Ventilatory constraints and dyspnea during exercise in chronic obstructive pulmonary disease
Abstract
Dyspnea (respiratory difficulty) and activity limitation are the primary symptoms of chronic obstructive pulmonary disease (COPD) and progress relentlessly as the disease advances, contributing to reduced quality of life. In COPD, the mechanisms of dyspnea are multifactorial, but abnormal dynamic ventilatory mechanics are believed to play a central role. In flow-limited patients with COPD, dynamic lung hyperinflation (DH) occurs during exercise and has serious sensory and mechanical consequences. In several studies, indices of DH strongly correlate with ratings of dyspnea intensity during exercise, and strategies that reduce resting hyperinflation (either pharmacological or surgical) consistently result in reduced exertional dyspnea. The mechanisms by which DH gives rise to exertional dyspnea and exercise intolerance are complex, but recent mechanistic studies suggest that DH-induced inspiratory muscle loading, restriction of tidal volume expansion during exercise, and consequent neuromechanical uncoupling of the respiratory system are key components. This review examines the specific derangements of ventilatory mechanics that occur in COPD during exercise and attempts to provide a mechanistic rationale for the attendant respiratory discomfort and activity limitation.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The ventilatory response during exercise of a healthy elderly subject could be similar to that of a patient with GOLD stage 1 COPD.
“Likewise, the ventilatory response during exercise of a healthy elderly subject could be similar to that of a patient with GOLD stage 1 COPD.53”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [53]
Cites
O'DONNELL, D. E., LAM, M., & WEBB, K. A. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.5.9804004 · Cited by 532 · see citing works
Self-citationBelman, M. J., Botnick, W. C., & Shin, J. W. (1996) · American journal of respiratory and critical care medicine · doi:10.1164/ajrccm.153.3.8630581 · Cited by 402 · see citing works
O'Donnell, D. E., Voduc, N., Fitzpatrick, M., & Webb, K. A. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00072703 · Cited by 365 · see citing works
Self-citationBreathlessness in humans activates insular cortex
Banzett, R. B., Mulnier, H. E., Murphy, K., Rosen, S. D., S. Wise, R. J., & Adams, L. (2000) · NeuroReport · doi:10.1097/00001756-200007140-00012 · Cited by 350 · see citing works
Where Does Sherrington's "Muscular Sense" Originate? Muscles, Joints, Corollary Discharges?
Matthews, P. B. C. (1982) · Annual Review of Neuroscience · doi:10.1146/annurev.ne.05.030182.001201 · Cited by 319 · see citing works
Diaz, O., Villafranca, C., Ghezzo, H., Borzone, G., Leiva, A., Milic-Emil, J., & Lisboa, C. (2000) · European Respiratory Journal · doi:10.1034/j.1399-3003.2000.16b14.x · Cited by 300 · see citing works
Regional chest wall volumes during exercise in chronic obstructive pulmonary disease
Aliverti, A. (2004) · Thorax · doi:10.1136/thorax.2003.011494 · Cited by 226 · see citing works
Diaphragm Activation during Exercise in Chronic Obstructive Pulmonary Disease
SINDERBY, C., SPAHIJA, J., BECK, J., KAMINSKI, D., YAN, S., COMTOIS, N., & SLIWINSKI, P. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.7.2007033 · Cited by 201 · see citing works
Effect of aging alone on mechanical properties of the normal adult human lung
Knudson, R. J., Clark, D. F., Kennedy, T. C., & Knudson, D. E. (1977) · Journal of Applied Physiology · doi:10.1152/jappl.1977.43.6.1054 · Cited by 197 · see citing works
Mechanical Constraints on Exercise Hyperpnea in a Fit Aging Population
Johnson, B. D., Reddan, W. G., Seow, K. C., & Dempsey, J. A. (1991) · American Review of Respiratory Disease · doi:10.1164/ajrccm/143.5_pt_1.968 · Cited by 150 · see citing works
Peters, M. M. (2006) · Thorax · doi:10.1136/thx.2005.053470 · Cited by 128 · see citing works
Effect of Lung Volume Reduction Surgery on Neuromechanical Coupling of the Diaphragm
LAGHI, F., JUBRAN, A., TOPELI, A., FAHEY, P. J., GARRITY, E. R., ARCIDI, J. M., de PINTO, D. J., EDWARDS, L. C., & TOBIN, M. J. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.157.2.9705082 · Cited by 108 · see citing works
Schwartzstein, R. M., Manning, H. L., Weiss, J. W., & Weinberger, S. E. (1990) · Lung · doi:10.1007/bf02719692 · Cited by 80 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE
Bolton, C. E., Bevan-Smith, E. F., Blakey, J. D., Crowe, P., Elkin, S. L., Garrod, R., Greening, N. J., Heslop, K., Hull, J. H., Man, W. D.-C., et al. (2013) · Thorax · doi:10.1136/thoraxjnl-2013-203808 · Cited by 717 · see citing works
“124 An intervention that reduced dyspnoea could therefore potentially permit greater exercise and increase the bene fi ts seen with pulmonary rehabilitation programmes.”
BackgroundEffects of inspiratory muscle training in COPD patients: A systematic review and meta‐analysis
Beaumont, M., Forget, P., Couturaud, F., & Reychler, G. (2018) · The Clinical Respiratory Journal · doi:10.1111/crj.12905 · Cited by 280 · see citing works
Pathogenesis of hyperinflation in chronic obstructive pulmonary disease
Saey, Gagnon, P., Guenette, J., Langer, D., Laviolette, L., Mainguy, V., Maltais, F., & Ribeiro, F. (2014) · International Journal of Chronic Obstructive Pulmonary Disease · doi:10.2147/copd.s38934 · Cited by 180 · see citing works
“healthy elderly subject could be similar to that of a patient with GOLD stage 1 COPD.(53)”
Chronic Obstructive Pulmonary Disease
O’Donnell, D. E., Laveneziana, P., Webb, K. A., & Neder, J. A. (2013) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2013.09.008 · Cited by 136 · see citing works
“Most patients with COPD experience dyspnea during daily activities.(117,124,167) As COPD progresses, dyspnea intensity ratings become progressively higher at any given V0E, power output, or metabolic load (Fig.”
BackgroundSelf-citationFactors Limiting Exercise Tolerance in Chronic Lung Diseases
Vogiatzis, I., & Zakynthinos, S. (2012) · Comprehensive Physiology · doi:10.1002/j.2040-4603.2012.tb00444.x · Cited by 102 · see citing works
“Therefore, expiratory pressure generation to the degree seen at exercise in COPD (155) may compromise venous return and biventricular preload that intensify the negative cardiovascular effects of dynamic hyperinflation (e.”
InfluentialCOPD symptoms in the morning: impact, evaluation and management
Roche, N., Chavannes, N., & Miravitlles, M. (2013) · Respiratory Research · doi:10.1186/1465-9921-14-112 · Cited by 95
“Breathlessness, which is a consequence of the characteristic lung hyperinflation seen in COPD [4], is one of the most frequently reported symptoms [3] and significantly limits exercise capacity [5].”
BackgroundMechanisms of Physical Activity Limitation in Chronic Lung Diseases
Vogiatzis, I., Zakynthinos, G. Ε., & Andrianopoulos, V. (2012) · Pulmonary Medicine · doi:10.1155/2012/634761 · Cited by 70 · see citing works
“This disparity leads to intense dyspnea sensation that is the symptom limiting physical activity in a large fraction of patients with chronic lung diseases [28, 29].”
BackgroundCalik-Kutukcu, E., Savcı, S., Sağlam, M., Vardar-Yagli, N., Inal-Ince, D., Arikan, H., Arıbaş, Z., Ozer, O., Bosnak-Guclu, M., & Coplu, L. (2014) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-14-6 · Cited by 56 · see citing works
“The limitations to exercise in COPD reflect the abnormalities of the respiratory, cardiovascular, neuromuscular and neurosensory systems in highly variable combinations with multifactorial interactions [5].”
BackgroundResponse of the respiratory muscles to rehabilitation in COPD.
Decramer, M. (2009) · Journal of applied physiology · doi:10.1152/japplphysiol.91459.2008 · Cited by 52 · see citing works
“, who studied 403 COPD patients recently enrolled in multinational clinical trials (37).”
BackgroundActivity limitation and exertional dyspnea in adult asthmatic patients: What do we know?
Vermeulen, F., Garcia, G., Ninane, V., & Laveneziana, P. (2016) · Respiratory Medicine · doi:10.1016/j.rmed.2016.06.003 · Cited by 50 · see citing works
Self-citationMorris, N. R., Hill, K., Walsh, J., & Sabapathy, S. (2020) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2020.08.007 · Cited by 35 · see citing works
Exercise therapy in the management of dyspnea in patients with cancer
Koelwyn, G. J., Jones, L. W., Hornsby, W., & Eves, N. D. (2012) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e32835391dc · Cited by 30 · see citing works
“Beyond mortality risk prediction in patients with respiratory disease, dyspnea is usually the most debilitating of all disease-related symptoms [27,28], and often leads to premature cessation of exercise and exercise avoidance.”
BackgroundLaveneziana, P., Guenette, J., Webb, K., & O'Donnell, D. (2012) · Expert Review of Respiratory Medicine · doi:10.1586/ers.12.70 · Cited by 27 · see citing works
Self-citationNeder, J. A., Berton, D. C., Marillier, M., Bernard, A., & O.Donnell, D. E. (2019) · Respiratory Medicine · doi:10.1016/j.rmed.2019.09.007 · Cited by 31 · see citing works
De l’interprétation de l’exploration fonctionnelle d’exercice (EFX) à la décision médicale
Aguilaniu, B., & Wallaert, B. (2013) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2013.05.002 · Cited by 20 · see citing works
The Role of Illness Perceptions in Dyspnoea-Related Fear in Chronic Obstructive Pulmonary Disease
Hill, K., Hug, S., Smith, A. J., & O’Sullivan, P. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm13010200 · Cited by 19 · see citing works
“Even changes in end-expiratory volume, which quantify dynamic pulmonary hyperinflation during exercise, explain approximately 50% of the variance in measures of exertional dyspnoea [12] and only 30% of the variance in activity restriction resulting from this symptom [13].”
Backgrounddo Amaral, A. F., Gallo, L., Vannucchi, H., Crescêncio, J. C., Vianna, É. O., & Martínez, J. A. B. (2012) · Clinics · doi:10.6061/clinics/2012(06)12 · Cited by 16 · see citing works
“This latter result is also compatible with the concept that progressive respiratory constraints are central limiting factors for maximal exercise capacity in COPD, and it highlights the importance of IC measurements in this setting (33-35).”
ResultRolland-Debord, C., Fry, S., Giovannelli, J., Langlois, C., Bricout, N., Aguilaniu, B., Bellocq, A., Rouzic, O. L., Dominique, S., Delobbe, A., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170035 · Cited by 12
“In chronic obstructive pulmonary disease, air trapping impacts exercise capacity by inducing dynamic hyperinflation [17, 18] leading to reduced inspiratory capacity and finally to an inability to increase VT [19].”
BackgroundComputerized Respiratory Sounds: Novel Outcomes for Pulmonary Rehabilitation in COPD
Jácome, C., & Marques, A. (2017) · Respiratory care · doi:10.4187/respcare.04987 · Cited by 11 · see citing works
Wibmer, T., Rüdiger, S., Kropf-Sanchen, C., Stoiber, K., Rottbauer, W., & Schumann, C. (2014) · Respiratory Care · doi:10.4187/respcare.03082 · Cited by 11 · see citing works
Kagawa, H., Miki, K., Kitada, S., Miki, M., Yoshimura, K., Oshitani, Y., Nishida, K., Sawa, N., Tsujino, K., & Maekura, R. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.01293 · Cited by 10 · see citing works
“the exercise-limiting factor in each case is fundamental for developing treatment strategies for COPD (Laveneziana et al., 2007; Cote et al., 2008; Watz et al., 2014).”
BackgroundAdaptation à l’altitude dans les maladies respiratoires
Wuyam, B., Baillieul, S., Doutreleau, S., & Vergès, S. (2022) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2021.11.004 · Cited by 7 · see citing works
The effect of abdominal bracing on respiration during a lifting task: a cross-sectional study
Sembera, M., Busch, A., Kobesova, A., Hanychova, B., Sulc, J., & Kolář, P. (2023) · BMC Sports Science, Medicine and Rehabilitation · doi:10.1186/s13102-023-00729-w · Cited by 6 · see citing works
Richter, M., Voswinkel, R., Tiede, H., Seeger, W., Schulz, R., Ghofrani, H., & Reichenberger, F. (2013) · Pneumologie · doi:10.1055/s-0033-1343148 · Cited by 6
“Bei allen COPD-Patienten zeigen unsere Daten die charakteristische DH mit Abnahme der IC bei funktionell reduzierter maxima-ler Leistung, hierbei lag die Δ IC vergleichbar bei dem aus mehreren Studien gemittelten Wert von – 20% [18].”
Kerwin, E., & Williams, J. D. (2013) · Therapeutic Advances in Respiratory Disease · doi:10.1177/1753465812470018 · Cited by 5 · see citing works
“Patients can be severely limited in the physical activities they are able to undertake, and this contributes to their impaired health-related quality of life [Laveneziana et al. 2007].”
BackgroundFrisk, B., Sundør, I. E., Dønåsen, M. R., Refvem, O., & Borge, C. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-053503 · Cited by 4 · see citing works
Exertional inspiratory capacity and operating lung volumes in health: a population-based study
Stubbe, B., Müller, P. T., Obst, A., Kaczmarek, S., Mick, R., Neder, J., & Ewert, R. (2025) · ERJ Open Research · doi:10.1183/23120541.00741-2024 · Cited by 3
Rodríguez, I., & Zenteno, D. (2021) · Neumología Pediátrica · doi:10.51451/np.v9i1.388 · Cited by 3 · see citing works
Rodríguez, I., & Zenteno, D. (2021) · Neumología Pediátrica · doi:10.51451/np.v9i1.391 · Cited by 1
Inspiratory muscle training for chronic obstructive pulmonary disease
Blakey, J., Hodgson, D., & Bolton, C. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009428.pub2 · Cited by 1 · see citing works
Vignati, C., Agostoni, P., & Pezzuto, B. (2026) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd13100526
Canena, M. V., & Zhang, L.-J. (2023) · Revista Foco · doi:10.54751/revistafoco.v16n6-114
“As the disease progresses, dyspnea and decreased exercise tolerance are the main incapacitating factors contributing to a decrease in the quality of life of these patients (O’DONNELL & LAVENEZIANA, 2007; LAVENEZIANA, et al., 2007).”
BackgroundThe Effects of Chronic Obstructive Pulmonary Disease
Cissik, J. M. (2013) · Strength and conditioning journal · doi:10.1519/ssc.0b013e31829776b3
“Patients with COPD have a slowed increase in pulmonary oxygen uptake, which when combined with their impaired central and peripheral cardiovascular adjustments to the demands of exercise creates a mismatch between utilization and delivery of oxygen, further limiting performance (6,18,19).”
BackgroundAssessment of Exercise Capacity
Vogiatzis, I., Palange, P., & Laveneziana, P. (2017) · Springer eBooks · doi:10.1007/978-3-319-65888-9_5
Self-citationThe muscle metaboreflex during exercise in chronic obstructive pulmonary disease
Sherman, M. F. B. (2010) · cIRcle (University of British Columbia) · doi:10.14288/1.0069213
- Authors
- Laveneziana, P., Parker, C. M., & O’Donnell, D. E.
- Affiliations
- Queen's University (CA)
- Venue
- Applied Physiology, Nutrition, and Metabolism
- Publisher
- Canadian Science Publishing
- Published
- 2007-12
- Volume
- 32
- Issue
- 6
- Pages
- 1225-1238
- ISSN
- 1715-5312 (ISSN-L)
- 1715-5320
- OpenAlex
- W2153976222
- Cited by
- 39
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 3 · 2014: 4 · 2013: 6 · 2012: 7
- FWCI
- 0.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Applied Physiology Nutrition and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- chronic obstructive pulmonary disease, exertional dyspnea, respiratory mechanics, exercise intolerance, activity limitation, lung volume reduction surgery
- MeSH terms
- Affect, Aged, Biomechanical Phenomena, Dyspnea, Exercise Therapy, Humans, Respiratory Muscles, Exercise, Respiratory Mechanics, Exercise Tolerance, Pulmonary Disease, Chronic Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
