Clinics in chest medicine
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Clinics in chest medicine · Jun 1994
ReviewExercise limitation and clinical exercise testing in chronic obstructive pulmonary disease.
Clinical exercise testing is an important tool in assessment of exercise limitation in COPD patients, in assessment of physiologic and psychological factors that contribute to exercise limitation, and in the differential diagnosis of cardiorespiratory disease. Further studies that examine the clinical utility of exercise testing are needed because there are currently insufficient data regarding the utility of many exercise variables.
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The medical history is the first step in the clinical evaluation of exertional dyspnea. It should include pertinent questions about the characteristics of dyspnea, especially descriptive qualities, onset, frequency, severity, and activities that provoke the symptom. Based on this information, along with the physical examination, the health care provider should be able to categorize the cause of exertional dyspnea as suspected cardiac disease, suspected respiratory disease, or as unexplained. ⋯ Cardiopulmonary exercise testing is indicated to differentiate cardiac and respiratory limitation, to document deconditioning, and to identify psychogenic dyspnea. The measurement of dyspnea and leg discomfort during exercise testing can be performed using the Borg 0 to 10 category-ratio scale or the visual analog scale. These perceptual responses can provide useful information about symptom limitation, which is complementary to physiologic data.
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Clinics in chest medicine · Jun 1994
ReviewThe role of cardiopulmonary exercise testing in lung and heart-lung transplantation.
Cardiopulmonary exercise testing in recipients of lung and heart-lung transplants demonstrates significant restoration of exercise tolerance to individuals severely disabled by their underlying cardiopulmonary disease. Recipients can perform moderate levels of activity compatible with a normal lifestyle. Considerable exercise limitation, however, remains in most recipients as measured by maximum oxygen uptake and work rate, despite substantial improvement and often normalization in resting cardiopulmonary function. ⋯ Peripheral factors limiting exercise (which may include abnormalities in the peripheral circulation and peripheral neuromuscular structure and function) are almost universally seen and are probably the primary determinant of exercise limitation in these patients. At present, the relative contributions of various peripheral factors to exercise limitation are unclear. Further study may help elucidate these issues.
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To understand why someone is dyspneic during exercise, we need to follow the advice of Sir Francis Bacon: "No natural phenomenon can be adequately studied in itself alone, but to be understood must be considered as it stands connected with all of nature." In the present context, this implies the careful measurement of events related to metabolism, circulation, and respiration and of the associated sensory events as these systems adapt to the strain and stress of exercise.
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Clinics in chest medicine · Jun 1994
ReviewRole of exercise stress testing in preoperative evaluation of patients for lung resection.
Patients with diagnosed or suspected lung cancer first require appropriate staging and proven anatomic resectability. Excellent pre-operative spirometric data (FEV1 > 2.0 L, > 60% predicted) should recommend the patient for surgery immediately without further testing. Those whose preoperative FEV1 is less than 60% predicted or whose DLCO is less than 60% predicted should be sent for quantitative lung scanning to estimate postoperative spirometry and diffusing capacity. ⋯ Those who do not meet these criteria, however, should not be summarily refused surgery if they are willing to accept the possibility of an earlier death or prolonged disability over the certainty of a cancer-related death in the foreseeable months ahead. Because the lung scan prediction of postoperative regional physiology and the exercise test of global oxygen transport examine different aspects of physiologic operability, we would not disagree with anyone who would advocate doing both tests in those at high risk by virtue of spirometric criteria. The logic of this combined approach is illustrated by Figure 1.