1
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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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2
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Mizusawa H, Matsumoto H, Shiraishi M, Sugiya R, Takeda Y, Noguchi M, Kimura T, Ishikawa A, Nishiyama O, Higashimoto Y. Evaluation of patients with chronic obstructive pulmonary disease by maximal inspiratory pressure and diaphragmatic excursion with ultrasound sonography. Respir Investig 2024; 62:234-239. [PMID: 38237482 DOI: 10.1016/j.resinv.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Decreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia. METHODS Patients with COPD underwent spirometry, exercise tolerance (VO2peak) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography. RESULTS Overall, 58 patients with COPD (median age, 76 years; median %FEV1, 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV1, Δinspiratory capacity, VO2peak, and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV1, these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index. CONCLUSION Measuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia.
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Affiliation(s)
- Hiroki Mizusawa
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan; Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe (Hyogo Pref), Japan. 7-10-2 Tomogaoka, Kobe-city, 654-0142, Japan.
| | - Hisako Matsumoto
- Faculty of Medicine, Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan
| | - Masashi Shiraishi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Ryuji Sugiya
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Yu Takeda
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Masaya Noguchi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Tamotsu Kimura
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Akira Ishikawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe (Hyogo Pref), Japan. 7-10-2 Tomogaoka, Kobe-city, 654-0142, Japan
| | - Osamu Nishiyama
- Faculty of Medicine, Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan
| | - Yuji Higashimoto
- Faculty of Medicine, Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan; Faculty of Medicine, Department of Rehabilitation Medicine, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan
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3
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Jonkman AH, Warnaar RSP, Baccinelli W, Carbon NM, D'Cruz RF, Doorduin J, van Doorn JLM, Elshof J, Estrada-Petrocelli L, Graßhoff J, Heunks LMA, Koopman AA, Langer D, Moore CM, Nunez Silveira JM, Petersen E, Poddighe D, Ramsay M, Rodrigues A, Roesthuis LH, Rossel A, Torres A, Duiverman ML, Oppersma E. Analysis and applications of respiratory surface EMG: report of a round table meeting. Crit Care 2024; 28:2. [PMID: 38166968 PMCID: PMC10759550 DOI: 10.1186/s13054-023-04779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.
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Affiliation(s)
- A H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - W Baccinelli
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - N M Carbon
- Department of Anesthesiology, Friedrich Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - R F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Elshof
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Estrada-Petrocelli
- Facultad de Ingeniería and Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) - Sistema Nacional de Investigación (SNI), Universidad Latina de Panamá (ULATINA), Panama, Panama
| | - J Graßhoff
- Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - L M A Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Koopman
- Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - D Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - C M Moore
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - J M Nunez Silveira
- Hospital Italiano de Buenos Aires, Unidad de Terapia Intensiva, Ciudad de Buenos Aires, Argentina
| | - E Petersen
- Technical University of Denmark (DTU), DTU Compute, 2800, Kgs. Lyngby, Denmark
| | - D Poddighe
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - M Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rodrigues
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - L H Roesthuis
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rossel
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - A Torres
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona Institute of Science and Technology (BIST) and Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands.
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4
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Terada M, Kosik KB, Gribble PA. Association of Diaphragm Contractility and Postural Control in a Chronic Ankle Instability Population: A Preliminary Study. Sports Health 2024; 16:19-25. [PMID: 36691689 PMCID: PMC10732118 DOI: 10.1177/19417381221147304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Altered reorganization of the sensorimotor system after an initial lateral ankle sprain may lead to a chronic neuromuscular maladaptation in multiple body locations. Specifically, decreased diaphragm contractility has been observed in patients with chronic ankle instability (CAI). The diaphragm has an essential role in postural control. Decreased diaphragm contractility could associate with diminished postural control commonly observed in patients with CAI. However, no study has determined if diaphragm contractility contributes to postural control in a CAI population. HYPOTHESIS Decreased diaphragm contractility would be negatively associated with static postural control in patients with CAI. STUDY DESIGN Cross-sectional study design. LEVEL OF EVIDENCE Level 4. METHODS A total of 15 participants with CAI participated voluntarily. An ultrasonography assessment was performed to quantify the right and left hemidiaphragm thickness at the end of resting inspiration and expiration in supine while breathing quietly. The degree of diaphragm contractility was calculated from the diaphragm thickness. Participants performed 3 eyes-open trials of a 20-second single-leg balance task on the involved limb. Static postural control measures included the center of pressure velocity (COPV) and mean of time-to-boundary (TTB) minima in the anteroposterior (AP) and mediolateral directions. RESULTS Moderate correlations of the right hemidiaphragm contractility were observed with COPV (ρ = -0.54) and TTB mean minima (ρ = 0.56) (P < 0.05) in the AP direction. The left hemidiaphragm contractility was moderately correlated with COPV (ρ = -0.56) and TTB mean minima (ρ = 0.60) (P < 0.05) in the AP direction. CONCLUSION Lower diaphragm contractility may be associated with diminished static postural control in the AP direction in patients with CAI. CLINICAL RELEVANCE This study highlights diaphragm contractility could be a potential connection with diminished static postural control in patients with CAI. Our data raise new avenues for future exploration including potential beneficial effects of implementation of diaphragm breathing exercises and techniques for restoring static postural control in patients with CAI.
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Affiliation(s)
- Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kyle B. Kosik
- The Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Phillip A. Gribble
- The Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
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El-Koa AA, Eid HA, Abd Elrahman SR, El Kalashy MM. Value of incentive spirometry in routine management of COPD patients and its effect on diaphragmatic function. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023. [DOI: 10.1186/s43168-023-00185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
Incentive spirometry (IS) is mostly used postoperatively to avoid pulmonary complications, but its effect on COPD patients and its effect on diaphragmatic functions are still not fully studied. The current study aimed to evaluate the value of IS on arterial blood gases, mMRC dyspnea scale, spirometry, and diaphragmatic functions by ultrasound in patients hospitalized for COPD exacerbation.
Methods and patients
Forty patients (37 males, 3 females) were admitted for COPD exacerbations and divided randomly into 2 groups: Group1 (G1) =20 patients (mean age 60.7±5.99) used incentive spirometry (IS) for 2 months with medical treatment. Group 2 as a control group (G2) = 20 patients (mean age 60.3±6.44) were given medical treatment only. ABG, spirometry, mMRC dyspnea scale, and diaphragmatic ultrasound functions were assessed on admission and after 2 months of treatment in the groups.
Results
There were statistically significant differences between G1 and G2 after 2 months regarding PaCO2, FEV1/FVC (p=0.001 and 0.042, respectively), and Lt diaphragmatic excursion and diaphragm thickness ratio. There was a statistically significant increase in results of PaO2, PaCO2, FEV1/FVC, PEFR, and all diaphragmatic findings in group I before and after 2 months of IS but no difference in FVC and mMRC dyspnea scale.
Conclusion
Incentive spirometry in COPD patients seems to improve ABG, and spirometry functions together with improving diaphragmatic functions.
Trial registration
ClinicalTrials.gov NCT05679609. Retrospectively egistered on 10 January 2023
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Patel P, Mancuso A. A Holistic Approach to Physical and Mental Health: Associations Between Chronic Disease and Psychiatric Conditions. PSYCHOL HEALTH MED 2022:1-9. [PMID: 35726840 DOI: 10.1080/13548506.2022.2088815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prior studies suggest that patients with chronic conditions are more likely to develop psychiatric disorders compared to healthy individuals without any medical conditions. The objective of this study was to investigate the link between chronic conditions and psychiatric disorders. The authors hypothesize that patients with chronic conditions have a higher comorbidity of certain psychiatric disorders compared to healthy individuals. Patients from Rowan University School of Osteopathic Medicine (Rowan SOM) Family Medicine offices completed an anonymous survey about medical and psychiatric diagnoses (Appendix 1). Multivariate analysis was used to examine the relationships between patients' rank of control of their chronic medical and psychiatric conditions compared to the age of onset and total number of conditions. One-hundred thirteen study participants reported having at least one chronic condition and seventy-four reported having at least one psychiatric disorder listed on the survey. Among the participants comorbid with both medical and psychiatric conditions, patients' ranking of control of their chronic conditions positively correlated with their ranking of control of their psychiatric disorders (p = 0.009). Patients' ranking of control of their chronic conditions negatively correlated with the total number of psychiatric disorders (p = 0.002). The study did not generate significant evidence to support the original hypothesis. The results highlight a strong relationship between patients' perceived control of their physical health and mental health. The comorbidity of both chronic conditions and psychiatric disorders may present challenges for patients. Utilizing a holistic approach to patient care can help clinicians improve patient outcomes.
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Affiliation(s)
- Pooja Patel
- Department of Internal Medicine, Rutgers University New Jersey Medical School, Newark, New Jersey
| | - Alison Mancuso
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
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Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
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Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
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8
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Domnik NJ, Phillips DB, James MD, Ayoo GA, Taylor SM, Scheeren RE, Di Luch AT, Milne KM, Vincent SG, Elbehairy AF, Crinion SJ, Driver HS, Neder JA, O'Donnell DE. Compensatory responses to increased mechanical abnormalities in COPD during sleep. Eur J Appl Physiol 2022; 122:663-676. [PMID: 35034195 DOI: 10.1007/s00421-021-04869-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess whether night-time increases in mechanical loading negatively impact respiratory muscle function in COPD and whether compensatory increases in inspiratory neural drive (IND) are adequate to stabilize ventilatory output and arterial oxygen saturation, especially during sleep when wakefulness drive is withdrawn. METHODS 21 patients with moderate-to-severe COPD and 20 age-/sex-matched healthy controls (CTRL) participated in a prospective, cross-sectional, one-night study to assess the impact of COPD on serial awake, supine inspiratory capacity (IC) measurements and continuous dynamic respiratory muscle function (esophageal manometry) and IND (diaphragm electromyography, EMGdi) in supine sleep. RESULTS Supine inspiratory effort and EMGdi were consistently twice as high in COPD versus CTRL (p < 0.05). Despite overnight increases in awake total airways resistance and dynamic lung hyperinflation in COPD (p < 0.05; not in CTRL), elevated awake EMGdi and respiratory effort were unaltered in COPD overnight. At sleep onset (non-rapid eye movement sleep, N2), EMGdi was decreased versus wakefulness in COPD (- 43 ± 36%; p < 0.05) while unaffected in CTRL (p = 0.11); however, respiratory effort and arterial oxygen saturation (SpO2) were unchanged. Similarly, in rapid eye movement (stage R), sleep EMGdi was decreased (- 38 ± 32%, p < 0.05) versus wakefulness in COPD, with preserved respiratory effort and minor (2%) reduction in SpO2. CONCLUSIONS Despite progressive mechanical loading overnight and marked decreases in wakefulness drive, inspiratory effort and SpO2 were well maintained during sleep in COPD. Preserved high inspiratory effort during sleep, despite reduced EMGdi, suggests continued (or increased) efferent activation of extra-diaphragmatic muscles, even in stage R sleep. CLINICAL TRIAL INFORMATION The COPD data reported herein were secondary data (Placebo arm only) obtained through the following Clinical Trial: "Effect of Aclidinium/Formoterol on Nighttime Lung Function and Morning Symptoms in Chronic Obstructive Pulmonary Disease" ( https://clinicaltrials.gov/ct2/show/NCT02429765 ; NCT02429765).
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Affiliation(s)
- Nicolle J Domnik
- Department of Medicine, Queen's University, Kingston, Canada.,Department of Physiology and Pharmacology, Western University, London, Canada
| | | | - Matthew D James
- Department of Medicine, Queen's University, Kingston, Canada
| | - Grace A Ayoo
- Department of Medicine, Queen's University, Kingston, Canada
| | - Sarah M Taylor
- Department of Medicine, Queen's University, Kingston, Canada
| | | | | | - Kathryn M Milne
- Department of Medicine, Queen's University, Kingston, Canada
| | | | - Amany F Elbehairy
- Department of Medicine, Queen's University, Kingston, Canada.,Manchester University NHS Foundation Trust, Manchester, UK.,Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sophie J Crinion
- Department of Medicine, Queen's University, Kingston, Canada.,Sleep Disorders Laboratory, Kingston Health Sciences Centre, Kingston, Canada.,Division of Respiratory Medicine, Queen's University, Kingston, Canada
| | - Helen S Driver
- Department of Medicine, Queen's University, Kingston, Canada.,Sleep Disorders Laboratory, Kingston Health Sciences Centre, Kingston, Canada.,Division of Respiratory Medicine, Queen's University, Kingston, Canada
| | - J Alberto Neder
- Department of Medicine, Queen's University, Kingston, Canada.,Division of Respiratory Medicine, Queen's University, Kingston, Canada
| | - Denis E O'Donnell
- Department of Medicine, Queen's University, Kingston, Canada. .,Division of Respiratory Medicine, Queen's University, Kingston, Canada. .,Respiratory Investigation Unit, Kingston Health Sciences Centre, 102 Stuart St, Kingston, ON, K7L 2V7, Canada.
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Taniguchi K, Ando Y, Kobayashi M, Toba S, Nobori H, Sanaki T, Noshi T, Kawai M, Yoshida R, Sato A, Shishido T, Naito A, Matsuno K, Okamatsu M, Sakoda Y, Kida H. Characterization of the In Vitro and In Vivo Efficacy of Baloxavir Marboxil against H5 Highly Pathogenic Avian Influenza Virus Infection. Viruses 2022; 14:v14010111. [PMID: 35062315 PMCID: PMC8777714 DOI: 10.3390/v14010111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
Human infections caused by the H5 highly pathogenic avian influenza virus (HPAIV) sporadically threaten public health. The susceptibility of HPAIVs to baloxavir acid (BXA), a new class of inhibitors for the influenza virus cap-dependent endonuclease, has been confirmed in vitro, but it has not yet been fully characterized. Here, the efficacy of BXA against HPAIVs, including recent H5N8 variants, was assessed in vitro. The antiviral efficacy of baloxavir marboxil (BXM) in H5N1 virus-infected mice was also investigated. BXA exhibited similar in vitro activities against H5N1, H5N6, and H5N8 variants tested in comparison with seasonal and other zoonotic strains. Compared with oseltamivir phosphate (OSP), BXM monotherapy in mice infected with the H5N1 HPAIV clinical isolate, the A/Hong Kong/483/1997 strain, also caused a significant reduction in viral titers in the lungs, brains, and kidneys, thereby preventing acute lung inflammation and reducing mortality. Furthermore, compared with BXM or OSP monotherapy, combination treatments with BXM and OSP using a 48-h delayed treatment model showed a more potent effect on viral replication in the organs, accompanied by improved survival. In conclusion, BXM has a potent antiviral efficacy against H5 HPAIV infections.
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Affiliation(s)
- Keiichi Taniguchi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
| | - Yoshinori Ando
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Masanori Kobayashi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Shinsuke Toba
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
| | - Haruaki Nobori
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Takao Sanaki
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Takeshi Noshi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Makoto Kawai
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Ryu Yoshida
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Akihiko Sato
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
| | - Takao Shishido
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- Correspondence: ; Tel.: +81-6-6331-7263
| | - Akira Naito
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Keita Matsuno
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
| | - Masatoshi Okamatsu
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
| | - Yoshihiro Sakoda
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
| | - Hiroshi Kida
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
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10
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Dempsey JA, Neder JA, Phillips DB, O'Donnell DE. The physiology and pathophysiology of exercise hyperpnea. HANDBOOK OF CLINICAL NEUROLOGY 2022; 188:201-232. [PMID: 35965027 DOI: 10.1016/b978-0-323-91534-2.00001-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In health, the near-eucapnic, highly efficient hyperpnea during mild-to-moderate intensity exercise is driven by three obligatory contributions, namely, feedforward central command from supra-medullary locomotor centers, feedback from limb muscle afferents, and respiratory CO2 exchange (V̇CO2). Inhibiting each of these stimuli during exercise elicits a reduction in hyperpnea even in the continuing presence of the other major stimuli. However, the relative contribution of each stimulus to the hyperpnea remains unknown as does the means by which V̇CO2 is sensed. Mediation of the hyperventilatory response to exercise in health is attributed to the multiple feedback and feedforward stimuli resulting from muscle fatigue. In patients with COPD, diaphragm EMG amplitude and its relation to ventilatory output are used to decipher mechanisms underlying the patients' abnormal ventilatory responses, dynamic lung hyperinflation and dyspnea during exercise. Key contributions to these exercise-limiting responses across the spectrum of COPD severity include high dead space ventilation, an excessive neural drive to breathe and highly fatigable limb muscles, together with mechanical constraints on ventilation. Major controversies concerning control of exercise hyperpnea are discussed along with the need for innovative research to uncover the link of metabolism to breathing in health and disease.
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Affiliation(s)
- Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States.
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
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11
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Shiraishi M, Higashimoto Y, Sugiya R, Mizusawa H, Takeda Y, Fujita S, Nishiyama O, Kudo S, Kimura T, Chiba Y, Fukuda K, Tohda Y, Matsumoto H. Diaphragmatic excursion is correlated with the improvement in exercise tolerance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Respir Res 2021; 22:271. [PMID: 34686189 PMCID: PMC8532083 DOI: 10.1186/s12931-021-01870-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In patients with chronic obstructive pulmonary disease (COPD), the maximum level of diaphragm excursion (DEmax) is correlated with dynamic lung hyperinflation and exercise tolerance. This study aimed to elucidate the utility of DEmax to predict the improvement in exercise tolerance after pulmonary rehabilitation (PR) in patients with COPD. METHODS This was a prospective cohort study. Of the 62 patients with stable COPD who participated in the outpatient PR programme from April 2018 to February 2021, 50 completed the programme. Six-minute walk distance (6MWD) was performed to evaluate exercise tolerance, and ultrasonography was performed to measure DEmax. Responders to PR in exercise capacity were defined as patients who demonstrated an increase of > 30 m in 6MWD. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of DEmax to predict responses to PR. RESULTS Baseline levels of forced expiratory volume in 1 s, 6MWD, maximum inspiratory pressure, DEmax and quadriceps muscle strength were significantly higher, and peak dyspnoea of modified Borg (mBorg) scale score was lower in responders (n = 30) than in non-responders (n = 20) to PR (p < 0.01). In multivariate analysis, DEmax was significantly correlated with an increase of > 30 m in 6MWD. The area under the ROC curve of DEmax to predict responders was 0.915, with a sensitivity and specificity of 83% and 95%, respectively, at a cut-off value of 44.9 mm of DEmax. CONCLUSION DEmax could adequately predict the improvement in exercise tolerance after PR in patients with COPD.
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Affiliation(s)
- Masashi Shiraishi
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan.
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan.
| | - Yuji Higashimoto
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Ryuji Sugiya
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Hiroki Mizusawa
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Yu Takeda
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Shuhei Fujita
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Tamotsu Kimura
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kindai University School of Medicine, Osaka, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kindai University School of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 5898511, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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12
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Luu BL, McDonald RJ, Bolsterlee B, Héroux ME, Butler JE, Hudson AL. Movement of the ribs in supine humans for small and large changes in lung volume. J Appl Physiol (1985) 2021; 131:174-183. [PMID: 34013751 DOI: 10.1152/japplphysiol.01046.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An object-tracking algorithm was used on computed tomography (CT) images of the thorax from six healthy participants and nine participants with chronic obstructive pulmonary disease (COPD) to describe the movement of the ribs between the static lung volumes of functional residual capacity (FRC) and total lung capacity (TLC). The continuous motion of the ribs during tidal breathing was also described using four-dimensional CT datasets from seven participants with thoracic esophageal malignancies. Rib motion was defined relative to a local joint coordinate system where rotations about the axes that predominantly affected the anteroposterior and transverse diameters of the rib cage were referred to as pump-handle and bucket-handle movements, respectively. Between TLC and FRC, pump-handle movements were 1.8 times larger in healthy participants than in participants with COPD, in line with their 1.6 times larger inspiratory capacities. However, when rib motion was normalized to the change in lung volume, pump-handle movements were similar for healthy participants and participants with COPD. We found no differences in bucket-handle movements between participant groups before and after normalization. Pump-handle movement was the dominant rib motion between FRC and TLC, on average four times greater than bucket-handle movement in healthy participants. For expiratory tidal volume, pump-handle movements were 20% smaller than bucket-handle movements. When normalized to tidal volume and compared with inspiratory capacity, pump-handle movements were smaller and bucket-handle movements were larger during tidal breathing. The findings suggest that the pump-handle and bucket-handle components of rib motion vary for small and large changes in lung volume.NEW & NOTEWORTHY Rib movements over inspiratory capacity are comparable for healthy participants and participants with chronic obstructive pulmonary disease when normalized to the change in lung volume. The kinematics of the ribs during tidal breathing were described from four-dimensional computed tomography images. For large changes in lung volume with inspiratory capacity, pump-handle movements of the ribs are four times greater than bucket-handle movements, whereas at tidal volume, pump-handle movements are 20% smaller than bucket-handle movements.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Rhys J McDonald
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Bart Bolsterlee
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Martin E Héroux
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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13
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Porto EF, Clares S, Ferracioli AM, de Sousa MR, de Oliveira Leite JR, Malheiros RT, De Castro AA. Influence of Lung Hyperinflation on Respiratory Muscles Pressures During a Submaximal Test in Patients With COPD: A Clinical Perspective. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201026222938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and Objective:
Reduction of exercise tolerance is associated with expiratory
flow-limitation (EFL) and lung hyperinflation; those are only partially reversible to bronchodilator.
Lung hyperinflation lowers the diaphragm muscle provoking a mechanical disadvantage that,
eventually, reduces maximal inspiratory (MIP) and expiratory (MEP) pressures. We aimed to assess
the influence of the dynamic lung hyperinflation on respiratory pressures changes at rest and
after a submaximal exercise test in COPD patients with and without a bronchodilator.
Methods::
We prospectively analyzed 16 COPD patients (FEV1 36.4±10% pred.; age 61.0±8 years,
height 165±12 cm and BMI 25.9±6 kg/m2). MIP and MEP were measured before and after performing
the six minutes walking test (6MWT) with and without bronchodilator (400 mcg of albuterol).
Results::
Nine of 16 patients increased IC more than 150 ml after bronchodilator use. Right after
the 6MWT was accomplished without bronchodilator, IC decreased by 7.05% as compared to the
6MWT baseline value (p<0.01). Nine patients decreased IC more than 150ml. After bronchodilator
use, patients performed the 6MWT without any IC significant reduction (p>0.05). Twelve patients
increased the MIP (ranging from 70±11cmH2O to 77±10cmH2O, p = 0.0043) using 400mcg of albuterol.
Thirteen patients reduced MIP after the 6MWT without bronchodilator use (p <0.007).
There was no significant reduction (p> 0.05) in MIP when patients performed the 6MWT after
bronchodilator use. We also found a significant correlation between MIP and inspiratory capacity
(IC) and MEP and the IC before and after the 6MWT (r=0.61, p=0.0054; r=0.60, p=0.0031, respectively).
Conclusions::
Dynamic pulmonary hyperinflation directly interferes with the ability of respiratory
muscles to generate inspiratory and expiratory pressures. The previous use of bronchodilators in patients
with COPD reduced dynamic hyperinflation when accomplishing a sub-maximal exercise.
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Affiliation(s)
- Elias F. Porto
- Pulmonary Rehabilitation Center of the Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Sabrina Clares
- Research fellow at the Pulmonary Rehabilitation Center UNASP, Sao Paulo, Brazil
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14
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Shiraishi M, Higashimoto Y, Sugiya R, Mizusawa H, Takeda Y, Fujita S, Nishiyama O, Kudo S, Kimura T, Chiba Y, Fukuda K, Tohda Y. Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients. ERJ Open Res 2020; 6:00589-2020. [PMID: 33447614 PMCID: PMC7792831 DOI: 10.1183/23120541.00589-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD. Methods Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmax and the ventilation parameters. Results The DEmax of patients with COPD was significantly lower than that of the controls (45.0±12.8 mm versus 64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmax in patients with COPD. During CPET, oxygen uptake/weight (V′O2/W) and minute ventilation (V′E) were significantly positively correlated with DEmax, while V′E/V′O2 and V′E/carbon dioxide output (V′CO2) were significantly negatively correlated with DEmax in patients with COPD. DEmax was also significantly positively correlated with ΔIC, reflecting DLH, and with V′O2/W, reflecting exercise capacity. Conclusion Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients. Reduced diaphragmatic excursion, as measured on ultrasound images, might predict decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patientshttps://bit.ly/3jkERxZ
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Affiliation(s)
- Masashi Shiraishi
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan.,Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Yuji Higashimoto
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Ryuji Sugiya
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Hiroki Mizusawa
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yu Takeda
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Shuhei Fujita
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Osamu Nishiyama
- Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Health Sciences, Osaka, Japan
| | - Tamotsu Kimura
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kindai University School of Medicine, Osaka, Japan
| | - Kanji Fukuda
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yuji Tohda
- Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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15
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Rodríguez-Núñez I, Torres G, Luarte-Martinez S, Manterola C, Zenteno D. RESPIRATORY MUSCLE IMPAIRMENT EVALUATED WITH MEP/MIP RATIO IN CHILDREN AND ADOLESCENTS WITH CHRONIC RESPIRATORY DISEASE. ACTA ACUST UNITED AC 2020; 39:e2019414. [PMID: 33331560 PMCID: PMC7747779 DOI: 10.1590/1984-0462/2021/39/2019414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/23/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the strength of respiratory muscles and to compare maximum inspiratory (MIP) and expiratory (MEP) pressure and MEP/MIP ratio between patients with chronic respiratory diseases and healthy individuals. METHODS Case-control study. Individuals with neuromuscular disease and post-infectious bronchiolitis obliterans were considered. In addition, they were also matched according to anthropometric and demographic characteristics with healthy children and adolescents. MIP, MEP in the three groups, and pulmonary function only in patients with chronic respiratory diseases were recorded. RESULTS A total of 52 subjects with CRD (25 with neuromuscular disease, and 27 with post-infectious bronchiolitis obliterans) and 85 healthy individuals were included, with an average age of 11.3±2.1 years. Patients with neuromuscular disease and post-infectious bronchiolitis obliterans presented lower MIP and MEP when compared with healthy individuals, although MEP/MIP ratio was lower in patients with neuromuscular disease (0.87±0.3) and higher in patients with post-infectious bronchiolitis obliterans (1.1±0.3) compared to the healthy group (0.97±0.2). Only in patients with neuromuscular disease a negative correlation was observed between MEP/MIP ratio and age (r=-0.50; p=0.01). CONCLUSIONS Differences in the pattern of muscular weakness between patients with chronic respiratory diseases were observed. In patients with neuromuscular disease, a decrease in the MEP/MIP ratio depending on MIP was verified; and in those patients with post-infectious bronchiolitis obliterans, an increase in the MEP/MIP ratio depending on MIP was also observed.
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Affiliation(s)
| | - Gerardo Torres
- Dr. Guillermo Grant Benavente Hospital, Concepción, Chile
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16
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Louvaris Z, Rodrigues A, Dacha S, Gojevic T, Janssens W, Vogiatzis I, Gosselink R, Langer D. High-intensity exercise impairs extradiaphragmatic respiratory muscle perfusion in patients with COPD. J Appl Physiol (1985) 2020; 130:325-341. [PMID: 33119468 DOI: 10.1152/japplphysiol.00659.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The study investigated whether high-intensity exercise impairs inspiratory and expiratory muscle perfusion in patients with chronic obstructive pulmonary disease (COPD). We compared respiratory local muscle perfusion between constant-load cycling[sustained at 80% peak work rate (WRpeak)] and voluntary normocapnic hyperpnea reproducing similar work of breathing (WoB) in 18 patients [forced expiratory volume in the first second (FEV1): 58 ± 24% predicted]. Local muscle blood flow index (BFI), using indocyanine green dye, and fractional oxygen saturation (%StiO2) were simultaneously assessed by near-infrared spectroscopy (NIRS) over the intercostal, scalene, rectus abdominis, and vastus lateralis muscles. Cardiac output (impedance cardiography), WoB (esophageal/gastric balloon catheter), and diaphragmatic and extradiaphragmatic respiratory muscle electromyographic activity (EMG) were also assessed throughout cycling and hyperpnea. Minute ventilation, breathing pattern, WoB, and respiratory muscle EMG were comparable between cycling and hyperpnea. During cycling, cardiac output and vastus lateralis BFI were significantly greater compared with hyperpnea [by +4.2 (2.6-5.9) L/min and +4.9 (2.2-7.8) nmol/s, respectively] (P < 0.01). Muscle BFI and %StiO2 were, respectively, lower during cycling compared with hyperpnea in scalene [by -3.8 (-6.4 to -1.2) nmol/s and -6.6 (-8.2 to -5.1)%], intercostal [by -1.4 (-2.4 to -0.4) nmol/s and -6.0 (-8.6 to -3.3)%], and abdominal muscles [by -1.9 (-2.9 to -0.8) nmol/s and -6.3 (-9.1 to -3.4)%] (P < 0.001). The difference in respiratory (scalene and intercostal) muscle BFI between cycling and hyperpnea was associated with greater dyspnea (Borg CR10) scores (r = -0.54 and r = -0.49, respectively, P < 0.05). These results suggest that in patients with COPD, 1) locomotor muscle work during high-intensity exercise impairs extradiaphragmatic respiratory muscle perfusion and 2) insufficient adjustment in extradiaphragmatic respiratory muscle perfusion during high-intensity exercise may partly explain the increased sensations of dyspnea.NEW & NOTEWORTHY We simultaneously assessed the blood flow index (BFI) in three respiratory muscles during hyperpnea and high-intensity constant-load cycling sustained at comparable levels of work of breathing and respiratory neural drive in patients with COPD. We demonstrated that high-intensity exercise impairs respiratory muscle perfusion, as intercostal, scalene, and abdominal BFI increased during hyperpnea but not during cycling. Insufficient adjustment in respiratory muscle perfusion during exercise was associated with greater dyspnea sensations in patients with COPD.
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Affiliation(s)
- Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Antenor Rodrigues
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil.,Research Aimed at Muscle Performance Laboratory (RAMP), Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Sauwaluk Dacha
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Tin Gojevic
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Faculty of Health and Life Sciences, Department of Sport, Exercise, and Rehabilitation, Northumbria University Newcastle, Newcastle, United Kingdom
| | - Rik Gosselink
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
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17
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Blanco-Almazan D, Groenendaal W, Lozano-Garcia M, Estrada-Petrocelli L, Lijnen L, Smeets C, Ruttens D, Catthoor F, Jane R. Combining Bioimpedance and Myographic Signals for the Assessment of COPD During Loaded Breathing. IEEE Trans Biomed Eng 2020; 68:298-307. [PMID: 32746014 DOI: 10.1109/tbme.2020.2998009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic conditions. The current assessment of COPD requires a maximal maneuver during a spirometry test to quantify airflow limitations of patients. Other less invasive measurements such as thoracic bioimpedance and myographic signals have been studied as an alternative to classical methods as they provide information about respiration. Particularly, strong correlations have been shown between thoracic bioimpedance and respiratory volume. The main objective of this study is to investigate bioimpedance and its combination with myographic parameters in COPD patients to assess the applicability in respiratory disease monitoring. We measured bioimpedance, surface electromyography and surface mechanomyography in forty-three COPD patients during an incremental inspiratory threshold loading protocol. We introduced two novel features that can be used to assess COPD condition derived from the variation of bioimpedance and the electrical and mechanical activity during each respiratory cycle. These features demonstrate significant differences between mild and severe patients, indicating a lower inspiratory contribution of the inspiratory muscles to global respiratory ventilation in the severest COPD patients. In conclusion, the combination of bioimpedance and myographic signals provides useful indices to noninvasively assess the breathing of COPD patients.
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18
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Nambi G, Abdelbasset WK, Elshehawy AA, Eltrawy HH, Abodonya AM, Saleh AK, Hussein RS. Yoga in Burn: Role of pranayama breathing exercise on pulmonary function, respiratory muscle activity and exercise tolerance in full-thickness circumferential burns of the chest. Burns 2020; 47:206-214. [PMID: 32709430 DOI: 10.1016/j.burns.2020.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Circumferential burn of chest (CBC) is a significant type of burn and considers as a major cause of restrictive lung disease (RLD). Patient who has CBC with RLD leads to respiratory symptoms such as breathing difficulty, airway obstruction, reduced exercise capacity and altered pulmonary functions. However, studies examining the role of pranayama breathing exercise on pulmonary function, respiratory muscle activity and exercise tolerance in full thickness circumferential burn of chest are lacking. OBJECTIVE To find the short term effects of pranayama breathing exercise on pulmonary function, respiratory muscle activity and exercise tolerance in full thickness circumferential burns of chest. METHODS Through simple random sampling method thirty subjects (N = 30) with RLD following CBC were allocated to pranayama breathing exercise group (PBE-G; n = 15) and conventional breathing exercise group (CBE-G; n = 15). They received pranayama breathing exercise and conventional breathing exercise for 4 weeks respectively. All the subjects received chest mobility exercise as common treatment. Primary (Numeric Pain Rating Scale - NPRS, forced expiratory volume (FEV1), forced vital capacity (FVC) and maximum voluntary ventilation (MVV) and secondary (Electromyogram of sternocleidomastoid, scalene, external intercostal and diaphragm muscle, 6 min walk test & Global Rating of Change - GRC) outcome measures were measured at baseline, after four weeks and after three months follow up. RESULTS Baseline demographic and clinical variables show homogenous distribution between the groups (p > 0.05). Four weeks following different breathing exercises, PBE-G group shows more significant changes in pain intensity, pulmonary function, respiratory muscle activity, exercise tolerance and global rating of change than CBE-G group (p ≤ 0.05) at four weeks and three months follow up. CONCLUSION Both groups showed improvement over time. However, differences between the groups were noticed small. Still physiotherapy management, which included pranayama breathing exercises with chest mobilization program, had an effective strategy in the treatment of restrictive lung disease following circumferential burn of chest.
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Affiliation(s)
- Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia.
| | - Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Ahmed A Elshehawy
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt; Department of Physical Therapy, Faculty of Applied Medical Sciences, Tabuk University, Tabuk, Saudi Arabia
| | - Heba H Eltrawy
- Department of Chest Diseases, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ahmed M Abodonya
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ayman K Saleh
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; Department of Orthopedic, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ramadan S Hussein
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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19
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Roesthuis LH, van der Hoeven JG, van Hees HWH, Schellekens WJM, Doorduin J, Heunks LMA. Recruitment pattern of the diaphragm and extradiaphragmatic inspiratory muscles in response to different levels of pressure support. Ann Intensive Care 2020; 10:67. [PMID: 32472272 PMCID: PMC7256918 DOI: 10.1186/s13613-020-00684-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/16/2020] [Indexed: 01/16/2023] Open
Abstract
Background Inappropriate ventilator assist plays an important role in the development of diaphragm dysfunction. Ventilator under-assist may lead to muscle injury, while over-assist may result in muscle atrophy. This provides a good rationale to monitor respiratory drive in ventilated patients. Respiratory drive can be monitored by a nasogastric catheter, either with esophageal balloon to determine muscular pressure (gold standard) or with electrodes to measure electrical activity of the diaphragm. A disadvantage is that both techniques are invasive. Therefore, it is interesting to investigate the role of surrogate markers for respiratory dive, such as extradiaphragmatic inspiratory muscle activity. The aim of the current study was to investigate the effect of different inspiratory support levels on the recruitment pattern of extradiaphragmatic inspiratory muscles with respect to the diaphragm and to evaluate agreement between activity of extradiaphragmatic inspiratory muscles and the diaphragm. Methods Activity from the alae nasi, genioglossus, scalene, sternocleidomastoid and parasternal intercostals was recorded using surface electrodes. Electrical activity of the diaphragm was measured using a multi-electrode nasogastric catheter. Pressure support (PS) levels were reduced from 15 to 3 cmH2O every 5 min with steps of 3 cmH2O. The magnitude and timing of respiratory muscle activity were assessed. Results We included 17 ventilated patients. Diaphragm and extradiaphragmatic inspiratory muscle activity increased in response to lower PS levels (36 ± 6% increase for the diaphragm, 30 ± 6% parasternal intercostals, 41 ± 6% scalene, 40 ± 8% sternocleidomastoid, 43 ± 6% alae nasi and 30 ± 6% genioglossus). Changes in diaphragm activity correlated best with changes in alae nasi activity (r2 = 0.49; P < 0.001), while there was no correlation between diaphragm and sternocleidomastoid activity. The agreement between diaphragm and extradiaphragmatic inspiratory muscle activity was low due to a high individual variability. Onset of alae nasi activity preceded the onset of all other muscles. Conclusions Extradiaphragmatic inspiratory muscle activity increases in response to lower inspiratory support levels. However, there is a poor correlation and agreement with the change in diaphragm activity, limiting the use of surface electromyography (EMG) recordings of extradiaphragmatic inspiratory muscles as a surrogate for electrical activity of the diaphragm.
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Affiliation(s)
- L H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H W H van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - J Doorduin
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M A Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
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20
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Redolfi S, Grassion L, Rivals I, Chavez M, Wattiez N, Arnulf I, Gonzalez-Bermejo J, Similowski T. Abnormal Activity of Neck Inspiratory Muscles during Sleep as a Prognostic Indicator in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 201:414-422. [PMID: 31644879 DOI: 10.1164/rccm.201907-1312oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: In patients with chronic obstructive pulmonary disease (COPD), increased activity of neck inspiratory muscles has been reported as a compensatory response to hyperinflation-related diaphragmatic dysfunction. The persistence of this activity during sleep could attenuate sleep-related hypoventilation and also negatively impact sleep and clinical outcomes.Objectives: To assess the persistence of neck-muscle activity during sleep in patients with COPD recovering from severe exacerbations (i.e., requiring hospitalization) and its impact on sleep quality and recurrence of exacerbations.Methods: Video polysomnography with neck-muscle EMG was performed in patients with COPD who were recovering from a severe exacerbation. The follow-up period lasted 6 months to record the next severe exacerbation.Measurements and Main Results: Twenty-nine patients were included in the study (median [25th-75th percentile] age, 71 [64-72] yr; 55% male; body mass index, 24 [21-29]; FEV1% predicted, 37 [29-45]; and BODE [body mass index, airflow obstruction, dyspnea, and exercise] index, 6 [5-7]). Twenty-six of these patients exhibited sleep-related neck-muscle activity, which was intermittent (limited to stage 3 sleep) in 17 and permanent throughout sleep in 9. α-Delta EEG activity during stage 3 sleep was observed in 87% of the patients. Compared with patients with no or intermittent neck-muscle activity, those with permanent neck-muscle activity showed more disrupted sleep, had experienced more exacerbations in the previous year, and suffered their next severe exacerbation earlier.Conclusions: Sleep-related neck-muscle activity occurs frequently in patients with COPD who are recovering from a severe exacerbation and seems to negatively affect sleep quality and prognosis; therefore, identification of this activity might improve COPD management after a severe exacerbation.
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Affiliation(s)
- Stefania Redolfi
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.,Service de Pathologies du Sommeil, Département R3S, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Leo Grassion
- Service des Maladies Respiratoires, CHU de Haut-Lévêque, Pessac, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Isabelle Rivals
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.,Equipe de Statistique Appliquée-ESPCI Paris, PSL Research University, France; and
| | - Mario Chavez
- CNRS-UMR 7225, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nicolas Wattiez
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France
| | - Isabelle Arnulf
- Service de Pathologies du Sommeil, Département R3S, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Jesus Gonzalez-Bermejo
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.,Service des Maladies Respiratoires, CHU de Haut-Lévêque, Pessac, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.,Service des Maladies Respiratoires, CHU de Haut-Lévêque, Pessac, France
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21
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Ramachandran P, Devaraj U, Patrick B, Saxena D, Venkatnarayan K, Louis V, Krishnaswamy UM, D'souza GA. Ultrasonographic assessment of skeletal muscle mass and diaphragm function in patients with chronic obstructive pulmonary disease: A case-control study. Lung India 2020; 37:220-226. [PMID: 32367843 PMCID: PMC7353944 DOI: 10.4103/lungindia.lungindia_103_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although muscle dysfunction is a major contributor to morbidity in chronic obstructive pulmonary disease (COPD), assessment of skeletal muscle, and diaphragm function is not routinely performed in COPD patients. OBJECTIVES (1) The aim is to assess muscle dysfunction in COPD by measuring the zone of apposition of diaphragm, diaphragm excursion, thickness of diaphragm, and rectus femoris cross-sectional area (RFCSA) with ultrasonography.(2) To correlate the above assessments with spirometric parameters; notably forced expiratory volume in 1 s (FEV1). METHODS Twenty-four consecutive stable COPD patients and 18 controls were included after obtaining written informed consent. Demographic and clinical data, spirometric values, 6-min walk distance, and sonographic parameters mentioned above were compiled for the analysis. RESULTS All included participants were male with a mean age of 62.5 ± 8.4 years. The mean FEV1in cases was 1.12 ± 0.4 L versus 2.41 ± 0.5 L in controls. The diaphragm thickness (1.8 ± 0.5 mm vs. 2.2 ± 0.6 mm;P = 0.005) and RFCSA was significantly lower in COPD patients (4.8 ± 1.3 cm[2] vs. 6.12 ± 1.2 cm[2];P = 0.02). However, diaphragm excursion (5.35 ± 2.8 cm vs. 7 ± 2.6 cm) although lower in COPD patients, was not significantly different between the groups. Correlation between FEV1and ultrasound diaphragm measurements and RFCSA by Spearman's Rho correlation was poor (ρ= 0.2). CONCLUSION Ultrasonographic assessment of the diaphragm and rectus femoris can be used as markers to assess skeletal muscle dysfunction in COPD as diaphragmatic function and RFCSA were lower in COPD patients.
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Affiliation(s)
- Priya Ramachandran
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Uma Devaraj
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Bhavna Patrick
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Deepali Saxena
- Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Varghese Louis
- Department of Pulmonary Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | | | - George A D'souza
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
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22
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More Impaired Dynamic Ventilatory Muscle Oxygenation in Congestive Heart Failure than in Chronic Obstructive Pulmonary Disease. J Clin Med 2019; 8:jcm8101641. [PMID: 31591369 PMCID: PMC6832638 DOI: 10.3390/jcm8101641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/25/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) often have dyspnea. Despite differences in primary organ derangement and similarities in secondary skeletal muscle changes, both patient groups have prominent functional impairment. With similar daily exercise performance in patients with CHF and COPD, we hypothesized that patients with CHF would have worse ventilatory muscle oxygenation than patients with COPD. This study aimed to compare differences in tissue oxygenation and blood capacity between ventilatory muscles and leg muscles and between the two patient groups. Demographic data, lung function, and maximal cardiopulmonary exercise tests were performed in 134 subjects without acute illnesses. Muscle oxygenation and blood capacity were measured using frequency-domain near-infrared spectroscopy (fd-NIRS). We enrolled normal subjects and patients with COPD and CHF. The two patient groups were matched by oxygen-cost diagram scores, New York Heart Association functional classification scores, and modified Medical Research Council scores. COPD was defined as forced expired volume in one second and forced expired vital capacity ratio ≤0.7. CHF was defined as stable heart failure with an ejection fraction ≤49%. The healthy subjects were defined as those with no obvious history of chronic disease. Age, body mass index, cigarette consumption, lung function, and exercise capacity were different across the three groups. Muscle oxygenation and blood capacity were adjusted accordingly. Leg muscles had higher deoxygenation (HHb) and oxygenation (HbO2) and lower oxygen saturation (SmO2) than ventilatory muscles in all participants. The SmO2 of leg muscles was lower than that of ventilatory muscles because SmO2 was calculated as HbO2/(HHb+HbO2), and the HHb of leg muscles was relatively higher than the HbO2 of leg muscles. The healthy subjects had higher SmO2, the patients with COPD had higher HHb, and the patients with CHF had lower HbO2 in both muscle groups throughout the tests. The patients with CHF had lower SmO2 of ventilatory muscles than the patients with COPD at peak exercise (p < 0.01). We conclud that fd-NIRS can be used to discriminate tissue oxygenation of different musculatures and disease entities. More studies on interventions on ventilatory muscle oxygenation in patients with CHF and COPD are warranted.
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23
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Kalil-Filho FA, Campos ACL, Tambara EM, Tomé BKA, Treml CJ, Kuretzki CH, Furlan FLS, Albuquerque JP, Malafaia O. PHYSIOTHERAPEUTIC APPROACHES AND THE EFFECTS ON INSPIRATORY MUSCLE FORCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN THE PRE-OPERATIVE PREPARATION FOR ABDOMINAL SURGICAL PROCEDURES. ACTA ACUST UNITED AC 2019; 32:e1439. [PMID: 31460599 PMCID: PMC6713053 DOI: 10.1590/0102-672020190001e1439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 11/22/2022]
Abstract
Background: Abdominal disorders can alter respiratory function and increase the morbidity
and mortality of patients with chronic obstructive pulmonary disease. Aim: To improve the physiotherapeutic and muscular capacity in chronic obstructive
pulmonary muscular inspiration in the preoperative preparation in abdominal
surgeries. Method: Retrospective and documentary study using SINPE© , clinical database software of patients with chronic obstructive
pulmonary disease and candidates to abdominal operation. The sample
consisted of 100 men aged 55-70 years, all with chronic obstructive
pulmonary disease who underwent preoperative physiotherapeutic treatment.
They were divided into two groups of 50 individuals (group A and group B).
In group A the patients were treated with modern mobility techniques for
bronchial clearance and the strengthening of the respiratory muscles was
performed with IMT® Threshold. In group B the treatment performed for bronchial
obstruction was with classic maneuvers and for the strengthening of the
respiratory muscles for flow incentive was used Respiron® . Results: Both groups obtained improvement in the values of the PiMáx after the
different treatments. Group A obtained greater change in the intervals and a
more significant increase of the values of the PiMax in relation to the
average pre and post-treatment. However, when analyzing the variance and the
standard deviation of the samples, group B presented the best results
showing more homogeneity. Conclusions: The modern and traditional bronchial clearance techniques associated with
inspiratory muscle training were equally effective in gaining inspiratory
muscle strength with increased Pmax. In this way, the two can be used in the
preoperative preparation of patients with chronic obstructive pulmonary
disease and referred to abdominal operations.
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Affiliation(s)
- Faruk Abrão Kalil-Filho
- Program of Post-Graduation in Surgical Clinic, Sector of Health Sciences, Federal University of Paraná
| | | | - Elizabeth Milla Tambara
- Program of Post-Graduation in Surgical Clinic, Sector of Health Sciences, Federal University of Paraná
| | - Bruna Karoline Alves Tomé
- Program of Post-Graduation in Surgical Clinic, Sector of Health Sciences, Federal University of Paraná
| | - Cleiton José Treml
- Program of Post-Graduation in Surgical Clinic, Sector of Health Sciences, Federal University of Paraná
| | - Carlos Henrique Kuretzki
- Program of Post-Graduation in Surgical Clinic, Sector of Health Sciences, Federal University of Paraná
| | | | | | - Osvaldo Malafaia
- Post-Graduate Program in Principles of Surgery, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
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24
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Abstract
Pathologic processes that involve the central nervous system, phrenic nerve, neuromuscular junction, and skeletal muscle can impair diaphragm function. When these processes are of sufficient severity to cause diaphragm dysfunction, respiratory failure may be a consequence. This article reviews basic diaphragm anatomy and physiology and then discusses diagnostic and therapeutic approaches to disorders that result in unilateral or bilateral diaphragm dysfunction. This discussion provides a context in which disorders of the diaphragm and their implications on respiratory function can be better appreciated.
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Affiliation(s)
- F Dennis McCool
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA.
| | - Kamran Manzoor
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
| | - Taro Minami
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA
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25
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Ozsoy I, Ozcan Kahraman B, Ozsoy G, Ilcin N, Kahraman T, Acar S, Tekin N, Savci S. Determinants of the 6-minute pegboard and ring test as an unsupported upper-extremity exercise capacity measure in older adults with chronic obstructive pulmonary disease. Eur Geriatr Med 2018; 9:863-870. [PMID: 34674474 DOI: 10.1007/s41999-018-0111-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 09/15/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Upper extremities play an important role in performing of many activities of daily living. Physical and pathological changes limit upper extremity functions in older adults with chronic obstructive pulmonary disease (COPD). Although the 6-minute pegboard and ring test (6PBRT) is a reliable and commonly used method for the assessment of unsupported upper-extremity exercise capacity in patients with COPD, there is lack of evidence about the possible determinants of the 6PBRT score. The study aimed to investigate the possible determinants of the 6PBRT in older adults with COPD. METHODS Fifty-two older adults (age ≥ 65 years) with stable COPD and 23 age-matched healthy older adults participated in this study. Demographic characteristics, unsupported upper-extremity exercise capacity, pulmonary function, functional exercise capacity, disease related symptoms, peripheral and respiratory muscle strength were evaluated. Stepwise multiple linear regression analysis was used to investigate the possible determinants of the 6PBRT score. RESULTS The 6PBRT score was significantly higher in healthy participants compared with those with COPD (p = 0.024). In participants with COPD, shoulder flexor muscle strength, age and functional exercise capacity were significant and independent predictors of the unsupported upper-extremity exercise capacity with explaining 55.4% of the variance. CONCLUSIONS This study suggests that shoulder flexor muscle strength, age and functional exercise capacity are independent determinants of the unsupported upper-extremity exercise capacity assessed by the 6PBRT in older adults with COPD.
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Affiliation(s)
- Ismail Ozsoy
- School of Physical Therapy and Rehabilitation, Kırsehir Ahi Evran University, Kırsehir, Turkey.
| | - Buse Ozcan Kahraman
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Gulsah Ozsoy
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Nursen Ilcin
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Serap Acar
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Nil Tekin
- Family Medicine, Narlıdere Nursing Home Elderly Care and Rehabilitation Center, Izmir, Turkey
| | - Sema Savci
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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26
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van der Leest S, Duiverman ML. High-intensity non-invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice. Respirology 2018; 24:318-328. [PMID: 30500099 DOI: 10.1111/resp.13450] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 01/12/2023]
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) frequently develop chronic hypercapnic respiratory failure (CHRF), with disabling symptoms and poor survival. The use of long-term nocturnal non-invasive ventilation (NIV) to treat CHRF in COPD has long been subject of debate due to conflicting evidence. However, since the introduction of high-intensity NIV (HI-NIV) in COPD, physiological and clinical benefits have been shown. HI-NIV refers to specific ventilator settings used for NIV aimed at achieving normocapnia or the lowest partial arterial carbon dioxide pressure (PaCO2 ) values as possible. This review will provide an overview of existing evidence of the efficacy of HI-NIV stable COPD patients with CHRF. Secondly, we will discuss hypotheses underlying NIV benefit in stable hypercapnic COPD, providing insight into better patient selection and hopefully more individually titrated HI-NIV. Finally, we will provide practical advice on how to initiate and follow-up patients on HI-NIV, with special emphasis on monitoring that should be available during the initiation and follow-up of HI-NIV, and will discuss more extended monitoring techniques that could improve HI-NIV treatment in the future.
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Affiliation(s)
- Sietske van der Leest
- Cardiovascular and Respiratory Physiology Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
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27
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Nguyen DAT, Boswell-Ruys CL, McBain RA, Eckert DJ, Gandevia SC, Butler JE, Hudson AL. Inspiratory pre-motor potentials during quiet breathing in ageing and chronic obstructive pulmonary disease. J Physiol 2018; 596:6173-6189. [PMID: 29971827 DOI: 10.1113/jp275764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS A cortical contribution to breathing, as indicated by a Bereitschaftspotential (BP) in averaged electroencephalographic signals, occurs in healthy individuals when external inspiratory loads are applied. Chronic obstructive pulmonary disease (COPD) is a condition where changes in the lung, chest wall and respiratory muscles produce an internal inspiratory load. These changes also occur in normal ageing, although to a lesser extent. In the present study, we determined whether BPs are present during quiet breathing and breathing with an external inspiratory load in COPD compared to age-matched and young healthy controls. We demonstrated that increased age, rather than COPD, is associated with a cortical contribution to quiet breathing. A cortical contribution to inspiratory loading is associated with more severe dyspnoea (i.e. the sensation of breathlessness). We propose that cortical mechanisms may be engaged to defend ventilation in ageing with dyspnoea as a consequence. ABSTRACT A cortical contribution to breathing is determined by the presence of a Bereitschaftspotential, a low amplitude negativity in the averaged electroencephalographic (EEG) signal, which begins ∼1 s before inspiration. It occurs in healthy individuals when external inspiratory loads to breathing are applied. In chronic obstructive pulmonary disease (COPD), changes in the lung, chest wall and respiratory muscles produce an internal inspiratory load. We hypothesized that there would be a cortical contribution to quiet breathing in COPD and that a cortical contribution to breathing with an inspiratory load would be linked to dyspnoea, a major symptom of COPD. EEG activity was analysed in 14 participants with COPD (aged 57-84 years), 16 healthy age-matched (57-87 years) and 15 young (18-26 years) controls during quiet breathing and inspiratory loading. The presence of Bereitschaftspotentials, from ensemble averages of EEG epochs at Cz and FCz, were assessed by blinded assessors. Dyspnoea was rated using the Borg scale. The incidence of a cortical contribution to quiet breathing was significantly greater in participants with COPD (6/14) compared to the young (0/15) (P = 0.004) but not the age-matched controls (6/16) (P = 0.765). A cortical contribution to inspiratory loading was associated with higher Borg ratings (P = 0.007), with no effect of group (P = 0.242). The data show that increased age, rather than COPD, is associated with a cortical contribution to quiet breathing. A cortical contribution to inspiratory loading is associated with more severe dyspnoea. We propose that cortical mechanisms may be engaged to defend ventilation with dyspnoea as a consequence.
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Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Rachel A McBain
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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Cabral EEA, Fregonezi GAF, Melo L, Basoudan N, Mathur S, Reid WD. Surface electromyography (sEMG) of extradiaphragm respiratory muscles in healthy subjects: A systematic review. J Electromyogr Kinesiol 2018; 42:123-135. [PMID: 30077087 DOI: 10.1016/j.jelekin.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022] Open
Abstract
The aim of this systematic review was to examine procedures used and outcome measures reported from surface EMG (sEMG) of extradiaphragm inspiratory muscles in healthy people. Relevant articles were searched using the concepts "electromyography (EMG)", "respiratory muscles (sternocleidomastoid [SM], scalene, intercostal [IC] and parasternal)" and "healthy" in the electronic databases: MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and Database of Systematic Reviews, CINAHL, SPORTDiscus, LILACS, and PEDro. Twenty-five papers were included and quality assessment was performed using an adapted Downs and Black checklist. Twenty-eight percent of included papers were classified as moderate quality and the rest were low quality. The SM was the muscle most often investigated. Description of EMG techniques were often incomplete for features such as the procedure before electrode placement, description of the surface electrodes, the EMG detection mode and amplification. Of note, descriptions of the IC muscle electrode positioning varied widely. Comparison of outcomes among studies was challenging because of the very diverse EMG outcomes reported. There are many controversies regarding methods and technique used to assess sEMG of extradiaphragm inspiratory muscles. Therefore, studies with higher methodological quality utilizing standardized EMG procedures including electrode positioning will enable accurate and reliable comparison among studies of the extradiaphragm inspiratory muscles.
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Affiliation(s)
- Elis E A Cabral
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil; PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), UFRN, Natal, RN, Brazil
| | - Guilherme A F Fregonezi
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil; PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), UFRN, Natal, RN, Brazil
| | - Luana Melo
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Nada Basoudan
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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29
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Louvaris Z, Habazettl H, Wagner H, Zakynthinos S, Wagner P, Vogiatzis I. Near-infrared spectroscopy using indocyanine green dye for minimally invasive measurement of respiratory and leg muscle blood flow in patients with COPD. J Appl Physiol (1985) 2018; 125:947-959. [PMID: 29927736 DOI: 10.1152/japplphysiol.00959.2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Reliability of near-infrared spectroscopy, measuring indocyanine green (ICG) for minimally invasive assessment of relative muscle blood flow during exercise has been examined in fit young individuals but not in chronic obstructive pulmonary disease (COPD). Here we ask whether it could be used to evaluate respiratory and locomotor muscle perfusion in COPD patients. Vastus lateralis muscle blood flow (MBF, the reference method calculated from arterial and muscle ICG concentration curves) and a blood flow index [BFI, calculated using only the (same) muscle ICG concentration curves] were compared in 10 patients (forced expiratory volume in 1 s: 51 ± 6% predicted) at rest and during cycling at 25, 50, 75, and 100% of peak work rate (WRpeak). Intercostal muscle MBF and BFI were also compared during isocapnic hyperpnea at rest, reproducing ventilation levels up to those at WRpeak. Intercostal and vastus lateralis BFI increased with increasing ventilation during hyperpnea (from 2.5 ± 0.3 to 4.5 ± 0.7 nM/s) and cycling load (from 1.0 ± 0.2 to 12.8 ± 1.9 nM/s), respectively. There were strong correlations between BFI and MBF for both intercostal ( r = 0.993 group mean data, r = 0.872 individual data) and vastus lateralis ( r = 0.994 group mean data, r = 0.895 individual data). Fold changes from rest in BFI and MBF did not differ for either the intercostal muscles or the vastus lateralis. Group mean BFI data showed strong interrelationships with respiratory and cycling workload, and whole body metabolic demand ( r ranged from 0.913 to 0.989) simultaneously recorded during exercise. We conclude that BFI is a reliable and minimally invasive tool for evaluating relative changes in respiratory and locomotor muscle perfusion from rest to peak exercise in COPD patient groups. NEW & NOTEWORTHY We show that noninvasive near-infrared spectroscopic (NIRS) detection of indocyanine green dye (ICG) after peripheral venous injection adequately reflects intercostal and locomotor muscle perfusion during exercise and hyperpnea in patients with chronic obstructive pulmonary disease (COPD). Mean, individual, and fold change responses from rest to exercise or hyperpnea correlated closely with the reference method, which requires arterial sampling. NIRS-ICG is a reliable, robust, and essentially noninvasive tool for assessing relative changes in intercostal and locomotor muscle perfusion in COPD patient groups.
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Affiliation(s)
- Zafeiris Louvaris
- GP Livanos and M Simou Laboratories, Department of Critical Care Medicine and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital , Athens , Greece.,Department of Physical Education and Sports Sciences, National and Kapodistrian University of Athens , Athens , Greece.,Faculty of Kinesiology and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Department Rehabilitation Sciences KU Leuven, University Hospitals Leuven , Leuven , Belgium
| | - Helmut Habazettl
- Institute of Physiology, Charite-University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,Institute of Anesthesiology, German Heart Institute Berlin , Berlin , Germany
| | - Harrieth Wagner
- Department of Medicine, University of California San Diego , La Jolla, California
| | - Spyros Zakynthinos
- GP Livanos and M Simou Laboratories, Department of Critical Care Medicine and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital , Athens , Greece
| | - Peter Wagner
- Department of Medicine, University of California San Diego , La Jolla, California
| | - Ioannis Vogiatzis
- GP Livanos and M Simou Laboratories, Department of Critical Care Medicine and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital , Athens , Greece.,Department of Physical Education and Sports Sciences, National and Kapodistrian University of Athens , Athens , Greece.,Faculty of Health and Life Sciences, Department of Sport, Exercise, and Rehabilitation, Northumbria University , Newcastle , United Kingdom
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Acute hypercapnia does not alter voluntary drive to the diaphragm in healthy humans. Respir Physiol Neurobiol 2018; 258:60-68. [PMID: 29859322 DOI: 10.1016/j.resp.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 05/28/2018] [Indexed: 11/21/2022]
Abstract
Although systemic hypercapnia is a common outcome of pulmonary disease, the relationship between hypercapnia and voluntary diaphragmatic activation (VAdi) is unclear. To examine whether hypercapnia independent of ventilatory work contributes to reduced central motor drive to the diaphragm in healthy humans, 14 subjects spontaneously breathed room air (NN) or a hypercapnic gas mixture (HH; 7% CO2 with air) while at rest. Thereafter, subjects volitionally hyperventilated room air (NH) matching the minute ventilation recorded during HH while maintained at eucapnic levels. Twitch interpolation with bilateral magnetic stimulation of phrenic nerves at functional residual capacity was used to assess VAdi during the three trials. Although PETCO2 was elevated during HH compared with NN and NH (52 vs 36 mmHg), VAdi was not altered across the trials (HH = 93.3 ± 7.0%, NN = 94.4 ± 5.0%, NH = 94.9 ± 4.6%, p = 0.48). Our findings indicate that the magnitude of hypercapnia acutely imposed may not be effective in inhibiting voluntary neural drives to the diaphragm in normal resting individuals.
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The Link between Reduced Inspiratory Capacity and Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2018; 14:S30-S39. [PMID: 28398073 DOI: 10.1513/annalsats.201610-834fr] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Low inspiratory capacity (IC), chronic dyspnea, and reduced exercise capacity are inextricably linked and are independent predictors of increased mortality in chronic obstructive pulmonary disease. It is no surprise, therefore, that a major goal of management is to improve IC by reducing lung hyperinflation to improve respiratory symptoms and health-related quality of life. The negative effects of lung hyperinflation on respiratory muscle and cardiocirculatory function during exercise are now well established. Moreover, there is growing appreciation that a key mechanism of exertional dyspnea in chronic obstructive pulmonary disease is critical mechanical constraints on tidal volume expansion during exercise when resting IC is reduced. Further evidence for the importance of lung hyperinflation comes from multiple studies, which have reported the clinical benefits of therapeutic interventions that reduce lung hyperinflation and increase IC. A reduced IC in obstructive pulmonary disease is further eroded by exercise and contributes to ventilatory limitation and dyspnea. It is an important outcome for both clinical and research studies.
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Kang JI, Jeong DK, Choi H. Correlation between diaphragm thickness and respiratory synergist muscle activity according to severity of chronic obstructive pulmonary disease. J Phys Ther Sci 2018; 30:150-153. [PMID: 29410587 PMCID: PMC5788796 DOI: 10.1589/jpts.30.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022] Open
Abstract
[Purpose] This study aims to analyze the effect that moderate to severe chronic
obstructive pulmonary disease (COPD) has on the respiratory synergist muscles. The results
will provide basic data that can be used in the clinical management of COPD. [Subjects and
Methods] The subjects in the study were 47 male patients with COPD between 55 and 70 years
old who were treated in a medical institution located in Jeollanam-do Province, South
Korea, from October 2015 to December 2016. Measurements were analyzed to determine the
correlation between the diaphragm thickness and the respiratory synergist muscle activity
in patients with mild COPD. [Results] The results showed that there was a negative
correlation between the diaphragm thickness and the sternocleidomastoid muscle and between
the diaphragm thickness and the scalene muscle; however, there was a positive correlation
between the diaphragm thickness and the external intercostal. For patients with severe
COPD, negative correlations were found between the diaphragm thickness and the
sternocleidomastoid muscle and between the diaphragm thickness and the scalene muscle.
[Conclusion] The mechanical deformation of the thoracic cage caused by severe COPD reduces
the lung capacity of patients and, thus, increases the difficulty in breathing. As the
disease worsens, the patients tend to maintain ventilation using the respiratory synergist
muscles. Thus, offering early and aggressive treatment and a respiration rehabilitation
program to patients with COPD can help to reduce the actions of the respiratory synergist
muscles to ensure normal breathing.
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Affiliation(s)
- Jeong-Il Kang
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Dae-Keun Jeong
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Hyun Choi
- Department of Physical Therapy, Mokpo Mirae Hospital, Republic of Korea
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33
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Ratnovsky A, Gino O, Naftali S. The impact of breathing pattern and rate on inspiratory muscles activity. Technol Health Care 2017; 25:823-830. [PMID: 28582937 DOI: 10.3233/thc-170826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Different rehabilitation programs are used to relieve dyspnea for hyper-inflated lung patients. In this study, a new approach, based on integrated changes in respiratory rate and pattern, for inspiratory muscles rehabilitation and training was examined utilizing noninvasive measurements of the two inspiratory muscles (rib cage inspiratory and neck inspiratory muscles) activity during controlled breathing in healthy subjects. Muscles activity was measured using electromyography, while subjects, breathed at different combinations of respiratory rate (6, 10, 16 breath per minutes) and inspiratory duty cycles (TI/Ttot). The results clearly show that both muscles were most active at the lowest evaluated respiratory rate, and that alteration of the duty cycle at the lowest rate significantly (p< 0.05) changes their electrical activity. Breathing at low respiratory rate RR is recommended for hyper-inflated lung patients in order to improve their gas exchange, therefore, it is recommended for these patients to find their most effective combination of RR and TI/Ttot and to use control breathing to practice their breath at optimum combination.
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34
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Washino S, Kanehisa H, Yoshitake Y. Neck inspiratory muscle activation patterns during well-controlled inspiration. Eur J Appl Physiol 2017; 117:2085-2097. [PMID: 28823081 DOI: 10.1007/s00421-017-3699-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Surprisingly, the activation characteristics of the neck inspiratory muscles as a function of key inspiratory mechanical parameters have yet to be demonstrated experimentally under well-controlled conditions. This study aimed to elucidate the muscle activation patterns of the neck inspiratory muscles by strictly controlling flow rate and lung volume. METHODS Thirteen healthy subjects matched their inspiratory flow rate at approximately 20-100% of peak flow rate (PFR) as steady as possible during inspiration. Amplitude of surface electromyogram (EMG) of the sternocleidomastoid (SCM) and scalene were calculated for every increase in %PFR over a duration corresponding to an increase in lung volume by 10% of forced vital capacity (FVC), as well as for every 5% increment of FVC over a point corresponding to an increase in flow rate by 20%PFR to determine the %PFR-EMG and %FVC-EMG relations, respectively. RESULTS Regression analyses showed that EMGs of the neck inspiratory muscles exponentially increased with increase in %PFR and their associated variables which reflect recruitment onset when increasing flow rate increased with increasing %FVC. In %FVC-EMG relation, a linear regression analysis showed positive slope at all %PFR and positive y-intercept at 80% PFR. CONCLUSIONS The main new finding is that the neck inspiratory muscle activities increase with flow rate as well as lung volume. The positive y-intercept of the %FVC-EMG relation at higher %PFR indicates that the neck inspiratory muscles are always activated even when lung volume level is low, implying that SCM is not necessarily an "accessory" muscle as described in previous observations.
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Affiliation(s)
- Sohei Washino
- Graduate School of Physical Education, National Institute of Fitness and Sports in Kanoya, 1 Shiromizu, Kanoya, Kagoshima, 8912393, Japan
| | - Hiroaki Kanehisa
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, 1 Shiromizu, Kanoya, Kagoshima, 8912393, Japan
| | - Yasuhide Yoshitake
- Department of Sports and Life Sciences, National Institute of Fitness and Sports in Kanoya, 1 Shiromizu, Kanoya, Kagoshima, 8912393, Japan.
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35
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de Sá RB, Pessoa MF, Cavalcanti AGL, Campos SL, Amorim C, Dornelas de Andrade A. Immediate effects of respiratory muscle stretching on chest wall kinematics and electromyography in COPD patients. Respir Physiol Neurobiol 2017; 242:1-7. [DOI: 10.1016/j.resp.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 01/17/2023]
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36
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Oppersma E, Hatam N, Doorduin J, van der Hoeven JG, Marx G, Goetzenich A, Fritsch S, Heunks LMA, Bruells CS. Functional assessment of the diaphragm by speckle tracking ultrasound during inspiratory loading. J Appl Physiol (1985) 2017; 123:1063-1070. [PMID: 28522757 DOI: 10.1152/japplphysiol.00095.2017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/16/2022] Open
Abstract
Assessment of diaphragmatic effort is challenging, especially in critically ill patients in the phase of weaning. Fractional thickening during inspiration assessed by ultrasound has been used to estimate diaphragm effort. It is unknown whether more sophisticated ultrasound techniques such as speckle tracking are superior in the quantification of inspiratory effort. This study evaluates the validity of speckle tracking ultrasound to quantify diaphragm contractility. Thirteen healthy volunteers underwent a randomized stepwise threshold loading protocol of 0-50% of the maximal inspiratory pressure. Electric activity of the diaphragm and transdiaphragmatic pressures were recorded. Speckle tracking ultrasound was used to assess strain and strain rate as measures of diaphragm tissue deformation and deformation velocity, respectively. Fractional thickening was assessed by measurement of diaphragm thickness at end-inspiration and end-expiration. Strain and strain rate increased with progressive loading of the diaphragm. Both strain and strain rate were highly correlated to transdiaphragmatic pressure (strain r2 = 0.72; strain rate r2 = 0.80) and diaphragm electric activity (strain r2 = 0.60; strain rate r2 = 0.66). We conclude that speckle tracking ultrasound is superior to conventional ultrasound techniques to estimate diaphragm contractility under inspiratory threshold loading.NEW & NOTEWORTHY Transdiaphragmatic pressure using esophageal and gastric balloons is the gold standard to assess diaphragm effort. However, this technique is invasive and requires expertise, and the interpretation may be complex. We report that speckle tracking ultrasound can be used to detect stepwise increases in diaphragmatic effort. Strain and strain rate were highly correlated with transdiaphragmatic pressure, and therefore, diaphragm electric activity and speckle tracking might serve as reliable tools to quantify diaphragm effort in the future.
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Affiliation(s)
- Eline Oppersma
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Nima Hatam
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jonne Doorduin
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gernot Marx
- Department of Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; and
| | - Andreas Goetzenich
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Fritsch
- Department of Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; and
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; .,Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Christian S Bruells
- Department of Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; and
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Cano Porras D, Lunardi AC, Marques da Silva CCB, Paisani DM, Stelmach R, Moriya HT, Carvalho CRF. Comparison between the phase angle and phase shift parameters to assess thoracoabdominal asynchrony in COPD patients. J Appl Physiol (1985) 2017; 122:1106-1113. [DOI: 10.1152/japplphysiol.00508.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/22/2022] Open
Abstract
Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD. NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.
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Affiliation(s)
- Desiderio Cano Porras
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Adriana C. Lunardi
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Denise M. Paisani
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; and
| | - Henrique T. Moriya
- Biomedical Engineering Laboratory, Department of Telecommunication and Control Engineering, School of Engineering, University of São Paulo, São Paulo, Brazil
| | - Celso R. F. Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Rocha FR, Brüggemann AKV, Francisco DDS, de Medeiros CS, Rosal D, Paulin E. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD. J Bras Pneumol 2017; 43:32-37. [PMID: 28380186 PMCID: PMC5790674 DOI: 10.1590/s1806-37562016000000097] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/31/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. METHODS: We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. RESULTS: In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. CONCLUSIONS: In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL. OBJETIVO: Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC. MÉTODOS: Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia. RESULTADOS: No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD. CONCLUSÕES: A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percepção de dispneia, mas não com AFVD.
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Affiliation(s)
- Flávia Roberta Rocha
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | | | - Davi de Souza Francisco
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | | | - Danielle Rosal
- . Fundação Universidade Regional de Blumenau - FURB - Blumenau (SC) Brasil
| | - Elaine Paulin
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
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The presence of respiratory disorders in individuals with low back pain: A systematic review. ACTA ACUST UNITED AC 2016; 26:77-86. [PMID: 27501326 DOI: 10.1016/j.math.2016.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Inspiratory muscles, such as the diaphragm, play a key role in both respiration and spinal control. Therefore, diaphragm dysfunctions are often related to low back pain (LBP). However, few is known on the association between the presence of LBP and the presence of respiratory disorders (RD). OBJECTIVES To perform a systematic review on the relation between RD and LBP. STUDY DESIGN Systematic review. METHODS Two reviewers searched on PubMed/MEDLINE for studies concerning LBP and RD, from 1950 up to January 2016. The search string consisted of the following key words: low back pain, dyspnea, respiratory problems, lung diseases, comorbidity, pulmonary disease, chronic obstructive, smoking, asthma, allergy, sinusitis, respiratory tract infection and hyperventilation. The aim was to evaluate a potential correlation, co-occurrence or causality between RD and LBP. RESULTS A total of 16 articles were included. A significant correlation between the presence of LBP and the presence of RD such as dyspnea, asthma, different forms of allergy, and respiratory infections was found. No correlation was found between Chronic Obstructive Pulmonary Disease (COPD) and LBP, and no articles were found on the correlation between hyperventilation and LBP. CONCLUSIONS This is the first study providing an overview of the literature on the relation between LBP and RD. Immunological, biomechanical, psychosocial and socio-economic factors might explain this correlation. Smoking is likely to contribute. Future studies must reveal the causative relationship. LEVEL OF EVIDENCE Therapy, level 2a.
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40
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Ovechkin AV, Sayenko DG, Ovechkina EN, Aslan SC, Pitts T, Folz RJ. Respiratory motor training and neuromuscular plasticity in patients with chronic obstructive pulmonary disease: A pilot study. Respir Physiol Neurobiol 2016; 229:59-64. [PMID: 27137413 PMCID: PMC4887410 DOI: 10.1016/j.resp.2016.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/03/2016] [Accepted: 04/11/2016] [Indexed: 12/29/2022]
Abstract
The objective of this study was to examine the feasibility of a full-scale investigation of the neurophysiological mechanisms of COPD-induced respiratory neuromuscular control deficits. Characterization of respiratory single- and multi-muscle activation patterns using surface electromyography (sEMG) were assessed along with functional measures at baseline and following 21±2 (mean±SD) sessions of respiratory motor training (RMT) performed during a one-month period in four patients with GOLD stage II or III COPD. Pre-training, the individuals with COPD showed significantly increased (p<0.05) overall respiratory muscle activity and disorganized multi-muscle activation patterns in association with lowered spirometrical measures and decreased fast- and slow-twitch fiber activity as compared to healthy controls (N=4). Following RMT, functional and respiratory sEMG activation outcomes during quite breathing and forced expiratory efforts were improved suggesting that functional improvements, induced by task-specific RMT, are evidence respiratory neuromuscular networks re-organization.
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Affiliation(s)
- Alexander V Ovechkin
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | - Dimitry G Sayenko
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, USA
| | - Elena N Ovechkina
- Department of Medicine: Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, Louisville, KY, USA
| | - Sevda C Aslan
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Teresa Pitts
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Rodney J Folz
- Department of Medicine: Division of Pulmonary, Critical Care and Sleep Disorders, University of Louisville, Louisville, KY, USA; Department of Medicine: Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals and Case Western Reserve University, Cleveland, OH, USA
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Chang Y, Bae J, Kim N, Park JY, Lee SM, Seo JB. Three-dimensional quadratic modeling and quantitative evaluation of the diaphragm on a volumetric CT scan in patients with chronic obstructive pulmonary disease. Med Phys 2016; 43:4273. [DOI: 10.1118/1.4953451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Woo SD, Kim TH, Lim JY. The effects of breathing with mainly inspiration or expiration on pulmonary function and chest expansion. J Phys Ther Sci 2016; 28:927-31. [PMID: 27134386 PMCID: PMC4842467 DOI: 10.1589/jpts.28.927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine the effects of inspiration- and
expiration-oriented breathing on pulmonary function and chest expansion. [Subjects and
Methods] Twenty healthy male university students were divided randomly into
inspiration-oriented and expiration-oriented breathing groups. Their pulmonary function
and chest size during inspiration or expiration were evaluated and then re-evaluated after
15 minutes of breathing exercise five times a week for four weeks. [Results] The breathing
with mainly inspiration group (BMIG) showed significant differences in chest size during
inspiration (CSI), chest expansion values (CEVs), forced vital capacity (FVC), forced
expiratory volume in one second (FEV1), and peak expiratory flow (PEF) after
four weeks. The breathing with mainly expiration group (BMEG) showed significant
differences in all measured variables except CSI. Comparison of the groups after exercise
showed that the BMEG demonstrated differences from the BMIG in chest size during
expiration (CSE), CEV, and PEF. Comparison of the changes in variables after exercise
showed that the BMEG demonstrated significantly different changes in CSE, CEV,
FEV1/FVC, and PEF. The BMIG showed a significantly different change in FVC.
[Conclusion] Although both groups demonstrated improvements in pulmonary function and
chest expansion, inter-group differences were observed. Therefore, inspiration- or
expiration-oriented breathing may be recommended differently according to the desired
outcome.
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Affiliation(s)
- Seong-Dae Woo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University: 15 Jillyang, Gyeongsan-si, Gyeongsangbuk-do 712-714, Republic of Korea
| | - Tae-Ho Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University: 15 Jillyang, Gyeongsan-si, Gyeongsangbuk-do 712-714, Republic of Korea
| | - Jin-Yong Lim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University: 15 Jillyang, Gyeongsan-si, Gyeongsangbuk-do 712-714, Republic of Korea
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43
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Diaphragm: A vital respiratory muscle in mammals. Ann Anat 2016; 205:122-7. [PMID: 27045597 DOI: 10.1016/j.aanat.2016.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 11/22/2022]
Abstract
The diaphragm is a respiratory muscle that is primarily responsible for the respiratory function in normal individuals. In mammals, the diaphragm muscle has been studied from the early days of zoology, comparative and experimental anatomy, physiology, medicine, physics, and philosophy. However, even with these early advances in knowledge pertaining to the diaphragm, comprehensive morphological data on the diaphragm are still incomplete. In this review, we summarize the beginnings of the morphological description of the diaphragm, and we describe the current status of the known morphological and embryological features. In addition, we correlate how the impairment of the diaphragm muscle in Duchenne muscular dystrophy (DMD) can lead to patient deaths. DMD is the most common X-linked muscle degenerative disease and is caused by a lack of dystrophin protein. Dystrophin is an important muscle protein that links the cellular cytoskeleton with the extracellular matrix. In the absence of dystrophin, the muscle becomes susceptible to damage during muscle contraction. This review allows researchers to obtain an overview of the diaphragm, transcending the morphological data from animals described in conventional literature.
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Kang JI, Jeong DK, Choi H. The effects of breathing exercise types on respiratory muscle activity and body function in patients with mild chronic obstructive pulmonary disease. J Phys Ther Sci 2016; 28:500-5. [PMID: 27064889 PMCID: PMC4792999 DOI: 10.1589/jpts.28.500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/31/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Fragmentary studies on characteristics of respiratory muscles are being done to
increase respiratory capacity by classifying exercises into voluntary respiratory exercise
which relieves symptoms and prevents COPD and exercise using breathing exercise equipment.
But this study found changes on respiratory pattern through changes on the activity
pattern of agonist and synergist respiratory muscles and studied what effect they can have
on body function improvement. [Subjects and Methods] Fifteen subjects in experimental
group I that respiratory exercise of diaphragm and 15 subjects in experimental group II
that feedback respiratory exercise were randomly selected among COPD patients to find the
effective intervention method for COPD patients. And intervention program was conducted
for 5 weeks, three times a week, once a day and 30 minutes a session. They were measured
with BODE index using respiratory muscle activity, pulmonary function, the six-minute
walking test, dyspnea criteria and BMI Then the results obtained were compared and
analyzed. [Results] There was a significant difference in sternocleidomastoid muscle and
scalene muscle and in 6-minute walk and BODE index for body function. Thus the group
performing feedback respiratory had more effective results for mild COPD patients.
[Conclusion] Therefore, the improvement was significant regarding the activity of
respiratory muscles synergists when breathing before doing breathing exercise. Although,
it is valuable to reduce too much mobilization of respiratory muscles synergists through
the proper intervention it is necessary to study body function regarding improvement of
respiratory function for patients with COPD.
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Affiliation(s)
- Jeong-Il Kang
- Department of Physical Therapy, Sehan University, Republic of Korea
| | - Dae-Keun Jeong
- Department of Physical Therapy, Sehan University, Republic of Korea
| | - Hyun Choi
- Department of Physical Therapy, Mokpo Mirae Hosipital, Republic of Korea
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Tselebis A, Pachi A, Ilias I, Kosmas E, Bratis D, Moussas G, Tzanakis N. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatr Dis Treat 2016; 12:297-328. [PMID: 26929625 PMCID: PMC4755471 DOI: 10.2147/ndt.s79354] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms. Worldwide, the incidence of COPD presents a disturbing continuous increase. Anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative. Pharmacological treatment based on selective serotonin reuptake inhibitors has almost replaced tricyclic antidepressants. The main psychological intervention is cognitive behavioral therapy. Of particular interest are pulmonary rehabilitation programs, which can reduce anxiety and depressive symptoms in these patients. Although the literature on treating anxiety and depression in patients with COPD is limited, we believe that it points to the implementation of personalized strategies to address their psychopathological comorbidities.
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Affiliation(s)
- Athanasios Tselebis
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Argyro Pachi
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Ioannis Ilias
- Endocrinology Department, “Elena Venizelou” Hospital, Athens, Greece
| | | | - Dionisios Bratis
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Georgios Moussas
- Psychiatric Department, “Sotiria” General Hospital of Chest Disease, Athens, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University of Crete Medical School, Heraklion, Greece
- Social Medicine, Laboratory of Epidemiology, University of Crete Medical School, Heraklion, Greece
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Sarlabous L, Torres A, Fiz JA, Gea J, Martínez-Llorens JM, Jané R. Efficiency of mechanical activation of inspiratory muscles in COPD using sample entropy. Eur Respir J 2015; 46:1808-11. [PMID: 26493808 DOI: 10.1183/13993003.00434-2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/22/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Leonardo Sarlabous
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona, Spain CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Abel Torres
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona, Spain CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain Dept ESAII, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - José A Fiz
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona, Spain CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain Dept of Pulmonology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Joaquim Gea
- Respiratory Medicine Dept, Hospital del Mar - IMIM. DCEXS, UPF. CIBERES, ISCiii, Barcelona, Spain
| | - Juana M Martínez-Llorens
- Respiratory Medicine Dept, Hospital del Mar - IMIM. DCEXS, UPF. CIBERES, ISCiii, Barcelona, Spain
| | - Raimon Jané
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona, Spain CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain Dept ESAII, Universitat Politècnica de Catalunya, Barcelona, Spain
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47
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O’Donnell DE, Webb KA, Neder JA. Lung hyperinflation in COPD: applying physiology to clinical practice. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40749-015-0008-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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48
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When obesity and chronic obstructive pulmonary disease collide. Physiological and clinical consequences. Ann Am Thorac Soc 2015; 11:635-44. [PMID: 24625243 DOI: 10.1513/annalsats.201312-438fr] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In many parts of the world, the prevalence of both chronic obstructive pulmonary disease (COPD) and obesity is increasing at an alarming rate. Such patients tend to have greater respiratory symptoms, more severe restriction of daily activities, poorer health-related quality of life, and greater health care use than their nonobese counterparts. Physiologically, increasing weight gain is associated with lung volume reduction effects in both health and disease, and this should be considered when interpreting common pulmonary function tests where lung volume is the denominator, such as FEV1/FVC and the ratio of diffusing capacity of carbon monoxide to alveolar volume, or indeed when evaluating the physiological consequences of emphysema in obese individuals. Contrary to expectation, the presence of mild to moderate obesity in COPD appears to have little deleterious effect on respiratory mechanics and muscle function, exertional dyspnea, and peak symptom-limited oxygen uptake during cardiopulmonary exercise testing. Thus, in evaluating obese patients with COPD reporting activity restriction, additional nonpulmonary factors, such as increased metabolic loading, cardiocirculatory impairment, and musculoskeletal abnormalities, should be considered. Care should be taken to recognize the presence of obstructive sleep apnea in obese patients with COPD, as effective treatment of the former condition likely conveys an important survival advantage. Finally, morbid obesity in COPD presents significant challenges to effective management, given the combined effects of erosion of the ventilatory reserve and serious metabolic and cardiovascular comorbidities that collectively predispose to an increased risk of death from respiratory failure.
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Abstract
COPD is characterized by airflow limitation that is not fully reversible. The morphological basis for airflow obstruction results from a varying combination of obstructive changes in peripheral conducting airways and destructive changes in respiratory bronchioles, alveolar ducts, and alveoli. A reduction of vascularity within the alveolar septa has been reported in emphysema. Typical physiological changes reflect these structural abnormalities. Spirometry documents airflow obstruction when the FEV1/FVC ratio is reduced below the lower limit of normality, although in early disease stages FEV1 and airway conductance are not affected. Current guidelines recommend testing for bronchoreversibility at least once and the postbronchodilator FEV1/FVC be used for COPD diagnosis; the nature of bronchodilator response remains controversial, however. One major functional consequence of altered lung mechanics is lung hyperinflation. FRC may increase as a result of static or dynamic mechanisms, or both. The link between dynamic lung hyperinflation and expiratory flow limitation during tidal breathing has been demonstrated. Hyperinflation may increase the load on inspiratory muscles, with resulting length adaptation of diaphragm. Reduction of exercise tolerance is frequently noted, with compelling evidence that breathlessness and altered lung mechanics play a major role. Lung function measurements have been traditionally used as prognostic indices and to monitor disease progression; FEV1 has been most widely used. An increase in FVC is also considered as proof of bronchodilatation. Decades of work has provided insight into the histological, functional, and biological features of COPD. This has provided a clearer understanding of important pathobiological processes and has provided additional therapeutic options.
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50
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Kuhlman DR, Khuder SA, Lane RD. Factors influencing the diameter of human anterior and posterior intercostal arteries. Clin Anat 2014; 28:219-26. [PMID: 25220637 DOI: 10.1002/ca.22460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/14/2014] [Accepted: 08/16/2014] [Indexed: 12/25/2022]
Abstract
At present, there have not been any detailed studies examining the size relationships of the intercostal arteries. This study was carried out to investigate the relationship between the vessel lumenal diameter of ipsilateral, paired anterior and posterior IC arteries, as well as with the length of the IC space supplied by each artery. Samples were collected from the second-sixth anterior and posterior IC arteries near their site of origin, and the lengths of the corresponding IC spaces were measured in 42 cadavers. Lumenal diameters of both the anterior and posterior IC arteries at consecutive IC space closely followed second degree polynomial regression models (R(2) = 0.9655, and R(2) = 0.9741, respectively), and reached maximum size at the fifth IC space, which was found to be the longest of the IC spaces. No direct relationship was observed between diameters of the paired anterior and posterior IC arteries, although there was a trend for the larger anterior IC arteries to be paired with the larger posterior IC arteries. The calculated rate of blood flow at each IC artery was approximately two-fold greater in males than in females. These results suggest that the length of the IC space, and hence the extent of the thoracic wall supplied, is a major factor in determining the diameter of both anterior and posterior IC arteries. Since COPD is such a prevalent disease, this study also examined its influence on the IC arteries, and found that the posterior IC arteries are significantly larger among afflicted subjects.
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Affiliation(s)
- David R Kuhlman
- Department of Neurosciences, University of Toledo, College of Medicine, Toledo, Ohio
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