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Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing

Ekström, Magnus LU orcid ; Li, Pei Zhi ; Lewthwaite, Hayley ; Bourbeau, Jean ; Tan, Wan C. ; Schiöler, Linus ; Brotto, Andrew ; Stickland, Michael K. and Jensen, Dennis (2024) In Annals of the American Thoracic Society 21(1). p.56-67
Abstract

Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0–10 category ratio) response in men and women aged >40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged >40 years undergoing symptom-limited incremental cycle CPET (10 W/ min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories ,5 pack-years and... (More)

Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0–10 category ratio) response in men and women aged >40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged >40 years undergoing symptom-limited incremental cycle CPET (10 W/ min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories ,5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0–10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression.Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (n = 86) of healthy Canadian adults. Results: We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42–91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m2. Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81–0.92, C statistic for women = 0.81–0.96). Conclusions: Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.

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author
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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
dyspnea, exercise capacity, normal values
in
Annals of the American Thoracic Society
volume
21
issue
1
pages
12 pages
publisher
American Thoracic Society
external identifiers
  • pmid:37708387
  • scopus:85181395951
ISSN
2329-6933
DOI
10.1513/AnnalsATS.202305-394OC
language
English
LU publication?
yes
id
40a6a392-b54b-4d5e-b28b-53a74cc5d6bb
date added to LUP
2024-02-07 15:34:33
date last changed
2024-04-23 23:14:21
@article{40a6a392-b54b-4d5e-b28b-53a74cc5d6bb,
  abstract     = {{<p>Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0–10 category ratio) response in men and women aged &gt;40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged &gt;40 years undergoing symptom-limited incremental cycle CPET (10 W/ min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories ,5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0–10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression.Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (n = 86) of healthy Canadian adults. Results: We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42–91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m2. Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81–0.92, C statistic for women = 0.81–0.96). Conclusions: Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.</p>}},
  author       = {{Ekström, Magnus and Li, Pei Zhi and Lewthwaite, Hayley and Bourbeau, Jean and Tan, Wan C. and Schiöler, Linus and Brotto, Andrew and Stickland, Michael K. and Jensen, Dennis}},
  issn         = {{2329-6933}},
  keywords     = {{dyspnea; exercise capacity; normal values}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{56--67}},
  publisher    = {{American Thoracic Society}},
  series       = {{Annals of the American Thoracic Society}},
  title        = {{Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing}},
  url          = {{http://dx.doi.org/10.1513/AnnalsATS.202305-394OC}},
  doi          = {{10.1513/AnnalsATS.202305-394OC}},
  volume       = {{21}},
  year         = {{2024}},
}