RESUMEN

La disnea es un síntoma complejo y desafortunadamente los mecanismos que la ocasionan son multifactoriales. Dentro de los mecanismos más importantes responsables de la percepción del síntoma se encuentra el incremento de la carga mecánica intrínseca de los músculos inspiratorios, la debilidad de los músculos inspiratorios, el incremento en la demanda ventilatoria; las anomalías en el intercambio de gases, la compresión dinámica de la vía aérea, y factores cardiovasculares entre otros. Cuando los pacientes con EPOC realizan ejercicio, estas condiciones mencionadas previamente le ocurren. En contraste con sujetos sanos, los pacientes con EPOC cursan durante el reposo con marcada hiperinflación pulmonar la cual se incrementa conforme el ejercicio se incrementa. En este capítulo detallaremos los mecanismos involucrados de la disnea y modifican su intensidad, los estímulos que la producen y las diferentes formas de su evaluación.

PALABRAS CLAVE

Disnea, ejercicio, hiperinflación pulmonar, escalas de medición.

REFERENCIAS

1. O’Donell DE. Exertional breathlessness in chronic respiratory disease. In: DA Mahler, ed. Dyspnea. New York, Dekker, 1998; 97-147.

2. Manning HL, Schwartzstein R. Mechanisms of Dyspnea. In: DA Mahler, ed. Dyspnea. New York, Deker, 1998; 63-95.

3. Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis 1987; 136: 58-61.

4. Simon PM, Basner RX, Weinberger SE, Fenci V, Weiss JW, Schwartzstein RM. Oral mucosal stimulation modulates intensity of breathlessness induced in normal subjects. Am Rev Respir Dis 1991; 144: 419-422.

5. O’Donell DE. Brathlessness in patients with chronic airflow limitation: mechanisms and management. Chest 1994; 106: 904-912.

6. O’Donell DE, Bertley J, Chau LKL, Webb KA. Qualitative aspects of exertional breathlessness in chronic-airflow limitation: Pathophysiological mechanisms. Am J Respir Crit Care Med 1997; 155: 109-115.

7. O’Donell DE, Webb KA. Exertional breathlessness in patients with chronic airflow limitation. The role of hyperinflation. Am Rev Respir Dis 1993; 148: 1351-1357.

8. Zachman FW Jr., Wiley RL. Afferent inputs to breathing respiratory sensation. In: Fishman AP. Ed Handbook of Physiological Society. 1986: 449-474.

9. O´Donell DE, Sanii R, Giebrescht G, Younes M. Effect of continuous positive airway pressure on respiratory sensation in patients with chronic obstructive pulmonary disease during submaximal exercise. Am Rev Respir Dis 1988; 138: 1185-1191.

10. Feinstein AR. “Clinical Judgment” revisited: the distraction of quantitative models. Ann Intern Med 1994; 120: 799-805.

11. Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377-381.

12. Borg GAV. A category scale with ratio properties for intermodal and interindividual comparisons. In: Geissler HG, Petzold P. eds. Psychophysical judgement and the process of perception. Berlin: Veb Deutsche Verlag Wissen Schaften, 1982: 25-34.

13. Noseda A, Carpiaux JP, Schmerber J, Yernault JC. Dyspnea assessed by visual analogue scale in patients with chronic obstructive lung disease during progressive and high intensity exercise. Thorax 1992; 47: 363-368.

14. Mador MJ, Kufel TJ. Reproducibility of visual analog scale measurements of dyspnea in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1992; 146: 82-87.

15. Muza SR, Silverman MT, Giolmore GC, Hellerstein HK, Kelsen SG. Comparison of scales used to quantify the sense of effort to breathe in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1990; 141: 909-913.

16. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987; 42: 773-778.

17. Simpson K, Killiean K, Mc Cartney N, Stubbing DG, Jones NL. Randomized controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax 1992;

18. 47: 70-75.

19. Mahler DA, Weinberg DH, Wells CK, Feinstein AR. The measurement of dyspnea: contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest 1984; 85: 751-758.

20. Fletcher CM, Elmes PC, Wood CH. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. BMJ 1959; 1: 257-266.

21. Celli BR, MacNee W, and Committee members. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932-946.

22. Celli BR, Cote CG, Marin JM, Casanova Ciro, Montes de Oca M, Mendez RA, Pinto V, Cabral HJ. The body-massindex, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 1005-1012.