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Research ArticleSymposium Papers

Mechanisms of Functional Loss in Patients With Chronic Lung Disease

Neil R MacIntyre
Respiratory Care September 2008, 53 (9) 1177-1184;
Neil R MacIntyre
Respiratory Care Services, Duke University Medical Center, Durham, North Carolina
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Abstract

Functional loss (often quantified as exercise limitation) is common in patients with chronic lung disease. The factors involved are multiple and many may be present together in a given patient. Ventilatory factors involve an imbalance in load/capacity relationships. Specifically, breathing loads from abnormal respiratory-system mechanics and/or excessive ventilatory demand cannot be handled by respiratory muscles that are dysfunctional or malpositioned. Gas-exchange factors involve impaired ventilation-perfusion relationships that lead to hypoxemia, impaired oxygen delivery, and pulmonary hypertension. Cardiovascular factors involve coexisting intrinsic heart disease, right-ventricular overload from pulmonary vascular abnormalities, and simple deconditioning. Skeletal muscle (both respiratory and limb) factors involve direct inflammatory mediator effects on muscle function, malnutrition, blood-gas abnormalities, compromised oxygen delivery from right-heart dysfunction, electrolyte imbalances, drugs, and comorbid states. Other less well understood factors include excessive dyspnea, impaired motivation, orthopedic issues, and psychiatric issues.

  • FUNCTIONAL LOSS
  • EXERCISE LIMITATION
  • CHRONIC LUNG DISEASE
  • VENTILATION
  • RESPIRATORY MECHANICS
  • VENTILATION-PERFUSION
  • HYPOXEMIA
  • PULMONARY HYPERTENSION
  • OXYGENATION

Footnotes

  • Correspondence: Neil R MacIntyre MD FAARC, Respiratory Care Services, PO Box 3911, Duke University Medical Center, Durham NC 27710. E-mail: neil.macintyre{at}duke.edu.
  • The author reports no conflicts of interest related to the content of this paper.

  • Dr MacIntyre presented a version of this paper at the 23rd Annual New Horizons Symposium at the 53rd International Respiratory Congress of the American Association for Respiratory Care, held December 1-4, 2007, in Orlando, Florida.

  • Copyright © 2008 by Daedalus Enterprises Inc.
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Respiratory Care: 53 (9)
Respiratory Care
Vol. 53, Issue 9
1 Sep 2008
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Mechanisms of Functional Loss in Patients With Chronic Lung Disease
Neil R MacIntyre
Respiratory Care Sep 2008, 53 (9) 1177-1184;

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Mechanisms of Functional Loss in Patients With Chronic Lung Disease
Neil R MacIntyre
Respiratory Care Sep 2008, 53 (9) 1177-1184;
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Keywords

  • FUNCTIONAL LOSS
  • exercise limitation
  • chronic lung disease
  • ventilation
  • respiratory mechanics
  • VENTILATION-PERFUSION
  • hypoxemia
  • pulmonary hypertension
  • oxygenation

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