Dynamic Hyperinflation and Exercise Intolerance in  Chronic Obstructive Pulmonary Disease

O’Donnell, Denis E.; Revill, Susan M.; Webb, Katherine A.

doi:10.1164/ajrccm.164.5.2012122

Cited by 910 publications

(840 citation statements)

References 28 publications

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“…However, the extent of the reduction in IC with exercise in COPD is variable. In a population of 105 patients with moderate-to-severe COPD, IC at end-exercise was reduced by 20% of its already-reduced resting value [81], as exemplified in figure 1. In another smaller group of 27 severe COPD patients, a similar reduction was found at the end of high-intensity exercise [80].…”

Section: Chronic Obstructive Pulmonary Diseasementioning

confidence: 94%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

560

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Chronic Obstructive Pulmonary Diseasementioning

confidence: 94%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

560

390

View full text Add to dashboard Cite

show abstract

“…Breathing pattern (timing, flow, and volume measurements) and dynamic IC were measured using the SensorMedics Vmax229 system as previously described (38). Operating lung volumes and their changes during exercise were derived from measurements of dynamic IC that were performed at rest, within the last 30-s period of each increment of exercise, and at peak exercise.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Sex differences in the perceived intensity of breathlessness during exercise with advancing age

Ofir

Laveneziana²,

Webb³

et al. 2008

Journal of Applied Physiology

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prevalence of activity-related breathlessness increases with age, particularly in women, but the specific underlying mechanisms have not been studied. This novel cross-sectional study was undertaken to examine the effects of age and sex, and their interaction, on the perceptual and ventilatory responses to incremental treadmill exercise in 73 healthy participants (age range 40 -80 yr old) with normal pulmonary function. Age-related changes at a standardized oxygen uptake (V O2) during exercise included significant increases in breathlessness ratings (Borg scale), ventilation (V E), ventilatory equivalent for carbon dioxide, and the ratio of tidal volume (VT) to dynamic inspiratory capacity (IC) (all P Ͻ 0.05). These changes were quantitatively similar in women (n ϭ 39) and in men (n ϭ 34). For the group as a whole, exertional breathlessness ratings increased as resting static inspiratory muscle strength diminished (P ϭ 0.05), as exercise ventilation increased relative to capacity (P ϭ 0.013) and as the VT/IC ratio increased (P ϭ 0.003) during exercise. Older women (60 -80 yr old, n ϭ 23) reported greater (P Ͻ 0.05) intensity of exertional breathlessness at a standardized V O2 and V E than age-matched men (n ϭ 16), despite similar age-related changes in ventilatory demand and dynamic ventilatory mechanics. These increases in breathlessness ratings in older women disappeared when sex differences in baseline maximal ventilatory capacity were accounted for. In conclusion, although increased exertional breathlessness with advancing age is multifactorial, contributory factors included higher ventilatory requirements during exercise, progressive inspiratory muscle weakness, and restrictive mechanical constraints on VT expansion related to reduced IC. The sensory consequences of this age-related respiratory impairment were more pronounced in women, who, by nature, have relatively reduced maximal ventilatory reserve. dyspnea; aging; inspiratory capacity CARDIOVASCULAR FACTORS are widely accepted as a proximate limit to maximal oxygen uptake (V O 2 ) during weight-bearing exercise in healthy humans (42,48). By contrast, the respiratory system is regarded as relatively "overbuilt" and less likely to contribute to exercise limitation except in elite athletes at very high power outputs (15, 21). However, it is recognized that in sedentary older individuals, intolerable exertional breathlessness may contribute to exercise limitation even before physiological maxima are attained (39). A number of studies have reported that more than 30% of the elderly (Ͼ65 yr) experience breathlessness during activities of daily living (23,24,30,47). The nature and mechanisms of exertional breathlessness in older healthy humans are poorly understood.While the physiological effects of aging on the respiratory system are well established (14,25,40), the interaction between these changes in respiratory system compliance, muscle function, and ventilation/perfusion (V /Q ) matching and the perceptual responses to physical exertion is largely unknow...

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“…Lung IC has been shown to correlate significantly with increased exercise endurance and with reduced dyspnoea during exercise 5,19 . It has been shown that the reduction in breathlessness during exercise and improved exercise tolerance are closely related to the bronchodilator-induced change in IC at rest, regardless of the change in resting FEV 1 20 .…”

Section: A C C E P T E D Article In Pressmentioning

confidence: 99%