Abnormal exertional breathlessness on cardiopulmonary cycle exercise testing in relation to self-reported and physiological responses in chronic airflow limitation
Date
2024
Authors
Ekström, M.
Li, P.Z.
Lewthwaite, H.
Bourbeau, J.
Tan, W.C.
Jensen, D.
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Journal article
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Chest, 2024; 66(1):81-94
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Background: Exertional breathlessness is a cardinal symptom of cardiorespiratory disease.
Research Question: How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiological responses in people with chronic airflow limitation (CAL)?
Study Design and Methods: An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output (W), rate of oxygen uptake (o2), and minute ventilation (e) at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated.
Results: We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40–89 years); FEV1/FVC, 57.3% ± 8.2%; FEV1, 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak o2 < lower limit of normal) was present in 26%. Relative to peak W, o2, and e, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiological abnormalities during CPET.
Interpretation: Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness.
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Copyright 2024 American College of Chest Physicians