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Gouzi F, Dubois-Gamez AS, Lacoude P, Abdellaoui A, Hédon C, Charriot J, Boissin C, Vachier I, Hayot M, Molinari N, Bourdin A. Feasibility of a nasal breathing training during pulmonary rehabilitation. A pilot randomized controlled study. Respir Physiol Neurobiol 2023; 308:103987. [PMID: 36372120 DOI: 10.1016/j.resp.2022.103987] [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: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on exercise dyspnea (primary outcome) and capacity and health-related quality of life in patients. In this open label randomized controlled trial, 19 HVS patients (age=48.3 ± 15.2 y.o, female/male=18/1, Nijmegen score=33 ± 7.7) were randomized in a NV+PR (n = 9) or vHV+PR (n = 10) group. Modified Medical Research Council (mMRC) dyspnea, 6-minute walking distance (6MWD) with nasal/oral ventilation were assessed before and after 3 months of PR, and questionnaires (Nijmegen, VQ-11). There was a significant effect of PR of but no significant difference between groups in the improvements of dyspnea@max exercise (time effect (T): p < 0.01; group (G): p = 0.63; group*time interaction (G*T): p = 0.49), mMRC dyspnea (T: p < 0.01; G: p = 0.45; G*T: p = 0.62), 6MWD (T: p < 0.05; G: p = 0.36; G*T: p = 0.31), VQ-11 (T: p < 0.001; G: p = 0.16; G*T: p = 0.09) and plasma HCO3- (T: p < 0.05; G: p = 0.93; G*T; p = 0.36), Yet, Nijmegen score (T: p < 0.01; G: p = 0.32; G*T: p < 0.05) improvement was larger in NV+PR group. The exercise oronasal breathing shift during the 6MWT was significantly delayed in all patients (T: p < 0.05; G: p = 0.30; G*T: p = 0.32) and positively correlated with plasma HCO3-(r = 0.42; p < 0.05). Nasal exercise was not superior versus voluntary hypoventilation during PR in HVS patients. Yet, nasal exercise appeared feasible, leading to acquisition of a nasal breathing pattern during walking, improvement of PR outcomes and ventilatory alkalosis. The link between nasal breathing and hyperventilation is discussed in the light of the nasal ventilation rhythm in the limbic system and its role on the limbic emotional and ventilatory functions.
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Affiliation(s)
- F Gouzi
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France.
| | - A S Dubois-Gamez
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - P Lacoude
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - A Abdellaoui
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - C Hédon
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - J Charriot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - C Boissin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - I Vachier
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - M Hayot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - N Molinari
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - A Bourdin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
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Medeiros da Fonsêca JD, Aliverti A, Benício K, de Farias Sales VS, Fontes Silva da Cunha Lima L, Resqueti VR, Augusto de Freitas Fregonezi G. Breathing pattern and muscle activity using different inspiratory resistance devices in children with MBS. ERJ Open Res 2022; 8:00480-2021. [PMID: 35539438 PMCID: PMC9081542 DOI: 10.1183/23120541.00480-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022] Open
Abstract
Aim The aim of this study was to evaluate the acute effects of different inspiratory resistance devices and intensity of loads via nasal airway on the breathing pattern and activity of respiratory muscles in children with mouth breathing syndrome (MBS). Methods Children with MBS were randomised into two groups based on inspiratory load intensity (20% and 40% of the maximal inspiratory pressure). These subjects were assessed during quiet breathing, breathing against inspiratory load via nasal airway and recovery. The measurements were repeated using two different devices (pressure threshold and flow resistance). Chest wall volumes and respiratory muscle activity were evaluated by optoelectronic plethysmography and surface electromyography, respectively. Results During the application of inspiratory load, there was a significant reduction in respiratory rate (p<0.04) and an increase in inspiratory time (p<0.02), total time of respiratory cycle (p<0.02), minute ventilation (p<0.03), tidal volume (p<0.01) and scalene and sternocleidomastoid muscles activity (root mean square values, p<0.01) when compared to quiet spontaneous breathing and recovery, regardless of load level or device applied. The application of inspiratory load using the flow resistance device showed an increase in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02). Conclusion For both devices, the addition of inspiratory loads using a nasal interface had a positive effect on the breathing pattern. However, the flow resistance device was more effective in generating volume and, therefore, has advantages compared to pressure threshold. In children with mouth breathing syndrome, adding inspiratory load using a nasal interface improves chest wall volumes and respiratory muscle activity, and a flow resistance device increases lung volume more than a pressure threshold devicehttps://bit.ly/3IzlayK
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Milanesi JDM, Pasinato F, Berwig LC, Silva AMTD, Corrêa ECR. Body posture and pulmonary function in mouth and nose breathing children: cross-sectional study. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.001.ao12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Mouth breathing can lead to changes in body posture and pulmonary function. However, the consequences are still inconclusive and a number of studies are controversial. Objective: Evaluate and correlate spirometric parameters and postural measures in mouth breathing children, and compare them to nose breathers. Methods: two groups of 6 to 12 year-old children were evaluated: mouth breathers (MB, n = 55) and nose breathers (NB, n = 45). Spirometry and body posture analysis using photogrammetry (SAPo 0.68® v) were carried out. The following spirometric measures were evaluated: peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio (%) and forced expiratory flow between 25% and 75% of FVC (FEF 25-75%). Biophotogrammetric measures analyzed were: horizontal alignment of acromions (HAA) and anterior superior iliac spine (HAASIS), Charpy angle, horizontal alignment of the head (HAH), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), cervical distance (CD) and lumbar distance (LD). Results: There were no intergroup differences in spirometric and postural variables. Positive and moderate correlations were found between CL and CD measures with PEF, FEV1, FVC and FEF 25-75%, while weak correlations were observed between lumbar lordosis and PEF, FEV1 and FVC. Conclusion: The breathing mode had no influence on postural and respiratory measures. However, greater forward head posture, with smaller cervical lordosis, was related to higher lung volumes and flows in both groups.
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Veron HL, Antunes AG, Milanesi JDM, Corrêa ECR. Implicações da respiração oral na função pulmonar e músculos respiratórios. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618111915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A Síndrome do Respirador Oral é caracterizada por um conjunto de sinais e sintomas que podem estar presentes em indivíduos que substituem o modo adequado e eficiente da respiração nasal pelo modo respiratório oral ou misto, por um período igual ou superior a seis meses. O modo respiratório oral ou misto pode estar associado a mudanças na função e mecânica ventilatória. Esta revisão tem como objetivo investigar mais profundamente as consequências da respiração oral na função pulmonar e músculos respiratórios, ressaltando o desenvolvimento de tais alterações desde a infância até a idade adulta. Foram selecionados 18 artigos por meio das bases de dados Pubmed e Web of Science e foram agrupados no texto, compreendendo os seguintes tópicos: 1) Implicações da respiração oral sobre a função pulmonar e 2) Implicações da respiração oral sobre os músculos respiratórios. A partir das informações oriundas dos resultados dos artigos analisados, percebe-se que poucos estudos refutam ou não encontram alguma relação entre as alterações pulmonares e a respiração oral. Sugere-se que, o desequilíbrio muscular produzido por estas alterações pode contribuir para a desvantagem mecânica do músculo diafragma e aumento do trabalho dos músculos acessórios da inspiração. Entretanto, são necessários estudos com métodos mais criteriosos, incluindo avaliações objetivas e reprodutíveis dos músculos respiratórios.
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de Castilho LS, Abreu MHNG, de Oliveira RB, Souza E Silva ME, Resende VLS. Factors associated with mouth breathing in children with -developmental -disabilities. SPECIAL CARE IN DENTISTRY 2016; 36:75-9. [PMID: 26763202 DOI: 10.1111/scd.12157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the prevalence and factors associated with mouth breathing among patients with developmental disabilities of a dental service. METHODS We analyzed 408 dental records. Mouth breathing was reported by the patients' parents and from direct observation. Other variables were as -follows: history of asthma, bronchitis, palate shape, pacifier use, thumb -sucking, nail biting, use of medications, gastroesophageal reflux, bruxism, gender, age, and diagnosis of the patient. Statistical analysis included descriptive analysis with ratio calculation and multiple logistic regression. Variables with p < 0.25 were included in the model to estimate the adjusted OR (95% CI), calculated by the forward stepwise method. Variables with p < 0.05 were kept in the model. RESULTS Being male (p = 0.016) and use of centrally acting drugs (p = 0.001) were the variables that remained in the model. CONCLUSION Among patients with -developmental disabilities, boys and psychotropic drug users had a greater chance of being mouth breathers.
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Affiliation(s)
- Lia Silva de Castilho
- Professor Doctor, Department of Restorative Dentistry of Dental School, Coordinator of the Extension Project "Dental Care for disabled, Federal University of Minas Gerais State, Minas Gerais, Brazil
| | | | | | - Maria Elisa Souza E Silva
- Professor Doctor, Department of Restorative Dentistry, Dental School, Federal University of Minas Gerais State, Minas Gerais, Brazil
| | - Vera Lúcia Silva Resende
- Professor Doctor, Department of Restorative Dentistry, Dental School, Federal University of Minas Gerais State, Minas Gerais, Brazil
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Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: A cross-sectional study. J Electromyogr Kinesiol 2015; 25:463-8. [DOI: 10.1016/j.jelekin.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
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Trevisan ME, Bellinaso JH, Pacheco ADB, Augé LB, Silva AMTD, Corrêa ECR. Respiratory mode, nasal patency and palatine dimensions. Codas 2015; 27:201-6. [DOI: 10.1590/2317-1782/20152014177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/07/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose: To investigate the influence of breathing mode and nasal patency in the dimensions of the hard palate by comparing mouth breathing (MB) and nasal breathing (NB) adults. Methods: Seventy-seven individuals, distributed into the MB group (n=38) and the NB group (n=39), of both genders and aged between 18 and 30 years old, took part in the study. The respiratory mode diagnosis was based on anamnesis, physical characteristics, and otorhinolaryngological examination. The volunteers were evaluated in terms of nasal patency, with a peak nasal inspiratory flow (PNIF) meter, and obstruction symptoms, by a Nasal Obstruction Symptom Evaluation (NOSE) scale, and had their transversal and vertical hard palate dimensions measured with a digital caliper in plaster models. Results: Comparing both groups, the MB group presented significantly higher values in the NOSE scale, lower values in the PNIF, lower values in the transversal distance of the palate in the intercanine region, and significantly higher values in the vertical distance in the regions of the first and second premolars and molars. There was a negative correlation between PNIF and NOSE, and a positive correlation between PNIF and transversal distance of the palate in the region of the first premolars. Conclusion: MB adults presented reduced nasal patency and a higher degree of nasal obstruction symptoms. The hard palate was morphologically narrower and deeper in adults with the MB mode compared to the NB mode. Moreover, it was concluded that the smaller the nasal patency, the greater the obstruction symptoms and the narrower the hard palate.
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