PT - JOURNAL ARTICLE AU - Denis E. O'Donnell AU - Amany F. Elbehairy AU - Azmy Faisal AU - Katherine A. Webb AU - J. Alberto Neder AU - Donald A. Mahler TI - Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing AID - 10.1183/16000617.0054-2016 DP - 2016 Sep 01 TA - European Respiratory Review PG - 333--347 VI - 25 IP - 141 4099 - http://err.ersjournals.com/content/25/141/333.short 4100 - http://err.ersjournals.com/content/25/141/333.full SO - EUROPEAN RESPIRATORY REVIEW2016 Sep 01; 25 AB - Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET.Measurement of symptom intensity, ventilatory control and mechanics during exercise exposes mechanisms of dyspnoea http://ow.ly/6OXQ3020tEA