Maximum Expiratory Research Articles

Variación de la fuerza muscular respiratoria postabdominoplastia

Introduction The abdominoplastia is an esthetics surgery that permits to define the contour of the body. Some complications, as the pulmonary, deep vein thrombosis, alterations of sensibility, nervous wounds, seromas, necrosis and even the death they can happen, in the postoperative period. Objective The proposition of this study was to evaluate the possible alterations of the function muscular respiratory in patient the abdominoplasty. Method 4 patients were evaluated, all women, mean age of 43. 7 (SD=10.3) years, Indicate of Corporal Mass of 22.0 (SD=1.9). An evaluation respiratory was carried out subject to al start of the chirurgic, in the two you gave followed to the same one and after a week of the intervention. In the evaluation they were measured: the muscular force through the pressure inspiratory and expiratory maximum, current volume, volume minute and vital capacity. Results The study confirmed that there are changes in the values of the measures al to be compared the pre one withthe post surgery, remaining under the normal respected values still of the first week of the intervention, being able to involve to some complication respiratory.

The effects of isothermic and hypothermic carbon dioxide pneumoperitoneum on respiratory function test results

This study investigated the effects of isothermic and hypothermic carbon dioxide, used for pneumoperitoneum during laparoscopic cholecystectomy, on respiratory function test results. Thirty patients who underwent elective laparoscopic cholecystectomy were enrolled in this prospective randomized study. The patients were divided into two groups. Carbon dioxide at 37 degrees C (isothermic) was used in the isothermic group, and carbon dioxide at 21 degrees C (hypothermic) was used in the hypothermic group. Respiratory function tests were performed in the preoperative period and at 12 h after the operation. Mean forced vital capacity (FVC), forced expiratory volume (FEV1), maximum peak expiratory flow (PEF), and the FEV1/FVC ratio were significantly higher in the isothermic group than in the hypothermic group (P < 0.05). Using isothermic carbon dioxide for pneumoperitoneum has fewer negative effects than hypothermic carbon dioxide on respiratory function tests results. Isothermic carbon dioxide may be preferable for patients with respiratory problems.

Impairment of Nitric Oxide Output of Conducting Airways in Primary Ciliary Dyskinesia

Nasal nitric oxide (NO) concentration is dramatically reduced in primary ciliary dyskinesia (PCD). The aims of this study were to apply a multiple-flow NO analysis to investigate whether NO output from the bronchial tree was affected in a similar way to nasal NO output, and to search for a relationship between flow-independent exchange parameters and airflow limitation. Multiple flow rate analysis of exhaled NO, allowing the calculation of maximum airway wall flux and alveolar NO concentration, was performed in 17 PCD patients (median age, 25-75th percentiles: 13.5, 12.1-17.6) with documented ultrastructural cilia abnormalities and 28 healthy subjects (16.0, 11.0-21.0). Median maximum airway wall flux and median alveolar NO concentration were significantly reduced in PCD patients compared to healthy subjects: 16.0, 7.5-29.5, vs. 25.0, 15.0-32.5 nl/min (P<0.05) and 2.5, 1.6-3.3, vs. 5.0, 3.6-6.5 ppb (P<0.01), respectively. Significant correlations between maximum airway wall flux and airflow limitation were found, i.e., resistance of respiratory system (rho=0.74, P<0.005), forced expiratory volume in one second (FEV(1))/VC (rho= -0.61, P<0.05), FEV(1) (rho=-0.52, P< 0.05), mid expiratory flow between 25 and 75% of forced vital capacity (MEF(25-75)) (rho=-0.54, P<0.05), and maximal instantaneous expiratory flow at 50% of the vital capacity (MEF(50)) (rho=-0.55, P<0.05). In conclusion, the impairment of NO output is less pronounced in the lower than in the upper (nasal) respiratory tract in PCD. A decrease in maximal NO output from conducting airways is associated with limited airflow impairment.

Risk Stratification in Cardiac Amyloidosis: Novel Approaches

Amyloidosis is a term for diseases with extracellular deposition of insoluble beta-fibrillar proteins in different organs. The heart is primarily involved in more than half of patients with immunoglobulin light-chain amyloidosis or hereditary amyloidosis and associated with poor prognosis. Different traditional diagnostic tools that have been described for risk stratification lack of sufficient sensitivity and specificity for patient survival. Until November 2004 in 50 consecutive patients with light chain amyloidosis and 15 patients with hereditary amyloidosis electrocardiography, echocardiography, Holter monitoring, cardiopulmonary exercise test, lung function testing, tilt-test, and laboratory investigations have been performed at our department. Cardiac amyloidosis was found in 32 patients. Interventricular septum (14.3+/-0.5 mm vs. 12.3+/-0.7 mm, P<0.05), plasma NT-proBNP (7154+/-2122 ng/l vs. 380+/-113 ng/l; P<0.01), cardiac Troponin T (0.105+/-0.030 vs. 0.019+/-0.010 microg/l; P<0.05) were increased in patients with cardiac amyloidosis as compared to patients light chain amyloidosis but no cardiac involvement. Maximal inspiratory (Pimax) and expiratory (Pemax) mouth pressure were decreased with CA compared to controls. Correlation of NT-proBNP and interventricular septum thickness (r=0.53, P=0.029) as well as and Pimax (r=0.72, P<0.01) or Pemax (r=0.69; P<0.01) was noticed. A correlation of grade of arrhythmias in Holter monitoring and syncopes was not observed. Cardiac involvement of amyloid disease carries a poor prognosis and is not well characterized by classic heart failure determinants. Heart transplantation based on novel risk markers including NT-proBNP might be a suitable therapeutic approach for patients with manifest cardiac amyloidosis, but will require alternative patient selection and listing criteria.

Spirometry Testing Standards in Spinal Cord Injury

Because muscle paralysis makes it uncertain whether subjects with spinal cord injury (SCI) can perform spirometry in accordance with American Thoracic Society (ATS) standards, determinants of test failure were examined. Cross-sectional study. Veterans Affairs (VA) medical center. Veterans with SCI at VA Boston Healthcare System and nonveterans recruited by mail and advertisement. Two hundred thirty of 278 subjects (83%) were able to produce three expiratory efforts lasting > or = 6 s and without excessive back-extrapolated volume (EBEV). In 217 of 230 subjects (94%), FVC and FEV(1) were each reproducible in accordance with 1994 ATS standards. In the remaining 48 subjects, efforts with smooth and continuous volume-time tracings and acceptable flow-volume loops were identified. These subjects had a lower percentage of predicted FVC, FEV(1), and maximum expiratory and inspiratory pressures compared to the others, and a greater proportion had neurologically complete cervical injury (42% compared to 16%). In 19 subjects (40%), some expiratory efforts were not sustained maximally for > or = 6 s but had at least a 0.5-s plateau at residual volume (short efforts). In eight subjects (17%), some efforts were not short but had EBEV. In the remaining 21 subjects (44%), some efforts were short, some had EBEV, and some had both. If these efforts were not rejected, 262 of 278 subjects (94%) would have produced three acceptable efforts, and in 257 subjects (92%), the efforts were reproducible. Subjects with SCI with the most impaired respiratory muscles and abnormal pulmonary function are able to perform spirometry reproducibly despite not meeting usual ATS acceptability standards. Exclusion of these subjects would lead to bias in studies of respiratory function in SCI. The modification of spirometry testing standards to include efforts with EBEV and with a 0.5-s plateau if < 6 s would reduce the potential for bias.

Influence d'un triathlon courte distance sur la performance des muscles respiratoires

Objectives – The aim of the present study was to investigate the influence of a short distance triathlon (1.5 km swim, 40 km cycle, and 10 km run) on respiratory muscle performance. Methods and results – Nine male triathletes underwent the measurement of respiratory muscle strength (maximal expiratory and inspiratory pressures), and respiratory muscle endurance (Time limit), before the competition (Pre-T), at the end (Post-T) and 24 h later (post-T-24 h). The results showed, 1) the absence of significant difference in maximal expiratory pressure ( P > 0.05), 2) a significant decrease in maximal inspiratory pressure and time limit at Post-T and Post-T-24 h ( P < 0.05). Conclusion – We concluded that a short distance triathlon induced an inspiratory muscle fatigue, showed by a significant decrease in strength and endurance of these muscles.

RESPIRATORY MUSCLE FUNCTION AFTER EXERCISE IN COMPETITIVE FEMALE CYCLISTS

Previous studies have shown significant reductions in respiratory muscle strength, as evidenced by maximal sustained inspiratory (PImax) and expiratory (PEmax) mouth pressures, in subjects demonstrating average fitness following maximal exercise. However, studies utilizing trained endurance athletes have shown non-signficant reductions in both PImax and PEmax following maximal exercise. PURPOSE: To examine the effects of prior endurance training on respiratory muscle strength following short-term maximal exercise in competitive female athletes. METHODS: Seven competitive female cyclists (20.9 ± 2.3 yr) performed progressive intensity exercise to voltional fatigue on their personal cycles utilizing a Computrainer device. Maximal oxygen consumption (VO2max) was determined via open circuit spirometry (MedGraphics CPX/D). PImax and PEmax values were obtained before and immediately after the maximal cycle test. The highest value of 3–4 consistent trials was used for analysis. Differences in pre- and post-exercise values for PImax and PEmax were analyzed with a paired t-test (α = 0.05). RESULTS: The progressive intensity exercise test revealed a mean VO2max of 49.4 ± 7.3 ml/kg/min for the group. No significant reduction in PImax (p = 0.39) or PEmax (p = 0.71) were detected after the maximal exercise bout when compared to pre-exercise values. CONCLUSION: These results suggest that the respiratory musculature does not fatigue in aerobically trained female cyclists during short-term maximal exercise. These findings confirm the results of other studies utilizing female cyclists of similar fitness that suggest a possible adaptation of the respiratory musculature to endurance exercise training.

Lung elastic recoil in acute and chronic asthma.

This review emphasizes the mechanisms responsible for maximum expiratory airflow limitation in acute and chronic persistent asthma. The phenomenon of acute but reversible loss of lung elastic recoil during acute asthma is reviewed, although no plausible physiologic explanations are offered. The authors have recently studied adult chronic, stable asthmatics with persistent forced expiratory volume in 1 second less than 80% predicted, despite optimal polytherapy. The asthmatics had unsuspected marked loss of lung elastic recoil in the absence of emphysema that was responsible for a 32 to 35% reduction in maximum expiratory airflow at 80% total lung capacity and a 28 to 60% reduction in maximum expiratory airflow at 70% total lung capacity. Work in progress indicates that persistent reduced maximum expiratory airflow may be present for at least 12 +/- 4 years (mean +/- SD) and suggests possible early loss of lung elastic recoil. These observations provide a challenge to the concept of intrinsic airway narrowing resulting from airway remodeling as the major cause of expiratory maximum expiratory airflow limitation in chronic, moderate asthma and severe, persistent asthma. No morphologic or physiologic abnormalities readily explain the chronic, persistent loss of lung recoil.

RESPIRATORY MUSCLE FUNCTION FOLLOWING ENDURANCE EXERCISE IN A THERMAL ENVIRONMENT

Respiratory muscle fatigue has been demonstrated following endurance exercise. The purpose of this study was to determine the additive effect of endurance exercise and a thermal load on respiratory muscle strength. Nine healthy female subjects (24.4 ± 0.7 yr; VO2max = 112%pred.) performed a 60 min endurance exercise bout (60% VO2max) in a neutral (23C / 45% RH) and thermal (37C / 45% RH) environment in a randomized fashion on separate days. Maximal sustained inspiratory (MIP) and expiratory (MEP) mouth pressures were obtained pre and immediately post exercise. Additional variables obtained during exercise included: rectal temperature (TRE), heart rate (HR), minute ventilation (VE), and oxygen consumption (VO2). Both MIP and MEP were significantly reduced (p < 0.05) after endurance exercise for both environmental conditions and changed similarly from pre to post exercise between conditions. HR was significantly higher (p < 0.05) in the thermal compared to the neutral environment. TRE and VE tended to be higher in the thermal compared to the neutral environment, though the changes were nonsignificant. VO2 was not significantly different between environmental conditions during exercise. These results suggest that respiratory muscle strength is reduced following endurance exercise though the addition of a thermal load has minimal effect.

Spirometric performance in Belgian Blue calves: II. Analysis of environmental factors and estimation of genetic parameters.

Genetic parameters and environmental effects for spirometric variables (SV) in calves were estimated using 734 Belgian Blue calves (15 to 297 d of age), sired by 20 AI bulls. For each calf, the following SV were measured: 1) the average ventilation (l/min) recorded during the 15 s of maximal ventilatory changes induced by lobeline administration (0.25 mg/kg, i.v.) (15-s MV(L)); 2) the vital capacity, and the maximal peak expiratory and inspiratory flows recorded after lobeline administration; and 3) the ventilatory reserve (15-s MV(L) - ventilation at rest). Analysis of environmental factors showed age of calf, herd, sex, and vaccination status had significant effects on SV. A sire model and a multiple-trait derivative-free REML procedure were used to estimate genetic parameters for SV, body weight, and muscling score. Heritabilities for SV ranged from 0.28 +/- 0.11 to 0.44 +/- 0.16. Genetic correlations among SV varied from 0.76 to 0.98 and environmental correlations from 0.69 to 0.80. Genetic correlations of SV with body weight (0.25 to 0.56) and with muscling score (0.21 to 0.76) were positive, as were environmental correlations of SV with body weight (0.44 to 0.70) and muscling score (0.09 to 0.25). These results suggest that selection may improve SV without impairing other traits of economic importance.

Spirometric Variables Recorded after Lobeline Administration in Healthy Friesian and Belgian White and Blue Calves: Normal Values and Effects of Somatic Growth

The purposes of the present study were: (1) to develop original equations to predict spirometric variables (SV) in healthy Friesian and Belgian White and Blue (BWB) calves < 1 year of age; and (2) to determine the effects of somatic growth on SV. Sixty-seven Friesian and 500 BWB calves were investigated. For each calf, the following SV were calculated: (1) the average minute volume derived using all the ventilatory cycles recorded during the 15 s of maximal ventilatory changes induced by lobeline administration (0.25 mg/kg, i.v.) (15-s LMV); (2) the maximal tidal volume, the maximal peak expiratory flow and the maximal peak inspiratory flow recorded from single breaths after lobeline administration (MVTL, MPEFLand MPIFL, respectively); (3) the ventilatory reserve (VRL= 15-s LMV – VEr; VEr= minute volume at rest). Mass specific (s) values were also calculated. All SV changed linearly with somatic growth in both Friesian and BWB calves. Since the rise in SV was more related to body weight than the age of calves, equations for reference values of SV always had body weight as the only independent variable. In the youngest calves,sSV were lower in the BWB breed. In the oldest calves (i.e. 1 year of age),sMPEFLandsMPIFLremained small in BWB calves whereassMVTL,s15-s LMV andsVRLwere almost equal in both breeds. These results could be related to the lower resistance to respiratory disorders in BWB calves < 1 year of age than in Friesian calves < 1 year of age.

Airway function tests and vocal cord paralysis in lung transplant recipients

Maximum expiratory and inspiratory flow-volume (MEFV, MIFV) curves, specific airway conductance (sGaw), and flexible fiberoptic laryngoscopy were examined in 8 pediatric lung transplant recipients with vocal cord paralysis (VCP). Six were heart-lung (H-L) and 2 double-lung (D-L) recipients, 7 had left VCP, and 1 had right VCP. Based on the pulmonary function tests (PFT), 2 subgroups could be distinguished in the 8 recipients with VCP. Group A (5/8 recipients; mean age, 13 +/- 3.4 years; mean height, 144.3 +/- 12.3 cm) had significantly reduced specific airway conductance (sGaw; < 2 SD from predicted) and normal MEF25, MEF50, peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and %FEV1/forced vital capacity (FVC); this pattern suggested variable extrathoracic airway obstruction. PIF was normal in 4/5 and reduced in 1/5 of these recipients. Group B (3/8 recipients with VCP; mean age, 17 +/- 2.4 years; mean height, 156.3 +/- 12.0 cm) had significantly reduced sGaw, MEF25, MEF50, PEF, FEV1, and %FEV1/FVC, implying primarily small airway obstruction. These recipients had bronchiolitis obliterans. The results suggest that a pattern of reduced sGaw and normal MEFs, PEF, FEV1, and PIF should raise the possibility of VCP in patients after lung transplantation. sGaw is more sensitive than PIF and PEF in identifying airway obstruction due to VCP, and should be routinely included in the follow-up evaluation of lung transplant recipients.

Lung volumes and respiratory muscle strength in adult patients with childhood- or adult-onset growth hormone deficiency: effect of 12 months' growth hormone replacement therapy.

We have described impairment of the respiratory function in adult patients with childhood-onset growth hormone (GH) deficiency. The aim of the present study was to evaluate lung volumes and respiratory muscle strength in patients diagnosed as GH deficient before and after 6 and 12 months of recombinant GH treatment. Ten adults diagnosed as GH deficient in childhood, ten adults diagnosed as GH deficient in adulthood and ten healthy subjects entered the study. For each subject, evaluation of respiratory function followed the same standard approach, consisting of respiratory muscle strength assessment, record of flow-volume curves, measurement of static lung volumes and lung diffusing capacity. Childhood-onset GH-deficient patients had a significant reduction of maximal inspiratory (p < 0.01) and maximal expiratory (p < 0.05) mouth pressures. Total lung capacity, vital capacity and functional residual capacity were significantly reduced compared to healthy subjects (p < 0.05). Conversely, residual volume and diffusing lung capacity did not show any significant change. No significant change of the ratio between the percentage forced expiratory volume in 1 s and the forced vital capacity was observed. The decrease of respiratory mouth pressures was not correlated to the decrease of lung volumes. Adult-onset GH-deficient patients had only a significant reduction of maximal expiratory pressure compared to healthy subjects (p < 0.05). After 6 months of treatment no significant differences in any of the evaluated parameters were found. After 12 months of treatment patients with childhood-onset GH deficiency show a significant improvement of lung volumes (p < 0.01) and maximal respiratory mouth pressures (p < 0.005), whereas adult-onset GH-deficient patients show a significant improvement of maximal expiratory pressure (p < 0.05). In conclusion, the results of this study showed that adult patients affected with childhood-onset GH deficiency suffer from an impairment of the ventilatory function due to a reduction of lung volumes and a decrease of respiratory pressures probably due to a reduction of respiratory muscle strength. This impairment was reversed after 12 months of treatment with recombinant GH. Conversely, adult-onset GH-deficient patients had only an impairment of the maximal expiratory pressure, probably due to respiratory muscle weakness re-established after 12 months of GH therapy.

The relationship between wheezing and lung mechanics during methacholine-induced bronchoconstriction in asthmatic subjects.

Wheeze is a classic sign of airflow obstruction but relatively little is known of its mechanism of production or its relationship to the development of airflow obstruction. We studied eight asthmatic subjects age (mean +/- 5D) 42 +/- 5 yr, FEV1 2.46 +/- 0.36 L during an extended, symptom-limited methacholine challenge test. Breath sounds were detected by a microphone over the right upper anterior chest. Spectral analysis was by a fast Fourier transform algorithm. Mean FEV1 fell by 51 +/- 14% to 1.28 +/- 0.61 L during the challenge and airways resistance increased by 119 +/- 50%. There were no consistent changes in breathing pattern or tidal volume during the challenge. Wheeze occurred late in the challenge at the highest concentration of methacholine administered and only after expiratory tidal flow limitation had been reached. Five subjects developed wheeze on tidal breathing, the remaining three only wheezed on deep breathing. Wheezing sounds were reproducible between breaths, coefficient of variation of starting sound frequency was 4.2% and ending frequency 12%. Mean frequency of expiratory wheezes was 669 +/- 100 Hz and inspiratory wheezes 710 +/- 76 Hz. Expiratory wheeze fell in pitch during a breath (mean fall in sound frequency 187 +/- 43 Hz) but inspiratory wheezes were more variable. Expiratory wheezes occurred late in the respiratory cycle at a mean of 58% of the maximal tidal expiratory flow, whereas inspiratory wheezes occurred around maximal tidal inspiratory flows, suggesting that the mechanisms of production of inspiratory and expiratory wheezes may be different. In this model, the presence of wheeze during tidal breathing was a sign of severe airflow limitation.

Differential effects of nasal continuous positive airway pressure on reversible or fixed upper and lower airway obstruction.

Our study was to assess whether there were differential effects of nasal continuous positive airway pressure (nCPAP) on different kinds of obstruction in either upper or lower airways in patients with chronic obstructive pulmonary disease (COPD). nCPAP (6 cmH2O for ten minutes) was applied to 7 patients with reversible extrathoracic upper airway obstruction (RUAO) and 3 patients with fixed extrathoracic upper airway obstruction (FUAO). Eighteen stable asthmatics, receiving methacholine challenge to induce a more than 20% reduction in FEV1, were randomly investigated for the effect of nCPAP or sham pressure on reversible lower airway obstruction. Nine stable COPD patients were enrolled to study the effect on irreversible lower airway obstruction. Maximal expiratory and inspiratory flow volume curves and dyspnoea scores were obtained before and after immediate withdrawal of nCPAP. In the RUAO group, nCPAP significantly improved stridor and dyspnoea scores, decreased the ratio of FEF50/FIF50 from 2.05 +/- 0.25 to 1.42 +/- 0.16, and increased peak inspiratory flow (PIF) as well as forced inspiratory vital capacity by 26 +/- 8% and 9 +/- 4%, respectively. In expiratory phase, there was no significant change in pulmonary functions. In asthmatics, nCPAP significantly reversed methacholine-induced bronchoconstriction increasing forced vital capacity by 10 +/- 3%, FEV1 by 15 +/- 4% and PIF by 32 +/- 11%. nCPAP significantly increased the response to bronchodilators. The improvement in airflow rate persisted for at least 5 min after nCPAP withdrawal and was highly correlated with the response to bronchodilators. There was no significant effect of nCPAP on airflow rate in COPD patients. Subjective dyspnoea score changes paralleled the pulmonary function improvement. We conclude that there are differential effects of nCPAP on airflow rates in patients with different nature of airway obstruction. Patients with airway obstruction caused by structural changes may not benefit from the use of nCPAP in improving airflow rates.

Tidal breathing analysis as a measure of airway obstruction in children three years of age and older.

This study was designed to evaluate the value and applicability of tidal breathing pattern analysis to assess airflow obstruction in young children. The time needed to reach maximal tidal expiratory flow (TME) divided by total expiratory time (TE) was measured in 228 healthy children 3 to 11 yr of age, 64 patients with asthma, and 12 children with cystic fibrosis. In 70 patients both TME/TE and forced maximal expiratory flow volume (MEFV) parameters were measured. The mean TME/TE in healthy subjects was 43.0 +/- 7.6%. The within-subject reproducibility was high (repeatability index, 5.3%). In the asthmatic patients the mean TME/TE was significantly lower (30.0 +/- 8.2%, p < 0.001), and it increased to 36.5 +/- 7.9% after bronchodilation (n = 44, p < 0.001). The TME/TE level of the subgroup of patients with asthma and FEV1/FVC > or = 0.80 was lower when compared with age-matched normal subjects (30.9 +/- 8.5, p < 0.0001), but it was in a higher range when compared with asthmatics with FEV1/FVC < 0.80 (25.9 +/- 7.9, p < 0.001). In the cystic fibrosis group the mean TME/TE was 27.4 +/- 10.7% without a significant change after bronchodilation. TME/TE correlated significantly with MEFV parameters. Tidal breathing analysis proved easy to perform in children older than 3 yr of age. The TME/TE ratio may be a reliable and simple indicator for airway obstruction.

Respiratory muscle function in physically active elderly women.

This study was performed in 52 women, aged 60 to 76 years: 27 were engaged in a gymnastics program, 3 h a week, for at least 2 years; 25 were age-matched controls. All were lifelong nonsmokers, free of disease symptoms and lived independently at home; none had previously engaged in exercise programs. Spirometry included volumes, flows and maximal voluntary ventilation (MVV); maximal mouth pressures both inspiratory (MIP) and expiratory (MEP) were also measured. The two groups differed only in the mean value of MEP (cm of water) which was 107.7 +/- 37.3 S.D. in the active group and 87.4 +/- 22.8 S.D. in the controls (P = 0.028). MIP and MVV were also higher in the active group but the differences were not significant. However, a significant correlation between MVV and both MIP and MEP was only found in the active group, suggesting a relation between muscular endurance and strength. This exercise program, although not oriented towards the respiratory system, improved the performance of the respiratory muscles probably by an effect on the abdominal musculature.

Peripheral muscle weakness contributes to exercise limitation in COPD.

Recently, it was suggested that fatigue of peripheral muscles could contribute to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). In order to quantify the role of peripheral muscle force, we restudied potential determinants of exercise capacity (6-min walking distance [6 MWD] and maximal oxygen consumption [V02max]) in 41 consecutive COPD patients (FEV1, 43 +/- 19% of predicted, TLCO, 56 +/- 25% of predicted) admitted to our pulmonary rehabilitation program. VO2max (incremental cycle ergometer test), 6 MWD (best of three), lung function (FEV1, FVC, TLC, FRC), diffusing capacity (TLCO), isometric quadriceps force (QF), hand grip force (HF), and maximal inspiratory (PImax) and expiratory (PEmax) pressures were measured. Patients had a poor 6 MWD (372 +/- 136 m) and VO2max (1.35 +/- 0.60 L, 71%), reduced respiratory (PImax 65 +/- 27%) and peripheral muscle force (QF 74 +/- 27%, HF 82 +/- 23%). In single regression analysis, significant correlations (r) were found for VO2max and TLCO (0.68), FEV1 (0.64), QF (0.55), HF (0.53), and body weight (0.49). Walking distance was significantly correlated with QF (0.63), HF (0.61), PImax (0.49), and TLCO (0.38). In stepwise multiple regression analysis, the variables significantly contributing to 6 MWD were QF and Plmax. For VO2max, variables significantly contributing were TLCO, QF, and FEV1. We conclude that lung function and peripheral muscle force are important determinants of exercise capacity in COPD.

Control of breathing in patients with limb girdle dystrophy: a controlled study.

In patients with limb girdle dystrophy the relative contribution of peripheral factors (respiratory muscle weakness, and lung and/or airway involvement) and central factors (blunted and/or inadequate chemoresponsiveness) in respiratory insufficiency has not yet been established. To resolve this, lung volumes, arterial blood gas tensions, respiratory muscle strength, breathing pattern and neural respiratory drive were investigated in a group of 15 patients with limb girdle dystrophy. An age-matched normal group was studied as a control. Respiratory muscle strength was assessed as an arithmetic mean of maximal inspiratory (MIP) and expiratory (MEP) pressures. Breathing pattern was evaluated in terms of volume (ventilation VE, tidal volume VT) and time (respiratory frequency Rf, inspiratory time TI, expiratory time TE) components of the respiratory cycle. Neural respiratory drive was assessed as the mean inspiratory flow (VT/TI), mouth occlusion pressure (P0.1) and electromyographic activity (EMG) of the diaphragm (EMGd) and the intercostal parasternal (EMGp) muscles. In 10 of the 15 patients the responses to carbon dioxide (PCO2) stimulation were also evaluated. Most patients exhibited a moderate decrease in vital capacity (VC) (range 37-87% of predicted), MIP (range 23-84% of predicted), and/or MEP (range 13-41% of predicted). The arterial carbon dioxide tension (PaCO2) was increased in three patients breathing room air, while PaO2 was normal in all. Compared with the control group Rf was higher, and VT, TI and TE were lower in the patients. EMGd and EMGp were higher whilst VT/TI and P0.1 were normal in the patients. Respiratory muscle strength was inversely related to EMGd and EMGp. PaCO2 was found to relate primarily to VC and duration of illness, but not to respiratory muscle strength. During hypercapnic rebreathing delta VE/delta PCO2, delta VT/delta PCO2, and delta P0.1/delta PCO2 were lower than normal, whilst delta EMGd/delta PCO2 and delta EMGp/delta PCO2 were normal in most patients. A direct relation between respiratory muscle strength and delta VT/delta PCO2 was found. The respiratory muscles, especially expiratory ones, are weak in patients with limb girdle dystrophy. Reductions in respiratory muscle strength are associated with increased neural drive and decreased ventilatory output (delta VT/delta PCO2). The decrease in VC, together with the duration of disease, influence PaCO2. VC is a more useful test than respiratory muscle strength for following the course of limb girdle dystrophy.

Benefit of Selective Respiratory Muscle Training on Exercise Capacity in Patients With Chronic Congestive Heart Failure

Diminished respiratory muscle strength and endurance have been demonstrated in patients with heart failure. This may contribute to exertional dyspnea and reduced exercise capacity in these patients. The purpose of this study was to investigate whether selective respiratory muscle training could alleviate dyspnea and improve exercise performance in patients with chronic congestive heart failure. Fourteen patients with chronic heart failure (left ventricular ejection fraction, 22 +/- 9%) were enrolled in a supervised respiratory muscle training program. This consisted of three weekly sessions of isocapnic hyperpnea at maximal sustainable ventilatory capacity, resistive breathing, and strength training. Maximum sustainable ventilatory capacity, maximum voluntary ventilation, maximal inspiratory and expiratory pressures, peak VO2, and the 6-minute walk test were measured before (pre) and after (post) 3 months of training. Eight patients completed the training program. Respiratory muscle endurance was improved with training, as evidenced by increases in maximal sustainable ventilatory capacity (pre, 48.6 +/- 10.7 versus post, 76.9 +/- 14.5 L/min; P < .05) and in maximal voluntary ventilation (pre, 100 +/- 36 versus post, 115 +/- 39 L/min; P < .05). Respiratory muscle strength was also increased with training as maximal inspiratory (pre, 64 +/- 31 versus post, 78 +/- 33 cm, H2O; P < .01) and expiratory (pre, 94 +/- 30 versus post, 133 +/- 53 cm H2O; P < .001) pressures rose. Submaximal and maximal exercise capacity were significantly improved with selective respiratory muscle training as the 6-minute walk (pre, 1101 +/- 351 versus post, 1421 +/- 328 ft; P < .001) and peak exercise VO2 (pre, 11.4 +/- 3.3 versus post, 13.3 +/- 2.7 mL.kg-1.min-1; P < .05) both significantly increased. Dyspnea during activities of daily living was subjectively improved in the majority of trained patients. Dyspnea quantified by the Borg scale was significantly reduced during progressive isocapnic hypernea but not during bicycle exercise. No statistically significant improvement in maximal sustainable ventilatory capacity, maximum voluntary ventilation, maximal inspiratory or expiratory mouth pressures, 6-minute walk, or peak VO2 was observed in the 6 patients who did not complete the training program. Selective respiratory muscle training improves respiratory muscle endurance and strength, with an enhancement of submaximal and maximal exercise capacity in patients with heart failure. Dyspnea during activities of daily living was subjectively improved in the majority of trained patients.