Patterns of dynamic hyperinflation during exercise and recovery in patients with severe chronic obstructive pulmonary disease.
BACKGROUND
Not all patients with severe chronic obstructive pulmonary disease (COPD) progressively hyperinflate during symptom limited exercise. The pattern of change in chest wall volumes (Vcw) was investigated in patients with severe COPD who progressively hyperinflate during exercise and those who do not.


METHODS
Twenty patients with forced expiratory volume in 1 second (FEV(1)) 35 (2)% predicted were studied during a ramp incremental cycling test to the limit of tolerance (Wpeak). Changes in Vcw at the end of expiration (EEVcw), end of inspiration (EIVcw), and at total lung capacity (TLCVcw) were computed by optoelectronic plethysmography (OEP) during exercise and recovery.


RESULTS
Two significantly different patterns of change in EEVcw were observed during exercise. Twelve patients had a progressive significant increase in EEVcw during exercise (early hyperinflators, EH) amounting to 750 (90) ml at Wpeak. In contrast, in all eight remaining patients EEVcw remained unchanged up to 66% Wpeak but increased significantly by 210 (80) ml at Wpeak (late hyperinflators, LH). Although at the limit of tolerance the increase in EEVcw was significantly greater in EH, both groups reached similar Wpeak and breathed with a tidal EIVcw that closely approached TLCVcw (EIVcw/TLCVcw 93 (1)% and 93 (3)%, respectively). EEVcw was increased by 254 (130) ml above baseline 3 minutes after exercise only in EH.


CONCLUSIONS
Patients with severe COPD exhibit two patterns during exercise: early and late hyperinflation. In those who hyperinflate early, it may take several minutes before the hyperinflation is fully reversed after termination of exercise.
Vogiatzis
I
I
National and Kapodistrian University of Athens Medical School, Thorax Foundation, Centre for Applied Biomedical Research and Education, 10675 Athens, Greece. gianvog@phed.uoa.gr
Georgiadou
O
O
Golemati
S
S
Aliverti
A
A
Kosmas
E
E
Kastanakis
E
E
Geladas
N
N
Koutsoukou
A
A
Nanas
S
S
Zakynthinos
S
S
Roussos
C
C
D015444:Exercise / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D035441:Thoracic Wall / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology; D014797:Vital Capacity / Q000502:physiology