Inspiratory Capacity, Dynamic Hyperinflation,  Breathlessness, and Exercise Performance during the 6-Minute-Walk Test in Chronic Obstructive Pulmonary Disease

Marı́n, José Marı́a; Carrizo, Santiago; Gascón, Maria Rita Polo; Sanchez, A.; Gallego, Begoña Carazo; Celli, Bartolomé R.

doi:10.1164/ajrccm.163.6.2003172

Cited by 348 publications

(245 citation statements)

References 29 publications

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“…This flow limitation leads to dynamic hyperinflation of the lungs that is present at rest and worsens with exercise as respiratory rate and flows increase [18,22,23,25]. Dyspnoea increases with the degree of hyperinflation and decreases with therapies that reduce hyperinflation [18,[26][27][28]. Treatment of severe COPD with both albuterol and ipratropium bromide results in less dyspnoea at rest and exercise and improved exercise performance.…”

Section: Discussionmentioning

confidence: 99%

Airway inflammation in COPD: physiological outcome measures and induced sputum

Crapo

Jensen²,

Hargreave³

2003

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a result of airway inflammation, and the best predictor of COPD is the early detection of airflow limitation by spirometry. The Global Initiative for Obstructive Lung Disease Workshop Report defines airflow limitation using simple spirometric indices. Available guidelines categorise the severity of COPD using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), with symptoms playing a minor role in the assessment.Current standards define COPD by progressive loss of FEV1, and thus longitudinal decline in FEV1 will be the primary outcome variable for intervention studies aimed at preventing or reducing the loss of pulmonary function. There is evidence, however, that the variable FEV1/FVC and FEV1 are often not measured properly in all settings.This article will discuss the roles of physiological measurements in diagnosing COPD and physiological outcome measures for COPD. It does not formally compare physiological measures with other outcome measures, such as symptoms or quality of life. Additionally, improved treatment of established disease requires a better understanding of the inflammatory process and its clinical effects and treatment.The inflammatory process, and how drugs affect it, can be studied noninvasively or relatively noninvasively by using refined methods of examining spontaneous or induced sputum. Enhanced understanding of the use of induced sputum will assist in predicting patients9 responses to short-and long-term inhaled corticosteroid treatment, and the methods of sputum examination need to be simplified so that they can be applied more easily to clinical practice. Eur Respir J 2003; 21: Suppl. 41, 19s- Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Obstructive Lung Disease (GOLD) as a "disease state characterised by airflow limitation that is not fully reversible. …The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases" [1]. The absence of reversibility tends to exclude asthma by definition, although asthma can coexist with COPD. Methods of assessing airflow limitation: current recommendations and their limitationsAvailable guidelines categorise the severity of COPD primarily by using forced expiratory volume in one second (FEV1), whereas symptoms play a minor role in the assessment [1][2][3][4][5]. This tight link between FEV1 and COPD reflects the fact that spirometry is the standard for defining the presence of airway obstruction and the progressive loss of FEV1, the physiological variable that characterises COPD severity and predicts its mortality. Spirometry has become the standard, in part, because good quality and inexpensive tests are widely available.The GOLD Workshop Report explicitly defines airflow limitation using simple spirometric indices. Specifically, airflow limitation is defined as an FEV1/forced vital capacity (FVC)v70% and a postbronchodilator FEV1v80% of predict...

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Section: Discussionmentioning

confidence: 99%

Airway inflammation in COPD: physiological outcome measures and induced sputum

Crapo

Jensen²,

Hargreave³

2003

Eur Respir J

View full text Add to dashboard Cite

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“…Esses resultados concordam com a literatura pertinente, na qual se observam adaptações metabólicas e morfológicas das fibras musculares com a preservação da força diafragmática em pacientes com DPOC, mesmo diante do encurtamento das fibras musculares devido à hiperinsuflação (15) . A correlação entre o Tc6 e parâmetros como sobrevida, função pulmonar, qualidade de vida e capacidade cognitiva já vem sendo discutida amplamente pela literatura (1,6,16) . Em estudo prospectivo, Bowen et al (17) afirmaram que os pacientes portadores de DPOC que apresentam maior distância percorrida no Tc6 possuem maior sobrevida, em relação aos que têm pior rendimento neste teste.…”

Section: Discussionunclassified

“…Em estudo prospectivo, Bowen et al (17) afirmaram que os pacientes portadores de DPOC que apresentam maior distância percorrida no Tc6 possuem maior sobrevida, em relação aos que têm pior rendimento neste teste. Ainda mais, o Tc6 foi considerado melhor preditor de sobrevida que os parâmetros tradicionais, como a necessidade da oxigenioterapia a longo prazo e a gravidade da obstrução ao fluxo aéreo avaliado pelo VEF 1 . Em nosso estudo, o Tc6 correlacionou-se de forma significativa (p < 0,05) com o VEF 1 , sugerindo que a utilização do Tc6 pode auxiliar na avaliação da deterioração da função pulmonar, da sobrevida e do nível de funcionalidade física dos portadores de DPOC.…”

Section: Discussionunclassified

“…Esse auxílio favorece a contração diafragmática, a ventilação pulmonar e, conseqüentemente, a capacidade físi-ca do paciente portador de DPOC. Este estudo apresenta limitações que devem ser consideradas. A espirometria não contemplou os volumes pulmonares e a capacidade de difusão do monóxido de carbono (D L CO), sabidamente, importantes fatores relacionados ao desempenho físico na DPOC (1,15) .…”

Section: Discussionunclassified

“…O paciente portador de doença pulmonar obstrutiva crônica (DPOC) pode ter redução importante da sua capacidade física devido a vários fatores, tais como: hiperinsuflação dinâmica e aumento do metabolismo muscular glicolítico, acompanhado de descondicionamento físico progressivo associado à inatividade (1) . Na estimativa da limitação ventilatória e do prognóstico desses pacientes, são largamente utilizadas a espirometria e a gasometria arterial (2) .…”

Section: Introductionunclassified

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