Does carbon dioxide retention during exercise predict a more rapid decline in FEV1 in cystic fibrosis?
BACKGROUND
Carbon dioxide (CO2) retention during exercise is uncommon in mild to moderate lung disease in cystic fibrosis (CF). The ability to deal with increased CO2 is dependent on the degree of airflow limitation and inherent CO2 sensitivity. CO2 retention (CO2R) can be defined as a rise in P(ET)CO2 tension of > or =5 mm Hg with exercise together with a failure to reduce P(ET)CO2 tension after peak work by at least 3 mm Hg by the termination of exercise.


OBJECTIVE
To ascertain if carbon dioxide retention during exercise is associated with more rapid decline in lung function.


METHODS
Annual spirometric and exercise data from 58 children aged 11-15 years, with moderate CF lung disease between 1996 and 2002 were analysed.


RESULTS
The mean FEV1 at baseline for the two groups was similar; the CO2R group (n = 15) was 62% and the non-CO2 retention group (CO2NR) was 64% (n = 43). The decline in FEV1 after 12 months was -3.2% (SD 1.1) in the CO2R group and -2.3% (SD 0.9) in the CO2NR group. The decline after 24 months was -6.3% (SD 1.3) and -1.8% (SD 1.1) respectively. After 36 months, the decline in FEV1 was -5.3% (SD 1.2) and -2.6% (SD 1.1) respectively. The overall decline in lung function was 14.8% (SD 2.1) in the CO2R group and 6.7% (SD 1.8) in the CO2NR group. Using the primary outcome measure as a decline in FEV(1) of >9%, final multivariate analysis showed that the relative risks for this model were (95% CIs in parentheses): DeltaP(ET)CO2 11.61 (3.41 to 24.12), peak VO2 1.23 (1.10 to 1.43), and initial FEV(1) 1.14 (1.02 to 1.28).


CONCLUSIONS
Results show that the inability to defend carbon dioxide during exercise is associated with a more rapid decline in lung function.
Javadpour
S M
SM
Department of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Selvadurai
H
H
Wilkes
D L
DL
Schneiderman-Walker
J
J
Coates
A L
AL
D000293:Adolescent; D002245:Carbon Dioxide / Q000378:metabolism*; D002648:Child; D003550:Cystic Fibrosis / Q000378:metabolism* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D016017:Odds Ratio; D011659:Pulmonary Gas Exchange; D012189:Retrospective Studies; D018570:Risk Assessment; D013147:Spirometry; D013997:Time Factors
D002245:Carbon Dioxide