REVIEW COPD Physiological and clinical relevance of exercise ventilatory efficiency in COPD J. Alberto Neder1, Danilo C. Berton1,2, Flavio F. Arbex3, Maria Clara Alencar4, Alcides Rocha3, Priscila A. Sperandio3, Paolo Palange5 and Denis E. O’Donnell1 Affiliations: 1Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen’s University and Kingston General Hospital, Kingston, ON, Canada. 2Division of Respiratory Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. 3Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil. 4Division of Cardiology, Federal University of Minas Gerais, Belo Horizonte, Brazil. 5Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. Correspondence: J. Alberto Neder, 102 Stuart Street, Kingston, Ontario, Canada K7L 2V6. E-mail:
[email protected] @ERSpublications Ventilatory efficiency is a key measurement for the interpretation of cardiopulmonary exercise testing in COPD http://ow.ly/1nsY307pbz8 Cite this article as: Neder JA, Berton DC, Arbex FF, et al. Physiological and clinical relevance of exercise ventilatory efficiency in COPD. Eur Respir J 2017; 49: 1602036 [https://doi.org/10.1183/13993003.02036- 2016]. ABSTRACT Exercise ventilation (V′E) relative to carbon dioxide output (V′CO2) is particularly relevant to patients limited by the respiratory system, e.g. those with chronic obstructive pulmonary disease (COPD). ′ − ′ High V E V CO2 (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV1). Establishing an ′ − ′ association between high V E V CO2 and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining.