Exercise Limitation in Obstructive Lung Disease

doi:10.1378/chest.114.4.965

Chest

Volume 114, Issue 4, October 1998, Pages 965-968

https://doi.org/10.1378/chest.114.4.965 Get rights and content

Objective

To study the relationship of resting pulmonary function to maximal exercise power output (Wmax) in obstructive lung disease (OLD).

Setting

University Hospital Pulmonary Function Laboratory.

Subjects

Twenty-five patients with OLD (6 with asthma and 19 with COPD).

Methods

Measurement of pulmonary lung function, resting arterial blood gases, and maximal symptom-limited exercise on a cycle ergometer.

Results and conclusions

In OLD, the only significant contributor to $\dot{w}$ max was the inspiratory capacity (r² = 0.66; p < 0.001).

Section snippets

Subjects

We studied 25 patients (16 male) with OLD, of whom 19 had COPD and 6 had asthma. Their diagnosis was made according to the recommendations of the American Thoracic Society.⁷ The anthropometric characteristics are given in Table 1. At the time of the study, all patients were in stable clinical and functional state, and had no contraindications for exercise testing. Patients with evidence of cardiovascular disorders were excluded. To avoid any potential influence of medication on testing,

RESULTS

The resting pulmonary function variables and $\dot{w}$ max (percent predicted) of the OLD patients are given in Table 2. The severity of OLD ranged from mild to very severe (33 FEV₁, percent predicted). Table 3 lists the correlation and variation coefficients of the relationships between $\dot{w}$ max and different anthropometric characteristics and respiratory variables in which the correlation of the simple linear regressions was significant. The highest correlation coefficient was found

DISCUSSION

The main findings of the present study are that in patients with OLD, there is a close correlation between $\dot{w}$ max and resting IC.

According to the stepwise multiple regression analysis, in OLD the sole contributor to $\dot{w}$ max was resting IC, which explained about 70% of the variance (r² = 0.66). The residual variance is probably due to the fact that in OLD patients, (1) the $\dot{w}$ max during exercise is not limited only by ventilation but also by skeletal muscle dysfunction,¹⁴ and (2) only

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Cited by (40)

Cardiopulmonary exercise testing in patients with asthma: What is its clinical value?
2020, Respiratory Medicine
Citation Excerpt :
DH was previously recorded in obese asthmatics, during bronchial bronchoprovocation [87,88]. Moreover, Murariu et al. reported that in patients with obstructive airway disease (asthma or COPD) a close relationship was noted between exercise capacity and resting IC, suggesting that hyperinflation might play a role in limiting exercise performance [89]. Nevertheless, very few studies have assessed the presence of DH and its severity among asthmatic patients.
Asthma is one of the most common respiratory disorders, characterized by fully or largely reversible airflow limitation. Asthma symptoms can be triggered or magnified during exertion, while physical activity limitation is often present among asthmatic patients. Cardiopulmonary exercise testing (CPET) is a dynamic, non-invasive technique which provides a thorough assessment of exercise physiology, involving the integrative assessment of cardiopulmonary, neuromuscular and metabolic responses during exercise. This review summarizes current evidence regarding the utility of CPET in the diagnostic work-up, functional evaluation and therapeutic intervention among patients with asthma, highlighting its potential role for thorough patient assessment and physician clinical desicion-making.
Dynamic hyperinflation in patients with asthma and exercise-induced bronchoconstriction
2017, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
Inclusion of such patients meant that the patients with asthma without EIB evaluated by Kosmas et al13 had less exercise tolerance than ours, with a peak oxygen uptake of 1.87 (0.44) mL/min vs 2.78 (0.46) mL/min in our patients. Given that dynamic hyperinflation has been defined as a cause of exercise intolerance in patients with asthma,29 it is likely that differences in patient profiles justify the differences found in the frequency of dynamic hyperinflation. Given the frequency of dynamic hyperinflation in patients with asthma and EIB and the association between the EELV increase and postexercise FEV1 decrease, our data cannot determine whether dynamic hyperinflation is an early marker of EIB or whether it could contribute to its development.
Little is known about the behavior of operative lung volumes during exercise in patients with asthma and exercise-induced bronchoconstriction (EIB).
To compare the presence of dynamic hyperinflation (DH) in patients with mild asthma with and without EIB and in healthy individuals and to relate the changes in end-expiratory lung volume (EELV) with postexercise airflow reduction.
A total of 122 consecutive stable patients (>12 years of age) with mild asthma and 38 controls were studied. Baseline lung volumes were measured, and all patients performed an exercise bronchial challenge. At each minute of exercise, EELV and end-inspiratory lung volume (EILV) were estimated from inspiratory capacity measurements to align the tidal breathing flow-volume loops to within the maximal expiratory curve.
DH was more frequent in patients with asthma and EIB (76%) than in patients with asthma but without EIB (11%) or controls (18%). The EELV increased in patients with asthma and EIB and decreased in patients with asthma without EIB and controls during exercise. In the patients with asthma, the decrease in forced expiratory volume in 1 second after the exercise challenge correlated with age (r = −0.179, P = .05), baseline forced vital capacity (r = 0.255, P = .005), EELV increase (r = 0.447, P < .001), and EILV increase (r = 0.246, P = .007). Age, baseline forced vital capacity, and magnitude of DH were retained as independent predictors of EIB intensity.
In patients with asthma and EIB, the development of DH is very frequent and related to the intensity of postexercise bronchoconstriction. This finding could implicate DH in the development of EIB.
Activity limitation and exertional dyspnea in adult asthmatic patients: What do we know?
2016, Respiratory Medicine
Citation Excerpt :
Moreover, it was shown to be an independent marker of air trapping in severe asthmatic patients [63]. A strong correlation between the inspiratory capacity at rest, a marker of hyperinflation, and the maximum workload has been documented [64]. Finally, the ratio minute ventilation/maximal voluntary ventilation (VE/MVV) used to evaluate the ventilatory limitation during a cardio-pulmonary exercise testing (CPET) was observed as correlated with FEV1, in a group of asthmatic subjects having a baseline FEV1 about 81.1 ± 17.1%pred [43].
Limitation of activity is the most cited symptom described by uncontrolled asthma patients. Assessment of activity limitation can be undertaken through several ways, more or less complex, subjective or objective. Yet little is known about the link between patients sensations and objective measurements.
The present review reports the current knowledge regarding activity limitation and symptom perception (i.e., exertional dyspnea) in adult patients with asthma. This work is based on references indexed by PubMed, irrespective of the year of publication.
Overall, patients with stable asthma do not have a more sedentary lifestyle than healthy subjects. However, during a cycle ergometric test, the maximal load is reduced when FEV1, FVC and muscle strengths are decreased. Additionally, during the six-minute walking test, mild asthma patients walk less than healthy subjects even if the minimal clinically important difference is not reached.
The major complaint of asthma patients when exercising is dyspnea that is mainly related to the inspiratory effort and also to dynamic hyperinflation in some circumstances. Finally, the administration of bronchodilator does not improve the ventilatory pattern and the exercise capacity of asthma patients and little is known on its effect on exertional dyspnea.
The present review allows to conclude that until now there is no gold standard test allowing the objective assessment of “activity limitation and exertional dyspnea” in asthma patients.
Evaluation and follow up of hyperinflation in COPD
2009, Revue des Maladies Respiratoires
La distension pulmonaire ou volume excessif de gaz intraparenchymateux est une conséquence fonctionnelle majeure de la BPCO.
Elle est le plus souvent mesurée par pléthysmographie, méthode de référence. Celle-ci nécessite une méthodologie rigoureuse, en particulier chez les patients très obstructifs. Les techniques par dilution (azote ou plus souvent hélium) exposent à un risque de sous-estimation des volumes si elles sont utilisées seules car elles ne mesurent pas les volumes piégés.
La tomodensitométrie thoracique devrait être de plus en plus utilisée avec les progrès de l’imagerie fonctionnelle et la réduction des doses d’irradiation. La capacité inspiratoire est la seule méthode utilisable pour mesurer la distension dynamique d’exercice. C’est par contre un substitut imparfait à la pléthysmographie pour évaluer l’impact d’un bronchodilatateur sur la distension. L’hyperventilation de repos paraît une alternative simple et séduisante pour rechercher une distension dynamique.
L’évaluation de la distension est un critère important pour le phénotypage de l’obstruction dans la BPCO. Son histoire naturelle reste à ce jour mal connue.
T. Perez, H. Guenard
Plethysmography is the reference method and requires rigorous methodology, particularly in patients with severe airflow limitation. Dilution techniques (nitrogen or most often helium) may underestimate true lung volumes as they do not measure trapped gas.
Inspiratory capacity is the only available method to evaluate exercise induced dynamic hyperinflation. It is an imperfect surrogate of plethysmography for evaluating the reversibility of hyperinflation with bronchodilators. Resting hyperventilation has recently been shown to be a sensitive method to detect dynamic hyperinflation.
Evaluation of hyperinflation is an important criterion in the phenotyping of COPD patients. However, its natural history remains at present poorly defined.
Comparison of bronchodilatory properties of transdermal and inhaled long-acting β<inf>2</inf>-agonists
2008, Pulmonary Pharmacology and Therapeutics
Citation Excerpt :
We also evaluated the effect of transdermal β2-agonist tulobuterol and inhaled β2-agonist salmeterol on lung volume such as FVC and IC. Recently, the importance of lung volume parameters, especially IC, in the relationship with dyspnea and exercise endurance in COPD has been described [18–20]. In the present study, both transdermal β2-agonist tulobuterol and inhaled β2-agonist salmeterol also showed an improvement in FVC and IC after dosing compared with those at baseline.
Regular use of long-acting bronchodilators is recommended for symptomatic COPD patients. A transdermal type of β₂-agonist, tulobuterol, was recently developed. This agent shows the pharmacokinetic property of a sustained serum concentration for 24 h. However, little has been reported about the bronchodilatory properties of this agent.
The aim of the present study was to compare the bronchodilatory action of transdermal β₂-agonist tulobuterol with that of inhaled long-acting β₂-agonist salmeterol.
An open-label, randomized crossover study was performed. Eleven patients with stable COPD were enrolled in the study. Tulobuterol (2 mg/day) or salmeterol (50 μg, twice daily) was administered in a randomized, crossover manner. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and inspiratory capacity (IC) were measured before administration, every 2 h from 12 to 24 h, and at 36 h after the initial administration.
Transdermal β₂-agonist tulobuterol showed an improvement in FEV₁, FVC and IC after dosing compared with those at baseline. Salmeterol also improved all parameters of FEV₁, FVC and IC, and showed a greater improvement compared with the transdermal β₂-agonist tulobuterol (p<0.05). The values of the area under the curve (AUC) of FEV₁, FVC and IC during the administration of tulobuterol were 2.98±1.05, 1.81±0.98, 0.75±0.85 L h, respectively, and during the administration of salmeterol they were 6.39±1.12, 6.61±1.34, 4.28±0.91 L h, respectively.
The transdermal β₂-agonist tulobuterol showed bronchodilatory action for at least 24 h by once daily administration. However, its bronchodilatory potency was about three times less than that of the inhaled β₂-agonist salmeterol.
Accuracy of pulmonary function tests in predicted exercise capacity in COPD patients
2005, Respiratory Medicine
Purpose: The purpose of this study was to examine exercise tolerance in patients with COPD from measurements of resting pulmonary function parameters.
Methods: A total of 57 COPD patients were administered the pulmonary function test (PFT) and cardiopulmonary exercise test. The results were analyzed and essentially linear relationships emerged when each subject's VO₂ peak was plotted against his individual PFT parameters. Those significant contributors were then introduced in a stepwise multiple regression analysis to determine the best predictor of the VO₂ peak.
Results: Stepwise multiple regressions in variables revealed that peak oxygen consumption (VO₂ peak) was predicted best by the following equation: VO₂ peak=(maximum voluntary ventilation×0.024)+(forced mid-expiratory flow×0.47)+(body surface area×0.988)−0.913 ( $r = 0.90$ ; $r^{2} = 0.81$ SE=0.29 L/min).
Conclusion: We conclude that exercise capacity was predicted from measurements of resting pulmonary function parameters with excellent accuracy in the COPD patient.

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Chest

Clinical Investigations: COPDExercise Limitation in Obstructive Lung Disease

Objective

Setting

Subjects

Methods

Results and conclusions

Section snippets

Subjects

RESULTS

DISCUSSION

Exercise tolerance in chronic airway obstruction

Am Rev Respir Dis

The ventilatory capacity of patients with chronic airway obstruction

Clin Sci

A simple method to detect expiratory flow limitation during spontaneous breathing

Eur Respir J

Relationship between chronic dyspnea and expiratory flow-limitation in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Detection of expiratory flow limitation during exercise in COPD patients

J Appl Physiol

Exertional breathlessness in patients with chronic airflow limitation: the role of lung hyperinflation

Am Rev Respir Dis

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma

Am Rev Respir Dis

Standardization of spirometry

Am J Respir Crit Care Med

Reliability of inspiratory capacity for estimating end-expiratory lung volume changes during exercise in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Clinical Investigations: COPD
Exercise Limitation in Obstructive Lung Disease