Inspiratory loading and limb blood flow in COPD: The modulating effects of resting lung hyperinflation

• Inspiratory resistive loading may have deleterious cardiocirculatory effects leading to poor peripheral perfusion in patients with COPD.
• We examined the relationship between resting lung hyperinflation, acute inspiratory overload and calf blood flow (CBF).
• Severe lung hyperinflation was associated with lower calf blood flow and increased calf vascular resistance.
• Marked impairments in CBF in severely-hyperinflated patients were seen only after inspiratory muscle loading in less hyperinflated patients.

Inspiratory resistive loading (IRL) may have deleterious cardiocirculatory effects leading to poor peripheral perfusion in severely-hyperinflated patients with COPD. Nineteen patients (13 severely-hyperinflated with inspiratory capacity/total lung capacity ratio ≤ 0.28) underwent calf blood flow (CBF) measurements by venous occlusion plethysmography at rest and during IRL at 60% maximal inspiratory pressure. Severely-hyperinflated patients had lower resting CBF and greater calf vascular resistance (CVR) than moderately-hyperinflated patients (p < 0.05). All severely-hyperinflated patients had markedly reduced CBF (p = 0.01). Opposite to our main hypothesis, however, IRL did not further reduce CBF in these patients (p > 0.05). Conversely, it significantly decreased CBF and increased CVR in moderately-hyperinflated patients; in fact, end-trial CBF and CVR did not differ between the groups (p > 0.05). In conclusion, marked impairments in resting appendicular blood flow in severely-hyperinflated patients with COPD were seen only after acute IRL in less hyperinflated patients. These findings set the stage for studies investigating the effects of lung deflation on peripheral hemodynamics in patients with severe hyperinflation.