The role of phenotype on ventilation and exercise capacity in patients affected by COPD: a retrospective study

  • Rocco F. Rinaldo | rocco.rinaldo@unimi.it Department of Health Sciences, University of Milan; Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Michele Mondoni Department of Health Sciences, University of Milan; Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Sofia Comandini Department of Health Sciences, University of Milan; Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Pietro Lombardo Department of Health Sciences, University of Milan; Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Beatrice Vigo Department of Health Sciences, University of Milan; Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Silvia Terraneo Department of Health Sciences, University of Milan; Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Pierachille Santus Department of Biomedical and Clinical Sciences (DIBIC), University of Milan; Division of Respiratory Diseases, Luigi Sacco University Hospital, Milan, Italy.
  • Stefano Carugo Department of Health Sciences, University of Milan; Cardiology Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Stefano Centanni Department of Health Sciences, University of Milan; Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
  • Fabiano Di Marco Department of Health Sciences, University of Milan; Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.

Abstract

Background: The idea of phenotype in chronic obstructive pulmonary disease (COPD) has evolved in the last decades, and the importance of peculiar treatment strategies has now been acknowledged. Although dyspnea and exercise limitation are hallmarks of COPD, this aspect has never been fully explored in literature in terms of disease phenotype. The aim of the present study was to explore the relevance of clinical COPD phenotypes on exercise ventilation and maximal capacity.
Methods: In this observational cohort retrospective study we analyzed the data of 50 COPD patients who underwent cardiopulmonary exercise test, categorized as emphysematous (n=29), and non-emphysematous (n=21) according to a previously validated model.
Results: We found a significant difference in terms of VE/VCO2 slope (median values 32.4 vs 28.0, p=0.015) and VE/VCO2 ratio at nadir (median values 37 vs 33, p=0.004), which resulted higher in emphysematous patients, who also presented lower PETCO2 values (median values 32.6 vs 35.6, p=0.008). In a subgroup of 31 tests which met the maximality criteria, emphysematous patients presented a significantly lower work rate at peak (median value 51 vs 72 % predicted, p=0.016), and showed a lower peak oxygen consumption, although at the limit of significance (median values of 63 vs 85 % predicted, p=0.051).
Conclusions: This study extends our knowledge about the characterization of the COPD phenotypical expression of disease, showing that patients affected by emphysema are more prone to ventilatory inefficiency during exercise, and that this is likely to be an important cause of their overall reduced exercise capacity.

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Published
2020-02-03
Section
Original Research Articles
Keywords:
COPD, cardiopulmonary exercise test, ventilation, exercise capacity, phenotype, emphysema
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How to Cite
Rinaldo, R., Mondoni, M., Comandini, S., Lombardo, P., Vigo, B., Terraneo, S., Santus, P., Carugo, S., Centanni, S., & Di Marco, F. (2020). The role of phenotype on ventilation and exercise capacity in patients affected by COPD: a retrospective study. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.476