1
|
Ivan C, Andrea A, Simon ES, Walter P, Leif S, Konrad M, Mathias B, Onnen M, Caspar S. The role of the TMS parameters for activation of the corticospinal pathway to the diaphragm. Clin Neurophysiol 2022; 138:173-185. [DOI: 10.1016/j.clinph.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/12/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
|
2
|
Luo YM, Qiu ZH, Wang Y, He BT, Qin H, Xiao SC, Luo YM, Steier J, Moxham J, Polkey MI. Absence of dynamic hyperinflation during exhaustive exercise in severe COPD reflects submaximal IC maneuvers rather than a nonhyperinflator phenotype. J Appl Physiol (1985) 2020; 128:586-595. [DOI: 10.1152/japplphysiol.00695.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Approximately 20% of chronic obstructive pulmonary disease (COPD) patients have been considered to have a “nonhyperinflator phenotype.” However, this judgment depends on patients making a fully maximal inspiratory capacity (IC) maneuver at rest, since the IC during exercise is compared with this baseline measurement. We hypothesized that IC maneuvers at rest are sometimes submaximal and tested this hypothesis by measuring IC and associated neural respiratory drive at rest and during inhalation of CO2 and exercise in patients with COPD. Twenty-six COPD patients [age 66 ± 6 yr, mean forced expiratory volume in 1 s (FEV1) 40 ± 11% predicted] and 39 healthy subjects (age 39 ± 14 yr, FEV1 98 ± 12% predicted) were studied. IC and the diaphragm electromyogram (EMGdi) associated with it (EMGdi-IC) and forced inspiratory vital capacity (FIVC) and its corresponding EMGdi (EMGdi-FIVC) were measured during inhalation of 8% CO2 (8% CO2-92% O2) and room air. Incremental exhaustive cycle ergometer exercise was also performed in both patients with COPD and healthy subjects. IC, EMGdi-IC, FIVC, and EMGdi-FIVC during breathing 8% CO2 were significantly greater than those during breathing room air in both patients with COPD and healthy subjects (all P < 0.001). EMGdi-IC in patients with COPD constantly increased during exercise from 145 ± 40 µV at rest to 185 ± 52 µV at the end of exercise but change in IC was variable. Neural respiratory drive and its relevant IC increased during hypercapnia. Exercise-related hypercapnia in patients with COPD raises neural respiratory drives, which compensate for IC reduction, leading to underestimation of dynamic hyperinflation measured by IC at rest breathing room air. NEW & NOTEWORTHY Inspiratory capacity measured during hypercapnia is higher than that during eucapnia. Thus total lung capacity is not always be achieved by a standard inspiratory capacity maneuver, leading to risk of underestimation of dynamic hyperinflation in patients with severe chronic obstructive pulmonary disease after exhaustive exercise.
Collapse
Affiliation(s)
- Yuan-Ming Luo
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
- Department of Respiratory Medicine, King’s College London School of Medicine, London, United Kingdom
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Zhi-Hui Qiu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Yuan Wang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Bai-Ting He
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Hua Qin
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Si-chang Xiao
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Ying-mei Luo
- Respiratory Muscle Laboratory, Heart and Lung Institute, Imperial College and the Royal Brompton Hospital, London, United Kingdom
| | - Joerg Steier
- Department of Respiratory Medicine, King’s College London School of Medicine, London, United Kingdom
| | - John Moxham
- Department of Respiratory Medicine, King’s College London School of Medicine, London, United Kingdom
| | - Michael I Polkey
- Respiratory Muscle Laboratory, Heart and Lung Institute, Imperial College and the Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
3
|
Rebollar Y, Bourgoin-Heck M, Rault C, Ragot S, Petitpas F, Robert R, Coudroy R, Frat JP, Thille AW, Drouot X, Diaz V. Effects of repetitive magnetic cervical stimulation of phrenic roots on diaphragmatic function in healthy volunteers. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1713470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y. Rebollar
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Anesthésie-Réanimation, CHU de Poitiers, Poitiers, France
| | - M. Bourgoin-Heck
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - C. Rault
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - S. Ragot
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Biostatistiques, CHU de Poitiers, Poitiers, France
| | - F. Petitpas
- Anesthésie-Réanimation, CHU de Poitiers, Poitiers, France
| | - R. Robert
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - R. Coudroy
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - J.-P Frat
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - A.-W Thille
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - X. Drouot
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| | - V. Diaz
- INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Neurophysiologie clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France
| |
Collapse
|
4
|
Vitacca M, Kaymaz D, Lanini B, Vagheggini G, Ergün P, Gigliotti F, Ambrosino N, Paneroni M. Non-invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long-term ventilatory support: A randomized controlled trial. Respirology 2017; 23:182-189. [PMID: 28940820 DOI: 10.1111/resp.13181] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. METHODS All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone. Outcome measures were 6MWD (primary outcome), incremental and endurance cycle ergometer exercise time, respiratory muscle function, quality of life by the Maugeri Respiratory Failure questionnaire (MRF-28), dyspnoea (Medical Research Council scale) and leg fatigue at rest. RESULTS Forty-two patients completed the study. Following training, no significant difference in 6MWD changes were found between groups. Improvement in endurance time was significantly greater in the NIV group compared with the non-NIV training group (754 ± 973 vs 51 ± 406 s, P = 0.0271); dyspnoea improved in both groups, while respiratory muscle function and leg fatigue improved only in the NIV ET group. MRF-28 improved only in the group training without NIV. CONCLUSION In CRF patients on long-term NIV and long-term oxygen therapy (LTOT), the addition of NIV to ET sessions resulted in an improvement in endurance time, but not in 6MWD.
Collapse
Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
| | - Dicle Kaymaz
- Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Barbara Lanini
- Respiratory Unit, Fondazione Don Gnocchi IRCCS, Florence, Italy
| | | | - Pınar Ergün
- Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Nicolino Ambrosino
- Pulmonary and Respiratory Medicine Department, Medical Faculty Sebelas Maret University, Solo, Indonesia
| | - Mara Paneroni
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
| |
Collapse
|
5
|
Baz M, Haji GS, Menzies-Gow A, Tanner RJ, Hopkinson NS, Polkey MI, Hull JH. Dynamic laryngeal narrowing during exercise: a mechanism for generating intrinsic PEEP in COPD? Thorax 2015; 70:251-7. [PMID: 25586938 PMCID: PMC4345987 DOI: 10.1136/thoraxjnl-2014-205940] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Patients with COPD commonly exhibit pursed-lip breathing during exercise, a strategy that, by increasing intrinsic positive end-expiratory pressure, may optimise lung mechanics and exercise tolerance. A similar role for laryngeal narrowing in modulating exercise airways resistance and the respiratory cycle volume-time course is postulated, yet remains unstudied in COPD. The aim of this study was to assess the characteristics of laryngeal narrowing and its role in exercise intolerance and dynamic hyperinflation in COPD. METHODS We studied 19 patients (n=8 mild-moderate; n=11 severe COPD) and healthy age and sex matched controls (n=11). Baseline physiological characteristics and clinical status were assessed prior to an incremental maximal cardiopulmonary exercise test with continuous laryngoscopy. Laryngeal narrowing measures were calculated at the glottic and supra-glottic aperture at rest and peak exercise. RESULTS At rest, expiratory laryngeal narrowing was pronounced at the glottic level in patients and related to FEV1 in the whole cohort (r=-0.71, p<0.001) and patients alone (r=-0.53, p=0.018). During exercise, glottic narrowing was inversely related to peak ventilation in all subjects (r=-0.55, p=0.0015) and patients (r=-0.71, p<0.001) and peak exercise tidal volume (r=-0.58, p=0.0062 and r=-0.55, p=0.0076, respectively). Exercise glottic narrowing was also inversely related to peak oxygen uptake (% predicted) in all subjects (r=-0.65, p<0.001) and patients considered alone (r=-0.58, p=0.014). Exercise inspiratory duty cycle was related to exercise glottic narrowing for all subjects (r=-0.69, p<0.001) and patients (r=-0.62, p<0.001). CONCLUSIONS Dynamic laryngeal narrowing during expiration is prevalent in patients with COPD and is related to disease severity, respiratory duty cycle and exercise capacity.
Collapse
Affiliation(s)
- M Baz
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK Departamento Clinico de Medicina, Hospital de Clinicas, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - G S Haji
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - A Menzies-Gow
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - R J Tanner
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - N S Hopkinson
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - M I Polkey
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - J H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| |
Collapse
|
6
|
Abstract
During dynamic exercise, the healthy pulmonary system faces several major challenges, including decreases in mixed venous oxygen content and increases in mixed venous carbon dioxide. As such, the ventilatory demand is increased, while the rising cardiac output means that blood will have considerably less time in the pulmonary capillaries to accomplish gas exchange. Blood gas homeostasis must be accomplished by precise regulation of alveolar ventilation via medullary neural networks and sensory reflex mechanisms. It is equally important that cardiovascular and pulmonary system responses to exercise be precisely matched to the increase in metabolic requirements, and that the substantial gas transport needs of both respiratory and locomotor muscles be considered. Our article addresses each of these topics with emphasis on the healthy, young adult exercising in normoxia. We review recent evidence concerning how exercise hyperpnea influences sympathetic vasoconstrictor outflow and the effect this might have on the ability to perform muscular work. We also review sex-based differences in lung mechanics.
Collapse
Affiliation(s)
- Andrew William Sheel
- The School of Kinesiology, The University of British Columbia, Vancouver, Canada.
| | | |
Collapse
|
7
|
Zhang D, Gong H, Lu G, Guo H, Li R, Zhong N, Polkey M, Luo Y. Respiratory motor output during an inspiratory capacity maneuver is preserved despite submaximal exercise. Respir Physiol Neurobiol 2013; 189:87-92. [DOI: 10.1016/j.resp.2013.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 06/26/2013] [Accepted: 07/03/2013] [Indexed: 11/25/2022]
|
8
|
Qin YY, Steier J, Jolley C, Moxham J, Zhong NS, Luo YM. Efficiency of Neural Drive During Exercise in Patients With COPD and Healthy Subjects. Chest 2010; 138:1309-15. [DOI: 10.1378/chest.09-2824] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
9
|
Swallow EB, Gosker HR, Ward KA, Moore AJ, Dayer MJ, Hopkinson NS, Schols AMWJ, Moxham J, Polkey MI. A novel technique for nonvolitional assessment of quadriceps muscle endurance in humans. J Appl Physiol (1985) 2007; 103:739-46. [PMID: 17569771 DOI: 10.1152/japplphysiol.00025.2007] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Assessment of quadriceps endurance is of interest to investigators studying human disease. We hypothesized that repetitive magnetic stimulation (rMS) of the intramuscular branches of the femoral nerve could be used to induce and quantify quadriceps endurance. To test this hypothesis, we used a novel stimulating coil to compare the quadriceps endurance properties in eight normal humans and, to confirm that the technique could be used in clinical practice, in eight patients with advanced chronic obstructive pulmonary disease (COPD). To validate the method, we compared in vivo contractile properties of the quadriceps muscle with the fiber-type composition and oxidative enzyme capacity. We used a Magstim Rapid2 magnetic nerve stimulator with the coil wrapped around the quadriceps. Stimuli were given at 30 Hz, a duty cycle of 0.4 (2 s on, 3 s off), and for 50 trains. Force generation and the surface electromyogram were measured throughout. Quadriceps twitch force, elicited by supramaximal magnetic stimulation of the femoral nerve, was measured before and after the protocol. Quadriceps muscle biopsies were analyzed for oxidative (citrate synthase, CS) and glycolytic (phosphofructokinase, PFK) enzyme activity and myosin heavy chain isoform protein expression. The time for force to fall to 70% of baseline (T70) was shorter in the COPD group than the control group: 55.6 ± 26.0 vs. 121 ± 38.7 s ( P = 0.0014). Considering patients and controls together, positive correlations were observed between T70 and the proportion of type I fibers ( r = 0.68, P = 0.004) and CS-to-PFK ratio (CS/PFK) ( r = 0.67, P = 0.005). We conclude that quadriceps endurance assessed using rMS is feasible in clinical studies.
Collapse
Affiliation(s)
- E B Swallow
- Respiratory Muscle Laboratory, Royal Brompton Hospital, Fulham Rd., London SW3 6NP, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|