医学
运动不耐症
间质性肺病
内科学
心脏病学
呼吸肌
肺功能测试
肺活量
呼吸系统
肺容积
肺
肺功能
扩散能力
心力衰竭
作者
Pauliane Vieira Santana,Letícia Zumpano Cardenas,Jeferson Ferreira,Carlos Roberto Ribeiro Carvalho,André Luís Pereira de Albuquerque,Pedro Caruso
出处
期刊:Respirology
[Wiley]
日期:2021-04-16
卷期号:26 (7): 673-682
被引量:2
摘要
Abstract Background and objective The precise coordination of respiratory muscles during exercise minimizes work of breathing and avoids exercise intolerance. Fibrotic interstitial lung disease (f‐ILD) patients are exercise‐intolerant. We assessed whether respiratory muscle incoordination and thoracoabdominal asynchrony (TAA) occur in f‐ILD during exercise, and their relationship with pulmonary function and exercise performance. Methods We compared breathing pattern, respiratory mechanics, TAA and respiratory muscle recruitment in 31 f‐ILD patients and 31 healthy subjects at rest and during incremental cycle exercise. TAA was defined as phase angle (PhAng) >20°. Results During exercise, when compared with controls, f‐ILD patients presented increased and early recruitment of inspiratory rib cage muscle ( p < 0.05), and an increase in PhAng, indicating TAA. TAA was more frequent in f‐ILD patients than in controls, both at 50% of the maximum workload (42.3% vs. 10.7%, p = 0.01) and at the peak (53.8% vs. 23%, p = 0.02). Compared with f‐ILD patients without TAA, f‐ILD patients with TAA had lower lung volumes (forced vital capacity, p < 0.01), greater dyspnoea (Medical Research Council > 2 in 64.3%, p = 0.02), worse exercise performance (lower maximal work rate % predicted, p = 0.03; lower tidal volume, p = 0.03; greater desaturation and dyspnoea, p < 0.01) and presented higher oesophageal inspiratory pressures with lower gastric inspiratory pressures and higher recruitment of scalene ( p < 0.05). Conclusion Exercise induces TAA and higher recruitment of inspiratory accessory muscle in ILD patients. TAA during exercise occurred in more severely restricted ILD patients and was associated with exertional dyspnoea, desaturation and limited exercise performance.
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