Chen Ai-huan, Chen Rong-chang, Li Jun-mei, Zhong Nan-shan
Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical College, Guangzhou 510120, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2006 Apr;29(4):236-9.
To evaluate the relationship between expiratory flow limitation (EFL) and chronic dyspnea and the effect of bronchodilator on EFL in patients with chronic obstructive pulmonary disease (COPD).
Thirty-three ambulatory patients with COPD (46 - 78 yrs; male 31, female 2) were included in this study. The severity of chronic dyspnea was rated according to the dyspnea scale proposed by the Medical Research Council (MRC). EFL was measured by applying negative pressure at the mouth during tidal expiration before and after bronchodilation test (inhalation of 400 microg salbutamol).
EFL was detected in 12 (36%) of the 33 COPD patients in both seated and supine positions and in 11 (33%) only in supine position. There was a significant difference in the percent predicted forced expired volume in one second (FEV(1%)pred) between subgroups of the patients with or without EFL (t = 7.601, P < 0.01). The mean values of FEV(1%)pred in non-EFL group and EFL group was (66 +/- 16)% and (31 +/- 10)%, respectively, and the value was lowest in patients who showed EFL both in seated and supine positions [(24 +/- 7)%]. Both three-point EFL and five-point EFL were significantly correlated with FEV(1) (r = -0.836 and -0.818, respectively, all P < 0.01). There was a significant correlation between MRC dyspnea scale and three-point EFL and five-point EFL (r = 0.903 and 0.912, respectively, all P < 0.01). In the multiple regression analysis, five-point EFL was a better predictor of dyspnea than FEV(1) (regression coefficient was 0.679 and -0.265, respectively, P < 0.01 and 0.029, respectively). EFL persisted after salbutamol in all of the 23 patients with EFL under baseline conditions.
EFL as measured by negative expiratory pressure (NEP) technique may be more useful in the evaluation of dyspnea in COPD patients than routine lung function measurements. The EFL in COPD patients is irreversible after bronchodilator administration.
评估慢性阻塞性肺疾病（COPD）患者呼气流量受限（EFL）与慢性呼吸困难之间的关系以及支气管扩张剂对EFL的影响。
本研究纳入了33例门诊COPD患者（年龄46 - 78岁；男性31例，女性2例）。根据医学研究委员会（MRC）提出的呼吸困难量表对慢性呼吸困难的严重程度进行分级。在支气管扩张试验（吸入400μg沙丁胺醇）前后的潮气呼气期间，通过在口腔施加负压来测量EFL。
33例COPD患者中，12例（36%）在坐位和仰卧位均检测到EFL，11例（33%）仅在仰卧位检测到EFL。有EFL和无EFL患者亚组之间的一秒用力呼气容积预测值百分比（FEV(1%)pred）存在显著差异（t = 7.601，P < 0.01）。非EFL组和EFL组的FEV(1%)pred平均值分别为(66 ± 16)%和(31 ± 10)%，在坐位和仰卧位均显示EFL的患者中该值最低[(24 ± 7)%]。三点EFL和五点EFL均与FEV(1)显著相关（r分别为 -0.836和 -0.818，均P < 0.01）。MRC呼吸困难量表与三点EFL和五点EFL之间存在显著相关性（r分别为0.903和0.912，均P < 0.01）。在多元回归分析中，五点EFL比FEV(1)是更好的呼吸困难预测指标（回归系数分别为0.679和 -0.265，P分别 < 0.01和0.029）。在基线条件下，23例有EFL的患者在使用沙丁胺醇后EFL仍然存在。
通过呼气负压（NEP）技术测量的EFL在评估COPD患者的呼吸困难方面可能比常规肺功能测量更有用。COPD患者使用支气管扩张剂后EFL不可逆。
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