Maximal Expiratory Pressure Values Research Articles

Iraq/Afghanistan war lung injury reflects burn pits exposure

This descriptive case series retrospectively reviewed medical records from thirty-one previously healthy, war-fighting veterans who self-reported exposure to airborne hazards while serving in Iraq and Afghanistan between 2003 and the present. They all noted new-onset dyspnea, which began during deployment or as a military contractor. Twenty-one subjects underwent non-invasive pulmonary diagnostic testing, including maximum expiratory pressure (MEP) and impulse oscillometry (IOS). In addition, five soldiers received a lung biopsy; tissue results were compared to a previously published sample from a soldier in our Iraq Afghanistan War Lung Injury database and others in our database with similar exposures, including burn pits. We also reviewed civilian control samples (5) from the Stony Brook University database. Military personnel were referred to our International Center of Excellence in Deployment Health and Medical Geosciences, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell under the auspices of Northwell IRB: 17-0140-FIMR Feinstein Institution for Medical Research “Clinicopathologic characteristics of Iraq Afghanistan War Lung Injury.” We retrospectively examined medical records, including exposure data, radiologic imaging, and non-invasive pulmonary function testing (MGC Diagnostic Platinum Elite Plethysmograph) using the American Thoracic Society (ATS) standard interpretation based on Morgan et al., and for a limited cohort, biopsy data. Lung tissue, when available, was examined for carbonaceous particles, polycyclic aromatic hydrocarbons (Raman spectroscopy), metals, titanium connected to iron (Brookhaven National Laboratory, National Synchrotron Light Source II, Beamline 5-ID), oxidized metals, combustion temperature, inflammatory cell accumulation and fibrosis, neutrophil extracellular traps, Sirius red, Prussian Blue, as well as polarizable crystals/particulate matter/dust. Among twenty-one previously healthy, deployable soldiers with non-invasive pulmonary diagnostic tests, post-deployment, all had severely decreased MEP values, averaging 42% predicted. These same patients concurrently demonstrated abnormal airways reactance (X5Hz) and peripheral/distal airways resistance (D5–D20%) via IOS, averaging − 1369% and 23% predicted, respectively. These tests support the concept of airways hyperresponsiveness and distal airways narrowing, respectively. Among the five soldiers biopsied, all had constrictive bronchiolitis or bronchiolitis or severe pulmonary fibrosis. We detected the presence of polycyclic aromatic hydrocarbons (PAH)—which are products of incomplete combustion—in the lung tissue of all five warfighters. All also had detectable titanium and iron in the lungs. Metals were all oxidized, supporting the concept of inhaling burned metals. Combustion temperature was consistent with that of burned petrol rather than higher temperatures noted with cigarettes. All were nonsmokers. Neutrophil extracellular traps were reported in two biopsies. Compared to our prior biopsies in our Middle East deployment database, these histopathologic results are similar, since all database biopsies have constrictive bronchiolitis, one has lung fibrosis with titanium bound to iron in fixed mathematical ratios of 1:7 and demonstrated polarizable crystals. These results, particularly constrictive bronchiolitis and polarizable crystals, support the prior data of King et al. (N. Engl. J. Med. 365:222–230, 2011) Soldiers in this cohort deployed to Iraq and Afghanistan since 2003, with exposure to airborne hazards, including sandstorms, burn pits, and improvised explosive devices, are at high risk for developing chronic clinical respiratory problems, including: (1) reduction in respiratory muscle strength; (2) airways hyperresponsiveness; and (3) distal airway narrowing, which may be associated with histopathologic evidence of lung damage, reflecting inhalation of burned particles from burn pits along with particulate matter/dust. Non-invasive pulmonary diagnostic tests are a predictor of burn pit-induced lung injury.

Maximum expiratory pressure is a good predictor of the incidence of the frailty syndrome in elderly men

This article aims to investigate the association between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with the incidence of frailty syndrome (FS), in addition to testing the predictive ability of MIP and MEP to discriminate FS in elderly adults, according to sex. It is a longitudinal study with a five-year follow-up period (2014-2019), carried out with 104 elderly adults registered in the Family Health Strategy of a municipality in Bahia. The incidence of frailty syndrome was diagnosed according to criteria proposed by Fried et al., using data from 2019, after a five-year follow-up. The MIP and MEP were evaluated according to the recommendations of the Brazilian Society of Pulmonology and Phthisiology data in 2014 (baseline data). The total incidence of frailty syndrome was 16.3% (95%CI: 9.2-23.6), with 13.6% (95%CI: 4.56-22.55) in women and 20% (95%CI: 7.85-32.15) in men. The mean values of MIP and MEP were, respectively, 60,8±21,2 cmH2O and 76,7±23,1 cmH2O in women, and 79,5±27,0 cmH2O and 114,7±29,8 cmH2O in men. The frailty syndrome was associated with MEP in elderly adult men (adjusted RR: 0.96; 95%CI: 0.95-0.98; P-value: 0.002), indicating that the increase of 1cmH2O in MEP reduces by 4% the risk of developing the syndrome.

Distribuição padrão e percentuais dos valores de pressão respiratória máxima de crianças saudáveis de 7 a 10 anos de idade

Objective:This study aims to present standard reference for values of maximum respiratory pressures of healthy schoolchildren, according to gender.Methods:This is a cross-sectional study involving healthy children aged 7–10 years. Data of body mass and height were evaluated to calculate body mass index (BMI). In addition, forced expiratory volume in 1 second (FEV1) and maximal expiratory pressure values were evaluated according to the American Thoracic Society. The maximal inspiratory pressure (MIP) and data of maximal expiratory pressure (MEP) obtained in the study showed normal distribution and curves were built by the Lambda–Mu–Sigma (LMS) method, as well as the values of MIP and MEP percentiles 3, 10, 25, 50, 75, 90, and 97 for each gender.Results:MIP and MEP data were collected from 399 schoolchildren. All schoolchildren in the sample had adequate FEV1 and BMI. The study showed an increase in respiratory pressure values with age progression. The MIP and MEP values of girls were of 53.4±11.0 and 61.8±12.5cmH2O, respectively, and those of boys were 59.9±13.6 and 69.6±15.7cmH2O, respectively.Conclusions:Normal curves and percentiles were developed for MIP and MEP values of healthy schoolchildren. The extreme percentiles (3rd and 97th) were determined, and a specific graph was elaborated for each group. These graphs may help clinical follow-up and therapeutic monitoring of different pediatric populations.

Koroner Arter Bypass Greft Cerrahisi sonrası Fizyoterapi Programlarının Etkinliğinin Belirlenmesi

Objective: The aim of this study was to investigate the effects of incentive spirometer on respiratory muscle strength, exercise capacity and hemodynamic responses after CABG surgery. Methods: Between June 2017 and December 2018, a total of 35 patients underwent CABG surgery were included this prospective randomized controlled study. Patients divided into incentive spirometer (IS) group and physiotherapy (PT) group. All patients received standard physiotherapy postoperatively. In addition, IS group received volume-oriented incentive spirometer. Respiratory muscle strength (mouth pressure device) on 2nd and 5th postoperative day, exercise capacity (6-min.walking test (6-MWT)) on 3rd postoperative day, before and immediately after physiotherapy on the first post-operative day blood gases were assessed. Results: Demographic characteristics of the groups were similar in both groups. Statistically significant increases in maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), %MIP and %MEP values were observed in both two groups (p<0.05) but there was no statistically significant difference between the groups (p > 0.05). There were no significant differences in 6 MWT parameters between PT and IS group (p > 0.05). No significant difference was found in arterial blood gas values on first postoperative day in both groups (p > 0.05). Conclusion: Respiratory muscle strength improved and blood gas values maintained in both groups. There was no superiority of IS combined with PT in increasing respiratory muscle strength and in maintaining arterial blood gas results after CABG surgery. IS combined with physiotherapy could be used safely from the early period after cardiac surgery.

Exercise capacity, muscle strength, dyspnea, physical activity, and quality of life in preoperative patients with lung cancer.

To detect the extent to which physical impairments are observed in patients with lung cancer awaiting lung surgery, exercise capacity, muscle strength, physical activity, dyspnea, and quality of life (QOL) were objectively compared between the patients and healthy individuals in current study. Patients with lung cancer (n = 26) and healthy individuals (n = 21) were included. Exercise capacity, respiratory (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)) and quadriceps femoris muscle strength, physical activity, dyspnea and QOL were evaluated using 6-min walk test (6-MWT), a mouth pressure device, a hand-held dynamometer, a metabolic holter device, Modified Medical Research Council dyspnea scale and European Organization for Research and Treatment of Cancer QOL Questionnaire C30 version 3.0, respectively. The 6-MWT distance (mean difference: 78.97 m), percentages of predicted MIP and MEP values, physical activity parameters (energy expenditures, physical activity duration, average metabolic equivalent and number of steps) and QOL subscales scores (functional, social function and global health status) were significantly lower in the patients than healthy individuals (p < 0.05). Dyspnea perception and other QOL subscales scores (symptom and fatigue) were significantly higher in patients than healthy individuals (p < 0.05). No significant difference was prevalent in quadriceps femoris muscle strength (p > 0.05). Sixteen (66.7%) patients were sedentary. Severe reductions in exercise capacity, respiratory muscle strength, and physical activity level, poorer QOL and evident dyspnea exist in preoperative patients with lung cancer. Therefore, patients should be included in early protective rehabilitation program including aerobic exercise, respiratory muscle training and physical activity counseling before lung surgery.

Maximal Respiratory Pressures and Maximum Voluntary Ventilation in Young Arabs: Association with Anthropometrics and Physical Activity.

BackgroundMaximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV) measurements assist in determining the respiratory muscle strength and endurance. These determinants of respiratory muscles vary significantly by age, gender, height, and ethnic origin. Normative values for maximum respiratory pressures (MRPs) and MVV would aid in evaluating respiratory muscle function in athletes, estimating performance, and assisting in rehabilitation. In addition, the reference values may aid in determining the efficacy of therapeutic interventions in young people with chronic respiratory diseases. The purpose of this study was to see how respiratory muscle strength indices correlated with anthropometric and physical activity characteristics in young Arabs.MethodologyThe study included 80 male volunteers and 85 female volunteers ranging in age from 18 to 30 years. MicroRPM was used to measure MIP and MEP, and pulmonary function test data, including MVV values, were recorded. All subjects completed the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements. Unpaired t-tests or Mann–Whitney U-tests were used to determine male-female differences. Using the Pearson correlation coefficient and Spearman Rho correlation coefficient tests, MIP and MEP values were correlated with body composition and physical activity. Using stepwise multiple linear regression analysis, the relationships between respiratory function (MVV, MIP, and MEP) and PFT values (FVC, FEV1, and FEV1/FVC), physical activity, and sedentary behavior were investigated.ResultsMIP, MEP, and MVV values were significantly lower in females than in males. MIP, MEP, and MVV values had a moderate correlation with forced vital capacity, forced expiratory volume in 1 second, and height, but not with weight, BMI, or GPAQ. Age, gender, and body mass index were found to be significant predictors of maximal respiratory pressures in a young Arab population.ConclusionMaximum respiratory pressures and maximal voluntary ventilation were significantly lower in young Arabs than in other ethnic groups; these values were influenced by gender and height but not by levels of physical activity.

Efficacy of Incentive Spirometry in Expiratory Muscle Training Following Abdominal Surgery

BACKGROUND: Incentive spirometry is a device which helps in the improvement of lung function after abdominal surgery. It motivates the patients by giving visual feedback about their lung volumes. It is one of the less expensive and user-friendlydevices. Incentive spirometry facilitates the patients to take slow deep breath and there by producing a sustained maximal inspiration (SMI) that mainly helps in the prevention of atelectasis. But it is a common practice for physiotherapists to teach the patients to do expiratory exercise by reversing the incentive spirometer. The simplest way to measure the maximal inspiratory and expiratory pressures is by respiratory pressure meter in cmH2o. OBJECTIVE: To find out the efficacy of incentive spirometer in improving the expiratory muscle strength following abdominal surgery. METHODOLOGY: Quasi-Experimental study. PROCEDURE: 30 subjects were conveniently selected based on inclusion and exclusion criteria and allotted to group A (n=15) and group B (n= 15). Both groups were trained for inspiratory muscle and group A was also trained for expiratory muscle using incentive spirometry. OUTCOME MEASURES: Maximal inspiratory pressure (MIP), Maximal expiratory pressure (MEP). RESULT: This study shows that the mean MIP value have improved from 2nd to 7th postoperative day, but it is not statistically significant (P&gt;0.05). The mean MEP values shows statistically significant (P&lt;0.05) improvement from second to 7th postoperative day in group A when compared to group B. CONCLUSION:This study concludes that there is significant improvement in the expiratory muscle strength along with inspiratory muscle strength by training with the Incentive spirometry in the upside down and upright positions respectively.

How Many Maneuvers Should We Do for Maximal Inspiratory and Expiratory Muscle Pressure Testing in Children: A Retrospective Review in Children with Cystic Fibrosis

Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. All children achieved repeatable MIP/MEP values within 10-11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6-11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings.

The relationship between maximal expiratory pressure values and critical outcomes in mechanically ventilated patients: a post hoc analysis of an observational study

BackgroundLittle interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes.MethodsThis work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death.ResultsOne hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93–0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively).ConclusionsMEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone.Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015

The study of respiratory muscles activation during respiratory muscle strength effort in adult females with chronic neck pain.

[Purpose] This study aimed to compare maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) values and muscle activity during MIP and MEP between chronic neck pain and healthy participants. [Participants and Methods] Twenty chronic neck pain and 20 non-symptomatic females participated in this study. Maximal airway pressure (MIP and MEP) and surface electromyography (sEMG) for both sides of the upper trapezius, anterior scalene, pectoralis major and 6th intercostal muscles were recorded simultaneously. [Results] Significant differences of MIP and MEP values were found between the groups. The muscle activities of both sides of upper trapezius and 6th intercostal muscles during MEP were significantly higher in the chronic neck pain group than the healthy group except both sides of anterior scalene and pectoralis major muscles. During MIP, the activities of upper trapezius, 6th intercostal muscles and anterior scalene were significantly different between the two studied groups. Higher activity of left pectoralis major was found in the chronic neck pain group. [Conclusion] Decreasing values of MEP and MIP as well as muscles activities elevation in chronic neck pain participants were clearly demonstrated. Besides the musculoskeletal treatment, we suggest breathing exercise training to be considered in treatment programs.

Therapist-oriented home rehabilitation for adults with sickle cell anemia: effects on muscle strength, functional capacity, and quality of life

ABSTRACT Objectives Considering the advances in functional rehabilitation in recent decades, therapist-oriented home rehabilitation (TOHR) has been increasingly used in the field of physical therapy because it increases patient compliance and reduces health system costs. The objective of this study was to investigate the effects of TOHR on functional capacity, muscle strength, and quality of life (QoL) in adults with sickle cell anemia (SCA). Methods Forty adults with SCA underwent manually guided TOHR for 12 weeks. Before and at the end of training, the following variables were assessed in the participants: distance covered in the 6-min walk test (6MWD); maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); handgrip strength (HGS); quadriceps strength (QS); and QoL using the Short Form-36 physical component summary (SF-36PCS) and the Short Form-36 mental component summary (SF-36MCS). Results After TOHR, significant increases were observed in the mean values for the 6MWD, MIP, MEP, HGS, QS, and SF-36PCS and SF-36MCS scores. The relative delta between the pre- and post-TOHR 6MWDs correlated significantly with the relative deltas of MIP (rs = 0.640, p < 0.0001), MEP (rs = 0.587, p < 0.0001), HGS (rs = 0.360, p = 0.022), and QS (rs = 0.351, p = 0.026). When the participants were separated according to their use of hydroxyurea, significant increases were observed in the relative deltas of the 6MWD, MIP and MEP values. Conclusions This study shows that TOHR can potentially increase functional capacity, muscle strength, and QoL in adults with SCA. Furthermore, there appears to be a relationship between 6MWD gains and muscle strength gains with TOHR. Trial registration: ClinicalTrials.gov identifier: NCT04705792.

Cut-off Values of the Respiratory Muscle Power and Peak Cough Flow in Post-Stroke Dysphagia.

Background and objectives: This study aimed to determine the cut-off values of the following three respiratory pressure meters; the voluntary peak cough flow (PCF), maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP); associated with post-stroke dysphagia and assess which of these parameters show good diagnostic properties associated with post-stroke dysphagia. Materials and Methods: Retrospective analysis of a prospectively maintained database. Records of patients with first-ever diagnosed dysphagia attributable to cerebrovascular disease, who had performed spirometry measurements for the PCF, MIP and MEP. Results: From a total of 237 stroke patients, 163 patients were diagnosed with dysphagia. Those with dysphagia had significantly lower PCF values than those without dysphagia (116.3 ± 75.3 vs. 219.4 ± 91.8 L/min, p < 0.001). In addition, the former group also had lower MIP (30.5 ± 24.7 vs. 41.6 ± 25.7 cmH2O, p = 0.0002) and MEP (41.0 ± 27.9 vs. 62.8 ± 32.3 cmH2O, p < 0.001) values than the latter group. The receiver operating characteristic curve analysis showed that the PCF cut-off value of 151 L/min (area under the receiver operating characteristic curve [AUC] 0.81; sensitivity 72%; specificity 78.8%) was associated with post-stroke dysphagia. The optimum MEP and MIP cut-off were 38 cmH2O (AUC 0.70, sensitivity 58%; specificity 77.7%) and 20 cmH2O (AUC 0.65, sensitivity 49%; specificity 84%). PCF showed the highest AUC results. Results from the univariate analysis indicated that PCF values of ≤151 L/min increased risk of dysphagia by 9.51-fold (4.96–18.23). Multivariable analysis showed that after controlling of other clinical factor, the PCFs at this cut-off value still showed increased risk of by 4.19 (2.02–83.69) but this was not observed with the MIPs or MEPs. Conclusions: Our study has provided cut-off values that are associated with increased risk of dysphagia. Among the three parameters, PCF showed increased association with post-stroke dysphagia.

Relationship between maximal respiratory pressures and multiple childbearing in Brazilian middle-aged and older women: A cross-sectional community-based study.

ObjectivePrevious studies show that multiparity and a number of chronic conditions are correlated among women. Also, low respiratory muscle strength has been associated to adverse health outcomes such as chronic lung disease and early mortality. This study aimed to investigate associations between the number of lifetime pregnancies and maximal inspiratory/expiratory pressures.MethodsIn a cross-sectional study, 204 women ages 41–80 years-old, from the rural community of Santa Cruz, Brazil, provided data regarding demographics, socioeconomic characteristics, health behaviors, and number of lifetime pregnancies (≤3, 4–6 or ≥7). Maximal respiratory pressures were measured with a digital manometer. Multiple linear regression analysis was used to examine the association of multiple childbearing on maximal respiratory pressures.ResultsOf the participants, 44.1% had ≤3 pregnancies, 30.4% had 4–6 pregnancies and 25.5% had >7 pregnancies. In the unadjusted analyses, maximal inspiratory and expiratory pressures varied significantly according to multiple childbearing categories. After adjustment, the values remained statistically significant only for maximal expiratory pressure. Compared to women with ≤3 lifetime pregnancies, those who had ≥7 pregnancies had significantly lower maximal expiratory pressure values (β = -18.07, p = 0.01)ConclusionMultiple childbearing appears to be negatively associated with maximal respiratory pressures; women with a higher number of lifetime pregnancies had lower values of maximal respiratory pressures when compared to those with fewer pregnancies. This association may be due to biomechanical changes in the respiratory muscles promoted by multiple lifetime pregnancies. This finding indicates a need to motivate women, from the prenatal to postpartum period, to safely exercise their respiratory muscles, including abdominal muscle exercises as well as respiratory muscle training.

The Effects of Trunk Control on Respiratory Muscle Strength and Activities of Daily Living in Children with Cerebral Palsy

: There is not enough evidence regarding the effects of trunk control on respiratory muscle strength and activities of daily living (ADL) in children with cerebral palsy (CP). This study was planned to investigate the effects of trunk control on respiratory muscle strength and ADL in children with spastic CP. A total of 34 children with spastic CP (M ± SD age, 9.3 ± 2.4 years) and 30 typical peers (M ± SD age, 9.7 ± 2.1 years) were included in the study. Trunk control was evaluated by the Trunk Control Measurement Scale (TCMS), ADL was evaluated by Pediatric Evaluation of Disability Inventory (PEDI), and respiratory muscle strength was evaluated by mouth pressure meter. The trunk control, respiratory muscle strength, and ADL of the children with spastic CP were significantly lower than their typically peers (P < 0.001, respectively). There were statistically significant correlations between the trunk control and maximum inspiratory pressure (MIP) (r = 0.503, P < 0.05), maximum expiratory pressure (MEP) (r = 0.465, P < 0.05), mobility subscale of Functional Skills Scale of PEDI (FSS-MS) (r = 0.570, P < 0.001), self-care subscale of Caregiver Assistance Scale of PEDI (CAS-SS) (r = 0.431, P < 0.05), mobility subscale of Caregiver Assistance Scale of PEDI (CAS-MS) (r = .607, P < 0.001), and Gross Motor Functional Classification System (GMFCS) (r = -0.522, P < 0.05) in children with spastic CP. In addition, MIP, MEP, PEDI FSS-MS, CAS-SS, and CAS-MS were independently predictors of trunk control in children with spastic CP. The results of this study demonstrate that trunk control in children with spastic CP is correlated positively to MIP, MEP values and their daily living activities and we suggest this should be taken into account when planning an intervention to improve the ability of daily living function for children with spastic CP.

Effects of Pulmonary Rehabilitation on Respiratory Muscle Strength and Functional Capacity of Individuals with Chronic Obstructive Pulmonary Disease: Case Report

Chronic obstructive pulmonary disease is a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. The objective of this study was to evaluate the effects of a pulmonary rehabilitation program on respiratory muscle strength and functional capacity of individuals with chronic obstructive pulmonary disease. An elderly male patient participated in the pulmonary rehabilitation program and was evaluated before and after intervention. This program consisted of four phases: stretching, aerobic exercises, resistance training and relaxation. The physical activities were provided three times a week on alternate days, for 4 months, totaling 48 sessions. The results obtained after the rehabilitation program showed improvement in the physical functional capacity of the patient measured by the six-minute walk test (Pre=480; Post=540m). The maximal inspiratory pressure values increased (Pre=-60; Post=-120cmH2O) whereas the maximal expiratory pressure values remained the same (Pre=50; Post=50cmH2O). Therefore, the respiratory rehabilitation program has improved functional capacity and inspiratory muscle strength.

Exercise Capacity and Respiratory Profile in Patients after Orthopedic Liver Transplantation: a Follow-up Study

Introduction: We sought to describe: 1) The influence of orthotopic liver transplantation (OLT) on exercise capacity, pulmonary function and respiratory muscle strength after surgery, 2) The relationship between exercise capacity and symptoms of anxiety and depression.Material and methods. This is a prospective follow up study conducted with patients submitted to OLT. All patients were assessed before and 1 month after surgery through measurements: six minute walk test (6MWT), 6 min step test (6MST) and HADS (Hospital Anxiety and Depression Scale). FEV1% (forced expiratory volume), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured in the pre-operative and on 1st, 3rd, 5th day and 1 month after surgery.Results. In 77 patients, 6MWD improved 20.2 m (95%CI 8.1-32.3) and 6MST improved 7.8 steps after surgery (95%CI 3.9-11.6). Change in 6 MWD and 6 MST did not correlated with change HADS. The FEV1% at each time point were 88.8 ± 21.3 before surgery, 32.9 ± 9.9 on 1st day, 39.6 ± 11.5 on 3rd day, 46 ± 12.1 on 5th day and 86.6 ± 21.1 one month after surgery. MIP and MEP values at each time point were -67.4 ± 23.2 and 79.7 ± 26 before surgery, −30.8 ± 12.3 and 36.4 ± 15.4 on 1st day, −38.6 ± 14.1 and 43.8 ± 17 on 3rd day, −45.8 ± 15.9 and 49.7 ± 18.7 on 5th day and −67.1 ± 29.4 and 80.9 ± 23.9 one month after surgery.Conclusion. Exercise capacity was modestly increased after OLT without any correlation with symptoms of anxiety and depression. Pulmonary function and respiratory muscle strength decreased immediately after liver transplantation, and progressively recovered, returning to baseline values after 1 month.

Effects of Physiotherapeutic Interventions on Quality of Life and Respiratory Function of subjects with COPD

Background: Chronic Obstructive Pulmonary Disease (COPD) treatment includes a multidisciplinary approach, with physiotherapy a prominent role that promotes a positive impact on the quality of life (QOL) of these patients. Objective: To analyze the effects of physiotherapeutic interventions on QOL, lung volumes and capacities, and respiratory muscle strength in COPD patients. Methods: 17 subjects participated in the study, randomly divided into 2 groups: 1) Maneuvers: 62.7 ± 15.4 years, 1.65 ± 0.12 m, 81.4 ± 18.2 kg, body Mass Index (BMI) 29.9± 5.0 kg/m2 ; 2) Threshold: 64.4 ± 11.2 years, 1.58 ± 0.08 m, 70.7 ± 9.4 kg, BMI 28.6 ± 3.7 kg/m2 , with COPD, without neurological, musculoskeletal, cardiovascular or cognitive impairment, which made it impossible to participate in the physiotherapeutic intervention programs. QOL was analyzed using the Saint George Hospital questionnaire on Respiratory Disease (SGRQ); spirometry and respiratory muscle strength were analyzed by manovacuometry using a pneumotachograph. Data were analyzed in SPSS (20.0), Student’s t-test (paired) and Wilcoxon test were used for pre and post-intervention comparison of the SGRQ domains and total score, Vital Capacity (VC), Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1 ), Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP); and Student’s t-tests (independent) and Mann-Whitney were used in the intergroup comparison, all with a significance level of 5%. Results: There was a significant difference in both groups (P&lt;0.05) in the pre- and post-intervention comparison of the three domains (Symptoms, Activities and Psychosocial Impact) and total SGRQ score, but this did not occur with spirometric variables. In the manovacuometry, the Wilcoxon test showed a significant difference in the pre and post-intervention values of MIP and MEP. Conclusion: Improved QOL and MIP and MEP muscle strength of all COPD patients was observed, regardless of the groups Maneuvers or Threshold.

Perioperative Evaluation of Respiratory Muscle Strength after Scoliosis Correction in Patients with Duchenne Muscular Dystrophy

Study DesignRetrospective cohort study.PurposeTo investigate the effect of spinal correction on respiratory muscle strength in patients with Duchenne muscular dystrophy (DMD).Overview of LiteratureSeveral studies have reported that scoliosis correction in patients with DMD does not improve pulmonary function. In these studies, pulmonary function was evaluated using the traditional spirometric values of percent vital capacity (%VC) and percent forced vital capacity (%FVC). However, traditional spirometry may not be suitable for patients with DMD because the results can be influenced by patient fatigue or level of understanding. Therefore, we evaluated respiratory function focusing on respiratory muscle strength using maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP), in addition to %VC and %FVC.MethodsWe retrospectively reviewed 16 patients with DMD who underwent spinal correction surgery between 2006 and 2011 at Kitasato University Hospital. All patients were males, and the mean age was 13.5 years. Respiratory muscle strength was evaluated using MIP, MEP, and SNIP. Measurements were obtained preoperatively and at 1 and 6 months postoperatively, and %VC and %FVC were obtained preoperatively and within 6 months postoperatively.ResultsThe mean preoperative and postoperative %VC values were 54.0% and 51.7%, whereas the mean %FVC values were 53.9% and 53.2%, respectively. The mean MIP, MEP, and SNIP values obtained preoperatively and at 1 and 6 months postoperatively were as follows: MIP, 40.5, 42.7 and 47.2 cm H2O; MEP, 26.0, 28.0, and 29.0 cm H2O; and SNIP, 33.4, 33.0, and 33.0 cm H2O; respectively. The mean MIP and MEP values significantly improved postoperatively. There were no significant differences in SNIP, %VC, or %FVC preand postoperatively.ConclusionsBy focusing on respiratory muscle strength, our results suggest that scoliosis correction in patients with DMD might have a favorable effect on respiratory function.

Predictive equations for maximal respiratory pressures of children aged 7–10

BackgroundMeasurements of respiratory muscle strength are widely used for assessment in children; however, clearly defined predictive equations for the Brazilian pediatric population have yet to be established. ObjectiveTo determine the prediction equations for maximal respiratory pressures in healthy children. MethodCross-sectional observational study with normal-weight students aged 7–10 years (n=399, 198 boys) with health attested by the (International Study of Asthma and Allergies in Childhood) questionnaire and medical history. Biometric data were evaluated (weight, height, and body mass index) as predictors. Spirometry and maximal expiratory pressure values were measured according to the recommendations of the American Thoracic Society. To verify data normality, the Shapiro–Wilk test was applied, and Pearson's test was used to verify the correlation between variables. The models were developed using simple linear regression and multivariate analyses. For all tests, the significance level was p<0.05. ResultsBoys showed higher values of maximal respiratory pressures than girls, both increasing with age. For boys, these values had moderate correlation with age, weight, and height and weak correlation with body mass index. For girls, maximum inspiratory pressure had a weak correlation with age and moderate correlation with biometric data. Maximum expiratory pressure had a moderate correlation with age and biometric measures. The best predictive models were found in boys: Log(MIP)=1.577+0.006×weight (kg) (R2aj=14.1%) and Log(MEP)=1.282+0.409×height (m) (R2aj=13.9%); and for girls: Log(MIP)=1.548+0.006×weight (kg) (R2aj=15.0%) and Log(MEP)=1.524+0.012×age (years)+0.005×weight (kg) (R2aj=21.6%). ConclusionPrediction equations for maximal respiratory pressures were developed for boys and girls. The biometric measurements were shown to have a weak influence on the results.

Evaluation of the Maximal Respiratory Pressure in Children and Adolescents with Asthma between 7 and 14 Years Old

Objectives: To evaluate the respiratory muscle strength among children (<10 years old) and adolescents with asthma. Methods: This is a cross-sectional, retrospective study, among children and adolescents (7 years to 14 years of age) with asthma. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) [in cmH2O] were measured through digital manometer. The variables evaluated were: gender, age, BMI (body mass index), severity of asthma, use of inhaled corticosteroid (IC). Results: A total of 48 individuals were studied. MIP values were according: a) normal weight=69.5 ± 22.6; overweight=81.6 ± 25.4 (p<0.088); b) use of inhaled corticosteroid=70.5 ± 23.0; no use=25.1 ± 86.3 (p<0.045). MEP values according: a) ages 7-9 years=78.8 ± 19.4; 10-14 years=68.1 ± 22.7 (p<0.097); b) normal weight=66.1 ± 18.9; overweight=80.3 ± 23.3 (p<0.024); c) use of inhaled corticosteroid=68.3 ± 18.3; no use=83.1 ± 27.5 (p<0.036); d) with bronchiectasis=61.8 ± 19.2; without bronchiectasis=83.1 ± 27.5 (p<0.069). Conclusions: Patients who used inhaled corticosteroid had MIP and MEP lower than the others; patients with normal BMI tended to have lower MEP than the overweight group and lower MIP in the group of normal weight. There was a tendency of adolescents to present lower MEP than children.