Determinants of exercise-induced oxygen desaturation including pulmonary emphysema in COPD: Results from the ECLIPSE study

Vasileios Andrianopoulos; Bartolome R Celli; Frits M E Franssen; Victor M Pinto-Plata; Peter M A Calverley; Lowie E G W Vanfleteren; Ioannis Vogiatzis; Jørgen Vestbo; Alvar Agusti; Per S Bakke; Stephen I Rennard; William MacNee; Ruth Tal-Singer; Julie C Yates; Emiel F M Wouters; Martijn A Spruit

doi:10.1016/j.rmed.2016.08.023

Determinants of exercise-induced oxygen desaturation including pulmonary emphysema in COPD: Results from the ECLIPSE study

Respir Med. 2016 Oct:119:87-95. doi: 10.1016/j.rmed.2016.08.023. Epub 2016 Aug 25.

Authors

Vasileios Andrianopoulos¹, Bartolome R Celli², Frits M E Franssen³, Victor M Pinto-Plata⁴, Peter M A Calverley⁵, Lowie E G W Vanfleteren⁶, Ioannis Vogiatzis⁷, Jørgen Vestbo⁸, Alvar Agusti⁹, Per S Bakke¹⁰, Stephen I Rennard¹¹, William MacNee¹², Ruth Tal-Singer¹³, Julie C Yates¹⁴, Emiel F M Wouters¹⁵, Martijn A Spruit¹⁶

Affiliations

¹ Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany. Electronic address: [email protected].
² Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
³ Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. Electronic address: [email protected].
⁴ Department of Respiratory Medicine, School of Clinical Science, University of Liverpool, United Kingdom. Electronic address: [email protected].
⁵ Institute of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, United Kingdom. Electronic address: [email protected].
⁶ Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Electronic address: [email protected].
⁷ Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Greece. Electronic address: [email protected].
⁸ Centre for Respiratory Medicine and Allergy, University of Manchester, UK. Electronic address: [email protected].
⁹ Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain. Electronic address: [email protected].
¹⁰ Department of Clinical Science, University of Bergen, Bergen, Norway. Electronic address: [email protected].
¹¹ Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: [email protected].
¹² Medical Research Council Centre for Inflammation Research, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom. Electronic address: [email protected].
¹³ GSK Research and Development, King of Prussia, Philadelphia, PA, USA. Electronic address: [email protected].
¹⁴ GSK Research Triangle Park, NC, USA. Electronic address: [email protected].
¹⁵ Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Electronic address: [email protected].
¹⁶ Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. Electronic address: [email protected].

PMID: 27692154
DOI: 10.1016/j.rmed.2016.08.023

Abstract

Exercise-induced oxygen desaturation (EID) is related to mortality in patients with chronic obstructive pulmonary disease (COPD). We investigated: (1) the prevalence of EID; (2) the relative-weight of several physiological determinants of EID including pulmonary emphysema, and (3) the relationship of EID with certain patients' clinical characteristics. Data from 2050 COPD patients (age: 63.3 ± 7.1years; FEV₁: 48.7 ± 15.7%pred.) were analyzed. The occurrence of EID (SpO₂post ≤88%) at the six-minute walking test (6MWT) was investigated in association with emphysema quantified by computed-tomography (QCT), and several clinical characteristics. 435 patients (21%) exhibited EID. Subjects with EID had more QCT-emphysema, lower exercise capacity and worse health-status (BODE, ADO indexes) compared to non-EID. Determinant of EID were obesity (BMI≥30 kg/m²), impaired FEV₁ (≤44%pred.), moderate or worse emphysema, and low SpO₂ at rest (≤93%). Linear regression indicated that each 1-point increase on the ADO-score independently elevates odds ratio (≤1.5fold) for EID. About one in five COPD patients in the ECLIPSE cohort present EID. Advanced emphysema is associated with EID. In addition, obesity, severe airflow limitation, and low resting oxygen saturation increase the risk for EID. Patients with EID in GOLD stage II have higher odds to have moderate or worse emphysema compared those with EID in GOLD stage III-IV. Emphysematous patients with high ADO-score should be monitored for EID.

Keywords: 6MWD; ADO index; Computed tomography; EID; Emphysema; Imaging.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Body Mass Index
Exercise Tolerance / physiology
Female
Forced Expiratory Volume / physiology
Humans
Male
Middle Aged
Oxygen / blood*
Oxygen / metabolism
Prevalence
Prospective Studies
Pulmonary Disease, Chronic Obstructive / diagnostic imaging
Pulmonary Disease, Chronic Obstructive / metabolism*
Pulmonary Disease, Chronic Obstructive / mortality
Pulmonary Disease, Chronic Obstructive / physiopathology*
Pulmonary Emphysema / complications*
Pulmonary Emphysema / diagnostic imaging
Pulmonary Emphysema / epidemiology
Respiratory Function Tests / methods
Rest / physiology
Tomography, X-Ray Computed
Vital Capacity / physiology
Walk Test / methods

Substances

Oxygen