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Exercise Limitation in Patients With Chronic Obstructive Pulmonary Disease at the Altitude of Bogota (2640 m): Breathing Pattern and Arterial Gases at Rest and Peak Exercise
M. González-García
, M. Barrero, D. Maldonado
Corresponding author
mgonzalez@neumologica.org
Correspondence: Dr. M. González-García. Calle 163 A, 28-60. Bogota. Colombia
Correspondence: Dr. M. González-García. Calle 163 A, 28-60. Bogota. Colombia
Laboratorio de Fisiología y Función Pulmonar, Fundación Neumológica Colombiana, Bogota, Colombia
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"apellidos" => "González-García" "email" => array:1 [ 0 => "mgonzalez@neumologica.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Barrero" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Maldonado" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Laboratorio de Fisiología y Función Pulmonar, Fundación Neumológica Colombiana, Bogota, Colombia" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. M. González-García. Calle 163 A, 28-60. Bogota. Colombia" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-04-29" "fechaAceptado" => "2003-09-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec153263" "palabras" => array:6 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Exercise" 2 => "Dynamic hyperinflation" 3 => "Breathing pattern" 4 => "Arterial blood gases" 5 => "Altitude" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153262" "palabras" => array:6 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Ejercicio" 2 => "Hiperinflación pulmonary" 3 => "Patrón respiratorio" 4 => "Gases arteriales" 5 => "Altitud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">TO describe the response to exercise of normal subjects and patients with chronic obstructive pulmonary disease (COPD) in Bogota, Colombia (altitude: 2640 m; atmospheric pressure: 560 mm Hg) and compare it with data published on COPD patients at sea level. Healthy people increase their minute ventilation to attenuate hypoxemia (PaCO<span class="elsevierStyleInf">2</span>: 30 mm Hg; PaO<span class="elsevierStyleInf">2</span>: 63 mm Hg).</p> <span class="elsevierStyleSectionTitle">Material and method</span><p class="elsevierStyleSimplePara elsevierViewall">A descriptive study was carried out on healthy subjects and COPD patients. Exercise limitation was determined by an incremental test on a cycle ergometer.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The study enrolled 16 healthy subjects and 25 COPD patients (forced expiratory volume in 1 second: 43.3% [SD 13%]). Minute ventilation at rest was greater in COPD patients compared with healthy subjects, it was not adequately sustained during exercise, and there was a reduction in peak oxygen uptake (53.0% [15%]). At peak exercise, inspiratory capacity decreased (-0.62 [0.34] L), the ratio of minute ventilation to maximal voluntary ventilation increased, and severe hypoxemia occurred (PaO<span class="elsevierStyleInf">2</span>: 49.9 [9.9] mm Hg). There was significant correlation between hypoxemia and the percentage of predicted peak oxygen uptake (r=0.60), leg fatigue (r=-0.62), percentage of predicted peak inspiratory capacity (r=0.61), and the percentage of predicted peak tidal volume (r=0.49). Minute ventilation at rest was shown to be higher, there was a greater reduction in the inspiratory capacity during exercise, and hypoxemia was more severe at rest and during exercise for patients with COPD in Bogota, compared with those at sea level.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Patients with COPD living in Bogota were shown to have lower tolerance to exercise evidenced by ventilatory limitation and severe hypoxemia. Increased minute ventilation at rest, greater reduction in inspiratory capacity, and severity of hypoxemia during exercise were the main differences between COPD in Bogota and at sea level.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Describir la respuesta al ejercicio en sujetos normales y en pacientes con enfermedad pulmonar obstruc-tiva crónica (EPOC) en Bogotá (altura: 2.640 m; presión at-mosférica: 560 mmHg) y establecer diferencias con los datos publicados de pacientes con dicha enfermedad a nivel del mar. Las personas sanas a esta altura aumentan la ventilación alveolar para atenuar la hipoxemia (presión arterial de CO<span class="elsevierStyleInf">2</span>: 30 mmHg; presión arterial de O<span class="elsevierStyleInf">2</span>: 63 mmHg).</p> <span class="elsevierStyleSectionTitle">Material y método</span><p class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio descriptivo en pacientes con EPOC y en sujetos sanos. La capacidad de ejercicio se determinó con una prueba incremental en un cicloergómetro.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyó en el estudio a 16 sujetos sanos y 25 pacientes con EPOC (volumen espiratorio forzado en el primer segundo del 43,3 ± 13%). En comparación con los sujetos sanos, en los pacientes con EPOC se observó un au-mento de la ventilación minuto en reposo que no se mantuvo adecuadamente en el ejercicio, así como disminución del con-sumo de oxígeno pico (53,0 ± 15%). En ejercicio pico la capacidad inspiratoria disminuyó (-0,62 ± 0,34 1), la relación ventilación minuto/ventilación voluntaria máxima aumentó y hubo una intensa hipoxemia (presión arterial de O<span class="elsevierStyleInf">2</span> de 49,9 ± 9,9 mmHg). Esta hipoxemia se correlacionó significativa-mente con el porcentaje del valor predicho del consumo de oxígeno pico (r = 0,60), la fatiga de los miembros inferiores (r = -0,62), el porcentaje predicho de la capacidad inspiratoria pico (r = 0,61) y el porcentaje predicho del volumen corriente pico (r = 0,49). En comparación con los datos publicados a nivel del mar, en los pacientes con EPOC la ventilación minuto en reposo fue mayor, hubo una mayor disminución de la capacidad inspiratoria durante el ejercicio y la hipoxemia fue más grave tan to en reposo como en ejercicio.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">En los pacientes con EPOC residentes en Bogotá demostramos intolerancia al ejercicio determinada por limitación ventilatoria e hipoxemia severa. El aumento de la ventilación minuto en reposo, la mayor disminución de la capacidad inspiratoria y la gravedad de la hipoxemia durante el ejercicio fueron las principales diferencias con la EPOC a nivel del mar.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise limitation and clinical exercise testing in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "DE O'Donnell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Clinical exercise testing" "paginaInicial" => "138" "paginaFinal" => "158" "serieFecha" => "2002" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms and measures of exercise intolerance in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L Nici" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2000" "volumen" => "2" "paginaInicial" => "693" "paginaFinal" => "704" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise limitation and clinical exercise testing in chronic obstructive pulmonary diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "CG Gallagher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "1994" "volumen" => "15" "paginaInicial" => "305" "paginaFinal" => "326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8088095" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Responses to exercise in lung disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "AGN Agusti" 1 => "J Cotes" 2 => "PD Wagner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "titulo" => "Clinical exercise testing. 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| Year/Month | Html | Total | |
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| 2021 September | 18 | 58 | 76 |
| 2021 August | 9 | 28 | 37 |
| 2021 July | 17 | 27 | 44 |
| 2021 June | 25 | 46 | 71 |
| 2021 May | 12 | 18 | 30 |
| 2021 April | 20 | 70 | 90 |
| 2021 March | 20 | 24 | 44 |
| 2021 February | 11 | 15 | 26 |
| 2021 January | 9 | 8 | 17 |
| 2020 December | 10 | 21 | 31 |
| 2020 November | 7 | 7 | 14 |
| 2020 October | 10 | 12 | 22 |
| 2020 September | 14 | 10 | 24 |
| 2020 August | 5 | 17 | 22 |
| 2020 July | 11 | 17 | 28 |
| 2020 June | 6 | 4 | 10 |
| 2020 May | 17 | 12 | 29 |
| 2020 April | 13 | 25 | 38 |
| 2020 March | 13 | 15 | 28 |
| 2020 February | 15 | 20 | 35 |
| 2020 January | 10 | 18 | 28 |
| 2019 December | 10 | 12 | 22 |
| 2019 November | 9 | 13 | 22 |
| 2019 October | 13 | 13 | 26 |
| 2019 September | 9 | 11 | 20 |
| 2019 August | 11 | 8 | 19 |
| 2019 July | 21 | 22 | 43 |
| 2019 June | 7 | 5 | 12 |
| 2019 May | 17 | 9 | 26 |
| 2019 April | 12 | 18 | 30 |
| 2019 March | 17 | 11 | 28 |
| 2019 February | 13 | 15 | 28 |
| 2019 January | 13 | 9 | 22 |
| 2018 December | 15 | 9 | 24 |
| 2018 November | 44 | 37 | 81 |
| 2018 October | 26 | 24 | 50 |
| 2018 September | 15 | 13 | 28 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 4 | 8 | 12 |
| 2018 March | 6 | 4 | 10 |
| 2018 February | 8 | 8 | 16 |
| 2018 January | 3 | 11 | 14 |
| 2017 December | 6 | 10 | 16 |
| 2017 November | 6 | 3 | 9 |
| 2017 October | 4 | 7 | 11 |
| 2017 September | 8 | 9 | 17 |
| 2017 August | 6 | 11 | 17 |
| 2017 July | 9 | 11 | 20 |
| 2017 June | 11 | 11 | 22 |
| 2017 May | 14 | 6 | 20 |
| 2017 April | 15 | 7 | 22 |
| 2017 March | 11 | 4 | 15 |
| 2017 February | 4 | 3 | 7 |
| 2017 January | 7 | 7 | 14 |
| 2016 December | 10 | 7 | 17 |
| 2016 November | 16 | 10 | 26 |
| 2016 October | 15 | 8 | 23 |
| 2016 September | 16 | 18 | 34 |
| 2016 August | 11 | 4 | 15 |
| 2016 July | 4 | 5 | 9 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 100 | 1 | 101 |
| 2015 September | 92 | 14 | 106 |
| 2015 August | 63 | 15 | 78 |
| 2015 July | 97 | 12 | 109 |
| 2015 June | 72 | 8 | 80 |
| 2015 May | 67 | 12 | 79 |
| 2015 April | 78 | 8 | 86 |
| 2015 March | 84 | 8 | 92 |
| 2015 February | 94 | 7 | 101 |
| 2015 January | 57 | 7 | 64 |
| 2014 December | 76 | 9 | 85 |
| 2014 November | 87 | 9 | 96 |
| 2014 October | 106 | 8 | 114 |
| 2014 September | 76 | 11 | 87 |
| 2014 August | 78 | 7 | 85 |
| 2014 July | 87 | 7 | 94 |
| 2014 June | 110 | 12 | 122 |
| 2014 May | 81 | 11 | 92 |
| 2014 April | 81 | 8 | 89 |
| 2014 March | 104 | 12 | 116 |
| 2014 February | 80 | 8 | 88 |
| 2014 January | 64 | 10 | 74 |
| 2013 December | 57 | 6 | 63 |
| 2013 November | 57 | 10 | 67 |
| 2013 October | 63 | 12 | 75 |
| 2013 September | 52 | 18 | 70 |
| 2013 August | 41 | 9 | 50 |
| 2013 July | 57 | 20 | 77 |
| 2013 June | 49 | 9 | 58 |
| 2013 May | 42 | 8 | 50 |
| 2013 April | 37 | 4 | 41 |
| 2013 March | 16 | 7 | 23 |
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