title: Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing.
abstract: Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET.
authors: Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada odonnell@queensu.ca.
authors: Denis E
authors: DE
authors: O'Donnell
authors: Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada Dept of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors: Amany F
authors: AF
authors: Elbehairy
authors: Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada Faculty of Physical Education for Men, Alexandria University, Alexandria, Egypt.
authors: Azmy
authors: A
authors: Faisal
authors: Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada.
authors: Katherine A
authors: KA
authors: Webb
authors: Dept of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada.
authors: J Alberto
authors: JA
authors: Neder
authors: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors: Donald A
authors: DA
authors: Mahler
mesh_terms: D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D015444:Exercise; D005080:Exercise Test; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D012119:Respiration; D012132:Respiratory Muscles / Q000503:physiopathology; D012307:Risk Factors