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Vol. 45. Issue 10.
Pages 487-495 (October 2009)
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Vol. 45. Issue 10.
Pages 487-495 (October 2009)
Original article
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Relationship Between Expiratory Muscle Dysfunction and Dynamic Hyperinflation in Advanced Chronic Obstructive Pulmonary Disease
Relación entre disfunción de los músculos espiratorios e hiperinflación dinámica en la EPOC avanzada
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Susana Motaa,b,
Corresponding author
smota@ono.com

Corresponding author.
, Rosa Güellb, Esther Barreiroc, Pere Casanb, Joaquim Geac, Joaquín Sanchisb
a Unitat de Pneumologia, Servei de Medicina Interna, Hospital Santa Caterina, Salt, Girona, Spain. Departamento de Medicina Interna, Universitat Autònoma de Barcelona, Barcelona, Spain
b Departament de Pneumologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
c Servei de Pneumologia i Grup de Recerca en Múscul i Aparell Respiratori (URMAR), Hospital del Mar-IMIM, Departament CEXS, Universitat Pompeu Fabra, Barcelona, Spain CibeRes, ISC III, Bunyola, Balears, Spain
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Abstract
Background and objectives

Dynamic hyperinflation and expiratory flow limitation, which are physiologically linked phenomena, play a role in the pathophysiology of dyspnea and have a negative impact on quality of life in patients with chronic obstructive pulmonary disease (COPD). The expiratory muscle dysfunction associated with advanced COPD may be involved in the genesis of dynamic hyperinflation. Our objective was to study the relationship between expiratory muscle dysfunction and dynamic hyperinflation and to analyze their association with dyspnea and quality of life in patients with advanced COPD.

Patients and methods

In 25 patients we measured lung function, exercise capacity (measured by incremental ergometry and the 6-minute walk test), expiratory flow limitation and end-expiratory lung volume (EELV) during exercise, respiratory muscle function, dyspnea, and quality of life (using the St George's Respiratory Questionnaire [SGRQ]).

Results

The patients, whose mean forced expiratory volume in 1 second (FEV1) was 31% of predicted, exhibited a moderate decrease in respiratory muscle strength and resistance to fatigue. Expiratory flow limitation was observed in 19 patients at rest and in 24 patients at 70% of maximal workload (Wmax). EELV increased from rest to 70% of Wmax (9% of predicted forced vital capacity). At 70% of Wmax, EELV correlated inversely with expiratory flow limitation (ρ=−0.42), inspiratory (ρ=−0.43) and expiratory (ρ=−0.42) muscle endurance, and maximal oxygen uptake (ρ=−0.52). The increase in EELV from resting to 70% of Wmax correlated with dyspnea (ρ=0.53), and expiratory flow limitation at 70% of Wmax correlated with the activity score on the SGRQ (ρ=−0.56). FEV1, expiratory muscle endurance and expiratory flow limitation were independent predictors of EELV at 70% Wmax.

Conclusion

In advanced COPD, decreased resistance to fatigue in expiratory muscles is associated with an increase in dynamic hyperinflation (and less expiratory flow limitation) during exercise, a pattern that in turn correlates with more severe dyspnea and reduced quality of life.

Keywords:
COPD
Dyspnea
Exercise
Airflow limitation
Health-related quality of life
Hyperinflation
Respiratory muscles
Resumen
Introducción

La hiperinflación dinámica (HD) y la limitación del flujo espiratorio (LFE) están vinculadas fisiológicamente e intervienen en la fisiopatogenia de la disnea y del deterioro de la calidad de vida en la enfermedad pulmonar obstructiva crónica (EPOC). En la EPOC avanzada existe disfunción de los músculos espiratorios, que podría potenciar el desarrollo de HD. El objetivo del presente trabajo ha sido estudiar la relación entre disfunción muscular espiratoria y grado de HD en la EPOC avanzada, y su asociación con disnea y calidad de vida.

Pacientes y métodos

En 25 pacientes determinamos la función pulmonar, la capacidad de esfuerzo (ergometría incremental y prueba de la marcha), la LFE y el volumen telespiratorio (VTE) durante el ejercicio, la función muscular respiratoria, la disnea y la calidad de vida (con el St. George's Respiratory Questionnaire).

Resultados

Los pacientes (volumen espiratorio forzado en el primer segundo del 31% del valor de referencia) tenían moderadamente reducidas la fuerza y la resistencia musculares respiratorias. Diecinueve mostraban LFE en reposo y 24 al 70% de la carga máxima (Wmáx). El VTE aumentó desde el reposo hasta el 70% de la Wmáx (un 9% del valor de referencia de la capacidad vital forzada). Al 70% de la Wmáx el VTE se correlacionó inversamente con la LFE (rho = −0,42), las resistencias musculares inspiratoria (rho = −0,43) y espiratoria (rho = −0,42) y el consumo máximo de oxígeno (rho = −0,52). El incremento del VTE desde reposo hata el 70% de Wmáx se correlacionó con la disnea (rho = 0,53), y –la LFE al 70% de Wmáx con la escala de actividad del St. George's Respiratory Questionnaire (rho = −0,56). Fueron predictores independientes del VTE al 70% de Wmáx el volumen espiratorio forzado en el primer segundo, la resistencia muscular espiratoria y la LFE.

Conclusiones

En la EPOC avanzada la reducción de la resistencia de los músculos espiratorios está relacionada con mayor HD (y menor LFE) durante el ejercicio, lo que se asocia a mayor disnea y peor calidad de vida.

Palabras clave:
EPOC
Disnea
Ejercicio
Limitación del flujo aéreo
Calidad de vida relacionada con la salud
Hiperinflación
Músculos respiratorios
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Preliminary results presented at the Annual SEPAR Congress in Madrid in 2004.

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