Decline of resting inspiratory capacity in COPD: the impact on breathing pattern, dyspnea, and ventilatory capacity during exercise.

TitleDecline of resting inspiratory capacity in COPD: the impact on breathing pattern, dyspnea, and ventilatory capacity during exercise.
Publication TypeJournal Article
Year of Publication2012
AuthorsO'Donnell, DE, Guenette, JA, Maltais, F, Webb, KA
JournalChest
Volume141
Issue3
Pagination753-62
Date Published2012 Mar
ISSN1931-3543
KeywordsAged, Cross-Sectional Studies, Dyspnea, Exercise, Exercise Test, Female, Forced Expiratory Volume, Humans, Inspiratory Capacity, Lung, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Pulmonary Ventilation, Randomized Controlled Trials as Topic, Respiratory Function Tests, Respiratory Mechanics, Rest, Retrospective Studies, Tidal Volume, Time Factors
Abstract

BACKGROUND: To better understand the interrelationships among disease severity, inspiratory capacity (IC), breathing pattern, and dyspnea, we studied responses to symptom-limited cycle exercise in a large cohort with COPD.METHODS: Analysis was conducted on data from two previously published replicate clinical trials in 427 hyperinflated patients with COPD. Patients were divided into disease severity quartiles based on FEV(1) % predicted. Spirometry, plethysmographic lung volumes, and physiologic and perceptual responses to constant work rate (CWR) cycle exercise at 75% of the peak incremental work rate were compared.RESULTS: Age, body size, and COPD duration were similar across quartiles. As the FEV(1) quartile worsened (mean, 62%, 49%, 39%, and 27% predicted), functional residual capacity increased (144%, 151%, 164%, and 185% predicted), IC decreased (86%, 81%, 69%, and 60% predicted), and peak incremental cycle work rate decreased (66%, 55%, 50%, and 44% predicted); CWR endurance time was 9.7, 9.3, 8.2, and 7.3 min, respectively. During CWR exercise, as FEV(1) quartile worsened, peak minute ventilation ($$\dot{\mathrm{V}}$$e) and tidal volume (Vt) decreased, whereas an inflection or plateau of the Vt response occurred at a progressively lower $$\dot{\mathrm{V}}$$e (P < .0005), similar percentage of peak $$\dot{\mathrm{V}}$$e (82%-86%), and similar Vt/IC ratio (73%-77%). Dyspnea intensity at this inflection point was also similar across quartiles (3.1-3.7 Borg units) but accelerated steeply to intolerable levels thereafter.CONCLUSION: Progressive reduction of the resting IC with increasing disease severity was associated with the appearance of critical constraints on Vt expansion and a sharp increase in dyspnea to intolerable levels at a progressively lower ventilation during exercise.

DOI10.1378/chest.11-0787
Alternate JournalChest
PubMed ID21852298