Determinants of exercise-induced oxygen desaturation including pulmonary emphysema in COPD: Results from the ECLIPSE study.
Exercise-induced oxygen desaturation (EID) is related to mortality in patients with chronic obstructive pulmonary disease (COPD). We investigated: (1) the prevalence of EID; (2) the relative-weight of several physiological determinants of EID including pulmonary emphysema, and (3) the relationship of EID with certain patients' clinical characteristics. Data from 2050 COPD patients (age: 63.3 ± 7.1years; FEV1: 48.7 ± 15.7%pred.) were analyzed. The occurrence of EID (SpO2post ≤88%) at the six-minute walking test (6MWT) was investigated in association with emphysema quantified by computed-tomography (QCT), and several clinical characteristics. 435 patients (21%) exhibited EID. Subjects with EID had more QCT-emphysema, lower exercise capacity and worse health-status (BODE, ADO indexes) compared to non-EID. Determinant of EID were obesity (BMI≥30 kg/m2), impaired FEV1(≤44%pred.), moderate or worse emphysema, and low SpO2at rest (≤93%). Linear regression indicated that each 1-point increase on the ADO-score independently elevates odds ratio (≤1.5fold) for EID. About one in five COPD patients in the ECLIPSE cohort present EID. Advanced emphysema is associated with EID. In addition, obesity, severe airflow limitation, and low resting oxygen saturation increase the risk for EID. Patients with EID in GOLD stage II have higher odds to have moderate or worse emphysema compared those with EID in GOLD stage III-IV. Emphysematous patients with high ADO-score should be monitored for EID.
Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany. Electronic address: VAndrianopoulos@schoen-kliniken.de.
Vasileios
V
Andrianopoulos
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: bcelli@copdnet.org.
Bartolome R
BR
Celli
Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. Electronic address: fritsfranssen@ciro-horn.nl.
Frits M E
FM
Franssen
Department of Respiratory Medicine, School of Clinical Science, University of Liverpool, United Kingdom. Electronic address: vpinto@copdnet.org.
Victor M
VM
Pinto-Plata
Institute of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, United Kingdom. Electronic address: pmacal@liverpool.ac.uk.
Peter M A
PM
Calverley
Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Electronic address: lowievanfleteren@ciro-horn.nl.
Lowie E G W
LE
Vanfleteren
Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Greece. Electronic address: gianvog@phed.uoa.gr.
Ioannis
I
Vogiatzis
Centre for Respiratory Medicine and Allergy, University of Manchester, UK. Electronic address: Jorgen.Vestbo@manchester.ac.uk.
Jørgen
J
Vestbo
Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain. Electronic address: alvar.agusti@clinic.ub.es.
Alvar
A
Agusti
Department of Clinical Science, University of Bergen, Bergen, Norway. Electronic address: per.bakke@med.uib.no.
Per S
PS
Bakke
Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: srennard@unmc.edu.
Stephen I
SI
Rennard
Medical Research Council Centre for Inflammation Research, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom. Electronic address: w.macnee@ed.ac.uk.
William
W
MacNee
GSK Research and Development, King of Prussia, Philadelphia, PA, USA. Electronic address: Ruth.M.Tal-Singer@gsk.com.
Ruth
R
Tal-Singer
GSK Research Triangle Park, NC, USA. Electronic address: julie.c.yates@gsk.com.
Julie C
JC
Yates
Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Electronic address: e.wouters@mumc.nl.
Emiel F M
EF
Wouters
Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. Electronic address: martijnspruit@ciro-horn.nl.
Martijn A
MA
Spruit
D000368:Aged; D015992:Body Mass Index; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood* / Q000378:metabolism; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D012129:Respiratory Function Tests / Q000379:methods; D012146:Rest / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity / Q000502:physiology; D000070857:Walk Test / Q000379:methods
D010100:Oxygen
6MWD; ADO index; Computed tomography; EID; Emphysema; Imaging