Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance.

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  • Additional Information
    • Corporate Authors:
      CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network
    • Source:
      Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE
    • Publication Information:
      Publication: 2000- : New York, NY : American Thoracic Society
      Original Publication: New York, NY : American Lung Association, c1994-
    • Subject Terms:
      Dyspnea*/physiopathology ; Dyspnea*/etiology ; Spirometry* ; Exercise Tolerance*/physiology ; Pulmonary Disease, Chronic Obstructive*/physiopathology; Humans ; Male ; Female ; Cross-Sectional Studies ; Middle Aged ; Aged ; Exercise Test/methods ; Canada ; Forced Expiratory Volume/physiology
    • Abstract:
      Rationale: It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. Objectives: Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. Methods: We completed a cross-sectional analysis of the CanCOLD (Canadian Cohort Obstructive Lung Disease) population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV 1  < 80% predicted and FEV 1 /FVC ⩾ 0.7), 264 control participants, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing. Measurements and Main Results: Individuals with PRISm had lower total lung, vital, and inspiratory capacities than healthy controls (all P  < 0.05) and minimal small airway, pulmonary gas exchange, and radiographic parenchymal lung abnormalities. Compared with healthy controls, individuals with PRISm had higher dyspnea/[Formula: see text]o 2 ratio at peak exercise (4.0 ± 2.2 vs. 2.9 ± 1.9 Borg units/L/min; P  < 0.001) and lower [Formula: see text]o 2peak (74 ± 22% predicted vs. 96 ± 25% predicted; P  < 0.001). At standardized submaximal work rates, individuals with PRISm had greater Vt/inspiratory capacity (Vt%IC; P  < 0.001), reflecting inspiratory mechanical constraint. In contrast to participants with PRISm, those with COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas exchange abnormalities. Despite these physiological differences among the three groups, the relationship between increasing dyspnea and Vt%IC during cardiopulmonary exercise testing was similar. Resting IC significantly correlated with [Formula: see text]o 2peak ( r  = 0.65; P  < 0.001) in the entire sample, even after adjusting for airflow limitation, gas trapping, and diffusing capacity. Conclusions: In individuals with PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates. Clinical trial registered with www.clinicaltrials.gov (NCT00920348).
    • Comments:
      Comment in: Am J Respir Crit Care Med. 2024 Jun 1;209(11):1289-1291. doi: 10.1164/rccm.202401-0042ED. (PMID: 38324051)
    • Grant Information:
      93326 Canada CIHR
    • Contributed Indexing:
      Investigator: J Bourbeau; WC Tan; JM FitzGerald; DD Sin; DD Marciniuk; DE O'Donnell; P Hernandez; KR Chapman; B Walker; S Aaron; F Maltais; J Samet; M Puhan; Q Hamid; JC Hogg; D Doiron; P Mancino; PZ Li; D Jensen; C Baglole; Y Fortier; J Yang; J Road; J Comeau; A Png; K Johnson; H Coxson; M Kirby; J Leipsic; C Hague; M Sadatsafavi; T To; A Gershon; Z Song; A Benedetti; C Lo; S Cheng; E Un; C Fung; WT Wang; L Zheng; F Faroon; O Radivojevic; S Chung; C Zou; J Baril; L Labonté; P McClean; N Audisho; C Dumonceaux; L Machado; S Fulton; K Osterling; D Wigerius; K Vandemheen; G Pratt; A Bergeron; M McNeil; K Whelan; C Brouillard; R Clemens; J Baran; C Leuschen
      Keywords: dyspnea; exercise capacity; preserved ratio impaired spirometry; pulmonary function; spirometry
    • Molecular Sequence:
      ClinicalTrials.gov NCT00920348
    • Publication Date:
      Date Created: 20240103 Date Completed: 20240531 Latest Revision: 20240801
    • Publication Date:
      20240802
    • Accession Number:
      10.1164/rccm.202307-1184OC
    • Accession Number:
      38170674