Evaluation of exercise ventilation function in patients with chronic duration of not well controlled asthma_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Lijun ¹ , HUANG Nanxin ¹ , LUO Jiaqi ² , QI Yongjian ³ ,  LIU Lanying ^1,4 ,  WANG Hesheng ¹

1. Department of Acupuncture and rehabilitation, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China;
2. Department of Rehabilitation Medicine, Suzhou Hospital Affiliated To Medical College of Nanjing University, Suzhou, Jiangsu 215153, P. R. China;
3. Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China;
4. Nanjing University of Chinese Medicine Combined with Key Laboratory of Ministry of Education, Nanjing, JIangsu 210023, P. R. China;

Corresponding author：

LIU Lanying, Email: bluelany@163.com; WANG Hesheng, Email: wanghesheng2010@126.com

Keywords：

Asthma; exercise ventilation; cardiopulmonary exercise test; pulmonary function; ventilation efficiency

DOI：

10.7507/1671-6205.202401050

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Objective To explore the characteristics of exercise ventilation function in patients with chronic duration of asthma, and the correlation of cardiopulmonary exercise test and control level and conventional lung function in patients with chronic duration of asthma. Methods Seventy-three patients with chronic duration of asthma admitted from December 2021 to December 2022 were recruited in the study. The asthma control level was assessed with the asthma control test (ACT) and the patients were divided into a well-controlled group and a poorly-controlled group. Routine pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) were performed in both groups, to analyze the difference of related parameters between the two groups and observe the correlation between CPET and PFT, ACT score in the patients with chronic persistent asthma. Results CPET results showed that the VE/VCO₂ slope, anaerobic threshold carbon dioxide equivalent (EqCO₂@AT), and physiologically ineffective peak during exercise (VD/VTpeak) were higher in the poorly-controlled group than those in the well-controlled group (all P<0.05). The peak minute ventilation (VEpeak) and tidal volume (VTpeak) of the patients in the poorly-controlled group were lower than those in the well-controlled group (both P<0.05). The peak respiratory rate (BFpeak) and respiratory reserve (BRpeak) of the two groups were not significantly different (both P>0.05). The results of correlation analysis showed that the VE/VCO₂ slope, EqCO₂@AT, VD/VTpeak were negatively correlated with ACT score, and VEpeak was positively correlated with FVC%pred and MMEF%pred in the patients with chronic persistent asthma. BRpeak was positively correlated with FEV₁%pred, FEV₁/FVC%pred, MMEF%pred in routine pulmonary function. Multivariate logistic regression analysis showed that the increase of VE/VCO₂ slope and VD/VTpeak were independent risk factors for poor asthma control (P<0.05). Conclusions Patients with poorly-controlled asthma have decreased exercise ventilatory function, mainly showing decreased ventilation and tidal volume during peak exercise and decreased ventilatory efficiency. There is some correlation between exercise ventilatory function and conventional lung function of control level in patients with chronic duration of asthma. The relevant indicators of ventilation efficiency in CPET have suggestive significance for asthma that is not well controlled, so it is necessary to carry out CPET in patients with asthma to improve the comprehensive evaluation of asthma.

Citation： LIU Lijun, HUANG Nanxin, LUO Jiaqi, QI Yongjian, LIU Lanying, WANG Hesheng. Evaluation of exercise ventilation function in patients with chronic duration of not well controlled asthma. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(5): 305-311. doi: 10.7507/1671-6205.202401050 Copy

1.	Huang KW, Yang T, Xu JY, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
2.	林江涛, 王文巧, 周新, 等. 我国30个省市城区门诊支气管哮喘患者控制水平的调查结果. 中华结核和呼吸杂志, 2017, 40(7): 494-498.
3.	王行之, 吴诚, 张娟, 等. 运动对哮喘的影响及哮喘患儿运动处方研究进展. 中国实用儿科杂志, 2021, 36(09): 714-720.
4.	石月, 陈佩杰, 李斐, 等. 运动、支气管痉挛与哮喘—厘清、正视与平衡. 体育科学, 2018, 38(8): 75-85.
5.	朱巧巧. 成年哮喘患者日常运动和哮喘控制的相关性研究. 中国社区医师, 2016, 32(8): 76-76.
6.	Parsons JP, Craig TJ, Stoloff SW, et al. Impact of exercise-related respiratory symptoms in adults with asthma: Exercise-Induced Bronchospasm Landmark National Survey. Allergy Asthma Proc, 2011, 32(6): 431-437.
7.	Boulding R, Stacey R, Niven R, et al. Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev, 2016, 25(141): 287-294.
8.	林鉴, 郝继光. 肺功能检查和呼出气一氧化氮离线式检测在学龄前哮喘患儿管理中的应用. 中国妇幼保健, 2021, 36(6): 1301-1304.
9.	刘杰, 叶继伦, 文斌, 等. 多参数运动心肺功能测试系统的初步应用. 中国医学物理学杂志, 2021, 38(03): 344-349.
10.	Sylvester KP, Clayton N, Cliff I, et al. ARTP statement on pulmonary function testing 2020. BMJ Open Respir Res, 2020, 7(1): e000575.
11.	车琳. 心肺运动试验临床操作新进展. 中国实用内科杂志, 2022, 42(5): 367-370.
12.	张也, 孙兴国, 郝璐, 等. Max试验验证个体化症状限制性心肺运动试验为最大极限运动临床研究. 中国全科医学, 2019, 22(20): 2441-2447, 2454.
13.	Bhatia R. Cardiopulmonary exercise testing for pediatric exercise-induced dyspnea especially in patients whose asthma treatment failed. Ann Allergy Asthma Immunol, 2020, 124(1): 101-102.
14.	邢双涛, 冯世杰, 张一凡, 等. 不同运动方式对哮喘患儿肺功能影响的网状Meta分析. 河南师范大学学报(自然科学版), 2023(2): 149-156.
15.	中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版). 中华结核和呼吸杂志, 2020, 43(12): 1023-1048.
16.	王丹, 李瑾, 高民, 等. 男性非小细胞肺癌合并慢性阻塞性肺疾病患者运动耐量、通气效率特点临床研究. 中国康复医学杂志, 2021, 36(9): 1094-1100.
17.	彭千, 谢航宇, 刘春涛. 肺通气灌注显像在定量评估哮喘患者肺功能中的应用. 中国呼吸与危重监护杂志, 2021, 20(4): 247-253.
18.	Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis, 1984, 129(2 Pt 2): S49-S55.
19.	Moreau J, Socchi F, Renoux MC, et al. Cardiopulmonary fitness in children with asthma versus healthy children. Arch Dis Child, 2023, 108(3): 204-210.
20.	Sanz SV, Diez VI, Donadio MVF, et al. Comparison of physical fitness between healthy and mild to moderate asthmatic children with exercise symptoms: a cross sectional study. Pediatr Pulmonol, 2021, 56(8): 2512-2521.
21.	Laveneziana P, Bruni GI, Presi I, et al. Tidal volume inflection and its sensory consequences during exercise in patients with stable asthma. Respir Physiol Neurobiol, 2013, 185(2): 374-379.
22.	Boutou AK, Daniil Z, Pitsiou G, et al. Cardiopulmonary exercise testing in patients with asthma: What is its clinical value? Respir Med, 2020, 167: 105953.
23.	Ghozali MT, Mohany M, Milošević M, et al. Impact of a mobile-app assisted self-management educational intervention on the scores of asthma control test (ACT) questionnaire among young asthmatic patients. Res Social Adm Pharm, 2023, 19(10): 1354-1359.
24.	Haverkamp HC, Dempsey JA, Pegelow DF, et al. Treatment of airway inflammation improves exercise pulmonary gas exchange and performance in asthmatic subjects. J Allergy Clin Immunol, 2007, 120(1): 39-47.
25.	Collins SÉ, Phillips DB, Brotto AR, et al. Ventilatory efficiency in athletes, asthma and obesity. Eur Respir Rev, 2021, 30(161): 200206.
26.	O'Donnell DE, Elbehairy AF, Berton DC, et al. Advances in the evaluation of respiratory pathophysiology during exercise in chronic lung diseases. Front Physiol, 2017, 8: 245917.
27.	Rinaldo RF, Masseroni A, Vigo B, et al. Patients with severe asthma show reduced exercise capacity assessed with cardiopulmonary exercise test. Eur Respir J, 2019, 54(S63): PA4141.
28.	Rinaldo RF, Imeri G, Mondoni M, et al. Does the severity of asthma affect exercise capacity and daily physical activity? J Asthma, 2023, 60(8): 1622-1631.

1. Huang KW, Yang T, Xu JY, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
2. 林江涛, 王文巧, 周新, 等. 我国30个省市城区门诊支气管哮喘患者控制水平的调查结果. 中华结核和呼吸杂志, 2017, 40(7): 494-498.
3. 王行之, 吴诚, 张娟, 等. 运动对哮喘的影响及哮喘患儿运动处方研究进展. 中国实用儿科杂志, 2021, 36(09): 714-720.
4. 石月, 陈佩杰, 李斐, 等. 运动、支气管痉挛与哮喘—厘清、正视与平衡. 体育科学, 2018, 38(8): 75-85.
5. 朱巧巧. 成年哮喘患者日常运动和哮喘控制的相关性研究. 中国社区医师, 2016, 32(8): 76-76.
6. Parsons JP, Craig TJ, Stoloff SW, et al. Impact of exercise-related respiratory symptoms in adults with asthma: Exercise-Induced Bronchospasm Landmark National Survey. Allergy Asthma Proc, 2011, 32(6): 431-437.
7. Boulding R, Stacey R, Niven R, et al. Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev, 2016, 25(141): 287-294.
8. 林鉴, 郝继光. 肺功能检查和呼出气一氧化氮离线式检测在学龄前哮喘患儿管理中的应用. 中国妇幼保健, 2021, 36(6): 1301-1304.
9. 刘杰, 叶继伦, 文斌, 等. 多参数运动心肺功能测试系统的初步应用. 中国医学物理学杂志, 2021, 38(03): 344-349.
10. Sylvester KP, Clayton N, Cliff I, et al. ARTP statement on pulmonary function testing 2020. BMJ Open Respir Res, 2020, 7(1): e000575.
11. 车琳. 心肺运动试验临床操作新进展. 中国实用内科杂志, 2022, 42(5): 367-370.
12. 张也, 孙兴国, 郝璐, 等. Max试验验证个体化症状限制性心肺运动试验为最大极限运动临床研究. 中国全科医学, 2019, 22(20): 2441-2447, 2454.
13. Bhatia R. Cardiopulmonary exercise testing for pediatric exercise-induced dyspnea especially in patients whose asthma treatment failed. Ann Allergy Asthma Immunol, 2020, 124(1): 101-102.
14. 邢双涛, 冯世杰, 张一凡, 等. 不同运动方式对哮喘患儿肺功能影响的网状Meta分析. 河南师范大学学报(自然科学版), 2023(2): 149-156.
15. 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版). 中华结核和呼吸杂志, 2020, 43(12): 1023-1048.
16. 王丹, 李瑾, 高民, 等. 男性非小细胞肺癌合并慢性阻塞性肺疾病患者运动耐量、通气效率特点临床研究. 中国康复医学杂志, 2021, 36(9): 1094-1100.
17. 彭千, 谢航宇, 刘春涛. 肺通气灌注显像在定量评估哮喘患者肺功能中的应用. 中国呼吸与危重监护杂志, 2021, 20(4): 247-253.
18. Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis, 1984, 129(2 Pt 2): S49-S55.
19. Moreau J, Socchi F, Renoux MC, et al. Cardiopulmonary fitness in children with asthma versus healthy children. Arch Dis Child, 2023, 108(3): 204-210.
20. Sanz SV, Diez VI, Donadio MVF, et al. Comparison of physical fitness between healthy and mild to moderate asthmatic children with exercise symptoms: a cross sectional study. Pediatr Pulmonol, 2021, 56(8): 2512-2521.
21. Laveneziana P, Bruni GI, Presi I, et al. Tidal volume inflection and its sensory consequences during exercise in patients with stable asthma. Respir Physiol Neurobiol, 2013, 185(2): 374-379.
22. Boutou AK, Daniil Z, Pitsiou G, et al. Cardiopulmonary exercise testing in patients with asthma: What is its clinical value? Respir Med, 2020, 167: 105953.
23. Ghozali MT, Mohany M, Milošević M, et al. Impact of a mobile-app assisted self-management educational intervention on the scores of asthma control test (ACT) questionnaire among young asthmatic patients. Res Social Adm Pharm, 2023, 19(10): 1354-1359.
24. Haverkamp HC, Dempsey JA, Pegelow DF, et al. Treatment of airway inflammation improves exercise pulmonary gas exchange and performance in asthmatic subjects. J Allergy Clin Immunol, 2007, 120(1): 39-47.
25. Collins SÉ, Phillips DB, Brotto AR, et al. Ventilatory efficiency in athletes, asthma and obesity. Eur Respir Rev, 2021, 30(161): 200206.
26. O'Donnell DE, Elbehairy AF, Berton DC, et al. Advances in the evaluation of respiratory pathophysiology during exercise in chronic lung diseases. Front Physiol, 2017, 8: 245917.
27. Rinaldo RF, Masseroni A, Vigo B, et al. Patients with severe asthma show reduced exercise capacity assessed with cardiopulmonary exercise test. Eur Respir J, 2019, 54(S63): PA4141.
28. Rinaldo RF, Imeri G, Mondoni M, et al. Does the severity of asthma affect exercise capacity and daily physical activity? J Asthma, 2023, 60(8): 1622-1631.

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