Frontiers reviewMechanism of augmented exercise hyperpnea in chronic heart failure and dead space loading
Section snippets
Whipp's law on ventilatory compensation for changes in physiological
Despite more than a century of extensive and intensive research and continuing passionate debates, the mechanisms underlying the control of exercise hyperpnea in health and in disease remain far from clear. It is well established that in healthy subjects undergoing incremental exercise, the ventilatory response (in terms of total pulmonary ventilation, ) increases with metabolic CO2 production (metabolic CO2 flow to the lungs, ) according to a linear relationship over a wide
Exercise hyperpnea relationship in CHF
According to Whipp's law, the regulation of (Fig. 1a) through the interplay between physiological and (Figs. 1b, c) accounts for the small positive Y-intercept in the linear relationship in healthy subjects (Fig. 1d). By the same token, one would expect that under conditions where physiological is increased (making less efficient with respect to alveolar ventilation) the controller would also “know” that “needs” to increase more per unit to
Exercise hyperpnea relationship in dead space loading
In CHF, apparent metabolic CO2 load is augmented primarily by increases in parallel (alveolar) and secondarily by increases in series (anatomical) (see footnote 4). In both healthy subjects and CHF patients, series can be exaggerated by dead space loading (tube breathing). The resultant augmentation in relative to explains the increase in slope that is typical during dead space loading (Poon, 1992b, Poon, 2008, Ward and Whipp, 1980, Wood et al., 2011) (
Influence of within-breath oscillations on respiratory chemosensing
A fundamental premise of Eq. (9) is that the controller's perception of or (real or virtual) and under varying disturbances of the chemical plant (CO2 breathing or changes in series or parallel at rest and during exercise) is influenced by putative dynamic chemoreceptor signaling mediated by within-breath oscillations instead of (or in addition to) breath-to-breath fluctuations of the mean level. To test this hypothesis, we next apply Eq. (9) to three
Concluding remarks
The general framework of respiratory chemosensing presented above rectifies several deep-rooted misconceptions and ill-conceived dogmas and taboos in the field that have long impeded understanding of ventilatory control mechanisms in health and in disease. First, we have shown that the control of at rest and during exercise is determined not only by the total to be eliminated but also by the total that impairs pulmonary CO2 elimination. The resultant is coupled to the
Acknowledgments
We thank Drs. S.A. Ward, K. Wasserman and the late Dr. N.S. Cherniack for generous advice and encouragement and Drs. P.G. Agostoni, M. Amann, T.G. Babb, A.J. Coats, J.A. Dempsey, J. Duffin, B.D. Johnson, M.J.Joyner, H.R. Middlekauff, C.F. Notarius, D.J. Paterson, R. Pellegrino, M.F. Piepoli, H.T. Robertson, N.H. Secher, G.D. Swanson, J.W. Severinghaus, G. Song, D.S. Ward, J.B. West, and C.B. Wolff for valuable comments on the final manuscript. C. Tin was supported by an American Heart
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Cited by (23)
Simulation of mechanical resistive loading on an optimal respiratory control model with added dead space and CO<inf>2</inf> breathing
2017, Applied Mathematical ModellingCitation Excerpt :Patients with chronic heart failure (CHF) also found to suffer increased alveolar dead-space-to-tidal-volume ratio, but they demonstrate increased pulmonary ventilation such that arterial PCO2 remains normal from rest to moderate exercise. The ventilatory effects of dead space loading are therefore similar to those of increased alveolar VD/VT and CO2 breathing combined [50]. Future studies could also investigate the relative behavior of respiratory signals and the comparative relationship of ventilatory responses between dead space loading and unloading during rest, CO2 inhalation, and eucapnic and hypercapnic exercise [51-55]; such research would provide a further understanding of the increases in the central respiratory motor command output of human respiratory control, which is also associated with dyspnea (respiratory discomfort) upon exertion.
Type III-IV muscle afferents are not required for steady-state exercise hyperpnea in healthy subjects and patients with COPD or heart failure
2015, Respiratory Physiology and NeurobiologyReply to Dr. S.A. Ward: Whipp's law, Comroe's law and generality of the optimization model of ventilatory control
2015, Respiratory Physiology and NeurobiologySubmissive hypercapnia: Why COPD patients are more prone to CO<inf>2</inf> retention than heart failure patients
2015, Respiratory Physiology and NeurobiologyCitation Excerpt :Presently, the precise brain mechanisms underlying the respiratory controller's intelligent subliminal decision-making governing the maintenance of normocapnia in some circumstances vis-à-vis submission to hypercapnia or hypocapnia in others are unknown. What is for certain is that such principled ventilatory strategies cannot result from simple knee-jerk reflexes but likely involve adaptive reflexes through complex cognition, perception and decision processes in the respiratory controller, perhaps through the adaptation of an ‘internal model’ of the environment that it interacts with, such as those seen in higher brain functions (Poon, 2009, 2010, 2011, 2014; Poon and Merfeld, 2005; Poon and Tin, 2013; Poon et al., 2007; Tin and Poon, 2014). Even in the field of psychology, it is now increasingly recognized that cost/benefit decisions for adaptive recruitment of effort in pursuit of reward could occur at an unconscious level in rudimentary brain structures (Bijleveld et al., 2012).
Commentary on "Mechanism of augmented exercise hyperpnea in chronic heart failure and dead space loading" by Poon and Tin
2013, Respiratory Physiology and NeurobiologyRespiratory system as the main determinant of dyspnea in patients with pulmonary hypertension
2022, Pulmonary Circulation
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Current address: Department of Mechanical and Biomedical Engineering, City University of Hong Kong, Hong Kong, China.