Highlights
- •The Dyspnea Challenge is reliable in heart failure.
- •The Dyspnea Challenge is reliable in COPD.
- •The Dyspnea Challenge can differentiate between pathophysiology.
Abstract
Background
In heart failure (HF), exertional dyspnea is a common symptom, but validated field-based
tests for its measurement are limited. The Dyspnea Challenge is a two-minute uphill
treadmill walk designed to measure exertional dyspnea in cardiopulmonary disease.
Objectives
The purpose of this study was to establish the test-retest reliability of the Dyspnea
Challenge in HF and to compare the exercise responses to a group with chronic obstructive
pulmonary disease (COPD).
Methods
The study was an experimental, single-blind, randomized, multi-site project that recruited
individuals with HF (New York Heart Association I-III) and COPD (Global Initiative
for Chronic Obstructive Lung Disease II-IV). Participants completed two visits. On
the first visit, participants performed two six-minute walk tests (6MWT), followed
by two to three Dyspnea Challenges to calculate treadmill speed and gradient. At Visit
Two, participants performed two separate Dyspnea Challenges, with one including measures
of pulmonary gas exchange and central hemodynamics.
Results
Twenty-one individuals with HF (10 female; 66±11years; ejection fraction:45.3 ± 6.1%;
six-minute distance(6MWD) 520 ± 97 m), and 25 COPD (11 female; 68 ± 10 yr; forced
expiratory volume in 1 s:47.6 ± 11.5%; 6MWD: 430 ± 101 m). Intraclass correlation
coefficients demonstrated excellent test-retest reliability for HF (0.94, P<.01) and COPD (0.95, P<.01). While achieving similar end-exercise exertional dyspnea intensities (P=.60), the HF group walked at a higher average speed (4.2 ± 0.8 vs. 3.5 ± 0.8km·h−1) and gradient (10.3 ± 2.8 vs. 9.6 ± 2.8%) and a greater oxygen uptake (P<.01) and ventilation (P<.01) than those with COPD. While achieving similar cardiac outputs (P=.98), stroke volumes (P=.97), and heart rates (P=.83), those with HF displayed a larger arteriovenous oxygen difference (P<.01), while those with COPD exhibited greater decreases in inspiratory capacity (P=.03), arterial oxygen saturation (P=.02), and breathing reserve (P<.01).
Conclusions
The Dyspnea Challenge is a reliable test-retest measure of exertional dyspnea in HF.
Typical to their pathologies, HF seemed limited by an inadequate modulation of cardiac
output, while ventilatory constraints hampered those with COPD.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Examining the repeatability of a novel test to measure exertional dyspnoea in chronic obstructive pulmonary disease.Respir Physiol Neurobiol. 2022; 296103826
- Exertional Dyspnoea responses reported in the Dyspnoea Challenge and measures of disease severity in COPD.Respir Physiol Neurobiol. 2022; 304103941
- Optimising the Dyspnoea Challenge: exertional dyspnoea responses to changing treadmill gradients.Respir Physiol Neurobiol. 2022; 103915
- Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors.Eur Respir Rev. 2016; 25: 317-332
- How can we cure a heart "in flame"? A translational view on inflammation in heart failure.Basic Res Cardiol. 2013; 108: 356
- Exertional dyspnoea in pulmonary arterial hypertension.Eur Respir Rev. 2017; 26170039
- Dynamic respiratory mechanics and exertional dyspnoea in pulmonary arterial hypertension.Eur Respir J. 2013; 41: 578-587
- Determinants of dyspnea in chronic heart failure.J Card Fail. 2016; 22: 201-209
- Cardiac output changes during exercise in heart failure patients: focus on mid-exercise.ESC Heart Fail. 2021; 8: 55-62
- Mechanisms That Modulate Peripheral Oxygen Delivery during Exercise in Heart Failure.Ann Am Thorac Soc. 2017; 14: 40-47
- Pathophysiology of dyspnea in COPD.Postgrad Med. 2017; 129: 366-374
- A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.J Chiropr Med. 2016; 15: 155-163
- Standardized measurement of breathlessness during exercise.Curr Opin Support Palliat Care. 2019; 13: 152-160
- Australian and New Zealand Pulmonary Rehabilitation Guidelines.Respirology. 2017; 22: 800-819
- Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12.Thorax. 2010; 65: 21-26
- Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research.Eur Respir J. 2015; 45: 1681-1691
- Spirometry: step by step.Breathe. 2012; 8: 232-240
- An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1428-1446
- Ease of Noninvasive Measurement of Cardiac Output Coupled With Peak VO2 Determination at Rest and During Exercise in Patients With Heart Failure.Am J Cardiol. 2007; 99: 404-405
- Accuracy of impedance cardiography for evaluating trends in cardiac output: a comparison with oesophageal Doppler.Br J Anaesth. 2014; 113: 596-602
- Inspiratory Capacity during Exercise: Measurement, Analysis, and Interpretation.Pulm Med. 2013; 2013956081
- Reliability of inspiratory capacity for estimating end-expiratory lung volume changes during exercise in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1997; 156: 55-59
- Oxygen Uptake Efficiency Slope and Breathing Reserve, Not Anaerobic Threshold, Discriminate Between Patients With Cardiovascular Disease Over Chronic Obstructive Pulmonary Disease.JACC Heart Fail. 2016; 4: 252-261
- A Web-based Sample Size Calculator for Reliability Studies.Educ Med J. 2018; 10: 67-76
- Exercise-Induced Pulmonary Edema in Heart Failure.Circulation. 2003; 108: 2666-2671
- Responses of group III and IV muscle afferents to dynamic exercise.J Appl Physiol. 1997; 82 (1985): 1811-1817
- Alterations of skeletal muscle in chronic heart failure.Circulation. 1992; 85: 1751-1759
- Respiratory muscle function and dyspnea in patients with chronic congestive heart failure.Circulation. 1992; 86: 909-918
- The ergoreflex: how the skeletal muscle modulates ventilation and cardiovascular function in health and disease.Eur J Heart Fail. 2021; 23: 1458-1467
- Skeletal muscle metabolism during exercise under ischemic conditions in congestive heart failure. Evidence for abnormalities unrelated to blood flow.Circulation. 1988; 78: 320-326
- Skeletal muscle alterations in patients with chronic heart failure.Eur Heart J. 1997; 18: 971-980
- The Effect of Respiratory Muscle Fatigue on Respiratory Sensations.Clin Sci. 1981; 60: 463-466
- Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2014; 95: 1398-1407
- Chronic obstructive pulmonary disease: clinical integrative physiology.Clin Chest Med. 2014; 35: 51-69
- Exercise limitation in chronic obstructive pulmonary disease. The O'Donnell threshold.Am J Respir Crit Care Med. 2015; 191: 873-875
- Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable.Proc Am Thorac Soc. 2007; 4: 145-168
- Inspiratory Capacity, Dynamic Hyperinflation, Breathlessness, and Exercise Performance during the 6-Minute-Walk Test in Chronic Obstructive Pulmonary Disease.Am J Respir Crit Care Med. 2001; 163: 1395-1399
- The clinical importance of dynamic lung hyperinflation in COPD.COPD: J Chronic Obstruct Pulmonary Dis. 2006; 3: 219-232
- Voluntary Versus Reflex Regulation of Maximal Exercise Flow: Volume Loops1-3.Am Rev Respir Dis. 1989; 139: 150-156
- Emerging concepts in the evaluation of ventilatory limitation during exercise: the exercise tidal flow-volume loop.Chest. 1999; 116: 488-503
- Breathlessness measurement should be standardised for the level of exertion.Eur Respir J. 2018; 51
Article info
Publication history
Published online: November 28, 2022
Accepted:
November 20,
2022
Received in revised form:
November 7,
2022
Received:
August 30,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
