Exercise tolerance and dyspnea in patients with chronic obstructive pulmonary disease

Background/Aim. Peripheral muscle weakness and nutritional disorders, firstly loss of body weight, are common findings in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the impact of pulmonary function parameters, nutritional status and state of peripheral skeletal muscles on exercise tolerance and development of dyspnea in COPD patients. Methods. Thirty COPD patients in stable state of disease were analyzed. Standard pulmonary function tests, including spirometry, body pletysmography, and measurements of diffusion capacity were performed. The 6-minute walking distance test (6MWD) was done in order to assess exercise tolerance. Level of dyspnea was measured with Borg scale. In all patients midthigh muscle cross-sectional area (MTCSA) was measured by computerized tomography scan. Nutritional status of patients was estimated according to body mass index (BMI). Results. Statistically significant correlations were found between parameters of pulmonary function and exercise tolerance. Level of airflow limitation and lung hyperinflation had significant impact on development of dyspnea at rest and especially after exercise. Significant positive correlation was found between MTCSA and exercise tolerance. Patients with more severe airflow limitation, lung hyperinflation and reduced diffusion capacity had significantly lower MTCSA. Conclusion. Exercise tolerance in COPD patients depends on severity of bronchoobstruction, lung hyperinflation and MTCSA. Severity of bronchoobstruction and lung hyperinflation have significant impact on dyspnea level.

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Correlates of variability in endurance shuttle walk test time in patients with chronic obstructive pulmonary disease

PLoS ONE ◽

10.1371/journal.pone.0249786 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249786

Author(s):

Anouk A. F. Stoffels ◽

Bram van den Borst ◽

Jeannette B. Peters ◽

Mariska P. M. Klaassen ◽

Hanneke A. C. van Helvoort ◽

...

Keyword(s):

Physical Activity ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Function ◽

Pulmonary Disease ◽

Performance Measures ◽

Exercise Tolerance ◽

Chronic Obstructive ◽

Walk Test ◽

Obstructive Pulmonary Disease ◽

Copd Patients

Background The endurance shuttle walk test (ESWT) is used to evaluate exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). The recommended pre-intervention tolerated duration (Tlim) is between 3–8 minutes for optimal interpretation of treatment effects. However, this window may be exceeded and factors determining ESWT Tlim are not completely understood. Therefore, we aimed to determine whether pulmonary function, physical and incremental shuttle walk test (ISWT) performance measures are associated with ESWT Tlim in COPD patients. Methods Assessment data from patients eligible for pulmonary rehabilitation was retrospectively analyzed. Inclusion criteria were: diagnosis of COPD and complete data availability regarding ESWT and ISWT. Patients performed an ESWT at 85% of ISWT speed and were divided into three groups (ESWT Tlim: <3 minutes, 3–8 minutes, >8 minutes). Subject characteristics, severity of complaints, pulmonary function, physical capacity and activity, exercise tolerance and quadriceps muscle strength were evaluated. Results 245 COPD patients (FEV1 38 (29–52)% predicted) were included. Median ESWT Tlim was 6.0 (3.7–10.3) minutes, 41 (17%) patients walked <3 minutes and 80 (33%) patients walked >8 minutes. Body mass index, maximal oxygen consumption, Tlim on constant work rate cycle test, physical activity level, maximal ISWT speed, dyspnoea Borg score at rest and increase of leg fatigue Borg score during ISWT independently predicted Tlim in multivariate regression analysis (R2 = 0.297, p<0.001). Conclusion This study reported a large variability in ESWT Tlim in COPD patients. Secondly, these results demonstrated that next to maximal ISWT speed, other ISWT performance measures as well as clinical measures of pulmonary function, physical capacity and physical activity were independent determinants of ESWT Tlim. Nevertheless, as these determinants only explained ~30% of the variability, future studies are needed to establish whether additional factors can be used to better adjust individual ESWT pace in order to reduce ESWT Tlim variability.

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Intercept of minute ventilation vs. carbon dioxide output relationship in chronic obstructive pulmonary disease: utility as an index of ventilatory inefficiency

10.21203/rs.3.rs-19544/v1 ◽

2020 ◽

Author(s):

Haoyan Wang ◽

Fang Lin ◽

Shan Nie ◽

Ranran Zhao ◽

Min Cao ◽

...

Keyword(s):

Carbon Dioxide ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Minute Ventilation ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Lung Hyperinflation ◽

Carbon Dioxide Output ◽

Copd Patients

Abstract Background: Ventilatory inefficiency is known to be a contributor to exercise intolerance in chronic obstructive pulmonary disease (COPD). The intercept of the minute ventilation (V̇E) vs. carbon dioxide output (V̇CO2) plot is a key ventilator inefficiency parameter. However, its relationships with lung hyperinflation (LH) and airflow limitation are not known. This study aimed to evaluate the correlations between the V̇E/V̇CO2 intercept and LH in COPD to determine its utility as an index of functional impairment.Methods: We conducted a retrospective analysis of data from 53 COPD patients and 14 healthy controls performed incremental cardiopulmonary exercise tests and resting pulmonary function. Ventilatory inefficiency was represented by parameters reflecting the V̇E/V̇CO2 nadir and slope (linear region), and intercept of the V̇E/V̇CO2 plot. Their correlations with measures of LH and airflow limitation were evaluated.Results: Compared to the control, the slope (30.58±3.62) and intercept (4.85±1.11) higher in COPDstages1-2, leading to a higher nadir (31.47±4.47) (p<0.05). Despite an even higher intercept in COPDstages3-4 (7.16±1.41), the slope diminished with disease progression (from 30.58±3.62 in COPDstages1-2 to 28.36±4.58 in COPDstages3-4). Compared to the V̇E/V̇CO2 nadir and V̇E/V̇CO2 slope, the intercept was better correlated with peak V̇E/maximal voluntary ventilation (MVV) (r=0.489, p<0.001) and peak V̇O2/watt (r=0.354, p=0.003). The intercept was also significantly correlated with RV/TLC (r=0.588, p<0.001), IC/TLC (r=-0.574, p<0.001), peak VT/TLC (r=-0.585, p<0.001); and airflow limitation forced expiratory volume in 1s (FEV1) % predicted (r=-0.606, p<0.001) and FEV1/forced vital capacity (FVC) (r=-0.629, p<0.001).Conclusion: V̇E/V̇CO2intercept was consistently better correlated with worsening static and dynamic lung hyperinflation and airflow limitation in COPD. V̇E/V̇CO2 intercept emerged as a useful index of ventilatory inefficiency across the severity spectrum of COPD patients.

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Nutrition in chronic obstructive pulmonary disease: A review

Journal of Translational Internal Medicine ◽

10.1515/jtim-2015-0021 ◽

2015 ◽

Vol 3 (4) ◽

pp. 151-154 ◽

Cited By ~ 22

Author(s):

Gautam Rawal ◽

Sankalp Yadav

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Exercise Tolerance ◽

Muscle Wasting ◽

Nutritional Supplement ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Supplement Therapy

AbstractCachexia and muscle wasting is a frequent but partly reversible complication in patients with chronic obstructive pulmonary disease (COPD), and affects the disease progression and prognosis. Weight loss in COPD is a consequence of increased energy requirements unbalanced by dietary intake. Nutritional supplement therapy has been shown to be effective for maintaining and improving the muscle strength and exercise tolerance in poorly nourished COPD patients, thereby decreasing morbidity and mortality. This mini review discusses the role of nutritional supplement therapy in the treatment of COPD.

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Predictors of co-morbidities in chronic obstructive pulmonary disease patients at a tertiary care centre in north India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194984 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4154

Author(s):

Kaushlendra Pratap Narayan ◽

S. K. Verma ◽

Surya Kant ◽

R. A. S. Kushwaha ◽

Santosh Kumar ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inflammatory Process ◽

Tertiary Care ◽

Airflow Limitation ◽

Pulmonary Vasculature ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Co Morbidity

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.

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Non-invasive Assessment of Respiratory Muscle Function and its Relationship to Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease

Journal of International Medical Research ◽

10.1177/147323000603400302 ◽

2006 ◽

Vol 34 (3) ◽

pp. 240-246 ◽

Cited By ~ 1

Author(s):

J Chlumský ◽

P Filipova ◽

M Terl

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Muscle Function ◽

Exercise Tolerance ◽

Respiratory Muscle ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Non Invasive ◽

Respiratory Muscle Function ◽

Copd Patients

Most patients with chronic obstructive pulmonary disease (COPD) have impaired respiratory muscle function. Maximal oesophageal pressure correlates closely with exercise tolerance and seems to predict the distance walked during the 6-min walk test. This study assessed the non-invasive parameters of respiratory muscle function in 41 patients with COPD to investigate their relationship to pulmonary function tests and exercise tolerance. The COPD patients, who demonstrated the full range of airway obstruction severity, had a mean forced expiratory volume in 1 s of 42.5% predicted (range, 20–79% predicted). Both the maximal inspiratory muscle strength and non-invasive tension-time index were significantly correlated with the degree of lung hyperinflation, as expressed by the ratio of residual volume to total lung capacity, and the distance walked in 6 min. We conclude that respiratory muscle function was influenced mainly by lung hyperinflation and that it had an important effect on exercise tolerance in COPD patients.

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Increased levels of Nε-(carboxymethyl)lysine in epithelial lining fluid from peripheral airways in patients with chronic obstructive pulmonary disease: a pilot study

Clinical Science ◽

10.1042/cs20100096 ◽

2010 ◽

Vol 119 (3) ◽

pp. 143-149 ◽

Cited By ~ 9

Author(s):

Hiroshi Kanazawa ◽

Toyoki Kodama ◽

Kazuhisa Asai ◽

Saeko Matsumura ◽

Kazuto Hirata

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Epithelial Lining ◽

Obstructive Pulmonary Disease ◽

Epithelial Lining Fluid ◽

Peripheral Airways ◽

Copd Patients ◽

Carboxymethyl Lysine

It has been reported that small airway inflammation is closely associated with the severity of airflow limitation in COPD (chronic obstructive pulmonary disease). We tested a new method of measurement of biochemical constituents in ELF (epithelial lining fluid) obtained separately from the central or peripheral airways using a bronchoscopic microsampling technique. The present study was designed to determine the validity of measuring CML [Nε-(carboxymethyl)lysine] levels in ELF for the assessment of small airway inflammation in COPD. Ten non-smokers, ten current smokers and 16 COPD patients were included in the present study. Concentrations of CML, 8-isoprostane and IL-8 (interleukin-8) were measured in ELF separately from the central or peripheral airways. CML levels in central airways did not differ significantly, but were markedly higher in peripheral than in central airways in the three groups. However, CML levels in peripheral airways of COPD patients were significantly higher than those in non-smokers and current smokers. In COPD patients, the CML level in peripheral airways was significantly correlated with FEV1 (forced expiratory volume in 1 s) (r=−0.82, P=0.002) and FEV1/FVC (forced vital capacity) (r=−0.57, P=0.03). Moreover, CML levels in peripheral airways were significantly correlated with levels of both 8-isoprostane (r=0.76, P=0.003) and IL-8 (r=0.67, P=0.01). In conclusion, these findings suggest that elevated levels of CML in ELF from peripheral airways were observed in COPD patients, and this parameter was correlated with the severity of airflow limitation.

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Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: echocardiography changes and their relation to the level of airflow limitation

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.848 ◽

2019 ◽

Vol 7 (21) ◽

pp. 3568-3573

Author(s):

Daniela Buklioska Ilievska ◽

Jordan Minov ◽

Nade Kochovska Kamchevska ◽

Biljana Prgova Veljanova ◽

Natasha Petkovikj ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Doppler Echocardiography ◽

Mean Value ◽

Airflow Limitation ◽

Left Ventricular Ejection ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients

Objective. To compare frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. Methods. Study population included 120 subjects divided in two groups. Group 1 included 60 patients with COPD (52 male and 8 female, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire , pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. Results. We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000) showing linear relationship with severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs. 64.8 ± 2.7; P = 0.0000) with no correlation with severity of airflow limitation. Conclusion. Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention. Key words: airflow limitation, chronic obstructive pulmonary disease, Doppler echocardiography, pulmonary hypertension, ventricular dysfunction.

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Study on correlation between six minute walk test and BODE index in chronic obstructive pulmonary disease patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204876 ◽

2020 ◽

Vol 8 (11) ◽

pp. 3911

Author(s):

Babulal Bansiwal ◽

Anees K. V. ◽

Maneesha Jelia ◽

Satyam Agarwal

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Clinical Symptoms ◽

Pearson Correlation ◽

Outpatient Department ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Bode Index ◽

Copd Patients

Background: Chronic obstructive pulmonary disease is preventable and treatable disease with progressive persistent airflow limitation and enhanced chronic inflammatory response in the airways. Indian council of medical research conducted a study and found that total burden of COPD in India has more than doubled to about 14.84 million in 2011 from about 6.45 million in 1971Methods: It was an open label cross sectional study. It was conducted on patients attending the outpatient department of respiratory medicine, new medical college and hospital, Kota, over a period of one year. 100 COPD patients attending the respiratory outpatient department of GMC, Kota and fulfilling the inclusion criteria’s were included in the study. A diagnosis and severity of COPD was established by clinical symptoms and spirometric data as per GOLD guideline (ratio of FEV1 and forced vital capacity <0.7).Results: We found a significant negative correlation (Pearson correlation coefficient r = -0.664, p< 0.001) between 6 MWD and BODE index in study population.Conclusions: Thus, we concluded that the functional exercise capacity of COPD patients measured by 6MWT deteriorates linearly with severity of the disease assessed by the GOLD staging criteria. Hence we can use 6 MWT for assessing the severity of COPD in place of spirometry where the facility of spirometry is not feasible.

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Extended Bacteria Culture-Based Clustering Identifies a Phenotype Associating Increased Cough and Enterobacterales in Stable Chronic Obstructive Pulmonary Disease

Frontiers in Microbiology ◽

10.3389/fmicb.2021.781797 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anaëlle Muggeo ◽

Jeanne-Marie Perotin ◽

Audrey Brisebarre ◽

Sandra Dury ◽

Valérian Dormoy ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Clinical Symptoms ◽

Bacterial Load ◽

Stable State ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Mass Spectrometry Identification

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by airflow limitation. This chronic respiratory disease represents the third leading cause of death worldwide. Alteration of the airway microbiota has been reported to be associated with exacerbation frequency in COPD, but its role on the symptoms in patients at stable state is still incompletely described. This study aimed to determine whether bacteria isolated in sputum can be associated with the clinical features of COPD patients within stable state. Our study highlights, for the first time, that altered microbiota with Enterobacterales is associated with pejorative clinical symptoms in stable COPD patients. The airway microbiota of 38 patients was analyzed using an extended culture approach and mass spectrometry identification. Cluster analysis by principal coordinate analysis of the bacterial communities showed that the patients could be classified into three distinct clusters in our cohort. The clusters showed no differences in proportions of the phylum, but one of them was associated with a high prevalence of Enterobacterales (71.4% in cluster 1 vs. 0% in cluster 3), loss of microbiota diversity, and higher bacterial load (107 vs. 105 CFU/ml, respectively) and characterized by predominant cough and impact on mental health. These novel findings, supported by further studies, could lead to modifying the processing of COPD sputum in the everyday practice of clinical microbiology laboratories.

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Extracellular adenosine triphosphate is associated with airflow limitation severity and symptoms burden in patients with chronic obstructive pulmonary disease

Scientific Reports ◽

10.1038/s41598-019-51855-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Iva Hlapčić ◽

Andrea Hulina-Tomašković ◽

Anita Somborac-Bačura ◽

Marija Grdić Rajković ◽

Andrea Vukić Dugac ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Disease Severity ◽

Adenosine Triphosphate ◽

Quantitative Polymerase Chain Reaction ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Extracellular Adenosine ◽

Copd Patients

Abstract Extracellular adenosine triphosphate (eATP)-driven inflammation was observed in chronic obstructive pulmonary disease (COPD) but was not investigated in patients’ blood. Therefore, this study aimed to investigate eATP concentration in plasma of COPD patients and its association with disease severity and smoking. Study included 137 patients with stable COPD and 95 control subjects. eATP concentration was determined in EDTA plasma by luminometric method, and mRNA expression of eATP receptors P2X7R and P2Y2R was analysed by quantitative polymerase chain reaction (qPCR). eATP concentration was increased in COPD patients compared to controls (P < 0.001). Moreover, it was increasing with disease severity (GOLD 2–4) as well as symptoms burden and exacerbations history (GOLD A–D) (P < 0.05). eATP in healthy smokers differed from healthy non-smokers (P < 0.05) but was similar to GOLD 2 and GOLD A patients. eATP showed great diagnostic performances (OR = 12.98, P < 0.001) and correctly classified 79% of study participants. It demonstrated association with FEV1 and multicomponent indices (ADO, BODEx, BODCAT, CODEx, DOSE). Regarding gene expression, P2Y2R was increased in the blood of COPD patients. Plasma eATP could become a diagnostic and/or prognostic biomarker in COPD, as it seems to be associated with patients’ condition, quality of life and disease progression.

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