Dynamic Ventilatory Reserve During Incremental Exercise: Reference Values and Clinical Validation in Chronic Obstructive Pulmonary Disease

作者：Danilo Cortozi Berton, Franciele Plachi, Matthew D. James, Sandra G. Vincent, Reginald M. Smyth, Nicolle Jasmin Domnik, Devin B. Phillips, Juan Pablo de-Torres, Luíz Eduardo Nery, Denis E. O’Donnell, José Alberto Neder · 发表于：Annals of the American Thoracic Society · 年份：2023 · DOI：10.1513/annalsats.202304-303oc · 被引用次数：15 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Cardiovascular and exercise physiology、Respiratory Support and Mechanisms

Abstract Rationale Ventilatory demand–capacity imbalance, as inferred based on a low ventilatory reserve, is currently assessed only at peak cardiopulmonary exercise testing (CPET). Peak ventilatory reserve, however, is poorly sensitive to the submaximal, dynamic mechanical ventilatory abnormalities that are key to dyspnea genesis and exercise intolerance. Objectives After establishing sex- and age-corrected norms for dynamic ventilatory reserve at progressively higher work rates, we compared peak and dynamic ventilatory reserve for their ability to expose increased exertional dyspnea and poor exercise tolerance in mild to very severe chronic obstructive pulmonary disease (COPD). Methods We analyzed resting functional and incremental CPET data from 275 controls (130 men, aged 19–85 yr) and 359 Global Initiative for Chronic Obstructive Lung Disease patients with stage 1–4 obstruction (203 men) who were prospectively recruited for previous ethically approved studies in three research centers. In addition to peak and dynamic ventilatory reserve (1 − [ventilation / estimated maximal voluntary ventilation] × 100), operating lung volumes and dyspnea scores (0–10 on the Borg scale) were obtained. Results Dynamic ventilatory reserve was asymmetrically distributed in controls; thus, we calculated its centile distribution at every 20 W. The lower limit of normal (lower than the fifth centile) was consistently lower in women and older subjects. Peak and dynamic ventilatory reserve disag...