CONSIDERAÇÕES FINAIS

Muitos pacientes com DPOC apresentam disfunção muscular esquelética. São evidentes alterações musculares funcionais, estruturais e bioenergéticas; entretanto, os fatores determinantes dessa disfunção ainda não estão esclarecidos. Fatores como desnutrição, uso crônico de corticosteróides, diminuição de hormônios anabólicos, diminuição crônica do condicionamento, redução do metabolismo de aminoácidos, inflamação local ou sistêmica, e estresse oxidativo, podem estar envolvidos na patogênese das anormalidades musculares nesses pacientes. As estratégias para pesquisas futuras devem ter como objetivo a determinação dos principais fatores desencadeantes da disfunção muscular e a real influência de cada um deles, além de estabelecer estratégias de tratamento efetivas.

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87 36 ⁴² 26 43 31 0 10 20 30 40 50 Dispnéia Fadiga de MMII Ambos Pacientes (%) Controle DPOC

Figura 1 Sintomatologia no exercício máximo em 92 pacientes com DPOC e em 320

indivíduos saudáveis homogêneos. A maioria dos pacientes com DPOC interrompeu o teste incremental máximo, por sintomas de fadiga de membros inferiores (MMII), o que sugere a influência dos músculos esqueléticos periféricos em sua capacidade para realizar exercícios. Dados do estudo de Killian et al.3

Figura 2 Ciclo de dispnéia-sedentarismo-dispnéia apresentado por pacientes com doença pulmonar obstrutiva crônica

Figura 3 Mecanismo de lactacidose precoce apresentado por pacientes com doença pulmonar obstrutiva crônica e duas possíveis estratégias de tratamento (engrenagem à direita) Atenção, diagramação: autor pede para retirar a palavra “ anabolizantes” da roda à direita