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Primäre und sekundäre Atemmuskeln

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Physiotherapie bei chronischen Atemwegs- und Lungenerkrankungen

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Zusammenfassung

Als Folge der chronischen Lungenüberblähung kommt es bei COPD-Patienten zu einer Verkürzung der Atemmuskeln. Diese hat eine Absenkung und Abflachung des Zwerchfells zur Folge. Smith et al. weisen darauf hin, dass die resultierende Kraftentwicklung bei Verkürzung der Muskulatur vermindert ist [39]. Bei chronischer Verkürzung werden die seriell verknüpften Sarkomere zur Anpassung an die erhöhte Belastung zurückgebildet. Die Adaptation der Sarkomere kann die Verkürzung der Zwerchfellmuskulatur nur teilweise kompensieren, da die Veränderung der Geometrie und der Interaktion zwischen Zwerchfell und Thorax nur unzureichend ausgeglichen wird. Die Atemarbeit wird durch erhöhte Atemwegswiderstände, erhöhte Atemfrequenz und ungünstige Faserlänge der Atemmuskulatur, bedingt durch die Überblähung mit Abflachung des Zwerchfells und Verkürzung der Muskelfasern, negativ beeinflusst [40]. Die zusätzliche Rekrutierung der Atemmuskeln ist bei COPD-Patienten durch eine vermehrte Totraumventilation, Malnutrition, steroidinduzierte Muskelatrophie, erhöhte Atemwegswiderstände, reduzierte Elastizität des Lungenparenchyms (Compliance) und Retraktionskraft des Thorax mit hoher Atemarbeit und hohem Energieaufwand verbunden.

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Authors and Affiliations

  1. Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften (ZHAW), Technikumstrasse 71, CH-8401, Winterthur

    Dr. rer. medic. A. J. R. van Gestel PT (Hochschuldozent: innere Organe und Gefässe)

  2. Facharzt für Innere Medizin und Pneumologie Ruhrlandklinik, Westdeutsches Lungenzentrum, Tüschener Weg 40, D-45239, Essen

    Dr. med. Jörg Steier (ERS Senior Clinical Research Fellow)

  3. King’s College London School of Medicine, Denmark Hill Campus, London, SE5 9RS, UK

    Dr. med. Jörg Steier (ERS Senior Clinical Research Fellow)

  4. Abt. Pneumologie, Ruhrlandklinik Westdeutsches Lungenzentrum, Tüschener Weg 40, 45239, Essen, Deutschland

    Univ. Prof. Dr. med. Dipl. Ing. Helmut Teschler (Direktor)

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  1. Dr. rer. medic. A. J. R. van Gestel PT
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  2. Dr. med. Jörg Steier
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  3. Univ. Prof. Dr. med. Dipl. Ing. Helmut Teschler
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van Gestel, A.J.R., Steier, J., Teschler, H. (2010). Primäre und sekundäre Atemmuskeln. In: Physiotherapie bei chronischen Atemwegs- und Lungenerkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01435-2_7

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  • DOI: https://doi.org/10.1007/978-3-642-01435-2_7

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-01434-5

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