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Ventilatory Threshold and Risk of Pulmonary Exacerbations in Cystic Fibrosis

Natália E Campos¹, Fernanda M Vendrusculo¹, Margarita Pérez-Ruiz²

¹Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Respiratory Care

|April 4, 2023

Abstract

Background:

Whereas pulmonary exacerbations and aerobic fitness play a key role in the prognosis of cystic fibrosis (CF), the use of ventilatory threshold data as markers of exacerbation risk has been scarcely addressed. This study sought to examine the association between aerobic fitness, assessed through ventilatory threshold variables recorded during cardiopulmonary exercise testing (CPET), and the risk of exacerbations in individuals with CF.

Methods:

Participants of this retrospective cohort study were subjects from 6 y of age. Over a 4-y period, the following data were recorded: lung function indicators, CPET variables, time to first exacerbation and antibiotic use, along with demographic, clinical, and anthropometric data.

Results:

The mean age of 20 subjects included was 16 ± 5.4 y. Univariate regression analysis revealed that lung function (FEV₁: Cox hazard ratio [HR] 0.97, P = .03; and forced expiratory flow between 25-75% of vital capacity [FEF_25-75]: Cox HR 0.98, P = .036) and aerobic fitness (oxygen consumption [V̇_O ] at ventilatory threshold: Cox HR 0.94, P = .01; and ventilatory equivalent for carbon dioxide [V̇_E/V̇_CO ] at ventilatory threshold: Cox HR 1.13, P = .049) were associated with exacerbation risk, whereas in the multivariate model, only V̇_O at the ventilatory threshold (%max) (Cox HR 0.92, P = .01) had a significant impact on this risk. Consistently, individuals experiencing exacerbation had significantly lower V̇_O values (%max) at the ventilatory threshold (P = .050) and higher ventilatory equivalent for oxygen consumption (V̇_E/V̇_O ) (P = .040) and V̇_E/V̇_O (P = .037) values at the ventilatory threshold. Time to exacerbation was significantly correlated with V̇_O at the ventilatory threshold (r = 0.50, P = .02), V̇_E/V̇_O (r = -0.48, P = .02), and V̇_E/V̇_CO (r = -0.50, P = .02).

Conclusions:

Our results suggest an association between CPET variables at the ventilatory threshold and exacerbations. Percentage V̇_O at the ventilatory threshold could serve as a complementary variable to monitor exacerbations in people with CF.

Keywords:

anaerobic threshold cystic fibrosis exercise capacity oxygen consumption prognosis pulmonary exacerbation

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