Controversies in the Cardiopulmonary Exercise Test use in evaluation of impairment and disability in Portugal
Pulmonologists are involved in the assessment of functional impairment in patients with occupational respiratory diseases.bb0005, bb0010, bb0015 These patients often complain that dyspnea on exertion interferes with their ability to do their job and they may be legally compensated according to the functional deficit reported.bb0020, bb0025
Cardiopulmonary exercise testing (CPET) is a valuable clinical test for assessment of exercise intolerance and is taken into account when providing relevant information to assess functional impairment and disability. bb0030, bb0035, bb0040, bb0045, bb0050, bb0055, bb0060, bb0065, bb0070, bb0075 Several researchers have demonstrated the utility of CPET in determining the functional deficit. bb0080, bb0085, bb0090, bb0095, bb0100, bb0105, bb0110 Of all parameters determined, maximal Oxygen consumption (VO2 max) is the one that reveals exercise limitation and is used in most guidelines for quantifying functional impairment.bb0035, bb0040, bb0045 A normal VO2 max implies that respiratory function is preserved, showing no significant functional deficit. A decreased VO2 max may have several causes and the other parameters provide information to determine the factors that contribute to exercise intolerance (psychogenic, deconditioning, cardiovascular limitation, ventilatory limitation or limitation by gas exchange abnormalities). bb0080, bb0085, bb0090, bb0095, bb0115 The maximal oxygen consumption in office work is 5–7mL/kg/min, in moderate physical work about 15mL/kg/min and in physically demanding work 20 to 30mL/kg/min13, these are approximate figures.
In Portugal, respiratory disability is regulated by law, according to a scale of disability resulting from accidents at work and occupational diseases, the Tabela Nacional de Incapacidades por Acidentes de Trabalho e Doencas Profissionais (Decreto-Lei n.° 352/2007 de 23 de Outubro).24 It relies mainly on pulmonary function tests and the...
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