Effects of breathing maneuver and sitting posture on muscle activity in inspiratory accessory muscles in patients with chronic obstructive pulmonary disease

Case Report: Difficulties faced by a home oxygen therapy patient who died after the Fukushima Daiichi nuclear power plant accident

Following the Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant accident in 2011, mandatory evacuation orders were issued to residents living near the nuclear power plant in Fukushima prefecture, including some patients receiving home oxygen therapy. Although the vulnerability of patients with home oxygen therapy (one of the population groups most vulnerable to disasters) has been noted, there is little information on the health effects of evacuation in the event of a radiation disaster. A 90-year-old man diagnosed with chronic obstructive pulmonary disease since the age of 70, and lived in a town located approximately 20 km south of the nuclear power plant, died 8 months after the disaster due to worsening health conditions. This case reveals the potential for both physical and psychological burdens experienced by vulnerable groups like patients undergoing home oxygen therapy during evacuations in times of disaster. Although it is only a case report and the information is limited, severe respiratory distress requiring home oxygen therapy may present a significant risk factor for disaster-related deaths, especially in cases where evacuations are prolonged, such as in nuclear disasters. Due to the challenge of obtaining prompt public support immediately after a disaster, home oxygen therapy patients may need to prioritize self-help and mutual assistance in their disaster preparedness efforts.

Mucopolysaccharidosis (MPS IIIA) mice have increased lung compliance and airway resistance, decreased diaphragm strength, and no change in alveolar structure

Mucopolysaccharidosis type IIIA (MPS IIIA) is characterized by neurological and skeletal pathologies caused by reduced activity of the lysosomal hydrolase, sulfamidase, and the subsequent primary accumulation of undegraded heparan sulfate (HS). Respiratory pathology is considered secondary in MPS IIIA and the mechanisms are not well understood. Changes in the amount, metabolism, and function of pulmonary surfactant, the substance that regulates alveolar interfacial surface tension and modulates lung compliance and elastance, have been reported in MPS IIIA mice. Here we investigated changes in lung function in 20-wk-old control and MPS IIIA mice with a closed and open thoracic cage, diaphragm contractile properties, and potential parenchymal remodeling. MPS IIIA mice had increased compliance and airway resistance and reduced tissue damping and elastance compared with control mice. The chest wall impacted lung function as observed by an increase in airway resistance and a decrease in peripheral energy dissipation in the open compared with the closed thoracic cage state in MPS IIIA mice. Diaphragm contractile forces showed a decrease in peak twitch force, maximum specific force, and the force-frequency relationship but no change in muscle fiber cross-sectional area in MPS IIIA mice compared with control mice. Design-based stereology did not reveal any parenchymal remodeling or destruction of alveolar septa in the MPS IIIA mouse lung. In conclusion, the increased storage of HS which leads to biochemical and biophysical changes in pulmonary surfactant also affects lung and diaphragm function, but has no impact on lung or diaphragm structure at this stage of the disease.NEW & NOTEWORTHY Heparan sulfate storage in the lungs of mucopolysaccharidosis type IIIA (MPS IIIA) mice leads to changes in lung function consistent with those of an obstructive lung disease and includes an increase in lung compliance and airway resistance and a decrease in tissue elastance. In addition, diaphragm muscle contractile strength is reduced, potentially further contributing to lung function impairment. However, no changes in parenchymal lung structure were observed in mice at 20 wk of age.

Effect on Physical Position of Peak Inspiratory Flow in Stable COPD: An Observational Study

Background

We examined the effect of physical position on peak inspiratory flow (PIF) in patients with chronic obstructive pulmonary disease (COPD) using dry-powder inhalers (DPIs) with low‑medium internal resistance (R2) and/or high internal resistance (R5).

Methods

This prospective study in stable, ambulatory patients with spirometry-confirmed COPD evaluated the effect of 3 physical positions on maximal PIF achieved. Participants had PIFs of 30-90L/min (R5) or 60-90L/min (R2 DPIs) using the In-Check™ DIAL. PIF was measured in triplicate randomly in 3 positions that patients might be in while using their inhaler (standing, sitting, and semi-upright [supine position with the head of the bed at 45°, neck flexed forward]) against prescribed DPI resistance (R2/R5/both). Correlations between PIF and percentage decline in PIF between positions and differences in participant characteristics with >10% versus ≤10% PIF decline standing to semi-upright were calculated.

Results

A total of 76 participants (mean age, 65.2 years) had positional measurements; 59% reported seated DPI use at home. The mean (standard deviation) PIF standing, sitting, and semi-upright was 80.7 (13.4), 77.8 (14.3), and 74.0 (14.5) L/min, respectively, for R2 and 51.1 (9.52), 48.6 (9.84), and 45.8 (7.69) L/min, respectively, for R5 DPIs. PIF semi-upright was significantly lower than sitting and standing (R2; P < 0.0001) and standing (R5; P= 0.002). Approximately half of the participants had >10% decline in PIF from standing to semi-upright. Patient characteristics exceeding the 0.10 absolute standardized difference threshold with the decline in PIF for both the R2 and R5 DPIs were waist-to-hip ratio, modified Medical Research Council dyspnea score, and postbronchodilator percentage predicted forced vital capacity and PIF by spirometry.

Conclusions

PIF was significantly affected by physical position regardless of DPI resistance. PIF was highest when standing and lowest when semi-upright. We recommend that patients with COPD stand while using an R2 or R5 DPI. Where unfeasible, the position should be sitting rather than semi-upright. ClinicalTrials.gov identifier NCT04168775.

Cigarette smoking and disproportionate changes of thoracic skeletal muscles in low-dose chest computed tomography

Association between smoking intensity and the quantity and quality of thoracic skeletal muscles (TSMs) remains unexplored. Skeletal muscle index (SMI; skeletal muscle area/height2) and percentage of normal attenuation muscle area (NAMA%) were measured to represent the quantity and quality of the skeletal muscles, respectively, and quantification was performed in pectoralis muscle at aortic arch (AA-PM), TSM at carina (C-TSM), erector spinae muscle at T12 (T12-ESM), and skeletal muscle at L1 (L1-SM). Among the 258 men (median age, 62 years [IQR: 58-69]), 183 were current smokers (median smoking intensity, 40 pack-years [IQR: 30-46]). SMI and NAMA% of AA-PM significantly decreased with pack-year (β =  - 0.028 and - 0.076; P < 0.001 and P = 0.021, respectively). Smoking intensity was inversely associated with NAMA% of C-TSM (β =  - 0.063; P = 0.001), whereas smoking intensity showed a borderline association with SMI of C-TSM (β =  - 0.023; P = 0.057). Smoking intensity was associated with the change in NAMA% of L1-SM (β =  - 0.040; P = 0.027), but was not associated with SMI of L1-SM (P > 0.05). Neither NAMA% nor SMI of T12-ESM was affected by smoking intensity (P > 0.05). In conclusion, smoking intensity was associated with the change of TSMs. Its association varied according to the location of TSMs, with the most associated parts being the upper (AA-PM) and middle TSMs (C-TSM).

Ultrasound assessment of the respiratory system using diaphragm motion-volume indices

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.

Non-pharmacological Management in Palliative Care for Patients With Advanced COPD

Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation and lung tissue damage; its main symptoms are breathlessness, fatigue, cough, and sputum production. In the advanced stage of the disease, these symptoms may severely impact on a person's physical and psychological functioning, with some also developing chronic respiratory failure, associated with blood gas abnormalities. Non-pharmacological interventions can improve quality of life and functioning in the management of people living with advanced COPD. This article will provide an overview of common non-pharmacological methods used in the symptomatic management of severe COPD, including: breathlessness and fatigue management strategies, anxiety management, pulmonary rehabilitation (PR) and physical activity (PA), neuromuscular electrical stimulation (NMES), airway clearance techniques (ACTs), nutrition and non-invasive ventilation (NIV). The importance of a holistic and multi-disciplinary approach to people living with COPD will be discussed.

Effect of pursed-lip breathing and forward trunk lean positions on regional chest wall volume and ventilatory pattern in older adults: An observational study

ABSTRACT

Pursed-lip breathing (PLB) and forward trunk lean posture (FTLP) are commonly used to relieve dyspnea and improve ventilation in a rehabilitation program. However, their effect on chest wall volumes and movements in older adults without chronic obstructive pulmonary disease has never been investigated. This observational study aimed to identify the effect of combined PLB and FTLP on total and regional chest wall volumes, ventilatory pattern, and thoracoabdominal movement using in older adults. It was hypothesized that the combined PLB with FTLP would result in the highest chest wall volumes among the experimental tasks. Twenty older adults performed 2 breathing patterns of quiet breathing (QB) and PLB during a seated upright (UP) position and FTLP. An optoelectronic plethysmography system was used to capture the chest wall movements during the 4 experimental tasks. Tidal volume (VT) was separated into pulmonary ribcage, abdominal ribcage, and abdomen volume. The changes in anterior-posterior (AP) and medial-lateral (ML) chest wall diameters at 3 levels were measured and used to identify chest wall mechanics to improve chest wall volumes. The PLB significantly improved ventilation and chest wall volumes than the QB (P < .05). VT of pulmonary ribcage, VT of abdominal ribcage, and VT were significantly higher during the PLB + UP (P < .05) and during the PLB + FTLP (P < .01) as compared to those of QB performed in similar body positions. However, there was no significant in total and regional lung volumes between the PLB + UP and the PLB + FTLP. The AP diameter changes at the angle of Louis and xiphoid levels were greater during the PLB + UP than the QB + UP and the QB + FTLP (P < .01). The AP diameter changes at the umbilical level and the ML diameter changes at the xiphoid level were significantly larger during the PLB + FTLP than the QB + FTLP and the QB + UP (P < .05). The ML diameter changes at the umbilical level were significantly greater during the PLB + FTLP than the QB + UP (P < .05). However, no significant difference in the relative regional chest wall volumes and phase angle among the experimental tasks (P > .05). In conclusion, a combined PLB performed in an FTLP or UP sitting could be used as a strategy to improve chest wall volumes and ventilation in older adults.

Effects of pursed-lip breathing and forward trunk lean postures on total and compartmental lung volumes and ventilation in patients with mild to moderate chronic obstructive pulmonary disease: An observational study

ABSTRACT

This study identified the effects of pursed-lip breathing (PLB), forward trunk lean posture (FTLP), and combined PLB and FTLP on total and compartmental lung volumes, and ventilation in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with mild to moderate COPD performed 2 breathing patterns of quiet breathing (QB) and PLB during FTLP and upright posture (UP). The total and compartmental lung volumes and ventilation of these 4 tasks (QB-UP, PLB-UP, QB-FTLP, PLB-FTLP) were evaluated using optoelectronic plethysmography. Two-way repeated measures ANOVA was used to identify the effect of PLB, FTLP, and combined strategies on total and compartmental lung volumes and ventilation. End-expiratory lung volume of ribcage compartment was significantly lower in PLB-UP than QB-UP and those with FTLP (P < .05). End-inspiratory lung volume (EILV) and end-inspiratory lung volume of ribcage compartment were significantly greater during PLB-FTLP and PLB-UP than those of QB (P < .05). PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELVAB ) end-expiratory lung volume, EILVAB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05). UP significantly increased tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation and decreased EELVAB, end-expiratory lung volume, and EILVAB than FTLP (P < .05). In conclusion, combined PLB with UP or FTLP demonstrates a positive change in total and compartmental lung volumes in patients with mild to moderate COPD.

Work of breathing during arm bracing in normal male subjects

Objective

Although chronic obstructive pulmonary disease patients get relief from their dyspnea by arm bracing, the mechanics of this effect are unknown. This study aimed to investigate the mechanisms by which arm bracing affects dyspnea by measuring the work of breathing (WOB) in the arm bracing posture.

Methods

Six normal male subjects were studied in two standing postures: erect and with their arms braced. For the arm bracing posture, the subjects leaned forward with their arms stretched and rested their hands on a platform. Respiratory frequency was set at 20 tidal breaths/min with the use of a metronome, and tidal volume was set at 1 L by observing the lung volume on a monitor. All the subjects randomly adopted the two postures, and a preset respiratory pattern was measured for 30 s in each posture. Lung volume and flow rate were measured using a hot-wire flowmeter. Esophageal pressure was measured using a 12-cm balloon catheter. The WOB was estimated using modified Campbell diagrams.

Results

Lung volume increased and inspiratory resistive WOB decreased, while inspiratory elastic WOB increased significantly with arm bracing compared with that of the erect posture (P < 0.05).

Conclusion

Arm bracing posture increases the chest wall expansion thereby increasing the end-expiratory lung volume and decreasing the inspiratory resistive WOB among healthy individuals.

Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup

BACKGROUND

With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus.

MATERIALS AND METHODS

Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method.

RESULTS

The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001.

CONCLUSION

This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings.

HOW TO CITE THIS ARTICLE

Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

Comparing Skype (video calling) and in-person qualitative interview modes in a study of people with irritable bowel syndrome - an exploratory comparative analysis

Background

Within qualitative research in-person interviews have the reputation for being the highest standard of interviewer-participant encounter. However, there are other approaches to interviewing such as telephone and e-mail, which may be appropriate for a variety of reasons such as cost, time and privacy. Although there has been much discussion of the relative values of different interview methods, little research has been conducted to assess what differentiates them using quantifiable measures. None of this research has addressed the video call, which is the interview mode most like the in-person interview. This study uses quantifiable measures generated by the interview to explore the relative value of in-person and video call interview modes.

Methods

Interview data gathered by a qualitative research study exploring the views of people with IBS about hypnotherapy for their condition were used. In-person and video call interviews using the same topic guide were compared on measures of length (time and word count), proportion of time the interviewer was dominant, the number of topics generated (codes) and the number of individual statements on which those topics were based.

Results

Both interview methods produced a similar number of words and a similar number of topics (codes) were discussed, however the number of statements upon which the variety of topics was based was notably larger for the in-person interviews.

Conclusion

These findings suggest that in in-person study interviews were marginally superior to video calls in that interviewees said more, although this was on a similar range of topics. However, the difference is sufficiently modest that time and budget constraints may justify the use of some video call interviews within a qualitative research study.

Retropharyngeal Calcific Tendonitis in a Patient Seeking Chiropractic Care for Neck Pain: A Case Report

Objective

The purpose of this report is to describe the evaluation and treatment of a patient initially presenting for chiropractic care of neck pain (NP) who was subsequently diagnosed with retropharyngeal calcific tendonitis (RCT).

Clinical Features

A 53-year-old woman presented to a chiropractic office with severe idiopathic NP, loss of cervical mobility, and intermittent painful swallowing. She had a motor vehicle accident 6 months before with NP that resolved within a week without treatment. A brief examination and some manual palliative care were attempted by the chiropractor. Two days later, the patient developed severe NP and fever, sought emergency medical care on her own, and requested the chiropractor meet her at the hospital. The emergency physicians initially considered an infection, and antibiotics were provided along with oxycodone and naproxen sodium for pain. After advanced (computed tomography) imaging, RCT was diagnosed, and she was discharged the next day.

Interventions and Outcome

After being diagnosed, the patient's primary care provider prescribed prednisone and physical therapy. After 3 weeks, the patient stated her pain continued and she went for chiropractic care and was treated for mechanical neck pain with manipulation, manual muscle treatment, postural training, and rehabilitative exercises.

Conclusion

Practitioners should recognize the clinical presentation of RCT, order appropriate computed tomography imaging, and implement effective treatments. Although uncommon, RCT should be considered in patients with NP, limited mobility, and painful swallowing.

Surface electromyography in inspiratory muscles in adults and elderly individuals: A systematic review

INTRODUCTION

Electromyography (EMG) helps to evaluate disorders and pulmonary behavior, as impairments in respiratory muscle function are associated with the development of diseases. There is a wide range of methods and protocols used to record and analyze EMG obtained from respiratory muscles, demonstrating a lack of standardization.

OBJECTIVE

To identify the most common procedures used to record surface EMG (sEMG) of inspiratory muscles in adults and elderly individuals through a systematic review (primary), and to evaluate the quality of the report presented by the studies (secondary).

METHOD

Studies published from January 1995 until June 2018 were searched for in the Web of Science, PubMed, LILACS, EBSCO and Embase databases. Only studies evaluating sEMG of inspiratory muscles were included.

RESULTS

The electronic search retrieved a total of 6697 titles and 92 of them were included. A great variability on the methods applied to both recording and processing/analyzing data was found. Therefore, the synthesis of practical/clinical evidence to support immediate recommendations was impaired. In general, the descriptions presented by the studies are poor.

CONCLUSION

The most common procedures used for sEMG were identified. Methodological studies with objective comparisons were fundamental for improving standardization, given the impossibility of recommendations from this review.

Forward trunk lean with arm support affects the activity of accessory respiratory muscles and thoracoabdominal movement in healthy individuals

Despite the reported benefits of postures involving leaning the trunk forward with arm support for relieving dyspnea, how those postures influence the mechanics of breathing remains unclear. In response, the aim of the study reported here was to evaluate how posture (i.e., standing and sitting) and leaning the trunk forward with arm support affect the activity of accessory respiratory muscles and thoracoabdominal movement in healthy individuals. Thirty-five volunteers (15 males and 20 females) aged 18-29 years breathed with the same rhythm in standing and sitting positions while upright and while leaning the trunk forward with arm support. Surface electromyography was performed to assess the activity of accessory inspiratory (i.e., during inspiration) and abdominal (i.e., during inspiration and expiration) muscles, and a motion capture system was used to assess thoracoabdominal movement. Results revealed that upper trapezius activity was significantly lower in forward-leaning postures than in upright ones (P = 005; η_p² = 0.311), although the activity of the sternocleidomastoideus and scalenus (P < 0.001; η_p² = 0.427-0.529), along with the anterior-to-posterior movement of the upper ribcage (P < 0.001; η_p² = 0.546), were significantly greater in forward-leaning postures than in upright ones. The activity of the external oblique and transversus abdominis/internal oblique was significantly lower in sitting than in standing postures (P < 0.050; η_p² = 0.206-0.641), and though the activity of the transversus abdominis/internal oblique was significantly lower in forward-leaning than in upright postures (P ≤ 0.001; η_p² = 0.330-0.541), a significantly greater anterior-to-posterior movement of the abdomen was observed (P < 0.001; η_p² = 0.662). However, the magnitude of the lower ribcage's medial-to-lateral movement was significantly lower in forward-leaning than in upright postures (P = 0.039; η_p² = 0.149). Leaning the trunk forward with arm support not only increased the use of accessory inspiratory muscles but also decreased the use of the transversus abdominis/internal oblique, which improved thoracoabdominal movement.

[Effect of Breathing Exercise Using Panflutes on the Postoperative Compliance, Pulmonary Infections and Life Satisfaction in Elderly Patients Undergoing Spinal Surgery]

PURPOSE

The purpose of this study was to examine the effects of breathing exercises performed using panflutes in elderly patients undergoing spinal surgery.

METHODS

The study design was a nonequivalent control group non-synchronized pre-post test. The study included 24 patients in both the experimental group and the control group. The experimental group completed a daily breathing exercise regimen using panflutes for 30minutes after meals, whereas the control group was provided standard preoperative education, including breathing exercises using incentive spirometers. After the exercise regimen, breathing exercise compliance, pulmonary infections, and life satisfaction were measured in both groups, and the data were analyzed using the SPSS/WIN program.

RESULTS

The compliance rate of breathing exercises was significantly higher in the experimental group. The experimental group presented no pulmonary infections in the later period, whereas the control group presented higher pulmonary infection rates in the same period. In addition, the life satisfaction score in the experimental group significantly increased.

CONCLUSION

The breathing exercise program using panflutes for elderly patients undergoing spinal surgery enhanced their breathing exercise compliance and their daily life satisfaction in addition to reducing their pulmonary infection rates.

A descriptive analysis of the climbing mechanics of a mountain goat (Oreamnos americanus)

The mountain goat (Oreamnos americanus) is one of the most extraordinary mountaineers in the animal kingdom. While observational descriptions exist to indicate factors that may influence their climbing ability, these have never been assessed biomechanically. Here, we describe whole-body motion of a mountain goat during ascent of a 45° incline based on a video recording in the Canadian Rocky Mountains, and discuss the results in a mechanical context. During the push-off phase, the hindlimb extended and the forelimb was tucked close to the torso. During the pull-up phase, the hindlimb was raised near to the torso, while the forelimb humerus seemed to "lock" in a constant position relative to the torso, allowing the elbow to be held in close proximity to the whole-body center of mass. Extension of the elbow and carpal joints resulted in a vertical translation of the center of mass up the mountain slope. Based on the observations from this naturalistic study, hypotheses for future controlled studies of mountain goat climbing mechanics are proposed.

Effect of Different Positions on FVC and FEV1 Measurements of Asthmatic Patients

[Purpose] The purpose of our study was to investigate the effect of different positions on pulmonary function test (PFT) values such as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) of asthmatic patients .[Subjects and Methods] Thirty subjects with severe asthma aged between 20-39 years were enrolled after they had signed a written consent. Subjects were selected using the inclusion criteria, and PFT were randomly administered. Spirometer measurements (FVC, FEV1) were taken in the supine, side lying on right, side lying on left, sitting and standing positions. Each measurement was taken three times, and the average values were analyzed. [Results] One- way analysis of variance (ANOVA) and Tukey's Test (post hoc) for pair- wise comparison indicated that there was a significant difference in the FEV1 values of the asthmatic patients however a significant difference was obtained between standing and supine positions. There was also a significant difference in the FVC values between the standing and supine lying position in the pair -wise comparison. [Conclusion] This study showed standing is the best position for measuring FEV1 and FVC of asthmatic subjects. The more upright the position, the higher the FEV1 and FVC will be.