Sayas Catalán Javier, Lalmolda Cristina, Hernández-Voth Ana, Corral Blanco Marta, Murphy Patrick, Gonzalez-Ramos Laura, Florez-Solarana Pablo, Lloret-Puig Berta, Lujan Manel
Hospital Universitario 12 de Octubre, Pneumology Service, Madrid, Spain; Universidad Complutense de Madrid, Spain.
Consorci Corporació Sanitària Parc Taulí, Pneumology Service, Sabadell, Spain; Centro de Investigación Médica en Red de Enfermedades Respiratorias (CIBERES), Respiratory Research, Spain.
Arch Bronconeumol. 2025 Sep;61(9):544-554. doi: 10.1016/j.arbres.2025.01.010. Epub 2025 Jan 31.
Patients with severe Chronic Obstructive Pulmonary Disease (COPD) often experience breathlessness and exercise limitations due to expiratory flow limitation. Pulmonary rehabilitation programmes, including exercise with non-invasive ventilation (NIV) or high-flow nasal therapy (HFT), aims to improve quality of life and exercise tolerance. This study investigates the relationship between thoracoabdominal asynchrony (TAA) during supported (NIV and HFT) and unsupported (conventional oxygen therapy - COT) exercise and clinical and functional parameters in severe COPD patients awaiting lung transplantation.
This experimental, longitudinal, prospective, controlled study included 20 severe COPD patients on the lung transplant waiting list. Patients underwent three constant load exercise tests under COT, NIV, and HFT conditions. TAA was measured using respiratory inductance plethysmography, and neurorrespiratory drive (NRD) was assessed via parasternal electromyography.
Patients exhibited distinct TAA patterns during exercise. Clockwise rotation (thorax ahead) was associated with worse baseline lung function, higher peak exercise dyspnoea and higher peak exercise NRD compared to counterclockwise rotation (abdomen ahead). No significant differences in TAA were observed between the three exercise conditions (COT, NIV, HFT). However, patients with clockwise TAA were more likely to have reduction in breathlessness with NIV compared to COT than those with counterclockwise rotation.
TAA patterns during exercise in severe COPD patients can indicate the severity of lung function impairment and predict severity of exercise induced dyspnoea. Analysis of TAA may predict response to respiratory support modalities and therefore monitoring TAA and NRD should be further studied to allow better tailoring of respiratory support during rehabilitation.
重度慢性阻塞性肺疾病（COPD）患者常因呼气气流受限而出现呼吸急促和运动受限。包括无创通气（NIV）或高流量鼻导管治疗（HFT）的运动在内的肺康复计划旨在提高生活质量和运动耐力。本研究调查了等待肺移植的重度COPD患者在支持性（NIV和HFT）和非支持性（传统氧疗 - COT）运动期间胸腹部不同步（TAA）与临床和功能参数之间的关系。
这项实验性、纵向、前瞻性、对照研究纳入了20名等待肺移植的重度COPD患者。患者在COT、NIV和HFT条件下进行了三次恒定负荷运动测试。使用呼吸感应体积描记法测量TAA，并通过胸骨旁肌电图评估神经呼吸驱动（NRD）。
患者在运动期间表现出不同的TAA模式。与逆时针旋转（腹部在前）相比，顺时针旋转（胸部在前）与更差的基线肺功能、更高的运动高峰呼吸困难和更高的运动高峰NRD相关。在三种运动条件（COT、NIV、HFT）之间未观察到TAA的显著差异。然而，与COT相比，顺时针TAA的患者使用NIV时呼吸困难减轻的可能性比逆时针旋转的患者更大。
重度COPD患者运动期间的TAA模式可表明肺功能损害的严重程度，并预测运动诱发呼吸困难的严重程度。TAA分析可能预测对呼吸支持方式的反应，因此应进一步研究监测TAA和NRD，以便在康复期间更好地调整呼吸支持。
