Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, P. O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
Chest. 2010 May;137(5):1116-21. doi: 10.1378/chest.09-1847. Epub 2009 Dec 1.
One of the contributors to exercise limitation in COPD is dynamic hyperinflation. Although dynamic hyperinflation appears to occur during several exercise protocols in COPD and seems to increase with increasing disease severity, it is unknown whether dynamic hyperinflation occurs at different severity stages according to the Global initiative for chronic Obstructive Lung Disease (GOLD) in daily life. The present study, therefore, aimed to compare dynamic hyperinflation between COPD GOLD stages II-IV during daily activities.
Thirty-two clinically stable patients with COPD GOLD II (n = 10), III (n = 12), and IV (n = 10) participated in this study. Respiratory physiology during a daily activity was measured at patients' homes with Oxycon Mobile. Inspiratory capacity maneuvers were performed at rest, at 2-min intervals during the activity, and at the end of the activity. Change in inspiratory capacity is commonly used to reflect change in end-expiratory lung volume (DeltaEELV) and, therefore, dynamic hyperinflation. The combination of static and dynamic hyperinflation was reflected by inspiratory reserve volume (IRV) during the activity.
Overall, increase in EELV occurred in GOLD II-IV without significant difference between the groups. There was a tendency for a smaller DeltaEELV in GOLD IV. DeltaEELV was inversely related to static hyperinflation. IRV during the daily activity was related to the level of airflow obstruction.
Dynamic hyperinflation occurs independent of GOLD stage during real-life daily activities. The combination of static and dynamic hyperinflation, however, increases with increasing airflow obstruction.
COPD 患者运动受限的原因之一是动态过度充气。虽然动态过度充气似乎在 COPD 的几种运动方案中发生，并且似乎随着疾病严重程度的增加而增加，但尚不清楚在日常生活中根据全球慢性阻塞性肺疾病倡议（GOLD），动态过度充气是否会在不同严重程度阶段发生。因此，本研究旨在比较日常活动中 COPD GOLD Ⅱ-IV 期之间的动态过度充气。
32 名临床稳定的 COPD GOLD II（n=10）、III（n=12）和 IV（n=10）期患者参与了本研究。使用 Oxycon Mobile 在患者家中测量日常活动期间的呼吸生理。在休息时、活动期间每隔 2 分钟以及活动结束时进行吸气量动作。吸气量的变化通常用于反映呼气末肺容积（DeltaEELV）的变化，因此反映了动态过度充气。活动期间的吸气储备量（IRV）反映了静态和动态过度充气的综合作用。
总体而言，EELV 在 GOLD II-IV 中增加，各组之间无显著差异。GOLD IV 中 DeltaEELV 有减小的趋势。DeltaEELV 与静态过度充气呈负相关。日常活动期间的 IRV 与气流阻塞程度相关。
在日常生活中的真实活动中，动态过度充气独立于 GOLD 分期发生。然而，静态和动态过度充气的组合随着气流阻塞程度的增加而增加。
