Excess ventilation and ventilatory constraints during exercise in patients with chronic obstructive pulmonary disease

• Excess ventilation and ventilatory constraints occur in COPD during exercise.
• VE/VCO2 slope and intercept give complementary information on ventilatory response.
• Excess ventilation and ventilatory constraints analysis may define COPD phenotypes.

We assessed the relationship between minute ventilation/carbon dioxide output (VE/VCO2) and ventilatory constraints during an incremental cardiopulmonary exercise testing (CPET) in patients with chronic obstructive pulmonary disease (COPD).Slope and intercept of the VE/VCO2 linear relationship, the ratios of inspiratory capacity/total lung capacity (IC/TLC) and of tidal volume (VT) over vital capacity (VTpeak/VC) and IC (VTpeak/IC) and over forced expiratory volume at 1st second (VTpeak/FEV1) at peak of exercise were measured in 52 COPD patients during a CPET. The difference peak-rest in end-tidal pressure of CO2 (PETCO2) was also measured.VE/VCO2 intercept showed a negative correlation with IC/TLC peak (p < 0.01) and a positive one with VTpeak/FEV1 (p < 0.01) and with PETCO2 peak-rest (p < 0.01). VE/VCO2 slope was negatively related to VTpeak/VC, VTpeak/IC and VTpeak/FEV1 (all correlations p < 0.05) and to PETCO2 peak-rest (p < 0.01).In COPD, VE/VCO2 slope and intercept provide complementary information on the ventilatory limitation to exercise, as assessed by changes in the end-expiratory lung volume and in tidal volume excursion.