title: Respiratory constraints during activities in daily life and the impact on health status in patients with early-stage COPD: a cross-sectional study.
abstract: In patients with chronic obstructive pulmonary disease (COPD), exercise capacity is reduced, resulting over time in physical inactivity and worsened health status. It is unknown whether ventilatory constraints occur during activities of daily life (ADL) in early stages of COPD. The aim of this study was to assess respiratory mechanics during ADL and to study its consequences on dyspnoea, physical activity and health status in early-stage COPD compared with healthy controls. In this cross-sectional study, 39 early-stage COPD patients (mean FEV188±s.d. 12% predicted) and 20 controls performed 3 ADL: climbing stairs, vacuum cleaning and displacing groceries in a cupboard. Respiratory mechanics were measured during ADL. Physical activity was measured with accelerometry. Health status was assessed by the Nijmegen Clinical Screening Instrument. Compared with controls, COPD patients had greater ventilatory inefficiency and higher ventilatory requirements during ADL (P<0.05). Dyspnoea scores were increased in COPD compared with controls (P<0.001). During ADL, >50% of the patients developed dynamic hyperinflation in contrast to 10-35% of the controls. Higher dyspnoea was scored by patients with dynamic hyperinflation. Physical activity was low but comparable between both groups. From the patients, 55-84% experienced mild-to-severe problems in health status compared with 5-25% of the controls. Significant ventilatory constraints already occur in early-stage COPD patients during common ADL and result in increased dyspnoea. Physical activity level is not yet reduced, but many patients already experience limitations in health status. These findings reinforce the importance of early diagnosis of COPD and assessment of more than just spirometry.
authors.affiliation: Department of Pulmonary Diseases, Radboud university medical center, Nijmegen, The Netherlands.|Department of Pulmonary Diseases, University center for chronic diseases Dekkerswald, Groesbeek, The Netherlands.
authors.forename: Hanneke Ac
authors.initials: HA
authors.lastname: van Helvoort
authors.affiliation: Department of Pulmonary Diseases, Radboud university medical center, Nijmegen, The Netherlands.|Department of Pulmonary Diseases, University center for chronic diseases Dekkerswald, Groesbeek, The Netherlands.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Willems
authors.affiliation: Department of Pulmonary Diseases, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Pn Richard
authors.initials: PR
authors.lastname: Dekhuijzen
authors.affiliation: Department of Pulmonary Diseases, Radboud university medical center, Nijmegen, The Netherlands.|Department of Pulmonary Diseases, University center for chronic diseases Dekkerswald, Groesbeek, The Netherlands.
authors.forename: Hieronymus Wh
authors.initials: HW
authors.lastname: van Hees
authors.affiliation: Department of Pulmonary Diseases, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Yvonne F
authors.initials: YF
authors.lastname: Heijdra
mesh_terms: D061725:Accelerometry; D000203:Activities of Daily Living; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology*; D015444:Exercise; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D012123:Pulmonary Ventilation; D015656:Respiratory Mechanics; D011795:Surveys and Questionnaires