Spiroergometrie bei chronisch obstruktiver Lungenerkrankung (COPD) – atemfunktionelle Phänotypisierung und Schweregradbeurteilung

Zusammenfassung

Die COPD ist eine heterogene Erkrankung mit einem breiten Spektrum klinischer Phänotypen und atemfunktioneller Störungen. Mit der Spiroergometrie steht ein kardiopulmonaler Belastungstest zur Verfügung, der es bei COPD-Patienten ermöglicht, alle Teilbereiche der Atmung abzubilden sowie den Umfang und die Mechanismen einer Leistungseinschränkung zu objektivieren.

Es erfolgte bei 64 COPD-Patienten der GOLD-Stadien II bis IV eine Spiroergometrie mit der Frage, ob diese Methode unter Praxisbedingungen im Vergleich zur Standarddiagnostik eine bessere funktionelle Charakterisierung der Erkrankung COPD ermöglicht.

Wir konnten zeigen, dass die Spiroergometrie in einer pneumologischen Praxis bei stabilen COPD-Patienten aller Schweregrade sicher und aussagefähig durchführbar ist. Mit Hilfe dieser Methode kann eine klinische und prognostische Leistungsbewertung aller Patienten erfolgen. Dabei offenbarten sich bedeutsame Differenzen der Spitzensauerstoffaufnahme innerhalb der einzelnen GOLD-Stadien, sodass die Patienten trotz identischem GOLD-Schweregrad nach spiroergometrischen Kriterien unterschiedlichen Prognosegruppen zuzuordnen waren. Darüber hinaus fanden sich relevante Unterschiede der individuellen Muster von Ventilation und Gasaustausch unter Belastung, welche mit der Lungenfunktionsanalyse in Ruhe nicht zu erfassen, aber auch nicht vorauszubestimmen waren.

Die Spiroergometrie ermöglicht somit, neben einer objektiven klinischen und prognostischen Schweregradbeurteilung, auch eine subtile atemfunktionelle Beschreibung des COPD-Patienten. Der mehrdimensionale Aspekt der Erkrankung mit variablen Störungen der Ventilation, des Gasaustausches, der Zirkulation und des Muskelstoffwechsels sowie assoziierten kardiovaskulären Komorbiditäten konnte detailliert erfasst werden. Die atemfunktionelle Phänotypisierung des COPD-Patienten kann ggf. als Grundlage für ein individualisiertes Therapiemanagement von Wert sein.

Abstract

COPD is a heterogeneous disease with a wide range of clinical phenotypes and breath-functional dysfunctions. Cardiopulmonary exercise testing (CPET) allows describing all component parts of breathing and determining exercise capacity and the mechanisms of exercise limitation.

From these aspects 64 COPD patient stages II, III and IV according to the conventional GOLD classification were examined by means of CPET to evaluate whether CPET can provide a better functional characterization of COPD than the standard investigation procedures in pulmonary practice.

We could show that in pulmonary practice CPET is safely and effectively practicable in stable COPD patients of all GOLD stages. This method allowed a clinical and prognostic disease severity assessment of all patients, proving important differences of peak oxygen uptake in each GOLD stage, so that patients in spite of identical GOLD disease severity were to be assigned to different prognostic groups according CPET criteria.

Furthermore, we found relevant differences of individual breath-functional patterns in exercise, which can neither be objectified nor be prognosticated by standard investigation procedures at rest.

Therefore CPET allows, aside from an objective clinical and prognostic disease severity assessment, also a breath-functional evaluation in a subtly way in COPD patients reflecting the multidimensional background of the disease with variable dysfunctions in pulmonary ventilation, gas exchange, circulation and muscular function as well as associated cardio vascular comorbidities. The breath-functional phenotyping of the COPD patient seems to be meaningful in particular for an individualised therapy management.

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