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Dynamic hyperinflation in patients with COPD

Martin Kohlhaufl, MD, PhD
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD


Exercise-induced air trapping is referred to as dynamic hyperinflation. Patients with chronic obstructive pulmonary disease (COPD) are particularly susceptible to dynamic hyperinflation. Common questions include:

What causes dynamic hyperinflation?

What are its clinical manifestations?

How is it diagnosed?

What is the treatment?


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Literature review current through: Sep 2015. | This topic last updated: Jun 1, 2015.
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  1. MacNee W. Pathophysiology of acute exacerbations of chronic obstructive pulmonary disease. In: Acute exacerbations of chronic obstructive pulmonary disease. Lung Biology in Health and Disease, vol 183, Siafakas NM, Anthonisen NR, Georgopoulos D (Eds), 2004. p.29.
  2. Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343:269.
  3. Milic-Emili J. Dynamic pulmonary hyperinflation and intrinsic PEEP: consequences and management in patients with chronic obstructive pulmonary disease. Recenti Prog Med 1990; 81:733.
  4. Johnson BD, Beck KC, Zeballos RJ, Weisman IM. Advances in pulmonary laboratory testing. Chest 1999; 116:1377.
  5. Decramer M. Respiratory muscle interaction during acute and chronic hyperinflation. Monaldi Arch Chest Dis 1993; 48:483.
  6. Mahler DA. Mechanisms and measurement of dyspnea in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006; 3:234.
  7. Hannink JD, van Helvoort HA, Dekhuijzen PN, Heijdra YF. Dynamic hyperinflation during daily activities: does COPD global initiative for chronic obstructive lung disease stage matter? Chest 2010; 137:1116.
  8. Calverley PM, Koulouris NG. Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J 2005; 25:186.
  9. Younes M, Kivinen G. Respiratory mechanics and breathing pattern during and following maximal exercise. J Appl Physiol Respir Environ Exerc Physiol 1984; 57:1773.
  10. Satake M, Shioya T, Uemura S, et al. Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis 2015; 10:153.
  11. Johnson BD, Reddan WG, Seow KC, Dempsey JA. Mechanical constraints on exercise hyperpnea in a fit aging population. Am Rev Respir Dis 1991; 143:968.
  12. Johnson BD, Saupe KW, Dempsey JA. Mechanical constraints on exercise hyperpnea in endurance athletes. J Appl Physiol (1985) 1992; 73:874.
  13. Babb TG, Viggiano R, Hurley B, et al. Effect of mild-to-moderate airflow limitation on exercise capacity. J Appl Physiol (1985) 1991; 70:223.
  14. Johnson BD, Scanlon PD, Beck KC. Regulation of ventilatory capacity during exercise in asthmatics. J Appl Physiol (1985) 1995; 79:892.
  15. O'Donnell DE, Flüge T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 2004; 23:832.
  16. O'Donnell DE, Lam M, Webb KA. Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160:542.
  17. Gelb AF, Taylor CF, Cassino C, et al. Tiotropium induced bronchodilation and protection from dynamic hyperinflation is independent of extent of emphysema in COPD. Pulm Pharmacol Ther 2009; 22:237.
  18. Bellamy D, Hutchison DC. The effects of salbutamol aerosol on lung function in patients with pulmonary emphysema. Br J Dis Chest 1981; 75:190.
  19. O'Donnell DE, Voduc N, Fitzpatrick M, Webb KA. Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease. Eur Respir J 2004; 24:86.
  20. Rabe KF. Improving dyspnea in chronic obstructive pulmonary disease: optimal treatment strategies. Proc Am Thorac Soc 2006; 3:270.
  21. O'Donnell DE, Sciurba F, Celli B, et al. Effect of fluticasone propionate/salmeterol on lung hyperinflation and exercise endurance in COPD. Chest 2006; 130:647.
  22. Stav D, Raz M. Effect of N-acetylcysteine on air trapping in COPD: a randomized placebo-controlled study. Chest 2009; 136:381.
  23. Chrystyn H, Mulley BA, Peake MD. Dose response relation to oral theophylline in severe chronic obstructive airways disease. BMJ 1988; 297:1506.
  24. Casaburi R, Porszasz J. Reduction of hyperinflation by pharmacologic and other interventions. Proc Am Thorac Soc 2006; 3:185.
  25. Somfay A, Porszasz J, Lee SM, Casaburi R. Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients. Eur Respir J 2001; 18:77.
  26. Stevenson NJ, Calverley PM. Effect of oxygen on recovery from maximal exercise in patients with chronic obstructive pulmonary disease. Thorax 2004; 59:668.
  27. Eves ND, Petersen SR, Haykowsky MJ, et al. Helium-hyperoxia, exercise, and respiratory mechanics in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006; 174:763.
  28. Porszasz J, Emtner M, Goto S, et al. Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD. Chest 2005; 128:2025.
  29. Martinez FJ, de Oca MM, Whyte RI, et al. Lung-volume reduction improves dyspnea, dynamic hyperinflation, and respiratory muscle function. Am J Respir Crit Care Med 1997; 155:1984.
  30. Laghi F, Jubran A, Topeli A, et al. Effect of lung volume reduction surgery on neuromechanical coupling of the diaphragm. Am J Respir Crit Care Med 1998; 157:475.
  31. Lammi MR, Marchetti N, Criner GJ. Reduced dynamic hyperinflation after LVRS is associated with improved exercise tolerance. Respir Med 2014; 108:1491.
  32. O'Donnell DE, Webb KA, Bertley JC, et al. Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema. Chest 1996; 110:18.