scholarly journals Cardiopulmonary exercise testing in interstitial lung diseases and the value of ventilatory efficiency

2021 ◽  
Vol 30 (162) ◽  
pp. 200355
Author(s):  
Thomas Gille ◽  
Pierantonio Laveneziana

Interstitial lung diseases (ILDs) are diverse parenchymal pulmonary disorders, primarily characterised by alveolar and interstitial inflammation and/or fibrosis, and sharing pathophysiological similarities. Thus, patients generally harbour common respiratory symptoms, lung function abnormalities and modified exercise adaptation. The most usual and disabling complaint is exertional dyspnoea, frequently responsible for premature exercise interruption. Cardiopulmonary exercise testing (CPET) is increasingly used for the clinical assessment of patients with ILD. This is because exercise performance or dyspnoea on exertion cannot reliably be predicted by resting pulmonary function tests. CPET, therefore, provides an accurate evaluation of functional capacity on an individual basis. CPET can unmask anomalies in the integrated functions of the respiratory, cardiovascular, metabolic, peripheral muscle and neurosensory systems in ILDs. CPET uniquely provides an evaluation of all above aspects and can help clinicians shape ILD patient management. Preliminary evidence suggests that CPET may also generate valuable prognostic information in ILDs and can be used to shed light on the presence of associated pulmonary hypertension. This review aims to provide comprehensive and updated evidence concerning the clinical utility of CPET in ILD patients, with particular focus on the physiological and clinical value of ventilatory efficiency (V˙E/V˙CO2).

2017 ◽  
Vol 26 (143) ◽  
pp. 160099 ◽  
Author(s):  
Matteo Bonini ◽  
Giuseppe Fiorenzano

Interstitial lung diseases (ILDs) represent a heterogeneous group of pathologies characterised by alveolar and interstitial damage, pulmonary inflammation (usually associated with fibrosis), decreased lung function and impaired gas exchange, which can be attributed to either a known or an unknown aetiology. Dyspnoea is one of the most common and disabling symptoms in patients with ILD, significantly impacting quality of life. The mechanisms causing dyspnoea are complex and not yet fully understood. However, it is recognised that dyspnoea occurs when there is an imbalance between the central respiratory efferent drive and the response of the respiratory musculature. The respiratory derangement observed in ILD patients at rest is even more evident during exercise. Pathophysiological mechanisms responsible for exertional dyspnoea and reduced exercise tolerance include altered respiratory mechanics, impaired gas exchange, cardiovascular abnormalities and peripheral muscle dysfunction.This review describes the respiratory physiology of ILD, both at rest and during exercise, and aims to provide comprehensive and updated evidence on the clinical utility of the cardiopulmonary exercise test in the assessment and management of these pathological entities. In addition, the role of exercise training and pulmonary rehabilitation programmes in the ILD population is addressed.


Author(s):  
Gonçalo António Cintrão Samouco ◽  
Rebeca Natal ◽  
João Costa ◽  
Andreia Filipa Carriço ◽  
Ana Filipa Fernandes ◽  
...  

2019 ◽  
Vol 199 (8) ◽  
pp. 987-995 ◽  
Author(s):  
Helge Hebestreit ◽  
Erik H. J. Hulzebos ◽  
Jane E. Schneiderman ◽  
Chantal Karila ◽  
Steven R. Boas ◽  
...  

2019 ◽  
Vol 54 (6) ◽  
pp. 1901441 ◽  
Author(s):  
Thomas Radtke ◽  
Ioannis Vogiatzis ◽  
Don S. Urquhart ◽  
Pierantonio Laveneziana ◽  
Richard Casaburi ◽  
...  

2021 ◽  
Vol 30 (159) ◽  
pp. 200187
Author(s):  
Pierantonio Laveneziana ◽  
Marcello Di Paolo ◽  
Paolo Palange

Cardiopulmonary exercise testing (CPET) has long been used as diagnostic tool for cardiac diseases. During recent years CPET has been proven to be additionally useful for 1) distinguishing between normal and abnormal responses to exercise; 2) determining peak oxygen uptake and level of disability; 3) identifying factors contributing to dyspnoea and exercise limitation; 4) differentiating between ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular, metabolic and peripheral muscle causes of exercise intolerance; 5) identifying anomalies of ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular and metabolic systems, as well as peripheral muscle and psychological disorders; 6) screening for coexistent ischaemic heart disease, peripheral vascular disease and arterial hypoxaemia; 7) assisting in planning individualised exercise training; 8) generating prognostic information; and 9) objectively evaluating the impact of therapeutic interventions. As such, CPET is an essential part of patients' clinical assessment. This article belongs to the special series on the “Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders”, addressed to clinicians, physiologists and researchers, and aims at encouraging them to get acquainted with CPET in order to help and orient the clinical decision concerning individual patients.


2017 ◽  
Vol 127 ◽  
pp. 7-13 ◽  
Author(s):  
Fabiano Di Marco ◽  
Silvia Terraneo ◽  
Sara Job ◽  
Rocco Francesco Rinaldo ◽  
Giuseppe Francesco Sferrazza Papa ◽  
...  

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