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Exercise Induced Arterial Hypoxemia: The role of Ventilation-Perfusion Inequality and Pulmonary Diffusion Limitation

  • Conference paper
Book cover Hypoxia and Exercise

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 588))

Abstract

Many apparently healthy individuals experience pulmonary gas exchange limitations during exercise, and the term “exercise induced arterial hypoxemia” (EIAH) has been used to describe the increase in alveolar-arterial difference for oxygen (AaDO2), which combined with a minimal alveolar hyperventilatory response, results in a reduction in arterial PO2. Despite more than two decades of research, the mechanisms of pulmonary gas exchange limitations during exercise are still debated. Using data in 166 healthy normal subjects collated from several previously published studies it can be shown that ∼20% of the variation in PaO2 between individuals can be explained on the basis of variations in alveolar ventilation, whereas variations in AaDO2 explain ∼80%. Using multiple inert gas data the relative contributions of ventilation-perfusion (“\( \dot V_A /\dot Q \) ”) inequality and diffusion limitation to the AaDO2 can be assessed. During maximal exercise, both in individuals with minimal (AaDO2 < 20 Torr, x = 13±5, means ±SD, n = 35) and moderate to severe (AaDO2= 25–40 Torr, x = 33±6, n = 20) gas exchange limitations, \( \dot V_A /\dot Q \) inequality is an important contributor to the AaDO2. However, in subjects with minimal gas exchange impairment, \( \dot V_A /\dot Q \) inequality accounts for virtually all of the AaDO2 (12±6 Torr), whereas in subjects with moderate to severe gas exchange impairment it accounts for less than 50% of the AaDO2 (15±6 Torr). Using this framework, the difficulties associated with unraveling the mechanisms of pulmonary gas exchange limitations during exercise are explored, and current data discussed.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of California, San Diego, La Jolla, CA, USA

    Susan R. Hopkins

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  1. Susan R. Hopkins
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Editors and Affiliations

  1. Altitude Research Center, University of Colorado Health Sciences Center, Mail Stop F524, PO Box 6508, Aurora, Colorado, 80045-0508

    Robert C. Roach Ph.D. (Research Director) (Research Director)

  2. UCSD Dept Medicine, 0623 9500 Gilman Avenue, La Jolla, CA, 92093-0623

    Peter D. Wagner

  3. Telluride Medical Center, 500 W. Pacific, Telluride, Colorado, 81435

    Peter H. Hackett

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Hopkins, S.R. (2006). Exercise Induced Arterial Hypoxemia: The role of Ventilation-Perfusion Inequality and Pulmonary Diffusion Limitation. In: Roach, R.C., Wagner, P.D., Hackett, P.H. (eds) Hypoxia and Exercise. Advances in Experimental Medicine and Biology, vol 588. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-34817-9_3

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