Pulmonary diffusion limitation after prolonged strenuous exercise

Manier, G.; Moinard, J.; Techoueyres, P.; Varene, N.; Guénard, H.

doi:10.1016/0034-5687(91)90024-d

Cited by 94 publications

(93 citation statements)

References 19 publications

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“…Furthermore, heterogeneous ventilation may reflect airway compression by interstitial edema secondary to the increased alveolar epithelial permeability. The decreases in the membrane component of the lung diffusion capacity in the hours after exercise have been interpreted as transient interstitial edema (27,31,37,40). However, other studies using chest radiography (13) or computed tomography and magnetic resonance imaging (29) have failed to provide visual evidence of such edema.…”

Section: Discussionmentioning

confidence: 99%

Maximal rowing has an acute effect on the blood-gas barrier in elite athletes

Hanel

Law²,

Mortensen³

2003

Journal of Applied Physiology

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Hanel, Birgitte, Ian Law, and Jann Mortensen. Maximal rowing has an acute effect on the blood-gas barrier in elite athletes. J Appl Physiol 95: 1076-1082, 2003. First published April 25, 2003 10.1152/japplphysiol.00082.2002The purpose of the study was to evaluate the effects of maximal exercise on the integrity of the alveolar epithelial membrane using the clearance rate of aerosolized 99m Tclabeled diethylenetriaminepentaacetic acid as an index for the permeability of the lung blood-gas barrier. Ten elite rowers (24.3 Ϯ 4.6 yr of age) completed two 20-min pulmonary clearance measurements immediately after and 2 h after 6 min of all-out rowing (initial and late, respectively). All subjects participated in resting control measurements on a separate day. For each 20-min measurement, lung clearance was calculated for 0-7 and 10-20 min. Furthermore, scintigrams were processed from the initial and late measurements of diethylenetriaminepentaacetic acid clearance. Compared with control levels, the pulmonary clearance measurement after rowing was increased from 1.2 Ϯ 0.5 to 2.4 Ϯ 1.0%/min (SD) at 0-7 min (P Ͻ 0.01) and from 0.8 Ϯ 0.3 to 1.5 Ϯ 0.4%/min at 10-20 min (P Ͻ 0.0005), returning to resting levels within 2 h. In 6 of 10 subjects, ventilation distribution on the lung scintigrams was inhomogeneous at the initial measurement. The study demonstrates an acute increased pulmonary clearance after maximal rowing. The ventilation defects identified on the lung scintigrams may represent transient interstitial edema secondary to increased blood-gas barrier permeability induced by mechanical stress. lung function; oarsmen; ventilation defects THERE IS EVIDENCE TO SUGGEST that the integrity of the lung blood-gas barrier (BGB) in elite athletes is altered after short-term maximal exercise (19). The finding of red blood cells and protein in the fluid of bronchoalveolar lavage suggests that this effect may be caused by mechanical stress on the alveolar capillary membrane. In contrast, sustained submaximal exercise [77% of maximal O 2 uptake (V O 2 max )] in elite athletes did not elicit the same ultrastructural changes (18). Hence, only extreme levels of exercise in elite athletes may disrupt the integrity of the BGB, with possibly secondary development of interstitial edema. During maximal exercise, the BGB is subjected to conflicting requirements. A thin barrier is most optimal for efficient gas exchange by diffusion, whereas a strong barrier is needed to withstand the increased pulmonary capillary pressure and the longitudinal tension in the alveolar wall associated with lung inflation (42). If any injury should occur, it may cause these layers to become leaky, thereby increasing permeability.A very sensitive method to evaluate the BGB permeability is measurement of the pulmonary clearance rate using 99m

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Section: Discussionmentioning

confidence: 99%

Maximal rowing has an acute effect on the blood-gas barrier in elite athletes

Hanel

Law²,

Mortensen³

2003

Journal of Applied Physiology

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“…[5,9,10,13,19] was used as the theoretical ratio of DL,NO to Dm,CO during single-breath manoeuvres since those ratios have both been used in the past. The ratio of 2.42 has been determined recently during rebreathing manoeuvres at rest and during exercise [11,12], which can result in Dm,CO values that are more in line with the current normative values [25].…”

Section: Single-breath Apparatus and Techniquementioning

confidence: 99%

“…Therefore, diffusing capacity of the lung for nitric oxide (DL,NO) equals the membrane diffusing capacity for NO (Dm,NO), and is independent of Vc and haemoglobin concentration [8]. Others have made the same assumption that (1/HNO) is negligible [9][10][11][12][13][14], and it was recently determined that a nonzero 1/ HNO would not be able to explain their experimental data [12]. Therefore, these data suggest that DL,NO is a good measure of Dm,NO.…”

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confidence: 99%

“…Several researchers have previously obtained DL,NO from single-breath [4,5,9,10,13,14,[16][17][18][19] or rebreathing manoeuvres [11,12], along with the simultaneous measurement of DL,CO to obtain Dm,CO and Vc. Since brief exposure to NO does not interfere with physiological function [11,12,20,21], it seems pertinent to use NO as a test gas to assess lung diffusion capacity.…”

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A small amount of inhaled nitric oxide does not increase lung diffusing capacity

Zavorsky

Murias²

2006

Eur Respir J

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The aim of the present study was to determine: 1) whether 40-50 ppm nitric oxide (NO) increases diffusing capacity of the lung for NO (DL,NO) and carbon monoxide (DL,CO), membrane diffusing capacity for CO (Dm,CO) and pulmonary capillary blood volume (Vc); 2) the actual number of tests required to provide a reasonable estimate of DL,NO, DL,CO, Dm,CO and Vc; and 3) repeatability of these parameters using the single-breath DL,NO-DL,CO method.In total, 31 subjects performed five single-breath hold manoeuvres at rest, inhaling 43¡3 ppm NO together with a standard diffusion mixture.DL,NO (Dm,CO) remained unchanged from the first to fifth trial. However, compared with the first trial, DL,CO and Vc had decreased by the fourth (-4¡5%; 95% confidence interval (CI)5-5--2%) and third trial (-5¡7%; 95% CI5-7--2%), respectively. Repeatability over five trials was 17, 3 and 7 mL?min -1?mmHg -1 for DL,NO, DL,CO and Dm,CO, respectively, and 13 mL for Vc when Dm,CO5DL,NO/2.42.In conclusion, nitric oxide inhaled during sequential single-breath manoeuvres has no effect on diffusing capacity of the lung for nitric oxide and, thus, membrane diffusing capacity for carbon monoxide. Since more than two and three trials will lower pulmonary capillary blood volume and diffusing capacity of the lung for carbon monoxide, respectively, the average value of only two properly performed trials is suggested.

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“…Restricted post-exercise pulmonary diffusing capacity (DLco) has been well documented following endurance field events (Miles et al 1983;Manier et al 1991;Caillaud et al 1995) and in prolonged laboratory trials by triathletes (Hue et al 2001b, c). Recently, the DLco decrease observed after an experimental cycle-run succession of the triathlon was shown to be induced mainly by the prior cycle segment (Hue et al 2001b), certainly in relation to differences in fluid shifts between cycling and subsequent running.…”

Section: Introductionmentioning

confidence: 98%

Effects of the order of running and cycling of similar intensity and duration on pulmonary diffusing capacity in triathletes

Galy

Hue²,

Boussana³

et al. 2003

Eur J Appl Physiol

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To study the pathophysiological mechanisms involved in the decrease of post-triathlon diffusing capacity (DLco), blood rheologic properties (blood viscosity: eta(b); changes in plasma volume: deltaPV) and atrial natriuretic factor (ANF) were assessed in ten triathletes during cycle-run (CR) and run-cycle (RC) trials at a metabolic intensity of 75% of maximal oxygen consumption ( VO(2max)). The DLco was measured before and 10 min after trials. ANF and deltaPV were measured at rest, after the cycle and run of CR and RC trials, and at the end of and 10 min after exercise. RC led to a greater deltaDLco decrease, a lower ANF concentration and a lower deltaPV than did CR, whereas for both CR and RC eta(b) was increased throughout exercise and 10 min after. In addition, after CR the deltaDLco decrease was inversely correlated ( r=-0.764; P<0.01) with deltaPV. The association of decreased plasma volume, increased eta(b), and lower ANF concentrations after RC suggested that lower blood pulmonary volume may have caused the greater decrease in Dlco as compared with CR. The inverse correlation between deltaPV and deltaDLco reinforces the hypothesis that fluid shifts limit the post-exercise DLco decrease after the CR succession in triathletes. Lastly, cycling in the crouched position might increase intra-thoracic pressure, decrease thorax volume due to the forearm position on the handlebars, and weaken peripheral muscular pump efficacy, all of which would limit venous return to the heart, and thus result in low pulmonary blood volume. Compared with cycling, running appeared to induce the opposite effects.

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Pulmonary diffusion limitation after prolonged strenuous exercise

Cited by 94 publications

References 19 publications

Maximal rowing has an acute effect on the blood-gas barrier in elite athletes

Maximal rowing has an acute effect on the blood-gas barrier in elite athletes

A small amount of inhaled nitric oxide does not increase lung diffusing capacity

Effects of the order of running and cycling of similar intensity and duration on pulmonary diffusing capacity in triathletes

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