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Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

Matteo Bonini, Giuseppe Fiorenzano
European Respiratory Review 2017 26: 160099; DOI: 10.1183/16000617.0099-2016
Matteo Bonini
1National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
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  • For correspondence: m.bonini@imperial.ac.uk
Giuseppe Fiorenzano
2Medicina Interna e Malattie dell’ Apparato Respiratorio, A.O.U. “S. Maria” di Terni, Terni, Italy
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  • FIGURE 1
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    FIGURE 1

    Idiopathic and non-idiopathic interstitial lung disease (ILD). IIP: idiopathic interstitial pneumonia; CTD: connective tissue disease; IPAF: interstitial pneumonia with autoimmune features; LIP: lymphocytic interstitial pneumonia; PPFE: pleuroparenchymal fibroelastosis; COP: cryptogenic organising pneumonia; AIP: acute interstitial pneumonitis; IPF: idiopathic pulmonary fibrosis; NSIP: nonspecific interstitial pneumonia; RB: respiratory bronchiolitis; DIP: desquamative interstitial pneumonia.

Tables

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  • TABLE 1

    Factors associated with increased risk of mortality in idiopathic pulmonary fibrosis

    At baselineLevel of dyspnoea
    DLCO <40% predicted
    Desaturation <88% during 6MWT
    Peak V′O2 <8.3 mL·kg−1·min−1 on CPET
    Extent of honeycombing on HRCT
    Pulmonary hypertension
    Longitudinal factorsIncrease in level of dyspnoea
    FVC <10% of absolute value
    DLCO <15% of absolute value
    Worsening of fibrosis on HRCT
    • Information from [9, 12]. DLCO: diffusion capacity of the lung for carbon monoxide; 6MWT: 6-min walk test; V′O2: oxygen uptake; CPET: cardiopulmonary exercise test; HRCT: high-resolution computed tomography; FVC: forced vital capacity.

  • TABLE 2

    Common cardiopulmonary exercise test features at peak exercise in interstitial lung disease (ILD) patients compared to healthy subjects

    Healthy subjectsILD patientsCause
    Peak V′O2 L·min−1≥85%<85%Hypoxia, ventilatory limitation, deconditioning
    Maximum work W≥85%<85%Hypoxia, ventilatory limitation, deconditioning
    Heart rate beats·min−1≥85%<85%Ventilator limitation to exercise, deconditioning
    Oxygen saturationPreservedReducedIncreased V/Q mismatch, diffusion limitation, shunt, reduced mixed venous oxygen concentration
    Respiratory frequency breaths·min−1<50>50Respiratory muscle elastic loading, stimulation of peripheral mechanoreceptors
    VT LIncreasedReducedReduced lung compliance
    V′E L·min−150–80% of MVV>90% of MVVVentilator limitation to exercise
    VD/VTReducedUnchanged or increasedIncreased V/Q mismatch, rapid, shallow breathing pattern
    V′E/V′CO2 slope25–35>35Increased V/Q mismatch
    Anaerobic threshold L·min−1>45% peak V′O2<45% peak V′O2Hypoxia, pulmonary hypertension
    • Data are presented as n, unless otherwise stated. V′O2: oxygen uptake; VT: tidal volume; V′E: minute ventilation; VD: dead space volume; V′CO2: carbon dioxide production; MVV: maximal voluntary ventilation; V/Q: ventilation/perfusion.

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Vol 26 Issue 143 Table of Contents
European Respiratory Review: 26 (143)
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Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing
Matteo Bonini, Giuseppe Fiorenzano
European Respiratory Review Mar 2017, 26 (143) 160099; DOI: 10.1183/16000617.0099-2016

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Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing
Matteo Bonini, Giuseppe Fiorenzano
European Respiratory Review Mar 2017, 26 (143) 160099; DOI: 10.1183/16000617.0099-2016
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  • Article
    • Abstract
    • Abstract
    • Introduction
    • Resting respiratory physiology in ILD
    • Exercise respiratory physiology in ILD
    • The role of cardiopulmonary exercise test in ILDs
    • Exercise training and pulmonary rehabilitation in ILD
    • Conclusions
    • Footnotes
    • References
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Subjects

  • Pulmonary vascular disease
  • Respiratory clinical practice
  • Lung structure and function
  • Interstitial and orphan lung disease
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