The major limitation to exercise performance in COPD is dynamic hyperinflation

O’Donnell, Denis E.; Webb, Katherine A.

doi:10.1152/japplphysiol.90336.2008b

Cited by 176 publications

(175 citation statements)

References 31 publications

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“…In hyperinflation, the respiratory system's relaxation volume can move to a higher level because of parenchymal destruction of emphysema, which increases lung compliance (29). In the case of expiratory flow limitation, EELV can also dynamically change and vary with the time constant for emptying (the product of resistance and compliance) of the respiratory system.…”

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

“…In the case of expiratory flow limitation, EELV can also dynamically change and vary with the time constant for emptying (the product of resistance and compliance) of the respiratory system. DH therefore refers to this temporary and variable increase in EELV (28,29). In flow-limited patients, EELV is a continuous dynamic variable, which depends on expiratory flow limitation and breathing pattern.…”

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

“…DH in flow-limited patients is a consequence: as ventilation increases and expiratory duration decreases, there is not enough time to allow EELV to decline to its baseline resting value. Finally, inspiration begins before expiration is complete and DH is the result (28,29).…”

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

“…In asthma, DH may develop because of active braking by the ribcage muscles during expiration but there is no evidence for the same phenomenon in COPD (29). As a potential mechanism, DH during induced bronchoconstriction may develop asthma as a result of afferent sensory feedback from vagal airway mechanosensors activated by dynamic airway compression during expiration (29).…”

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

“…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.…”

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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: Mechanisms To Hyperinflationmentioning

confidence: 99%

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

Section: Mechanisms To Hyperinflationmentioning

confidence: 99%

mentioning

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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Long‐Acting Muscarinic Antagonists in Asthma and COPD

Lougheed¹,

Ora²,

O’Donnell³

2012

Advances in Combination Therapy for Asthma and COPD

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Factors Limiting Exercise Tolerance in Chronic Lung Diseases

Vogiatzis

Zakynthinos

2012

Comprehensive Physiology

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The major limitation to exercise performance in patients with chronic lung diseases is an issue of great importance since identifying the factors that prevent these patients from carrying out activities of daily living provides an important perspective for the choice of the appropriate therapeutic strategy. The factors that limit exercise capacity may be different in patients with different disease entities (i.e., chronic obstructive, restrictive or pulmonary vascular lung disease) or disease severity and ultimately depend on the degree of malfunction or miss coordination between the different physiological systems (i.e., respiratory, cardiovascular and peripheral muscles). This review focuses on patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and pulmonary vascular disease (PVD). ILD and PVD are included because there is sufficient experimental evidence for the factors that limit exercise capacity and because these disorders are representative of restrictive and pulmonary vascular disorders, respectively. A great deal of emphasis is given, however, to causes of exercise intolerance in COPD mainly because of the plethora of research findings that have been published in this area and also because exercise intolerance in COPD has been used as a model for understanding the interactions of different pathophysiologic mechanisms in exercise limitation. As exercise intolerance in COPD is recognized as being multifactorial, the impacts of the following factors on patients' exercise capacity are explored from an integrative physiological perspective: (i) imbalance between the ventilatory capacity and requirement; (ii) imbalance between energy demands and supplies to working respiratory and peripheral muscles; and (iii) peripheral muscle intrinsic dysfunction/weakness.

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The major limitation to exercise performance in COPD is dynamic hyperinflation

Cited by 176 publications

References 31 publications

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Long‐Acting Muscarinic Antagonists in Asthma and COPD

Factors Limiting Exercise Tolerance in Chronic Lung Diseases

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