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The dyspnoea – inactivity vicious circle in COPD: development and external validation of a conceptual model



Maria A Ramon, Gerben Ter Riet, Anne-Elie Carsin, et al.
Eur Respir J 2018; 52:1800079.
doi: 10.1183/13993003.00079-2018

The chronic airflow obstruction that characterises chronic obstructive pulmonary disease (COPD) limits a person’s activities, which in turn leads to the patient’s physical deconditioning. This is known as the ‘vicious circle’ theory of dyspnoea. The literature contains various versions of this theory, but it has never been validated prospectively.

In this European study, Ramon and colleagues sought to establish an empirically validated model for the dyspnoea–inactivity vicious circle in COPD through: (1) identifying and validating all published vicious circle models using real patients’ longitudinal measurements, and (2) building and externally validating a comprehensive new vicious model, using repeated measurements from two European COPD cohort studies.

The vicious circle that the authors propose in this study has two main differences from other models: (1) COPD exacerbations are of relevance to the vicious circle, and (2) exercise capacity has a more central role than previously considered.

In conclusion, the comprehensive model proposed in this paper gives a more relevant role to exercise capacity and COPD exacerbations, and will facilitate the design and testing of targeted therapeutic interventions.




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