Ventilatory and gas exchange kinetics during exercise in chronic airways obstruction

The influence of chronic obstructive pulmonary disease (COPD) on exercise ventilatory and gas exchange kinetics was assessed in nine patients with stable airway obstruction (forced expired volume at 1 s = 1.1 +/- 0.33 liters) and compared with that in six normal men. Minute ventilation (VE), CO2 output (VCO2), and O2 uptake (VO2) were determined breath-by-breath at rest and after the onset of constant-load subanaerobic threshold exercise. The initial increase in VE, VCO2, and VO2 from rest (phase I), the subsequent slow exponential rise (phase II), and the steady-state (phase III) responses were analyzed. The COPD group had a significantly smaller phase I increase in VE (3.4 +/- 0.89 vs. 6.8 +/- 1.05 liters/min), VCO2 (0.10 +/- 0.03 vs. 0.22 +/- 0.03 liters/min), VO2 (0.10 +/- 0.03 vs. 0.24 +/- 0.04 liters/min), heart rate (HR) (6 +/- 0.9 vs. 16 +/- 1.4 beats/min), and O2 pulse (0.93 +/- 0.21 vs. 2.2 +/- 0.45 ml/beat) than the controls. Phase I increase in VE was significantly correlated with phase I increase in VO2 (r = 0.88) and HR (r = 0.78) in the COPD group. Most patients also had markedly slower phase II kinetics, i.e., longer time constants (tau) for VE (87 +/- 7 vs. 65 +/- 2 s), VCO2 (79 +/- 6 vs. 63 +/- 3 s), and VO2 (56 +/- 5 vs. 39 +/- 2 s) and longer half times for HR (68 +/- 9 vs. 32 +/- 2 s) and O2 pulse (42 +/- 3 vs. 31 +/- 2 s) compared with controls. However, tau VO2/tau VE and tau VCO2/tau VE were similar in both groups. The significant correlations of the phase I VE increase with HR and VO2 are consistent with the concept that the immediate exercise hyperpnea has a cardiodynamic basis. The slow ventilatory kinetics during phase II in the COPD group appeared to be more closely related to a slowed cardiovascular response rather than to any index of respiratory function. O2 breathing did not affect the phase I increase in VE but did slow phase II kinetics in most subjects. This confirms that the role attributed to the carotid bodies in ventilatory control during exercise in normal subjects also operates in patients with COPD.     

Ventilatory muscle recruitment during unsupported arm exercise in normal subjects

To test the hypothesis that during unsupported arm exercise (UAE) some of the inspiratory muscles of the rib cage partake in upper torso and arm positioning and thereby decrease their contribution to ventilation, we studied 11 subjects to measure pleural (Ppl) and gastric (Pga) pressures, heart rate, respiratory frequency, O2 uptake (VO2), and tidal volume (VT) during symptom-limited UAE. We used leg ergometry (LE) as a reference. Exercise duration was shorter for UAE vs. LE (207 +/- 67 vs. 514 +/- 224 s, P less than 0.05) even though the end-exercise VO2 was lower for UAE (9.3 +/- 1.1 vs. 30.8 +/- 3.2 ml.kg-1.min-1, P less than 0.05). Eight subjects had positive Ppl-Pga slopes and less negative end-inspiratory Ppl during UAE vs. LE (-11.8 +/- 6 vs. -19 +/- 7 cmH2O, P less than 0.05). This was not due to the lower VT's achieved during UAE, since at a similar VT, UAE resulted in a rightward and downward displacement of the Ppl-Pga slopes. Three of the subjects had irregular breathing rhythm and negative Ppl-Pga slopes as early as 1 min after initiation of UAE. They had shorter UAE duration and more dyspnea than the eight with positive Ppl-Pga slopes. In most subjects UAE decreases the ventilatory contribution of some of the inspiratory muscles of the rib cage as they have to partake in nonventilatory functions. This results in a shift of the dynamic work to the diaphragm and abdominal muscles of exhalation. In a few subjects UAE results in an irregular breathing pattern and very short exercise tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ventilatory response to helium-oxygen breathing during exercise: effect of airway anesthesia

Krishnan, Bharath S., Ron E. Clemens, Trevor A. Zintel,Martin J. Stockwell, and Charles G. Gallagher. Ventilatory response to helium-oxygen breathing during exercise: effect of airwayanesthesia. J. Appl. Physiol. 83(1):82-88, 1997.The substitution of a normoxic helium mixture(HeO₂) for room air (Air) during exercise results in a sustained hyperventilation, which is present evenin the first breath. We hypothesized that this response is dependent onintact airway afferents; if so, airway anesthesia (Anesthesia) shouldaffect this response. Anesthesia was administered to the upper airwaysby topical application and to lower central airways by aerosolinhalation and was confirmed to be effective for over 15 min. Subjectsperformed constant work-rate exercise (CWE) at 69 ± 2 (SE) % maximal work rate on a cycle ergometer on three separate days: twiceafter saline inhalation (days 1 and3) and once after Anesthesia(day 2). CWE commenced after a briefwarm-up, with subjects breathing Air for the first 5 min (Air-1),HeO₂ for the next 3 min, and Airagain until the end of CWE (Air-2). The resistance of the breathingcircuit was matched for Air andHeO₂. BreathingHeO₂ resulted in a small butsignificant increase in minute ventilation(I) anddecrease in alveolar PCO₂ in both theSaline (average of 2 saline tests; not significant) and Anesthesiatests. Although Anesthesia had no effect on the sustainedhyperventilatory response to HeO₂breathing, theI transientswithin the first six breaths ofHeO₂ were significantly attenuatedwith Anesthesia. We conclude that theI response to HeO₂ is not simply due to areduction in external tubing resistance and that, in humans, airwayafferents mediate the transient but not the sustained hyperventilatoryresponse to HeO₂ breathing duringexercise.

     

Cardiovascular responses in paraplegic subjects during arm exercise

The purpose of this study was to examine cardiovascular responses during arm exercise in paraplegics compared to a well-matched control group. A group of 11 male paraplegics (P) with complete spinal cord-lesions between T6 and T12 and 11 male control subjects (C), matched for physical activity, sport participation and age performed maximal arm-cranking exercise and submaximal exercise at 20%, 40% and 60% of the maximal load for each individual. Cardiac output (Qc) was determined by the CO2 rebreathing method. Maximal oxygen uptake was significantly lower and maximal heart rate (fc) was significantly higher in P compared to C. At the same oxygen uptakes no significant differences were observed in Qc between P and C; however, stroke volume (SV) was significantly lower and fc significantly higher in P than in C. The lower SV in P could be explained by an impaired redistribution of blood and, therefore, a reduced ventricular filling pressure, due to pooling of venous blood caused by inactivity of the skeletal muscle pump in the legs and lack of sympathetic vasoconstriction below the lesion. In conclusion, in P maximal performance appears to have been limited by a smaller active muscle mass and a lower SV despite the higher fc,max. During submaximal exercise, however, this lower SV was compensated for by a higher fc and, thus at the same submaximal oxygen uptake, Qc was similar to that in the control group.     

Pulmonary gas mixing during spontaneous breathing and at high-frequency ventilation

This work is intended to estimate the contribution of either laminar or turbulent dispersion during spontaneous breathing on one hand, and at high-frequency pulmonary ventilation on the other. For that purpose, we performed a computer simulation of a mathematical model of gas transport in the human airways governed by a combination of axial convection and longitudinal dispersion. Calculations were carried out by incorporating two dispersion coefficients, proposed by Taylor and Scherer respectively, into the mathematical model. Moreover, computations were performed with five constant flow rates and two inert heavy (SF₆) and light (He) gases to enhance the effect of mixing. It is concluded that Taylor laminar dispersion cannot play a significant role in the human airways; however, it seems that convective gas mixing with disturbed dispersion - corresponding to a regime of quasi-steady state-can account for most gas transport during spontaneous respiration and high-frequency ventilation.     

Pulmonary gas exchange during exercise in pigs

Increased ventilation-perfusion(A/)inequality is observed in ~50% of humans during heavy exercise andcontributes to the widening of the alveolar-arterialO₂ difference(A-aD_O2). Despite extensive investigation, the cause remains unknown. As a firststep to more direct examination of this problem, we developed an animalmodel. Eight Yucatan miniswine were studied at rest and duringtreadmill exercise at ~30, 50, and 85% of maximalO₂ consumption (O_{2 max}). Multipleinert-gas, blood-gas, and metabolic data were obtained. TheA-aD_O2increased from 0 ± 3 (SE) Torr at rest to 14 ± 2 Torr duringthe heaviest exercise level, but arterialPO₂(Pa_O2) remained at resting levels during exercise. There was normalA/inequality [log SD of the perfusion distribution(log) = 0.42 ± 0.04] at rest, and moderate increases(log = 0.68 ± 0.04, P < 0.0001) wereobserved with exercise. This result was reproducible on a separate day.TheA/inequality changes are similar to those reported in highly trainedhumans. However, in swine, unlike in humans, there was no inert gasevidence for pulmonary end-capillary diffusion limitation during heavyexercise; there was no systematic difference in the measuredPa_O2 and the Pa_O2 as predicted from the inertgases. These data suggest that the pig animal model iswell suited for studying the mechanism of exercise-inducedA/ inequality.

     

Ventilatory responses of the horse to exercise: effect of gas collection systems

Experiments were undertaken to determine whether respiratory masks worn by horses exercising strenuously on a treadmill may interfere with normal gas exchange. Four collection systems, two flow-through systems and two incorporating one-way valve systems with subject-generated airflow were studied. Six horses performed standard treadmill exercise tests consisting of a 2-min warm up followed by galloping 1 min each at 8,9, and 10 m/s. Each horse exercised six times while wearing each of the four respiratory masks. Each flow-through system was used twice with flow rates of 2,360 and 3,840 l/min for one system, and 3,840 and 6,300 l/min for the other. Arterial blood gas tensions were measured during exercise at each speed for each system and were compared with values measured when the horses performed the same test without wearing a mask. Hypercapnia developed during exercise with each of the respiratory masks except with the 6,300-l/min flow-through system. All horses became hypoxemic during every exercise test, but it was most severe when systems incorporating one-way valves were used. This, plus the degree of hypercapnia observed and a suboptimal heart rate-O2 uptake relationship, indicated that such systems severely impede ventilation and suggest that experiments performed while utilizing them do not represent the normal exercise condition.     

The influence of gas exchange on lung gas concentrations during air breathing

A model study is made of the contribution that continuing respiratory gas exchange makes to the alveolar plateau slope for O₂ during air breathing. Calculations in the model of the O₂ concentration appearing at the mouth during expiration, are performed for single breaths of air at constant flow rates 18 litres/min and 120 litres/min. At 18 litres/min the breathing period is 5 sec, the initial lung volume is 2300 ml, and the O₂ uptake rate is 300 ml STPD/min; whereas at 120 litres/min these parameters are 4 sec, 1200 ml, and 1800 ml STPD/min respectively. In each case the initial lung O₂ tension is taken to be 98 mm Hg. It is found that at 18 litres/min, the O₂ concentration difference on the alveolar plateau over the last second of expiration is 0.4 mm Hg when gas exchange is omitted and 1.2 mm Hg when gas exchange is included in the model. At 120 litres/min, this difference is zero and 5.0 mm Hg respectively. The gas exchange component predicted from a corresponding well-mixed compartment model is the same at 18 litres/min (0.8 mm Hg) but is 6.0 mm Hg at 120 litres/min.