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Ferguson ON, Mitchell RA, Schaeffer MR, Ramsook AH, Boyle KGPJM, Dhillon SS, Zhang J, Hind AS, Jensen D, Guenette JA. Physiological Factors Associated with Unsatisfied Inspiration at Peak Exercise in Healthy Adults. Med Sci Sports Exerc 2024; 56:1488-1494. [PMID: 38547388 DOI: 10.1249/mss.0000000000003437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Contrary to common belief, a growing body of evidence suggests that unsatisfied inspiration (UI), an inherently uncomfortable quality of dyspnea, is experienced by ostensibly healthy adults during high-intensity exercise. Based on our understanding of the mechanisms of UI among people with chronic respiratory conditions, this analysis tested the hypothesis that the experience of UI at peak exercise in young, healthy adults reflects the combination of high ventilatory demand and critical inspiratory constraints. METHODS In a retrospective analysis design, data included 321 healthy individuals (129 females) aged 25 ± 5 yr. Data were collected during one visit to the laboratory, which included anthropometrics, spirometry, and an incremental cardiopulmonary cycling test to exhaustion. Metabolic and cardiorespiratory variables were measured at peak exercise, and qualitative descriptors of dyspnea at peak exercise were assessed using a list of 15 descriptor phrases. RESULTS Thirty-four percent of participants ( n = 109) reported sensations of UI at peak exercise. Compared with the non-UI group, the UI group achieved a significantly higher peak work rate (243 ± 77 vs 235 ± 69 W, P = 0.016, d = 0.10), rate of O 2 consumption (3.32 ± 1.02 vs 3.27 ± 0.96 L·min -1 , P = 0.018, d = 0.05), minute ventilation (120 ± 38 vs 116 ± 35 L·min -1 , P = 0.047, d = 0.11), and breathing frequency (50 ± 9 vs 47 ± 9 breaths per minute, P = 0.014, d = 0.33), while having a lower exercise-induced change (peak-baseline) in inspiratory capacity (0.07 ± 0.41 vs 0.20 ± 0.49 L, P = 0.023, d = 0.29). The inspiratory reserve volume to minute ventilation ratio at peak exercise was also lower in the UI versus non-UI group. Dyspnea intensity and unpleasantness ratings were significantly higher in the UI versus non-UI group at peak exercise (both P < 0.001). CONCLUSIONS Healthy individuals reporting UI at peak exercise have relatively greater inspiratory constraints compared with those who do not select UI.
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Affiliation(s)
| | | | | | | | | | - Satvir S Dhillon
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, BC, CANADA
| | - Julia Zhang
- Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St. Paul's Hospital, Vancouver, BC, CANADA
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Smyth RM, James MD, Vincent SG, Milne KM, Marillier M, Domnik NJ, Parker CM, de-Torres JP, Moran-Mendoza O, Phillips DB, O'Donnell DE, Neder JA. Systemic Determinants of Exercise Intolerance in Patients With Fibrotic Interstitial Lung Disease and Severely Impaired D LCO. Respir Care 2023; 68:1662-1674. [PMID: 37643871 PMCID: PMC10676244 DOI: 10.4187/respcare.11147] [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: 08/31/2023]
Abstract
BACKGROUND The precise mechanisms driving poor exercise tolerance in patients with fibrotic interstitial lung diseases (fibrotic ILDs) showing a severe impairment in single-breath lung diffusing capacity for carbon monoxide (DLCO < 40% predicted) are not fully understood. Rather than only reflecting impaired O2 transfer, a severely impaired DLCO may signal deranged integrative physiologic adjustments to exercise that jointly increase the burden of exertional symptoms in fibrotic ILD. METHODS Sixty-seven subjects (46 with idiopathic pulmonary fibrosis, 24 showing DLCO < 40%) and 22 controls underwent pulmonary function tests and an incremental cardiopulmonary exercise test with serial measurements of operating lung volumes and 0-10 Borg dyspnea and leg discomfort scores. RESULTS Subjects from the DLCO < 40% group showed lower spirometric values, more severe restriction, and lower alveolar volume and transfer coefficient compared to controls and participants with less impaired DLCO (P < .05). Peak work rate was ∼45% (vs controls) and ∼20% (vs DLCO > 40%) lower in the former group, being associated with lower (and flatter) O2 pulse, an earlier lactate (anaerobic) threshold, heightened submaximal ventilation, and lower SpO2 . Moreover, critically high inspiratory constrains were reached at lower exercise intensities in the DLCO < 40% group (P < .05). In association with the greatest leg discomfort scores, they reported the highest dyspnea scores at a given work rate. Between-group differences lessened or disappeared when dyspnea intensity was related to indexes of increased demand-capacity imbalance, that is, decreasing submaximal, dynamic ventilatory reserve, and inspiratory reserve volume/total lung capacity (P > .05). CONCLUSIONS A severely reduced DLCO in fibrotic ILD signals multiple interconnected derangements (cardiovascular impairment, an early shift to anaerobic metabolism, excess ventilation, inspiratory constraints, and hypoxemia) that ultimately lead to limiting respiratory (dyspnea) and peripheral (leg discomfort) symptoms. DLCO < 40%, therefore, might help in clinical decision-making to indicate the patient with fibrotic ILD who might derive particular benefit from pharmacologic and non-pharmacologic interventions aimed at lessening these systemic abnormalities.
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Affiliation(s)
- Reginald M Smyth
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Kathryn M Milne
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mathieu Marillier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and Department of Biomedical and Molecular Sciences and Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Parker
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Juan P de-Torres
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and Pulmonary Department, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Navarra, Spain
| | - Onofre Moran-Mendoza
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada.
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Burt JS, Davenport MP, Welch JF, Davenport PW. fNIRS analysis of rostral prefrontal cortex activity and perception of inspiratory loads. Respir Physiol Neurobiol 2023; 316:104113. [PMID: 37442516 DOI: 10.1016/j.resp.2023.104113] [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: 02/21/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 07/15/2023]
Abstract
It is well-established that the brainstem is responsible for the automatic control of breathing, however, cortical areas control perception and conscious breathing. This study investigated activity in the prefrontal cortex (PFC) during breathing difficulty using functional near-infrared spectroscopy (fNIRS). It was hypothesized that extrinsic inspiratory loads will elicit regional changes in PFC activity and increased perception ratings, as a function of load magnitude and type. Participants were exposed to varying magnitudes of resistive (R) and pressure threshold (PT) inspiratory loads to increase breathing effort. Perception ratings of breathing effort and load magnitude were positively correlated (p < 0.05). PT loads were rated more effortful than R loads (p < 0.05). Differences in perceived effort were a function of inspiratory pressure-time-product (PTP) and inspiratory work of breathing (WoB). PFC activity increased with the largest PT load (p < 0.01), suggesting that the PFC is involved in processing respiratory stimuli. The results support the hypothesis that the PFC is an element of the neural network mediating effortful breathing perception.
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Affiliation(s)
- Juliana S Burt
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA
| | - Matthew P Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA
| | - Joseph F Welch
- Department of Physical Therapy, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA.
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Decavèle M, Bureau C, Campion S, Nierat MC, Rivals I, Wattiez N, Faure M, Mayaux J, Morawiec E, Raux M, Similowski T, Demoule A. Interventions Relieving Dyspnea in Intubated Patients Show Responsiveness of the Mechanical Ventilation-Respiratory Distress Observation Scale. Am J Respir Crit Care Med 2023; 208:39-48. [PMID: 36973007 DOI: 10.1164/rccm.202301-0188oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
Rationale: Breathing difficulties are highly stressful. In critically ill patients, they are associated with an increased risk of posttraumatic manifestations. Dyspnea, the corresponding symptom, cannot be directly assessed in noncommunicative patients. This difficulty can be circumvented using observation scales such as the mechanical ventilation-respiratory distress observation scale (MV-RDOS). Objective: To investigate the performance and responsiveness of the MV-RDOS to infer dyspnea in noncommunicative intubated patients. Methods: Communicative and noncommunicative patients exhibiting breathing difficulties under mechanical ventilation were prospectively included and assessed using a dyspnea visual analog scale, MV-RDOS, EMG activity of alae nasi and parasternal intercostals, and EEG signatures of respiratory-related cortical activation (preinspiratory potentials). Inspiratory-muscle EMG and preinspiratory cortical activities are surrogates of dyspnea. Assessments were conducted at baseline, after adjustment of ventilator settings, and, in some cases, after morphine administration. Measurements and Main Results: Fifty patients (age, 67 [(interquartile interval [IQR]), 61-76] yr; Simplified Acute Physiology Score II, 52 [IQR, 35-62]) were included, 25 of whom were noncommunicative. Relief occurred in 25 (50%) patients after ventilator adjustments and in 21 additional patients after morphine administration. In noncommunicative patients, MV-RDOS score decreased from 5.5 (IQR, 4.2-6.6) at baseline to 4.2 (IQR, 2.1-4.7; P < 0.001) after ventilator adjustments and 2.5 (IQR, 2.1-4.2; P = 0.024) after morphine administration. MV-RDOS and alae nasi/parasternal EMG activities were positively correlated (ρ = 0.41 and 0.37, respectively). MV-RDOS scores were higher in patients with EEG preinspiratory potentials (4.9 [IQR, 4.2-6.3] vs. 4.0 [IQR, 2.1-4.9]; P = 0.002). Conclusions: The MV-RDOS seems able to detect and monitor respiratory symptoms reasonably well in noncommunicative intubated patients. Clinical trial registered with www.clinicaltrials.gov (NCT02801838).
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Affiliation(s)
- Maxens Decavèle
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Service de Médecine Intensive et Réanimation (Département R3S) and
| | - Côme Bureau
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Service de Médecine Intensive et Réanimation (Département R3S) and
| | - Sébastien Campion
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Département d'Anesthésie Réanimation, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, site Pitié-Salpêtrière, Paris, France; and
| | - Marie-Cécile Nierat
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Isabelle Rivals
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Equipe de Statistique Appliquée, Ecole Supérieure de Physique et de Chimie Industrielles Paris, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Nicolas Wattiez
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Morgane Faure
- Service de Médecine Intensive et Réanimation (Département R3S) and
| | - Julien Mayaux
- Service de Médecine Intensive et Réanimation (Département R3S) and
| | - Elise Morawiec
- Service de Médecine Intensive et Réanimation (Département R3S) and
| | - Mathieu Raux
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Département d'Anesthésie Réanimation, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, site Pitié-Salpêtrière, Paris, France; and
| | - Thomas Similowski
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Département d'Anesthésie Réanimation, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, site Pitié-Salpêtrière, Paris, France; and
| | - Alexandre Demoule
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Service de Médecine Intensive et Réanimation (Département R3S) and
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Smyth RM, Neder JA, James MD, Vincent SG, Milne KM, Marillier M, de-Torres JP, Moran-Mendoza O, O'Donnell DE, Phillips DB. Physiological underpinnings of exertional dyspnoea in mild fibrosing interstitial lung disease. Respir Physiol Neurobiol 2023; 312:104041. [PMID: 36858334 DOI: 10.1016/j.resp.2023.104041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/20/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
The functional disturbances driving "out-of-proportion" dyspnoea in patients with fibrosing interstitial lung disease (f-ILD) showing only mild restrictive abnormalities remain poorly understood. Eighteen patients (10 with idiopathic pulmonary fibrosis) showing preserved spirometry and mildly reduced total lung capacity (≥70% predicted) and 18 controls underwent an incremental cardiopulmonary exercise test with measurements of operating lung volumes and Borg dyspnoea scores. Patients' lower exercise tolerance was associated with higher ventilation (V̇E)/carbon dioxide (V̇CO2) compared with controls (V̇E/V̇CO2 nadir=35 ± 3 versus 29 ± 2; p < 0.001). Patients showed higher tidal volume/inspiratory capacity and lower inspiratory reserve volume at a given exercise intensity, reporting higher dyspnoea scores as a function of both work rate and V̇E. Steeper dyspnoea-work rate slopes were associated with lower lung diffusing capacity, higher V̇E/V̇CO2, and lower peak O2 uptake (p < 0.05). Heightened ventilatory demands in the setting of progressively lower capacity for tidal volume expansion on exertion largely explain higher-than-expected dyspnoea in f-ILD patients with largely preserved dynamic and "static" lung volumes at rest.
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Affiliation(s)
- Reginald M Smyth
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - J Alberto Neder
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Matthew D James
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Sandra G Vincent
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Kathryn M Milne
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada; Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
| | - Mathieu Marillier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France.
| | - Juan P de-Torres
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Onofre Moran-Mendoza
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Denis E O'Donnell
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Devin B Phillips
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
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6
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Nicolò A, Sacchetti M. Differential control of respiratory frequency and tidal volume during exercise. Eur J Appl Physiol 2023; 123:215-242. [PMID: 36326866 DOI: 10.1007/s00421-022-05077-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
The lack of a testable model explaining how ventilation is regulated in different exercise conditions has been repeatedly acknowledged in the field of exercise physiology. Yet, this issue contrasts with the abundance of insightful findings produced over the last century and calls for the adoption of new integrative perspectives. In this review, we provide a methodological approach supporting the importance of producing a set of evidence by evaluating different studies together-especially those conducted in 'real' exercise conditions-instead of single studies separately. We show how the collective assessment of findings from three domains and three levels of observation support the development of a simple model of ventilatory control which proves to be effective in different exercise protocols, populations and experimental interventions. The main feature of the model is the differential control of respiratory frequency (fR) and tidal volume (VT); fR is primarily modulated by central command (especially during high-intensity exercise) and muscle afferent feedback (especially during moderate exercise) whereas VT by metabolic inputs. Furthermore, VT appears to be fine-tuned based on fR levels to match alveolar ventilation with metabolic requirements in different intensity domains, and even at a breath-by-breath level. This model reconciles the classical neuro-humoral theory with apparently contrasting findings by leveraging on the emerging control properties of the behavioural (i.e. fR) and metabolic (i.e. VT) components of minute ventilation. The integrative approach presented is expected to help in the design and interpretation of future studies on the control of fR and VT during exercise.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135, Rome, Italy.
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135, Rome, Italy
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James MD, Phillips DB, Vincent SG, Abdallah SJ, Donovan AA, de-Torres JP, Neder JA, Smith BM, Jensen D, O'Donnell DE. Exertional dyspnoea in patients with mild-to-severe chronic obstructive pulmonary disease (COPD): Neuromechanical mechanisms. J Physiol 2022; 600:4227-4245. [PMID: 35861594 DOI: 10.1113/jp283252] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Dyspnoea during exercise is a common and troublesome symptom reported by patients with chronic obstructive pulmonary disease (COPD) and is linked to an elevated inspiratory neural drive (IND). The precise mechanisms of elevated IND and dyspnoea across the continuum of airflow obstruction severity in COPD remains unclear. The present study sought to determine the mechanisms of elevated IND [by diaphragm EMG, EMGdi (%max)] and dyspnoea during cardiopulmonary exercise testing (CPET) across the continuum of COPD severity. There was a strong association between increasing dyspnoea intensity and EMGdi (%max) during CPET across the COPD continuum despite significant heterogeneity in underlying pulmonary gas exchange and respiratory mechanical impairments. Critical inspiratory constraints occurred at progressively lower ventilation during exercise with worsening severity of COPD. This was associated with the progressively lower resting inspiratory capacity with worsening disease severity. Earlier critical inspiratory constraint was associated with earlier neuromechanical dissociation and greater likelihood of reporting the sensation of 'unsatisfied inspiration'. ABSTRACT In patients with COPD, exertional dyspnoea generally arises when there is imbalance between ventilatory demand and capacity, but the neurophysiological mechanisms are unclear. We therefore determined if disparity between elevated inspiratory neural drive (IND) and tidal volume (VT ) responses (neuromechanical dissociation) impacted dyspnoea intensity and quality during exercise, across the COPD severity spectrum. In this two-centre, cross-sectional observational study, 89 participants with COPD divided into tertiles of FEV1 %predicted (Tertile 1 = FEV1 = 87 ± 9%, Tertile 2 = 60 ± 9%, Tertile 3 = 32 ± 8%) and 18 non-smoking controls, completed a symptom-limited cardiopulmonary exercise tests (CPET) with measurement of IND by diaphragm electromyography [EMGdi (%max)]. The association between increasing dyspnoea intensity and EMGdi (%max) during CPET was strong (r = 0.730, P < 0.001) and not different between the four groups who showed marked heterogeneity in pulmonary gas exchange and mechanical abnormalities. Significant inspiratory constraints (tidal volume/inspiratory capacity (VT /IC) ≥ 70%) and onset of neuromechanical dissociation (EMGdi (%max):VT /IC > 0.75) occurred at progressively lower V̇E from Control to Tertile 3. Lower resting IC meant earlier onset of neuromechanical dissociation, heightened dyspnoea intensity and greater propensity (93% in Tertile 3) to select qualitative descriptors of 'unsatisfied inspiration'. We concluded that, regardless of marked variation in mechanical and pulmonary gas exchange abnormalities in our study sample, exertional dyspnoea intensity was linked to the magnitude of EMGdi (%max). Moreover, onset of critical inspiratory constraints and attendant neuromechanical dissociation amplified dyspnoea intensity at higher exercise intensities. Simple measurements of IC and breathing pattern during CPET provide useful insights into mechanisms of dyspnoea and exercise intolerance in individuals with COPD. Abstract figure legend As chronic obstructive pulmonary disease severity increases, worsening gas exchange and respiratory mechanical impairment causes increased afferent receptor stimulation, increasing inspiratory neural drive at a given ventilation. The widening disparity between progressively greater inspiratory neural drive and reduced ventilatory output causes, 'neuromechanical dissociation'. This is strongly associated with a rapid increase in the intensity of dyspnea during exercise, and the onset of the sensation of 'unsatisfied inspiration'. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Sara J Abdallah
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Quebec, Canada.,Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Adamo A Donovan
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Juan P de-Torres
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Benjamin M Smith
- Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Quebec, Canada.,Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
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- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
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8
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Mitrouska I, Bolaki M, Vaporidi K, Georgopoulos D. Respiratory system as the main determinant of dyspnea in patients with pulmonary hypertension. Pulm Circ 2022; 12:e12060. [PMID: 35506092 PMCID: PMC9053013 DOI: 10.1002/pul2.12060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
Dyspnea on exertion is a devastating symptom, commonly observed in patients with pulmonary hypertension (PH). The pathophysiology of dyspnea in these patients has been mainly attributed to cardiovascular determinants and isolated abnormalities of the respiratory system during exercise, neglecting the contribution of the control of the breathing system. The aim of this review is to provide a novel approach to the interpretation of dyspnea in patients with PH, focused on the impact of the control of the breathing system during exercise. Exercise through multiple mechanisms affects the (1) ventilatory demands, as dictated by respiratory center activity, (2) actual ventilation, and (3) metabolic hyperbola. In patients with PH, exertional dyspnea can be explained by exercise-induced alterations in these variables. Compared to healthy subjects, at a given CO2 production during exercise, ventilatory demands in patients with PH are higher due to metabolic acidosis (early reaching the anaerobic threshold), hypoxemia, and excessive upward movement of metabolic hyperbola owing to abnormal exercise response of dead space to tidal volume ratio. Simultaneously, dynamic hyperinflation and respiratory muscles weakness decreases the actual ventilation for a given respiratory center activity, creating a dissociation between demands and ventilation. Consequently, a progressive increase in ventilatory demands and respiratory center activity occurs during exercise. The forebrain projection of high respiratory center activity causes exertional dyspnea despite the relatively low ventilation and significant ventilatory reserve. This type of analysis suggests that the respiratory system is the main determinant of exertional dyspnea in patients with PH, with the cardiovascular system being an indirect contributor.
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Affiliation(s)
- Ioanna Mitrouska
- Department of Pulmonary Medicine, University Hospital of Heraklion, Medical SchoolUniversity of CreteHeraklionCreteGreece
| | - Maria Bolaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical SchoolUniversity of CreteHeraklionCreteGreece
| | - Katerina Vaporidi
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical SchoolUniversity of CreteHeraklionCreteGreece
| | - Dimitris Georgopoulos
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical SchoolUniversity of CreteHeraklionCreteGreece
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Regnard J, Veil-Picard M, Bouhaddi M, Castagna O. A neoprene vest hastens dyspnoea and leg fatigue during exercise testing: entangled breathing and cardiac hindrance? Diving Hyperb Med 2021; 51:376-381. [PMID: 34897604 PMCID: PMC8920901 DOI: 10.28920/dhm51.4.376-381] [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: 02/15/2021] [Accepted: 09/24/2021] [Indexed: 11/05/2022]
Abstract
Symptoms and contributing factors of immersion pulmonary oedema (IPO) are not observed during non-immersed heart and lung function assessments. We report a case in which intense snorkelling led to IPO, which was subsequently investigated by duplicating cardiopulmonary exercise testing with (neoprene vest test - NVT) and without (standard test - ST) the wearing of a neoprene vest. The two trials utilised the same incremental cycling exercise protocol. The vest hastened the occurrence and intensity of dyspnoea and leg fatigue (Borg scales) and led to an earlier interruption of effort. Minute ventilation and breathing frequency rose faster in the NVT, while systolic blood pressure and pulse pressure were lower than in the ST. These observations suggest that restrictive loading of inspiratory work caused a faster rise of intensity and unpleasant sensations while possibly promoting pulmonary congestion, heart filling impairment and lowering blood flow to the exercising muscles. The subject reported sensations close to those of the immersed event in the NVT. These observations may indicate that increased external inspiratory loading imposed by a tight vest during immersion could contribute to pathophysiological events.
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Affiliation(s)
- Jacques Regnard
- University Hospitals Dept of Physiology, EA3920 University of Bourgogne Franche Comté, Besançon, France
- Corresponding author: Dr Jacques Regnard, University Hospitals Dept of Physiology, EA3920 University of Bourgogne Franche Comté, Besançon, 25000, France,
| | | | - Malika Bouhaddi
- University Hospitals Dept of Physiology, EA3920 University of Bourgogne Franche Comté, Besançon, France
| | - Olivier Castagna
- Underwater Research Team (ERRSO), Military Biomedical Research Institute, Toulon, France
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10
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Akoumianaki E, Vaporidi K, Bolaki M, Georgopoulos D. Happy or Silent Hypoxia in COVID-19-A Misnomer Born in the Pandemic Era. Front Physiol 2021; 12:745634. [PMID: 34733177 PMCID: PMC8558242 DOI: 10.3389/fphys.2021.745634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Evangelia Akoumianaki
- Department of Intensive Care, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Katerina Vaporidi
- Department of Intensive Care, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Maria Bolaki
- Department of Intensive Care, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Dimitris Georgopoulos
- Department of Intensive Care, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece
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11
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Niro F, Dubuc B, Gaynor-Sodeifi K, Jensen D. Effect of end-inspiratory lung volume and breathing pattern on neural activation of the diaphragm and extra-diaphragmatic inspiratory muscles in healthy adults. J Appl Physiol (1985) 2021; 131:1679-1690. [PMID: 34734781 DOI: 10.1152/japplphysiol.01118.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the effect of changes in end-inspiratory lung volume (EILV) and breathing pattern on neural activation of the crural diaphragm (EMGDIA) and of the sternocleidomastoid (EMGSCM), scalene (EMGSCA) and external intercostal muscles (EMGINT) at constant ventilation (V̇E). Twelve healthy adults performed a series of 30-sec breathing trials at a constant V̇E corresponding to 15% of their maximum voluntary ventilation while (i) altering EILV at a constant breathing pattern and (ii) altering breathing pattern at a constant EILV. Using a real-time visual display of each participant's spirogram, EILV was voluntarily targeted at 65% (EILV65%), 75% (EILV75%), 85% (EILV85%) and 95% (EILV95%) of each participant's inspired vital capacity, while breathing frequency (fR) was targeted at 15, 35 and 50 breaths/min using a metronome. The tidal volume needed for a participant to maintain V̇E constant across trials was achieved via changes in end-expiratory lung volume. A multipair esophageal electrode catheter was used to record EMGDIA, while surface electrodes were used to record EMGSCM, EMGSCA and EMGINT. On average, EMGDIA, EMGSCM, EMGSCA and EMGINT increased as a function of increasing EILV at constant V̇E, independent of changes in breathing pattern. The magnitudes of these increases were particularly notable in the transition from EILV85% to EILV95%, especially for EMGSCM and EMGSCA. In healthy adults, as EILV increases towards total lung capacity, progressive compensatory increases in neural activation of the diaphragm and extra-diaphragmatic inspiratory muscles are needed to support V̇E, independent of changes in breathing pattern.
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Affiliation(s)
- Frank Niro
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Benjamin Dubuc
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Kaveh Gaynor-Sodeifi
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montreal, Quebec, Canada.,Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Quebec, Canada
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12
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Tiller NB, Cao M, Lin F, Yuan W, Wang CY, Abbasi A, Calmelat R, Soriano A, Rossiter HB, Casaburi R, Stringer WW, Porszasz J. Dynamic airway function during exercise in COPD assessed via impulse oscillometry before and after inhaled bronchodilators. J Appl Physiol (1985) 2021; 131:326-338. [PMID: 34013748 PMCID: PMC8325613 DOI: 10.1152/japplphysiol.00148.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/21/2023] Open
Abstract
Assessing airway function during exercise provides useful information regarding mechanical properties of the airways and the extent of ventilatory limitation in COPD. The primary aim of this study was to use impulse oscillometry (IOS) to assess dynamic changes in airway impedance across a range of exercise intensities in patients with GOLD 1-4, before and after albuterol administration. A secondary aim was to assess the reproducibility of IOS measures during exercise. Fifteen patients with COPD (8 males/7 females; age = 66 ± 8 yr; prebronchodilator FEV1 = 54.3 ± 23.6%Pred) performed incremental cycle ergometry before and 90 min after inhaled albuterol. Pulmonary ventilation and gas exchange were measured continuously, and IOS-derived indices of airway impedance were measured every 2 min immediately preceding inspiratory capacity maneuvers. Test-retest reproducibility of exercise IOS was assessed as mean difference between replicate tests in five healthy subjects (3 males/2 females). At rest and during incremental exercise, albuterol significantly increased airway reactance (X5) and decreased airway resistance (R5, R5-R20), impedance (Z5), and end-expiratory lung volume (60% ± 12% vs. 58% ± 12% TLC, main effect P = 0.003). At peak exercise, there were moderate-to-strong associations between IOS variables and IC, and between IOS variables and concavity in the expiratory limb of the spontaneous flow-volume curve. Exercise IOS exhibited moderate reproducibility in healthy subjects which was strongest with R5 (mean diff. = -0.01 ± 0.05 kPa/L/s; ICC = 0.68), R5-R20 (mean diff. = -0.004 ± 0.028 kPa/L/s; ICC = 0.65), and Z5 (mean diff. = -0.006 ± 0.021 kPa/L/s; ICC = 0.69). In patients with COPD, exercise evoked increases in airway resistance and decreases in reactance that were ameliorated by inhaled bronchodilators. The technique of exercise IOS may aid in the clinical assessment of dynamic airway function during exercise.NEW & NOTEWORTHY This study provides a novel, mechanistic insight into dynamic airway function during exercise in COPD, before and after inhaled bronchodilators. The use of impulse oscillometry (IOS) to evaluate airway function is unique among exercise studies. We show strong correlations among IOS variables, dynamic hyperinflation, and shape-changes in the spontaneous expiratory flow-volume curve. This approach may aid in the clinical assessment of airway function during exercise.
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Affiliation(s)
- Nicholas B Tiller
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Min Cao
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Respiratory and Critical Care Medicine, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fang Lin
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Respiratory, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Yuan
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Respiratory, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chu-Yi Wang
- Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California
| | - Asghar Abbasi
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Robert Calmelat
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - April Soriano
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Harry B Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - William W Stringer
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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13
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Broad individual immersion-scattering of respiratory compliance likely substantiates dissimilar breathing mechanics. Sci Rep 2021; 11:9434. [PMID: 33941815 PMCID: PMC8093428 DOI: 10.1038/s41598-021-88925-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Head-out water immersion alters respiratory compliance which underpins defining pressure at a “Lung centroid” and the breathing “Static Lung Load”. In diving medicine as in designing dive-breathing devices a single value of lung centroid pressure is presumed as everyone’s standard. On the contrary, we considered that immersed respiratory compliance is disparate among a homogenous adult group (young, healthy, sporty). We wanted to substantiate this ample scattering for two reasons: (i) it may question the European standard used in designing dive-breathing devices; (ii) it may contribute to understand the diverse individual figures of immersed work of breathing. Resting spirometric measurements of lung volumes and the pressure–volume curve of the respiratory system were assessed for 18 subjects in two body positions (upright Up, and supine Sup). Measurements were taken in air (Air) and with subjects immersed up to the sternal notch (Imm). Compliance of the respiratory system (Crs) was calculated from pressure–volume curves for each condition. A median 60.45% reduction in Crs was recorded between Up-Air and Up-Imm (1.68 vs 0.66 L/kPa), with individual reductions ranging from 16.8 to 82.7%. We hypothesize that the previously disregarded scattering of immersion-reduced respiratory compliance might participate to substantial differences in immersed work of breathing.
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14
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Archiza B, Leahy MG, Kipp S, Sheel AW. An integrative approach to the pulmonary physiology of exercise: when does biological sex matter? Eur J Appl Physiol 2021; 121:2377-2391. [PMID: 33903937 DOI: 10.1007/s00421-021-04690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada.
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - Shalaya Kipp
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
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15
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Albarrati A, Taher M, Nazer R. Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial. J Diabetes 2021; 13:292-298. [PMID: 33471439 DOI: 10.1111/1753-0407.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is usually associated with respiratory manifestations including inspiratory muscle weakness which affects exercise capacity. The present study aimed to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and exercise capacity in patients with Type 2 diabetes mellitus (T2DM). METHODS This was a randomized controlled trial in patients with type 2 diabetes mellitus with no previous cardiopulmonary or neuromuscular diseases. Patients had no back pain. Patients were randomized into interventional or placebo groups. Sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and six-minute walking test (6MWT) were measured at baseline and 8 weeks post incremental inspiratory muscle training. RESULTS At baseline, interventional and placebo groups were similar in age, body mass index, sex inspiratory muscle strength, and exercise capacity. After 8 weeks of incremental inspiratory muscle training at 40% of MIP, the interventional group had a significant increase in the SNIP (mean difference: 18.5 ± 5.30 cm H2O vs 2.8 ± 4.8 cm H2O) and MIP (mean difference: 19.4 ± 4.3 Vs 5.4 ± 3.6 cm H2O) compared to the placebo group, respectively. The interventional group showed improvement in the 6MWT (mean difference: 70 ± 29 m vs 34 ± 24 m) compared to the placebo group, P < .05. CONCLUSION Incremental inspiratory muscle training increased the diaphragm strength in patients with T2DM and improved exercise capacity.
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Affiliation(s)
- Ali Albarrati
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Taher
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Faculty of Physical Therapy, Cairo University, Egypt
| | - Rakan Nazer
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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16
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Abstract
The sensation that develops as a long breath hold continues is what this article is about. We term this sensation of an urge to breathe "air hunger." Air hunger, a primal sensation, alerts us to a failure to meet an urgent homeostatic need maintaining gas exchange. Anxiety, frustration, and fear evoked by air hunger motivate behavioral actions to address the failure. The unpleasantness and emotional consequences of air hunger make it the most debilitating component of clinical dyspnea, a symptom associated with respiratory, cardiovascular, and metabolic diseases. In most clinical populations studied, air hunger is the predominant form of dyspnea (colloquially, shortness of breath). Most experimental subjects can reliably quantify air hunger using rating scales, that is, there is a consistent relationship between stimulus and rating. Stimuli that increase air hunger include hypercapnia, hypoxia, exercise, and acidosis; tidal expansion of the lungs reduces air hunger. Thus, the defining experimental paradigm to evoke air hunger is to elevate the drive to breathe while mechanically restricting ventilation. Functional brain imaging studies have shown that air hunger activates the insular cortex (an integration center for perceptions related to homeostasis, including pain, food hunger, and thirst), as well as limbic structures involved with anxiety and fear. Although much has been learned about air hunger in the past few decades, much remains to be discovered, such as an accepted method to quantify air hunger in nonhuman animals, fundamental questions about neural mechanisms, and adequate and safe methods to mitigate air hunger in clinical situations. © 2021 American Physiological Society. Compr Physiol 11:1449-1483, 2021.
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Affiliation(s)
- Robert B Banzett
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Lansing
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrew P Binks
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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17
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Domnik NJ, Walsted ES, Langer D. Clinical Utility of Measuring Inspiratory Neural Drive During Cardiopulmonary Exercise Testing (CPET). Front Med (Lausanne) 2020; 7:483. [PMID: 33043023 PMCID: PMC7530180 DOI: 10.3389/fmed.2020.00483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) has traditionally included ventilatory and metabolic measurements alongside electrocardiographic characterization; however, research increasingly acknowledges the utility of also measuring inspiratory neural drive (IND) through its surrogate measure of diaphragmatic electromyography (EMGdi). While true IND also encompasses the activation of non-diaphragmatic respiratory muscles, the current review focuses on diaphragmatic measurements, providing information about additional inspiratory muscle groups for context where appropriate. Evaluation of IND provides mechanistic insight into the origins of dyspnea and exercise limitation across pathologies; yields valuable information reflecting the integration of diverse mechanical, chemical, locomotor, and metabolic afferent signals; and can help assess the efficacy of therapeutic interventions. Further, IND measurement during the physiologic stress of exercise is uniquely poised to reveal the underpinnings of physiologic limitations masked during resting and unloaded breathing, with important information provided not only at peak exercise, but throughout exercise protocols. As our understanding of IND presentation across varying conditions continues to grow and methods for its measurement become more accessible, the translation of these principles into clinical settings is a logical next step in facilitating appropriate and nuanced management tailored to each individual's unique physiology. This review provides an overview of the current state of understanding of IND measurement during CPET: its origins, known patterns of behavior and links with dyspnea in health and major respiratory diseases, and the possibility of expanding this approach to applications beyond exercise.
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Affiliation(s)
| | - Emil S. Walsted
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Daniel Langer
- Research Group for Rehabilitation in Internal Disorders, Respiratory Rehabilitation and Respiratory Division, Department of Rehabilitation Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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18
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A multidimensional assessment of dyspnoea in healthy adults during exercise. Eur J Appl Physiol 2020; 120:2533-2545. [DOI: 10.1007/s00421-020-04479-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
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19
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Vaporidi K, Akoumianaki E, Telias I, Goligher EC, Brochard L, Georgopoulos D. Respiratory Drive in Critically Ill Patients. Pathophysiology and Clinical Implications. Am J Respir Crit Care Med 2020; 201:20-32. [DOI: 10.1164/rccm.201903-0596so] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Katerina Vaporidi
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School University of Crete, Heraklion, Greece
| | - Evangelia Akoumianaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School University of Crete, Heraklion, Greece
| | - Irene Telias
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; and
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Dimitris Georgopoulos
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School University of Crete, Heraklion, Greece
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20
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Mainra A, Abdallah SJ, Reid RE, Andersen RE, Jensen D. Effect of weight loss via bariatric surgery for class III obesity on exertional breathlessness. Respir Physiol Neurobiol 2019; 266:130-137. [DOI: 10.1016/j.resp.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/03/2019] [Accepted: 05/11/2019] [Indexed: 12/19/2022]
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21
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Almeida VP, Ferreira AS, Guimarães FS, Papathanasiou J, Lopes AJ. The impact of physical activity level, degree of dyspnoea and pulmonary function on the performance of healthy young adults during exercise. J Bodyw Mov Ther 2019; 23:494-501. [PMID: 31563361 DOI: 10.1016/j.jbmt.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/30/2018] [Accepted: 05/26/2018] [Indexed: 02/08/2023]
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22
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Lanfranconi F, Ferri A, Pollastri L, Bartesaghi M, Novarina M, De Vito G, Beretta E, Tremolizzo L. Impact of Hanging Motionless in Harness on Respiratory and Blood Pressure Reflex Modulation in Mountain Climbers. High Alt Med Biol 2019; 20:122-132. [PMID: 31009248 PMCID: PMC6602116 DOI: 10.1089/ham.2018.0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Harness hang syncope (HHS) is a risk that specifically affects safety of harness users in mountain climbing. Aims: To evaluate individual patterns of breathing resulting from deranged cardiovascular reflexes triggering a syncopal event when a mismatch between cerebral O2 demand and supply is present. Results: Forty healthy participants [aged 39.1 (8.2) years] were enrolled in a motionless suspension test while hanging in harness. Respiratory gas exchange values were analyzed to assess the pattern of breathing (EpInWel, respiratory elastic power) and cardiovascular parameters were monitored (BP, blood pressure). Four participants experienced HHS after 30.0 (7.6) minutes, with an early manifestation of loss of control of both a sustainable EpInWel and BP, starting after 10–12 minutes. Among the other participants, two different reactions were observed during suspension: (1) group G1 tolerated 32.7 (11.4) minutes of suspension by a favorable adaptation of the EpInWel and BP parameters and (2) group G2 showed significantly shorter time of suspension 24.0 (10.4) minutes with unfavorable increase in EpInWel and BP. Conclusions: Greater resistance to HHS occurs in people developing less marked fluctuations of both respiratory and cardiovascular reflex responses. Conversely, wider fluctuations both in control of EpInWel and BP were observed in the event of decreased suspension tolerance or in syncopal events.
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Affiliation(s)
- Francesca Lanfranconi
- 1 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,2 Foundation Monza and Brianza for the Mother and Her Child, Monza, Italy
| | - Alessandra Ferri
- 1 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,3 Institute for Health and Sport, Victoria University, Melbourne, Australia
| | | | | | | | - Giovanni De Vito
- 1 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Egidio Beretta
- 1 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- 1 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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23
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Abdallah SJ, Smith BM, Wilkinson-Maitland C, Li PZ, Bourbeau J, Jensen D. Effect of Abdominal Binding on Diaphragmatic Neuromuscular Efficiency, Exertional Breathlessness, and Exercise Endurance in Chronic Obstructive Pulmonary Disease. Front Physiol 2018; 9:1618. [PMID: 30487757 PMCID: PMC6246714 DOI: 10.3389/fphys.2018.01618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
We tested the hypothesis that abdominal binding (AB) would reduce breathlessness and improve exercise tolerance by enhancing neuromuscular efficiency of the diaphragm during exercise in adults with chronic obstructive pulmonary disease (COPD). In a randomized, controlled, crossover trial, 20 adults with COPD (mean ± SD FEV1, 60 ± 16% predicted) completed a symptom-limited constant-load cycle endurance exercise test at 75% of their peak incremental power output with concomitant measures of the diaphragm electromyogram (EMGdi) and respiratory pressures without (CTRL) vs. with AB sufficient to increase end-expiratory gastric pressure (Pga,ee) by 6.7 ± 0.3 cmH2O at rest. Compared to CTRL, AB enhanced diaphragmatic neuromuscular efficiency during exercise (p < 0.05), as evidenced by a 25% increase in the quotient of EMGdi to tidal transdiaphragmatic pressure swing. By contrast, AB had no demonstrable effect on exertional breathlessness and exercise tolerance; spirometry and plethysmography-derived pulmonary function test parameters at rest; and cardiac, metabolic, breathing pattern, inspiratory reserve volume and EMGdi responses during exercise (all p > 0.05 vs. CTRL). In conclusion, enhanced neuromuscular efficiency of the diaphragm during exercise with AB was not associated with relief of exertional breathlessness and improved exercise tolerance in adults with COPD. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01852006.
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Affiliation(s)
- Sara J Abdallah
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Benjamin M Smith
- Respiratory Epidemiology & Clinical Research Unit, Division of Respiratory Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Courtney Wilkinson-Maitland
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Pei Zhi Li
- Respiratory Epidemiology & Clinical Research Unit, Division of Respiratory Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology & Clinical Research Unit, Division of Respiratory Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada.,Respiratory Epidemiology & Clinical Research Unit, Division of Respiratory Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.,McGill Research Centre for Physical Activity and Health, McGill University, Montreal, QC, Canada
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24
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Stevens D, Halaki M, Chow CM, O'Dwyer N. The effects of multi-stage exercise with and without concurrent cognitive performance on cardiorespiratory and cerebral haemodynamic responses. Eur J Appl Physiol 2018; 118:2121-2132. [PMID: 30014452 DOI: 10.1007/s00421-018-3942-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 07/10/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Studies of cerebral haemodynamics have shown changes with increased exercise intensity, but the patterns have been highly variable and reliable associations with cognitive performance have not been identified. The aim of this study was to examine whether exercise-induced changes in oxygenated haemoglobin (O2Hb) led to changes in concomitant cognitive performance. METHODS This study examined cardiorespiratory and cerebral haemodynamics during multi-stage exercise from rest to exhaustion, with (Ex + C) and without (Ex) concurrent cognitive performance (Go/No-go task). RESULTS The presence of the cognitive task affected both cardiorespiratory and cerebral haemodynamics. The patterns in the cerebral haemodynamics during Ex and Ex + C diverged above the respiratory compensation threshold (RCT), but differences were significant only at 100% [Formula: see text], displaying increased deoxygenated haemoglobin (HHb), decreased difference between oxygenated and deoxygenated haemoglobin (HbDiff), and decreased cerebral oxygenation (COx) during Ex + C. More complex haemodynamic trends against intensity during Ex + C suggested that the presence of a cognitive task increases cerebral metabolic demand at high exercise intensities. The levels of O2Hb, HHb, HbDiff and total haemoglobin increased most steeply at intensities around the RCT during both Ex and Ex + C, but these changes were not accompanied by improved cognitive performance. CONCLUSION The primary hypothesis, that cognitive performance would match changes in O2Hb, was not supported. Small variations in reaction time and response accuracy across exercise intensities were not significant, suggesting that cognitive performance is unaffected by intense short-duration exercise. Our results add further evidence that exercise-induced changes in cerebral haemodynamics do not affect cognitive performance.
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Affiliation(s)
- David Stevens
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia. .,Adelaide Institute for Sleep Health - A Flinders Centre for Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Chin Moi Chow
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas O'Dwyer
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,School of Exercise Science, Sport and Health, Faculty of Science, Charles Sturt University, Bathurst, NSW, Australia
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25
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Waskiw-Ford M, Wu A, Mainra A, Marchand N, Alhuzaim A, Bourbeau J, Smith BM, Jensen D. Effect of Inhaled Nebulized Furosemide (40 and 120 mg) on Breathlessness during Exercise in the Presence of External Thoracic Restriction in Healthy Men. Front Physiol 2018; 9:86. [PMID: 29483879 PMCID: PMC5816054 DOI: 10.3389/fphys.2018.00086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/25/2018] [Indexed: 01/04/2023] Open
Abstract
Inhalation of nebulized furosemide has been shown to alleviate breathlessness provoked experimentally in health and disease; however, it remains unclear whether the efficacy of nebulized furosemide on breathlessness is dose-dependent. We tested the hypothesis that inhaled nebulized furosemide would be associated with a dose-dependent relief of breathlessness during exercise testing in the setting of abnormal restrictive constraints on tidal volume (VT) expansion. In a randomized, double-blind, crossover study, 24 healthy men aged 25.3 ± 1.2 years (mean ± SE) completed a symptom-limited constant-load cycle endurance exercise test in the setting of external thoracic restriction via chest wall strapping to reduce vital capacity by ~20% following single-dose inhalation nebulized furosemide (40 and 120 mg) and 0.9% saline. Compared with 0.9% saline, neither 40 nor 120 mg of inhaled nebulized furosemide had an effect on ratings of perceived breathlessness during exercise or an effect on cardiometabolic, ventilatory, breathing pattern, or dynamic operating lung volume responses during exercise. Urine production rate, the percentage of participants reporting an "urge to urinate" and the intensity of perceived "urge to urinate" were all significantly greater after inhaling the 120 mg furosemide solution compared with both 0.9% saline and 40 mg furosemide solutions. We concluded that, under the experimental conditions of this study, inhalation of nebulized furosemide at doses of 40 and 120 mg did not alleviate breathlessness during exercise in healthy men.
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Affiliation(s)
- Marcus Waskiw-Ford
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada
| | - Anne Wu
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada
| | - Amar Mainra
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada
| | - Noah Marchand
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada
| | - Abdullatif Alhuzaim
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada
| | - Jean Bourbeau
- Department of Medicine, Respiratory Division, McGill University, Montréal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, QC, Canada.,Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montréal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Center, Montréal, QC, Canada.,Research Centre for Physical Activity and Health, McGill University, Montréal, QC, Canada
| | - Benjamin M Smith
- Department of Medicine, Respiratory Division, McGill University, Montréal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, QC, Canada.,Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montréal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Center, Montréal, QC, Canada.,Research Centre for Physical Activity and Health, McGill University, Montréal, QC, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada.,Department of Medicine, Respiratory Division, McGill University, Montréal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, QC, Canada.,Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Center, Montréal, QC, Canada.,Research Centre for Physical Activity and Health, McGill University, Montréal, QC, Canada
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26
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Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, Sancho J, Fauroux B, Andersen T, Hov B, Nygren-Bonnier M, Lacombe M, Pernet K, Kampelmacher M, Devaux C, Kinnett K, Sheehan D, Rao F, Villanova M, Berlowitz D, Morrow BM. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med 2018; 136:98-110. [PMID: 29501255 DOI: 10.1016/j.rmed.2018.01.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 12/13/2022]
Abstract
This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice. For this review, we have classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.
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Affiliation(s)
- Michelle Chatwin
- Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK.
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Pulmonology Department, Emergency and Intensive Care Medicine Department, São João University Hospital, Faculty of Medicine, University of Porto, Portugal
| | - Nicole Sheers
- Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia
| | - Uwe Mellies
- Departement of Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center Essen, University of Essen, Germany
| | - Jesus Gonzales-Bermejo
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France
| | - Jesus Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, Valencia, Institute of Health Research INCLIVA, Valencia, Spain
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, Paris, Paris Descartes University, Paris Research Unit INSERM U 955, Team 13, Creteil, France
| | - Tiina Andersen
- Norwegian Centre of Excellence for Home Mechanical Ventilation, Thoracic Department and Department of Physiotherapy, Haukeland University Hospital, Bergen Norway, Department of Clinical Science, Medical Faculty, University of Bergen, Bergen, Norway
| | - Brit Hov
- Dept of Peadiatric Medicine, Oslo University Hospital, Oslo, Norway and Norwegian Centre of Excellence for Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Matthieu Lacombe
- Adult Intensive Care Unit, Raymond Poincaré Hospital (AP-HP) Garches, France
| | - Kurt Pernet
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Mike Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christian Devaux
- Direction des Actions Médicales, Paramédicales et Psychologiques, Association Française Contre Les Myopathies-Téléthon, 91000 EVRY, France
| | - Kathy Kinnett
- Parent Project Muscular Dystrophy, 401 Hackensack Ave 9th Floor, Hackensack, NJ 07601, United States
| | - Daniel Sheehan
- Assisted Breathing Center, Women and Children's Hospital of Buffalo Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, United States
| | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy
| | - Marcello Villanova
- Neuromuscular Rehabilitation Unit, Nigrisoli Hospital, Viale Ercolani 7/b - 40125, Bologna, Italy
| | - David Berlowitz
- Institute for Breathing and Sleep and Victorian Respiratory Support Service, Austin Health, Melbourne, Australia
| | - Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, South Africa
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27
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Abdallah SJ, Wilkinson-Maitland C, Saad N, Li PZ, Smith BM, Bourbeau J, Jensen D. Effect of morphine on breathlessness and exercise endurance in advanced COPD: a randomised crossover trial. Eur Respir J 2017; 50:50/4/1701235. [DOI: 10.1183/13993003.01235-2017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/21/2017] [Indexed: 01/11/2023]
Abstract
The objective of the present study was to evaluate the effect of morphine on exertional breathlessness and exercise endurance in advanced chronic obstructive pulmonary disease (COPD).In a randomised crossover trial, we compared the acute effect of immediate-release oral morphineversusplacebo on physiological and perceptual responses during constant-load cardiopulmonary cycle exercise testing (CPET) in 20 adults with advanced COPD and chronic breathlessness syndrome.Compared with placebo, morphine reduced exertional breathlessness at isotime by 1.2±0.4 Borg units and increased exercise endurance time by 2.5±0.9 min (both p≤0.014). During exercise at isotime, morphine decreased ventilation by 1.3±0.5 L·min−1and breathing frequency by 2.0±0.9 breaths·min−1(both p≤0.041). Compared with placebo, morphine decreased exertional breathlessness at isotime by ≥1 Borg unit in 11 participants (responders) and by <1 Borg unit in nine participants (non-responders). Baseline participant characteristics, including pulmonary function and cardiorespiratory fitness, were similar between responders and non-responders. A higher percentage of respondersversusnon-responders stopped incremental CPET due to intolerable breathlessness: 82versus33% (p=0.028).Immediate-release oral morphine improved exertional breathlessness and exercise endurance in some, but not all, adults with advanced COPD. The locus of symptom-limitation on laboratory-based CPET may help to identify patients most likely to benefit from morphine.
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28
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Charlton JM, Ramsook AH, Mitchell RA, Hunt MA, Puyat JH, Guenette JA. Respiratory Mechanical and Cardiorespiratory Consequences of Cycling with Aerobars. Med Sci Sports Exerc 2017; 49:2578-2584. [PMID: 28767523 DOI: 10.1249/mss.0000000000001393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Aerobars place a cyclist in a position where the trunk is flexed forward and the elbows are close to the midline of the body. This position is known to improve cycling aerodynamics and time trial race performance compared with upright cycling positions. However, the aggressive nature of this position may have important cardiorespiratory and metabolic consequences. The purpose of this investigation was to examine the respiratory mechanical, ventilatory, metabolic, and sensory consequences of cycling while using aerobars during laboratory-based cycling. METHODS Eleven endurance-trained male cyclists (age, 26 ± 9 yr; V˙O2peak, 55 ± 5 mL·kg·min) were recruited. Visit 1 consisted of an incremental cycling test to determine peak power output. Visit 2 consisted of 6-min bouts of constant load cycling at 70% of peak incremental power output in the aerobar position, drop position, and upright position while grasping the brake hoods. Metabolic and ventilatory responses were measured using a commercially available metabolic cart, and respiratory pressures were measured using an esophageal catheter. RESULTS Cycling in the aerobar position significantly increased the work of breathing (Wb), power of breathing (Pb), minute ventilation, ventilatory equivalent for oxygen and carbon dioxide, and transdiaphragmatic pressure compared with the upright position. Increases in the Wb and Pb in the aerobars relative to the upright position were strongly correlated with the degree of thoracic restriction, measured as the shoulder-to-aerobar width ratio (Wb: r = 0.80, P = 0.01; Pb: r = 0.69, P = 0.04). CONCLUSIONS Aerobars significantly increase the mechanical cost of breathing and leads to greater ventilatory inefficiency compared with upright cycling. Future work is needed to optimize aerobar width to minimize the respiratory mechanical consequences while optimizing aerodynamics.
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Affiliation(s)
- Jesse M Charlton
- 1Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, CANADA; 2Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, CANADA; and 3Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, CANADA
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29
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Abdallah SJ, Chan DS, Glicksman R, Mendonca CT, Luo Y, Bourbeau J, Smith BM, Jensen D. Abdominal Binding Improves Neuromuscular Efficiency of the Human Diaphragm during Exercise. Front Physiol 2017; 8:345. [PMID: 28620310 PMCID: PMC5449468 DOI: 10.3389/fphys.2017.00345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
We tested the hypothesis that elastic binding of the abdomen (AB) would enhance neuromuscular efficiency of the human diaphragm during exercise. Twelve healthy non-obese men aged 24.8 ± 1.7 years (mean ± SE) completed a symptom-limited constant-load cycle endurance exercise test at 85% of their peak incremental power output with diaphragmatic electromyography (EMGdi) and respiratory pressure measurements under two randomly assigned conditions: unbound control (CTRL) and AB sufficient to increase end-expiratory gastric pressure (Pga,ee) by 5-8 cmH2O at rest. By design, AB increased Pga,ee by 6.6 ± 0.6 cmH2O at rest. Compared to CTRL, AB significantly increased the transdiaphragmatic pressure swing-to-EMGdi ratio by 85-95% during exercise, reflecting enhanced neuromuscular efficiency of the diaphragm. By contrast, AB had no effect on spirometric parameters at rest, exercise endurance time or an effect on cardiac, metabolic, ventilatory, breathing pattern, dynamic operating lung volume, and perceptual responses during exercise. In conclusion, AB was associated with isolated and acute improvements in neuromuscular efficiency of the diaphragm during exercise in healthy men. The implications of our results are that AB may be an effective means of enhancing neuromuscular efficiency of the diaphragm in clinical populations with diaphragmatic weakness/dysfunction.
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Affiliation(s)
- Sara J Abdallah
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill UniversityMontréal, QC, Canada
| | - David S Chan
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill UniversityMontréal, QC, Canada
| | - Robin Glicksman
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill UniversityMontréal, QC, Canada
| | - Cassandra T Mendonca
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill UniversityMontréal, QC, Canada
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical UniversityGuangzhou, China
| | - Jean Bourbeau
- Department of Medicine, Respiratory Division, McGill UniversityMontréal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health CentreMontréal, QC, Canada.,Meakins-Christie Laboratories, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,McConnell Centre for Innovative Medicine, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Research Centre for Physical Activity and Health, McGill UniversityMontréal, QC, Canada
| | - Benjamin M Smith
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill UniversityMontréal, QC, Canada.,Department of Medicine, Respiratory Division, McGill UniversityMontréal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health CentreMontréal, QC, Canada.,Meakins-Christie Laboratories, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,McConnell Centre for Innovative Medicine, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Research Centre for Physical Activity and Health, McGill UniversityMontréal, QC, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill UniversityMontréal, QC, Canada.,Department of Medicine, Respiratory Division, McGill UniversityMontréal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health CentreMontréal, QC, Canada.,Meakins-Christie Laboratories, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,McConnell Centre for Innovative Medicine, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health CentreMontréal, QC, Canada.,Research Centre for Physical Activity and Health, McGill UniversityMontréal, QC, Canada
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30
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Garske LA, Lal R, Stewart IB, Morris NR, Cross TJ, Adams L. Exertional dyspnea associated with chest wall strapping is reduced when external dead space substitutes for part of the exercise stimulus to ventilation. J Appl Physiol (1985) 2017; 122:1179-1187. [DOI: 10.1152/japplphysiol.00051.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 11/22/2022] Open
Abstract
Chest wall strapping has been used to assess mechanisms of dyspnea with restrictive lung disease. This study examined the hypothesis that dyspnea with restriction depends principally on the degree of reflex ventilatory stimulation. We compared dyspnea at the same (iso)ventilation when added dead space provided a component of the ventilatory stimulus during exercise. Eleven healthy men undertook a randomized controlled crossover trial that compared four constant work exercise conditions: 1) control (CTRL): unrestricted breathing at 90% gas exchange threshold (GET); 2) CTRL+dead space (DS): unrestricted breathing with 0.6-l dead space, at isoventilation to CTRL due to reduced exercise intensity; 3) CWS: chest wall strapping at 90% GET; and 4) CWS+DS: chest strapping with 0.6-l dead space, at isoventilation to CWS with reduced exercise intensity. Chest strapping reduced forced vital capacity by 30.4 ± 2.2% (mean ± SE). Dyspnea at isoventilation was unchanged with CTRL+DS compared with CTRL (1.93 ± 0.49 and 2.17 ± 0.43, 0–10 numeric rating scale, respectively; P = 0.244). Dyspnea was lower with CWS+DS compared with CWS (3.40 ± 0.52 and 4.51 ± 0.53, respectively; P = 0.003). Perceived leg fatigue was reduced with CTRL+DS compared with CTRL (2.36 ± 0.48 and 2.86 ± 0.59, respectively; P = 0.049) and lower with CWS+DS compared with CWS (1.86 ± 0.30 and 4.00 ± 0.79, respectively; P = 0.006). With unrestricted breathing, dead space did not change dyspnea at isoventilation, suggesting that dyspnea does not depend on the mode of reflex ventilatory stimulation in healthy individuals. With chest strapping, dead space presented a less potent stimulus to dyspnea, raising the possibility that leg muscle work contributes to dyspnea perception independent of the ventilatory stimulus. NEW & NOTEWORTHY Chest wall strapping was applied to healthy humans to simulate restrictive lung disease. With chest wall strapping, dyspnea was reduced when dead space substituted for part of a constant exercise stimulus to ventilation. Dyspnea associated with chest wall strapping depended on the contribution of leg muscle work to ventilatory stimulation. Chest wall strapping might not be a clinically relevant model to determine whether an alternative reflex ventilatory stimulus mimics the intensity of exertional dyspnea.
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Affiliation(s)
- Luke A. Garske
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ravin Lal
- Allied Health Sciences and Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ian B. Stewart
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Norman R. Morris
- Allied Health Sciences and Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Troy J. Cross
- Allied Health Sciences and Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; and
| | - Lewis Adams
- Allied Health Sciences and Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
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31
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Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. J Appl Physiol (1985) 2017; 122:1267-1275. [PMID: 28255085 DOI: 10.1152/japplphysiol.00046.2017] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/13/2017] [Accepted: 02/26/2017] [Indexed: 11/22/2022] Open
Abstract
Inspiratory muscle training (IMT) has consistently been shown to reduce exertional dyspnea in health and disease; however, the physiological mechanisms remain poorly understood. A growing body of literature suggests that dyspnea intensity can be explained largely by an awareness of increased neural respiratory drive, as measured indirectly using diaphragmatic electromyography (EMGdi). Accordingly, we sought to determine whether improvements in dyspnea following IMT can be explained by decreases in inspiratory muscle electromyography (EMG) activity. Twenty-five young, healthy, recreationally active men completed a detailed familiarization visit followed by two maximal incremental cycle exercise tests separated by 5 wk of randomly assigned pressure threshold IMT or sham control (SC) training. The IMT group (n = 12) performed 30 inspiratory efforts twice daily against a 30-repetition maximum intensity. The SC group (n = 13) performed a daily bout of 60 inspiratory efforts against 10% maximal inspiratory pressure (MIP), with no weekly adjustments. Dyspnea intensity was measured throughout exercise using the modified 0-10 Borg scale. Sternocleidomastoid and scalene EMG was measured using surface electrodes, whereas EMGdi was measured using a multipair esophageal electrode catheter. IMT significantly improved MIP (pre: -138 ± 45 vs. post: -160 ± 43 cmH2O, P < 0.01), whereas the SC intervention did not. Dyspnea was significantly reduced at the highest equivalent work rate (pre: 7.6 ± 2.5 vs. post: 6.8 ± 2.9 Borg units, P < 0.05), but not in the SC group, with no between-group interaction effects. There were no significant differences in respiratory muscle EMG during exercise in either group. Improvements in dyspnea intensity ratings following IMT in healthy humans cannot be explained by changes in the electrical activity of the inspiratory muscles.NEW & NOTEWORTHY Exertional dyspnea intensity is thought to reflect an increased awareness of neural respiratory drive, which is measured indirectly using diaphragmatic electromyography (EMGdi). We examined the effects of inspiratory muscle training (IMT) on dyspnea, EMGdi, and EMG of accessory inspiratory muscles. IMT significantly reduced submaximal dyspnea intensity ratings but did not change EMG of any inspiratory muscles. Improvements in exertional dyspnea following IMT may be the result of nonphysiological factors or physiological adaptations unrelated to neural respiratory drive.
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Affiliation(s)
- Andrew H Ramsook
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yannick Molgat-Seon
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina S Wilkie
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pat G Camp
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; and
| | - Lee M Romer
- Centre for Human Performance, Exercise, and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; .,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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LoMauro A, Cesareo A, Agosti F, Tringali G, Salvadego D, Grassi B, Sartorio A, Aliverti A. Effects of a multidisciplinary body weight reduction program on static and dynamic thoraco-abdominal volumes in obese adolescents. Appl Physiol Nutr Metab 2016; 41:649-58. [PMID: 27175804 DOI: 10.1139/apnm-2015-0269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The objective of this study was to characterize static and dynamic thoraco-abdominal volumes in obese adolescents and to test the effects of a 3-week multidisciplinary body weight reduction program (MBWRP), entailing an energy-restricted diet, psychological and nutritional counseling, aerobic physical activity, and respiratory muscle endurance training (RMET), on these parameters. Total chest wall (VCW), pulmonary rib cage (VRC,p), abdominal rib cage (VRC,a), and abdominal (VAB) volumes were measured on 11 male adolescents (Tanner stage: 3-5; BMI standard deviation score: >2; age: 15.9 ± 1.3 years; percent body fat: 38.4%) during rest, inspiratory capacity (IC) maneuver, and incremental exercise on a cycle ergometer at baseline and after 3 weeks of MBWRP. At baseline, the progressive increase in tidal volume was achieved by an increase in end-inspiratory VCW (p < 0.05) due to increases in VRC,p and VRC,a with constant VAB. End-expiratory VCW decreased with late increasing VRC,p, dynamically hyperinflating VRC,a (p < 0.05), and progressively decreasing VAB (p < 0.05). After MBWRP, weight loss was concentrated in the abdomen and total IC decreased. During exercise, abdominal rib cage hyperinflation was delayed and associated with 15% increased performance and reduced dyspnea at high workloads (p < 0.05) without ventilatory and metabolic changes. We conclude that otherwise healthy obese adolescents adopt a thoraco-abdominal operational pattern characterized by abdominal rib cage hyperinflation as a form of lung recruitment during incremental cycle exercise. Additionally, a short period of MBWRP including RMET is associated with improved exercise performance, lung and chest wall volume recruitment, unloading of respiratory muscles, and reduced dyspnea.
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Affiliation(s)
- Antonella LoMauro
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ambra Cesareo
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Fiorenza Agosti
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy
| | - Gabriella Tringali
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy
| | - Desy Salvadego
- c Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Bruno Grassi
- c Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Alessandro Sartorio
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy.,d Division of Metabolic Diseases and Auxology, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy
| | - Andrea Aliverti
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Muscat KM, Kotrach HG, Wilkinson-Maitland CA, Schaeffer MR, Mendonca CT, Jensen D. Physiological and perceptual responses to incremental exercise testing in healthy men: effect of exercise test modality. Appl Physiol Nutr Metab 2015; 40:1199-209. [DOI: 10.1139/apnm-2015-0179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a randomized cross-over study of 15 healthy men aged 20–30 years, we compared physiological and perceptual responses during treadmill and cycle exercise test protocols matched for increments in work rate — the source of increased locomotor muscle metabolic and contractile demands. The rates of O2 consumption and CO2 production were higher at the peak of treadmill versus cycle testing (p ≤ 0.05). Nevertheless, work rate, minute ventilation, tidal volume (VT), breathing frequency (fR), inspiratory capacity (IC), inspiratory reserve volume (IRV), tidal esophageal (Pes,tidal) and transdiaphragmatic pressure swings (Pdi,tidal), peak expiratory gastric pressures (Pga,peak), the root mean square of the diaphragm electromyogram (EMGdi,rms) expressed as a percentage of maximum EMGdi,rms (EMGdi,rms%max), and dyspnea ratings were similar at the peak of treadmill versus cycle testing (p > 0.05). Ratings of leg discomfort were higher at the peak of cycle versus treadmill exercise (p ≤ 0.05), even though peak O2 consumption was lower during cycling. Oxygen consumption, CO2 production, minute ventilation, fR, Pes,tidal, Pdi,tidal and Pga,peak were higher (p ≤ 0.05), while VT, IC, IRV, EMGdi,rms%max, and ratings of dyspnea and leg discomfort were similar (p > 0.05) at all or most submaximal work rates during treadmill versus cycle exercise. Our findings highlight important differences (and similarities) in physiological and perceptual responses at maximal and submaximal work rates during incremental treadmill and cycle exercise testing protocols. The lack of effect of exercise test modality on peak work rate advocates for the use of this readily available parameter to optimize training intensity determination, regardless of exercise training mode.
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Affiliation(s)
- Kristina M. Muscat
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Houssam G. Kotrach
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Courtney A. Wilkinson-Maitland
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Michele R. Schaeffer
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Cassandra T. Mendonca
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Research Centre for Physical Activity and Health, McGill University, Montréal, QC H2W 1S4, Canada
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34
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Silva CS, Nogueira FR, Porto EF, Gazzotti MR, Nascimento OA, Camelier A, Jardim JR. Dynamic hyperinflation during activities of daily living in COPD patients. Chron Respir Dis 2015; 12:189-96. [DOI: 10.1177/1479972315576143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities ( p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of these ADLs.
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Affiliation(s)
- Cláudia S Silva
- Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina (EPM), Federal University of São Paulo (Unifesp), Brazil
| | - Fabiana R Nogueira
- Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina (EPM), Federal University of São Paulo (Unifesp), Brazil
| | - Elias F Porto
- Pulmonary Rehabilitation Center (EPM/Unifesp) and Adventist University of São Paulo, Brazil
| | - Mariana R Gazzotti
- Pulmonary Rehabilitation Center (EPM/Unifesp) and São Camilo University of São Paulo, Brazil
| | - Oliver A Nascimento
- Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina (EPM), Federal University of São Paulo (Unifesp), Brazil
| | | | - José R Jardim
- Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina (EPM), Federal University of São Paulo (Unifesp), Brazil
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Kotrach HG, Bourbeau J, Jensen D. Does nebulized fentanyl relieve dyspnea during exercise in healthy man? J Appl Physiol (1985) 2015; 118:1406-14. [PMID: 26031762 DOI: 10.1152/japplphysiol.01091.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/10/2015] [Indexed: 12/21/2022] Open
Abstract
Few therapies exist for the relief of dyspnea in restrictive lung disorders. Accumulating evidence suggests that nebulized opioids selective for the mu-receptor subtype may relieve dyspnea by modulating intrapulmonary opioid receptor activity. Our respective primary and secondary objectives were to test the hypothesis that nebulized fentanyl (a mu-opioid receptor agonist) relieves dyspnea during exercise in the presence of abnormal restrictive ventilatory constraints and to identify the physiological mechanisms of this improvement. In a randomized, double-blind, placebo-controlled crossover study, we examined the effect of 250 μg nebulized fentanyl, chest wall strapping (CWS), and their interaction on detailed physiological and perceptual responses to constant work rate cycle exercise (85% of maximum incremental work rate) in 14 healthy, fit young men. By design, CWS decreased vital capacity by ∼20% and mimicked the negative consequences of a mild restrictive lung disorder on exercise endurance time and on dyspnea, breathing pattern, dynamic operating lung volumes, and diaphragmatic electromyographic and respiratory muscle function during exercise. Compared with placebo under both unrestricted control and CWS conditions, nebulized fentanyl had no effect on exercise endurance time, integrated physiological response to exercise, sensory intensity, unpleasantness ratings of exertional dyspnea. Our results do not support a role for intrapulmonary opioids in the neuromodulation of exertional dyspnea in health nor do they provide a physiological rationale for the use of nebulized fentanyl in the management of dyspnea due to mild restrictive lung disorders, specifically those arising from abnormalities of the chest wall and not affiliated with airway inflammation.
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Affiliation(s)
- Houssam G Kotrach
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology & Physical Education, McGill University, Montréal, Quebec, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, Quebec, Canada; and
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology & Physical Education, McGill University, Montréal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, Quebec, Canada; and Research Centre for Physical Activity and Health, McGill University, Montréal, Quebec, Canada
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36
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Jolley CJ, Luo YM, Steier J, Rafferty GF, Polkey MI, Moxham J. Neural respiratory drive and breathlessness in COPD. Eur Respir J 2014; 45:355-64. [PMID: 25323229 DOI: 10.1183/09031936.00063014] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to test the hypothesis that neural respiratory drive, measured using diaphragm electromyogram (EMGdi) activity expressed as a percentage of maximum (EMGdi%max), is closely related to breathlessness in chronic obstructive pulmonary disease. We also investigated whether neuroventilatory uncoupling contributes significantly to breathlessness intensity over an awareness of levels of neural respiratory drive alone. EMGdi and ventilation were measured continuously during incremental cycle and treadmill exercise in 12 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s±sd was 38.7±14.5 % pred). EMGdi was expressed both as EMGdi%max and relative to tidal volume expressed as a percentage of predicted vital capacity to quantify neuroventilatory uncoupling. EMGdi%max was closely related to Borg breathlessness in both cycle (r=0.98, p=0.0001) and treadmill exercise (r=0.94, p=0.005), this relationship being similar to that between neuroventilatory uncoupling and breathlessness (cycling r=0.94, p=0.005; treadmill r=0.91, p=0.01). The relationship between breathlessness and ventilation was poor when expansion of tidal volume became limited. In chronic obstructive pulmonary disease the intensity of exertional breathlessness is closely related to EMGdi%max. These data suggest that breathlessness in chronic obstructive pulmonary disease can be largely explained by an awareness of levels of neural respiratory drive, rather than the degree of neuroventilatory uncoupling. EMGdi%max could provide a useful physiological biomarker for breathlessness in chronic obstructive pulmonary disease.
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Affiliation(s)
- Caroline J Jolley
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK.
| | - Yuanming M Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical College, Guangzhou, China
| | - Joerg Steier
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK. Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gerrard F Rafferty
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - John Moxham
- King's College London Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, King's Health Partners, London, UK
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37
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Guenette JA, Chin RC, Cheng S, Dominelli PB, Raghavan N, Webb KA, Neder JA, O'Donnell DE. Mechanisms of exercise intolerance in global initiative for chronic obstructive lung disease grade 1 COPD. Eur Respir J 2014; 44:1177-87. [PMID: 25142487 DOI: 10.1183/09031936.00034714] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to determine if a dissociation existed between respiratory drive, as estimated by diaphragmatic electromyography (EMGdi), and its pressure-generating capacity during exercise in mild chronic obstructive pulmonary disease (COPD) and whether this, if present, had negative sensory consequences. Subjects meeting spirometric criteria for mild COPD (n=16) and age and sex-matched controls (n=16) underwent detailed pulmonary function testing and a symptom limited cycle test while detailed ventilatory, sensory and respiratory mechanical responses were measured. Compared with controls, subjects with mild COPD had greater ventilatory requirements throughout submaximal exercise. At the highest equivalent work rate of 60 W, they had a significantly higher: total work of breathing (32±17 versus 16±7 J·min(-1); p<0.01); EMGdi (37.3±17.3 versus 17.9±11.7% of maximum; p<0.001); and EMGdi to transdiaphragmatic pressure ratio (0.87±0.38 versus 0.52±0.27; p<0.01). Dyspnoea-ventilation slopes were significantly higher in mild COPD than controls (0.17±0.12 versus 0.10±0.05; p<0.05). However, absolute dyspnoea ratings reached significant levels only at high levels of ventilation. Increased respiratory effort and work of breathing, and a wider dissociation between diaphragmatic activation and pressure-generating capacity were found at standardised work rates in subjects with mild COPD compared with controls. Despite these mechanical and neuromuscular abnormalities, significant dyspnoea was only experienced at higher work rates.
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Affiliation(s)
- Jordan A Guenette
- Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada Dept of Physical Therapy, University of British Columbia, Vancouver, BC, Canada Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Roberto C Chin
- Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Sicheng Cheng
- Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Natya Raghavan
- Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Katherine A Webb
- Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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