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      Effect of obesity on constant workrate exercise in hyperinflated men with COPD

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          Abstract

          Background

          Chronic obstructive pulmonary disease (COPD) and a high body mass index (BMI) can both affect pulmonary volumes as well as exercise tolerance, but their combined effect on these outcomes is not well known. The aim of this study was to investigate the effects of increased BMI during constant workrate cycle ergometry in patients with COPD.

          Methods

          Men with COPD and hyperinflation were divided according to World Health Organization BMI classification: 84 normal BMI (NBMI), 130 overweight (OW) and 64 obese (OB). Patients underwent spirometric and lung volumes assessment and an incremental cycling exercise test. This was followed by a constant workrate exercise test (CET) at 75% of peak capacity. Inspiratory capacity and Borg dyspnea scores were measured at baseline, during and at the end of CET.

          Results and discussion

          FEV 1 % predicted was not different across BMI classes. Total lung capacity and functional residual capacity were significantly lower in OB and OW compared to NBMI patients. Peak VO 2 in L·min -1 was significantly higher in OB and OW patients than in NBMI patients. CET time was not different across BMI classes (p = 0.11). Changes in lung volumes and dyspnea during CET were not different between BMI categories.

          Conclusions

          OB and OW patients with COPD had a higher peak VO 2 than their lean counterparts. Endurance time, dyspnea and changes in lung volumes during CET were similar between BMI categories.

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          Most cited references17

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          Effects of obesity on respiratory function.

          Obesity, because it alters the relationship between the lungs, chest wall, and diaphragm, has been expected to alter respiratory function. We studied 43 massively obese but otherwise normal, nonsmoking, young adults with spirometry, lung volume measurement by nitrogen washout, and single-breath diffusing capacity for carbon monoxide (DLCO). Changes in respiratory function were of two types, those that changed in proportion to degree of obesity--expiratory reserve volume (ERV) and DLCO--and those that changed only with extreme obesity--vital capacity, total lung capacity, and maximal voluntary ventilation. When compared with commonly used predicting equations, we found that mean values of subjects grouped by degree of obesity were very close to predicted values, except in those with extreme obesity in whom weight (kg)/height (cm) exceeded 1.0. In 29 subjects who lost a mean of 56 kg, significant increases in vital capacity, ERV, and maximal voluntary ventilation were found, along with a significant decrease in DLCO. Because most subjects fell within the generally accepted 95% confidence limits for the predicted values, we concluded that obesity does not usually preclude use of usual predictors. An abnormal pulmonary function test value should be considered as caused by intrinsic lung disease and not by obesity, except in those with extreme obesity.
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            Compliance of the respiratory system and its components in health and obesity.

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              COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care.

              To describe the distribution of COPD disease severity in primary care based on airway obstruction, and to assess the extent to which dyspnoea scores, body mass index (BMI) and fat free mass (FFM) index contribute to the distribution of COPD severity in primary care. Cross sectional population-based study. 317 patients with COPD were recruited from an outpatient disease management programme. Prevalence of moderate to severe dyspnoea, underweight, obesity and FFM depletion by GOLD stage were measured. According to GOLD guidelines, 29% of patients had mild COPD, 48% moderate, 17% severe and 5% very severe. A substantial number of patients classified as GOLD stage 2 reported severe dyspnoea (28.1%) and/or suffered from FFM depletion (16.3%). Prevalence of low body weight strongly increased in GOLD stage 4. Prevalence of obesity is highest in GOLD stages 1 and 2. The use of a multidimensional grading system, taking into account dyspnoea as well as the nutritional status of COPD patients, is likely to influence the distribution of disease severity in a primary care population. This might have implications for prevention, non-medical treatment, and estimates of health care utilisation in primary care.
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                Author and article information

                Journal
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central
                1471-2466
                2010
                30 May 2010
                : 10
                : 33
                Affiliations
                [1 ]Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
                [2 ]Respiratory Investigation Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
                [3 ]Boehringer Ingelheim (Canada) Limited, Burlington, Ontario, Canada
                [4 ]Boehringer Ingelheim Corporation, Ingelheim, Germany
                Article
                1471-2466-10-33
                10.1186/1471-2466-10-33
                2891696
                20509967
                500ea408-0019-4763-9fcf-31060dd59293
                Copyright ©2010 Laviolette et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 February 2010
                : 30 May 2010
                Categories
                Research article

                Respiratory medicine
                Respiratory medicine

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