The effect of carotid chemoreceptor inhibition on exercise tolerance in chronic obstructive pulmonary disease: A randomized-controlled crossover trial

• Published in: Respiratory medicine 2019-11, Vol.160, p.105815-105815, Article 105815
• Main Authors: Phillips, Devin B., Collins, Sophie É., Bryan, Tracey L., Wong, Eric Y.L., McMurtry, M. Sean, Bhutani, Mohit, Stickland, Michael K.
• Format: Article
• Language: English
• Subjects: Airway management; Blood pressure; Carbon dioxide; Cardiac output; Cardiography; Carotid chemoreceptor; Chronic obstructive pulmonary disease; Conductance; COPD; Disease control; Dopamine; Dyspnea; Exercise; Exercise tolerance; Exhaustion; Family medical history; Heart; Hypoxia; Intolerance; Intravenous administration; Lung diseases; Maneuvers; Mortality; Obstructive lung disease; Peak load; Physical fitness; Physiology; Randomization; Respiration; Ventilation; Ventilatory behavior
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2019.105815

Patients with chronic obstructive pulmonary disease (COPD) have an exaggerated ventilatory response to exercise, contributing to exertional dyspnea and exercise intolerance. We recently demonstrated enhanced activity and sensitivity of the carotid chemoreceptor (CC) in COPD which may alter ventilatory and cardiovascular regulation and negatively affect exercise tolerance. We sought to determine whether CC inhibition improves ventilatory and cardiovascular regulation, dyspnea and exercise tolerance in COPD. Twelve mild-moderate COPD patients (FEV1 83 ± 15 %predicted) and twelve age- and sex-matched healthy controls completed two time-to-symptom limitation (TLIM) constant load exercise tests at 75% peak power output with either intravenous saline or low-dose dopamine (2 μg·kg−1·min−1, order randomized) to inhibit the CC. Ventilatory responses were evaluated using expired gas data and dyspnea was evaluated using a modified Borg scale. Inspiratory capacity maneuvers were performed to determine operating lung volumes. Cardiac output was estimated using impedance cardiography and vascular conductance was calculated as cardiac output/mean arterial pressure (MAP). At a standardized exercise time of 4-min and at TLIM; ventilation, operating volumes and dyspnea were unaffected by dopamine in COPD patients and controls. In COPD, dopamine decreased MAP and increased vascular conductance at all time points. In controls, dopamine increased vascular conductance at TLIM, while MAP was unaffected. There was no change in time to exhaustion in either group with dopamine. These data suggest that the CC plays a role in cardiovascular regulation during exercise in COPD; however, ventilation, dyspnea and exercise tolerance were unaffected by CC inhibition in COPD patients. •COPD patients have elevated activity/sensitivity of the carotid chemoreceptor (CC).•CC inhibition increased vascular conductance during exercise in COPD.•CC inhibition had no consistent effect on ventilation during exercise in COPD.•Exertional dyspnea and exercise tolerance were unaffected by CC inhibition in COPD.•Elevated CC activity/sensitivity does not influence exercise intolerance in COPD.