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Sensory consequences of critical inspiratory constraints during exercise in pulmonary arterial hypertension.
Respiratory Physiology & Neurobiology 2019 January 8
We aimed to assess detailed ventilatory and sensory responses to exercise contrasting subjects with and without PAH. 20 non-smoking patients with PAH (37.5 ± 12.1 ys; FEV1 /FVC = 0.77 ± 0.04; mPAP by heart catheterization = 50.6 ± 18.1 mmHg) and 10 matched controls performed cycling cardiopulmonary exercise test with serial assessments of dyspnea, airway occlusion pressure during the first 0.1 s (P0.1) of tidal volume and inspiratory capacity (IC). Patients showed lower spirometric variables compared to controls. Dyspnea and ventilation (V̇E ) were significantly higher in patients for a given work rate. Dyspnea persisted more intense in patients even when expressed as a function of V̇E . Lower IC at rest (in non-hyperinflators; n = 10) or exercise-induced reduction in IC (in hyperinflators) predisposed patients to achieve earlier and at lower workloads a critical inspiratory reserve volume. At this point, there was a sudden rise in P0.1 and dyspnea perception. Attainment of a critical IRV at premature workloads leads to neuromechanical dissociation with an abrupt increment in exertional dyspnea.
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