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

Video：

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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.	林江濤, 王文巧, 周新, 等. 我國30個省市城區門診支氣管哮喘患者控制水平的調查結果. 中華結核和呼吸雜志, 2017, 40(7): 494-498.
3.	王行之, 吳誠, 張娟, 等. 運動對哮喘的影響及哮喘患兒運動處方研究進展. 中國實用兒科雜志, 2021, 36(09): 714-720.
4.	石月, 陳佩杰, 李斐, 等. 運動、支氣管痙攣與哮喘—厘清、正視與平衡. 體育科學, 2018, 38(8): 75-85.
5.	朱巧巧. 成年哮喘患者日常運動和哮喘控制的相關性研究. 中國社區醫師, 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.	林鑒, 郝繼光. 肺功能檢查和呼出氣一氧化氮離線式檢測在學齡前哮喘患兒管理中的應用. 中國婦幼保健, 2021, 36(6): 1301-1304.
9.	劉杰, 葉繼倫, 文斌, 等. 多參數運動心肺功能測試系統的初步應用. 中國醫學物理學雜志, 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.	車琳. 心肺運動試驗臨床操作新進展. 中國實用內科雜志, 2022, 42(5): 367-370.
12.	張也, 孫興國, 郝璐, 等. Max試驗驗證個體化癥狀限制性心肺運動試驗為最大極限運動臨床研究. 中國全科醫學, 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.	邢雙濤, 馮世杰, 張一凡, 等. 不同運動方式對哮喘患兒肺功能影響的網狀Meta分析. 河南師范大學學報(自然科學版), 2023(2): 149-156.
15.	中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南(2020年版). 中華結核和呼吸雜志, 2020, 43(12): 1023-1048.
16.	王丹, 李瑾, 高民, 等. 男性非小細胞肺癌合并慢性阻塞性肺疾病患者運動耐量、通氣效率特點臨床研究. 中國康復醫學雜志, 2021, 36(9): 1094-1100.
17.	彭千, 謝航宇, 劉春濤. 肺通氣灌注顯像在定量評估哮喘患者肺功能中的應用. 中國呼吸與危重監護雜志, 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, Milo?evi? 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. 林江濤, 王文巧, 周新, 等. 我國30個省市城區門診支氣管哮喘患者控制水平的調查結果. 中華結核和呼吸雜志, 2017, 40(7): 494-498.
3. 王行之, 吳誠, 張娟, 等. 運動對哮喘的影響及哮喘患兒運動處方研究進展. 中國實用兒科雜志, 2021, 36(09): 714-720.
4. 石月, 陳佩杰, 李斐, 等. 運動、支氣管痙攣與哮喘—厘清、正視與平衡. 體育科學, 2018, 38(8): 75-85.
5. 朱巧巧. 成年哮喘患者日常運動和哮喘控制的相關性研究. 中國社區醫師, 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. 林鑒, 郝繼光. 肺功能檢查和呼出氣一氧化氮離線式檢測在學齡前哮喘患兒管理中的應用. 中國婦幼保健, 2021, 36(6): 1301-1304.
9. 劉杰, 葉繼倫, 文斌, 等. 多參數運動心肺功能測試系統的初步應用. 中國醫學物理學雜志, 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. 車琳. 心肺運動試驗臨床操作新進展. 中國實用內科雜志, 2022, 42(5): 367-370.
12. 張也, 孫興國, 郝璐, 等. Max試驗驗證個體化癥狀限制性心肺運動試驗為最大極限運動臨床研究. 中國全科醫學, 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. 邢雙濤, 馮世杰, 張一凡, 等. 不同運動方式對哮喘患兒肺功能影響的網狀Meta分析. 河南師范大學學報(自然科學版), 2023(2): 149-156.
15. 中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南(2020年版). 中華結核和呼吸雜志, 2020, 43(12): 1023-1048.
16. 王丹, 李瑾, 高民, 等. 男性非小細胞肺癌合并慢性阻塞性肺疾病患者運動耐量、通氣效率特點臨床研究. 中國康復醫學雜志, 2021, 36(9): 1094-1100.
17. 彭千, 謝航宇, 劉春濤. 肺通氣灌注顯像在定量評估哮喘患者肺功能中的應用. 中國呼吸與危重監護雜志, 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, Milo?evi? 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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