ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

Thomas Radtke, Sarah Crook, Georgios Kaltsakas, Zafeiris Louvaris, Danilo Berton, Don S Urquhart, Asterios Kampouras, Roberto A Rabinovich, Samuel Verges, Dimitris Kontopidis, Jeanette Boyd, Thomy Tonia, Daniel Langer, Jana De Brandt, Yvonne M J Goërtz, Chris Burtin, Martijn A Spruit, Dionne C W Braeken, Sauwaluk Dacha, Frits M E Franssen, Pierantonio Laveneziana, Ernst Eber, Thierry Troosters, J Alberto Neder, Milo A Puhan, Richard Casaburi, Ioannis Vogiatzis, Helge Hebestreit, Thomas Radtke, Sarah Crook, Georgios Kaltsakas, Zafeiris Louvaris, Danilo Berton, Don S Urquhart, Asterios Kampouras, Roberto A Rabinovich, Samuel Verges, Dimitris Kontopidis, Jeanette Boyd, Thomy Tonia, Daniel Langer, Jana De Brandt, Yvonne M J Goërtz, Chris Burtin, Martijn A Spruit, Dionne C W Braeken, Sauwaluk Dacha, Frits M E Franssen, Pierantonio Laveneziana, Ernst Eber, Thierry Troosters, J Alberto Neder, Milo A Puhan, Richard Casaburi, Ioannis Vogiatzis, Helge Hebestreit

Abstract

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2-3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.

Conflict of interest statement

Conflict of interest: T. Radtke reports personal fees for registration and travel/accomodation for conferences from Vifor Pharma, outside of the submitted work. Conflict of interest: S. Crook has nothing to disclose. Conflict of interest: G. Kaltsakas has nothing to disclose. Conflict of interest: G. Louvaris has nothing to disclose. Conflict of interest: D. Berton has nothing to disclose. Conflict of interest: D.S. Urquhart has nothing to disclose. Conflict of interest: A. Kampouras has nothing to disclose. Conflict of interest: R.A. Rabinovich has nothing to disclose. Conflict of interest: S. Verges has nothing to disclose. Conflict of interest: D. Kontopidis is President of the Hellenic Cystic Fibrosis Association. Conflict of interest: J. Boyd reports is an employee of the European Lung Foundation. Conflict of interest: T. Tonia reports acting as ERS Methodologist. Conflict of interest: D. Langer has nothing to disclose. Conflict of interest: J. De Brandt has nothing to disclose. Conflict of interest: Y.M.J. Goërtz has nothing to disclose. Conflict of interest: C. Burton has nothing to disclose. Conflict of interest: M.A. Spruit reports grants and personal fees from Boehringer-Ingelheim and AstraZeneca, personal fees from GSK and Novartis, congress travel support from TEVA, and grants from the Netherlands Lung Foundation, outside the submitted work. Conflict of interest: D.C.W. Braeken has nothing to disclose. Conflict of interest: S. Dacha has nothing to disclose. Conflict of interest: F.M.E. Franssen reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and TEVA, and grants and personal fees from Novartis, outside the submitted work. Conflict of interest: P. Laveneziana reports personal fees from Novartis France and Boehringer France, outside the submitted work. Conflict of interest: E. Eber has nothing to disclose. Conflict of interest: T. Troosters has nothing to disclose. Conflict of interest: J.A Neder has nothing to disclose. Conflict of interest: M.A. Puhan has nothing to disclose. Conflict of interest: R. Casaburi reports that he shares patent US 7927251 B1, relating to a linear treadmill testing protocol, issued to Los Angeles Biomedical Research Institute. Conflict of interest: I. Vogiatzis has nothing to disclose. Conflict of interest: H. Hebestreit reports grants and personal fees from Vertex Pharmaceuticals, grants from Mukoviszidose e.V. (German CF Organization), outside the submitted work; and is the Coordinator of the European Cystic Fibrosis Society Exercise Working Group who discuss exercise testing and organise respective symposia.

Copyright ©ERS 2019.

Figures

FIGURE 1
FIGURE 1
Flow chart describing the usual practice by Task Force members on different protocol phases and specifications during cardiopulmonary exercise testing. It is not intended as a recommendation for clinical practice.
FIGURE 2
FIGURE 2
Algorithm for determining maximal effort and cause of exercise limitation. This figure describes how the Task Force members determine the maximal effort and cause of exercise limitation. It is not intended as a recommendation for clinical practice. V′O2: oxygen uptake; V′O2peak: peak oxygen uptake; V′Epeak: peak minute ventilation; MVV: maximum voluntary ventilation; RER: respiratory exchange ratio; HR: heart rate; AT: anaerobic threshold; IC: inspiratory capacity; SpO2: arterial oxygen saturation measured by pulse oximetry.

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