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Mu H, Zhang Q. The Application of Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2024; 21:2331202. [PMID: 38634575 DOI: 10.1080/15412555.2024.2331202] [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: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition that poses a significant burden on individuals and society due to its high morbidity and mortality rates. The diaphragm is the main respiratory muscle, its function has a direct impact on the quality of life and prognosis of COPD patients. This article aims to review the structural measurement and functional evaluation methods through the use of diaphragmatic ultrasound and relevant research on its application in clinical practice for COPD patients. Thus, it serves to provide valuable insights for clinical monitoring of diaphragm function in COPD patients, facilitating early clinical intervention and aiding in the recovery of diaphragm function.
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Affiliation(s)
- Heng Mu
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
| | - Qunxia Zhang
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
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2
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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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Morís DI, de Moura J, Aslani S, Jacob J, Novo J, Ortega M. Multi-task localization of the hemidiaphragms and lung segmentation in portable chest X-ray images of COVID-19 patients. Digit Health 2024; 10:20552076231225853. [PMID: 38313365 PMCID: PMC10836150 DOI: 10.1177/20552076231225853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024] Open
Abstract
Background The COVID-19 can cause long-term symptoms in the patients after they overcome the disease. Given that this disease mainly damages the respiratory system, these symptoms are often related with breathing problems that can be caused by an affected diaphragm. The diaphragmatic function can be assessed with imaging modalities like computerized tomography or chest X-ray. However, this process must be performed by expert clinicians with manual visual inspection. Moreover, during the pandemic, the clinicians were asked to prioritize the use of portable devices, preventing the risk of cross-contamination. Nevertheless, the captures of these devices are of a lower quality. Objectives The automatic quantification of the diaphragmatic function can determine the damage of COVID-19 on each patient and assess their evolution during the recovery period, a task that could also be complemented with the lung segmentation. Methods We propose a novel multi-task fully automatic methodology to simultaneously localize the position of the hemidiaphragms and to segment the lung boundaries with a convolutional architecture using portable chest X-ray images of COVID-19 patients. For that aim, the hemidiaphragms' landmarks are located adapting the paradigm of heatmap regression. Results The methodology is exhaustively validated with four analyses, achieving an 82.31% ± 2.78% of accuracy when localizing the hemidiaphragms' landmarks and a Dice score of 0.9688 ± 0.0012 in lung segmentation. Conclusions The results demonstrate that the model is able to perform both tasks simultaneously, being a helpful tool for clinicians despite the lower quality of the portable chest X-ray images.
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Affiliation(s)
- Daniel I Morís
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - Joaquim de Moura
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - Shahab Aslani
- Department of Computer Science, Centre for Medical Image Computing, University College London, UK
| | - Joseph Jacob
- Department of Computer Science, Centre for Medical Image Computing, University College London, UK
- Satsuma Lab, Centre for Medical Image Computing, University College London, UK
| | - Jorge Novo
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - Marcos Ortega
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain
- Grupo VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
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Fogagnolo A, Spadaro S, Karbing DS, Scaramuzzo G, Mari M, Guirrini S, Ragazzi R, Al-Husinat L, Greco P, Rees SE, Volta CA. Effect of expiratory flow limitation on ventilation/perfusion mismatch and perioperative lung function during pneumoperitoneum and Trendelenburg position. Minerva Anestesiol 2023; 89:733-743. [PMID: 36748283 DOI: 10.23736/s0375-9393.22.17006-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic surgery and Trendelenburg position may affect the respiratory function and alter the gas exchange. Further the reduction of the lung volumes may contribute to the development of expiratory flow limitation (EFL). The latter is associated with an increased risk of postoperative pulmonary complications. Our aim was to investigate the incidence of EFL and to evaluate its effect on pulmonary function and intraoperative V/Q mismatch. METHODS This is a prospective study on patients undergoing elective laparoscopic gynecological surgery. We evaluated respiratory mechanics, V/Q mismatch and presence of EFL after anesthesia induction, during pneumoperitoneum and Trendelenburg position and at the end of surgery. Intraoperative gas exchange and hemodynamic were also recorded. Clinical data were collected until seven days after surgery to evaluate the onset of pulmonary postoperative complications (PPCs). RESULTS Among the 66 patients enrolled, 25/66 (38%) exhibited EFL during surgery, of whom 10/66 (15%) after anesthesia induction, and the remaining 15 patients after pneumoperitoneum and Trendelenburg position. Median PEEP able to reverse flow limitation was 7 [7-10] cmH2O after anesthesia induction and 9 [8-15] cmH2O after pneumoperitoneum and Trendelenburg position. Patients with EFL had significantly higher shunt (17 [2-25] vs. 9 [1-19]; P=0.05), low V̇/Q̇ (27 [20-70] vs. 15 [10-22]; P=0.05) and high V̇/Q̇ (10 [7-14] vs. 6 [4-7]; P=0.024). At the end of surgery, only high V/Q was significantly higher in EFL patients. Further, they exhibited higher incidence of postoperative pulmonary complication (48% (12/25) vs. 15% (6/41), P=0.005), hypoxemia and hypercapnia (80% [20/25] vs. 32% [13/41]; P<0.001). CONCLUSIONS Expiratory flow limitation is a common phenomenon during gynecological laparoscopic surgery associated with worsen gas exchange, increased V/Q mismatch and altered lung mechanics. Our study showed that patients experiencing EFL during surgery showed a higher risk for PPCs.
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Affiliation(s)
| | - Savino Spadaro
- Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy -
- Department of Translational Medicine and for Romagna, University of Ferrara, AOU Ferrara, Ferrara, Italy
| | - Dan S Karbing
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gaetano Scaramuzzo
- Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy
- Department of Translational Medicine and for Romagna, University of Ferrara, AOU Ferrara, Ferrara, Italy
| | - Matilde Mari
- Department of Translational Medicine and for Romagna, University of Ferrara, AOU Ferrara, Ferrara, Italy
| | - Silvia Guirrini
- Department of Translational Medicine and for Romagna, University of Ferrara, AOU Ferrara, Ferrara, Italy
| | - Riccardo Ragazzi
- Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy
- Department of Translational Medicine and for Romagna, University of Ferrara, AOU Ferrara, Ferrara, Italy
| | - Lou'i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Pantaleo Greco
- Section of Obstetrics and Gynecology, Department of Surgical Sciences, AOU Ferrara, Ferrara, Italy
| | - Stephen E Rees
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Carlo A Volta
- Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy
- Department of Translational Medicine and for Romagna, University of Ferrara, AOU Ferrara, Ferrara, Italy
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YEGİN D, OSKAY A, OSKAY T, ENVER DİNÇ S, ŞENOL H, ÖZEN M, ÇAKMAK V, SEYİT M, YILMAZ A, TÜRKÇÜER İ. Emergency ultrasound of respiratory muscles: a promising tool for determining the outcomes of COPD exacerbations. Turk J Med Sci 2023; 53:1001-1011. [PMID: 38031950 PMCID: PMC10760574 DOI: 10.55730/1300-0144.5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 08/18/2023] [Accepted: 05/25/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The respiratory muscles of patients with chronic obstructive pulmonary disease (COPD) exhibit structural and functional changes that can be evaluated and monitored by ultrasonography. METHODS This single-center, prospective study was conducted in the emergency department (ED) of a tertiary care hospital over an eight-month period (September 2020-May 2021). Diaphragmatic excursions, end-expiratory thickness, and thickening fractions, as well as right and left intercostal muscle thicknesses, of all adult subjects manifesting COPD exacerbation, were assessed. The data were analyzed regarding ward/intensive care unit (ICU) hospitalization or discharge from the ED, mortality, and readmission within 15 days. RESULTS Sixty-three subjects were recruited for the study. Diaphragmatic excursion, end-expiratory diaphragmatic thickness, and intercostal muscle thickness measurements were significantly different between the ward, ICU, and discharge groups (p < 0.001) but lower in the deceased subjects (all p < 0.05). The diaphragmatic excursion value of 3.25 cm was the threshold value measured for distinguishing discharge from ED, and 1.82 cm was measured for admission to the ICU, both with 100% sensitivity and selectivity (AUC = 1). DISCUSSION Diaphragmatic excursion, diaphragmatic end-expiratory thickness, and right and left intercostal muscle thicknesses vary in the prognosis of subjects presenting with COPD exacerbation.
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Affiliation(s)
- Dinçer YEGİN
- Department of Emergency Medicine, Ardahan State Hospital, Ardahan,
Turkiye
| | - Alten OSKAY
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Tülay OSKAY
- Department of Cardiology, Bucak State Hospital, Burdur,
Turkiye
| | - Selcan ENVER DİNÇ
- Department of Emergency Medicine, Kepez State Hospital, Antalya,
Turkiye
| | - Hande ŞENOL
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Mert ÖZEN
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Vefa ÇAKMAK
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Murat SEYİT
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Atakan YILMAZ
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - İbrahim TÜRKÇÜER
- Department of Emergency Medicine, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
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Silveira BMF, Martins HR, Ribeiro-Samora GA, Oliveira LF, Mancuzo EV, Velloso M, Parreira VF. Maximal respiratory pressures: Measurements at functional residual capacity in individuals with different health conditions using a digital manometer. Braz J Phys Ther 2023; 27:100529. [PMID: 37566990 PMCID: PMC10440449 DOI: 10.1016/j.bjpt.2023.100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Measuring maximal respiratory pressure is a widely used method of investigating the strength of inspiratory and expiratory muscles. OBJECTIVES To compare inspiratory pressures obtained at functional residual capacity (FRC) with measures at residual volume (RV), and expiratory pressures obtained at FRC with measures at total lung capacity (TLC) in individuals with different health conditions: post-COVID-19, COPD, idiopathic pulmonary fibrosis (IPF), heart failure (CHF), and stroke; and to compare the mean differences between measurements at FRC and RV/TLC among the groups. METHODS Inspiratory and expiratory pressures were obtained randomly at different lung volumes. Mixed factorial analysis of covariance with repeated measures was used to compare measurements at different lung volumes within and among groups. RESULTS Seventy-five individuals were included in the final analyses (15 individuals with each health condition). Maximal inspiratory pressures at FRC were lower than RV [mean difference (95% CI): 11.3 (5.8, 16.8); 8.4 (2.3, 14.5); 11.1 (5.5, 16.7); 12.8 (7.1, 18.4); 8.0 (2.6, 13.4) for COVID-19, COPD, IPF, CHF, and stroke, respectively] and maximal expiratory pressures at FRC were lower than TLC [mean difference (95% CI): 51.9 (37.4, 55.5); 60.9 (44.2, 77.7); 62.9 (48.1, 77.8); 58.0 (43.9, 73.8); 57.2 (42.9, 71.6) for COVID-19, COPD, IPF, CHF, and stroke, respectively]. All mean differences were similar among groups. CONCLUSION Although inspiratory and expiratory pressures at FRC were lower than measures obtained at RV/TLC for the five groups of health conditions, the mean differences between measurements at different lung volumes were similar among groups, which raises the discussion about the influence of the viscoelastic properties of the lungs on maximal respiratory pressure.
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Affiliation(s)
- Bruna M F Silveira
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Henrique R Martins
- Electrical Engineering Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giane A Ribeiro-Samora
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciano F Oliveira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eliane V Mancuzo
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Lung function Laboratory, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Velloso
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Verônica F Parreira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Boussuges A, Chaumet G, Boussuges M, Menard A, Delliaux S, Brégeon F. Ultrasound assessment of the respiratory system using diaphragm motion-volume indices. Front Med (Lausanne) 2023; 10:1190891. [PMID: 37275363 PMCID: PMC10235454 DOI: 10.3389/fmed.2023.1190891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
Background Although previous studies have determined limit values of normality for diaphragm excursion and thickening, it would be beneficial to determine the normal diaphragm motion-to-inspired volume ratio that integrates the activity of the diaphragm and the quality of the respiratory system. Methods To determine the normal values of selected ultrasound diaphragm motion-volume indices, subjects with normal pulmonary function testing were recruited. Ultrasound examination recorded diaphragm excursion on both sides during quiet breathing and deep inspiration. Diaphragm thickness was also measured. The inspired volumes of the corresponding cycles were systematically recorded using a spirometer. The indices were calculated using the ratio excursion, or percentage of thickening, divided by the corresponding breathing volume. From this corhort, normal values and limit values for normality were determined. These measurements were compared to those performed on the healthy side in patients with hemidiaphragm paralysis because an increase in hemidiaphragm activity has been previously demonstated in such circumstances. Results A total of 122 subjects (51 women, 71 men) with normal pulmonary function were included in the study. Statistical analysis revealed that the ratio of excursion, or percentage of thickening, to inspired volume ratio significantly differed between males and females. When the above-mentioned indices using excursion were normalized by body weight, no gender differences were found. The indices differed between normal respiratory function subjects and patients with hemidiaphragm paralysis (27 women, 41 men). On the paralyzed side, the average ratio of the excursion divided by the inspired volume was zero. On the healthy side, the indices using the excursion and the percentage of thickening during quiet breathing or deep inspiration were significantly increased comparedto patients with normal lung function. According to the logistic regression analysis, the most relevant indice appeared to be the ratio of the excursion measured during quiet breathing to the inspired volume. Conclusion The normal values of the diaphragm motion-volume indices could be useful to estimate the performance of the respiratory system. Proposed indices appear suitable in a context of hyperactivity.
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Affiliation(s)
- Alain Boussuges
- Center for Cardiovascular and Nutrition Research, C2VN (Aix Marseille University, INSERM 1263, INRAE 1260), Faculté de Médecine, Marseille, France
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
| | | | - Martin Boussuges
- Aix Marseille University, APHM, Département de Pneumologie, Hôpital Nord, Marseille, France
| | - Amelie Menard
- APHM, Hôpital Nord, Unité Post COVID, Service de Médecine Interne, Marseille, France
| | - Stephane Delliaux
- Center for Cardiovascular and Nutrition Research, C2VN (Aix Marseille University, INSERM 1263, INRAE 1260), Faculté de Médecine, Marseille, France
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
| | - Fabienne Brégeon
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
- Aix Marseille University, APHM, Microbes Evolution Phylogeny and Infections Department, IHU-Méditerranée Infection, Marseille, France
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Li D, Li Z, Zhang Z, Liu Y, Wang C, Cheng A. Effect of respiratory training on respiratory failure secondary to unilateral phrenic nerve injury: A case report. Medicine (Baltimore) 2023; 102:e32566. [PMID: 36800600 PMCID: PMC9936005 DOI: 10.1097/md.0000000000032566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Diaphragm is one of the most important respiratory muscles dominated by the phrenic nerve. Phrenic nerve injury would induce a series of clinical symptoms, including respiratory failure. Respiratory training could assist in regular treatment in improving the respiratory function and daily ability of respiratory failure patients. CASE PRESENTATION A 71-years-old female was enrolled for the disorders of consciousness of 4.5 hours observed by her family and was diagnosed with respiratory failure secondary to unilateral phrenic nerve injury. The patient received basic therapy combined with rehabilitation training, including the training of aspirate muscle, limb resistance, thoracic loosening, aerobic training, electrical stimulation on respiratory nerves, and airway clearance. The combining therapeutic strategy significantly improved the daily ability and respiratory of the patient. The ultrasound showed that after therapy, the diaphragmatic muscles were thickened and the range of diaphragmatic movement was also enhanced. The pulmonary function was also improved after therapy. CONCLUSION The combination of rehabilitation is suitable for the treatment of respiratory failure patients with clear causes of phrenic nerve injury. For patients with unexplained causes, rehabilitation could also be performed before the diagnosis. Patients with irreversible injury need long-term and family rehabilitation prescriptions.
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Affiliation(s)
- Dawei Li
- Neurorehabilitation Department, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Zhendong Li
- Neurorehabilitation Department, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Zhiyou Zhang
- Neurorehabilitation Department, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Yueyang Liu
- Neurorehabilitation Department, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Congcong Wang
- Neurorehabilitation Department, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Aixia Cheng
- Neurorehabilitation Department, Shengli Oilfield Central Hospital, Dongying, Shandong, China
- * Correspondence: Aixia Cheng, Neurorehabilitation Department, Shengli Oilfield Central Hospital, No.31 Jinan Road, Dongying 257000, Shandong, China (e-mail: )
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Jiang M, Li P, Wang Y, Cao Y, Han X, Jiang L, Liu X, Wu W. Role of Nrf2 and exercise in alleviating COPD-induced skeletal muscle dysfunction. Ther Adv Respir Dis 2023; 17:17534666231208633. [PMID: 37966017 PMCID: PMC10652666 DOI: 10.1177/17534666231208633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex chronic respiratory disease with cumulative impacts on multiple systems, exhibiting significant extrapulmonary impacts, and posing a serious public health problem. Skeletal muscle dysfunction is one of the most pronounced extrapulmonary effects in patients with COPD, which severely affects patient prognosis and mortality primarily through reduced productivity resulting from muscle structural and functional alterations. Although the detailed pathogenesis of COPD has not been fully determined, some researchers agree that oxidative stress plays a significant role. Oxidative stress not only catalyzes the progression of pulmonary symptoms but also drives the development of skeletal muscle dysfunction. Nuclear factor erythroid 2-related factor 2 (Nrf2), is a key transcription factor that regulates the antioxidant response and plays an enormous role in combating oxidative stress. In this review, we have summarized current research on oxidative stress damage to COPD skeletal muscle and analyzed the role of Nrf2 in improving skeletal muscle dysfunction in COPD through exercise. The results suggest that oxidative stress drives the occurrence and development of skeletal muscle dysfunction in COPD. Exercise may improve skeletal muscle dysfunction in patients with COPD by promoting the dissociation of Kelch-like ECH-associated protein 1 (Keap1) and Nrf2, inducing sequestosome1(p62) phosphorylation to bind with Keap1 competitively leading to Nrf2 stabilization and improving dynamin-related protein 1-dependent mitochondrial fission. Nrf2 may be a key target for exercise anti-oxidative stress to alleviate skeletal muscle dysfunction in COPD.
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Affiliation(s)
- Meiling Jiang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yingqi Wang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaoyu Han
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Linhong Jiang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200 Cailun Road Pudong New District Shanghai 201203, P.R. China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, No. 650 Qingyuanhuan Road, Yangpu District Shanghai 200438, P.R. China
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Erfan A, Khalil M, Elmaraghy A, Abd Elkader M. Ultrasonographic assessment of diaphragmatic performance in two chronic obstructive pulmonary disease phenotypes admitted with acute exacerbation and its relation to outcome. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Lee HY, Lee J, Lee SM. Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial. Crit Care 2022; 26:402. [PMID: 36564808 PMCID: PMC9783722 DOI: 10.1186/s13054-022-04281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A spontaneous breathing trial (SBT) is used to determine whether patients are ready for extubation, but the best method for choosing the SBT strategy remains controversial. We investigated the effect of high-flow oxygen versus T-piece ventilation strategies during SBT on rates of weaning failure among patients receiving mechanical ventilation. METHODS This randomized clinical trial was conducted from June 2019 through January 2022 among patients receiving mechanical ventilation for ≥ 12 h who fulfilled the weaning readiness criteria at a single-center medical intensive care unit. Patients were randomized to undergo either T-piece SBT or high-flow oxygen SBT. The primary outcome was weaning failure on day 2, and the secondary outcomes were weaning failure on day 7, ICU and hospital length of stay, and ICU and in-hospital morality. RESULTS Of 108 patients (mean age, 67.0 ± 11.1 years; 64.8% men), 54 received T-piece SBT and 54 received high-flow oxygen SBT. Weaning failure on day 2 occurred in 5 patients (9.3%) in the T-piece group and 3 patients (5.6%) in the high-flow group (difference, 3.7% [95% CI, - 6.1-13.6]; p = 0.713). Weaning failure on day 7 occurred in 13 patients (24.1%) in the T-piece group and 7 patients (13.0%) in the high-flow group (difference, 11.1% [95% CI, - 3.4-25.6]; p = 0.215). A post hoc subgroup analysis showed that high-flow oxygen SBT was significantly associated with a lower rate of weaning failure on day 7 (OR, 0.17 [95% CI, 0.04-0.78]) among those patients intubated because of respiratory failure (p for interaction = 0.020). The ICU and hospital length of stay and mortality rates did not differ significantly between the two groups. During the study, no serious adverse events were recorded. CONCLUSIONS Among patients receiving mechanical ventilation, high-flow oxygen SBT did not significantly reduce the risk of weaning failure compared with T-piece SBT. However, the study may have been underpowered to detect a clinically important treatment effect for the comparison of high-flow oxygen SBT versus T-piece SBT, and a higher percentage of patients with simple weaning and a lower weaning failure rate than expected should be considered when interpreting the findings. Clinical trial registration This trial was registered with ClinicalTrials.gov (number NCT03929328) on April 26, 2019.
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Affiliation(s)
- Hong Yeul Lee
- grid.412484.f0000 0001 0302 820XDepartment of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinwoo Lee
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Sang-Min Lee
- grid.412484.f0000 0001 0302 820XDepartment of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Republic of Korea
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12
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Graca FA, Rai M, Hunt LC, Stephan A, Wang YD, Gordon B, Wang R, Quarato G, Xu B, Fan Y, Labelle M, Demontis F. The myokine Fibcd1 is an endogenous determinant of myofiber size and mitigates cancer-induced myofiber atrophy. Nat Commun 2022; 13:2370. [PMID: 35501350 PMCID: PMC9061726 DOI: 10.1038/s41467-022-30120-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/14/2022] [Indexed: 12/19/2022] Open
Abstract
Decline in skeletal muscle cell size (myofiber atrophy) is a key feature of cancer-induced wasting (cachexia). In particular, atrophy of the diaphragm, the major muscle responsible for breathing, is an important determinant of cancer-associated mortality. However, therapeutic options are limited. Here, we have used Drosophila transgenic screening to identify muscle-secreted factors (myokines) that act as paracrine regulators of myofiber growth. Subsequent testing in mouse myotubes revealed that mouse Fibcd1 is an evolutionary-conserved myokine that preserves myofiber size via ERK signaling. Local administration of recombinant Fibcd1 (rFibcd1) ameliorates cachexia-induced myofiber atrophy in the diaphragm of mice bearing patient-derived melanoma xenografts and LLC carcinomas. Moreover, rFibcd1 impedes cachexia-associated transcriptional changes in the diaphragm. Fibcd1-induced signaling appears to be muscle selective because rFibcd1 increases ERK activity in myotubes but not in several cancer cell lines tested. We propose that rFibcd1 may help reinstate myofiber size in the diaphragm of patients with cancer cachexia.
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Affiliation(s)
- Flavia A Graca
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mamta Rai
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Liam C Hunt
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Anna Stephan
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yong-Dong Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Brittney Gordon
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
- Xenograft Core, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Ruishan Wang
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Giovanni Quarato
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Beisi Xu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yiping Fan
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Myriam Labelle
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Fabio Demontis
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States.
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States.
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13
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Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med 2022; 11:jcm11092451. [PMID: 35566577 PMCID: PMC9103623 DOI: 10.3390/jcm11092451] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.
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14
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Momb BA, Patino E, Akchurin OM, Miller MS. Iron Supplementation Improves Skeletal Muscle Contractile Properties in Mice with CKD. KIDNEY360 2022; 3:843-858. [PMID: 36128477 PMCID: PMC9438424 DOI: 10.34067/kid.0004412021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/18/2022] [Indexed: 01/12/2023]
Abstract
Background Patients with chronic kidney disease (CKD) frequently have compromised physical performance, which increases their mortality; however, their skeletal muscle dysfunction has not been characterized at the single-fiber and molecular levels. Notably, interventions to mitigate CKD myopathy are scarce. Methods The effect of CKD in the absence and presence of iron supplementation on the contractile function of individual skeletal muscle fibers from the soleus and extensor digitorum longus muscles was evaluated in 16-week-old mice. CKD was induced by the adenine diet, and iron supplementation was by weekly iron dextran injections. Results Maximally activated and fatigued fiber force production was decreased 24%-52% in untreated CKD, independent of size, by reducing strongly bound myosin/actin cross-bridges and/or decreasing myofilament stiffness in myosin heavy chain (MHC) I, IIA, and IIB fibers. Additionally, myosin/actin interactions in untreated CKD were slower for MHC I and IIA fibers and unchanged or faster in MHC IIB fibers. Iron supplementation improved anemia and did not change overall muscle mass in CKD mice. Iron supplementation ameliorated CKD-induced myopathy by increasing strongly bound cross-bridges, leading to improved specific tension, and/or returning the rate of myosin/actin interactions toward or equivalent to control values in MHC IIA and IIB fibers. Conclusions Skeletal muscle force production was significantly reduced in untreated CKD, independent of fiber size, indicating that compromised physical function in patients is not solely due to muscle mass loss. Iron supplementation improved multiple aspects of CKD-induced myopathy, suggesting that timely correction of iron imbalance may aid in ameliorating contractile deficits in CKD patients.
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Affiliation(s)
- Brent A. Momb
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts
| | - Edwin Patino
- Joan and Sanford I. Weill Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York
| | - Oleh M. Akchurin
- Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York,New York-Presbyterian Hospital, New York, New York
| | - Mark S. Miller
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts
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15
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Albarrati A, Taher M, Nazer R, Alshameri T. The immediate effect of thoracolumbar manipulation and diaphragmatic release on inspiratory muscle strength in healthy smokers: A randomized clinical trial. J Back Musculoskelet Rehabil 2022; 35:85-91. [PMID: 34151820 DOI: 10.3233/bmr-200182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diaphragmatic release technique and thoracolumbar manipulation have been found effective in restoring normal diaphragmatic movement in healthy and diseased populations. Smoking has deleterious effects on human systems, including the musculoskeletal system. OBJECTIVE The current study aimed to investigate the immediate effects of diaphragmatic release technique and thoracolumbar manipulation on diaphragm muscle strength in healthy smokers. METHODS A double-blinded randomized clinical trial was conducted on 30 asymptomatic healthy smokers randomly assigned into two groups [intervention group (IG) and sham group (SG)] with 15 participants each. The IG received thoracolumbar manipulation and diaphragmatic release techniques, while the SG received no active treatment. The outcome measure was sniff nasal inspiratory pressure (SNIP). RESULTS The IG showed a significant increase in the SNIP with a mean difference of 20.13 cmH2O (95% CI: 13.62-26.64; P< 0.001), while the SG had a reduction in the SNIP value -3.27 cmH2O (95% CI: -0.65 to -5.89; P= 0.02). Diaphragmatic release technique and thoracolumbar manipulation significantly improved SNIP values immediately after the intervention, with a between-group difference of 31.07 cmH2O (95% CI: 15.26-46.87; P< 0.001). CONCLUSIONS Diaphragmatic release technique and thoracolumbar manipulation increased the diaphragm strength in healthy adult smokers, suggesting its potential utility in the management of participants with reduced respiratory muscle strength.
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Affiliation(s)
- Ali Albarrati
- Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Taher
- Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Rakan Nazer
- Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Thamer Alshameri
- Rehabilitation Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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16
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Şendur HN, Cerit MN, Şendur AB, Özhan Oktar S, Yücel C. Evaluation of Diaphragm Thickness and Stiffness Using Ultrasound and Shear-Wave Elastography. Ultrasound Q 2022; 38:89-93. [PMID: 35001026 DOI: 10.1097/ruq.0000000000000593] [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: 10/19/2022]
Abstract
ABSTRACT The purposes of this study are to measure the thickness and stiffness of diaphragm in association with the respiratory cyclus and to assess the reproducibility of these measurements. Forty individuals who are volunteered for participating diaphragm evaluation were included in the study. Two radiologists with 14 and 15 years of experiences in abdominal ultrasound performed all examinations independently. Furthermore, 8 chronic obstructive pulmonary disease (COPD) patients were examined by only the first radiologist. Gray scale and shear-wave elastography imaging of only the right hemidiaphragm of all participants were performed. Thickness and stiffness of diaphragm were measured at the peak inspiration and end expiration phases. Intraclass correlation coefficients test was used to assess the interobserver agreement. The thickness and stiffness of diaphragm significantly increased with inspiration (P < 0.001). The mean ± SD stiffness of diaphragm in peak inspiration and end expiration phases was 51.84 ± 16.83 kPa and 38.49 ± 9.42 kPa, respectively, for the first radiologist and 49.61 ± 13.83 kPa and 37.52 ± 10.71 kPa, respectively, for the second radiologist. Intraclass correlation coefficient values for diaphragm stiffness were 0.667 and 0.736 in peak inspiration and end expiration phases, respectively. In COPD patients, there was no significant difference between stiffness measurements of respiratory phases. In conclusion, the current study revealed that diaphragm thickness and stiffness increase at inspiration, and these measurements are slightly more reproducible at the end of expiration. However, diaphragm stiffness changes between respiratory phases may not be valid for COPD patients, and this may be related to loss of force-generating capacity of diaphragm in COPD patients.
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Affiliation(s)
| | - Mahi Nur Cerit
- Department of Radiology, Gazi University Faculty of Medicine
| | | | | | - Cem Yücel
- Department of Radiology, Gazi University Faculty of Medicine
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17
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Xu JH, Wu ZZ, Tao FY, Zhu ST, Chen SP, Cai C, Liang ZH, Shi BB, Chen B, Xie YP. Ultrasound Shear Wave Elastography for Evaluation of Diaphragm Stiffness in Patients with Stable COPD: A Pilot Trial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2655-2663. [PMID: 33615538 DOI: 10.1002/jum.15655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Skeletal muscle dysfunction is one of the most common comorbidities in chronic obstructive pulmonary disease (COPD). The occurrence of respiratory failure in COPD is common and leads to the patient's death. The diaphragm is the most important muscle in the respiratory system and plays a key role in the onset of respiratory failure. This study explores the feasibility of ultrasound shear wave elastography (SWE) to measure diaphragmatic stiffness and evaluates its changes in COPD patients. METHODS In total, 77 participants (43 patients with stable COPD and 34 healthy controls) were enrolled. All subjects underwent complete diaphragmatic ultrasound SWE measurements and pulmonary function tests. The diaphragmatic stiffness was indicated via diaphragmatic shear wave velocity (SWV) at functional residual capacity (FRC). A trained operator performed the ultrasound SWE examinations of the first 15 healthy controls thrice to assess the reliability of diaphragmatic SWE. RESULTS A good to excellent reliability was found in diaphragmatic SWV at FRC (ICC = 0.93, 95%CI 0.82-0.98). As compared to the control group, the diaphragmatic SWV at FRC was considerably high in the COPD group (median 2.5 m/s versus 2.1 m/s, P = .008). Diaphragmatic SWV at FRC was linked to forced expiratory volume in one second (r = -0.30, P = .009), forced vital capacity (r = -0.33, P = .003), modified Medical Research Council score (r = 0.30, P = .001), and COPD assessment test score (r = 0.48, P < .001). CONCLUSIONS Ultrasound SWE may be employed as an effective tool for quantitative evaluation of diaphragm stiffness and can help in personalized management of COPD, such as treatment guidance and follow-up monitoring.
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Affiliation(s)
- Jing-Hong Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Zhen-Zhou Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang-Yi Tao
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Shu-Ting Zhu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Shun-Ping Chen
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Chang Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zeng-Hui Liang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Bin-Bin Shi
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Bin Chen
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Yu-Peng Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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18
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Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Disease. Pharmaceuticals (Basel) 2021; 14:ph14100979. [PMID: 34681202 PMCID: PMC8539950 DOI: 10.3390/ph14100979] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading global causes of morbidity and mortality. A hallmark of COPD is progressive airflow obstruction primarily caused by cigarette smoke (CS). CS exposure causes an imbalance favoring pro- over antioxidants (oxidative stress), leading to transcription factor activation and increased expression of inflammatory mediators and proteases. Different cell types, including macrophages, epithelial cells, neutrophils, and T lymphocytes, contribute to COPD pathophysiology. Alteration in cell functions results in the generation of an oxidative and inflammatory microenvironment, which contributes to disease progression. Current treatments include inhaled corticosteroids and bronchodilator therapy. However, these therapies do not effectively halt disease progression. Due to the complexity of its pathophysiology, and the risk of exacerbating symptoms with existing therapies, other specific and effective treatment options are required. Therapies directly or indirectly targeting the oxidative imbalance may be promising alternatives. This review briefly discusses COPD pathophysiology, and provides an update on the development and clinical testing of novel COPD treatments.
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19
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Ultrasound Evaluation of Diaphragm Force Reserve in Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2021; 17:1222-1230. [PMID: 32614240 DOI: 10.1513/annalsats.202002-129oc] [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] [Indexed: 11/20/2022] Open
Abstract
Rationale: Diaphragm function is a key determinant of dyspnea in chronic obstructive pulmonary disease (COPD); however, it is rarely assessed in clinical practice. Lung hyperinflation can also impair diaphragm function. Ultrasound can assess the activity, function, and force reserve of the diaphragm.Objectives: To compare diaphragm activity, function, and force reserve among patients with COPD and healthy control subjects.Methods: Patients with stable COPD (n = 80) and healthy control subjects (n = 20) were enrolled (97% of them were men). Ultrasound was used to measure the thickening fraction of the diaphragm during tidal breathing and maximum volitional effort. Outcome measures were as follows: 1) the difference in diaphragm force reserve, activity, and function between patients with COPD and control subjects; 2) the correlation between lung volumes and diaphragm force reserve, activity, and function; and 3) the relationship between diaphragm force reserve and the rate of moderate to severe exacerbation of COPD.Results: The tidal thickening fraction of the diaphragm during resting breathing (TFdi-tidal) was higher in patients with COPD than in control subjects (P = 0.002); it was approximately twice as high in patients with severe COPD than in control subjects. Patients with COPD had poorer diaphragm function than control subjects as assessed by the maximal thickening fraction of the diaphragm during Muller maneuver (P < 0.01). Diaphragm force reserve ratio assessed by 1-(tidal thickening fraction of the diagphragm during resting breathing/maximal thickening fraction of the diaphragm) was lower in patients with COPD than in control subjects, and it fell with increasing Global Initiative for Chronic Obstructive Lung Disease stages (P < 0.001); it correlated with inspiratory capacity (r = 0.46) and the body mass index, airflow obstruction, dyspnea, exercise capacity (BODE) index, a multidimensional scoring system (r = -0.49). Patients who developed exacerbation during the following 2 years had less force reserve than patients without exacerbation (P = 0.024).Conclusions: Male patients with COPD have increased diaphragm workload, impaired diaphragm function, and reduced force reserve compared with healthy subjects. Ultrasound assessment of the diaphragm in COPD provides important functional information.Clinical trial registered with the Thai Clinical Trials Registry (TCTR20160411001). Registered 31 April 5, 2016.
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20
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Diaphragm Morphology Assessed by Computed Tomography in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2021; 18:955-962. [PMID: 33321048 DOI: 10.1513/annalsats.202007-865oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is associated with abnormal skeletal muscle morphology and function. Objectives: To test the hypothesis that in vivo diaphragm muscle morphology assessed by computed tomography (CT) imaging would be associated with COPD severity, exacerbations, health status, and exercise capacity. Methods: The COPD Morphometry Study is a cross-sectional study that enrolled a clinical sample of smokers with COPD. Spirometry was performed and COPD severity was defined according to guidelines. Three-dimensional left hemidiaphragm morphology was segmented from contiguous axial CT images acquired at maximal inspiration, yielding quantitative measures of diaphragm CT density in Hounsfield units, dome height, and muscle volume. Exacerbations prompting pharmacotherapy or hospitalization in the preceding 12 months and St. George's Respiratory Questionnaire for COPD were assessed. Incremental symptom-limited cycle ergometry quantified peak oxygen uptake ([Formula: see text]o2Peak). Associations were adjusted for age, sex, body height, body mass index, and smoking status. Results: Among 65 smokers with COPD (75% male; [mean ± standard deviation (SD)] 56 ± 26 pack-years; forced expiratory volume in 1 second [FEV1] percentage predicted 55 ± 23%), mean diaphragm CT density was 3.1 ± 10 Hounsfield units, dome height was 5.2 ± 1.3 cm, and muscle volume was 57 ± 24 cm3. A 1-SD decrement in the diaphragm CT density was associated with 8.3% lower FEV1, 3.27-fold higher odds of exacerbation history, 9.7-point higher score on the St. George's Respiratory Questionnaire for COPD, and 2.5 ml/kg/min lower [Formula: see text]o2Peak. A 1-SD decrement in dome height was associated with 11% lower FEV1 and 1.3 ml/kg/min lower [Formula: see text]o2Peak. There were no associations with diaphragm volume observed. Conclusions: CT-assessed diaphragm morphology was associated with COPD severity, exacerbations, impaired health status, and exercise intolerance. The mechanisms and functional impact of lower diaphragm CT density merit investigation.
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21
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Zhang B, Li P, Li J, Liu X, Wu W. Effect of Oxidative Stress on Diaphragm Dysfunction and Exercise Intervention in Chronic Obstructive Pulmonary Disease. Front Physiol 2021; 12:684453. [PMID: 34163375 PMCID: PMC8215263 DOI: 10.3389/fphys.2021.684453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) can cause extrapulmonary injury such as diaphragm dysfunction. Oxidative stress is one of the main factors causing diaphragm dysfunction in COPD. Exercise plays a positive role in the prevention and treatment of diaphragm dysfunction in COPD, and the changes in diaphragm structure and function induced by exercise are closely related to the regulation of oxidative stress. Therefore, on the basis of the review of oxidative stress and the changes in diaphragm structure and function in COPD, this article analyzed the effects of exercise on oxidative stress and diaphragm dysfunction in COPD and explored the possible mechanism by which exercise improves oxidative stress. Studies have found that diaphragm dysfunction in COPD includes the decline of muscle strength, endurance, and activity. Oxidative stress mainly affects the structure and function of the diaphragm in COPD through protein oxidation, protease activation and calcium sensitivity reduction. The effects of exercise on oxidative stress level and diaphragm dysfunction may differ depending on the intensity, duration, and style of exercise. The mechanism of exercise on oxidative stress in the diaphragm of COPD may include improving antioxidant capacity, reducing oxidase activity and improving mitochondrial function.
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Affiliation(s)
- Bingzhi Zhang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
| | - Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, China
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22
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Birinci T, Kısa EP, Akıncı B, Kuran Aslan G, Kıyan E. The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD. COPD 2021; 18:147-156. [PMID: 33821729 DOI: 10.1080/15412555.2021.1904867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = -0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = -0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.
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Affiliation(s)
- Tansu Birinci
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul, Turkey.,Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eylul Pınar Kısa
- Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Biruni University, Istanbul, Turkey
| | - Buket Akıncı
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Biruni University, Istanbul, Turkey
| | - Goksen Kuran Aslan
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esen Kıyan
- Istanbul Medical Faculty, Department of Chest Disease, Istanbul University, Istanbul, Turkey
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23
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Fiala JA, Coleman JM. Tailoring the Sleep Laboratory for Chronic Respiratory Failure. Sleep Med Clin 2020; 15:557-568. [PMID: 33131665 DOI: 10.1016/j.jsmc.2020.08.009] [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: 11/19/2022]
Abstract
"Many seemingly mundane aspects of the sleep laboratory can have outsized effects on the quality of polysomnographic data obtained from, and care provided to, patients. This is particularly true when performing polysomnography on patients with chronic respiratory failure due to various causes. This article uses a disease-based approach to review physical and protocol-based accommodations that should be considered when performing polysomnography on this patient population."
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Affiliation(s)
- Justin A Fiala
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North Street Clair Street, Suite 1400, Chicago, IL 60611, USA
| | - John M Coleman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North Street Clair Street, Suite 1400, Chicago, IL 60611, USA.
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24
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Abstract
The role of noninvasive positive pressure ventilation (NIV) in severe chronic obstructive pulmonary disease (COPD) has been controversial. Over the past two decades, data primarily obtained from Europe have begun to define the clinical characteristics of patients likely to respond, the role of high-intensity NIV, and the potential best timing of initiating therapy. These approaches, however, have not been validated in the context of the U.S. healthcare delivery system. Use of NIV in severe COPD in the United States is limited by the practicalities of doing in-hospital titrations as well as a complex system of reimbursement. These systematic complexities, coupled with a still-emerging clinical trial database regarding the most effective means to deliver NIV, have led to persistent uncertainty regarding when in stable severe COPD treatment with NIV is actually appropriate. In this review, we propose an assessment algorithm and treatment plan that can be used in clinical practice in the United States, but we acknowledge that the absence of pivotal clinical trials largely precludes a robust evidence-based approach to this potentially valuable therapy.
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25
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Rodrigues GC, Rocha NN, Maia LDA, Melo I, Simões AC, Antunes MA, Bloise FF, Woyames J, da Silva WS, Capelozzi VL, Abela GP, Ball L, Pelosi P, Rocco PRM, Silva PL. Impact of experimental obesity on diaphragm structure, function, and bioenergetics. J Appl Physiol (1985) 2020; 129:1062-1074. [PMID: 32909923 DOI: 10.1152/japplphysiol.00262.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Obesity is associated with bioenergetic dysfunction of peripheral muscles; however, little is known regarding the impact of obesity on the diaphragm. We hypothesized that obesity would be associated with diaphragm dysfunction attributable to mitochondrial oxygen consumption and structural and ultrastructural changes. Wistar rat litters were culled to 3 pups to induce early postnatal overfeeding and consequent obesity. Control animals were obtained from unculled litters. From postnatal day 150, diaphragm ultrasound, computed tomography, high-resolution respirometry, immunohistochemical, biomolecular, and ultrastructural histological analyses were performed. The diaphragms of obese animals, compared with those of controls, presented changes in morphology as increased thickening fraction, diaphragm excursion, and diaphragm dome height, as well as increased mitochondrial respiratory capacity coupled to ATP synthesis and maximal respiratory capacity. Fatty acid synthase gene expression was also higher in obese animals, suggesting a source of energy for the respiratory chain. Myosin heavy chain-IIA was increased, indicating shift from glycolytic toward oxidative muscle fiber profile. Diaphragm tissue also exhibited ultrastructural changes, such as compact, round, and swollen mitochondria with fainter cristae and more lysosomal bodies. Dynamin-1 expression in the diaphragm was reduced in obese rats, suggesting decreased mitochondrial fission. Furthermore, gene expressions of peroxisome γ proliferator-activated receptor coactivator-1α and superoxide dismutase-2 were lower in obese animals than in controls, which may indicate a predisposition to oxidative injury. In conclusion, in the obesity model used herein, muscle fiber phenotype was altered in a manner likely associated with increased mitochondrial respiratory capability, suggesting respiratory adaptation to increased metabolic demand.NEW & NOTEWORTHY Obesity has been associated with peripheral muscle dysfunction; however, little is known about its impact on the diaphragm. In the current study, we found high oxygen consumption in diaphragm tissue and changes in muscle fiber phenotypes toward a more oxidative profile in experimental obesity.
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Affiliation(s)
- Gisele C Rodrigues
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nazareth N Rocha
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Fluminense Federal University, Niteroi, Brazil
| | - Ligia de A Maia
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabella Melo
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Carolina Simões
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana A Antunes
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavia F Bloise
- Laboratory of Translational Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Woyames
- Laboratory of Molecular Endocrinology, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Wagner S da Silva
- Laboratory of Metabolic Adaptations, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vera L Capelozzi
- Laboratory of Pulmonary Genomics, Department of Pathology, University of São Paulo, São Paulo, Brazil
| | - Glenn Paul Abela
- Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro L Silva
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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26
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Pandey PR, Yang JH, Tsitsipatis D, Panda AC, Noh JH, Kim KM, Munk R, Nicholson T, Hanniford D, Argibay D, Yang X, Martindale JL, Chang MW, Jones SW, Hernando E, Sen P, De S, Abdelmohsen K, Gorospe M. circSamd4 represses myogenic transcriptional activity of PUR proteins. Nucleic Acids Res 2020; 48:3789-3805. [PMID: 31980816 PMCID: PMC7144931 DOI: 10.1093/nar/gkaa035] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 02/02/2023] Open
Abstract
By interacting with proteins and nucleic acids, the vast family of mammalian circRNAs is proposed to influence many biological processes. Here, RNA sequencing analysis of circRNAs differentially expressed during myogenesis revealed that circSamd4 expression increased robustly in mouse C2C12 myoblasts differentiating into myotubes. Moreover, silencing circSamd4, which is conserved between human and mouse, delayed myogenesis and lowered the expression of myogenic markers in cultured myoblasts from both species. Affinity pulldown followed by mass spectrometry revealed that circSamd4 associated with PURA and PURB, two repressors of myogenesis that inhibit transcription of the myosin heavy chain (MHC) protein family. Supporting the hypothesis that circSamd4 might complex with PUR proteins and thereby prevent their interaction with DNA, silencing circSamd4 enhanced the association of PUR proteins with the Mhc promoter, while overexpressing circSamd4 interfered with the binding of PUR proteins to the Mhc promoter. These effects were abrogated when using a mutant circSamd4 lacking the PUR binding site. Our results indicate that the association of PUR proteins with circSamd4 enhances myogenesis by contributing to the derepression of MHC transcription.
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Affiliation(s)
- Poonam R Pandey
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Jen-Hao Yang
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Dimitrios Tsitsipatis
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Amaresh C Panda
- Institute of Life Sciences, Nalco Square, Bhubaneswar, Odisha, India
| | - Ji Heon Noh
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
- Department of Biotechnology, Chonnam National University, Yeosu, Chonnam, Republic of Korea
| | - Kyoung Mi Kim
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
- Department of Biological Sciences, Chungnam National University, Daejeon, Republic of Korea
| | - Rachel Munk
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Thomas Nicholson
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Douglas Hanniford
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Diana Argibay
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Xiaoling Yang
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Jennifer L Martindale
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Ming-Wen Chang
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Simon W Jones
- Institute of Inflammation and Ageing, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Eva Hernando
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Payel Sen
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Supriyo De
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Kotb Abdelmohsen
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
| | - Myriam Gorospe
- Laboratory of Genetics and Genomics, National Institute on Aging Intramural Research Program, National Institutes of Health, Baltimore, MD 21224, USA
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27
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Okura K, Iwakura M, Shibata K, Kawagoshi A, Sugawara K, Takahashi H, Satake M, Shioya T. Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2020; 14:521-526. [PMID: 32043736 DOI: 10.1111/crj.13161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/17/2020] [Accepted: 02/06/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ultrasound imaging has been widely used for imaging of the diaphragm thickness (Tdi) and thickening. Few studies assessed the Tdi using ultrasonography in patients with chronic obstructive pulmonary disease (COPD). We measured the Tdi and thickening in patients with COPD compared with healthy younger and healthy older adults to reveal the influence of ageing and/or COPD. METHODS Thirty-eight male patients with COPD (age 72 ± 8 years), 15 healthy younger (age 22 ± 1 years) and 15 healthy older (age 72 ± 5 years) male volunteers were recruited. We measured Tdi at total lung capacity (TdiTLC ), functional residual capacity (TdiFRC ) and residual volume (TdiRV ) using B-mode ultrasonography. We calculated the change ratio of TdiTLC and TdiRV (ΔTdi%). We used a one-way analysis of variance and multiple comparison test for the comparison analysis. RESULTS The TdiTLC and the ΔTdi% were significantly lower in patients with COPD compared to the healthy adults. There was no significant difference in these values with age. There was no between group difference in the TdiFRC or TdiRV . CONCLUSIONS Our results indicate significant differences in TdiTLC and ΔTdi% between patients with COPD and healthy adults. Therefore, diaphragm ultrasonography can assess diaphragm dysfunction associated with COPD. We suggest that it is better to use TdiTLC and ΔTdi% (not only Tdi at rest) to assess diaphragm function.
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Affiliation(s)
- Kazuki Okura
- Department of Rehabilitation, Akita University Hospital, Akita City, Japan
| | - Masahiro Iwakura
- Department of Rehabilitation, Akita City Hospital, Akita City, Japan
| | - Kazuyuki Shibata
- Department of Rehabilitation, Akita City Hospital, Akita City, Japan
| | | | - Keiyu Sugawara
- Department of Rehabilitation, Akita City Hospital, Akita City, Japan
| | - Hitomi Takahashi
- Department of Rehabilitation, Akita City Hospital, Akita City, Japan
| | - Masahiro Satake
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita City, Japan
| | - Takanobu Shioya
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita City, Japan
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28
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Coleman JM, Gates KL, Kalhan R. Home Noninvasive Ventilation for Patients With Chronic Obstructive Pulmonary Disease and Chronic Respiratory Failure. JAMA 2020; 323:421-422. [PMID: 32016294 DOI: 10.1001/jama.2019.22484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John M Coleman
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Khalilah L Gates
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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29
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Zhang D, Cao L, Wang Z, Feng H, Cai X, Xu M, Li M, Yu N, Yin Y, Wang W, Kang J. Salidroside mitigates skeletal muscle atrophy in rats with cigarette smoke-induced COPD by up-regulating myogenin and down-regulating myostatin expression. Biosci Rep 2019; 39:BSR20190440. [PMID: 31702007 PMCID: PMC6879355 DOI: 10.1042/bsr20190440] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/17/2019] [Accepted: 11/06/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The present study aimed at investigating the therapeutic effect of Salidroside on skeletal muscle atrophy in a rat model of cigarette smoking-induced chronic obstructive pulmonary disease (COPD) and its potential mechanisms. METHODS Male Wistar rats were randomized, and treated intraperitoneally (IP) with vehicle (injectable water) or a low, medium or high dose of Salidroside, followed by exposure to cigarette smoking daily for 16 weeks. A healthy control received vehicle injection and air exposure. Their lung function, body weights and gastrocnemius (GN) weights, grip strength and cross-section area (CSA) of individual muscular fibers in the GN were measured. The levels of TNF-α, IL-6, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) in serum and GN tissues as well as myostatin and myogenin expression in GN tissues were measured. RESULTS In comparison with that in the healthy control, long-term cigarette smoking induced emphysema, significantly impaired lung function, reduced body and GN weights and CSA values in rats, accompanied by significantly increased levels of TNF-α, IL-6 and MDA, but decreased levels of SOD and GSH in serum and GN tissues. Furthermore, cigarette smoking significantly up-regulated myostatin expression, but down-regulated myogenin expression in GN tissues. Salidroside treatment decreased emphysema, significantly ameliorated lung function, increased antioxidant, but reduced MDA, IL-6 and TNF-α levels in serum and GN tissues of rats, accompanied by decreased myostain, but increased myogenin expression in GN tissues. CONCLUSION Salidroside mitigates the long-term cigarette smoking-induced emphysema and skeletal muscle atrophy in rats by inhibiting oxidative stress and inflammatory responses and regulating muscle-specific transcription factor expression.
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Affiliation(s)
- Dan Zhang
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning, China
| | - Lihua Cao
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning, China
| | - Zhenshan Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning, China
| | - Haoshen Feng
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Xu Cai
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Mingtao Xu
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Menglu Li
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Na Yu
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Yan Yin
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Wei Wang
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Jian Kang
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
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30
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Lim SY, Lim G, Lee YJ, Cho YJ, Park JS, Yoon HI, Lee JH, Lee CT. Ultrasound Assessment Of Diaphragmatic Function During Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: A Pilot Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2479-2484. [PMID: 31806957 PMCID: PMC6844220 DOI: 10.2147/copd.s214716] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose Impairment of diaphragmatic function is one of the main pathophysiological mechanisms of chronic obstructive pulmonary disease (COPD) and is known to be related to acute exacerbation. Ultrasonography (US) allows for a simple, non-invasive assessment of diaphragm kinetics. The purpose of this study was to investigate the changes in diaphragmatic function during acute exacerbation of COPD, by US. Methods This single-center, prospective study included patients with acute exacerbation of COPD symptoms. US measurements were performed within 72 hrs after exacerbation and after improvement of symptoms. Diaphragmatic excursion and its thickening fraction (TF) were measured as markers of diaphragmatic function. TF was calculated as (thickness at end inspiration – thickness at end expiration)/thickness at end expiration. Results Ten patients were enrolled. All patients were male, and the mean age was 79.8 years. The TF of the right diaphragm showed a significant increase from the initial to the follow-up values (80.1 ± 104.9 mm vs. 159.5 ± 224.6 mm, p = 0.011); however, the diaphragmatic excursion did not vary significantly between the initial and follow-up values (22 ± 6 mm vs 23 ±12 mm). The change in excursion between the stable and exacerbation periods was positively correlated with time to the next exacerbation and negatively correlated with the time taken to recover from the exacerbation. Conclusion These data support the possibility that a defect in diaphragm thickening is related to acute exacerbation of COPD.
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Affiliation(s)
- Sung Yoon Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gajin Lim
- Division of Pulmonology Medicine, Department of Internal Medicine, Cheongju Hana Hospital, Cheongju-si, Korea
| | - Yeon Joo Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jae Cho
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Sun Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Il Yoon
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Division of Pulmonology Medicine, Department of Internal Medicine, Cheongju Hana Hospital, Cheongju-si, Korea
| | - Jae Ho Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Division of Pulmonology Medicine, Department of Internal Medicine, Cheongju Hana Hospital, Cheongju-si, Korea
| | - Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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31
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Acute effects of photobiomodulation therapy applied to respiratory muscles of chronic obstructive pulmonary disease patients: a double-blind, randomized, placebo-controlled crossover trial. Lasers Med Sci 2019; 35:1055-1063. [PMID: 31654154 DOI: 10.1007/s10103-019-02885-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
To investigate the effects of photobiomodulation applied to respiratory muscles on lung function, thoracoabdominal mobility, respiratory muscle strength, and functional capacity in COPD patients. This is a randomized double-blind crossover clinical trial. Twelve male COPD patients participated in the study. Participants were randomly allocated to receive two photobiomodulation sessions, 1 week apart: (1) an effective photobiomodulation session applied at the main respiratory muscles by means of a cluster with 69 light-emitting diodes (LEDs), containing 35 red (630 ± 10 nm; 10 mW; 0.2 cm2) and 34 near-infrared (830 ± 20 nm; 10 mW; 0.2 cm2) LEDs and (2) a sham photobiomodulation session, following the same procedures without emitting light. The primary outcomes were pulmonary function (spirometric indexes); thoracoabdominal mobility (cirtometry); respiratory muscle strength (maximal respiratory pressures), assessed at three moments: (1) baseline, (2) 1 h after intervention, and (3) 24 h after intervention; and the functional capacity, assessed by the 6-min walk test (6MWT) at baseline and 24 h after intervention. No significant interactions were found for spirometric variables, maximal respiratory pressures, and cirtometry. However, there was a Time × Condition interaction (F = 18.63; p = 0.001; η2p = 0.62) in the walked distance on the 6MWT, with a significant increase after photobiomodulation intervention (p < 0.01) compared with the baseline. Photobiomodulation applied to respiratory muscles was effective in improving acute functional capacity in COPD patients. To the best of our knowledge, this is the first study assessing the effects of photobiomodulation applied to respiratory muscles in patients with COPD.
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32
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Jaitovich A, Barreiro E. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients. Am J Respir Crit Care Med 2019; 198:175-186. [PMID: 29554438 DOI: 10.1164/rccm.201710-2140ci] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
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Affiliation(s)
- Ariel Jaitovich
- 1 Division of Pulmonary and Critical Care Medicine and.,2 Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Esther Barreiro
- 3 Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain; and.,4 Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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33
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Daynes E, Greening N, Sidiqqui S, Singh S. A randomised controlled trial to investigate the use of high-frequency airway oscillations as training to improve dyspnoea in COPD. ERJ Open Res 2019; 5:00064-2019. [PMID: 31367635 PMCID: PMC6661317 DOI: 10.1183/23120541.00064-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is characterised by expiratory flow limitation resulting in symptomatic dyspnoea, sputum retention and ventilation heterogeneity. Changes in breathing mechanics affect the ability of respiratory muscles to respond to the ventilatory demands, increasing the sensation of dyspnoea. A high-frequency airway oscillating device has been developed to combine respiratory muscle training and oscillations to improve dyspnoea and sputum retention within COPD. Methods and analysis Patients with symptomatic COPD (Medical Research Council Breathlessness scale grade ≥2) will be recruited to a double-blind, randomised, sham-controlled trial. Both groups will follow an 8-week intervention phase using the device three times per day for 5 min at a time. This will be recorded in a self-reported diary. The device applies a flow resistive load and oscillations for combined training. Those receiving the sham device will follow the same protocol; however, the mechanism of action will be removed from the device. Improvements in the Chronic Respiratory Questionnaire-Dyspnoea domain will be the primary outcome measure. Secondary outcomes will explore respiratory muscle function, health-related quality of life, exercise capacity and physical activity. The Lung Clearance Index will be an exploratory outcome. Outcomes will be explored using the most appropriate statistical test, dependent on the sample distribution. Focus groups will be an exploratory outcome and analysed by thematic analysis. Ethics and dissemination Ethical approval has been obtained from the East Midlands-Leicester South Research Ethics Committee and the trial has been registered through the ISRCTN Registry. The study results will be disseminated to the appropriate stakeholders through presentations, conferences and peer-reviewed journals. A double-blind, placebo-controlled, randomised trial investigating the effects of high-frequency airway oscillations on dyspnoea, sputum, quality of life and exercise capacity in #COPD.http://bit.ly/2F8bQ6s
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Affiliation(s)
- Enya Daynes
- Centre of Exercise and Rehabilitation Sciences, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK.,University of Leicester, Leicester, UK
| | - Neil Greening
- Centre of Exercise and Rehabilitation Sciences, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK.,University of Leicester, Leicester, UK
| | - Salman Sidiqqui
- NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK.,University of Leicester, Leicester, UK
| | - Sally Singh
- Centre of Exercise and Rehabilitation Sciences, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK.,University of Leicester, Leicester, UK
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de Oliveira MV, Rocha NDN, Santos RS, Rocco MRM, de Magalhães RF, Silva JD, Souza SAL, Capelozzi VL, Pelosi P, Silva PL, Rocco PRM. Endotoxin-Induced Emphysema Exacerbation: A Novel Model of Chronic Obstructive Pulmonary Disease Exacerbations Causing Cardiopulmonary Impairment and Diaphragm Dysfunction. Front Physiol 2019; 10:664. [PMID: 31191356 PMCID: PMC6546905 DOI: 10.3389/fphys.2019.00664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/09/2019] [Indexed: 12/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disorder of the lung parenchyma which also involves extrapulmonary manifestations, such as cardiovascular impairment, diaphragm dysfunction, and frequent exacerbations. The development of animal models is important to elucidate the pathophysiology of COPD exacerbations and enable analysis of possible therapeutic approaches. We aimed to characterize a model of acute emphysema exacerbation and evaluate its consequences on the lung, heart, and diaphragm. Twenty-four Wistar rats were randomly assigned into one of two groups: control (C) or emphysema (ELA). In ELA group, animals received four intratracheal instillations of pancreatic porcine elastase (PPE) at 1-week intervals. The C group received saline under the same protocol. Five weeks after the last instillation, C and ELA animals received saline (SAL) or E. coli lipopolysaccharide (LPS) (200 μg in 200 μl) intratracheally. Twenty-four hours after saline or endotoxin administration, arterial blood gases, lung inflammation and morphometry, collagen fiber content, and lung mechanics were analyzed. Echocardiography, diaphragm ultrasonography (US), and computed tomography (CT) of the chest were done. ELA-LPS animals, compared to ELA-SAL, exhibited decreased arterial oxygenation; increases in alveolar collapse (p < 0.0001), relative neutrophil counts (p = 0.007), levels of cytokine-induced neutrophil chemoattractant-1, interleukin (IL)-1β, tumor necrosis factor-α, IL-6, and vascular endothelial growth factor in lung tissue, collagen fiber deposition in alveolar septa, airways, and pulmonary vessel walls, and dynamic lung elastance (p < 0.0001); reduced pulmonary acceleration time/ejection time ratio, (an indirect index of pulmonary arterial hypertension); decreased diaphragm thickening fraction and excursion; and areas of emphysema associated with heterogeneous alveolar opacities on chest CT. In conclusion, we developed a model of endotoxin-induced emphysema exacerbation that affected not only the lungs but also the heart and diaphragm, thus resembling several features of human disease. This model of emphysema should allow preclinical testing of novel therapies with potential for translation into clinical practice.
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Affiliation(s)
- Milena Vasconcellos de Oliveira
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nazareth de Novaes Rocha
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Niterói, Brazil
| | - Raquel Souza Santos
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcella Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel Ferreira de Magalhães
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Johnatas Dutra Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio Augusto Lopes Souza
- Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vera Luiza Capelozzi
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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van der Pijl RJ, Granzier HL, Ottenheijm CAC. Diaphragm contractile weakness due to reduced mechanical loading: role of titin. Am J Physiol Cell Physiol 2019; 317:C167-C176. [PMID: 31042425 DOI: 10.1152/ajpcell.00509.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The diaphragm, the main muscle of inspiration, is constantly subjected to mechanical loading. Only during controlled mechanical ventilation, as occurs during thoracic surgery and in the intensive care unit, is mechanical loading of the diaphragm arrested. Animal studies indicate that the diaphragm is highly sensitive to unloading, causing rapid muscle fiber atrophy and contractile weakness; unloading-induced diaphragm atrophy and contractile weakness have been suggested to contribute to the difficulties in weaning patients from ventilator support. The molecular triggers that initiate the rapid unloading atrophy of the diaphragm are not well understood, although proteolytic pathways and oxidative signaling have been shown to be involved. Mechanical stress is known to play an important role in the maintenance of muscle mass. Within the muscle's sarcomere, titin is considered to play an important role in the stress-response machinery. Titin is a giant protein that acts as a mechanosensor regulating muscle protein expression in a sarcomere strain-dependent fashion. Thus titin is an attractive candidate for sensing the sudden mechanical arrest of the diaphragm when patients are mechanically ventilated, leading to changes in muscle protein expression. Here, we provide a novel perspective on how titin and its biomechanical sensing and signaling might be involved in the development of mechanical unloading-induced diaphragm weakness.
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Affiliation(s)
- Robbert J van der Pijl
- Department of Cellular and Molecular Medicine, University of Arizona , Tucson, Arizona.,Department of Physiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henk L Granzier
- Department of Cellular and Molecular Medicine, University of Arizona , Tucson, Arizona
| | - Coen A C Ottenheijm
- Department of Cellular and Molecular Medicine, University of Arizona , Tucson, Arizona.,Department of Physiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Koutsoukou A, Pecchiari M. Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury? World J Crit Care Med 2019; 8:1-8. [PMID: 30697515 PMCID: PMC6347666 DOI: 10.5492/wjccm.v8.i1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/24/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
Expiratory flow limitation (EFL), that is the inability of expiratory flow to increase in spite of an increase of the driving pressure, is a common and unrecognized occurrence during mechanical ventilation in a variety of intensive care unit conditions. Recent evidence suggests that the presence of EFL is associated with an increase in mortality, at least in acute respiratory distress syndrome (ARDS) patients, and in pulmonary complications in patients undergoing surgery. EFL is a major cause of intrinsic positive end-expiratory pressure (PEEPi), which in ARDS patients is heterogeneously distributed, with a consequent increase of ventilation/perfusion mismatch and reduction of arterial oxygenation. Airway collapse is frequently concomitant to the presence of EFL. When airways close and reopen during tidal ventilation, abnormally high stresses are generated that can damage the bronchiolar epithelium and uncouple small airways from the alveolar septa, possibly generating the small airways abnormalities detected at autopsy in ARDS. Finally, the high stresses and airway distortion generated downstream the choke points may contribute to parenchymal injury, but this possibility is still unproven. PEEP application can abolish EFL, decrease PEEPi heterogeneity, and limit recruitment/derecruitment. Whether increasing PEEP up to EFL disappearance is a useful criterion for PEEP titration can only be determined by future studies.
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Affiliation(s)
- Antonia Koutsoukou
- ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, Athens 11527, Greece
| | - Matteo Pecchiari
- Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milan 20133, Italy
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Beaumont M, Forget P, Couturaud F, Reychler G. Effects of inspiratory muscle training in COPD patients: A systematic review and meta-analysis. CLINICAL RESPIRATORY JOURNAL 2018; 12:2178-2188. [DOI: 10.1111/crj.12905] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/13/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Beaumont
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre; European University of Occidental Brittany; Brest France
| | - Patrice Forget
- Department of Anesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel; Brussels Belgium
| | - Francis Couturaud
- Department of Internal Medicine and Chest Diseases, EA3878 (G.E.T.B.O.), CIC INSERM 0502; University Hospital of Brest, European University of Occidental Brittany; Brest France
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Université Catholique de Louvain; Brussels Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc; Brussels Belgium
- Cliniques Universitaires Saint-Luc, De Médecine Physique Et Réadaptation Service; Brussels Belgium
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Junhasavasdikul D, Telias I, Grieco DL, Chen L, Gutierrez CM, Piraino T, Brochard L. Expiratory Flow Limitation During Mechanical Ventilation. Chest 2018; 154:948-962. [PMID: 29432712 DOI: 10.1016/j.chest.2018.01.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/13/2022] Open
Abstract
Expiratory flow limitation (EFL) is present when the flow cannot rise despite an increase in the expiratory driving pressure. The mechanisms of EFL are debated but are believed to be related to the collapsibility of small airways. In patients who are mechanically ventilated, EFL can exist during tidal ventilation, representing an extreme situation in which lung volume cannot decrease, regardless of the expiratory driving forces. It is a key factor for the generation of auto- or intrinsic positive end-expiratory pressure (PEEP) and requires specific management such as positioning and adjustment of external PEEP. EFL can be responsible for causing dyspnea and patient-ventilator dyssynchrony, and it is influenced by the fluid status of the patient. EFL frequently affects patients with COPD, obesity, and heart failure, as well as patients with ARDS, especially at low PEEP. EFL is, however, most often unrecognized in the clinical setting despite being associated with complications of mechanical ventilation and poor outcomes such as postoperative pulmonary complications, extubation failure, and possibly airway injury in ARDS. Therefore, prompt recognition might help the management of patients being mechanically ventilated who have EFL and could potentially influence outcome. EFL can be suspected by using different means, and this review summarizes the methods to specifically detect EFL during mechanical ventilation.
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Affiliation(s)
- Detajin Junhasavasdikul
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Irene Telias
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Domenico Luca Grieco
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Lu Chen
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Cinta Millan Gutierrez
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Thomas Piraino
- Department of Respiratory Therapy, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Wolpat A, Lima FV, Silva FM, Tochetto M, de Freitas A, Grandi T, Rodrigues L, Paiva V, Cipriano G, Chiappa AM, Zago J, Chiappa GR. Association between inspiratory muscle weakness and slowed oxygen uptake kinetics in patients with chronic obstructive pulmonary disease. Appl Physiol Nutr Metab 2017; 42:1239-1246. [DOI: 10.1139/apnm-2016-0568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may have poor inspiratory muscle function, which reduces minute and alveolar ventilation, leading to increased hypoxemia and slow pulmonary oxygen uptake kinetics. However, little is known about the effect of inspiratory muscle weakness (IMW) on oxygen uptake kinetics in patients with COPD. Thus, we tested the hypothesis that COPD patients with IMW have slowed oxygen uptake kinetics. An observational study was conducted that included COPD patients with moderate to severe airflow limitation and a history of intolerance to exercise. Participants were divided into 2 groups: (IMW+; n = 22) (IMW–; n = 23) of muscle weakness. The maximal inspiratory, expiratory, and sustained inspiratory strength as well as the maximal endurance of the inspiratory muscles were lower in IMW+ patients (36 ± 9.5 cm H2O; 52 ± 14 cm H2O; 20 ± 6.5 cm H2O; 94 ± 84 s, respectively) than in IMW– patients (88 ± 12 cm H2O; 97 ± 28 cm H2O; 82.5 ± 54 cm H2O; 559 ± 92 s, respectively; p < 0.05). Moreover, the 6-min walk test and peak oxygen uptake were reduced in the IMW+ patients. During the constant work test, oxygen uptake kinetics were slowed in the IMW+ compared with IMW– patients (88 ± 29 vs 61 ± 18 s, p < 0.05). Our findings demonstrate that inspiratory muscle weakness in COPD is associated with slowed oxygen uptake kinetics, and thus, reduced functional capacity.
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Affiliation(s)
- Andiara Wolpat
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Francisco V. Lima
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Fabiola M. Silva
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Micheli Tochetto
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | | | - Tatiane Grandi
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Leonardo Rodrigues
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Verônica Paiva
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Adriana M. Chiappa
- Intensive Medicine Service, Hospital de clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julio Zago
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Gaspar R. Chiappa
- Anhanguera Faculty of Porto Alegre, Avenida Cavalhada 4890, 91740-000
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40
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Elsawy SB. Impact of chronic obstructive pulmonary disease severity on diaphragm muscle thickness. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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41
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Boriek AM, Lopez MA, Velasco C, Bakir AA, Frolov A, Wynd S, Babb TG, Hanania NA, Hoffman EA, Sharafkhaneh A. Obesity modulates diaphragm curvature in subjects with and without COPD. Am J Physiol Regul Integr Comp Physiol 2017; 313:R620-R629. [PMID: 28903915 DOI: 10.1152/ajpregu.00173.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/08/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
Obesity is a common comorbidity of chronic obstructive pulmonary disease (COPD) and has been associated with worse outcomes. However, it is unknown whether the interaction between obesity and COPD modulates diaphragm shape and consequently its function. The body mass index (BMI) has been used as a correlate of obesity. We tested the hypothesis that the shape of the diaphragm muscle and size of the ring of its insertion in non-COPD and COPD subjects are modulated by BMI. We recruited 48 COPD patients with postbronchiodilator forced expiratory volume in 1 s (FEV1)-to-forced vital capacity (FVC) < 0.7 and 29 age-matched smoker/exsmoker control (non-COPD) subjects, who underwent chest computed tomography (CT) at lung volumes ranging from functional residual capacity (FRC) to total lung capacity (TLC). We then computed maximum principal diaphragm curvature in the midcostal region of the left hemidiaphragm at the end of inspiration during quiet breathing (EI) and at TLC. The radius of maximum curvature of diaphragm muscle increased with BMI in both COPD and non-COPD subjects. The size of diaphragm ring of insertion on the chest wall also increased significantly with increasing BMI. Surprisingly, COPD severity did not appear to cause significant alteration in diaphragm shape except in normal-weight subjects at TLC. Our data uncovered important factors such as BMI, the size of the diaphragm ring of insertion, and disease severity that modulate the structure of the ventilatory pump in non-COPD and COPD subjects.
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Affiliation(s)
| | | | | | | | | | - Shari Wynd
- Texas Chiropractic College, Houston, Texas
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas; and
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42
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43
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Ju S, Lee SJ, Park MJ, Cho YJ, Jeong YY, Jeon KN, Bae K, Lee JD, Kim HC. Clinical importance of cross-sectional area of intercostal muscles in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 12:939-947. [PMID: 28054460 DOI: 10.1111/crj.12609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Limb muscle wasting is one of main systemic manifestation of chronic obstructive pulmonary disease (COPD). However, the change of respiratory muscle is unclear. OBJECTIVES This study assessed the cross-sectional area (CSA) of the intercostal muscles (ICMs) in patients with COPD, using chest computed tomography (CT) and determined its association with the clinical characteristics of COPD. METHODS They retrospectively reviewed 60 patients with stable COPD and compared them with 30 controls. CSA (mm2 ) of the ICM on chest CT was measured at the midline level of the lateral arch of the bilateral first rib with a 3-mm slice thickness by using CT histogram software. The association with the clinical characteristics of COPD and with the control groups was assessed. RESULTS CSA of the ICM and the CSA/body mass index (BMI) were lower in the COPD group than in the control group. Patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 4 had a significantly lower CSA of the ICM than patients with stage 1, 2, and 3. CSA of the ICM was positively associated with FEV1 , %FEV1 predicted, FEV1 /FVC ratio, and BMI and negatively associated with age. However, there were no associations with PaO2 , PaCO2 , smoking status, 6-minute walk test, frequency of acute exacerbation of COPD, and serum C-reactive protein level. CONCLUSION Intercostal muscle atrophy occurs in COPD patients and is associated with severity of airway obstruction, BMI, and increasing age.
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Affiliation(s)
- Sunmi Ju
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Jun Lee
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Mi Jung Park
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yu Ji Cho
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yi Yeong Jeong
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung Nyeo Jeon
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyungsoo Bae
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Deog Lee
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ho Cheol Kim
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Duiverman ML, Huberts AS, van Eykern LA, Bladder G, Wijkstra PJ. Respiratory muscle activity and patient-ventilator asynchrony during different settings of noninvasive ventilation in stable hypercapnic COPD: does high inspiratory pressure lead to respiratory muscle unloading? Int J Chron Obstruct Pulmon Dis 2017; 12:243-257. [PMID: 28138234 PMCID: PMC5238808 DOI: 10.2147/copd.s119959] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient–ventilator asynchrony (PVA). Patients and methods Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA. Results Compared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings (P=0.017). Conclusion High-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA.
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Affiliation(s)
- Marieke L Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen
| | | | | | - Gerrie Bladder
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen
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Lewis P, O'Halloran KD. Diaphragm Muscle Adaptation to Sustained Hypoxia: Lessons from Animal Models with Relevance to High Altitude and Chronic Respiratory Diseases. Front Physiol 2016; 7:623. [PMID: 28018247 PMCID: PMC5149537 DOI: 10.3389/fphys.2016.00623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/28/2016] [Indexed: 12/13/2022] Open
Abstract
The diaphragm is the primary inspiratory pump muscle of breathing. Notwithstanding its critical role in pulmonary ventilation, the diaphragm like other striated muscles is malleable in response to physiological and pathophysiological stressors, with potential implications for the maintenance of respiratory homeostasis. This review considers hypoxic adaptation of the diaphragm muscle, with a focus on functional, structural, and metabolic remodeling relevant to conditions such as high altitude and chronic respiratory disease. On the basis of emerging data in animal models, we posit that hypoxia is a significant driver of respiratory muscle plasticity, with evidence suggestive of both compensatory and deleterious adaptations in conditions of sustained exposure to low oxygen. Cellular strategies driving diaphragm remodeling during exposure to sustained hypoxia appear to confer hypoxic tolerance at the expense of peak force-generating capacity, a key functional parameter that correlates with patient morbidity and mortality. Changes include, but are not limited to: redox-dependent activation of hypoxia-inducible factor (HIF) and MAP kinases; time-dependent carbonylation of key metabolic and functional proteins; decreased mitochondrial respiration; activation of atrophic signaling and increased proteolysis; and altered functional performance. Diaphragm muscle weakness may be a signature effect of sustained hypoxic exposure. We discuss the putative role of reactive oxygen species as mediators of both advantageous and disadvantageous adaptations of diaphragm muscle to sustained hypoxia, and the role of antioxidants in mitigating adverse effects of chronic hypoxic stress on respiratory muscle function.
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Affiliation(s)
- Philip Lewis
- Department of Physiology, School of Medicine, University College CorkCork, Ireland; Environmental Medicine and Preventative Research, Institute and Policlinic for Occupational Medicine, University of CologneCologne, Germany
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, University College Cork Cork, Ireland
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Haarmann H, Folle J, Nguyen XP, Herrmann P, Heusser K, Hasenfuß G, Andreas S, Raupach T. Impact of Non-Invasive Ventilation on Sympathetic Nerve Activity in Chronic Obstructive Pulmonary Disease. Lung 2016; 195:69-75. [DOI: 10.1007/s00408-016-9965-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
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47
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Biselli PJC, Kirkness JP, Grote L, Fricke K, Schwartz AR, Smith P, Schneider H. Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study. J Appl Physiol (1985) 2016; 122:82-88. [PMID: 27815367 DOI: 10.1152/japplphysiol.00279.2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) endure excessive resistive and elastic loads leading to chronic respiratory failure. Oxygen supplementation corrects hypoxemia but is not expected to reduce mechanical loads. Nasal high-flow (NHF) therapy supports breathing by reducing dead space, but it is unclear how it affects mechanical loads of patients with COPD. The objective of this study was to compare the effects of low-flow oxygen and NHF therapy on ventilation and work of breathing (WOB) in patients with COPD and controls during sleep. Patients with COPD (n = 12) and controls (n = 6) were recruited and submitted to polysomnography to measure sleep parameters and ventilation in response to administration of oxygen and NHF. A subset of six patients also had an esophageal catheter inserted for the purpose of measuring WOB. Patients with COPD had similar minute ventilation (V̇e) but lower tidal volumes than matched controls. With oxygen, [Formula: see text]was increased and V̇e was reduced in both controls and patients with COPD, but there was an increase in transcutaneous CO2 levels. NHF produced a greater reduction in V̇e and was associated with a reduction in CO2 levels. Although NHF halved WOB, oxygen produced only a minor reduction in this parameter. We conclude that oxygen produced little change in WOB, which was associated with CO2 elevations. On the other hand, NHF produced a large reduction in V̇e and WOB with a concomitant decrease in CO2 levels. Our data indicate that NHF improves alveolar ventilation during sleep compared with oxygen and room air in patients with COPD and therefore can decrease their cost of breathing. NEW & NOTEWORTHY Nasal high-flow (NHF) therapy can support ventilation in patients with chronic obstructive pulmonary disease during sleep by decreasing the work of breathing and improving CO2 levels. On the other hand, oxygen supplementation corrects hypoxemia, but it produces only a minimal reduction in work of breathing and is associated with increased CO2 levels. Therefore, NHF can be a useful method to assist ventilation in patients with increased respiratory mechanical loads.
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Affiliation(s)
- Paolo J C Biselli
- Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland; .,Intensive Care Unit, Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; and
| | - Jason P Kirkness
- Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ludger Grote
- Center of Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kathrin Fricke
- Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alan R Schwartz
- Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Philip Smith
- Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hartmut Schneider
- Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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48
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Okura K, Kawagoshi A, Iwakura M, Sugawara K, Takahashi H, Kashiwagura T, Homma M, Satake M, Shioya T. Contractile capability of the diaphragm assessed by ultrasonography predicts nocturnal oxygen saturation in COPD. Respirology 2016; 22:301-306. [PMID: 27611719 DOI: 10.1111/resp.12897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/16/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpO2 ) in COPD. METHODS Twenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEV1 ), 54.2 ± 17.0% predicted) were included. The thickness of the diaphragm (Tdi) was assessed by ultrasonography. We calculated the change ratio of Tdi at the end of maximal inspiration and expiration (%ΔTdi). The mean value of NSpO2 (NSpO2mean ), the percentage of total sleep time (TST) with desaturation above 4% (DA4%) and the percentage of TST with saturation below 90% (SB90%) were measured by overnight oximetry. Daytime arterial oxygen pressure (PaO2 ) and maximal inspiratory mouth pressure (PImax ) were also measured. RESULTS All participants had mild or no daytime hypoxaemia (PaO2 , 77.3 ± 8.6 mm Hg). The NSpO2mean , DA4% and SB90% were significantly correlated with %ΔTdi, PaO2 , %PImax of the predicted value and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The %ΔTdi and PaO2 were predictors of NSpO2 mean by multiple regression analysis. CONCLUSION This study suggested a close relationship between the NSpO2 and the contractile capability of the diaphragm assessed by ultrasonography in COPD. The %ΔTdi combined with PaO2 might predict NSpO2 in COPD patients with mild or no daytime hypoxaemia.
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Affiliation(s)
- Kazuki Okura
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | | | | | - Keiyu Sugawara
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | | | | | - Mitsunobu Homma
- Department of Respiratory Medicine, Akita City Hospital, Akita, Japan
| | - Masahiro Satake
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Takanobu Shioya
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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49
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Bordoni B, Marelli F, Morabito B, Sacconi B. Manual evaluation of the diaphragm muscle. Int J Chron Obstruct Pulmon Dis 2016; 11:1949-56. [PMID: 27574419 PMCID: PMC4993263 DOI: 10.2147/copd.s111634] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The respiratory diaphragm is the most important muscle for breathing. It contributes to various processes such as expectoration, vomiting, swallowing, urination, and defecation. It facilitates the venous and lymphatic return and helps viscera located above and below the diaphragm to work properly. Its activity is fundamental in the maintenance of posture and body position changes. It can affect the pain perception and emotional state. Many authors reported on diaphragmatic training by using special instruments, whereas only a few studies focused on manual therapy approaches. To the knowledge of the authors, the existing scientific literature does not exhaustively examines the manual evaluation of the diaphragm in its different portions. A complete evaluation of the diaphragm is mandatory for several professional subjects, such as physiotherapists, osteopaths, and chiropractors not only to elaborate a treatment strategy but also to obtain information on the validity of the training performed on the patient. This article aims to describe a strategy of manual evaluation of the diaphragm, with particular attention to anatomical fundamentals, in order to stimulate further research on this less explored field.
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Affiliation(s)
- Bruno Bordoni
- Department of Cardiology, Foundation Don Carlo Gnocchi IRCCS, Institute of Hospitalization and Care with Scientific Address, Milan; CRESO, School of Osteopathic Centre for Research and Studies, Castellanza; CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima
| | - F Marelli
- CRESO, School of Osteopathic Centre for Research and Studies, Castellanza; CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima
| | - B Morabito
- CRESO, School of Osteopathic Centre for Research and Studies, Castellanza; CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima; Foundation Polyclinic University A Gemelli, University Cattolica del Sacro Cuore
| | - B Sacconi
- Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
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50
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Role of Protein Carbonylation in Skeletal Muscle Mass Loss Associated with Chronic Conditions. Proteomes 2016; 4:proteomes4020018. [PMID: 28248228 PMCID: PMC5217349 DOI: 10.3390/proteomes4020018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/23/2016] [Accepted: 05/04/2016] [Indexed: 01/06/2023] Open
Abstract
Muscle dysfunction, characterized by a reductive remodeling of muscle fibers, is a common systemic manifestation in highly prevalent conditions such as chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), cancer cachexia, and critically ill patients. Skeletal muscle dysfunction and impaired muscle mass may predict morbidity and mortality in patients with chronic diseases, regardless of the underlying condition. High levels of oxidants may alter function and structure of key cellular molecules such as proteins, DNA, and lipids, leading to cellular injury and death. Protein oxidation including protein carbonylation was demonstrated to modify enzyme activity and DNA binding of transcription factors, while also rendering proteins more prone to proteolytic degradation. Given the relevance of protein oxidation in the pathophysiology of many chronic conditions and their comorbidities, the current review focuses on the analysis of different studies in which the biological and clinical significance of the modifications induced by reactive carbonyls on proteins have been explored so far in skeletal muscles of patients and animal models of chronic conditions such as COPD, disuse muscle atrophy, cancer cachexia, sepsis, and physiological aging. Future research will elucidate the specific impact and sites of reactive carbonyls on muscle protein content and function in human conditions.
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