Effects of Sarcopenia on Ventilatory Behavior and the Multidimensional Nature of Dyspnea in Patients With Chronic Obstructive Pulmonary Disease
Effects of Sarcopenia on Ventilatory Behavior and the Multidimensional Nature of Dyspnea in Patients With Chronic Obstructive Pulmonary Disease
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肌肉减少症对慢性阻塞性肺疾病患者通气行为和呼吸困难的多维性质的影响
DOI：
10.1016/j.jamda.2021.01.081
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发表时间：
2021
影响因子：
7.6
通讯作者：
Sato Susumu
中科院分区：
文献类型：
--
作者：
Kanezaki Masashi;Terada Kunihiko;Tanabe Naoya;Shima Hiroshi;Hamakawa Yoko;Sato Susumu
目的本研究检验了这样的假设：肌肉减少症是慢性阻塞性肺疾病 (COPD) 的常见肺外特征，可影响通气行为，并使 COPD 患者呼吸困难的多维性质恶化。设计横断面调查研究。背景和参与者：在全科诊所和呼吸科遇到的稳定的 COPD 门诊患者 临床方法根据基于电阻抗和握力测量的四肢骨骼肌质量指数诊断肌少症。使用 3 分钟步行测试和 6 分钟步行测试来测试劳力性呼吸困难。通过多维呼吸困难概况评估呼吸困难的维度。结果 60 名稳定的 COPD 患者中，16 名符合肌少症标准。在 3 分钟步进测试中，每分钟通气量占运动时间的比例、潮气量占吸气量的比例、吸气量的变化以及通气量占最大通气量的比例在患有和不患有肌少症的患者之间没有差异。与没有肌肉减少症的患者相比，肌肉减少症患者在 3 分钟步行测试中表现出潮气量变化较低、呼吸频率与通气量和呼吸不适的变化较高，以及在 6 分钟步行测试中物理呼吸努力增加。在使用逆概率加权调整的多变量模型中，肌肉减少症与 3 分钟步行测试期间的呼吸不适和 6 分钟步行测试期间的物理呼吸努力独立相关。结论和含义肌肉减少症可能与 COPD 患者的浅呼吸以及劳力性呼吸困难的多种感觉和情感成分相关。该研究表明，改善快速呼吸模式可能为缓解老年慢性阻塞性肺病和肌肉减少症患者的呼吸困难提供独特的方法。
ObjectivesThis study tested the hypothesis that sarcopenia, a common extrapulmonary feature of chronic obstructive pulmonary disease (COPD), can affect ventilatory behavior, and worsen the multidimensional nature of dyspnea in patients with COPD.DesignCross-sectional survey study.Settingand Participants: Stable outpatients with COPD encountered in general practice and respiratory clinic.MethodSarcopenia was diagnosed according to an appendicular skeletal muscle mass index based on measurements of electrical impedance and handgrip strength. Exertional dyspnea was tested using a 3-minute Step Test and a 6-minute Walk Test. The dimensions of dyspnea were assessed by a multidimensional dyspnea profile.ResultsOf 60 stable patients with COPD, 16 met the criteria for sarcopenia. During the 3-minute Step Test, minute ventilation as a proportion of exercise time, tidal volume as a proportion of inspiratory capacity, the change in inspiratory capacity, and ventilation as a proportion of maximal voluntary ventilation did not differ between patients with and without sarcopenia. Patients with sarcopenia exhibited lower evolution of tidal volume, higher evolution of respiratory frequency versus ventilation and breathing discomfort on the 3-minute Step Test, as well as increased physical breathing effort on the 6-minute Walk Test, compared with those without sarcopenia. In a multivariable model adjusted using inverse probability weighting, sarcopenia was independently associated with breathing discomfort during the 3-minute Step Test and physical breathing effort during the 6-minute Walk Test.Conclusions and ImplicationsSarcopenia may be associated with shallow breathing and diverse sensory and affective components of exertional dyspnea in patients with COPD. The study indicates that improvement of the rapid breathing pattern may offer unique ways to alleviate dyspnea in older patients with COPD and sarcopenia.