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L Puente-Maestu

Publications and source records attributed to L Puente-Maestu.

13 recordsLinked to original sources
PubMed2007

Recommendations on the use of exercise testing in clinical practice.

Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest. For symptom-limited incremental exercise, CPET indices, such as peak O(2) uptake (V'O(2)), V'O(2) at lactate threshold, the slope of the ventilation-CO(2) output relationship and the presence of arterial O(2) desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable. In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) "When should an evaluation of exercise intolerance be sought?"; 2) "Which particular form of test should be asked for?"; and 3) "What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?"

Exercise Test↗
PubMed2003

Long-term effects of a maintenance program after supervised or self-monitored training programs in patients with COPD.

The evaluation of a 13-month maintenance program (MP) for 39 severe COPD patients with FEV(1)%pred 44(7)% who, as result of two different 8-week leg exercise training (LET) programs, one supervised at the hospital (group S; n = 20) and the other self-monitored (SM; n = 19), had achieved different levels of exercise tolerance. After LET, patients in group S had a higher maximal oxygen uptake and endurance time than patients in the SM group [ O(2)max 1.43(0.30) l. min(-1)] vs l.25(0.27) l. min(-1) and endurance-time 16(4) min vs 12 (5) min, respectively). During the MP patients were advised to walk vigorously at least 4 km/day, 4 times/wk. After the MP, while endurance time remained higher than at baseline, it had decreased ( p < 0.01) immediately after LET in both groups and no differences were evident between groups (11(4) min and 10(4), respectively). In contrast, Chronic Respiratory Diseases Questionnaire scores, which had improved significantly after LET in both groups, remained high. Long-term effects of MP were independent of the training strategy or whether physiological improvements had been obtained with the initial LET. SM exercise programs do not seem capable of maintaining physiological improvements in exercise tolerance, though "quality of life" can be maintained.

Exercise Therapy↗
PubMed2003

[Pneumonia in the patient with chronic obstructive pulmonary disease. Levels of severity and risk classification].

OBJECTIVES: To analyze the severity, clinical course and mortality in patients with community-acquired pneumonia and COPD. METHOD: Retrospective study of patients admitted with pneumonia over a period of 12 months. From records, we gathered information related to patient characteristics, signs and symptoms and concomitant disease and classified each patient according to risk. RESULTS: One hundred twenty-nine patients with a mean age of 71.13 (SD 17) were identified; 43 (33.3%) had COPD with severe airflow obstruction (FEV1 937 mL, SD 309), although there were no differences from one risk classification to another. No significant differences were found in mortality, as 8 patients (18.6%) with COPD died and 9 patients (10.7%) without COPD. The length of hospital stay was similar in both groups. Patients with COPD suffered more severe pneumonia and were at higher risk (classes IV and V). The percentage of COPD patients using chronic domiciliary oxygen therapy who died (75%) was different from the percentage of such patients who lived (37%); percent mortality also differed by level of risk. Patients receiving oxygen therapy had greater obstruction and greater respiratory insufficiency upon admission (PaO2/FiO2: 216.9, SD 41.92). CONCLUSIONS: The mortality rates and mean hospital stays of patients with and without COPD who are admitted with community-acquired pneumonia are similar, but patients with COPD suffer more severe pneumonia. Mortality is higher in patients with community-acquired pneumonia and COPD who are receiving domiciliary oxygen therapy and have greater airflow obstruction and respiratory deterioration upon admission.

Age Factors↗
PubMed2001

Reproducibility of the parameters of the on-transient cardiopulmonary responses during moderate exercise in patients with chronic obstructive pulmonary disease.

To be clinically useful as indices reflective of altered physiological function consequent to interventions in patients with chronic obstructive pulmonary disease (COPD), the time constant (tau) and steady-state amplitude of the kinetic responses for oxygen uptake (VO2) carbon dioxide output (VCO2) ventilation (VE) and heart rate (HR) have to be appropriately differentiable and reproducible. We therefore assessed the reproducibility of tau and steady state amplitude values in 41 patients with severe COPD [mean (SD)] [forced expiratory volume in 1 s = 41 (7)% predicted], aged 64 (5) years. Of the total, 6 of the patients (15%) did not produce breath-by-breath data of sufficient quality to warrant kinetic analysis. The remaining 35 patients completed two moderate-intensity 10 min square-wave exercise tests separated by 2 h, both before and after an endurance training programme. Tests were conducted on an electromagnetically-braked cycle ergometer at an exercise intensity corresponding to 80% of the estimated lactate threshold (thetaLa) or 50% of peak oxygen uptake if thetaLa was insufficiently differentiable. Breath-by-breath measurements of VO2, VCO2, VE and HR were averaged into 10 s bins and the on-transient response kinetics were estimated using a mono-exponential model. Analysing the pre-training and the post-training test 1 and test 2 comparisons together, the test 1- test 2 differences were not significantly different from 0 for either tau or A. The standard deviation of the test 1- test 2 differences allowed us to define the magnitude of change that would reach statistical significance. For tau, this averaged some 8, 10, 11 and 8 s, for VO2, VCO2, VE and HR, respectively, for a one-tailed paired-comparisons test (i.e. appropriate for assessing hypothesised improvements resulting from an intervention); for a two-tailed comparison, the differences were approximately 2 s greater. The corresponding one-tailed values for A were 100 ml x min(-1), 95 ml x min(-1), 2.5 1 x min(-1) and 4 beats x min(-1), respectively; the two-tailed values were 10%-15% greater. We therefore conclude that both tau and A for moderate-intensity exercise can be reproducibly estimated in patients with COPD when the data set provides a sufficiently large amplitude of response and sufficiently low sample variability to allow appropriate parameter estimation.

Aged↗
PubMed2000

Effects of two types of training on pulmonary and cardiac responses to moderate exercise in patients with COPD.

The effects of two 8-week programmes of exercise reconditioning on the time constants (tau) of the pulmonary gas exchange, ventilatory and heart rate responses to moderate intensity exercise in patients with chronic obstructive pulmonary disease (COPD) were studied. Thirty-five subjects (mean+/-SD 64+/-5 yrs; forced expiratory volume in one second (FEV1) 1.09+/-0.17 L; 41+/-6.2% predicted) were randomly assigned either to supervised (s) training on a treadmill, 4 days x week(-1) (group S; n=21) or self-monitored (SM) walking 3 or 4 km in 1 h 4 days x week(-l) (group SM; n=20). The different levels of supervision resulted in a different estimated intensity of training (35+/-10 W in the SM group and 70+/-22 W in the S group). The kinetics were evaluated with a constant-load exercise test on a cycle-ergometer at a work rate corresponding to 80% the highest oxygen consumption (V'O2) that can be achieved without blood lactic acidosis (V'O2,LAT) or 50% of V'O2,max, if maximum oxygen consumption V'O2,LAT was not found. Mean endurance time at a work rate equivalent to 70% of the pretraining V'O2,max increased by 493+/-281 s in the S group and 254+/-283 s in the SM group (p<0.001). Mean tauV'O2 decreased from 83+/-17 s to 67+/-11 s (p<0.0001) in the S group and from 84+/-12 to 79+/-16 (p=0.04) in the SM group. Mean tau for carbon dioxide output minute ventilation and heart rate were also speeded after training, again more markedly in the S group. In the S group there was a significant correlation between the decrease in tauV'O2 and the increase in endurance time (r=-0.56, SEM=0.21). It is concluded that training speeds the kinetic response of oxygen consumption, carbon dioxide production, minute ventilation and heart rate to moderate exercise and that the effect is greater after supervised, more intense training.

Aged↗
PubMed2000

Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease.

The effects of two 8 week programmes of reconditioning in chronic obstructive pulmonary disease (COPD) patients were studied. Forty one subjects (mean+/-SD) 644.5) yrs; forced expiratory volume in one second (FEV1) 1.09+/-0.16 L; 40.6+/-6.2% predicted were randomly assigned either to supervised training on a treadmill, 4 days x week(-1) (group S; n=21) or walking 3 or 4 km in 1 h 4 days x week(-1), self-monitored with a pedometer, with weekly visits to encourage adherence (group SM; n=20). Patients were evaluated with the chronic respiratory diseases questionnaire (CRQ) and two exercise tests on a treadmill: incremental (IT) and constant (CT), above lactic threshold or 70% of maximal oxygen uptake (VO2, max) with arterial blood lactate determinations. Estimated mean work rate of training was 69+/-27 W and 25+/-5 W respectively for groups S and SM. Both types of training produced similar changes in the four dimensions of the CRQ. In group S reconditioning yielded significant (p<0.05) increases in VO2, max and increases in duration, with decreased lactate accumulation, ventilation, CO2 output (VCO2), heart rate (HR) and diastolic blood pressure (DBP) at the end of CT. They also adopted a deeper slower pattern of breathing during exercise. The SM group showed significant (p<0.05) increases in duration, lower HR and DBP at the end of CT. Significantly (p<0.05) different effects between S and SM programmes were changes in VO2, max 100+/-101 mL x min(-1) versus 5+/-101 mL x min(-1)), duration of the CT (8.1+/-4.4 min versus 3.9+/-4.7 min), VCO2 (-94+/-153 mL x min(-1) versus 48+/-252 mL x min(-1)), lactate accumulation (-1.3+/-2.2 mmol x L(-1) versus 0+/-1.2 mmol x L(-1) and respiratory rate at the end of CT (4.3+/-3.4 min(-1) versus -1+/-4.2 min(-1)). Supervised, intense training yields physiological improvements in severe chronic obstructive pulmonary disease patients not induced by self-monitored training. The self-monitored, less intense training, increases submaximal exercise endurance, although to a lesser degree.

Aged↗
PubMed1998

[Prediction of exercise capacity after lung resection in patients with chronic airflow limitation].

To assess the usefulness of a method for predicting postoperative peak oxygen uptake based on lost lung function after lung resection (VO2peak-PPO) and to establish the underlying physiological foundation for the relation between VO2peak-PPO and the measured postoperative value VO2peak-PO), we studied 29 patients (26 men) [age 60 (SD9)] with chronic airflow limitation [FEV1 = 66 (SD13)%] undergoing lobectomy or major pulmonary resection to treat lung cancer. The patients were assigned to groups according to whether postoperative exercise tolerance was considered to be limited by exhaustion of ventilatory reserve (LV) or not (NLV). Data to estimate postoperative pulmonary function was obtained one week before surgery: patients performed pulmonary function tests and exercise tests on a treadmill; dyspnea was also evaluated and perfusion scintigraphs were obtained. Pulmonary function, exercise tolerance and dyspnea were evaluated again approximately five months after surgery. The mean difference between VO2peak-PPO and VO2peak-PO was -0.034 (CI 0.293 to -0.348) l.min-1 and the between-group correlation coefficient was 0.76. The correlation between VO2peak-PPO and VO2peak-PO was 0.86 (SE 0.1) [0.89 (SE 0.13) for LV (n = 14) patients and 0.85 (SE 0.16) for NLV (n = 15) patients]. The correlations after adjusting for preoperative VO2peak-PPO were 0.73 (SE 0.2) and 0.35 (SE 0.27) for LV and NLV patients, respectively. We conclude that VO2peak-PPO provides a valid but only moderately precise estimate of VO2peak-PO. Only in LV patients is there a true relation between a decrease in VO2peak and loss of lung function.

Adult↗
PubMedDate not supplied

[Relationship between tobacco smoke exposure and the concentrations of carboxyhemoglobin and hemoglobin].

To determine the carboxyhemoglobin (CO-Hb) predictive intervals in active and passive smokers and to obtain an equation expressing the relation of CO-Hb to number of cigarettes smoked, we studied 233 outpatients referred to an urban university hospital for arterial gas measurement. Patients were excluded if they were receiving oxygen therapy or had been hospitalized in the two months before the study. The patients were classified as non smokers (57), passive smokers (54), smokers of less than 11 cigarettes (22), smokers of 11 to 20 (41) smokers of 21 to 40 (44) and smokers of over 40 (15). All patients answered a questionnaire on exposure to tobacco smoke or other sources of CO. Blood gases and co-oximetry were measured in all patients. Mean CO-Hb and 95% confidence intervals were 1.53% (0.78-1.85%) in smokers and 2.59% (1.89-3.29%) in passive smokers. The linear equation that best expressed the relationship was CO-Hb = 0.153 x number of cigarettes + 1.1 exposure to other sources (1 or 0) + 1.39 (SD 0.84)%. Hemoglobin level was significantly higher in the two groups smoking more than 21 cigarettes. We conclude that the predictive intervals is 1.9% in non smokers who are not exposed to other sources of CO. Passive smokers have significantly higher levels of CO-Hb than non smokers. Heavy smokers have polycythemia.

Analysis of Variance↗