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Rinaldi S, Balsillie C, Truchon C, AL‐Mubarak A, Mura M, Madill J. Nutrition implications of intrinsic restrictive lung disease. Nutr Clin Pract 2022; 37:239-255. [DOI: 10.1002/ncp.10849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sylvia Rinaldi
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Christine Balsillie
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Cassandra Truchon
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Awatif AL‐Mubarak
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Marco Mura
- Division of Respirology, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Janet Madill
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
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2
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Automatic detection of obstructive and restrictive lung disease from features extracted from ECG and ECG derived respiration signals. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.102791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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3
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Shnoda M, Gajjar K, Ivanova V. COPD and Cardiovascular Disease: A Review of Association, Interrelationship, and Basic Principles for Integrated Management. Crit Care Nurs Q 2021; 44:91-102. [PMID: 33234862 DOI: 10.1097/cnq.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of comorbid cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD) can result in unfavorable outcomes, ranging from deterioration in quality of life to increases in all-cause and cardiovascular mortality. Moreover, cardiovascular events are major cause of hospitalization in patients with COPD and contributing significantly to the economic burden of the disease. Despite the acknowledgment of the prognostic significance of CVD comorbidity in COPD patients, CVD remains underrecognized and undertreated in this patient population. In this article, we address the current knowledge about the estimated prevalence, pathophysiologic association, as well as important considerations in the diagnosis and management of CVD in COPD patients.
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Affiliation(s)
- Mina Shnoda
- Divisions of Internal Medicine (Dr Shnoda) and Cardiovascular Institute (Drs Gajjar and Ivanova), Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
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Berton DC, Gass R, Feldmann B, Plachi F, Hutten D, Mendes NBS, Schroeder E, Balzan FM, Peyré-Tartaruga LA, Gazzana MB. Responses to progressive exercise in subjects with chronic dyspnea and inspiratory muscle weakness. CLINICAL RESPIRATORY JOURNAL 2020; 15:26-35. [PMID: 33480479 DOI: 10.1111/crj.13265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/26/2020] [Accepted: 08/12/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under-appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work-up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterized. OBJECTIVES To identify the physiological and sensorial responses to progressive exercise in dyspneic patients with IMW without concomitant cardiorespiratory or neuromuscular diseases. METHODS Twenty-three subjects (18 females, 55.2 ± 16.9 years) complaining of chronic daily life dyspnea (mMRC = 3 [2-3]) plus maximal inspiratory pressure < the lower limit of normal and 12 matched controls performed incremental cycling CPET. FEV1/FVC<0.7, significant abnormalities in chest CT or echocardiography, and/or an established diagnosis of neuromuscular disease were among the exclusion criteria. RESULTS AND CONCLUSION Patients presented with reduced aerobic capacity (peak V̇O2: 79 ± 26 vs 116 ± 21 %predicted), a tachypneic breathing pattern (peak breathing frequency/tidal volume = 38.4 ± 22.7 vs 21.7 ± 14.2 breaths/min/L) and exercise-induced inspiratory capacity reduction (-0.17 ± 0.33 vs 0.10 ± 0.30 L) (all P < .05) compared to controls. In addition, higher ventilatory response (ΔV̇E/ΔV̇CO2 = 34.1 ± 6.7 vs 27.0 ± 2.3 L/L) and symptomatic burden (dyspnea and leg discomfort) to the imposed workload were observed in patients. Of note, pulse oximetry was similar between groups. Reduced aerobic capacity in the context of a tachypneic breathing pattern, inspiratory capacity reduction and preserved oxygen exchange during progressive exercise should raise the suspicion of inspiratory muscle weakness in subjects with otherwise unexplained breathlessness.
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Affiliation(s)
- Danilo C Berton
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Ricardo Gass
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bianca Feldmann
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Franciele Plachi
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Debora Hutten
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Nathalia Branco Schweitzer Mendes
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Elisa Schroeder
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fernanda M Balzan
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Leonardo A Peyré-Tartaruga
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo B Gazzana
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Parulekar AD, Wang T, Li GW, Hoang V, Kao CC. Pectoralis muscle area is associated with bone mineral density and lung function in lung transplant candidates. Osteoporos Int 2020; 31:1361-1367. [PMID: 32170395 DOI: 10.1007/s00198-020-05373-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED Loss of bone mineral density and skeletal muscle area are linked in lung transplant patients. This loss is greater in patients with restrictive compared with obstructive lung diseases. INTRODUCTION Sarcopenia and osteoporosis are associated with aging and chronic illnesses and may be linked in patients with advanced lung disease. Pectoralis muscle index (PMI) quantitated on computed tomography (CT) of the chest can be used to measure skeletal muscle mass. This study aimed to determine the relationship of PMI to clinical parameters including bone mineral density (BMD) in candidates for lung transplantation. METHODS A retrospective review of transplant candidates at a single center was performed. Demographic, anthropomorphic, and clinical data were recorded. Pectoralis muscle area (PMA) was determined on an axial slice from a chest CT. PMI was calculated as the PMA divided by height squared. BMD was obtained from routine dual-energy X-ray absorptiometry (DXA) scan. RESULTS In 226 included patients, mean PMI was 8.2 ± 3.0 cm2/m2 in males and 6.1 ± 2.1 cm2/m2 in females. Osteopenia was present in 44.4%, and 23.2% of patients had osteoporosis. Patients with obstructive lung disease had lower body mass index (22.0 ± 4.9 versus 27.9 ± 4.9 kg/m2, p < 0.001), PMI (6.0 ± 2.3 versus 8.2 ± 2.8 cm2/m2, p < 0.001), and BMD (- 2.3 ± 1.1 versus - 1.3 ± 1.1, p < 0.001) compared with patients with restrictive lung disease. PMI was a significant predictor of BMD (β = 0.16, p < 0.001). CONCLUSION The association between muscle area and BMD in lung transplant candidates suggests that similar mechanisms may underlie the development of both. Differences in PMI and BMD in patients with obstructive versus restrictive lung disease may result from differences in respiratory physiology or disease processes.
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Affiliation(s)
- A D Parulekar
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, 6620 Main Street, Houston, TX, 77030, USA
| | - T Wang
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - G W Li
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, 6620 Main Street, Houston, TX, 77030, USA
| | - V Hoang
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, 6620 Main Street, Houston, TX, 77030, USA
| | - C C Kao
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, 6620 Main Street, Houston, TX, 77030, USA.
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Fabi M, Balducci A, Cazzato S, Aceti A, Gallucci M, Di Palmo E, Gargiulo G, Donti A, Lanari M. Resting respiratory lung volumes are "healthier" than exercise respiratory volumes in different types of palliated or corrected congenital heart disease. Pediatr Pulmonol 2020; 55:697-705. [PMID: 31951681 DOI: 10.1002/ppul.24640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/27/2019] [Indexed: 11/12/2022]
Abstract
AIMS Cardiac surgery has improved life expectancy of patients with congenital heart diseases (CHDs). Exercise capacity is an important determinant of survival in patients with CHDs. There is a lack of studies focusing on the role of resting respiratory performance in reducing exercise tolerance in these patients. OBJECTIVES To determine the prevalence and severity of respiratory functional impairment in different types of corrected/palliated CHDs, and its impact on an exercise test. MATERIALS AND METHODS Retrospective single-center study involving 168 corrected/palliated patients with CHD and 52 controls. Patients CHD were divided into subgroups according to the presence of native pulmonary blood flow or total cavopulmonary connection (TCPC). All subjects performed complete pulmonary function tests and gas diffusion; patients with CHD also performed cardiopulmonary exercise test (CPX). RESULTS Mean values of lung volumes were within the normal range in all CHD groups. Comparing to controls, patients with the reduced pulmonary flow and with TCPC had the highest reduction in lung volumes. CPX was reduced in all groups, most severely in TCPC, and it was correlated to decreased dynamic volumes in all CHD groups except in TCPC. Younger age at intervention and number of surgical operations negatively affected lung volumes. CONCLUSIONS Respiratory function is within the normal range in our patients with different CHDs at rest but altered in all CHDs during exercise when cardiorespiratory balance is likely to be inadequate. Comparing the different groups, patients with reduced pulmonary flow and TCPC are the most impaired.
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Affiliation(s)
- Marianna Fabi
- Department of Cardiac, Thoracic and Vascular Sciences, Paediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Balducci
- Department of Cardiac, Thoracic and Vascular Sciences, Paediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Arianna Aceti
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela Di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gaetano Gargiulo
- Department of Pediatric and Adult Congenital Heart Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Donti
- Department of Cardiac, Thoracic and Vascular Sciences, Paediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Darwiche T, Collum SD, Bi W, Reynolds JO, Wilson C, Wareing N, Hernandez AM, Mertens TCJ, Zhou Z, Pandit LM, Karmouty-Quintana H. Alterations in cardiovascular function in an experimental model of lung fibrosis and pulmonary hypertension. Exp Physiol 2019; 104:568-579. [PMID: 30663834 DOI: 10.1113/ep087321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/18/2019] [Indexed: 01/02/2023]
Abstract
NEW FINDINGS What is the central question of this study? We have evaluated changes in cardiovascular physiology using echocardiography in an experimental model of lung fibrosis. What is the main finding and its importance? Remarkably, we report changes in cardiovascular function as early as day 7, concomitant with evidence of vascular remodelling. We also report that isolated pulmonary arteries were hypercontractile in response to a thromboxane A2 agonist. These findings are significant because the development of pulmonary hypertension is one of the most significant predictors of mortality in patients with lung fibrosis, where there are no available therapies and a lack of animal models. ABSTRACT Group III pulmonary hypertension is observed in patients with chronic lung diseases such as chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) develops as a result of extensive pulmonary vascular remodelling and resultant changes in vascular tone that can lead to right ventricle hypertrophy. This eventually leads to right heart failure, which is the leading indicator of mortality in patients with idiopathic pulmonary fibrosis. Treatments for group III PH are not available, in part owing to a lack of viable animal models. Here, we have evaluated the cardiovascular changes in a model of lung fibrosis and PH. Data obtained from this study indicated that structural alterations in the right heart, such as right ventricular wall hypertrophy, occurred as early as day 14, and similar increases in right ventricle chamber size were seen between days 21 and 28. These structural changes were correlated with decreases in the systolic function of the right ventricle and right ventricular cardiac output, which also occurred between the same time points. Characterization of pulmonary artery dynamics also highlighted that PH might be occurring as early as day 21, indicated by reductions in the velocity-time integral; however, evidence for PH is apparent as early as day 7, indicated by the significant reduction in pulmonary acceleration time values. These changes are consistent with evidence of vascular remodelling observed histologically starting on day 7. In addition, we report hyperactivity of bleomycin-exposed pulmonary arteries to a thromboxane A2 receptor (Tbxa2r) agonist.
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Affiliation(s)
- Tamara Darwiche
- Department of Pharmacology, School of Biomedical Sciences, King's College London, London, UK.,Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Scott D Collum
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Weizhen Bi
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Julia O Reynolds
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Cory Wilson
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nancy Wareing
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adriana M Hernandez
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tinne C J Mertens
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhen Zhou
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lavannya M Pandit
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Harry Karmouty-Quintana
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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When the Heart Is Not to Blame: Managing Lung Disease in Adult Congenital Heart Disease. Prog Cardiovasc Dis 2018; 61:314-319. [PMID: 30041022 DOI: 10.1016/j.pcad.2018.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/21/2022]
Abstract
It is well-recognized now that adult survivors with congenital heart disease (CHD) are at risk for non-cardiac co-morbidities and complications that can impact symptoms and clinical outcomes. Lung disease, in particular, is common in this population, but likely an under-recognized and undertreated cause for long-term morbidity. Abnormal lung function contributes to exercise intolerance and is associated with a higher risk for mortality in this population. The exact mechanisms that contribute to abnormal measurements of lung function are not entirely known, and are likely multifactorial and variable depending on the underlying CHD. Nevertheless, lung disease is a potentially modifiable risk factor in this patient population, the management of which may result in improved clinical outcomes. This review summarizes our current understanding of the prevalence, impact and management of lung disease in adults with CHD.
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Crytzer TM, Keramati M, Anthony SJ, Cheng YT, Robertson RJ, Dicianno BE. Exercise Prescription Using a Group-Normalized Rating of Perceived Exertion in Adolescents and Adults With Spina Bifida. PM R 2018; 10:738-747. [PMID: 29408563 DOI: 10.1016/j.pmrj.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/12/2018] [Accepted: 01/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with spina bifida (SB) face personal and environmental barriers to exercise that contribute to physical inactivity, obesity, risk of cardiovascular disease, and poor aerobic fitness. The WHEEL rating of perceived exertion (RPE) Scale was validated in people with SB to monitor exercise intensity. However, the psycho-physiological link between RPE and ventilatory breakpoint (Vpt), the group-normalized perceptual response, has not been determined and would provide a starting point for aerobic exercise in this cohort. OBJECTIVES The primary objectives were to determine the group-normalized RPE equivalent to Vpt based on WHEEL and Borg Scale ratings and to develop a regression model to predict Borg Scale (conditional metric) from WHEEL Scale (criterion metric). The secondary objective was to create a table of interchangeable values between WHEEL and Borg Scale RPE for people with SB performing a load incremental stress test. DESIGN Cross-sectional observational. SETTING University laboratory. PARTICIPANTS Twenty-nine participants with SB. METHODS Participants completed a load incremented arm ergometer exercise stress test. WHEEL and Borg Scale ratings were recorded the last 15 seconds of each 1-minute test phase. OUTCOME MEASURES WHEEL and Borg Scale ratings, metabolic measures (eg, oxygen consumption, carbon dioxide production). Determined Vpt via plots of oxygen consumption and carbon dioxide production against time. RESULTS Nineteen of 29 participants achieved Vpt (Group A). The mean ± standard deviation peak oxygen consumption at Vpt for Group A was 61.76 ± 16.26. The WHEEL and Borg Scale RPE at Vpt were 5.74 ± 2.58 (range 0-10) and 13.95 ± 3.50 (range 6-19), respectively. A significant linear regression model was developed (Borg Scale rating = 1.22 × WHEEL Scale rating + 7.14) and used to create a WHEEL-to-Borg Scale RPE conversion table. CONCLUSION A significant linear regression model and table of interchangeable values was developed for participants with SB. The group-normalized RPE (WHEEL, 5.74; Borg, 13.95) can be used to prescribe and self-regulate arm ergometer exercise intensity approximating the Vpt. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mariam Keramati
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven J Anthony
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yu-Ting Cheng
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert J Robertson
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; and Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bakery Square, 6425 Penn Avenue, Suite 400, Pittsburgh, PA 15206
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Endocrine and Metabolism Laboratory, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
- Center for Exercise and Health-Fitness Research, School of Education, University of Pittsburgh, Pittsburgh, PA
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System; Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh; and Department of Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Rizzetti DA, Quadros JRB, Ribeiro BE, Callegaro L, Veppo AA, Wiggers GA, Peçanha FM. Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water. ACTA ACUST UNITED AC 2018; 43:409-415. [PMID: 29340488 PMCID: PMC5792039 DOI: 10.1590/s1806-37562017000000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/15/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. METHODS This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. RESULTS We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. CONCLUSIONS When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.
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Affiliation(s)
| | | | - Bruna Esmerio Ribeiro
- . Curso de Fisioterapia, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | - Letícia Callegaro
- . Curso de Fisioterapia, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | - Aline Arebalo Veppo
- . Residência Multiprofissional em Saúde, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
| | | | - Franck Maciel Peçanha
- . Curso de Fisioterapia, Universidade Federal do Pampa - UNIPAMPA - Uruguaiana (RS) Brasil
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11
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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Pulmonary Hypertension Associated with Idiopathic Pulmonary Fibrosis: Current and Future Perspectives. Can Respir J 2017; 2017:1430350. [PMID: 28286407 PMCID: PMC5327768 DOI: 10.1155/2017/1430350] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/19/2017] [Indexed: 12/12/2022] Open
Abstract
Pulmonary hypertension (PH) is commonly present in patients with chronic lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) or Idiopathic Pulmonary Fibrosis (IPF) where it is classified as Group III PH by the World Health Organization (WHO). PH has been identified to be present in as much as 40% of patients with COPD or IPF and it is considered as one of the principal predictors of mortality in patients with COPD or IPF. However, despite the prevalence and fatal consequences of PH in the setting of chronic lung diseases, there are limited therapies available for patients with Group III PH, with lung transplantation remaining as the most viable option. This highlights our need to enhance our understanding of the molecular mechanisms that lead to the development of Group III PH. In this review we have chosen to focus on the current understating of PH in IPF, we will revisit the main mediators that have been shown to play a role in the development of the disease. We will also discuss the experimental models available to study PH associated with lung fibrosis and address the role of the right ventricle in IPF. Finally we will summarize the current available treatment options for Group III PH outside of lung transplantation.
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Panagiotou M, Church AC, Johnson MK, Peacock AJ. Pulmonary vascular and cardiac impairment in interstitial lung disease. Eur Respir Rev 2017; 26:26/143/160053. [PMID: 28096284 PMCID: PMC9488566 DOI: 10.1183/16000617.0053-2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/02/2016] [Indexed: 12/19/2022] Open
Abstract
Pulmonary vascular and cardiac impairment is increasingly appreciated as a major adverse factor in the natural history of interstitial lung disease. This clinically orientated review focuses on the current concepts in the pathogenesis, pathophysiology and implications of the detrimental sequence of increased pulmonary vascular resistance, pre-capillary pulmonary hypertension and right heart failure in interstitial lung disease, and provides guidance on its management. Development of pulmonary hypertension is a major adverse factor in the natural history of interstitial lung diseasehttp://ow.ly/nJB0302XAmD
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Affiliation(s)
- Marios Panagiotou
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Alistair C Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
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Effect of Lung Fibrosis on Glycogen Content in Different Extrapulmonary Tissues. Lung 2013; 192:125-31. [DOI: 10.1007/s00408-013-9539-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 11/11/2013] [Indexed: 11/25/2022]
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15
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Ho SC, Lin HC, Kuo HP, Chen LF, Sheng TF, Jao WC, Wang CH, Lee KY. Exercise training with negative pressure ventilation improves exercise capacity in patients with severe restrictive lung disease: a prospective controlled study. Respir Res 2013; 14:22. [PMID: 23421438 PMCID: PMC3598345 DOI: 10.1186/1465-9921-14-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Exercise training is of benefit for patients with restrictive lung disease. However, it tends to be intolerable for those with severe disease. We examined whether providing ventilatory assistance by using negative pressure ventilators (NPV) during exercise training is feasible for such patients and the effects of training. Methods 36 patients with restrictive lung disease were prospectively enrolled for a 12-week multidisciplinary rehabilitation program. During this program, half of them (n:18; 60.3 ± 11.6 years; 6 men; FVC: 32.5 ± 11.7% predicted ) received regular sessions of exercise training under NPV, whilst the 18 others (59.6 ± 12.3 years; 8 men; FVC: 37.7 ± 10.2% predicted) did not. Exercise capacity, pulmonary function, dyspnea and quality of life were measured. The primary endpoint was the between-group difference in change of 6 minute-walk distance (6MWD) after 12 weeks of rehabilitation. Results All patients in the NPV-exercise group were able to tolerate and completed the program. The between-group differences were significantly better in the NPV-exercise group in changes of 6MWD (34.1 ± 12.7 m vs. -32.5 ± 17.5 m; P = 0.011) and St George Score (−14.5 ± 3.6 vs. 11.8 ± 6.0; P < 0.01). There was an improvement in dyspnea sensation (Borg’s scale, from 1.4 ± 1.5 point to 0.8 ± 1.3 point, P = 0.049) and a small increase in FVC (from 0.85 ± 0.09 L to 0.91 ± 0.08 L, P = 0.029) in the NPV-exercise group compared to the control group. Conclusion Exercise training with NPV support is feasible for patients with severe restrictive lung diseases, and improves exercise capacity and health-related quality of life.
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Affiliation(s)
- Shu-Chuan Ho
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun-Hwa North Road, Taipei, Taiwan
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Elevated cardiovascular risk among adults with obstructive and restrictive airway functioning in the United States: a cross-sectional study of the National Health and Nutrition Examination Survey from 2007-2010. Respir Res 2012; 13:115. [PMID: 23237325 PMCID: PMC3546884 DOI: 10.1186/1465-9921-13-115] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States. METHODS We used data from adults aged 20-79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria. RESULTS Among 7249 participants, 80.9% had a normal pulmonary function test, 5.7% had a restrictive impairment, 7.9% had mild obstructive impairment, and 5.5% had moderate or severe/very severe obstructive impairment. Participants with obstructive impairment had high rates of smoking and increased serum concentrations of cotinine. Compared to participants with normal pulmonary functioning, participants with at least moderate obstructive impairment had elevated concentrations of C-reactive protein but lower concentrations of total cholesterol and non-high-density lipoprotein cholesterol. Among participants aged 50-74 years, participants with at least a moderate obstructive impairment or a restrictive impairment had an elevated predicted 10-year risk for cardiovascular disease. CONCLUSIONS The high rates of smoking among adults with impaired pulmonary functioning, particularly those with obstructive impairment, point to a need for aggressive efforts to promote smoking cessation in these adults. In addition, adults with restrictive impairment may require increased attention to and fine-tuning of their cardiovascular risk profile.
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Ginde S, Bartz PJ, Hill GD, Danduran MJ, Biller J, Sowinski J, Tweddell JS, Earing MG. Restrictive lung disease is an independent predictor of exercise intolerance in the adult with congenital heart disease. CONGENIT HEART DIS 2012; 8:246-54. [PMID: 23075089 DOI: 10.1111/chd.12010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Following repair of congenital heart disease (CHD), adult patients are at risk for reduced exercise capacity. Restrictive lung disease (RLD) may contribute to reduced exercise capacity in this population. The aim of this study was to determine the prevalence of RLD and its impact on exercise tolerance in the adult with CHD. METHODS One hundred consecutive adult patients with CHD, who underwent routine cardiopulmonary exercise testing with spirometry, were evaluated. Clinical data were obtained by retrospective chart review. RESULTS Patients from 10 major diagnostic groups were identified. The median age for the cohort was 31 years (range 18-63) and included 43 males and 57 females. Most patients, 79%, had at least one previous surgical procedure. Based on spirometry and flow/volume loops, 50 patients were classified as normal pulmonary function, 44 patients had patterns suggestive of RLD, 4 suggestive of mixed (obstructive and restrictive), and 2 indeterminate. Risk factors associated with RLD include history of multiple thoracotomies (odds ratio = 9.01, P =.05) and history of atrial arrhythmias (odd ratio = 4.25, P =.05). Overall, 56% of the patients had abnormal exercise capacity. Spirometry suggestive of RLD was a significant risk factor for decreased exercise capacity (odds ratio = 3.65, P =.03). Patients with spirometry suggesting RLD also had lower exercise duration (P =.004) and a higher New York Heart Association Functional Class (P =.02). History of previous surgery and decreased heart rate reserve were also significant risk factors for decreased exercise capacity. CONCLUSION Abnormal spirometry suggestive of RLD is common in the adult with CHD and is a significant risk factor for decreased exercise tolerance in this population. Further studies are needed to evaluate the relationship between RLD and exercise intolerance and its relationship to mortality in the adult with CHD.
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Affiliation(s)
- Salil Ginde
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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DREHER MICHAEL, KABITZ HANSJOACHIM. Impact of obesity on exercise performance and pulmonary rehabilitation. Respirology 2012; 17:899-907. [DOI: 10.1111/j.1440-1843.2012.02151.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011; 123:668-80. [PMID: 21321183 DOI: 10.1161/circulationaha.109.914788] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond Virginia 23298-0224, USA.
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Salhi B, Troosters T, Behaegel M, Joos G, Derom E. Effects of Pulmonary Rehabilitation in Patients With Restrictive Lung Diseases. Chest 2010; 137:273-9. [DOI: 10.1378/chest.09-0241] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Effects of proportional assisted ventilation on exercise performance in idiopathic pulmonary fibrosis patients. Respir Med 2010; 104:134-41. [DOI: 10.1016/j.rmed.2009.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 07/24/2009] [Accepted: 08/02/2009] [Indexed: 11/22/2022]
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Hsia CCW, Dane DM, Estrera AS, Wagner HE, Wagner PD, Johnson RL. Shifting sources of functional limitation following extensive (70%) lung resection. J Appl Physiol (1985) 2008; 104:1069-79. [PMID: 18258800 DOI: 10.1152/japplphysiol.01198.2007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously found that, following surgical resection of approximately 58% of lung units by right pneumonectomy (PNX) in adult canines, oxygen-diffusing capacity (Dl(O(2))) fell sufficiently to become a major factor limiting exercise capacity, although the decline was mitigated by recruitment, remodeling, and growth of the remaining lung units. To determine whether an upper limit of compensation is reached following the loss of even more lung units, we measured pulmonary gas exchange, hemodynamics, and ventilatory power requirements in adult canines during treadmill exercise following two-stage resection of approximately 70% of lung units in the presence or absence of mediastinal distortion. Results were compared with that in control animals following right PNX or thoracotomy without resection (Sham). Following 70% lung resection, peak O(2) uptake was 45% below normal. Ventilation-perfusion mismatch developed, and pulmonary arterial pressure and ventilatory power requirements became markedly elevated. In contrast, the relationship of Dl(O(2)) to cardiac output remained normal, indicating preservation of Dl(O(2))-to-cardiac output ratio and alveolar-capillary recruitment up to peak exercise. The impairment in airway and vascular function exceeded the impairment in gas exchange and imposed the major limitation to exercise following 70% resection. Mediastinal distortion further reduced air and blood flow conductance, resulting in CO(2) retention. Results suggest that adaptation of extra-acinar airways and blood vessels lagged behind that of acinar tissue. As more lung units were lost, functional compensation became limited by the disproportionately reduced convective conductance rather than by alveolar diffusion disequilibrium.
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Affiliation(s)
- Connie C W Hsia
- Pulmonary and Critical Care Medicine, Univ. of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9034, USA
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Chlif M, Keochkerian D, Feki Y, Vaidie A, Choquet D, Ahmaidi S. Inspiratory muscle activity during incremental exercise in obese men. Int J Obes (Lond) 2007; 31:1456-63. [PMID: 17593906 DOI: 10.1038/sj.ijo.0803546] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to assess overall inspiratory muscle activity during incremental exercise in obese men and healthy controls using the non-invasive, inspiratory muscle tension-time index (T(T0.1)). We studied 17 obese subjects (mean age+/-s.d.; 49+/-13 years) and 14 control subjects (42+/-16) during an incremental, maximal exercise test. METHODS Measurements included anthropometric parameters, spirometry, breathing patterns and inspiratory muscle activity. T(T0.1) was calculated using the equation T(T0.1)=P(0.1)/P(Imax) x T(I)/T(TOT) (where P(0.1) is mouth occlusion pressure, P(Imax) is maximal inspiratory pressure and T(I)/T(TOT) is the duty cycle). RESULTS At same levels of maximal exercise (%W(max)) (20, 40, 60, 80, 100% W(max)), obese subjects showed higher P(0.1) (P<0.001) and P(0.1)/P(Imax) (P<0.001) values than controls. T(T0.1) was thus higher in obese subjects for each workload increment and at maximal exercise (P<0.001). CONCLUSIONS During exercise, patients with obesity show alterations in inspiratory muscle activity as a result of both reduced inspiratory strength (as measured by maximal inspiratory pressure) and increased ventilatory drive (as reflected by mouth occlusion pressure), which prone obese subject to respiratory muscle weakness. Our results suggest that impaired respiratory muscle activity could contribute to a decrease in exercise capacity. T(T0.1) may be useful in our understanding concerning the benefits of endurance training.
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Affiliation(s)
- M Chlif
- EA 3300 APS and Motor Patterns: Adaptations-Rehabilitation, Faculté des Sciences du Sport, Sport Science Department, Picardie Jules Verne University, Amiens Cedex, France.
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Mura M, Ferretti A, Ferro O, Zompatori M, Cavalli A, Schiavina M, Fabbri M. Functional predictors of exertional dyspnea, 6-min walking distance and HRCT fibrosis score in idiopathic pulmonary fibrosis. Respiration 2005; 73:495-502. [PMID: 16484770 DOI: 10.1159/000089656] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 08/10/2005] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Exertional dyspnea and exercise incapacity are the most prominent and disabling symptoms and the main contributors to health-related quality of life in patients with idiopathic pulmonary fibrosis (IPF). OBJECTIVES There are no comprehensive studies on pulmonary function tests (PFTs), dyspnea, exercise capacity and radiographic scores in IPF. We therefore sought to investigate the functional variables that can predict dyspnea, exercise capacity and disease extent in IPF. METHODS Thirty-four patients with IPF according to the ATS/ERS criteria underwent PFTs, Medical Research Council (MRC) dyspnea scoring, 6-min walking distance (6-MWD) and radiographic evaluation of fibrosis (HRCT score). RESULTS The 6-MWD (% pred.) was more impaired than PFTs. Residual volume (RV) showed the best correlation with the extent of fibrosis (r = -0.67, p = 0.0001) and, together with the alveolar-arterial gradient for O(2) [DeltaP(A - a)O(2)], was an independent predictor of disease extent (R(2) = 0.44). PFTs showed significant though weak correlations with MRC score and 6-MWD. According to the regression analysis, DL(CO) and the HRCT fibrosis score were independent predictors of dyspnea, though they explained only 28% of the overall variance. FEV(1) and DeltaP(A - a)O(2) were independent predictors of 6-MWD (R(2) = 0.31). CONCLUSIONS PFTs and lung volumes in particular are closely related to the HRCT score, a measure of the extent of IPF. The correlation of dyspnea score and 6-MWD to PFTs is limited, due to the complexity of mechanisms leading to exercise limitation in IPF. Therefore dyspnea and exercise performance are largely independent indices and should be followed together with PFTs and HRCT score in order to better assess the status and progress of IPF patients.
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Affiliation(s)
- Marco Mura
- UO Fisiopatologia Respiratoria, Policlinico Sant'Orsola-Malpighi, Bologna, Italia, Italy.
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Abstract
OBJECTIVE Subjects with restrictive pulmonary disease exhibit a decreased exercise capacity compared to non-diseased subjects, as do subjects in certain workplace situations, for example when wearing bullet-proof vests. The purpose of this study was to examine the effects of varying degrees of chest wall restrictive loading on exercise performance. We have designed and validated a chest wall restrictor that mimics the elastic loading occurring in some disease states and some occupational situations. METHODOLOGY In this study, 18 subjects performed five graded maximal cycling tests while wearing the device at four different inflation pressures (0, 20, 40, and 60 mmHg). RESULTS Maximal values of oxygen uptake (VO2max), minute ventilation (VImax), tidal volume (VT at max) and breathing frequency (fB at max) were monitored, as was the time to maximal exercise (TTM). VO2, VI, VT, and fB were also measured at three submaximal loads. The results showed that VO2max, VImax, TTM, and VT at max were significantly decreased, while fB at max was maintained. At submaximal loads, the ventilatory parameters VT, and fB were altered with load, but VI and VO2 were not affected by load. CONCLUSIONS These results indicate that the wearing of this device decreases variables associated with maximal exercise, and that the decreases are related to the degree of chest wall restriction. Furthermore, submaximal exercise ventilation was minimally altered, with an increase in fB and a decrease in VT associated with increasing restrictive loads. Submaximal oxygen uptake was not affected by breathing restriction.
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Affiliation(s)
- J Richard Coast
- S.A. Rasmussen Exercise Physiology Laboratory, Department of Exercise Science, Northern Arizona University, Flagstaff, AZ 86011, USA.
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Borowitz D, Cerny F, Zallen G, Sharp J, Burke M, Gross K, Glick PL. Pulmonary function and exercise response in patients with pectus excavatum after Nuss repair. J Pediatr Surg 2003; 38:544-7. [PMID: 12677562 DOI: 10.1053/jpsu.2003.50118] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE The Ravitch repair of pectus excavatum removes segments of abnormal costal cartilages after which the sternum is elevated and stabilized. Some investigators have found a worsening in total lung capacity postoperatively. Recently, a technique has been used in which the costal cartilages are preserved, and the sternum is elevated with an internal steel bar (Nuss repair). The authors hypothesized that placement of a substernal bar in the first stage of the Nuss repair will not adversely affect pulmonary and exercise function. METHODS Patients who presented to the Children's Hospital of Buffalo for surgical repair of pectus excavatum from June 1997 through June 2000 underwent pulmonary function and exercise testing before and 6 to 12 months after the first stage of a Nuss repair. RESULTS Ten patients were studied (all boys; mean age at operative repair, 13.4 +/- 3 years). Mean baseline pulmonary function was normal, and no significant differences were seen before and after placement of the intrathoracic bar. Peak oxygen consumption was near normal, although work at VO2max was less than predicted (mean, 68.2% before v. 71.8% after surgery). V(E) was below normal and Vt/FVC was below the expected 50% to 60% level both before and after surgery (41.3% +/- 3 SE and 41.6% +/- 3 SE pre- and postoperatively, respectively). CONCLUSIONS Placement of a substernal steel bar in the first stage of the Nuss procedure for repair of pectus excavatum does not cause adverse effects on either static pulmonary function or on the ventilatory response to exercise.
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Affiliation(s)
- Drucy Borowitz
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York, USA
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Abstract
Chronic lung disease has significant impact on cardiovascular function. Much of this effect is because of increased right ventricular afterload caused by increased pulmonary vascular resistance resulting from structural changes in the pulmonary circulation, and because of hypoxic pulmonary vasoconstriction. In the case of chronic obstructive diseases, there may be additional increases in afterload resulting from dynamic hyperinflation. These processes can lead to structural changes in the heart (cor pulmonale), including right ventricular dilatation and hypertrophy, to maintain right ventricular output. In most ambulatory patients with chronic obstructive disease, it appears that cardiac output may be maintained at levels that are similar to normal both at rest and during exercise, with no consistent improvement in maximal exercise function afforded by interventions that increase blood flow. In contrast, diseases characterized by fibrosis or infiltration of the lung parenchyma may be associated with a disproportionate increase in pulmonary vascular resistance and more pronounced cardiovascular impairment, particularly with exercise.
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Affiliation(s)
- K Sietsema
- Harbor-UCLA Medical Center, Harbor-UCLA Research and Education Institute, Torrance, CA 90502, USA.
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