Resting and ADL-induced dynamic hyperinflation explain physical inactivity in COPD better than FEV1

Lahaije, Anke; Helvoort, H.A.C. van; Dekhuijzen, P.N.R.; Vercoulen, J.H.M.M.; Heijdra, Yvonne F.

doi:10.1016/j.rmed.2013.02.017

Cited by 34 publications

(30 citation statements)

References 33 publications

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“…The increment of dynamic hyperinflation and decrease in inspiratory reserve volume (IRV = TLC (total lung capacity)-EELV) increase dyspnoea and reduce exercise tolerance in COPD patients (15). Physical activity in patients with COPD decreases with dynamic hyperinflation during exercise.…”

Section: Critical Inspiratory Reserve Volume and Exercise Tolerancementioning

confidence: 99%

“…Physical activity in patients with COPD decreases with dynamic hyperinflation during exercise. Dynamic hyperinflation worsens dyspnoea on exercise and quality of life (15). As dynamic hyperinflation increases, IRV can fall below a critical level in daily life (7,15).…”

Section: Critical Inspiratory Reserve Volume and Exercise Tolerancementioning

confidence: 99%

“…Dynamic hyperinflation worsens dyspnoea on exercise and quality of life (15). As dynamic hyperinflation increases, IRV can fall below a critical level in daily life (7,15). IRV and the degree of dyspnoea have no linear relationship in patients with moderate to severe COPD.…”

Section: Critical Inspiratory Reserve Volume and Exercise Tolerancementioning

confidence: 99%

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Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

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Expiratory flow limitation can develop in parallel with the progression of COPD, and as a consequence, dynamic hyperinflation and lung mechanical abnormalities can develop. Dynamic hyperinflation can cause increased breathlessness and reduction in exercise tolerance. Achievement of critical inspiratory reserve volume is one of the main factors in exercise intolerance. Obesity has specific lung mechanical effects. There is also a difference concerning gender and dyspnoea. Increased nerve activity is characteristic in hyperinflation. Bronchodilator therapy, lung volume reduction surgery, endurance training at submaximal intensity, and heliox or oxygen breathing can decrease the degree of dynamic hyperinflation.Keywords: COPD, dyspnoea, expiratory flow limitation, dynamic hyperinflation, lung mechanics, exercise toleranceOne of the main symptoms in chronic obstructive pulmonary disease (COPD) is dyspnoea, and initially it is manifested during exercise and later at rest with the progression of the disease. Dyspnoea leads to exercise intolerance in parallel with physical inactivity, and as a consequence, disability may develop (28). The main causes of exercise intolerance may be lung mechanical abnormalities and patient's deconditioning (28). Dyspnoea is characterised by an increase in the following factors: respiratory work/ effort ratio, breathing load, end-expiratory lung volume (EELV) related dynamic hyperinflation, intrinsic positive end-expiratory pressure (PEEP) related elastic effort, and neurological sensation (Fig. 1) (28). Dyspnoea manifestation is often associated with dynamic hyperinflation (DH) in patients with COPD from moderate to severe obstruction (26,28,29,35,42). The discrepancy between respiratory centre induced respiratory muscle work and muscle load, and capacity related lung volume changes lead to neuromechanical dissociation (Fig. 2). The consequence of this process is the development of dynamic hyperinflation as a cause of chronic and exertional dyspnoea (28).

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Section: Critical Inspiratory Reserve Volume and Exercise Tolerancementioning

confidence: 99%

Section: Critical Inspiratory Reserve Volume and Exercise Tolerancementioning

confidence: 99%

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Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

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“…Even one third of the patients with mild COPD in our study showed DH during ADL. In a recent study, also including patients with mild COPD, we found that a lower level of physical activity in patients with COPD is related to hyperinflation during ADL, independently of the severity of airflow limitation [23]. Testing patient performance in ADL, however, is not practical in most clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Can COPD Patients Who Hyperinflate During Daily Life Activities Be Identified by Laboratory Tests?

Lahaije

Helvoort

Dekhuijzen³

et al. 2013

Respiration

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Background: Identification of patients with chronic obstructive pulmonary disease (COPD) who develop dynamic hyperinflation (DH) during activities in daily life (ADL) is important, because of the association between DH and dyspnea and exercise limitation. Objective: We aimed to answer the question whether measurements of DH during metronome-paced tachypnea (MPT) or cardiopulmonary exercise testing (CPET) can be used to identify patients who develop DH during ADL. Methods: DH was measured by tracking changes in inspiratory capacity during CPET, MPT and ADL. Bland-Altman plots were used to evaluate agreement in DH between methods. With a receiver operating characteristic (ROC) analysis, the overall accuracy of MPT and CPET to identify patients who hyperinflate during ADL was assessed. Results: There are broad limits of agreement in DH between methods. ROC curve analyses showed good overall accuracy of both CPET and MPT to identify patients who hyperinflate during ADL. For CPET, area under the curve (AUC) = 0.956 (95% CI 0.903-1.009). For MPT, AUC = 0.840 (95% CI 0.699-0.981). Sensitivity and specificity to identify patients who hyperinflate during ADL with CPET were 96 and 83%, respectively, and with MPT, they were 89 and 77%, respectively. Conclusion: Both CPET and MPT can serve as screening tools to identify patients who are susceptible to developing DH during ADL. In practice, MPT is the most simple and inexpensive surrogate. However, the sensitivity of MPT is not optimal. When DH does not occur during CPET, it is unlikely to occur during ADL.

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“…A study of 56 COPD evaluated the relation between lung function indices (including a measure of DH during an activity of daily living (ADL) task performed at the patient's home) and average daily physical activity. The authors found that both resting IC/TLC ratio and ADL-induced change in IC were the two main determinants of daily activity levels, with no significant contribution of FEV1 [68].…”

Section: Characteristics Of the Eh Phenotype: Emphysemamentioning

confidence: 97%

The clinical relevance of the emphysema-hyperinflated phenotype in COPD

et al. 2015

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The classification of chronic pulmonary obstructive disease (COPD) into clinical and pathophysiological subsets is not new, but increasing data is available on the relation of these different phenotypes to clinically meaningful outcomes. This review focuses on the "emphysema-hyperinflation" (EH) phenotype, which is characterised by a prominent loss of lung elastic recoil and hyperinflation burden that translates into marked exercise intolerance and a heightened sense of dyspnoea. Although no single genetic profile has been associated with the EH phenotype, recent data have shown that certain single nucleotide polymorphisms, such as DNAH5, appear to have an effect on the preferential development of hyperinflation in smokers. Static and dynamic hyperinflation are hallmarks of the EH phenotype, and abnormal increases in resting lung function indices such as total lung capacity (TLC), functional residual capacity (FRC) and inspiratory to TLC ratio (IC/TLC) seem more associated with the clinical EH phenotype than others markers of gas trapping. An increased level of dyspnoea on exertion and exercise intolerance are also characteristic of the EH presentation and are likely related in part to critical mechanical constraints imposed on tidal volume expansion in situations where ventilatory demands are increased, but also possibly on cardiac and hemodynamic anomalies related to emphysema and hyperinflation. Importantly, the clinical relevance of the EH phenotype is underlined by the finding that indices of hyperinflation such as IC/TLC and residual volume (RV) can be used as independent predictors of mortality in patients with COPD. Treatment of patients with the EH phenotype should primarily focus on smoking cessation and maximal bronchodilator therapy. New long-acting combined bronchodilators options provide clinicians with safe and effective ways to address the hyperinflation issue in this population. Pulmonary rehabilitation also has a positive impact on exercise tolerance, quality of life and hyperinflation, and should be routinely considered in patients with EH presentation that remain symptomatic despite optimal treatment, whereas as lung volume reduction techniques should be reserved for highly selected patients.

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Resting and ADL-induced dynamic hyperinflation explain physical inactivity in COPD better than FEV1

Abstract: The presence of resting hyperinflation and occurrence of dynamic hyperinflation during ADL contribute to reduced physical activity levels in patients with COPD, independently of the degree of airflow limitation.

Cited by 34 publications

References 33 publications

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Can COPD Patients Who Hyperinflate During Daily Life Activities Be Identified by Laboratory Tests?

The clinical relevance of the emphysema-hyperinflated phenotype in COPD

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