Normal pulmonary gas exchange efficiency and absence of exercise-induced arterial hypoxemia in adults with bronchopulmonary dysplasia

Lovering, Andrew T.; Laurie, Steven S.; Elliott, Jonathan E.; Beasley, Kara M.; Yang, Ximeng; Gust, Caitlyn E.; Mangum, Tyler S.; Goodman, Randall D.; Hawn, Jerold A.; Gladstone, Igor M.

doi:10.1152/japplphysiol.00592.2013

Cited by 41 publications

(78 citation statements)

References 49 publications

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“…Furthermore, this is the first study that has shown lower efficiency in pulmonary gas exchange during exercise in adults born preterm. This study further confirms previous studies (12,13) that show a decreased power output in this population.…”

Section: Discussionsupporting

confidence: 93%

“…This higher A-aDO 2 was accompanied by a lower Pa O 2 ( Figure 3). Other reports (13,22) showed no difference in A-aDO 2 in preterm subjects during exercise. The reason for the discrepancy in the findings could be multifactorial and include differences in the subject populations and in exercise protocol.…”

Section: Gas Exchange Efficiency During Exercisementioning

confidence: 75%

“…Studies report abnormal chest radiographs (11), lower pulmonary function (12,13), and lower resting gas transfer (14) in adults born preterm. Furthermore, some preterm adults have obstructive lung disease (15), and computer tomographic evidence of emphysema (16)(17)(18) suggesting that the alveolar simplification persists.…”

mentioning

confidence: 99%

“…Furthermore, some preterm adults have obstructive lung disease (15), and computer tomographic evidence of emphysema (16)(17)(18) suggesting that the alveolar simplification persists. Blunted vasculogenesis and alveolar simplification may lead to ventilation-toperfusion mismatch and diffusion limitations that could in part contribute to the decreased exercise capacity reported in this population (12,13,(19)(20)(21). Indeed, Lovering and colleagues reported a case of a preterm adult susceptible to high-altitude pulmonary edema (21) and who exhibited significant gas exchange inefficiency, evidenced by an excessive widening of the alveolar-to-arterial oxygen difference (A-aDO 2 ), with normoxic and hypoxic exercise.…”

mentioning

confidence: 99%

“…Indeed, Lovering and colleagues reported a case of a preterm adult susceptible to high-altitude pulmonary edema (21) and who exhibited significant gas exchange inefficiency, evidenced by an excessive widening of the alveolar-to-arterial oxygen difference (A-aDO 2 ), with normoxic and hypoxic exercise. However, of the comprehensive studies that have examined exercise tolerance (12)(13)(14)22) and gas exchange during exercise (13,14,22), several show reduced aerobic exercise capacity in adult preterms (12,13), yet none showed differences in gas exchange. We hypothesized that preterm adults would develop a wider A-aDO 2 during normoxic exercise and that the gas exchange inefficiency would be augmented during hypoxic exercise.…”

mentioning

confidence: 99%

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Pulmonary Gas Exchange and Exercise Capacity in Adults Born Preterm

Farrell¹,

Bates²,

Pegelow³

et al. 2015

Annals ATS

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Rationale: Preterm birth, and its often-required medical interventions, can result in respiratory and gas exchange deficits into childhood. However, the long-term sequelae into adulthood are not well understood.Objectives: To determine exercise capacity and pulmonary gas exchange efficiency during exercise in adult survivors of preterm birth.Methods: Preterm (n = 14), very low birth weight (,1,500 g) adults (20-23 yr) and term-born, age-matched control subjects (n = 16) performed incremental exercise on a cycle ergometer to volitional exhaustion while breathing one of two oxygen concentrations: normoxia (fraction of inspired oxygen, 0.21) or hypoxia (fraction of inspired oxygen, 0.12).Measurements and Main Results: Ventilation, mixed expired gases, arterial blood gases, power output, and oxygen consumption were measured during rest and exercise. We calculated the alveolar-to-arterial oxygen difference to determine pulmonary gas exchange efficiency. Preterm subjects had lower power output at volitional exhaustion than did control subjects in normoxia (150 6 10 vs. 180 6 10 W; P = 0.01), despite similar normoxic oxygen consumption. However, during hypoxic exercise, there was no difference in power output at volitional exhaustion between the two groups (116 6 10 vs. 135 6 10 W; P = 0.11). Preterm subjects also exhibited a more acidotic, acid-base balance throughout exercise compared with control subjects. In contrast to other studies, adults born preterm, as a group developed a wider alveolarto-arterial oxygen difference and lower Pa O 2 than did control subjects during normoxic but not hypoxic exercise.Conclusions: This study demonstrates that pulmonary gas exchange efficiency is lower in some adult survivors of preterm birth during exercise compared with control subjects. The gas exchange inefficiency, when present, is accompanied by low arterial blood oxygen tension. Preterm subjects also exhibit reduced power output. Overall, our findings suggest potential long-term consequences of extreme preterm birth and very low birth weight on cardiopulmonary function.

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Section: Discussionsupporting

confidence: 93%

Section: Gas Exchange Efficiency During Exercisementioning

confidence: 75%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Pulmonary Gas Exchange and Exercise Capacity in Adults Born Preterm

Farrell¹,

Bates²,

Pegelow³

et al. 2015

Annals ATS

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Assessment of inhibited alveolar‐capillary membrane structural development and function in bronchopulmonary dysplasia

Ahlfeld

Conway

2014

Birth Defects Research

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Bronchopulmonary dysplasia (BPD) is a chronic lung disease of extreme prematurity and is defined clinically by dependence on supplemental oxygen due to impaired gas exchange. Optimal gas exchange is dependent on the development of a sufficient surface area for diffusion. In the mammalian lung, rapid acquisition of distal lung surface area is accomplished in neonatal and early adult life by means of vascularization and secondary septation of distal lung airspaces. Extreme preterm birth interrupts secondary septation and pulmonary capillary development and ultimately reduces the efficiency of the alveolar-capillary membrane. Although pulmonary health in BPD infants rapidly improves over the first few years, persistent alveolar-capillary membrane dysfunction continues into adolescence and adulthood. Preventative therapies have been largely ineffective, and therapies aimed at promoting normal development of the air-blood barrier in infants with established BPD remain largely unexplored. The purpose of this review will be: (1) to summarize the histological evidence of aberrant alveolar-capillary membrane development associated with extreme preterm birth and BPD, (2) to review the clinical evidence assessing the long-term impact of BPD on alveolar-capillary membrane function, and (3) to discuss the need to develop and incorporate direct measurements of functional gas exchange into clinically relevant animal models of inhibited alveolar development.

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Sex Hormones and Their Impact on the Respiratory Responses to Exercise and the Environment

Porter

Duke

2023

Sex Hormones, Exercise and Women

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Normal pulmonary gas exchange efficiency and absence of exercise-induced arterial hypoxemia in adults with bronchopulmonary dysplasia

Cited by 41 publications

References 49 publications

Pulmonary Gas Exchange and Exercise Capacity in Adults Born Preterm

Pulmonary Gas Exchange and Exercise Capacity in Adults Born Preterm

Assessment of inhibited alveolar‐capillary membrane structural development and function in bronchopulmonary dysplasia

Sex Hormones and Their Impact on the Respiratory Responses to Exercise and the Environment

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