RT Journal Article
SR Electronic
T1 Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing
JF European Respiratory Review
JO EUROPEAN RESPIRATORY REVIEW
FD European Respiratory Society
SP 333
OP 347
DO 10.1183/16000617.0054-2016
VO 25
IS 141
A1 Denis E. O'Donnell
A1 Amany F. Elbehairy
A1 Azmy Faisal
A1 Katherine A. Webb
A1 J. Alberto Neder
A1 Donald A. Mahler
YR 2016
UL http://err.ersjournals.com/content/25/141/333.abstract
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