SPECIAL SESSION: Innovative Breathing Strategies to Reduce Dyspnea and Improve Function in COPD

Description/Overview: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway obstruction and limited exercise tolerance. A major determinant of limited exercise tolerance in COPD is the development of exercise-induced dynamic hyperinflation. The severity of exercise-induced dynamic hyperinflation can be reduced using several strategies including a novel breathing-retraining technique that we developed. During whole body exercise, healthy subjects experience a reduction in end-expiratory lung volume (EELV). This reduction in EELV results from the activation of abdominal and expiratory rib-cage muscles. In contrast, during exercise, most patients with COPD experience an increase in EELV. This increase results from expiratory flow limitation and is associated with tachypnea that further increases EELV. This air trapping results in exercise-induced dyspnea that becomes unsustainable and patients stop exercising. Unsustainable dyspnea occurs because the critical reduction in IRV is accompanied by progressive neuromechanical uncoupling between respiratory muscle effort and the magnitude of tidal volume that that effort can generate. Approximately 50% of COPD patients instinctively use pursed lips breathing during exercise to slow their respiratory rate and reduce dynamic hyperinflation and dyspnea. Based on these observations, we developed a computerized visual-feedback system that successfully decreases respiratory frequency and prolongs exhalation during exercise in patients with COPD. By combining this technique with exercise-training, patients with COPD can achieve improvements in symptoms, functional status, and quality of life. This presentation will proved a brief overview of dyspnea in COPD and will focus on the development of our computerized breathing training computerized program from prototype to successful funding. Results will be presented from multiple randomized, clinical trials focused on breathing retraining techniques for patients with COPD enrolled in pulmonary rehabilitation. This presentation will focus on a unique program of research that evolved over the past two decades. The importance of patient involvement and input in research decisions and cross-disciplinary collaboration will be emphasized. Additionally, directions for future research will be discussed.