A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension

Abdullah Al-Shimemeri; Itani M; Alghadeer Hend; Al-Jahdali Hamdan; Al-Moamary Mohamed; A. Al-Duhaim Ahmad; Mobeireek Abdullah

doi:doi:10.11648/j.ajim.20130104.12

A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension

Abdullah Al-Shimemeri, Itani M, Alghadeer Hend, Al-Jahdali Hamdan, Al-Moamary Mohamed, A. Al-Duhaim Ahmad, Mobeireek Abdullah

Published in American Journal of Internal Medicine (Volume 1, Issue 4)

Received: 20 September 2013 Published: 10 November 2013

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Abstract

It has previously been proposed that the pattern of breathing during exercise, and particularly maximum tidal volume, can be used to distinguish between interstitial lung disease and pulmonary vascular disease; however this has never been formally investigated. This study looks at the impact of incremental exercise on a bicycle ergometer and the impact that such exercise has on breathing pattern, specifically maximum tidal volume. Method: We retrospectively reviewed the incremental exercise tests of 10 patients with pulmonary fibrosis (PF) and 9 with primary pulmonary hypertension (PPH). Patients were exercised using a bicycle ergometer, seated, and breathing into a mouthpiece. Results: The VE/VCO2 relationship was linear in all patients, but PPH patients had higher VE/VCO2 slopes (0.058±0.03) mean ±SD than PF patients (0.039±0.01, P<0.04). The respiratory rate/VE slopes were also higher in PPH patients (0.48±0.17) than in PF patients (0.30±0.14, P<0.02). There was no correlation between the VTmax/IC at the end of exercise and the IC %predicted in either group. However, VTmax as % of IC at the end of exercise in PPH patients (59.1±7.6) was lower than in PF patients (87.0±14.5%, P<0.001). Conclusion: The pattern of breathing during exercise, specifically maximum tidal volume, is different in patients with primary pulmonary hypertension compared with pulmonary fibrosis patients. These changes in the breathing pattern are unrelated to underlying static and dynamic lung function. Thus, the conclusion is that patients who have lung diseases which restrict their breathing often compensate, likely in an effort to avoid dyspnea, by modifying their natural breathing into a more tightly constrained pattern.

Published in	American Journal of Internal Medicine (Volume 1, Issue 4)
DOI	10.11648/j.ajim.20130104.12
Page(s)	31-35
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2013. Published by Science Publishing Group

Keywords

Pulmonary Vascular Diseases, Primary Pulmonary Hypertension, Cardiopulmonary Exercise Testing, Chronic Thromboembolic Diseases, Eisenmenger, Riyadh, Saudi Arabia

References

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[2]	Borg GA. Psychophysical Bases of Perceived Exertion. Med Sci Exerc 1982; 14:377-81
[3]	Colton T. Statistics in Medicine. Boston: Little, Brown & Co, 1974
[4]	Ross T. and Hunninghake G. Idiopathic Pulmonary Fibrosis. N Engl J Med, Vol. 345, No. 7 August 16, 2001
[5]	Archer SL, Michelakis ED. An Evidence-based Approach to the Management of Pulmonary Arterial Hypertension. Curr Opin Cardiol. 2006 Jul;21(4):385-92.
[6]	Gaine S.Pulmonary Hypertension. JAMA. 2000 Dec 27;284(24):3160-8.
[7]	De Bois R. Idiopathic Pulmonary Fibrosis Egyptian Journal of Bronchology Vol 2, No 2, December, 2008
[8]	Strange, Charlie. Idiopathic Pulmonary Fibrosis: A Systematic Approach to Diagnosis Monograph, 2004
[9]	Fell CD, Liu LX, Motika C., Kazerooni EA, Gross BH. Travis WD., Colby TV et al. The Prognostic Value of Cardiopulmonary Exercise Testing in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med, Dec, 2008
[10]	ATS/ACCP Statement on Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med Vol 167. pp 211–277, 2003
[11]	Sun XG, Hansen JR, Oudiz RJ, Wasserman K. Exercise Pathophysiology in Patients with Primary Pulmonary Hypertension. Circulation 2001;104:429–435.
[12]	Whipp B.J., Wagner P.D., Agusti A. Determinants of the Physiological Systems Responses to Muscular Exercise in Healthy Subjects in Larsen (ed.) European Respiratory Monograph on Clinical Exercise Testing. Eur Respir Mon,Vol 12 mon 40, 2007
[13]	Brack T, Jubran A, Tobin MJ. Dyspnea and Decreased Variability of Breathing in Patients with Restrictive Lung Disease. Am J Respir Crit Care Med. 2002 May 1;165(9):1260-4.

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APA Style

Abdullah Al-Shimemeri, Itani M, Alghadeer Hend, Al-Jahdali Hamdan, Al-Moamary Mohamed, et al. (2013). A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension. American Journal of Internal Medicine, 1(4), 31-35. https://doi.org/10.11648/j.ajim.20130104.12

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Abdullah Al-Shimemeri; Itani M; Alghadeer Hend; Al-Jahdali Hamdan; Al-Moamary Mohamed, et al. A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension. Am. J. Intern. Med. 2013, 1(4), 31-35. doi: 10.11648/j.ajim.20130104.12

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AMA Style

Abdullah Al-Shimemeri, Itani M, Alghadeer Hend, Al-Jahdali Hamdan, Al-Moamary Mohamed, et al. A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension. Am J Intern Med. 2013;1(4):31-35. doi: 10.11648/j.ajim.20130104.12

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@article{10.11648/j.ajim.20130104.12,
  author = {Abdullah Al-Shimemeri and Itani M and Alghadeer Hend and Al-Jahdali Hamdan and Al-Moamary Mohamed and A. Al-Duhaim Ahmad and Mobeireek Abdullah},
  title = {A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension},
  journal = {American Journal of Internal Medicine},
  volume = {1},
  number = {4},
  pages = {31-35},
  doi = {10.11648/j.ajim.20130104.12},
  url = {https://doi.org/10.11648/j.ajim.20130104.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20130104.12},
  abstract = {It has previously been proposed that the pattern of breathing during exercise, and particularly maximum tidal volume, can be used to distinguish between interstitial lung disease and pulmonary vascular disease; however this has never been formally investigated. This study looks at the impact of incremental exercise on a bicycle ergometer and the impact that such exercise has on breathing pattern, specifically maximum tidal volume. Method: We retrospectively reviewed the incremental exercise tests of 10 patients with pulmonary fibrosis (PF) and 9 with primary pulmonary hypertension (PPH). Patients were exercised using a bicycle ergometer, seated, and breathing into a mouthpiece. Results: The VE/VCO2 relationship was linear in all patients, but PPH patients had higher VE/VCO2 slopes (0.058±0.03) mean ±SD than PF patients (0.039±0.01, P<0.04).  The respiratory rate/VE slopes were also higher in PPH patients (0.48±0.17) than in PF patients (0.30±0.14, P<0.02).  There was no correlation between the VTmax/IC at the end of exercise and the IC %predicted in either group.  However, VTmax as % of IC at the end of exercise in PPH patients (59.1±7.6) was lower than in PF patients (87.0±14.5%, P<0.001). Conclusion: The pattern of breathing during exercise, specifically maximum tidal volume, is different in patients with primary pulmonary hypertension compared with pulmonary fibrosis patients.  These changes in the breathing pattern are unrelated to underlying static and dynamic lung function. Thus, the conclusion is that patients who have lung diseases which restrict their breathing often compensate, likely in an effort to avoid dyspnea, by modifying their natural breathing into a more tightly constrained pattern.},
 year = {2013}
}

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TY  - JOUR
T1  - A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension
AU  - Abdullah Al-Shimemeri
AU  - Itani M
AU  - Alghadeer Hend
AU  - Al-Jahdali Hamdan
AU  - Al-Moamary Mohamed
AU  - A. Al-Duhaim Ahmad
AU  - Mobeireek Abdullah
Y1  - 2013/11/10
PY  - 2013
N1  - https://doi.org/10.11648/j.ajim.20130104.12
DO  - 10.11648/j.ajim.20130104.12
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 31
EP  - 35
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20130104.12
AB  - It has previously been proposed that the pattern of breathing during exercise, and particularly maximum tidal volume, can be used to distinguish between interstitial lung disease and pulmonary vascular disease; however this has never been formally investigated. This study looks at the impact of incremental exercise on a bicycle ergometer and the impact that such exercise has on breathing pattern, specifically maximum tidal volume. Method: We retrospectively reviewed the incremental exercise tests of 10 patients with pulmonary fibrosis (PF) and 9 with primary pulmonary hypertension (PPH). Patients were exercised using a bicycle ergometer, seated, and breathing into a mouthpiece. Results: The VE/VCO2 relationship was linear in all patients, but PPH patients had higher VE/VCO2 slopes (0.058±0.03) mean ±SD than PF patients (0.039±0.01, P<0.04).  The respiratory rate/VE slopes were also higher in PPH patients (0.48±0.17) than in PF patients (0.30±0.14, P<0.02).  There was no correlation between the VTmax/IC at the end of exercise and the IC %predicted in either group.  However, VTmax as % of IC at the end of exercise in PPH patients (59.1±7.6) was lower than in PF patients (87.0±14.5%, P<0.001). Conclusion: The pattern of breathing during exercise, specifically maximum tidal volume, is different in patients with primary pulmonary hypertension compared with pulmonary fibrosis patients.  These changes in the breathing pattern are unrelated to underlying static and dynamic lung function. Thus, the conclusion is that patients who have lung diseases which restrict their breathing often compensate, likely in an effort to avoid dyspnea, by modifying their natural breathing into a more tightly constrained pattern.
VL  - 1
IS  - 4
ER  -

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Author Information

Abdullah Al-Shimemeri

Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh 11426
Itani M

Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Riyadh 11426
Alghadeer Hend

Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Al-Jahdali Hamdan

Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Al-Moamary Mohamed

Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
A. Al-Duhaim Ahmad

Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Mobeireek Abdullah

King Saud University, Riyadh, Saudi Arabia

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APA Style

Abdullah Al-Shimemeri, Itani M, Alghadeer Hend, Al-Jahdali Hamdan, Al-Moamary Mohamed, et al. (2013). A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension. American Journal of Internal Medicine, 1(4), 31-35. https://doi.org/10.11648/j.ajim.20130104.12

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ACS Style

Abdullah Al-Shimemeri; Itani M; Alghadeer Hend; Al-Jahdali Hamdan; Al-Moamary Mohamed, et al. A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension. Am. J. Intern. Med. 2013, 1(4), 31-35. doi: 10.11648/j.ajim.20130104.12

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AMA Style

Abdullah Al-Shimemeri, Itani M, Alghadeer Hend, Al-Jahdali Hamdan, Al-Moamary Mohamed, et al. A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension. Am J Intern Med. 2013;1(4):31-35. doi: 10.11648/j.ajim.20130104.12

Copy | Download

@article{10.11648/j.ajim.20130104.12,
  author = {Abdullah Al-Shimemeri and Itani M and Alghadeer Hend and Al-Jahdali Hamdan and Al-Moamary Mohamed and A. Al-Duhaim Ahmad and Mobeireek Abdullah},
  title = {A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension},
  journal = {American Journal of Internal Medicine},
  volume = {1},
  number = {4},
  pages = {31-35},
  doi = {10.11648/j.ajim.20130104.12},
  url = {https://doi.org/10.11648/j.ajim.20130104.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20130104.12},
  abstract = {It has previously been proposed that the pattern of breathing during exercise, and particularly maximum tidal volume, can be used to distinguish between interstitial lung disease and pulmonary vascular disease; however this has never been formally investigated. This study looks at the impact of incremental exercise on a bicycle ergometer and the impact that such exercise has on breathing pattern, specifically maximum tidal volume. Method: We retrospectively reviewed the incremental exercise tests of 10 patients with pulmonary fibrosis (PF) and 9 with primary pulmonary hypertension (PPH). Patients were exercised using a bicycle ergometer, seated, and breathing into a mouthpiece. Results: The VE/VCO2 relationship was linear in all patients, but PPH patients had higher VE/VCO2 slopes (0.058±0.03) mean ±SD than PF patients (0.039±0.01, P<0.04).  The respiratory rate/VE slopes were also higher in PPH patients (0.48±0.17) than in PF patients (0.30±0.14, P<0.02).  There was no correlation between the VTmax/IC at the end of exercise and the IC %predicted in either group.  However, VTmax as % of IC at the end of exercise in PPH patients (59.1±7.6) was lower than in PF patients (87.0±14.5%, P<0.001). Conclusion: The pattern of breathing during exercise, specifically maximum tidal volume, is different in patients with primary pulmonary hypertension compared with pulmonary fibrosis patients.  These changes in the breathing pattern are unrelated to underlying static and dynamic lung function. Thus, the conclusion is that patients who have lung diseases which restrict their breathing often compensate, likely in an effort to avoid dyspnea, by modifying their natural breathing into a more tightly constrained pattern.},
 year = {2013}
}

Copy | Download

TY  - JOUR
T1  - A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension
AU  - Abdullah Al-Shimemeri
AU  - Itani M
AU  - Alghadeer Hend
AU  - Al-Jahdali Hamdan
AU  - Al-Moamary Mohamed
AU  - A. Al-Duhaim Ahmad
AU  - Mobeireek Abdullah
Y1  - 2013/11/10
PY  - 2013
N1  - https://doi.org/10.11648/j.ajim.20130104.12
DO  - 10.11648/j.ajim.20130104.12
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 31
EP  - 35
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20130104.12
AB  - It has previously been proposed that the pattern of breathing during exercise, and particularly maximum tidal volume, can be used to distinguish between interstitial lung disease and pulmonary vascular disease; however this has never been formally investigated. This study looks at the impact of incremental exercise on a bicycle ergometer and the impact that such exercise has on breathing pattern, specifically maximum tidal volume. Method: We retrospectively reviewed the incremental exercise tests of 10 patients with pulmonary fibrosis (PF) and 9 with primary pulmonary hypertension (PPH). Patients were exercised using a bicycle ergometer, seated, and breathing into a mouthpiece. Results: The VE/VCO2 relationship was linear in all patients, but PPH patients had higher VE/VCO2 slopes (0.058±0.03) mean ±SD than PF patients (0.039±0.01, P<0.04).  The respiratory rate/VE slopes were also higher in PPH patients (0.48±0.17) than in PF patients (0.30±0.14, P<0.02).  There was no correlation between the VTmax/IC at the end of exercise and the IC %predicted in either group.  However, VTmax as % of IC at the end of exercise in PPH patients (59.1±7.6) was lower than in PF patients (87.0±14.5%, P<0.001). Conclusion: The pattern of breathing during exercise, specifically maximum tidal volume, is different in patients with primary pulmonary hypertension compared with pulmonary fibrosis patients.  These changes in the breathing pattern are unrelated to underlying static and dynamic lung function. Thus, the conclusion is that patients who have lung diseases which restrict their breathing often compensate, likely in an effort to avoid dyspnea, by modifying their natural breathing into a more tightly constrained pattern.
VL  - 1
IS  - 4
ER  -

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