Effect of Bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema

被引:176
作者
Hopkinson, NS
Toma, TP
Hansell, DM
Goldstraw, P
Moxharn, J
Geddes, DM
Polkey, MI
机构
[1] Royal Brompton Hosp, Resp Muscle Lab, London SW3 6NP, England
[2] Royal Brompton Hosp, Dept Resp Med, London SW3 6NP, England
[3] Royal Brompton Hosp, Dept Radiol, London SW3 6NP, England
[4] Royal Brompton Hosp, Dept Cardiothorac Surg, London SW3 6NP, England
[5] Kings Coll Hosp London, Guys Kings & St Thomas Sch Med, Resp Muscle Lab, London, England
关键词
bronchoscopic lung volume reduction; chronic obstructive pulmonary disease; diaphragm; dynamic hyperinflation;
D O I
10.1164/rccm.200407-961OC
中图分类号
R4 [临床医学];
学科分类号
1002 [临床医学]; 100602 [中西医结合临床];
摘要
Endobronchial valve placement improves pulmonary function in some patients with chronic obstructive pulmonary disease, but its effects on exercise physiology have not been investigated. In 19 patients with a mean (SD) FEV1 of 28.4 (11.9)% predicted, studied before and 4 weeks after unilateral valve insertion, functional residual capacity decreased from 7.1 (1.5) to 6.6 (1.7) L (p = 0.03) and diffusing capacity rose from 3.3 (1.1) to 3.7 (1.2) mmol minute(-1) kPa(-1) (p = 0.03). Cycle endurance time at 80% of peak workload increased from 227 (129) to 315 (195) seconds (p = 0.03). This was associated with a reduction in end-expiratory lung volume at peak exercise from 7.6 (1.6) to 7.2 (1.7) L (p 0.03). Using stepwise logistic regression analysis, a model containing changes in transfer factor and resting inspiratory capacity explained 81% of the variation in change in exercise time (p < 0.0001). The same variables were retained if the five patients with radiologic atelectasis were excluded from analysis. In a subgroup of patients in whom invasive measurements were performed, improvement in exercise capacity was associated with a reduction in lung compliance (r(2) = 0.43; p = 0.03) and isotime esophageal pressure-time product (r(2) = 0.47; p = 0.03). Endobronchial valve placement can improve lung volumes and gas transfer in patients with chronic obstructive pulmonary disease and prolong exercise time by reducing dynamic hyperinflation.
引用
收藏
页码:453 / 460
页数:8
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