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Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease
Aims: In contrast to cardiovascular disease, low rather than high ventilatory inefficiency, evaluated by the minute ventilation-carbon dioxide output (V'(E)-V'(CO2))-slope, has been recognized as being related to greater disease severity in chronic obstructive pulmonary disease (COPD). To...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8355815/ https://www.ncbi.nlm.nih.gov/pubmed/34393822 http://dx.doi.org/10.3389/fphys.2021.703977 |
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author | Miki, Keisuke Tsujino, Kazuyuki Maekura, Ryoji Matsuki, Takanori Miki, Mari Hashimoto, Hisako Kagawa, Hiroyuki Kawasaki, Takahiro Kuge, Tomoki Kida, Hiroshi |
author_facet | Miki, Keisuke Tsujino, Kazuyuki Maekura, Ryoji Matsuki, Takanori Miki, Mari Hashimoto, Hisako Kagawa, Hiroyuki Kawasaki, Takahiro Kuge, Tomoki Kida, Hiroshi |
author_sort | Miki, Keisuke |
collection | PubMed |
description | Aims: In contrast to cardiovascular disease, low rather than high ventilatory inefficiency, evaluated by the minute ventilation-carbon dioxide output (V'(E)-V'(CO2))-slope, has been recognized as being related to greater disease severity in chronic obstructive pulmonary disease (COPD). To better care for patients with cardiopulmonary disease, understanding the physiological correlation between ventilatory inefficiency and exercise limitation is necessary, but remains inadequate. Given that oxygen uptake (V'(O2)) evaluated by cardiopulmonary exercise testing (CPET) depends on both the ventilatory capability and oxygen extraction, i.e., the difference between inspiratory and expiratory oxygen concentration (ΔFO(2)), the aim of this study was to investigate the correlations between V'(E)-V'(CO2)-slope and the ΔFO(2) during exercise and their physiological implications in patients with COPD. Methods: A total of 156 COPD patients (mean age, 70.9 ± 7.2 years) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV and 16 controls underwent CPET with blood gas analysis. Results: With the progression of COPD, mechanical ventilatory constraints together with a slower respiratory frequency led to exertional respiratory acidosis. In GOLD IV cases, (1) decrease in the dependence of reduced peak V'(O2) on V'(E) led to an increase in its dependence on peak ΔFO(2) during exercise; and (2) the ΔFO(2)-V'(CO2)-slope became steeper, correlating with the severity of exertional respiratory acidosis (r = 0.6359, p < 0.0001). No significant differences in peak exercise ΔFO(2) or V'(E)-V'(CO2)-slope were observed among the various GOLD stages. In all subjects, including controls, peak exercise ΔFO(2) had the strongest correlation with the V'(E)-V'(CO2)-slope (r = −0.8835, p < 0.0001) and correlated well with body mass index (r = 0.3871, p < 0.0001), although it did not correlate with the heart rate-V'(CO2)-relationship and V'(E). Conclusions: Ventilatory efficiency related to CO(2) clearance might depend on exertional oxygen extraction in the body. Measuring ΔFO(2) might be a key component for identifying ventilatory inefficiency and oxygen availability. Increasing ΔFO(2) would help to improve ventilatory inefficiency and exercise tolerance separately from cardiac and ventilatory capability in COPD patients. |
format | Online Article Text |
id | pubmed-8355815 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83558152021-08-12 Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease Miki, Keisuke Tsujino, Kazuyuki Maekura, Ryoji Matsuki, Takanori Miki, Mari Hashimoto, Hisako Kagawa, Hiroyuki Kawasaki, Takahiro Kuge, Tomoki Kida, Hiroshi Front Physiol Physiology Aims: In contrast to cardiovascular disease, low rather than high ventilatory inefficiency, evaluated by the minute ventilation-carbon dioxide output (V'(E)-V'(CO2))-slope, has been recognized as being related to greater disease severity in chronic obstructive pulmonary disease (COPD). To better care for patients with cardiopulmonary disease, understanding the physiological correlation between ventilatory inefficiency and exercise limitation is necessary, but remains inadequate. Given that oxygen uptake (V'(O2)) evaluated by cardiopulmonary exercise testing (CPET) depends on both the ventilatory capability and oxygen extraction, i.e., the difference between inspiratory and expiratory oxygen concentration (ΔFO(2)), the aim of this study was to investigate the correlations between V'(E)-V'(CO2)-slope and the ΔFO(2) during exercise and their physiological implications in patients with COPD. Methods: A total of 156 COPD patients (mean age, 70.9 ± 7.2 years) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV and 16 controls underwent CPET with blood gas analysis. Results: With the progression of COPD, mechanical ventilatory constraints together with a slower respiratory frequency led to exertional respiratory acidosis. In GOLD IV cases, (1) decrease in the dependence of reduced peak V'(O2) on V'(E) led to an increase in its dependence on peak ΔFO(2) during exercise; and (2) the ΔFO(2)-V'(CO2)-slope became steeper, correlating with the severity of exertional respiratory acidosis (r = 0.6359, p < 0.0001). No significant differences in peak exercise ΔFO(2) or V'(E)-V'(CO2)-slope were observed among the various GOLD stages. In all subjects, including controls, peak exercise ΔFO(2) had the strongest correlation with the V'(E)-V'(CO2)-slope (r = −0.8835, p < 0.0001) and correlated well with body mass index (r = 0.3871, p < 0.0001), although it did not correlate with the heart rate-V'(CO2)-relationship and V'(E). Conclusions: Ventilatory efficiency related to CO(2) clearance might depend on exertional oxygen extraction in the body. Measuring ΔFO(2) might be a key component for identifying ventilatory inefficiency and oxygen availability. Increasing ΔFO(2) would help to improve ventilatory inefficiency and exercise tolerance separately from cardiac and ventilatory capability in COPD patients. Frontiers Media S.A. 2021-07-28 /pmc/articles/PMC8355815/ /pubmed/34393822 http://dx.doi.org/10.3389/fphys.2021.703977 Text en Copyright © 2021 Miki, Tsujino, Maekura, Matsuki, Miki, Hashimoto, Kagawa, Kawasaki, Kuge and Kida. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Physiology Miki, Keisuke Tsujino, Kazuyuki Maekura, Ryoji Matsuki, Takanori Miki, Mari Hashimoto, Hisako Kagawa, Hiroyuki Kawasaki, Takahiro Kuge, Tomoki Kida, Hiroshi Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease |
title | Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease |
title_full | Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease |
title_fullStr | Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease |
title_full_unstemmed | Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease |
title_short | Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease |
title_sort | oxygen extraction based on inspiratory and expiratory gas analysis identifies ventilatory inefficiency in chronic obstructive pulmonary disease |
topic | Physiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8355815/ https://www.ncbi.nlm.nih.gov/pubmed/34393822 http://dx.doi.org/10.3389/fphys.2021.703977 |
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