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1 Dipartimento di Medicina Clinica, Servizio di Fisiopatologia Respiratoria, Universita "La Sapienza", Rome, Italy
* To whom correspondence should be addressed. E-mail: paolo.palange{at}uniroma1.it.
We tested the hypothesis that Heliox breathing, by reducing lung dynamic hyperinflation (DH) and dyspnea sensation (DYS), may significantly improve exercise endurance capacity in patients with chronic obstructive pulmonary disease (COPD) (n=12, FEV1=1.15±0.32 l). Each subject underwent two cycle ergometer high-intensity constant work rate (CWR) exercise to exhaustion, one on room air and one on Heliox (79%He, 21%O2). Minute ventilation (V'E), carbon dioxide output (V'CO2), heart rate (HR), inspiratory capacity (IC), DYS and arterial partial pressure of CO2 (PaCO2) were measured. Exercise endurance time increased significantly with Heliox (9.0±4.5 vs 4.2±2.0SD min; P<0.001). This was associated with a significant reduction in lung DH at isotime (ISO), as reflected by the increase in IC (1.97±0.40 vs 1.77±0.41 l; P<0.001), and a decrease in DYS (6±1 vs 8±1 score; P<0.001). Heliox induced a state of relative hyperventilation, as reflected by the increased in V'E (38.3±7.7 vs 35.5±8.8 l/min; p< 0.01) and V'E/V'CO2 (36.3±6.0 vs 33.9±5.6; P<0.01) at peak exercise, and by the reduction in PaCO2 at isotime (44±6 vs 48±6 Torr; P<0.05) and at peak exercise (46±6 vs 48±6 Torr; P<0.05). The reduction in dyspnea at isotime (
DYSISO) correlated significantly (R=-0.75; P<0.01) with the increase in IC (ICISO) induced by Heliox. The increment induced by Heliox in exercise endurance time (END) correlated significantly with resting FEV1 (R= 0.88; P<0.01), ICISO (R= 0.70; P<0.02) and DYSISO (R= -0.71; P<0.01). In COPD, Heliox breathing improves high-intensity exercise endurance capacity by increasing maximal ventilatory capacity and by reducing lung DH and DYS.
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