Spiroergometrie bei Patienten mit chronisch obstruktiver Lungenerkrankung – multizentrischer Vergleich von zwei Belastungsprotokollen

Zusammenfassung

Die Spiroergometrie erlaubt bei COPD-Patienten eine valide Beurteilung der kardiopulmonalen Belastbarkeit und die Beschreibung vorliegender Limitierungen. Während die Messungen von Ventilation und Gasaustausch weitgehend standardisiert sind, existiert keine allgemeine Empfehlung bezüglich des zu wählenden Belastungsprotokolls. Wir haben daher multizentrisch zwei Belastungsprotokolle in pneumologischen Facharztpraxen verglichen. Es wurden 90 COPD-Patienten der GOLD-Stadien II − IV mittels symptomlimitierter Fahrradbelastung mit zwei unterschiedlichen Rampenprotokollen (10 Watt vs. 16 Watt/min) innerhalb von 7 Tagen untersucht. Die Ergebnisse zeigen, dass eine höhere Steigerungsrate mit einer kürzeren Belastungszeit und höheren Leistung assoziiert ist. Alle anderen spiroergometrischen Parameter der Ventilation und des Gasaustausches zeigen keine signifikanten Veränderungen beim Vergleich beider Protokolle. In pneumologischen Praxen können COPD-Patienten der GOLD-Stadien II − IV sicher und valide mittels Spiroergometrie untersucht werden. Die Anwendung eines Rampenprotokolls mit Steigerung von 16 Watt/Minute kann empfohlen werden, zumal hierfür aktuelle Normwerte vorliegen.

Abstract

Cardiopulmonary exercise testing (CPET) allows a valid evaluation of cardiopulmonary function capability and the recognition of existing limitations in COPD patients. Whereas the measurement of the different parameters of CPET and the evaluation of the results are standardised, this does not apply to the protocols chosen. The aim of this study was to evaluate whether the results of two different exercise protocols were comparable in an outpatient multicentre setting. Ninety COPD patients stages II − IV according to the Gold classification were examined by means of symptom-limited exercise testing on a bicycle with two different ramp protocols (10 Watts vs. 16 Watts/min) within seven days. The results show that a higher acceleration rate of the load was associated with shorter exercise duration and higher achieved exercise capacity. Gas exchange and ventilatory parameters did not show significant differences on comparing both protocols. In pulmonary practices COPD patients of the Gold stages II − IV can be examined safely and with validity by means of CPET. The application of a ramp protocol with a stepwise increase of 16 Watts/minute can be recommended, particularly as for this regimen standardised normal values are available.

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