Optimization of sniff nasal inspiratory pressure (SNIP) measurement methodology in healthy subjects

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 (SNIP_R) and left (SNIP_L) nostril, and the contralateral nostril occluded (SNIP_O) or non-occluded (SNIP_NO). 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. SNIP_O was significantly higher than SNIP_NO (P < 0.00001) but SNIP_L and SNIP_R 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 SNIP_O is a more reliable RMS indicator than SNIP_NO, 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.

International union of physiological sciences physiology teaching workshop, March 31-April 1, 2012, Arabian Gulf University, Kingdom of Bahrain

Since 2009, the Department of Physiology had planned an International Union of Physiological Sciences Physiology Teaching Workshop at Arabian Gulf University. The date was set for March 5-6, 2011; however, due to civil unrest, the workshop was postponed to March 31-April 1, 2012. The workshop was a success, bringing together 92 speakers and participants from 23 countries. Twenty-eight participants from economically disadvantaged countries were given travel support. The workshop included plenary lectures, breakout workshops, poster sessions, dinners, and a social trip. On April 2, 2012, an AD Instruments satellite workshop on data-acquisition systems for laboratory teaching was held, with 60 participants from 12 countries.

Lung Function in Pakistani Welding Workers

Our objective was to study the effects of welding fumes and their duration of exposure on lung function. This was a matched case-control cross-sectional study of spirometry in 50 nonsmoking manual metal arc welders who work without the benefit of welding fume control ventilation or respiratory protective devices. Welding workers, with exposures longer than 9 years, showed a significant reduction in spirometry (forced expiratory volume in one second [FEV1], FEV1/forced vital capacity [FVC%], and peak expiratory flow [PEF]) relative to controls. Lung function in nonsmoking welding workers is impaired and stratification of results shows a dose-effect of years of welding on lung function. This effect primarily shows an obstructive pattern of airways disease. Preventive measures in developing countries have to be adopted to avert long-term lung damage in welders.

Cardiac acceleration as a marker of vagal withdrawal in heart rate control during exercise in humans

OBJECTIVE

To investigate whether the time rate of change in heart rate i.e. cardiac acceleration, during aerobic exercise in human subjects could be used to differentiate vagal withdrawal from sympathetic stimulation.

METHODS

Fifteen male subjects exercised on a bicycle ergometer at 50 Watts (Step 1), then 100 Watts (Step 2), for 2 minutes each.

RESULTS

Heart rate (HR) was monitored from a resting value (mean +/- SD) of 80.3 +/- 12.9 to 113.8 +/- 13.6 beats min-1 in Step 1. In Step 2 exercise, HR increased from 113.8 +/- 13.6 to 145 +/- 20 beats min-1. At the initiation of Step 1, a rapid acceleration of HR was observed in the form of an overshoot response. In contrast to Step 1, a small overshoot response of cardiac acceleration was observed during Step 2. The difference between the mean cardiac acceleration at 10 seconds in Steps 1 and 2 was significant (2.40 +/- 0.19 and 0.71 +/- 0.12 beats min-1 sec-1, p<0.0001).

CONCLUSION

The initial vagal withdrawal of exercise-induced tachycardia, as a frontline adaptive mechanism, can be indirectly identified from HR transients using cardiac acceleration as a new marker.