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Published ahead of print on September 18, 2003, doi:10.1164/rccm.200305-627OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 1, January 2004, 89-96

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Submitted on May 29, 2003
Accepted on September 17, 2003

REDUCED MECHANICAL EFFICIENCY IN COPD, BUT NORMAL PEAK VO2 WITH SMALL MUSCLE MASS EXERCISE

Russell S Richardson1*, Bryan T Leek1, Timothy P Gavin1, Luke J Haseler1, Sundar R.D. Mudaliar1, Robert Henry1, Andrew L Ries1, Odile D Mathieu-Costello1, and Peter D Wagner1

1 Medicine, University of California, San Diego, La Jolla, CA, USA

* To whom correspondence should be addressed. E-mail: rrichardson{at}ucsd.edu.

We studied 6 patients with COPD (FEV1 = 1.1 ± 0.2 L, 32% of predicted) and 6 age and activity level matched controls while performing both maximal bicycle exercise and single leg knee-extensor exercise. Arterial and femoral venous blood sampling, thermodilution blood flow measurements and needle biopsies allowed the assessment of muscle O2 supply, utilization and structure. Maximal work rates and single leg maximal oxygen consumption (controls = 0.63 ± 0.1; COPD = 0.37 ± 0.1 l/min) were significantly greater in the control group during bicycle exercise. During knee-extensor exercise this difference in maximal oxygen consumption disappeared, while maximal work capacity was reduced (flywheel resistance: controls = 923 ± 198; COPD = 612 ± 81 g) revealing a significantly reduced mechanical efficiency (work per unit O2 consumed) with COPD. The patients had an elevated number of less efficient Type II muscle fibers while muscle fiber cross sectional areas, capillarity and mitochondrial volume density were not different between the groups. Therefore although metabolic capacity per se is unchanged, fiber type differences associated with COPD may account for the reduced muscular mechanical efficiency that becomes clearly apparent during knee-extensor exercise, when muscle is no longer overshadowed by the decrement in lung function.
Key words: lung disease,Oxygen consumption, blood flow, fiber type, quadriceps




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