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J Appl Physiol 101: 1025-1035, 2006. First published May 4, 2006; doi:10.1152/japplphysiol.01470.2005
8750-7587/06 $8.00
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Sensory-mechanical relationships during high-intensity, constant-work-rate exercise in COPD

Denis E. O’Donnell,1 Alan L. Hamilton,2 and Katherine A. Webb1

1Respiratory Investigation Unit, Departments of Medicine and Physiology, Queen’s University, Kingston; and 2Boehringer Ingelheim (Canada) Ltd., Burlington, Ontario, Canada

Submitted 22 November 2005 ; accepted in final form 27 April 2006

During constant-work-rate exercise in chronic obstructive pulmonary disease, dyspnea increases steeply once inspiratory reserve volume (IRV) falls to a critical level that prevents further expansion of tidal volume (VT). We studied the effects of this mechanical restriction on the quality and intensity of exertional dyspnea and examined the impact of an anticholinergic bronchodilator. In a randomized, double-blind, crossover study, 18 patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 s = 40 ± 3%predicted; mean ± SE) inhaled tiotropium 18 µg or placebo once daily for 7–10 days each. Pulmonary function tests and symptom-limited cycle exercise at 75% of each patient’s maximal work capacity were performed 2 h after dosing. Dyspnea intensity (Borg scale), operating lung volumes, breathing pattern, and esophageal pressure (n = 11) were measured during exercise. Dynamic hyperinflation reached its maximal value early in exercise and was associated with only mild increases in dyspnea intensity and the effort-displacement ratio, which is defined as the ratio between tidal swings of esophageal pressure (expressed relative to maximum inspiratory pressure) and VT (expressed relative to predicted vital capacity). After a minimal IRV of 0.5 ± 0.1 liter was reached, both dyspnea and the effort-displacement ratio rose steeply until an intolerable level was reached. Tiotropium did not alter dyspnea-IRV relationships, but the increase in resting and exercise inspiratory capacity was associated with an improved effort-displacement ratio throughout exercise. Once a critically low IRV was reached during exercise, dyspnea rose with the disparity between respiratory effort and the VT response. Changes in dyspnea intensity after tiotropium were positively correlated with changes in this index of neuromechanical coupling.

chronic obstructive pulmonary disease; respiratory mechanics; tiotropium


Address for reprint requests and other correspondence: D. O’Donnell, 102 Stuart St., Kingston, Ontario, Canada K7L 2V6 (e-mail: odonnell{at}post.queensu.ca)




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