Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan.
Thorax. 2023 Dec 15;79(1):23-34. doi: 10.1136/thorax-2022-219755.
Despite strategies acting on peripheral airway obstruction in chronic obstructive pulmonary disease (COPD), exercise intolerance remains inadequately improved. We hypothesised that laryngeal narrowing is a potential treatment target of expiratory pressure load training (EPT) to improve exercise intolerance in COPD.
The effect of 3-month EPT was assessed in 47 patients with COPD divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) mild-to-moderate (I-II) and severe-to-very severe (III-IV), randomly allocating 1:1 to EPT or control groups. The primary outcome was endurance time in the constant work rate exercise test in GOLD III-IV patients.
Compared with controls, EPT increased: (1) endurance time, with estimated treatment effect: +703 (95% CI: 379 to 1031) s, p=0.0008 (GOLD I-II); +390 (95% CI: 205 to 574) s, p=0.0006 (GOLD III-IV); (2) peak oxygen uptake (p=0.0086 in GOLD I-II; p=0.0004 in GOLD III-IV); (3) glottic dilatation ratio at maximum collapse on laryngoscopy in the submaximal exercise (p=0.0062 in GOLD I-II; p=0.0001 in GOLD III-IV); and (4) the inflection point of expiratory tidal volume relative to minute ventilation during the incremental exercise (p=0.0015 in GOLD I-II; p=0.0075 in GOLD III-IV). Across GOLD grades, the responses of glottic dilatation ratio at maximum collapse and the expiratory tidal volume at the inflection point were selected as more influential variables correlating with the improvement in peak oxygen uptake and endurance time, respectively.
These results show that EPT improved aerobic capacity and endurance time with larger laryngeal widening and adequate ventilation despite advanced COPD.
UMIN000041250.
尽管针对慢性阻塞性肺疾病（COPD）外周气道阻塞采取了策略，但运动耐量仍得不到充分改善。我们假设声门狭窄是呼气压力负荷训练（EPT）的一个潜在治疗靶点，可以改善 COPD 患者的运动耐量。
将 47 例 COPD 患者分为全球慢性阻塞性肺疾病倡议（GOLD）轻度至中度（I-II）和重度至极重度（III-IV）两组，每组 1:1 随机分配至 EPT 或对照组，评估 3 个月 EPT 的效果。主要结局是 GOLD III-IV 患者恒功率运动试验中的耐力时间。
与对照组相比，EPT 增加了：（1）耐力时间，估计治疗效果：+703（95%CI：379 至 1031）s，p=0.0008（GOLD I-II）；+390（95%CI：205 至 574）s，p=0.0006（GOLD III-IV）；（2）峰值摄氧量（p=0.0086 在 GOLD I-II 中；p=0.0004 在 GOLD III-IV 中）；（3）亚最大运动时喉镜下最大塌陷时的声门扩张率（p=0.0062 在 GOLD I-II 中；p=0.0001 在 GOLD III-IV 中）；（4）递增运动时呼气潮气量相对于分钟通气量的拐点（p=0.0015 在 GOLD I-II 中；p=0.0075 在 GOLD III-IV 中）。在整个 GOLD 分级中，最大塌陷时声门扩张率和拐点时呼气潮气量的反应被选为与峰值摄氧量和耐力时间改善相关的更具影响力的变量。
这些结果表明，尽管 COPD 已经很严重，但 EPT 仍能通过更大的声门扩张和充足的通气来改善有氧运动能力和耐力时间。
UMIN000041250。
