Maximum Inspiratory Research Articles

Interval versus constant-load exercise training in adults with Cystic Fibrosis

BackgroundThe efficacy of interval exercise (IE) compared to constant-load exercise (CLE) training remains unsettled in adults with Cystic Fibrosis (CF). MethodsTwenty-four adults with CF were randomised to 30-min IE (100 % peak work capacity (WRpeak) for 30-s alternated with 40 % WRpeak for 30-s; n = 12) or 30-min CLE (70 % WRpeak; n = 12) training, 3 times weekly, for 12 weeks. Isometric quadriceps muscle strength was assessed using a strain gauge Myometer. ResultsThe magnitude of improvement in quadriceps muscle strength was greater (p = 0.037) in the IE (by 32 ± 13 Nm) compared to the CLE (by 23 ± 12 Nm) groups. Maximum inspiratory and expiratory mouth pressures were significantly improved only in the IE group (by 30 ± 10 cmH2O; p = 0.009 and 13 ± 4 cmH2O; p = 0.007, respectively). Arterial oxygen saturation during training was higher (p = 0.002) for IE (94 ± 1%) compared to CLE (91 ± 1%), whereas dyspnoea scores were lower (p = 0.001) for IE (3.8 ± 0.7) compared to CLE (5.9 ± 0.8) ConclusionsIE is superior to CLE in improving peripheral and respiratory muscle strength and preferable to CLE because it is associated with lower exercise-induced arterial oxygen desaturation and breathlessness.

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.

Influence of Lung Hyperinflation on Respiratory Muscles Pressures During a Submaximal Test in Patients With COPD: A Clinical Perspective

Background and Objective: Reduction of exercise tolerance is associated with expiratory flow-limitation (EFL) and lung hyperinflation; those are only partially reversible to bronchodilator. Lung hyperinflation lowers the diaphragm muscle provoking a mechanical disadvantage that, eventually, reduces maximal inspiratory (MIP) and expiratory (MEP) pressures. We aimed to assess the influence of the dynamic lung hyperinflation on respiratory pressures changes at rest and after a submaximal exercise test in COPD patients with and without a bronchodilator. Methods:: We prospectively analyzed 16 COPD patients (FEV1 36.4±10% pred.; age 61.0±8 years, height 165±12 cm and BMI 25.9±6 kg/m2). MIP and MEP were measured before and after performing the six minutes walking test (6MWT) with and without bronchodilator (400 mcg of albuterol). Results:: Nine of 16 patients increased IC more than 150 ml after bronchodilator use. Right after the 6MWT was accomplished without bronchodilator, IC decreased by 7.05% as compared to the 6MWT baseline value (p&lt;0.01). Nine patients decreased IC more than 150ml. After bronchodilator use, patients performed the 6MWT without any IC significant reduction (p&gt;0.05). Twelve patients increased the MIP (ranging from 70±11cmH2O to 77±10cmH2O, p = 0.0043) using 400mcg of albuterol. Thirteen patients reduced MIP after the 6MWT without bronchodilator use (p &lt;0.007). There was no significant reduction (p&gt; 0.05) in MIP when patients performed the 6MWT after bronchodilator use. We also found a significant correlation between MIP and inspiratory capacity (IC) and MEP and the IC before and after the 6MWT (r=0.61, p=0.0054; r=0.60, p=0.0031, respectively). Conclusions:: Dynamic pulmonary hyperinflation directly interferes with the ability of respiratory muscles to generate inspiratory and expiratory pressures. The previous use of bronchodilators in patients with COPD reduced dynamic hyperinflation when accomplishing a sub-maximal exercise.

Comparison of Lung Capacity in Communities in Low Land and High Land

The environment in which they live has a major influence on the development of a person's physical characteristics and abilities. One of the physical capacities that is strongly influenced by the anthropometric measurements of the body and the body's adaptability to the environment is the vital capacity of the lungs. The vital capacity is the maximum volume of air that can enter and leave the lungs during one breathing cycle after maximum inspiration and maximum expiration. This study aims to determine the difference in the vital capacity of the lungs in the people in the lowlands of Mataram city and the highlands of Sembalun village. Sampling was done using purposive sampling technique with a sample of 20 people in each research area with an age range of 21-25 years. The data were collected using a simple spirometer made by the researcher. The control variables in this study included gender, age, height, body weight and sample hemoglobin levels. The results showed the average value of vital lung capacity in the lowlands was 2837.5 ml, while the vital capacity of the lungs in the highlands was 2767.5 ml. The results of hypothesis testing were carried out using the Independent Sample t-test using SPSS 16 and the results of the significance value (2-tailed) 0.740&gt; 0.05 so that Ho was accepted, which means that there is no difference in the vital capacity of the lungs in the highlands and lowlands.

Effects of Inspiratory Muscle Training on Respiratory Muscle Strength, Trunk Control, Balance and Functional Capacity in Stroke Patients: A single-blinded randomized controlled study

ABSTRACT Objective Aim of the study was to examine the effects of inspiratory muscle training (IMT) on respiratory function, respiratory muscle strength, trunk control, balance, and functional capacity in stroke patients. Methods 21 stroke individuals were randomly divided into two groups as control group and treatment group. Respiratory function test, Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) were evaluated. Also, Trunk Impairment Scale (TIS), Timed Up and Go Test (TUG) Berg Balance Scale (BBS), and Six-Minute Walk Test (6MWT) were performed. Neurodevelopmental treatment program was performed in both groups for 5 days a week for 6 weeks, and IMT was given to the treatment group. IMT was started from 40% of MIP. Results After treatment, respiratory functions, respiratory muscle strength, and trunk control and balance improved in the treatment group. In the control group; however, only the balance level was improved. When the changes in the evaluation parameters between the groups were compared, there were only statistically significant differences in the TIS, Peak Expiratory Flow (PEF) and MIP in the treatment group (p˂0.05), the change amounts in other evaluation parameters were similar (p˃0.05). When the effect size of the groups was compared, the effect size of the variables in the treatment group was found to be higher. Conclusion As a conclusion, IMT, which was given in addition to the neurological physiotherapy and rehabilitation program to our patients, improved inspiratory muscle strength and trunk control. We believe that this result will raise awareness for physiotherapists working in the field of neurological rehabilitation about including respiratory muscle training in the rehabilitation program of stroke patients.

RESPIRATORY MUSCLE IMPAIRMENT EVALUATED WITH MEP/MIP RATIO IN CHILDREN AND ADOLESCENTS WITH CHRONIC RESPIRATORY DISEASE.

ABSTRACTObjective: To evaluate the strength of respiratory muscles and to compare maximum inspiratory (MIP) and expiratory (MEP) pressure and MEP/MIP ratio between patients with chronic respiratory diseases and healthy individuals.Methods: Case-control study. Individuals with neuromuscular disease and post-infectious bronchiolitis obliterans were considered. In addition, they were also matched according to anthropometric and demographic characteristics with healthy children and adolescents. MIP, MEP in the three groups, and pulmonary function only in patients with chronic respiratory diseases were recorded.Results: A total of 52 subjects with CRD (25 with neuromuscular disease, and 27 with post-infectious bronchiolitis obliterans) and 85 healthy individuals were included, with an average age of 11.3±2.1 years. Patients with neuromuscular disease and post-infectious bronchiolitis obliterans presented lower MIP and MEP when compared with healthy individuals, although MEP/MIP ratio was lower in patients with neuromuscular disease (0.87±0.3) and higher in patients with post-infectious bronchiolitis obliterans (1.1±0.3) compared to the healthy group (0.97±0.2). Only in patients with neuromuscular disease a negative correlation was observed between MEP/MIP ratio and age (r=-0.50; p=0.01).Conclusions: Differences in the pattern of muscular weakness between patients with chronic respiratory diseases were observed. In patients with neuromuscular disease, a decrease in the MEP/MIP ratio depending on MIP was verified; and in those patients with post-infectious bronchiolitis obliterans, an increase in the MEP/MIP ratio depending on MIP was also observed.

Respiratory muscle strength and quality of life in chronic kidney disease patients undergoing hemodialysis

Abstract Introduction: Hemodialysis (HD) sessions associated with the chronic kidney disease (CKD) repercussions may cause respiratory muscle impairment and limitations of daily living activities, which may compromise the quality of life. Objective: To evaluate respiratory muscle strength and quality of life in HD patients. Methods: A cross-sectional study involving CKD patients of both sexes undergoing HD. All were evaluated during HD, using an evaluation form containing personal and clinical data, presence of comorbidities, lifestyle (including self-reported physical activity) and vital signs. Respiratory muscle strength was analyzed by maximum inspiratory (MIP) and maximum expiratory (MEP) pressures by manovacuometer and quality of life using the SF-36 questionnaire. Results: Sixty-eight patients were evaluated (69.1% men), with a mean age of 54.9 ± 13.6 years. The MEP% was below of predicted (79.5 ± 25.7) and the MIP% was reduced only in women (77.8 ± 38.7). The MIP% was related to CKD time (p = 0.04) in men. The SF-36 domain that showed the most impairment was physical limitation [25.0 (13.0-67.0)], while mental health was the least impaired domain [72.0 (62.0-84.0)]. Those who reported the practice of physical activity obtained better results in vitality domain (p = 0.01). In the analysis stratified by sex, the functional capacity domain was less compromised in men who practiced self-reported physical activity (p = 0.02). Conclusion: CKD patients undergoing HD had a reduction in MEP relative to predicted, in addition to a greater impairment of MIP in men with longer CKD time and in women alone, although the clinical relevance of this finding is uncertain. Quality of life was more compromised in the physical limitation domain, where those who self-reported physical activity achieved better results in the domains of vitality (total sample) and functional capacity (men).

Correlation and Predicted Equations of MIP/MEP from the Pulmonary Function, Demographics and Anthropometrics in Healthy Thai Participants aged 19 to 50 Years.

Objective:To identify the correlations and possible predicted equations of maximal inspiratory (MIP) and expiratory mouth pressure (MEP) values from pulmonary function test (PFT), demographics, and anthropometrics.Methods:This study involved 217 healthy participants (91 males and 126 females) aged 19 to 50 years. The PFT (forced vital capacity; FVC, forced expiratory volume in 1 second; FEV1, maximal mid-expiratory flow; MMEF, and peak expiratory flow; PEF) was performed by spirometry, whereas MIP and MEP were evaluated by a respiratory pressure meter. Pearson correlation and multiple linear regression, with the stepwise method, were used for statistical analysis.Results:The MIP and MEP had a significant positive correlation with weight, height, body mass index (BMI), and waist circumference. MIP had a significant positive correlation with FVC (%) and PEF (L/s and %), as well as a negative correlation with FEV1/FVC (ratio and %) and MMEF (%). Whereas, MEP showed a significant positive correlation with PEF (L/s and %) and negative correlation with FEV1/FVC (ratio and %) and MMEF (L/s). Finally, the predicted MIP and MEP equations were 103.988−97.70 × FEV1/FVC + 31.292 × Sex (male = 1 and female = 0) + 0.662 × PEF (%) and 47.384 + 3.603 × PEF (L/s)−9.514 × MMEF(L/s) + 30.458 × Sex (male = 1 and female = 0) + 0.534 × PEF (%), respectively.Conclusion:The respiratory muscle strengths can be predicted from the pulmonary function test, and gender data.

Investigation of inspiratory intercostal muscle activity in patients with spinal cord injury: a pilot study using electromyography, ultrasonography, and respiratory inductance plethysmography.

[Purpose] The respiratory function in patients with cervical spinal cord injury is influenced by inspiratory intercostal muscle function. However, inspiratory intercostal muscle activity has not been conclusively evaluated. We evaluated the inspiratory intercostal muscle activity in patients with cervical spinal cord injury by using inspiratory intercostal electromyography, respiratory inductance plethysmography, and ultrasonography. [Participants and Methods] Three patients with cervical spinal cord injury were assessed. The change in mean amplitude (rest vs. maximum inspiration) was calculated by using intercostal muscle electromyography. Changes in intercostal muscle thickness (resting expiration and maximum inspiration) were also evaluated on ultrasonography. The waveform was converted to spirometry ventilation with respiratory inductance plethysmography, and the waveform at the xiphoid was considered to determine the rib cage volume. Each index was compared with the inspiratory capacities in each case. [Results] Intercostal muscle electromyography failed to measure the notable myoelectric potential in all the patients. The rib cage volume was higher at higher inspiratory capacities. The changes in muscle thickness were not significantly different between the patients. [Conclusion] The rib cage volume (measured with inductance plethysmography) was greater in the patients with cervical spinal cord injury when inspiratory intercostal muscle activity was high. Respiratory inductance plethysmography can capture inspiratory intercostal muscle function in patients with cervical spinal cord injury.

Efficacy of Respiratory Control under Local Anesthesia during Endovascular Therapy in the Tortuous Vertebral Artery with the Use of Respiratory Dislocation of the Aortic Arch.

Endovascular therapy (EVT) through the tortuous access route is increasingly performed in neurovascular procedures. In the posterior circulation through the vertebral artery (VA), ischemic complications, including vessel dissection and cerebral vessel infarction, are sometimes observed, especially during navigation of the guiding catheter, because of small vessel diameter and tortuous origin. We describe an adjunctive technique for passing the guiding catheter safely to the tortuous VA and reducing ischemic complication using respiratory displacement of the aortic arch. The guidewire is advanced to the origin of the VA until it is caught in the tortuosity. Then we instruct the patient to take a maximum deep inspiration and hold his or her breath. In this manner, the aortic arch and side branches are dislocated to the caudal direction, which reduces the tortuosity of the VA origin and facilitates passage of the guidewire. Here, we discuss three representative cases which demonstrate that our techniques are effective in navigating the catheter to the tortuous VA. In the EVT of a patient who has a tortuous VA, respiration control under local anesthesia, maximum deep inspiration, and breath holding induce the respiratory dislocation of the aortic arch. This enables safe navigation of the guiding catheter, reduces the likelihood of interruption in blood flow, and helps avoid dissection and ischemic complications during EVT.

Is the diaphragm thickness related to gait speed in patients with hemiplegia caused by cerebrovascular accident?

[Purpose] We aimed to determine the relationship between gait speed and diaphragm thickness in community-residing patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] We recruited 11 elderly participants (six male and five female, mean age 71.1 ± 13.6 years) from an outpatient rehabilitation unit. The inclusion criteria were as follows: patients with hemiplegia caused by cerebrovascular accidents, those able to walk without assistance, and those able to understand our instructions. We measured the diaphragm thickness on both the paretic and non-paretic sides in each participant during maximum exhalation and inhalation during three laboured breaths by ultrasonography with a 7.5-MHz linear scanner. The liner scanner was placed on the eighth or ninth rib between the anterior and middle axillary lines. And their gait speed was measured during a 10 m walk. [Results] There was a strong positive correlation between gait speed and the ratio of diaphragm thickness between the paretic and the non-paretic sides during maximal inspiration. The other measured parameters did not show significant correlation with gait speed. [Conclusion] The symmetrical thickness of the diaphragm is a key factor in increasing gait speed in patients with hemiplegia. These findings may contribute to the development of trunk muscle strength-training programs that improve trunk function and gait speed in patients with hemiplegia.

Effects of pulmonary rehabilitation on diaphragm thickness and contractility in patients with chronic obstructive pulmonary disease.

Studies are showing that pulmonary rehabilitation (PR) increases diaphragmatic excursion by decreasing hyperinflation in patients with chronic obstructive pulmonary disease (COPD). However, there is a lack of knowledge about its effects on the diaphragm thickness (dt) and contractility. This study aims to evaluate the dt and contractility before and after PR in patients with COPD. All subjects participated in an out-patient PR of 6 weeks and 3 sessions per week prospectively. Dyspnea severity, the disease-specific quality of life (St. Georges Respiratory Questionnaire-SGRQ), pulmonary function tests (PFT), exercise capacity, the dt at the end of the expiration and at maximal inspiration (B-mode ultrasound) were evaluated at baseline and after PR. A total of 34 patients with a mean age and FEV1 61.05 ± 8.22 years and 57.9 ± 20.4% predicted respectively showed improvements in exercise capacity and some items of PFT and SGRQ. Diaphragmatic thickness at the end of the expiration also significantly improved regardless of the disease severity and was positively correlated with functional performance. The 6-weeks of PR didn't result in a significant difference in diaphragm contractility.

In-vivo Evaluation of Bleomycin-induced Lung Fibrosis Model Mouse Using Ultra High-field 7 T-MRI and Micro-CT

This study aimed to perform longitudinal observation using 4D-computed tomography (CT) and compare images acquired by 3D-CT and 3D-ultrashort echo time (UTE) for evaluation of bleomycin-induced lung fibrosis model. The pulmonary fibrosis model was induced by instilling intratracheally with 50 μl of bleomycin. 4D-CT images were classified into four phases after acquisition and analyzed. To study the effects of respiratory gating, we aquired 3D-CT and 3D-UTE images with and without respiratory gating. For comparison between CT and UTE images, we performed no-triggerd 3D-CT and 3D-UTE under free-breathing. MR signal intensity ratio and CT values were measured in three regions of the upper, middle, and lower lung. At 4DCT, total lung volume at maximum inspiration (4th phase) decreased significantly compared with control mouse and the ratio of lung volume at inspiration to expiration also showed a significant decrease. In comparison of the images between with and without respiratory gating, clearer images were obtained by respiratory gating. However, there was no significant difference between both. In comparison between CT and UTE images, magnetic resonance (MR) signal intensity ratio and CT value were significantly correlated, but 3D-UTE images showed poor delineation of the lower lung and that near the diaphragm compared with 3D-CT images. 4D micro-CT and nontriggered 3D UTE-magnetic resonance imaging (MRI) under free breathing can be useful to evaluate bleomycininduced lung fibrosis model mouse.

Systolic Blood Pressure and Heart Rate Responses of Individuals with Neck Versus Abdominal Obesity in Response to – Incentive Spirometry Based 10 Sustained Maximal Inspirations (A Possible Clinical Tool)

Systolic Blood Pressure and Heart Rate Responses of Individuals with Neck Versus Abdominal Obesity in Response to – Incentive Spirometry Based 10 Sustained Maximal Inspirations (A Possible Clinical Tool)

Increased body mass index: what is the influence on ventilatory muscular strength?

Introduction: Ventilatory muscle strength (VMS) and anatomical/biological factors are important in the functioning and maintenance of body homeostasis. Thus, the study of respiratory mechanics and conditions that can alter them is fundamental. Studies indicate that obesity decreases the Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP), however, these studies are contradictory in their results. Objective: To verify if there is a difference between the VMS of obese and eutrophic individuals. Methods: Comparative observational study, in which 40 individuals of both sexes were evaluated, divided into two groups: 20 individuals with grade I obesity and 20 eutrophic individuals. Abdominal circumference was considered to be &gt; 102 cm for men and 88 cm for women. Two-way unpaired Student's t-test was applied to compare the Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) of the evaluated groups. The BioEstat 5.0 program was used and a p ˂ 0.05 was adopted as significant. Results: The mean MIP for obese and eutrophic individuals was 147 ± 73 vs 145 ± 70 cmH2O, respectively (p = 0.91). For MEP, the mean for the obese and eutrophic group was 133 ± 28 vs 135 ± 27 cmH2O, respectively (p = 0.93). Conclusion: Sedentary individuals with grade I obesity associated with increased waist circumference do not differ in MIP and MEP when compared to eutrophic individuals.Keywords: obesity, work capacity assessment, functional physical performance.

SAĞLIKLI OLGULARDA GÖVDE KAS ENDURANSI, SOLUNUM FONKSİYONLARI VE SOLUNUM KAS KUVVETİ İLİŞKİSİ

Purpose: Trunk muscles are acrive in the forceful expiration, and trunk this study aimed to examine the relationship between pulmonary function, respiratory muscle strength, and trunk muscle endurance. Methods: The study was conducted with 60 volunteer and healthy individuals whose ages varied between 20 and 36 years. Pulmonary function and maximum inspiratory and expiratory pressure (MIP and MEP) were measured using a desktop spirometer. Trunk muscle endurance of the subjects was evaluated using the prone bridge, side bridge, flexor endurance, and Sorensen tests. Results: A positive significant relationship was observed between the percentage of forced vital capacity (%FVC) and prone bridge (r=0.395, p=0.002), flexor endurance (r=0.256, p=0.049), and Sorensen (r=0.255, p=0.049) tests. Likewise, a positivesignificant correlation was found between the percentage of forced expiratory volume in 1 second (%FEV1) and prone bridge (r=0.408, p=0.001), flexor endurance (r=0.358, p=0.005), and side bridge (r=0.277, p=0.032) tests. The results revealed a positive relationship between MIP and prone bridge (r=0.376, p=0.003) and side bridge tests (r=0.470, p&amp;lt;0.001). Likewise, there was a positive correlation between MEP and prone bridge test (r=0.401, p=0.004) and side bridge test (r=0.365 p=0.002). Conclusion: Pulmonary function and respiratory muscle strength are associated with the endurance of the trunk muscles, which ensure core stability. Trunk muscle endurance exercises may have a positive influence on respiratory function.

Inspiratory muscle training combined with pursed lip technique in women with chronic obstructive pulmonary disease: a case study

Objective. To improve pulmonary function, exercise capacity and quality of life of two women with Chronic Obstructive Pulmonary Disease (COPD). Material and Methods. Study of two clinical cases, both women. An intervention of 8 weeks was performed, in which the patients performed 3 weekly sessions, of which 1 was performed with supervision of the physiotherapist and 2 sessions were performed at home. The treatment sessions consisted of inspiratory muscle training with an inspiratory threshold and controlled breathing exercises with the pursed lip technique. Results. Quality of life of both women improved at the end of the study. In the woman with severe COPD, Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) increased after the intervention. The Peak Expiratory Flow (PEF) improved in both cases, but not the rest of the spirometric values. Dyspnea improved in the woman with moderate COPD but not in the case of the one with severe COPD. Finally, the distance walked in the 6MWT improved in both cases. Conclusions. The training of the inspiratory muscles together with the pursed lip technique positively influences quality of life and exercise capacity of two women with COPD.

Diaphragm Morphology Assessed by Computed Tomography in Chronic Obstructive Pulmonary Disease.

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with abnormal skeletal muscle morphology and function. Objectives: To test the hypothesis that in vivo diaphragm muscle morphology assessed by computed tomography (CT) imaging would be associated with COPD severity, exacerbations, health status, and exercise capacity. Methods: The COPD Morphometry Study is a cross-sectional study that enrolled a clinical sample of smokers with COPD. Spirometry was performed and COPD severity was defined according to guidelines. Three-dimensional left hemidiaphragm morphology was segmented from contiguous axial CT images acquired at maximal inspiration, yielding quantitative measures of diaphragm CT density in Hounsfield units, dome height, and muscle volume. Exacerbations prompting pharmacotherapy or hospitalization in the preceding 12 months and St. George's Respiratory Questionnaire for COPD were assessed. Incremental symptom-limited cycle ergometry quantified peak oxygen uptake ([Formula: see text]o2Peak). Associations were adjusted for age, sex, body height, body mass index, and smoking status. Results: Among 65 smokers with COPD (75% male; [mean ± standard deviation (SD)] 56 ± 26 pack-years; forced expiratory volume in 1 second [FEV1] percentage predicted 55 ± 23%), mean diaphragm CT density was 3.1 ± 10 Hounsfield units, dome height was 5.2 ± 1.3 cm, and muscle volume was 57 ± 24 cm3. A 1-SD decrement in the diaphragm CT density was associated with 8.3% lower FEV1, 3.27-fold higher odds of exacerbation history, 9.7-point higher score on the St. George's Respiratory Questionnaire for COPD, and 2.5 ml/kg/min lower [Formula: see text]o2Peak. A 1-SD decrement in dome height was associated with 11% lower FEV1 and 1.3 ml/kg/min lower [Formula: see text]o2Peak. There were no associations with diaphragm volume observed. Conclusions: CT-assessed diaphragm morphology was associated with COPD severity, exacerbations, impaired health status, and exercise intolerance. The mechanisms and functional impact of lower diaphragm CT density merit investigation.

Comparação das técnicas de facilitação neuromuscular proprioceptiva na função respiratória de indivíduos com doença de Parkinson

Introdução: A Doença de Parkinson (DP) é uma patologia crônica e neurodegenerativa, caracterizada pelo tremor, bradicinesia, rigidez e instabilidade postural, através da progressão da doença, de caráter multifatorial, o sistema respiratório apresenta disfunções. Objetivo: Comparar o efeito imediato da facilitação neuromuscular proprioceptiva (FNP) respiratória e de escápula e pelve na função respiratória de indivíduos com doença de Parkinson. Materiais e métodos: Ensaio clínico randomizado, simples cego, realizado na Clínica Escola de Fisioterapia da Universidade Luterana do Brasil-ULBRA/Canoas, com uma amostra de 12 indivíduos, com diagnóstico de Doença de Parkinson. Os mesmos assinaram o Termo de Consentimento Livre e Esclarecido e foram avaliados através do Miniexame do Estado Mental (MEEM), da escala de Hoehn e Yahr Modificada, capacidade inspiratória, pico de fluxo expiratório e pressões inspiratória e expiratória máximas. Após, foram alocados por sorteio em Grupo A (FNP respiratório) e Grupo B (FNP de escápula e pelve). Resultados: O FNP respiratório se mostrou eficaz nos parâmetros respiratórios avaliados, sendo estatisticamente significativo (p&lt;0,05), assim como o FNP de escápula e pelve para a capacidade inspiratória (p=0,041). Já a comparação entre os dois grupos mostrou que o FNP respiratório foi mais eficaz, apesar de não apresentar significância estatística. Conclusão: As duas técnicas foram eficazes no aumento da capacidade inspiratória, porém a técnica de FNP respiratória mostrou-se efetiva também no aumento do pico de fluxo expiratório e pressões inspiratória e expiratória máximas.

Improvement in Lung Insufflation in Spontaneously Breathing Tracheostomized Patients by Using a New Pulmonary Expansion Device: A Pilot Study

Abstract Lung expansion techniques (LETs) are a key component of pulmonary rehabilitation. Nevertheless, these can be limited in tracheostomized patients because of the infraglottic position of tracheostomy cannulas. We propose a novel pulmonary expansion device (PED) that allows deep inspiration with a postinspiratory pause for a few seconds by means of a unidirectional valve and an occlusion/flow release cap. It is equipped with a relief valve that opens at 60 cm H2O in cases in which this threshold is attained. We aimed to evaluate the impact on lung volume and pressure in spontaneously breathing tracheostomized patients subjected to LETs. A single-arm pilot interventional study was conducted in an adult intensive care unit (ICU), including spontaneously breathing tracheostomized patients. 80 treatments were performed on 10 patients with tracheostomies with PED over a period of 3 months. The maximal inspiratory volume (MIV) was significantly increased by using PED (MIV-PED) at both day 1 (725 (600–820) mL versus 1550 (1250–1700) mL, P &amp;lt; 0.001) and day 3 (870 (750–950) mL versus 1662 (1550–1900) mL, P &amp;lt; 0.001). Inspiratory pause pressure (PIP-PED) did not significantly change from day 1 to day 3 (18 (14–20) cm H2O versus 14 (12–22) cm H2O, P = 0.36). The use of the PED in tracheostomy patients acted as an artificial glottis by performing a novel pulmonary re-expansion maneuver, and increased volumes and intrapulmonary pressure with prolongation of maximum inspiration were achieved.