1. Effects of bi-level positive airway pressure on ventilatory and perceptual responses to exercise in comorbid heart failure-COPD.
- Author
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Souza A, Sperandio PA, Mazzuco A, Alencar MCN, Arbex FF, Oliveira M, Medeiros W, Rocha A, Nery LE, O Donnell DE, and Neder JA
- Subjects
- Aged, Comorbidity, Continuous Positive Airway Pressure instrumentation, Dyspnea epidemiology, Dyspnea etiology, Heart Failure complications, Heart Failure epidemiology, Humans, Male, Middle Aged, Physical Endurance physiology, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive epidemiology, Treatment Outcome, Continuous Positive Airway Pressure methods, Dyspnea physiopathology, Dyspnea therapy, Exercise physiology, Exercise Tolerance physiology, Heart Failure physiopathology, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
This study tested the hypothesis that, by increasing the volume available for tidal expansion (inspiratory capacity, IC), bi-level positive airway pressure (BiPAP™) would lead to greater beneficial effects on dyspnea and exercise intolerance in comorbid heart failure (HF)-chronic obstructive pulmonary disease (COPD) than HF alone. Ten patients with HF and 9 with HF-COPD (ejection fraction = 30 ± 6% and 35 ± 7%; FEV
1 = 83 ± 12% and 65 ± 15% predicted, respectively) performed a discontinuous exercise protocol under sham ventilation or BiPAP™. Time to intolerance increased with BiPAP™ only in HF-COPD (p < 0.05). BiPAP™ led to higher tidal volume and lower duty cycle with longer expiratory time (p < 0.05). Of note, BiPAP™ improved IC (by ∼0.5 l) across exercise intensities only in HF-COPD. These beneficial consequences were associated with lower dyspnea scores at higher levels of ventilation (p < 0.05). By improving the qualitative" (breathing pattern and operational lung volumes) and sensory (dyspnea) features of exertional ventilation, BiPAP™ might allow higher exercise intensities to be sustained for longer during cardiopulmonary rehabilitation in HF-COPD., (Copyright © 2019 Elsevier B.V. All rights reserved.)- Published
- 2019
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