ReviewRespiratory physiology & neurobiology2015
Submissive hypercapnia: Why COPD patients are more prone to CO2 retention than heart failure patients.
Review in Respiratory physiology & neurobiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
18 citing papers in PubMed, 42 citations in OpenAlex.
- Therapeutic hypercapnia after cardiac arrest: still promising or time to move on?Intensive care medicine experimental · 2026Review
- Sex Differences in Long-Term Survival of Chronic Obstructive Pulmonary Disease Patients following Initiation of Home Noninvasive Ventilation after Acute Hospitalization due to Respiratory Failure.Respiration; international review of thoracic diseases · 2026Article
- Development and validation of a nomogram based on immune-inflammation-nutrition indictors for predicting 28-day mortality in sepsis patients with severe fungal pneumonia.Frontiers in cellular and infection microbiology · 2026Article
- Prevalence and clinical correlates of chronic obstructive pulmonary disease in heart failure patients: a cross-sectional study in China.Frontiers in medicine · 2025Article
- The rate of hypercapnic respiratory failure in a pulmonary function test laboratory database.ERJ open research · 2024Article
- Chronic moderate hypercapnia suppresses ventilatory responses to acute CO<sub>2</sub> challenges.Journal of applied physiology (Bethesda, Md. : 1985) · 2022Article
- Hypercapnia in COPD: Causes, Consequences, and Therapy.Journal of clinical medicine · 2022Review
- Associations of the distance-saturation product and low-attenuation area percentage in pulmonary computed tomography with acute exacerbation in patients with chronic obstructive pulmonary disease.Frontiers in medicine · 2022Article
- Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications.European respiratory review : an official journal of the European Respiratory Society · 2021Review
- Ventilatory efficiency in athletes, asthma and obesity.European respiratory review : an official journal of the European Respiratory Society · 2021Review
- Carotid body chemosensitivity is not attenuated during cold water diving.American journal of physiology. Regulatory, integrative and comparative physiology · 2021Article
- Exercise Capacity, Ventilatory Response, and Gas Exchange in COPD Patients With Mild to Severe Obstruction Residing at High Altitude.Frontiers in physiology · 2021Article
- Overlap syndrome: the coexistence of OSA further impairs cardiorespiratory fitness in COPD.Sleep & breathing = Schlaf & Atmung · 2020Article
- Carotid body chemosensitivity at 1.6 ATA breathing air versus 100% oxygen.Journal of applied physiology (Bethesda, Md. : 1985) · 2020Article
- The role of phenotype on ventilation and exercise capacity in patients affected by COPD: a retrospective study.Multidisciplinary respiratory medicine · 2020Article
- Advances in the Evaluation of Respiratory Pathophysiology during Exercise in Chronic Lung Diseases.Frontiers in physiology · 2017Review
- Type III-IV muscle afferents are not required for steady-state exercise hyperpnea in healthy subjects and patients with COPD or heart failure.Respiratory physiology & neurobiology · 2015Article
- Muscle and cerebral oxygenation during cycling in chronic obstructive pulmonary disease: A scoping review.Chronic respiratory diseaseArticle
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
Patients with late-stage chronic obstructive pulmonary disease (COPD) are prone to CO2 retention, a condition which has been often attributed to increased ventilation-perfusion mismatch particularly during oxygen therapy. However, patients with mild-to-moderate COPD or chronic heart failure (CHF) also suffer similar ventilatory inefficiency but they remain near-normocapnic at rest and during exercise with an augmented respiratory effort to compensate for the wasted dead space ventilation. In severe COPD, the augmented exercise ventilation progressively reverses as the disease advances, resulting in hypercapnia at peak exercise as ventilatory limitation due to increasing expiratory flow limitation and dynamic lung hyperinflation sets in. Submissive hypercapnia is an emerging paradigm for understanding optimal ventilatory control and cost/benefit decision-making under prohibitive respiratory chemical-mechanical constraints, where the need to maintain normocapnia gives way to the mounting need to conserve the work of breathing. In severe/very severe COPD, submissive hypercapnia epitomizes the respiratory controller's 'can't breathe, so won't breathe' say-uncle policy when faced with insurmountable ventilatory limitation. Even in health, submissive hypercapnia ensues during CO2 breathing/rebreathing when the inhaled CO2 renders normocapnia difficult to restore even with maximal respiratory effort, hence the respiratory controller's 'ain't fresh, so won't breathe' modus operandi. This 'wisdom of the body' with a principled decision to tolerate hypercapnia when faced with prohibitive ventilatory or gas exchange limitations rather than striving for untenable normocapnia at all costs is analogous to the notion of permissive hypercapnia in critical care, a clinical strategy to minimize the risks of ventilator-induced lung injury in patients receiving mechanical ventilation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.