Author Archives: Paul Older

Cardiopulmonary exercise testing to evaluate the exercise capacity of patients with inoperable chronic thromboembolic pulmonary hypertension: An endothelin receptor antagonist improves the peak PETCO2

Hirashiki, Akihiro; Adachi, Shiro; Nakano, Yoshihisa; Kono, Yuji;
Shimazu, Shuzo; Shimizu, Shinya; Morimoto, Ryota; Okumura, Takahiro;
Takeshita, Kyosuke; Yamada, Sumio; Murohara, Toyoaki; Kondo, Takahisa.

Life Sciences, November 2014, Vol. 118 Issue: Number 2 p397-403, 7p;
Abstract: The 6-min walking distance is often used for assessing the
exercise capacity under the treatment with an endothelin receptor
antagonist (ERA) in patients with chronic thromboembolic pulmonary
hypertension (CTEPH). The cardiopulmonary exercise testing (CPX) was
reported to be more useful for the patients with pulmonary arterial
hypertension (PAH), however, few reports exist in patients with
inoperable CTEPH. The aim of this study was to investigate the effects
of an oral dual ERA, bosentan, on exercise capacity using CPX in
patients with PAH and inoperable CTEPH.;

Reference values for cardiopulmonary exercise testing in healthy adults: a systematic review

Paap, Davy; Takken, Tim.
Expert Review of Cardiovascular Therapy, December 2014, Vol. 12 Issue: Number 12 p1439-1453, 15p

Abstract: Reference values (RV) for cardiopulmonary exercise testing (CPET) provide the comparative basis for answering
important questions concerning the normality of exercise response in
patients and significantly impacts the clinical decision-making
process. The aim of this study is to systematically review the
literature on RV for CPET in healthy adults. A secondary aim is to make
appropriate recommendations for the practical use of RV for CPET.
Systematic searches of MEDLINE, EMBASE and PEDro databases up to March
2014 were performed. In the last 30 years, 35 studies with CPET RV were
published. There is no single set of ideal RV; characteristics of each
population are too diverse to pool the data in a single equation.
Therefore, each exercise laboratory must select appropriate sets of RV
that best reflect the characteristics of the population/patient tested,
and equipment and methodology utilized.

Putting lung function and physiology into perspective: cystic fibrosis in adults

Horsley, Alex; Siddiqui, Salman
Respirology, January 2015, Vol. 20 Issue: Number 1 p33-45, 13p
Abstract: Adult cystic fibrosis (CF) is notable for the wide heterogeneity in severity
of disease expression, both between patients and within the lungs of
individuals. Although CFairways disease appears to start in the small
airways, in adults there is typically widespread bronchiectasis,
increased airway secretions, and extensive obstruction and inflammation
of the small airways. The complexity and heterogeneity of airways
disease in CFmeans that although there are many different methods of
assessing and describing lung ‘function’, none of these
single‐dimensional tests is able to provide a comprehensive assessment
of lung physiology across the spectrum seen in adult CF. The most
widely described measure, the forced expiratory volume in 1 s, remains
a useful and simple clinical tool, but is insensitive to early changes
and may be dissociated from other more detailed assessments of disease
severity such as computed tomography. In this review, we also discuss
the use of more sensitive novel assessments such as multiple breath
washout tests and impulse oscillometry, as well as the role of
cardiopulmonary exercise testing. In the future, hyperpolarized gas
magnetic resonance imaging techniques that combine regional structural
and functional information may help us to better understand these
measures, their applications and limitations.;

The global peripheral chemoreflex drive in patients with systemic sclerosis: a rebreathing and exercise study

Ninaber, M.K.; Hamersma,
W.B.G.J.; Schouffoer, A.A.; van ’t Wout, E.F.A.; Stolk, J.. QJM:

An International Journal of Medicine, January 2015, Vol. 108 Issue: Number
1 p33-33, 1p;


Background: Exercise intolerance (EI) in
systemic sclerosis (SSc) is difficult to manage by the clinician. The
peripheral chemoreflex drive compensates for metabolic acidosis during
exercise and may be related to EI. Aim: To assess the global peripheral
chemoreflex drive (GPCD) in patients with SSc at rest and during

Methods: Consecutively tested SSc patients (n = 49) were
evaluated by pulmonary function tests, carbon dioxide (CO2)
rebreathing studies and non-invasive cardiopulmonary exercise testing
(CPET). Results of their CO2 rebreathing tests were compared
with those of controls (n = 32). Respiratory compensation for
metabolic acidosis during CPET was defined by the occurrence of a sharp
increase in minute ventilation (VdotE) and the ventilatory equivalent
for CO2 (V’E and V’CO2) at the end of the
isocapnic buffer phase. Euoxic (eVHR) and hyperoxic (hVHR) ventilatory
responses to hypercapnia were measured and its difference (eVHR − hVHR)
was considered to reflect the GPCD. Results: In 45 patients with SSc,
CPET results showed respiratory compensation at the occurrence of
metabolic acidosis. eVHR − hVHR in patients with diffuse cutaneous SSc
(dcSSc) differed significantly from that in patients with limited
cutaneous SSc (lcSSc) and from that in controls (0.47 ± 0.38 (dcSSc)
vs. 0.90 ± 0.77 (lcSSc) and 0.90 ± 0.49 (controls) l/min/mmHg; P =
0.04 and P = 0.03, respectively).

Conclusions: Respiratory
compensation for metabolic acidosis occurred in all patients. However,
the GPCD was diminished in dcSSc patients, suggesting an altered
control of breathing. Its assessment may help the clinician to better
understand reported EI and exertional dyspnea in dcSSc patients.;