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[Dyspnea and handicap in chronic obstructive pulmonary disease: interaction of their mechanisms].

Authors
  • Aguilaniu, Bernard1
  • Plaindoux, Agnès
  • Brosson, Christophe
  • Jeanmart, Michel
  • Maitre, Jocelyne
  • Diab, Samia
  • 1 HYLAB, Laboratoire de Physiologie Clinique et Exercice, Clinique du Mail, Grenoble, France. [email protected] , (France)
Type
Published Article
Journal
Presse medicale (Paris, France : 1983)
Publication Date
Mar 01, 2009
Volume
38
Issue
3
Pages
413–420
Identifiers
DOI: 10.1016/j.lpm.2008.12.002
PMID: 19152776
Source
Medline
Language
French
License
Unknown

Abstract

Today, dyspnea in chronic obstructive pulmonary disease (COPD) is attributed to thoracic distention secondary to bronchial obstruction and hyperventilation. It inevitably occurs during exercise, even in patients with little obstruction, when they are capable of the elevated and prolonged power output that necessitates substantial hyperventilation. Exercise intolerance is due mainly to dyspnea, but muscle fatigue is also involved, especially in COPD patients who are malnourished. Deterioration of muscle function follows a substantial reduction in daily physical activity. In malnourished and hypoxemic subjects, however, responsibility for this is attributed to diverse aggravating biological processes related to chronic low-grade inflammation and to accentuated oxidative stress. The drastic diminution of physical activity results from ventilatory and muscle impairment and from symptoms that make movement painful. Improvement of ventilatory and muscle function, however, does not lead to recovery that allows sufficient physical activity. The spiral of disengagement, a morbid, psychodynamic process, accompanies chronic diseases and has the strongest effect in patients who were not highly physically active before becoming ill. Improvement of this handicap therefore requires a comprehensive management of patients, not confined to the prescription of physical activity under medical supervision. The aim is to offer diverse treatment propositions that can produce sustainable behavioral change.

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