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Pressure Support Reduces Inspiratory Effort and Dyspnea during Exercise in Chronic Airflow Obstruction
Abstract
Exercise training has been of limited success in patients with severe chronic airflow obstruction (CAO), in part because of the reduced ventilatory capacity and excessive dyspnea experienced. Pressure support (PS) is a new form of mechanical ventilation which can effectively assist ventilation when applied noninvasively to patients in acute respiratory failure. It was hypothesized that PS might also be used to improve exercise performance, and ultimately physical conditioning, in ambulatory patients with CAO undergoing exercise training. To begin to address this concept, the objectives of the present study were (1) to examine the feasibility of providing PS to exercising patients with CAO and (2) to determine its effects on breathing pattern, inspiratory effort, and dyspnea. Flow and volume, mouth, esophageal, and gastric pressure were measured in seven patients with severe CAO (mean FEV1 = 0.75 +/- SEM 0.09 L) performing constant workload bicycle exercise (33 +/- 6 watts) during control conditions and with the application of PS (approximately 10 cm H2O). PS increased minute ventilation as a result of changes in both tidal volume and respiratory rate. This occurred despite marked reductions in inspiratory effort, as indicated by the pressure-time integrals of esophageal (68 +/- 5% control, p < 0.0005) and transdiaphragmatic pressure (52 +/- 8% control, p < 0.0005). Using a 5-point bidirectional scale to assess changes in dyspnea, breathlessness improved significantly with the addition of PS (2.3 +/- 0.6, p < 0.05) and worsened to a similar degree when it was removed (2.1 +/- 0.5, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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“The effects of these interventions on dyspnea are probably mostly related to unloading of the inspiratory muscles during exercise.155,157–160”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [159]
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Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D.-C., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201309-1634st · Cited by 3,938
Self-citationAmerican Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation
Nici, L., Donner, C., Wouters, E., Zuwallack, R., Ambrosino, N., Bourbeau, J., Carone, M., Celli, B., Engelen, M., Fahy, B., et al. (2006) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200508-1211st · Cited by 1,966
Self-citationDyspnea Mechanisms, Assessment and Management: A Consensus Statement
Editorial, A. (2005) · PULMONOLOGIYA · doi:10.18093/0869-0189-2005-0-2-9-36 · Cited by 859
ERS statement on respiratory muscle testing at rest and during exercise
Laveneziana, P., de Albuquerque, A. L. P., Aliverti, A., Babb, T. G., Barreiro, E., Dres, M., Dubé, B., Fauroux, B., Gea, J., Guenette, J. A., et al. (2019) · European Respiratory Journal · doi:10.1183/13993003.01214-2018 · Cited by 881
Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease
Troosters, T., Casaburi, R. H., Gosselink, R., & Decramer, M. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200408-1109so · Cited by 656
Metadata
- Authors
- Maltais, F., Reissmann, H., & Gottfried, S. B.
- Affiliations
- Montreal General Hospital (CA)
- ORCID
- Maltais, François
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1995-04-01
- Volume
- 151
- Issue
- 4
- Pages
- 1027-1033
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2059358834
- Cited by
- 132
- References
- 0
- Citations by year
- 2024: 2 · 2022: 1 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 5 · 2015: 9 · 2014: 8 · 2013: 6 · 2012: 5
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- pressure support ventilation, chronic airflow obstruction, exercise training, inspiratory effort, dyspnea, esophageal pressure, transdiaphragmatic pressure, minute ventilation, breathing pattern, exercise performance, non-invasive ventilation
- MeSH terms
- Adult, Aged, Dyspnea, Female, Humans, Lung Diseases, Obstructive, Male, Middle Aged, Respiration, Artificial, Respiratory Muscles, Exercise, Respiratory Mechanics
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