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Lopes AJ, de Melo PL. Brazilian studies on pulmonary function in COPD patients: what are the gaps? Int J Chron Obstruct Pulmon Dis 2016; 11:1553-67. [PMID: 27468230 PMCID: PMC4946858 DOI: 10.2147/copd.s54328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on sensitive methods for lung-function testing. A wide body of knowledge has been accumulated in recent years showing that these methods have been significantly refined and seems promising for detection of early disease. OBJECTIVES This review focuses on research on pulmonary function analysis in COPD performed in Brazil during this century. MATERIALS AND METHODS The literature was searched using a systematic search strategy limited to English language studies that were carried out in Brazil from the year 2000 onward, with study objectives that included a focus on lung function. RESULTS After we applied our inclusion and exclusion criteria, 94 articles addressed our stated objectives. Among the new methods reviewed are the forced-oscillation technique and the nitrogen-washout test, which may provide information on small-airway abnormalities. Studies investigating the respiratory muscles and thoracoabdominal motion are also discussed, as well as studies on automatic clinical decision-support systems and complexity measurements. We also examined important gaps in the present knowledge and suggested future directions for the cited research fields. CONCLUSION There is clear evidence that improvements in lung-function methods allowed us to obtain new pathophysiological information, contributing to improvement in our understanding of COPD. In addition, they may also assist in the diagnosis and prevention of COPD. Further investigations using prospective and longitudinal design may be of interest to elucidate the use of these new methods in the diagnosis and prevention of COPD.
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Affiliation(s)
- Agnaldo José Lopes
- Pulmonary Function Laboratory, State University of Rio de Janeiro; Pulmonary Rehabilitation Laboratory, Augusto Motta University Center
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Puente-Maestu L, Palange P, Casaburi R, Laveneziana P, Maltais F, Neder JA, O'Donnell DE, Onorati P, Porszasz J, Rabinovich R, Rossiter HB, Singh S, Troosters T, Ward S. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J 2016; 47:429-60. [DOI: 10.1183/13993003.00745-2015] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
Abstract
This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others.
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Chen R, Lin L, Tian JW, Zeng B, Zhang L, Chen X, Yan HY. Predictors of dynamic hyperinflation during the 6-minute walk test in stable chronic obstructive pulmonary disease patients. J Thorac Dis 2015; 7:1142-50. [PMID: 26380729 DOI: 10.3978/j.issn.2072-1439.2015.07.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/27/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Dynamic hyperinflation (DH) is a major contributor to exercise limitation in chronic obstructive pulmonary disease (COPD). Therefore, we aimed to elucidate the physiological factors responsible for DH development during the 6-minute walk test (6MWT) in COPD patients and compare ventilatory response to the 6MWT in hyperinflators and non-hyperinflators. METHODS A total of 105 consecutive subjects with stable COPD underwent a 6MWT, and the Borg dyspnea scale, oxygen saturation (SpO2), breathing pattern, and inspiratory capacity (IC) were recorded before and immediately after walking. The change in IC was measured, and subjects were divided into hyperinflators (ΔIC >0.0 L) and non-hyperinflators (ΔIC ≤0.0 L). Spirometry, the Modified Medical Research Council (MMRC) dyspnea scale and St George's Respiratory Questionnaire (SGRQ) were also assessed. RESULTS DH was present in 66.67% of subjects. ΔIC/IC was significantly and negatively correlated with the small airway function. On multiple stepwise regression analysis forced expiratory flow after exhaling 50% of the forced vital capacity (FEF50%) was the only predictor of ΔIC/IC. Non-hyperinflators had a higher post-walking VT (t=2.419, P=0.017) and post-walking VE (t=2.599, P=0.011) than the hyperinflators did. Age and resting IC were independent predictors of the 6-minute walk distance (6MWD) in hyperinflators. CONCLUSIONS DH was considerably common in subjects with COPD. Small airway function may partly contribute to the DH severity during walking. The ventilator response to the 6MWT differed between hyperinflators and non-hyperinflators. Resting hyperinflation is an important predictor of functional exercise capacity in hyperinflators.
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Affiliation(s)
- Rui Chen
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lin Lin
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jing-Wei Tian
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Bin Zeng
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lei Zhang
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xin Chen
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Hai-Yan Yan
- 1 Department of Respiratory Diseases, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 2 Laboratory of Rehabilitation, Guangdong Provincial Hospital, Guangzhou 510055, China ; 3 Department of Respiratory Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China ; 4 Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Langer D, Ciavaglia CE, Neder JA, Webb KA, O'Donnell DE. Lung hyperinflation in chronic obstructive pulmonary disease: mechanisms, clinical implications and treatment. Expert Rev Respir Med 2014; 8:731-49. [PMID: 25159007 DOI: 10.1586/17476348.2014.949676] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung hyperinflation is highly prevalent in patients with chronic obstructive pulmonary disease and occurs across the continuum of the disease. A growing body of evidence suggests that lung hyperinflation contributes to dyspnea and activity limitation in chronic obstructive pulmonary disease and is an important independent risk factor for mortality. In this review, we will summarize the recent literature on pathogenesis and clinical implications of lung hyperinflation. We will outline the contribution of lung hyperinflation to exercise limitation and discuss its impact on symptoms and physical activity. Finally, we will examine the physiological rationale and efficacy of selected pharmacological and non-pharmacological 'lung deflating' interventions aimed at improving symptoms and physical functioning.
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Affiliation(s)
- Daniel Langer
- Respiratory Investigation Unit, Queen's University & Kingston General Hospital, 102 Stuart Street, Kingston, ON K7L 2V6, Canada
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