Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA.
Kingston General Hospital Health Research Institute, Kingston, Ontario, CANADA.
Med Sci Sports Exerc. 2021 Dec 1;53(12):2467-2476. doi: 10.1249/MSS.0000000000002741.
Evaluation of the intensity and quality of activity-related dyspnea is potentially useful in people with chronic obstructive pulmonary disease (COPD). The present study sought to examine associations between qualitative dyspnea descriptors, dyspnea intensity ratings, dynamic respiratory mechanics, and exercise capacity during cardiopulmonary exercise testing (CPET) in COPD and healthy controls.
In this cross-sectional study, 261 patients with mild-to-very severe COPD (forced expiratory volume in 1 s, 62 ± 25%pred) and 94 age-matched controls (forced expiratory volume in 1 s, 114 ± 14%pred) completed an incremental cycle CPET to determine peak oxygen uptake (V˙O2peak). Throughout exercise, expired gases, operating lung volumes, and dyspnea intensity were assessed. At peak exercise, dyspnea quality was assessed using a modified 15-item questionnaire.
Logistic regression analysis revealed that among 15 dyspnea descriptors, only those alluding to the cluster "unsatisfied inspiration" were consistently associated with an increased likelihood for both critical inspiratory mechanical constraint (end-inspiratory lung volume/total lung capacity ratio ≥0.9) during exercise and reduced exercise capacity (V˙O2peak < lower limit of normal) in COPD (odds ratio (95% confidence interval), 3.26 (1.40-7.60) and 3.04 (1.24-7.45), respectively; both, P < 0.05). Thus, patients reporting "unsatisfied inspiration" (n = 177 (68%)) had an increased relative frequency of critical inspiratory mechanical constraint and low exercise capacity compared with those who did not select this descriptor, regardless of COPD severity or peak dyspnea intensity scores.
In patients with COPD, regardless of disease severity, reporting descriptors in the unsatisfied inspiration cluster complemented traditional assessments of dyspnea during CPET and helped identify patients with critical mechanical abnormalities germane to exercise intolerance.
评估与活动相关的呼吸困难的强度和质量在慢性阻塞性肺疾病（COPD）患者中可能具有潜在的作用。本研究旨在探讨 COPD 患者和健康对照者在心肺运动测试（CPET）中呼吸困难定性描述、呼吸困难强度评分、动态呼吸力学和运动能力之间的关系。
在这项横断面研究中，261 名轻度至重度 COPD 患者（1 秒用力呼气量占预计值的 62±25%）和 94 名年龄匹配的对照者（1 秒用力呼气量占预计值的 114±14%）完成了递增式踏车 CPET，以确定峰值摄氧量（V˙O2peak）。在整个运动过程中，评估呼气气体、工作肺容积和呼吸困难强度。在峰值运动时，使用改良的 15 项问卷评估呼吸困难质量。
逻辑回归分析显示，在 15 项呼吸困难描述符中，只有那些暗示“吸气不满足”集群的描述符与运动过程中吸气力学受限的临界情况（吸气末肺容积/总肺容量比≥0.9）和运动能力下降（V˙O2peak<正常下限）均有一致的相关性（优势比（95%置信区间），3.26（1.40-7.60）和 3.04（1.24-7.45）；均 P<0.05）。因此，与未选择该描述符的患者相比，报告“吸气不满足”（n=177（68%））的患者更有可能出现吸气力学受限的临界情况和运动能力较低，无论 COPD 严重程度或峰值呼吸困难评分如何。
在 COPD 患者中，无论疾病严重程度如何，报告在“吸气不满足”集群中的描述符补充了 CPET 期间对呼吸困难的传统评估，并有助于识别与运动不耐受相关的关键机械异常的患者。
