哮喘联盟

   摘要
   尽管哮喘和肥胖之间存在紧密联系，但是没有研究对肥胖哮喘患者体育锻炼时的感官反应和生理反应进行过评估。我们近来证实：相对于非哮喘对照者，体重正常且哮喘控制良好患者对于体育锻炼具有储备的心肺反应和感官反应。然而，对于肥胖哮喘患者，这些相似之处可能不适用。因此，我们试图弄清楚哮喘兼肥胖是否会对心肺功能、运动效能、呼吸障碍及体育锻炼时生理反应产生不利影响。纳入14例肥胖且哮喘控制良好的患者和14例年龄相仿的体重正常哮喘患者，对他们进行常规的呼吸量测定和增量心肺循环测试，从而评估通气功能、肺部换气功能、体育锻炼时的心血管反应和感官反应。根据年龄、身高、肺功能和哮喘控制情况，进行组间配对。相对于体重正常的哮喘患者，肥胖哮喘患者具有更大的身高体重指数(33 ± 3 vs. 23 ± 1 kg/m, p < 0.001)和更低的自我报告活动水平（为体重正常的哮喘患者活动水平的47%，p < 0.05）。相对于体重正常的哮喘患者，肥胖哮喘患者具有更低的最大摄氧量(VO2) (82 ± 14 vs. 92 ± 10 %预计值，p < 0.05) 和工作效率(75 ± 8 vs. 89 ± 13 %预计值，p < 0.05)。相对于体重正常的哮喘患者，肥胖哮喘患者的无氧阈值发生于较低的VO2 (54 ± 15 vs. 66 ± 16 %预计值, p < 0.05)。两组在整个体育锻炼过程中的通气发应呈叠加性，均无通气限制。两组的心血管发应均正常。两组的呼吸障碍相似，但是肥胖哮喘患者在次级工作效率时的腿部疲乏更显著。总之，与正常体重的哮喘患者相比，肥胖且哮喘控制良好患者的心肺功能降低且腿部疲乏更显著。肥胖哮喘患者相对降低的心肺功能和运动效能很大可能是由于他们久坐的生活方式和随之的去适应作用所致，而非呼吸因素所致。

 

（苏欣 审校）
Respir Med. 2015 Nov;109(11):1397-403. doi: 10.1016/j.rmed.2015.09.010. Epub 2015 Sep 25.


 

Combined effects of mild-to-moderate obesity and asthma on physiological and sensory responses to exercise.
 

Cortés-Télles A1, Torre-Bouscoulet L2, Silva-Cerón M2, Mejía-Alfaro R2, Syed N3, Zavorsky GS4, Guenette JA5.
 

Abstract
Despite the close link between asthma and obesity, there are no studies that have evaluated the sensory and physiological responses to exercise in obese asthmatics. We recently demonstrated that normal weight asthmatics with well controlled disease have preserved cardiorespiratory and sensory responses to exercise relative to non-asthmatic controls. However, these similarities may not hold true in patients with combined obesity and asthma. Accordingly, we sought to determine if combined asthma and obesity was associated with deleterious effects on cardiorespiratory fitness, exercise performance, dyspnoea, and physiological responses to exercise. Fourteen well-controlled obese asthmatics and fourteen age-matched normal weight asthmatics performed routine spirometry and underwent an incremental cardiopulmonary cycle test to assess the ventilatory, pulmonary gas exchange, cardiovascular, and sensory responses to exercise. Groups were well matched for age, height, spirometry, and asthma control. Obese asthmatics had a significantly greater body mass index (33 ± 3 vs. 23 ± 1 kg/m(2), p < 0.001) and lower self-reported activity levels by 47 % relative to normal weight asthmatics (p < 0.05). Obese asthmatics had a significantly lower maximal oxygen uptake (VO2) (82 ± 14 vs. 92 ± 10 %predicted) and work rate (75 ± 8 vs. 89 ± 13 %predicted) relative to normal weight asthmatics (p < 0.05). The anaerobic threshold occurred at a lower VO2 in obese asthmatics vs. normal weight asthmatics (54 ± 15 vs. 66 ± 16 %predicted, p < 0.05). Ventilatory responses were superimposed throughout exercise with no evidence of a ventilatory limitation in either group. Cardiovascular responses were normal in both groups. Dyspnoea responses were similar but the obese asthmatics experienced greater leg fatigue ratings at submaximal work rates. In conclusion, obese individuals with well controlled asthma have reduced cardiorespiratory fitness and greater leg fatigue ratings relative to normal weight asthmatics. The relatively reduced cardiorespiratory fitness and exercise performance in obese compared to normal weight asthmatics is most likely driven by their more sedentary lifestyle and resultant deconditioning rather than due to respiratory factors.
 

Respir Med. 2015 Nov;109(11):1397-403. doi: 10.1016/j.rmed.2015.09.010. Epub 2015 Sep 25.