Cardiopulmonary exercise testing in chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a common lung disease causing airflow obstruction and breathing problems. Despite the current advances in the treatment of COPD, exercise intolerance remains a challenge, impacting quality of life and increased morbidity. Cardiopulmonary exercise testing (CPET) is a non-invasive test with concomitant gas exchange analysis that provides a thorough assessment of exercise physiology, involving the integrative respiratory, cardiovascular, muscle and metabolic responses to exercise, and, thus providing insights into exercise limitation mechanisms. This review hypothesizes that CPET offers prognostic value in COPD and can be used to evaluate the response to several therapeutic interventions. Aim: To investigate the clinical usefulness of CPET in assessing exercise tolerance, disease progression and therapeutic outcomes in COPD patients. Methods: This this systematic literature review was conducted to analyse studies published between 2020 and 2024 on the role of CPET in COPD management. Studies were reviewed focusing on CPET's prognostic value, its correlation with disease severity, and its impact on therapeutic strategies. The quality of the selected studies was assessed by using PRISMA guidelines. Results: As a result, CPET-integrated monitoring supports as a valuable tool for evaluating exercise intolerance in COPD, with parameters such as peak oxygen uptake (V̇O2 peak), ventilatory efficiency (V̇E/V̇CO2 slope), and dynamic hyperinflation correlating with disease severity and prognosis. According to studies a V̇O2 peak value below 15 mL kg-1 min-1 is associated with increased mortality risk and hospitalizations. Undoubtedly, CPET-derived thresholds for ventilatory and cardiovascular limitations remain an invaluable tool for COPD diagnosis and management, and contribute to optimizing rehabilitation strategies and pharmacological interventions. Conclusion: CPET provides important information about the pathophysiology of exercise intolerance in COPD, helping with personalized treatment planning and risk stratification. CPET should be integrated into COPD management guidelines.