Exertional Dyspnoea responses reported in the Dyspnoea Challenge and measures of disease severity in COPD

The Dyspnoea Challenge has been developed to facilitate the field-based measure of exertional dyspnoea(ED). To further validate the test, we aimed to; investigate the relationship between end-exercise ED, generated by a fixed-intensity Dyspnoea Challenge(DC_FIX), and measures of disease severity (Forced expiratory volume in 1 s(FEV₁), six-minute walk distance(6MWD), breathing reserve(V̇_E/MVV), modified medical research council dyspnoea scale (mMRC), Body-mass index, airflow Obstruction, Dyspnoea, and Exercise (BODE index) and compare the physiological response of the DC_FIX to a six-minute walk test(6MWT).

Thirty-two individuals (15 female) with COPD (GOLD II-IV) (age: 69.7 ± 9.4 yrs; FEV₁: 49.1 ± 18.2 %) performed 2×6MWT and 2xDC_FIX at a treadmill speed of 3 km h^-1 and gradient of 4 %. The intensity of ED was measured using the modified Borg dyspnoea scale at baseline and end-exercise with heart rate (HR) and oxygen saturation (S_pO₂) monitored continuously. During 1×6MWT and 1xDC_FIX pulmonary gas exchange, cardiac output (Q̇) and dynamic hyperinflation were measured.

End-exercise ED measured during the DC_FIX was not correlated to FEV₁, but moderately correlated to; 6MWD(r_s = -0.54, P < .01), V̇_E/MVV (r_s = 0.46, P = .02), mMRC(r_s = 0.45, P = .01), and the BODE index(r_s = 0.53, P < .01). When comparing the DC_FIX and 6MWT, participants walked to comparable levels of oxygen consumption(P = .38), ventilation(P = .37), Q̇(P = .20), V̇_E/MVV(P = .83), maximum HR percentages(P = .67) and dynamically hyperinflated to a similar degree(P = .37).

The Dyspnoea Challenge is correlated to different parameters of disease severity and produces a similar physiological and ED response to that of the 6MWT with the added benefit of being appropriate for longitudinal assessment of ED.