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Elevated VE/VCO2 slope predicts higher mortality in hypersensitivity pneumonitis

In patients with hypersensitivity pneumonitis, an elevated VE/VCO2 slope (≥42) was associated with a higher risk of 5-year mortality (HR 3.65; 95% CI 1.04 to 12.80). Restricting analysis to HP patients showed a similar hazard ratio of 5.49 (95% CI 1.19 to 33.54).

Last updated: Jul 14, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Prognostic value of ventilatory efficiency in hypersensitivity pneumonitis.

observational

Chumpagern W, Spagnolo P, Ratanawatkul P, Mohning MP, Fernández Pérez ER · BMJ open respiratory research (2026)

Participants: N/A
Duration: 5 years (follow-up for mortality)
Intervention: Measurement of VE/VCO2 slope during cardiopulmonary exercise testing
Outcome: 5-year mortality
Effect Size: HR 3.65 (95% CI 1.04 to 12.80) for VE/VCO2 slope ≥42; HR 5.49 (95% CI 1.19 to 33.54) in HP-only analysis
Population: Patients with hypersensitivity pneumonitis (non-fibrotic and fibrotic) and idiopathic pulmonary fibrosis as comparison group

Result:

PubMed: 42425739DOI: 10.1136/bmjresp-2026-004221

Mechanism Graph

VE/VCO2 slope reflects ventilatory efficiency
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Higher VE/VCO2 indicates impaired gas exchange and increased dead space ventilation
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Impaired gas exchange is associated with pulmonary fibrosis and pulmonary hypertension
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Result: Higher mortality risk

Limitations

  • ⚠Retrospective cohort design limits causal inference
  • ⚠Small sample size for subgroup analyses (e.g., nfHP n=25)
  • ⚠Potential selection bias from single-center study

Frequently Asked Questions

What does VE/VCO2 slope measure?▼

VE/VCO2 slope measures ventilatory efficiency during exercise, indicating how much ventilation is needed to eliminate carbon dioxide.

What is the threshold for increased mortality risk?▼

A VE/VCO2 slope of 42 or higher was associated with significantly increased mortality risk in HP patients.

Does this apply to both fibrotic and non-fibrotic HP?▼

The study included both types, but the majority of patients had fibrotic HP (66 out of 91 HP patients), and the predictive value was strongest in fibrotic cases.

How does this compare to IPF?▼

The study included IPF as a comparison group, and similar associations between VE/VCO2 and mortality were observed across both HP and IPF.

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References

  1. 1.Chumpagern W, Spagnolo P, Ratanawatkul P, Mohning MP, Fernández Pérez ER. "Prognostic value of ventilatory efficiency in hypersensitivity pneumonitis.." BMJ open respiratory research, 2026. PMID: 42425739 DOI: 10.1136/bmjresp-2026-004221
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.