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Vol. 15. Issue 1.
Pages 11-25 (January - February 2009)
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Vol. 15. Issue 1.
Pages 11-25 (January - February 2009)
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Correlation of levels of obstruction in COPD with lactate and six-minute walk test
Correlação dos graus de obstrução na DPOC com lactato e teste de caminhada de seis minutos
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Dante Brasil Santos1,
Corresponding author
dante@unb.br

Correspondence to/Endereço para correspondência: SQN 206 BLOCO J APT 503. CEP: 70844-100 – Brasília-DF – Brasil. Telefone: 061-32452503.
, Carlos Alberto de Assis Viegas2
1 Fisioterapeuta do Hospital Universitário de Brasília da Universidade de Brasília (HUB/UnB) / Physiotherapist, Hospital Universitário de Brasília da Universidade de Brasília (HUB/UnB)
2 Professor Adjunto IV da Universidade de Brasília – Departamento de Clínica Médica – Universidade de Brasília / Assistant Professor IV, Universidade de Brasília, Departamento de Clínica Médica, Universidade de Brasília
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Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbid-mortality world wide, leading not only to pulmonary damage but also to multisystemic impairment, with repercussions on skeletal muscles and the ability to undertake effort, as measured in the six-minute walk test (6-MWT).

Aims

To correlate the level of obstruction in COPD with lactate concentration and heart rate (HR) at rest, and distance walked. To correlate distance walked with blood gas analysis and correlate desaturation in 6-MWT with post 6-MWT lactate concentration and heart rate.

Methods

COPD patients underwent spirometry, blood gas analysis and 6-MWT to evaluate distance walked, heart rate, capillary lactate (CL) concentration pre– and post 6MWT, and desaturation with 6-MWT.

Results

91 patients with all levels of obstruction were evaluated. HR and CL increased significantly post 6-MWT. The decrease in peripheral saturation of haemoglobin to oxygen observed with 6-MWT was also significant. The distance walked was shorter the greater the obstruction. The correlation analysis was significantly positive between FEV1 and distance walked, negative between FEV1 and HR at rest and negative between distance walked and PaCO2, and not significant for the other variables.

Conclusions

Increased obstruction in COPD and higher PaCO2 values contribute to a reduction in distance walked in 6-MWT. The level of obstruction in COPD leads to a haemodynamic impairment with increased HR at rest of these patients.

Key-words:
Chronic obstructive pulmonary disease
lactate
exercise test
exercise desaturation
Resumo
Contextualização

A doença pulmonar obstrutiva crónica (DPOC), importante causa de morbimortalidade em todo mundo, leva não só ao comprometimento pulmonar, mas também a alterações sistémicas, com repercussões sobre músculos esqueléticos e a capacidade de realizar esforços, mensurável pelo teste de caminhada de seis minutos (TC6’).

Objectivos

correlacionar obstrução da DPOC com lactato de repouso, frequência cardíaca de repouso, bem como com distância percorrida. Correlacionar distância percorrida com gasometria e ainda correlacionar dessaturação ao TC6’ com lactato e frequência cardíaca pós-TC6’.

Método

Portadores de DPOC realizaram espirometria, gasometria e TC6’, que avaliou: distância percorrida, frequência cardíaca (FC), lactato capilar (Lct) pré e pós-TC6’, além de dessaturação ao TC6’.

Resultados

Foram avaliados 91 doentes abrangendo todos os graus de obstrução. Os parâmetros pós-TC6’, como FC e Lct, aumentaram de maneira significativa com a realização do mesmo. A queda da saturação da hemoglobina ao oxigénio diante do TC6’ também foi significativa. A análise de correlação significativa mostrou-se positiva entre VEF1 e distância percorrida, negativa entre VEF1 e FC de repouso e negativa entre distância percorrida e PaCO2, sendo não significante para as demais variáveis.

Conclusões

A progressão da obstrução na DPOC, bem como valores maiores de PaCO2, contribuem para a redução da distância percorrida no TC6’. O grau de obstrução na DPOC leva a alteração hemodinâmica com o aumento da frequência cardíaca de repouso destes doentes.

Palavras-chave:
Doença pulmonar obstrutiva crónica
lactato
teste de esforço
dessaturação ao exercício
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Bibliography/Bibliografia
[1.]
B.R. Celli, C.G. Cote, J.M. Marin, et al.
The body-mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary Disease.
NEJM, 350 (2004), pp. 1005-1012
[2.]
R.A. Pauwels, A.S. Buist, P.M.A. Calverley, C.R. Jenkins, S.S. Hurd.
Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (GOLD).
Am J Respir Crit Care Med, 163 (2001), pp. 1256-1276
[3.]
A.G.N. Agustí, A. Noguera, J. Sauleda, E. Sala, J. Pons, X. Busquets.
Systemic effects of chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 347-360
[4.]
M. Faucher, J.G. Steinberg, D. Barbier, F. Hug, Y. Jammes.
Influence of chronic hypoxemia on peripheral muscle dysfunction and oxidative stress in humans.
Clin Physiol Funct Imaging, 24 (2004), pp. 75-84
[5.]
H.R. Gosker, H. van Maneren, P.J. van Dijk, M.P.K.J. Engelen, G.J. van der Vusse, E.F.M. Wouters, et al.
Skeletal muscle fibre-type shifting and metabolic profile in patients with chronic obstructive pulmonary disease.
Eur Respir J, 19 (2002), pp. 617-625
[6.]
J. Allaire, F. Maltais, J.-F. Doyon, M. Noel, P. LeBlanc, G. Carrier, et al.
Peripheral muscle endurance and the oxidative profile of the quadriceps in patients with COPD.
Thorax, 59 (2004), pp. 673-678
[7.]
ATS, ERS. Skeletal muscle dysfunction in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 159 (1999), pp. 510-540
[8.]
M.P.K.J. Engelen, A.M.W.J. Schols, J.D. Does, N.E.P. Deutz, E.F.M. Wouters.
Altered glutamate metabolism is associated with reduced muscle glutathione levels in patients with emphysema.
Am J Respir Crit Care Med, 161 (2000), pp. 98-103
[9.]
M.P.K.J. Engelen, A.M.W.J. Schols, J.D. Does, H.R. Gosker, N.E.P. Deuts, E.F.M. Wouters.
Exercise-induced lactate increase in relation to muscle substrates in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 162 (2000), pp. 1697-1704
[10.]
A. Couillard, F. Maltais, D. Saey, R. Debigaré, A. Michaud, C. Koechlin, et al.
Exercise-induced quadriceps oxidative stress and peripheral muscle dysfunction in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 167 (2003), pp. 1664-1669
[11.]
R.S. Richardson, J. Sheldon, D.C. Poole, S.R. Hopkins, A.L. Ries, P.D. Wagner.
Evidence of skeletal muscle metabolic reserve during whole body exercise in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 159 (1999), pp. 881-885
[12.]
ATS Statement: guidelines for the six-minute walk test.
Am J Respir Crit Care Med, (2002),
[13.]
M. Poulain, F. Durand, B. Palomba, F. Ceugniet, J. Desplan, A. Varray, et al.
6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD.
Chest, 123 (2003), pp. 1401-1407
[14.]
V. Bittner, D.H. Weiner, S. Yusuf, W.J. Rogers, K.M. McIntyre, S.I. Bangdiwala, et al.
Prediction of mortality and morbidity with a 6 minute walk test in patients with left ventricular dysfunction.
JAMA, 270 (1993), pp. 1702-1707
[15.]
R. Carter, D.B. Holiday, C. Nwasuruba, J. Stocks, C. Grothues, B. Tiep, et al.
Six minute walk work for assessment of functional capacity in patients with COPD.
Chest, 123 (2003), pp. 1408-1415
[16.]
F. Maltais, A.A. Simard, C. Simard, J. Jobin, P. Desgagnes, P. LeBlanc.
Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD.
Am J Respir Crit Care Med, 153 (1996), pp. 288-293
[17.]
Sociedade Brasileira de Pneumologia e Tisiologia.
Oxigenoterapia domiciliar prolongada (ODP).
J Pneumol, 26 (2000), pp. 341-349
[18.]
G.F. Souza.
Produção de acidose lática durante teste de exercício com membros superiores sem apoio em pacientes portadores de doença pulmonar obstrutiva crônica. Tese de mestrado.
UNIFESP-SP, (2002),
[19.]
B.R. Celli.
The importance of spirometry in COPD and asthma – effect on approach to management.
Chest, 117 (2000), pp. 15S-19S
[20.]
K. Wasserman, W.L. Beaver, J.A. Davis, J.Z. Pu, D. Heber, B.J. Whipp.
Lactate, pyruvate and lactate-to-pyruvate ratio during exercise and recovery.
J Appl Physiol, 59 (1985), pp. 935-940
[21.]
M.P.K.J. Engelen, R. Casaburi, R. Rucker, E. Carithers.
Contribution of respiratory muscles to the lactic acidosis of heavy exercise in COPD.
Chest, 108 (1995), pp. 1246-1251
[22.]
F. Maltais, J. Jobin, M.J. Sullivan, S. Bernard, F. Whittom, J. Kieran, et al.
Metabolic and hemodynamic responses of lower limb during exercise in patients with COPD.
J Appl Physiol, 84 (1998), pp. 1573-1580
[23.]
J.G. Toffaletti.
Blood lactate: biochemistry, laboratory methods and clinical interpretation.
Crit Rev Clin Lab Sci, 28 (1991), pp. 253-268
[24.]
D. Saey, A. Michaud, A. Couillard, C.H. Côté, M.J. Mador, P. LeBlanc, et al.
Contractile fatigue, muscle morphometry, and blood lactate in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 171 (2005), pp. 1109-1115
[25.]
J.R. Williams, N. Armstrong, B.J. Kirby.
The influence of site sampling and assay medium upon the measurement and interpretation of blood lactate responses to exercise.
J Sports Sci, 10 (1992), pp. 95-107
[26.]
J.O. Holloszy, E.F. Coyle.
Adaptations of skeletal muscle to endurance exercise and their metabolic consequences.
J Appl Physiol, 56 (1984), pp. 831-838
[27.]
R. Casaburi, A. Patessio, F. Ioli, S. Zanaboni, C.F. Donner, K. Wasserman.
Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease.
Am Rev Respir Dis, 143 (1991), pp. 9-18
[28.]
K. Wasserman, J.E. Hansen, D.Y. Sue.
Principles of exercise testing & interpretation.
Lippincott Williams & Wilkins, (1999),
[29.]
M.P.K.J. Engelen, E.F.M. Wouters, N.E.P. Deutz, J.D. Does, A.M.W.J. Schols.
Effects of exercise on amino acid metabolism in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 163 (2001), pp. 859-864
[30.]
R.A. Malthay.
Clínicas médicas da América do Norte – doenças pulmonares obstrutivas crônicas.
Ed Interamericana, (1981),

Trabalho realizado no Serviço de Pneumologia do Hospital Universitário de Brasília da Universidade de Brasília (HUB-UnB) / Work undertaken at the Pulmonology Unit, Hospital Universitário de Brasília, Universidade de Brasília (HUB-UnB).

Directora do Serviço de Pneumologia do HUB-UnB / Head, Pulmonology Unit HUB-UnB: MD Verônica Amado.

Copyright © 2009. Sociedade Portuguesa de Pneumologia
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