Neural drive to nasal dilator muscles: influence of exercise intensity and oronasal flow partitioning

Nose vs. mouth breathing- acute effect of different breathing regimens on muscular endurance

BACKGROUND

It has been reported that the way we breathe (whether through the nose or mouth) can influence many aspects of our health and to some extent, sport performance. The purpose of this study was to evaluate the acute effects of different breathing regimens on muscular endurance and physiological variables.

METHODS

A randomized experiment to verify the acute effect of different breathing regimens (NN- inhaling and exhaling through the nose; NM- inhaling through the nose, exhaling through the mouth; MM- inhaling and exhaling through the mouth) on the muscular endurance performance was conducted. 107 physically active college students (68 males, 39 females) performed repeated bench press testing protocol (repetitions to failure (RTF) with 60% of body weight for males (BP60), respectively 40% of body weight for females (BP40)) with various breathing regimens (NN, NM, MM) in random order. Heart rate (HR), blood oxygen saturation (SpO2) and perceived exertion by Borg scale (RPE) were measured as well. A short questionnaire, given after the testing protocol and observation during familiarization, was used to detect each subject's normal breathing approach during resistance training.

RESULTS

In both genders, no significant differences in RTF, RPE and SpO2 were found. No individual case of deviation of arterial oxygen saturation outside the physiological norm was recorded. ​​In the male group, significantly lower HR values were found during the NN trials, compared to during the NM (p = 0.033) and MM (p = 0.047) trials with no significant differences in females. The HR differences in the males demonstrated a small effect size (NN < NM, d = 0.32; NN < MM, d = 0.30). Questionnaire results suggest that 80% of our participants use NM breathing, 15% use MM breathing and 5% use NN breathing during resistance training.

CONCLUSION

It seems, that various breathing regimens have none or only minor effect on muscular endurance performance and selected physiological parameters. NN seems to be as efficient as other two regimens, which are mostly used in practice (NM, MM).

Insights into exercise-induced rhinitis based on nasal aerodynamics induced by airway morphology

BACKGROUND

Exercise-induced rhinitis (EIR) is a poorly understood phenomenon that may be related to increased inspiratory airflow. Characterization of the development of EIR is important to understand contributing factors.

OBJECTIVE

To characterize how different nasal morphologies respond to airflow-related variables during rapid/deep inspiratory conditions.

METHODS

Subject-specific nasal airways were reconstructed from radiographic images. Unilateral airways were classified as Standard, Notched, or Elongated accord to their distinct nasal vestibule morphology. Computational fluid dynamics simulations were performed at various airflow rates.

RESULTS

For all simulated flow rates, average resistance at the nasal vestibule, airflow velocity and wall sheer stress were highest in Notched. Average mucosal heat flux was highest in Standard. Notched phenotypes showed lower mean percent increases from 10 L/min to 50 L/min in all computed variables.

CONCLUSION

Resistance values and airflow velocities depicted a more constricted nasal vestibule in the Notched phenotypes, while perception of nasal mucosal cooling (heat flux) favored the Standard phenotypes. Different nasal phenotypes may predispose to EIR.

Septal deviation in the nose of the longest faced crocodylian: A description of nasal anatomy and airflow in the Indian gharial (Gavialis gangeticus) with comments on acoustics

The remarkably thin rostrum in the Indian gharial (Gavialis gangeticus) imparts challenges to nasal physiology. Competition for space in the slim jaws necessitates a thin nasal septum, leaving this taxon susceptible to nasal passage abnormalities such as septal deviation. Here we describe the nasal anatomy of gharials based on multiple individuals including one that showcases an extreme instance of nasal septum deviation. We found that gharials have both confluent nostrils and choanae, which may be important for their unique nasal acoustics. The deviated nasal septum in the female showed distinct waviness that affected the nasal passages by alternately compressing them. We performed a computational fluid dynamic analysis on the nasal passages to visualize the effects of septal deviation on airflow. Our analysis found the deviated septum increased nasal resistance and wall shear stress during respiration, resulting in unequal distribution of the air field between both sides of the nasal passage. Our findings indicate that gharials-and potentially other longirostrine crocodylians-may be particularly susceptible to septal deviations. Lastly, we observed pterygoid bullae to be present in both sexes, though their morphology differed. Airflow in the male pterygoid bullae produced a Bernoulli effect which may be responsible for the unique "pop" sounds recorded in this species.

Effects of the Turbine™ on Ventilatory and Sensory Responses to Incremental Cycling

INTRODUCTION

The Turbine™ is a nasal dilator marketed to athletes to increase airflow, which may serve to reduce dyspnea and improve exercise performance, presumably via reductions in the work of breathing (WOB). However, the unpublished data supporting these claims were collected in individuals at rest that were exclusively nasal breathing. These data are not indicative of how the device influences breathing during exercise at higher ventilations when a larger proportion of breathing is through the mouth. Accordingly, the purpose of this study was to empirically test the efficacy of the Turbine™ during exercise. We hypothesized that the Turbine™ would modestly reduce the WOB at rest and very low exercise intensities but would have no effect on the WOB at moderate to high exercise intensities.

METHODS

We conducted a randomized crossover study in young, healthy individuals (7M:1F; age = 27 ± 5 yr) with normal lung function. Each participant performed two incremental cycle exercise tests to exhaustion with the Turbine™ device or under a sham control condition. For the sham control condition, participants were told they were breathing a low-density gas to reduce the WOB, but they were actually breathing room air. The WOB was determined through the integration of ensemble averaged esophageal pressure-volume loops. Standard cardiorespiratory measures were recorded using a commercially available metabolic cart. Dyspnea was assessed throughout exercise using the 0-10 Borg scale.

RESULTS

Peak V˙O2 and work rate were not different between conditions (P = 0.70 and P = 0.35, respectively). In addition, there was no interaction or main effect of condition on dyspnea, ventilation, or WOB throughout the exercise (all P > 0.05).

CONCLUSION

These findings suggest that the Turbine™ does not reduce the WOB and has no effect on dyspnea or exercise capacity.

A New Nasal Restriction Device Called FeelBreathe® Improves Breathing Patterns in Chronic Obstructive Pulmonary Disease Patients during Exercise

A device called FeelBreathe (FB)^® was designed, developed, and patented for inspiratory muscle training. The main aim was to determine the acute responses on lung ventilation, gas exchange, and heart rate during exercise in patients with chronic obstructive pulmonary disease (COPD) with and without the use of FB. In this study, a randomized cross-over trial was performed with 18 men diagnosed with COPD (FEV₁ between 30% and 70% of its predicted value). Each participant randomly conducted two trials with 30 min of rest between them with the same protocol on a treadmill for 10 min at a constant rate of 50% of VO_2peak. Each test was performed randomly and in a crossover randomized design in two different conditions: (1) oronasal breathing; and (2) nasal breathing with FB (nasal ventilatory flow restriction device). It was observed that FB had positive effects on dynamic hyperinflation, breathing pattern, and breathing efficiency, with higher expiratory and inspiratory time. Despite these differences, blood oxygen saturation percentage, oxygen uptake, and heart rate showed a similar response for both conditions during exercise. The results suggest that exercise performed with FB improved ventilatory responses compared to the oronasal mode in COPD patients. This new tool could be used during most daily tasks and exercise programs.

Muscles of Breathing: Development, Function, and Patterns of Activation

This review is a comprehensive description of all muscles that assist lung inflation or deflation in any way. The developmental origin, anatomical orientation, mechanical action, innervation, and pattern of activation are described for each respiratory muscle fulfilling this broad definition. In addition, the circumstances in which each muscle is called upon to assist ventilation are discussed. The number of "respiratory" muscles is large, and the coordination of respiratory muscles with "nonrespiratory" muscles and in nonrespiratory activities is complex-commensurate with the diversity of activities that humans pursue, including sleep (8.27). The capacity for speech and adoption of the bipedal posture in human evolution has resulted in patterns of respiratory muscle activation that differ significantly from most other animals. A disproportionate number of respiratory muscles affect the nose, mouth, pharynx, and larynx, reflecting the vital importance of coordinated muscle activity to control upper airway patency during both wakefulness and sleep. The upright posture has freed the hands from locomotor functions, but the evolutionary history and ontogeny of forelimb muscles pervades the patterns of activation and the forces generated by these muscles during breathing. The distinction between respiratory and nonrespiratory muscles is artificial, as many "nonrespiratory" muscles can augment breathing under conditions of high ventilator demand. Understanding the ontogeny, innervation, activation patterns, and functions of respiratory muscles is clinically useful, particularly in sleep medicine. Detailed explorations of how the nervous system controls the multiple muscles required for successful completion of respiratory behaviors will continue to be a fruitful area of investigation. © 2019 American Physiological Society. Compr Physiol 9:1025-1080, 2019.

Neither internal nor external nasal dilation improves cycling 20-km time trial performance

OBJECTIVES

Research is equivocal regarding endurance performance benefits of external nasal dilators, and currently research focusing on internal nasal dilators is non-existent. Both devices are used within competitive cycling. This study examined the influence of external and internal nasal dilation on cycling economy of motion and 20-km time trial performance.

DESIGN

The study utilized a randomized, counterbalanced cross-over design.

METHODS

Fifteen trained cyclists completed three exercise sessions consisting of a 15min standardized warm up and 20-km cycling time trial while wearing either a Breathe Right^® external nasal dilator, Turbine^® internal nasal dilator or no device (control). During the warm up, heart rate, ratings of perceived exertion and dyspnea and expired gases were collected. During the time trial, heart rate, perceived exertion, and dyspnea were collected at 4-km intervals and mean 20-km power output was recorded.

RESULTS

No differences were observed for mean 20-km power output between the internal (270±45W) or external dilator (271±44W) and control (272±44W). No differences in the economy of motion were observed throughout the 15-min warm up between conditions.

CONCLUSIONS

The Turbine^® and Breathe Right^® nasal dilators are ineffective at enhancing 20-km cycling time trial performance.

Nasal function and dysfunction in exercise

BACKGROUND

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.

METHODS

The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.

RESULTS

There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.

CONCLUSION

Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

Motor unit number in a small facial muscle, dilator naris

A loss of functioning motor units underlies many neuromuscular disorders. The facial nerve innervates the muscles of facial expression, including nasal muscles, which also play an important role in the regulation of airflow resistance. It is difficult to accurately assess motor unit number in the facial muscles, because the muscles are difficult to activate in isolation. Here, we apply the manual McComas method to estimate the number of motor units in a nasal dilator muscle. EMG of the dilator naris was recorded during graded stimulation of the zygomatic branch of the facial nerve in 26 subjects (12 males and 14 females), aged 20-41 years. Each subject was studied twice, on separate days, to estimate method reproducibility. As a check on our use of the McComas method, we also estimated motor unit number in the first dorsal interosseus muscle (FDI) of six subjects, as the muscle is also small and has been studied with the McComas method. Reproducibility was evaluated with a rigorous statistical approach, the Bland-Altman procedure. We estimate that dilator naris is composed of 75 ± 15.6 (SD) motor units, compared to 144 ± 35.5 in FDI. The coefficient of variation for test-retest reproducibility of dilator naris motor unit estimates was 29.6 %, similar to separate-day reproducibility reported for other muscles. Recording and stimulation were done with surface electrodes, and the recordings were of high quality and reproducible. This simple technique could be applied clinically to track motor neuron loss and to monitor facial nerve integrity.

A comprehensive assessment of genioglossus electromyographic activity in healthy adults

The genioglossus (GG) is an extrinsic muscle of the human tongue that plays a critical role in preserving airway patency. In the last quarter century, >50 studies have reported on respiratory-related GG electromyographic (EMG) activity in human subjects. Remarkably, of the studies performed, none have duplicated subject body position, electrode recording locations, and/or breathing task(s), making interpretation and integration of the results across studies extremely challenging. In addition, more recent research assessing lingual anatomy and muscle contractile properties has identified regional differences in muscle fiber type and myosin heavy chain expression, giving rise to the possibility that the anterior and posterior regions of the muscle fulfill distinct functions. Here, we assessed EMG activity in anterior and posterior regions of the GG, across upright and supine, in rest breathing and in volitionally modulated breathing tasks. We tested the hypotheses that GG EMG is greater in the posterior region and in supine, except when breathing is subject to volitional modulation. Our results show differences in the magnitude of EMG (%regional maximum) between anterior and posterior muscle regions (7.95 ± 0.57 vs. 11.10 ± 0.99, respectively; P < 0.001), and between upright and supine (8.63 ± 0.73 vs. 10.42 ± 0.90, respectively; P = 0.008). Although the nature of a task affects the magnitude of EMG (P < 0.001), the effect is similar for anterior and posterior muscle regions and across upright and supine (P > 0.2).

The effects of mouthpiece use on gas exchange parameters during steady-state exercise in college-aged men and women

BACKGROUND

The authors conducted a study to assess the effects of custom-fitted mouthpieces on gas exchange parameters, including volume of oxygen consumption over time [corrected] (VO(2)), volume of oxygen consumption over time per kilogram of body weight [corrected] (VO(2) /kg) and volume of carbon dioxide production over time [corrected] (VO(2)).

METHODS

Sixteen physically fit college students aged 18 through 21 years performed two 10-minute treadmill runs (6.5 miles per hour, 0 percent grade) for each of three treatment conditions (mouthpiece, no mouthpiece and nose breathing). The authors assigned the conditions randomly for each participant and for each session. They assessed gas exchange parameters by using a metabolic measurement system.

RESULTS

The authors used analysis of variance to compare all variables. They set the significance level at α = .05 and used a Tukey post hoc analysis of treatment means to identify differences between groups. The results showed significant improvements (P < .05) in VO(2,) VO(2) /kg and VCO(2) in the mouthpiece condition.

CONCLUSIONS

The study findings show that use of a custom-fitted mouthpiece resulted in improved specific gas exchange parameters. The authors are pursuing further studies to explain the mechanisms involved in the improved endurance performance exhibited with mouthpiece use.

CLINICAL IMPLICATIONS

Dental care professionals have an obligation to understand the increasing research evidence in support of mouthpiece use during exercise and athletic activity and to educate their patients.

Force-EMG changes during sustained contractions of a human upper airway muscle

Human upper airway and facial muscles support breathing, swallowing, speech, mastication, and facial expression, but their endurance performance in sustained contractions is poorly understood. The muscular fatigue typically associated with task failure during sustained contractions has both central and intramuscular causes, with the contribution of each believed to be task dependent. Previously we failed to show central fatigue in the nasal dilator muscles of subjects that performed intermittent maximal voluntary contractions (MVCs). Here we test the hypothesis that central mechanisms contribute to the fatigue of submaximal, sustained contractions in nasal dilator muscles. Nasal dilator muscle force and EMG activities were recorded in 11 subjects that performed submaximal contractions (20, 35, and 65% MVC) until force dropped to <or=90% of the target force for >or=3 s, which we defined as task failure. MVC and twitch forces (the latter obtained by applying supramaximal shocks to the facial nerve) were recorded before the trial and at several time points over the first 10 min of recovery. The time to task failure was inversely related to contraction intensity. MVC force was depressed by roughly 30% at task failure in all three trials, but recovered within 2 min. Twitch force fell by 30-44% depending on contraction intensity and remained depressed after 10 min of recovery, consistent with low-frequency fatigue. Average EMG activity increased with time, but never exceeded 75% of the maximal, pretrial level despite task failure. EMG mean power frequency declined by 20-25% in all trials, suggesting reduced action potential conduction velocity at task failure. In contrast, the maximal evoked potential did not change significantly in any of the tasks, indicating that the EMG deficit at task failure was due largely to mechanisms proximal to the neuromuscular junction. Additional experiments using the interpolated twitch technique suggest that subjects can produce about 92% of the maximal evocable force with this muscle, which is not a large enough deficit to explain the entire shortfall in the EMG at task failure. These data show that the nervous system fails to fully activate the nasal dilator muscles during sustained, submaximal contractions; putative mechanisms are discussed.

Effects of an external nasal dilator on athletic performance of male adolescents

This study examined the effect of an external nasal dilator strip (ENDS) on three field tests of maximal performance and monitored the rating of perceived breathing effort (RPBE). Thirty male Chinese students (age 15.2 +/- 1.6 yrs) performed three maximal field tests: (a) short-term anaerobic power (SAnP: 40-m sprint); (b) long-term anaerobic power (LAnP: shuttle sprint); and (c) peak aerobic performance (AeP: multistage 20-m shuttle run) under three conditions: ENDS, placebo, and control. Students were randomly placed into 6 groups using a fully counterbalanced single-blind design. No significant differences were seen between conditions in the anaerobic performances measured by SAnP and LAnP. However, the ENDS produced a significant improvement in peak aerobic performance (p = 0.037) compared to the control condition of 3.2% (95% CI= 6.2-0.2; Cohen effect size = 0.2), and also compared to the placebo condition (p = 0.018) of 2.9% (95% CI = 5.1-0.2; Cohen effect size =0.2). The ENDS condition also significantly reduced RPBE during the AeP and LAnP tests by an average of 5.5% and 3.8%, respectively. Wearing an external nasal dilator can significantly reduce breathing effort and improve peak aerobic performance during field tests involving maximal running.

Cardiovascular implications of exposure to traffic air pollution during exercise

Regular aerobic exercise is recommended by physicians to improve health and longevity. However, individuals exercising in urban regions are often in contact with air pollution, which includes particles and gases associated with respiratory disease and cancer. We describe the recent evidence on the cardiovascular effects of air pollution, and the implications of exercising in polluted environments, with a view to informing clinicians and other health professionals. There is now strong evidence that fine and ultra fine particulate matter present in air pollution increases cardiovascular morbidity and mortality. The main mechanisms of disease appear to be related to an increase in the pathogenic processes associated with atherosclerosis. People exercising in environments pervaded by air contaminants are probably at increased risk, due to an exercise-induced amplification in respiratory uptake, lung deposition and toxicity of inhaled pollutants. We make evidence-based recommendations for minimizing exposure to air-borne toxins while exercising, and suggest that this advice be passed on to patients where appropriate.

Use of a hybrid computational fluid dynamics and physiologically based inhalation model for interspecies dosimetry comparisons of ester vapors

Numerous inhalation studies have demonstrated that exposure to high concentrations of a wide range of volatile acids and esters results in cytotoxicity to the nasal olfactory epithelium. Previously, a hybrid computational fluid dynamics (CFD) and physiologically based pharmacokinetic (PBPK) dosimetry model was constructed to estimate the regional tissue dose of organic acids in the rodent and human nasal cavity. This study extends this methodology to a representative volatile organic ester, ethyl acrylate (EA). An in vitro exposure of explants of rat olfactory epithelium to EA with and without an esterase inhibitor demonstrated that the organic acid, acrylic acid, released by nasal esterases is primarily responsible for the olfactory cytotoxicity. Estimates of the steady-state concentration of acrylic acid in olfactory tissue were made for the rat nasal cavity by using data from a series of short-term in vivo studies and from the results of CFD-PBPK computer modeling. Appropriate parameterization of the CFD-PBPK model for the human nasal cavity and to accommodate human systemic anatomy, metabolism, and physiology allowed interspecies dose comparisons. The CFD-PBPK model simulations indicate that the olfactory epithelium of the human nasal cavity is exposed to at least 18-fold lower tissue concentrations of acid released from EA than the olfactory epithelium of the rat nasal cavity under the same exposure conditions. The magnitude of this difference varies with the specific exposure scenario that is simulated and with the specific dataset of human esterase activity used for the simulations. The increased olfactory tissue dose in rats relative to humans may be attributed to both the vulnerable location of the rodent olfactory tissue (comprising greater than 50% of the nasal cavity) and the high concentration of rat olfactory esterase activity (comparable to liver esterase activity) relative to human olfactory tissue. These studies suggest that the human olfactory epithelium is protected from vapors of organic esters significantly better than rat olfactory epithelium due to substantive differences in nasal anatomy, nasal and systemic metabolism, systemic physiology, and air flow. Although the accumulation of acrylic acid in the nasal tissues may be a primary concern for nasal irritation and human risk assessment, acute animal inhalation studies to evaluate lethality (LD50-type studies) conducted at very high vapor concentrations of ethyl acrylate indicated that a different mechanism is primarily responsible for mortality. The rodent studies demonstrated that systemic tissue nonprotein sulfhydryl depletion is a primary cause of death at exposure concentrations more than two orders of magnitude above the concentrations that induce nasal irritation. The CFD-PBPK model adequately simulated the severe depletion of glutathione in systemic tissues (e.g., liver and lung) associated with acute inhalation exposures in the 500-1000 ppm range. These results indicate that the CFD-PBPK model can simulate both the low-dose nasal tissue dosimetry associated with irritation and the high-dose systemic tissue dosimetry associated with mortality. In addition, the comparison of simulation results for ethyl acetate and acetone to nasal deposition data suggests that the CFD-PBPK model has general utility as a tool for dosimetry estimates for a wide range of other esters and slowly metabolized vapors.

Effects of an external nasal dilator on the work of breathing during exercise

PURPOSE

The effect of an external nasal dilator on the work of breathing (WOB) was measured during exercise in 14 untrained college students (age, 23 +/- 2.7 yr).

METHODS

Two maximal, incremental ergometer tests were performed to exhaustion. Subjects wore a placebo or an active nasal dilator strip, in random order, during each test. An esophageal balloon was placed through each of the subject's mouth into the esophagus for measurement of inspiratory elastic work (INEW), inspiratory resistive work (INRW), and expiratory resistive work (EXRW). Subjects breathed through a Hans Rudolph(R) face mask that covered both the mouth and nose during both tests. Measured variables included oxygen uptake (VO2), ventilation (VE), tidal volume (VT), frequency of breathing (f), INEW, INRW, and EXRW (work expressed in joules). An alpha level was set at P < 0.05.

RESULTS

No significant differences were found in INEW, INRW, and EXRW between conditions at 70% of VO2max (mean +/- SD; Placebo: INEW, 25.6 +/- 17.8 J.min-1; INRW, 22.4 +/- 15.8 J.min-1; EXRW, 16.7 +/- 12.3 J.min-1; Active: INEW, 24.7 +/- 12.9 J.min-1; INRW, 19.7 +/- 11.9 J.min-1; EXRW, 15.2 +/- 8.6 J.min-1; P > 0.05). No difference was found in INEW, INRW, and EXRW at maximal exercise between conditions (mean +/- SD; Placebo: INEW, 50.2 +/- 29.9 J.min-1; INRW, 67.3 +/- 42.3 J.min-1; EXRW, 102.3 +/- 78.4 J.min-1; Active: INEW, 45.7 +/- 19.6 J.min-1; INRW, 62.6 +/- 36.7 J.min-1; EXRW, 86.3 +/- 50.9 J.min-1; P > 0.05). There were no differences in VO2, VE, VT, or f between conditions.

CONCLUSION

Wearing an external nasal dilator does not significantly reduce the work of breathing during exercise.

Nasal resistance and flow resistive work of nasal breathing during exercise: effects of a nasal dilator strip

Using posterior rhinomanometry, we measured nasal airflow resistance (Rn) and flow-resistive work of nasal breathing (WONB), with an external nasal dilator strip (ENDS) and without (control), in 15 healthy adults (6 men, 9 women) during exclusive nasal breathing and graded (50-230 W) exercise on a cycle ergometer. ENDS decreased resting inspiratory and/or expiratory Rn (at 0.4 l/s) by >0.5 cmH(2)O. l(-1). s in 11 subjects ("responders"). Inspired ventilation (VI) increased with external work rate, but tended to be greater with ENDS. Inspiratory and expiratory Rn (at 0.4 l/s) decreased as VI increased but, in responders, tended to remain lower with ENDS. Inspiratory (but not expiratory) Rn at peak nasal airflow (Vn) increased as VI increased but, again, was lower with ENDS. At a VI of approximately 35 l/min, ENDS decreased flow limitation and hysteresis of the inspiratory transnasal pressure-flow curve. In responders, ENDS reduced inspiratory WONB per breath and inspiratory nasal power values during exercise. We conclude that ENDS stiffens the lateral nasal vestibule walls and, in responders, may reduce the energy required for nasal ventilation during exercise.

Influence of posture and breathing route on neural drive to upper airway dilator muscles during exercise

Our purpose was to determine the influence of posture and breathing route on electromyographic (EMG) activities of nasal dilator (NDM) and genioglossus (GG) muscles during exercise. Nasal and oral airflow rates and EMG activities of the NDM and GG were recorded in 10 subjects at rest and during upright and supine incremental cycling exercise to exhaustion. EMG activities immediately before and after the switch from nasal to oronasal breathing were also determined for those subjects who demonstrated a clear switch point (n = 7). NDM and GG EMG activities were significantly correlated with increases in nasal, oral, and total ventilatory rates during exercise, and these relationships were not altered by posture. In both upright and supine exercise, NDM activity rose more sharply as a function of nasal inspired ventilation compared with total or oral inspired ventilation (P < 0.01), but GG activity showed no significant breathing-route dependence. Peak NDM integrated EMG activity decreased (P = 0.008), and peak GG integrated EMG activity increased (P = 0.032) coincident with the switch from nasal to oronasal breathing. In conclusion, 1) neural drive to NDM and GG increases as a function of exercise intensity, but the increase is unaltered by posture; 2) NDM activity is breathing-route dependent in steady-state exercise, but GG activity is not; and 3) drive to both muscles changes significantly at the switch point, but the change in GG activity is more variable and is often transient. This suggests that factors other than the breathing route dominate drive to the GG soon after the initial changes in the configuration of the oronasal airway are made.

The breathing route dependence of ventilatory responses to hypercapnia and exercise is modulated by upper airway resistance

OBJECTIVE

The ventilatory response to hypercapnia is greater breathing orally than nasally.

METHODOLOGY

We hypothesize that this is due to higher nasal resistance to airflow compared with oral resistance. Seven normal male subjects were studied during both progressive hyperoxic hypercapnia (HC) and exercise (EX) until ventilation exceeded 40 L/min. Under each condition, subjects breathed via the nose only or the mouth only. For each breathing route, ventilation and pathway resistance were calculated simultaneously at the highest common exercise workload (140 +/- 20 watt; mean +/- SE) or the same end-tidal CO2 level (8.0 +/- 0.5%).

RESULTS

The ventilatory response breathing nasally was decreased by a similar amount for both EX and HC when compared with the oral route. The difference between nasal and oral ventilation was highly correlated with the difference between nasal resistance and oral resistance for both EX and HC (linear regression analysis; r = 0.91 for EX and r = 0.86 for HC; both P < 0.01).

CONCLUSION

We conclude that the breathing route dependence of ventilatory responses to respiratory stimuli in normal subjects is independent of the method of stimulation and is substantially determined by the added resistance of nasal breathing.

Nasal splinting effects on breathing patterns and cardiorespiratory responses

The aim of this study was to compare the effects of nasal splinting during different modes of breathing on breathing patterns and cardiorespiratory responses. Ten healthy subjects (4 males, 6 females) performed five maximal treadmill tests while breathing through the nose, nose + dilator, mouth, nose + mouth, and nose + mouth + dilator. Repeated-measures analysis of variance and Tukey HSD revealed no significant differences between trials for maximal oxygen consumption, minute ventilation at an oxygen consumption of 30 ml.kg-1.min-1, carbon dioxide production, respiratory exchange ratio, tidal volume, dead space to tidal volume ratio, or completed treadmill stages to exhaustion. No significant difference was found in subjective dyspnoea ratings between stages of nose versus nose + dilator breathing. Minute ventilation, ventilatory equivalent for oxygen, and breath frequency for nose and nose + dilator versus mouth, nose + mouth, and nose + mouth + dilator were significantly lower. Ventilatory equivalent for carbon dioxide was significantly lower for nose versus mouth, and nose + dilator versus nose + mouth + dilator breathing. End-tidal carbon dioxide was significantly higher in nose versus mouth, nose + mouth, and nose + mouth + dilator breathing, and in nose + dilator versus mouth breathing. Nose breathing revealed a significantly lower heart rate versus nose + dilator, mouth, nose + mouth, and nose + mouth + dilator breathing. These results suggest that nasal splinting during exercise has minimal effects when nasal breathing and no effects when oronasal breathing.

Nasal dilator strips increase maximum inspiratory flow via nasal wall stabilization

OBJECTIVE

Inspiratory flow limitation associated with collapse of the nasal vestibular walls is a feature of nasal breathing at high ventilatory levels. We examined whether an external nasal dilator strip (ENDS) device (Breathe Right, CNS Inc., Chanhassen, MN) influences maximum inspiratory and expiratory flow rates.

STUDY DESIGN

Prospective, randomized.

METHODS

We studied 20 Caucasian subjects (13 female, 7 male; age range, 16-49 y) performing maximum-effort nasal flow-volume loop studies with (ENDS) and without ENDS (control) and following topical nasal decongestant (oxymetazoline hydrochloride, 0.2 mg per nostril).

RESULTS

ENDS increased peak inspiratory flow from 2.55+/-0.24 L/s (mean+/-standard error [SE]) to 2.86+/-0.25 L/s and forced inspiratory flow at 50% of vital capacity from 2.23+/-0.24 L/s to 2.53+/-0.24 L/s (both, P<.0001), but had no effect on maximum expiratory flows. Nasal decongestant increased the forced expiratory volume in 1 second from 3.39+/-0.22 L/s to 3.59+/-0.22 L/s and the average forced expiratory flow over 25% to 75% of vital capacity from 3.31+/-0.31 L/s to 3.61+/-0.28 L/s (both, P< or = .008), but had no effect on maximum inspiratory flows. The combination of decongestant and ENDS increased both inspiratory and expiratory maximum flows.

CONCLUSION

Since ENDS selectively increases maximum nasal inspiratory flow rates, we conclude that ENDS increases inspiratory nasal patency during maximum inspiratory efforts through the nose by supporting the lateral nasal vestibular walls and making them more resistant to collapse.

Objective assessment of the breathe-right device during exercise in adult males

In order to improve nasal breathing during competition, many athletes recently have been wearing a spring-loaded, external nasal dilator referred to as the Breathe-Right device (BRD). Although there are many subjective claims that this device improves breathing during exercise, there are currently no controlled studies documenting its efficacy. To determine objectively whether the device improves the nasal airway, 20 subjects (10 Caucasian and 10 African-American) were studied during rest and after 15 minutes of exercise using anterior rhinomanometry and acoustic rhinometry to measure changes in airway resistance and minimal cross-sectional area, respectively. We found that the BRD exerts its main effect in the region of the nasal valve improving the airway an overall 21% in our group of subjects. This anatomic improvement in nasal airway resulted in an overall 27% reduction in nasal resistance in the Caucasian group. However, in the African-American group, a wider range of resistance changes was observed with application of the BRD with significant improvement in nasal resistance in some subjects but paradoxical worsening in others. In the African-American group as a whole, no significant change in nasal resistance occurred with application of the BRD. These measured differences are likely due to variations in nasal anatomy that exist not only between races but also between individuals within a given race. In addition, this study confirms the well known decongestant effects of exercise providing anatomic data with acoustic rhinometry not previously documented in the literature. Overall improvement in nasal airway seen with application of the BRD occurred independent of these exercise-related decongestant effects.