Chest
Volume 92, Issue 2, August 1987, Pages 253-259
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Predicting Maximal Exercise Ventilation in Patients with Chronic Obstructive Pulmonary Disease

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Shortness of breath is a chief complaint of many individuals with cardiopulmonary diseases. Exercise testing is often used to help differentiate cardiac from pulmonary involvement. In assessing pulmonary dysfunction during exercise it is essential to know the point at which ventilatory limitation will occur. Numerous authors have presented regression equations based on the FEV1 for predicting either MVV or V˙emax. Resting pulmonary function studies were obtained from 53 patients with COPD. Symptom-limited maximal exercise testing was completed on a cycle ergometer using increments of 10 watts/min. Each regression equation for predicting MVV or V˙emax was then applied to the data set. Results showed that the FEV1 correlated with the measured V˙emax (r = .81) as did PEF (r = .81), MVV (r = .78), IC (r = .78), Dco (r = .68), V˙a (r = .67), V˙e (r = .65) and FVC (r = .64). Single post-bronchodilator FEV, measurements ranged from 0.56 to 1.64 L (mean 1.0 L) while V˙emax ranged from 16 to 78 L/min (mean 37.69 L/min). The equation V˙emax = 37.5 × FEV1 was the most robust equation found in the literature for predicting V˙emax in this sample. This equation was not statistically different from the line of identity when predicted V˙emax was plotted against the measured V˙emax. The intercept was 0.91 with a slope of 0.98. In addition, this equation had a smaller mean square error in predicting V˙emax than those of the other equations investigated.

Section snippets

Subjects

Fifty-three patients, 36 men and 17 women, with chronic obstructive pulmonary disease were studied. All patients met the following criteria: 1) radiographic evidence of COPD; 2) ratio of FEV1 to FVC (FEV1/FVC) of less than 50 percent; 3) total lung capacity of greater than 80 percent of predicted; 4) change in FEV1 of less than 20 percent following bronchodilator administration; 5) V˙emax to MVV ratio greater than 80 percent; and 6) no underlying cardiac symptomatology which would limit

RESULTS

The study group (Table 2) consisted of 36 men and 17 women with a racial composition of 49 whites, three blacks and one Hispanic. Ages ranged from 38 to 75 years (mean 62 years). FEV1 ranged from 0.56 to 1.64 L. The mean values for TLC, VC and IC were 7.25, 2.78 and 1.83 L respectively.

Exercise capacity, presented in Table 3, varied greatly among patients tested. Peak workload ranged from 10 to 100 watts, peak oxygen uptake ranged from 347 to 2,470 ml/min, and maximal ventilation ranged from 16

DISCUSSION

In patients with COPD, the ventilatory pump undoubtedly contributes to exercise limitation.22 Thus, by understanding the ventilatory limits imposed by the disease process, a more accurate assessment of exercise limitation can be made. In addition, this knowledge will help the clinician judge the true ventilatory reserve prior to exercise testing, thus allowing for selection of an appropriate exercise protocol.

Currently, two distinct types of regression equations are employed for predicting

ACKNOWLEDGMENT

We wish to thank Gerri Dingler for typing this manuscript; Willie Blevins, David Campbell, Marla Harter, Pat Smith, Barbara Pruitt, Judy Berry, Dana Griner and Jon Divine for their technical assistance.

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    Supported in part by a grant from Ray and Ipha Morrow.

    Manuscript received May 12; revision accepted December 16.

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