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1 Beth Israel Deaconess Medical Center
2 Brigham & Womens Hospital
* To whom correspondence should be addressed. E-mail: sloring{at}bidmc.harvard.edu.
Mechanical characteristics and gas exchange inefficiencies of the lungs contribute to increased work of ventilation in COPD at rest and during exercise, and the energy cost of ventilation is increased in COPD at any external work level. Assuming typical ventilatory variables and respiratory characteristics, we estimated the relative contributions to work of breathing of the following parameters: inspiratory and expiratory resistance, dynamic elastance, PEEPi, and gas exchange inefficiency to the work of breathing. We found that the last of these is likely to be of major importance. Dynamic hyperinflation can be seen as both an impediment to inspiratory muscle function and an essential component of adaptation to severe obstruction. Extrinsic restriction, in which the chest wall fails to achieve and maintain abnormally high lung volumes in COPD, can limit ventilatory function and contribute to disability.
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