Editorial
Exercise-induced Oxygen Desaturation in Chronic Obstructive Pulmonary Disease Patients
Desaturación de oxígeno inducido por el ejercicio en pacientes con enfermedad pulmonar obstructiva crónica
Ignacio García-Talavera
, Patricia Jiménez González, Rafael Dorta Sánchez
Corresponding author
Unidad de Investigación, Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de la Laguna, Santa Cruz de Tenerife, Canary Islands, Spain
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The range of clinical symptoms and other specific characteristics of COPD patients has led it be considered more as a syndrome than a disease, and many investigators have been motivated to define new phenotypes that reflect the particular features or responses of these patients. GesEPOC<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> guidelines classify phenotypes as non-exacerbator and exacerbator, predominant emphysema or chronic bronchitis, while the GOLD classification<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> includes moderate, severe and symptomatic or at-risk. It is clear that we are about to see a surge in COPD classifications, as it seems likely that guidelines will emerge in the near future that try to account for any particular characteristics that modify the clinical course or prognosis of the disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">One characteristic that has been well defined but little understood is exercise-induced oxygen desaturation. About one third of COPD patients are thought to suffer desaturation during exercise, so this phenomenon is encountered relatively often in these patients. Nevertheless, consensus has not yet been reached on the definition of desaturation: some authors define it as a drop in blood oxygen saturation of 4% or more, while for others, it is a drop in blood oxygen saturation of 4% along with a reduction in minimum saturation to below 90% oxygen saturation in hemoglobin. This phenomenon has been mostly observed in patients with more severe disease in terms of FEV1, and in patients with predominant emphysema phenotype. Although oxygen saturation may be detected during maximal effort on a cycle ergometer or during shorter exercise tests, it is mostly observed during submaximal effort on the 6-min walk test. This test is widely used and can be implemented in any center. In addition to determining the number of meters walked, it can be used to determine how the patient walked or how oxygen saturation changed during the test. Thus, the qualitative component of the walk test, an aspect that has received little attention to date, can also be analyzed. The correlation between desaturation during the 6-minute walk test and desaturation observed during activities of daily living have already been analyzed: patients experiencing saturation within 1<span class="elsevierStyleHsp" style=""></span>min of starting the walk test, known as early desaturators, have a high probability of desaturation during activities of daily living, i.e., during a normal day with regular activity.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Thus, patients who are early desaturators during a submaximal exercise tolerance walk test performed in a hospital, also have desaturations outside the hospital, during low-level exercise or while performing regular activities. These patients, in principle, should be more closely monitored than those who do not experience desaturation or who do so at a later stage (after 5.30<span class="elsevierStyleHsp" style=""></span>min). Thus, desaturation does appear to be an important characteristic of COPD patients, and one that impacts on the exercise tolerance and the quality of life of many. Moreover, in another study in which arterial PaO<span class="elsevierStyleInf">2</span> levels were analyzed in early and late desaturators, after 5 years of follow-up, the early desaturators were seen to develop respiratory failure before the late desaturators.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Desaturation during exercise, then, is a rather common occurrence, more so in patients with severe disease. Early or more rapid desaturation, moreover, is predictive of future respiratory failure. Indeed, it seems that while the number of meters walked in the 6-minute test provides useful data with prognostic value,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the manner of walking and the moment in which COPD patients present desaturation are equally relevant.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Nevertheless, factors predicting desaturation during exercise remain unclear. For some authors, FEV1 is important, while for others carbon monoxide diffusion (DLCO) or PaO<span class="elsevierStyleInf">2</span><a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> are of more interest. Furthermore, not only are the extent and time of desaturation important, recovery after exercise is probably significant too. Time to recovery of baseline pre-test values may be of clinical interest and prognostic value.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Another consideration is that some patients, generally those with severe obstruction, desaturate more deeply, to levels as low as 20% below baseline. Indeed, it is not uncommon to see patients who desaturate more than 10%, with a minimum saturation of less than 90% and FEV1 below 50% predicted value and severely diminished DLCO. This phenomenon has also been seen in other milder desaturators, but the clinical impact in these patients has still to be defined.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The next question to be addressed is whether COPD patients with exercise-induced desaturation are candidates for oxygen therapy during exercise. Current guidelines are unclear in this regard, and ambulatory oxygen therapy is recommended if it improves dyspnea or exercise tolerance.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Oxygen therapy may be really effective in patients with large or early desaturations. More studies are needed to provide new data on the clinical consequences of severe exercise-induced desaturations during exercise in COPD patients and the possible benefits of oxygen therapy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Talavera I, Jiménez González P, Dorta Sánchez R. Desaturación de oxígeno inducido por el ejercicio en pacientes con enfermedad pulmonar obstructiva crónica. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 77 | 18 | 95 |
| 2024 September | 73 | 14 | 87 |
| 2024 August | 98 | 32 | 130 |
| 2024 July | 76 | 17 | 93 |
| 2024 June | 83 | 29 | 112 |
| 2024 May | 89 | 31 | 120 |
| 2024 April | 70 | 29 | 99 |
| 2024 March | 72 | 21 | 93 |
| 2024 February | 40 | 21 | 61 |
| 2023 October | 1 | 1 | 2 |
| 2023 March | 18 | 5 | 23 |
| 2023 February | 80 | 23 | 103 |
| 2023 January | 69 | 31 | 100 |
| 2022 December | 80 | 33 | 113 |
| 2022 November | 76 | 29 | 105 |
| 2022 October | 83 | 59 | 142 |
| 2022 September | 65 | 38 | 103 |
| 2022 August | 63 | 54 | 117 |
| 2022 July | 55 | 41 | 96 |
| 2022 June | 62 | 39 | 101 |
| 2022 May | 83 | 44 | 127 |
| 2022 April | 93 | 37 | 130 |
| 2022 March | 87 | 43 | 130 |
| 2022 February | 103 | 46 | 149 |
| 2022 January | 110 | 34 | 144 |
| 2021 December | 100 | 59 | 159 |
| 2021 November | 73 | 63 | 136 |
| 2021 October | 89 | 75 | 164 |
| 2021 September | 105 | 55 | 160 |
| 2021 August | 96 | 47 | 143 |
| 2021 July | 72 | 31 | 103 |
| 2021 June | 116 | 53 | 169 |
| 2021 May | 127 | 36 | 163 |
| 2021 April | 274 | 106 | 380 |
| 2021 March | 189 | 37 | 226 |
| 2021 February | 155 | 26 | 181 |
| 2021 January | 131 | 27 | 158 |
| 2020 December | 128 | 29 | 157 |
| 2020 November | 105 | 25 | 130 |
| 2020 October | 125 | 24 | 149 |
| 2020 September | 219 | 59 | 278 |
| 2020 August | 148 | 21 | 169 |
| 2020 July | 162 | 19 | 181 |
| 2020 June | 149 | 14 | 163 |
| 2020 May | 168 | 24 | 192 |
| 2020 April | 224 | 34 | 258 |
| 2020 March | 135 | 18 | 153 |
| 2020 February | 161 | 26 | 187 |
| 2020 January | 172 | 18 | 190 |
| 2019 December | 163 | 22 | 185 |
| 2019 November | 190 | 30 | 220 |
| 2019 October | 179 | 17 | 196 |
| 2019 September | 244 | 21 | 265 |
| 2019 August | 142 | 21 | 163 |
| 2019 July | 161 | 32 | 193 |
| 2019 June | 187 | 29 | 216 |
| 2019 May | 232 | 21 | 253 |
| 2019 April | 395 | 29 | 424 |
| 2019 March | 516 | 27 | 543 |
| 2019 February | 421 | 31 | 452 |
| 2019 January | 430 | 23 | 453 |
| 2018 December | 451 | 22 | 473 |
| 2018 November | 621 | 30 | 651 |
| 2018 October | 562 | 35 | 597 |
| 2018 September | 289 | 19 | 308 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 100 | 0 | 100 |
| 2018 April | 205 | 8 | 213 |
| 2018 March | 177 | 6 | 183 |
| 2018 February | 132 | 11 | 143 |
| 2018 January | 139 | 11 | 150 |
| 2017 December | 115 | 7 | 122 |
| 2017 November | 159 | 8 | 167 |
| 2017 October | 200 | 8 | 208 |
| 2017 September | 197 | 21 | 218 |
| 2017 August | 165 | 14 | 179 |
| 2017 July | 124 | 17 | 141 |
| 2017 June | 180 | 33 | 213 |
| 2017 May | 127 | 30 | 157 |
| 2017 April | 125 | 22 | 147 |
| 2017 March | 102 | 37 | 139 |
| 2017 February | 78 | 25 | 103 |
| 2017 January | 57 | 12 | 69 |
| 2016 December | 70 | 20 | 90 |
| 2016 November | 92 | 24 | 116 |
| 2016 October | 61 | 28 | 89 |
| 2016 September | 60 | 39 | 99 |
| 2016 August | 49 | 10 | 59 |
| 2016 July | 50 | 20 | 70 |
| 2016 May | 0 | 12 | 12 |
| 2016 April | 0 | 1 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 3 | 4 |
| 2016 January | 0 | 11 | 11 |
| 2015 October | 2 | 4 | 6 |
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