Berna KÖMÜRCÜOĞLU, İlknur NAZ, Yelda VAROL, Hülya ŞAHİN

Obezitenin koah’lı hastalarda dispne, egzersiz kapasitesi, yürüme işi ve iş yükü üzerine etkisi

ET Obezitenin KOAH'lı hastalarda dispne, egzersiz kapasitesi, yürüme işi ve iş yükü üzerine etkisiGiriş: Kronik obstrüktif akciğer hastalığı (KOAH) ve obezite tüm dünyada mortalite ve morbiditeye neden olan önemli birer halk sağlığı sorunudur. KOAH ve obezite birlikteliğinin önümüzdeki yıllarda daha da artacağı tahmin edilmektedir. Obezite öncelikle solunum fonksiyonlarını, egzersiz kapasitesini, akciğer gazı değişimini ve solunum kaslarının dayanıklılığını ve gücünü değiştirerek pulmoner sistemi etkiler. Bu çalışmada obez KOAH'lı hastalardaki dispne algısı, egzersiz kapasitesi, yürüme işi ve iş yükü değerlerini preobez ve normal kilolu KOAH'lı hastalara göre karşılaştırmayı amaçladık.Materyal ve Metod: Çalışmaya 218 KOAH'lı hasta dahil edildi. Hastaları vücut kitle indeksi (VKİ) hesaplandı, Dünya Sağlık Örgütü (DSÖ) kriterlerine göre normal kilolu (VKİ= 18.5-24.9 kg/m2), pre-obez (VKİ= 25-29.9 kg/m2) ve obez (VKİ= 30-39.9 kg/m2) olmak üzere gruplandırıldı. Bütün hastalara solunum fonksiyon testleri ve arteryel kan gazı analizi yapıldı.Hastaların dispne algısını değerlendirmek için mMRC dispne skalası kullanıldı. Hastaların egzersiz kapasiteleri 6 dakika yürüme testi ile belirlendi. Yürüme işi ve iş yükü, yürüme mesafesine göre hesaplandı. Elde edilen değerler üç grup arasında karşılaştırıldı..Bulgular: KOAH'lı hastaların 72'si normal kilolu, 80'i pre-obez ve 66'sı obezdi. KOAH'lı obez hastaların solunum fonksiyon testlerinde FEV/FVC oranı ve TLCO değeri anlamlı derecede yüksek, VC değeri ise anlamlı derecede düşük bulundu (p= 0.001, p< 0.001, p= 0.01). Arteryel kan gazı değerlerinden; parsiyel karbondioksit basıncı obez KOAH'lılarda diğer hastalara göre anlamlı derecede yüksek bulundu (p= 0.001). Dispne algılarıve yürüme mesafeleri ise gruplar arasında anlamlı farklılık göstermiyordu. Yürüme işi ve iş yükü obez KOAH'lı hastalarda anlamlı olarak daha yüksekti (p< 0.001, p= 0.005).Sonuç: Obezite, KOAH'lı hastaların kan gazında ve solunum fonksiyon testlerinde kısmi değişimlere neden olur. Aynı zamanda yürüme işini ve iş yükünü artırır. Tüm bu değişimlere rağmen dispne algısı ve egzersiz kapasitesi üzerinde olumsuz etkiye sahip değildir

The effect of obesity on dyspnea, exercise capacity, walk work and workload in patients with COPD

Introduction: COPD and obesity are major public health problems that cause mortality and morbidity all over the world. The combined of COPD and obesity is predicted to increase further in the coming years. Obesity primarily affects the pulmonary system by altering respiratory functions, exercise capacity, pulmonary gas exchange, and endurance and power of respiratory muscles. In this study, we aimed to compare the dyspnea sensation, exercise capacity, walk work and workload in obese COPD patients compared to preobese and normal overweight COPD patients.Materials and Methods: 218 patients with COPD were included in the study. According to the WHO criteria for body mass index (BMI), the patients were classified as normal-weight (BMI=18.5-24.9 kg/m2), pre-obese (BMI= 25-29.9 kg/m2) and obese (BMI= 30-39.9 kg/m2). All patient respiratory function tests and arterial blood gas analysis were performed. The mMRC dyspnea scale was used to assess the dyspnoea of the patients. The exercise capacities of the patients were determined by the 6-min walking test. Walk work and workload were calculated based on 6 minutes walking distance. The obtained values were compared between the three groups.Results: The FEV/FVC ratio and TLCO value in pulmonary function tests are significantly higher in obese COPD patients than in other patients, while the VC value is significantly lower in patients with COPD (p= 0.001, p< 0.001, p= 0.01). Partial carbon dioxidewas significantly higher in obese COPD patients compared to other patients (p= 0.001). Dyspnea perceptions and walking distances did not differ significantly between groups. Walkwork and workload were significantly higher in obese COPD patients (p< 0.001, p= 0.005).Conclusion: Obesity causes partial changes in blood gas and pulmonary function tests of patients with COPD. At the same time, it increases walkwork and workload. Despite all these changes, it has no negative effect on dyspnea perception and exercise capacity

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