Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiological Responses in Chronic Airflow Limitation

Magnus Ekström; Pei Zhi Li; Hayley Lewthwaite; Jean Bourbeau; Wan C Tan; Dennis Jensen; CanCOLD Collaborative Research Group

doi:10.1016/j.chest.2024.02.034

Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiological Responses in Chronic Airflow Limitation

Chest. 2024 Feb 27:S0012-3692(24)00270-8. doi: 10.1016/j.chest.2024.02.034. Online ahead of print.

Authors

Magnus Ekström¹, Pei Zhi Li², Hayley Lewthwaite³, Jean Bourbeau⁴, Wan C Tan⁵, Dennis Jensen⁶; CanCOLD Collaborative Research Group

Collaborators

CanCOLD Collaborative Research Group:
Jean Bourbeau⁷, Wan C Tan⁸, J Mark FitzGerald⁸, Don D Sin⁸, Darcy D Marciniuk⁹, Denis E O'Donnell¹⁰, Paul Hernandez¹¹, Kenneth R Chapman¹², Brandie Walker¹³, Shawn Aaron¹⁴, François Maltais¹⁵, Jonathon Samet¹⁶, Milo Puhan¹⁷, Qutayba Hamid⁷, James C Hogg⁸, Jean Bourbeau⁷, Dany Doiron⁷, Palmina Mancino⁷, Pei Zhi Li⁷, Dennis Jensen⁷, Carolyn Baglole⁷, Yvan Fortier¹⁸, Wan C Tan⁸, Don Sin⁸, Julia Yang⁸, Jeremy Road⁸, Joe Comeau⁸, Adrian Png⁸, Kyle Johnson⁸, Harvey Coxson⁸, Jonathon Leipsic⁸, Cameron Hague⁸, Miranda Kirby¹⁹, Mohsen Sadatsafavi⁸, Teresa To¹², Andrea Gershon¹², Wan C Tan⁸, Harvey Coxson⁸, Wan C Tan⁸, Harvey Coxson⁸, Jean Bourbeau⁷, Pei-Zhi Li⁷, Zhi Song⁷, Andrea Benedetti⁷, Dennis Jensen⁷, Yvan Fortier²⁰, Miranda Kirby¹⁹, Wan C Tan⁸, Christine Lo⁸, Sarah Cheng⁸, Elena Un⁸, Cynthia Fung⁸, Wen Tiang Wang⁸, Liyun Zheng⁸, Faize Faroon⁸, Olga Radivojevic⁸, Sally Chung⁸, Carl Zou⁸, Jean Bourbeau⁷, Palmina Mancino⁷, Jacinthe Baril⁷, Laura Labonte⁷, Kenneth Chapman¹², Patricia McClean¹², Nadeen Audisho¹², Brandie Walker¹³, Curtis Dumonceaux¹³, Lisette Machado¹³, Paul Hernandez²¹, Scott Fulton²¹, Kristen Osterling²¹, Denise Wigerius²¹, Shawn Aaron¹⁴, Kathy Vandemheen¹⁴, Gay Pratt¹⁴, Amanda Bergeron¹⁴, Denis O'Donnell¹⁰, Matthew McNeil¹⁰, Kate Whelan¹⁰, François Maltais¹⁵, Cynthia Brouillard¹⁵, Darcy Marciniuk⁹, Ron Clemens⁹, Janet Baran⁹, Candice Leuschen⁹

Affiliations

¹ Division of Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada. Electronic address: magnus.ekstrom@med.lu.se.
² Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada.
³ Centre of Research Excellence Treatable Traits, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.
⁴ Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada.
⁵ Department of Medicine, University of British Columbia Centre for Heart Lung Innovation, Vancouver, BC, Canada.
⁶ Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada.
⁷ McGill University, Montreal, QC, Canada.
⁸ University of British Columbia, Vancouver, BC, Canada.
⁹ University of Saskatoon, Saskatoon, SK, Canada.
¹⁰ Queen's University, Kingston, ON, Canada.
¹¹ Dalhousie University, Halifax, NS, Canada.
¹² University of Toronto, Toronto, ON, Canada.
¹³ University of Calgary, Calgary, AB, Canada.
¹⁴ University of Ottawa, Ottawa, ON, Canada.
¹⁵ University of Laval, Quebec City, QC, Canada.
¹⁶ Keck School of Medicine of USC, Los Angeles, CA.
¹⁷ Johns Hopkins School of Public Health, Baltimore, MD.
¹⁸ Laboratoire Telematique, Quebec Respiratory Health Network, Fonds de Recherche du Québec-Santé [FRQS].
¹⁹ Ryerson University, Toronto, ON, Canada.
²⁰ Laboratoire Telematique, Quebec Respiratory Health Network, FRQS.
²¹ University of Halifax, Halifax, NS, Canada.

PMID: 38423279
DOI: 10.1016/j.chest.2024.02.034

Abstract

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 (V˙o₂), and minute ventilation (V˙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 V˙o₂ < lower limit of normal) was present in 26%. Relative to peak W, V˙o₂, and V˙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.

Keywords: dyspnea; exercise capacity; exercise test; reference values.