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Original Research: COPD |

Effective Bronchoscopic Lung Volume Reduction Accelerates Exercise Oxygen Uptake Kinetics in Emphysema

Azmy Faisal, PhD; Zaid Zoumot, MD, PhD; Pallav L. Shah, MD; J. Alberto Neder, MD, PhD; Michael I. Polkey, MD, PhD; Nicholas S. Hopkinson, MD, PhD
Author and Funding Information

Drs Faisal and Zoumot are joint first authors, and Drs Polkey, Neder, and Hopkinson are joint senior authors.

FUNDING/SUPPORT: The study was supported by the NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, England, which partially funded the salaries of M. I. P. and Z. Z. A. F. received financial support from the British Academy of Medical Sciences through the Daniel Turnberg UK/Middle East Travel Fellowship scheme.

CORRESPONDENCE TO: Nicholas S. Hopkinson, MD, PhD, Department of Respiratory Medicine, Royal Brompton Hospital, Fulham Rd, London, SW3 6NP, England


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):435-446. doi:10.1378/chest.15-0404
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Background  The impact of bronchoscopic lung volume reduction (BLVR) on physiologic responses to exercise in patients with advanced emphysema remains incompletely understood. We hypothesized that effective BLVR (e-BLVR), defined as a reduction in residual volume > 350 mL, would improve cardiovascular responses to exercise and accelerate oxygen uptake (o2) kinetics.

Methods  Thirty-one patients (FEV1, 36% ± 9% predicted; residual volume, 219% ± 57% predicted) underwent a constant intensity exercise test at 70% peak work rate to the limit of tolerance before and after treatment bronchoscopy (n = 24) or sham bronchoscopy (n = 7). Physiologic responses in patients who had e-BLVR (n = 16) were compared with control subjects (ineffective BLVR or sham bronchoscopy; n = 15).

Results  e-BLVR reduced residual volume (−1.1 ± 0.5 L, P = .001), improved lung diffusing capacity by 12% ± 13% (P = .001), and increased exercise tolerance by 181 ± 214 s (P = .004). o2 kinetics were accelerated in the e-BLVR group but remained unchanged in control subjects (Δ mean response time, −20% ± 29% vs 1% ± 25%, P = .04). Acceleration of o2 kinetics was associated with reductions in heart rate and oxygen pulse response half-times by 8% (84 ± 14 to 76 ± 15 s, P = .04) and 20% (49 ± 16 to 34 ± 16 s, P = .01), respectively. There were also increases in heart rate and oxygen pulse amplitudes during the cardiodynamic phase post e-BLVR. Faster o2 kinetics in the e-BLVR group were significantly correlated with reductions in residual volume (r = 0.66, P = .005) and improvements in inspiratory reserve volume (r = 0.56, P = .024) and exercise tolerance (r = 0.63, P = .008).

Conclusions  Lung deflation induced by e-BLVR accelerated exercise o2 kinetics in patients with emphysema. This beneficial effect appears to be related mechanistically to an enhanced cardiovascular response to exercise, which may contribute to improved functional capacity.

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