Adiposity increases weight-bearing exercise-induced dyspnea despite favoring resting lung hyperinflation in COPD

Abstract

Objectives Our aim was to study the associations between resting lung hyperinflation, weight-bearing exercise-induced dyspnea and adipose distribution in obese and normal-weight COPD patients. Methods We performed a comparison between 80 obese COPD patients (COPDOB) with 80 age- and FEV1 matched normal-weight COPD patients (COPDNW). Dyspnea was assessed by the mMRC scale and the Borg dyspnea score before and after a 6 min walk test. Further characterization included spirometry, body plethysmography and metronome paced tachypnea (MPT) to estimate dynamic hyperinflation. Body composition was assessed with bioelectrical impedance analysis. Associations between dyspnea scores and BMI and body composition groups were studied using logistic regression models. Results COPDOB patients had attenuated increases in TLC, FRC and RV compared to COPDNW patients ( p < 0.01). The groups had comparable 6 min walking distance and ΔFRC upon MPT ( p > 0.05). Compared to COPDNW, COPDOB patients reported more often a mMRC ≥ 2 (65 vs 46%; p = 0.02; OR 3.0, 95% CI 1.4–6.2, p < 0.01) and had higher ΔBorg upon 6MWT: 2.0 (SEM 0.20) vs. 1.4 (SEM 0.16), p = 0.01; OR for ΔBorg ≥ 2: 2.4, 95% CI 1.1–5.2, p = 0.03. Additional logistic regression analyses on the associations between body composition and dyspnea indicated that increased body fat percentage, fat mass index and waist-to-hip ratio were associated with higher ORs for mMRC ≥ 2 and ΔBorg upon 6MWT ≥ 2. Conclusion Despite its beneficial effect on resting lung hyperinflation, adiposity is associated with increased weight-bearing exercise-induced dyspnea in COPD.

Knowledge, attitude, and practice toward interstitial lung disease among patients: a cross-sectional study

“…Therefore, efforts involving healthcare providers, patient advocacy groups, and public health initiatives are necessary to educate the population about the diverse nature of ILD and its common signs. In the attitude dimension, 37.28% of participants attributed their dyspnea or tachypnea symptoms more to obesity or aging than ILD, which reflected the broader awareness of the impacts of these prevalent health factors on respiratory issues (30,31). However, due to dyspnea and tachypnea as hallmark symptoms of ILD, the delay in awareness could impact disease management (32).…”

CRD editor’s corner archive: January-March

“…In addition to the somewhat counter-intuitive prognostic benefit of being overweight or obese in COPD, researchers have documented a potential advantage of increased body weight in reducing hyperinflation. In the journal this month, Zewari et al 7 provide further insight by comparing weight bearing exercise performance between normal and overweight people with COPD. They confirm a reduction in hyperinflation but suggest this is offset by the disadvantage of carrying additional weight.…”

Exercise ventilation and dyspnea in the obese patient with chronic obstructive pulmonary disease: “how much” versus “how well”

“…8 If the patients anchor their accessory inspiratory muscles by firmly holding the handlebars, larger IC can be reached on cycling than walking. 20 Zewari and colleagues 17 argue that the negative consequences of mild-moderate obesity on dyspnea during walking have more than eclipsed its putative salutary effects previously described by Ora et al in response to cycling. 3 As mentioned, however, these assertions were based on indirect comparisons between different populations.…”

“…In the current issue of Chronic Respiratory Disease , Zewari and colleagues 17 dealt with another feature of the obesitydyspnea conundrum in COPD: the influence of exercise modality. Despite the lack of direct comparisons between walking versus cycling and the dearth of physiological measurements on exertion, the authors conclude that even mild-moderate obesity may have a detrimental effect on exercise tolerance and dyspnea in these patients.…”