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Behnia M, Sietsema KE. Utility of Cardiopulmonary Exercise Testing in Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2895-2910. [PMID: 38089541 PMCID: PMC10710955 DOI: 10.2147/copd.s432841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease defined by airflow obstruction with a high morbidity and mortality and significant economic burden. Although pulmonary function testing is the cornerstone in diagnosis of COPD, it cannot fully characterize disease severity or cause of dyspnea because of disease heterogeneity and variable related and comorbid conditions affecting cardiac, vascular, and musculoskeletal systems. Cardiopulmonary exercise testing (CPET) is a valuable tool for assessing physical function in a wide range of clinical conditions, including COPD. Familiarity with measurements made during CPET and its potential to aid in clinical decision-making related to COPD can thus be useful to clinicians caring for this population. This review highlights pulmonary and extrapulmonary impairments that can contribute to exercise limitation in COPD. Key elements of CPET are identified with an emphasis on measurements most relevant to COPD. Finally, clinical applications of CPET demonstrated to be of value in the COPD setting are identified. These include quantifying functional capacity, differentiating among potential causes of symptoms and limitation, prognostication and risk assessment for operative procedures, and guiding exercise prescription.
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Affiliation(s)
- Mehrdad Behnia
- Pulmonary and Critical Care, University of Central Florida, Orlando, FL, USA
| | - Kathy E Sietsema
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA, USA
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Casaburi R, Hess M, Porszasz J, Clark W, Diesem R, Tal-Singer R, Ferguson C. Evaluation of Over-the-Counter Portable Oxygen Concentrators Utilizing a Metabolic Simulator. Respir Care 2023; 68:445-451. [PMID: 36400446 PMCID: PMC10173114 DOI: 10.4187/respcare.10495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Supplemental oxygen is designed to raise alveolar PO2 to facilitate diffusion into arterial blood. Oxygen is generally delivered by nasal cannula either by continuous or pulsatile flow. Battery-powered portable oxygen concentrators (POCs) facilitate ambulation in patients experiencing exertional hypoxemia. In the United States, the Food and Drug Administration (FDA) clears these devices to be sold by physician prescription. Recently, however, lower-cost devices described as POCs have been advertised by online retailers. These devices lack FDA clearance and are obtained over the counter (OTC) without prescription. This study determined whether a selected group of OTC POCs have oxygen delivery characteristics suitable for use by hypoxemic patients. METHODS A metabolic simulator, capable of simulating a range of metabolic rates and minute ventilations, determined effects of oxygen supplementation delivered by a variety of devices on alveolar PO2 . Devices tested included 3 OTC POCs, an FDA-cleared POC, and continuous-flow oxygen from a compressed oxygen cylinder. End-tidal PETO2 , a surrogate of alveolar PO2 , was determined at each of each device's flow settings at 3 metabolic rates. RESULTS Continuous-flow tank oxygen yielded a linear PETO2 increase as flow increased, with progressively lower slope of increase for higher metabolic rate. The prescription POC device yielded similar PETO2 elevations, though with somewhat smaller elevations in pulse-dose operation. One OTC POC was only technically portable (no on-board battery); it provided only modest PETO2 elevation that failed to increase as flow setting was incremented. A second OTC POC produced only minimal PETO2 elevation. A third OTC POC, a pulsed-dose device, produced meaningful PETO2 increases, though not as great as the prescription device. CONCLUSIONS Only one of 3 OTC POCs tested was potentially of use by patients requiring ambulatory oxygen. Physicians and respiratory therapists should inform patients requiring portable oxygen that OTC devices may not meet their oxygenation requirements.
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Affiliation(s)
- Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California.
| | | | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | - Ryan Diesem
- Valley Inspired Products, Apple Valley, Minnesota
| | | | - Carrie Ferguson
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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Casaburi R, Merrill D, Dolmage TE, Garcia-Aymerich J, Fageras M, Goldstein R, Harding G, Kline Leidy N, Maltais F, O’Donnell D, Porszasz J, Puente-Maestu L, Rennard S, Sciurba F, Spruit MA, Tal-Singer R, Tetzlaff K, van ’t Hul A, Yu R, Hamilton A. Endurance Time During Constant Work Rate Cycle Ergometry in COPD: Development of an Integrated Database From Interventional Studies. Chronic Obstr Pulm Dis 2022; 9:520-537. [PMID: 36066494 PMCID: PMC9718584 DOI: 10.15326/jcopdf.2022.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction The COPD Biomarkers Qualification Consortium (CBQC) was formed under COPD Foundation management, with the goal of qualifying biomarkers and clinical outcome assessments through established regulatory processes for chronic obstructive pulmonary disease (COPD). Within CBQC, a working group evaluated opportunities for qualification of an exercise endurance measure. In a recent publication (Chronic Obstr Pulm Dis. 2022; 9[2]:252-265), we described a conceptual framework establishing exercise endurance's direct relationship to an individual with COPD's experience of physical functioning in daily life, and that increase in exercise endurance is a patient-centered, meaningful treatment benefit. We further proposed endurance time during constant work rate cycle ergometery (CWRCE) as a useful efficacy endpoint in clinical therapeutic intervention trials. In this current publication, we describe the process of assembling an integrated database of endurance time responses to interventions in COPD. Methods We sought participant-level data from published studies incorporating CWRCE as an outcome measure. A literature search screened 2993 publications and identified 553 studies for assessment. Two interventions had sufficient data across studies to warrant data extraction: bronchodilators and rehabilitative exercise training. Investigators were contacted and requested to provide participant-by-participant data from their published studies. Results The final dataset included data from 8 bronchodilator studies (2166) participants and 15 exercise training studies (3488 participants). The database includes 71 variables per participant, comprising demographic, pulmonary function, and detailed physiologic response data. This paper provides a detailed description of the analysis population, while analysis supporting the validation/qualification process and addressing other scientific questions will be described in subsequent publications.
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Affiliation(s)
- Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
| | | | - Thomas E. Dolmage
- Respiratory Diagnostic and Evaluation Services and Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain
| | - Malin Fageras
- Biopharmaceuticals, Respiratory and Immunology, AstraZeneca, Gothenburg Sweden
| | - Roger Goldstein
- Department of Medicine and Rehabilitation Science, University of Toronto, Toronto, Canada
| | | | | | | | - Denis O’Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
| | - Luis Puente-Maestu
- Hospital General Universitario Gregorio Marañón Universidad, Madrid, Spain,Complutense de Madrid-Medical School, Madrid, Spain
| | - Stephen Rennard
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Frank Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Horn and Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Kay Tetzlaff
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany,Department of Sports Medicine, University of Tübingen, Tübingen, Germany
| | - Alex van ’t Hul
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ren Yu
- Evidera, Bethesda, Maryland, United States
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