Skip to main content

Advertisement

SpringerLink
Log in

Cardiopulmonary Exercise Testing Allows Discrimination Between Idiopathic Non-specific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis in Mild to Moderate Stages of the Disease

  • INTERSTITIAL LUNG DISEASE
  • Published:
Lung Aims and scope Submit manuscript

Abstract

It is unclear whether there are cardiopulmonary exercise testing (CPET) parameters which may indicate poor prognosis in the early course of fibrosing interstitial lung disease. 27 untreated consecutive subjects (13 idiopathic non-specific interstitial pneumonia (iNSIP), 14 idiopathic pulmonary fibrosis (IPF); 19 male; age 69 ± 10 years) were enrolled in this observational pilot study. Subjects underwent routine pulmonary function testing and CPET. Statistically, the t test and the Mann–Whitney-U test were applied in the presence of normal and non-normal distribution (according to Shapiro–Wilk), respectively. Analyzing the whole cohort, only mild functional impairments were determined. Comparison of iNSIP and IPF groups detected significant differences for the CPET parameters V’O2Peak[%pred] (p = 0.011), V’O2/kgPeak (p = 0.033), Watt[%pred] (p = 0.048), V’E/V’CO2 (Rest: p = 0.016; AT: p = 0.011; Peak: p = 0.019; Slope: p = 0.040), V’E/V’O2 (Rest: p = 0.033 AT: p = 0.014; Peak: p = 0.035). CPET parameters may indicate IPF-specific impairments even in mild disease. It may be hypothesized that these parameters are early biomarkers of poor prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Abbreviations

AaDO2 :

Alveolar-arterial oxygen partial pressure difference

AT:

Anaerobic threshold

BMI:

Body mass index

BR:

Breathing reserve

CPET:

Cardiopulmonary exercise test

DLCO:

Diffusion capacity of the lung for carbon monoxide

FEV1:

Forced exspiratory volume in one second

FVC:

Exspiratory forced vital capacity

ILD:

Interstitial lung disease

IPF:

Idiopathic pulmonary fibrosis

iNSIP:

Idiopathic non-specific interstitial pneumonia

KCO:

Transfer coefficient for carbon monoxide

OUES:

Oxygen uptake efficiency slope

O2 pulse:

Oxygen pulse

PFT:

Pulmonary function test

SB:

Single breath

TLC:

Total lung capacity

VA:

Alveolar volume

VC:

In inspiratory vital capacity

VE’:

Minute ventilation

V'CO2 :

Carbon dioxide output

V'O2 :

Oxygen uptake

%pred:

Percent of predicted value

References

  1. Vainshelboim B, Oliveira J, Fox BD, Adir Y, Ollech JE, Kramer MR (2016) Physiological profile and limitations in exercise in idiopathic pulmonary fibrosis. J Cardiopulm Rehabil Prev 36(4):270–278

    Article  Google Scholar 

  2. Faisal A, Alghamdi BJ, Ciavaglia CE, Elbehairy AF, Webb KA, Ora J, Neder JA, O'Donnell DE (2016) Common mechanisms of dyspnea in chronic interstitial and obstructive lung disorders. Am J Respir Crit Care Med 193(3):299–309

    Article  CAS  Google Scholar 

  3. Degani-Costa LH, Levarge B, Digumarthy SR, Eisman AS, Harris RS, Lewis GD (2015) Pulmonary vascular response patterns during exercise in interstitial lung disease. Eur Respir J 46(3):738–749

    Article  CAS  Google Scholar 

  4. Fell CD, Liu LX, Motika C, Kazerooni EA, Gross BH, Travis WD, Colby TV, Murray S, Toews GB, Martinez FJ, Flaherty KR (2009) The prognostic value of cardiopulmonary exercise testing in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 179(5):402–407

    Article  Google Scholar 

  5. Triantafillidou C, Manali E, Lyberopoulos P, Kolilekas L, Kagouridis K, Gyftopoulos S, Vougas K, Kotanidou A, Alchanatis M, Karakatsani A, Papiris SA (2013) The role of cardiopulmonary exercise test in IPF prognosis. Pulm Med 2013:514817

    Article  Google Scholar 

  6. Vainshelboim B, Oliveira J, Fox BD, Kramer MR (2016) The prognostic role of ventilatory inefficiency and exercise capacity in idiopathic pulmonary fibrosis. Respir Care 61(8):1100–1109

    Article  Google Scholar 

  7. Layton AM, Armstrong HF, Kim HP, Meza KS, D'Ovidio F, Arcasoy SM (2017) Cardiopulmonary exercise factors predict survival in patients with advanced interstitial lung disease referred for lung transplantation. Respir Med 126:59–67

    Article  Google Scholar 

  8. Ryerson CJ, Vittinghoff E, Ley B, Lee JS, Mooney JJ, Jones KD, Elicker BM, Wolters PJ, Koth LL, King TE Jr, Collard HR (2014) Predicting survival across chronic interstitial lung disease: the ILD-GAP model. Chest 145(4):723–728

    Article  Google Scholar 

  9. Thomeer MJ, Vansteenkiste J, Verbeken EK, Demedts M (2004) Interstitial lung diseases: characteristics at diagnosis and mortality risk assessment. Respir Med 98(6):567–573

    Article  Google Scholar 

  10. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE Jr, Kondoh Y, Myers J, Muller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, Griss BS, Protzko SL, Schunemann HJ, ATS, ERS, JRS, ALAT Committee on Idiopathic Pulmonary Fibrosis, (2011) An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 183(6):788–824

    Article  Google Scholar 

  11. Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D, ATS, ERS Committee on Idiopathic Interstitial Pneumonias, (2013) An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188(6):733–748

    Article  Google Scholar 

  12. American Thoracic Society, American College of Chest Physicians (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med:167(2):211.

    Article  Google Scholar 

  13. Task Force ERS, Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, O'Donnell DE, Puente-Maestu L, Schols AM, Singh S, Whipp BJ (2007) Recommendations on the use of exercise testing in clinical practice. Eur Respir J 29(1):185–209

    Google Scholar 

  14. Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, Nishibata K (1996) Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol 28(6):1567–1572

    Article  CAS  Google Scholar 

  15. Agusti AG, Roca J, Gea J, Wagner PD, Xaubet A, Rodriguez-Roisin R (1991) Mechanisms of gas-exchange impairment in idiopathic pulmonary fibrosis. Am Rev Respir Dis 143(2):219–225

    Article  CAS  Google Scholar 

  16. Wallaert B, Guetta A, Wemeau-Stervinou L, Terce G, Valette M, Neviere R, Aguilaniu B (2011) Prognostic value of clinical exercise testing in idiopathic pulmonary fibrosis. Rev Mal Respir 28(3):290–296

    Article  CAS  Google Scholar 

  17. Miki K, Maekura R, Hiraga T, Okuda Y, Okamoto T, Hirotani A, Ogura T (2003) Impairments and prognostic factors for survival in patients with idiopathic pulmonary fibrosis. Respir Med 97(5):482–490

    Article  CAS  Google Scholar 

  18. Nathan SD, Meyer KC (2014) IPF clinical trial design and endpoints. Curr Opin Pulm Med 20(5):463–471

    Article  Google Scholar 

  19. King TE Jr, Tooze JA, Schwarz MI, Brown KR, Cherniack RM (2001) Predicting survival in idiopathic pulmonary fibrosis: scoring system and survival model. Am J Respir Crit Care Med 164(7):1171–1181

    Article  Google Scholar 

  20. Erbes R, Schaberg T, Loddenkemper R (1997) Lung function tests in patients with idiopathic pulmonary fibrosis. Are they helpful for predicting outcome? Chest 111(1), 51–57.

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported by Intermune/Roche. Intermune/Roche was not involved in preparation of data or the manuscript.

Author information

Authors and Affiliations

  1. Hospital Bethanien Solingen, Institute of Pneumology, University of Cologne, Solingen, Germany

    Lars Hagmeyer, Simon Herkenrath, Norbert Anduleit, Marcel Treml & Winfried Randerath

  2. Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Aufderhöher Straße 169-175, 42699, Solingen, Germany

    Lars Hagmeyer, Simon Herkenrath & Winfried Randerath

Authors
  1. Lars Hagmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simon Herkenrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norbert Anduleit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcel Treml
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Winfried Randerath
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LH was involved in study conception and design, data acquisition, data analysis and interpretation, manuscript drafting, critical revision, and final approvement. SH was involved in data acquisition, data analysis and interpretation, critical revision of the manuscript, and final approvement. NA was involved in data acquisition, data analysis and interpretation, critical revision of the manuscript, and final approvement. MT was involved in data analysis and interpretation, manuscript drafting, critical revision of the manuscript, and final approvement. WR was involved study conception and design, data analysis and interpretation, critical revision of the manuscript, and final approvement.

Corresponding author

Correspondence to Lars Hagmeyer.

Ethics declarations

Conflict of interest

Lars Hagmeyer reports travel grants and speaking fees by Roche and Boehringer Ingelheim. Simon Herkenrath, Norbert Anduleit, Marcel Treml states that there is no conflict of interest. Winfried Randerath reports travel grants and speaking fees by Roche.

Ethical Approval

This study was approved by the Ethics Committee of the University Witten/Herdecke. ClinicalTrials.gov NCT02636452.

Informed Consent

All subjects have given their written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hagmeyer, L., Herkenrath, S., Anduleit, N. et al. Cardiopulmonary Exercise Testing Allows Discrimination Between Idiopathic Non-specific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis in Mild to Moderate Stages of the Disease. Lung 197, 721–726 (2019). https://doi.org/10.1007/s00408-019-00282-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-019-00282-9

Keywords

Search

Navigation