Ferda ÖNER, Gülseren KARABIYIKOĞLU, Sevgi SARYAL, Öznur AKKOCA, Elif ŞEN

Hafif ve orta şiddetteki kronik obstrüktif akciğer hastalıklarında egzersiz kapasitesi

Kronik obstrüktif akciğer hastalığı (KOAH) olan olgularda egzersiz kapasitesi azalabilmektedir. Egzersiz testi, egzersiz kapasitesindeki azalmayı ve fonksiyonel değişiklikleri objektif olarak gösteren iyi bir testtir. Yapılan çalışmalarda solunum fonksiyon testleri (SFT) ile egzersiz testi parametreleri karşılaştırıldığında, büyük değişkenliklerin olduğu gözlenmektedir. Bu nedenle, bu olgularda semptom sınırlı egzersiz testinin sonuçlarını analiz etmek, SFT ve arter kan gazları (AKG) parametreleriyle ilişkisini araştırmak amacıyla 20 KOAH olan olgu ve 12 sağlıklı kontrol olgusu çalışmaya alındı. KOAH olgularının tümü nefes darlığı nedeniyle testi sonlandırdı. Bu olgulardaki pik (zirve) oksijen tüketimi (pik VO2) ve iş yükü, kontrol grubundan anlamlı olarak düşüktü (KOAH grubunda: Pik VO2: 1.03 ± 0.32 L/dakika, kontrol grubunda: Pik VO2: 2.31 ± 0.50 L/dakika) (p< 0.001). KOAH olgularında egzersizle tidal volüm (VT) ve solunum sayısı artarken (p< 0.001), inspirasyon süresi/total nefes süresi (Ti/Ttot) oranında değişiklik gözlenmedi. Yine PaO2 ve PaCO2'de değişiklik olmazken, pH'da anlamlı azalma vardı (p< 0.001). Pik VO2 ile; DLCO (%), Pimax (%), dakika ventilasyonu VT, Ti, Ttot, VT/VC (%) arasında, pik iş yükü ile; FEV1/FVC (%), FEF75 (%), VC, Pimax (%), PaO2, SaO2 arasında önemli derecede ilişki vardı (p< 0.05, p< 0.01). Sonuç olarak, hafif-orta şiddetteki KOAH olgularında, pik oksijen tüketimi ve iş yükü azalmaktadır ve buna bağlı olarak egzersiz kapasitesi de kısıtlanmaktadır. Bu olgularda egzersiz kısıtlanmasının özellikle hava akım hızları, difüzyon kapasitesi, inspiratuvar solunum kas gücü, solunum paterni ve arter kan gazları parametreleriyle ilişkili olduğu gösterildi.

Exercise capacity in mild-moderate chronic obstructive pulmonary disease

Exercise capacity decreases in patients with chronic obstructive pulmonary disease (COPD). Exercise testing is an accurate test, in the determination of limitation of exercise capacity and functional changes, objectively. Certain studied showed great variability when pulmonary function test (PFT) parameters are correlated with exercise testing capacity. The aim of this study was to analyze the results of symptom-limited exercise testing and the relationship between these results and PFT and arterial blood gases (ABG) parameters in 20 patients with COPD and 12 healthy controls. All patients with COPD ceased exercise testing because of dyspnea. Peak oxygen consumption (peak VO2) and work in patients with COPD was significantly lower than that in controls (peak VO2: 1.03 ± 0.32 L/min in patient with COPD, peak VO2: 2.31 ± 0.50 L/min in controls) (p< 0.001). Inspiratory duty cycle (Ti/Ttot) did not show any significant change during exercise, whereas tidal volume (VT) and frequency increased (p< 0.001). Also PaO2 and PaCO2 did not show significant change whereas pH decreased significantly p< 0.001. There was significant correlation between peak VO2 and DLCO (pred%), Pimax (pred%), minute ventilation, VT, Ti, Ttot, VT/VC (%). Also peak work showed significant correlation with FEV1/FVC (%), FEF75 (pred%), VC, Pimax (pred%), PaO2, SaO2 (p< 0.05, p< 0.01). In conclusion, in patients with mild-moderate COPD, the decrease peak oxygen consumption and work indicator of decreased exercise capacity. In these patients, exercise limitation seemed to be correlated with airflow rates, diffusing capacity, inspiratory muscle strength, breathing pattern and ABG parameters.

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