Effect of inspiratory pressure support on exercise tolerance and breathlessness in patients with severe stable chronic obstructive pulmonary disease.

S E Keilty, J Ponte, T A Fleming, J Moxham

Department of Thoracic Medicine, King's College School of Medicine and Dentistry, London, UK.

BACKGROUND--In patients with chronic obstructive pulmonary disease exercise tolerance is commonly limited by breathlessness. These patients have an increased ventilatory load at rest which is exacerbated during exercise. The purpose of this study was to investigate the effect of supporting ventilation by non-invasive inspiratory pressure support (IPS) during submaximal treadmill exercise in such patients to see if they would experience less breathlessness and improve their exercise capacity. METHODS--Eight men with disabling breathlessness due to chronic obstructive pulmonary disease (COPD) (mean (SD) FEV1 0.73 (0.2) 1) were studied. Patients walked on a treadmill until their sensation of breathlessness, scored at one minute intervals, reached level 5 ("severe") on the 10-point Borg scale. Studies were performed with IPS (mean airway pressure 12-15 cm H2O), continuous positive airway pressure (CPAP 6 cm H2O), and with oxygen (2 l/min via a mask) in random order on three separate days. Each of these walks was compared with a control walk using a sham circuit (breathing air via an oxygen mask at 2 l/min from an unlabelled cylinder), and with a baseline walk in which patients walked freely on the treadmill. On cessation of exercise, distance achieved and a leg fatigue score were recorded. RESULTS--No patients stopped due to leg fatigue, all stopping only when their sensation of breathlessness had reached level 5 on the Borg scale. IPS improved median walking distance by 62% compared with the control walk (sham circuit). There was no change in walking distance with either CPAP or oxygen at 2 l/min. There was no difference between the control and the baseline walks. CONCLUSIONS--Inspiratory pressure support can reduce breathlessness and increase exercise tolerance to submaximal treadmill exercise in patients with COPD. This could have implications for the rehabilitation of these severely disabled patients.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Aboussouan, L. (2009). Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chronic Respiratory Disease 6: 231-249 [Abstract]  
• Decramer, M. (2009). Response of the respiratory muscles to rehabilitation in COPD. J. Appl. Physiol. 107: 971-976 [Abstract] [Full Text]  
• Clini, E. M., Ambrosino, N. (2008). Nonpharmacological treatment and relief of symptoms in COPD. Eur Respir J 32: 218-228 [Abstract] [Full Text]  
• Dreher, M., Storre, J. H., Windisch, W. (2007). Noninvasive ventilation during walking in patients with severe COPD: a randomised cross-over trial. Eur Respir J 29: 930-936 [Abstract] [Full Text]  
• Nici, L., Donner, C., Wouters, E., Zuwallack, R., Ambrosino, N., Bourbeau, J., Carone, M., Celli, B., Engelen, M., Fahy, B., Garvey, C., Goldstein, R., Gosselink, R., Lareau, S., MacIntyre, N., Maltais, F., Morgan, M., O'Donnell, D., Prefault, C., Reardon, J., Rochester, C., Schols, A., Singh, S., Troosters, T., on behalf of the ATS/ERS Pulmonary Rehabilitation, (2006). American thoracic society/european respiratory society statement on pulmonary rehabilitation.. Am. J. Respir. Crit. Care Med. 173: 1390-1413 [Full Text]  
• O'Donnell, D. E. (2006). Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease.. Proc Am Thorac Soc 3: 180-184 [Abstract] [Full Text]  
• Troosters, T., Casaburi, R., Gosselink, R., Decramer, M. (2005). Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 172: 19-38 [Full Text]  
• Ambrosino, N., Strambi, S. (2004). New strategies to improve exercise tolerance in chronic obstructive pulmonary disease. Eur Respir J 24: 313-322 [Abstract] [Full Text]  
• van 't Hul, A., Gosselink, R., Hollander, P., Postmus, P., Kwakkel, G. (2004). Acute effects of inspiratory pressure support during exercise in patients with COPD. Eur Respir J 23: 34-40 [Abstract] [Full Text]  
• Highcock, M.P., Shneerson, J.M., Smith, I.E. (2003). Increased ventilation with NiIPPV does not necessarily improve exercise capacity in COPD. Eur Respir J 22: 100-105 [Abstract] [Full Text]  
• Hawkins, P, Johnson, L C, Nikoletou, D, Hamnegard, C-H, Sherwood, R, Polkey, M I, Moxham, J (2002). Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease. Thorax 57: 853-859 [Abstract] [Full Text]  
• Johnson, J. E., Gavin, D. J., Adams-Dramiga, S. (2002). Effects of Training With Heliox and Noninvasive Positive Pressure Ventilation on Exercise Ability in Patients With Severe COPD*. Chest 122: 464-472 [Abstract] [Full Text]  
• Highcock, M. P., Smith, I. E., Shneerson, J. M. (2002). The Effect of Noninvasive Intermittent Positive-Pressure Ventilation During Exercise in Severe Scoliosis*. Chest 121: 1555-1560 [Abstract] [Full Text]  
• Polkey, M. I. (2002). Muscle Metabolism and Exercise Tolerance in COPD*. Chest 121 : 131S-135S [Abstract] [Full Text]  
• MEHTA, S., HILL, N. S. (2001). Noninvasive Ventilation. Am. J. Respir. Crit. Care Med. 163: 540-577 [Full Text]  
• Steiner, M C, Morgan, M D L (2001). Enhancing physical performance in chronic obstructive pulmonary disease. Thorax 56: 73-77 [Full Text]  
• GARROD, R., MIKELSONS, C., PAUL, E. A., WEDZICHA, J. A. (2000). Randomized Controlled Trial of Domiciliary Noninvasive Positive Pressure Ventilation and Physical Training in Severe Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 162: 1335-1341 [Abstract] [Full Text]  
• Polkey, M. I, Hawkins, P., Kyroussis, D., Ellum, S. G, Sherwood, R., Moxham, J. (2000). Inspiratory pressure support prolongs exercise induced lactataemia in severe COPD. Thorax 55: 547-549 [Abstract] [Full Text]