLB received a familiarization session before the first 6-min walking test (6MWT). During the first visit, patients performed the 6MWT under natural breathing (NB1) without oxygen (O2); during the second visit, they performed the 6MWT twice, once each with PLB (PLB1) and natural breathing (NB2) under O2 supplementation, to compare the effectiveness of NB and PLB. RESULTS Twenty participants were recruited; half had exercise-induced desaturation (EID) and half normal SpO2. In the normoxemia group (NG), the difference in the 6-min walking distance (6MWD) between NB1 and PLB1 was 28.8 ± 24.0 m, indicating reduced exercise capacity in PLB1. There were no significant differences in the quadriceps tissue saturation index (TSI), SpO2, and 6MWD between the PLB1 and NB2 in any patient or subgroup. All participants showed a significant increase in the SpO2 at rest, nadir SpO2, and mean SpO2 during the 6MWT with PLB and NB2 using a POC than with NB1. TSI showed a significant improvement at the beginning of 6MWT in ILD patients with EID in the PLB and NB2 condition. CONCLUSION Acute exposure to PLB did not improve symptoms, muscle oxygenation, or SpO2; however, it decreased the walking distance in the normoxemia group. POC improved leg muscle oxygenation in ILD patients with EID. The use of PLB and POC should be prescribed according to disease characteristics and severity.
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Affiliation(s)
- Sang Hun Kim
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Myung-Jun Shin
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Cho Hui Hong
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Physical Therapy, Graduate School, Kyungsung University, Busan, Republic of Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wanho Yoo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kwangha Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea. Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
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12
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Tomlinson OW, Markham L, Wollerton RL, Knight BA, Duckworth A, Gibbons MA, Scotton CJ, Williams CA. Validity and repeatability of cardiopulmonary exercise testing in interstitial lung disease. BMC Pulm Med 2022; 22:485. [PMID: 36550475 PMCID: PMC9784077 DOI: 10.1186/s12890-022-02289-0] [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: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET), and its primary outcome of peak oxygen uptake (VO2peak), are acknowledged as biomarkers in the diagnostic and prognostic management of interstitial lung disease (ILD). However, the validity and repeatability of CPET in those with ILD has yet to be fully characterised, and this study fills this evidence gap. METHODS Twenty-six people with ILD were recruited, and 21 successfully completed three CPETs. Of these, 17 completed two valid CPETs within a 3-month window, and 11 completed two valid CPETs within a 6-month window. Technical standards from the European Respiratory Society established validity, and repeatability was determined using mean change, intraclass correlation coefficient and typical error. RESULTS Every participant (100%) who successfully exercised to volitional exhaustion produced a maximal, and therefore valid, CPET. Approximately 20% of participants presented with a plateau in VO2, the primary criteria for establishing a maximal effort. The majority of participants otherwise presented with secondary criteria of respiratory exchange ratios in excess of 1.05, and maximal heart rates in excess of their predicted values. Repeatability analyses identified that the typical error (expressed as percent of coefficient of variation) was 20% over 3-months in those reaching volitional exhaustion. CONCLUSION This work has, for the first time, fully characterised how patients with ILD respond to CPET in terms of primary and secondary verification criteria, and generated novel repeatability data that will prove useful in the assessment of disease progression, and future evaluation of therapeutic regimens where VO2peak is used as an outcome measure.
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Affiliation(s)
- Owen W. Tomlinson
- grid.8391.30000 0004 1936 8024Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Laura Markham
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Rebecca L. Wollerton
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Bridget A. Knight
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,grid.477603.1NIHR Exeter Clinical Research Facility, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
| | - Anna Duckworth
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Michael A. Gibbons
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Chris J. Scotton
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Craig A. Williams
- grid.8391.30000 0004 1936 8024Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
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13
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Amin R, Maiya GA, Mohapatra AK, Acharya V, Alison JA, Dale M, Vaishali K. Effect of a home-based pulmonary rehabilitation program on functional capacity and health-related quality of life in people with interstitial lung disease – A randomized controlled trial protocol. Respir Med 2022; 201:106927. [DOI: 10.1016/j.rmed.2022.106927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 01/17/2023]
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14
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Glaab T, Taube C. Practical guide to cardiopulmonary exercise testing in adults. Respir Res 2022; 23:9. [PMID: 35022059 PMCID: PMC8754079 DOI: 10.1186/s12931-021-01895-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Unexplained exertional dyspnoea or fatigue can arise from a number of underlying disorders and shows only a weak correlation with resting functional or imaging tests. Noninvasive cardiopulmonary exercise testing (CPET) offers a unique, but still under-utilised and unrecognised, opportunity to study cardiopulmonary and metabolic changes simultaneously. CPET can distinguish between a normal and an abnormal exercise response and usually identifies which of multiple pathophysiological conditions alone or in combination is the leading cause of exercise intolerance. Therefore, it improves diagnostic accuracy and patient health care by directing more targeted diagnostics and facilitating treatment decisions. Consequently, CPET should be one of the early tests used to assess exercise intolerance. However, this test requires specific knowledge and there is still a major information gap for those physicians primarily interested in learning how to systematically analyse and interpret CPET findings. This article describes the underlying principles of exercise physiology and provides a practical guide to performing CPET and interpreting the results in adults.
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Affiliation(s)
- Thomas Glaab
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany.
- MVZ Urdenbacher Allee, Düsseldorf, Germany.
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
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15
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Gille T, Laveneziana P. Cardiopulmonary exercise testing in interstitial lung diseases and the value of ventilatory efficiency. Eur Respir Rev 2021; 30:30/162/200355. [PMID: 34853093 DOI: 10.1183/16000617.0355-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/26/2021] [Indexed: 12/27/2022] Open
Abstract
Interstitial lung diseases (ILDs) are diverse parenchymal pulmonary disorders, primarily characterised by alveolar and interstitial inflammation and/or fibrosis, and sharing pathophysiological similarities. Thus, patients generally harbour common respiratory symptoms, lung function abnormalities and modified exercise adaptation. The most usual and disabling complaint is exertional dyspnoea, frequently responsible for premature exercise interruption. Cardiopulmonary exercise testing (CPET) is increasingly used for the clinical assessment of patients with ILD. This is because exercise performance or dyspnoea on exertion cannot reliably be predicted by resting pulmonary function tests. CPET, therefore, provides an accurate evaluation of functional capacity on an individual basis. CPET can unmask anomalies in the integrated functions of the respiratory, cardiovascular, metabolic, peripheral muscle and neurosensory systems in ILDs. CPET uniquely provides an evaluation of all above aspects and can help clinicians shape ILD patient management. Preliminary evidence suggests that CPET may also generate valuable prognostic information in ILDs and can be used to shed light on the presence of associated pulmonary hypertension. This review aims to provide comprehensive and updated evidence concerning the clinical utility of CPET in ILD patients, with particular focus on the physiological and clinical value of ventilatory efficiency (V˙E/V˙CO2 ).
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Affiliation(s)
- Thomas Gille
- Université Sorbonne Paris Nord (USPN), INSERM, UMR 1272 Hypoxia & the Lung, UFR SMBH Léonard de Vinci, Bobigny, France .,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Paris-Seine-Saint-Denis (GHUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles du Département Médico-Universitaire NARVAL, Bobigny, France
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Assistance Publique - Hôpitaux de Paris (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
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16
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Vonbank K, Lehmann A, Bernitzky D, Gysan MR, Simon S, Krotka P, Zwick RH, Idzko M, Burtscher M. Comparison of heart rates at fixed percentages and the ventilatory thresholds in patients with interstitial lung disease. Scand J Med Sci Sports 2021; 32:754-764. [PMID: 34923682 PMCID: PMC9304263 DOI: 10.1111/sms.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Heart rate (HR) responses to maximal exercise are commonly used for the prescription of training intensities in pulmonary rehabilitation. Those intensities are usually based on fixed percentages of peak HR (HRpeak), heart rate reserve (HRR), or peak work load (Wpeak), and rarely on HRs at the individual ventilatory thresholds (VT1 and VT2) derived from cardiopulmonary exercise testing (CPET). For patients suffering from interstitial lung disease (ILD), data on cardiorespiratory responses to CPET are scarce. Thus, the aim of this study was to record cardiorespiratory responses to CPET and to compare fixed HR percentages with HRs at VT1 and VT2 in ILD patients. A total of 120 subjects, 80 ILD patients and 40 healthy controls, underwent a symptom‐limited CPET. From the ILD patient, 32 suffered from idiopathic pulmonary fibrosis (IPF), 37 from connective tissue disease (CTD), and 11 from sarcoidosis. HRs at fixed percentages, that is, at 70%HRpeak, at 70%Wpeak, and at 60%HRR were significantly lower in the ILD patients compared with the control group (p‐values: 0.001, 0.044, and 0.011). Large percentages of HR values at 70%Wpeak and 60%HRR ranged between the HRs at VT1 and VT2 in ILD subgroups and controls as well. HRs at 70%HRpeak were lower than HRs at VT1 in 66% of the IPF patients, 54% of the CTD patients, and 55% of patients with sarcoidosis compared with 18% in the control group. Our findings demonstrate a considerable scattering of fixed HR percentages compared with HRs at the individual VTs derived from CPET in ILD patients. These findings may provide valuable information for the prescription of exercise intensity in pulmonary rehabilitation of ILD patients.
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Affiliation(s)
- Karin Vonbank
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Antje Lehmann
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Bernitzky
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Simon
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Pavla Krotka
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ralf-Harun Zwick
- ThermeWienMed, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Marco Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Burtscher
- Department of Sports Sciences, Medical Section, University of Innsbruck, Innsbruck, Austria
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17
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Mendes RG, Castello-Simões V, Trimer R, Garcia-Araújo AS, Gonçalves Da Silva AL, Dixit S, Di Lorenzo VAP, Archiza B, Borghi-Silva A. Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:744102. [PMID: 36188788 PMCID: PMC9397914 DOI: 10.3389/fresc.2021.744102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022]
Abstract
Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients.
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Affiliation(s)
- Renata G. Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
- *Correspondence: Renata G. Mendes
| | - Viviane Castello-Simões
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Renata Trimer
- Cardiorespiratory Rehabilitation Laboratory, Health Sciences Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Adriana S. Garcia-Araújo
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Andrea Lucia Gonçalves Da Silva
- Cardiorespiratory Rehabilitation Laboratory, Health Sciences Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Valéria Amorim Pires Di Lorenzo
- Laboratory of Spirometry and Respiratory Physiotherapy, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Bruno Archiza
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
- Audrey Borghi-Silva
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18
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Badenes-Bonet D, Cejudo P, Rodó-Pin A, Martín-Ontiyuelo C, Chalela R, Rodríguez-Portal JA, Vázquez-Sánchez R, Gea J, Duran X, Caguana OA, Rodriguez-Chiaradia DA, Balcells E. Impact of high-flow oxygen therapy during exercise in idiopathic pulmonary fibrosis: a pilot crossover clinical trial. BMC Pulm Med 2021; 21:355. [PMID: 34749699 PMCID: PMC8573951 DOI: 10.1186/s12890-021-01727-9] [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: 08/19/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT. METHODS This was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO2) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO2) and respiratory and leg symptoms. RESULTS Ten IPF patients [71.7 (6) years old, 90% males] were included. FVC and DLCO were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO2 during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices. CONCLUSIONS This is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.
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Affiliation(s)
- Diana Badenes-Bonet
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Pilar Cejudo
- Grupo CB17/06/00030, Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Sevilla, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, University Hospital Virgen del Rocío, Sevilla, Spain.,Biomedical Institute of Seville (IBIS), Sevilla, Spain
| | - Anna Rodó-Pin
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain
| | - Clara Martín-Ontiyuelo
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Roberto Chalela
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jose Antonio Rodríguez-Portal
- Grupo CB17/06/00030, Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Sevilla, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, University Hospital Virgen del Rocío, Sevilla, Spain.,Biomedical Institute of Seville (IBIS), Sevilla, Spain
| | - Rosa Vázquez-Sánchez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Joaquim Gea
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,Grupo CB06/06/0043, Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Xavier Duran
- Scientific, Statistics and Technical Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Oswaldo Antonio Caguana
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain
| | - Diego Agustín Rodriguez-Chiaradia
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain. .,Pompeu Fabra University (UPF), Barcelona, Spain. .,Grupo CB06/06/0043, Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. .,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Eva Balcells
- Respiratory Department, Servei de Pneumologia, Hospital del Mar, Passeig Marítim 27, 08003, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,Grupo CB06/06/0043, Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Alyami RM, Alhowikan AM. Effect of supervised exercise training on exercise capacity, pulmonary function and growth differentiation factor 15 levels in patients with interstitial lung disease: A preliminary study. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Interstitial lung disease is characterized by exertion dyspnea, exercise limitation and reduced quality of life. The role of exercise training in this diverse patient group is unclear. The growth differentiation factor 15 (GDF15) is a stress-sensitive circulating factor that regulates systemic energy balance and could be a possible biomarker in interstitial lung disease. OBJECTIVE: To evaluate the effect of supervised exercise (endurance and resistance) training (SET) on exercise capacity, pulmonary function parameters and GDF15 levels in patients with interstitial lung disease (PwILD). METHODS: In this non-randomized case-control trial, the experimental group comprised of 10 PwILD (7 women and 3 men) while the control group consisted of of 18 apparently healthy participants s 11 women and 7 men). All subjects completed an 8-week supervised exercise training program, at a rate of twice a week. Dyspnea was evaluated using the Shortness of Breath Respiratory Questionnaire. Exercise capacity was measured using the 6-min walk test while the heart rate (HR) was monitored before and after the exercise training. GDF15 levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS: PwILD had significantly shorter 6-min walk distance than the control subjects at both the 1st and the 15th visit. However, both groups improved significantly in this test. The change (pre to post-exercise) in HR value was smaller in PwILD compared to the controls. Moreover, PwILD had higher Shortness of Breath Respiratory Questionnaire score than controls. While the mean pre-post GDF15 change values in both groups remained statistically unchanged the GDF15 values of the PwILD patients were significantly higher compared to the controls with respect to pre-post exercise training respectively. CONCLUSION: Supervised exercise training did not affect GDF15 levels in both patient and control groups but its values in PwILD were significantly higher compared to those of controls (p⩽0.05). The exercise capacity and dyspnea in these patients improved after exercise training program.
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Affiliation(s)
- Rahmah Mohammad Alyami
- College of Medicine, Department of Physiology, King Saud University, Riyadh, Saudi Arabia
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20
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Dipla K, Boutou AK, Markopoulou A, Papadopoulos S, Kritikou S, Pitsiou G, Stanopoulos I, Kioumis I, Zafeiridis A. Differences in cerebral oxygenation during exercise in patients with idiopathic pulmonary fibrosis with and without exertional hypoxemia: does exercise intensity matter? Pulmonology 2021; 29:221-229. [PMID: 34274251 DOI: 10.1016/j.pulmoe.2021.06.006] [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: 01/20/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Patients with idiopathic pulmonary fibrosis (IPF) present respiratory derangements at rest and during exercise, accompanied by exercise intolerance. Some patients may develop profound exertional desaturation even without resting hypoxemia. Evidence suggests the involvement of reduced cerebral-oxygenation in exercise intolerance. We aimed to examine (i) differences in cerebral-oxygenation during exercise between IPF patients with and without isolated exertional desaturation, (ii) whether the impairments in cerebral-oxygenation are detected at similar exercise intensity, and (iii) correlations between cerebral-oxygenation indices, disease severity, and 6-min walk test (6MWT). MATERIALS AND METHODS Patients with IPF (n = 24; 62.1 ± 9.3 years) without resting hypoxemia underwent cardiopulmonary exercise testing (CPET) with cerebral-oxygenation monitoring via near-infrared-spectroscopy (NIRS). Βased on their pulse-oxymetry saturation (SpO2) during CPET, patients were divided into the "exertional-desaturators" group (SpO2nadir≤89% and ≥6% drop in SpO2) and the "non-exertional-desaturators" group (SpO2nadir≥90% and ≤5% drop). RESULTS During CPET, the "exertional-desaturators" group exhibited lower oxygenated-hemoglobin (-0.67 ± 1.48 vs. 0.69 ± 1.75 μmol/l; p < 0.05) and higher deoxygenated-hemoglobin (1.67 ± 1.13 vs. 0.17 ± 0.62 μmol/l; p < 0.001) than the "non-exertional-desaturators" group. A different pattern (p < 0.01) in cerebral-oxygenation responses was observed in the two groups. In exertional-desaturators oxygenated-hemoglobin declined below baseline even at low/moderate-intensity exercise (p < 0.05), whereas, in non-exertional-desaturators cerebral-oxygenation declined (p < 0.05) at high-intensity exercise. Cerebral-NIRS indices correlated (p < 0.05) with CPET-duration, dyspnea, diffusion capacity, and 6MWT. CONCLUSIONS During incremental exercise, patients with IPF and exertional desaturation present a significant decline in cerebral-oxygenation even during low-intensity exercise. Our findings support the implementation of longer-duration rehabilitation programs in IPF so that lower intensity exercise can be applied at the initial stages. (NCT03683082).
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Affiliation(s)
- Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Ippokratous 22, Ag. Ioannis, Serres 621 22, Greece.
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Stavros Papadopoulos
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Ippokratous 22, Ag. Ioannis, Serres 621 22, Greece
| | - Stella Kritikou
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Ippokratous 22, Ag. Ioannis, Serres 621 22, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Dept. of Sport Sciences at Serres, Aristotle University of Thessaloniki, Ippokratous 22, Ag. Ioannis, Serres 621 22, Greece
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21
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Tomlinson O, Duckworth A, Markham L, Wollerton R, Knight B, Spiers A, Gibbons M, Williams C, Scotton C. Feasibility of cardiopulmonary exercise testing in interstitial lung disease: the PETFIB study. BMJ Open Respir Res 2021; 8:8/1/e000793. [PMID: 33926958 PMCID: PMC8094359 DOI: 10.1136/bmjresp-2020-000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiopulmonary exercise testing (CPET) provides a series of biomarkers, such as peak oxygen uptake, which could assess the development of disease status in interstitial lung disease (ILD). However, despite use in research and clinical settings, the feasibility of CPET in this patient group has yet to be established. Methods Twenty-six patients with ILD (19 male) were recruited to this study. Following screening for contraindications to maximal exercise, participants underwent an incremental CPET to volitional exhaustion. Feasibility of CPET was assessed by the implementation, practicality, acceptability and demand, thus providing clinical-driven and patient-driven information on this testing procedure. Results Of the 26 recruited participants, 24 successfully completed at least one CPET, with 67/78 prospective tests being completed. Contraindications included hypertension, low resting oxygen saturation and recent pulmonary embolism. Of the CPETs undertaken, 63% successfully reached volitional exhaustion, with 31% being terminated early by clinicians due to excessive desaturation. Quantitative and qualitative feedback from participants revealed a positive experience of CPET and desire for it to be included as a future monitoring tool. Conclusion CPET is feasible in patients with ILD. Identification of common clinical contraindications, and understanding of patient perspectives will allow for effective design of future studies utilising CPET as a monitoring procedure.
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Affiliation(s)
- Owen Tomlinson
- Sport and Health Science, University of Exeter, Exeter, UK.,Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Anna Duckworth
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Laura Markham
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Rebecca Wollerton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Bridget Knight
- Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Alexander Spiers
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Michael Gibbons
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Craig Williams
- Sport and Health Science, University of Exeter, Exeter, UK.,Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Scotton
- Academic Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK .,Institute of Biomedical & Clinical Science, College of Medicine & Health, University of Exeter, Exeter, UK
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22
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Zamboti CL, Gonçalves AFL, Garcia T, Krinski GG, Bertin LD, Almeida HDS, Pimpão HA, Fujisawa DS, Ribeiro M, Pitta F, Camillo CA. Functional performance tests in interstitial lung disease: Impairment and measurement properties. Respir Med 2021; 184:106413. [PMID: 33991844 DOI: 10.1016/j.rmed.2021.106413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is limited information regarding impairment in functional performance tests and their measurement properties in ILD. The present study aimed to verify the impairment and measurement properties of functional performance tests in ILD. METHODS ILD and healthy individuals underwent assessments of pulmonary function, peripheral muscle strength (handgrip force and maximum isometric contraction of quadriceps femoris - MIVCq) and exercise capacity (6-min walk test - 6MWT). Functional performance was assessed by timed-up-and-go with usual (TUGu) and fast (TUGf) gait speeds, 4-m gait speed (4MGS), sit-to-stand in 30 s (30sec-STS), 1 min (1min-STS) and with 5 repetition (5rep-STS) and Short Physical Performance Battery (SPPB). Functional performance was compared between groups, validity (correlation with 6MWT and MIVCq) and reliability of tests were checked in subjects with ILD (intra- and inter-rater agreement analysis). RESULTS Seventy-six participants (40 ILD [25 women, 61 ± 11 years, FVC 75 ± 17 %pred] and 36 healthy [22 women, 61 ± 9 years, FVC 97 ± 11 %pred]) were included. Functional performance in ILD was worse than in healthy individuals in all tests, except for the 30sec-STS (p = 0.13). Pre-specified validity criteria were reached for TUGu, TUGf, 4MGS and 5rep-STS (-0.69 < r < 0.55; p < 0.05 for all). Except for 4MGS and SPPB, all tests showed good to excellent inter-rater (0.85 < ICC<0.93; p < 0.05 for all) and all tests showed good to excellent intra-rater (0.83 < ICC< 0.94; p < 0.05 for all) reliability. CONCLUSIONS Subjects with ILD present worse functional performance than healthy individuals. According to reliability and validity results, TUGu, TUGf and 5rep-STS seem to be the most appropriate tests to evaluate functional performance in ILD.
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Affiliation(s)
- Camile Ludovico Zamboti
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Aline Ferreira Lima Gonçalves
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Thatielle Garcia
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Gabriela Garcia Krinski
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Larissa Dragonetti Bertin
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Heloiza Dos Santos Almeida
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Heloise Angélico Pimpão
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Dirce Shizuko Fujisawa
- Post-graduation Program in Rehabilitation Sciences, Centre of Research and Post-graduation, State University of Londrina, Londrina, Brazil
| | - Marcos Ribeiro
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Carlos Augusto Camillo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil; Department of Rehabilitation Sciences, University Pitágoras UNOPAR, Londrina, Brazil.
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23
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Dipla K, Boutou AK, Markopoulou A, Pitsiou G, Papadopoulos S, Chatzikosti A, Stanopoulos I, Zafeiridis A. Exertional Desaturation in Idiopathic Pulmonary Fibrosis: The Role of Oxygen Supplementation in Modifying Cerebral-Skeletal Muscle Oxygenation and Systemic Hemodynamics. Respiration 2021; 100:463-475. [PMID: 33784706 DOI: 10.1159/000514320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with idiopathic pulmonary fibrosis (IPF) with isolated exertional desaturation, there are limited data regarding the effectiveness of oxygen supplementation during exercise training; the underlying mechanisms that contribute to these responses are unknown. OBJECTIVES To examine in these IPF patients the effects of oxygen supplementation during submaximal exercise (vs. medical air) on cerebral/skeletal muscle oxygenation and systemic hemodynamics. METHODS In this randomized, cross-over, placebo-controlled trial, IPF patients (n = 13; 63.4 ± 9.6 years) without resting hypoxemia but a significant desaturation during maximal cardiopulmonary exercise testing underwent 2 steady-state exercise trials (65% peak-work-load), breathing either oxygen-enriched or medical air. Cerebral/skeletal muscle oxygenation (near-infrared spectroscopy) and beat-by-beat hemodynamics (photoplethysmography) were monitored. RESULTS In the air protocol, from the initial minutes of submaximal exercise, patients exhibited a marked decline in cerebral oxygenated hemoglobin (O2Hb) and an abrupt rise in deoxygenated hemoglobin (HHb). Oxygen supplementation alleviated desaturation, lessened dyspnea, and prolonged exercise duration (p < 0.01). Oxygen supplementation during exercise (i) attenuated cerebral deoxygenation (cerebral-HHb: 0.7 ± 1.9 vs. 2.5 ± 1.5 μmol/L, O2 and air protocol; p = 0.009) and prevented cerebral-Hbdifference decline (2.1 ± 2.7 vs. -1.7 ± 2.0 μmol/L; p = 0.001), (ii) lessened the decline in muscle O2-saturation index, and (iii) at isotime exercise, it resulted in lower muscle-HHb (p = 0.05) and less leg fatigue (p < 0.05). No differences between protocols were observed in exercise cardiac output and vascular resistance. CONCLUSIONS IPF patients with isolated exertional hypoxemia exhibit an inability to increase/maintain cerebral oxygenation during submaximal exercise. Correcting desaturation with O2 supplementation prevented the decline in brain oxygenation, improved muscle oxygenation, and lessened dyspnea, suggesting an efficacy of acute oxygen supplementation during exercise training in protecting brain hypoxia in these IPF patients.
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Affiliation(s)
- Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | | | - Georgia Pitsiou
- Department of Respiratory Failure, "G. Papanikolaou" Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Papadopoulos
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Anastasia Chatzikosti
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Ioannis Stanopoulos
- Department of Respiratory Failure, "G. Papanikolaou" Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
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Kolta MF, Goneimy MBI. Visual and quantitative assessment of HRCT pulmonary changes in idiopathic interstitial pneumonia with PFT correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Our study was designed to correlate the degree of parenchymal affection in idiopathic interstitial pneumonia using visual and semi-quantitative HRCT assessment with pulmonary function test results.
The study involved 50 patients diagnosed as idiopathic interstitial pneumonia. They were referred from a chest outpatient clinic to the Radiology Department in the Faculty of Medicine, Cairo University for HRCT assessment in the period from January 2017 to March 2019. Variable lung parenchymal affection was studied using HRCT and variable post acquisition processing (multi-planar reconstruction, volumetric assessment, 3D color-coded images).
Results
Usual interstitial pneumonia was the most common type of IP, found in approximately 40 patients (80% of cases) followed by nonspecific interstitial pneumonia found in 5 patients (10% of cases) and lymphocytic interstitial pneumonia found in 3 patients (6% of cases), and desquamative interstitial pneumonia was the least common type of IP, found only in 2 patients (4% of cases).
Honeycombing was significantly correlated with FVC%, FEV1%, and FEV1/FVC% (p = 0.013, p = <0.001, p = 0.002 respectively). Also, reticular was significantly correlated with FVC% (p = 0.041).
Conclusion
Semi-quantitative image analysis, including the use of machine learning, provides a great deal of promise in the ILD field; such methods may be used together with visual analysis to obtain the most accurate diagnostic and prognostic information.
Summary/keywords
HRCT is most sensitive in the detection of ILD than chest radiography or conventional chest computed tomography (CT). Advances in HRCT scanning and interpretation have facilitated and improved accuracy for use in diagnosing idiopathic pulmonary fibrosis (IPF), eliminating the need for a surgical biopsy in many patients. Consequently, HRCT scans became sufficient to allow a confident IPF diagnosis
It is important to note that there are potential differences in interpretation of HRCT patterns between thoracic radiologists. However, these differences seem to be in general within a clinically acceptable range of observer variation and can be partially mitigated by review of difficult cases at ILD referral centers.
Semi-quantitative CT assessment is increasingly being used in ILD to identify pulmonary abnormalities and diagnose specific ILDs; recent studies showed that outcomes of computer-assisted imaging can be correlated with lung function tests and degree of dyspnea and functional disability
This study was designed to correlate the degree of parenchymal affection in IP using visual and semi-quantitative HRCT assessment with PFT results. Semi-quantitative imaging, including color-coded images (HU related), is a new and promising approach in the field of ILD diagnosis and prognosis.
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25
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Barratt SL, Davis R, Sharp C, Pauling JD. The prognostic value of cardiopulmonary exercise testing in interstitial lung disease: a systematic review. ERJ Open Res 2020; 6:00027-2020. [PMID: 32832530 PMCID: PMC7430148 DOI: 10.1183/23120541.00027-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
The heterogeneity of interstitial lung disease (ILD) results in prognostic uncertainty concerning end-of-life discussions and optimal timing for transplantation. Effective prognostic markers and prediction models are needed. Cardiopulmonary exercise testing (CPET) provides a comprehensive assessment of the physiological changes in the respiratory, cardiovascular and musculoskeletal systems in a controlled laboratory environment. It has shown promise as a prognostic factor for other chronic respiratory conditions. We sought to evaluate the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. MEDLINE, Embase and the Cochrane Database of Systematic Reviews were used to identify studies reporting the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. Study quality was assessed using the Quality in Prognosis Study risk of bias tool. Thirteen studies were included that reported the prognostic value of CPET in ILD. All studies reported at least one CPET parameter predicting clinical outcomes in ILD, with survival being the principal outcome assessed. Maximum oxygen consumption, reduced ventilatory efficiency and exercise-induced hypoxaemia were all reported to have prognostic value in ILD. Issues with study design (primarily due to inherent problems of retrospective studies, patient selection and presentation of numerous CPET parameters), insufficient adjustment for important confounders and inadequate statistical analyses limit the strength of the conclusions that can be drawn at this stage. There is insufficient evidence to confirm the value of CPET in facilitating “real-world” clinical decisions in ILD. Additional prospective studies are required to validate the putative prognostic associations reported in previous studies in carefully phenotyped patient populations. There is presently insufficient evidence to confirm the value of CPET in facilitating “real-world” clinical decisions in ILD. Additional prospective studies are required to validate the putative prognostic associations reported in previous studies.https://bit.ly/3dfp5kq
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Affiliation(s)
- Shaney L Barratt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.,Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Westbury-on-Trym, Bristol, UK
| | - Richard Davis
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Charles Sharp
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - John D Pauling
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, UK
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Molgat-Seon Y, Schaeffer MR, Ryerson CJ, Guenette JA. Cardiopulmonary Exercise Testing in Patients With Interstitial Lung Disease. Front Physiol 2020; 11:832. [PMID: 32754054 PMCID: PMC7365876 DOI: 10.3389/fphys.2020.00832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022] Open
Abstract
Interstitial lung disease (ILD) is a heterogeneous group of conditions characterized by fibrosis and/or inflammation of the lung parenchyma. The pathogenesis of ILD consistently results in exertional dyspnea and exercise intolerance. Cardiopulmonary exercise testing (CPET) provides important information concerning the pathophysiology of ILD that can help inform patient management. Despite the purported benefits of CPET, its clinical utility in ILD is not well defined; however, there is a growing body of evidence that provides insight into the potential value of CPET in ILD. Characteristic responses to CPET in patients with ILD include exercise-induced arterial hypoxemia, an exaggerated ventilatory response, a rapid and shallow breathing pattern, critically low inspiratory reserve volume, and elevated sensations of dyspnea and leg discomfort. CPET is used in ILD to determine cause(s) of symptoms such as exertional dyspnea, evaluate functional capacity, inform exercise prescription, and determine the effects of pharmacological and non-pharmacological interventions on exercise capacity and exertional symptoms. However, preliminary evidence suggests that CPET in ILD may also provide valuable prognostic information and can be used to ascertain the degree of exercise-induced pulmonary hypertension. Despite these recent advances, additional research is required to confirm the utility of CPET in patients with ILD. This brief review outlines the clinical utility of CPET in patients with ILD. Typical patterns of response are described and practical issues concerning CPET interpretation in ILD are addressed. Additionally, important unanswered questions relating to the clinical utility of CPET in the assessment, prognostication, and management of patients with ILD are identified.
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Affiliation(s)
- Yannick Molgat-Seon
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Alyami RM, Alhowikan AM, Alharbi AR, AL-Nafisah G. Impact of supervised exercise training on pulmonary function parameters, exercise capacity and Irisin Biomarker in Interstitial lung disease patients. Pak J Med Sci 2020; 36:1089-1095. [PMID: 32704295 PMCID: PMC7372690 DOI: 10.12669/pjms.36.5.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To assess the impact of supervised exercise training (SET) on pulmonary function Parameters, exercise capacity and Irisin biomarker in Interstitial Lung Disease (ILD) patients. METHODS Ten (10)patients with ILD and 18 healthy controls of age between 30-40+ years were selected for 8-week SET program. Before and after SET all subjects performed exercise capacity six minutes' walk test (6MWT), heart rate (HR) changes were recorded, shortness of Breath Respiratory Questionnaire (SOBQ) was obtained and Irisin levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA). This interventional study was carried out at Department of Physiology, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, from October 2018 to February 2019. RESULTS Mean six minutes' walk distance (6MWD) was 395 ± 68.4 m at 1st visit increased significantly (p=0.001) to 458.8± 87.1 mat 15 visit. However, 6MWD values found significantly higher in controls (517.4±84.1 m; 561.7±81.6 m; p=0.013) than ILD patients. Overall change (difference between post and pre exercise) in HRvalue was recorded lower in ILD patients (30-35 bpm) as compared to controls (40-45 bpm). Moreover, ILD patients had overall higher SOBQ score than controls. Pre SET Irisin levels of ILD patients (4.24 ±1.73 pg/ml) and controls (3.43 ±1.04pg/ml) were found unchanged dafter SET (4.48±2.02pg/ml, 3.39 ±1.41pg/ml, p=0.677, p=0.093)respectively. However, patients Irisin values were found higher as compared to controls before and after SET. CONCLUSION Exercise capacity and Dyspneain patients with ILD were improved after 8-week of SET program. No major changes in Irisin levels among patients with ILD and controls were observed. Additional research requires to be carried out on large number of subjects to deter Minutese the advantages of exercise in ILD.
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Affiliation(s)
- Rahma Mohammad Alyami
- Rahma Mohammad Alyami, MS. College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdulrahman Mohammed Alhowikan
- Abdulrahman Mohammed Alhowikan, PhD. Department of Physiology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Rashed Alharbi
- Abdullah Rashed Alharbi, MBBS. Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada AL-Nafisah
- Ghada AL-Nafisah, MS. Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Neder JA, Berton DC, O'Donnell DE. The Lung Function Laboratory to Assist Clinical Decision-making in Pulmonology: Evolving Challenges to an Old Issue. Chest 2020; 158:1629-1643. [PMID: 32428514 DOI: 10.1016/j.chest.2020.04.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
The lung function laboratory frequently provides relevant information to the practice of pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has been complicated more recently by temporal changes in demographic characteristics (higher life expectancy), anthropometric attributes (increased obesity prevalence), and the surge of polypharmacy in a sedentary population with multiple chronic degenerative diseases. In this narrative review, we concisely discuss some key challenges to test interpretation that have been affected by these epidemiologic shifts: (a) the confounding effects of advanced age and severe obesity, (b) the contemporary controversies in the diagnosis of obstruction (including asthma and/or COPD), (c) the importance of considering the diffusing capacity of the lung for carbon monoxide (Dlco)/"accessible" alveolar volume (carbon monoxide transfer coefficient) in association with Dlco to uncover the causes of impaired gas exchange, and (d) the modern role of the pulmonary function laboratory (including cardiopulmonary exercise testing) in the investigation of undetermined dyspnea. Following a Bayesian perspective, we suggest interpretative algorithms that consider the pretest probability of abnormalities as indicated by additional clinical information. We, therefore, adopt a pragmatic approach to help the practicing pulmonologist to apply the information provided by the lung function laboratory to the care of individual patients.
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Affiliation(s)
- J Alberto Neder
- Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada.
| | - Danilo C Berton
- Division of Respirology, Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denis E O'Donnell
- Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
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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: 1.3] [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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Schulze AB, Evers G, Kümmel A, Rosenow F, Sackarnd J, Hering JP, Schülke C, Engelbertz JA, Görlich D, Barth PJ, Lenz G, Becker H, Mohr M, Schmidt LH. Cyclophosphamide pulse therapy as treatment for severe interstitial lung diseases. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:157-166. [PMID: 32476949 DOI: 10.36141/svdld.v36i2.7636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/24/2019] [Indexed: 11/02/2022]
Abstract
Introduction Besides invasive or non-invasive ventilation, treatment of severe forms of interstitial lung diseases (ILD) includes immunosuppressive medication. In case of refractory organ- or life-threatening courses of disease, cyclophosphamide pulse therapy can serve as a rescue treatment option. Objectives To investigate therapeutic and prognostic effects of cyclophosphamide for the treatment of severe forms of ILD on intensive care unit (ICU) we performed this analysis. Methods Between 2009 and 2017 we identified 14 patients, who were treated on intensive care unit (ICU) with severe forms of ILD. Retrospectively, clinical, radiologic and prognostic data were collected and evaluated. Results Our analysis demonstrated a prognostic impact of cyclophosphamide on the ILD in general. Whereas pulmonary manifestations of both systemic sclerosis (SSc) and ANCA-associated vasculitis had an improved outcome, a reduced overall survival was found for Goodpasture syndrome (GPS), dermatomyositis (DM), cryptogenic organizing pneumonia (COP) and drug reaction with eosinophilia and systemic symptoms (DRESS; p=0.040, logrank test). Besides, additional plasmapheresis and initiation of cyclophosphamide within ten days following initial diagnosis of ILD were associated with improved prognosis. Conclusion Positive prognostic effects of cyclophosphamide pulse therapy in ICU treated patients suffering from severe respiratory failure due to pulmonary manifestations of both SSc and ANCA-associated-vasculitis were observed. Further prognostic and therapeutic data are needed for cyclophosphamide for this indication in order to prevent patients from its toxic side-effects, who most likely will not benefit from its application.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as first authors
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as first authors
| | - Andreas Kümmel
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Philipp Hering
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schülke
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Jonas Andreas Engelbertz
- Unit of Cytostatic Reconstitution, Hospital pharmacy, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Peter J Barth
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, Muenster, Germany
| | - Heidemarie Becker
- Department of Medicine D, Nephrology, Rheumatology and Hypertensiology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as senior authors
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as senior authors
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Wilson RJT, Yates DRA, Walkington JP, Davies SJ. Ventilatory inefficiency adversely affects outcomes and longer-term survival after planned colorectal cancer surgery. Br J Anaesth 2019; 123:238-245. [PMID: 30916023 DOI: 10.1016/j.bja.2019.01.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 01/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Impaired cardiorespiratory reserve is an accepted risk factor for patients having major surgery. Ventilatory inefficiency, defined by an elevated ratio of minute ventilation to carbon dioxide excretion (VE/VCO2), and measured by cardiopulmonary exercise testing (CPET), is a pathophysiological characteristic of patients with cardiorespiratory disease. We set out to evaluate the prevalence of ventilatory inefficiency in a colorectal cancer surgical population, and its influence on surgical outcomes and long-term cancer survival. METHODS In this retrospective study of 1375 patients who had undergone preoperative CPET followed by colorectal cancer surgery, we used receiver operating characteristic curve analysis to identify an optimal value of VE/VCO2 associated with 90-day mortality. Binary logistic regression was used to evaluate whether this degree of ventilatory inefficiency was independently associated with decreased survival, both after surgery and in the longer term. RESULTS We identified an optimal VE/VCO2 >39 cut-off for predicting 90-day mortality; 245 patients (17.8%) had VE/VCO2 >39, of which 138 (10% of total cohort) had no known cardiorespiratory risk factors. Ventilatory inefficiency was independently associated with death at 90-days (8.2% mortality vs 1.9%; adjusted odds ratio [OR], 4.04; 95% confidence interval [CI], 2.09-7.84), with death after unplanned critical care admission (OR=4.45; 95% CI, 1.37-14.46) and with decreased survival at 2 yr (OR=2.21; 95%, 1.49-3.28) and 5 yr (OR=2.87; 95% CI, 1.54-5.37) after surgery. CONCLUSIONS A significant proportion of patients having colorectal cancer surgery have ventilatory inefficiency observed on CPET, the majority of whom have no history of cardiorespiratory risk factors. This group of patients has significantly decreased survival both after surgery and in the long-term, irrespective of cancer stage. Survival might be improved by formal medical evaluation and intervention in this group.
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Almendros I, Crespo A, Tura-Ceide O, Bonsignore MR. Clinical physiology and sleep: insights from the European Respiratory Society Congress 2017. J Thorac Dis 2017; 9:S1532-S1536. [PMID: 29255634 PMCID: PMC5717356 DOI: 10.21037/jtd.2017.11.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 28029-Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Andrea Crespo
- Unidad de Sueño. Hospital Universitario Rio Hortega de Valladolid, Valladolid, Spain
| | - Olga Tura-Ceide
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 28029-Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clinic, Barcelona, Spain
| | - Maria R. Bonsignore
- Biomedical Department of Internal and Specialistic Medicine (DiBiMIS), University of Palermo, Palermo, Italy
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
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El-Ghawet HA, Gadallah AA, El-Mansi AA, Amin AH, El-Sayyad HIH. Markers of Heart, Lung and Dorsal Aorta Damage of Mother Rats and Their Neonates Post Therapeutic Treatment with Doxorubicin, Cisplatin and 5-Flurouracil. Chin Med 2017. [DOI: 10.4236/cm.2017.83007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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