Philips DB; Neder JA; Elbehairy AF; Milne KM; James MD; Vincent SG ;Day AG; de-Torres JP; Webb KA; O’Donnell DE;

Medicine and science in sports and exercise [Med Sci Sports Exerc] 2021 Jul 07.
Date of Electronic Publication: 2021 Jul 07.

Introduction: Evaluation of the intensity and quality of activity-related dyspnea is potentially useful in people with chronic obstructive pulmonary disease (COPD). The present study sought to examine associations between qualitative dyspnea descriptors, dyspnea intensity ratings, dynamic respiratory mechanics, and exercise capacity during cardiopulmonary exercise testing (CPET) in COPD and healthy controls.
Methods: In this cross-sectional study, 261 patients with mild-to-very severe COPD (forced expiratory volume in 1 second [FEV1] 62 ± 25 %pred) and 94 age-matched controls (FEV1 114 ± 14 %pred) completed an incremental cycle CPET to determine peak oxygen uptake (V[Combining Dot Above]O2peak). Throughout exercise, expired gases, operating lung volumes and dyspnea intensity were assessed. At peak exercise, dyspnea quality was assessed using a modified 15-item questionnaire.
Results: Logistic regression analysis revealed that amongst 15 dyspnea descriptors, only those alluding to the cluster “unsatisfied inspiration” were consistently associated with an increased likelihood for both critical inspiratory mechanical constraint (end-inspiratory lung volume/total lung capacity ratio ≥ 0.9) during exercise and reduced exercise capacity (V[Combining Dot Above]O2peak < lower limit of normal) in COPD (odds ratio [95% confidence interval] =3.26 [1.40-7.60] and 3.04 [1.24-7.45], respectively, both p < 0.05). Thus, patients reporting “unsatisfied inspiration” (n = 177 (68%)) had an increased relative frequency of critical inspiratory mechanical constraint and low exercise capacity, compared with those who did not select this descriptor, regardless of COPD severity or peak dyspnea intensity scores.
Conclusion: In patients with COPD, regardless of disease severity, reporting descriptors in the unsatisfied inspiration cluster complemented traditional assessments of dyspnea during CPET and helped identify patients with critical mechanical abnormalities germane to exercise intolerance.