Journal Club: Impaired Ventilatory Efficiency and Exercise Intolerance in Former/Current Smokers With Dyspnea Disproportionate to Their Lung Function: Pathophysiological Insights Gained Through Cardiopulmonary Exercise Testing

Balkissoon, Ron; Mkorombindo, Takudzwa

doi:10.15326/jcopdf.2022.0344

Cited by 1 publication

(1 citation statement)

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“…Smoking not only leads to progressive deterioration of the airways but also contributes directly to pulmonary vascular remodelling, 39 40 both of which can affect ventilatory efficiency during exercise. 41 Our results provide a theoretical basis for smoking cessation. However, about one-third of Chinese are current smokers, and the Chinese government needs to take stronger antitobacco measures.…”

Section: Discussionmentioning

confidence: 68%

Clinical features and associated factors of impaired ventilatory efficiency: findings from the ECOPD study in China

Deng,

Wu,

Wan

et al. 2024

BMJ Open Resp Res

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BackgroundImpaired ventilatory efficiency during exercise is a predictor of mortality in chronic obstructive pulmonary disease. However, little is known about the clinical features and associated factors of impaired ventilatory efficiency in China.MethodsWe conducted a cross-sectional community-based study in China and collected demographic and clinical information, cardiopulmonary exercise testing, spirometry, and CT data. Impaired ventilatory efficiency was defined by a nadir ventilatory equivalent for CO2production above the upper limit of normal. Multivariable linear and logistic regression models were used to explore the clinical features and associated factors of impaired ventilatory efficiency.ResultsThe final analyses included 941 subjects, 702 (74.6%) of whom had normal ventilatory efficiency and 239 (25.4%) had impaired ventilatory efficiency. Participants with impaired ventilatory efficiency had more chronic respiratory symptoms, poorer lung function and exercise capacity, and more severe emphysema (natural logarithm transformation of the low-attenuation area of the lung with attenuation values below −950 Hounsfield units, logLAA−950: 0.19±0.65 vs −0.28±0.63, p<0.001) and air trapping (logLAA−856: 1.03±0.65 vs 0.68±0.70, p<0.001) than those with normal ventilatory efficiency. Older age (60–69 years, OR 3.10 (95% CI 1.33 to 7.21), p=0.009 and 70–80 years, OR 6.48 (95% CI 2.56 to 16.43), p<0.001 vs 40–49 years) and smoking (former, OR 3.19 (95% CI 1.29 to 7.86), p=0.012; current, OR 4.27 (95% CI 1.78 to 10.24), p=0.001 vs never) were identified as high risk factors of impaired ventilatory efficiency.ConclusionsImpaired ventilatory efficiency was associated with poorer respiratory characteristics. Longitudinal studies are warranted to explore the progression of individuals with impaired ventilatory efficiency.

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Section: Discussionmentioning

confidence: 68%