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PubMed2006

Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance.

Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and prognostic value. The pathophysiology determining exercise ventilatory inefficiency is complex and not definitively clarified. Three different mechanisms have been identified: (i) increased dead space, (ii) early occurrence of lactic acidosis, and (iii) abnormal chemoreflex and/or metaboreflex activity. Besides its prognostic value, abnormal ventilation can be influenced by pharmacological and non-pharmacological therapies such as beta-blockers, selective cyclic 3'-5' guanosine monosphosphate phosphodiesterase inhibitors, physical training, and nocturnal continuous positive airway pressure. There is an increasing interest for the exercise periodic breathing, which is frequently associated with HF syndrome and has prognostic importance. The precise mechanisms sustaining exercise periodic breathing are not fully defined but ventilatory and metabo-haemodynamic hypotheses have been proposed.

Adrenergic beta-Antagonists↗
PubMed2004

Complementary and alternative medicine for bronchial asthma: is there new evidence?

PURPOSE OF REVIEW: Complementary and alternative medicine is widely used in bronchial asthma. Data on efficacy of these treatment modalities are lacking. RECENT FINDINGS: Studies published since June 2002 on complementary and alternative medicine in bronchial asthma were systematically reviewed. SUMMARY: Studies do not support the use of homeopathy, air ionizers, manual therapy, or acupuncture for asthma. These methods bear some risks to patients related to undertreatment and side effects. There might be a possible, but so far not clearly established, role for antioxidant dietary supplementation, and some natural antiinflammatory and immunomodulatory remedies. However, their effect size compared with the classical treatment and side-effect profile is not clearly established. Strategies influencing breathing technique or perception, such as breathing or retraining exercises, need to be studied over the next few years to establish their additive role in the treatment of asthma. Breathing exercises could improve lung function and quality of life in different studies. Psychotherapy-related methods such as relaxation, hypnosis, autogenic training, speleotherapy, and biofeedback might have a small effect in selected cases, but have not proven to be superior to placebo. Nevertheless, more randomized controlled trials of good methodological quality are required to allow firm conclusions.

Acupuncture Therapy↗
PubMed1989

Changes in breath 13CO2/12CO2 consequent to exercise and hypoxia.

Because the natural enrichment of carbohydrate with 13C is greater than that of lipid, we hypothesized that the natural enrichment of exhaled CO2 with 13C (EN) could be used to gauge endogenous substrate utilization in exercising human subjects. To test this, EN and the respiratory exchange ratio (R) which equals the respiratory quotient (RQ) in the steady state, were measured simultaneously in seven subjects. Rest and exercise protocols, performed under conditions of room air (sea level) and hypoxic (inspired O2 fraction = 0.15) breathing, were chosen to cause a variety of patterns of oxidative substrate utilization. Work rates were performed both below and above the subject's lactate threshold (LT). Work above the LT was expected to cause the greatest increase in EN reflecting greater utilization of glucose. There was significant intersubject (P less than 0.05) but not intrasubject variability in resting EN. By 40 min of exercise, EN increased significantly (P less than 0.05) over resting values in all exercise protocols during both room air and hypoxia conditions. In the room air studies, we found no difference in EN during the below-LT work, even though there were significant increases in O2 uptake (VO2). In contrast, above-LT work resulted in significantly greater increases in EN by 20 and 40 min of exercise (P less than 0.05). Contrary to our expectations, we observed no separate effect by hypoxia on the EN during exercise. Both EN and R tended to increase from rest to exercise, but during exercise there was no overall correlation between R and the EN. EN reflects changes in endogenous substrate utilization over relatively long periods of time such as at rest, but delays in the appearance of 13CO2 at the mouth due to dilution in body CO2 pools, and possibly isotopic fractionation, preclude the usefulness of EN as an indicator of endogenous fuel mix during short-term exercise.

Adult↗
PubMed1990

Timing of deep breaths during rest and light exercise in man.

1. We used digital filtering techniques and segmental analysis to dissect a series of respiratory variables into three components: (a) outlying values, including deep breaths or sighs; (b) random variation; (c) non-stationary baseline variation. 2. Records of about 30 min breathing were obtained from normal adults at rest and at 50 W exercise. 3. Deep breaths were defined as having a tidal volume greater than 2.5 sd above the mean. 4. We related these deep breaths to preceding trends in tidal volume and end-tidal partial pressure of CO2. 5. At rest, there was no relation between deep breaths and tidal volume, but the deep breaths were significantly clustered around the troughs in end-tidal partial pressure of CO2. 6. At 50 W exercise, there was no relation between deep breaths and end-tidal partial pressure of CO2, but the deep breaths were significantly clustered around tidal volume troughs. 7. Results obtained by pneumography were concordant with those obtained by using a mouthpiece to measure ventilation.

Adult↗
PubMed1997

Nitric oxide inhalation during exercise in chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) may develop hypoxemia and pulmonary hypertension when exercising. To investigate whether inhaled nitric oxide (NO), a selective pulmonary vasodilator, modifies the changes induced by exercise in pulmonary hemodynamics and gas exchange in COPD, we studied nine patients (FEV1, = 39 +/- 2% predicted), at rest and at submaximal exercise, during breathing of room air and NO (40 ppm). NO inhalation decreased pulmonary artery pressure (Ppa) both at rest and during exercise (analysis of variance [ANOVA] p < 0.05). However, the effect of NO on PaO2 was different at rest than during exercise. At rest, NO decreased PaO2 from 72 +/- 3 mm Hg to 65 +/- 2 mm Hg, due to an increase in ventilation-perfusion (VA/Q) inequality (dispersion of blood flow distribution from 0.9 +/- 0.1 to 1.1 +/- 0.1). During exercise, PaO2 decreased during breathing of room air (-5 +/- 3 mm Hg), whereas it remained essentially unchanged during inhalation of NO (+2 +/- 3 mm Hg), with both changes being significantly different (p < 0.05). VA/Q relationships improved during exercise during breathing of both room air and NO, as a result of a reduction in the dispersion of ventilation distribution. Moreover, NO administered on exertion contributed to redistribute blood flow from alveolar units with low VA/Q ratios to units with normal ratios (p < 0.05). We conclude that in patients with COPD, the inhalation of NO during exercise moderately reduces pulmonary hypertension, and that in contrast with the effects of such inhalation at rest, it may prevent the exercise-associated decrease of PaO2. This effect is probably explained by a preferential distribution of inhaled NO during exercise to well-ventilated alveolar units with faster time constants and normal VA/Q ratios.

Administration, Inhalation↗
PubMed1999

Do fire-fighters develop specific ventilatory responses in order to cope with exercise whilst wearing self-contained breathing apparatus?

In the present study we compared the ventilatory performance whilst wearing self-contained breathing apparatus (SCBA) during exercise, of a group of male fire-fighters (FF, n = 8), with a matched group of male civilians (CV, n = 7). The mean (SEM) physiological characteristics of the subjects (FF vs CV) were: age 31 (2) years vs 32 (4) years; height 179 (2) cm vs 183 (3) cm, P < 0.05; mass 80 (2) kg vs 84 (3) kg; maximum oxygen uptake 4.52 (0.14) 1 x min(-1) vs 4.39 (0.27) 1 x min(-1). Volunteers performed a 23-minute fire-fighting simulation (Firetest), without and with SCBA (Fire-fighter II, Siebe-Gorman/North Safety, Cheshire, UK). During SCBA wear, the FF group used significantly less air and rated their breathlessness significantly lower than the CV group. The mean tidal volume (V(T)) of the FF group remained constant between non-SCBA and SCBA wear conditions, but the CV group increased their mean V(T) by 18%, (P < 0.01). There were no significant between-group differences during the Firetest in total breath duration, inspiratory or expiratory duration, breathing frequency (fb), or heart rate. These data suggest that the respiratory responses of firefighters while wearing SCBA, which are characterised by increases in (fb) but not V(T), may help to reduce their breathlessness during exercise while wearing SCBA.

Adult↗