Martin A Daniel, Davenport Paul W
Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL.
Cardiopulm Phys Ther J. 2011 Sep;22(3):5-10.
Most patients with chronic obstructive pulmonary disease (COPD) complain of dyspnea during and following exercise, and the development of intrinsic positive end-expiratory pressure (PEEP) is thought to contribute to lung hyperinflation and dyspnea. Many people with COPD use pursed lip breathing (PLB) in an attempt to produce extrinsic PEEP to reduce lung hyperinflation and dyspnea during and following exertion. We hypothesized that the use of a threshold, extrinsic PEEP device would reduce post-exercise dyspnea in people with COPD.
A double blind, crossover study was conducted on post-exercise dyspnea in 8 patients with COPD whose exercise tolerance was limited by dyspnea. Subjects performed two identical 6-minute treadmill bouts that led to a Borg dyspnea rating of at least 5/10. Dyspnea, heart rate, and oxygen-hemoglobin saturation (SpO(2)) were recorded at rest, every 2 minutes during exercise and at 2, 5, and 10 minutes post-exercise. Immediately following the exercise bouts, the subjects used either a threshold PEEP device for 6 breaths at 10 cm H(2)O or a Sham device.
Heart rate and SpO(2) were not different between treatments any time point before, during, or after exercise. Dyspnea ratings were not different between devices at rest or during exercise, but were lower in the post-exercise period following use of PEEP (p < 0.05). When asked which device, if any, the subjects would prefer to use to relieve post-exercise dyspnea, 7 of 8 chose the PEEP device and one had no preference.
We found that the use of a PEEP device can help reduce postexercise dyspnea in patients with COPD.
大多数慢性阻塞性肺疾病（COPD）患者在运动期间及运动后会出现呼吸困难，内在呼气末正压（PEEP）的产生被认为会导致肺过度充气和呼吸困难。许多COPD患者采用缩唇呼吸（PLB），试图产生外在PEEP，以减轻运动期间及运动后的肺过度充气和呼吸困难。我们假设使用阈值性外在PEEP装置可减轻COPD患者运动后的呼吸困难。
对8例运动耐量受呼吸困难限制的COPD患者进行了一项关于运动后呼吸困难的双盲交叉研究。受试者进行两次相同的6分钟跑步机运动，运动导致Borg呼吸困难评分至少为5/10。在静息状态、运动期间每2分钟以及运动后2、5和10分钟记录呼吸困难、心率和氧合血红蛋白饱和度（SpO₂）。运动结束后，受试者立即使用阈值PEEP装置以10 cm H₂O进行6次呼吸，或使用假装置。
在运动前、运动期间或运动后的任何时间点，两种治疗方法的心率和SpO₂均无差异。在静息状态或运动期间，两种装置的呼吸困难评分无差异，但在使用PEEP后的运动后阶段评分较低（p < 0.05）。当被问及受试者更愿意使用哪种装置（如果有的话）来缓解运动后的呼吸困难时，8名受试者中有7名选择了PEEP装置，1名无偏好。
我们发现使用PEEP装置有助于减轻COPD患者运动后的呼吸困难。
