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LoMauro A, De Luca A, Scarpazza P, Aliverti A. In Vivo Measurement of Tidal Volume During Non-invasive Respiratory Support by Continuous-Flow Helmet CPAP. Ann Biomed Eng 2024; 52:2546-2555. [PMID: 38886251 PMCID: PMC11329575 DOI: 10.1007/s10439-024-03545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024]
Abstract
Recently, the interest in the Helmet interface during non-invasive respiratory support (NIRS) has increased due to the COVID-19 pandemic. During NIRS, positive end-expiratory pressure (PEEP) can be given as continuous positive airway pressure (CPAP), which maintains a positive airway pressure throughout the whole respiratory cycle with Helmet as an interface (H-CPAP). The main disadvantage of the H-CPAP is the inability to measure tidal volume (VT). Opto-electronic plethysmography (OEP) is a non-invasive technique that is not sensitive to gas compression/expansion inside the helmet. OEP acquisitions were performed on 28 healthy volunteers (14 females and 14 males) at baseline and during Helmet CPAP. The effect of posture (semi-recumbent vs. prone), flow (50 vs. 60 L/min), and PEEP (0 vs. 5 vs. 10 cmH2O) on the ventilatory and thoracic-abdominal pattern and the operational volumes were investigated. Prone position limited vital capacity, abdominal expansion and chest wall recruitment. A constant flow of 60 L/min reduced the need for the subject to ventilate while having a slight recruitment effect (100 mL) in the semi-recumbent position. A progressive increasing recruitment was found with higher PEEP but limited by the prone position. It is possible to accurately measure tidal volume during H-CPAP to deliver non-invasive ventilatory support using opto-electronic plethysmography during different clinical settings.
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Affiliation(s)
- A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy.
| | - A De Luca
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
| | - P Scarpazza
- Pneumology Unit, Ospedale Civile, Vimercate, Milan, Italy
| | - A Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
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Balaji L, Farrar MA, D'Silva AM, Kariyawasam DS. Decision-making and challenges within the evolving treatment algorithm in spinal muscular atrophy: a clinical perspective. Expert Rev Neurother 2023; 23:571-586. [PMID: 37227306 DOI: 10.1080/14737175.2023.2218549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The clinical application of disease modifying therapies has dramatically changed the paradigm of the management of people with spinal muscular atrophy (SMA), from sole reliance on symptomatic care directed toward the downstream consequences of muscle weakness, to proactive intervention and even preventative care. AREAS COVERED In this perspective, the authors evaluate the contemporary therapeutic landscape of SMA and discuss the evolution of novel phenotypes and the treatment algorithm, including the key factors that define individual treatment choice and treatment response. The benefits achieved by early diagnosis and treatment through newborn screening are highlighted, alongside an appraisal of emerging prognostic methods and classification frameworks to inform clinicians, patients, and families about disease course, manage expectations, and improve care planning. A future perspective of unmet needs and challenges is provided, emphasizing the key role of research. EXPERT OPINION SMN-augmenting therapies have improved health outcomes for people with SMA and powered the practice of personalized medicine. Within this new proactive diagnostic and treatment paradigm, new phenotypes and different disease trajectories are emerging. Ongoing collaborative research efforts to understand the biology of SMA and define optimal response are critical to refining future approaches.
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Affiliation(s)
- Lakshmi Balaji
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
- UNSW Kensington Campus, Sydney, Australia
| | - Arlene M D'Silva
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
- UNSW Kensington Campus, Sydney, Australia
| | - Didu S Kariyawasam
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
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3
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Rad N, Cai H, Weiss MD. Management of Spinal Muscular Atrophy in the Adult Population. Muscle Nerve 2022; 65:498-507. [PMID: 35218574 DOI: 10.1002/mus.27519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 12/14/2022]
Abstract
Spinal muscular atrophy (SMA) is a group of neurodegenerative disorders resulting from the loss of spinal motor neurons. 95% of patients share a pathogenic mechanism of loss of survival motor neuron (SMN) 1 protein expression due to homozygous deletions or other mutations of the SMN1 gene, with the different phenotypes influenced by variable copy numbers of the SMN2 gene. Advances in supportive care, disease modifying treatment and novel gene therapies have led to an increase in the prevalence of SMA, with a third of SMA patients now represented by adults. Despite the growing number of adult patients, consensus on the management of SMA has focused primarily on the pediatric population. As the disease burden is vastly different in adult SMA, an approach to treatment must be tailored to their unique needs. This review will focus on the management of the adult SMA patient as they age and will discuss proper transition of care from a pediatric to adult center, including the need for continued monitoring for osteoporosis, scoliosis, malnutrition, and declining mobility and functioning. As in the pediatric population, multidisciplinary care remains the best approach to the management of adult SMA. Novel and emerging therapies such as nusinersen and risdiplam provide hope for these patients, though these medications are of uncertain efficacy in this population and require additional study.
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Affiliation(s)
- Nassim Rad
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Haibi Cai
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Michael D Weiss
- Department of Neurology, University of Washington, Seattle, Washington, USA
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Chacko A, Sly PD, Ware RS, Begum N, Deegan S, Thomas N, Gauld LM. Effect of nusinersen on respiratory function in paediatric spinal muscular atrophy types 1-3. Thorax 2021; 77:40-46. [PMID: 33963091 DOI: 10.1136/thoraxjnl-2020-216564] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nusinersen is used in spinal muscular atrophy (SMA) to improve peripheral muscle function; however, respiratory effects are largely unknown. AIM To assess the effects of nusinersen on respiratory function in paediatric SMA during first year of treatment. METHODS A prospective observational study in paediatric patients with SMA who began receiving nusinersen in Queensland, Australia, from June 2018 to December 2019. Outcomes assessed were the age-appropriate respiratory investigations: spirometry, oscillometry, sniff nasal inspiratory pressure, mean inspiratory pressure, mean expiratory pressure, lung clearance index, as well as polysomnography (PSG) and muscle function testing. Lung function was collected retrospectively for up to 2 years prior to nusinersen initiation. Change in lung function was assessed using mixed effects linear regression models, while PSG and muscle function were compared using the Wilcoxon signed-rank test. RESULTS Twenty-eight patients (15 male, aged 0.08-18.58 years) were enrolled: type 1 (n=7); type 2 (n=12); type 3 (n=9). The annual rate of decline in FVC z-score prior to nusinersen initiation was -0.58 (95% CI -0.75 to -0.41), and post initiation was -0.25 (95% CI -0.46 to -0.03), with a significant difference in rate of decline (0.33 (95% CI 0.02 to 0.66) (p=0.04)). Most lung function measures were largely unchanged in the year post nusinersen initiation. The total Apnoea-Hypopnoea Index (AHI) was reduced from a median of 5.5 events/hour (IQR 2.1-10.1) at initiation to 2.7 events/hour (IQR 0.7-5.3) after 1 year (p=0.02). All SMA type 1% and 75% of SMA types 2 and 3 had pre-defined peripheral muscle response to nusinersen. CONCLUSION The first year of nusinersen treatment saw reduced lung function decline (especially in type 2) and improvement in AHI.
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Affiliation(s)
- Archana Chacko
- Centre for Children's Research, The University of Queensland, South Brisbane, Queensland, Australia .,Respiratory and Sleep Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Peter D Sly
- Centre for Children's Research, The University of Queensland, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Nelufa Begum
- Centre for Children's Research, The University of Queensland, South Brisbane, Queensland, Australia
| | - Sean Deegan
- Respiratory and Sleep Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Nicole Thomas
- Neuromuscular Physiotherapy Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Leanne M Gauld
- Respiratory and Sleep Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
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5
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Edel L, Grime C, Robinson V, Manzur A, Abel F, Munot P, Ridout D, Scoto M, Muntoni F, Chan E. A new respiratory scoring system for evaluation of respiratory outcomes in children with spinal muscular atrophy type1 (SMA1) on SMN enhancing drugs. Neuromuscul Disord 2021; 31:300-309. [PMID: 33752934 DOI: 10.1016/j.nmd.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
Nusinersen (NUS), the first treatment approved for Spinal Muscular Atrophy type 1 (SMA1), was made available in the UK for SMA1 through the Expanded Access Program (EAP) in 2017. The Great Ormond Street Respiratory (GSR) score was developed as an objective respiratory assessment for children with SMA1 during their treatment. Aims: Track respiratory status of SMA1 children over the course of Nusinersen treatment and compare GSR scores amongst SMA1 sub-types. Single centre study on SMA1 patients using the GSR score at set time points: prior to first NUS dose; 2 weeks post end of loading doses; 2 weeks post-subsequent doses. GSR score ranges 1-28, being 1-9 = Stable minimal support, thorough to 23-28 = Poor reserve with maximum support. 20 SMA1 children underwent NUS treatment between January 2017 - November 2018. Median age of diagnosis was 5.0 months. NUS started at median of 9.57 months. From 5th dose onwards, GSR scores were significantly lower for Type 1C patients compared to Type 1B By month 18, irrespective of subtypes, the whole cohort appears to stabilise GSR Scores. As treatment duration increases, an overall stabilisation of respiratory status across the cohort was observed. Further longitudinal studies are needed to validate the GSR.
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Affiliation(s)
- L Edel
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK.
| | - C Grime
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - V Robinson
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - A Manzur
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - F Abel
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - P Munot
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - D Ridout
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - M Scoto
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK; The Dubowitz Neuromuscular Centre, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - F Muntoni
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK; The Dubowitz Neuromuscular Centre, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - E Chan
- Respiratory Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
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Gomes DC, Azevedo IG, de Figueiredo Araújo AG, da Costa Lopes LD, Nagem DAP, Magalhães FA, Pereira SA. Thoracoabdominal motion in newborns: Reliability between two interactive computing environments. Pediatr Pulmonol 2020; 55:1184-1189. [PMID: 32168420 DOI: 10.1002/ppul.24709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantifying the chest wall is useful in documenting thoracoabdominal synchrony during the neonatal period. Subjective measures are often used rather than gold-standard methods due to their practicality in clinical practice. The aim of the present study is to compare the reliability between a newly proposed method (video analysis in MATLAB) and image analysis using AutoCad tools, both applied to assess thoracoabdominal motion in newborns (NBs). MATERIALS AND METHODS This is an observational cross-sectional study of full-term NBs. A digital camera was used to film thoracoabdominal motion for 2 minutes in the supine position, with movements measured by the two aforementioned methodologies. RESULTS A total of 139 images were used, showing agreement between AutoCAD and MATLAB (BIAS = -1.68; CI = -6.59:3.22, Bland-Altman plot). CONCLUSION The programs were interchangeable and the routine developed in MATLAB was simpler and faster, allowing dynamic analysis and suggesting its clinical utility in quantifying respiratory motion in NBs.
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Affiliation(s)
- Danielle C Gomes
- Rehabilitation Sciences Graduate Program, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Ingrid G Azevedo
- Kinesiología Course, Universidad Católica de Temuco, Temuco, Chile
| | - Ana G de Figueiredo Araújo
- Rehabilitation Sciences Graduate Program, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Lenice D da Costa Lopes
- FACISA, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Danilo A P Nagem
- Departamento de Engenharia Biomédica, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Fabrício A Magalhães
- Departamento de Fisioterapia, Graduate Program in Rehabilitation Sciences, Univerisdade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana A Pereira
- Rehabilitation Sciences Graduate Program, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil.,Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Farber HJ, Phillips WA, Kocab KL, Hanson DS, Heydemann JA, Dahl BT, Spoede ET, Jefferson LS. Impact of scoliosis surgery on pulmonary function in patients with muscular dystrophies and spinal muscular atrophy. Pediatr Pulmonol 2020; 55:1037-1042. [PMID: 32012473 DOI: 10.1002/ppul.24664] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/13/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Scoliosis is a common complication of severe neuromuscular diseases. The aim of this study is to determine the impact of posterior spinal fusion on pulmonary function parameters in patients with severe neuromuscular disease at our medical center. METHODS Retrospective chart review of all patients with severe neuromuscular disease who had posterior spinal fusion between 2012 and 2017 at Texas Children's Hospital. Patients with growing rods, brain injury or malformation, and/or spina bifida were excluded. Pulmonary function measures before and after spinal surgery were determined. RESULTS A total of 20 eligible patients were identified, 7 with Duchenne muscular dystrophy, 6 with spinal muscular atrophy, 3 with merosin deficient muscular dystrophy, 2 with Charcot-Marie-Tooth, 1 with central core disease, and 1 with dystroglycanopathy. The mean change in vital capacity from pre- to postspine surgery was a loss of 0.63 L for the spinal muscular atrophy patients, a loss of 0.36 L for the Duchenne muscular dystrophy patients, and a gain of 0.23 L for the merosin deficient patients. The difference between spinal muscular atrophy and merosin deficient patients was statistically significant (P = .02) CONCLUSION: In this single-center retrospective study, we found that after spine surgery for scoliosis, all patients with spinal muscular atrophy and most patients with Duchenne muscular dystrophy lost vital capacity, while the patients with merosin deficient muscular dystrophy gained vital capacity. These differences were not associated with differences is respiratory strength, body mass index, or surgical outcomes.
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Affiliation(s)
- Harold J Farber
- Section of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - William A Phillips
- Department of Orthopedic Surgery, Texas Children's Hospital Orthopedic Surgery Service, Baylor College of Medicine, Houston, Texas
| | - Kenneth L Kocab
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - Darrell S Hanson
- Department of Orthopedic Surgery, Houston Methodist Hospital, Texas Children's Hospital Orthopedic Surgery Service, Houston, Texas
| | - John A Heydemann
- Department of Orthopedic Surgery, Texas Children's Hospital Orthopedic Surgery Service, Baylor College of Medicine, Houston, Texas
| | - Benny T Dahl
- Department of Orthopedic Surgery, Texas Children's Hospital Orthopedic Surgery Service, Baylor College of Medicine, Houston, Texas
| | | | - Larry S Jefferson
- Section of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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8
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Wan HWY, Carey KA, D'Silva A, Vucic S, Kiernan MC, Kasparian NA, Farrar MA. Health, wellbeing and lived experiences of adults with SMA: a scoping systematic review. Orphanet J Rare Dis 2020; 15:70. [PMID: 32164772 PMCID: PMC7068910 DOI: 10.1186/s13023-020-1339-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a neurodegenerative disease that has a substantial and multifaceted burden on affected adults. While advances in supportive care and therapies are rapidly reshaping the therapeutic environment, these efforts have largely centered on pediatric populations. Understanding the natural history, care pathways, and patient-reported outcomes associated with SMA in adulthood is critical to advancing health policy, practice and research across the disease spectrum. The aim of this study was to systematically review research investigating the healthcare, well-being and lived experiences of adults with SMA. METHODS In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, seven electronic databases were systematically searched until January 2020 for studies examining clinical (physical health, natural history, treatment) and patient-reported (symptoms, physical function, mental health, quality of life, lived experiences) outcomes in adults with SMA. Study risk of bias and the level of evidence were assessed using validated tools. RESULTS Ninety-five articles met eligibility criteria with clinical and methodological diversity observed across studies. A heterogeneous clinical spectrum with variability in natural history was evident in adults, yet slow declines in motor function were reported when observational periods extended beyond 2 years. There remains no high quality evidence of an efficacious drug treatment for adults. Limitations in mobility and daily activities associated with deteriorating physical health were commonly reported, alongside emotional difficulties, fatigue and a perceived lack of societal support, however there was no evidence regarding effective interventions. CONCLUSIONS This systematic review identifies the many uncertainties regarding best clinical practice, treatment response, and long-term outcomes for adults with SMA. This comprehensive identification of the current gaps in knowledge is essential to guide future clinical research, best practice care, and advance health policy with the ultimate aim of reducing the burden associated with adult SMA.
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Affiliation(s)
- Hamish W Y Wan
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, 2031, Australia
| | - Kate A Carey
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, 2031, Australia
| | - Arlene D'Silva
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, 2031, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital and Western Clinical School, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, University of Sydney, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, 2006, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, 2031, Australia.,Cincinnati Children's Center for Heart Disease and the Developing Mind, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michelle A Farrar
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, 2031, Australia. .,Department of Neurology, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.
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9
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Cough, sniff and maximal static pressure patterns in spinal muscular atrophy. Respir Physiol Neurobiol 2019; 271:103308. [PMID: 31561013 DOI: 10.1016/j.resp.2019.103308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
In spinal muscular atrophy (SMA), respiratory muscles are heterogeneously involved with a weakness of the intercostal muscles, possibly of the abdominal wall muscles, and a relatively spared diaphragm, resulting in cough impairment. An abnormal inspiratory cough phase pattern has been reported in SMA II and III. This short communication analyzed the esogastric pressures during voluntary cough in 49 SMA II and III patients. Four different patterns of coughing, reflecting an increasing degree of respiratory muscle weakness, were identified. The "mild weakness" profile was observed mainly in SMA III, while the "severe weakness" profile, which seems to correspond to the absence of abdominal muscle activity, was observed only in a few patients with SMA II. The cough profiles of 6 patients are presented together with their sniff and maximal static pressures measurements. Different esogastric pressure patterns were observed during these forceful maneuvers, suggesting variable involvement of the intercostal and abdominal muscles, and diaphragm during the evolution of SMA II and III.
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10
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LoMauro A, Aliverti A. Respiratory muscle activation and action during voluntary cough in healthy humans. J Electromyogr Kinesiol 2019; 49:102359. [PMID: 31568991 DOI: 10.1016/j.jelekin.2019.102359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/20/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Cough is a defensive airway reflex consisting of a modified respiratory act which involves the sequential activation of several laryngeal and respiratory muscles. The contraction of the latter results in thoraco-abdominal volume variations in order to provide enough amount of air available, the operating volume (OV), to be expelled. Because both posture and OV could influence muscular activation and thoraco-abdominal displacements during voluntary cough, we aimed to verify if and how they play a role during inspiratory (ICP) and expiratory (ECP) cough phases, in terms of flow, volumes and surface electromyography activity (sEMG). In 10 healthy subjects, we measured sEMG of 7 muscles (scalene, sternocleidomastoid, parasternal, intercostal, diaphragm (assessed at the 8th intercostal space), external abdominal oblique and rectus abdominis) in supine and seated position during cough maneuvers performed at 4 different OV measured by opto-electronic plethismography: total lung capacity (TLC), functional residual capacity and two intermediate volumes. The amplitude of sEMG signals tended to be maximal at TLC (p < 0.005) during ICP in the neck and parasternal muscles and during ECP in abdominal muscles. Postures slightly affected only sEMG of the thoracic muscles. sEMG data were similar (p > 0.05) in the other OV, but cough peak flow increased with OV. Thoraco-abdominal volume variations during cough were unaffected by posture and OV as well, being predominantly thoracic (supine: 60 and 64%; seated: 68 and 69%, respectively during ICP and ECP). Our results suggest that voluntary cough OV or posture do not have an important effect on voluntary cough that seems more likely to be resulting from a motor mechanism that activates a synergetic antagonistic contraction of inspiratory and expiratory muscles leading to a specific thoraco-abdominal pattern, in which the rib cage is the predominant.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
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11
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LoMauro A, Banfi P, Mastella C, Alberti K, Baranello G, Aliverti A. A New Method for Measuring Bell-Shaped Chest Induced by Impaired Ribcage Muscles in Spinal Muscular Atrophy Children. Front Neurol 2018; 9:703. [PMID: 30271372 PMCID: PMC6146085 DOI: 10.3389/fneur.2018.00703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
Abstract
The involvement of the respiratory muscular pump makes SMA children prone to frequent hospitalization and morbidity, particularly in type 1. Progressive weakness affects ribcage muscles resulting in bell-shaped chest that was never quantified. The aims of the present work were: (1) to quantify the presence of bell-shaped chest in SMA infants and children and to correlate it with the action of ribcage muscles, assessed by the contribution of pulmonary ribcage to tidal volume (ΔVRC, p); (2) to verify if and how the structure of the ribcage and ΔVRC, p change after 1-year in SMA type 2. 91 SMA children were studied in supine position during awake spontaneous breathing: 32 with type 1 (SMA1, median age: 0.8 years), 51 with type 2 (SMA2, 3.7 years), 8 with type 3 (SMA3, 5.4 years) and 20 healthy children (HC, 5.2 years). 14 SMA2 showed negative ΔVRC, p (SMA2px), index of paradoxical inspiratory inward motion. The bell-shaped chest index was defined as the ratio between the distance of the two anterior axillary lines at sternal angle and the distance between the right and left 10th costal cartilage. If this index was < < 1, it indicated bell shape, if ~1 it indicated rectangular shape, while if >> 1 an inverted triangle shape was identified. While the bell-shaped index was similar between HC (0.92) and SMA3 (0.91), it was significantly (p < 0.05) reduced in SMA2 (0.81), SMA2px (0.74) and SMA1 (0.73), being similar between the last two. There was a good correlation (Spearman's rank correlation coefficient, ρ = 0.635, p < 0.001) between ribcage geometry and ΔVRC, p. After 1 year, ΔVRC, p reduced while bell-shaped chest index did not change being significantly lower than HC. The shape of the ribcage was quantified and correlated with the action of ribcage muscles in SMA children. The impaired ribcage muscles function alters the ribcage structure. HC and SMA3 show an almost rectangular ribcage shape, whereas SMA2, SMA2px and SMA1 are characterized by bell-shaped chest. In SMA, therefore, a vicious cycle starts since infancy: the disease progressively affects ribcage muscles resulting in reduced expansion of lung and ribcage that ultimately alters ribcage shape. This puts the respiratory muscles at mechanical disadvantage.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza Leonardo Da Vinci, Milan, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Chiara Mastella
- Fondazione IRCCS Cà' Granda Ospedale Maggiore Policlinico, SAPRE-UONPIA, Neuropsichiatria dell'Infanzia e dell'Adolescenza, Milan, Italy
| | - Katia Alberti
- Fondazione IRCCS Cà' Granda Ospedale Maggiore Policlinico, SAPRE-UONPIA, Neuropsichiatria dell'Infanzia e dell'Adolescenza, Milan, Italy
| | - Giovanni Baranello
- UO Neurologia dello Sviluppo, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza Leonardo Da Vinci, Milan, Italy
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Abstract
OBJECTIVE This study sought to validate pediatric models with normal and altered pulmonary mechanics. METHODS PubMed and CINAHL databases were searched for studies directly measuring pulmonary mechanics of healthy infants and children, infants with severe bronchopulmonary dysplasia and neuromuscular disease. The ASL 5000 was used to construct models using tidal volume (VT), inspiratory time (TI), respiratory rate, resistance, compliance, and esophageal pressure gleaned from literature. Data were collected for a 1-minute period and repeated three times for each model. t tests compared modeled data with data abstracted from the literature. Repeated measures analyses evaluated model performance over multiple iterations. Statistical significance was established at a P value of less than 0.05. RESULTS Maximum differences of means (experimental iteration mean - clinical standard mean) for TI and VT are the following: term infant without lung disease (TI = 0.09 s, VT = 0.29 mL), severe bronchopulmonary dysplasia (TI = 0.08 s, VT = 0.17 mL), child without lung disease (TI = 0.10 s, VT = 0.17 mL), and child with neuromuscular disease (TI = 0.09 s, VT = 0.57 mL). One-sample testing demonstrated statistically significant differences between clinical controls and VT and TI values produced by the ASL 5000 for each iteration and model (P < 0.01). The greatest magnitude of differences was negligible (VT < 1.6%, TI = 18%) and not clinically relevant. CONCLUSIONS Inconsistencies occurred with the models constructed on the ASL 5000. It was deemed accurate for the study purposes. It is therefore essential to test models and evaluate magnitude of differences before use.
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A Novel Method to Compute Breathing Volumes via Motion Capture Systems: Design and Experimental Trials. J Appl Biomech 2017; 33:361-365. [PMID: 28338381 DOI: 10.1123/jab.2016-0271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Respiratory assessment can be carried out by using motion capture systems. A geometrical model is mandatory in order to compute the breathing volume as a function of time from the markers' trajectories. This study describes a novel model to compute volume changes and calculate respiratory parameters by using a motion capture system. The novel method, ie, prism-based method, computes the volume enclosed within the chest by defining 82 prisms from the 89 markers attached to the subject chest. Volumes computed with this method are compared to spirometry volumes and to volumes computed by a conventional method based on the tetrahedron's decomposition of the chest wall and integrated in a commercial motion capture system. Eight healthy volunteers were enrolled and 30 seconds of quiet breathing data collected from each of them. Results show a better agreement between volumes computed by the prism-based method and the spirometry (discrepancy of 2.23%, R 2 = .94) compared to the agreement between volumes computed by the conventional method and the spirometry (discrepancy of 3.56%, R 2 = .92). The proposed method also showed better performances in the calculation of respiratory parameters. Our findings open up prospects for the further use of the new method in the breathing assessment via motion capture systems.
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Robin V, Griffith G, Carter JPL, Leumann CJ, Garcia L, Goyenvalle A. Efficient SMN Rescue following Subcutaneous Tricyclo-DNA Antisense Oligonucleotide Treatment. MOLECULAR THERAPY. NUCLEIC ACIDS 2017. [PMID: 28624227 PMCID: PMC5415958 DOI: 10.1016/j.omtn.2017.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Spinal muscular atrophy (SMA) is a recessive disease caused by mutations in the SMN1 gene, which encodes the protein survival motor neuron (SMN), whose absence dramatically affects the survival of motor neurons. In humans, the severity of the disease is lessened by the presence of a gene copy, SMN2. SMN2 differs from SMN1 by a C-to-T transition in exon 7, which modifies pre-mRNA splicing and prevents successful SMN synthesis. Splice-switching approaches using antisense oligonucleotides (AONs) have already been shown to correct this SMN2 gene transition, providing a therapeutic avenue for SMA. However, AON administration to the CNS presents additional hurdles. In this study, we show that systemic delivery of tricyclo-DNA (tcDNA) AONs in a type III SMA mouse augments retention of exon 7 in SMN2 mRNA both in peripheral organs and the CNS. Mild type III SMA mice were selected as opposed to the severe type I model in order to test tcDNA efficacy and their ability to enter the CNS after maturation of the blood brain barrier (BBB). Furthermore, subcutaneous treatment significantly improved the necrosis phenotype and respiratory function. In summary, our data support that tcDNA oligomers effectively cross the blood-brain barrier and offer a promising systemic alternative for treating SMA.
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Affiliation(s)
- Valérie Robin
- Université Versailles Saint Quentin, INSERM U1179, 78180 Montigny-le-Bretonneux, France.
| | - Graziella Griffith
- Université Versailles Saint Quentin, INSERM U1179, 78180 Montigny-le-Bretonneux, France
| | - John-Paul L Carter
- Université Versailles Saint Quentin, INSERM U1179, 78180 Montigny-le-Bretonneux, France
| | - Christian J Leumann
- Department of Chemistry and Biochemistry, University of Bern, 3012 Bern, Switzerland
| | - Luis Garcia
- Université Versailles Saint Quentin, INSERM U1179, 78180 Montigny-le-Bretonneux, France
| | - Aurélie Goyenvalle
- Université Versailles Saint Quentin, INSERM U1179, 78180 Montigny-le-Bretonneux, France.
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LoMauro A, Aliverti A, Mastella C, Arnoldi MT, Banfi P, Baranello G. Spontaneous Breathing Pattern as Respiratory Functional Outcome in Children with Spinal Muscular Atrophy (SMA). PLoS One 2016; 11:e0165818. [PMID: 27820869 PMCID: PMC5098831 DOI: 10.1371/journal.pone.0165818] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/18/2016] [Indexed: 12/21/2022] Open
Abstract
Introduction SMA is characterised by progressive motor and respiratory muscle weakness. We aimed to verify if in SMA children 1)each form is characterized by specific ventilatory and thoraco-abdominal pattern(VTAp) during quiet breathing(QB); 2)VTAp is affected by salbutamol therapy, currently suggested as standard treatment, or by the natural history(NH) of SMA; 3)the severity of global motor impairment linearly correlates with VTAp. Materials and methods VTAp was analysed on 32 SMA type I (SMA1,the most severe form), 51 type II (SMA2,the moderate), 8 type III (SMA3,the mildest) and 20 healthy (HC) using opto-electronic plethysmography. Spirometry, cough and motor function were measured in a subgroup of patients. Results In SMA1, a normal ventilation is obtained in supine position by rapid and shallow breathing with paradoxical ribcage motion. In SMA2, ventilation is within a normal range in seated position due to an increased respiratory rate(p<0.05) with reduced tidal volume(p<0.05) secondary to a poor contribution of pulmonary ribcage(%ΔVRC,P, p<0.001). Salbutamol therapy had no effect on VTAp during QB(p>0.05) while tachypnea occurred in type I NH. A linear correlation(p<0.001) was found between motor function scales and VTAp. Conclusion A negative or reduced %ΔVRC,P, indicative of ribcage muscle weakness, is a distinctive feature of SMA1 and SMA2 since infancy. Its quantitative assessment represents a non-invasive, non-volitional index that can be obtained in all children, even uncollaborative, and provides useful information on the action of ribcage muscles that are known to be affected by the disease.Low values of motor function scales indicate impairment of motor but also of respiratory function.
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Affiliation(s)
- A. LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano, Italy
- * E-mail:
| | - A. Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano, Italy
| | - C. Mastella
- S.A.PRE., Ospedale Policlinico Maggiore Mangiagalli, and Regina Elena Foundation, Milan, Italy
| | - M. T. Arnoldi
- Developmental Neurology Unit, Carlo Besta Neurological Research Institute Foundation, Milan, Italy
| | - P. Banfi
- Pulmonary Rehabilitation Fondazione Don Carlo Gnocchi, Milan, Italy
| | - G. Baranello
- Developmental Neurology Unit, Carlo Besta Neurological Research Institute Foundation, Milan, Italy
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Reinaux CMA, Aliverti A, da Silva LGM, da Silva RJ, Gonçalves JN, Noronha JB, Filho JEC, de Andrade AD, de Amorim Britto MC. Tidal volume measurements in infants: Opto-electronic plethysmography versus pneumotachograph. Pediatr Pulmonol 2016; 51:850-7. [PMID: 26991671 DOI: 10.1002/ppul.23394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/18/2015] [Accepted: 01/15/2016] [Indexed: 11/11/2022]
Abstract
Tidal breathing measurements by Opto-Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP ) and a heated pneumotachograph (PNT) (VT,PNT ) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3-4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT ) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement -4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP , respectively. The OEP experimental protocol based on 52 markers and a three-compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850-857. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Cyda Maria Albuquerque Reinaux
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | | | - Rafael Justino da Silva
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Juliane Neves Gonçalves
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Jessica Brito Noronha
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Sansone VA, Racca F, Ottonello G, Vianello A, Berardinelli A, Crescimanno G, Casiraghi JL. 1st Italian SMA Family Association Consensus Meeting: Management and recommendations for respiratory involvement in spinal muscular atrophy (SMA) types I-III, Rome, Italy, 30-31 January 2015. Neuromuscul Disord 2015; 25:979-89. [PMID: 26453142 DOI: 10.1016/j.nmd.2015.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/24/2015] [Accepted: 09/09/2015] [Indexed: 12/24/2022]
Affiliation(s)
- V A Sansone
- Centro Clinico NEMO, Neurorehabilitation Unit, University of Milano, Milano, Italy.
| | - F Racca
- Pediatric Anesthesiology and Intensive Care Unit, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - G Ottonello
- Famiglie SMA Scientific Committee, Milan, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University - City Hospital of Padova, Padova, Italy
| | - A Berardinelli
- I.R.C.C.S Istituto Neurologico Nazionale Casimiro Mondino, Pavia, Italy
| | - G Crescimanno
- A.O. Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
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Silva L, Barcelar JDM, Rattes CS, Sayão LB, Reinaux CA, Campos SL, Brandão DC, Fregonezi G, Aliverti A, Dornelas de Andrade A. The influence of supine posture on chest wall volume changes is higher in obese than in normal weight children. Appl Physiol Nutr Metab 2015; 40:178-183. [PMID: 25641171 DOI: 10.1139/apnm-2014-0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
The objective of this study was to analyze thoraco-abdominal kinematics in obese children in seated and supine positions during spontaneous quiet breathing. An observational study of pulmonary function and chest wall volume assessed by optoelectronic plethysmography was conducted on 35 children aged 8-12 years that were divided into 2 groups according to weight/height ratio percentiles: there were 18 obese children with percentiles greater than 95 and 17 normal weight children with percentiles of 5-85. Pulmonary function (forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC); and FEV1/FVC ratio), ventilatory pattern, total and compartment chest wall volume variations, and thoraco-abdominal asynchronies were evaluated. Tidal volume was greater in seated position. Pulmonary and abdominal rib cage tidal volume and their percentage contribution to tidal volume were smaller in supine position in both obese and control children, while abdominal tidal volume and its percentage contribution was greater in the supine position only in obese children and not in controls. No statistically significant differences were found between obese and control children and between supine and seated positions regarding thoraco-abdominal asynchronies. We conclude that in obese children thoraco-abdominal kinematics is influenced by supine posture, with an increase of the abdominal and a decreased rib cage contribution to ventilation, suggesting that in this posture areas of hypoventilation can occur in the lung.
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Affiliation(s)
- Letícia Silva
- a Departamento de Fisioterapia da Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
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