Lung

, Volume 191, Issue 1, pp 43–52 | Cite as

Is There an Added Value of Cardiopulmonary Exercise Testing in Sarcoidosis Patients?

  • Rik G. J. Marcellis
  • Antoine F. Lenssen
  • Geeuwke J. de Vries
  • Robert P. Baughman
  • Chris P. van der Grinten
  • Johny A. Verschakelen
  • Jolanda De Vries
  • Marjolein Drent
Article

Abstract

Background

Cardiopulmonary exercise testing (CPET) with blood gas analysis may be helpful when there is a discrepancy between clinical findings and physiologic tests at rest. The aim of this study was to examine the added value of CPET compared to the measurement of the diffusing capacity of the lung for carbon monoxide (DLCO) in detecting impaired pulmonary gas exchange in sarcoidosis patients.

Methods

The clinical records of 160 (age = 41.3 ± 10.0 years; number of females = 63) sarcoidosis patients referred to the former MUMC ild care center were retrospectively reviewed. Patients performed a symptom-limited incremental exercise test with blood gas analysis on a bicycle ergometer. DLCO was measured by the single-breath method.

Results

DLCO (mean = 83.2 ± 18.0 %) below 80 % of predicted was demonstrated by 38 % of the sarcoidosis patients in our sample. Of the patients with normal DLCO (n = 99, 61.9 %), the P(A-a)O2 at maximal exercise [P(A-a)O2max] was moderately increased (>2.5 kPa) in 69.7 % and excessively increased (>4.7 kPa) in 18.2 %. Pulmonary gas exchange impairment (PGEI) was more obvious in patients with lower DLCO values. A DLCO value below 60 % of predicted indicated substantial gas exchange impairment. PaO2 at rest, DLCO, and FVC as a percentage of predicted and radiographic staging predicted 40 % of the PGEI at maximal exercise.

Conclusion

A substantial number of the symptomatic sarcoidosis patients with normal DLCO appeared to have PGEI at maximal exercise, suggesting that normal DLCO at rest is an inappropriate predictor of abnormal pulmonary gas exchange during exercise. CPET appeared to offer added value in detecting impaired gas exchange during exercise in sarcoidosis patients with unexplained disabling symptoms.

Keywords

Sarcoidosis Cardiopulmonary exercise testing DLCO Pulmonary gas exchange impairment Muscle strength Lung function 

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Rik G. J. Marcellis
    • 1
  • Antoine F. Lenssen
    • 1
  • Geeuwke J. de Vries
    • 2
  • Robert P. Baughman
    • 3
  • Chris P. van der Grinten
    • 4
  • Johny A. Verschakelen
    • 5
  • Jolanda De Vries
    • 6
  • Marjolein Drent
    • 7
    • 8
  1. 1.Department of Physical TherapyMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
  2. 2.Department of Respiratory MedicineORBIS MCSittard-GeleenThe Netherlands
  3. 3.University of Cincinnati Medical CenterCincinnatiUSA
  4. 4.Department of Respiratory MedicineMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
  5. 5.Department of RadiologyUniversity Hospital GasthuisbergLeuvenBelgium
  6. 6.Department of Medical Psychology, St. Elisabeth Hospital Tilburg and Center of Research on Psychology in Somatic Diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands
  7. 7.Faculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
  8. 8.Department of interstitial lung diseasesGelderse Vallei HospitalEdeThe Netherlands

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