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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 FEV1 88±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.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterised by chronic inflammation of the airways and lungs, persistent airflow limitation and, often, a progressive decline in lung function
Oxygen uptake was comparable for patients and controls in each activity, ventilation was significantly higher in patients with COPD
COPD patients had greater ventilator inefficiency compared with controls in all three activities of daily life (ADL)
Summary
Chronic obstructive pulmonary disease (COPD) is characterised by chronic inflammation of the airways and lungs, persistent airflow limitation and, often, a progressive decline in lung function. There is growing evidence that even mild airway obstruction is associated with a reduction in exercise capacity and physical activity in patients with COPD.[3,4,5,6] Even before patients are aware of their illness, they often evade some of their (more strenuous) activities to avoid unpleasant symptoms, such as dyspnoea. This can, over time, lead to a negative spiral of worsening symptoms, deconditioning and exercise intolerance, as patients become progressively more sedentary.[7,8]
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