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Vol. 61. Issue 9.
Pages 544-554 (September 2025)
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Vol. 61. Issue 9.
Pages 544-554 (September 2025)
Original Article
Thoracoabdominal Asynchrony in Very Severe COPD: Clinical and Functional Correlates During Exercise
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Javier Sayas Catalána,f,
, Cristina Lalmoldab,c, Ana Hernández-Votha, Marta Corral Blancoa, Patrick Murphyd, Laura Gonzalez-Ramosa, Pablo Florez-Solaranab, Berta Lloret-Puigb, Manel Lujanb,e
a Hospital Universitario 12 de Octubre, Pneumology Service, Madrid, Spain
b Consorci Corporació Sanitària Parc Taulí, Pneumology Service, Sabadell, Spain
c Centro de Investigación Médica en Red de Enfermedades Respiratorias (CIBERES), Respiratory Research, Spain
d Guy's & St. Thomas’ NHS Foundation Trust, Lane Fox Respiratory Unit, London, United Kingdom
e Pneumology Department, Universitat Autònoma de Barcelona, Spain
f Universidad Complutense de Madrid, Spain
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Figures (6)
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Tables (3)
Table 1. Anthropometric and Lung Function Data for the Entire Cohort.
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Table 2. Thoracoabdominal Synchrony During Exercise With Conventional Oxygen Therapy and Group Correlation Based on TAA and Pulmonary Function Tests.
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Table 3. Predominant Direction of Rotation (Clockwise or Counterclockwise) for Each Individual Patient and Each Exercise Condition.
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Abstract
Introduction

Patients with severe Chronic Obstructive Pulmonary Disease (COPD) often experience breathlessness and exercise limitations due to expiratory flow limitation. Pulmonary rehabilitation programmes, including exercise with non-invasive ventilation (NIV) or high-flow nasal therapy (HFT), aims to improve quality of life and exercise tolerance. This study investigates the relationship between thoracoabdominal asynchrony (TAA) during supported (NIV and HFT) and unsupported (conventional oxygen therapy – COT) exercise and clinical and functional parameters in severe COPD patients awaiting lung transplantation.

Methods

This experimental, longitudinal, prospective, controlled study included 20 severe COPD patients on the lung transplant waiting list. Patients underwent three constant load exercise tests under COT, NIV, and HFT conditions. TAA was measured using respiratory inductance plethysmography, and neurorrespiratory drive (NRD) was assessed via parasternal electromyography.

Results

Patients exhibited distinct TAA patterns during exercise. Clockwise rotation (thorax ahead) was associated with worse baseline lung function, higher peak exercise dyspnoea and higher peak exercise NRD compared to counterclockwise rotation (abdomen ahead). No significant differences in TAA were observed between the three exercise conditions (COT, NIV, HFT). However, patients with clockwise TAA were more likely to have reduction in breathlessness with NIV compared to COT than those with counterclockwise rotation.

Conclusions

TAA patterns during exercise in severe COPD patients can indicate the severity of lung function impairment and predict severity of exercise induced dyspnoea. Analysis of TAA may predict response to respiratory support modalities and therefore monitoring TAA and NRD should be further studied to allow better tailoring of respiratory support during rehabilitation.

Keywords:
COPD pathology
Exercise
Non invasive ventilation
Pulmonary rehabilitation
Abbreviations:
COPD
COT
NIV
HFT
EMG
TAA
OEP
RIP
NRD
RMS
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