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Ventilatory response to carbon dioxide and to exercise in relation to the pathophysiologic type of chronic obstructive pulmonary disease.

The ventilatory responses to carbon dioxide (CO2) and exercise were studied in 30 patients with moderately severe chronic obstructive pulmonary disease. Diminished lung recoil at full inspiration as an index of emphysema, and increased pulmonary flow resistance during quiet breathing as an index of chronic bronchitis were used to define three groups: A, predominant emphysema; B, predominant bronchitis; C, mixed disease. Groups Band C had ventilatory hyporesponsiveness to both CO2 and exercise. Responses to both exercise and CO2 correlated best with pulmonary resistance and did not correlate with loss of recoil or with limitation of maximal expiratory flow. During CO2 breathing, the rate of inspiratory work per liter of ventilation as an estimate of respiratory center output was equivalent in all three groups. Rather than by directly impeding the translation of respiratory center output into ventilation, an increase in R is thought to initiate hyporesponsiveness.