Kurzfristige Effekte einer Sauerstoffsubstitution unter Belastung bei Patienten mit idiopathische pulmonaler Fibrose (IPF)
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Philipps-Universität Marburg
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Abstract
Background: National and international guidelines recommend a
supplemental oxygen therapy during exercise for patients with idiopathic
pulmonary fibrosis (Behr et al., 2013; Magnussen et al., 2008; Raghu et al.,
2011). There is a lack of studies supporting this suggestion. Dowman et al.
demonstrate an improvement of exercise capacity in IPF Patients while
breathing supplemental oxygen (Dowman et al., 2017). Nishiyama et al. did not
find an enhancement of exercice capacity in 6-minute walking test for those
Patients under oxygen therapy (Nishiyama et al., 2008). A retrospective
analysis does find an improvement in walking distance in 6-minute walking test
for IPF Patients breathing oxygen (Frank et al., 2012). These studies are
restricted by a limited number of cases and yield different results.
The present study aimed to examine the short-term effects of supplemental
oxygen therapy in a larger group of IPF Patients. We expected those Patients
to increase exercise capacity and SpO2 when being treated with oxygen. We
also investigated the effects of oxygen therapy on breathing frequency, heart
rate and partial pressure of carbon dioxide.
Methods: 40 Patients (age: 68.98 ± 7.31 years, 39 male, 1 female) diagnosed
with idiopathic pulmonary fibrosis and hypoxemia during exercise were
included in this study. All were participating in an inpatient pulmonary
rehabilitation programm at m Schön Klinik Berchtesgadener Land. Body
plethysmography, diffusing capacity, bioelectrical impedance analysis and
capillary bloodgas testing were conducted in all patients. ISWT was used to
determine peak walking speed. ESWT was performed by all patients at 85% of
peak walking speed. Study protocol included one ESWT applying room air, one
ESWT applying 2 L O2/min and one ESWT applying 4 L O2/min. Tests were
conducted in randomised order and double blinding was used to reduce bias.
Patients were instructed to maintain predetermined speed for as long as
possible. Primary endpoint was the exercise capacity (in seconds) until a
patient had to stop walking. SpO2, breathing frequency, heart rate and tcpCO2
were measured condinuously during ESWT. We used results at isotime
(duration of the shortest ESWT of one patient) to sustain comparability of
measurements in between tests of different length. Dyspnea was inquired
using modified borg-scale at the end of every ESWT.
Results: We found a significant improvement in exercise capacity in IPF
patients breathing oxygen compared to room air. Patients could maintain
predetermined walking speed significantly longer at a rate of 2 L O2/min
(p=0.003) and 4 L O2/min (p<0.001) compared to room air. At isotime, there
was an increase in oxygen saturation under oxygen therapy opposed to room
air. This increase was highly significant under 2 L O2/min (p<0.001) and under
4 L O2/min (p<0.001). Patients heart rate was significantly lower under both 2
L O2/min (p=0.021) and 4 L O2/min (p=0.003). Partial pressure of carbon
dioxide at isotime was significantly higher when breathing 2 L O2/min (p=0.030)
and 4 L O2/min (p=0.040) compared to room air. There were no significant
differences in breathing frequency and dyspnea after exercising with oxygen or
room air.
Discussion: Our results demonstrate a significant and clinically relevant
improvement in exercise capacity and oxygen saturation in IPF Patients when
breathing oxygen. These results are in line with the results presented by earlier
studies. Those studies were limited by number of participants (Dowman et al.,
2017) or a retrospective design (Frank et al., 2012). The ESWT reflects a
common physical exertion and measurements at isotime allow for a good
comparability of results in between tests. Our study indicates a significant
increase of partial pressure of carbon dioxide in IPF patients while breathing
oxygen during exercise. Since patients remained normocapnic, we consider
these results clinically irrelevant.
An important limitation of our study is the lack of female participants.
Conclusion: Our results improve the evidence for oxygen therapy during
exercise in patients suffering from IPF. These patients can improve their
exercise capacity and SpO2 while breathing oxygen. Both surrogates are
important factors of daily activity (Bahmer et al., 2016) and quality of life in IPF
(Nishiyama et al., 2005; Verma et al., 2011). Further studies are needed to
examine the effects of oxygen therapy on mortality.
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Dates
Created: 2021Issued: 2021-03-31Updated: 2021-03-31
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
oxygen therapycarbon dioxiKohleexerciseidiopatische pulmonale FibroseSauerstoffsättigungIPFSpO2SauerstofftherapieESWTLungenfibroseendurance shuttle walk testtrainingoxygen saturationidiopathic pulmonary fibrosisIPFDyspnoedyspnoeaBelastung
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610
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Schneider, Christoph: Kurzfristige Effekte einer Sauerstoffsubstitution unter Belastung bei Patienten mit idiopathische pulmonaler Fibrose (IPF). : Philipps-Universität Marburg 2021-03-31. DOI: https://doi.org/10.17192/z2021.0157.
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This item has been published with the following license: In Copyright