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Background:  Air trapping and gas exchange abnormalities are major causes of exercise limitation in chronic obstructive pulmonary disease (COPD). During incremental cardiopulmonary exercise testing, ventilatory equivalents for carbon dioxide (V E /VCO 2 ) and oxygen (V E /VO 2 ) may be difficult to identify in COPD patients because of limited ventilatory compensation capacity. Therefore, we aimed to detect a possible correlation between the magnitude of ventilation augmentation, as manifested by increments in ventilatory equivalents from nadir to peak effort values and air trapping, detected with static testing.       Methods:  In this observational study, we studied data obtained previously from 20 COPD patients who, during routine follow-up, underwent a symptom-limited incremental exercise test and in whom a plethysmography was obtained concurrently. Air trapping at rest was assessed by measurement of the residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC). Gas exchange data collected during the symptom-limited incremental cardiopulmonary exercise test allowed determination of the nadir and peak effort values of V E /VCO 2  and V E /VO 2 , thus enabling calculation of the difference between peak effort value and nadir values of  V E /VCO 2  and V E /VO 2 , designated ΔV E /VCO 2  and ΔV E /VO 2 , respectively.    Results:  We found a statistically significant inverse correlation between both ΔV E /VCO 2  (r = -0. 5058, 95% CI -0.7750 to -0.08149, p = 0.0234) and ΔV E /VO 2  (r = -0.5588, 95% CI -0.8029 to -0.1545, p = 0.0104) and the degree of air trapping (RV/TLC). There was no correlation between                ΔV E /VCO 2  and peak oxygen consumption, forced expiratory volume in the first second, or body mass index.     Conclusions:  The ventilatory equivalents increment to compensate for acidosis during incremental exercise testing was inversely correlated with air trapping (RV/TLC) and may be a candidate prognostic biomarker.

Ventilatory compensation during the incremental exercise test is inversely correlated with air trapping in COPD