The DOI matches its Crossref record; 43 of the 44 references it cites were found in a registry or an index; none of the 26 sources its claims cite is checked for support yet.
Mechanisms of exertional dyspnoea in symptomatic smokers without COPD
Open accessAbstract
Dyspnoea and activity limitation can occur in smokers who do not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) but the underlying mechanisms are unknown. Detailed pulmonary function tests and sensory–mechanical relationships during incremental exercise with respiratory pressure measurements and diaphragmatic electromyography (EMG di ) were compared in 20 smokers without spirometric COPD and 20 age-matched healthy controls. Smokers (mean± sd post-bronchodilator forced expiratory volume in 1 s (FEV 1 )/forced vital capacity 75±4%, mean± sd FEV 1 104±14% predicted) had greater activity-related dyspnoea, poorer health status and lower physical activity than controls. Smokers had peripheral airway dysfunction: higher phase-III nitrogen slopes (3.8±1.8 versus 2.6±1.1%·L −1 ) and airway resistance (difference between airway resistance measured at 5 Hz and 20 Hz 19±11 versus 12±7% at 5 Hz) than controls (p<0.05). Smokers had significantly (p<0.05) lower peak oxygen uptake (78±40 versus 107±45% predicted) and ventilation (61±26 versus 97±29 L·min −1 ). Exercise ventilatory requirements, operating lung volumes and cardio-circulatory responses were similar. However, submaximal dyspnoea ratings, resistive and total work of breathing were increased in smokers compared with controls (p<0.05); diaphragmatic effort (transdiaphragmatic pressure/maximumal transdiaphragmatic pressure) and fractional inspiratory neural drive to the diaphragm (EMG di /maximal EMG di ) were also increased (p<0.05) mainly reflecting the reduced denominator. Symptomatic smokers at risk for COPD had greater exertional dyspnoea and lower exercise tolerance compared with healthy controls in association with greater airways resistance, contractile diaphragmatic effort and fractional inspiratory neural drive to the diaphragm.
Overview
CoChat Summary
TL;DR
Symptomatic smokers without spirometric COPD had greater exertional dyspnoea and lower exercise tolerance than age-matched healthy controls, despite similar ventilatory requirements and operating lung volumes. The findings link their dyspnoea to peripheral airway dysfunction, greater resistive work of breathing, higher diaphragmatic effort, and increased fractional inspiratory neural drive to the diaphragm.
Key findings
- Smokers (n=20) had post-bronchodilator FEV1/FVC 75±4% and FEV1 104±14% predicted, with greater activity-related dyspnoea, poorer health status, and lower physical activity than controls; they also showed peripheral airway dysfunction, including higher phase-III nitrogen slope (3.8±1.8 versus 2.6±1.1%·L⁻¹) and higher R5–20 (19±11 versus 12±7% at 5 Hz) (p<0.05).
- At peak exercise, smokers had lower peak oxygen uptake (78±40 versus 107±45% predicted) and ventilation (61±26 versus 97±29 L·min⁻¹), while ventilatory requirements, operating lung volumes, and cardio-circulatory responses were similar; at 80 W, dyspnoea was 1.9 Borg units higher, and dyspnoea–ventilation slopes were greater (0.108±0.05 versus 0.067±0.04 Borg units·L⁻¹·min⁻¹, p=0.008).
- Submaximal resistive and total work of breathing were increased in smokers, as were Pdi/Pdi,max and EMGdi/EMGdi,max, mainly reflecting a reduced denominator; EMGdi,max during the highest inspiratory capacity was lower in smokers (113±65 versus 165±56 µV, p=0.028).
- Dyspnoea intensity correlated with EMGdi/EMGdi,max (partial R²=0.67, p<0.0005) and inspiratory Pdi/Pdi,max (partial R²=0.61, p<0.0005), with similar relationships across groups.
Methods
- Cross-sectional study of 20 symptomatic current or ex-smokers without spirometric COPD (post-bronchodilator FEV1 >80% predicted, FEV1/FVC >0.7 and above lower limit of normal; age ≥40 years; ≥20 pack-years) and 20 age-matched healthy non-smoking controls.
- Participants completed questionnaires, pre- and post-bronchodilator pulmonary function tests, small airway tests (single-breath nitrogen washout and impulse oscillometry), and incremental cycle cardiopulmonary exercise testing with respiratory pressure measurements and diaphragmatic electromyography (EMGdi); 14 subjects per group accepted the EMGdi/pressure catheter.
- Between-group comparisons used unpaired t-tests at rest, iso-work rates, and peak exercise; multivariable linear regression evaluated dyspnoea intensity against EMGdi/EMGdi,max and inspiratory Pdi/Pdi,max, with group, interaction, and subject random effects.
Limitations
- Stated: not all subjects consented to EMGdi and respiratory pressure measurements because of invasiveness, though the n=14 subgroup was sufficient to detect differences; results cannot be generalised to asymptomatic smokers; EMGdi measured only the crural diaphragm, so ribcage and accessory muscle activity could not be assessed.
- Stated in discussion: the skeletal muscle deconditioning hypothesis for greater leg discomfort was not formally tested.
- Evident from the text: the cross-sectional design cannot establish causality, and the modest sample size (20 per group; 14 per group for EMGdi) limits broader generalisability.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
0 Valid · 0 Not valid · 17 Not checked · 86 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fractional inspiratory neural drive to the diaphragm was increased both at rest and during exercise in smokers compared with controls (figure 3).”
§ Mechanisms of exertional dyspnoea in symptomatic smokers without COPD > Discussion
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no significant differences in resting pulmonary function and IOS measurements between active and ex-smokers (all p>0.05).”
§ Mechanisms of exertional dyspnoea in symptomatic smokers without COPD > Pulmonary function and small airway function
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Poes-derived indices of global inspiratory muscle effort (inspiratory Poes/Pi,max) and expiratory muscle activity (expiratory rise in Pga) were not significantly different between groups (figure 3, figures E1 and E3).”
§ Mechanisms of exertional dyspnoea in symptomatic smokers without COPD > Exercise responses, respiratory mechanics and diaphragmatic function
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, submaximal dyspnoea ratings, resistive and total work of breathing were increased in smokers compared with controls ( p<0.05); diaphragmatic effort (transdiaphragmatic pressure/ maximumal transdiaphragmatic pressure) and fractional inspiratory neural drive to the diaphragm (EMGdi/maximal EMGdi) were also”
- Also stated in: § Exercise responses, respiratory mechanics and diaphragmatic function · plain
“Inspiratory Pdi was similar for a given work rate and V′E, while inspiratory Pdi/Pdi,max was greater in smokers at rest and during exercise due to reduced Pdi,max (figure 3, figure E3).”
§ Mechanisms of exertional dyspnoea in symptomatic smokers without COPD > Abstract
plainstates an associationn = 20- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Exercise responses, respiratory mechanics and diaphragmatic function · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“EMGdi,max during the highest inspiratory capacity was lower in smokers versus controls (113±65 versus 165±56 µV, p=0.028).”
§ Mechanisms of exertional dyspnoea in symptomatic smokers without COPD > Exercise responses, respiratory mechanics and diaphragmatic function
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
73 more claims
Create a free account to see all 103 claims and to verify the 25 references still open.
- It may state two separate claims as one. 13
- Probably not a substantial claim. 13
Citations
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742
Psychophysical bases of perceived exertion
BORG, G. A. V. (1982) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198205000-00012 · Cited by 16,580
Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., Barnes, P. J., Fabbri, L. M., Martinez, F. J., Nishimura, M., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201204-0596pp · Cited by 15,983
Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Crapo, R., Enright, P., van der Grinten, C. P. M., Gustafsson, P., et al. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00034805 · Cited by 15,627
Global Initiative for Chronic Obstructive Lung Disease
Gerald, L. B., & Bailey, W. C. (2002) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200207000-00004 · Cited by 5,806
Development and first validation of the COPD Assessment Test
Jones, P., Harding, G., Berry, P., Wiklund, I. E., Chen, W.-H., & Leidy, N. K. (2009) · European Respiratory Journal · doi:10.1183/09031936.00102509 · Cited by 3,225
Jones, P. W., Quirk, F. H., Baveystock, C. M., & Littlejohns, P. (1992) · American Review of Respiratory Disease · doi:10.1164/ajrccm/145.6.1321 · Cited by 3,035
ATS/ACCP statement on cardiopulmonary exercise testing
(2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.167.2.211 · Cited by 3,026
ATS/ERS Statement on Respiratory Muscle Testing
(2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.166.4.518 · Cited by 2,991
Standardisation of the measurement of lung volumes
Wanger, J., Clausen, J. L., Coates, A., Pedersen, O. F., Brusasco, V., Burgos, F., Casaburi, R., Crapo, R., Enright, P., van der Grinten, C. P. M., et al. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00035005 · Cited by 2,768
Research works printed but not linked: 1
- Brooks, 1982, Surveillance for respiratory hazards in the occupational setting, Am Rev Respir Dis, 126, 952
Cited by
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 896
Self-citationDyspnea in COPD: New Mechanistic Insights and Management Implications
O’Donnell, D. E., Milne, K. M., James, M. D., de-Torres, J. P., & Neder, J. A. (2019) · Advances in Therapy · doi:10.1007/s12325-019-01128-9 · Cited by 298
Self-citationInspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD
Langer, D., Ciavaglia, C. E., Faisal, A., Webb, K. A., Neder, J. A., Gosselink, R., Dacha, S., Topalovic, M., Ivanova, A., & O’Donnell, D. E. (2018) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01078.2017 · Cited by 227
Self-citationHanania, N. A., & O’Donnell, D. E. (2019) · International Journal of COPD · doi:10.2147/copd.s188141 · Cited by 159
Self-citationPhysiological and clinical relevance of exercise ventilatory efficiency in COPD
Neder, J. A., Berton, D. C., Arbex, F. F., Alencar, M. C. N., Rocha, A., Sperandio, P. A., Palange, P., & O’Donnell, D. E. (2017) · European Respiratory Journal · doi:10.1183/13993003.02036-2016 · Cited by 107
Self-citationAdvances in the Evaluation of Respiratory Pathophysiology during Exercise in Chronic Lung Diseases
O’Donnell, D. E., Elbehairy, A. F., Berton, D. C., Domnik, N. J., & Neder, J. A. (2017) · Frontiers in Physiology · doi:10.3389/fphys.2017.00082 · Cited by 105
Self-citationExertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing
O’Donnell, D. E., Elbehairy, A. F., Faisal, A., Webb, K. A., Neder, J. A., & Mahler, D. A. (2016) · European Respiratory Review · doi:10.1183/16000617.0054-2016 · Cited by 103
Self-citationRossi, A., Petanjek, B. B., Chilosi, M., Cosío, B. G., Fležar, M., Koulouris, N. G., Marín, J. M., Miculinić, N., Polese, G., Samaržija, M., et al. (2017) · International Journal of COPD · doi:10.2147/copd.s132236 · Cited by 70
The Pathophysiology of Dyspnea and Exercise Intolerance in Chronic Obstructive Pulmonary Disease
O’Donnell, D. E., James, M. D., Milne, K. M., & Neder, J. A. (2019) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2019.02.007 · Cited by 68
Self-citationAsthma and smoking-induced airway disease without spirometric COPD
Thomson, N. C. (2017) · European Respiratory Journal · doi:10.1183/13993003.02061-2016 · Cited by 64
Ventilatory Inefficiency and Exertional Dyspnea in Early Chronic Obstructive Pulmonary Disease
Neder, J. A., Berton, D. C., Müller, P. D. T., Elbehairy, A. F., Rocha, A., Palange, P., & O’Donnell, D. E. (2017) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201612-1033fr · Cited by 57
Self-citationJames, M. D., Phillips, D. B., Vincent, S. G., Abdallah, S. J., Donovan, A. A., de-Torres, J. P., Neder, J. A., Smith, B. M., Jensen, D., & O’Donnell, D. E. (2022) · The Journal of Physiology · doi:10.1113/jp283252 · Cited by 49
Self-citationLung volume indices predict morbidity in smokers with preserved spirometry
Zeng, S., Tham, A., Bos, B., Jin, J., Giang, B., & Arjomandi, M. (2018) · Thorax · doi:10.1136/thoraxjnl-2018-211881 · Cited by 44
Ribeiro, C. O., Faria, Á. C. D., Lopes, A. J., & de Melo, P. L. (2018) · International Journal of COPD · doi:10.2147/copd.s173686 · Cited by 44
Elbehairy, A. F., Faisal, A., Guenette, J. A., Jensen, D., Webb, K. A., Ahmed, R., Neder, J. A., O’Donnell, D. E., & on behalf of Canadian Respiratory Research Network (CRRN) (2017) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2017.1281901 · Cited by 44
Self-citationIncreased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction
Walsted, E. S., Faisal, A., Jolley, C. J., Swanton, L. L., Pavitt, M. J., Luo, Y., Backer, V., Polkey, M. I., & Hull, J. H. (2017) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00691.2017 · Cited by 43
Self-citationExercise Training Reverses Extrapulmonary Impairments in Smoke-exposed Mice
Bowen, T. S., Aakerøy, L., Eisenkolb, S., KUNTH, P., Bækkerud, F. H., Wohlwend, M., Berre, A. M. O., FISCHER, T., Wisløff, U., Schuler, G., et al. (2016) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001195 · Cited by 37
Phillips, D. B., James, M. D., Vincent, S. G., Elbehairy, A. F., Neder, J. A., Kirby, M., Ora, J., Day, A. G., Tan, W. C., Bourbeau, J., et al. (2024) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202307-1184oc · Cited by 36
Self-citationD’Ascanio, M., Viccaro, F., Calabrò, N., Guerrieri, G., Salvucci, C., Pizzirusso, D., Mancini, R., Vitis, C. D., Pezzuto, A., & Rícci, A. (2020) · International Journal of COPD · doi:10.2147/copd.s264261 · Cited by 36
Evaluation of Dynamic Respiratory Mechanical Abnormalities During Conventional CPET
Milne, K. M., Domnik, N. J., Phillips, D. B., James, M. D., Vincent, S. G., Neder, J. A., & O’Donnell, D. E. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00548 · Cited by 34
Self-citationThe Integrative Physiology of Exercise Training in Patients with COPD
Neder, J. A., Marillier, M., Bernard, A., James, M. D., Milne, K. M., & O’Donnell, D. E. (2019) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2019.1606189 · Cited by 34
Self-citationMolgat‐Seon, Y., Ramsook, A. H., Peters, C. M., Schaeffer, M. R., Dominelli, P. B., Romer, L. M., ROAD, J. D., Guenette, J. A., & Sheel, A. W. (2018) · The Journal of Physiology · doi:10.1113/jp277476 · Cited by 32
Self-citationLung Function Testing in Chronic Obstructive Pulmonary Disease
Neder, J. A., de-Torres, J. P., Milne, K. M., & O’Donnell, D. E. (2020) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2020.06.004 · Cited by 29
Self-citationRibeiro, C. O., Lopes, A. J., & de Melo, P. L. (2020) · International Journal of COPD · doi:10.2147/copd.s276690 · Cited by 27
Domnik, N. J., Walsted, E. S., & Langer, D. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00483 · Cited by 23
Pulmonary Vascular Volume by Quantitative CT in Dyspneic Smokers with Minor Emphysema
Elbehairy, A. F., Vincent, S. G., Phillips, D. B., James, M. D., Veugen, J., Párraga, G., O’Donnell, D. E., & Neder, J. A. (2023) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2023.2169121 · Cited by 22
Self-citationDyspnea and Exercise Limitation in Mild COPD: The Value of CPET
James, M. D., Milne, K. M., Phillips, D. B., Neder, J. A., & O’Donnell, D. E. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00442 · Cited by 22
Self-citationMechanisms of Exertional Dyspnea in Patients with Mild COPD and a Low Resting DLCO
James, M. D., Phillips, D. B., Elbehairy, A. F., Milne, K. M., Vincent, S. G., Domnik, N. J., de-Torres, J. P., Neder, J. A., & O’Donnell, D. E. (2021) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2021.1932782 · Cited by 21
Self-citationMechanisms of orthopnoea in patients with advanced COPD
Elbehairy, A. F., Faisal, A., McIsaac, H., Domnik, N. J., Milne, K. M., James, M. D., Neder, J. A., & O’Donnell, D. E. (2020) · European Respiratory Journal · doi:10.1183/13993003.00754-2020 · Cited by 21
Self-citationMild chronic obstructive pulmonary disease: why spirometry is not sufficient!
Elbehairy, A. F., Párraga, G., Webb, K. A., Neder, J. A., & O’Donnell, D. E. (2017) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2017.1334553 · Cited by 20
Self-citationSin, D. D. (2023) · Tuberculosis & respiratory diseases · doi:10.4046/trd.2023.0005 · Cited by 19
Neder, J. A., Berton, D. C., Phillips, D. B., & O’Donnell, D. E. (2021) · European Respiratory Review · doi:10.1183/16000617.0190-2020 · Cited by 18
Self-citationImpaired exercise ventilatory efficiency in smokers with low transfer factor but normal spirometry
Barbosa, G., Neder, J. A., Utida, K. A. M., O’Donnell, D. E., & Müller, P. D. T. (2017) · European Respiratory Journal · doi:10.1183/13993003.02511-2016 · Cited by 18
Self-citationSadaka, A. S., Faisal, A., Khalil, Y. M., Mourad, S., Zidan, M. H., Polkey, M. I., & Hopkinson, N. S. (2021) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00762.2020 · Cited by 17
Self-citationSymptomatic smokers without COPD have physiological changes heralding the development of COPD
Bazzan, E., Semenzato, U., Turato, G., Biondini, D., Cubero, P., Marín‐Oto, M., Forner, M., Tinè, M., Casara, A., Baraldo, S., et al. (2022) · ERJ Open Research · doi:10.1183/23120541.00202-2022 · Cited by 17
Exertional dyspnea and operating lung volumes in asthma
Moore, L. E., Brotto, A. R., Phillips, D. B., Bhutani, M., & Stickland, M. K. (2018) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00216.2018 · Cited by 17
A comparison of methods used to quantify the work of breathing during exercise
Cross, T. J., Gideon, E. A., Morris, S. J., Coriell, C. L., Hubbard, C. D., & Duke, J. W. (2021) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00411.2021 · Cited by 16
Arjomandi, M., Zeng, S., Geerts, J., Stiner, R. K., Bos, B., van Koeverden, I. D., Keene, J., Elicker, B. M., Blanc, P. D., & Gold, W. M. (2018) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2018-000284 · Cited by 16
Syed, N., Ryu, M. H., Dhillon, S. S., Schaeffer, M. R., Ramsook, A. H., Leung, J. M., Ryerson, C. J., Carlsten, C., Guenette, J. A., Aaron, S. D., et al. (2021) · CHEST Journal · doi:10.1016/j.chest.2021.10.020 · Cited by 16
Self-citationMüller, P. D. T., Barbosa, G., O’Donnell, D. E., & Neder, J. A. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00859 · Cited by 15
Self-citationSensory-mechanical effects of a dual bronchodilator and its anticholinergic component in COPD
O’Donnell, D. E., Elbehairy, A. F., Faisal, A., Neder, J. A., & Webb, K. A. (2017) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2017.10.001 · Cited by 15
Self-citationPérez‐Padilla, R., Wehrmeister, F. C., de, M. M., López, M. V., Jardim, J. R., Muiño, A., Valdivia, G. G., & Menezes, A. M. B. (2018) · International Journal of COPD · doi:10.2147/copd.s175527 · Cited by 15
Marco, F. D., Terraneo, S., Job, S., Rinaldo, R. F., Papa, G. F. S., Roggi, M. A., Santus, P., & Centanni, S. (2017) · Respiratory Medicine · doi:10.1016/j.rmed.2017.04.006 · Cited by 14
Pre-chronic obstructive pulmonary disease: a pathophysiologic process or an opinion term?
Mkorombindo, T., & Dransfield, M. T. (2021) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000854 · Cited by 14
Introduction: CPET in clinical practice. Recent advances, current challenges and future directions
Neder, J. A., Laveneziana, P., Ward, S. A., & Palange, P. (2018) · European Respiratory Society eBooks · doi:10.1183/2312508x.10015318 · Cited by 14
Self-citationMüller, A., Wouters, E. F. �., Burney, P., Potts, J., Cardoso, J., Ghobain, M. A., Studnicka, M., Obaseki, D., Elsony, A., Mortimer, K. J., et al. (2025) · Pulmonology · doi:10.1080/25310429.2025.2470566 · Cited by 12
Beyond Spirometry: Linking Wasted Ventilation to Exertional Dyspnea in the Initial Stages of COPD
Neder, J. A., Santyr, G. E., Zanette, B., Kirby, M., Pourafkari, M., James, M. D., Vincent, S. G., Ferguson, C., Wang, C.-Y., Domnik, N. J., et al. (2024) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2023.2301549 · Cited by 12
Self-citationHan, D., Wang, X., Sun, X., Cao, Y., Li, C., Guo, W., Hu, Y., Hang, J., Li, J., Xie, Q., et al. (2024) · International Journal of Surgery · doi:10.1097/js9.0000000000001856 · Cited by 12
Wang, S., Liang, H.-W., Lu, G., Jiang, Z., Zhang, B., Deng, Q., Sun, Q., Lin, Z., Chen, Q., Yang, C., et al. (2021) · Annals of Translational Medicine · doi:10.21037/atm-21-3408 · Cited by 12
Neurophysiological mechanisms of exertional dyspnea in post-pulmonary embolism syndrome
Milne, K. M., James, M. D., Smyth, R. M., Vincent, S. G., Singh, N., D’Arsigny, C. L., de-Torres, J. P., de Wit, K., Johri, A. M., Neder, J. A., et al. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00677.2022 · Cited by 10
Self-citationNishimura, K., Oga, T., Nakayasu, K., Ogasawara, M., Hasegawa, Y., & Mitsuma, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-025132 · Cited by 10
Exercise testing in the evaluation of pharmacotherapy in COPD
O’Donnell, D. E., Elbehairy, A. F., Berton, D. C., Domnik, N. J., Webb, K. A., & Neder, J. A. (2018) · European Respiratory Society eBooks · doi:10.1183/2312508x.10012017 · Cited by 10
Self-citationPatterns of cardiopulmonary response to exercise in COPD
O’Donnell, D. E., Elbehairy, A. F., Domnik, N. J., Vincent, S. G., Guenette, J. A., Webb, K. A., & Neder, J. A. (2018) · European Respiratory Society eBooks · doi:10.1183/2312508x.10011317 · Cited by 9
Self-citationPeng, X., Huang, M., Zhao, W., Yuan, Y., Li, B., Ye, Y., Liang, J., Zhu, S., Liu, L., Cai, S., et al. (2018) · Europe PMC (PubMed Central) · doi:10.12122/j.issn.1673-4254.2018.12.08 · Cited by 9
Borrelli, M., Doria, C., Toninelli, N., Longo, S., Coratella, G., Cè, E., Rampichini, S., & Esposito, F. (2024) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003602 · Cited by 8
Isolated Small Airway Dysfunction and Ventilatory Response to Cardiopulmonary Exercise Testing
Holley, A. B., Mabe, D. L., Hunninghake, J., Collen, J. F., Walter, R. J., Sherner, J. H., Huprikar, N., & Morris, M. J. (2020) · Respiratory Care · doi:10.4187/respcare.07424 · Cited by 8
Abdallah, S. J., Smith, B. M., Wilkinson-Maitland, C. A., Li, P. Z., Bourbeau, J., & Jensen, D. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.01618 · Cited by 8
Self-citationChronic Bronchitis Affects Outcomes in Smokers without Chronic Obstructive Pulmonary Disease (COPD)
Casara, A., Turato, G., Marín‐Oto, M., Semenzato, U., Biondini, D., Tinè, M., Bernardinello, N., Cocconcelli, E., Cubero, P., Balestro, E., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11164886 · Cited by 7
Impaired exercise capacity in individuals with non-obstructive small airway dysfunction
Deng, Z., Li, X., Li, C., Zheng, Y., Wu, F., Wang, Z., Liu, S., Tian, H., Zheng, J., Peng, J., et al. (2023) · Journal of Thoracic Disease · doi:10.21037/jtd-22-1328 · Cited by 7
McMahon, M. J., Holley, A. B., Warren, W. A., Collen, J. F., Sherner, J. H., Zeman, J. E., & Morris, M. J. (2021) · CHEST Journal · doi:10.1016/j.chest.2021.03.057 · Cited by 7
Juneau, D., Leblond, A., Chatta, R., Lévesque, V., Lussier, A., & Dubé, B. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1417463 · Cited by 6
Topcuoğlu, C., Yümin, E. T., Sağlam, M., Çankaya, T., Konuk, S., Özsarı, E., & Göksülük, M. B. (2024) · Respiratory Care · doi:10.4187/respcare.11790 · Cited by 6
Hijleh, A., Berton, D. C., O’Donnell, D. E., & Neder, J. A. (2026) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01051.2025 · Cited by 5
Self-citationPigakis, K., Stavrou, V. T., Kontopodi, A., Pantazopoulos, I. N., Daniil, Z. D., & Gourgoulianis, K. I. (2024) · Sports · doi:10.3390/sports12040112 · Cited by 5
Keane, R., & Brennan, V. (2025) · Breathe · doi:10.1183/20734735.0096-2024 · Cited by 5
Exposing Pre–Chronic Obstructive Pulmonary Disease: When Physiology Matters!
Neder, J. A., de-Torres, J. P., & O’Donnell, D. E. (2021) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202102-0474le · Cited by 5
Self-citationNagumo, D., Hamazaki, N., Kamiya, K., Miki, T., Kobayashi, S., Nozaki, K., Ichikawa, T., Yamashita, M., Uchida, S., Noda, T., et al. (2024) · Cardiology · doi:10.1159/000542856 · Cited by 4
GPs should not try to detect mild COPD
Enright, P., & Fragoso, C. A. V. (2020) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-020-0176-0 · Cited by 4
What is the origin of dyspnoea in smokers without airway disease?
Clini, E. M., Beghé, B., & Fabbri, L. M. (2016) · European Respiratory Journal · doi:10.1183/13993003.01170-2016 · Cited by 4
Phillips, D. B., James, M. D., Vincent, S. G., Smyth, R. M., Chau, B., Darko, C. A., Milne, K. M., Collins, S. É., D’Arsigny, C. L., de-Torres, J. P., et al. (2026) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00916.2025 · Cited by 3
Self-citationA Brief History of COPD: As Told by Some of Its Senior Scientists and Clinicians
Nici, L. L., Celli, B. R., Mannino, D. M., Rennard, S., Agusti, A. A., Lareau, S. C., Meek, P., O'Donnell, D. E., Neder, J. A., Wedzicha, J. A., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15103914 · Cited by 3
Self-citationMild airways obstruction: spirometric diagnostic pitfalls and solutions
Alotaibi, N. M., Eddy, R. L., & Sin, D. D. (2023) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000001023 · Cited by 3
Monica, M., Suwarno, M. L., & Hidayah, A. J. (2021) · JURNAL MUTIARA NERS · doi:10.51544/jmn.v4i1.1336 · Cited by 3
Identifying bronchoconstriction from the ratio of diaphragm EMG to tidal volume
He, B., Luo, Y., Wang, L.-S., Chen, Y.-Y., Jolley, C. J., Steier, J. S., Moxham, J., Polkey, M. I., & Luo, Y. (2021) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2021.103692 · Cited by 3
Thomson, N. C. (2018) · Respirology · doi:10.1111/resp.13246 · Cited by 3
Wasted ventilation in mild COPD: protocol for a clinical physiology and functional imaging study
James, M. D., Voskrebenzev, A., Klimeš, F., Zanette, B., Alosta, K. A., Hijleh, A., Vincent, S. G., Domnik, N. J., Phillips, D. B., Pourafkari, M., et al. (2025) · ERJ Open Research · doi:10.1183/23120541.00686-2024 · Cited by 2
Self-citationBorrelli, M., Motalli, A., Doria, C., Toninelli, N., Longo, S., Coratella, G., Cè, E., Rampichini, S., & Esposito, F. (2026) · European Journal of Applied Physiology · doi:10.1007/s00421-026-06150-8 · Cited by 2
Faisal, A., Giles, A., Jones, S., Morse, C. I., Degens, H., Jolley, C. J., Rogers, S. K., Ahmed, R., Elbehairy, A. F., & Junejo, R. T. (2026) · ERJ Open Research · doi:10.1183/23120541.00425-2026 · Cited by 2
Self-citationIdentification of exercise‐regulated genes in mice exposed to cigarette smoke
Aakerøy, L., Cheng, C. W., Sustova, P., Scrimgeour, N. R., Wahl, S. G. F., Steinshamn, S., Bowen, T. S., & Brønstad, E. (2022) · Physiological Reports · doi:10.14814/phy2.15505 · Cited by 2
Rose, D. K., Brunetti, G., Cavka, K., Hoisington, J. B., Snyder, H., Wei, X., & Smith, B. K. (2024) · JMIR Research Protocols · doi:10.2196/59749 · Cited by 2
Exercise in Chronic Obstructive Pulmonary Disease
Laveneziana, P., & Palange, P. (2019) · Springer eBooks · doi:10.1007/978-3-030-05258-4_5 · Cited by 1
Elbehairy, A. F., Naish, J. H., Baghertash, H., Parker, G. J. M., Miller, C., Vestbo, J., & Horsley, A. R. (2025) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2024-002784 · Cited by 1
Self-citationElbehairy, A. F., Faisal, A., McIsaac, H., James, M. D., Domnik, N. J., Neder, J. A., & O’Donnell, D. E. (2026) · European Respiratory Journal · doi:10.1183/13993003.01348-2025 · Cited by 1
Self-citationLessons from the North: CanCOLD, Exercise, and Chronic Obstructive Pulmonary Disease
Calverley, P. M. A. (2022) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202203-0579ed · Cited by 1
Candemir, İ. Ç., Ergün, P., & Vitacca, M. (2023) · Springer eBooks · doi:10.1007/978-3-031-22483-6_87-1 · Cited by 1
Trujillo, M. T., Gil-Torres, P., Torres-González, J., Arboleda, A. C., & Celis-Preciado, C. A. (2018) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201711-2256rr
Kahraman, B. Ö., Tanrıverdi, A., Özsoy, İ., Acar, S., Sevinç, C., Özpelit, E., Akdeniz, B., & Savcı, S. (2020) · Journal of Basic and Clinical Health Sciences · doi:10.30621/jbachs.2020.1247
The Lancet COPD Commission: broader questions remain
Guenette, J. A., Milne, K. M., & O’Donnell, D. E. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00555-x
Self-citationRay, A. D., Carl, E. M., Hyland, A. J., Reid, M. E., Mahoney, M. C., & Sheffer, C. E. (2025) · Tobacco Induced Diseases · doi:10.18332/tid/196755
Alosta, K. A., James, M. D., Vincent, S. G., Smyth, R. M., Hijleh, A., Back, G. D., Porcella, A., Domnik, N. J., O’Donnell, D. E., & Neder, J. A. (2025) · ERJ Open Research · doi:10.1183/23120541.01323-2024
Self-citationImpaired Ventilatory Efficiency as a Novel Indicator of Pre-COPD
Deng, Z., Wu, F., Wan, Q., Tang, G., Zhou, K., Wu, X., Dai, C., Lu, L., Peng, J., Huang, S., et al. (2025) · CHEST Pulmonary · doi:10.1016/j.chpulm.2025.100218
Avaliação, reabilitação e sobrevida na doença pulmonar obstrutiva cronica
Rodrigues, A. L. L. (2019) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas)
Willms, A. J. (2018) · eScholarship@McGill (McGill) · doi:10.82308/40193
Hashimoto, M., Yoshida, H., & Tabuchi, T. (2026) · Respirology · doi:10.1002/resp.70256
Mechanisms of dyspnoea and exercise intolerance in smokers with preserved ratio impaired spirometry
Scussel, A., Rodrigues, N. G., Santos, A. Z., Trombin, L. C. D. B., Pinto, A. C., Wagner, L. E., Knorst, M. M., Dean, J. P., Singh, D., & Berton, D. C. (2026) · European Journal of Applied Physiology · doi:10.1007/s00421-026-06244-3
Ventilatory efficiency: Physiological modelling and mechanistic validation
Müller, P. D. T., Stubbe, B., Ittermann, T., Ferreira, E., Neder, J. A., & Ewert, R. (2026) · The Journal of Physiology · doi:10.1113/jp290456
Self-citationLago, P. D., Berton, D. C., Hijleh, A., Cardoso, J. V., James, M. D., Smyth, R. M., Coyle, M., de Vincent, S., Elbehairy, A. F., Domnik, N. J., et al. (2026) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2026.104632
Self-citationJames, M. D., Vincent, S. G., Elbehairy, A. F., PHILLIPS, D. B., Neder, J. A., Dhillon, S. S., Ryerson, C. J., Tan, W., Guenette, J. A., Stickland, M. K., et al. (2026) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2026.2705831
Self-citationBorrelli, M., Motalli, A., Toninelli, N., Longo, S., Coratella, G., Cè, E., Limonta, E., Rampichini, S., & Esposito, F. (2026) · European Journal of Sport Science · doi:10.1002/ejsc.70238
Metadata
- Authors
- 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.
- Affiliations
- Queen's University (CA)
- University of British Columbia (CA)
- McGill University (CA)
- ORCID
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2016-08-04
- Volume
- 48
- Issue
- 3
- Pages
- 694-705
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2484791473
- Semantic Scholar
- 79fcd24a2c301bce450f06ef2a1b6735bee48618
- Cited by
- 99
- References
- 44
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 9 · 2023: 7 · 2022: 5 · 2021: 11 · 2020: 10 · 2019: 9 · 2018: 15 · 2017: 11 · 2016: 3
- FWCI
- 8.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Thoracic Society
- Canadian Institutes of Health Research
- William Spear/Richard Start Endowment Fund, Queen's University, Canada
- Canadian Lung Association (CLA)/Canadian Thoracic Society
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Keywords
- exertional dyspnea, smokers, COPD risk, airway resistance, work of breathing, diaphragm electromyography, exercise tolerance, peak oxygen uptake, health status
- MeSH terms
- Adult, Aged, Inhalation, Cross-Sectional Studies, Diaphragm, Dyspnea, Electromyography, Exercise Test, Female, Forced Expiratory Volume, Humans, Lung, Male, Middle Aged, Oxygen, Phenotype, Respiration, Respiratory Function Tests, Risk, Smoking, Spirometry, Vital Capacity, Body Mass Index, Multivariate Analysis, 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.
A language model drew the claims from the paper on 2026-11-13, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-13 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
