Lung function, breathing pattern, and gas exchange in interstitial lung disease.

Javaheri, Shahrokh; Sicilian, Leonard

doi:10.1136/thx.47.2.93

Cited by 67 publications

(53 citation statements)

References 31 publications

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“…Altered respiratory mechanics Subjects with ILD show a rapid and shallow breathing pattern during mild to moderate exercise [25], which differs to the response observed in healthy subjects, where the augmented ventilatory demand causes an increase in tidal volume (VT). Therefore, the markedly elevated minute ventilation (V′E) in ILD patients during exercise is mainly due to the effect of an increased respiratory frequency ( fR) in the setting of reduced lung compliance and low VT [26,27]. The small VT and rapid respiratory rate observed in ILD patients are thought to occur secondary to increased inspiratory elastic loading on respiratory muscles and stimulation of peripheral mechanoreceptors [28].…”

Section: Exercise Respiratory Physiology In Ildmentioning

confidence: 99%

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Bonini

Fiorenzano

2017

Eur Respir Rev

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Interstitial lung diseases (ILDs) represent a heterogeneous group of pathologies characterised by alveolar and interstitial damage, pulmonary inflammation (usually associated with fibrosis), decreased lung function and impaired gas exchange, which can be attributed to either a known or an unknown aetiology. Dyspnoea is one of the most common and disabling symptoms in patients with ILD, significantly impacting quality of life. The mechanisms causing dyspnoea are complex and not yet fully understood. However, it is recognised that dyspnoea occurs when there is an imbalance between the central respiratory efferent drive and the response of the respiratory musculature. The respiratory derangement observed in ILD patients at rest is even more evident during exercise. Pathophysiological mechanisms responsible for exertional dyspnoea and reduced exercise tolerance include altered respiratory mechanics, impaired gas exchange, cardiovascular abnormalities and peripheral muscle dysfunction.This review describes the respiratory physiology of ILD, both at rest and during exercise, and aims to provide comprehensive and updated evidence on the clinical utility of the cardiopulmonary exercise test in the assessment and management of these pathological entities. In addition, the role of exercise training and pulmonary rehabilitation programmes in the ILD population is addressed.

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Section: Exercise Respiratory Physiology In Ildmentioning

confidence: 99%

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Bonini

Fiorenzano

2017

Eur Respir Rev

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“…Rapid, shallow breathing is more pronounced in those with more severe disease. 4 Despite this abnormal ventilatory pattern, respiratory mechanics are not thought to be the major contributor to exercise limitation in most patients. In two studies of ILD patients with varying diagnoses, most participants had a large ventilatory reserve at the end of exercise despite reduced exercise performance.…”

Section: Mechanisms Of Exercise Limitation In Ildmentioning

confidence: 99%

Review series: Aspects of interstitial lung disease: Exercise limitation in interstitial lung disease - mechanisms, significance and therapeutic options

2010

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Exercise limitation is a cardinal feature of the interstitial lung diseases and is frequently associated with marked dyspnoea on exertion. People with interstitial lung disease exhibit a rapid, shallow breathing pattern during exercise that worsens as disease progresses. Despite this, ventilatory mechanics are not the major limitation to exercise in most patients, with impaired gas exchange and circulatory limitation playing a more important role. Peripheral and respiratory muscle dysfunction may also contribute to impaired exercise tolerance, either due to systemic manifestations of the underlying disease, treatment side-effects or deconditioning. Measures of exercise capacity or desaturation obtained from maximal and submaximal exercise tests are good predictors of survival in patients with idiopathic pulmonary fibrosis. However, to date few pharmaceutical treatments have affected exercise outcomes despite improvements in other important clinical markers. Supplemental oxygen acutely improves exercise capacity in interstitial lung disease and is recommended for hypoxic patients, although quality of life or survival benefits have not yet been demonstrated. Exercise training improves walking capacity and dyspnoea in short-term trials and is useful to maximize functional capacity. The role of exercise testing in the routine management of patients with interstitial lung disease is not clearly defined. However, given the poor prognosis in patients with idiopathic pulmonary fibrosis and the marked variation in clinical course, assessment of exercise capacity may provide useful information for both clinicians and patients when evaluating the risks and benefits of new treatments. The extent of resting or exercise-induced hypoxia in patients with interstitial lung disease may influence the selection of an appropriate exercise test, and oxygen administration should be standardized on repeat testing.

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“…In adults with ILD, measurements of VC strongly correlate with most static lung volumes and with DCO. Recently, it was suggested that standard lung function tests, such as VC and TLC, may yield more useful information than other extensive tests [57,58].…”

Section: Pulmonary Function Testingmentioning

confidence: 99%

Task force on chronic interstitial lung disease in immunocompetent children

2004

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Chronic interstitial lung diseases in children represent a heterogeneous group of disorders of both known and unknown causes that share common histological features. Despite many efforts these diseases continue to present clinical management dilemmas, principally because of their rare frequency that limits considerably the possibilities of collecting enough cases for clinical and research studies. Through a Task Force conducted by the European Respiratory Society, which comprised respiratory physicians and basic scientists from across Europe, 185 cases of interstitial lung diseases in immunocompetent children were collected and reviewed. The present report provides important clinically-relevant information on the current approach to diagnosis and management of chronic interstitial lung diseases in children. In addition, recommendations for the management of paediatric interstitial lung diseases, as well as new insights into interstitial lung diseases pathophysiology during childhood are discussed

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Lung function, breathing pattern, and gas exchange in interstitial lung disease.

Cited by 67 publications

References 31 publications

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Review series: Aspects of interstitial lung disease: Exercise limitation in interstitial lung disease - mechanisms, significance and therapeutic options

Task force on chronic interstitial lung disease in immunocompetent children

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