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Author Spotlight: Integrating Alveolar-Capillary Reserve Measurements in Exercise Adaptation and Therapeutic Strategies
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Exercise-induced oxygen desaturation in COPD patients without resting hypoxemia
Vasileios Andrianopoulos1, Frits M E Franssen, Jos P I Peeters
1Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, 6085 NM Horn, The Netherlands.
Respiratory Physiology & Neurobiology
|October 15, 2013
Summary
Exercise-induced oxygen desaturation (EID) in COPD patients is common. A baseline SpO2 of 95% or less is not a reliable predictor of EID alone.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
Background:
- Exercise-induced oxygen desaturation (EID) increases mortality risk in Chronic Obstructive Pulmonary Disease (COPD).
- Predictive screening tests for EID, including FEV1, DLCO, and baseline SpO2, are under investigation.
Purpose of the Study:
- To validate a baseline SpO2 cutoff of ≤95% for predicting EID during the six-minute walk test (6MWT) in COPD patients.
- To determine the prevalence and characteristics of patients experiencing EID (SpO2 nadir ≤88%).
Main Methods:
- 402 non-hypoxemic COPD patients underwent a 6MWT.
- Assessed sensitivity, specificity, and predictive values of baseline SpO2 ≤95% for EID.
- Identified determinants of EID using multivariate analysis.
Main Results:
- 39% of patients (158/402) exhibited EID.
- Sensitivity of baseline SpO2 ≤95% for EID was 81.0%; specificity was 49.2%.
- DLCO <50%, FEV1 <45%, PaO2 <10kPa, baseline SpO2 <95%, and female sex were significant determinants of EID.
Conclusions:
- Baseline SpO2 alone is insufficient for accurately predicting EID in COPD.
- A combination of clinical factors (DLCO, FEV1, PaO2, baseline SpO2, sex) improves the prediction of EID in COPD patients.
Keywords:
6MWD6MWTAUCBMICOPDDLCOEIDExercise testingFEV(1)FEV(1)/FVCFFMIFMFRCFVCMRCOximetryOxygen saturationPaCO(2)PaO(2)ROCSaO(2)Six-minute walk testSpO(2)TLCWDSarea under the receiver operating characteristic (ROC) curvebody mass indexchronic obstructive pulmonary diseasediffusion capacity for carbon monoxideexercise-induced oxygen desaturationfat free mass indexfat massforce expiratory volume in 1sforced vital capacityfunctional residual capacitymedical research council dyspnea scalepartial arterial pressure of carbon dioxidepartial arterial pressure of oxygenreceiver operating characteristic curvessaturation of arterial oxygen (hemoglobin)saturation of peripheral oxygensix-minute walk distancesix-minute walk testthe ratio (r) of forced expiratory volume in 1s and forced vital capacitytotal lung capacitywalking desaturation score
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