Pulmonary Function and Exercise Testing

  • Timothy R. Chappell


The objective of this chapter is to examine the role of pulmonary function and exercise testing in the clinical evaluation of patients with pulmonary heart disease. Although much has been written about both static and dynamic pulmonary function testing, the significance of this literature relative to patients with pulmonary heart disease is limited, because frequently no differentiation was made between patients with and without pulmonary heart disease or because the diagnosis of pulmonary heart disease was based on clinical findings rather than hemodynamic measurements. Whenever possible, I will distinguish patients with chronic lung disease alone from those with pulmonary hypertension in order to keep the focus of this review on pulmonary function and exercise testing, as these tests specifically relate to patients with pulmonary heart disease.


Chronic Obstructive Pulmonary Disease Pulmonary Hypertension Forced Vital Capacity Pulmonary Artery Pressure Pulmonary Vascular Resistance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Rubin LJ, Peter RH. Hemodynamics at rest and during exercise after oral hydralazine in patients with cor pulmonale. Am J Cardiol 47: 116–122, 1981.PubMedCrossRefGoogle Scholar
  2. 2.
    Sturani C, Bassein L, Schiavina M, Gunella G. Oral nifedipine in chronic cor pulmonale secondary to severe chronic obstructive pulmonary disease. Chest 84: 135–142, 1983.PubMedCrossRefGoogle Scholar
  3. 3.
    Pearl RG, Rosenthal MH, Schroeder JJ, Ashton JPA. Acute hemodynamic effects of nitroglycerin in pulmonary hypertension. Ann Intern Med 99: 9–13, 1983.PubMedGoogle Scholar
  4. 4.
    Rubin LJ, Peter RH. Oral hydralazine therapy for primary pulmonary hypertension. N Engl J Med 302: 69–73, 1980.PubMedCrossRefGoogle Scholar
  5. 5.
    Kadowitz PJ, Hyman AL. Hydralazine and the treatment of primary pulmonary hypertension. N Engl J Med 307: 1357–1358, 1982.CrossRefGoogle Scholar
  6. 6.
    Morrison D, Goldman S, Wright AL, Henry R, Sorenson S, Caldwell J, Ritchie J. The effect of pulmonary hypertension on systolic function of the right ventricle. Chest 84: 250–257, 1983.PubMedCrossRefGoogle Scholar
  7. 7.
    Berger HJ, Matthay RA, Loke J, Marshall RC, Gottschalk A, Zaret B. Assessment of cardiac performance with quantitative radionuclide angiocardiography: Right and left ventricular ejection fraction with reference to findings in chronic obstructive pulmonary disease. Am J Cardiol 41: 897–905, 1978.PubMedCrossRefGoogle Scholar
  8. 8.
    Nanda NC, Gramiak R, Robinson TL, Shah PM. Echocardiography evaluation of pulmonary hypertension. Circulation 50: 575–581. 1974.PubMedGoogle Scholar
  9. 9.
    Hirschfeld S, Meyer R, Schwartz DC, Korfhagen J, Kaplan S. The echocardiography assessment of pulmonary artery pressure and resistance. Circulation 52: 642–650, 1975.PubMedGoogle Scholar
  10. 10.
    Emirgil C, Sobol BJ, Herbert WH, Trout K. The lesser circulation in pulmonary fibrosis secondary to sarcoidosis and its relationship to respiratory function. Chest 60: 371–378. 1971.PubMedCrossRefGoogle Scholar
  11. 11.
    Enson Y, Thomas HM, III, Bosken CH, Wood JA, LeRoy EC, Blanc WA, Wigger HJ, Harvey RM. Pulmonary hypertension in interstitial lung disease: Relation of vascular resistance to abnormal lung structure. Trans Assoc Am Phys 88: 248–255, 1975.PubMedGoogle Scholar
  12. 12.
    Ferrer MI, Harvey RM, Cathcart RT, Webster CA, Richards DW, Cournand A. Some effects of digoxin upon the heart and circulation in man. Digoxin in chronic cor pulmonale. Circulation 1: 161–186. 1950.PubMedGoogle Scholar
  13. 13.
    Harvey RM, Ferrer MI. A clinical consideration of cor pulmonale. Circulation 21: 236–255, 1960.PubMedGoogle Scholar
  14. 14.
    Ferrer MI. Cor pulmonale (pulmonary heart disease): Present day status. Am Heart J 89: 657–664, 1975.PubMedCrossRefGoogle Scholar
  15. 15.
    Continuous nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease in a clinical trial. Ann Intern Med 93: 391–398, 1980.Google Scholar
  16. 16.
    Packer M, Greenberg B, Massie B, Dash H. Deleterious effects of hydralazine in patients with pulmonary hypertension. N Engl J Med 306: 1326–1331, 1982.PubMedCrossRefGoogle Scholar
  17. 17.
    Parker JO, Kelkan K, West PO. Hemodynamic effects of aminophyllinc in cor pulmonale. Circulation 33: 17 - 25. 1966.PubMedGoogle Scholar
  18. 18.
    Evans TO, VanDerReis L, Selzer A. Circulatory effects of chronic pulmonary emphysema. Am Heart J 66: 741–747, 1963.PubMedCrossRefGoogle Scholar
  19. 19.
    Harris P, Segel N, Green K, Housley E. The influence of the airways resistance and alveolar pressure on the pulmonary vascular resistance in chronic bronchitis. Cardiovasc Dis 2: 84–92, 1968.Google Scholar
  20. 20.
    Burrows B, Kettel LJ, Niden AH, Rabinowitz M, Diener CF. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 286: 912–918, 1972.PubMedCrossRefGoogle Scholar
  21. 21.
    Timsit G, Neukirch F, Castillon D, Perron M, Verdier F, Drutel P, Legrand M, Botto MJ, Lesobre R, Statistical correlation between PAP, spirographic data and arterial and mixed venous blood gases in 22 subjects with chronic obstructive lung disease. Prog Resp Res 9: 105–111, 1975.Google Scholar
  22. 22.
    Emirgil C, Sobol BJ, Herbert WH, Trout KW. Routine pulmonary function studies as a key to the status of the lesser circulation in chronic obstructive pulmonary disease. Am J Med 50: 191–199, 1971.PubMedCrossRefGoogle Scholar
  23. 23.
    Borden CW, Wilson RH, Ebert RU, Wells HS. Pulmonary hypertension in chronic pulmonary emphysema. Am J med 8: 701–709, 1950.PubMedCrossRefGoogle Scholar
  24. 24.
    Harvey RM, Enson Y, Betti R, Lewis ML, Rochester DF, Ferrer MI. Further observations on the effects of hydrogen ion on the pulmonary circulation. Circulation 35: 1019–1027, 1967.PubMedGoogle Scholar
  25. 25.
    Yu PNG, Lovejoy FW, Joos HA, Nye RE, McCann WS. Studies of pulmonary hypertension. I. Pulmonary circulatory dynamics in patients with pulmonary emphysema at rest. J Clin Invest 32: 130–137, 1953.PubMedCrossRefGoogle Scholar
  26. 26.
    Emirgil C, Sobol BJ, Williams MH Jr. Long-term study of pulmonary sarcoidosis—The effect of steroid therapy as evaluated by pulmonary function studies. J Chronic Dis 22: 69–86, 1969.PubMedCrossRefGoogle Scholar
  27. 27.
    Stern RC, Borkat G, Hirschfeld SS, Boat TF, Matthews LW, Liebman J, Doershuk CF. Heart failure in cystic fibrosis. Am J Dis Child 134: 267–272, 1980.PubMedGoogle Scholar
  28. 28.
    Mounsey JPD, Ritzman LW, Selverstone NJ, Briscoe WA, McLemore GA. Circulatory changes in severe pulmonary emphysema. Br Heart J 14: 153–172, 1952.PubMedCrossRefGoogle Scholar
  29. 29.
    Harvey RM, Ferrer MI, Richards DW Jr, Cournand A. Influence of chronic obstructive pulmonary heart disease on the heart and circulation. Am J Med 10: 719–738, 1951.PubMedCrossRefGoogle Scholar
  30. 30.
    Williams JF, Behnke RH. The effect of pulmonary emphysema upon cardiopulmonary hemodynamics at rest and during exercise. Ann Int Med 60: 824–842, 1964.PubMedGoogle Scholar
  31. 31.
    Lim TPK, Brownlee WE. Pulmonary hemodynamics in obstructive lung disease. Dis Chest 53: 113–125, 1968.PubMedCrossRefGoogle Scholar
  32. 32.
    Enson Y, Giuntini C, Lewis ML, Morris TQ, Ferrer MI, Harvey RM. The influence of hydrogen ion concentration and hypoxia on the pulmonary circulation. J Clin Invest 43: 1146–1162. 1964.PubMedCrossRefGoogle Scholar
  33. 33.
    Sackner MA, Akgun N, Kimbel P, Lewis DH. The pathophysiology of scleroderma involving the heart and respiratory system. Ann Intern Med 60: 611–630, 1964.PubMedGoogle Scholar
  34. 34.
    Herbert FA, Nahmias BB, Gaensler EA, MacMahon HE. Pathophysiology of interstitial pulmonary fibrosis. Arch Int Med 110: 628–648, 1962.Google Scholar
  35. 35.
    Williams MH, Adler JJ, Colp C. Pulmonary function studies as an aid in the differential diagnosis of pulmonary hypertension. Am J Med 47: 378–383, 1969.PubMedCrossRefGoogle Scholar
  36. 36.
    Turino GM, Goldring RM, Fishman AP. Cor pulmonale in musculoskeletal abnormalities of the thorax. Bull NY Acad Med 41: 959–980, 1965.Google Scholar
  37. 37.
    Harris P. Relation of airways resistance and pulmonary vascular resistance. Bull Physio-Path Resp 4: 65–74, 1968.Google Scholar
  38. 38.
    Harris P, Heath D. The Human Pulmonary Circulation, 2nd edition. Edinburgh; Livingstone, 1977, pp. 522–546.Google Scholar
  39. 39.
    Whitaker W. Pulmonary hypertension in congestive heart failure complicating chronic lung disease. Quart J Med 23: 57–72, 1954.PubMedGoogle Scholar
  40. 40.
    Aber GM, Baylery TJ, Bishop JM. Inter-relationships between renal and cardiac function and respiratory gas exchange in obstructive airways disease. Clin Sci 25: 159–170, 1963.PubMedGoogle Scholar
  41. 41.
    Cournand A. Some aspects of the pulmonary circulation in normal man and in chronic cardiopulmonary diseases. Circulation 2: 641–657, 1950.PubMedGoogle Scholar
  42. 42.
    Ferrer MI. Disturbances in the circulation in patients with cor pulmonale. Bull NY Acad Med 41: 942–958, 1965.Google Scholar
  43. 43.
    Lewis CS, Samuels AJ, Dames MC, Hecht H. Chronic lung disease, polycythemia and congestive heart failure. Circulation 6: 874–887, 1952.PubMedGoogle Scholar
  44. 44.
    Herles F, Jezek V, Daum S. Site of pulmonary resistance in cor pulmonale in chronic bronchitis. Br Heart J 30: 654–660, 1968.PubMedCrossRefGoogle Scholar
  45. 45.
    Dantzker DR, Patten GA, Bower JS. Gas exchange at rest and during exercise in adults with cystic fibrosis. Am Rev Respir Dis 125: 400–405, 1982.PubMedGoogle Scholar
  46. 46.
    Segel N, Bishop JM. The circulation in the patients with chronic bronchitis and emphysema at rest and during exercise, with special reference to the influence of changes in blood viscosity and blood volume on the pulmonary circulation. J Clin Invest 45: 1555–1568, 1960.CrossRefGoogle Scholar
  47. 47.
    Fowler NO, Wescott RN, Scott RC, Hess E. The cardiac output in chronic cor pulmonale. Circulation 6: 888–893, 1952.PubMedGoogle Scholar
  48. 48.
    Enson Y. Pulmonary heart disease: Relation of pulmonary hypertension to abnormal lung structure and function. Bull NY Acad Med 53: 551–566, 1977.Google Scholar
  49. 49.
    Harvey RM, Enson Y, Ferrer MI. A reconsideration of the origins of pulmonary hypertension. Chest 59: 82–94, 1971.PubMedCrossRefGoogle Scholar
  50. 50.
    Harris P, Segel N, Bishop JM. The relation between pressure and flow in the pulmonary circulation in normal subjects and in patients with chronic bronchitis and mitral stenosis. Cardiovasc Res 2: 73–83. 1968.PubMedCrossRefGoogle Scholar
  51. 51.
    Lockhardt A, Sestier F, Sentissi M, Gauthier JJ, Schrijen F. Effects of exercise and postural changes on pulmonary hemodynamics in patients with chronic lung disease. Scand J Resp Dis 77 (suppl): 77–81, 1971.Google Scholar
  52. 52.
    Williams MH Jr, Zohman LR. Cardiopulmonary function in chronic obstructive emphysema. Am Rev Respir Dis 80: 689–699, 1959.PubMedGoogle Scholar
  53. 53.
    Westcott RN, Fowler NO, Scott RC, Harrenstein VD, McGuire J. Anoxia and human pulmonary vascular resistance. J Clin Invest 30: 957–970, 1951.PubMedCrossRefGoogle Scholar
  54. 54.
    Bergofsky EH, Lehr DE, Fishman AP. The effect of changes in hydrogen ion concentration on the pulmonary circulation. J Clin Invest 41: 1492–1502. 1962.PubMedCrossRefGoogle Scholar
  55. 55.
    Fishman AP, Fritts WH Jr, Cournand A. Effects of breathing carbon dioxide upon the pulmonary circulation. Circulation 22: 220–225, 1960.PubMedGoogle Scholar
  56. 56.
    Abraham AS, Cole RB, Green ID. Hedworth-Whitty RB, Clarke SW, Bishop JM. Factors contributing to the reversible pulmonary hypertension of patients with acute respiratory failure studied by serial observations during recovery. Circ Res 24: 51–60, 1969.PubMedGoogle Scholar
  57. 57.
    Fishman AP, McClement J, Himmelstein A, Cournand A. Effects of acute anoxia on the circulation and respiration in patients with chronic pulmonary disease studied during the steady state. J Clin Invest 31: 770–781, 1952.PubMedCrossRefGoogle Scholar
  58. 58.
    Wagner PD, Dantzker DR, Dueck R, Clausen JL, West JB. Ventilation-perfusion inequality in chronic obstructive pulmonary disease. J Clin Invest 59: 203–216, 1977.PubMedCrossRefGoogle Scholar
  59. 59.
    Harvey RM. The influence of hydrogen ion in the control of pulmonary artery pressures in patients with obstructive lung disease. Med Thorac 22: 108–117, 1965.PubMedGoogle Scholar
  60. 60.
    Housley E, Clarke SW, Hedworth-Witty RB, Bishop JM. Effect of acute and chronic acidemia and associated hypoxia on the pulmonary circulation of patients with chronic bronchitis. Bull Physio Path Resp 5: 347–361, 1969.Google Scholar
  61. 61.
    Paul G, Varnauskas SA, Forsberg R, Sannerstedt R, Widimsky J. Effect of carbon dioxide breathing upon the pulmonary circulation in patients with mitral valve disease. Clin Sci 26: 111–120, 1964.PubMedGoogle Scholar
  62. 62.
    Lloyd TC Jr. Influence of blood pH on hypoxic pulmonary vasoconstriction. J Appl Physiol 21: 358–364, 1966.PubMedGoogle Scholar
  63. 63.
    Sibald WJ, Paterson NAM, Holliday RL, Anderson RA, Lobb TR, Duff JH. Pulmonary hypertension in sepsis. Chest 73: 583–591, 1978.CrossRefGoogle Scholar
  64. 64.
    McNeill RS, Rankin J, Forster RE. The diffusing capacity of the pulmonary membrane and the pulmonary capillary blood volume in cardiopulmonary disease. Clin Sci 17: 465–482, 1958.PubMedGoogle Scholar
  65. 65.
    Bates DV. The uptake of carbon monoxide in health and in emphysema. Clin Sci 11: 21–32, 1952.PubMedGoogle Scholar
  66. 66.
    Marshall R. A comparison of methods of measuring the diffusing capacity of the lungs for carbon monoxide. Investigation by fractional analysis of the alveolar air. J Clin Invest 37: 397–407, 1958.CrossRefGoogle Scholar
  67. 67.
    Ogilvie CM, Forster RE, Blakemore WS, Morton JW: A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J Clin Invest 36: 1–17, 1957.PubMedCrossRefGoogle Scholar
  68. 68.
    Bates DV, Varvis CJ, Donevan RE. Christie RV. Variations in the pulmonary capillary blood volume and membrane diffusion component in health and disease. J Clin Invest 39: 1401–1412, 1960.PubMedCrossRefGoogle Scholar
  69. 69.
    Filley FG, MacIntosh DJ, Wright GW. Carbon monoxide uptake and pulmonary diffusing capacity in normal subjects at rest and during exercise. J Clin Invest 33: 530–539, 1954.PubMedCrossRefGoogle Scholar
  70. 70.
    Sackner MA, Greeneltch D, Heiman M, Epstein S, Atkins N. Diffusing capacity, membrane diffusing capacity, capillary blood volume, pulmonary tissue volume and cardiac output measured by a rebreathing technique. Am Rev Respir Dis 111: 157–165, 1975.PubMedGoogle Scholar
  71. 71.
    Lewis BM, Lin TH, Noe FE, Hayford-Welsing EJ. The measurement of pulmonary diffusing capacity for carbon monoxide by a rebreathing method. J Clin Invest 38: 2073–2086. 1959.PubMedCrossRefGoogle Scholar
  72. 72.
    Roughton FJW, Forster RE. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. J Appl Physiol 11: 290–302, 1957.PubMedGoogle Scholar
  73. 73.
    Lewis BM, Lin TH, Noe FE, Komisaruk R. The measurement of pulmonary capillary blood volume and pulmonary membrane diffusing capacity in normal subjects; the effects of exercise and position. J Clin Invest 37: 1061–1070, 1958.PubMedCrossRefGoogle Scholar
  74. 74.
    McCredie RM. The pulmonary capillary bed in various forms of pulmonary hypertension. Circulation 33: 854–861, 1966.PubMedGoogle Scholar
  75. 75.
    McCredie RM. The diffusing characteristics and pressure-volume relationships of the pulmonary capillary bed in mitral valve disease. J Clin Invest 43: 2279–2289, 1964.PubMedCrossRefGoogle Scholar
  76. 76.
    Burgess JH. Pulmonary diffusing capacity in disorders of the pulmonary circulation. Circulation 39: 541–550, 1974.Google Scholar
  77. 77.
    MacIntosh DJ, Sinnott JC, Milne IG, Reid EAS. Some aspects of disordered pulmonary function in mitral stenosis. Ann Int Med 49: 1294–1304, 1958.PubMedGoogle Scholar
  78. 78.
    Riley RL, Johns CJ, Cohen G, Cohn JE, Carroll DG, Shepard RH. The diffusing capacity of the lungs in patients with mitral stenosis studied postoperatively. J Clin Invest 35: 1008–1014, 1956.PubMedCrossRefGoogle Scholar
  79. 79.
    Parker F Jr, Weiss S. The nature and significance of structural changes in the lungs in mitral stenosis. Am J Path 12: 573–598, 1936.PubMedGoogle Scholar
  80. 80.
    Jain BP, Pande JN, Guleria JS. Membrane diffusing capacity and pulmonary capillary blood volume in chronic obstructive lung disease. Am Rev Respir Dis 105: 900–907, 1972.PubMedGoogle Scholar
  81. 81.
    Herzog H, Daum S. Lung function in primary obstructive pulmonary hypertension. Prog Resp Res 5: 400–405, 1970.Google Scholar
  82. 82.
    Sundstrom G, Zauner CW, Arborelius M Jr. Decrease in pulmonary diffusing capacity during lipid infusion in healthy men. J Appl Physiol 34: 816–820, 1973.PubMedGoogle Scholar
  83. 83.
    Sharma GVRK, Burleson VA, Sasahara AA. Effect of thrombolytic therapy on pulmonary capillary bed volume in patients with pulmonary embolism. N Engl J Med 303: 842–845. 1980.PubMedCrossRefGoogle Scholar
  84. 84.
    Parker JO, Ashekian PB, DiGiorgi S, West RO. Hemodynamic effects of aminophylline in chronic obstructive pulmonary disease. Circulation 35: 365–372, 1967.PubMedGoogle Scholar
  85. 85.
    Stockley RA, Finnegan P, Bishop JM. Effect of intravenous terbutaline on arterial blood gas tensions, ventilation, and pulmonary circulation in patients with chronic bronchitis and cor pulmonale. Thorax 32: 601–605, 1977.PubMedCrossRefGoogle Scholar
  86. 86.
    Goldring RM, Fishman AP, Turino GM, Cohen HI, Denning CR, Andersen DH. Pulmonary hypertension and cor pulmonale in cystic fibrosis of the pancreas. J Ped 65: 501–524, 1964.CrossRefGoogle Scholar
  87. 87.
    Hickman JI, Cargill WH. Effect of exercise on cardiac output and pulmonary arterial pressure in normal persons and in patients with cardiovascular disease and pulmonary emphysema. J Clin Invest 27: 10–23, 1948.CrossRefGoogle Scholar
  88. 88.
    Kanner RE, Morris AH. Clinical pulmonary function testing. Salt Lake City Intermountain Thoracic Society. VI: 37–93, 1975.Google Scholar
  89. 89.
    Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 123: 659–664, 1981.PubMedGoogle Scholar
  90. 90.
    Thurlbeck WM, Henderson JA, Fraser RG, Bates DV. Chronic obstructive lung disease: A comparison between clinical, roentgenologic, functional and morphologic criteria in chronic bronchitis, emphysema, asthma and bronchiectasis. Medicine 49: 81–145, 1970.CrossRefGoogle Scholar
  91. 91.
    Filley GF, Beckwith HJ, Reeves JT, Mitchell RS. Chronic obstructive bronchopulmonary disease. II. Oxygen transport in two clinical types. Am J Med 44: 26–38, 1968.PubMedCrossRefGoogle Scholar
  92. 92.
    Bates DV. Impairment of respiratory function in bronchial asthma. Clin Sci 11: 203–207, 1952Google Scholar
  93. 93.
    Guilleminault C, Eldridge FL, Simmon FB, Dement WC. Sleep apnea syndrome: Can it induce hemodynamic changes? West J Med 123: 7–16, 1975.PubMedGoogle Scholar
  94. 94.
    Koo KW, Sax DS, Snider GL. Arterial blood gases and pH during sleep in chronic obstructive pulmonary disease. Am J Med 58: 665–670, 1975.CrossRefGoogle Scholar
  95. 95.
    Flick MR, Block AJ. Continuous in vivo monitoring of arterial oxygenation in chronic obstructive lung disease. Ann Int Med 86: 725–730, 1977.PubMedGoogle Scholar
  96. 96.
    Boysen PG, Block AJ, Wynne JW, Hunt LA, Flick MR. Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chest 76: 536–542, 1979.PubMedCrossRefGoogle Scholar
  97. 97.
    Kearley R, Wynne JW, Block AJ, Boysen PG, Lindsey S, Martin C. The effect of low-flow oxygen on sleep-disordered breathing and oxygen desaturation. Chest 78: 682–685, 1980.PubMedCrossRefGoogle Scholar
  98. 98.
    McIlroy MB, Apthorp GH. Pulmonary function in pulmonary hypertension. Br Heart J 20: 397–402, 1958.PubMedCrossRefGoogle Scholar
  99. 99.
    Sleeper JC, Orgain ES, McIntosh HD. Primary pulmonary hypertension. Review of clinical features and pathologic physiology with a report of pulmonary hemodynamics derived from repeated catheterization. Circulation 26: 1358–1369, 1962PubMedGoogle Scholar
  100. 100.
    Fowler NO, Black-Schaffer B, Scott RC, Gueron M. Idiopathic and thromboembolic pulmonary hypertension. Am J Med 40: 331–345, 1966.CrossRefGoogle Scholar
  101. 101.
    Scharf SM, Feldman NT, Graboys TB, Wellman JJ. Restrictive ventilatory defect in a patient with primary pulmonary hypertension. Am Rev Respir Dis 118: 409–413. 1978.PubMedGoogle Scholar
  102. 102.
    Benjamin JJ, Murtagh PS, Proctor DF, Menkes JA, Permutt S. Pulmonary vascular interdependence in excised dog lobes. J Appl Physiol 37: 887–894, 1974.PubMedGoogle Scholar
  103. 103.
    Yernault JC, Detroyer A. Mechanics of breathing in patients with primary pulmonary hypertension. Am Rev Respir Dis 119: 320–321, 1979.PubMedGoogle Scholar
  104. 104.
    Llamas R, Swenson EW. Diagnostic clues in pulmonary thrombembolism evaluated by angiographic and ventilation-blood flow studies. Thorax 20: 327–336, 1965.PubMedCrossRefGoogle Scholar
  105. 105.
    Jones NL, Goodwin JF. Respiratory function in pulmonary thromboembolic disorders. Br Med J 1: 1089–1093, 1965.PubMedCrossRefGoogle Scholar
  106. 106.
    Nadel JA, Gold WM, Jennings DB, Wright RR, Fudenberg HH. Unusual disease of pulmonary arteries with dyspnea. Am J Med 41: 440–447, 1966.PubMedCrossRefGoogle Scholar
  107. 107.
    Wasserman K, VanKessel AL, Burton GG. Interaction of physiological mechanisms during exercise. J Appl Physiol 22: 71–85, 1967.PubMedGoogle Scholar
  108. 108.
    Wasserman K, Whipp BJ. Exercise physiology in health and disease. Am Rev Respir Dis 112: 219–249. 1975.PubMedGoogle Scholar
  109. 109.
    Wasserman K, Whipp BJ, Koyal SN, Beaver WL. Anaerobic threshold and respiratory gas exchange during exercisce. J Appl Physiol 35: 236–243. 1973.PubMedGoogle Scholar
  110. 110.
    Jones NL. Exercise testing in pulmonary evaluation: Rationale, methods and normal respiratory response to exercise. N Engl J Med 293: 541–544, 647–650, 1975.PubMedCrossRefGoogle Scholar
  111. 111.
    Brown HV, Wasserman K. Exercise performance in chronic obstructive pulmonary diseases. Med Clin North Am 65: 525–547, 1981.PubMedGoogle Scholar
  112. 112.
    Jones NL, Campbell EJM. Clinical Exercise Testing. Philadelphia: W. B. Saunders. 1982.Google Scholar
  113. 113.
    Harvey M, Levine RJ. The risk of research procedures: Methodologic problems and proposed standards. Clin Res 31: 126–139, 1983.PubMedGoogle Scholar
  114. 114.
    Johnson RL Jr. Exercise testing in lung disease. In Diagnostic Techniques in Pulmonary Disease, Sackner MA (ed). New York: Marcel Dekker, 1980, pp. 473–501.Google Scholar
  115. 115.
    Sue DY, Hansen JE, Blais M, Wasserman K. Measurement and analysis of gas exchange during exercise using a programmable calculator. J Appl Physiol 49: 456–461, 1980.PubMedGoogle Scholar
  116. 116.
    Wasserman K. Breathing during exercise. N Engl J Med 298: 780–785, 1978.PubMedCrossRefGoogle Scholar
  117. 117.
    Furuike AN, Sue DY, Hansen JE, Wasserman K. Comparison of physiologic deadspace/tidal volume ratio and alveolar-arterial PO2 difference during incremented and constant work exercise. Am Rev Respir Dis 125: 579–583, 1982.Google Scholar
  118. 118.
    Shuey CB Jr, Pierce AK, Johnson RL Jr. An evaluation of exercise tests in chronic obstructive lung disease. J Appl Physiol 27: 256–261, 1969.PubMedGoogle Scholar
  119. 119.
    Downs JB, Rackstein AD, Klein EF Jr, Hawkins IF Jr. Hazards of radial artery catheterization. Anesthesiology 38 (3): 283–286, 1973.PubMedCrossRefGoogle Scholar
  120. 120.
    Lowenstein E, Little JW, III, Hing HL. Prevention of cerebral embolization from flushing radial artery cannulas. N Engl J Med 285: 1414–1415, 1971.PubMedCrossRefGoogle Scholar
  121. 121.
    Bedford RF, Wollman H. Complications of percutaneous radial artery cannulation: An objective prospective study in man. Anesthesiology 38: 228–236. 1973.PubMedCrossRefGoogle Scholar
  122. 122.
    Marcus JH, McLean RL, Duffell GM, Ingram RH. Exercise performance in relation to the pathophysiologic type of chronic obstructive pulmonary disease. Am J Med 14–22, 1970.Google Scholar
  123. 123.
    Hughes RL, Davison R. Limitations of exercise reconditioning in COLD. Chest 83: 241–249, 1983.PubMedCrossRefGoogle Scholar
  124. 124.
    Spiro SG, Hahn HL, Edwards RHT, Pride NB. Cardiorespiratory adaptations at the start of exercise in normal subjects and in patients with chronic obstructive bronchitis. Clin Sci Mol Med 47: 165–172, 1974.PubMedGoogle Scholar
  125. 125.
    Wasserman K. Physiology of gas exchange and exertional dyspnea. Clin Sci 61: 7–13, 1981.PubMedGoogle Scholar
  126. 126.
    Rebuck AS, Vandenberg RA. The relationship between pulmonary artery pressure and physiologic deadspace in patients with obstructive lung disease. Am Rev Respir Dis 107: 425–428, 1973.Google Scholar
  127. 127.
    Pierce AK, Taylor HF, Archer RK, Miller WF. Responses to exercise training in patients with emphysema. Arch Int Med 113: 28–36, 1964.Google Scholar
  128. 128.
    Kanarek D, Kaplan D, Kazemi H. The anaerobic threshold in severe chronic obstructive lung disease. Bull Europ Physiopath Resp 15: 163–169, 1979.Google Scholar
  129. 129.
    DiPrampero PE, Davies CTM, Cerretelli P, Margaria R. An analysis of O2, debt contracted in submaximal exercise. J Appl Physiol 29: 547–551, 1970.Google Scholar
  130. 130.
    Whipp BJ, Wasserman K. Oxygen uptake kinetics for various intensities of constant workload. J Appl Physiol 33: 351–356, 1972.PubMedGoogle Scholar
  131. 131.
    Minh VD, Lee HM, Dolan GF, Light RW, Bell J, Vasquez P. Hypoxemia during exercise in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 120: 787–794, 1979.PubMedGoogle Scholar
  132. 132.
    Belman MJ, Wasserman K. Exercise training and testing in patients with chronic obstructive pulmonary disease. Basics of RD 10: 38–43, 1982.Google Scholar
  133. 133.
    Bradley BL, Garner AE, Billie D. Mestas JM, Forman M. Oxygen-assisted exercise in chronic obstructive lung disease. Am Rev Respir Dis 118: 239–243, 1978.PubMedGoogle Scholar
  134. 134.
    Jones NL, Jone G, Edwards HT. Exercise tolerance in chronic airway obstruction. Am Rev Respir Dis 103: 477–491, 1974.Google Scholar
  135. 135.
    Armstrong BW, Workman JN, Hurt HH Jr, Roemich WR. Clinico-physiologic evaluation of physical working capacity in persons with pulmonary disease. Am Rev Respir Dis 93:90–99, 223–233, 1966.PubMedGoogle Scholar
  136. 136.
    Wehr KL, Johnson RL Jr. Maximal oxygen consumption in patients with lung disease. J Clin Invest 58: 880–890, 1976.PubMedCrossRefGoogle Scholar
  137. 137.
    Young IH, Woolcock AJ. Arterial blood gas tension changes at the start of exercise in chronic obstructive pulmonary disease. Am Rev Respir Dis 119: 213–221, 1979.PubMedGoogle Scholar
  138. 138.
    Field S, Kelly SM, Macklem PT. The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis 126: 9–13, 1982.PubMedGoogle Scholar
  139. 139.
    McIlroy MB. Dyspnea and the work of breathing in diseases of the heart and lungs. Prog Cardiovasc Dis 1: 284–297, 1959.PubMedCrossRefGoogle Scholar
  140. 140.
    Kawakami Y, Kishi F, Yamamoto H, Miyamato K. Relation of oxygen delivery, mixed venous oxygenation, and pulmonary hemodynamics to prognosis in chronic obstructive pulmonary disease. N Engl J Med 208: 1045–1049, 1983.CrossRefGoogle Scholar
  141. 141.
    Bergofsky EH. Tissue oxygen delivery and cor pulmonale in chronic obstructive pulmonary disease. N Engl J Med 308: 1092–1094, 1983.PubMedCrossRefGoogle Scholar
  142. 142.
    Tenney SM, Mithoefet JC. The relationship of mixed venous oxygenation to oxygen transport: With special reference to adaptations to high altitude and pulmonary disease. Am Rev Respir Dis 125: 474–479, 1982.PubMedGoogle Scholar
  143. 143.
    Kawakami Y, Terai T, Yamamoto H, Murao M. Exercise and oxygen inhalation in relation to prognosis of chronic obstructive pulmonary disease. Chest 81: 182–188, 1982.PubMedCrossRefGoogle Scholar
  144. 144.
    Mitchell RS, Webb NC, Filley GF. Chronic obstructive bronchopulmonary disease. III. Factors influencing prognosis. Am Rev Respir Dis 89: 878–896, 1964.PubMedGoogle Scholar
  145. 145.
    Renzetti AD Jr, McClement JH, Li HBD. The Veterans Administration Cooperative Study of pulmonary function. III. Mortality in relation to respiratory function in chronic obstructive pulmonary disease. Am J Med 41: 115–129, 1966.PubMedCrossRefGoogle Scholar
  146. 146.
    Rafterstin B, Escourrou P, Legrand A, Duroux P, Lockhart A. Circulatory transport of oxygen in patients with chronic airflow obstruction exercising maximally. Am Rev Respir Dis 125: 426–431, 1982.Google Scholar
  147. 147.
    Jezek V, Schrijen F, Sadoul P. Right ventricular function and pulmonary hemodynamics during exercise in patients with chronic obstructive bronchopulmonarv disease. Cardiology 58: 20–31, 1973.PubMedCrossRefGoogle Scholar
  148. 148.
    Berger HJ, Matthay RA, Pytlik LM, Gottschalk A, Zaret BL. First pass radionuclide assessment of right and left ventricular performance in patients with cardiac and pulmonary disease. Semin Nucl Med 9: 275–295, 1982.CrossRefGoogle Scholar
  149. 149.
    Matthay RA, Berger HJ, Loke J. Gottschalk A, Zaret BL. Effects of aminophylline upon right and left ventricular performance in chronic obstructive pulmonary disease: Noninvasive assessment by radionuclide angiocardiography. Am J Med 65: 903–910, 1978.PubMedCrossRefGoogle Scholar
  150. 150.
    Matthay RA, Berger HJ, Davies RA, Loke J, Mahler DA, Gottschalk A, Zaret BL. Right and left ventricular exercise performance in chronic obstructive pulmonary disease: Radionuclide assessment. Ann Intern Med 93: 234–239, 1980.PubMedGoogle Scholar
  151. 151.
    Piene H, Sund T. Flow and power output of right ventricle facing load with variable input impedance. Am J Physiol 237: H125–H130. 1979.PubMedGoogle Scholar
  152. 152.
    Sarnoff SJ, Berglund E. Ventricular function. I. Starling’s law of the heart studied by means of simultaneous right and left ventricular function curves in the dog. Circulation 9: 706–718, 1954.PubMedGoogle Scholar
  153. 153.
    Smith DE, Bissett JK, Phillips JR, Doherty IF., Murphy ML. Improved right ventricular systolic time intervals after digitalis in patients with cor pulmonale and chronic obstructive pulmonary disease. Am J Cardiol 41: 1299–1304, 1978.PubMedCrossRefGoogle Scholar
  154. 154.
    Jezek V. Rate of right ventricular isometric pressure increase in patients with chronic cor pulmonale studied by ventricular derivative curves. Cardiologia 48: 461–470, 1966.PubMedCrossRefGoogle Scholar
  155. 155.
    Rubin LJ. Cardiovascular effects of vasodilator therapy of pulmonary artery hypertension. Clinics in Chest Medicine 4: 309–314, 1983.PubMedGoogle Scholar
  156. 156.
    Goldberg HS, Rabson J. Control of cardiac output by systemic vessels. Am J Med 47: 696–702, 1981.Google Scholar
  157. 157.
    Horsfield K, Segel N, Bishop JM. The pulmonary circulation in chronic bronchitis at rest and during exercise breathing air and 80% oxygen. Clin Sci 43: 473–483, 1968.Google Scholar
  158. 158.
    Lockhart A, Trareva M, Nader F, Leblanc P, Schrijen F, Sadoul P. Elevated pulmonary artery wedge pressure at rest and during exercise in chronic bronchitis: Fact or fancy. Clin Sci 37: 503–517, 1969.PubMedGoogle Scholar
  159. 159.
    Rao BS, Cohn KE, Eldridge FL, Hancock EW. Left ventricular failure secondary to chronic pulmonary disease. Am J Med 45: 229 - 241, 1968.PubMedCrossRefGoogle Scholar
  160. 160.
    Shaw DB, Grover RF, Reeves JT, Blount G Jr. Pulmonary circulation in chronic bronchitis and emphysema. Br Heart J 27: 674–683, 1965.PubMedCrossRefGoogle Scholar
  161. 161.
    Widimsky J, Riedel M, Stanek V. Central hemodynamics during exercise in patients with restrictive pulmonary disease. Bull Europ Physiopath Resp 13: 369–379, 1977.Google Scholar
  162. 162.
    Wilson JR, Mason UG, Bahler RC, Chester EH, Picken JJ, Baum GL. Vectorcardiographs detection of early hemodynamic abnormalities in chronic obstructive pulmonary disease. Chest 76: 160–165, 1979.PubMedCrossRefGoogle Scholar
  163. 163.
    Chapman CB, Fisher IN, Sproule BJ Behavior of stroke volume at rest and during exercise in human beings. J Clin Invest 39: 1208–1213, 1960.PubMedCrossRefGoogle Scholar
  164. 164.
    Matthay RA, Berger HJ. Davies RA, Loke J, Zaret BL, Gottschalk A. Effect of steady state exercise on right and left ventricular performance in chronic obstructive pulmonary disease. Chest 77 (suppl): 303–304, 1980.Google Scholar
  165. 165.
    Brent BN, Berger HJ, Matthay RA. Mahler D, Pytlik L. Zaret BL. Physiologic correlates of right ventricular ejection fraction in chronic obstructive pulmonary disease: A combined radionuclide and hemodynamic study. Am J Cardiol 50: 255–262, 1982.PubMedCrossRefGoogle Scholar
  166. 166.
    Riley RL, Himmelstein A, Motley HL. Studies of the pulmonary circulation at rest and during exercise in normal individuals and in patients with chronic pulmonary disease. Am J Physiol 152: 372–382, 1948.PubMedGoogle Scholar
  167. 167.
    Kitchin AH, Lowther CP, Matthews MB. The effects of exercise of breathing oxygen enriched air on the pulmonary circulation in emphysema. Clin Sci 21: 93–106, 1961.PubMedGoogle Scholar
  168. 168.
    Burkart F. The exercise test in patients with obstructive pulmonary hypertension. Prog Resp Res 5: 395–399, 1970.Google Scholar
  169. 169.
    Hermiller JB, Bambach D, Thompson MJ, Huss P, Fontana ME, Magorien RD, Unverferth DV, Leier CV. Vasodilators or prostaglandin inhibitors in primary pulmonary hypertension. Ann Int Med 97: 480–489, 1982.PubMedGoogle Scholar
  170. 170.
    Gazetopoulos N, Salonikides N. Davies H. Cardiopulmonary function in patients with pulmonary hypertension. Br Heart J 36: 19–28, 1974.PubMedCrossRefGoogle Scholar
  171. 171.
    Cotes JE, Pisa Z, Thomas AJ. Effect of breathing oxygen upon cardiac output, heart rate, ventilation, systemic and pulmonary blood pressure in patients with chronic lung disease. Clin Sci 25: 305–321, 1963.PubMedGoogle Scholar
  172. 172.
    Rubin LJ, Handel F, Peter RH. The effects of oral hydralazine on right ventricular end-diastolic pressure in patients with right ventricular failure. Circulation 65: 1369–1373, 1982.PubMedCrossRefGoogle Scholar
  173. 173.
    Rubin LJ, Nicod P, Hillis LD, Firth BG. The acute and chronic treatment of primary pulmonary hypertension with nifedipine: A hemodynamic and scintigraphic evaluation. Ann Int Med 99: 433–438, 1983.PubMedGoogle Scholar
  174. 174.
    Morrison D, Sorenson S, Caldwell J, Wright N, Ritchie J, Kennedy JW, Hamilton G. The normal right ventricular response to supine exercise. Chest 82: 686–691, 1982.PubMedCrossRefGoogle Scholar
  175. 175.
    Martorana PA, Schaper J, Van Even P. The effect of physical exercise on elastase-induced emphysema in hamsters. Am Rev Respir Dis 120: 1209–1213, 1979.PubMedGoogle Scholar
  176. 176.
    Weitzenblum E, Loiseau A, Hirth C, Mirhom R, Rasaholinjanahary J. Course of pulmonary hemodynamics in patients with chronic obstructive pulmonary disease. Chest 75: 656–662, 1979.PubMedCrossRefGoogle Scholar
  177. 177.
    Fishman AP, Ledlie JF, Dyspnea. Bull Europ Physiopath Resp 15: 789–804, 1979.Google Scholar
  178. 178.
    Gandevia B. Ventilatory response to exercise and the results of standardized execrcise test in chronic obstructive lung disease. Am Rev Respir Dis 88: 66. 406–408, 1963.PubMedGoogle Scholar
  179. 179.
    McFadden ER Jr, Ingram RH Jr. Exercise-induced asthma. N Engl J Med 301: 763–769, 1979.PubMedCrossRefGoogle Scholar
  180. 180.
    McFadden ER Jr. Exercise-induced asthma. Am J Med 68: 471–172, 1980.PubMedCrossRefGoogle Scholar
  181. 181.
    Rice DL, Awe RJ, Gaasch WH, Alexander JK, Jenkins DE. Wedge pressure measurement in obstructive pulmonary disease. Chest 66: 628–632, 1974.PubMedCrossRefGoogle Scholar
  182. 182.
    Buda AJ, Pinskey MR, Ingels NB Jr, Daughters GT II, Stinson EB, Alderman EL. Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 301: 453–459. 1979.PubMedCrossRefGoogle Scholar
  183. 183.
    Permutt S. Relation between pulmonary arterial pressure and pleural pressure during the acute asthmatic attack. Chest 63 (suppl): 25–28, 1973.CrossRefGoogle Scholar
  184. 184.
    Culver BH, Marini JJ, Butler J. Lung volume and pleural pressure effects on ventricular Junction. J Appl Physiol 50: 630–635. 1981.PubMedGoogle Scholar
  185. 185.
    Nadel JA, Gold WM, Burgess JH. Early diagnosis of chronic pulmonary vascular obstruction. Am J Med 44: 16–25, 1968.PubMedCrossRefGoogle Scholar
  186. 186.
    Heilman RS, Tabakin BS, Hanson JS, Naeye RL. Alterations of circulatory and ventilatory dynamics in pulmonary vascular obstruction secondary to recurrent pulmonary emboli. Am J Med 32: 298–303, 1962.PubMedCrossRefGoogle Scholar
  187. 187.
    Dantzker DR, Bower JS, Mechanisms of gas exchange abnormality in patients with chronic obliterative pulmonary vascular disease. J Clin Invest 64: 1050–1055, 1979.PubMedCrossRefGoogle Scholar
  188. 188.
    Mohsenifar Z, Tashkin DP. Levy SE, Bjerke RD, Clements PJ, Furst D. Lack of sensitivity of measurements of VD/VT at rest and during exercise in detection of hemodynamically significant pulmonary vascular abnormalities in collagen vascular disease. Am Rev Respir Dis 123: 508–512, 1981.PubMedGoogle Scholar
  189. 189.
    Wise RA, Wigley F, Newball HH, Stevens MB. The effect of cold exposure on diffusing capacity in patients with Raynaud’s phenomenon. Chest 81: 695–698, 1982.PubMedCrossRefGoogle Scholar
  190. 190.
    Ettinger WH, Wise RA, Stevens MB, Wigley FM. Absence of positional changes in pulmonary diffusing capacity in systemic sclerosis. Am J Med 75: 305–312, 1983.PubMedCrossRefGoogle Scholar
  191. 191.
    Miller MJ. Effect of the cold pressor test on diffusing capacity: comparison of normal subjects and those with Raynaud’s disease and progressive systemic sclerosis. Chest 85: 264–266, 1983.CrossRefGoogle Scholar
  192. 192.
    Jones NL. Pulmonary gas exchange during exercise in patients with chronic airway obstruction. Clin Sci 31: 39–50, 1966.PubMedGoogle Scholar
  193. 193.
    Johnson RL Jr, Spicer WS, Bishop JM, Forster RE. Pulmonary capillary blood volume, flow and diffusing capacity during exercise. J Appl Physiol 15: 893–902. 1970.Google Scholar
  194. 194.
    Bjure J. Pulmonary diffusing capacity for carbon monoxide in relation to cardiac output in man. ScandJ Clin Lab Invest 17 (suppl 81): 1–113, 1965.Google Scholar
  195. 195.
    Schrijen F, Urtiaga B. Pulmonary blood volume in chronic lung disease. Chest 81: 545–549, 1982.CrossRefGoogle Scholar
  196. 196.
    Austrian R, McClement JH, Renzetti AD Jr, Donald KW, Riley RL, Cournand A. Clinical and physiologic features of some types of pulmonary diseases with impairment of alveolar- capillary diffusion. Am J Med 667–685, 1951.Google Scholar
  197. 197.
    Shepard RH, Cohn JE, Cohn G, Armstrong BW, Carroll DG, Denoso H, Riley RL. The maximal diffusing capacity of the lung in chronic obstructive disease of the airways. Amer Rev Tuberc 71: 249–259, 1955.Google Scholar
  198. 198.
    Finley TN, Swenson EW, Comroe JH Jr. The cause of arterial hypoxemia at rest in patients with “alveolar capillary block syndrome.” J Clin Invest 41: 618–622, 1962.PubMedCrossRefGoogle Scholar
  199. 199.
    Johnson RL Jr. Pulmonary diffusion as a limiting factor in exercise stress. Circ Res 21 (suppl 11): 154–160, 1967.Google Scholar
  200. 200.
    DeGraff AC, Taylor HF, Ord JW, Chuang TH, Johnson RL Jr. Exercise limitation following extensive pulmonary resection. J Clin Invest 44: 1514–1522, 1965.PubMedCrossRefGoogle Scholar
  201. 201.
    Minh VD, Chun D. Dolan GF. Lee HM, Vasquez P. Mixed venous oxygenation, exercise, body posture and V/Q ratio in chronic obstructive pulmonary disease. Am Rev Respir Dis 124: 226–231, 1981.PubMedGoogle Scholar
  202. 202.
    Hyman AL, Higashida RT, Spannhake EW, Kadowitz PJ. Pulmonary vasoconstrictor responses to graded decreases in precapillary blood PO2 in intact chest cat. J Appl Physiol 51: 1009–1016, 1981.PubMedGoogle Scholar
  203. 203.
    Benumof JL, Pirlo AF. Johanson I, Trousdale FR. Interaction of PvO2 with PaO2, on hypoxic pulmonary vasoconstriction. J Appl Physiol 51: 871–874, 1981.PubMedGoogle Scholar

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© Martinus Nijoff Publishing 1984

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  • Timothy R. Chappell

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