Ventilación dirigida contrastada y entrenamiento muscular aeróbico-anaeróbico mejoran un paciente con EPOC severo por enfisema pulmonar

Abstract

Objective To analyze the effects of the combination of Comprehensive Directed Breathing (CDB) with training Square Wave Endurance Exercise Test (SWEET), 4-min aerobic and 1-min anaerobic repeated nine times in 45 min, with oxygen therapy during exercise, in a patient (73 years) with severe COPD, hyperinflation and hypoxemia during exercises. Methodology Clinical examination, functional testing and 4 exercise testing: 6-min walking test (6MWT), two step stool, incremental exercise and the SWEET, with control of exertional Dyspnea (Borg’ scale), SpO 2 and heart rate (HR). Arterial blood gases (PaO 2, PaCO 2, pH, lactic acid), metabolism (O 2, CO 2), ventilatory pattern (E, FR, VT) and heart rate (HR) were compared before and immediately after 11 tailored sessions of 120-min supervised by the respiratory physiotherapist and the physiatrist specialists. Then, he continued at home applying himself the full learning protocol and a fast-control was made six months later. Results The thoraco-abdominal asynchrony and paradoxical ventilation were corrected and the spirometry improved discreetly, but the maximal flows and respiratory pressures increase strongly (+132 and +119%), as well as aerobic capacity (+111%), ambulation (32%) and the two step stool (+119%). The ventilatory efficiency increases and the resting metabolism decreases. Exertional dyspnea is reduced by 35% as the residual volume by 33%. Conclusion The protocol CDB plus SWEET has been made effective in reducing exertional Dyspnea, increased MVV, maximum exercise capacity and maximal respiratory flows and pressures in this patient with severe emphysema and COPD.