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Vol. 40. Issue 2.
Pages 54-61 (February 2004)
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Vol. 40. Issue 2.
Pages 54-61 (February 2004)
Original Articles
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Exercise Limitation in Patients With Chronic Obstructive Pulmonary Disease at the Altitude of Bogota (2640 m): Breathing Pattern and Arterial Gases at Rest and Peak Exercise
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M. González-García
Corresponding author
mgonzalez@neumologica.org

Correspondence: Dr. M. González-García. Calle 163 A, 28-60. Bogota. Colombia
, M. Barrero, D. Maldonado
Laboratorio de Fisiología y Función Pulmonar, Fundación Neumológica Colombiana, Bogota, Colombia
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Objective

TO describe the response to exercise of normal subjects and patients with chronic obstructive pulmonary disease (COPD) in Bogota, Colombia (altitude: 2640 m; atmospheric pressure: 560 mm Hg) and compare it with data published on COPD patients at sea level. Healthy people increase their minute ventilation to attenuate hypoxemia (PaCO2: 30 mm Hg; PaO2: 63 mm Hg).

Material and method

A descriptive study was carried out on healthy subjects and COPD patients. Exercise limitation was determined by an incremental test on a cycle ergometer.

Results

The study enrolled 16 healthy subjects and 25 COPD patients (forced expiratory volume in 1 second: 43.3% [SD 13%]). Minute ventilation at rest was greater in COPD patients compared with healthy subjects, it was not adequately sustained during exercise, and there was a reduction in peak oxygen uptake (53.0% [15%]). At peak exercise, inspiratory capacity decreased (-0.62 [0.34] L), the ratio of minute ventilation to maximal voluntary ventilation increased, and severe hypoxemia occurred (PaO2: 49.9 [9.9] mm Hg). There was significant correlation between hypoxemia and the percentage of predicted peak oxygen uptake (r=0.60), leg fatigue (r=-0.62), percentage of predicted peak inspiratory capacity (r=0.61), and the percentage of predicted peak tidal volume (r=0.49). Minute ventilation at rest was shown to be higher, there was a greater reduction in the inspiratory capacity during exercise, and hypoxemia was more severe at rest and during exercise for patients with COPD in Bogota, compared with those at sea level.

Conclusions

Patients with COPD living in Bogota were shown to have lower tolerance to exercise evidenced by ventilatory limitation and severe hypoxemia. Increased minute ventilation at rest, greater reduction in inspiratory capacity, and severity of hypoxemia during exercise were the main differences between COPD in Bogota and at sea level.

Key words:
Chronic obstructive pulmonary disease
Exercise
Dynamic hyperinflation
Breathing pattern
Arterial blood gases
Altitude
Objetivo

Describir la respuesta al ejercicio en sujetos normales y en pacientes con enfermedad pulmonar obstruc-tiva crónica (EPOC) en Bogotá (altura: 2.640 m; presión at-mosférica: 560 mmHg) y establecer diferencias con los datos publicados de pacientes con dicha enfermedad a nivel del mar. Las personas sanas a esta altura aumentan la ventilación alveolar para atenuar la hipoxemia (presión arterial de CO2: 30 mmHg; presión arterial de O2: 63 mmHg).

Material y método

Se realizó un estudio descriptivo en pacientes con EPOC y en sujetos sanos. La capacidad de ejercicio se determinó con una prueba incremental en un cicloergómetro.

Resultados

Se incluyó en el estudio a 16 sujetos sanos y 25 pacientes con EPOC (volumen espiratorio forzado en el primer segundo del 43,3 ± 13%). En comparación con los sujetos sanos, en los pacientes con EPOC se observó un au-mento de la ventilación minuto en reposo que no se mantuvo adecuadamente en el ejercicio, así como disminución del con-sumo de oxígeno pico (53,0 ± 15%). En ejercicio pico la capacidad inspiratoria disminuyó (-0,62 ± 0,34 1), la relación ventilación minuto/ventilación voluntaria máxima aumentó y hubo una intensa hipoxemia (presión arterial de O2 de 49,9 ± 9,9 mmHg). Esta hipoxemia se correlacionó significativa-mente con el porcentaje del valor predicho del consumo de oxígeno pico (r = 0,60), la fatiga de los miembros inferiores (r = -0,62), el porcentaje predicho de la capacidad inspiratoria pico (r = 0,61) y el porcentaje predicho del volumen corriente pico (r = 0,49). En comparación con los datos publicados a nivel del mar, en los pacientes con EPOC la ventilación minuto en reposo fue mayor, hubo una mayor disminución de la capacidad inspiratoria durante el ejercicio y la hipoxemia fue más grave tan to en reposo como en ejercicio.

Conclusions

En los pacientes con EPOC residentes en Bogotá demostramos intolerancia al ejercicio determinada por limitación ventilatoria e hipoxemia severa. El aumento de la ventilación minuto en reposo, la mayor disminución de la capacidad inspiratoria y la gravedad de la hipoxemia durante el ejercicio fueron las principales diferencias con la EPOC a nivel del mar.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Ejercicio
Hiperinflación pulmonary
Patrón respiratorio
Gases arteriales
Altitud
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