Source: Annual Congress 2010 - Respiratory and peripheral muscles: From basic mechanisms to altered function
Disease area: Airway diseases

Abstract

Rationale: It has been hypothesized that owing to the high work of breathing sustained by patients with COPD during exercise, blood flow may increase in favour of the respiratory muscles, thereby compromising locomotor muscle blood flow.
Objectives: To investigate whether at the same work of breathing, intercostal muscle blood flow during exercise is as high as during resting isocapnic hyperpnoea when respiratory and locomotor muscles do not compete for the available blood flow.
Methods: Intercostal and vastus lateralis muscle perfusion was measured simultaneously in ten patients (FEV₁=50±5% pred.) by near-infrared spectroscopy using indocyanine green dye. Measurements were made at several exercise intensities up to peak work rate (WRpeak) and subsequently during hyperpnoea at minute ventilation levels up to those at WRpeak.
Results: During resting hyperpnoea, intercostal muscle blood flow increased with the power of breathing to 11.4±1.6 ml^.min^-1.100^.gr^-1 at the same ventilation recorded at WRpeak. Conversely, during graded exercise, intercostal muscle blood flow remained unchanged from rest up to 50% WRpeak (6.8±1.3 ml^.min^-1.100^.gr^-1), and then fell to 4.5±0.8 ml^.min^-1.100^.gr^-1 at WRpeak (p=0.003). Cardiac output plateaued above 50% WRpeak (8.4±0.1 l^.min^-1), whilst vastus lateralis muscle blood flow increased progressively, reaching 39.8±7.1 ml^.min^-1.100^.gr^-1 at WRpeak.
Conclusions: During intense exercise in COPD, restriction of intercostal muscle perfusion but preservation of quadriceps muscle blood flow along with attainment of a plateau in cardiac output, represent the inability of the circulatory system to satisfy the energy demands of both locomotor and respiratory muscles.

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I. Vogiatzis, D. Athanasopoulos, H. Habazettl, A. Aliverti, Z. Louvaris, E. Herouvim, H. Wagner, C. Roussos, P. D. Wagner, S. Zakynthinos (Greece; Berlin, Germany; , Italy; San Diego, United States Of America). Intercostal muscle blood flow limitation during exercise in chronic obstructive pulmonary disease. Eur Respir J 2010; 36: Suppl. 54, 3411

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