The Utility of Cardiopulmonary Exercise Testing in Difficult Asthma
The Utility of Cardiopulmonary Exercise Testing in Difficult Asthma
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DOI：
10.1378/chest.10-2321
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发表时间：
2011-05-01
期刊：
影响因子：
9.6
通讯作者：
Heaney, Liam G.
中科院分区：
文献类型：
--
作者：
McNicholl, Diarmuid M.;Megarry, Jacqui;Heaney, Liam G.
背景：难治性哮喘患者尽管接受多种治疗，但不明原因的持续呼吸困难是一个常见的临床问题。心脏运动试验（CPX）可能有助于确定导致这些症状的机制，允许适当的management.Methods：这是一个回顾性分析的患者参加专家提供的服务困难的哮喘谁进行CPX作为我们的评估协议的一部分。将患者的人口统计学资料、肺功能、医疗保健和急救药物的使用情况与难治性哮喘患者进行比较。CPX后6个月的药物使用与CPX.Results期间的治疗进行了比较：302序贯转诊，39例患者接受CPX。在30例患者中确定了一个解释性特征，在9例患者中确定了两个特征：换气过度（n = 14）、运动诱导的支气管收缩（n = 8）、次最大试验（n = 8）、正常试验（n = 8）、呼吸受限（n = 7）、失调（n = 2）、心肌缺血（n = 1）。与难治性哮喘患者相比，CPX治疗无“肺限制”的患者吸入皮质类固醇（ICS）的剂量相似（中位数，1，300 μ g [四分位距（IQR），800- 2，000 μ g] vs 1，800 μ g [IQR，1，000 - 2，000 μ g]）和前一年的补救口服类固醇疗程（中位数，5 [1-6] vs 5 [1-6]）。在该组中，CPX后6个月，ICS剂量减少（中位数，1，300 μ g [IQR，800- 2，000 μ g]至800 μ g [IQR，400- 1，000 μ g]; P <0.001），并停止额外的药物治疗（n = 7）。肺功能受限患者的ICS剂量不变后CPX和额外的治疗introduced.Conclusions：在困难的哮喘，CPX可以确认，持续劳力性呼吸困难是由于哮喘，但也可以确定其他因素。非肺功能受限的患者被不适当地给予高剂量的类固醇治疗，CPX可以识别呼吸困难的主要机制，促进类固醇减少。胸部2011; 139（5）：1117-1123
Background: Unexplained persistent breathlessness in patients with difficult asthma despite multiple treatments is a common clinical problem. Cardiopulmonary exercise testing (CPX) may help identify the mechanism causing these symptoms, allowing appropriate management.Methods: This was a retrospective analysis of patients attending a specialist-provided service for difficult asthma who proceeded to CPX as part of our evaluation protocol. Patient demographics, lung function, and use of health care and rescue medication were compared with those in patients with refractory asthma. Medication use 6 months following CPX was compared with treatment during CPX.Results: Of 302 sequential referrals, 39 patients underwent CPX. A single explanatory feature was identified in 30 patients and two features in nine patients: hyperventilation (n = 14), exercise-induced bronchoconstriction (n = 8), submaximal test (n = 8), normal test (n = 8), ventilatory limitation (n = 7), deconditioning (n = 2), cardiac ischemia (n = 1). Compared with patients with refractory asthma, patients without "pulmonary limitation" on CPX were prescribed similar doses of inhaled corticosteroid (ICS) (median, 1,300 mu g [interquartile range (IQR), 800-2,000 mu g] vs 1,800 mu g [IQR, 1,000-2,000 mu g]) and rescue oral steroid courses in the previous year (median, 5 [1-6] vs 5 [1-6]). In this group 6 months post-CPX, ICS doses were reduced (median, 1,300 mu g [IQR, 800-2,000 mu g] to 800 mu g [IQR, 400-1,000 mu g]; P < .001) and additional medication treatment was withdrawn (n = 7). Patients with pulmonary limitation had unchanged ICS doses post CPX and additional therapies were introduced.Conclusions: In difficult asthma, CPX can confirm that persistent exertional breathlessness is due to asthma but can also identify other contributing factors. Patients with nonpulmonary limitation are prescribed inappropriately high doses of steroid therapy, and CPX can identify the primary mechanism of breathlessness, facilitating steroid reduction. CHEST 2011; 139(5):1117-1123