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Pathophysiological mechanisms of exertional breathlessness in chronic obstructive pulmonary disease and interstitial lung disease

Jensen, Dennisa,b,c; Schaeffer, Michele R.d,e; Guenette, Jordan A.d,e

Current Opinion in Supportive and Palliative Care: September 2018 - Volume 12 - Issue 3 - p 237–245
doi: 10.1097/SPC.0000000000000377
RESPIRATORY PROBLEMS: Edited by David C. Currow and Miriam J. Johnson

Purpose of review Breathlessness is a common and distressing symptom in patients with chronic obstructive pulmonary disease (COPD) and fibrotic interstitial lung disease (ILD), particularly during exercise. Effective medical management of exertional breathlessness in people living with COPD and fibrotic ILD is challenging for healthcare providers and requires an understanding of its mechanisms. Thus, in this brief review we summarize recent advances in our understanding of the pathophysiological mechanisms of exertional breathlessness in COPD and fibrotic ILD.

Recent findings The collective results of recent physiological and clinical trials suggest that higher intensity ratings of exertional breathlessness in both COPD and fibrotic ILD compared to healthy control individuals is mechanistically linked to the awareness of greater neural respiratory drive (quantified using inspiratory muscle electromyography) needed to compensate for pathophysiological abnormalities in respiratory mechanics and pulmonary gas exchange efficiency.

Summary Any therapeutic intervention capable of decreasing intrinsic mechanical loading of the respiratory system and/or increasing pulmonary gas exchange efficiency has the potential to decrease the prevalence and severity of activity-related breathlessness and improve related clinical and patient-reported outcomes (e.g., exercise tolerance and health-related quality of life) by decreasing neural respiratory drive in people with COPD and fibrotic ILD.

aClinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology & Physical Education, Faculty of Education, McGill University

bResearch Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montréal, Quebec

cResearch Centre for Physical Activity and Health, McGill University

dDepartment of Physical Therapy, University of British Columbia

eCentre for Heart Lung Innovation, Providence Healthcare Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada

Correspondence to Dennis Jensen, PhD, Department of Kinesiology and Physical Education, 475 Pine Avenue West, Montréal, Quebec, Canada, H2W 1S4. Tel: +1 514 398 4184; fax: +1 514 398 4186; e-mail:

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