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Is There an Added Value of Cardiopulmonary Exercise Testing in Sarcoidosis Patients?

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Abstract

Background

Cardiopulmonary exercise testing (CPET) with blood gas analysis may be helpful when there is a discrepancy between clinical findings and physiologic tests at rest. The aim of this study was to examine the added value of CPET compared to the measurement of the diffusing capacity of the lung for carbon monoxide (DLCO) in detecting impaired pulmonary gas exchange in sarcoidosis patients.

Methods

The clinical records of 160 (age = 41.3 ± 10.0 years; number of females = 63) sarcoidosis patients referred to the former MUMC ild care center were retrospectively reviewed. Patients performed a symptom-limited incremental exercise test with blood gas analysis on a bicycle ergometer. DLCO was measured by the single-breath method.

Results

DLCO (mean = 83.2 ± 18.0 %) below 80 % of predicted was demonstrated by 38 % of the sarcoidosis patients in our sample. Of the patients with normal DLCO (n = 99, 61.9 %), the P(A-a)O2 at maximal exercise [P(A-a)O2max] was moderately increased (>2.5 kPa) in 69.7 % and excessively increased (>4.7 kPa) in 18.2 %. Pulmonary gas exchange impairment (PGEI) was more obvious in patients with lower DLCO values. A DLCO value below 60 % of predicted indicated substantial gas exchange impairment. PaO2 at rest, DLCO, and FVC as a percentage of predicted and radiographic staging predicted 40 % of the PGEI at maximal exercise.

Conclusion

A substantial number of the symptomatic sarcoidosis patients with normal DLCO appeared to have PGEI at maximal exercise, suggesting that normal DLCO at rest is an inappropriate predictor of abnormal pulmonary gas exchange during exercise. CPET appeared to offer added value in detecting impaired gas exchange during exercise in sarcoidosis patients with unexplained disabling symptoms.

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Acknowledgments

This study was financially supported by a Grant from the ild care foundation (Maastricht, the Netherlands; http://www.ildcare.eu). This is a nonrestricted educational grant. The authors thank P. Wijnen for helping gather and manage the data.

Conflict of interest

Dr. Baughman has received research grants to study pulmonary sarcoidosis from Actelion, Centocor, Celgene, and Gilead. R. G. J. Marcellis, A. F. Lenssen, G. J. de Vries, C. P. van der Grinten, J. A. Verschakelen, J. de Vries, and M. Drent have no conflicts of interest with any companies/organizations whose products or services are discussed in this article.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands

    Rik G. J. Marcellis & Antoine F. Lenssen

  2. Department of Respiratory Medicine, ORBIS MC, Sittard-Geleen, The Netherlands

    Geeuwke J. de Vries

  3. University of Cincinnati Medical Center, Cincinnati, OH, USA

    Robert P. Baughman

  4. Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands

    Chris P. van der Grinten

  5. Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium

    Johny A. Verschakelen

  6. Department of Medical Psychology, St. Elisabeth Hospital Tilburg and Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands

    Jolanda De Vries

  7. Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 3100, 6202 NC, Maastricht, The Netherlands

    Marjolein Drent

  8. Department of interstitial lung diseases, Gelderse Vallei Hospital, Ede, The Netherlands

    Marjolein Drent

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  1. Rik G. J. Marcellis
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Correspondence to Marjolein Drent.

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Marcellis, R.G.J., Lenssen, A.F., de Vries, G.J. et al. Is There an Added Value of Cardiopulmonary Exercise Testing in Sarcoidosis Patients?. Lung 191, 43–52 (2013). https://doi.org/10.1007/s00408-012-9432-6

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