Patterns of dynamic hyperinflation during execrise and recovery in patients with severe chronic obstructive pulmonary disease

Ioannis Vogiatzis ^1*, Olga Georgiadou ¹, Spyretta Golemati ¹, Andrea Aliverti ¹, Epaminondas Kosmas ¹, Emmanouil Kastanakis ¹, Nikos Geladas ¹, Antonia Koutsoukou ¹, Serafeim Nanas ¹, Spyros Zakynthinos ¹ and Charis Roussos ¹

¹ University of Athens, Greece

^* To whom correspondence should be addressed. E-mail: gianvog{at}phed.uoa.gr.

Accepted 2 June 2005

Abstract

Background: Not all patients with severe chronic obstructive pulmonary disease (COPD) progressively hyperinflate during symptom-limited exercise. We investigated the pattern of change in chest wall volumes (Vcw) in patients with severe COPD who progressively hyperinflate during exercise and those who do not.

Methods: Twenty patients with FEV1 of 35 (2) % predicted were studied during a ramp-incremental cycling test to the limit of tolerance (Wpeak). Changes in Vcw at the end of expiration (EEVcw), inspiration (EIVcw) and at total lung capacity (TLCVcw) were computed by Optoelectronic Plethysmography (OEP) during exercise and recovery.

Results: Two significantly different patterns of change in EEVcw were observed during exercise in our patients. Twelve patients exhibited a progressive significant increase in EEVcw during exercise (early hyperinflators, EH) amounting to 750 (90) ml at Wpeak. In contrast, in all 8 remaining patients EEVcw remained unchanged up to 66% Wpeak, whilst it significantly increased by 210 (80) ml at Wpeak (late hyperinflators, LH). Although at the limit of tolerance the increase in EEVcw was significantly greater in EH, both groups reached similar Wpeak and breathed with a tidal EIVcw that closely approached TLCVcw: [EIVcw/TLCVcw (%): 93 (1) and 93 (3), respectively]. EEVcw was increased by 254 (130) ml above baseline 3-min post-exercise only in EH.

Conclusions: Our patients with severe COPD exhibited two patterns during exercise, namely early and late hyperinflation. In the EH group, hyperinflation may take several minutes before is fully reversed after termination of exercise.

Keywords: COPD, dynamic hyperinflation, exercise tolerance

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