Unraveling the Causes of Unexplained Dyspnea: The Value of Exercise Testing

Denis E O'Donnell; Kathryn M Milne; Sandra G Vincent; J Alberto Neder

doi:10.1016/j.ccm.2019.02.014

Unraveling the Causes of Unexplained Dyspnea: The Value of Exercise Testing

Clin Chest Med. 2019 Jun;40(2):471-499. doi: 10.1016/j.ccm.2019.02.014.

Authors

Denis E O'Donnell¹, Kathryn M Milne², Sandra G Vincent³, J Alberto Neder³

Affiliations

¹ Department of Medicine, Queen's University, Kingston Health Sciences Centre, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada. Electronic address: odonnell@queensu.ca.
² Department of Medicine, Queen's University, Kingston Health Sciences Centre, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada; Department of Medicine, Clinician Investigator Program, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Medicine, Queen's University, Kingston Health Sciences Centre, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.

PMID: 31078223
DOI: 10.1016/j.ccm.2019.02.014

Abstract

Unexplained dyspnea presents a significant diagnostic challenge. Dyspnea arises when inspiratory neural drive (IND) to the respiratory muscles is increased and the respiratory system fails to meet this increased demand. Cardiopulmonary exercise testing (CPET) is a valuable tool to unravel the causes of exertional dyspnea in the individual. Moreover, analysis of breathing pattern, operating lung volumes and flow-volume loops allows characterization of abnormal dynamic mechanical response to increased IND - an important source of breathing discomfort. We illustrate the clinical utility of this approach which examines respiratory sensation, ventilatory control, respiratory mechanics and cardio-circulatory responses in cases of unexplained dyspnea.

Keywords: Cardiopulmonary exercise testing; Disproportionate dyspnea; Dyspnea of unknown origin; Dyspnea physiology; Unexplained dyspnea.

Publication types

Review

MeSH terms

Dyspnea / etiology*
Exercise Test / methods*
Female
Humans
Male