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de Lima JCC, Resqueti VR, Marcelino AA, da Fonsêca JDM, Paz AL, Dias FAL, Otto-Yañez M, Fregonezi GAF. Reliability of maximal respiratory nasal pressure tests in healthy young adults. PLoS One 2023; 18:e0287188. [PMID: 38019835 PMCID: PMC10686475 DOI: 10.1371/journal.pone.0287188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Sniff nasal inspiratory (SNIP) and expiratory pressure (SNEP) may complement the assessment of respiratory muscle strength. Thus, specifying their reliability is relevant to improving the clinical consistency of both tests. OBJECTIVE To assess the reliability of SNIP and SNEP in healthy young adults. METHODS This cross-sectional study included self-reported healthy aged 18 to 29 years. SNIP was performed using a plug to occlude one nostril, while SNEP was conducted using a facemask. Participants performed 20 SNIP and SNEP maneuvers with 30-second intervals in between. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) assessed the reliability of SNIP and SNEP. Analyses were conducted between the highest peak pressure and the first reproducible maneuver in men and women. RESULTS The total sample comprised 32 participants: 16 men and 16 women. The ICC, SEM, and MDC for SNIP maneuvers were 0.994 (95%CI 0.988 to 0.997), 1.820 cmH2O, and 5.043 cmH2O, respectively. For SNEP, these parameters were 0.950 (95%CI 0.897 to 0.976), 6.03 cmH2O, and 16.716 cmH2O. The SNIP and SNEP in men showed ICC of 0.992 (95%CI 0.977 to 0.997) and 0.877 (95%CI 0.648 to 0.957), SEM of 2.07 and 7.66 cmH2O, and MDC of 5.74 and 21.23 cmH2O. In women, SNIP and SNEP presented ICC of 0.992 (95%CI 0.977 to 0.997) and 0.957 (95%CI 0.878 to 0.985), SEM of 1.15 and 6.11 cmH2O, and MDC of 3.19 and 16.95 cmH2O. Also, 60% of the highest SNIPs occurred among the 11th and 20th maneuvers in men and women. In men, 55% of the highest SNEPs occurred among the 11th and 20th maneuvers; this value was 50% in women. CONCLUSION SNIP and SNEP showed excellent reliability. The reliability of SNIP and SNEP in men was good and excellent, respectively, whereas both tests had excellent reliability in women. Also, women reached the highest peak pressure faster than men in both tests.
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Affiliation(s)
- Jackson C. C de Lima
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Vanessa R. Resqueti
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Ana Aline Marcelino
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Jéssica Danielle M. da Fonsêca
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Ana Lista Paz
- Facultad de Fisioterapia, Universidade da Coruña, A Coruña, España
| | | | | | - Guilherme A. F. Fregonezi
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) & Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
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Mętel S, Kostrzon M, Adamiak J, Janus P. Respiratory Muscle Function in Older Adults with Chronic Respiratory Diseases after Pulmonary Rehabilitation in Subterranean Salt Chambers. J Clin Med 2023; 12:5120. [PMID: 37568522 PMCID: PMC10419711 DOI: 10.3390/jcm12155120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Training the respiratory muscles is a crucial aspect of pulmonary rehabilitation. The purpose of this study was to assess the function of respiratory muscles in older adults both before and after a period of pulmonary rehabilitation and treatment stay within the underground chambers of a salt mine. A total of 50 patients aged 65 years and older with chronic respiratory conditions was enrolled in the study. These participants underwent a 3-week subterranean pulmonary rehabilitation (PR) program in the "Wieliczka" Salt Mine. Levels of sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured using the MicroRPM both before and after the outpatient PR program conducted 135 m underground. A total of 44 patients with a mean age of 68.8 ± 2.9 years who completed the PR program and tests were included in the analysis. The average changes in the parameters of pulmonary function before and after the PR were: MIP 8.8 cmH2O, MEP 7.1 cmH2O, and SNIP 11.2 cmH2O (for p < 0.05). For patients older than 70 years, beneficial changes were only observed for MEP, which increased by 9.3 cmH2O (for p < 0.05). Speleotherapy combined with pulmonary rehabilitation improves respiratory muscle function in older adults with chronic respiratory diseases, mainly in terms of MEP. Therefore, a greater emphasis on inspiratory muscle training in the rehabilitation program should be considered.
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Affiliation(s)
- Sylwia Mętel
- Department of Motor Rehabilitation, Institute of Applied Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland;
| | - Magdalena Kostrzon
- ‘Wieliczka’ Salt Mine Health Resort, 32-020 Wieliczka, Poland; (M.K.); (P.J.)
| | - Justyna Adamiak
- Department of Motor Rehabilitation, Institute of Applied Sciences, University of Physical Education in Krakow, 31-571 Krakow, Poland;
| | - Paweł Janus
- ‘Wieliczka’ Salt Mine Health Resort, 32-020 Wieliczka, Poland; (M.K.); (P.J.)
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Wilding RJ, Thynne M, Subhan MMF. Optimization of sniff nasal inspiratory pressure (SNIP) measurement methodology in healthy subjects. BMC Pulm Med 2023; 23:66. [PMID: 36793023 PMCID: PMC9930287 DOI: 10.1186/s12890-023-02348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Maximal inspiratory pressure (MIP) is currently the most commonly used measure for respiratory muscle strength (RMS) estimation, however, requires significant effort. Falsely low values are therefore common, especially in fatigue-prone subjects, such as neuromuscular disorder patients. In contrast, sniff nasal inspiratory pressure (SNIP) requires a short, sharp sniff; this is a natural manoeuvre, decreasing required effort. Consequently, it has been suggested that use of SNIP could confirm the accuracy of MIP measurements. However, no recent guidelines regarding the optimal method of SNIP measurement exist, and varied approaches have been described. OBJECTIVES We compared SNIP values from three conditions, namely with 30, 60 or 90 s time intervals between repeats, the right (SNIPR) and left (SNIPL) nostril, and the contralateral nostril occluded (SNIPO) or non-occluded (SNIPNO). Additionally, we determined the optimal number of repeats for accurate SNIP measurement. METHOD 52 healthy subjects (23 males) were recruited for this study, of which a subset of 10 subjects (5 males) completed tests comparing the time interval between repeats. SNIP was measured from functional residual capacity via a probe in one nostril, while MIP was measured from residual volume. RESULTS There was no significant difference in SNIP depending on the interval between repeats (P = 0.98); subjects preferred the 30 s. SNIPO was significantly higher than SNIPNO (P < 0.00001) but SNIPL and SNIPR did not significantly differ (P = 0.60). There was an initial learning effect for the first SNIP test; SNIP did not decline during 80 repeats (P = 0.64). CONCLUSIONS We conclude that SNIPO is a more reliable RMS indicator than SNIPNO, as there is reduced risk of RMS underestimation. Allowing subjects to choose which nostril to use is appropriate, as this did not significantly affect SNIP, but may increase ease of performance. We suggest that twenty repeats is sufficient to overcome any learning effect and that fatigue is unlikely after this number of repeats. We believe these results are important in aiding the accurate collection of SNIP reference value data in the healthy population.
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Affiliation(s)
- R. J. Wilding
- grid.418670.c0000 0001 0575 1952University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH UK
| | - M. Thynne
- grid.418670.c0000 0001 0575 1952Chest Clinic, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH UK
| | - M. M. F. Subhan
- grid.11201.330000 0001 2219 0747School of Biomedical Sciences, Faculty of Health, University of Plymouth, C507, Portland Square, Drake Circus, Plymouth, PL4 8AA UK
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