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Mandoli GE, Sciaccaluga C, Bandera F, Cameli P, Esposito R, D'Andrea A, Evola V, Sorrentino R, Malagoli A, Sisti N, Nistor D, Santoro C, Bargagli E, Mondillo S, Galderisi M, Cameli M. Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings. Heart Fail Rev 2020; 26:263-275. [PMID: 32860180 PMCID: PMC7895796 DOI: 10.1007/s10741-020-10014-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cor pulmonale is the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process. Depending on the speed of onset of the pathological condition and subsequent effects on the right ventricle, it is possible to distinguish the acute cor pulmonale from the chronic type of disease. Echocardiography plays a central role in the diagnostic and therapeutic work-up of these patients, because of its non-invasive nature and wide accessibility, providing its greatest usefulness in the acute setting. It also represents a valuable tool for tracking right ventricular function in patients with cor pulmonale, assessing its stability, deterioration, or improvement during follow-up. In fact, not only it provides parameters with prognostic value, but also it can be used to assess the efficacy of treatment. This review attempts to provide the current standards of an echocardiographic evaluation in both acute and chronic cor pulmonale, focusing also on the findings present in the most common pathologies causing this condition.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS, Policlinico San Donato, San Donato Milanese and Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Antonello D'Andrea
- Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Vincenzo Evola
- Department of Health Promotion Sciences, Maternal-Infant Care, Internal Medicine and Specialities of Excellence "G. D'Alessandro", University of Palermo, Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, "S. Agostino-Estense" Public Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Dan Nistor
- Institute for Emergency Cardiovascular Diseases and Transplant Targu Mures, Targu Mures, Romania
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
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Qian X, Zhao H, Feng Q. Involvement of miR-200b-PKCα signalling in pulmonary hypertension in cor pulmonale model. Clin Exp Pharmacol Physiol 2019; 47:478-484. [PMID: 31730233 DOI: 10.1111/1440-1681.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Abstract
The right ventricle (RV) enlargement and pulmonary fibrosis are involved in cor pulmonale. The role of miR-200b in cor pulmonale is less well understood. This study was designed to evaluate the regulatory roles of miR-200b in cor pulmonale. Cor pulmonary mouse model was built via monocrotaline injection of monocrotaline (MCT). The expression of miR-200b in the lungs, RV and left ventricle (LV) are using real-time polymerase chain reaction. The transthoracic echocardiography was employed to determine the effects of miR-200b mimics and Gö6976 injection on MCT mice. The protein levels of protein kinase C α (PKCα), collagen, and fibronectin in the lung, RV, and LV in the mice with and without miR-200b mimics and Gö6976 injection were evaluated using western blot. The expression of miR-200b decreased in MCT mice, while there was no difference in LV. Both the miR-200b mimics and Gö6976 injection reversed the muscularization in the pulmonary artery, reversed RV hypertrophy, reduced RV systolic pressure, wall thickness and pulmonary fibrosis. The injection of miR-200b can reduce the PKCα expression in the lung, RV, and LV. This study confirmed the down-regulation of miR-200b in cor pulmonale. The reverse effects of miR-200b in the present study may provide a potential tool for cor pulmonary treatment.
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Affiliation(s)
- Xiaojun Qian
- Wuxi No.2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Hongqin Zhao
- Wuxi No.2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Qiuting Feng
- Wuxi No.2 People's Hospital, Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
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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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Cheyne WS, Gelinas JC, Eves ND. The haemodynamic response to incremental increases in negative intrathoracic pressure in healthy humans. Exp Physiol 2018; 103:581-589. [DOI: 10.1113/ep086654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- William S. Cheyne
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences; University of British Columbia; Kelowna BC Canada
| | - Jinelle C. Gelinas
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences; University of British Columbia; Kelowna BC Canada
| | - Neil D. Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences; University of British Columbia; Kelowna BC Canada
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Verhoeff K, Mitchell JR. Cardiopulmonary physiology: why the heart and lungs are inextricably linked. ADVANCES IN PHYSIOLOGY EDUCATION 2017; 41:348-353. [PMID: 28679570 DOI: 10.1152/advan.00190.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/12/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
Because the heart and lungs are confined within the thoracic cavity, understanding their interactions is integral for studying each system. Such interactions include changes in external constraint to the heart, blood volume redistribution (venous return), direct ventricular interaction (DVI), and left ventricular (LV) afterload. During mechanical ventilation, these interactions can be amplified and result in reduced cardiac output. For example, increased intrathoracic pressure associated with mechanical ventilation can increase external constraint and limit ventricular diastolic filling and, therefore, output. Similarly, high intrathoracic pressures can alter blood volume distribution and limit diastolic filling of both ventricles while concomitantly increasing pulmonary vascular resistance, leading to increased DVI, which may further limit LV filling. While LV afterload is generally considered to decrease with increased intrathoracic pressure, the question arises if the reduced LV afterload is primarily a consequence of a reduced LV preload. A thorough understanding of the interaction between the heart and lungs can be complicated but is essential for clinicians and health science students alike. In this teaching review, we have attempted to highlight the present understanding of certain salient aspects of cardiopulmonary physiology and pathophysiology, as well as provide a resource for multidisciplined health science educators and students.
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Affiliation(s)
- Kevin Verhoeff
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and
| | - Jamie R Mitchell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
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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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Cheyne WS, Williams AM, Harper MI, Eves ND. Heart-lung interaction in a model of COPD: importance of lung volume and direct ventricular interaction. Am J Physiol Heart Circ Physiol 2016; 311:H1367-H1374. [PMID: 27765746 DOI: 10.1152/ajpheart.00458.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/03/2016] [Indexed: 01/29/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with dynamic lung hyperinflation (DH), increased pulmonary vascular resistance (PVR), and large increases in negative intrathoracic pressure (nITP). The individual and interactive effect of these stressors on left ventricular (LV) filling, emptying, and geometry and the role of direct ventricular interaction (DVI) in mediating these interactions have not been fully elucidated. Twenty healthy subjects were exposed to the following stressors alone and in combination: 1) inspiratory resistive loading of -20 cmH2O (nITP), 2) expiratory resistive loading to cause dynamic hyperinflation (DH), and 3) normobaric-hypoxia to increase PVR (hPVR). LV volumes and geometry were assessed using triplane echocardiography. LV stroke volume (LVSV) was reduced during nITP by 7 ± 7% (mean ± SD; P < 0.001) through a 4 ± 5% reduction in LV end-diastolic volume (LVEDV) (P = 0.002), while DH reduced LVSV by 12 ± 13% (P = 0.001) due to a 9 ± 10% reduction in LVEDV (P < 0.001). The combination of nITP and DH (nITP+DH) caused larger reductions in LVSV (16 ± 16%, P < 0.001) and LVEDV (12 ± 10%, P < 0.001) than nITP alone (P < 0.05). The addition of hPVR to nITP+DH did not further reduce LV volumes. Significant septal flattening (indicating DVI) occurred in all conditions, with a significantly greater leftward septal shift occurring with nITP+DH than either condition alone (P < 0.05). In summary, the interaction of nITP and DH reduces LV filling through DVI. However, DH may be more detrimental to LV hemodynamics than nITP, likely due to mediastinal constraint of the heart amplifying DVI.
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Affiliation(s)
- William S Cheyne
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Alexandra M Williams
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Megan I Harper
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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Ba A, Brégeon F, Delliaux S, Cissé F, Samb A, Jammes Y. Cardiopulmonary response to exercise in COPD and overweight patients: relationship between unloaded cycling and maximal oxygen uptake profiles. BIOMED RESEARCH INTERNATIONAL 2015; 2015:378469. [PMID: 25866778 PMCID: PMC4383510 DOI: 10.1155/2015/378469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/03/2014] [Accepted: 09/21/2014] [Indexed: 11/25/2022]
Abstract
Cardiopulmonary response to unloaded cycling may be related to higher workloads. This was assessed in male subjects: 18 healthy sedentary subjects (controls), 14 hypoxemic patients with chronic obstructive pulmonary disease (COPD), and 31 overweight individuals (twelve were hypoxemic). They underwent an incremental exercise up to the maximal oxygen uptake (VO2max), preceded by a 2 min unloaded cycling period. Oxygen uptake (VO2), heart rate (HR), minute ventilation (VE), and respiratory frequency (fR) were averaged every 10 s. At the end of unloaded cycling period, HR increase was significantly accentuated in COPD and hypoxemic overweight subjects (resp., +14 ± 2 and +13 ± 1.5 min(-1), compared to +7.5 ± 1.5 min(-1) in normoxemic overweight subjects and +8 ± 1.8 min(-1) in controls). The fR increase was accentuated in all overweight subjects (hypoxemic: +4.5 ± 0.8; normoxemic: +3.9 ± 0.7 min(-1)) compared to controls (+2.5 ± 0.8 min(-1)) and COPDs (+2.0 ± 0.7 min(-1)). The plateau VE increase during unloaded cycling was positively correlated with VE values measured at the ventilatory threshold and VO2max. Measurement of ventilation during unloaded cycling may serve to predict the ventilatory performance of COPD patients and overweight subjects during an exercise rehabilitation program.
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Affiliation(s)
- Abdoulaye Ba
- Service des Explorations Fonctionnelles Respiratoires, Hopital Nord (Assistance Publique-Hôpitaux de Marseille) and UMR MD2, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Cedex 20 Marseille, France
- Laboratory of Physiology, Faculty of Medicine, University of Cheikh Anta Diop, Dakar, P.O. Box 45698, Dakar Fann, Dakar, Senegal
- Unité Mixte Internationale Environnement, Santé, Sociétés (UMI3189 ESS), Université Cheikh Anta Diop (UCAD), P.O. Box 5005, Dakar Fann, Senegal
| | - Fabienne Brégeon
- Service des Explorations Fonctionnelles Respiratoires, Hopital Nord (Assistance Publique-Hôpitaux de Marseille) and UMR MD2, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Cedex 20 Marseille, France
| | - Stéphane Delliaux
- Service des Explorations Fonctionnelles Respiratoires, Hopital Nord (Assistance Publique-Hôpitaux de Marseille) and UMR MD2, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Cedex 20 Marseille, France
| | - Fallou Cissé
- Laboratory of Physiology, Faculty of Medicine, University of Cheikh Anta Diop, Dakar, P.O. Box 45698, Dakar Fann, Dakar, Senegal
| | - Abdoulaye Samb
- Laboratory of Physiology, Faculty of Medicine, University of Cheikh Anta Diop, Dakar, P.O. Box 45698, Dakar Fann, Dakar, Senegal
- Unité Mixte Internationale Environnement, Santé, Sociétés (UMI3189 ESS), Université Cheikh Anta Diop (UCAD), P.O. Box 5005, Dakar Fann, Senegal
| | - Yves Jammes
- Service des Explorations Fonctionnelles Respiratoires, Hopital Nord (Assistance Publique-Hôpitaux de Marseille) and UMR MD2, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Cedex 20 Marseille, France
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2136] [Impact Index Per Article: 194.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Brønstad E, Tjonna AE, Rognmo Ø, Dalen H, Heggli AM, Wisloff U, Ingul CB, Steinshamn S. Aerobic exercise training improves right- and left ventricular systolic function in patients with COPD. COPD 2012; 10:300-6. [PMID: 23272664 DOI: 10.3109/15412555.2012.745843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of moderate continuous training (MCT) and high intensity aerobic interval training (AIT) on systolic ventricular function and aerobic capacity in COPD patients. METHODS Seventeen patients with COPD (64 ± 8 years, 12 men) with FEV1 of 52.8 ± 11% of predicted, were randomly assigned to isocaloric programs of MCT at 70% of max heart rate (HR) for 47 minutes) or AIT (~90% of max HR for 4×4 minutes) three times per week for 10 weeks. Baseline cardiac function was compared with 17 age- and sex-matched healthy individuals. Peak oxygen uptake (VO(2-peak)) and left (LV) and right ventricular (RV) function examined by echocardiography, were measured at baseline and after 10 weeks of training. RESULTS At baseline, the COPD patients had reduced systolic function compared to healthy controls (p < 0.05). After the training, AIT and MCT increased VO(2-peak) by 8% and 9% and work economy by 7% and 10%, respectively (all p < 0.05). LV and RV systolic function both improved (p < 0.05), with no difference between the groups after the two modes of exercise training. Stroke volume increased by 17% and 20%, LV systolic tissue Doppler velocity (S') by 18% and 17% and RV S' by 15% after AIT and MCT, respectively (p < 0.05). CONCLUSION Systolic cardiac function is reduced in COPD. Both AIT and MCT improved systolic cardiac function. In contrast to other patient groups studied, higher exercise intensity does not seem to have additional effects on cardiac function or aerobic capacity in COPD patients.
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Affiliation(s)
- Eivind Brønstad
- K. G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
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11
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Moga AM, de Marchie M, Saey D, Spahija J. Mechanisms of non-pharmacologic adjunct therapies used during exercise in COPD. Respir Med 2012; 106:614-26. [PMID: 22341681 DOI: 10.1016/j.rmed.2012.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 01/04/2012] [Accepted: 01/12/2012] [Indexed: 11/16/2022]
Abstract
Individuals with chronic obstructive pulmonary disease (COPD) are often limited in their ability to perform exercise due to a heightened sense of dyspnea and/or the occurrence of leg fatigue associated with a reduced ventilatory capacity and peripheral skeletal muscle dysfunction, respectively. Pulmonary rehabilitation programs have been shown to improve exercise tolerance and health related quality of life. Additional therapeutic approaches such as non-invasive ventilatory support (NIVS), heliox (He-O(2)) and supplemental oxygen have been used as non-pharmacologic adjuncts to exercise to enhance the ability of patients with COPD to exercise at a higher exercise-intensity and thus improve the physiological benefits of exercise. The purpose of the current review is to examine the pathophysiology of exercise limitation in COPD and to explore the physiological mechanisms underlying the effect of the adjunct therapies on exercise in patients with COPD. This review indicates that strategies that aim to unload the respiratory muscles and enhance oxygen saturation during exercise alleviate exercise limiting factors and improve exercise performance in patients with COPD. However, available data shows significant variability in the effectiveness across patients. Further research is needed to identify the most appropriate candidates for these forms of therapies.
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Affiliation(s)
- A M Moga
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec H3G 1Y5, Canada
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12
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Vagaggini B, Nieri D, Malagrinò L, Antonelli S, De Cusatis G, De Simone C, Costa F, Paggiaro PL. Acute administration of bronchodilators on exercise tolerance in treated COPD patients. Pulm Pharmacol Ther 2010; 24:49-54. [PMID: 20970517 DOI: 10.1016/j.pupt.2010.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/04/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
Exercise intolerance is a major feature in patients with Chronic Obstructive Pulmonary Disease (COPD). Bronchodilators increase endurance time (ET) and reduce dynamic hyperinflation (DH). We evaluated whether a single-dose of salbutamol/ipratropium + flunisolide (BD+ICS), added on top of the regular treatment, may improve ET in COPD patients. In a single-blind randomized crossover pilot trial, nebulised BD+ICS or placebo (PL) was administered 30 min before a constant load cardiopulmonary test, in 22 moderate-to-severe COPD patients (FEV₁: 53.9% pred). ET was the primary outcome measured. BD+ICS did not improve ET or VO₂ peak with respect to PL. BD+ICS increased pre-test FEV₁ and pre-test Inspiratory Capacity but did not modify DH. In a retrospective analysis, patients were divided in Improvers (N=11) and Non-Improvers (N=11) according to the difference in ET between BD+ICS and PL (> 25 s). Improvers had a worst BODE index, a higher static hyperinflation and poorer Vd/Vt ratio at peak of exercise with respect to Non-Improvers. Improvers only had a significant increase from BD+ICS on pre-test FEV₁ and IC. In conclusion, although a single-dose BD+ICS did not improve ET in COPD patients under regular treatment, a subgroup of more severe patients may have some benefit from that.
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Affiliation(s)
- Barbara Vagaggini
- Cardio-Thoracic and Vascular Department, Section of Pneumology, University of Pisa, Italy.
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Alm AS, Ingvarsson A, Wang X. Significance of lung hyperinflation in chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17471060600845190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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14
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Gayan-Ramirez G, Decramer M. Réhabilitation respiratoire des patients souffrant de bronchopneumopathie chronique obstructive. Presse Med 2009; 38:452-61. [DOI: 10.1016/j.lpm.2008.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/15/2008] [Indexed: 11/28/2022] Open
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Abstract
Chronic obstructive pulmonary disease (COPD) no longer is regarded simply as a disease of the lungs and airways. There is growing awareness of the multisystemic nature of this disease. Research has shown increased levels of systemic inflammation and cardiovascular, neurologic, psychiatric, and endocrine system dysfunction associated with COPD. Skeletal muscle dysfunction associated with COPD is discussed in the article by Schols in this issue of Clinics in Chest Medicine. In this article, other systemic manifestations of COPD are discussed. Although this field is expanding rapidly, this article focuses on recent advances and reviews.
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Affiliation(s)
- Andrew C Stone
- Brown University School of Medicine, Providence, RI, USA
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Derom E, Marchand E, Troosters T. Pulmonary rehabilitation in chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2007; 50:615-26, 602-14. [PMID: 17559963 DOI: 10.1016/j.annrmp.2007.04.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 04/24/2007] [Indexed: 10/23/2022]
Abstract
Pulmonary rehabilitation, a multidisciplinary and structured intervention for patients with chronic pulmonary diseases, has been shown to improve exercise tolerance, reduce dyspnea and improve health-related quality of life. Pulmonary rehabilitation appears to be cost-effective, since it reduces health care utilization. Exercise training represents the cornerstone of every pulmonary rehabilitation program. To obtain clinically relevant effects, training should closely supervised, of high intensity, lasting 30-45 min for at least 3 days/week. Patients should undertake a minimum of 20 sessions, but longer programs result in larger and more long-lasting effects. Education and self-management programs have been shown to result in a substantial reduction in hospital admissions. Nutritional intervention should be considered for patients who are underweight or those with body composition abnormalities. Patients reporting fear and anxiety may benefit from psychosocial support, and the integration of occupational therapy in a pulmonary rehabilitation program can improve independence in activity. Multidisciplinary pulmonary rehabilitation is preferably implemented in an outpatient hospital- or community-based setting. Inpatient programs are suited for patients with limited transportation capabilities or severe deconditioning. The most convincing effects of home-based rehabilitation are in maintaining the improvements obtained in an outpatient setting.
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Affiliation(s)
- E Derom
- Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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17
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Derom E, Marchand E, Troosters T. Réhabilitation du malade atteint de bronchopneumopathie chronique obstructive. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Fabre C, Grosbois JM, Bart F, Borel B, Mucci P. At identical isowork rates, ageing influences cardiorespiratory adaptations in COPD out-patients. Respir Med 2007; 101:2305-11. [PMID: 17689237 DOI: 10.1016/j.rmed.2007.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 06/13/2007] [Accepted: 06/20/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the extent to which younger COPD patients improve their cardiorespiratory function during exercise in comparison with older COPD patients, as a result of exercise training. METHODS Thirty-nine COPD patients underwent an exercise program. They were divided into two groups: a younger group (57.2+/-1.0 years, n=18 patients) and an older group (68.8+/-0.6 years, n=21 patients). Forced expiratory volume in 1s was lower than 55% of the predicted value for all patients. RESULTS After training, VO2 symptom-limited significantly improved by 10.3% and 8.4% for the younger and older COPD patients, respectively (P<0.05). Peak power significantly improved by 25.2% and 17.8% in the younger and older groups, respectively (P<0.05) with a greater improvement for the younger group (P<0.05). At submaximal exercise, ventilation and heart rate significantly decreased after training in the younger COPD patients (P<0.05) with no significant modification in the older COPD patients. CONCLUSIONS The results suggest that all patients with COPD benefit from exercise rehabilitation at maximal exercise workload, however, according to their age, submaximal cardiorespiratory adaptations were greater in younger patients.
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Affiliation(s)
- C Fabre
- Faculté des Sciences du Sport et de l'Education Physique, Laboratoire d'Etudes de la Motricité Humaine (LEMH), EA:3608, Université de Lille 2, 9 rue de l'Université, 59790 Ronchin, France.
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Butcher SJ, Jones RL. The impact of exercise training intensity on change in physiological function in patients with chronic obstructive pulmonary disease. Sports Med 2006; 36:307-25. [PMID: 16573357 DOI: 10.2165/00007256-200636040-00003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pulmonary rehabilitation incorporating exercise training is an effective method of enhancing physiological function and quality of life for patients with chronic obstructive pulmonary disease (COPD). Despite the traditional belief that exercise is primarily limited by the inability to adequately increase ventilation to meet increased metabolic demands in these patients, significant deficiencies in muscle function, oxygen delivery and cardiac function are observed that contribute to exercise limitation. Because of this multifactorial exercise limitation, defining appropriate exercise training intensities is difficult. The lack of a pure cardiovascular limitation to exercise prohibits the use of training guidelines that are based on cardiovascular factors such as oxygen consumption or heart rate. Current recommendations for exercise training intensity for patients with COPD include exercising at a 'maximally tolerable level', at an intensity corresponding with 50% of peak oxygen consumption (V-O2peak), or at 60-80% of peak power output obtained on a symptom-limited exercise tolerance test. In general, it appears that higher intensity training elicits greater physiological change than lower intensity training; however, there is no consensus as to the exercise training intensity that elicits the greatest physiological benefit while remaining tolerable to patients. The 'optimal' intensity of training likely depends upon the individual goals of each patient. If the goal is to increase the ability to sustain tasks that are currently able to be performed, lower to moderate-intensity training is likely to be sufficient. If the goal of training, however, is to increase the ability to perform tasks that are above the current level of tolerance, higher intensity training is likely to elicit greater performance increases. In order to perform higher intensity exercise, an interval training model is likely required. High-intensity interval training involves significant anaerobic energy utilisation and, therefore, may better mimic the physiological requirements of activities of daily living. Also, high-intensity interval training is tolerable to patients and may, in fact, reduce the degree of dyspnoea and dynamic hyperinflation through a reduced ventilatory demand. Another factor that will determine the optimal intensity of training is the relative contribution of ventilatory limitation to exercise tolerance. If peak exercise tolerance is limited by a patient's ability to increase ventilation, it is possible that interval training at an intensity higher than peak will elicit greater muscular adaptation than an intensity at or below peak power on an incremental exercise test. More research is required to determine the optimal training intensity for pulmonary rehabilitation patients.
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Affiliation(s)
- Scott J Butcher
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173:1390-413. [PMID: 16760357 DOI: 10.1164/rccm.200508-1211st] [Citation(s) in RCA: 1095] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Borghi-Silva A, Baldissera V, Sampaio LMM, Pires-DiLorenzo VA, Jamami M, Demonte A, Marchini JS, Costa D. L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs. Braz J Med Biol Res 2006; 39:465-74. [PMID: 16612469 DOI: 10.1590/s0100-879x2006000400006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 +/- 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 +/- 16 and 36 +/- 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 +/- 14 vs 14 +/- 5 cmH2O, and 87 +/- 30 vs 34 +/- 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 +/- 0.7 vs 2.3 +/- 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.
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Affiliation(s)
- A Borghi-Silva
- Laboratório de Fisioterapia Cardiovascular, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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Silva AB, Di Lorenzo VAP, Jamami M, Sampaio LMM, Demonte A, Cardello L, Costa D. Efeitos da suplementação oral de L-carnitina associada ao treinamento físico na tolerância ao exercício de pacientes com doença pulmonar obstrutiva crônica. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0102-35862003000600010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUÇÃO: Pacientes portadores de doença pulmonar obstrutiva crônica apresentam redução da tolerância ao exercício físico, principalmente devido à limitação ventilatória. A L-carnitina tem sido utilizada com o objetivo de melhorar a capacidade aeróbia de pacientes com doenças crônicas, porém não existem estudos em pacientes portadores de doença pulmonar obstrutiva crônica. OBJETIVO: Avaliar a influência da suplementação de L-carnitina, associada ao treinamento físico por seis semanas, três vezes por semana em pacientes portadores de doença pulmonar obstrutiva crônica. MÉTODO: A amostra foi constituída de 30 pacientes portadores de doença pulmonar obstrutiva crônica (69 ± 7 anos) com volume expiratório forçado no primeiro segundo < 65% do previsto, dividida em três grupos de 10 pacientes: grupo 1 com treinamento físico e suplementação com 2g/dia de L-carnitina, grupo 2 que recebeu treinamento físico e placebo e grupo 3 que não foi submetido a treinamento físico e recebeu 2g/dia de L-carnitina. Os pacientes foram submetidos a avaliação espirométrica, a teste de caminhada de seis minutos e à mensuração dos níveis plasmáticos de carnitina livre no inicio e no final do estudo. RESULTADOS: Foi constatado aumento significativo (p < 0,05) da distância percorrida no teste de caminhada de seis minutos somente nos pacientes dos dois primeiros grupos (de 421 ± 100 para 508 ± 80,7 e de 496 ± 78,7 para 526 ± 64,3 respectivamente). Além disso, com intensidade de exercício semelhante, a subida da freqüência cardíaca foi menor no grupo 1 quando comparado com o grupo 2. As variáveis espirométricas, a saturação da oxihemoglobina e a dispnéia não se alteraram em nenhum dos grupos estudados. Os valores de L-carnitina livre no plasma aumentaram somente nos pacientes do terceiro grupo (59,2 ± 13,8 para 102,3 ± 15,32mmol/L). CONCLUSÃO: A L-carnitina associada ao treinamento físico pode proporcionar maior tolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica.
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