Chest
Clinical InvestigationsMultidisciplinary Treatment of Chronic Pulmonary Insufficiency: 4. The Influence of Intrathoracic Pressure Variations on Increases in Pulmonary Vascular Pressure During Exercise in Patients with Chronic Obstructive Pulmonary Disease
Section snippets
MATERIALS AND METHODS
The group of subjects contained 28 male patients with a mean age of 50 years and with COPD of sufficient severity to be participants in a study of pulmonary rehabilitation. Patients with known coronary arterial disease, hypertension, or prior cardiac failure were excluded. All subjects had normal electrocardiograms, their S-T segments remained normal during exercise, and none had cardiomegaly by chest x-ray film.
Studies of pulmonary function were carried out within several days of the
RESULTS
The subjects had severe obstructive airway disease and moderate hypoxemia.7 The hemodynamic data obtained at rest and during exercise are summarized in Table 1. The mean pulmonary arterial pressure at rest exceeded 20 mm Hg in only nine subjects, whereas the increase in this pressure during exercise was abnormal in all subjects (Fig 2).
Only two subjects had a resting PAW above 12 mm Hg, but exercise led to a value of 15 mm Hg or more in 15 subjects. The PAW p-p ranged from 6 to 40 mm Hg. The
DISCUSSION
Early hemodynamic investigations of the pulmonary circulation in patients with a variety of pulmonary diseases stressed the normalcy of the PAW.12, 13 Some of these studies included observations during exercise, but the emphasis was on the abnormal increase in mean pulmonary artery pressure, and measurements of the PAW were not included.14, 15 Later, a number of reports focused on subjects with COPD and noted that the resting PAW was occasionally elevated3, 16, 17, 18 and that further increases
ACKNOWLEDGMENTS
We wish to thank Dr. George Schey, Dr. Edmundo Anteola, and Dr. Pernundu Buch for their invaluable assistance in both the management of patients and the coordination of the program of rehabilitation. We appreciate the continued support of Dr. Cathel MacLeod, the former Director of the Catheterization Laboratory.
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The acute effects of low flow oxygen and isosorbide dinitrate on left and right ventricular ejection fractions in chronic obstructive pulmonary disease
1983, Journal of the American College of CardiologyExercise performance in chronic obstructive pulmonary diseases
1981, Medical Clinics of North AmericaReliance on end-expiratory wedge pressure leads to misclassification of pulmonary hypertension
2014, European Respiratory JournalThe effect of exercise training and rehabilitation on functional status in patients with chronic obstructive pulmonary disease (COPD)
1996, International Journal of Rehabilitation and Health
Supported in part by Veterans Administration research funds and in part by grant 13-P-55324/5 from the Social and Rehabilitation Services of the US Department of Health, Education, and Welfare.
Manuscript received February 14; revision accepted April 20.