Muscular Dysfunction in COPD: Systemic Effect or Deconditioning?

Pleguezuelos, Eulogio; Esquinas, Cristina; Moreno, Eva; Guirao, Lluís; Ortíz, Javier; Garcia-Alsina, Joan; Merí, Alex; Miravitlles, Marc

doi:10.1007/s00408-015-9838-z

Cited by 42 publications

(30 citation statements)

References 30 publications

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“…early metabolic acidosis) due to deconditioning [23,24]. The negative haemodynamic consequences of hyperinflation may increase pulmonary vascular resistance and decrease left ventricular filling pressures [25].…”

Section: Increased Reflex Chemostimulationmentioning

confidence: 99%

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: Increased Reflex Chemostimulationmentioning

confidence: 99%

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

et al. 2016

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“…Patients with COPD start to reduce physical activity levels early in disease progression in order to avoid symptoms such as dyspnea [32, 33]. The resultant muscle deconditioning, which is present even in mild disease [34, 35], contributes further to a vicious cycle of inactivity [36, 37]. Maintaining physical activity levels is important in COPD as it is associated with a better disease prognosis, as well as reduced hospitalization and mortality [38–40].…”

Section: Copd Symptoms and Physical Activitymentioning

confidence: 99%

Understanding the impact of symptoms on the burden of COPD

2017

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Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.

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“…Despite maximal medical therapy, patients with COPD characteristically experience breathlessness, which leads to a downward spiral of sedentary behavior, physical inactivity, muscle deconditioning, and functional disability 61666768. Even at the early stages of disease, people with COPD spend significantly longer being sedentary, and thus less time being physically active, compared with healthy people,6970 and COPD exacerbations accelerate the decline in physical activity 71.…”

Section: Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilimentioning

confidence: 99%

Advances in rehabilitation for chronic diseases: improving health outcomes and function

Richardson

Franklin

Moy

et al. 2019

BMJ

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Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.

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Muscular Dysfunction in COPD: Systemic Effect or Deconditioning?

Abstract: Our results suggest that muscular dysfunction in patients with COPD differs in different muscular compartments. The main factor for a reduced exercise capacity was a reduction in inspiratory capacity.

Cited by 42 publications

References 30 publications

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

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

Understanding the impact of symptoms on the burden of COPD

Advances in rehabilitation for chronic diseases: improving health outcomes and function

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