Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease (original) (raw)
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Respiratory care, 2018
The primary objective of this study was to investigate whether noninvasive ventilation (NIV) can positively affect exercise capacity, maximum oxygen uptake ( ), and symptoms after a 6-week physical training program for subjects with moderate to very severe COPD. 47 subjects with COPD who were enrolled in a physical training program were randomized to either physical training alone or NIV + physical training (NIV-Physical training). Physical training consisted of dynamic aerobic exercises on a treadmill 3 times/week for 6 weeks, for a total of 18 sessions. NIV was titrated according to the subject's tolerance at rest and during exercise. Assessments included physiological responses and symptoms at the incremental cardiopulmonary exercise test peak and during submaximal exercise on a treadmill, 6-min walk distance, maximum inspiratory (P) and expiratory pressure (P), BODE index, and health-related quality of life. 43 subjects completed the 6-week physical training program. Both gr...
Physiological and clinical relevance of exercise ventilatory efficiency in COPD
The European respiratory journal, 2017
Exercise ventilation (V'E) relative to carbon dioxide output (V'CO2 ) is particularly relevant to patients limited by the respiratory system, e.g. those with chronic obstructive pulmonary disease (COPD). High V'E-V'CO2 (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV1). Establishing an association between high V'E-V'CO2 and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV1 impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase V'E-V'CO2 In fact, a high V'E-V'CO2 has been found to be a powerful predictor of poor outcome in lung resection su...
Ventilatory Inefficiency as a Limiting Factor for Exercise in Patients With COPD
Respiratory Care, 2012
BACKGROUND: Ventilatory inefficiency increases ventilatory demand; corresponds to an abnormal increase in the ratio of minute ventilation (V E) to CO 2 production (V CO 2); represents increased dead space, deregulation of respiratory control, and early lactic threshold; and is associated with expiratory flow limitation that enhances dynamic hyperinflation and may limit exercise capacity. OBJECTIVE: To evaluate the influence of ventilatory inefficiency over exercise capacity in COPD patients. METHODS: Prospective study of 35 COPD subjects with different levels of severity, in whom cardiopulmonary stress test was performed. Ventilatory inefficiency was represented by the V E /V CO 2 relation. Its influence over maximal oxygen consumption (V O 2 max), power (W), and ventilatory threshold was evaluated. Surrogate parameters of cardiac function, like oxygen pulse (V O 2 /heart rate) and circulatory power (%V O 2 max ؋ peak systolic pressure), were also evaluated. RESULTS: Cardiopulmonary stress test was stopped due to dyspnea with elevated V E and marked reduction of breathing reserve. A severe increase in V E /V CO 2 (mean ؎ SD 35.9 ؎ 5.6), a decrease of V O 2 max (mean ؎ SD 75.2 ؎ 20%), and a decrease of W (mean ؎ SD 68.6 ؎ 23.3%) were demonstrated. Twenty-eight patients presented dynamic hyperinflation. Linear regression showed a reduction of 2.04% on V O 2 max (P < .001), 2.6% on W (P < .001), 1% on V O 2 /heart rate (P ؍ .049), and 322.7 units on circulatory power (P ؍ .02) per each unit of increment in V E /V CO 2 , respectively. CONCLUSIONS: Ventilatory inefficiency correlates with a reduction in exercise capacity in COPD patients. Including this parameter in the evaluation of exercise limitation in this patient population may mean a contribution toward the understanding of its pathophysiology.
Respiratory Medicine, 2006
Dyspnoea measurements in chronic obstructive pulmonary disease (COPD) can be broadly divided into two categories: those that assess breathlessness during exercise, and those that assess breathlessness during daily activities. We investigated the relationships between dyspnoea at the end of exercise and during daily activities with clinical measurements and mortality in COPD patients. We examined 143 male outpatients with moderate to very severe COPD. The peak Borg score at the end of progressive cycle ergometry was used for the assessment of peak dyspnoea rating during exercise, and the Baseline Dyspnea Index (BDI) score was used for dyspnoea with activities of daily living. Relationships between these dyspnoea ratings with other clinical measurements of pulmonary function, exercise indices, health status and psychological status were then investigated. In addition, their relationship with the 5-year mortality of COPD patients was also analyzed to examine their predictive ability. Although the BDI score was significantly correlated with airflow limitation, diffusing capacity, exercise indices, health status and psychological status, the Borg score at the end of exercise had non-existent or only weak correlations with them. The BDI score was strongly significantly correlated with mortality, whereas the Borg score was not.
Exercise ventilatory inefficiency in mild to end-stage COPD
The European respiratory journal, 2014
Ventilatory inefficiency during exercise is a key pathophysiological feature of chronic obstructive pulmonary disease. Currently, it is unknown how this physiological marker relates to clinically relevant outcomes as resting ventilatory impairment progresses across disease stages. Slope and intercept of the linear region of the ventilation-carbon dioxide output relationship and the ratio between these variables, at the lowest point (nadir), were contrasted in 316 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-4 (forced expiratory volume in 1 s, ranging from 148% pred to 12% pred) and 69 aged- and gender-matched controls, Compared to controls, slope and intercept were higher in GOLD stages 1 and 2, leading to higher nadirs (p<0.05). Despite even larger intercepts in GOLD stages 3 and 4, slopes diminished as disease evolved (from mean±sd 35±6 in GOLD stage 1 to 24±5 in GOLD stage 3, p<0.05). As a result, there were no significant differences...
Adjuncts to Physical Training of Patients With Severe COPD: Oxygen or Noninvasive Ventilation?
Respiratory Care, 2010
BACKGROUND: Previous studies have shown positive effects from noninvasive ventilation (NIV) or supplemental oxygen on exercise capacity in patients with COPD. However, the best adjunct for promoting physiologic adaptations to physical training in patients with severe COPD remains to be investigated. METHODS: Twenty-eight patients (mean ؎ SD age 68 ؎ 7 y) with stable COPD (FEV 1 34 ؎ 9% of predicted) undergoing an exercise training program were randomized to either NIV (n ؍ 14) or supplemental oxygen (n ؍ 14) during group training to maintain peripheral oxygen saturation (S pO 2) > 90%. Physical training consisted of treadmill walking (at 70% of maximal speed) 3 times a week, for 6 weeks. Patients were assessed at baseline and after 6 weeks. Assessments included physiological adaptations during incremental exercise testing (ratio of lactate concentration to walk speed, oxygen uptake [V O 2 ], and dyspnea), exercise tolerance during 6-min walk test, leg fatigue, maximum inspiratory pressure, and health-related quality of life. RESULTS: Two patients in each group dropped out due to COPD exacerbations and lack of exercise program adherence, and 24 completed the training program. Both groups improved 6-min walk distance, symptoms, and health-related quality of life. However, there were significant differences between the NIV and supplemental-oxygen groups in lactate/speed ratio (33% vs ؊4%), maximum inspiratory pressure (80% vs 23%), 6-min walk distance (122 m vs 47 m), and leg fatigue (25% vs 11%). In addition, changes in S pO 2 /speed, V O 2 , and dyspnea were greater with NIV than with supplemental-oxygen. CONCLUSIONS: NIV alone is better than supplemental oxygen alone in promoting beneficial physiologic adaptations to physical exercise in patients with severe COPD.
International Journal of Chronic Obstructive Pulmonary Disease, 2016
Introduction: Intensity of exercise is believed to be a key determinant of response to chronic obstructive pulmonary disease (COPD) rehabilitation. We hypothesized that a higher intensity of exercise, in combination with physiotherapist-led instructions and education in management of breathlessness, would lead to better self-management, possibly delaying calls to the emergency service and preventing hospitalization. Objective: We aimed to test this hypothesis in a subsequent randomized trial, and in order to test study processes and estimate hospitalization rates, we did a small preliminary prospective cohort study on severe COPD patients referred to outpatient rehabilitation. Methods: In 2013, four rehabilitation courses were scheduled (spring, summer, autumn, and winter) each lasting 8 weeks and including eight to ten patients. This preliminary study was designed as a controlled cohort study. The biweekly exercise sessions in the spring and autumn courses included a high-intensity walking exercise at 95% of estimated VO 2 max for as long as possible. The other two rehabilitation courses included the usual walking exercise intensity (85% of estimated VO 2 max). Hospitalization rates were assessed from the participants' medical records in an 18-month period. Results: We were able to enroll 31 patients in total (15 in the high-intensity exercise group and 16 in regular intensity). There were no group differences in the hospitalization rates. However, during review of the medical records, we observed a striking mortality rate among participants who had attended the high-intensity rehabilitation courses (five deaths) compared to the standard rehabilitation (zero deaths). Four of the five deaths were COPD exacerbations. Fisher's exact test was statistically significant (P=0.046), as was a log-rank test (P=0.019) of the Kaplan-Meier estimated survival rates. Conclusion: These results from this small preliminary cohort study are alarming and raise concerns about the possible serious risks associated with high-intensity exercise rehabilitation of severe COPD patients.
Effect of portable non-invasive ventilation on exercise tolerance in COPD: One size does not fit all
Respiratory Physiology & Neurobiology, 2020
Highlights • The study provides proof of concept on how to select COPD patients likely to respond to portable NIV (pNIV) during intermittent exercise. • One third of patients (8/24) did not improve dynamic hyperinflation (DH nonresponders) with the application of pNIV compared to pursed lip breathing (PLB). • DH non-responders exhibited greater resting hyperinflation and tend towards worse spirometric measures compared to responders.
International Journal of Chronic Obstructive Pulmonary Disease, 2015
Introduction: The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies. Methods: This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group). Results: A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient-24.48; 95% CI-48.74 to-0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI-3.79 to 57.66, P=0.085). Conclusion: The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving home NIMV treatment on long-term depends on etiological diagnoses.