PT  - JOURNAL ARTICLE
AU  - Michael I Polkey
AU  - John Moxham
TI  - Attacking the disease spiral in chronic obstructive pulmonary disease: an update
AID  - 10.7861/clinmedicine.11-5-461
DP  - 2011 Oct 01
TA  - Clinical Medicine
PG  - 461--464
VI  - 11
IP  - 5
4099  - http://www.rcpjournals.org/content/11/5/461.short
4100  - http://www.rcpjournals.org/content/11/5/461.full
SO  - Clin Med2011 Oct 01; 11
AB  - In chronic obstructive pulmonary disease (COPD) a pathophysiological cycle occurs such that locomotor muscle weakness and fatiguabilty exist, which in turn limit exercise performance both because of leg discomfort and also because anaerobic metabolism leads to lactic acid production. Since the lactic acid is buffered by bicarbonate there is consequent carbon dioxide (CO2) production. Patients with advanced COPD are flow limited and cannot excrete the CO2 by raising ventilation and thus these patients experience breathlessness which discourages exercise and, in turn, prompts further deconditioning. Structured exercise, termed pulmonary rehabilitation is at the core of reversing the cycle but novel strategies should be employed for patients with advanced disease and alternative therapeutic opportunities may soon be available to improve pulmonary mechanics.