Effort Restriction in Cases with Chronic Obstructive Pulmonary Disease

Abstract

Patients with chronic obstructive pulmonary disease usually manifest decreases in functional capacity, endurance time at submaximal exercise, and maximal exercise performance compared to age- and sex-matched healthy individuals. The main pathophysiologic changes in this disease are obstruction of expiratory airways and/or pathologic alterations in the lung parenchyma. Many factors are associated with decreased exercise tolerance, including increased airway resistance, inadequate ventilation, increased elastic loading of ventilation, hyperinflation, gas exchange abnormalities, mechanical weakness of respiratory muscles, and varying degrees of disturbances in the central and peripheral nervous systems due to hypoxic response. Skeletal muscles also undergo pathological changes similar to those in ventilation muscles. All these result in decreases in functional capacity and exercise tolerance, giving rise to dyspnea during minimal activity and even at rest. In order to break this vicious circle, supporting rehabilitation programs have to be combined with medical treatment. Turkish Başlık: Kronik Obstrüktif Akciğer Hastalığı Olan Olgularda Efor Kısıtlılığı Anahtar Kelimeler: Solunum egzersizi; egzersiz testi; egzersiz terapisi; egzersiz toleransı/fizyoloji; akciğer hastalığı, obstrüktif/ fizyopatoloji; kas zayıflığı/etyoloji; solunum mekaniği; solunum kasları/patoloji Kronik obstrüktif akciğer hastalığı olan olguların fonksiyonel kapasiteleri, submaksimal egzersizlerdeki dayanıklılık süreleri ve maksimal egzersiz performansları, aynı yaş ve cinsteki kişilerle karşılaştırıldığında genellikle azalmıştır. Bu hastalıkla ilgili temel fizyopatolojik değişiklikler, ekspiratuvar hava akımında obstrüksiyon ve/veya akciğer parenkimindeki patolojik değişikliklerdir. Hava yolu direncinin artması, verimsiz ventilasyon, solunumun elastik yükünün artması, hiperenflasyon, gaz değişim anomalileri ve mekanik olarak solunum kaslarının güçsüzlüğü, merkezi ve periferik sinir sisteminde hipoksik yanıtla ilgili değişik derecelerdeki bozukluklar, egzersize toleransın azalmasına yol açmaktadır. İskelet kaslarında da solunum kaslarına benzer şekilde patolojik değişiklikler gözlenmiştir. Zamanla fonksiyonel kapasite ve egzersiz toleransı azalır, bunlara bağlı olarak hafif düzeyde bir aktivite sırasında, hatta istirahat sırasında dahi dispne gelişir. Bu kısır döngünün kırılması için tıbbi tedavinin yanında mutlaka destekleyici rehabilitasyon programları uygulanmalıdır.

Keywords

• Breathing exercises; exercise test; exercise therapy; exercise tolerance/physiology; lung diseases, obstructive/ physiopathology; muscle weakness/etiology; respiratory mechanics; respiratory muscles/pathology

Koroner Arter Bypass Cerrahisi Öncesindeki Plazma Total Antioksidan Kapasite Düzeylerinin İskemi-Reperfüzyon Hasarı İle İlişkisi

Öz

Anahtar Kelimeler

• Antioksidan/metabolizma, biyolojik marker, koroner arter bypass, lipid peroksidasyonu, miyokard iskemisi/metabolizma, miyokard reperfüzyon hasarı/metabolizma, oksidatif stres

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