Behnia M; Sietsema KE;  Harbor-UCLA Medical Center, Torrance, CA, USA.

International Journal of Copd. 18:2895-2910, 2023.

Chronic obstructive pulmonary disease (COPD) is a disease defined by
airflow obstruction with a high morbidity and mortality and significant
economic burden. Although pulmonary function testing is the cornerstone in
diagnosis of COPD, it cannot fully characterize disease severity or cause
of dyspnea because of disease heterogeneity and variable related and
comorbid conditions affecting cardiac, vascular, and musculoskeletal
systems. Cardiopulmonary exercise testing (CPET) is a valuable tool for
assessing physical function in a wide range of clinical conditions,
including COPD. Familiarity with measurements made during CPET and its
potential to aid in clinical decision-making related to COPD can thus be
useful to clinicians caring for this population. This review highlights
pulmonary and extrapulmonary impairments that can contribute to exercise
limitation in COPD. Key elements of CPET are identified with an emphasis
on measurements most relevant to COPD. Finally, clinical applications of
CPET demonstrated to be of value in the COPD setting are identified. These
include quantifying functional capacity, differentiating among potential
causes of symptoms and limitation, prognostication and risk assessment for
operative procedures, and guiding exercise prescription.