Exertional Breathlessness in Patients with Chronic Airflow Limitation: The Role of Lung Hyperinflation
Abstract
There is considerable intersubject variability in the perceived intensity of breathlessness for a given level of activity among patients with chronic airflow limitation (CAL). To examine possible factors contributing to this variability we compared breathing pattern parameters, dynamic operational lung volumes, and Borg dyspnea ratings in 23 patients with severe CAL and in 10 healthy age-matched normal subjects during cycle ergometry to symptom-limitation. Patients with CAL had significantly (p < 0.01) higher levels of ventilation (% maximal voluntary ventilation) for a given work rate (slope of e(%MVV)/WR(% pred max) = 1.51 ± 0.18 versus 0.63 ± 0.10; mean ± SEM) and greater dynamic lung hyperinflation (DH) (change [Δ] in end-expiratory lung volume [EELVdyn] = +0.31 ± 0.11 L versus −0.16 ± 0.22 L). Compared with normal subjects at a standardized e (30 L/min), the CAL group was more breathless (Borg = 4 ± 1 versus 2 ± 1, p < 0.01) and hyperinflated (EELVdyn = 75 ± 3 versus 46 ± 6 %TLC, p < 0.001; end-inspiratory lung volume [EILVdyn] = 85 ± 3 versus 67 ± 5 %TLC, p < 0.01). Within the CAL group, change in Borg ratings correlated with Δ e(%MVV) (r = 0.77, p < 0.001) and with slope of e(%MVV)/WR(% pred max) (r = 0.48, p < 0.01). Regression analysis selected ΔEILVdyn (or Δ inspiratory reserve volume [ΔIRVdyn]) from various dynamic ventilatory parameters as the strongest predictor of Δ Borg (r = 0.63, p < 0.001). Components of ΔEILVdyn (i.e., ΔEELVdyn, ΔVt) each contributed significantly (p < 0.001) to breathlessness and with A breathing frequency accounted for 61% of the variance in ΔBorg (r = 0.78, f = 38.20, p < 0.001). Accounting for ventilation, EELVdyn continued to contribute significantly to breathlessness; at a standardized e (30 L/min), EELVdyn predicted 31% of the variance in Borg ratings (p < 0.01). Exertional breathlessness in CAL is a function of ventilatory demand and intensifies with encroachment on the inspiratory reserve volume or ventilatory reserve. Acute DH, with its attendant intrinsic mechanical loading, contributes importantly to intersubject variability in the perception of breathlessness for a given ventilation.
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In severe COPD, EELV and VT combined with breathing frequency accounted for 61% of the variance in dyspnea intensity.
“In this study, EELV and VT (both components of EILV) combined with breathing frequency accounted for 61% of the variance in dyspnea intensity.”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [54]
In severe COPD, the change in EILV from baseline was the strongest predictor of the change in Borg dyspnea ratings (r=0.63, P<0.001).
“O’Donnell and Webb54 evaluated 23 patients with severe COPD and found that the change in EILV from baseline was the strongest predictor of the change in Borg dyspnea ratings (r=0.63, P<0.001).”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [54]
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Self-citation
- Authors
- O'Donnell, D. E., & Webb, K. A.
- Affiliations
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Queen's University (CA)
- ORCID
- Webb, Katherine A.
- Venue
- American Review of Respiratory Disease
- Publisher
- Oxford University Press (OUP)
- Published
- 1993-11-01
- Volume
- 148
- Issue
- 5
- Pages
- 1351-1357
- ISSN
- 0003-0805 (ISSN-L)
- OpenAlex
- W2001019019
- Cited by
- 543
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 7 · 2022: 12 · 2021: 10 · 2020: 11 · 2019: 11 · 2018: 11 · 2017: 11 · 2016: 13 · 2015: 19 · 2014: 11 · 2013: 14 · 2012: 30
- FWCI
- 6.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Review of Respiratory Disease (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 › Physiology › Asthma and respiratory diseases
- Keywords
- exertional dyspnea, chronic airflow obstruction, lung hyperinflation, dynamic hyperinflation, end-inspiratory lung volume, end-expiratory lung volume, inspiratory reserve volume, Borg dyspnea scale, maximal voluntary ventilation, breathing pattern, respiratory rate, inspiratory effort, cycle ergometry, chronic obstructive pulmonary disease, asthma, asthma-COPD overlap
- MeSH terms
- Aged, Chronic Disease, Dyspnea, Exercise Test, Female, Humans, Inspiratory Capacity, Inspiratory Reserve Volume, Lung, Male, Total Lung Capacity
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