Diagnostic Performance of Cardiopulmonary Exercise Testing (CPET) in Chronic Obstructive Pulmonary Disease (COPD) at a Tertiary Hospital in Indonesia

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a major global health burden. Spirometry is the diagnostic gold standard but has limitations for functional assessment. CPET provides a comprehensive evaluation of integrated cardiopulmonary and metabolic responses during exercise and may improve diagnostic and management decisions in COPD. This study aim to determine the diagnostic quality of CPET parameters for COPD.

Methods: Observational analytic cross-sectional study using synchronized spirometry and CPET data from medical records at Universitas Sebelas Maret Hospital. Thirty-seven eligible records were analyzed after ethics approval. CPET parameters included VO₂max, respiratory exchange ratio (RER), and VE/VCO₂ slope. Discrimination was assessed with AUC; diagnostic performance used chi-square; correlation with obstruction severity used GOLD classification (p<0.05).

Results: Of 37 subjects, 23 had COPD; COPD status was significantly associated with older age and smoking (both p<0.05). VO₂max (sensitivity = 73.9%; specificity = 78.6%), RER (78.3%; 78.6%), and VE/VCO₂ slope (78.3%; 71.4%) showed useful discrimination (AUC = 0.795, 0.846, and 0.742; χ² p = 0.002, 0.001, and 0.003, respectively). Among CPET parameters, RER correlated significantly with obstruction severity by GOLD (p<0.05), while VO₂max and VE/VCO₂ slope did not (p>0.05), though trends were worse with more severe disease.

Conclusion: Spirometry and CPET together aid diagnosis, evaluation, and prognostication in COPD; combining them may enhance comprehensive management.