Cardiopulmonary Exercise Test Interpretation Using Age-Matched Controls to Evaluate Exertional Dyspnea

Sill, Joshua; Morris, Michael J.; Johnson, James E.; Allan, Patrick F.; Grbach, Vincent X.

doi:10.7205/milmed-d-05-0308

Cited by 11 publications

(14 citation statements)

References 11 publications

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“…A recent study by Sill et al examining CPET in a similar normal population of military personnel (mean age of 25.4 ± 4.3 years, body mass index of 24.4 ± 2.8, and percent body fat of 21.3 ± 6.1) found only a slight decrease in the predicted normal VO 2 max to 82% predicted [7]. In a 1974 study in which 710 healthy, active duty Air Force personnel underwent maximal exercise testing, the authors published a regression equation used to predict VO 2 max.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Predicted Exercise Capacity Equations and the Effect of Actual versus Ideal Body Weight among Subjects Undergoing Cardiopulmonary Exercise Testing

Ahmadian

Sclafani

Emmons

et al. 2013

Cardiology Research and Practice

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Background. Oxygen uptake at maximal exercise (VO2 max) is considered the best available index for assessment of exercise capacity. The purpose of this study is to determine if the use of actual versus ideal body weight in standard regression equations for predicted VO2 max results in differences in predicted VO2 max. Methods. This is a retrospective chart review of patients who were predominantly in active military duty with complaints of dyspnea or exercise tolerance and who underwent cardiopulmonary exercise testing (CPET) from 2007 to 2009. Results. A total of 230 subjects completed CPET on a bicycle ergometer with a male predominance (62%) and an average age of 37 ± 15 years. There was significant discordance between the measured VO2 max and predicted VO2 max when measured by the Hansen and Wasserman reference equations (P < 0.001). Specifically, there was less overestimation when predicted VO2 max was based on ideal body weight as opposed to actual body weight. Conclusion. Our retrospective analysis confirmed the wide variations in predicted versus measured VO2 max based on varying prediction equations and showed the potential advantage of using ideal body weight as opposed to actual body weight in order to further standardize reference norms.

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Section: Discussionmentioning

confidence: 99%

Comparison of Predicted Exercise Capacity Equations and the Effect of Actual versus Ideal Body Weight among Subjects Undergoing Cardiopulmonary Exercise Testing

Ahmadian

Sclafani

Emmons

et al. 2013

Cardiology Research and Practice

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“…In a study, Sill et al . [ 9 ] compared the CPET findings in 105 patients with exercise-induced dyspnea with 69 normal volunteers and observed that the use of CPET in patients with exercise-induced dyspnea causes the increased specificity and the reduced diagnosis sensitivity. They stated that the CPET has not the required sensitivity in diagnosis of mild illness in young people.…”

Section: Discussionmentioning

confidence: 99%

Exertional-induced bronchoconstriction: Comparison between cardiopulmonary exercise test and methacholine challenging test

et al. 2015

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Introduction:Exertional-induced bronchoconstriction is a condition in which the physical activity causes constriction of airways in patients with airway hyper- responsiveness. In this study, we tried to study and evaluate any relationship between the findings of cardiopulmonary exercise testing (CPET) and the response to methacholine challenge test (MCT) in patients with dyspnea after activity.Materials and Methods:Thirty patients with complaints of dyspnea following activity referred to “Lung Clinic” of Baqiyatallah Hospital but not suffering from asthma were entered into the study. The subjects were excluded from the study if: Suffering from any other pulmonary diseases, smoking more than 1 cigarette a week in the last year, having a history of smoking more than 10 packets of cigarettes/year, having respiratory infection in the past 4 weeks, having abnormal chest X-ray or electrocardiogram, and cannot discontinue the use of medicines interfering with bronchial provocation. Baseline spirometry was performed for all the patients, and the values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV/FVC were recorded. The MCT and then the CPET were performed on all patients.Results:The mean VO2 (volume oxygen) in patients with positive methacholine test (20.45 mL/kg/min) was significantly lower than patients with negative MCT (28.69 mL/kg/min) (P = 0.000). Respiratory rates per minute (RR) and minute ventilation in the group with positive MCT (38.85 and 1.636 L) were significantly lower than the group with negative methacholine test (46.78 and 2.114 L) (P < 0.05). Also, the O2 pulse rate in the group with negative methacholine test (116.27 mL/beat) was significantly higher than the group with positive methacholine test (84.26 mL/beat) (P < 0.001).Conclusion:Pulmonary response to exercise in patients with positive methacholine test is insufficient. The dead space ventilation in these patients has increased. Also, dynamic hyperinflation in patients with positive methacholine test causes the reduced stroke volume and O2 pulse in these patients.

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“…However, for the younger military population, there is little cardiac disease and the presence of most pulmonary disease can be detected by other testing. Additionally, there are no established reference values for CPET parameters in this population [Sill et al 2009]. Despite these limitations, CPET may provide an estimate of the patient’s ability to perform maximal exercise, which is important in determining further invasive testing.…”

Section: Evaluation Of Deployed Military Personnelmentioning

confidence: 99%

Diagnosis and management of chronic lung disease in deployed military personnel

Morris

Lucero

Zanders

et al. 2013

Ther Adv Respir Dis

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Abstract:Military personnel are a unique group of individuals referred to the pulmonary physician for evaluation. Despite accession standards that limit entrance into the military for individuals with various pre-existing lung diseases, the most common disorders found in the general population such as asthma and chronic obstructive pulmonary disease remain frequently diagnosed. Military personnel generally tend to be a more physically fit population who are required to exercise on a regular basis and as such may have earlier presentations of disease than their civilian counterparts. Exertional dyspnea is a common complaint; establishing a diagnosis may be challenging given the subtle nature of symptoms and lack of specificity with pulmonary function testing. The conflicts over the past 10 years in Iraq and Afghanistan have also given rise to new challenges for deployed military. Various respiratory hazards in the deployed environment include suspended geologic dusts, burn pits, vehicle exhaust emissions, industrial air pollution, and isolated exposure incidents and may give rise to both acute respiratory symptoms and chronic lung disease. In the evaluation of deployed military personnel, establishing the presence of actual pulmonary disease and the relationship of existing disease to deployment is an ongoing issue to both military and civilian physicians. This paper reviews the current evidence for chronic lung disease in the deployed military population and addresses any differences in diagnosis and management.

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Cardiopulmonary Exercise Test Interpretation Using Age-Matched Controls to Evaluate Exertional Dyspnea

Abstract: The use of age-matched controls for CPET results in an increase in specificity and decrease in sensitivity for respiratory limitations to exercise, when compared to reference values. The study findings suggest that CPET may be insensitive in detecting mild disease in young healthy adults.

Cited by 11 publications

References 11 publications

Comparison of Predicted Exercise Capacity Equations and the Effect of Actual versus Ideal Body Weight among Subjects Undergoing Cardiopulmonary Exercise Testing

Comparison of Predicted Exercise Capacity Equations and the Effect of Actual versus Ideal Body Weight among Subjects Undergoing Cardiopulmonary Exercise Testing

Exertional-induced bronchoconstriction: Comparison between cardiopulmonary exercise test and methacholine challenging test

Diagnosis and management of chronic lung disease in deployed military personnel

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