Abstract
Assessment of the ventilatory response to exercise is important in evaluating mechanisms of dyspnea and exercise intolerance in chronic cardiopulmonary diseases. The characteristic mechanical derangements that occur during exercise in chronic respiratory conditions have previously been determined in seminal studies using esophageal catheter pressure-derived measurements. In this brief review, we examine the emerging role and clinical utility of conventional assessment of dynamic respiratory mechanics during exercise testing. Thus, we provide a physiologic rationale for measuring operating lung volumes, breathing pattern, and flow–volume loops during exercise. We consider standardization of inspiratory capacity-derived measurements and their practical implementation in clinical laboratories. We examine the evidence that this iterative approach allows greater refinement in evaluation of ventilatory limitation during exercise than traditional assessments of breathing reserve. We appraise the available data on the reproducibility and responsiveness of this methodology. In particular, we review inspiratory capacity measurement and derived operating lung volumes during exercise. We demonstrate, using recent published data, how systematic evaluation of dynamic mechanical constraints, together with breathing pattern analysis, can provide valuable insights into the nature and extent of physiological impairment contributing to exercise intolerance in individuals with common chronic obstructive and restrictive respiratory disorders.
Highlights
Assessment of the ventilatory response to exercise is important in evaluating mechanisms of dyspnea and exercise intolerance in cardiopulmonary diseases [1]
Our objective is to provide a brief synopsis of characteristic respiratory mechanical responses to exercise, important assumptions, and limitations involved in measuring operating lung volumes using conventional inspiratory capacity (IC) maneuvers, and the rationale for these measurements as they apply to clinical cardiopulmonary exercise tests (CPETs) for the frontline clinician
The differences in exertional breathlessness observed in older adults are at least in part related to increased awareness of VE and changes in respiratory mechanical responses during exercise [23,24,25,26]
Summary
The characteristic mechanical derangements that occur during exercise in chronic respiratory conditions have previously been determined in seminal studies using esophageal catheter pressure-derived measurements. In this brief review, we examine the emerging role and clinical utility of conventional assessment of dynamic respiratory mechanics during exercise testing. We provide a physiologic rationale for measuring operating lung volumes, breathing pattern, and flow–volume loops during exercise. We demonstrate, using recent published data, how systematic evaluation of dynamic mechanical constraints, together with breathing pattern analysis, can provide valuable insights into the nature and extent of physiological impairment contributing to exercise intolerance in individuals with common chronic obstructive and restrictive respiratory disorders
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