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Phenotyping Exertional Breathlessness Using Cardiopulmonary Cycle Exercise Testing in People With Chronic Airflow Limitation

Ekström, Magnus LU orcid ; Li, Pei Zhi ; Lewthwaite, Hayley ; Bourbeau, Jean ; Tan, Wan C. and Jensen, Dennis (2025) In Chest 168(2). p.379-389
Abstract

Background: Exertional breathlessness is a cardinal symptom of people with chronic airflow limitation (CAL) and can be evaluated using cardiopulmonary exercise testing (CPET). Research Question: Does abnormally high exertional breathlessness in relationship to the rate of oxygen uptake (V′O2) and minute ventilation (V′E) indicate different underlying pathophysiologic mechanisms and clinical characteristics in people with CAL? Study Design and Methods: Analysis of people aged ≥ 40 years with CAL (FEV1 to FVC ratio after bronchodilation less than lower limit of normal) undergoing symptom-limited incremental cycle CPET in the Canadian Cohort Obstructive Lung Disease study. Using published normative... (More)

Background: Exertional breathlessness is a cardinal symptom of people with chronic airflow limitation (CAL) and can be evaluated using cardiopulmonary exercise testing (CPET). Research Question: Does abnormally high exertional breathlessness in relationship to the rate of oxygen uptake (V′O2) and minute ventilation (V′E) indicate different underlying pathophysiologic mechanisms and clinical characteristics in people with CAL? Study Design and Methods: Analysis of people aged ≥ 40 years with CAL (FEV1 to FVC ratio after bronchodilation less than lower limit of normal) undergoing symptom-limited incremental cycle CPET in the Canadian Cohort Obstructive Lung Disease study. Using published normative references, breathlessness phenotypes at peak exercise were categorized as abnormal (Borg 0-10 scale intensity rating more than upper limit of normal) by V′O2 alone, abnormal by both V′O2 and V′E, or normal by both V′O2 and V′E. Exercise physiologic responses and clinical characteristics were compared between groups. Results: We included 325 people (44% female) with CAL (mean [SD]) FEV1, 75.4 [17.5] % predicted). Compared with the normal by both V′O2 and V′E group (n = 237 [73%]), the abnormal by V′O2 only group (n = 29 [9%]) showed lower pulmonary diffusing capacity and greater exercise ventilatory inefficiency, whereas the abnormal by both V′O2 and V′E group (n = 50 [15%]) showed even worse lung function, dynamic critical inspiratory constraints, and exertional breathlessness along with greater symptom burden in daily life, lower physical activity, and worse health status. Interpretation: Our results show that exertional breathlessness phenotyped in relationship to V′O2 and V′E using normative reference equations enables multivariable analyses of underlying symptom mechanisms and associated clinical characteristics.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
dyspnea, exercise capacity, mechanisms, outcomes, ventilation
in
Chest
volume
168
issue
2
pages
11 pages
publisher
American College of Chest Physicians
external identifiers
  • pmid:40081656
  • scopus:105010430896
ISSN
0012-3692
DOI
10.1016/j.chest.2025.02.033
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s)
id
29c6a8bc-e104-4f01-8cb7-b8c79021ceea
date added to LUP
2025-12-12 15:40:36
date last changed
2025-12-13 03:00:05
@article{29c6a8bc-e104-4f01-8cb7-b8c79021ceea,
  abstract     = {{<p>Background: Exertional breathlessness is a cardinal symptom of people with chronic airflow limitation (CAL) and can be evaluated using cardiopulmonary exercise testing (CPET). Research Question: Does abnormally high exertional breathlessness in relationship to the rate of oxygen uptake (V′O<sub>2</sub>) and minute ventilation (V′<sub>E</sub>) indicate different underlying pathophysiologic mechanisms and clinical characteristics in people with CAL? Study Design and Methods: Analysis of people aged ≥ 40 years with CAL (FEV<sub>1</sub> to FVC ratio after bronchodilation less than lower limit of normal) undergoing symptom-limited incremental cycle CPET in the Canadian Cohort Obstructive Lung Disease study. Using published normative references, breathlessness phenotypes at peak exercise were categorized as abnormal (Borg 0-10 scale intensity rating more than upper limit of normal) by V′O<sub>2</sub> alone, abnormal by both V′O<sub>2</sub> and V′<sub>E</sub>, or normal by both V′O<sub>2</sub> and V′<sub>E</sub>. Exercise physiologic responses and clinical characteristics were compared between groups. Results: We included 325 people (44% female) with CAL (mean [SD]) FEV<sub>1</sub>, 75.4 [17.5] % predicted). Compared with the normal by both V′O<sub>2</sub> and V′<sub>E</sub> group (n = 237 [73%]), the abnormal by V′O<sub>2</sub> only group (n = 29 [9%]) showed lower pulmonary diffusing capacity and greater exercise ventilatory inefficiency, whereas the abnormal by both V′O<sub>2</sub> and V′<sub>E</sub> group (n = 50 [15%]) showed even worse lung function, dynamic critical inspiratory constraints, and exertional breathlessness along with greater symptom burden in daily life, lower physical activity, and worse health status. Interpretation: Our results show that exertional breathlessness phenotyped in relationship to V′O<sub>2</sub> and V′<sub>E</sub> using normative reference equations enables multivariable analyses of underlying symptom mechanisms and associated clinical characteristics.</p>}},
  author       = {{Ekström, Magnus and Li, Pei Zhi and Lewthwaite, Hayley and Bourbeau, Jean and Tan, Wan C. and Jensen, Dennis}},
  issn         = {{0012-3692}},
  keywords     = {{dyspnea; exercise capacity; mechanisms; outcomes; ventilation}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{379--389}},
  publisher    = {{American College of Chest Physicians}},
  series       = {{Chest}},
  title        = {{Phenotyping Exertional Breathlessness Using Cardiopulmonary Cycle Exercise Testing in People With Chronic Airflow Limitation}},
  url          = {{http://dx.doi.org/10.1016/j.chest.2025.02.033}},
  doi          = {{10.1016/j.chest.2025.02.033}},
  volume       = {{168}},
  year         = {{2025}},
}