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Case 1

Clinical Findings

This 22-year-old apprentice was evaluated because of complaints of dyspnoea. He stated that he had been unable to play a full game of rugby for the last 3 years and that he gets out of breath and has to stop after climbing three to four flights of stairs at work. He never smoked. He denied cough, chest pain, oedema, or other symptoms. Physical, X-rays, and laboratory examinations were normal.

Exercise Findings:

The patient performed exercise on a cycle ergometer. He pedalled at 60rpm without added load for 3minutes. The work rate was then increased 20W per minute to his symptom-limited maximum. He stopped exercise because of general fatigue. Resting and exercise ECGs were normal.

Selected Respiratory Function Data – were all within normal limits

Measurement	Predicted	Measured
Age, yr		22
Sex		Male
Height, cm		189
Weight, kg		76
Hb, g/L	[130-165 g/L]	154
VC, L	3.30	4.30
IC, L	2.20	2.80
TLC, L	4.52	5.30
FEV1, L	2.66	3.52
FEV1/VC, %	81	80
MVV, L/min	127	124
DLCO, ml/mm HG/Min	22.4	29.8

Selected Exercise Data

Measurement	Predicted	Measured
Exercise duration		13:09
Peak workload	262	254
RER at end		1.22
VO2peak (max) (mL/kg/min)	42.5	46.3 (109%)
VO2 at AT		28.4 (67%)
VE/VCO at AT		25
Maximum VE, L.min	209.0	108.4 (52%)
Breathing Reserve		48%
BP (rest, max)		110/70; 180/60
ECG (rest, max)		82; 194 (98%)
Vd/Vt		0.28 – 0.09
VE/VCO2 slope		26.34
O2 pulse		14 – 18