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Clinica di Semeiotica Metodologia Medica, University of Ancona, Ospedale Regionale Torrette, Ancona 60020; and Istituto di Medicina Interna e Scienze Endocrine e Metaboliche, University of Perugia, Perugia 06100, Italy
Received 30 March 1995; accepted in final form 10 January 1996.
Tantucci, C., P. Bottini, M. L. Dottorini, E. Puxeddu, G. Casucci, L. Scionti, and C. A. Sorbini. Ventilatory response to
exercise in diabetic subjects with autonomic neuropathy.
J. Appl. Physiol. 81(5):
1978-1986, 1996.
We have used diabetic autonomic neuropathy as a
model of chronic pulmonary denervation to study the ventilatory
response to incremental exercise in 20 diabetic subjects, 10 with
(Dan+) and 10 without (Dan
) autonomic dysfunction, and in 10 normal control subjects. Although both Dan+ and Dan subjects
achieved lower O2 consumption and
CO2 production
(
CO2) than
control subjects at peak of exercise, they attained similar values of
either minute ventilation
(E) or
adjusted ventilation (E/maximal
voluntary ventilation). The increment of respiratory rate with
increasing adjusted ventilation was much higher in Dan+ than in
Dan and control subjects (P < 0.05). The slope of the linear
E/CO2
relationship was 0.032 ± 0.002, 0.027 ± 0.001 (P < 0.05), and 0.025 ± 0.001 (P < 0.001) ml/min in
Dan+, Dan, and control subjects, respectively. Both
neuromuscular and ventilatory outputs in relation to increasing
CO2 were progressively
higher in Dan+ than in Dan and control subjects. At peak of
exercise, end-tidal PCO2 was much
lower in Dan+ (35.9 ± 1.6 Torr) than in Dan (42.1 ± 1.7 Torr; P < 0.02) and control (42.1 ± 0.9 Torr; P < 0.005) subjects.
We conclude that pulmonary autonomic denervation affects ventilatory
response to stressful exercise by excessively increasing respiratory
rate and alveolar ventilation. Reduced neural inhibitory modulation
from sympathetic pulmonary afferents and/or increased
chemosensitivity may be responsible for the higher inspiratory
output.
diabetes; pulmonary denervation; control of breathing; breathing pattern
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