Cardiopulmonary exercise testing in chronic obstructive pulmonary disease (COPD)
Keywords:
COPD, exercise tolerance, cardiopulmonary exercise testingAbstract
Impairment of exercise tolerance in chronic obstructive pulmonary disease (COPD) has important implications on health-related quality of life. Consequently, exercise testingis progressively being considered an essential component in the routine clinical assessment of these patients’ functional status. The mechanisms for exercise intolerance in chronic
obstructive pulmonary disease are complex. Although ventilatory limitation caused by abnormal pulmonary function is a major contributor to this phenomenon, other factors may play an important role in limiting exercise. These other factors include depressed cardiac function, respiratory and peripheral muscle weakness, nutritional imbalances, psychological factors and the distressing exertional symptoms of dyspnea and leg discomfort.
Cardiopulmonary exercise testing is a unique tool to assess the limits and mechanisms of exercise tolerance. It also provides indices of the functional reserve of the organ systems involved in the exercise response, with inferences for system limitation at peak exercise.
The main focus of this article will be cardiopulmonary exercise testing in COPD patients, including indications, important
measurements, the usual cardiopulmonary exercise response patterns and the special situation during exercise in these patients at the altitude of Bogotá.
References
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11. BAUERLE OTTO, CHRUSCH CARL, YOUNES MAGD. Mechanisms by Which COPD Affects Exercise Tolerance. Am J Respir Crit Care Med 1998; 157(1):57-68.
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13. Johnson BD, Weisman IM, Zeballos RJ et al. Emerging Concepts in the Evaluation of Ventilatory Limitation During Exercise*. Chest 1999; 116(2):488-503.
14. O’Donnell DE. Hyperinflation, Dyspnea, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 2006; 3(2):180-184.
15. O’Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. J Appl Physiol 2008; 105(2):753- 755.
16. Montes dO, Rassulo J, Celli BR. Respiratory muscle and cardiopulmonary function during exercise in very severe COPD. Am J Respir Crit Care Med 1996; 154(5):1284-1289.
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21. Sorli J, Grassino A, Lorange G et al. Control of breathing in patients with chronic obstructive lung disease. Clin Sci Mol Med 1978; 54(3):295-304.
22. Parot S, Saunier C, Gautier H et al. Breathing pattern and hypercapnia in patients with obstructive pulmonary disease. Am Rev Respir Dis 1980; 121(6):985-991.
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24. Light RW, Mahutte CK, Brown SE. Etiology of carbon dioxide retention at rest and during exercise in chronic airflow obstruction. Chest 1988; 94(1):61-67.
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26. Singh SJ, Morgan MD, Scott S et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47(12):1019- 1024.
27. ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med 2003; 167(2):211-277.
28. Burgos F, Casan P, Ortega F et al. Pruebas de Ejercicio cardiopulmonar. Arch Bronconeumol 2001; 37(7):247-268.
29. Palange P, Ward SA, Carlsen KH et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007; 29(1):185-209.
30. Beck KC, Weisman IM. Methods for Cardiopulmonary Exercise Testing. In: Weisman IM, Zeballos RJ, editors. Clinical Exercise Testing. Basel (Zwizerland)t: Karger, 2002: 43-59.
31. Wasserman K, Hansen JE, Sue DY et al. Clinical Exercise Testing. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 115-138.
32. Wasserman K, Hansen JE, Sue DY et al. Normal Values. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 143-164.
33. Wasserman K, Hansen JE, Sue DY et al. Measurements During Integrative Cardiopulmonary Exercise Testing. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 62-94.
34. Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis 1984; 129(2 Pt 2):S49-S55.
35. O’DONNELL DENI, LAM MIU, WEBB KATH. Measurement of Symptoms, Lung Hyperinflation, and Endurance during Exercise in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1998; 158(5):1557-1565.
36. O’Donnell DE, Revill S, Webb KA. Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2001; 164(5):770- 777.
37. Troosters T, Casaburi R, Gosselink R et al. Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2005; 172(1):19-38.
38. E et al. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med 2006; 173(12):1390- 1413.
39. Pulmonary rehabilitation. British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Thorax 2001;56(11):827-834.
40. Emtner M, Porszasz J, Burns M et al. Benefits of Supplemental Oxygen in Exercise Training in Nonhypoxemic Chronic Obstructive Pulmonary Disease Patients. Am J Respir Crit Care Med 2003; 168(9):1034-1042.
41. Maldonado D, Gonzalez M, Barrero M et al. Exercise Endurance in hypoxemic COPD patients at an altitude of 2640m breathing air and oxygen (FIO2 28 and 35%). Chest 2007; 132(4):454a.
42. O’Donnell DE, Fluge T, Gerken F et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 2004; 23(6):832-840.
43. Porszasz J, Emtner M, Goto S et al. Exercise Training Decreases Ventilatory Requirements and Exercise-Induced Hyperinflation at Submaximal Intensities in Patients With COPD*. Chest 2005; 128(4):2025-2034.
44. Hiraga T, Maekura R, Okuda Y et al. Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2003; 23(6):324-331.
45. Oga T, Nishimura K, Tsukino M et al. Analysis of the Factors Related to Mortality in Chronic Obstructive Pulmonary Disease: Role of Exercise Capacity and Health Status. Am J Respir Crit Care Med 2003; 167(4):544-549.
46. O’Donnell DE. Exercise Limitation and Clinical Exercise Testing in Chronic Obstructive Pulmonary Disease. In: Weisman IM, Zeballos RJ, editors. Clinical Exercise Testing. Basel (Zwitzerland): Karger, 2002: 138-158.
47. Wasserman K, Hansen JE, Sue DY et al. Pathophysiology of Disorders Limiting Exercise. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 95-114.
48. West JB. The Physiologic Basis of High- Altitude Diseases. Annals of Internal Medicine 2004; 141(10):789-800.
49. Acevedo L, Solarte I. Gasimetria arterial en adultos sanos a nivel de Bogotá. Acta Med Colomb 1984; 9(1):7-14.
50. Restrepo J, Reyes P, Vásquez P. Gasimetria arterial y alveolar en adultos sanos a nivel de Bogotá. Acta Med Colomb 1982; (6):461-466.
51. Roa J, de Arroyo S, Salcedo MC et al. Gasimetria arterial a diferentes edades en Bogotá. Acta Med Colomb 1988; 13S:415A(C217).
52. Gonzalez-Garcia M, Barrero M, Maldonado D. [Exercise limitation in patients with chronic obstructive pulmonary disease at the altitude of Bogota (2640 m). Breathing pattern and arterial gases at rest and peak exercise]. Arch Bronconeumol 2004; 40(2):54-61.
53. Gonzalez M, Barrero M, Maldonado D. The major limitation to exercise performance in COPD patients at the altitude of Bogotá (2640m) is hypoxemia. Chest 2009; 136(4):62S-62f.
2. Dennis RJ, Maldonado D, Norman S et al. Woodsmoke exposure and risk for obstructive airways disease among women. Chest 1996; 109(1):115-119.
3. Perez-Padilla R, Regalado J, Vedal S et al. Exposure to biomass smoke and chronic airway disease in Mexican women. A casecontrol study. Am J Respir Crit Care Med 1996; 154(3 Pt 1):701-706.
4. González M, Páez S, Jaramillo C et al. Enfermedad pulmonar obstructiva crónica (EPOC) por humo de leña en mujeres. Comparación con la EPOC por cigarrillo. Acta Med Colomb 2004; 29(1):17-25.
5. Menezes AMB, Perez-Padilla R, Jardim JB et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005; 366:1875-1881.
6. Caballero A, Torres-Duque CA, Jaramillo C et al.Prevalence of COPD in Five Colombian Cities Situated at Low, Medium, and High Altitude (PREPOCOL Study)*. Chest 2008;133(2):343-349.
7. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. A statement of the American Thoracic Society and European Respiratory Society. Am J Respir Crit Care Med 1999; 159(4 Pt 2):S1-40.
8. Maltais F, Leblanc P, Jobin J et al. Peripheral muscle dysfunction in chronic obstructive pulmonary disease. Clin Chest Med 2000; 21(4):665-677.
9. Nici L. Mechanisms and measures of exercise intolerance in chronic obstructive pulmonary disease. Clin Chest Med 2000; 21(4):693-704.
10. Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996; 153(3):976-980.
11. BAUERLE OTTO, CHRUSCH CARL, YOUNES MAGD. Mechanisms by Which COPD Affects Exercise Tolerance. Am J Respir Crit Care Med 1998; 157(1):57-68.
12. Marin JM, Carrizo SJ, Gascon M et al. Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minutewalk test in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 163(6):1395-1399.
13. Johnson BD, Weisman IM, Zeballos RJ et al. Emerging Concepts in the Evaluation of Ventilatory Limitation During Exercise*. Chest 1999; 116(2):488-503.
14. O’Donnell DE. Hyperinflation, Dyspnea, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 2006; 3(2):180-184.
15. O’Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. J Appl Physiol 2008; 105(2):753- 755.
16. Montes dO, Rassulo J, Celli BR. Respiratory muscle and cardiopulmonary function during exercise in very severe COPD. Am J Respir Crit Care Med 1996; 154(5):1284-1289.
17. Boushy SF, Coates EO Jr. The prognostic value of pulmonary function tests in emphysema. With special reference to arterial blood studies. Am Rev Respir Dis 1964; 90:553-563.
18. Boushy SF, Thompson HK, Jr., North LB et al. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1973; 108(6):1373-1383.
19. Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease. A prospective study of 200 patients. N Engl J Med 1969; 280(8):397-404.
20. Kanner RE, Renzetti AD, Jr., Stanish WM et al. Predictors of survival in subjects with chronic airflow limitation. Am J Med 1983; 74(2):249-255.
21. Sorli J, Grassino A, Lorange G et al. Control of breathing in patients with chronic obstructive lung disease. Clin Sci Mol Med 1978; 54(3):295-304.
22. Parot S, Saunier C, Gautier H et al. Breathing pattern and hypercapnia in patients with obstructive pulmonary disease. Am Rev Respir Dis 1980; 121(6):985-991.
23. Skatrud JB, Dempsey JA, Bhansali P et al. Determinants of chronic carbon dioxide retention and its correction in humans. J Clin Invest 1980; 65(4):813-821.
24. Light RW, Mahutte CK, Brown SE. Etiology of carbon dioxide retention at rest and during exercise in chronic airflow obstruction. Chest 1988; 94(1):61-67.
25. ATS Statement: Guidelines for the Six- Minute Walk Test. Am J Respir Crit Care Med 2002; 166(1):111-117.
26. Singh SJ, Morgan MD, Scott S et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47(12):1019- 1024.
27. ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med 2003; 167(2):211-277.
28. Burgos F, Casan P, Ortega F et al. Pruebas de Ejercicio cardiopulmonar. Arch Bronconeumol 2001; 37(7):247-268.
29. Palange P, Ward SA, Carlsen KH et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007; 29(1):185-209.
30. Beck KC, Weisman IM. Methods for Cardiopulmonary Exercise Testing. In: Weisman IM, Zeballos RJ, editors. Clinical Exercise Testing. Basel (Zwizerland)t: Karger, 2002: 43-59.
31. Wasserman K, Hansen JE, Sue DY et al. Clinical Exercise Testing. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 115-138.
32. Wasserman K, Hansen JE, Sue DY et al. Normal Values. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 143-164.
33. Wasserman K, Hansen JE, Sue DY et al. Measurements During Integrative Cardiopulmonary Exercise Testing. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 62-94.
34. Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis 1984; 129(2 Pt 2):S49-S55.
35. O’DONNELL DENI, LAM MIU, WEBB KATH. Measurement of Symptoms, Lung Hyperinflation, and Endurance during Exercise in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1998; 158(5):1557-1565.
36. O’Donnell DE, Revill S, Webb KA. Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2001; 164(5):770- 777.
37. Troosters T, Casaburi R, Gosselink R et al. Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2005; 172(1):19-38.
38. E et al. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med 2006; 173(12):1390- 1413.
39. Pulmonary rehabilitation. British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Thorax 2001;56(11):827-834.
40. Emtner M, Porszasz J, Burns M et al. Benefits of Supplemental Oxygen in Exercise Training in Nonhypoxemic Chronic Obstructive Pulmonary Disease Patients. Am J Respir Crit Care Med 2003; 168(9):1034-1042.
41. Maldonado D, Gonzalez M, Barrero M et al. Exercise Endurance in hypoxemic COPD patients at an altitude of 2640m breathing air and oxygen (FIO2 28 and 35%). Chest 2007; 132(4):454a.
42. O’Donnell DE, Fluge T, Gerken F et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 2004; 23(6):832-840.
43. Porszasz J, Emtner M, Goto S et al. Exercise Training Decreases Ventilatory Requirements and Exercise-Induced Hyperinflation at Submaximal Intensities in Patients With COPD*. Chest 2005; 128(4):2025-2034.
44. Hiraga T, Maekura R, Okuda Y et al. Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2003; 23(6):324-331.
45. Oga T, Nishimura K, Tsukino M et al. Analysis of the Factors Related to Mortality in Chronic Obstructive Pulmonary Disease: Role of Exercise Capacity and Health Status. Am J Respir Crit Care Med 2003; 167(4):544-549.
46. O’Donnell DE. Exercise Limitation and Clinical Exercise Testing in Chronic Obstructive Pulmonary Disease. In: Weisman IM, Zeballos RJ, editors. Clinical Exercise Testing. Basel (Zwitzerland): Karger, 2002: 138-158.
47. Wasserman K, Hansen JE, Sue DY et al. Pathophysiology of Disorders Limiting Exercise. In: Weinberg R, editor. Principles of Exercise Testing and Interpretation. Baltimore: Lippincott, 1999: 95-114.
48. West JB. The Physiologic Basis of High- Altitude Diseases. Annals of Internal Medicine 2004; 141(10):789-800.
49. Acevedo L, Solarte I. Gasimetria arterial en adultos sanos a nivel de Bogotá. Acta Med Colomb 1984; 9(1):7-14.
50. Restrepo J, Reyes P, Vásquez P. Gasimetria arterial y alveolar en adultos sanos a nivel de Bogotá. Acta Med Colomb 1982; (6):461-466.
51. Roa J, de Arroyo S, Salcedo MC et al. Gasimetria arterial a diferentes edades en Bogotá. Acta Med Colomb 1988; 13S:415A(C217).
52. Gonzalez-Garcia M, Barrero M, Maldonado D. [Exercise limitation in patients with chronic obstructive pulmonary disease at the altitude of Bogota (2640 m). Breathing pattern and arterial gases at rest and peak exercise]. Arch Bronconeumol 2004; 40(2):54-61.
53. Gonzalez M, Barrero M, Maldonado D. The major limitation to exercise performance in COPD patients at the altitude of Bogotá (2640m) is hypoxemia. Chest 2009; 136(4):62S-62f.
How to Cite
1.
González García M. Cardiopulmonary exercise testing in chronic obstructive pulmonary disease (COPD). Rev. Colomb. Med. Fis. Rehabil. [Internet]. 2012 Apr. 19 [cited 2025 Dec. 18];20(2):49-61. Available from: https://revistacmfrorg.biteca.online/index.php/rcmfr/article/view/24
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