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Am. J. Respir. Crit. Care Med., Volume 164, Number 5, September 2001, 770-777

Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease

DENIS E. O'DONNELL, SUSAN M. REVILL, and KATHERINE A. WEBB

Respiratory Investigation Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada

The role of dynamic hyperinflation (DH) in exercise limitation in chronic obstructive pulmonary disease (COPD) remains to be defined. We examined DH during exercise in 105 patients with COPD (FEV1 = 37 ± 13% predicted; mean ± SD) and studied the relationships between resting lung volumes, DH during exercise, and peak oxygen consumption (V O2). Patients completed pulmonary function tests and incremental cycle exercise tests. We measured the change in inspiratory capacity (Delta IC) during exercise to reflect changes in DH. During exercise, 80% of patients showed significant DH above resting values. IC decreased 0.37 ± 0.39 L or 14 ± 15% predicted during exercise (p < 0.0005), but with large variation in range. Delta IC correlated best with resting IC, both expressed %predicted (r = -0.50, p < 0.0005). Peak V O2 (%predicted maximum) correlated best with the peak tidal volume attained (VT standardized as % of predicted vital capacity) (r = 0.68, p < 0.0005), which, in turn, correlated strongly with IC at peak exercise (r = 0.79, p < 0.0005) or at rest (r = 0.75, p < 0.0005). The extent of DH during exercise in COPD correlated best with resting IC. DH curtailed the VT response to exercise. This inability to expand VT in response to increasing metabolic demand contributed importantly to exercise intolerance in COPD.




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D.E. O'Donnell, T. Fluge, F. Gerken, A. Hamilton, K. Webb, B. Aguilaniu, B. Make, and H. Magnussen
Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD
Eur. Respir. J., June 1, 2004; 23(6): 832 - 840.
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 Eur Respir JHome page
B.R. Celli, W. MacNee, A. Agusti, A. Anzueto, B. Berg, A.S. Buist, P.M.A. Calverley, N. Chavannes, T. Dillard, B. Fahy, et al.
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper
Eur. Respir. J., June 1, 2004; 23(6): 932 - 946.
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 Chronic Respiratory DiseaseHome page
J P Fuldl and M M Cotton
Performance enhancement in chronic obstructive pulmonary disease
Chronic Respiratory Disease, April 1, 2004; 1(2): 95 - 98.
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 ThoraxHome page
A Aliverti, N Stevenson, R L Dellaca, A Lo Mauro, A Pedotti, and P M A Calverley
Regional chest wall volumes during exercise in chronic obstructive pulmonary disease
Thorax, March 1, 2004; 59(3): 210 - 216.
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 Eur Respir JHome page
R.L. Dellaca, P. Santus, A. Aliverti, N. Stevenson, S. Centanni, P.T. Macklem, A. Pedotti, and P.M.A. Calverley
Detection of expiratory flow limitation in COPD using the forced oscillation technique
Eur. Respir. J., February 1, 2004; 23(2): 232 - 240.
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 ChestHome page
H. Haverkamp, J. Miller, J. Rodman, L. Romer, D. Pegelow, M. Santana, and J. Dempsey
Extrathoracic Obstruction and Hypoxemia Occurring During Exercise in a Competitive Female Cyclist
Chest, October 1, 2003; 124(4): 1602 - 1605.
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 ChestHome page
G. I. Snell, L. Holsworth, Z. L. Borrill, K. R. Thomson, V. Kalff, J. A. Smith, and T. J. Williams
The Potential for Bronchoscopic Lung Volume Reduction Using Bronchial Prostheses: A Pilot Study
Chest, September 1, 2003; 124(3): 1073 - 1080.
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 ChestHome page
D. Y. Sue
Peripheral Muscle Dysfunction in Patients With COPD: Comparing Apples to Apples?
Chest, July 1, 2003; 124(1): 1 - 4.
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 ChestHome page
F. Gigliotti, C. Coli, R. Bianchi, I. Romagnoli, B. Lanini, B. Binazzi, and G. Scano
Exercise Training Improves Exertional Dyspnea in Patients With COPD: Evidence of the Role of Mechanical Factors
Chest, June 1, 2003; 123(6): 1794 - 1802.
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 Am. J. Respir. Crit. Care Med.Home page
T. L. Croxton, G. G. Weinmann, R. M. Senior, R. A. Wise, J. D. Crapo, and A. S. Buist
Clinical Research in Chronic Obstructive Pulmonary Disease: Needs and Opportunities
Am. J. Respir. Crit. Care Med., April 15, 2003; 167(8): 1142 - 1149.
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 Am. J. Respir. Crit. Care Med.Home page
ATS/ACCP Statement on Cardiopulmonary Exercise Testing
Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 211 - 277.
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 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
Compliance (COMmunicate PLease wIth Less Abbreviations, Noun Clusters, and Exclusiveness)
Am. J. Respir. Crit. Care Med., December 15, 2002; 166(12): 1534 - 1536.
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 Am. J. Respir. Crit. Care Med.Home page
J. A. Dempsey
Exercise Carbon Dioxide Retention in Chronic Obstructive Pulmonary Disease: A Case for Ventilation/Perfusion Mismatch Combined with Hyperinflation
Am. J. Respir. Crit. Care Med., September 1, 2002; 166(5): 634 - 635.
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 Am. J. Respir. Crit. Care Med.Home page
D. E. O'Donnell, C. D'Arsigny, M. Fitzpatrick, and K. A. Webb
Exercise Hypercapnia in Advanced Chronic Obstructive Pulmonary Disease: The Role of Lung Hyperinflation
Am. J. Respir. Crit. Care Med., September 1, 2002; 166(5): 663 - 668.
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 Am. J. Respir. Crit. Care Med.Home page
F. Ortega, J. Toral, P. Cejudo, R. Villagomez, H. Sanchez, J. Castillo, and T. Montemayor
Comparison of Effects of Strength and Endurance Training in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., September 1, 2002; 166(5): 669 - 674.
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 ChestHome page
R. Porta, L. Appendini, M. Vitacca, L. Bianchi, C. F. Donner, R. Poggi, and N. Ambrosino
Mask Proportional Assist vs Pressure Support Ventilation in Patients in Clinically Stable Condition With Chronic Ventilatory Failure*
Chest, August 1, 2002; 122(2): 479 - 488.
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 Am. J. Respir. Crit. Care Med.Home page
M. J. TOBIN
Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2001
Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 642 - 662.
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 Eur Respir JHome page
D.E. O'Donnell, L. Forkert, and K.A. Webb
Evaluation of bronchodilator responses in patients with "irreversible" emphysema
Eur. Respir. J., December 1, 2001; 18(6): 914 - 920.
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