Cardiopulmonary exercise test in chronic obstructive pulmonary disease at high altitude: A case report

Abstract

Chronic obstructive pulmonary disease (COPD) generates functional limitationsdue to functional deterioration and low tolerance to fatigue. Altitudinal hypoxialeads to a deterioration of physical fitness in patients with COPD. The Initiativefor Chronic Obstructive Lung Disease recommends prescribed physical exerciseprograms as an essential element for the treatment of COPD; therefore,cardiopulmonary exercise tests (CPET) should be performed to identifymaximum performance thresholds. However, typical CPET protocols may beinadequate for COPD patients residing at >2500 m as altitudinal hypoxia leadsto a deterioration of physical fitness in patients with COPD. We present acase report of a COPD patient residing at >2500 m who underwent 3 differentCPET protocols until reaching maximum thresholds of physical performance athigh altitude. Each test was performed on the same patient two weeks apartbetween tests. It was found that the CPET protocol for COPD developed at lowaltitude is not relevant for COPD patients residing in conditions of altitudinalhypoxia, since the minimum criteria of the American Thoracic Society (ATS)are not met, and the values could not be recorded ventilatory and metabolicmaximal. We believe that CPET protocols for people with COPD should beadjusted based on environmental conditions.