만성 폐쇄성폐질환의 폐기능 검사와 운동 검사의 비교
Comparison of spirometry with cardiopulmonary exercise test of chronic obstructive pulmonary disease
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목적: 일반폐기능 검사만으로는 COPD 환자가 실생활에서 겪는 장애정도와 운동 내성의 한계를 예측하는 데는 한계가 있어, 일반폐기능 검사와 운동부하심폐기능 검사를 이용하여 COPD 환자를 중증도별로 하여 각각 분류하고 그 결과를 비교하여, 운동부하폐기능 검사의 유용성을 알아보고자 하였다. 방법: COPD 환자 105명을 대상으로 안정 시 폐기능 검사와 운동부하심폐기능 검사를 시행하였고, 결과는 표준 의학 중증도 분류에 의해 categorical statistical comparison으로 분석하였다. 결과: 두 검사에서 COPD 환자 105명 중 오직 44명(42%)의 환자가 일치된 결과를 보였다. 나머지 환자들 중 21명(20%)은 일반폐기능 검사보다 운동부하심폐기능 검사에서 경한 판정을 받았고, 40명(38%)은 운동부하심폐기능 검사에서 더 심한 판정을 받았다. 운동부하심폐기능 검사에서 더 심한 판정을 받은 환자들은 운동부하 검사 심혈관계 지표들이 보다 감소되어 있었다. 결론: COPD 환자의 운동능력은 일반폐기능 검사만으로는 예측하는 데는 한계가 있으며, 전신질환으로서의 COPD질환을 이해하고 예측하는데 있어 운동부하폐기능 검사도 일부 도움을 주리라 생각되나, 앞으로 좀 더 많은 연구가 필요하리라 사료된다.
Abstract
Background/Aims: Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible airflow limitation. Pulmonary function test (PFT) has been considered the gold standard test for diagnosis and severity evaluation in COPD. However, PFT by spirometry does not provide information about exercise performance in COPD patients. Therefore, the present study was performed to compare pulmonary function determined by spirometry with exercise function determined by cardiopulmonary exercise test (CPET) for grading of COPD. Methods: A total of 105 patients with airway obstruction were examined. The patients’ mean age was 65 years, and the mean smoking history was 27 pack-years. The patients underwent spirometry and CPET. The results were analyzed by categorical statistical comparison, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and American Thoracic Society guidelines. Results: The two methods agreed on the classification of only 44 patients (42%). Of the remaining patients, 21 (20%) were found to be less severe according to CPET than according to PFT, whereas 40 (38%) were more severe. Those who were more severe according to CPET had significantly low maximal minute ventilation, low anaerobic threshold, low oxygen pulse, and high breathing reserve. Conclusions: The present study revealed the large disagreement between the results of resting and exercise pulmonary function tests, and therefore suggests the need for a novel approach or guideline. Additional cardiological evaluation may be needed in patients classified as more severe according to CPET, who are assumed to have a greater degree of impairment of cardiovascular function.
참고문헌 (16)
- Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI, "WHO Workshop Report", 2001, Publication number 2701
- Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI, "WHO Workshop Report", 2007
- Fink G, "Functional evaluation in patients with chronic obstructive pulmonary disease: pulmonary function test versus cardiopulmonary exercise test", J Occup Environ Med, 44, pp.54~58 (2002)
- Pineda H, "Accuracy of pulmonary function tests in predicting exercise tolerance in chronic obstructive pulmonary disease", Chest, 86, pp.564~567 (1984)
- Mahler DA, "Prediction of peak oxygen consumption in obstructive airway disease", Med Sci Sports Exerc, 20, pp.574~578 (1988)
- American Thoracic Society, American College of Chest Physicians, "ATS", ACCP statement on cardiopulmonary exercise testing, 2003, pp.167, 211~277
- Wasserman K, "Principles of exercise determination and interpretation" (1987), Lea and Febriger
- Cotes JE, "Lung function impairment as a guide to exercise limitation in work-related lung disorders", Am Rev Respir Dis, 137, pp.1089~1093 (1988)
- Ries AL, "Pulmonary function tests cannot predict exercise-induced hypoxemia in chronic obstructive pulmonary disease", Chest, 93, pp.454~459 (1988)
- Karlman W, "Principles of exercise test and interpretation" (1987), Lea and Febgier
- Beaver WL, "A new method for detecting the anaerobic threshold by gas exchange", J Appl Physiol, 60, pp.2020~2027 (1986)
- American Thoracic Society, "Evaluation of impairment", disability secondary to respiratory disorder, 1986, pp.133, 1205~1209
- Tojo N, "Pulmonary exercise testing predicts prognosis in patients with chronic obstructive pulmonary disease", Intern Med, 44, pp.20~25 (2005)
- Killian KH, "Relationship between pulmonary impairment, exercise capacity and intensity of dyspnea", Eur Respir J, 6(17), pp.571S~ (1993)
- Cotes J, "Estimation of maximal exercise ventilation and oxygen uptakes in patients with chronic lung disease", Bull Eur Physiopathol Respir, 18(4), pp.221~228 (1982)
- Oren A, "The role of exercise testing in impairment evaluation", Am Rev Respir Dis, 135, pp.230~235 (1987)