, Volume 191, Issue 2, pp 177–182 | Cite as

Dynamic Hyperinflation Correlates with Exertional Oxygen Desaturation in Patients with Chronic Obstructive Pulmonary Disease

  • Muhammad Ahsan Zafar
  • Wayne Tsuang
  • Laura Lach
  • William Eschenbacher
  • Ralph J. Panos



Dynamic hyperinflation (DH) causes exercise limitation and exertional dyspnea in patients with chronic obstructive pulmonary disease (COPD). Exertional desaturation (ED) also occurs commonly in COPD but neither routine physiologic parameters nor imaging predict ED accurately. In this study we evaluated the relationship between DH and ED during 6-min walk testing (6MWT).


We measured ED and DH in patients with stable COPD. SpO2 was measured by continuous pulse oximetry during 6MWT. ED was defined as a decline in SpO2 (ΔSpO2) ≥4 %. DH was determined by measuring inspiratory capacity (IC) before and after the 6MWT using a handheld spirometer. DH was defined as ΔIC >0.0 L. We correlated DH and ED with clinical and pulmonary physiologic variables by regression analysis, χ 2, and receiver operator curve (ROC) analysis.


Thirty males [age = 65 ± 9.4 years, FEV1 % predicted = 48 ± 14 %, and DLCO % predicted = 50 ± 21 % (mean ± SD)] were studied. ΔSpO2 correlated with ΔIC (r = 0.49, p = 0.005) and age (r = 0.39, p = 0.03) by univariate analysis; however, only ΔIC correlated on multivariate regression analysis (p = 0.01). ΔSpO2 did not correlate with FEV1, FVC, FEF25–75, RV, DLCO % predicted, BMI, smoking, BORG score, or distance covered in 6MWT. DH strongly correlated with ED (p = 0.001). On ROC analysis, DH had an area under the curve of 0.92 for the presence of ED (sensitivity = 90 %; specificity = 77 %, p < 0.001).


Routine pulmonary function test results and clinical variables did not correlate with ED in patients with stable COPD. Dynamic hyperinflation strongly correlates with exertional desaturation and could be a reason for this desaturation.


COPD Dynamic hyperinflation Exertion Desaturation 


Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Casanova C, Cote C, Marin JM et al (2008) Distance and oxygen desaturation during 6-min walk test as predictors of long-term mortality in patients with COPD. Chest 134:746–752PubMedCrossRefGoogle Scholar
  2. 2.
    Panos RJ, Eschenbacher W (2009) Exertional desaturation in patients with chronic obstructive pulmonary disease. COPD 6:478–487PubMedCrossRefGoogle Scholar
  3. 3.
    Emmanuel GE, Monreno F (1966) Distribution of ventilation and blood flow during exercise in emphysema. J Appl Physiol 21:1532–1544PubMedGoogle Scholar
  4. 4.
    Cutillo A, Bigler AH, Perondi R et al (1981) Exercise and distribution of inspired gas in patients with obstructive pulmonary disease. Bull Eur Physiopathol Respir 17:891–901PubMedGoogle Scholar
  5. 5.
    Dantzker DR, D’Alonzo GE (1986) The effect of exercise on pulmonary gas exchange in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 134:1135–1139PubMedGoogle Scholar
  6. 6.
    Owens GR, Rogers RM, Pennock BE et al (1984) The diffusing capacity as a predictor of arterial oxygen desaturation during exercise in patients with chronic obstructive pulmonary disease. N Engl J Med 310(19):1218–1221PubMedCrossRefGoogle Scholar
  7. 7.
    Knower MT, Dunagan DP, Adair NE et al (2001) Baseline oxygen saturation predicts exercise desaturation below prescription threshold in patients with chronic obstructive pulmonary disease. Arch Intern Med 161(5):732–736PubMedCrossRefGoogle Scholar
  8. 8.
    Blanch L, Bernabé F, Lucangelo U (2005) Measurement of air trapping, intrinsic positive end-expiratory pressure and dynamic hyperinflation in mechanically ventilated patients. Respir Care 50:110–123PubMedGoogle Scholar
  9. 9.
    Parker CM, Voduc N, Aaron SD et al (2005) Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur Respir J 26:420–428PubMedCrossRefGoogle Scholar
  10. 10.
    Satevenson NJ, Walker PP, Costello RW et al (2005) Lung mechanics and dyspnea during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 172:1510–1516CrossRefGoogle Scholar
  11. 11.
    Gelb AF, Guitierrez CA, Weisman IM et al (2004) Simplified detection of dynamic hyperinflation. Chest 126:1855–1860PubMedCrossRefGoogle Scholar
  12. 12.
    O’Donnell DE, Revill S, Webb KA (2001) Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:770–777PubMedGoogle Scholar
  13. 13.
    Hannink JD, Van Helvoort HA, Dekhuijzen PN et al (2011) Similar dynamic hyperinflation during arm and leg exercise at similar ventilation in chronic obstructive pulmonary disease. Med Sci Sports Exerc 43(6):996–1001PubMedCrossRefGoogle Scholar
  14. 14.
    Callens E, Graba S, Gillet-Juvin K et al (2009) Measurement of dynamic hyperinflation after a 6-minute walk test in patients with COPD. Chest 136(6):1466–1472PubMedCrossRefGoogle Scholar
  15. 15.
    Barbera JA, Roca J, Ramirez J et al (1991) Gas exchange during exercise in mild COPD. Correlation with lung structure. Am Rev Respir Dis 144:520–525PubMedCrossRefGoogle Scholar
  16. 16.
    Tzani P, Aiello M, Elia D et al (2011) Dynamic hyperinflation is associated with a poor cardiovascular response to exercise in COPD patients. Respir Res 12:150PubMedCrossRefGoogle Scholar
  17. 17.
    Vassaux C, Torre-Bouscoulet L, Zeineldine S et al (2008) Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance in COPD. Eur Respir J 32(5):1275–1282PubMedCrossRefGoogle Scholar
  18. 18.
    O’Donnell DE, D’Arsigny C, Fitzpatrick M et al (2002) Exercise hypercapnia in advanced chronic obstructive pulmonary disease: the role of lung hyperinflation. Am J Respir Crit Care Med 166:663–668PubMedCrossRefGoogle Scholar
  19. 19.
    ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117Google Scholar
  20. 20.
    Wilson RC, Jones PW (1989) A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci (Lond) 76(3):277–282Google Scholar
  21. 21.
    Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338PubMedCrossRefGoogle Scholar
  22. 22.
    Global Initiative for Chronic Obstructive Lung Disease: global strategy for the diagnosis, management and prevention of chronic obstructive lung disease. Accessed 10 Aug 2012
  23. 23.
    Jenkins S, Čečins N (2011) Six-minute walk test: observed adverse events and oxygen desaturation in a large cohort of patients with chronic lung disease. Intern Med J 41(5):416–422PubMedCrossRefGoogle Scholar
  24. 24.
    Lahaije AJ, van Helvoort HA, Dekhuijzen PN et al (2010) Physiologic limitations during daily life activities in COPD patients. Respir Med 104(8):1152–1159PubMedCrossRefGoogle Scholar
  25. 25.
    Garcia-Rio F, Lores V, Mediano O et al (2009) Daily physical activity in patients with chronic obstructive pulmonary disease is mainly associated with dynamic hyperinflation. Am J Respir Crit Care Med 180(6):506–512PubMedCrossRefGoogle Scholar
  26. 26.
    Guenette JA, Webb KA, O’Donnell DE (2012) Does dynamic hyperinflation contribute to dyspnoea during exercise in patients with COPD? Eur Respir J 40(2):322–329PubMedCrossRefGoogle Scholar
  27. 27.
    Hannink JD, van Helvoort HA, Dekhuijzen PN et al (2010) Dynamic hyperinflation during daily activities: does COPD global initiative for chronic obstructive lung disease stage matter? Chest 137(5):1116–1121PubMedCrossRefGoogle Scholar
  28. 28.
    Hannink J, Lahaije A, Bischoff E et al (2010) Dynamic hyperinflation after metronome-paced hyperventilation in COPD: a 2 year follow-up. Respir Med 104(11):1700–1705PubMedCrossRefGoogle Scholar
  29. 29.
    Guenette JA, Jensen D, Webb KA et al (2011) Sex differences in exertional dyspnea in patients with mild COPD: physiological mechanisms. Respir Physiol Neurobiol 177(3):218–227PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA)  2012

Authors and Affiliations

  • Muhammad Ahsan Zafar
    • 1
  • Wayne Tsuang
    • 1
  • Laura Lach
    • 1
  • William Eschenbacher
    • 1
  • Ralph J. Panos
    • 1
  1. 1.Cincinnati VAMCCincinnatiUSA

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