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Dynamic Ventilatory Reserve During Incremental Exercise: Reference Values and Clinical Validation in Chronic Obstructive Pulmonary Disease.
Berton, Danilo C; Plachi, Franciele; James, Matthew D; Vincent, Sandra G; Smyth, Reginald M; Domnik, Nicolle J; Phillips, Devin B; de-Torres, Juan P; Nery, Luiz E; O'Donnell, Denis E; Neder, J Alberto.
Afiliação
  • Berton DC; Unidade de Fisiologia Pulmonar, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
  • Plachi F; Unidade de Fisiologia Pulmonar, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
  • James MD; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
  • Vincent SG; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
  • Smyth RM; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
  • Domnik NJ; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
  • Phillips DB; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
  • de-Torres JP; School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada; and.
  • Nery LE; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
  • O'Donnell DE; Setor de Função Pulmonar e Fisiologia Clinica do Exercício, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
  • Neder JA; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
Ann Am Thorac Soc ; 20(10): 1425-1434, 2023 10.
Article em En | MEDLINE | ID: mdl-37413694
ABSTRACT
Rationale Ventilatory demand-capacity imbalance, as inferred based on a low ventilatory reserve, is currently assessed only at peak cardiopulmonary exercise testing (CPET). Peak ventilatory reserve, however, is poorly sensitive to the submaximal, dynamic mechanical ventilatory abnormalities that are key to dyspnea genesis and exercise intolerance.

Objectives:

After establishing sex- and age-corrected norms for dynamic ventilatory reserve at progressively higher work rates, we compared peak and dynamic ventilatory reserve for their ability to expose increased exertional dyspnea and poor exercise tolerance in mild to very severe chronic obstructive pulmonary disease (COPD).

Methods:

We analyzed resting functional and incremental CPET data from 275 controls (130 men, aged 19-85 yr) and 359 Global Initiative for Chronic Obstructive Lung Disease patients with stage 1-4 obstruction (203 men) who were prospectively recruited for previous ethically approved studies in three research centers. In addition to peak and dynamic ventilatory reserve (1 - [ventilation / estimated maximal voluntary ventilation] × 100), operating lung volumes and dyspnea scores (0-10 on the Borg scale) were obtained.

Results:

Dynamic ventilatory reserve was asymmetrically distributed in controls; thus, we calculated its centile distribution at every 20 W. The lower limit of normal (lower than the fifth centile) was consistently lower in women and older subjects. Peak and dynamic ventilatory reserve disagreed significantly in indicating an abnormally low test result in patients whereas approximately 50% of those with a normal peak ventilatory reserve showed a reduced dynamic ventilatory reserve, the opposite was found in approximately 15% (P < 0.001). Irrespective of peak ventilatory reserve and COPD severity, patients who had a dynamic ventilatory reserve below the lower limit of normal at an isowork rate of 40 W had greater ventilatory requirements, prompting earlier attainment of critically low inspiratory reserve. Consequently, they reported higher dyspnea scores, showing poorer exercise tolerance compared with those with preserved dynamic ventilatory reserve. Conversely, patients with preserved dynamic ventilatory reserve but reduced peak ventilatory reserve reported the lowest dyspnea scores, showing the best exercise tolerance.

Conclusions:

Reduced submaximal dynamic ventilatory reserve, even in the setting of preserved peak ventilatory reserve, is a powerful predictor of exertional dyspnea and exercise intolerance in COPD. This new parameter of ventilatory demand-capacity mismatch may enhance the yield of clinical CPET in the investigation of activity-related breathlessness in individual patients with COPD and other prevalent cardiopulmonary diseases.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica Tipo de estudo: Prognostic_studies Aspecto: Ethics / Patient_preference Limite: Female / Humans / Male Idioma: En Revista: Ann Am Thorac Soc Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica Tipo de estudo: Prognostic_studies Aspecto: Ethics / Patient_preference Limite: Female / Humans / Male Idioma: En Revista: Ann Am Thorac Soc Ano de publicação: 2023 Tipo de documento: Article