Sensory-mechanical relationships during high-intensity, constant-work-rate exercise in COPD
Abstract
During constant-work-rate exercise in chronic obstructive pulmonary disease, dyspnea increases steeply once inspiratory reserve volume (IRV) falls to a critical level that prevents further expansion of tidal volume (Vt). We studied the effects of this mechanical restriction on the quality and intensity of exertional dyspnea and examined the impact of an anticholinergic bronchodilator. In a randomized, double-blind, crossover study, 18 patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 s = 40 ± 3%predicted; mean ± SE) inhaled tiotropium 18 μg or placebo once daily for 7–10 days each. Pulmonary function tests and symptom-limited cycle exercise at 75% of each patient’s maximal work capacity were performed 2 h after dosing. Dyspnea intensity (Borg scale), operating lung volumes, breathing pattern, and esophageal pressure ( n = 11) were measured during exercise. Dynamic hyperinflation reached its maximal value early in exercise and was associated with only mild increases in dyspnea intensity and the effort-displacement ratio, which is defined as the ratio between tidal swings of esophageal pressure (expressed relative to maximum inspiratory pressure) and Vt (expressed relative to predicted vital capacity). After a minimal IRV of 0.5 ± 0.1 liter was reached, both dyspnea and the effort-displacement ratio rose steeply until an intolerable level was reached. Tiotropium did not alter dyspnea-IRV relationships, but the increase in resting and exercise inspiratory capacity was associated with an improved effort-displacement ratio throughout exercise. Once a critically low IRV was reached during exercise, dyspnea rose with the disparity between respiratory effort and the Vt response. Changes in dyspnea intensity after tiotropium were positively correlated with changes in this index of neuromechanical coupling.
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Interventions that deflate the lungs and delay the onset of critical VT constraints consistently reduce dyspnea intensity in patients with COPD during exercise.
“Moreover, interventions that deflate the lungs (ie, reduce EILV and EELV) and delay the onset of critical VT constraints consistently reduce dyspnea intensity in patients with COPD during exercise.45,46,55,56”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [56]
Pharmacological interventions that reduce operating lung volumes and delay the onset of ventilatory limitation consistently reduce the intensity of dyspnea during exercise in patients with COPD.
“Pharmacological interventions that reduce operating lung volumes and delay the onset of ventilatory limitation consistently reduce the intensity of dyspnea during exercise in patients with COPD.46,55,56”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [56]
Cites
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“Several recent mechanistic studies have provided evidence that mechanical factors, specifically acute dynamic lung hyperinflation, importantly influence respiratory discomfort during exercise (36, 37).”
BackgroundMethodResultInfluentialSelf-citationDistinguishable Types of Dyspnea in Patients with Shortness of Breath
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Effect of Lung Volume Reduction Surgery on Neuromechanical Coupling of the Diaphragm
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Parshall, M. B., Schwartzstein, R. M., Adams, L., Banzett, R. B., Manning, H. L., Bourbeau, J., Calverley, P. M., Gift, A. G., Harver, A., Lareau, S. C., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201111-2042st · Cited by 1,844 · see citing works
Self-citationPhysiology and consequences of lung hyperinflation in COPD
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Self-citationThe major limitation to exercise performance in COPD is dynamic hyperinflation
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Self-citationDyspnea and Activity Limitation in COPD: Mechanical Factors
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“Management and treatment of hyperinflation Bronchodilator therapy Pharmacological interventions that reduce operating lung volumes and delay the onset of ventilatory limitation consistently reduce the intensity of dyspnea during exercise in patients with COPD.(46,55,56) It should be noted, however, that the rates of i…”
Efficacy of a cell phone-based exercise programme for COPD
Liu, W.-T., Wang, C.-H., Lin, H.-C., Lin, S.-M., Lee, K.-Y., Lo, Y.-L., Hung, S.-H., Chang, Y.-M., Chung, K. F., & Kuo, H.-P. (2008) · European Respiratory Journal · doi:10.1183/09031936.00104407 · Cited by 176 · see citing works
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Self-citationEffect of obesity on respiratory mechanics during rest and exercise in COPD
Ora, J., Laveneziana, P., Wadell, K., Preston, M., Webb, K. A., & O'Donnell, D. E. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01131.2010 · Cited by 101 · see citing works
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Self-citation
- Authors
- O’Donnell, D. E., Hamilton, A. L., & Webb, K. A.
- Affiliations
- Queen's University (CA)
- Venue
- Journal of Applied Physiology
- Publisher
- American Physiological Society
- Published
- 2006-10
- Volume
- 101
- Issue
- 4
- Pages
- 1025-1035
- ISSN
- 0161-7567 (ISSN-L)
- 8750-7587
- 1522-1601
- OpenAlex
- W2145676647
- Cited by
- 242
- References
- 6
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 8 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 14 · 2019: 16 · 2018: 13 · 2017: 12 · 2016: 11 · 2015: 11 · 2014: 15 · 2013: 15 · 2012: 20
- FWCI
- 14.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Applied Physiology (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, inspiratory reserve volume, dynamic hyperinflation, tiotropium, anticholinergic bronchodilators, tidal volume, esophageal pressure, inspiratory capacity, constant work rate exercise, Borg scale
- MeSH terms
- Tiotropium Bromide, Administration, Inhalation, Bronchodilator Agents, Double-Blind Method, Dyspnea, Exercise Test, Physical Exertion, Female, Humans, Male, Middle Aged, Pulmonary Ventilation, Scopolamine Derivatives, Exercise, Respiratory Mechanics, Pulmonary Disease, Chronic Obstructive
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