Does impaired O-2 delivery during exercise accentuate central and peripheral fatigue in patients with coexistent COPD-CHF?

Does impaired O-2 delivery during exercise accentuate central and peripheral fatigue in patients with coexistent COPD-CHF?

Author Oliveira, Mayron Faria Autor UNIFESP Google Scholar
Zelt, Joel T. J. Google Scholar
Jones, Joshua H. Google Scholar
Hirai, Daniel M. Autor UNIFESP Google Scholar
O'Donnell, Denis E. Google Scholar
Verges, Samuel Google Scholar
Neder, Jose Alberto Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Queens Univ
Grenoble Alpes Univ
Abstract Impairment in oxygen (O-2) delivery to the central nervous system (brain) and skeletal locomotor muscle during exercise has been associated with central and peripheral neuromuscular fatigue in healthy humans. From a clinical perspective, impaired tissue O-2 transport is a key pathophysiological mechanism shared by cardiopulmonary diseases, such as chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). in addition to arterial hypoxemic conditions in COPD, there is growing evidence that cerebral and muscle blood flow and oxygenation can be reduced during exercise in both isolated COPD and CHF. Compromised cardiac output due to impaired cardiopulmonary function/interactions and blood flow redistribution to the overloaded respiratory muscles (i.e., up arrow work of breathing) may underpin these abnormalities. Unfortunately, COPD and CHF coexist in almost a third of elderly patients making these mechanisms potentially more relevant to exercise intolerance. in this context, it remains unknown whether decreased O-2 delivery accentuates neuromuscular manifestations of central and peripheral fatigue in coexistent COPD-CHF If this holds true, it is conceivable that delivering a low-density gas mixture (heliox) through non-invasive positive pressure ventilation could ameliorate cardiopulmonary function/interactions and reduce the work of breathing during exercise in these patients. the major consequence would be increased O-2 delivery to the brain and active muscles with potential benefits to exercise capacity (i.e.,,central and peripheral neuromuscular fatigue, respectively). We therefore hypothesize that patients with coexistent COPD-CHF stop exercising prematurely due to impaired central motor drive and muscle contractility as the cardiorespiratory system fails to deliver sufficient O-2 to simultaneously attend the metabolic demands of the brain and the active limb muscles.
Keywords chronic heart failure
chronic obstructive pulmonary disease
oxygenation
respiratory muscle
skeletal muscle
Language English
Date 2015-01-07
Published in Frontiers in Physiology. Lausanne: Frontiers Research Foundation, v. 5, 8 p., 2015.
ISSN 1664-042X (Sherpa/Romeo, impact factor)
Publisher Frontiers Research Foundation
Extent 8
Origin http://dx.doi.org/10.3389/fphys.2014.00514
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000348216400001
URI http://repositorio.unifesp.br/handle/11600/38631

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