Blackwell Science, LtdOxford, UKRESRespirology1323-77992004 Blackwell Science Asia Pty LtdSeptember 200493320325Original ArticleCOPD and treadmill exercise testingM

Yazici
et al.

Respirology (2004) 9, 320–325

ORIGINAL ARTICLE

Relationship between arterial blood gas values, pulmonary

function tests and treadmill exercise testing parameters in
patients with COPD
Mehmet YAZICI,1 Peri ARBAK,2 Oner BALBAY,2 Emin MADEN,3 Mete ERBAS,2 Enver ERBILEN,1
Sinan ALBAYRAK,1 Ramazan AKDEMIR1 AND Cihangir UYAN1

Departments of 1Cardiology and 2Chest Diseases, Duzce Medical Faculty, Abant Izzet Baysal University,
Duzce, Turkey and 3Department of Chest Diseases, Sureyyapasa State Hospital, Istanbul, Turkey

Relationship between arterial blood gas values, pulmonary function tests and treadmill exercise
testing parameters in patients with COPD
YAZICI M, ARBAK P, BALBAY O, MADEN E, ERBAS M, ERBILEN E, ALBAYRAK S, AKDEMIR R, UYAN
C. Respirology 2004; 9: 320–325
Objective: There have been controversial reports regarding the relationship between exercise tol-
erance and resting pulmonary function in patients with COPD. The aim of this study was to examine
the relationship between resting pulmonary function tests (rPFT) and cardiopulmonary exercise
testing parameters (CETP) and their value in estimating exercise tolerance of patients.
Methodology: In total, 45 patients with COPD (nine females, 36 males; mean age 61.2 ± 11.2) and
21 healthy subjects (four females, 17 males; mean age 60.3 ± 9.7) as a control group were studied.
COPD patients (group I) were divided into three subgroups according to their FEV1 (mild/group II:
FEV1 60–79% of predicted; moderate/group III: FEV1 40–59%; severe/group IV: FEV1 < 40%). In con-
trols FEV1 was ≥ 80%.
Results: There were significant correlations between FEV1 and CETP in group III (maximal O2 con-
sumption (mVO2), r = 0.35, P < 0.005; total treadmill time (TTT), r = 0.31, P < 0.01; total metabolic
equivalent values (TMET), r = 0.29, P < 0.01)) and in group IV (mVO2, r = 0.49, P < 0.001; TTT, r = 0.45,
P < 0.005; TMET, r = 0.31, P < 0.01; peak heart rate (pHR), r = 0.29, P < 0.02; frequency of ventricular
extrasystole (fVES), r = -0.27, P < 0.05). Additionally, in group IV there were significant correlations
between PaO2 and CETP (mVO2, r = 0.41, P < 0.02; TTT, r = 0.38, P < 0.03; TMET, r = 0.31, P < 0.05; pHR,
r = 0.29, P < 0.05; fVES, r = -0.28, P < 0.05).
Conclusion: There are significant correlations of resting FEV1% predicted and PaO2 values with
CETP in patients with moderate and severe COPD and these parameters may also have a role as indi-
cators of exercise tolerance in these COPD patients.

Key words: COPD, treadmill exercise testing.

INTRODUCTION abnormalities, including increased dead-space ven-

tilation, a reduced ventilatory reserve, increased
COPD is characterized by dyspnoea and limited work of breathing, and mechanical problems due to
exercise capacity as a result of changes in pulmo- the position of the diaphragm, may also affect the
nary mechanics, impaired cardiac function, abnor- exercise performance of patients with COPD.3–5 Max-
mal gas exchange, respiratory muscle dysfunction, imum exercise tolerance in patients with COPD has
and nutritional factors.1,2 Additionally, ventilatory multiple determinants and is not easy to estimate
from resting pulmonary function tests (rPFT). How-
ever, it has been reported that maximum exercise
Correspondence: Mehmet Yazici, Department of tolerance during cardiopulmonary exercise testing
Cardiology, Abant Izzet Baysal University, 14450 Duzce, (CET) may be useful in evaluating the disability and
Turkey. Email: yazicimehmet@hotmail.com determining the cause of exertional dyspnoea,
Received 4 July 2003; revised 17 December 2003; establishing exercise training programmes for pul-
accepted for publication 22 February 2004. monary rehabilitation, the assessment of treatment
COPD and treadmill exercise testing
results, and for preoperative evaluation.1,6–11 Further-
more, whether exercise intolerance is due to cardiac
dysfunction (unrecognized ischaemic heart disease)
or pulmonary disease can be differentiated by
CET.3,12 Nevertheless, a clear-cut relationship
between rPFT and exercise tolerance has not been
established in patients with COPD.13–16 In recent
years, studies investigating the relationship between
rPFT and exercise tolerance and the role of CET in
the evaluation of respiratory impairment have
regained popularity.7,13–21 CET may be performed
using either the treadmill or the cycle ergometer.
Thus, maximal O2 uptake (mVO2) indicating exer-
cise capacity, arterial oxygen desaturation and meta-
bolic acidosis, which are undetectable at rest, may
also be detected.7
The aim of this study was to examine the relation-
ship between rPFT and cardiopulmonary exercise
testing parameters (CETP) and their value in estimat-
ing exercise tolerance of patients.
METHODS
Study population
The study was carried out in the Departments of
Cardiology and Chest Disease, Faculty of Medicine,
Abant Izzet Baysal University. In toal, 45 patients
with COPD (nine female and 36 male; mean age
61.2 ± 11.2) and 21 healthy control subjects (four
female and 17 male; mean age 60.3 ± 9.7) were
studied. The control subjects had no known car-
diac, pulmonary or other disease by history, physi-
cal examination, spirometric values,
electrocardiogram (ECG), and CXR. All patients met
the following criteria: (i) a clinical diagnosis of
COPD confirmed by history, physical examination,
abnormal spirometric values (FEV1 £ 80% of pre-
dicted and FEV1/VC < 70%) and CXR; (ii) no other
significant lung disease; (iii) clinically stable on an
acceptable drug regimen (regular ipratropium bro-
mide, two puffs (40 mg), four times a day, and short
acting b2-agonists on demand); (iv) no known car-
diac disease by history, physical examination, ECG
and echocardiography; (v) no important ST seg-
ment and T wave changes or arrhythmias possibly
related to COPD or other disease on ECG; and (vi)
no neuromuscular disease or other medical prob-
lems that could prevent performance of a treadmill
exercise test. None of the COPD patients or control
subjects were smoking at the time of this study.
Patients with COPD were divided into three sub-
groups according to their FEV1 values, as suggested
by the British Thoracic Society:22 group II (mild
COPD patients had a FEV1 between 60% and 79% of
predicted), group III (moderate COPD patients had
an FEV1 between 40% and 59% of predicted) and
group IV (severe COPD patients had an FEV1 < 40%
of predicted).
All subjects gave written informed consent, and the
study protocol was approved by the Ethics Committee
of the Duzce Medical Faculty, Abant Izzet Baysal
University.
321
Spirometric measurements and arterial blood
gas analysis
Inhaled medications were withheld for 3 h or longer
prior to the exercise test. Before and after the exercise
test, arterial blood gas samples were obtained while
breathing room air, then arterial blood gas tensions
(PaO2, PaCO2) and pH were measured on an arterial
blood gas analyzer (I-STAT Corporation, USA).
Spirometry was performed using a Vitalograph alpha
(Ennis, Ireland) 1–2 h prior to the exercise test. Spiro-
metric values were obtained before and 30 min after
two inhalations of salbutamol. FEV1, FVC, FEV1/FVC
and FEF25-75% were recorded (as percentage of pre-
dicted). Maximal voluntary ventilation (MVV) was
measured indirectly and calculated as FEV1 ¥ 35.23
Spirometric measurements were repeated until three
technically satisfactory and consistent values were
achieved, and the highest value was recorded. The
spirometric standards of Morris et al. were used.24
Exercise testing
All patients and controls fasted for at least 2 h before
exercise testing, which was performed using a tread-
mill (Nihon-Kohden, ECG 9320 K), with patients in a
bronchodilated state and breathing room air. The
exercise test was performed according to Bruce’s mul-
tistage maximal treadmill protocol. Every 3 min the
gradient of the treadmill was increased by 2%, starting
from a 10% gradient at the first step, until the maximal
effort that the patient could support was reached.
ECG and heart rate (HR) were monitored prior to and
continuously during and for 5 min after the exercise
test. CET was stopped according to previously
defined reasons for termination.25 Simultaneously
during exercise the subjects breathed through a
breathing mask to measure mVO2. Some exercise
data, including total metabolic equivalent (TMET)
values, were obtained with a computer-based auto-
mated CET system (Metalyzer 3 B-CPX Systems, Scot
Medical Products, Leipzig, Germany). Metabolic
equivalent (MET) is a unit of sitting/resting oxygen
uptake (one MET is 3.5 mL O2 per kilogram of body
weight per minute (mL/kg per min)). Blood pressures
were taken manually before, after and at periodic
intervals during the exercise test. We used the for-
mula, maximal HR = 210 – 0.65 ¥ age, to calculate the
maximal predicted HR.11,26 In COPD patients, all tests
were stopped because of dyspnoea.
Echocardiographic assessment
M-mode, two-dimensional and pulsed-Doppler
examinations were performed in all individuals using
a commercially available system (Toshiba Diagnostic
Ultrasound System, Model SSA 270 A, Toshiba Corpo-
ration 1992, Tochigiken, Japan) that used 2.5 or
3.5 MHz. The measurements were carried out and
interpreted according to the recommendations of the
American Society of Echocardiography.27 Five repre-
sentative consecutive or nearly consecutive cardiac
322 M Yazici et al.

cycle sinus beats were measured and averaged for
each measurement. All studies were performed dur-
ing normal quiet respiration. All echocardiograms
were recorded and analyzed by one of the investiga-
tors who had no knowledge of the patient’s clinical
status. Left ventricular end-diastolic volume, end-
systolic volume and ejection fraction (normal 55–
70%) were determined from apical two or four cham-
ber views by using the modified Simpson method.
Right ventricular ejection fraction was evaluated by
measuring the excursion of tricuspid annulus in sys-
tole (TAPSE) recorded in the apical four chamber
view.28,29 The normal value of TAPSE is 24.9 ± 3.5 with
lateral measurement.
Statistical analysis
ues, peak heart rate (pHR)) were statistically signifi-
cantly different in COPD patients (group I) when
compared with the control group (Table 2). Similarly,
when compared with the control group, there were
significant differences in group III and group IV.
Additionally, in group IV the frequency of ven-
tricular extrasystole (fVES) was significantly increased
(2.9 ± 1.4 vs. 1.7 ± 1.1, P < 0.01). In group II (mild
COPD), all measurements were similar to those in the
controls subjects (Table 2). There were significant
correlations between FEV1 and CETP in group III
(Table 2). Additionally, in group IV there were signifi-
cant correlations between PaO2 and CETP (Table 3).
PaCO2 and pH values were similar in all groups
(Table 1). There were no correlations between PaCO2,
pH and any of the CETP (P > 0.05).

Values are presented as mean ± SD. The Mann– DISCUSSION

Whitney U-test was used to compare groups. Simple
regression analysis was used to examine correlations
between CETP, resting spirometric measurements,
and blood gas analyses. A P-value less than 0.05 was
considered significant. The r-value was the correla-
tion coefficient. The analyses were performed using
SPSS 7.5 for Windows (release 7.5; SPSS; Chicago, IL,
USA).
RESULTS
General characteristics, arterial blood gas analyses,
and pulmonary function test results for the study
populations are summarized in Table 1. CETP (maxi-
mum oxygen consumption (mVO2), total treadmill
time (TTT), total metabolic equivalent (TMET) val-
rPFT are used to assess patients with COPD and its
progression. FEV1 and FEV1/FVC are the most com-
monly used parameters in assessing the severity of
COPD. FEV1/FVC is sensitive in mild COPD while
FEV1 is sensitive in moderate to severe COPD. FEV1 is
easily measured, less variable than other measures of
airway dynamics, and predicts airway changes more
accurately.30
Knox et al. reported that there was a significant
relationship between walking distance and FEV1 and
FVC.31 Another study performed with a cycle ergom-
eter, showed a significant correlation between mVO2
and FEV1 in 81 COPD patients. In the same study, it
was concluded that there was no significant relation-
ship between mVO2 and resting or exercise arterial
gas values.32 Other studies show an inconsistent rela-

Table 1 Comparison of demographic and laboratory characteristics of COPD patients and controls

Controls Group I Group II Group III Group IV

(n = 21) (n = 45) (n = 15) (n = 13) (n = 17)

Age (years) 60.3 ± 9.7 61.2 ± 11.2 61.7 ± 9.8 60.6 ± 11.9 61.8 ± 10.8
Gender (female/male) 4/17 9/36 3/12 3/11 3/13
Weight (kg) 69.8 ± 8.7 67.9 ± 8.9 68.1 ± 7.2 67.3 ± 8.9 66.8 ± 9.3
Height (cm) 171 ± 14.6 168 ± 17.1 169 ± 13.4 166 ± 11.4 167 ± 15.1
BMI (kg/m2) 23.7 ± 4.7 22.4 ± 5.3 23.2 ± 3.7 22.3 ± 4.3 21.4 ± 3.9
LVEF (%) 64.5 ± 5.3 62.3 ± 6.7 64.9 ± 4.9 61.5 ± 5.3 59.8 ± 6.3
RVEF/TAPSE (mm) 24.2 ± 4.3 22.3 ± 5.3 23.7 ± 4.3 22.5 ± 3.7 21.2 ± 4.7
FVC (%) 94.7 ± 8.5 81.7 ± 8.6§ 86.2 ± 7.6¶ 82.7 ± 12.6§ 67.4 ± 4.5†
FEV1 (%) 85.9 ± 5.1 48.3 ± 7.1† 66.4 ± 6.2‡ 49.7 ± 5.9† 34.7 ± 3.9†
FEV1/FVC (%) 85.7 ± 5.6 52.7 ± 6.7† 66.7 ± 3.2‡ 51.8 ± 6.5† 37.6 ± 2.5†
FEF25-75% (%) 84.9 ± 4.3 56.3 ± 7.6† 79.8 ± 7.3 53.5 ± 6.1‡ 33.8 ± 5.1†
MVV (%) 85.3 ± 4.2 51.7 ± 11.4† 63.7 ± 6.9‡ 47.9 ± 5.7† 33.9 ± 4.3†
PaO2 (mmHg) 91.2 ± 7.3 70.2 ± 11. 7‡ 78.3 ± 8.7§ 68.7 ± 7.6‡ 61.8 ± 6.7†
PaCO2 (mmHg) 39.8 ± 3.7 38.7 ± 3.5 38.7 ± 4.3 36.3 ± 5.1 45.9 ± 6.3
pH 7.42 ± 0. 03 7.42 ± 0.06 7.43 ± 0.05 7.42 ± 0.05 7.39 ± 0.05

Values are presented as mean ± SD.

†
When compared to control group, P < 0.0001; ‡when compared to control group, P < 0.001; §when compared to control
group, P < 0.01; ¶when compared to control group, P < 0.05.
BMI, body mass index; LVEF, left ventricular ejection fraction; RVEF, right ventricular ejection fraction; TAPSE, tricuspid
annular plane systolic excursion.
COPD and treadmill exercise testing 323

Table 2 Comparison of cardiopulmonary exercise testing parameters in COPD and control groups and their correlations
with FEV1 values

Control group Group I Group II Group III Group IV

(n = 21) (n = 45) (n = 15) (n = 13) (n = 17)
FEV1% = 85.9 ± 5.1 FEV1% = 48.3 ± 7.1 FEV1% = 66.4 ± 6.2 FEV1% = 49.7 ± 5.9 FEV1% = 34.7 ± 3.9

mVO2 27.3 ± 5.9 19.7 ± 5.9‡ 25.9 ± 7.5 17.6 ± 4.9† 15.2 ± 5.3†
(mL/kg per min) r = 0.35, P < 0.05 r = 0.43, P < 0.005 r = 0.22, P > 0.05 r = 0.35, P < 0.005 r = 0.49, P < 0.001
TTT 7.1 ± 1.3 4.6 ± 1.5‡ 6.7 ± 1.5 3.8 ± 1.1† 3.3 ± 1.2†
(min) r = 0.34, P < 0.05 r = 0.41, P < 0.005 r = 0.23, P > 0.05 r = 0.31, P < 0.01 r = 0.45, P < 0.005
TMET 8.3 ± 2.2 5.3 ± 1.7‡ 7.6 ± 1.4 4.8 ± 1.3† 3.9 ± 1.5†
(mL/kg per min) r = 0.33, P < 0.05 r = 0.38, P < 0.01 r = 0.21, P > 0.05 r = 0.29 P < 0.01 r = 0.31, P < 0.01
pHR 137.3 ± 13.4 126.7 ± 19.4§ 134.9 ± 14.7 127.9 ± 17.3§ 114.9 ± 15.6‡
(beats/min) r = 0.23, P > 0.05 r = 0.31, P < 0.01 r = 0.19, P > 0.05 r = 0.21, P > 0.05 r = 0.29, P < 0.02
fVES 1.7 ± 1.1 2.1 ± 1.3 1.9 ± 0.9 1.6 ± 1.1 2.9 ± 1.4§
(beat/min) r = - 0.19, P > 0.05 r = - 0.21, P > 0.05 r = - 0.17, P > 0.05 r = - 0.15, P > 0.05 r = - 0.27, P < 0.05

Values are presented as mean ± SD.

†
When compared to control group: P < 0.0001; ‡when compared to control group: P < 0.001; §when compared to control
group: P < 0.01.
mVO2, maximal O2 consumption; TTT, total treadmill time; TMET, total metabolic equivalents values; pHR, peak heart rate;
fVES, frequency of ventricular extrasystole; r, correlation coefficient.

Table 3 Comparison of cardiopulmonary exercise testing parameters in COPD patients and control subjects and their cor-
relations with PaO2 values

Controls Group I Group II Group III Group IV

(n = 21) (n = 45) (n = 15) (n = 13) (n = 17)
PaO2 = 91.2 ± 7.3 PaO2 = 70.2 ± 11.7 PaO2 = 78.3 ± 8.7 PaO2 = 68.7 ± 7.6 PaO2 = 61.8 ± 6.7

mVO2 27.3 ± 5.9 19.7 ± 5.9 25.9 ± 7.5 17.6 ± 4.9 15.2 ± 5.9
(mL/kg per min) r = 0.23, P > 0.05 r = 0.35, P < 0.01 r = 0.17, P > 0.05 r = 0.23, P > 0.05 r = 0.41, P < 0.02
TTT 7.1 ± 1.3 4.6 ± 1.5 6.7 ± 1.5 3.8 ± 1.1 3.3 ± 1.2
(min) r = 0.23, P > 0.05 r = 0.31, P < 0.05 r = 0.13, P > 0.05 r = 0.19, P > 0.05 r = 0.38, P < 0.03
TMET 8.3 ± 2.2 5.3 ± 1.7 7.6 ± 1.4 4.8 ± 1.3 3.9 ± 1.5
(mL/kg per min) r = 0.21, P > 0.05 r = 0.31, P < 0.05 r = 0.12, P > 0.05 r = 0.21 P > 0.05 r = 0.31, P < 0.05
pHR 137.3 ± 13.4 126.7 ± 19.4 134.9 ± 14.7 127.9 ± 17.3 114.9 ± 15.6
(beats/min) r = 0.23, P > 0.05 r = 0.31, P < 0.01 r = 0.19, P > 0.05 r = 0.21, P > 0.05 r = 0.29, P < 0.05
fVES 1.7 ± 1.1 2.1 ± 1.3 1.9 ± 0.9 1.6 ± 1.1 2.9 ± 1.4
(beats/min) r = - 0.18, P > 0.05 r = - 0.21, P > 0.05 r = - 0.13, P > 0.05 r = - 0.09, P > 0.05 r = - 0.28, P < 0.05

Values are presented as mean ± SD.

mVO2, maximal O2 consumption; TTT, total treadmill time; TMET, total metabolic equivalents values; pHR, peak heart rate;
fVES, frequency of ventricular extrasystole; r, correlation coefficient.

tionship between rPFT values and parameters of
symptom-limited cardiopulmonary exercise testing
to a maximum tolerable level on a treadmill.15–17,21
Dillard et al. have reported a significant correlation
between mVO2 obtained by treadmill exercise testing
and DLCO and FEV1 in patients with less severe COPD
than the patients in our study.21 In addition, Carlson
et al. showed a strong correlation between mVO2 and
DLCO and FEV1 in 119 COPD patients, but they have
stressed that this correlation was not valid in individ-
ual cases.15 Ortega et al. performed spirometry in 78
COPD patients, then evaluated their exercise perfor-
mance on a treadmill ergometer. Only a weak corre-
lation was observed between mVO2 and FEV1. Thus,
they suggest that resting PFT, PaO2 and PaCO2 are not
predictive of exercise performance in patients with
COPD. In their study there was no control group and
their patients were younger than our patients.16 In our
study, mVO2, TTT, TMET and pHR were significantly
decreased in those with moderate to severe airflow
obstruction compared with the normal and mildly
obstructed groups. These results can be explained by
respiratory muscle weakness produced by the pres-
ence of increased airway resistance, hyperinflation,
severe limitation in airflow rate, and serious dec-
onditioning in advanced COPD.17,33 Furthermore,
functional deterioration in pulmonary vessels in
advanced COPD affects respiratory muscle oxygen-
ation, resulting in a decrease in the exercise capacity
of COPD patients.7 Moderate to severe COPD patients
could not walk sufficiently far to increase their HR
to their predicted level during exercise, therefore,
decreased pHR was observed in these groups. How-
ever, HR increases earlier during submaximal work in
324
patients with moderate to severe COPD than in
healthy individuals. It is most likely that different fac-
tors are responsible for exercise limitation in different
patients. Thus, some patients may have attained a
true ventilatory limitation based on mechanical fac-
tors, some may reach a true cardiac limitation based
on occult left ventricular disease or right ventricular
dysfunction, and others by deconditioning. However,
in other studies, the possibility of left ventricular dis-
ease or right ventricular dysfunction was not assessed
by echocardiography, as occurred in our study. Both
left and right ventricular ejection fraction were
slightly, but not significantly, decreased in the moder-
ate and severe COPD patients.
Rasche et al. using a cycle ergometer in 64 patients
with COPD, concluded that rPFT and blood gas values
were predictors of gas exchange during exercise. In
that study, abnormal PaO2 values were observed in
21.9% of patients with COPD and a negative correla-
tion was observed between exercise PaCO2 values and
resting FEV1.34 Conversely, Ortega et al. showed no
correlation between exercise mVCO2, mVO2, and PaO2
or PaCO2. They suggested that resting blood gas anal-
ysis was not predictive of exercise performance in
patients with COPD.16 These differences in results
may be related to differences in patient characteris-
tics, including age, gender and severity of disease. We
applied strict rules in the selection of patients with
stable COPD, excluding patients with confounding
factors, such as accompanying heart or other lung
diseases and especially factors affecting the cardio-
pulmonary system.
In COPD of mild to moderate severity, hypoxaemia
can exist without hypercapnia. When COPD becomes
severe, carbon dioxide retention occurs as total
alveolar ventilation decreases. Mild hypoxaemia and
hypercapnia is a terminal finding in COPD predomi-
nantly with emphysema. In contrast, hypoxaemia and
hypercapnia are observed in the earlier stages of
COPD, predominantly with bronchitis.35 Chronic
hypercapnia and acidosis seem to be significant
factors in determining the prognosis of COPD.36
An increased incidence of arrhythmias (20–86%) has
been observed in COPD37–40 and is related to multiple
factors, such as hypoxaemia, hypercapnia, acid-base
disturbance, cor pulmonale, and medications used
for treatment.37,39–44 It has been supposed that, espe-
cially during exercise, hypoxaemia affects left ven-
tricle performance directly or by increasing the
sympathetic activity, and increases the risk of tach-
yarrhythmias, especially in severe COPD.38 Similarly,
we also found weak positive correlations between
PaO2 and TTT and between pHR and mVO2 in the
severe COPD group. In addition, there was a weak
negative correlation between PaO2 and fVES (but not
with PaCO2) in the severe COPD group, while no cor-
relation was observed between pH, PaCO2 and CETP.
The differences between our findings and the results
of other studies might be explained by the relatively
small number of patients and the apparent lack of
hypercapnia. Some authors have proposed that respi-
ratory factors were more responsible than cardiovas-
cular factors in exercise limitation in COPD, and so
exercise testing should be performed to the maximal
M Yazici et al.
level in those patients.16,45 In our study, all patients
stopped the test due to dyspnoea. No cardiovascular
complication or primary cardiac reason for termina-
tion were observed during the exercise test.
We concluded that especially in severe and moder-
ate COPD patients, resting FEV1 and PaO2 values are
significantly correlated with CETP, but FEV1 is more
strongly correlated with CETP than resting PaO2. FEV1
and PaO2 values may have a modest role in estimating
exercise performance and predicting exercise
induced arrhythmias in moderate and severe COPD.
Maximal exercise testing could be performed safely in
mild and moderate COPD and in severe COPD, with
caution due to larger fVES values. Prospective studies
that include large patient populations are required to
reach a definitive conclusion in this area.
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