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Activity restriction in mild COPD: a challenging clinical problem

Authors O'Donnell DE, Gebke KB

Received 20 February 2014

Accepted for publication 1 April 2014

Published 4 June 2014 Volume 2014:9(1) Pages 577—588

DOI https://doi.org/10.2147/COPD.S62766

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Denis E O'Donnell,1 Kevin B Gebke2

1Division of Respiratory and Critical Care Medicine, Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada; 2Primary Care Sports Medicine Program, Indiana University School of Medicine, Indianapolis, IN, USA

Abstract: Dyspnea, exercise intolerance, and activity restriction are already apparent in mild chronic obstructive pulmonary disease (COPD). However, patients may not seek medical help until their symptoms become troublesome and persistent and significant respiratory impairment is already present; as a consequence, further sustained physical inactivity may contribute to disease progression. Ventilatory and gas exchange impairment, cardiac dysfunction, and skeletal muscle dysfunction are present to a variable degree in patients with mild COPD, and collectively may contribute to exercise intolerance. As such, there is increasing interest in evaluating exercise tolerance and physical activity in symptomatic patients with COPD who have mild airway obstruction, as defined by spirometry. Simple questionnaires, eg, the modified British Medical Research Council dyspnea scale and the COPD Assessment Test, or exercise tests, eg, the 6-minute or incremental and endurance exercise tests can be used to assess exercise performance and functional status. Pedometers and accelerometers are used to evaluate physical activity, and endurance tests (cycle or treadmill) using constant work rate protocols are used to assess the effects of interventions such as pulmonary rehabilitation. In addition, alternative outcome measurements, such as tests of small airway dysfunction and laboratory-based exercise tests, are used to measure the extent of physiological impairment in individuals with persistent dyspnea. This review describes the mechanisms of exercise limitation in patients with mild COPD and the interventions that can potentially improve exercise tolerance. Also discussed are the benefits of pulmonary rehabilitation and the potential role of pharmacologic treatment in symptomatic patients with mild COPD.

Keywords: chronic obstructive pulmonary disease (COPD), small airway dysfunction, dyspnea, physical activity, exercise


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