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Background: Age- and sex-based reference values for dyspnoea (0-10 Borg scale) as a function of ventilation (V’E) have been recently published (Neder et al.; ERJ 2020 1;56(4)). Increased dyspnoea-V’E may signal important lung mechanical abnormalities with potentially deleterious consequences for exercise tolerance and survival in COPD.

Methods: 300 patients (172 men) with mild to very severe COPD underwent a cardiopulmonary exercise test (CPET). Dyspnoea scores above the 75^th centile at the highest common V’E (25 L/min) indicated “severe” dyspnoea burden. All-cause mortality was assessed up to 20 years after the CPET.

Results: 136 patients (45.3%) died: “severe” dyspnoea-V’E₂₅ was found in 169/300 (56.3%). They presented with greater inspiratory constraints due to higher operating lung volumes at low V’E and poorer exercise tolerance compared to their counterparts (P<0.01). Kaplan-Meier …