{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:50:27Z","timestamp":1788825027928,"version":"build-2803163510"},"reference-count":94,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      In patients with chronic obstructive pulmonary disease (COPD), exertional dyspnoea generally arises when there is imbalance between ventilatory demand and capacity, but the neurophysiological mechanisms are unclear. We therefore determined if disparity between elevated inspiratory neural drive (IND) and tidal volume (\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>T<\/jats:sub>\n                      ) responses (neuromechanical dissociation) impacted dyspnoea intensity and quality during exercise, across the COPD severity spectrum. In this two\u2010centre, cross\u2010sectional observational study, 89 participants with COPD divided into tertiles of FEV\n                      <jats:sub>1<\/jats:sub>\n                      %predicted (Tertile 1\u00a0=\u00a0FEV\n                      <jats:sub>1<\/jats:sub>\n                      = 87\u00a0\u00b1\u00a09%, Tertile 2\u00a0=\u00a060\u00a0\u00b1\u00a09%, Tertile 3\u00a0=\u00a032\u00a0\u00b1\u00a08%) and 18 non\u2010smoking controls, completed a symptom\u2010limited cardiopulmonary exercise test (CPET) with measurement of IND by diaphragm electromyography (EMGdi (%max)). The association between increasing dyspnoea intensity and EMGdi (%max) during CPET was strong (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.730,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and not different between the four groups who showed marked heterogeneity in pulmonary gas exchange and mechanical abnormalities. Significant inspiratory constraints (tidal volume\/inspiratory capacity (\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>T<\/jats:sub>\n                      \/IC)\u00a0\u2265\u00a070%) and onset of neuromechanical dissociation (EMGdi (%max):\n                      <jats:italic>V<\/jats:italic>\n                      <jats:sub>T<\/jats:sub>\n                      \/IC\u00a0&gt;\u00a00.75) occurred at progressively lower minute ventilation () from Control to Tertile 3. Lower resting IC meant earlier onset of neuromechanical dissociation, heightened dyspnoea intensity and greater propensity (93% in Tertile 3) to select qualitative descriptors of \u2018unsatisfied inspiration\u2019. We concluded that, regardless of marked variation in mechanical and pulmonary gas exchange abnormalities in our study sample, exertional dyspnoea intensity was linked to the magnitude of EMGdi (%max). Moreover, onset of critical inspiratory constraints and attendant neuromechanical dissociation amplified dyspnoea intensity at higher exercise intensities. Simple measurements of IC and breathing pattern during CPET provide useful insights into mechanisms of dyspnoea and exercise intolerance in individuals with COPD.\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tjp15196-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Dyspnoea during exercise is a common and troublesome symptom reported by patients with chronic obstructive pulmonary disease (COPD) and is linked to an elevated inspiratory neural drive (IND). The precise mechanisms of elevated IND and dyspnoea across the continuum of airflow obstruction severity in COPD remains unclear.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The present study sought to determine the mechanisms of elevated IND (by diaphragm EMG, EMGdi (%max)) and dyspnoea during cardiopulmonary exercise testing (CPET) across the continuum of COPD severity.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>There was a strong association between increasing dyspnoea intensity and EMGdi (%max) during CPET across the COPD continuum despite significant heterogeneity in underlying pulmonary gas exchange and respiratory mechanical impairments.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Critical inspiratory constraints occurred at progressively lower ventilation during exercise with worsening severity of COPD. This was associated with the progressively lower resting inspiratory capacity with worsening disease severity.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Earlier critical inspiratory constraint was associated with earlier neuromechanical dissociation and greater likelihood of reporting the sensation of \u2018unsatisfied inspiration\u2019.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1113\/jp283252","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T09:24:49Z","timestamp":1658395489000},"page":"4227-4245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Exertional dyspnoea in patients with mild\u2010to\u2010severe chronic obstructive pulmonary disease: neuromechanical mechanisms"],"prefix":"10.1113","volume":"600","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1586-6897","authenticated-orcid":false,"given":"Matthew D.","family":"James","sequence":"first","affiliation":[{"name":"Respiratory Investigation Unit Department of Medicine Queen's University and Kingston Health Sciences Centre  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin B.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Respiratory Investigation Unit Department of Medicine Queen's University and Kingston Health Sciences Centre  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra G.","family":"Vincent","sequence":"additional","affiliation":[{"name":"Respiratory Investigation Unit Department of Medicine Queen's University and Kingston Health Sciences Centre  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara J.","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Clinical Exercise and Respiratory Physiology Laboratory Department of Kinesiology and Physical Education Faculty of Education McGill University  Montr\u00e9al Quebec Canada"},{"name":"Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit Research Institute of the McGill University Health Centre  Montr\u00e9al Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0949-4575","authenticated-orcid":false,"given":"Adamo A.","family":"Donovan","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine Department of Medicine McGill University Health Centre  Montr\u00e9al Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan P.","family":"de\u2010Torres","sequence":"additional","affiliation":[{"name":"Respiratory Investigation Unit Department of Medicine Queen's University and Kingston Health Sciences Centre  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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