Exercise capacity in chronic obstructive pulmonary disease: mechanisms of limitation

Patients with chronic obstructive pulmonary disease (COPD) are often caught in a downward spiral that progresses from expiratory flow limitation to poor quality of life and invalidity. Within this downward spiral, exercise tolerance represents a key intermediate outcome. As recently stated by the GOLD initiative, improvement in exercise tolerance is now rec ognized as an important goal of COPD treatment. This objective will be achieved only by a comprehensive understanding of the mechanism of exercise limitation in this disease. The objective of this paper is to review the mechanisms of exercise limitation in COPD and discuss their relative contribution to exercise intolerance in patients suffering from this disease.