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Effets de la distension thoracique dynamique sur la dyspnée induite par l'exercice physique dans les maladies cardio-pulmonaires

Abstract : Patients with GOLD stage I COPD, CHF and PAH may present with a reduction of expiratory flows at low lung volumes or an overt expiratory flow-limitation. This is known to promote exercise-related dynamic lung hyperinflation, a major determinant of exertional dyspnoea. Here we show that greater troublesome exertional symptoms ensue when increased ventilation/perfusion mismatching accompanies pre-existing abnormal airway function that promote dynamic lung hyperinflation in response to exercise-related increase in ventilation. Our results illustrate that dyspnoea is multifactorial. Indeed, we show that in clinical situations where lung mechanics is not an intuitive candidate to explain dyspnoea, dynamic lung hyperinflation-induced constraint of tidal volume (VT) expansion does play a significant role. This proposition is bolstered by the strong correlation between dyspnoea intensity and indices of dynamic lung hyperinflation and mechanical constraints on VT expansion in patients with PAH. The strength of this association is further confirmed by the 1st and 2nd study that have clearly demonstrated that pharmacological and non-pharmacological manipulation of dynamic lung hyperinflation is associated with relief or attenuation of exertional dyspnoea. This thesis contributes to a better understanding of the pathophysiological mechanisms of exertional dyspnoea in patients with cardiopulmonary diseases. Its findings open up also new horizons for research in the treatment of dyspnoea, by bearing in mind that every intervention that improves exertional dyspnoea is good even when this intervention is not directly related to the main/obvious pathophysiological determinant of the disease.
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  • HAL Id : tel-00831616, version 1

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Pierantonio Laveneziana. Effets de la distension thoracique dynamique sur la dyspnée induite par l'exercice physique dans les maladies cardio-pulmonaires. Médecine humaine et pathologie. Université Pierre et Marie Curie - Paris VI, 2012. Français. ⟨NNT : 2012PA066233⟩. ⟨tel-00831616⟩

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