Boucly Athénaïs, Morélot-Panzini Capucine, Garcia Gilles, Weatherald Jason, Jaïs Xavier, Savale Laurent, Montani David, Humbert Marc, Similowski Thomas, Sitbon Olivier, Laveneziana Pierantonio
Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
AP-HP, Hôpital Bicêtre, Service de Pneumologie et Soins Intensifs, Le Kremlin-Bicêtre, France.
Eur Respir J. 2020 Feb 12;55(2). doi: 10.1183/13993003.02108-2018. Print 2020 Feb.
Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea. The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated.26 patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Minute ventilation ('), breathing pattern, operating lung volumes and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially assessed during exercise using a three-item questionnaire (dyspnoea descriptors). The inflection point of tidal volume ( ) relative to ' was determined for each incremental test. Changes in inspiratory capacity during exercise defined two groups of patients: hyperinflators (65%) and non-hyperinflators (35%). Multidimensional characterisation of dyspnoea was performed after exercise using the Multidimensional Dyspnea Profile.In hyperinflators, inspiratory capacity decreased progressively throughout exercise by 0.36 L, while remaining stable in non-hyperinflators. The "work/effort" descriptor was most frequently selected throughout exercise in both types of patients (65% of all responses). At the /' inflection, work/effort plateaued while "unsatisfied inspiration" descriptors became selected predominantly only in hyperinflators (77% of all responses). In the affective domain, the emotion most frequently associated with dyspnoea was anxiety.In pulmonary hypertension patients who develop hyperinflation during exercise, dyspnoea descriptors referring to unsatisfied inspiration become predominant following the /' inflection. As these descriptors are generally associated with more negative emotional experiences, delaying or preventing the /' inflection may have important implications for symptom management in patients with pulmonary hypertension.
在60%临床病情稳定的肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）患者运动期间可观察到动态肺过度充气，这会加剧运动性呼吸困难。运动期间呼吸力学的动态变化对这些患者呼吸困难定性维度的影响尚未得到评估。26例患者（PAH患者17例；CTEPH患者9例）进行了递增症状限制的踏车运动试验。在整个运动过程中评估分钟通气量（）、呼吸模式、有效肺容积和呼吸困难强度。在运动期间使用一份三项问卷（呼吸困难描述词）对呼吸困难性质进行连续评估。为每个递增试验确定潮气量（）相对于分钟通气量的拐点。运动期间吸气量的变化确定了两组患者：肺过度充气者（65%）和非肺过度充气者（35%）。运动后使用多维呼吸困难量表对呼吸困难进行多维特征描述。在肺过度充气者中，吸气量在整个运动过程中逐渐下降0.36升，而在非肺过度充气者中保持稳定。在两种类型的患者中，“工作/努力”描述词在整个运动过程中最常被选中（占所有回答的65%）。在潮气量/分钟通气量拐点处，工作/努力达到平稳状态，而“吸气未满足”描述词仅在肺过度充气者中占主导地位（占所有回答的77%）。在情感领域，与呼吸困难最常相关的情绪是焦虑。在运动期间出现肺过度充气的肺动脉高压患者中，在潮气量/分钟通气量拐点后，指吸气未满足的呼吸困难描述词占主导地位。由于这些描述词通常与更负面的情绪体验相关联，延迟或防止潮气量/分钟通气量拐点可能对肺动脉高压患者的症状管理具有重要意义。
