Comorbidities and prevalence of dysfunctional breathing in patients referred for cardiopulmonary exercise testing due to exertional dyspnea

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Introduction: In a recent publication, we introduced a new index for the quantification of dysfunctional breathing (DB) derived from the analysis of ventilation slopes obtained during cardiopulmonary exercise tests (CPET). Patients referred for a CPET typically have a variety of conditions and comorbidities. Our aim was to investigate the association between comorbidities and the prevalence of DB in patients referred for a CPET due to exertional dyspnea. Material and Methods: Data were retrospectively extracted from 961 consecutive patients referred for a CPET in our institution between January 2019 and July 2022. DB was assessed based on the proportional tidal volume variation index. The association between comorbidities and DB was assessed using Fisher's exact tests and principal component analysis. Results: Among 961 patients, the most prevalent comorbidities included breathing abnormalities (R06), essential primary hypertension (I10), COPD (J44), sleep apnea (G47), asthma (J45), obesity (E66), lung cancer (C34), and chronic ischaemic heart disease (I25). The prevalence of DB in the overall population was 53%. Significant associations between DB and comorbidities were found. Patient with COPD had a significantly higher DB prevalence of 65% (OR = 1.9 [95% CI: 1.4 to 2.7]; p < 0.001). Conversely, patients undergoing preoperative assessment prior to lung cancer resection had a lower DB prevalence of 41%. Conclusion: Using a newly developed DB diagnostic index, we could assess the association between DB and patient comorbidities. Over 50% of patients referred for a CPET had DB and COPD was significantly associated with a higher prevalence of DB.

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