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Paneroni M, Vogiatzis I, Cavicchia A, Salvi B, Bertacchini L, Venturelli M, Vitacca M. Upper-limb interval versus constant-load exercise in patients with COPD: a physiological crossover study. ERJ Open Res 2024; 10:00779-2023. [PMID: 38410701 PMCID: PMC10895421 DOI: 10.1183/23120541.00779-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024] Open
Abstract
Objective Upper-limb exercise is recommended for patients with COPD, albeit there are limited data concerning the optimal modality to implement. We compared interval (INT-EX) to continuous (CONT-EX) upper-limb exercise in terms of exercise tolerance, ventilatory and metabolic responses when both conditions were sustained at an equivalent work rate. Methods 26 stable COPD patients undertook three upper-limb exercise sessions to initially establish peak work rate (PWR) via an incremental exercise test and subsequently two equivalent work rate tests to the limit tolerance in balanced order: 1) INT-EX consisting of 30-s work at 100% PWR interspersed with 30-s work at 40% of PWR; and 2) CONT-EX at 70% PWR. Results 20 patients (76.9%) had longer tolerance during INT-EX, while six out of 26 (23.1%) exhibited longer tolerance during CONT-EX. The average endurance time was 434.1±184.7 and 315.7±128.7 s for INT-EX and CONT-EX, respectively. During INT-EX at isotime (i.e. when work completed was the same between INT-EX and CONT-EX), the majority of patients manifested lower oxygen uptake, minute ventilation, pulmonary hyperinflation, heart rate, symptoms and higher CO2 blood concentration. Patients with longer INT-EX had a lower comorbidity score (Cumulative Illness Rating Scale: 1.58±0.30 versus 1.88±0.29, p=0.0395) and better-preserved lung function (forced vital capacity 84.7±15.31% versus 67.67±20.56%, p=0.0367; forced expiratory volume in 1 s 57.15±14.59 versus 44.67±12.99% predicted, p=0.0725) compared to patients with longer CONT-EX. Conclusion INT-EX is more sustainable than CONT-EX for the majority of COPD patients with moderate obstruction, leading to lower dynamic hyperinflation and symptoms at isotime. Further studies need to define the benefits of its application during pulmonary rehabilitation.
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Affiliation(s)
- Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Ioannis Vogiatzis
- Northumbria University, Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Newcastle, UK
| | - Alessandro Cavicchia
- University of Verona, Department of Neurosciences Biomedicine and Movement Sciences, Verona, Italy
| | - Beatrice Salvi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Laura Bertacchini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Massimo Venturelli
- University of Verona, Department of Neurosciences Biomedicine and Movement Sciences, Verona, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
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Palmer T, Obst SJ, Aitken CR, Walsh J, Sabapathy S, Adams L, Morris NR. Fixed-intensity exercise tests to measure exertional dyspnoea in chronic heart and lung populations: a systematic review. Eur Respir Rev 2023; 32:230016. [PMID: 37558262 PMCID: PMC10410401 DOI: 10.1183/16000617.0016-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Exertional dyspnoea is the primary diagnostic symptom for chronic cardiopulmonary disease populations. Whilst a number of exercise tests are used, there remains no gold standard clinical measure of exertional dyspnoea. The aim of this review was to comprehensively describe and evaluate all types of fixed-intensity exercise tests used to assess exertional dyspnoea in chronic cardiopulmonary populations and, where possible, report the reliability and responsiveness of the tests. METHODS A systematic search of five electronic databases identified papers that examined 1) fixed-intensity exercise tests and measured exertional dyspnoea, 2) chronic cardiopulmonary populations, 3) exertional dyspnoea reported at isotime or upon completion of fixed-duration exercise tests, and 4) published in English. RESULTS Searches identified 8785 papers. 123 papers were included, covering exercise tests using a variety of fixed-intensity protocols. Three modes were identified, as follows: 1) cycling (n=87), 2) walking (n=31) and 3) other (step test (n=8) and arm exercise (n=2)). Most studies (98%) were performed on chronic respiratory disease patients. Nearly all studies (88%) used an incremental exercise test. 34% of studies used a fixed duration for the exercise test, with the remaining 66% using an exhaustion protocol recording exertional dyspnoea at isotime. Exertional dyspnoea was measured using the Borg scale (89%). 7% of studies reported reliability. Most studies (72%) examined the change in exertional dyspnoea in response to different interventions. CONCLUSION Considerable methodological variety of fixed-intensity exercise tests exists to assess exertional dyspnoea and most test protocols require incremental exercise tests. There does not appear to be a simple, universal test for measuring exertional dyspnoea in the clinical setting.
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Affiliation(s)
- Tanya Palmer
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Central Queensland University, School of Health, Medical and Applied Sciences, College of Health Sciences, Bundaberg, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
| | - Steven J Obst
- Central Queensland University, School of Health, Medical and Applied Sciences, College of Health Sciences, Bundaberg, Australia
| | - Craig R Aitken
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - James Walsh
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - Surendran Sabapathy
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Lewis Adams
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Norman R Morris
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
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3
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Kostorz-Nosal S, Jastrzębski D, Żebrowska A, Bartoszewicz A, Ziora D. Three Weeks of Pulmonary Rehabilitation Do Not Influence Oscillometry Parameters in Postoperative Lung Cancer Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111551. [PMID: 36363507 PMCID: PMC9696075 DOI: 10.3390/medicina58111551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023]
Abstract
Background: Thoracic surgery is a recommended treatment option for non-small cell lung cancer patients. An important part of a patient’s therapy, which helps to prevent postoperative complications and improve quality of life, is pulmonary rehabilitation (PR). The aim of this study was to assess whether the implementation of physical activity has an influence on forced oscillation technique (FOT) values in patients after thoracic surgery due to lung cancer. Methods: In this observational study, we enrolled 54 patients after thoracic surgery due to lung cancer, 49 patients with idiopathic interstitial fibrosis (IPF), and 54 patients with chronic obstructive pulmonary disease/asthma−COPD overlap (COPD/ACO). All patients were subjected to three weeks of in-hospital PR and assessed at the baseline as well as after completing PR by FOT, spirometry, grip strength measurement, and the 6-min walk test (6MWT). Results: We observed differences between FOT values under the influence of physical activity in studied groups, mostly between patients after thoracic surgery and COPD/ACO patients; however, no significant improvement after completing PR among FOT parameters was noticed in any group of patients. Improvements in the 6MWT distance, left hand strength, and right hand strength after PR were noticed (p < 0.001, 0.002, and 0.012, respectively). Conclusions: Three weeks of pulmonary rehabilitation had no impact on FOT values in patients after thoracic surgery due to lung cancer. Instead, we observed improvements in the 6MWT distance and the strength of both hands. Similarly, no FOT changes were observed in IPF and COPD/ACO patients after completing PR.
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Affiliation(s)
- Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
- Correspondence:
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
| | - Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, Institute of Sport Sciences, Academy of Physical Education, 40-065 Katowice, Poland
| | - Agnieszka Bartoszewicz
- Independent Public Clinical Hospital No. 1, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
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4
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Yen HT, Kurosawa M, Kirimoto T, Hakozaki Y, Matsui T, Sun G. A medical radar system for non-contact vital sign monitoring and clinical performance evaluation in hospitalized older patients. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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5
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Vieira DSR, Mendes LPS, Alencar MCN, Hoffman M, Albuquerque ALP, Silveira BMF, Aguiar SC, Parreira VF. Rib cage distortion and dynamic hyperinflation during two exercise intensities in people with COPD. Respir Physiol Neurobiol 2021; 293:103724. [PMID: 34174483 DOI: 10.1016/j.resp.2021.103724] [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: 01/03/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between rib cage (RC) motion abnormalities, dynamic hyperinflation (DH), and exercise capacity in people with COPD is controversial. AIM To investigate RC distortion and operational chest wall volumes during moderate and high constant-rate exercises in people with COPD. METHODS Seven male participants [median(Q1-Q3) age: 63(60.0-66.0) years; FEV1: 39.0(38.0-63.0)% of predicted] performed a symptom-limited incremental exercise testing on cycle ergometer, followed by constant-rate tests (60 % and 80 % of peak work rate). Optoelectronic plethysmography was used to evaluate RC distortion: phase angle-PhAng, inspiratory phase ratio-PhRIB, expiratory phase ratio-PhREB; and chest wall volumes: end-inspiratory volume-Vei and end-expiratory volume-Vee. RESULTS PhRIB and PhREB significantly increased during both constant-rate exercise tests, without difference between them. In general, Vei of the chest wall significantly increased in both exercise intensities while Vee did not change. CONCLUSIONS The occurrence of RC distortion seemed not to limit the exercise capacity in people with COPD evaluated, and it was present even in the absence of DH.
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Affiliation(s)
- Danielle S R Vieira
- Rehabilitation Sciences Graduation Program, Universidade Federal de Santa Catarina, Rodovia Governador Jorge Lacerda, Jardim das Avenidas, 89906-072, Araranguá, Santa Catarina, Brazil; Department of Health Sciences, Universidade Federal de Santa Catarina, Rodovia Governador Jorge Lacerda, Jardim das Avenidas, 89906-072, Araranguá, Santa Catarina, Brazil
| | - Liliane P S Mendes
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Clara N Alencar
- Clinics Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Hoffman
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Andre L P Albuquerque
- Pulmonary Division, Heart Institute (Incor), University of Sao Paulo Medical School, Avenida Dr Enéas de Carvalho Aguiar, 44, Jardim Paulista, 05403-900, Sao Paulo, Brazil
| | - Bruna M F Silveira
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Susana C Aguiar
- Rehabilitation Sciences Graduation Program, Universidade Federal de Santa Catarina, Rodovia Governador Jorge Lacerda, Jardim das Avenidas, 89906-072, Araranguá, Santa Catarina, Brazil
| | - Verônica F Parreira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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Hedhli A, Slim A, Ouahchi Y, Mjid M, Koumenji J, Cheikh Rouhou S, Toujani S, Dhahri B. Maximal Voluntary Breath-Holding Tele-Inspiratory Test in Patients with Chronic Obstructive Pulmonary Disease. Am J Mens Health 2021; 15:15579883211015857. [PMID: 33993797 PMCID: PMC8127757 DOI: 10.1177/15579883211015857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Maximal voluntary inspiratory breath-holding time (MVIBHT) has proved to be of clinical utility in some obstructive ventilatory defects. This study aims to correlate the breath-holding time with pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD) and to determine the feasibility of using a breath-holding test in assessing the severity of COPD. A cross-sectional study including male patients with stable COPD were conducted. Patients with respiratory comorbidities and severe or unstable cardiac diseases were excluded. Patients were interviewed and examined. Six-minute walk test (6MWT) and plethysmography were performed.For MVIBHT collection, the subject was asked to inspire deeply and to hold the breath as long as possible at the maximum inspiratory level. This maneuver was repeated three times. The best value was used for further analysis. A total of 79 patients (mean age: 64.2 ± 8) were included in this study. The mean value of MVIBHT was 24.2 ± 8.5 s. We identified a positive and significant correlations between MVIBHT and forced vital capacity (r = .630; p < .001) as well as MVIBHT and forced expiratory volume in 1 s (FEV1%) (r = .671; p < .001). A significant inverse correlation with total lung capacity (r = −.328; p = .019) and residual volume to total lung capacity ratio (r = −.607; p < .001) was noted. MVIBHT was significantly correlated to the distance in the 6MWT (r = .494; p < .001). The mean MVIBHT was significantly different within spirometric grades (p < .001) and GOLD groups (p = .002). At 20.5 s, MVIBHT had a sensitivity of 72% and specificity of 96% in determining COPD patients with FEV1 <50%. Our results provide additional evidence of the usefulness of MVIBHT in COPD patients as a pulmonary function parameter.
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Affiliation(s)
- Abir Hedhli
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Azza Slim
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Yassine Ouahchi
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Meriem Mjid
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Jamel Koumenji
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Sana Cheikh Rouhou
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Sonia Toujani
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
| | - Besma Dhahri
- Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia
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Wang J, Li G, Ding S, Yu L, Wang Y, Qiao L, Wu Q, Ni W, Fan H, Zheng Q, Zhang Y, Li H. Liuzijue qigong versus traditional breathing training for patients with post-stroke dysarthria complicated by abnormal respiratory control: Results of a single-center randomized controlled trial. Clin Rehabil 2021; 35:999-1010. [PMID: 33517744 PMCID: PMC8193589 DOI: 10.1177/0269215521992473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of the study was to investigate whether liuzijue qigong could improve the ability of respiratory control and comprehensive speech in patients with stroke dysarthria. Design: A randomized controlled trial. Setting: The research was carried out in the department of rehabilitation. Participants: Altogether, a total of 98 stroke patients with dysarthria participated in the study. Interventions: Patients were randomly divided into two groups (the experimental group: basic articulation + liuzijue qigong, 48 patients or the control group: basic articulation + traditional breathing training, 50 patients). All therapies were conducted once a day, five times a week for three weeks. Main measures: Primary outcome measure: Speech breathing level of the modified Frenchay Dysarthria Assessment. Secondary outcome measures: the modified Frenchay Dysarthria Assessment, maximum phonation time, maximal counting ability, /s/, /z/, s/z ratio, and the loudness level. All outcome measures were assessed twice (at baseline and after three weeks). Results: At three weeks, There were significant difference between the two groups in the change of speech breathing level (81% vs 66%, P = 0.011), the modified Frenchay Dysarthria Assessment (5.54 (4.68–6.40) vs 3.66 (2.92–4.40), P = 0.001), maximum phonation time (5.55 (4.92–6.18) vs 3.01(2.31–3.71), P < 0.01), maximal counting ability (3.08(2.45–3.71) vs 2.10 (1.53–2.67), P = 0.018), and /s/ (3.08 (2.39–3.78) vs 1.87 (1.23–2.51), P = 0.004), while no significant differences were found in the change of /z/ (3.08 (2.31–3.86) vs 2.10 (1.5–2.64), P = 0.08), s/z ratio (1.26 (0.96–1.55) vs 1.03 (0.97–1.09), P = 0.714), and the change of loudness level (69% vs 60%, P = 0.562). Conclusions: Liuzijue qigong, combined with basic articulation training, could improve the respiratory control ability, as well as the comprehensive speech ability of stroke patients with dysarthria. Trial registration: ChiCTR-INR-16010215.
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Affiliation(s)
- Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China.,School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Shanshan Ding
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Qilin Wu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hang Fan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Qianyun Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hongli Li
- Department of Rehabilitation, Shanghai Shenyuan Rehabilitation Hospital, Shanghai, China
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8
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Louvaris Z, Rodrigues A, Dacha S, Gojevic T, Janssens W, Vogiatzis I, Gosselink R, Langer D. High-intensity exercise impairs extradiaphragmatic respiratory muscle perfusion in patients with COPD. J Appl Physiol (1985) 2020; 130:325-341. [PMID: 33119468 DOI: 10.1152/japplphysiol.00659.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The study investigated whether high-intensity exercise impairs inspiratory and expiratory muscle perfusion in patients with chronic obstructive pulmonary disease (COPD). We compared respiratory local muscle perfusion between constant-load cycling[sustained at 80% peak work rate (WRpeak)] and voluntary normocapnic hyperpnea reproducing similar work of breathing (WoB) in 18 patients [forced expiratory volume in the first second (FEV1): 58 ± 24% predicted]. Local muscle blood flow index (BFI), using indocyanine green dye, and fractional oxygen saturation (%StiO2) were simultaneously assessed by near-infrared spectroscopy (NIRS) over the intercostal, scalene, rectus abdominis, and vastus lateralis muscles. Cardiac output (impedance cardiography), WoB (esophageal/gastric balloon catheter), and diaphragmatic and extradiaphragmatic respiratory muscle electromyographic activity (EMG) were also assessed throughout cycling and hyperpnea. Minute ventilation, breathing pattern, WoB, and respiratory muscle EMG were comparable between cycling and hyperpnea. During cycling, cardiac output and vastus lateralis BFI were significantly greater compared with hyperpnea [by +4.2 (2.6-5.9) L/min and +4.9 (2.2-7.8) nmol/s, respectively] (P < 0.01). Muscle BFI and %StiO2 were, respectively, lower during cycling compared with hyperpnea in scalene [by -3.8 (-6.4 to -1.2) nmol/s and -6.6 (-8.2 to -5.1)%], intercostal [by -1.4 (-2.4 to -0.4) nmol/s and -6.0 (-8.6 to -3.3)%], and abdominal muscles [by -1.9 (-2.9 to -0.8) nmol/s and -6.3 (-9.1 to -3.4)%] (P < 0.001). The difference in respiratory (scalene and intercostal) muscle BFI between cycling and hyperpnea was associated with greater dyspnea (Borg CR10) scores (r = -0.54 and r = -0.49, respectively, P < 0.05). These results suggest that in patients with COPD, 1) locomotor muscle work during high-intensity exercise impairs extradiaphragmatic respiratory muscle perfusion and 2) insufficient adjustment in extradiaphragmatic respiratory muscle perfusion during high-intensity exercise may partly explain the increased sensations of dyspnea.NEW & NOTEWORTHY We simultaneously assessed the blood flow index (BFI) in three respiratory muscles during hyperpnea and high-intensity constant-load cycling sustained at comparable levels of work of breathing and respiratory neural drive in patients with COPD. We demonstrated that high-intensity exercise impairs respiratory muscle perfusion, as intercostal, scalene, and abdominal BFI increased during hyperpnea but not during cycling. Insufficient adjustment in respiratory muscle perfusion during exercise was associated with greater dyspnea sensations in patients with COPD.
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Affiliation(s)
- Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Antenor Rodrigues
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil.,Research Aimed at Muscle Performance Laboratory (RAMP), Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Sauwaluk Dacha
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Tin Gojevic
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Faculty of Health and Life Sciences, Department of Sport, Exercise, and Rehabilitation, Northumbria University Newcastle, Newcastle, United Kingdom
| | - Rik Gosselink
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
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9
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Louvaris Z, Chynkiamis N, Spetsioti S, Asimakos A, Zakynthinos S, Wagner PD, Vogiatzis I. Greater exercise tolerance in COPD during acute interval, compared to equivalent constant-load, cycle exercise: physiological mechanisms. J Physiol 2020; 598:3613-3629. [PMID: 32472698 DOI: 10.1113/jp279531] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS Exercise intolerance is common in chronic obstructive pulmonary disease (COPD) patients. In patients with COPD, we compared an interval exercise (IE) protocol (alternating 30 s at 100% peak work rate (WRpeak ) with 30 s at 50% WRpeak ) with moderate-intensity constant-load exercise (CLE) at 75% WRpeak , which yielded the same work rate. Exercise endurance time and total work output were almost twice as high for IE than CLE. At exercise isotime (when work completed was the same between IE and CLE), IE was associated with less dynamic hyperinflation, lower blood lactate concentration, and greater respiratory and locomotor muscle oxygenation, but there were no differences in ventilation or cardiac output. However, at the limit of tolerance for each modality, dynamic hyperinflation was not different between IE and CLE, while blood lactate remained lower and muscle oxygenation higher with IE. Taken together, these findings suggest that dynamic hyperinflation and not muscle-based factors dictate the limits of tolerance in these COPD patients. ABSTRACT The relative importance of ventilatory, circulatory and peripheral muscle factors in determining tolerance to exercise in patients with chronic obstructive pulmonary disease (COPD) is not known. In 12 COPD patients (forced expiratory volume in one second: 58 ± 17%pred.) we measured ventilation, cardiac output, dynamic hyperinflation, local muscle oxygenation, blood lactate and time to exhaustion during (a) interval exercise (IE) consisting of 30 s at 100% peak work rate alternating with 30 s at 50%, and (b) constant-load exercise (CLE) at 75% peak work rate, designed to produce the same average work rate. Exercise time was substantially longer during IE than CLE (19.5 ± 4.8 versus 11.4 ± 2.1 min, p = 0.0001). Total work output was therefore greater during IE than CLE (81.3 ± 27.7 versus 48.9 ± 23.8 kJ, p = 0.0001). Dynamic hyperinflation (assessed by changes from baseline in inspiratory capacity, ΔIC) was less during IE than CLE at CLE exhaustion time (isotime, p = 0.009), but was similar at exhaustion (ΔICCLE : -0.38 ± 0.10 versus ΔICIE : -0.33 ± 0.12 l, p = 0.102). In contrast, at isotime, minute ventilation, cardiac output and systemic oxygen delivery did not differ between protocols (P > 0.05). At exhaustion in both protocols, the vastus lateralis and intercostal muscle oxygen saturation were higher in IE than CLE (p = 0.014 and p = 0.0002, respectively) and blood lactate concentrations were lower (4.9 ± 2.4 mmol l-1 versus 6.4 ± 2.2 mmol l-1 , p = 0.039). These results suggest that (1) exercise tolerance with COPD is limited by dynamic hyperinflation; and (2) cyclically lower (50%) effort intervals in IE help to preserve muscle oxygenation and reduce metabolic acidosis compared with CLE at the same average work rate; but these factors do not appear to determine time to exhaustion.
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Affiliation(s)
- Zafeiris Louvaris
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece.,Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Stavroula Spetsioti
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Andreas Asimakos
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Spyros Zakynthinos
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Peter D Wagner
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ioannis Vogiatzis
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, National and Kapodistrian University of Athens, Greece.,Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
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10
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Silva GAG, Santos JSFD, Dantas DDS, Fernandes ATDNSF, Lima ÍNDF. Physiological responses of incremental and endurance shuttle walk tests in patients with chronic obstructive pulmonary disease (COPD): narrative review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1754463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gabriely Azevêdo Gonçalo Silva
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
| | - Juliana Simonelly Felix dos Santos
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
| | - Diego de Souza Dantas
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
| | | | - Íllia Nadinne Dantas Florentino Lima
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
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11
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Kebe M, Gadhafi R, Mohammad B, Sanduleanu M, Saleh H, Al-Qutayri M. Human Vital Signs Detection Methods and Potential Using Radars: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1454. [PMID: 32155838 PMCID: PMC7085680 DOI: 10.3390/s20051454] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/04/2023]
Abstract
Continuous monitoring of vital signs, such as respiration and heartbeat, plays a crucial role in early detection and even prediction of conditions that may affect the wellbeing of the patient. Sensing vital signs can be categorized into: contact-based techniques and contactless based techniques. Conventional clinical methods of detecting these vital signs require the use of contact sensors, which may not be practical for long duration monitoring and less convenient for repeatable measurements. On the other hand, wireless vital signs detection using radars has the distinct advantage of not requiring the attachment of electrodes to the subject's body and hence not constraining the movement of the person and eliminating the possibility of skin irritation. In addition, it removes the need for wires and limitation of access to patients, especially for children and the elderly. This paper presents a thorough review on the traditional methods of monitoring cardio-pulmonary rates as well as the potential of replacing these systems with radar-based techniques. The paper also highlights the challenges that radar-based vital signs monitoring methods need to overcome to gain acceptance in the healthcare field. A proof-of-concept of a radar-based vital sign detection system is presented together with promising measurement results.
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Affiliation(s)
- Mamady Kebe
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Rida Gadhafi
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
- College of Engineering & IT (CEIT), University of Dubai, P.O. Box 14143, Dubai, UAE
| | - Baker Mohammad
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Mihai Sanduleanu
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Hani Saleh
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Mahmoud Al-Qutayri
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
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12
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Massaroni C, Nicolò A, Lo Presti D, Sacchetti M, Silvestri S, Schena E. Contact-Based Methods for Measuring Respiratory Rate. SENSORS (BASEL, SWITZERLAND) 2019; 19:E908. [PMID: 30795595 PMCID: PMC6413190 DOI: 10.3390/s19040908] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 01/05/2023]
Abstract
There is an ever-growing demand for measuring respiratory variables during a variety of applications, including monitoring in clinical and occupational settings, and during sporting activities and exercise. Special attention is devoted to the monitoring of respiratory rate because it is a vital sign, which responds to a variety of stressors. There are different methods for measuring respiratory rate, which can be classed as contact-based or contactless. The present paper provides an overview of the currently available contact-based methods for measuring respiratory rate. For these methods, the sensing element (or part of the instrument containing it) is attached to the subject's body. Methods based upon the recording of respiratory airflow, sounds, air temperature, air humidity, air components, chest wall movements, and modulation of the cardiac activity are presented. Working principles, metrological characteristics, and applications in the respiratory monitoring field are presented to explore potential development and applicability for each method.
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Affiliation(s)
- Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy.
| | - Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135 Rome, Italy.
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy.
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135 Rome, Italy.
| | - Sergio Silvestri
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy.
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy.
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13
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Degani-Costa LH, O'Donnell DE, Webb K, Aranda LC, Carlstron JP, Cesar TDS, Plachi F, Berton DC, Neder JA, Nery LE. A Simplified Approach to Select Exercise Endurance Intensity for Interventional Studies in COPD. COPD 2018; 15:139-147. [PMID: 29485343 DOI: 10.1080/15412555.2018.1428944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Time to exercise limitation (Tlim) in response to constant work rate (CWR) is sensitive to interventions in chronic obstructive pulmonary disease (COPD). This is particularly true when the pre-intervention test lasts between 3 and 8 min (Tlim3'-8'). There is, however, no simple method to select a work rate which is consistently associated with Tlim3'-8' across the spectrum of COPD severity. We assessed 59 GOLD stages II-IV patients who initially cycled to Tlim at 75% peak. In case of short (<3 min, low-endurance) or long (>8 min, high-endurance) tests, patients exercised after 60 min at 50% or 90%, respectively (CWR50%⇐75%⇒90%). Critical mechanical constraints and limiting dyspnea at 75% were reached within the desired timeframe in 27 "mid-endurance" patients (46%). Increasing work rate intensity to 90% hastened the mechanical-ventilatory responses leading to Tlim3'-8' in 23/26 (88%) "high-endurance" patients; conversely, decreasing exercise intensity to 50% slowed those responses leading to Tlim3'-8' in 5/6 (83%) "high-endurance" patients. Repeating the tests at higher (60%) or lower (80%) intensities fail to consistently produce Tlim3'-8' in "low-" and "high-endurance", respectively (p > 0.05). Compared to a fixed work rate at 75%, CWR50%⇐75%⇒90% significantly decreased Tlim's coefficient of variation; consequently, the required N to detect 100 s or 33% improvement in Tlim decreased from 82 to 26 and 41 to 14, respectively. This simplified approach to individualized work rate adjustment (CWR50%⇐75%⇒90%) might allow greater sensitivity in evaluating interventional efficacy in improving respiratory mechanics and exercise tolerance while simultaneously reducing sample size requirements in patients with COPD.
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Affiliation(s)
- Luiza H Degani-Costa
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Denis E O'Donnell
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Katherine Webb
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Liliane C Aranda
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Júlio P Carlstron
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Tamires da Silva Cesar
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
| | - Franciele Plachi
- c Division of Respirology , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Danilo C Berton
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada.,c Division of Respirology , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - J Alberto Neder
- b Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Luiz E Nery
- a Respiratory Division, Department of Medicine, Sao Paulo School of Medicine , Federal University of Sao Paulo , Sao Paulo , SP , Brazil
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14
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Glittre-ADL Multiple Tasks Induce Similar Dynamic Hyperinflation With Different Metabolic and Ventilatory Demands in Patients With COPD. J Cardiopulm Rehabil Prev 2017; 37:450-453. [DOI: 10.1097/hcr.0000000000000235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Yun SH, Lee HJ, Lee YH, Park JC. Evaluation of Respiratory Dynamics in an Asymmetric Lung Compliance Model. Korean J Crit Care Med 2017; 32:174-181. [PMID: 31723631 PMCID: PMC6786710 DOI: 10.4266/kjccm.2016.00738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/01/2017] [Accepted: 03/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Unilateral lung hyperinflation develops in lungs with asymmetric compliance, which can lead to vital instability. The aim of this study was to investigate the respiratory dynamics and the effect of airway diameter on the distribution of tidal volume during mechanical ventilation in a lung model with asymmetric compliance. Methods Three groups of lung models were designed to simulate lungs with a symmetric and asymmetric compliance. The lung model was composed of two test lungs, lung1 and lung2. The static compliance of lung1 in C15, C60, and C120 groups was manipulated to be 15, 60, and 120 ml/cmH2O, respectively. Meanwhile, the static compliance of lung2 was fixed at 60 ml/cmH2O. Respiratory variables were measured above (proximal measurement) and below (distal measurement) the model trachea. The lung model was mechanically ventilated, and the airway internal diameter (ID) was changed from 3 to 8 mm in 1-mm increments. Results The mean ± standard deviation ratio of volumes distributed to each lung (VL1/VL2) in airway ID 3, 4, 5, 6, 7, and 8 were in order, 0.10 ± 0.05, 0.11 ± 0.03, 0.12 ± 0.02, 0.12 ± 0.02, 0.12 ± 0.02, and 0.12 ± 0.02 in the C15 group; 1.05 ± 0.16, 1.01 ± 0.09, 1.00 ± 0.07, 0.97 ± 0.09, 0.96 ± 0.06, and 0.97 ± 0.08 in the C60 group; and 1.46 ± 0.18, 3.06 ± 0.41, 3.72 ± 0.37, 3.78 ± 0.47, 3.77 ± 0.45, and 3.78 ± 0.60 in the C120 group. The positive end-expiratory pressure (PEEP) of lung1 was significantly increased at airway ID 3 mm (1.65 cmH2O) in the C15 group; at ID 3, 4, and 5 mm (2.21, 1.06, and 0.95 cmH2O) in the C60 group; and ID 3, 4, and 5 mm (2.92, 1.84, and 1.41 cmH2O) in the C120 group, compared to ID 8 mm (P < 0.05). Conclusions In the C15 and C120 groups, the tidal volume was unevenly distributed to both lungs in a positive relationship with lung compliance. In the C120 group, the uneven distribution of tidal volume was improved when the airway ID was equal to or less than 4 mm, but a significant increase of PEEP was observed.
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16
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Miki K, Maekura R, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Kagawa H, Oshitani Y, Satomi A, Nishida K, Sawa N, Inoue K. Pulmonary rehabilitation for COPD improves exercise time rather than exercise tolerance: effects and mechanisms. Int J Chron Obstruct Pulmon Dis 2017; 12:1061-1070. [PMID: 28435239 PMCID: PMC5388245 DOI: 10.2147/copd.s131061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND COPD patients undergoing pulmonary rehabilitation (PR) show various responses. The purpose of this study was to investigate the possible mechanisms and predictors of the response to PR in COPD patients. METHODS Thirty-six stable COPD patients underwent PR including a 4-week high-intensity exercise training program, and they were evaluated by cardiopulmonary exercise testing. All patients (mean age 69 years, severe and very severe COPD 94%) were classified into four groups by whether the exercise time (Tex) or the peak oxygen uptake [Formula: see text] increased after PR: two factors increased (both the Tex and the peak [Formula: see text] increased); two factors decreased; time only increased (the Tex increased, but the peak [Formula: see text] economized); and [Formula: see text] only increased (the Tex decreased, but the peak [Formula: see text] increased). Within all patients, the relationships between baseline variables and the post-to-pre-change ratio of the time-slope, Tex/(peak minus resting [Formula: see text]), were investigated. RESULTS Compared with the two factors increased group (n=11), in the time only increased group (n=18), the mean differences from pre-PR at peak exercise in 1) minute ventilation [Formula: see text] (P=0.004), [Formula: see text] (P<0.0001), and carbon dioxide output [Formula: see text] (P<0.0001) were lower, 2) [Formula: see text]/ [Formula: see text] (P=0.034) and [Formula: see text]/ [Formula: see text] (P=0.006) were higher, and 3) the dead space/tidal volume ratio (VD/VT) and the dyspnea level were similar. After PR, there was no significant difference in the ratio of the observed peak heart rate (HR) to the predicted peak HR (220 - age [years]) between the two groups. A significant negative correlation with the baseline time-slope (r=-0.496, P=0.002) and a positive correlation with the baseline body mass index (BMI) (r=0.496, P=0.002) were obtained. CONCLUSIONS PR in COPD patients improves Tex rather than exercise tolerance, economizing oxygen requirements, resulting in reduced ventilatory requirements without cardiac loads followed by reduced exertional dyspnea. In addition, the time-slope and BMI could be used to predict PR responses beforehand.
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Affiliation(s)
| | | | | | | | | | - Hiroshi Yamamoto
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
| | - Toshiko Kawabe
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
| | | | | | | | | | | | - Kimiko Inoue
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
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17
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Theodorakopoulou EP, Gennimata SA, Harikiopoulou M, Kaltsakas G, Palamidas A, Koutsoukou A, Roussos C, Kosmas EN, Bakakos P, Koulouris NG. Effect of pulmonary rehabilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients. Respir Physiol Neurobiol 2017; 238:47-54. [PMID: 28109942 DOI: 10.1016/j.resp.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
We hypothesized that severe COPD patients who present with the disadvantageous phenomenon of Expiratory Flow Limitation (EFL) may benefit as COPD patients without EFL do after implementation of a Pulmonary Rehabilitation (PR) program. Forty-two stable COPD patients were studied at rest and during exercise. EFL and dynamic hyperinflation (DH) were documented using the negative expiratory pressure (NEP) technique and inspiratory capacity (IC) maneuvers, respectively. Patient centered outcomes were evaluated by the Saint-George's Respiratory Questionnaire (SGRQ) and the mMRC dyspnea scale. Before PR, 16 patients presented with EFL at rest and/or during exercise. After PR, EFL was abolished in 15 out of those 16 EFL patients who exhibited a significant increase in IC values. These were mainly accomplished through a modification of the breathing pattern. In the 26 NFL patients no increase was noted in their IC or a modification of their breathing pattern. However, both NFL and EFL COPD patients improved exercise capacity and patients centered outcomes undergoing the same PR program.
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Affiliation(s)
- Elpida P Theodorakopoulou
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece; Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Sofia-Antiopi Gennimata
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Maria Harikiopoulou
- Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Georgios Kaltsakas
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Anastasios Palamidas
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Antonia Koutsoukou
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Charis Roussos
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Epameinondas N Kosmas
- Pulmonary Rehabilitation Center, 3rd Department of Pulmonary Medicine, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Petros Bakakos
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece
| | - Nickolaos G Koulouris
- Pulmonary Rehabilitation Unit, 1st Department of Respiratory Medicine, National & Kapodistrian University of Athens Medical School, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
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Puente-Maestu L, Palange P, Casaburi R, Laveneziana P, Maltais F, Neder JA, O'Donnell DE, Onorati P, Porszasz J, Rabinovich R, Rossiter HB, Singh S, Troosters T, Ward S. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J 2016; 47:429-60. [DOI: 10.1183/13993003.00745-2015] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
Abstract
This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others.
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19
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Higashimoto Y, Honda N, Yamagata T, Sano A, Nishiyama O, Sano H, Iwanaga T, Kume H, Chiba Y, Fukuda K, Tohda Y. Exertional dyspnoea and cortical oxygenation in patients with COPD. Eur Respir J 2015; 46:1615-24. [PMID: 26493791 DOI: 10.1183/13993003.00541-2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 07/08/2015] [Indexed: 11/05/2022]
Abstract
This study was designed to investigate the association of perceived dyspnoea intensity with cortical oxygenation and cortical activation during exercise in patients with chronic obstructive pulmonary disease (COPD) and exertional hypoxaemia.Low-intensity exercise was performed at a constant work rate by patients with COPD and exertional hypoxaemia (n=11) or no hypoxaemia (n=16), and in control participants (n=11). Cortical oxyhaemoglobin (oxy-Hb) and deoxyhaemoglobin (deoxy-Hb) concentrations were measured by multichannel near-infrared spectroscopy. Increased deoxy-Hb is assumed to reflect impaired oxygenation, whereas decreased deoxy-Hb signifies cortical activation.Exercise decreased cortical deoxy-Hb in control and nonhypoxaemic patients. Deoxy-Hb was increased in hypoxaemic patients and oxygen supplementation improved cortical oxygenation. Decreased deoxy-Hb in the pre-motor cortex (PMA) was significantly correlated with exertional dyspnoea in control participants and patients with COPD without hypoxaemia. In contrast, increased cortical deoxy-Hb concentration was correlated with dyspnoea in patients with COPD and hypoxaemia. With the administration of oxygen supplementation, exertional dyspnoea was correlated with decreased deoxy-Hb in the PMA of COPD patients with hypoxaemia.During exercise, cortical oxygenation was impaired in patients with COPD and hypoxaemia compared with control and nonhypoxaemic patients; this difference was ameliorated with oxygen supplementation. Exertional dyspnoea was related to activation of the pre-motor cortex in COPD patients.
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Affiliation(s)
- Yuji Higashimoto
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Noritsugu Honda
- Dept of Rehabilitation Medicine, Kinki University, Osaka, Japan
| | - Toshiyuki Yamagata
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Akiko Sano
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Osamu Nishiyama
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Hiroyuki Sano
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Takashi Iwanaga
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Hiroaki Kume
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kinki University, Osaka, Japan
| | - Kanji Fukuda
- Dept of Rehabilitation Medicine, Kinki University, Osaka, Japan
| | - Yuji Tohda
- Dept of Respiratory Medicine and Allergology, Kinki University, Osaka, Japan
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Nasis I, Kortianou E, Vasilopoulou Μ, Spetsioti S, Louvaris Z, Kaltsakas G, Davos C, Zakynthinos S, Koulouris N, Vogiatzis I. Hemodynamic effects of high intensity interval training in COPD patients exhibiting exercise-induced dynamic hyperinflation. Respir Physiol Neurobiol 2015; 217:8-16. [DOI: 10.1016/j.resp.2015.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Abstract
Patients with chronic lung disease may have mild hypoxemia at sea level. Some of these cases may go unrecognized, and even among those who are known to be hypoxemic, some do not use supplemental oxygen. During air travel in a hypobaric hypoxic environment, compensatory pulmonary mechanisms may be inadequate in patients with lung disease despite normal sea-level oxygen requirements. In addition, compensatory cardiovascular mechanisms may be less effective in some patients who are unable to increase cardiac output. Air travel also presents an increased risk of venous thromboembolism. Patients with cystic lung disease may also be at increased risk of pneumothorax. Although overall this risk appears to be relatively low, should a pneumothorax occur, it could present a significant challenge to the patient with chronic lung disease, particularly if hypoxemia is already present. As such, a thorough assessment of patients with chronic lung disease and cardiac disease who are contemplating air travel should be performed. The duration of the planned flight, the anticipated levels of activity, comorbid illnesses, and the presence of risk factors for venous thromboembolism are important considerations. Hypobaric hypoxic challenge testing reproduces an environment most similar to that encountered during actual air travel; however, it is not widely available. Assessment for hypoxia is otherwise best performed using a normobaric hypoxic challenge test. Patients in need of supplemental oxygen need to contact the airline and request this accommodation during flight. They should also be advised on arranging portable oxygen concentrators before air travel, and a discussion of the potential risks of travel should take place.
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Häussermann S, Schulze A, Katz IM, Martin AR, Herpich C, Hunger T, Texereau J. Effects of a helium/oxygen mixture on individuals' lung function and metabolic cost during submaximal exercise for participants with obstructive lung diseases. Int J Chron Obstruct Pulmon Dis 2015; 10:1987-97. [PMID: 26451096 PMCID: PMC4590345 DOI: 10.2147/copd.s88965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Helium/oxygen therapies have been studied as a means to reduce the symptoms of obstructive lung diseases with inconclusive results in clinical trials. To better understand this variability in results, an exploratory physiological study was performed comparing the effects of helium/oxygen mixture (78%/22%) to that of medical air. METHODS The gas mixtures were administered to healthy, asthmatic, and chronic obstructive pulmonary disease (COPD) participants, both moderate and severe (6 participants in each disease group, a total of 30); at rest and during submaximal cycling exercise with equivalent work rates. Measurements of ventilatory parameters, forced spirometry, and ergospirometry were obtained. RESULTS There was no statistical difference in ventilatory and cardiac responses to breathing helium/oxygen during submaximal exercise. For asthmatics, but not for the COPD participants, there was a statistically significant benefit in reduced metabolic cost, determined through measurement of oxygen uptake, for the same exercise work rate. However, the individual data show that there were a mixture of responders and nonresponders to helium/oxygen in all of the groups. CONCLUSION The inconsistent response to helium/oxygen between individuals is perhaps the key drawback to the more effective and widespread use of helium/oxygen to increase exercise capacity and for other therapeutic applications.
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Affiliation(s)
| | | | - Ira M Katz
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, France ; Department of Mechanical Engineering, Lafayette College, Easton, PA, USA
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | | | | | - Joëlle Texereau
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, France
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Zhang W, Lu H, Peng L, Ren X, Lu Y, An L, Zhang H, Tan X, Sun X, Huang K. Chronic bronchitis leads to accelerated hyperinflation in COPD patients during exercise. Respirology 2015; 20:618-25. [PMID: 25799924 DOI: 10.1111/resp.12504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE It is not known whether patients with chronic obstructive pulmonary disease (COPD) have a different exercise capacity with (CB(+) ) or without accompanying chronic bronchitis (CB(-) ). METHODS We conducted spirometry, a 6-min walk distance test and cardiopulmonary exercise test in 50 age-matched healthy control subjects, 45 COPD patients without CB (CB(-) ) and 37 COPD patients with CB (CB(+) ). A multiple regression model was established to identify factors independently associated with peak oxygen consumption ( V ˙ O 2 ). RESULTS Patients with and without CB had similar forced expiratory volume in 1 s (FEV1 ). CB(+) patients had a lower V ˙ O 2 . CB(+) and CB(-) participants had similar increases in tidal volume at peak exercise; however, CB(+) patients had an increased respiratory rate (RR). These patients reached the peak value for ratio of end-expiratory lung volume to total lung capacity (TLC) at a lower work load. A stepwise multiple linear regression analysis identified chronic bronchitis, FEV1 , diffusing capacity for carbon monoxide, the ratio of residual volume to TLC and serum tumour necrosis factor-α as independent predictors of peak V ˙ O 2 . CONCLUSIONS CB significantly lowers exercise capacity in COPD patients because of dynamic hyperinflation during exercise. The accelerated dynamic hyperinflation may contribute to increased airway and systemic inflammation in COPD patients.
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Affiliation(s)
- Wen Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Sakamoto Y, Sakamoto K, Minakata Y, Shiba S, Nakamura T, Ichinose M, Tajima F. Walking Pattern in COPD Patients. Rehabil Nurs 2015; 41:211-7. [PMID: 25773056 DOI: 10.1002/rnj.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] [Accepted: 11/21/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE To compare the activity and walking pattern of individuals with chronic obstructive pulmonary disease (COPD) and control subjects during a 24-hour period. DESIGN Cross-sectional study in home and community. METHODS The average walking velocity, time spent in sitting, standing, and lying, and numbers of steps per 24 hours were measured in nine individuals with COPD and eight healthy control subjects. FINDINGS The average walking velocity in individuals with COPD was equivalent to that of the control subjects. Individuals with COPD walked significantly less than the control subjects. The total time spent sitting, standing, and walking was similar in the two groups. CONCLUSIONS The results suggested that the walking velocity selected by individuals with COPD serves to minimize energy cost per distance. CLINICAL RELEVANCE The study findings emphasize the need to maintain walking velocity in any exercise prescription for individuals with COPD.
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Affiliation(s)
- Yukiko Sakamoto
- The School of Health and Nursing Science, Wakayama Medical University, Wakayama, Japan
| | - Keiko Sakamoto
- Research Center of Sports Medicine and Balneology, Wakayama Medical University, Wakayama, Japan
| | - Yoshiaki Minakata
- Third Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sumiko Shiba
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Hyogo, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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Zhao L, Peng L, Wu B, Bu X, Wang C. Effects of dynamic hyperinflation on exercise capacity and quality of life in stable COPD patients. CLINICAL RESPIRATORY JOURNAL 2015; 10:579-88. [PMID: 25620462 DOI: 10.1111/crj.12260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/11/2014] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Dynamic hyperinflation (DH) is an important pathophysiological characteristic of chronic obstructive pulmonary disease (COPD). There is increasing evidence that DH has negative effects on exercise performance and quality of life. The objective of this study was to explore effects of DH on exercise capacity and quality of life in stable COPD patients. METHODS Fifty-eight COPD patients and 20 matched healthy individuals underwent pulmonary function test, 6-min walk test and symptom-limited cardiopulmonary exercise test (CPET). End-expiratory lung volume/total lung capacity ratio (EELVmax/TLC) at peak exercise of CPET was evaluated, and EELVmax/TLC ≥ 75% was defined as 'severe dynamic hyperinflation (SDH)'. RESULTS Of the 58 patients studied, 29 (50.0%) presented with SDH (SDH+ group, EELVmax/TLC 79.60 ± 3.60%), having worse maximal exercise capacity reflected by lower peakload, maximal oxygen uptake (VO2 max), maximal carbon dioxide output (VCO2 max) and maximal minute ventilation (VEmax) than did those without SDH (SDH- group, EELVmax/TLC 67.44 ± 6.53%). The EELVmax/TLC ratio at peak exercise had no association with variables of pulmonary function and 6-min walk distance (6MWD), but correlated inversely with peakload, VO2 max, VCO2 max and VEmax (r = -0.300~-0.351, P < 0.05). Although no significant differences were observed, patients with EELVmax/TLC ≥ 75% tended to have higher COPD assessment test score (15.07 ± 6.55 vs 13.28 ± 6.59, P = 0.303). CONCLUSIONS DH develops variably during exercise and has a greater impact on maximal exercise capacity than 6MWD, even in those with the same extent of pulmonary function impairment at rest.
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Affiliation(s)
- Li Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Beijing, China.,Department of Surgery Intensive Care Unit, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyue Peng
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Beijing, China.,Department of Surgery Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Baomei Wu
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Xiaoning Bu
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Beijing, China.
| | - Chen Wang
- Department of Respiratory Medicine, China-Japan Friendship Hospital, Capital Medical University, National Clinical Research Center for Respiratory Medicine, Beijing, China.
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Beeh KM, Watz H, Puente-Maestu L, de Teresa L, Jarreta D, Caracta C, Garcia Gil E, Magnussen H. Aclidinium improves exercise endurance, dyspnea, lung hyperinflation, and physical activity in patients with COPD: a randomized, placebo-controlled, crossover trial. BMC Pulm Med 2014; 14:209. [PMID: 25539654 PMCID: PMC4364572 DOI: 10.1186/1471-2466-14-209] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluated the effects of aclidinium bromide, a long-acting muscarinic antagonist indicated for maintenance treatment of chronic obstructive pulmonary disease (COPD), on exercise endurance, dyspnea, lung hyperinflation, and physical activity. Methods In this randomized, double-blind, crossover study, patients with stable COPD and moderate-to-severe airflow limitation received aclidinium 400 μg twice daily or placebo via Genuair®/Pressair®a for 3 weeks (2-week washout between treatment periods). The primary endpoint was change from baseline to Week 3 in endurance time, measured by constant work rate cycle ergometry testing at 75% peak incremental work rate. Changes from baseline in intensity of exertional dyspnea (Borg CR10 Scale®) and trough inspiratory capacity were secondary endpoints. Additional endpoints included changes from baseline in other spirometric, plethysmographic, and physical activity (assessed by objective accelerometer measurement) parameters. Efficacy endpoints were analyzed using an analysis of covariance model. Results In total, 112 patients were randomized and treated (mean age 60.3 years; mean post-bronchodilator forced expiratory volume in 1 s 1.7 L [56.7% predicted]; mean endurance time 485.7 s). After 3 weeks, endurance time was significantly increased with aclidinium versus placebo (treatment difference 58.5 s; p < 0.05). At Week 3, aclidinium significantly reduced dyspnea intensity at isotime during exercise (treatment difference -0.63; p < 0.05) and improved trough inspiratory capacity (treatment difference 78 mL; p < 0.05) versus placebo. Significant improvements in spirometric, plethysmographic, and some physical activity parameters were observed with aclidinium versus placebo. Conclusions These results suggest that aclidinium significantly improves exercise endurance, exertional dyspnea, hyperinflation, and physical activity in patients with COPD. Trial registration ClinicalTrials.gov identifier: NCT01471171; URL: http://www.clinicaltrials.gov. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-14-209) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Helgo Magnussen
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Woehrendamm 80, D-22927 Grosshansdorf, Germany.
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Abstract
COPD is characterized by airflow limitation that is not fully reversible. The morphological basis for airflow obstruction results from a varying combination of obstructive changes in peripheral conducting airways and destructive changes in respiratory bronchioles, alveolar ducts, and alveoli. A reduction of vascularity within the alveolar septa has been reported in emphysema. Typical physiological changes reflect these structural abnormalities. Spirometry documents airflow obstruction when the FEV1/FVC ratio is reduced below the lower limit of normality, although in early disease stages FEV1 and airway conductance are not affected. Current guidelines recommend testing for bronchoreversibility at least once and the postbronchodilator FEV1/FVC be used for COPD diagnosis; the nature of bronchodilator response remains controversial, however. One major functional consequence of altered lung mechanics is lung hyperinflation. FRC may increase as a result of static or dynamic mechanisms, or both. The link between dynamic lung hyperinflation and expiratory flow limitation during tidal breathing has been demonstrated. Hyperinflation may increase the load on inspiratory muscles, with resulting length adaptation of diaphragm. Reduction of exercise tolerance is frequently noted, with compelling evidence that breathlessness and altered lung mechanics play a major role. Lung function measurements have been traditionally used as prognostic indices and to monitor disease progression; FEV1 has been most widely used. An increase in FVC is also considered as proof of bronchodilatation. Decades of work has provided insight into the histological, functional, and biological features of COPD. This has provided a clearer understanding of important pathobiological processes and has provided additional therapeutic options.
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Does expiratory muscle activity influence dynamic hyperinflation and exertional dyspnea in COPD? Respir Physiol Neurobiol 2014; 199:24-33. [DOI: 10.1016/j.resp.2014.04.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/24/2022]
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Laveneziana P, Guenette JA, Webb KA, O’Donnell DE. New physiological insights into dyspnea and exercise intolerance in chronic obstructive pulmonary disease patients. Expert Rev Respir Med 2014; 6:651-62. [DOI: 10.1586/ers.12.70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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O'Donnell DE, Laveneziana P, Webb K, Neder JA. Chronic obstructive pulmonary disease: clinical integrative physiology. Clin Chest Med 2013; 35:51-69. [PMID: 24507837 DOI: 10.1016/j.ccm.2013.09.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peripheral airway dysfunction, inhomogeneous ventilation distribution, gas trapping, and impaired pulmonary gas exchange are variably present in all stages of chronic obstructive pulmonary disease (COPD). This article provides a cogent physiologic explanation for the relentless progression of activity-related dyspnea and exercise intolerance that all too commonly characterizes COPD. The spectrum of physiologic derangements that exist in smokers with mild airway obstruction and a history compatible with COPD is examined. Also explored are the perceptual and physiologic consequences of progressive erosion of the resting inspiratory capacity. Finally, emerging information on the role of cardiocirculatory impairment in contributing to exercise intolerance in patients with varying degrees of airway obstruction is reviewed.
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Affiliation(s)
- Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
| | - Pierantonio Laveneziana
- Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée Hôpital Universitaire Pitié-Salpêtrière (AP-HP), Laboratoire de Physio-Pathologie Respiratoire, Faculty of Medicine, Pierre et Marie Curie University (Paris VI), 47-83 Boulevard de l'Hôpital,75013 Paris, France
| | - Katherine Webb
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
| | - J Alberto Neder
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
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Pessoa BV, Jamami M, Basso RP, Regueiro EMG, Oliveira Jr. ADD, Di Lorenzo VAP. Comparação de diferentes testes funcionais de membros inferiores em pacientes com doença pulmonar obstrutiva crônica: há concordância entre eles? FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000300003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) apresentam diminuição da capacidade funcional, tornando imprescindível a sua avaliação por meio de testes físicos funcionais. OBJETIVOS: Comparar, em pacientes com DPOC, saturação periférica de oxigênio (SpO2), dispneia e fadiga de membros inferiores (MMII) nos testes de caminhada de seis minutos em corredor (TC6) e em pista oval (TC6Po), do degrau de seis minutos (TD6) e de sentar-e-levantar da cadeira de dois minutos (TSL). Além disso, pretende-se verificar se há correlação e concordância dessas variáveis entre o TC6 e os demais testes. MATERIAIS E MÉTODOS: Foram avaliados 11 pacientes com DPOC (71 ± 8 anos, VEF1 < 80% previsto) por meio dos testes. RESULTADOS: Na análise intertestes, não se observaram diferenças significativas nos deltas da SpO2, dispneia (Δdispneia) e fadiga de MMII (ΔfadigaMMII). Constatou-se correlação significante, mas não concordância entre os menores valores da SpO2 no TC6 com os menores valores da SpO2 nos TC6Po, TD6 e TSL, sendo a média da diferença entre as médias com ± 1,96 desvio padrão: 0,8 ± 3,5; -1,9 ± 3,5 e -2,5 ± 4,6, respectivamente; entre Δdispneia e ΔfadigaMMII no TC6 com Δdispneia e ΔfadigaMMII no TC6Po: 0,0 ± 1,0 e 0,4 ± 0,8, respectivamente; e do ΔfadigaMMII no TC6 com ΔfadigaMMII no TSL: 0,1 ± 1,1. CONCLUSÃO: Os testes funcionais produziram respostas de oxigenação e perceptuais de esforço semelhantes em magnitude. Entretanto, de acordo com as variáveis analisadas, não foi encontrada concordância entre o TC6 com os demais testes, pelas grandes variações dos limites de concordância e grande variação interindividual, assim o TC6Po, TD6 e TSL não substitui o TC6.
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Lahaije A, van Helvoort H, Dekhuijzen R, Heijdra Y. Can COPD patients who hyperinflate during daily life activities be identified by laboratory tests? ACTA ACUST UNITED AC 2013; 86:237-42. [PMID: 23989464 DOI: 10.1159/000351108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/28/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of patients with chronic obstructive pulmonary disease (COPD) who develop dynamic hyperinflation (DH) during activities in daily life (ADL) is important, because of the association between DH and dyspnea and exercise limitation. OBJECTIVE We aimed to answer the question whether measurements of DH during metronome-paced tachypnea (MPT) or cardiopulmonary exercise testing (CPET) can be used to identify patients who develop DH during ADL. METHODS DH was measured by tracking changes in inspiratory capacity during CPET, MPT and ADL. Bland-Altman plots were used to evaluate agreement in DH between methods. With a receiver operating characteristic (ROC) analysis, the overall accuracy of MPT and CPET to identify patients who hyperinflate during ADL was assessed. RESULTS There are broad limits of agreement in DH between methods. ROC curve analyses showed good overall accuracy of both CPET and MPT to identify patients who hyperinflate during ADL. For CPET, area under the curve (AUC) = 0.956 (95% CI 0.903-1.009). For MPT, AUC = 0.840 (95% CI 0.699-0.981). Sensitivity and specificity to identify patients who hyperinflate during ADL with CPET were 96 and 83%, respectively, and with MPT, they were 89 and 77%, respectively. CONCLUSION Both CPET and MPT can serve as screening tools to identify patients who are susceptible to developing DH during ADL. In practice, MPT is the most simple and inexpensive surrogate. However, the sensitivity of MPT is not optimal. When DH does not occur during CPET, it is unlikely to occur during ADL.
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Affiliation(s)
- A Lahaije
- Radboud University Nijmegen Medical Centre, Department of Pulmonary Diseases, Nijmegen, The Netherlands
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Dolmage TE, Evans RA, Goldstein RS. Defining hyperinflation as 'dynamic': moving toward the slope. Respir Med 2013; 107:953-8. [PMID: 23478191 DOI: 10.1016/j.rmed.2013.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/29/2013] [Accepted: 02/11/2013] [Indexed: 11/26/2022]
Abstract
Measuring the severity of dynamic hyperinflation is a useful clinical approach to assess the effect of therapeutic interventions and explain their impact on exercise tolerance. Dynamic hyperinflation is typically quantified by the change in end expiratory lung volume from rest to the end of exercise. The result may be inconsistent with disease severity and does not clearly explain how exercise tolerance improves with therapy. Using a re-examination of selected studies, we suggest an operational definition of dynamic hyperinflation using the slope derived from serial measures of inspiratory capacity expressed as a linear function of ventilation that clearly differentiates whether therapies affect static or dynamic hyperinflation or affect lung volume only as a consequence of reducing ventilation. With this approach, the magnitude of the result is consistent with disease severity and is a more reliable outcome as it uses serial measures rather than a single time point estimate. The therapies re-evaluated are breathing helium or hyperoxic gas mixtures, bronchodilation and exercise training. A clear definition of dynamic hyperinflation will assist clinicians in assessing the impact of therapeutic interventions.
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Affiliation(s)
- Thomas E Dolmage
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto M6M 2J5, Canada
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Puente-Maestu L, Lázaro A, Humanes B. Metabolic derangements in COPD muscle dysfunction. J Appl Physiol (1985) 2013; 114:1282-90. [PMID: 23288549 DOI: 10.1152/japplphysiol.00815.2012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Mitochondrial muscle alterations are common in patients with chronic obstructive pulmonary disease (COPD) and manifest mainly as decreased oxidative capacity and excessive production of reactive oxygen species (ROS). The significant loss of oxidative capacity observed in the quadriceps of COPD patients is mainly due to reduced mitochondrial content in the fibers, a finding consistent with the characteristic loss of type I fibers observed in that muscle. Decreased oxidative capacity does not directly limit maximum performance; however, it is associated with increased lactate production at lower exercise intensity and reduced endurance. Since type I fiber atrophy does not occur in respiratory muscles, the loss of such fibers in the quadriceps could be to the result of disuse. In contrast, excessive production of ROS and oxidative stress are observed in both the respiratory muscles and the quadriceps of COPD patients. The causes of increased ROS production are not clear, and a number of different mechanisms can play a role. Several mitochondrial alterations in the quadriceps of COPD patients are similar to those observed in diabetic patients, thus suggesting a role for muscle alterations in this comorbidity. Amino acid metabolism is also altered. Expression of peroxisome proliferator-activated receptor-γ coactivator-1α mRNA is low in the quadriceps of COPD patients, which could also be a consequence of type I fiber loss; nevertheless, its response to exercise is not altered. Patterns of muscle cytochrome oxidase gene activation after training differ between COPD patients and healthy subjects, and the profile is consistent with hypoxic stress, even in nonhypoxic patients.
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Affiliation(s)
- Luis Puente-Maestu
- Servicio de Neumología, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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35
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A simple method to derive speed for the endurance shuttle walk test. Respir Med 2012; 106:1665-70. [DOI: 10.1016/j.rmed.2012.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/08/2012] [Accepted: 08/14/2012] [Indexed: 01/23/2023]
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Pessoa BV, Jamami M, Basso RP, Regueiro EMG, Di Lorenzo VAP, Costa D. Teste do degrau e teste da cadeira: comportamento das respostas metábolo-ventilatórias e cardiovasculares na DPOC. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000100011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Verificar as respostas metabólicas, ventilatórias, cardiovasculares e de percepção de esforço entre o isotime de dois minutos do teste do degrau (TD2) e o teste do degrau de seis minutos (TD6) com o teste de sentar-se e levantar-se da cadeira de dois minutos (TSL) nos indivíduos com DPOC. MATERIAIS E MÉTODOS: Foram avaliados 11 homens com DPOC (71 ± 8 anos, VEF1 = 46,1 ± 15,2% previsto), clinicamente estáveis, por meio do TD6 e TSL associados à análise de gases e à coleta de lactato sanguíneo, realizadas em dias diferentes e não consecutivos. No TD2 e TD6, os indivíduos foram instruídos a subir e descer um degrau de 20 cm de altura o mais rápido possível. O mesmo foi recomendado no TSL, que foi realizado em uma cadeira de 46 cm de altura. RESULTADOS:Na análise intertestes não se observou diferença significativa nas variáveis metábolo-ventilatórias, cardiovasculares e Δdispneia no pico de ambos os testes, bem como no TD2. Quanto ao Δfrequκncia cardíaca e ao Δfadiga nos membros inferiores, constataram-se valores significantemente maiores para o TSL comparado ao TD2; e correlações positivas entre o consumo de oxigênio, Δfrequência cardíaca e os desempenhos no TD2 e TD6, entre os desempenhos no TD6 e TSL, e no TD2 com TSL. CONCLUSÃO:Os testes realizados apresentaram respostas metábolo-ventilatórias, cardiovasculares e dispneia similares; e o TD2 mostrou-se uma alternativa para avaliar as limitações funcionais dos indivíduos com DPOC de obstrução grave, proporcionando menor estresse cardiovascular e fadiga muscular se comparado ao TSL, pelas exigências metabólicas periféricas e ajustes posturais.
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Tzani P, Aiello M, Elia D, Boracchia L, Marangio E, Olivieri D, Clini E, Chetta A. Dynamic hyperinflation is associated with a poor cardiovascular response to exercise in COPD patients. Respir Res 2011; 12:150. [PMID: 22074289 PMCID: PMC3225311 DOI: 10.1186/1465-9921-12-150] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 11/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary hyperinflation has the potential for significant adverse effects on cardiovascular function in COPD. The aim of this study was to investigate the relationship between dynamic hyperinflation and cardiovascular response to maximal exercise in COPD patients. Methods We studied 48 patients (16F; age 68 yrs ± 8; BMI 26 ± 4) with COPD. All patients performed spirometry, plethysmography, lung diffusion capacity for carbon monoxide (TLco) measurement, and symptom-limited cardiopulmonary exercise test (CPET). The end-expiratory lung volume (EELV) was evaluated during the CPET. Cardiovascular response was assessed by change during exercise in oxygen pulse (ΔO2Pulse) and double product, i.e. the product of systolic blood pressure and heart rate (DP reserve), and by the oxygen uptake efficiency slope (OUES), i.e. the relation between oxygen uptake and ventilation. Results Patients with a peak exercise EELV (%TLC) ≥ 75% had a significantly lower resting FEV1/VC, FEF50/FIF50 ratio and IC/TLC ratio, when compared to patients with a peak exercise EELV (%TLC) < 75%. Dynamic hyperinflation was strictly associated to a poor cardiovascular response to exercise: EELV (%TLC) showed a negative correlation with ΔO2Pulse (r = - 0.476, p = 0.001), OUES (r = - 0.452, p = 0.001) and DP reserve (r = - 0.425, p = 0.004). Furthermore, according to the ROC curve method, ΔO2Pulse and DP reserve cut-off points which maximized sensitivity and specificity, with respect to a EELV (% TLC) value ≥ 75% as a threshold value, were ≤ 5.5 mL/bpm (0.640 sensitivity and 0.696 specificity) and ≤ 10,000 Hg · bpm (0.720 sensitivity and 0.783 specificity), respectively. Conclusion The present study shows that COPD patients with dynamic hyperinflation have a poor cardiovascular response to exercise. This finding supports the view that in COPD patients, dynamic hyperinflation may affect exercise performance not only by affecting ventilation, but also cardiac function.
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Affiliation(s)
- Panagiota Tzani
- Cardiopulmonary Dept, Lung Function Unit, University Hospital (via Rasori 10), Parma (43125), Italy.
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Zainuldin R, Mackey MG, Alison JA. Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 2011:CD008008. [PMID: 22071841 PMCID: PMC8939846 DOI: 10.1002/14651858.cd008008.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intensity of exercise is considered a key determinant of training response, however, no systematic review has investigated the effects of different levels of training intensity on exercise capacity, functional exercise capacity and health-related quality of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). As type of training (continuous or interval) may also affect training response, the effects of the type of training in COPD also require investigation. OBJECTIVES To determine the effects of training intensity (higher versus lower) or type (continuous versus interval training) on primary outcomes in exercise capacity and secondary outcomes in symptoms and HRQoL for people with COPD. SEARCH METHODS We searched for studies in any language from the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and PubMed. Searches were current as of June 2011. SELECTION CRITERIA We included randomised controlled trials comparing higher training intensity to lower training intensity or comparing continuous training to interval training in people with COPD. We excluded studies that compared exercise training with no exercise training. DATA COLLECTION AND ANALYSIS We pooled results of comparable groups of studies and calculated the treatment effect and 95% confidence intervals (CI) using a random-effects model. We made two separate comparisons of effects between: 1) higher and lower training intensity; 2) continuous and interval training. We contacted authors of missing data. MAIN RESULTS We analysed three included studies (231 participants) for comparisons between higher and lower-intensity training and eight included studies (367 participants) for comparisons between continuous and interval training. Primary outcomes were outcomes at peak exercise (peak work rate, peak oxygen consumption, peak minute ventilation and lactate threshold), at isowork or isotime, endurance time on a constant work rate test and functional exercise capacity (six-minute walk distance). When comparing higher versus lower-intensity training, the pooled primary outcomes were endurance time and six-minute walk distance. There were no significant differences in endurance time improvement (mean difference (MD) 1.07 minutes; 95% CI -1.53 to 3.67) and six-minute walk distance improvement (MD 2.8 metres; 95% CI -10.1 to 15.6) following higher or lower-intensity training. However, heterogeneity of the endurance time results between studies was significant. When comparing continuous and interval training, there were no significant differences in any of the primary outcomes, except for oxygen consumption at isotime (MD 0.08; 95% CI 0.01 to 0.16) but the treatment effect was not considered clinically important. According to the GRADE system, studies were of low to moderate quality. AUTHORS' CONCLUSIONS Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.
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Affiliation(s)
- Rahizan Zainuldin
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.
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Rambod M, Porszasz J, Make BJ, Crapo JD, Casaburi R. Six-minute walk distance predictors, including CT scan measures, in the COPDGene cohort. Chest 2011; 141:867-875. [PMID: 21960696 DOI: 10.1378/chest.11-0870] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Exercise tolerance in COPD is only moderately well predicted by airflow obstruction assessed by FEV(1). We determined whether other phenotypic characteristics, including CT scan measures, are independent predictors of 6-min walk distance (6MWD) in the COPDGene cohort. METHODS COPDGene recruits non-Hispanic Caucasian and African American current and ex-smokers. Phenotyping measures include postbronchodilator FEV(1) % predicted and inspiratory and expiratory CT lung scans. We defined % emphysema as the percentage of lung voxels < -950 Hounsfield units on the inspiratory scan and % gas trapping as the percentage of lung voxels < -856 Hounsfield units on the expiratory scan. RESULTS Data of the first 2,500 participants of the COPDGene cohort were analyzed. Participant age was 61 ± 9 years; 51% were men; 76% were non-Hispanic Caucasians, and 24% were African Americans. Fifty-six percent had spirometrically defined COPD, with 9.3%, 23.4%, 15.0%, and 8.3% in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to IV, respectively. Higher % emphysema and % gas trapping predicted lower 6MWD (P < .001). However, in a given spirometric group, after adjustment for age, sex, race, and BMI, neither % emphysema nor % gas trapping, or their interactions with FEV(1) % predicted, remained a significant 6MWD predictor. In a given spirometric group, only 16% to 27% of the variance in 6MWD could be explained by age, male sex, Caucasian race, and lower BMI as significant predictors of higher 6MWD. CONCLUSIONS In this large cohort of smokers in a given spirometric stage, phenotypic characteristics were only modestly predictive of 6MWD. CT scan measures of emphysema and gas trapping were not predictive of 6MWD after adjustment for other phenotypic characteristics.
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Affiliation(s)
- Mehdi Rambod
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
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Higashimoto Y, Honda N, Yamagata T, Matsuoka T, Maeda K, Satoh R, Nishiyama O, Sano H, Iwanaga T, Miyara T, Muraki M, Tomita K, Kume H, Miyai I, Tohda Y, Fukuda K. Activation of the Prefrontal Cortex Is Associated with Exertional Dyspnea in Chronic Obstructive Pulmonary Disease. Respiration 2011; 82:492-500. [DOI: 10.1159/000324571] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 01/25/2011] [Indexed: 11/19/2022] Open
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Ng BH, Tsang HW, Jones AY, So C, Mok TY. Functional and Psychosocial Effects of Health Qigong in Patients with COPD: A Randomized Controlled Trial. J Altern Complement Med 2011; 17:243-51. [PMID: 21417809 DOI: 10.1089/acm.2010.0215] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Bobby H.P. Ng
- Centre for East-Meets-West, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Hector W.H. Tsang
- Centre for East-Meets-West, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Alice Y.M. Jones
- Centre for East-Meets-West, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - C.T. So
- Occupational Therapy Department, Kowloon Hospital, Kowloon, Hong Kong
| | - Thomas Y.W. Mok
- Respiratory Medical Department, Kowloon Hospital, Kowloon, Hong Kong
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Lahaije AJMC, van Helvoort HAC, Dekhuijzen PNR, Heijdra YF. Physiologic limitations during daily life activities in COPD patients. Respir Med 2010; 104:1152-9. [PMID: 20346641 DOI: 10.1016/j.rmed.2010.02.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 02/11/2010] [Accepted: 02/15/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with COPD are known to be limited in their performance of activities of daily life (ADL). This observational study aims to investigate the ventilatory and metabolic demand of ADL in home settings of patients and evaluate possible mechanisms involved in physiological limitation during ADL in COPD. METHODS In their home settings, 21 stable patients with COPD (GOLD II-IV, mean FEV(1) 43% predicted) were asked to perform their most dyspnea causing activities at their usual pace until symptoms discouraged further performance. Ten healthy control subjects, matched for age and gender, performed comparable activities. Ventilatory and metabolic demands of the ADL were studied using a portable breath-by-breath system. RESULTS Compared with healthy controls, ADL time was shorter in patients (530 +/- 38 s vs. 318 +/- 37 s respectively) and activities resulted in important complaints of dyspnea. Oxygen consumption (V O(2)) during the activities was higher in patients compared to healthy subjects (957 +/- 51 vs. 768 +/- 63 mL/min resp.). Ventilatory demand (V E) for comparable activity (at isoV O(2)) was higher in patients and went together with complaints of dyspnea in patients, but not in healthy subjects. Ventilatory constraints like low ventilatory reserve and inspiratory reserve volume and dynamic hyperinflation occurred in more than 80% of the patients, especially in (very) severe patients. CONCLUSION Patients with COPD experience limitations in the performance of ADL, which lead to reductions in ADL time and dyspnea complaints. There appears to be an important role for ventilatory limitations, which become more prominent as disease progresses.
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Affiliation(s)
- A J M C Lahaije
- Radboud University Nijmegen Medical Centre, Dept. of Pulmonary Diseases, Nijmegen, The Netherlands.
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Abstract
Dyspnea and activity limitation are the primary symptoms of chronic obstructive pulmonary disease and progress relentlessly as the disease advances. In COPD, dyspnea is multifactorial but abnormal dynamic ventilatory mechanics are believed to be important. Dynamic lung hyperinflation occurs during exercise in the majority of flow-limited patients with chronic obstructive pulmonary disease and may have serious sensory and mechanical consequences. This proposition is supported by several studies, which have shown a close correlation between indices of dynamic lung hyperinflation and measures of both exertional dyspnea and exercise performance. The strength of this association has been further confirmed by studies that have therapeutically manipulated this dependent variable. Relief of exertional dyspnea and improved exercise endurance following bronchodilator therapy correlate well with reduced lung hyperinflation. The mechanisms by which dynamic lung hyperinflation give rise to exertional dyspnea and exercise intolerance are complex. However, recent mechanistic studies suggest that dynamic lung hyperinflation-induced volume restriction and consequent neuromechanical uncoupling of the respiratory system are key mechanisms. This review examines, in some detail, the derangements of ventilatory mechanics that are peculiar to chronic obstructive pulmonary disease and attempts to provide a mechanistic rationale for the attendant respiratory discomfort and activity limitation.
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Affiliation(s)
- Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Abstract
Static lung hyperinflation is defined as the elevation of end- expiratory lung volume above its predicted value, with no increase in end-expiratory alveolar pressure, which remains equal to atmospheric pressure. Dynamic hyperinflation is the transient increase of this volume above the relaxation volume. In patients with COPD, dynamic hyperinflation is mainly determined by the mechanical properties of the respiratory system. Its measurement relies on plethysmography and, during exercise, inspiratory capacity. During exercise, dynamic hyperinflation attenuates expiratory flow limitation but increases the inspiratory loading and induces functional weakness of the diaphragm. It also has haemodynamic consequences and results in more rapid, shallow breathing and progressive reduction in dynamic lung compliance. These events explain exercise intolerance. Several approaches may help combat dynamic hyperinflation and its deleterious clinical effects: bronchodilators, hyperoxia, helium-oxygen mixtures, lung volume reduction surgery...
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Affiliation(s)
- D-E O'donnell
- Division of Respiratory and critical care medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Similowski P, Feuillet S. De l’inflammation des petites voies aériennes à la dyspnée d’effort dans la bronchopneumopathie chronique obstructive. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)59006-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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West JB. The major limitation to exercise performance in COPD is inadequate energy supply to the respiratory and locomotor muscles vs. lower limb muscle dysfunction vs. dynamic hyperinflation. J Appl Physiol (1985) 2008; 105:762. [DOI: 10.1152/japplphysiol.zdg-8100.pcpcomm.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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O'Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. J Appl Physiol (1985) 2008; 105:753-5; discussion 755-7. [DOI: 10.1152/japplphysiol.90336.2008b] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Laveneziana P, Parker CM, O'Donnell DE. Ventilatory constraints and dyspnea during exercise in chronic obstructive pulmonary disease. Appl Physiol Nutr Metab 2008; 32:1225-38. [PMID: 18059601 DOI: 10.1139/h07-119] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dyspnea (respiratory difficulty) and activity limitation are the primary symptoms of chronic obstructive pulmonary disease (COPD) and progress relentlessly as the disease advances, contributing to reduced quality of life. In COPD, the mechanisms of dyspnea are multifactorial, but abnormal dynamic ventilatory mechanics are believed to play a central role. In flow-limited patients with COPD, dynamic lung hyperinflation (DH) occurs during exercise and has serious sensory and mechanical consequences. In several studies, indices of DH strongly correlate with ratings of dyspnea intensity during exercise, and strategies that reduce resting hyperinflation (either pharmacological or surgical) consistently result in reduced exertional dyspnea. The mechanisms by which DH gives rise to exertional dyspnea and exercise intolerance are complex, but recent mechanistic studies suggest that DH-induced inspiratory muscle loading, restriction of tidal volume expansion during exercise, and consequent neuromechanical uncoupling of the respiratory system are key components. This review examines the specific derangements of ventilatory mechanics that occur in COPD during exercise and attempts to provide a mechanistic rationale for the attendant respiratory discomfort and activity limitation.
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Affiliation(s)
- Pierantonio Laveneziana
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart St., Kingston, ON K7L 2V6
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Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by poorly reversible airflow limitation. The pathological hallmarks of COPD are inflammation of the peripheral airways and destruction of lung parenchyma or emphysema. The functional consequences of these abnormalities are expiratory airflow limitation and dynamic hyperinflation, which then increase the elastic load of the respiratory system and decrease the performance of the respiratory muscles. These pathophysiologic features contribute significantly to the development of dyspnea, exercise intolerance and ventilatory failure. Several treatments may palliate flow limitation, including interventions that modify the respiratory pattern (deeper, slower) such as pursed lip breathing, exercise training, oxygen, and some drugs. Other therapies are aimed at its amelioration, such as bronchodilators, lung volume reduction surgery or breathing mixtures of helium and oxygen. Finally some interventions, such as inspiratory pressure support, alleviate the threshold load associated to flow limitation. The degree of flow limitation can be assessed by certain spirometry indexes, such as vital capacity and inspiratory capacity, or by other more complexes indexes such as residual volume/total lung capacity or functional residual capacity/total lung capacity. Two of the best methods to measure flow limitation are to superimpose a flow–volume loop of a tidal breath within a maximum flow–volume curve, or to use negative expiratory pressure technique. Likely this method is more accurate and can be used during spontaneous breathing. A definitive definition of dynamic hyperinflation is lacking in the literature, but serial measurements of inspiratory capacity during exercise will document the trend of end-expiratory lung volume and allow establishing relationships with other measurements such as dyspnea, respiratory pattern, exercise tolerance, and gas exchange.
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Affiliation(s)
- Luis Puente-Maestu
- Hospital General Universitario Gregorio Marañón, Servicio de Neumologia, Madrid, Spain.
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Ofir D, Laveneziana P, Webb KA, Lam YM, O'Donnell DE. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 177:622-9. [PMID: 18006885 DOI: 10.1164/rccm.200707-1064oc] [Citation(s) in RCA: 244] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Smokers with a relatively preserved FEV(1) may experience dyspnea and activity limitation but little is known about underlying mechanisms. OBJECTIVES To examine ventilatory constraints during exercise in symptomatic smokers with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage I chronic obstructive lung disease (COPD) so as to uncover potential mechanisms of dyspnea and exercise curtailment. METHODS We compared resting pulmonary function and ventilatory responses (breathing pattern, operating lung volumes, pulmonary gas exchange) with incremental cycle exercise as well as Borg scale ratings of dyspnea intensity in 21 patients (post-bronchodilator FEV(1), 91 +/- 7% predicted, and FEV(1)/FVC, 60 +/- 6%; mean +/- SD) with significant breathlessness and 21 healthy age- and sex-matched control subjects with normal spirometry. MEASUREMENTS AND MAIN RESULTS In patients with COPD compared with control subjects, peak oxygen consumption and power output were significantly reduced by more than 20% and dyspnea ratings were higher for a given work rate and ventilation (P < 0.05). Compared with the control group, the COPD group had evidence of extensive small airway dysfunction with increased ventilatory requirements during exercise, likely on the basis of greater ventilation/perfusion abnormalities. Changes in end-expiratory lung volume during exercise were greater in COPD than in health (0.54 +/- 0.34 vs. 0.06 +/- 0.32 L, respectively; P < 0.05) and breathing pattern was correspondingly more shallow and rapid. Across groups, dyspnea intensity increased as ventilation expressed as a percentage of capacity increased (P < 0.0005) and as inspiratory reserve volume decreased (P < 0.0005). CONCLUSIONS Exertional dyspnea in symptomatic patients with mild COPD is associated with the combined deleterious effects of higher ventilatory demand and abnormal dynamic ventilatory mechanics, both of which are potentially amenable to treatment.
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Affiliation(s)
- Dror Ofir
- F.R.C.P.C., 102 Stuart Street, Kingston, ON, K7L 2V6 Canada.
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