Chronic Obstructive Pulmonary Disease Management

Chronic obstructive lung disease (COPD) is arguably the most common chronic condition encountered in pulmonary practice and is associated with extremely high societal and patient burdens. COPD is a heterogenous set of conditions with respect to pulmonary impairment, symptom severity, and risk for morbidity and mortality.

COPD is a systemic condition and the proximal limitation to physical function in each individual may reside with any number of factors, including breathing capacity, dynamic changes in lung volumes or airway function during exercise, cardiovascular complications of lung disease, inefficiency of pulmonary gas exchange, skeletal muscle dysfunction, and/or comorbid conditions such as anemia, obesity, and physical deconditioning. The separate and combined effects of these processes are difficult to predict from diagnostic tests performed at rest alone.

CPET is recommended as part of the individualized assessment of impairment and the targeting of interventions to improve function and manage symptoms in COPD. One of the most effective interventions available in COPD is pulmonary rehabilitation, for which exercise training is a central component. In this context, CPET is used for screening patients for co-morbid cardiovascular diseases, defining supplemental oxygen requirements, identifying targets for intervention in breathing dynamics, and selecting effective work rates and protocols for exercise training.

Although predominantly used in the care of patients with COPD, pulmonary rehabilitation has increasingly been adapted to other chronic pulmonary conditions including interstitial lung diseases and pulmonary vascular disease, and to candidates for interventions ranging from cancer chemotherapy, lung cancer resection, lung transplant, and long COVID. CPET is also integral to the diagnostic assessment of patients with unexplained dyspnea and exertional respiratory symptoms from patients to athletes. Clinicians with knowledge and competence in CPET are essential to the comprehensive care of patients with COPD and other chronic pulmonary conditions.