Correlation of Diffusion Capacity With Gas Exchange Parameters on Cardiopulmonary Exercise Testing in Nonobese Patients With Exertional Dyspnea

In chronic obstructive pulmonary disease (COPD), exertional dyspnea, which increases with the disease’s progression, reduces exercise tolerance and limits physical activity, leading to a worsening prognosis. It is necessary to understand the diverse mechanisms of dyspnea and take appropriate measures to reduce exertional dyspnea, as COPD is a systemic disease with various comorbidities. A treatment focusing on the motor pathophysiology related to dyspnea may lead to improvements such as reducing dynamic lung hyperinflation, respiratory and metabolic acidosis, and eventually exertional dyspnea. However, without cardiopulmonary exercise testing (CPET), it may be difficult to understand the pathophysiological conditions during exercise. CPET facilitates understanding of the gas exchange and transport associated with respiration-circulation and even crosstalk with muscles, which is sometimes challenging, and provides information on COPD treatment strategies. For respiratory medicine department staff, CPET can play a significant role when treating patients with diseases that cause exertional dyspnea. This article outlines the advantages of using CPET to evaluate exertional dyspnea in patients with COPD.

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The Utility of Cardiopulmonary Exercise Testing in Determining the Cause of Exertional Dyspnea of Unclear Etiology on Routine Testing

CHEST Journal ◽

10.1378/chest.1387922 ◽

2012 ◽

Vol 142 (4) ◽

pp. 800A

Author(s):

Anupam Kumar ◽

D. Datta

Keyword(s):

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Exertional Dyspnea ◽

Routine Testing ◽

Cardiopulmonary Exercise ◽

Unclear Etiology

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Ventilatory compensation during the incremental exercise test is inversely correlated with air trapping in COPD

F1000Research ◽

10.12688/f1000research.20444.2 ◽

2020 ◽

Vol 8 ◽

pp. 1661

Author(s):

Rottem Kuint ◽

Neville Berkman ◽

Samir Nusair

Keyword(s):

Gas Exchange ◽

Exercise Testing ◽

Exercise Test ◽

Cardiopulmonary Exercise Testing ◽

Incremental Exercise ◽

Peak Exercise ◽

Air Trapping ◽

Incremental Exercise Test ◽

Cardiopulmonary Exercise ◽

Copd Patients

Background: Air trapping and gas exchange abnormalities are major causes of exercise limitation in chronic obstructive pulmonary disease (COPD). During incremental cardiopulmonary exercise testing, actual nadir values of ventilatory equivalents for carbon dioxide (V E/VCO 2) and oxygen (V E/VO 2) may be difficult to identify in COPD patients because of limited ventilatory compensation capacity. Therefore, we aimed in this exploratory study to detect a possible correlation between the magnitude of ventilation augmentation, as manifested by increments in ventilatory equivalents from nadir to peak exercise values and air trapping, detected with static testing. Methods: In this observational study, we studied data obtained previously from 20 COPD patients who, during routine follow-up, underwent a symptom-limited incremental exercise test and in whom a plethysmography was obtained concurrently. Air trapping at rest was assessed by measurement of the residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC). Gas exchange data collected during the symptom-limited incremental cardiopulmonary exercise test allowed determination of the nadir and peak exercise values of V E/VCO 2 and V E/VO 2, thus enabling calculation of the difference between peak exrcise value and nadir values of V E/VCO 2 and V E/VO 2, designated ΔV E/VCO 2 and ΔV E/VO 2, respectively. Results: We found a statistically significant inverse correlation between both ΔV E/VCO 2 (r = -0. 5058, 95% CI -0.7750 to -0.08149, p = 0.0234) and ΔV E/VO 2 (r = -0.5588, 95% CI -0.8029 to -0.1545, p = 0.0104) and the degree of air trapping (RV/TLC). There was no correlation between ΔV E/VCO 2 and forced expiratory volume in the first second, or body mass index. Conclusions: The ventilatory equivalents increment to compensate for acidosis during incremental exercise testing was inversely correlated with air trapping (RV/TLC).

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Ventilatory compensation during the incremental exercise test is inversely correlated with air trapping in COPD

F1000Research ◽

10.12688/f1000research.20444.1 ◽

2019 ◽

Vol 8 ◽

pp. 1661

Author(s):

Rottem Kuint ◽

Neville Berkman ◽

Samir Nusair

Keyword(s):

Gas Exchange ◽

Exercise Testing ◽

Exercise Test ◽

Cardiopulmonary Exercise Testing ◽

Incremental Exercise ◽

Peak Oxygen Consumption ◽

Air Trapping ◽

Incremental Exercise Test ◽

Cardiopulmonary Exercise ◽

Copd Patients

Background: Air trapping and gas exchange abnormalities are major causes of exercise limitation in chronic obstructive pulmonary disease (COPD). During incremental cardiopulmonary exercise testing, ventilatory equivalents for carbon dioxide (VE/VCO2) and oxygen (VE/VO2) may be difficult to identify in COPD patients because of limited ventilatory compensation capacity. Therefore, we aimed to detect a possible correlation between the magnitude of ventilation augmentation, as manifested by increments in ventilatory equivalents from nadir to peak effort values and air trapping, detected with static testing. Methods: In this observational study, we studied data obtained previously from 20 COPD patients who, during routine follow-up, underwent a symptom-limited incremental exercise test and in whom a plethysmography was obtained concurrently. Air trapping at rest was assessed by measurement of the residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC). Gas exchange data collected during the symptom-limited incremental cardiopulmonary exercise test allowed determination of the nadir and peak effort values of VE/VCO2 and VE/VO2, thus enabling calculation of the difference between peak effort value and nadir values of VE/VCO2 and VE/VO2, designated ΔVE/VCO2 and ΔVE/VO2, respectively. Results: We found a statistically significant inverse correlation between both ΔVE/VCO2 (r = -0. 5058, 95% CI -0.7750 to -0.08149, p = 0.0234) and ΔVE/VO2 (r = -0.5588, 95% CI -0.8029 to -0.1545, p = 0.0104) and the degree of air trapping (RV/TLC). There was no correlation between ΔVE/VCO2 and peak oxygen consumption, forced expiratory volume in the first second, or body mass index. Conclusions: The ventilatory equivalents increment to compensate for acidosis during incremental exercise testing was inversely correlated with air trapping (RV/TLC) and may be a candidate prognostic biomarker.

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