Contemporary physiological approaches to reversing the disease spiral in advanced COPD
Symposium Chairs: T. Troosters (Leuven, Belgium), M. Morgan (Leicester, United Kingdom)
Aims: In patients with COPD, ventilatory limitation results in reduced activity. This in turn leads to quadriceps myopathy, which in turn causes anaerobic metabolism during exercise, increasing ventilatory demands and, thus (because these cannot be met), further limits activity. This process has been termed a disease spiral. The aim of this session is to understand the evidence for this process and to evaluate three contemporary interventions (exogenous stimulation of the quadriceps muscle, ventilation-assisted pulmonary rehabilitation and lung volume reduction surgery) with the potential to break the spiral.