Determinants of exercise performance in normal men  with externally imposed expiratory flow limitation

Iandelli, Iacopo; Aliverti, Andréa; Kayser, Bengt; Dellacà, Raffaele L.; Cala, S. J.; Duranti, Roberto; Kelly, Susan J.; Scano, Giorgio; Śliwiński, Paweł; Shi, Yan; Macklem, Peter T.; Pedotti, A.

doi:10.1152/japplphysiol.00393.2000

Cited by 101 publications

(132 citation statements)

References 33 publications

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“…Studies describing the qualitative change in chest wall volume have used magnetometers to look at the contribution of different chest wall compartments, but these are technically demanding and require considerable subject cooperation [94][95][96]. Recently, a different approach that measures the volume of the chest wall has being applied in healthy subjects [97][98][99], patients in ICU [100] and those with COPD at rest and during exercise [101][102][103]. Optoelectronic plethysmography (OEP) is a noninvasive measurement based on computing the volume of the chest wall from a network of points identified by shining infrared light at a series of reflective markers attached to the ribcage and abdomen [104] (fig.…”

Section: Dynamic Hyperinflationmentioning

confidence: 99%

“…Normally, the change in volume at the mouth and those occurring with each breath derived from the chest wall signal are the same at rest (in health and COPD patients). This remains true during exercise in healthy subjects, but not if they breathe through a Starling resistor nor is it the case in many COPD patients [99,101]. In this latter group, the difference between the chest wall volume and that at the mouth reflects the effect of gas compression in the lungs, but also the displacement of blood away from the thorax and into the abdomen.…”

Section: Dynamic Hyperinflationmentioning

confidence: 99%

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Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

Eur Respir J

224

168

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Fashions in ideas, like clothes, come and go. From approximately 1950From approximately -1980, physiological research was seen as the key discipline in understanding lung disease and was at the cutting edge of pulmonary science. Subsequently, its importance has been down played amid a widely accepted but unfounded assumption that we now have a perfect working understanding of the physiological behaviour of the respiratory system in health and disease. Although it seems improbable that completely new disciplines within respiratory physiology will emerge with fundamentally different ways of describing the mechanical or gas exchanging function of the lung, advances in computing and new observations in disease have highlighted previously unsuspected physiological abnormalities that have changed the way we view lung disease and the interface between disordered lung mechanics, symptomatology and disability. This is especially true for the two related physiological concepts of expiratory flow limitation and dynamic hyperinflation, which are now being taken from the physiological laboratory to the bedside with dramatic effect. Each arises from well-established theoretical and practical observations first made 40 yrs ago and now adapted to a range of settings, particularly in the field of obstructive lung disease. This review focuses on how these conditions are defined and assessed and what evidence there is that they might be important in lung disease.

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Section: Dynamic Hyperinflationmentioning

confidence: 99%

Section: Dynamic Hyperinflationmentioning

confidence: 99%

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

Eur Respir J

224

168

View full text Add to dashboard Cite

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“…In healthy subjects, this method gives excellent agreement with lung volume measurements derived from recordings at the mouth made at rest and during exercise [37,38]. When healthy subjects exercised to their maximum performance breathing through a Starling resistor circuit, most of them maintained a relatively constant end-expiratory chest wall volume, although some tried to behave as they normally would and reduced EELV, which was an energetically counterproductive strategy [39].…”

Section: Optoelectronic Plethysmographymentioning

confidence: 83%

Exercise and dyspnoea in COPD

Calverley¹

2006

Eur Respir Rev

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Dyspnoea provoked either by exercise or during a disease exacerbation is one of the most feared symptoms of the chronic obstructive pulmonary disease (COPD) patient. It contributes to impaired quality of life and patients who are more limited by exertional dyspnoea are more likely to die. The physiological mechanisms responsible for these two outcomes vary in different settings, but in both situations, changes in the resting lung volume and increased activation of the respiratory muscles relative to their maximum capacity is the final common pathway.Although increased metabolic carbon dioxide production from weak or poorly conditioned muscles is an important cofactor, most patients limited by exertional dyspnoea exhibit dynamic hyperinflation that parallels their symptom intensity. This results from the longer respiratory time constant of the lungs in COPD and coexisting expiratory flow limitation during tidal breathing. The response of the chest wall muscles to this change in lung volume is variable: most patients with more severe COPD allow chest wall volume to increase, while others try to defend chest wall volume. The latter is not a good breathing strategy as the patient's exercise capacity is very limited.Treatment with bronchodilators reduces operating lung volumes and delays the time until tidal volume is mechanically limited by the inspiratory reserve volume. Breathing oxygen and heliox gas mixtures further increases exercise endurance and slows the rate at which end-expiratory lung volume increases.During exacerbations there is a consistent increase in end-expiratory lung volume and this parallels the reduction in forced vital capacity. This suggests that gas trapping due to airway closure is the main mechanism involved here, although changes in lung volume still track the symptomatic improvement in dyspnoea reported by patients both as the episode resolves and after nebulised bronchodilator treatment.

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“…A recent study proposed that two factors induce the difference between V L (SP) and V L (CW): underestimation of V L (CW) by gas compression effects when air is compressed by increasing pleural pressure 15) ; and overestimation of V L (CW) during inspiration and underestimation of V L (CW) during expiration because of the movement of blood from the thorax to the extremities 15) . The relationships between these factors were also investigated in this earlier study.…”

Section: Comparison Between V L (Sp) and V L (Cw)mentioning

confidence: 99%

Regional Chest Wall Volume Changes During Various Breathing Maneuvers in Normal Men

Nozoe

Mase

Tsutou

2011

J Jpn Phys Ther Assoc

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ABSTRACT. Purpose: The purpose of this study is to investigate the regional chest wall volume changes during various breathing maneuvers in normal men with an optical reflectance system (OR), which tracks refl ective markers in three dimensions. Methods: Chest wall volume was measured by the OR system [V L (CW)], and lung volume was measured by hot wire spirometry [V L (SP)] in 15 healthy men during quiet breathing (QB), during breathing at a rate of 50 tidal breaths/min paced using a metronome (MT: metronome-paced tachypnea), and during a maximal forced inspiratory and expiratory maneuver (MFIE maneuver). Results: There were few discrepancies between V L (CW) and V L (SP) for QB and MT. In the MFIE maneuver, however V L (CW) was often underestimated compared with V L (SP), particularly during forced maximal expiration, because of pulmonary rib cage volume changes. Furthermore, the regional chest wall volume changes were affected by breathing maneuver alternation. In the pulmonary and abdominal rib cage, inspiratory reserve volume was larger than expiratory reserve volume, respectively, and in the abdomen, expiratory reserve volume was larger than inspiratory reserve volume. Conclusion: Alternation of breathing maneuvers affects regional chest wall volume changes.

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Determinants of exercise performance in normal men with externally imposed expiratory flow limitation

Cited by 101 publications

References 33 publications

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Exercise and dyspnoea in COPD

Regional Chest Wall Volume Changes During Various Breathing Maneuvers in Normal Men

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