Dynamic laryngeal narrowing during exercise: a mechanism for generating intrinsic PEEP in COPD?

Introduction Patients with COPD commonly exhibit pursed-lip breathing during exercise, a strategy that, by increasing intrinsic positive end-expiratory pressure, may optimise lung mechanics and exercise tolerance. A similar role for laryngeal narrowing in modulating exercise airways resistance and t...

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Bibliographic Details
Published in:Thorax 2015-03, Vol.70 (3), p.251-257
Main Authors: Baz, M, Haji, G S, Menzies-Gow, A, Tanner, R J, Hopkinson, N S, Polkey, M I, Hull, J H
Format: Article
Language:English
Subjects:
Airway Resistance
Case-Control Studies
Chronic obstructive pulmonary disease
Exercise Test
Exercise Tolerance
Exhalation - physiology
Female
Forced Expiratory Volume
Glottis - physiopathology
Humans
Inhalation - physiology
Laryngoscopy
Larynx
Lung diseases
Male
Middle Aged
Oxygen Consumption
Positive-Pressure Respiration, Intrinsic - physiopathology
Pulmonary Disease, Chronic Obstructive - physiopathology
Pulmonary Ventilation
Respiration
Respiratory Physiology
Tidal Volume
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Summary:Introduction Patients with COPD commonly exhibit pursed-lip breathing during exercise, a strategy that, by increasing intrinsic positive end-expiratory pressure, may optimise lung mechanics and exercise tolerance. A similar role for laryngeal narrowing in modulating exercise airways resistance and the respiratory cycle volume–time course is postulated, yet remains unstudied in COPD. The aim of this study was to assess the characteristics of laryngeal narrowing and its role in exercise intolerance and dynamic hyperinflation in COPD. Methods We studied 19 patients (n=8 mild–moderate; n=11 severe COPD) and healthy age and sex matched controls (n=11). Baseline physiological characteristics and clinical status were assessed prior to an incremental maximal cardiopulmonary exercise test with continuous laryngoscopy. Laryngeal narrowing measures were calculated at the glottic and supra-glottic aperture at rest and peak exercise. Results At rest, expiratory laryngeal narrowing was pronounced at the glottic level in patients and related to FEV1 in the whole cohort (r=−0.71, p
ISSN:0040-6376
1468-3296
DOI:10.1136/thoraxjnl-2014-205940