La Trobe University, Victoria, Australia.
Chron Respir Dis. 2010;7(2):101-11. doi: 10.1177/1479972309354689. Epub 2010 Jan 7.
Exercise limitation is a cardinal feature of the interstitial lung diseases and is frequently associated with marked dyspnoea on exertion. People with interstitial lung disease exhibit a rapid, shallow breathing pattern during exercise that worsens as disease progresses. Despite this, ventilatory mechanics are not the major limitation to exercise in most patients, with impaired gas exchange and circulatory limitation playing a more important role. Peripheral and respiratory muscle dysfunction may also contribute to impaired exercise tolerance, either due to systemic manifestations of the underlying disease, treatment side-effects or deconditioning. Measures of exercise capacity or desaturation obtained from maximal and submaximal exercise tests are good predictors of survival in patients with idiopathic pulmonary fibrosis. However, to date few pharmaceutical treatments have affected exercise outcomes despite improvements in other important clinical markers. Supplemental oxygen acutely improves exercise capacity in interstitial lung disease and is recommended for hypoxic patients, although quality of life or survival benefits have not yet been demonstrated. Exercise training improves walking capacity and dyspnoea in short-term trials and is useful to maximize functional capacity. The role of exercise testing in the routine management of patients with interstitial lung disease is not clearly defined. However, given the poor prognosis in patients with idiopathic pulmonary fibrosis and the marked variation in clinical course, assessment of exercise capacity may provide useful information for both clinicians and patients when evaluating the risks and benefits of new treatments. The extent of resting or exercise-induced hypoxia in patients with interstitial lung disease may influence the selection of an appropriate exercise test, and oxygen administration should be standardized on repeat testing.
运动受限是间质性肺疾病的一个主要特征，常伴有明显的运动性呼吸困难。间质性肺疾病患者在运动时表现出快速、浅的呼吸模式，随着疾病的进展而恶化。尽管如此，在大多数患者中，通气力学并不是运动的主要限制因素，气体交换受损和循环限制起着更重要的作用。外周和呼吸肌功能障碍也可能导致运动耐量下降，这可能是由于潜在疾病的全身表现、治疗的副作用或身体适应不良。最大和次最大运动试验中获得的运动能力或饱和度测量值是特发性肺纤维化患者生存的良好预测指标。然而，尽管其他重要的临床指标有所改善，但到目前为止，很少有药物治疗能改善运动结果。补充氧气可急性改善间质性肺疾病患者的运动能力，建议对缺氧患者使用，但尚未证明能提高生活质量或延长生存时间。运动训练可改善短期试验中的步行能力和呼吸困难，对最大限度地提高功能能力很有用。运动测试在间质性肺疾病患者常规管理中的作用尚未明确界定。然而，鉴于特发性肺纤维化患者的预后较差，且临床病程差异很大，评估运动能力可能为临床医生和患者在评估新治疗方法的风险和益处时提供有用信息。间质性肺疾病患者的静息或运动诱导性缺氧程度可能会影响适当运动试验的选择，并且应在重复测试时标准化氧疗。
