Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications. (15th September 2021)

• Record Type: Journal Article
• Authors: Neder, J. Alberto; Berton, Danilo C.; Phillips, Devin B.; O'Donnell, Denis E.
• Is Part Of: European respiratory review. Volume 30:Number 161(2021)
• Publication Date: 2021-09-15
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0190-2020
• Languages: English
• ISSNs: 0905-9180

Abstract

There is well established evidence that the minute ventilation ( V ′E )/carbon dioxide output ( V ′CO2 ) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V ′E / V ′CO2 reflects an enlarged physiological dead space ("wasted" ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V ′E / V ′CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V ′E / V ′CO2 is valuable to ascertain a role for the "lungs" in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V ′E / V ′CO2 . A high V ′E / V ′CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V ′E / V ′CO2 should be valued in the clinical management of patients with COPD. The minute ventilation/carbon dioxide production relationship is relevant to a number of patient-related outcomes in COPD. Minute ventilation/carbon dioxide production, therefore, should be valued in the clinical management of these patients. https://bit.ly/3df2upH