Exercise respiratory cycle time components in patients with emphysema

Background: We have recently demonstrated that in patients with COPD the severity of emphysema (E) measured by high resolution computed tomography (HRCT) correlated with: ratio VTpeak/FEV1; VE/VCO2 slope and PETCO2 values at peak exercise. The aim of this study was to further investigate if exercise respiratory cycle time components correlated with % of E measured by HRCT. Method: Twelve patients (age = 65±8 yrs; FEV1 = 55±17%pred) with moderate to severe E (quantified by lung HRCT as % voxels < −910 HU) were evaluated with incremental cardiopulmonary exercise testing (CPET). Mean inspiratory time (TiM), mean total respiratory cycle time (TtotM), mean expiratory time during exercise (TeM) and mean expiratory time during the last third of exercise (TeM-end), has been calculated. Results: Both TeM and TeM-end had a good linear correlation with % of E (r = 0,61; p = 0,004 and r = 0,63; p = 0,003). Moreover, by dividing the patients in two groups based on the % of E (>50% and <50%), we observed that patients with higher % of E had longer TeM (TeM: 1,72±0,26sec vs 1,34±0,27sec, p = 0,005) and TeM-end. A good linear correlation has been observed also between TeM and PETCO2 and VE/VCO2 (r = 0,64; p = 0,002 and r = 0,7; p = 0,0005). TeM did not correlated with resting lung function values or inspiratory capacity (IC). Conclusion: The data confirm that distinct physiologic response pattern can be detected at CPET in these patients

Effect of heliox on heart rate kinetics and dynamic hyperinflation during high-intensity exercise in COPD

Respiratory mechanical abnormalities in patients with chronic obstructive pulmonary disease (COPD) may impair cardiodynamic responses and slow down heart rate (HR) kinetics compared with normal resulting in reduced convective oxygen delivery during exercise. We reasoned that heliox breathing (79% helium-21% oxygen) and the attendant reduction of operating lung volumes should accelerate HR kinetics in the transition from rest to high-intensity exercise. Eleven male ambulatory patients with clinically stable COPD undertook constant work-rate cycle testing at 80% of each individuals' maximum work capacity while breathing room air (RA) or heliox (HX), randomly. Mean response time (MRT) for HR and dynamic end-expiratory lung volume (EELV) were measured. Resting EELV was not affected by HX breathing, while exercise EELV decreased significantly by 0.23 L at isotime during HX breathing compared with RA. During FIX breathing, MRT for HR significantly accelerated (p = 0.002) by an average of 20 s (i.e., 17%). Speeded MRT for HR correlated with indices of reduced lung hyperinflation, such as EELV at isotime (r = 0.88, p = 0.03), and with improved exercise endurance time (r = -0.64, p = 0.03). The results confirm that HX-induced reduction of dynamic lung hyperinflation is associated with consistent improvement in indices of cardio-circulatory function such as HR kinetics in the rest-to-exercise transition in COPD patients

Effect of camptocormia on lung volumes in Parkinson's disease

Camptocormia is defined as an abnormal flexion of the thoracolumbar spine of 45 degrees, or more, that typically increases during walking or standing and completely disappears in the supine position. Camptocormia may occur in patients with Parkinson's disease; when it does, it is usually associated with greater disease severity. Respiratory complications, which may be secondary to abnormal chest function, are one of the most frequent causes of death in patients with Parkinson's disease. No data on lung volumes are available for Parkinson's disease patients with camptocormia. The aim of this study was to evaluate the effect of camptocormia on lung function. Eleven patients with Parkinson's disease and camptocormia and ten age-matched healthy subjects underwent lung spirometry (in the standing position, inclining the trunk forward at approx. 45 degrees and supine) measurement of arterial oxygen-hemoglobin saturation and heart rate. We found that Parkinson's disease with camptocormia is not associated with major clinical changes in lung volumes. (C) 2013 Elsevier B.V. All rights reserved

Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients

Non-invasive ventilation (NIV) is an effective treatment in patients with acute exacerbation of COPD (AECOPD). However, it may induce post-hypercapnic metabolic alkalosis (MA). This study aims to evaluate the effect of acetazolamide (ACET) in AECOPD patients treated with NIV