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Published ahead of print on September 15, 2005, doi:10.1164/rccm.200504-595OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 12, December 2005, 1510-1516

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Submitted on April 17, 2005
Accepted on September 14, 2005

Lung Mechanics and Dyspnea during Exacerbations of Chronic Obstructive Pulmonary Disease

Nicola J Stevenson1, Paul P Walker1, Richard W Costello2, and Peter M.A. Calverley1*

1 Department of Medicine, Clinical Sciences Centre, University Hospital Aintree, Liverpool, United Kingdom, 2 Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland

* To whom correspondence should be addressed. E-mail: pmacal{at}liverpool.ac.uk.

Rationale: Exacerbation of chronic obstructive pulmonary disease (COPD) commonly causes hospitalisation. The change in lung mechanics during exacerbation and its relationship to symptoms in spontaneously breathing individuals has not been described. Objective: We hypothesised that changes in both airflow and lung volumes would occur during an exacerbation but only volume change would relate to symptomatic improvement. Methods: Lung mechanics and resting dyspnea were recorded in 22 hospitalised patients during recovery from exacerbation. Measurements: Spirometry, inspiratory capacity, respiratory system resistance and reactance, tidal breathing patterns and expiratory flow limitation (EFL) were recorded after nebulised bronchodilators on the first three days following admission, at discharge and 6 weeks (day 42). Pre-bronchodilator measurements were taken on day two, discharge and day 42. Main Results: Post-bronchodilator inspiratory capacity increased 0.23 ± 0.07L by discharge and 0.42 ± 0.1L by day 42, FEV1 rose 0.09 ± 0.04L and 0.2 ± 0.05L at discharge and day 42 respectively while FVC increased 0.21 ± 0.08L and 0.47 ± 0.09L (all p<0.05). Consistent reduction in dyspnea was seen as the exacerbation resolved. Respiratory system resistance, FEV1/FVC and EFL were unchanged throughout indicating changes in lung volume rather than airflow resistance predominated. Conclusions: Improvement in operating lung volumes is the principal change seen as a COPD exacerbation resolves and increase in inspiratory capacity is a useful guide to a reduction in dyspnea.
Key words: breathlessness, lung function, inspiratory reserve volume, lung hyperinflation




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