Expiratory Threshold Loading Research Articles

Recruitment of Abdominal and Neck Muscles During Four Different Exercises in Healthy Adults

Background and Purpose: Prolonged mechanical ventilation can greatly increase morbidity and mortality. Diaphragm weakness has been identified as a major contributor for 50% of patients; however, other muscles besides the diaphragm contribute to efficient ventilatory function. The purpose of this study was to compare the change in deoxyhemoglobin (ΔHHb) and muscle oxygen saturation (ΔSmO2) (markers of muscle recruitment) of 3 extra-diaphragmatic muscles across 4 different bed exercises. Methods: Using a pretest–posttest design, healthy participants (n = 18) performed 3 minutes of 30 repetitions of 4 exercises: resisted trunk flexion (TF), resisted neck flexion (NF), expiratory threshold loading (ETL), and neuromuscular electrical stimulation (NMES) of the rectus abdominis and external obliques. Near infrared spectroscopy was used to measure ΔHHb, and ΔSmO2 in the sternocleidomastoid, rectus abdominis, and external obliques during these exercises. Results: Increases of ΔHHb were highest for the sternocleidomastoid during NF and for rectus abdominis and external obliques during TF (P < .010). The opposite pattern was shown for ΔSmO2; decreases of ΔSmO2 were largest for the sternocleidomastoid during NF and for rectus abdominis and external obliques during TF (P < .005). No significant differences were observed in ΔHHb and ΔSmO2 for rectus abdominis and external obliques during ETL versus NF or NMES nor were there differences when comparing NF versus NMES for these 2 muscles. Conclusion: TF and NF are most effective for recruiting abdominal muscles and sternocleidomastoid, respectively, whereas ETL showed a variable response. Stimulation parameters of NMES and its tolerance can limit outcomes.

Expiratory Threshold Loading and Attentional Performance.

INTRODUCTION: While there are numerous factors that may affect pilot attentional performance, we hypothesize that an increased expiratory work of breathing experienced by fighter pilots may impose a "distraction stimulus" by creating an increased expiratory effort sensation. Therefore, the purpose of this study was to determine the extent to which increasing expiratory pressure time product or expiratory effort sensation impacts attentional performance.METHODS: Data was collected on 10 healthy participants (age: 29 ± 6 yr). Participants completed six repetitions of a modified Masked Conjunctive Continuous Performance Task protocol while breathing against four different expiratory threshold loads. Repeated measures analysis of variances and generalized additive mixed effects models were used to investigate the effects of expiratory threshold load conditions on expiratory pressure time product, expiratory effort sensation, and the influence of altered end tidal gases on Masked Conjunctive Continuous Performance Task scores.RESULTS: The overall median hit reaction times were significantly longer as the expiratory threshold loads increased. Specific shape-conjunctive and non-conjunctive median hit reaction times were longer with increased expiratory effort sensation. Additionally, increased expiratory effort sensation did not significantly change commission error rates, but did significantly increase omission error rates.DISCUSSION: The findings of our work suggest that both progressively greater expiratory threshold loads during spontaneous breathing and expiratory effort sensation may impair subjects' attentional performance due to longer reaction times and increased stimuli recognition error rates.Kelley EF, Cross TJ, Johnson BD. Expiratory threshold loading and attentional performance. Aerosp Med Hum Perform. 2024; 95(7):367-374.

Intercostal muscle oxygenation and expiratory loaded breathing at rest: Respiratory pattern effect

In patients with airway obstruction, an increase in breathing frequency at rest is commonly associated with a dynamic hyperinflation (DH). In such a situation, intercostal muscle oxygenation may be disturbed. This hypothesis was examined in a context of simulated airway obstruction in healthy subjects.After a control period of 5 min, twelve participants (20 ± 2 years) breathed at rest through a 20-cmH2O expiratory threshold load, either by increasing or reducing their respiratory rate (ETLF+ or ETLF). Tissue saturation index (TSI) and concentration changes in oxyhaemoglobin (oxy[Hb+Mb]) were measured as well as cardiorespiratory variables.Inspiratory capacity was decreased in ETLF+ (p < 0.001) and correlated with dyspnea. An increase in oxy[Hb+Mb] occurred in ETLF+ that was higher than in ETLF (p < 0.01). TSI was not different between conditions.In healthy subjects at rest, an increase in respiratory rate during a simulated obstruction with an expiratory threshold load resulted in paradoxical response with DH emergence while intercostal muscle oxygenation was preserved.

Effects of mouthpiece shape and expiratory threshold loading on contraction of the lateral abdominal muscles: A cross-sectional study

BackgroundExpiratory tasks may facilitate transversus abdominis (TrA) activity for spinal stabilization. The purpose of this study was to verify whether a combination of pursed-lip breathing (PLB) and use of an expiratory threshold loading (ETL) device to increase expiratory resistance would promote TrA contraction comparable to that for a stabilization exercise. MethodsTwenty healthy men performed expiratory tasks or an abdominal drawing-in maneuver (ADIM). Expiratory tasks comprised combinations of ETL settings with 0%, 5%, or 15% of maximum expiratory pressure, and mouthpieces with a normal shape or pursed-lip shape. B-mode ultrasound imaging of the TrA, internal oblique, and external oblique muscles was performed to determine percentage changes in muscle thickness. Percentage changes among tasks were statistically compared for each muscle. FindingsTrA thickness increased with normal lips at 15% ETL, with PLB with 5% ETL, and with ADIM (p < 0.01 each). Internal oblique thickness increased under all PLB conditions (p < 0.01 each). No significant differences in external oblique thickness were seen for any tasks. The total thickness of the lateral abdominal muscles was significantly increased not only for 15% ETL tasks and ADIM, but also for PLB with 5% ETL (p < 0.02 each). InterpretationThese results indicated that PLB with 5% ETL could facilitate the same level of TrA activity as the ADIM. PLB with 5% ETL was the only task that simultaneously increased overall lateral abdominal muscles, including the internal obliques, and might be readily applicable in clinical situations.

Walking training augments the effects of expiratory muscle training in Parkinson's disease.

To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease. Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W+RMT, n=15) and the RMT (n=15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15min of inspiratory muscle training and 15min of expiratory muscle training in both groups, and 15min of walking training in the W+RMT group in addition to RMT, twice per day, 5days/week, for a total of 8weeks at home. Training intensity was adjusted once per week for the groups at the hospital. Respiratory muscle strength and 6-min walking distance were significantly increased (p=.001), and UPDRS-III scores were significantly improved (W+RMT: p=.008 and RMT: p=.01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W+RMT group than in the RMT group (p=.007). Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Intra-Arterial, but Not Intrathecal, Baclofen and Codeine Attenuates Cough in the Cat.

Centrally-acting antitussive drugs are thought to act solely in the brainstem. However, the role of the spinal cord in the mechanism of action of these drugs is unknown. The purpose of this study was to determine if antitussive drugs act in the spinal cord to reduce the magnitude of tracheobronchial (TB) cough-related expiratory activity. Experiments were conducted in anesthetized, spontaneously breathing cats (n = 22). Electromyograms (EMG) were recorded from the parasternal (PS) and transversus abdominis (TA) or rectus abdominis muscles. Mechanical stimulation of the trachea or larynx was used to elicit TB cough. Baclofen (10 and 100 μg/kg, GABA-B receptor agonist) or codeine (30 μg/kg, opioid receptor agonist) was administered into the intrathecal (i.t.) space and also into brainstem circulation via the vertebral artery. Cumulative doses of i.t. baclofen or codeine had no effect on PS, abdominal muscle EMGs or cough number during the TB cough. Subsequent intra-arterial (i.a.) administration of baclofen or codeine significantly reduced magnitude of abdominal and PS muscles during TB cough. Furthermore, TB cough number was significantly suppressed by i.a. baclofen. The influence of these drugs on other behaviors that activate abdominal motor pathways was also assessed. The abdominal EMG response to noxious pinch of the tail was suppressed by i.t. baclofen, suggesting that the doses of baclofen that were employed were sufficient to affect spinal pathways. However, the abdominal EMG response to expiratory threshold loading was unaffected by i.t. administration of either baclofen or codeine. These results indicate that neither baclofen nor codeine suppress cough via a spinal action and support the concept that the antitussive effect of these drugs is restricted to the brainstem.

Effect of expiratory loaded breathing during moderate exercise on intercostal muscle oxygenation.

BackgroundIn patients with obstructive lung disease, maintaining adequate ventilation during exercise may require greater contraction of the respiratory muscles, which may lead to a compression of muscle capillaries. Furthermore, dynamic hyperinflation (DH) is frequent during exercise in these patients, as it allows to reach higher expiratory flows and to satisfy respiratory demand. However, in such situation, intercostal muscles are likely to be stretched, which could affect the diameter of their capillaries. Thus, in a context of high level of expiratory resistance, intercostal muscle oxygenation may be disturbed during exercise, especially if DH occurs.MethodsTwelve participants (22±2 years) performed two sessions of moderate exercise (20 min) by breathing freely with and without a 20-cmH2O expiratory threshold load (ETL). Tissue saturation index (TSI) and concentration changes from rest (Δ) in oxygenated ([O2Hb]) and total haemoglobin ([tHb]) were measured in the seventh intercostal space using near-infrared spectroscopy. Respiratory, metabolic and cardiac variables were likewise recorded.ResultsThroughout exercise, dyspnea was higher and TSI was lower in ETL condition than in control (p<0.01). After a few minutes of exercise, Δ [O2Hb] was also lower in ETL condition, as well as Δ [tHb], when inspiratory capacity started to be reduced (p<0.05). Changes in [O2Hb] and dyspnea were correlated with changes in expiratory flow rate (Vt/Te) (r = -0.66 and 0.66, respectively; p<0.05).ConclusionDuring exercise with ETL, impaired muscle oxygenation could be due to a limited increase in blood volume resulting from strong muscle contraction and/or occurrence of DH.

Differential Cortical Control of Chest Wall Muscles During Pressure- and Volume-Related Expiratory Tasks and the Effects of Acute Expiratory Threshold Loading.

We examined whether or not coherence between chest wall intercostal and oblique muscles changed as a function of lung volume excursion, alveolar pressure, and muscular demand. We also assessed the effects of acute expiratory threshold loading (ETL) on chest wall muscular control. A total of 15 healthy adults (7 males; average age = 28 years) completed maximum performance and ETL tasks. Chest wall surface electromyographic and kinematic recordings were made. Participants also performed a session of acute ETL. We showed that corticomuscular control of the chest wall varied as a function of lung volume excursion and muscular effort. Acute ETL had some effect on respiratory kinematics but not coherence.

Standard and viscoelastic mechanical properties of respiratory system compartments in dogs: Effect of volume, posture, and shape

In 9 anesthetized, paralyzed dogs lung and chest-wall standard (viscous resistance, Rint, and quasi-static elastance, Est) and viscoelastic parameters (resistance, Rvel, and time constant, τvel) were measured in the supine posture before and after rib-cage block, after application of an expiratory threshold load, and after 75° head-up tilting before and after wide chest opening. Lung and chest-wall τvel were the same under all conditions. Rvel was independent of volume and posture, and greater for the lung. Chest-wall Rint was independent of flow, volume, and posture. Lung Rint decreased with increasing volume. Chest-wall Rint, Est and Rvel increased with rib-cage block, allowing the assessment of both abdominal-wall and rib-cage characteristics. When chest opening did not elicit bronchoconstriction, the decrease of Rvel was ∼6%. Main conclusions: lung and chest-wall exhibit linear tissue viscoelasticity within the range studied; rib-cage and abdomen characteristics are similar, and asynchronous motion is not expected at physiological respiratory rates; in normal lungs, heterogeneity of parallel time constants plays a marginal role.

Expiratory load compensation is associated with electroencephalographic premotor potentials in humans.

In normal humans during quiet breathing, expiration is mostly driven by elastic recoil of the lungs. Expiration becomes active when ventilation must be increased to meet augmented metabolic demands, or in response to expiratory loading, be it experimental or disease-related. The response to expiratory loading is considered to be mediated by both reflex and cortical mechanisms, but the latter phenomenon have not been neurophysiologically characterized. We recorded the EEG in 20 healthy volunteers (9 men, 11 women, age: 22 to 50 yr) during unloaded breathing, voluntary expirations, and in response to 50 cmH2O·l(-1)·s expiratory resistive load (ERL), 20 cmH2O expiratory threshold load (high ETL), and 10 cmH2O expiratory threshold load (low ETL). EEGs were processed by ensemble averaging expiratory time-locked segments and examined for pre-expiratory potentials, defined as a slow negative shift from the baseline signal preceding expiration, and suggestive of cortical preparation of expiration involving the supplementary motor area. Four subjects were excluded because of technical EEG problems. Pre-expiratory potentials were present in one subject at baseline and in all subjects during voluntary expirations. They were present in eight subjects during low ETL, in 15 subjects during high ETL, and in 13 subjets during ERL (control vs. low ETL, P = 0.008; control vs. high ETL, P < 0.001; and control vs. ERL, P < 0.001). Respiratory discomfort was more intense in the presence of pre-expiratory potentials (P < 0.001). These results provide a neurophysiological substrate to a cortical component of the physiological response to experimental expiratory loads in humans.

腹部引き込み運動および呼気筋運動時の姿勢別における腹横筋の筋厚変化

〔目的〕背臥位，座位，立位の姿勢別に，腹部引き込み運動（ADIM）および呼気筋運動（EMT）時の側腹筋群の筋厚を検討した．〔対象〕健常男性18名とした．〔方法〕各姿勢において安静条件で測定した後，ADIM条件およびEMT条件で対象者ごとにランダムな順序で行った．EMTではThresholdTMPEPを使用し，最大呼気圧の15％値を負荷圧とした．腹横筋，内腹斜筋，外腹斜筋の筋厚測定には超音波画像診断装置を使用した．〔結果〕背臥位と立位ではADIMおよびEMTともに安静条件と比較して腹横筋筋厚の有意な増大を認めたが，座位では有意差を認めなかった．〔結語〕背臥位と立位におけるEMTは，ADIMと同等に腹横筋の筋活動を促すことが示唆された．

W-I-050 EXPIRATORY THRESHOLD LOADING IN OBESITY AND OBSTRUCTIVE SLEEP APNEA

W-I-050 EXPIRATORY THRESHOLD LOADING IN OBESITY AND OBSTRUCTIVE SLEEP APNEA

Hyperinflation-induced cardiorespiratory failure in rats

We previously showed that severe inspiratory resistive loads cause acute (<1 h) cardiorespiratory failure characterized by arterial hypotension, multifocal myocardial infarcts, and diaphragmatic fatigue. The mechanisms responsible for cardiovascular failure are unknown, but one factor may be the increased ventricular afterload caused by the large negative intrathoracic pressures generated when breathing against an inspiratory load. Because expiratory threshold loads increase intrathoracic pressure and decrease left ventricular afterload, we hypothesized that anesthetized rats forced to breathe against such a load would experience only diaphragmatic failure. Loading approximately doubled end-expiratory lung volume, halved respiratory frequency, and caused arterial hypoxemia and hypercapnia, respiratory acidosis, and increased inspiratory drive. Although hyperinflation immediately reduced the diaphragm's mechanical advantage, fatigue did not occur until near load termination. Mean arterial pressure progressively fell, becoming significant (cardiovascular failure) midway through loading despite tachycardia. Loading was terminated (endurance 125 +/- 43 min; range 82-206 min) when mean arterial pressure dropped below 50 mmHg. Blood samples taken immediately after load termination revealed hypoglycemia, hyperkalemia, and cardiac troponin T, the last indicating myocardial injury that was, according to histology, mainly in the right ventricle. This damage probably reflects a combination of decreased O(2) delivery (decreased venous return and arterial hypoxemia) and greater afterload due to hyperinflation-induced increase in pulmonary vascular resistance. Thus, in rats breathing at an increased end-expiratory lung volume, cardiorespiratory, not just respiratory, failure still occurred. Right heart injury and dysfunction may contribute to the increased morbidity and mortality associated with acute exacerbations of obstructive airway disease.

Expiratory threshold loading impairs cardiovascular function in health and chronic heart failure during submaximal exercise

We determined the effects of augmented expiratory intrathoracic pressure (P(ITP)) production on cardiac output (Q(TOT)) and blood flow distribution in healthy dogs and dogs with chronic heart failure (CHF). From a control expiratory P(ITP) excursion of 7 +/- 2 cmH2O, the application of 5, 10, or 15 cmH2O expiratory threshold loads increased the expiratory P(ITP) excursion by 47 +/- 23, 67 +/- 32, and 118 +/- 18% (P < 0.05 for all). Stroke volume (SV) rapidly decreased (onset <10 s) with increases in the expiratory P(ITP) excursion (-2.1 +/- 0.5%, -2.4 +/- 0.9%, and -3.6 +/- 0.7%, P < 0.05), with slightly smaller reductions in Q(TOT) (0.8 +/- 0.6, 1.0 +/- 1.1, and 1.8 +/- 0.8%, P < 0.05) owing to small increases in heart rate. Both Q(TOT) and SV were restored to control levels when the inspiratory P(ITP) excursion was augmented by the addition of an inspiratory resistive load during 15 cmH2O expiratory threshold loading. The highest level of expiratory loading significantly reduced hindlimb blood flow by -5 +/- 2% owing to significant reductions in vascular conductance (-7 +/- 2%). After the induction of CHF by 6 wk of rapid cardiac pacing at 210 beats/min, the expiratory P(ITP) excursions during nonloaded breathing were not significantly changed (8 +/- 2 cmH2O), and the application of 5, 10, and 15 cmH2O expiratory threshold loads increased the expiratory P(ITP) excursion by 15 +/- 7, 23 +/- 7, and 31 +/- 7%, respectively (P < 0.05 for all). Both 10 and 15 cmH2O expiratory threshold loads significantly reduced SV (-3.5 +/- 0.7 and -4.2 +/- 0.7%, respectively) and Q(TOT) (-1.7 +/- 0.4 and -2.5 +/- 0.4%, P < 0.05) after the induction of CHF, with the reductions in SV predominantly occurring during inspiration. However, the augmentation of the inspiratory P(ITP) excursion now elicited further decreases in SV and Q(TOT). Only the highest level of expiratory loading significantly reduced hindlimb blood flow (-4 +/- 2%) as a result of significant reductions in vascular conductance (-5 +/- 2%). We conclude that increases in expiratory P(ITP) production-similar to those observed during severe expiratory flow limitation-reduce cardiac output and hindlimb blood flow during submaximal exercise in health and CHF.

Evaluation of Lateral Abdominal Muscle Activity during Expiratory Threshold Loading by Ultrasonography

We have examined whether the lateral abdominal muscle activity during expiratory loading can be noninvasively evaluated using ultrasonography. This study included 12 healthy adult men, and measured the thicknesses of their lateral abdominal muscles at the end of inspiration and the end of expiration, and the thickness differences when 5%, 10%, and 15% of the maximal expiratory pressure were loaded as expiratory threshold loads. Tidal volume, inspiratory reserve volume and expiratory reserve volume were also measured at the same time. Obtained data were compared by expiratory threshold load, and correlation between muscle thickness and the thickness difference was assessed. Muscle thickness at the end of expiration and thickness difference significantly increased in proportion to the expiratory threshold load, and were accompanied by increase of tidal volume. Additionally, a significant positive correlation was found between muscle thickness and the thickness difference. The results of this study indicate that expiration activities of the lateral abdominal muscles can be evaluated by ultrasonography, and that the thickness difference reflects expiration activities.

Ionotropic glutamate receptors mediate excitatory drive to caudal medullary expiratory neurons in the rabbit

Most of the neurons of the caudal ventral respiratory group (cVRG) are bulbospinal expiratory neurons that receive their main excitatory drive from more rostral, but not yet defined regions. This study was devoted to investigate the functional role of ionotropic excitatory amino acid (EAA) receptors in the excitatory drive transmission to cVRG expiratory neurons during eupnoeic breathing and some respiratory reflexes including cough induced by mechanical stimulation of the tracheobronchial tree. The experiments were performed on spontaneously breathing rabbits under pentobarbitone anesthesia making use of microinjections (30–50 nl) of EAA receptor antagonists into the cVRG. Phrenic nerve and abdominal muscle activities were recorded. Bilateral microinjections of 50 mM kynurenic acid (KYN), a broad-spectrum EAA antagonist, and 10 mM 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), a non-NMDA antagonist, or 5 mM 6-nitro-7-sulphamoylbenzo(f)quinoxaline-2,3-dione (NBQX), a more specific non-NMDA antagonist, completely suppressed spontaneous rhythmic abdominal activity and reflex expiratory responses either to tracheal occlusion at end-inspiration (Breuer–Hering inflation reflex) or to expiratory threshold loading (5 cm H 2O); they also suppressed both the inspiratory and expiratory components of the cough reflex. Spontaneous rhythmic abdominal activity and the reflex respiratory responses were strongly reduced, but not completely abolished by microinjections of 10 mM d(−)-2-amino-5-phosphonopentanoic acid (D-AP5), an NMDA antagonist. The results provide evidence that the excitatory drive to cVRG bulbospinal expiratory neurons during eupnoeic breathing and the investigated respiratory reflexes is mediated by EAA receptors. They also support the view that neurons located in the cVRG are not merely elements of the expiratory output system.

Reproducibilidad mecánica y metabólica de la prueba de resistencia de los músculos espiratorios con cargas umbrales incrementales

The study of respiratory muscle endurance has mainly focused on inspiratory muscles. A new method to measure expiratory muscle endurance, through incremental threshold loading using a weighted plunger valve, has recently been described. To evaluate the mechanical features of the plunger valve and the reproducibility of the method from the standpoint of both mechanics and metabolism. Four untrained healthy subjects performed an incremental test with expiratory threshold loading (50 g every 2 min) on each of three non-consecutive days; each test continued until the subject could no longer open the valve. Mouth pressure was recorded continuously during each test; on the first two test days, oxygen consumption (VO2) was also measured. Opening and closing pressures were the same and were independent of expiratory flow, with a linear load-pressure relationship (4 cmH2O) for every 10 g of weight). The maximal tolerated load (MTL) in the three tests was stable for two of the subjects, whereas the maximal load was reached by the other two subjects in the second and third tests, respectively. When MTL was reached in the third test, mean and peak mouth pressures (the latter expressed as percent of maximal expiratory pressure [MEP]) were 49 +/- 4% and 71 +/- 4%, respectively; the expiratory tension-time index measured at the mouth ([PMEANmouth/MEP] x [TE/Ttot]) was 0.25 +/- 0.02 (TE: expiratory time; Ttot: total time). In the first and second tests, we also measured oxygen consumption of the recruited muscles, which were mainly the expiratory muscles (VO2respmax); consumption in the last test was 213 +/- 65 ml O2/min (2.9 +/- 1.1 ml O2/kg/min). The intraindividual coefficient of variation ranged from 6.3% to 19.5% for the mechanical parameters and from 14% to 21% for the metabolic ones. The expiratory endurance test using a threshold valve allows quantification of muscle and metabolic reserve under incremental expiratory loads. The valve has appropriate mechanical characteristics for this purpose and reproducibility is acceptable, through the precise determination of the may require up to three tests.

Responses of the anterolateral abdominal muscles during cough and expiratory threshold loading in the cat.

The present study was conducted to determine the pattern of activation of the anterolateral abdominal muscles during the cough reflex. Electromyograms (EMGs) of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and parasternal muscles were recorded along with gastric pressure in anesthetized cats. Cough was produced by mechanical stimulation of the lumen of the intrathoracic trachea or larynx. The pattern of EMG activation of these muscles during cough was compared with that during graded expiratory threshold loading (ETL; 1-30 cmH(2)O). ETL elicited differential recruitment of abdominal muscle EMG activity (transversus abdominis > internal oblique > rectus abdominis congruent with external oblique). In contrast, both laryngeal and tracheobronchial cough resulted in simultaneous activation of all four anterolateral abdominal muscles with peak EMG amplitudes 3- to 10-fold greater than those observed during the largest ETL. Gastric pressures during laryngeal and tracheobronchial cough were at least eightfold greater than those produced by the largest ETL. These results suggest that, unlike their behavior during expiratory loading, the anterolateral abdominal muscles act as a unit during cough.

Perception of Respiratory Sensation Assessed by Means of Histamine Challenge and Threshold Loading Tests

Some asthmatic patients perceive the severity of their disease rather poorly. These patients may not receive optimal therapy because of underpresentation of their respiratory symptoms. It is therefore important to identify these patients. The present study evaluates a new threshold loading device for measuring the perception of respiratory sensation. This method for measuring the perception of respiratory sensation may be a viable alternative to the bronchial provocation test. The aim of the present study was to investigate whether the assessment of the perception of respiratory sensation based on a threshold loading test (inspiratory and expiratory) identifies the same subjects as poor perceivers as compared to assessment by histamine bronchial provocation test. In 36 subjects, the perception of respiratory sensation through a threshold loading device was compared to the perception of respiratory sensation during a histamine provocation test. Each test was performed with scoring of the magnitude of the respiratory sensation on a visual analog scale (VAS). The magnitude of the stimulus intensity was indicated by the percentage of decrease in FEV(1) during the histamine challenge test and by the percentage of the subject's maximum mouth pressure (percent maximal inspiratory pressure and percent maximal expiratory pressure) during the threshold loading test. The relationship between VAS values and the stimulus intensity was analyzed by determining the linear regression coefficient between the two parameters. No relationship was found between the perception of the sensation induced by the histamine challenge and that during breathing through a threshold loading device for both inspiration (Rs = 0.15; p = 0.40) and expiration (Rs = 0.13; p = 0.47). We did find a significant relation between the perception of respiratory sensation during the inspiratory and expiratory threshold loading test (Rs = 0.67; p = 0. 0001). Furthermore, we defined a subgroup of patients of special interest: those with low symptoms of breathlessness and high bronchial responsiveness. Compared to the inspiratory and expiratory threshold loading test, the histamine challenge test identified more patients in the special interest group as poorest perceivers. The measurement of perception by means of a threshold loading device and a histamine provocation test did not identify the same subjects as poor perceivers, probably because we did not measure the patient's perceptiveness for exactly the same stimuli. In the population with relatively more severe asthma and very low symptoms of breathlessness, the histamine-induced bronchoconstriction test identified more patients as poorest perceivers compared to the threshold loading test.

Abdominal motor unit activity during respiratory and nonrespiratory tasks.

Abdominal muscles serve multiple roles, but the functional organization of their motoneurons remains unclear. To gain insight, we recorded single motor unit potentials from the internal oblique (IO) and transversus abdominis (TA) muscles of three standing subjects during quiet breathing, a leg lift, and an expiratory threshold load. Inspiratory airflow, recorded from a pneumotachometer, provided tidal volumes and respiratory cycle timing. Fine wires, implanted under ultrasonic imaging, detected single motor unit potentials that were visually distinguished by their spike morphology. From the number of spikes, firing profiles, times of occurrence in the respiratory cycle, and their onset, instantaneous, mean, and peak firing frequencies we deduced that 1) breathing patterns varied across tasks, 2) different motor units were recruited for each task with essentially no overlap, 3) their firing displayed prominent expiratory activity during each task, and 4) the recruitment levels and discharge patterns of IO and TA were different. We conclude that the IO and TA motor pools receive a strong central respiratory drive, yet each pool receives its own distinct, task-dependent synaptic input.