Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Factors Associated with the Discrepancy between Exercise Capacity and Airflow Limitation in Patients with Chronic Obstructive Pulmonary Disease

  • Tae Hoon Kim (Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine) ;
  • I Re Heo (Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine) ;
  • Na Young Kim (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital) ;
  • Joo Hun Park (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Hee-Young Yoon (Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Ji Ye Jung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Seung Won Ra (Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Ki-Suck Jung (Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Kwang Ha Yoo (Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Ho Cheol Kim (Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine)
  • Received : 2023.05.13
  • Accepted : 2023.12.26
  • Published : 2024.04.30
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Abstract

Background: Exercise capacity is associated with lung function decline in chronic obstructive pulmonary disease (COPD) patients, but a discrepancy between exercise capacity and airflow limitation exists. This study aimed to explore factors contributing to this discrepancy in COPD patients. Methods: Data for this prospective study were obtained from the Korean COPD Subgroup Study. The exercise capacity and airflow limitation were assessed using the 6-minute walk distance (6-MWD; m) and forced expiratory volume in 1 second (FEV1). Participants were divided into four groups: FEV1 >50%+6-MWD >350, FEV1 >50%+6-MWD ≤350, FEV1 ≤50%+6-MWD >350, and FEV1 ≤50%+6-MWD ≤350 and their clinical characteristics were compared. Results: A total of 883 patients (male:female, 822:61; mean age, 68.3±7.97 years) were enrolled. Among 591 patients with FEV1 >50%, 242 were in the 6-MWD ≤350 group, and among 292 patients with FEV1 ≤50%, 185 were in the 6-MWD >350 group. The multiple regression analyses revealed that male sex (odds ratio [OR], 8.779; 95% confidence interval [CI], 1.539 to 50.087; p=0.014), current smoking status (OR, 0.355; 95% CI, 0.178 to 0.709; p=0.003), and hemoglobin levels (OR, 1.332; 95% CI, 1.077 to 1.648; p=0.008) were significantly associated with discrepancies in exercise capacity and airflow limitation in patients with FEV1 >50%. Meanwhile, in patients with FEV1 ≤50%, diffusion capacity of carbon monoxide (OR, 0.945; 95% CI, 0.912 to 0.979; p=0.002) was significantly associated with discrepancies between exercise capacity and airflow limitation. Conclusion: The exercise capacity of COPD patients may be influenced by factors other than airflow limitation, so these aspects should be considered when assessing and treating patients.

Keywords

Acknowledgement

This work was supported by a Research Program funded by the Korea National Institute of Health (Fund CODE 2016ER670100, 2016ER670101, 2016ER670102, 2018 ER67100, 2018ER67101, 2018ER67102, 2021ER120500, 2021ER120501, and 2021ER120502).

References

  1. Calverley PM. Exercise and dyspnoea in COPD. Eur Respir Rev 2006;15:72-9.
  2. Tantucci C, Modina D. Lung function decline in COPD. Int J Chron Obstruct Pulmon Dis 2012;7:95-9.
  3. Pinto-Plata VM, Celli-Cruz RA, Vassaux C, Torre-Bouscoulet L, Mendes A, Rassulo J, et al. Differences in cardiopulmonary exercise test results by American Thoracic Society/European Respiratory Society-Global Initiative for Chronic Obstructive Lung Disease stage categories and gender. Chest 2007;132:1204-11.
  4. Krishna BS, Mohapatra AK, Behera D, Jagaty SK, Subhankar S, Venkataram R, et al. Six-minute walk test and its correlation with spirometry in stable COPD patients. J Health Allied Sci NU 2021;12:280-5.
  5. Spruit MA, Watkins ML, Edwards LD, Vestbo J, Calverley PM, Pinto-Plata V, et al. Determinants of poor 6-min walking distance in patients with COPD: the ECLIPSE cohort. Respir Med 2010;104:849-57.
  6. O'Donnell DE, Revill SM, Webb KA. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:770-7.
  7. O'Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. J Appl Physiol (1985) 2008;105:753-7.
  8. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347-65.
  9. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update: an official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2019;200:e70-88.
  10. Vestbo J, Anderson W, Coxson HO, Crim C, Dawber F, Edwards L, et al. Evaluation of COPD longitudinally to identify predictive surrogate end-points (ECLIPSE). Eur Respir J 2008;31:869-73.
  11. Liu C, Cheng W, Zeng Y, Zhou Z, Zhao Y, Duan J, et al. Different characteristics of ex-smokers and current smokers with COPD: a cross-sectional study in China. Int J Chron Obstruct Pulmon Dis 2020;15:1613-19.
  12. Mesquita R, Goncalves CG, Hayashi D, Costa Vde S, Teixeira Dde C, de Freitas ER, et al. Smoking status and its relationship with exercise capacity, physical activity in daily life and quality of life in physically independent, elderly individuals. Physiotherapy 2015;101:55-61.
  13. Caram LM, Ferrari R, Bertani AL, Garcia T, Mesquita CB, Knaut C, et al. Smoking and early COPD as independent predictors of body composition, exercise capacity, and health status. PLoS One 2016;11:e0164290.
  14. Saetia M, Puangprachang K, Semanu P, Siaosirithaworn S. Effects of 6 minute walk test and lung function test between smoking and stop smoking in chronic obstruction pulmonary disease patients at Samut Songkhram. Tob Induc Dis 2021;19:A17.
  15. Kim Y, Kim SH, Rhee CK, Lee JS, Lee CY, Kim DK, et al. Air trapping and the risk of COPD exacerbation: analysis from prospective KOCOSS Cohort. Front Med (Lausanne) 2022;9:835069.
  16. Ferrari M, Manea L, Anton K, Bruzzone P, Meneghello M, Zamboni F, et al. Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease. BMC Pulm Med 2015;15:58.
  17. Cote C, Zilberberg MD, Mody SH, Dordelly LJ, Celli B. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007;29:923-9.
  18. Santer P, McGahey A, Frise MC, Petousi N, Talbot NP, Baskerville R, et al. Intravenous iron and chronic obstructive pulmonary disease: a randomised controlled trial. BMJ Open Respir Res 2020;7:e000577.
  19. Fujimoto H, Asai K, Watanabe T, Kanazawa H, Hirata K. Association of six-minute walk distance (6MWD) with resting pulmonary function in patients with chronic obstructive pulmonary disease (COPD). Osaka City Med J 2011;57:21-9.
  20. Diaz AA, Pinto-Plata V, Hernandez C, Pena J, Ramos C, Diaz JC, et al. Emphysema and DLCO predict a clinically important difference for 6MWD decline in COPD. Respir Med 2015;109:882-9.