Effective Bronchoscopic Lung Volume Reduction Accelerates Exercise Oxygen Uptake Kinetics in Emphysema

Article


Faisal, A., Zoumot, Zaid, Shah, Pallav L., Neder, J. Alberto, Polkey, Michael I. and Hopkinson, Nicholas S. 2016. Effective Bronchoscopic Lung Volume Reduction Accelerates Exercise Oxygen Uptake Kinetics in Emphysema. Chest. 149 (2), pp. 435-446. https://doi.org/10.1378/chest.15-0404
AuthorsFaisal, A., Zoumot, Zaid, Shah, Pallav L., Neder, J. Alberto, Polkey, Michael I. and Hopkinson, Nicholas S.
Abstract

Background

The impact of bronchoscopic lung volume reduction (BLVR) on physiologic responses to exercise in patients with advanced emphysema remains incompletely understood. We hypothesized that effective BLVR (e-BLVR), defined as a reduction in residual volume > 350 mL, would improve cardiovascular responses to exercise and accelerate oxygen uptake (

o2) kinetics.
Methods

Thirty-one patients (FEV1, 36% ± 9% predicted; residual volume, 219% ± 57% predicted) underwent a constant intensity exercise test at 70% peak work rate to the limit of tolerance before and after treatment bronchoscopy (n = 24) or sham bronchoscopy (n = 7). Physiologic responses in patients who had e-BLVR (n = 16) were compared with control subjects (ineffective BLVR or sham bronchoscopy; n = 15).
Results

e-BLVR reduced residual volume (−1.1 ± 0.5 L, P = .001), improved lung diffusing capacity by 12% ± 13% (P = .001), and increased exercise tolerance by 181 ± 214 s (P = .004).
o2 kinetics were accelerated in the e-BLVR group but remained unchanged in control subjects (Δ mean response time, −20% ± 29% vs 1% ± 25%, P = .04). Acceleration of o2 kinetics was associated with reductions in heart rate and oxygen pulse response half-times by 8% (84 ± 14 to 76 ± 15 s, P = .04) and 20% (49 ± 16 to 34 ± 16 s, P = .01), respectively. There were also increases in heart rate and oxygen pulse amplitudes during the cardiodynamic phase post e-BLVR. Faster

o2 kinetics in the e-BLVR group were significantly correlated with reductions in residual volume (r = 0.66, P = .005) and improvements in inspiratory reserve volume (r = 0.56, P = .024) and exercise tolerance (r = 0.63, P = .008).
Conclusions

Lung deflation induced by e-BLVR accelerated exercise

o2 kinetics in patients with emphysema. This beneficial effect appears to be related mechanistically to an enhanced cardiovascular response to exercise, which may contribute to improved functional capacity.

JournalChest
Journal citation149 (2), pp. 435-446
ISSN00123692
Year2016
PublisherElsevier
Digital Object Identifier (DOI)https://doi.org/10.1378/chest.15-0404
Web address (URL)https://doi.org/10.1378/chest.15-0404
Publication dates
Print12 Jan 2016
Publication process dates
Deposited13 Sep 2017
Copyright information© 2016 Elsevier
Permalink -

https://repository.uel.ac.uk/item/852vv

  • 125
    total views
  • 0
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

Effect of age-related ventilatory inefficiency on respiratory sensation during exercise
Faisal, A., Webb, Katherine A., Guenette, Jordan A., Jensen, Dennis, Neder, J. Alberto and O’Donnell, Denis E. 2014. Effect of age-related ventilatory inefficiency on respiratory sensation during exercise. Respiratory Physiology & Neurobiology. 205, pp. 129-139. https://doi.org/10.1016/j.resp.2014.10.017
Resting Physiological Correlates of Reduced Exercise Capacity in Smokers with Mild Airway Obstruction
Elbehairy, Amany F., Faisal, A., Guenette, Jordan A., Jensen, Dennis, Webb, Katherine A., Ahmed, Rashid, Neder, J. Alberto and O'Donnell, Denis E. 2017. Resting Physiological Correlates of Reduced Exercise Capacity in Smokers with Mild Airway Obstruction. COPD: Journal of Chronic Obstructive Pulmonary Disease. 14 (3), pp. 267-275. https://doi.org/10.1080/15412555.2017.1281901
Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction
Walsted, Emil Schwarz, Faisal, A., Jolley, Caroline J., Swanton, Laura L., Pavitt, Matthew J., Luo, Yuan-Ming, Backer, Vibeke, Polkey, Michael I. and Hull, James H. 2017. Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction. Journal of Applied Physiology. 124 (2), pp. 356-363. https://doi.org/10.1152/japplphysiol.00691.2017
Unraveling the Cause of Severe Exertional Dyspnea in a Heavy Smoker
Elbehairy, Amany F., Hockmann, Karlo, Ciavaglia, Casey E., Faisal, A., Hill, Elizabeth, Webb, Katherine A., Neder, J. Alberto and O’Donnell, Denis E. 2017. Unraveling the Cause of Severe Exertional Dyspnea in a Heavy Smoker. Annals of the American Thoracic Society. 14 (12), pp. 1849-1855. https://doi.org/10.1513/AnnalsATS.201705-382CC