Radboud University Nijmegen Medical Centre, Dept. of Pulmonary Diseases, Nijmegen, The Netherlands.
Respir Med. 2010 Aug;104(8):1152-9. doi: 10.1016/j.rmed.2010.02.011. Epub 2010 Mar 25.
Patients with COPD are known to be limited in their performance of activities of daily life (ADL). This observational study aims to investigate the ventilatory and metabolic demand of ADL in home settings of patients and evaluate possible mechanisms involved in physiological limitation during ADL in COPD.
In their home settings, 21 stable patients with COPD (GOLD II-IV, mean FEV(1) 43% predicted) were asked to perform their most dyspnea causing activities at their usual pace until symptoms discouraged further performance. Ten healthy control subjects, matched for age and gender, performed comparable activities. Ventilatory and metabolic demands of the ADL were studied using a portable breath-by-breath system.
Compared with healthy controls, ADL time was shorter in patients (530 +/- 38 s vs. 318 +/- 37 s respectively) and activities resulted in important complaints of dyspnea. Oxygen consumption (V O(2)) during the activities was higher in patients compared to healthy subjects (957 +/- 51 vs. 768 +/- 63 mL/min resp.). Ventilatory demand (V E) for comparable activity (at isoV O(2)) was higher in patients and went together with complaints of dyspnea in patients, but not in healthy subjects. Ventilatory constraints like low ventilatory reserve and inspiratory reserve volume and dynamic hyperinflation occurred in more than 80% of the patients, especially in (very) severe patients.
Patients with COPD experience limitations in the performance of ADL, which lead to reductions in ADL time and dyspnea complaints. There appears to be an important role for ventilatory limitations, which become more prominent as disease progresses.
患有 COPD 的患者在日常生活活动（ADL）中的表现受限是已知的。本观察性研究旨在调查患者家庭环境中 ADL 的通气和代谢需求，并评估 COPD 患者在 ADL 中生理受限的可能机制。
在他们的家庭环境中，21 名稳定的 COPD 患者（GOLD II-IV，平均 FEV1 为预计值的 43%）被要求以他们通常的速度进行最导致呼吸困难的活动，直到症状阻止进一步进行。10 名年龄和性别匹配的健康对照者进行了类似的活动。使用便携式逐口气分析系统研究 ADL 的通气和代谢需求。
与健康对照组相比，患者的 ADL 时间更短（分别为 530 ± 38 s 和 318 ± 37 s），活动导致重要的呼吸困难投诉。与健康受试者相比，患者在活动期间的耗氧量（V O2）更高（分别为 957 ± 51 和 768 ± 63 mL/min）。对于可比活动（在等 V O2 下），患者的通气需求（V E）更高，并且与患者的呼吸困难投诉相关，但与健康受试者无关。超过 80%的患者出现通气限制，如低通气储备和吸气储备量不足以及动态过度充气，尤其是在（非常）严重的患者中。
患有 COPD 的患者在进行 ADL 时会遇到限制，这会导致 ADL 时间缩短和呼吸困难投诉增加。似乎存在重要的通气限制作用，随着疾病的进展，这种作用变得更加明显。
