Exercise ventilatory inefficiency adds to lung function in predicting mortality in copd

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dc.contributor.authorNeder, J. Alberto [UNIFESP]
dc.contributor.authorAlharbi, Abdullah
dc.contributor.authorBerton, Danilo C.
dc.contributor.authorAlencar, Maria Clara N. [UNIFESP]
dc.contributor.authorArbex, Flavio F. [UNIFESP]
dc.contributor.authorHirai, Daniel M. [UNIFESP]
dc.contributor.authorWebb, Katherine A.
dc.contributor.authorO'Donnell, Denis E.
dc.date.accessioned2019-01-21T10:29:51Z
dc.date.available2019-01-21T10:29:51Z
dc.date.issued2016
dc.description.abstractSeverity of resting functional impairment only partially predicts the increased risk of death in chronic obstructive pulmonary disease (COPD). Increased ventilation during exercise is associated with markers of disease progression and poor prognosis, including emphysema extension and pulmonary vascular impairment. Whether excess exercise ventilation would add to resting lung function in predicting mortality in COPD, however, is currently unknown. After an incremental cardiopulmonary exercise test, 288 patients (forced expiratory volume in one second ranging from 18% to 148% predicted) were followed for a median (interquartile range) of 57 (47) months. Increases in the lowest (nadir) ventilation to CO2 output (VCO2) ratio determined excess exercise ventilation. Seventy-seven patients (26.7%) died during follow-up: 30/77 (38.9%) deaths were due to respiratory causes. Deceased patients were older, leaner, had a greater co-morbidity burden (Charlson Index) and reported more daily life dyspnea. Moreover, they had poorer lung function and exercise tolerance (p < 0.05). A logistic regression analysis revealed that ventilation/VCO2 nadir was the only exercise variable that added to age, body mass index, Charlson Index and resting inspiratory capacity (IC)/total lung capacity (TLC) ratio to predict all-cause and respiratory mortality (p < 0.001). Kaplan-Meier analyses showed that survival time was particularly reduced when ventilation/VCO2 nadir > 34 was associated with IC/TLC 0.34 or IC/TLC 0.31 for all-cause and respiratory mortality, respectively (p < 0.001). Excess exercise ventilation is an independent prognostic marker across the spectrum of COPD severity. Physiological abnormalities beyond traditional airway dysfunction and lung mechanics are relevant in determining the course of the disease.en
dc.description.affiliationRespiratory Investigation Unit & Laboratory of Clinical Exercise Physiology , Queen's University & Kingston General Hospital , Kingston , ON , Canada
dc.description.affiliationPulmonary Function and Clinical Exercise Physiology Unit (SEFICE) , Division of Respirology, Federal University of Sao Paulo , Sao Paulo , Brazil
dc.description.affiliationDivision of Respirology , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
dc.description.affiliationUnifespPulmonary Function and Clinical Exercise Physiology Unit (SEFICE) , Division of Respirology, Federal University of Sao Paulo , Sao Paulo , Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipBrazilian Higher Education National Council
dc.description.sponsorshipSenate Advisory Research Committee, Queen's University, Ontario, Canada
dc.description.sponsorshipNew Clinician Scientist Program from the Southeastern Ontario Academic Medical Association, Canada
dc.format.extent416-424
dc.identifierhttps://doi.org/10.3109/15412555.2016.1158801
dc.identifier.citationCopd-Journal Of Chronic Obstructive Pulmonary Disease. Philadelphia, v. 13, n. 4, p. 416-424, 2016.
dc.identifier.doi10.3109/15412555.2016.1158801
dc.identifier.issn1541-2555
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/49437
dc.identifier.wosWOS:000381019000002
dc.language.isoeng
dc.publisherHindawi Publishing Corp
dc.relation.ispartofCopd-Journal Of Chronic Obstructive Pulmonary Disease
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectSurvivalen
dc.subjectCopden
dc.subjectVentilationen
dc.subjectCardiopulmonary Exercise Testen
dc.subjectPhysiologyObstructive Pulmonary-Diseaseen
dc.subjectReduction Surgeryen
dc.subjectHeart-Failureen
dc.subjectMesa Copden
dc.subjectEfficiencyen
dc.subjectEmphysemaen
dc.subjectCapacityen
dc.subjectMilden
dc.subjectDyspneaen
dc.subjectConstraintsen
dc.titleExercise ventilatory inefficiency adds to lung function in predicting mortality in copden
dc.typeinfo:eu-repo/semantics/article
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