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Abnormal exertional breathlessness on cardiopulmonary cycle exercise testing in relation to self-reported and physiological responses in chronic airflow limitation

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dc.contributor.authorEkström, M.
dc.contributor.authorLi, P.Z.
dc.contributor.authorLewthwaite, H.
dc.contributor.authorBourbeau, J.
dc.contributor.authorTan, W.C.
dc.contributor.authorJensen, D.
dc.date.issued2024
dc.description.abstractBackground: 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.
dc.identifier.citationChest, 2024; 66(1):81-94
dc.identifier.doi10.1016/j.chest.2024.02.034
dc.identifier.issn0012-3692
dc.identifier.urihttps://hdl.handle.net/11541.2/38425
dc.language.isoen
dc.publisherAmerican College of Chest Physicians
dc.rightsCopyright 2024 American College of Chest Physicians
dc.source.urihttps://doi.org/10.1016/j.chest.2024.02.034
dc.subjectdyspneaexercise capacityexercise testreference values
dc.titleAbnormal exertional breathlessness on cardiopulmonary cycle exercise testing in relation to self-reported and physiological responses in chronic airflow limitation
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916835326501831

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