Eylem Sercan ÖZGÜR, Arzu KANIK, Sibel ATIŞ

KOAH’da dinamik hiperinflasyonun egzersiz dispnesi, egzersiz kapasitesi ve yaşam kalitesine etkisi

Kronik obstrüktif akciğer hastalığı (KOAH)’nda dinamik hiperinflasyonun egzersiz performansı ve yaşam kalitesi üzerine olumsuz etkileriyle ilgili kanıtlar giderek artmaktadır. Bu çalışmada, KOAH’lı hastalarda; dinamik hiperinflasyon derecesinin egzersiz kapasitesi, egzersiz dispnesi ve yaşam kalitesine etkisinin değerlendirilmesi amaçlandı. Stabil dönemde olan 72 KOAH’lı (orta-ağır evre) ve 30 sağlıklı, yaş ve cinsiyet karşılaştırması yapılmış kontrol birey çalışmaya dahil edildi. Altı dakika yürüme testi öncesi ve sonrası akciğer volümleri ve solunum kas gücü ölçümlerini de içeren solunum fonksiyon testleri, arter kan gazı analizleri, Borg skalası ile egzersiz dispnesi değerlendirmesi ve yaşam kalitesi anketi (SGRQ: St. George’s Respiratory Questionnaire, Türkçe versiyonu) uygulandı. Dinamik hiperinflasyonu değerlendirmede istirahat düzeyine göre egzersiz sonrasında görülen inspiratuar kapasitedeki değişim (ΔIC) kullanıldı. KOAH’lı hastaların %80’inde IC egzersiz sonrası anlamlı olarak azaldı (dinamik hiperinflasyon). ΔIC, KOAH’lı hastalarda -0.27 ± 0.26 L, kontrol grubunda 0.8 ± 0.17 L bulundu (p= 0.001). Egzersiz dispnesinin (ΔBorg), ΔIC (r= -0.44, p= 0.0001) ve bazal dispne indeksi (BDİ) (r= 0.34, p= 0.02) ile korelasyon gösterdiği saptandı. Çoklu regresyon analizinde KOAH varlığı, BDİ ve ΔIC altı dakika yürüme mesafesi için en güçlü belirleyici faktörler olarak bulundu (r2= 0.53, p< 0.001). FEV1’in bu parametrelere ek olarak egzersiz kapasitesini belirlemedeki katkısı %9 idi. ΔIC ile yaşam kalitesinin semptom (r= -0.36, p= 0.008), aktivite (r= -0.31, p= 0.03) ve total (r= -0.30, p= 0.04) bileşenleri arasında anlamlı ilişki bulundu. KOAH’lılarda egzersiz sırasında sıklıkla dinamik hiperinflasyon geliştiği ve bunun derecesinin egzersiz kapasitesi kısıtlılığını, egzersiz dispnesini ve yaşam kalitesi bozukluğunu açıklamada yardımcı olabilecek önemli bir belirleyici olduğu düşünüldü.

Effect of dynamic hyperinflation on exertional dyspnea, exercise performance and quality of life in COPD

There is increasing evidence that dynamic hyperinflation (DH) have negative effects on exercise performance and quality of life in chronic obstructive pulmonary disease (COPD) patients. The aim of this study was to investigate effect of dynamic hyperinflation on exertional dyspnea, exercise performance and quality of life in patients with COPD. 72 clinically stable patients with moderate to severe COPD and 30 healthy age-matched control subjects were included in this study. Pulmonary function tests including lung volumes and maximal respiratory muscle forces, arterial blood gas analyses, evaluation of exertional dyspnea with the Borg scale, and The Saint George Respiratory Questionnaire (SGRQ, Turkish version) were performed at rest and after a 6-min walk test. We measured the change in inspiratory capacity (ΔIC) after exercise to reflect DH. 80% of patients with COPD significantly decreased IC after exercise (DH). ΔIC were -0.27 ± 0.26 L in COPD and 0.8 ± 0.17 L in controls (p= 0.001). A stepwise multiple regression analysis showed that to be a patient with COPD, Basal Dyspnea Index (BDİ) and ΔIC were the best predictors of 6 MWD (r2= 0.53, p< 0.001). FEV1 added an additinal 9% to the variance in 6 MWD. Exertional dyspnea (ΔBorg) correlated with ΔIC (r= -0.44, p= 0.0001) and BDI (r= 0.34, p= 0.02). ΔIC significantly correlated with symptom (r= -0.36, p= 0.008), activity (r= -0.31, p= 0.03) and total scores (r= -0.30, p= 0.04) of SGRQ. Dynamic hyperinflation can often occur during exersice in patients with COPD. Extent of dynamic hyperinflation could able to explain exercise capacity limitation, exercise dyspnea, and poor quality of life in patients with COPD.

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