2017
DOI: 10.1164/rccm.201704-0675oc
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Excess Ventilation in Chronic Obstructive Pulmonary Disease–Heart Failure Overlap. Implications for Dyspnea and Exercise Intolerance

Abstract: Heightened neural drive promoting a ventilatory response beyond that required to overcome an increased "wasted" ventilation led to hypocapnia and poor exercise ventilatory efficiency in chronic obstructive pulmonary disease-heart failure overlap. Excessive ventilation led to better arterial oxygenation but at the expense of earlier critical mechanical constraints and intolerable dyspnea.

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Cited by 64 publications
(56 citation statements)
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“…Moreover, in these patients, V E -V CO 2 significantly correlates with decreased cardiac output and particularly with increased pulmonary vascular resistance (PVR) 15 . The ventilatory equivalent for carbon dioxide (V E -CO 2 ) is also increased in chronic respiratory patients 39 mainly as a result of increased V D /V T because of ventilation-perfusion mismatching 40,41 , the adoption of an inefficient breathing pattern 40 or concomitant heart failure 42 . More efficient ventilation has been shown after pulmonary rehabilitation in COPD 43,44 and bronchodilator therapy 45 , which will likely result in reduced V E -V CO 2 .…”
Section: Ventilatory Efficiencymentioning
confidence: 99%
“…Moreover, in these patients, V E -V CO 2 significantly correlates with decreased cardiac output and particularly with increased pulmonary vascular resistance (PVR) 15 . The ventilatory equivalent for carbon dioxide (V E -CO 2 ) is also increased in chronic respiratory patients 39 mainly as a result of increased V D /V T because of ventilation-perfusion mismatching 40,41 , the adoption of an inefficient breathing pattern 40 or concomitant heart failure 42 . More efficient ventilation has been shown after pulmonary rehabilitation in COPD 43,44 and bronchodilator therapy 45 , which will likely result in reduced V E -V CO 2 .…”
Section: Ventilatory Efficiencymentioning
confidence: 99%
“…Clinicians must consider maximising deflational therapy, particularly in the overlap group, in order to attenuate the negative haemodynamic consequences of higher operating lung volumes in these patients. Identification of the subgroup of COPD-heart failure patients with excessive exertional ventilation may guide therapeutic and rehabilitative interventions to positively impact on exertional dyspnoea and to select rehabilitative strategies with low-to-minimal ventilator stress [7]. The results reported in this issue of the European Respiratory Journal and in previous papers suggest that overlap patients are particularly prone to responding to interventions that increase skeletal muscle O 2 delivery and/or reduce O 2 demand [11,12].…”
mentioning
confidence: 88%
“…Indeed, these patients had to overcome an enlarged physiological dead space to hyperventilate leading to dynamic hyperinflation, earlier mechanical constraints, greater dyspnoea and reduced exercise capacity. Conversely, those patients with normocapnia seem to opt not to fight and delay critical inspiratory constraints [7].…”
mentioning
confidence: 99%
“…In overlapping COPD-HF patients, in particular breathlessness and poor exercise tolerance seem strongly influenced by interpatient variability on respiratory centers' chemostimulation. Particularly, in the subgroup of patients with resting hypocapnia the excessive ventilation hastens dynamic abnormalities in pulmonary mechanics [21].…”
Section: Cardiopulmonary Exercise Testing and Selection Of Training Mmentioning
confidence: 99%
“…Clinicians must consider maximizing lung deflation, particularly in the COPD-HF overlap group in order to attenuate the negative hemodynamic consequences of higher operating lung volumes in these patients [27]. Identification of the subgroup of COPD-HF patients with excessive exertional ventilation may guide rehabilitative interventions to select rehabilitative strategies with low-tominimal ventilator stress [21]. Overlap patients seem particularly prone to respond to interventions that increase skeletal muscle O 2 delivery and/or reduce O 2 demand [25,26].…”
Section: Cardiopulmonary Exercise Testing and Selection Of Training Mmentioning
confidence: 99%