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Mechanisms of exercise intolerance in Global Initiative for Chronic Obstructive Lung Disease grade 1 COPD
Abstract
The purpose of this study was to determine if a dissociation existed between respiratory drive, as estimated by diaphragmatic electromyography (EMG di ), and its pressure-generating capacity during exercise in mild chronic obstructive pulmonary disease (COPD) and whether this, if present, had negative sensory consequences. Subjects meeting spirometric criteria for mild COPD (n=16) and age and sex-matched controls (n=16) underwent detailed pulmonary function testing and a symptom limited cycle test while detailed ventilatory, sensory and respiratory mechanical responses were measured. Compared with controls, subjects with mild COPD had greater ventilatory requirements throughout submaximal exercise. At the highest equivalent work rate of 60 W, they had a significantly higher: total work of breathing (32±17 versus 16±7 J·min −1 ; p<0.01); EMG di (37.3±17.3 versus 17.9±11.7% of maximum; p<0.001); and EMG di to transdiaphragmatic pressure ratio (0.87±0.38 versus 0.52±0.27; p<0.01). Dyspnoea–ventilation slopes were significantly higher in mild COPD than controls (0.17±0.12 versus 0.10±0.05; p<0.05). However, absolute dyspnoea ratings reached significant levels only at high levels of ventilation. Increased respiratory effort and work of breathing, and a wider dissociation between diaphragmatic activation and pressure-generating capacity were found at standardised work rates in subjects with mild COPD compared with controls. Despite these mechanical and neuromuscular abnormalities, significant dyspnoea was only experienced at higher work rates.
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“Previous studies in GOLD 1 COPD have also shown that perceived leg discomfort is often the main sensory locus of exercise limitation although the underlying mechanisms are not fully understood [12,13,35,41].”
From Mechanisms of exertional dyspnoea in symptomatic smokers without COPD (2016) · cites this paper as [13]
In the citing paper
“dyspnoea intensity during exercise in health and in pulmonary diseases generally correlates well with physiological ratios that fundamentally reflect demand/capacity imbalance (e.g.VʹE/maximum ventilatory capacity, Poes/Poes,max, tidal volume/inspiratory capacity, EMGdi/EMGdi,max) [13,28,33,37,38].”
From Mechanisms of exertional dyspnoea in symptomatic smokers without COPD (2016) · cites this paper as [13]
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“Based on our previous experience in mild COPD patients [13], we estimated that sample sizes between 12 and 16 would be large enough to detect significant between-group differences in EMGdi and respiratory pressure measurements.”
From Mechanisms of exertional dyspnoea in symptomatic smokers without COPD (2016) · cites this paper as [13]
In the citing paper
“Such strategies might include increased neural drive to the inspiratory muscles to maintain ventilation appropriate to metabolic demand when the respiratory system is stressed [13].”
From Mechanisms of exertional dyspnoea in symptomatic smokers without COPD (2016) · cites this paper as [13]
In the citing paper
“Dyspnea intensity is more closely correlated with the reduction in IRV during exercise than the change in EELV (i.e., DH) per se [62].”
From Lung hyperinflation in COPD: applying physiology to clinical practice (2015) · cites this paper as [62]
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Cites
Distinguishable Types of Dyspnea in Patients with Shortness of Breath
Simon, P. M., Schwartzstein, R. M., Weiss, J. W., Fencl, V., Teghtsoonian, M., & Weinberger, S. E. (1990) · American Review of Respiratory Disease · doi:10.1164/ajrccm/142.5.1009 · Cited by 433
Ofir, D., Laveneziana, P., Webb, K. A., Lam, Y.-M., & O'Donnell, D. E. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200707-1064oc · Cited by 358
Self-citationInspiratory Capacity during Exercise: Measurement, Analysis, and Interpretation
Guenette, J. A., Chin, R. C., Cory, J. M., Webb, K. A., & O'Donnell, D. E. (2013) · Pulmonary Medicine · doi:10.1155/2013/956081 · Cited by 203
Self-citationDiaphragm 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
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Cited by
Mechanisms of exertional dyspnoea in symptomatic smokers without COPD
Elbehairy, A. F., Guenette, J. A., Faisal, A., Ciavaglia, C. E., Webb, K. A., Jensen, D., Ramsook, A. H., Neder, J. A., & O'Donnell, D. E. (2016) · European Respiratory Journal · doi:10.1183/13993003.00077-2016 · Cited by 99
Self-citationLung hyperinflation in COPD: applying physiology to clinical practice
O’Donnell, D. E., Webb, K. A., & Neder, J. A. (2015) · COPD Research and Practice · doi:10.1186/s40749-015-0008-8 · Cited by 93
Self-citation
Metadata
- Authors
- Guenette, J. A., Chin, R. C., Cheng, S., Dominelli, P. B., Raghavan, N., Webb, K. A., Neder, J. A., & O’Donnell, D. E.
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2014-08-19
- Volume
- 44
- Issue
- 5
- Pages
- 1177-1187
- ISSN
- 0903-1936
- 1399-3003
- Cited by
- 124
- References
- 4
- Language
- en
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- Guenette, J. A., Chin, R. C., Cheng, S., Dominelli, P. B., Raghavan, N., Webb, K. A., Neder, J. A., & O’Donnell, D. E. (2014). Mechanisms of exercise intolerance in Global Initiative for Chronic Obstructive Lung Disease grade 1 COPD. European Respiratory Journal. https://doi.org/10.1183/09031936.00034714
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