Document Detail

Regional chest wall volumes during exercise in chronic obstructive pulmonary disease.
MedLine Citation:
PMID:  14985554     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Dynamic hyperinflation of the lungs impairs exercise performance in chronic obstructive pulmonary disease (COPD). However, it is unclear which patients are affected by dynamic hyperinflation and how the respiratory muscles respond to the change in lung volume. METHODS: Using optoelectronic plethysmography, total and regional chest wall volumes were measured non-invasively in 20 stable patients with COPD (mean (SD) forced expiratory volume in 1 second 43.6 (11.6)% predicted) and dynamic hyperinflation was tracked breath by breath to test if this was the mechanism of exercise limitation. Resting ventilation, breathing pattern, symptoms, rib cage and abdominal volumes were recorded at rest and during symptom limited cycle ergometry. Pleural, abdominal, and transdiaphragmatic pressures were measured in eight patients. RESULTS: End expiratory chest wall volume increased by a mean (SE) of 592 (80) ml in 12 patients (hyperinflators) but decreased by 462 (103) ml in eight (euvolumics). During exercise, tidal volume increased in euvolumic patients by reducing end expiratory abdominal volume while in hyperinflators tidal volume increased by increasing end inspiratory abdominal and rib cage volumes. The maximal abdominal pressure was 22.1 (9.0) cm H(2)O in euvolumic patients and 7.6 (2.6) cm H(2)O in hyperinflators. Euvolumic patients were as breathless as hyperinflators but exercised for less time and reached lower maximum workloads (p<0.05) despite having better spirometric parameters and a greater expiratory flow reserve. CONCLUSIONS: Dynamic hyperinflation is not the only mechanism limiting exercise performance in patients with stable COPD. Accurate measurement of chest wall volume can identify the different patterns of respiratory muscle activation during exercise.
A Aliverti; N Stevenson; R L Dellacà; A Lo Mauro; A Pedotti; P M A Calverley
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thorax     Volume:  59     ISSN:  0040-6376     ISO Abbreviation:  Thorax     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-02-26     Completed Date:  2004-03-24     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  210-6     Citation Subset:  IM    
Dipartimento di Bioingegneria, Politecnico di Milano, Italy.
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MeSH Terms
Exercise / physiology*
Forced Expiratory Volume / physiology
Lung Volume Measurements
Pulmonary Disease, Chronic Obstructive / physiopathology*
Thoracic Wall / physiology
Vital Capacity / physiology
Work of Breathing / physiology

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