Agreement between spirometers: a challenge in the follow-up of patients and populations? Technical and functional assessment of 10 office spirometers: A multicenter comparative study.
Article PubMed Google Scholar. Ruppel GL. What is the clinical value of lung volumes? Sue DY. Measurement of lung volumes in patients with obstructive lung disease.
A matter of time constants. Ann Am Thorac Soc. Validity of the American Thoracic Society and other spirometric algorithms using FVC and forced expiratory volume at 6s for predicting a reduced total lung capacity. Wave-speed limitation on expiratory flow-a unifying concept.
J Appl Physiol. Accessed 24 Dec Test of wave-speed theory of flow limitation in elastic tubes. Am Rev Respir Dis. Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery. Closing volume: a reappraisal — Eur J Appl Physiol. Effects of age and body position on "airway closure" in man. Obstructive and restrictive lung disease and functional limitation: data from the Third National Health and Nutrition Examination. J Intern Med. Accessed 19 Oct Classification of restrictive and obstructive pulmonary diseases using spirometry data.
Stud Health Technol Inform. Javaheri S, Sicilian L. Lung function, breathing pattern, and gas exchange in interstitial lung disease. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology.
Clin Interv Aging. Accessed 16 Oct Zeleznik J. Normative aging of the respiratory system. Clin Geriatr Med. Relationship between chest wall and pulmonary compliance and age.
Google Scholar. Physiological changes in respiratory function associated with ageing. Eur Respir J. Airway size is related to sex but not lung size in normal adults. Thurlbeck WM. Postnatal human lung growth. The impact of sex and sex hormones on lung physiology and disease: lessons from animal studies.
Variation in lung volumes and capacities among young males in relation to height. J Ayub Med Coll Abbottabad. Littleton SW. Impact of obesity on respiratory function. The effects of body mass index on lung volumes. Obesity and Pulmonary Function in African Americans. PLoS One. Spirometry may underestimate airway obstruction in professional Greek athletes.
Clin Respir J. Myrianthefs P, Baltopoulos G. A higher tidal volume may be used for athletes according to measured FVC. Scientific World Journal. Effect of additional respiratory muscle endurance training in young well-trained swimmers. J Sports Sci Med. Lung function and cytokine levels in professional athletes. J Asthma. Nepal J Epidemiol. Differences between Finnish and European reference values for pulmonary diffusing capacity.
Int J Circumpolar Health. Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. Rossiter CE, Weill H. Ethnic differences in lung function: evidence for proportional differences. Int J Epidemiol. Are ethnic differences in lung function explained by chest size? Multi-ethnic reference values for spirometry for the 3—yr age range: the global lung function equations. Association between level of physical activity and lung function among Norwegian men and women: the HUNT study.
Int J Tuberc Lung Dis. Effect of altitude on spirometric parameters and the performance of peak flow meters. Respiratory function at different altitudes. J Phys Ther Sci. Kera T, Maruyama H. The effect of posture on respiratory activity of the abdominal muscles. Effects of posture on postoperative pulmonary function. Acta Anaesthesiol Scand. LoMauro A, Aliverti A. Respiratory physiology of pregnancy: Physiology masterclass. Breathe Sheff. Interpretative strategies for lung function tests.
Degens P, Merget R. For this study, 72 male subjects were randomly selected by simple random sampling technique SRS. Measurements of respiratory indices were taken three times in the pre- and post-exercise phases of each session, and their mean values were used for analysis.
Subjects were asked not to change their habitual physical activity during the study and not to take any nutritional supplements.
Each session began with a warmup period of five minutes. For the session itself, running time started at five minutes, and this interval was increased by ten minutes every three sessions, up to a maximum of 25 minutes. Subjects had to remain in the straight sitting or standing position throughout the test, and a nose clip was tightly attached to the nostrils, allowing no air to escape during the test.
FVC Maneuver: Each subject was asked to inhale completely and rapidly, pausing less than one second at total lung capacity TLC , and then exhale as quickly and completely as possible, expelling all the air. MVV maneuver: Subjects were tested in the sitting position while wearing a nose clip. They were instructed to breathe as rapidly and deeply as possible for 12 seconds after obtaining at least three resting tidal breaths with an airtight seal around the mouthpiece.
Statistical analysis was conducted using SPSS software version The Wilcoxon test, a nonparametric analysis paired t-test , was done to determine changes pre- to post-test. Table 1 shows the mean of the anthropometric characteristics of the 72 subjects.
The mean age was Table 2 shows the baseline spirometry data of predicted values for the 72 subjects. The mean predicted FVC was 4. The mean pre-exercise FVC was 3. Post-exercise mean FVC after 5, 15, and 25 minutes was 3. The post-exercise mean FEV 1 after 5, 15, and 25 minutes was 3.
Table 3 B shows the baseline spirometry data of MVV before and after exercise at different intensities. The pre-exercise mean MVV was However, the interrelationship between possible reductions in dynamic hyperinflation and improvements in dyspnea and exercise endurance with hyperoxia has been difficult to establish.
However, the magnitude of dynamic hyperinflation at peak exercise was unaffected by hyperoxia Figure 5 b , which is consistent with the recent work of Eves et al. It should be noted that the beneficial effects of delaying dynamic hyperinflation and reducing operating lung volumes during hyperoxic exercise may be less pronounced in normoxic or mildly hypoxemic COPD patients [ 72 , 77 ].
A study by Somfay et al. Their study demonstrated consistent increases in IC as the fraction of inspired O 2 increased from 0. However, this relationship has not been found in more recent studies [ 72 , 80 ].
Collectively, these studies suggest that hyperoxia consistently reduces and dyspnea and improves exercise tolerance in patients with COPD. Most studies show some favourable effect of hyperoxia on IC during submaximal exercise but responses are highly variable and are likely dependent on the baseline level of respiratory impairment e.
Well-designed exercise training interventions as part of a pulmonary rehabilitation program can improve exercise performance to a greater extent than other available treatment interventions for patients with COPD [ 81 ].
One of the primary mechanisms by which exercise training can improve exercise capacity is through a reduction in ventilatory stimulation due to lower levels of lactic acidosis and for any given exercise intensity [ 82 ]. The reduction in ventilation following exercise training seems to be mediated primarily through a reduced breathing frequency [ 83 , 84 ].
This permits greater time for expiration between breaths, and, like other interventions that reduce ventilation e. However, the impact of exercise training on IC behaviour during cycle exercise has been both modest and inconsistent across studies and it is clear that improvement in IC during exercise is not obligatory to achieve important improvements in the intensity and affective domains of dyspnea following exercise training [ 83 — 88 ].
This provides an estimate of demand versus capacity but gives little information on the source or nature of the ventilatory impairment. The resting IC provides valuable information on potential ventilatory capacity during exercise. A low IC increases the likelihood of critical dynamic mechanical constraints at relatively low exercise intensities, thus limiting further increases in ventilation.
This detailed approach to CPET interpretation can also give valuable insight into the mechanisms of dyspnea relief and exercise performance improvements following various therapeutic interventions. The wealth of data derived from IC measurements also allows detection of physiological impairment in dyspneic patients with near-normal spirometry e. Collectively, the valuable information gained from the IC and derived physiological parameters provide a solid rationale for their regular inclusion during standard CPET for both clinical and research purposes.
Guenette, R. Chin, J. Cory, and K. Webb have no conflict of interests to report. Guenette et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.
Read the winning articles. Journal overview. Special Issues. Guenette , 1,2,3 Roberto C. Chin, 3 Julia M. Cory, 3 Katherine A. Webb, 3 and Denis E. Academic Editor: Jose Alberto Neder. Received 20 Jul Accepted 21 Dec Published 07 Feb Abstract Cardiopulmonary exercise testing CPET is an established method for evaluating dyspnea and ventilatory abnormalities. Introduction Cardiopulmonary exercise testing CPET is increasingly recognized as an important clinical diagnostic tool for assessing exercise intolerance and exertional symptoms, and for objectively determining functional capacity and impairment [ 1 ].
Figure 1. Modified from [ 3 ]. The position of the tidal breaths along the -axis is based on the measurement of end-expiratory lung volume determined from inspiratory capacity maneuvers.
Table 1. Figure 2. Three examples of inspiratory capacity IC maneuvers performed during exercise. Table 2. Figure 3. Dynamic hyperinflation can be evaluated as the linear slope relating inspiratory capacity and minute ventilation [ 49 ].
Dynamic hyperinflation is typically assessed at a single time point during an exercise test. The slope method accounts for all inspiratory capacity measurements during an exercise test and takes into account possible changes in ventilation that can occur with various interventions e.
Figure 4. Inspiratory capacity IC , inspiratory reserve volume IRV , tidal volume , and breathing frequency responses versus minute ventilation during constant work rate exercise across the continuum of health and COPD severity.
The IC at rest and throughout exercise progressively decreases with advancing disease. Note the clear inflection plateau in the -ventilation relationship, which coincides with a simultaneous inflection in the IRV-ventilation relationship. After this point, further increases in ventilation are accomplished by accelerating. Figure 5. Operating lung volume plots during constant work rate cycle exercise in COPD patients following acute high-dose anticholinergic therapy versus placebo a and hyperoxia versus room air b.
The operating lung volumes i. The magnitude of dynamic hyperinflation at peak exercise calculated as the difference in EELV from resting values did not change following bronchodilation. Data for these graphs are based on previously published studies from our laboratory [ 43 , 74 ].
View at: Google Scholar J. Klas and J. View at: Google Scholar B. Johnson, I. Weisman, R. Zeballos, and K.
Guenette, P. Dominelli, S. Reeve, C. Durkin, N. Eves, and A. Johnson, K. Seow, D. Pegelow, and J. View at: Google Scholar C. Clarenbach, O. Senn, T. Brack, M. Kohler, and K. Aliverti, N. Stevenson, R. Lo Mauro, A. Pedotti, and P. Beck, L. Olson et al. Guenette, J. Witt, D. McKenzie, J. Road, and A. O'Donnell, M. Lam, and K. View at: Google Scholar S. McClaran, C.
Harms, D. View at: Google Scholar D. O'Donnell, J. Guenette, F. Maltais, and K. Di Marco, J. Milic-Emili, B. Boveri et al. O'Donnell, T. Gerken et al. Celli, R. ZuWallack, S. Wang, and S. Albuquerque, L. Nery, D. O'Donnell, S. Revill, and K. O'Donnell, C. D'Arsigny, M. Fitzpatrick, and K.
Casanova, C. Cote, J. De Torres et al. Zaman, S. Mahmood, and A. O'Donnell and P. Stubbing, L. The tidal volume-inspiratory duration curve shifted to a higher volume region during exercise compared with CO2 inhalation. Consequently, the volume-time threshold characteristic was better described by an end-inspiratory lung volume-inspiratory duration plot, resulting in a common relationship under these two different stimuli.
These results suggest that the depth and rate of breathing in humans can be affected by not only phasic but also tonic components.
0コメント