Strategies to reduce exertional dyspnea and increase functional capacity in patients with COPD

"My breathing has not changed, I am still very breathless". It is not uncommon to hear these words from patients with chronic obstructive pulmonary disease despite optimal pharmacological treatment. For these patients, breathlessness becomes a constant experience that worsens over time and becomes frightening. This refractory breathlessness, notably during physical activities, is a real problem as it can reduce adherence to therapeutic strategies such as pulmonary rehabilitation. The primary aim of this thesis is to look at different ways in some component of dyspnoea can be addressed to help patients better tolerate their breathlessness during exercise and improve their functional capacity. The first and second study discuss the effect of nasal high flow during exercise (improving ventilatory efficiency). The third study assess the impact of menthol on exertional dyspnoea (affective component). The fourth study evaluate the effects of an energy conservation technique on breathlessness and on the physiological response when patients with severe COPD climb stairs (reduction of ventilatory demand).