Chest
Original ResearchCOPDExertional Hypoxemia in Stable COPD Is Common and Predicted by Circulating Proadrenomedullin
Section snippets
Study Design and Ethics
Conducted in 11 centers in eight European countries, the Predicting Outcome Using Systemic Markers in Severe Exacerbations of COPD (PROMISE-COPD) study evaluated variables potentially identifying poor outcomes in patients with moderate to very severe COPD. Such disease was defined as postbronchodilator FEV1/FVC < 70% and FEV1 < 80% predicted (ie, GOLD [Global Initiative for Chronic Obstructive Lung Disease] grade II-IV airway obstruction); COPD exacerbation was defined as an acute change from
Results
The study design according to the CONSORT guidelines and patient disposition is summarized in Figure 1. Sixty-four patients were excluded from the analysis because of unavailable lowest oxygen saturation during 6MWT at baseline. The clinical characteristics (sex; race; BMI, airflow obstruction, dyspnea, exercise capacity [BODE] index; and 6-min walk distance [6MWD]) of these patients did not differ from the analysis cohort (P = not significant for all, data not shown). Thus, of 638 patients in
Discussion
We used data of a multinational, longitudinal cohort study to assess the prevalence and the annual probability to develop exertional hypoxemia among unselected, stable patients with moderate to very severe COPD followed up during a median time of 2 years. We found that exertional hypoxemia is present in almost one-third of the patients, with a prevalence ranging from one out of six patients in GOLD stage II to one out of two patients in GOLD stage IV. The cumulative HR of exertional hypoxemia
Acknowledgments
Author contributions: All authors take responsibility for the integrity of the work as a whole, from inception to published article.
D. S. and M. T. contributed to conceiving and designing the study and collected and analyzed study data; D. S. and S. H. contributed to conducting statistical analyses; W. B., F. B., R. L., B. M., K. K., J. G. A., G. R., J. R., L. B., A. S., A. M., A. T., T. W., and M. T. contributed to collecting study data; and D. S., W. B., F. B., R. L., B. M., K. K., J. G. A.,
References (53)
- et al.
Distance and oxygen desaturation during the 6-min walk test as predictors of long-term mortality in patients with COPD
Chest
(2008) - et al.
Effects of supplemental oxygen during activity in patients with advanced COPD without severe resting hypoxemia
Chest
(2001) - et al.
Cerebral oxygenation during exercise in patients with terminal lung disease
Chest
(2002) - et al.
6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD
Chest
(2003) - et al.
Isolated reduction in single-breath diffusing capacity in the evaluation of exertional dyspnea
Chest
(1992) - et al.
Predictors of oxygen desaturation during submaximal exercise in 8,000 patients
Chest
(2001) - et al.
Single-breath diffusing capacity of the lung for carbon monoxide: a predictor of PaO2, maximum work rate, and walking distance in patients with emphysema
Chest
(2003) - et al.
Identification of an Adrenomedullin precursor fragment in plasma of sepsis patients
Peptides
(2004) - et al.
Regulation by hypoxia of adrenomedullin output and expression in human trophoblast cells
Eur J Obstet Gynecol Reprod Biol
(2011) - et al.
Plasma pro-adrenomedullin but not plasma pro-endothelin predicts survival in exacerbations of COPD
Chest
(2008)
Ambulatory oximetry monitoring in patients with severe COPD: a preliminary study
Chest
Chronic administration of adrenomedullin attenuates hypoxic pulmonary vascular structural remodeling and inhibits proadrenomedullin N-terminal 20-peptide production in rats
Peptides
Home overnight pulse oximetry in patients with COPD: more than one recording may be needed
Chest
Pulmonary exercise testing predicts prognosis in patients with chronic obstructive pulmonary disease
Intern Med
Pulmonary hypertension in COPD
Eur Respir J
Systemic effects of chronic obstructive pulmonary disease
Proc Am Thorac Soc
Supplemental oxygen and exercise ability in chronic obstructive airways disease
Thorax
Cognitive function in COPD
Eur Respir J
Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients
Am J Respir Crit Care Med
Ambulatory oxygen improves quality of life of COPD patients: a randomised controlled study
Eur Respir J
Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report
Am J Respir Crit Care Med
Exertional desaturation in patients with chronic obstructive pulmonary disease
COPD
Gas exchange during exercise in mild chronic obstructive pulmonary disease. Correlation with lung structure
Am Rev Respir Dis
Baseline oxygen saturation predicts exercise desaturation below prescription threshold in patients with chronic obstructive pulmonary disease
Arch Intern Med
Measurement of midregional proadrenomedullin in plasma with an immunoluminometric assay
Clin Chem
Anti-inflammatory actions of adrenomedullin through fine tuning of HIF stabilization
FASEB J
Cited by (18)
Measures of physical performance in COVID-19 patients: a mapping review
2021, PulmonologyCitation Excerpt :Exercise induced desaturation is associated with exercise limitation. When evaluating individuals with EID a crucial point is the definition, which varies widely across clinical trials, ranging from SpO2 ≤ 88% to a decrease in SpO2 of ≥ 4% with or without a nadir SpO2 of < 90%.65–68 The results of our review confirm that patients with COVID-19 infection of differing severity suffer from a decline in physical performance in the short-4 and long-term.5
Stable-State Midrange Proadrenomedullin Is Associated With Severe Exacerbations in COPD
2018, ChestCitation Excerpt :Evidence has accumulated that MR-proADM is associated with morbidity and mortality at different time points during the course of COPD. In stable state, high MR-proADM level is associated with severe AECOPD, exertional hypoxemia,25 and mortality.20 During exacerbation, high MR-proADM level predicts length of hospital stay and mortality,17 and elevated MR-proADM at hospital discharge predicts survival as well.30
Clinical characteristics of COPD patients with early-onset desaturation in the 6-minute walk test
2018, PulmonologyCitation Excerpt :Exercise-induced oxygen desaturation (EID) occurs in up to 20% of the patients with chronic obstructive pulmonary disease (COPD).1
Exertional desaturation has higher mortality than non-desaturation in COPD
2021, Medicina (Lithuania)
FUNDING/SUPPORT: PROMISE-COPD was an investigator-initiated study primarily funded by the Clinic of Pulmonary Medicine and Respiratory Cell Research of the University Hospital Basel, Switzerland and by the Swiss National Foundation [Grant PP00-P3_128412/1]. Thermo Scientific Biomarkers (formerly BRAHMS AG), Hennigsdorf, Germany, provided all reagents for those analyses gratis and, through an unrestricted research grant, funded all costs of transporting blood samples to the central biomarker testing facility at University Hospital Basel.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.