Differences in Cardiopulmonary Exercise Test Results by American Thoracic Society/European Respiratory Society-Global Initiative for Chronic Obstructive Lung Disease Stage Categories and Gender

Pinto-Plata, Víctor; Celli-Cruz, Romulo A.; Vassaux, Carlos; Torre-Bouscoulet, Luis; Mendes, Asante; Rassulo, John; Celli, Bartolomé R.

doi:10.1378/chest.07-0593

Cited by 48 publications

(37 citation statements)

References 21 publications

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“…An inverse relationship between V E / V CO 2 and a decrease in V O 2 max and in Ẇ suggest participation of this mechanism in limiting exercise capacity in COPD patients. 18,19,21,22 Values are mean Ϯ SD. V O2 max ϭ maximum oxygen consumption Ẇ max ϭ maximum power V Emax ϭ maximum minute volume V O2 /heart rate ϭ oxygen pulse Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18] The V O 2 /heart rate is a surrogate for the systolic volume by the Fick equation: V O 2 ϭ cardiac output ϫ ⌬C(a-v)O 2 , and circulatory power (%V O 2 max ϫ peak systolic blood pressure) is a surrogate for cardiac power (cardiac output ϫ mean arterial pressure ϫ K). [16][17][18][19][20][21] …”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…Ventilatory inefficiency also involves deregulation of central and peripheral respiratory control and an augment in ergoreceptor activity, factors that are present in COPD. [19][20][21][22] On the other side, expiratory flow limitation during respiration causes dynamic hyperinflation and enhances respiratory work. This behavior increases when the closing volume exceeds the residual functional capacity, until expiratory flow limitation and dynamic hyperinflation develop.…”

Section: Role Of Ventilatory Inefficiency In Limiting Exercisementioning

confidence: 99%

“…3,4,[26][27][28] Ventilatory inefficiency enhances the ventilatory requirement, which, when associated with an increase in expiratory resistance, impedes deflation and enhances dynamic hyperinflation. 12,13,[19][20][21]23,24 During exercise there is a strong evidence of the limitation imposed by dynamic hyperinflation, a situation that has also been demonstrated in daily activities and in the 6-min walk test. 23,24 Dynamic hyperinflation is one of the main determinants of exercise limitation, and is commonly measured as ⌬ inspiratory capacity, as was performed in our study.…”

Section: Role Of Ventilatory Inefficiency In Limiting Exercisementioning

confidence: 99%

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Ventilatory Inefficiency as a Limiting Factor for Exercise in Patients With COPD

Caviedes¹,

Delgado

Soto³

2012

Respir Care

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BACKGROUND: Ventilatory inefficiency increases ventilatory demand; corresponds to an abnormal increase in the ratio of minute ventilation (V E ) to CO 2 production (V CO 2 ); represents increased dead space, deregulation of respiratory control, and early lactic threshold; and is associated with expiratory flow limitation that enhances dynamic hyperinflation and may limit exercise capacity. OBJECTIVE: To evaluate the influence of ventilatory inefficiency over exercise capacity in COPD patients. METHODS: Prospective study of 35 COPD subjects with different levels of severity, in whom cardiopulmonary stress test was performed. Ventilatory inefficiency was represented by the V E /V CO 2 relation. Its influence over maximal oxygen consumption (V O 2 max), power (W), and ventilatory threshold was evaluated. Surrogate parameters of cardiac function, like oxygen pulse (V O 2 /heart rate) and circulatory power (%V O 2 max ؋ peak systolic pressure), were also evaluated. RESULTS: Cardiopulmonary stress test was stopped due to dyspnea with elevated V E and marked reduction of breathing reserve. A severe increase in V E /V CO 2 (mean ؎ SD 35.9 ؎ 5.6), a decrease of V O 2 max (mean ؎ SD 75.2 ؎ 20%), and a decrease of W (mean ؎ SD 68.6 ؎ 23.3%) were demonstrated. Twenty-eight patients presented dynamic hyperinflation. Linear regression showed a reduction of 2.04% on V O 2 max (P < .001), 2.6% on W (P < .001), 1% on V O 2 /heart rate (P ‫؍‬ .049), and 322.7 units on circulatory power (P ‫؍‬ .02) per each unit of increment in V E /V CO 2 , respectively. CONCLUSIONS: Ventilatory inefficiency correlates with a reduction in exercise capacity in COPD patients. Including this parameter in the evaluation of exercise limitation in this patient population may mean a contribution toward the understanding of its pathophysiology.

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Section: Discussionmentioning

confidence: 99%

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Section: Role Of Ventilatory Inefficiency In Limiting Exercisementioning

confidence: 99%

Section: Role Of Ventilatory Inefficiency In Limiting Exercisementioning

confidence: 99%

See 2 more Smart Citations

Ventilatory Inefficiency as a Limiting Factor for Exercise in Patients With COPD

Caviedes¹,

Delgado

Soto³

2012

Respir Care

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“…However, lean muscle mass is expected to decrease over time, in particular in the lower limbs 13 and it is a well-known determinant of quadriceps muscle strength and peak V O 2 in patients with COPD 14,15 . In addition, gender and gas transfer capacity of the lungs have both been shown to be determinants of lean muscle mass, quadriceps muscle strength, and peak V O 2 in COPD and should therefore also be taken into consideration 10,14,[16][17][18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Age-graded reductions in quadriceps muscle strength and peak aerobic capacity in COPD

Spruit

Franssen²,

Rutten

et al. 2012

Rev. bras. fisioter.

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Factors Limiting Exercise Tolerance in Chronic Lung Diseases

Vogiatzis

Zakynthinos

2012

Comprehensive Physiology

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The major limitation to exercise performance in patients with chronic lung diseases is an issue of great importance since identifying the factors that prevent these patients from carrying out activities of daily living provides an important perspective for the choice of the appropriate therapeutic strategy. The factors that limit exercise capacity may be different in patients with different disease entities (i.e., chronic obstructive, restrictive or pulmonary vascular lung disease) or disease severity and ultimately depend on the degree of malfunction or miss coordination between the different physiological systems (i.e., respiratory, cardiovascular and peripheral muscles). This review focuses on patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and pulmonary vascular disease (PVD). ILD and PVD are included because there is sufficient experimental evidence for the factors that limit exercise capacity and because these disorders are representative of restrictive and pulmonary vascular disorders, respectively. A great deal of emphasis is given, however, to causes of exercise intolerance in COPD mainly because of the plethora of research findings that have been published in this area and also because exercise intolerance in COPD has been used as a model for understanding the interactions of different pathophysiologic mechanisms in exercise limitation. As exercise intolerance in COPD is recognized as being multifactorial, the impacts of the following factors on patients' exercise capacity are explored from an integrative physiological perspective: (i) imbalance between the ventilatory capacity and requirement; (ii) imbalance between energy demands and supplies to working respiratory and peripheral muscles; and (iii) peripheral muscle intrinsic dysfunction/weakness.

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Differences in Cardiopulmonary Exercise Test Results by American Thoracic Society/European Respiratory Society-Global Initiative for Chronic Obstructive Lung Disease Stage Categories and Gender

Cited by 48 publications

References 21 publications

Ventilatory Inefficiency as a Limiting Factor for Exercise in Patients With COPD

Ventilatory Inefficiency as a Limiting Factor for Exercise in Patients With COPD

Age-graded reductions in quadriceps muscle strength and peak aerobic capacity in COPD

Factors Limiting Exercise Tolerance in Chronic Lung Diseases

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