Chest
Clinical Investigations: ExercisePathophysiology of Activity Limitation in Patients With Interstitial Lung Disease
Section snippets
Population
We screened the records of the last 1,300 integrated cardiopulmonary clinical exercise tests performed in our medical center, as described below and previously reported.25 The laboratory is often referred patients with uncommon disorders. We did not include or exclude patients on the basis of their referring diagnoses and believe we found all patients who might be expected to have interstitial lung disease as their primary disorder. For the diagnosis of asbestosis, patients had to have
Patient Profile
Exercise studies and associated records for 42 patients with interstitial lung disease or pulmonary alveolar proteinosis (P) were found and analyzed (Table 2). Primary left heart disease was doubtful because of the absence of murmurs, left ventricular hypertrophy on chest radiograph or ECG, ECG evidence for myocardial infarction, or ST-segment depression during maximal exercise. Musculoskeletal disease did not limit exercise because no patient stopped exercise with complaints of back, hip, or
DISCUSSION
The major finding of this study suggests that physiologic defects accounting for the reduced peak in our patients with interstitial lung disease were more likely circulatory than ventilatory. In fact, the dominant measure of ventilatory impairment, the exercise breathing reserve, tended to be high when peak values were low. The circulatory impairment appears to be primarily due to pulmonary vascular disease with accompanying gas exchange impairment.
REFERENCES (32)
- et al.
Clinical and physiologic features of some types of pulmonary diseases with impairment of alveolar-capillary diffusion
Am J Med
(1951) - et al.
The regulation of ventilation in diffuse pulmonary fibrosis
Am J Med
(1965) - et al.
Prevalence and clinical correlates of pulmonary arterial hypertension in progressive systemic sclerosis
Am J Med
(1983) - et al.
Dead space loading and exercise limitation in patients with interstitial lung disease
Chest
(1994) Idiopathic pulmonary fibrosis
Clin Chest Med
(1982)- et al.
Regional ventilation-perfusion and hypoxia in cryptogenic fibrosing alveolitis
Am Rev Respir Dis
(1973) - et al.
Radiographic-physiologic-pathologic correlations in interstitial pneumonias
Prog Respir Res
(1975) - et al.
Maximal oxygen consumption in patients with lung disease
J Clin Invest
(1976) - et al.
Idiopathic pulmonary fibrosis
Ann Intern Med
(1976) - et al.
Central haemodynamics during exercise in patients with restrictive pulmonary disease
Bull Eur Physiopathol Respir
(1977)