Excess ventilation and ventilatory constraints during exercise in patients with chronic obstructive pulmonary disease

Teopompi, Elisabetta; Tzani, Panagiota; Aiello, Marina; Gioia, Michele De; Marangio, Emilio; Chetta, Alfredo

doi:10.1016/j.resp.2014.03.002

Cited by 25 publications

(37 citation statements)

References 18 publications

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“…Thus, despite the progression of "wasted" ventilation, the slope decreases as the disease evolves [19,96,97]. Concomitant increases in intercept, however, frequently uncover the presence of ventilatory abnormalities leading to a high nadir (slope+intercept) in most moderate-to-severe COPD patients (figure 6) [19].…”

Section: Increasing Exertional Dyspnoea With Disease Progressionmentioning

confidence: 99%

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Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

et al. 2016

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Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET. @ERSpublications Measurement of symptom intensity, ventilatory control and mechanics during exercise exposes mechanisms of dyspnoea

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Section: Increasing Exertional Dyspnoea With Disease Progressionmentioning

confidence: 99%

“…In other words, the V′E/V′CO 2 nadir equals the slope plus intercept [95]. As discussed in the following section of this review, COPD severity strongly influences the different metrics of ventilatory inefficiency (nadir, slope and intercept) [19,96,97].…”

Section: Cpet Interpretation: Panel Displaysmentioning

confidence: 99%

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

et al. 2016

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“…However, lower V′E-V′CO 2 slopes in more advanced disease, were explained by worsening mechanical constraints ( fig. 2c) [9,23] and, probably, an increase in carbon dioxide set-point [29]. Similar V′E/V′CO 2 nadirs across patient groups ( fig.…”

Section: Figurementioning

confidence: 67%

“…However, it is rather surprising that no previous study has systematically looked at this topic in a sufficiently large number of patients with varied degrees of disease severity. In fact, some smaller studies evaluated patients with advanced emphysema [9] or mid-stage disease [22,23]. The largest previous study did not evaluate GOLD stage 1 patients and restricted its analysis to V′E-V′CO 2 peak [10].…”

Section: Figurementioning

confidence: 99%

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Exercise ventilatory inefficiency in mild to end-stage COPD

et al. 2014

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Ventilatory inefficiency during exercise is a key pathophysiological feature of chronic obstructive pulmonary disease. Currently, it is unknown how this physiological marker relates to clinically relevant outcomes as resting ventilatory impairment progresses across disease stages.Slope and intercept of the linear region of the ventilation-carbon dioxide output relationship and the ratio between these variables, at the lowest point (nadir), were contrasted in 316 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-4 (forced expiratory volume in 1 s, ranging from 148% pred to 12% pred) and 69 aged-and gender-matched controls, Compared to controls, slope and intercept were higher in GOLD stages 1 and 2, leading to higher nadirs ( p<0.05). Despite even larger intercepts in GOLD stages 3 and 4, slopes diminished as disease evolved (from mean±SD 35±6 in GOLD stage 1 to 24±5 in GOLD stage 3, p<0.05). As a result, there were no significant differences in nadirs among patient groups. Higher intercepts, across all stages ( p<0.01), and to a lesser extent lower slopes in GOLD stages 2-4 ( p<0.05), were related to greater mechanical constraints, worsening pulmonary gas exchange, higher dyspnoea scores, and poorer exercise capacity.Increases in the ventilation intercept best indicate the progression of exercise ventilatory inefficiency across the whole spectrum of chronic obstructive pulmonary disease severity. @ERSpublications Exercise ventilatory inefficiency relates to dyspnoea and exercise intolerance across whole COPD severity spectrum

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Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

Guazzi

Wilhelm

Halle

et al. 2022

European J of Heart Fail

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Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype‐specific treatments.

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Excess ventilation and ventilatory constraints during exercise in patients with chronic obstructive pulmonary disease

Cited by 25 publications

References 18 publications

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

Exercise ventilatory inefficiency in mild to end-stage COPD

Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

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