Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiologic Responses in Chronic Airflow Limitation
Ekström, M. LU
and Jensen, D.
(2024)
In Chest
166(1).
p.81-94
- Abstract
- Background: Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. Research Question: How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiologic responses in people with chronic airflow limitation (CAL)? Study Design and Methods: An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output, rate of oxygen uptake, and minute ventilation at peak exercise, using normative reference equations... (More)
- Background: Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. Research Question: How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiologic responses in people with chronic airflow limitation (CAL)? Study Design and Methods: An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output, rate of oxygen uptake, and minute ventilation at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy people; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated. Results: We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40–89 years); FEV1/FVC, 57.3% ± 8.2%; FEV1, 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak rate of oxygen uptake < lower limit of normal) was present in 26%. Relative to peak power output, rate of oxygen uptake, and minute ventilation, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiologic abnormalities during CPET. Interpretation: Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness. © 2024 The Author(s) (Less)
Please use this url to cite or link to this publication:
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- author
- Ekström, M.
LU
and Jensen, D.
- author collaboration
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- dyspnea, exercise capacity, exercise test, reference values
- in
- Chest
- volume
- 166
- issue
- 1
- pages
- 14 pages
- publisher
- American College of Chest Physicians
- external identifiers
-
- scopus:85194032488
- pmid:38423279
- ISSN
- 0012-3692
- DOI
- 10.1016/j.chest.2024.02.034
- language
- English
- LU publication?
- yes
- id
- 77a6ea07-ed5d-4f5f-95d6-8d3626516665
- date added to LUP
- 2024-08-22 10:55:17
- date last changed
- 2024-08-23 03:00:03
@article{77a6ea07-ed5d-4f5f-95d6-8d3626516665,
abstract = {{Background: Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. Research Question: How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiologic responses in people with chronic airflow limitation (CAL)? Study Design and Methods: An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output, rate of oxygen uptake, and minute ventilation at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy people; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated. Results: We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40–89 years); FEV1/FVC, 57.3% ± 8.2%; FEV1, 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak rate of oxygen uptake < lower limit of normal) was present in 26%. Relative to peak power output, rate of oxygen uptake, and minute ventilation, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiologic abnormalities during CPET. Interpretation: Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness. © 2024 The Author(s)}},
author = {{Ekström, M. and Jensen, D.}},
issn = {{0012-3692}},
keywords = {{dyspnea; exercise capacity; exercise test; reference values}},
language = {{eng}},
number = {{1}},
pages = {{81--94}},
publisher = {{American College of Chest Physicians}},
series = {{Chest}},
title = {{Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiologic Responses in Chronic Airflow Limitation}},
url = {{http://dx.doi.org/10.1016/j.chest.2024.02.034}},
doi = {{10.1016/j.chest.2024.02.034}},
volume = {{166}},
year = {{2024}},
}