Thoracoabdominal asynchrony contributes to exercise limitation in mild asthmatic subjects

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

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Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice

American Journal of Nephrology ◽

10.1159/000515384 ◽

2021 ◽

pp. 1-15

Author(s):

Eva Pella ◽

Afroditi Boutou ◽

Marieta P. Theodorakopoulou ◽

Pantelis Sarafidis

Keyword(s):

Cardiovascular Risk ◽

Risk Stratification ◽

Cardiopulmonary Exercise Testing ◽

Adverse Outcomes ◽

Exercise Intolerance ◽

Exercise Limitation ◽

Integrative Evaluation ◽

Prognostic Utility ◽

Risk Potential

Background: Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes. Summary: The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. Key Messages: CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.

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Exercise limitation in juvenile onset Mixed Connective Tissue Disease (MCTD)

Pediatric Rheumatology ◽

10.1186/1546-0096-6-s1-p162 ◽

2008 ◽

Vol 6 (Suppl 1) ◽

pp. P162 ◽

Cited By ~ 1

Author(s):

JJ Net ◽

A van Royen-Kerkhof ◽

T Takken ◽

B Wissink

Keyword(s):

Connective Tissue ◽

Connective Tissue Disease ◽

Mixed Connective Tissue Disease ◽

Juvenile Onset ◽

Exercise Limitation

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Thoracoabdominal asynchrony associates with exercise intolerance in fibrotic interstitial lung diseases

Respirology ◽

10.1111/resp.14064 ◽

2021 ◽

Author(s):

Pauliane Vieira Santana ◽

Leticia Zumpano Cardenas ◽

Jeferson George Ferreira ◽

Carlos Roberto Ribeiro Carvalho ◽

André Luis Pereira Albuquerque ◽

...

Keyword(s):

Lung Diseases ◽

Interstitial Lung Diseases ◽

Exercise Intolerance ◽

Thoracoabdominal Asynchrony

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Muscle dysfunction and exercise limitation in adolescent idiopathic scoliosis

European Respiratory Journal ◽

10.1183/09031936.00025509 ◽

2009 ◽

Vol 36 (2) ◽

pp. 393-400 ◽

Cited By ~ 53

Author(s):

J. Martinez-Llorens ◽

M. Ramirez ◽

M. J. Colomina ◽

J. Bago ◽

A. Molina ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Muscle Dysfunction ◽

Exercise Limitation

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Deep breaths, methacholine, and airway narrowing in healthy and mild asthmatic subjects

Journal of Applied Physiology ◽

10.1152/japplphysiol.00209.2002 ◽

2002 ◽

Vol 93 (4) ◽

pp. 1384-1390 ◽

Cited By ~ 54

Author(s):

Emanuele Crimi ◽

Riccardo Pellegrino ◽

Manlio Milanese ◽

Vito Brusasco

Keyword(s):

Forced Vital Capacity ◽

Healthy Subjects ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Forced Expiration ◽

Airway Narrowing ◽

Significant Difference ◽

Mild Asthmatic ◽

Residual Capacity ◽

Airway Conductance

Deep breaths taken before inhalation of methacholine attenuate the decrease in forced expiratory volume in 1 s and forced vital capacity in healthy but not in asthmatic subjects. We investigated whether this difference also exists by using measurements not preceded by full inflation, i.e., airway conductance, functional residual capacity, as well as flow and residual volume from partial forced expiration. We found that five deep breaths preceding a single dose of methacholine 1) transiently attenuated the decrements in forced expiratory volume in 1 s and forced vital capacity in healthy ( n = 8) but not in mild asthmatic ( n = 10) subjects and 2) increased the areas under the curve of changes in parameters not preceded by a full inflation over 40 min, during which further deep breaths were prohibited, without significant difference between healthy ( n = 6) and mild asthmatic ( n = 16) subjects. In conclusion, a series of deep breaths preceding methacholine inhalation significantly enhances bronchoconstrictor response similarly in mild asthmatic and healthy subjects but facilitates bronchodilatation on further full inflation in the latter.

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Exercise Limitation in Survivors of Severe Acute Respiratory Syndrome (SARS)

CHEST Journal ◽

10.1378/chest.126.4_meetingabstracts.737s ◽

2004 ◽

Vol 126 (4) ◽

pp. 737S

Author(s):

Veronica L. Chan ◽

Judy Y. Lam ◽

Wah-Shing Leung ◽

Alsa W. Lin ◽

Chung-Ming Chu

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Exercise Limitation

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Portable High-Flow Nasal Oxygen during Walking in Patients with Severe Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Respiration ◽

10.1159/000517033 ◽

2021 ◽

pp. 1-7

Author(s):

Annalisa Carlucci ◽

Veronica Rossi ◽

Serena Cirio ◽

Manuela Piran ◽

Giuditta Bettinelli ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Oxygen Saturation ◽

High Flow ◽

Portable Device ◽

Chronic Obstructive ◽

Inspiratory Capacity ◽

Oxygen Supplementation ◽

Obstructive Pulmonary Disease ◽

Exercise Limitation ◽

Severe Exercise

Background: High-flow nasal oxygen (HFNO) improves exercise capacity, oxygen saturation, and symptoms in patients with chronic obstructive pulmonary disease (COPD). Due to the need of electricity supply, HFNO has not been applied during free ambulation. Objective: We evaluated whether HFNO delivered during walking by a battery-supplied portable device was more effective than usual portable oxygen in improving exercise capacity in patients with COPD and severe exercise limitation. The effects on 6-min walking tests (6MWTs) were the primary outcome. Methods: After a baseline 6MWT, 20 stable patients requiring an oxygen inspiratory fraction (FiO2) <0.60 during exercise, randomly underwent 2 6MWT carrying a rollator, under either HFNO with a portable device (HFNO test) or oxygen supplementation by a Venturi mask (Control) at isoFiO2. Walked distance, perceived dyspnea, pulse oximetry, and inspiratory capacity at end of the tests as well as patients’ comfort were compared between the tests. Results: As compared to baseline, walked distance improved significantly more in HFNO than in the control test (by 61.1 ± 37.8 and 39.7 ± 43.8 m, respectively, p = 0.01). There were no significant differences between the tests in dyspnea, peripheral oxygen saturation, or inspiratory capacity, but HFNO test was appreciated as more comfortable. Conclusion: In patients with COPD and severe exercise limitation, HFNO delivered by a battery-supplied portable device was more effective in improving walking distance than usual oxygen supplementation.

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