Phenotyping exertional breathlessness using cardiopulmonary cycle exercise testing in people with chronic airflow limitation.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2025-03-11 DOI:10.1016/j.chest.2025.02.033
Magnus Ekström, Pei Zhi Li, Hayley Lewthwaite, Jean Bourbeau, Wan C Tan, Dennis Jensen
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Abstract

Background: Exertional breathlessness is a cardinal symptom of people with chronic airflow limitation (CAL) and can be evaluated using cardiopulmonary exercise testing (CPET).

Research question: Does abnormally high exertional breathlessness in relation to the rate of oxygen uptake (V'O2) and minute ventilation (V'E) indicate different underlying pathophysiological mechanisms and clinical characteristics in people with CAL?

Study design and methods: Analysis of people aged ≥40 years with CAL (post-bronchodilator FEV1/FVC upper limit of normal) by V'O2 alone, abnormal by both V'O2 and V'E (B-V'O2+V'E), or normal by both V'O2 and V'E (B-normal). Exercise physiological responses and clinical characteristics were compared between groups.

Results: We included 325 people (44% women) with CAL (FEV1 75.4±[standard deviation] 17.5%predicted). Compared with the B-normal group (n=237[73%]), the B-V'O2 group (n=29 [9%]) had lower pulmonary diffusing capacity and greater exercise ventilatory inefficiency, whereas the B-V'O2+V'E group (n=50[15%]) had even worse lung function, dynamic critical inspiratory constraints, and exertional breathlessness along with greater symptom burden in daily life, lower physical activity, and worse health status.

Interpretation: Exertional breathlessness phenotyped in relation to V'O2 and V'E using normative reference equations enable multivariable analyses of underlying symptom mechanisms and associated clinical characteristics.

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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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