Effects of Expiratory Positive Airway Pressure on Exercise Tolerance, Dynamic Hyperinflation, and Dyspnea in COPD

被引:10
|
作者
Gass, Ricardo [1 ,2 ]
Merola, Pietro [1 ,2 ]
Monteiro, Mariane B. [4 ]
Cardoso, Dannuey M. [1 ,2 ]
Paiva, Dulciane N. [5 ]
Teixeira, Paulo J. Z. [3 ,4 ]
Knorst, Marli M. [1 ,2 ]
Berton, Danilo C. [1 ,2 ]
机构
[1] Univ Fed Rio Grande do Sul, Fac Med, Programa Posgrad Ciencias Pneumol, Porto Alegre, RS, Brazil
[2] Hosp Clin Porto Alegre, Serv Pneumol, Porto Alegre, RS, Brazil
[3] Univ Feevale, Novo Hamburgo, RS, Brazil
[4] Univ Fed Ciencias Saude Porto Alegre, Porto Alegre, RS, Brazil
[5] Univ Santa Cruz Do Sul UNISC, Santa Cruz Do Sul, Brazil
关键词
chronic obstructive pulmonary disease; exercise; positive-pressure respiration; inspiratory capacity; dyspnea; respiratory therapy; OBSTRUCTIVE PULMONARY-DISEASE; LUNG HYPERINFLATION; MECHANISMS; ENDURANCE; CAPACITY; PEP;
D O I
10.4187/respcare.05556
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
INTRODUCTION: The application of expiratory positive airway pressure (EPAP) in patients with COPD during exercise may reduce dynamic hyperinflation, while, on the other hand, it can increase the resistive work of breathing. Therefore, we evaluated the effects of 2 intensities of EPAP during exercise on tolerance, dynamic hyperinflation, and dyspnea in subjects with moderate to very severe COPD. METHODS: We performed a cross-sectional, experimental, 4-visit study. In visit 1, subjects performed symptom-limited cycling incremental cardiopulmonary exercise test (CPET). In visits 2-4, at least 48 h apart, in a randomized order, subjects performed constant CPET without EPAP, EPAP with 5 cm H2O (EPAP5), or EPAP with 10 cm H2O (EPAP10). RESULTS: The study included 15 non-hypoxemic subjects ranging from moderate to very severe COPD (mean FEV1 = 35 +/- 11% predicted). Increasing intensities of EPAP during constant CPET tended to cause progressive reduction in exercise tolerance (P = .11). Of note, 10 of 15 subjects demonstrated significantly shorter average exercise duration with EPAP10 compared to the test without EPAP (-151 +/- 105 s, P = .03 or 41 +/- 26%). Minute ventilation increment was constrained by EPAP, secondary to a limited increase in tidal volume (P = .01). Finally, dyspnea sensation and serial measurements of inspiratory capacity during exercise were similar when comparing the three interventions at isotime and at end-constant CPETs. CONCLUSIONS: The application of EPAP5 or EPAP10 during exercise tended to cause a progressive reduction in exercise tolerance in subjects with COPD without improvement in dyspnea or dynamic hyperinflation at equivalent exercise duration.
引用
收藏
页码:1298 / 1306
页数:9
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