Exercise performance with added dead space in chronic airflow obstruction

Abstract

Individuals with chronic airflow obstruction (CAO) are thought to have limited exercise tolerance primarily because of impaired ventilatory mechanics. We studied the effects of added external dead space (DS) on exercise capacity [maximum O2 consumption (VO2max)], maximum exercise ventilation (VEmax), and blood gases (arterial PO2, PCO2, pH) in 22 patients with CAO [forced expired volume at 1 s (FEV1) = 0.96 +/- 0.41 liter]. Maximum exercise testing (Emax) was performed by incremental cycle ergometry. Patients exercised at base line (BL) and with DS (0.25 liter if FEV1 less than 0.8, and 0.50 liter if FEV1 greater than 0.8 liter), in random-order single-blind fashion. DS resulted in a 12.2% increase in VEmax (P less than 0.001); tidal volume increased (P less than 0.025) while respiratory frequency was unchanged. The VO2max and maximum CO2 production decreased (P less than 0.001) with DS. Arterial PCO2 at rest and at exhaustion increased with DS (P less than 0.001). The pH and arterial PO2 showed small declines at rest and at Emax. Thus, at the lower maximum work load achieved with DS, the patients ventilated more and tolerated a higher arterial PCO2 and a lower arterial PO2 and pH before stopping from dyspnea as compared with the BL exercise run. In contrast, the VO2max of nine normal control subjects was unaffected by the addition of DS. Although VEmax can be increased in CAO patients with DS, this increase is not sufficient to prevent further CO2 retention or a decrease in exercise capacity. We conclude that exercise performance is limited primarily by impaired ventilatory mechanics in CAO.