Kronik Obstrüktif Akciğer Hastaları ile Sağlıklı Bireylerin Solunum İş Yükünün Termodinamik Analizi
Kronik Obstrüktif Akciğer Hastalığı (KOAH) sigara dumanı ve diğer zararlı partiküller nedeniyle akciğer enflamasyonu ve hava yolulimitasyonu ile karakterize bir hastalıktır. Dünya Sağlık Örgütü (DSÖ), yüksek morbidite ve mortaliteye sahip KOAH nedenli ölümlerin2030 yılında üçüncü sırada olacağını öngörmektedir. Havayolu limitasyonu ve respiratuvar kasların yapısal ve fonksiyonel olarakdeğişmesi solunum kas kuvvetinde azalmaya neden olarak solunum iş yükünü arttırır. Respiratuvar kasların termodinamik analizi ile,iş veriminin azalmasına yol açan enerji kayıplarının ölçülmesi (entropi) ve maksimum yararlı işin (ekserji) yıkımı hesaplanabilmektedir.Bu çalışmada, KOAH hastaları ile sağlıklı bireylerin solunum kas işlerinin termodinamik analizle karşılaştırılması amaçlanmıştır.Respiratuvar kasların yaptığı işe termodinamiğin birinci ve ikinci kanunları uygulanmıştır. KOAH’ lı hastaların ve sağlıklı bireylerinrespiratuvar kaslarında termodinamik analizler kütle, enerji, ekserji ve entropi balansları uygulanarak yapılmıştır. KOAH’lı hastalar ilesağlıklı bireylerin solunum iş yükünün termodinamik analizi sonucunda ekserji yıkımı sırasıyla 1.23x10-2 kJ/min ile 6.01x10-3 kJ/minolarak hesaplanmıştır. Entropi üretimi ise KOAH’lı hastalarda 4.12x10-5 (kJ/K)/min iken sağlıklı bireylerde 2.02x10-5 (kJ/K)/minolduğu görülmüştür. Enerji dengesi analizi sonuçlarına göre solunum işi için harcanan glikoz miktarları KOAH’lı ve sağlıklı bireyleriçin sırasıyla 0.32-0.16 mmol/min olarak hesaplanmıştır. Bu termodinamik analiz ile, KOAH hastası bireylerde respiratuvar kaslarınyaptığı iş yükünün artmasıyla ekserji yıkımı ve entropi üretiminin arttığı belirlenmiştir. Enerji dengesi analizlerinin sonuçlarınabakıldığında, solunum işi için KOAH hastası bir bireyin, sağlıklı bireye göre 2 kat daha fazla glikoz kullandığı görülmüştür. KOAHhastalarında entropi üretimi ve ekserji yıkımı sağlıklı bireylere göre yüksek olduğundan, bu hastalarda entropi artışının dokulardakihasarla sonuçlanacağı ve sağlıklı yaşlanma üzerinde olumsuz etkileri olacağı düşünülmektedir.
Thermodynamic Analysis of Work of Breathing of Healthy Individuals and Patients with Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by lung inflammation and airway limitation due to cigarette smoke and other harmful particles. World Health Organization (WHO) predicts that COPD with high morbidity and mortality will become the third leading cause of death worldwide by 2030. Airway limitation and structural and functional changes of respiratory muscles decrease respiratory muscle strength and increase work of breathing. By the thermodynamic analysis of the respiratory muscles, the measurement of energy losses (entropy) and the destruction of the maximum useful work (exergy) can be calculated. The aim of this study was to compare the work of respiratory muscles of patients with COPD and healthy individuals by thermodynamic analysis. Thermodynamic analyses were performed by applying the first and second laws of thermodynamics to the work done by respiratory muscles. Thermodynamic analyses of respiratory muscles of COPD patients and healthy individuals were performed by mass, energy, exergy and entropy balances. As a result of the thermodynamic analysis of the work of breathing of COPD patients and healthy subjects, exergy destruction was calculated as 1.23x10-2 kJ/min and 6.01x10-3 kJ/min respectively. Entropy generation was 4.12x10-5 (kJ/K)/min in individuals with COPD while 2.02x10-5 (kJ/K)/min in healthy individuals. According to the results of energy balance analysis, the amount of glucose consumed for work of breathing was calculated as 0.32-0.16 mmol/min for COPD and healthy subjects, respectively. With this thermodynamic analysis, it was determined that the exergy destruction and entropy generation increased with the increase of work of breathing in patients with COPD.
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- Adams PF, Hendershot GE, Marano MA., 1996. Current
estimates from the National Health Interview Survey,. National
Center for Health Statistics. Vital Health Stat 1991; 200: 93.
- Alvar, G., Agusti, N. 2005. Systemic Effects of Chronic
Obstructive Pulmoner Disease. Proceedings of the American
Thoracic Society, 2,367-370.
- Agusti, A. 2007. Systemic effects of chronic obstructive
pulmonary disease: what we know and what we don't know (but
should). Proceedings of the American Thoracic Society, 4 (7),
522-525.
- Aoki, I. 1994. Entropy Production in Human Life Span: A
Thermodynamical Measure for Aging. Age, 17:29-31.
- Balmer, R.T. 1982. Entropy and Aging in Biological Systems.
Chemical Engineering Communications, 17:171-181.
- Boregowda, S.C., Choate, R.E., Handy, R. 2012. Entropy
Generation Analysis of Human Thermal Stress Responses.
ISRN Thermodynamics.
- Cabello, B., Mancebo, J. 2012. Work of breathing. In Applied
Physiology in Intensive Care Medicine 1 (pp. 11-14). Springer,
Berlin, Heidelberg.
- Celli, B.R., MacNee, W.,Force, A.E.T. 2004. Standards for the
diagnosis and treatment of patients with COPD: a summary of
the ATS/ERS position paper. European Respiratory Journal, 23
(6), 932-946.
- Crisafulli, E., Costi, S., Fabbri, L.M.,Clini, E.M. 2007.
Respiratory muscles training in COPD patients. International
Journal of Chronic Obstructive Pulmonary Disease, 2 (1), 19-
25.
- Çatak, J., Develi, A. C., Sorguven, E., Özilgen, M., Inal, H. S.
2015. Lifespan entropy generated by the masseter muscles
during chewing: an indicator of the life expectancy?.
International Journal of Exergy, 18(1), 46-67.
- Çatak, J., Özilgen, M., Olcay, A. B., Yılmaz, B. 2018.
Assessment of the work efficiency with exergy method in
ageing muscles and healthy and enlarged hearts. International
Journal of Exergy, 25(1), 1-33.
- de Marco R, Accordini S, Marcon A, et al., 2011. Risk factors
for chronic obstructive pulmonary disease in a European cohort
of young adults. European Community Respiratory Health
Survey (ECRHS). Am J Respir Crit Care Med 183:891-7.
- Dincer, I., Cengel, Y. A. 2001. Energy, entropy and exergy
concepts and their roles in thermal engineering. Entropy, 3(3),
116-149.
- Gayan-Ramirez, G., Koulouris, N., Roca, J., Decramer, M. .
2006. Respiratory and skeletal muscles in chronic obstructive
pulmonary disease. European Respiratory Journal, 38, 201-223.
- Gea, J., Agusti, A.,Roca, J. 2013. Pathophysiology of muscle
dysfunction in COPD. Journal of Applied Physiology, 114 (9),
1222- 1234.
- Genc, S., Sorguven, E., Kurnaz, I. A., Ozilgen, M. 2013.
Exergetic efficiency of ATP production in neuronal glucose
metabolism. International Journal of Exergy, 13(1), 60-84.
- Guyton, A., Hall, J. 2011. In: Textbook of Medical Physiology,
12th edition, Elsevier Saunders, Philadelphia.
- Hayflick, L. 2007. Entropy Explains Aging, Genetic
Determinism Explains Longevity, and Undefined Terminology
Explains Misunderstanding Both. PLoS Genetics, 3:2351-
2354.
- Henriques, I. B., Mady, C. E. K., Neto, C. A., Yanagihara, J. I.,
Junior, S. O. 2014. The effect of altitude and intensity of
physical activity on the exergy efficiency of respiratory system.
International Journal of Thermodynamics, 17(4), 265-273.
- Jubrias, S. A., Vollestad, N. K., Gronka, R. K., Kushmerick, M.
J. 2008. Contraction coupling efficiency of human first dorsal
interosseous muscle. The Journal of physiology, 586(7), 1993-
2002.
- Luo, L.F. 2009. Entropy Production in a Cell and Reversal of
Entropy Flow as an Anticancer Therapy. Frontiers of Physics in
China, 4:122-136.
- Maclntyre, N.R. 2008. Mechanisms of functional loss in
patients with chronic lung disease. Respiratory Care, 53 (9),
1177-1184.
- Mady, C. E. K., Ferreira, M. S., Yanagihara, J. I., Saldiva, P. H.
N., de Oliveira Junior, S. 2012. Modeling the exergy behavior
of human body. Energy, 45(1), 546-553.
- Mannino, D.M.,Davis, K.J. 2006. Lung function decline and
outcomes in an elderly population. Thorax, 61 (6), 472-477.
- Martinez Garcia, M., Une, R. Y., de Oliveira Junior, S.,
Keutenedjian Mady, C. E. 2018. Exergy Analysis and Human
Body Thermal Comfort Conditions: Evaluation of Different
Body Compositions. Entropy, 20(4), 265.
- Mathers, C. D., Loncar, D. 2006. Projections of global mortality
and burden of disease from 2002 to 2030. PLoS medicine,
3(11), e442.
- Mirici, A., Kocabaş, A. 2008. Tanımdan tedaviye kronik
obstrüktif akciğer hastalığı. İstanbul: Galenos Yayıncılık.
Molnar, J., Thornton,B.S., Thornton-Benko, E., Varga, Z.G.
2011. The Second Law of Thermodynamics and Host-tumor
Relationships: Concepts and Opportunities. INTECH Open
Access Publisher.
- Neto, C.A., Pellegrini, L.F., Ferreira, M.S., de Oliveira Jr,
Yanagihara, J.I. 2010. Exergy Analysis of Human Respiration
Under Physical Activity. International Journal of
Thermodynamics, 13:105-109.
- Özilgen M. 2011. Handbook of Food Process Modeling and
Statistical Quality Control, CRC Books. 2nd ed. Taylor and
Francis.
- Özilgen, M. 2018a. Nutrition and production related energies
and exergies of foods. Renewable and Sustainable Energy
Reviews, 96, 275-295.
- Özilgen, M. 2018b. Assessment of nutrition with Dincer's 6‐
step approach of exergization. International Journal of Energy
Research, 42(12), 3707-3710.
- Pollack, G. H. 1990. Muscles & molecules: uncovering the
principles of biological motion (pp. 9-38). Seattle, WA: Ebner
& Sons Publishers.
- Prigogine, I., Wiame, J.M. 1946. Biologie et
Thermodynamique des Phénomènes Irréversibles. Experientia,
2:451-453.
- Rahman, M.A. 2007. A Novel Method for Estimating the
Entropy Generation Rate in a Human Body. Thermal Science,
11:75-92.
- Schrödinger, E. 1944.What is life?: the physical aspect of the
living cell; based on lectures delivered under the auspices of the
Inst. at Trinity College, Dublin, in Feb. 1943. Cambridge
University Press, Cambridge.
- Semerciöz, A. S., Yılmaz, B., Özilgen, M. 2018. Entropy
generation behaviour of the lean and obese rats shows the effect
of the diet on the wasted life span work. International Journal
of Exergy, 26(3), 359-391.
- Shelledy, D. C., Peters, J. I. (Eds.). 2014. Respiratory Care:
Patient Assessment and Care Plan Development. Jones &
Bartlett Publishers.
- Silva, C., Annamalai, K. 2008. Entropy Generation and Human
Aging: Lifespan Entropy and Effect of Physical Activity Level.
Entropy, 10:100-123.
- Silva, C.A. and Annamalai, K. 2009. Entropy Generation and
Human Aging: Lifespan Entropy and Effect of Diet
Composition and Caloric Restriction Diets. Journal of
Thermodynamics.
- Sorguven Oner, E., Ozilgen, M. 2015. First and second law
work production efficiency of a muscle cell. International
Journal of Exergy, 18(2), 142-156.
- Spanghero, G. M., Albuquerque, C., Lazzaretti Fernandes, T.,
Hernandez, A. J., Keutenedjian Mady, C. E. 2018. Exergy
Analysis of the Musculoskeletal System Efficiency during
Aerobic and Anaerobic Activities. Entropy, 20(2), 119.
- T.C. Sağlık Bakanlığı 2004. RSHMB Hıfzıssıhha Mektebi
Müdürlüğü. Türkiye Hastalık Yükü Çalışması. Ankara:
Aydoğdu Ofset; 2006. Sağlık Bakanlığı Yayın No: 701.
- Von Stockar, U., Liu, J.S. 1999. Does Microbial Life Always
Feed on Negative Entropy? Thermodynamic Analysis of
Microbial Growth. Biochimica et Biophysica Acta (BBA)-
Bioenergetics, 1412:191-211.
- Whittemore AS, Perlin SA, DiCiccio Y., 1995. Chronic
obstructive pulmonary disease in lifelong nonsmokers: results
from NHANES. Am. J. Public Health 85:702–6.
- WHO 2004. World Health Organization. The Global Burden of
Disease: 2004, Update. Geneva (2004).
- WHO 2008. World Health Organization. World Health Statics.
COPD predicted to be third leading cause of death in 2030.
http://www.who.int/respirotory/copd/World_Health_Statisitics
. Erişim tarihi: 28 Eylül, 2018.
- Yalçınkaya, B. H., Erikli, Ş., Özilgen, B. A., Olcay, A. B.,
Sorgüven, E., Özilgen, M. 2016. Thermodynamic analysis of
the squid mantle muscles and giant axon during slow swimming
and jet escape propulsion. Energy, 102, 537-549.
- Zotin, A.I., Zotina, R.S. 1967. Thermodynamic Aspects of
Developmental Biology. Journal of Theoretical Biology, 17:57-
75.