Maximal Expiratory Pressure Research Articles

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial

IntroductionCoronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss. ObjectiveTo evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG. Methodology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques. Results40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09). ConclusionIt is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.

Intradialytic periodized exercise improves cardiopulmonary fitness and respiratory function: A randomized controlled trial.

Chronic kidney disease (CKD) is a factor that predisposes to gradual physical deconditioning from its early stages leading to cardiorespiratory fitness and musculoskeletal system impairment. We evaluated the effects of combined and periodized intradialytic exercise training on cardiopulmonary fitness and respiratory function in HD subjects. A randomized controlled trial with HD subjects was allocated into two groups: exercise group (EXG) and usual care group (UCG). EXG performed a 12-week combined and periodized intradialytic training. UCG maintained the HD routine. Thirty-nine HD subjects were analyzed (EXG = 20; UCG = 19). The EXG in comparison with the UCG showed improvements in peak oxygen consumption (Δ3.1[0.4-5.5] vs. -0.2[-2.0-1.5]ml/kg/min; p = 0.003), forced expiratory volume in the first second (Δ0.1[-0.0-0.1] vs. -0.0[-0.1-0.0]L; p = 0.022), forced vital capacity (Δ0.1[0.0-0.2] vs. -0.1[-0.2-0.0]L; p = 0.005), peak expiratory flow (Δ0.4[-0.7-1.2] vs. -0.1[-0.5-0.2]L; p = 0.046), and maximal inspiratory pressure (Δ7.35[-8.5-17.5] vs. -4.0[-18.0-12.0]cmH2 O; p = 0.028). The EXG, different from the UCG, did not worsen the maximal expiratory pressure (Δ0.1[-8.8-7.5] vs. -2.5[-15.0-9.0]cmH2 O; p = 0.036). Besides, EXG showed a significant improvement in quadriceps strength (32.05 ± 10.61 vs. 33.35 ± 11.62 kg; p = 0.042). The combined and periodized intradialytic exercise training improved cardiopulmonary fitness, respiratory function, inspiratory muscle strength, and quadriceps strength, beyond maintaining the expiratory muscle strength in HD subjects.

Characterizing Expiratory Respiratory Muscle Degeneration in Duchenne Muscular Dystrophy Using MRI

Expiratory muscle weakness and impaired airway clearance are early signs of respiratory dysfunction in Duchenne muscular dystrophy (DMD), a degenerative muscle disorder in which muscle cells are damaged and replaced by fibrofatty tissue. Little is known about expiratory muscle pathology and its relationship to cough and airway clearance capacity; however, the level of muscle replacement by fat can be estimated using MRI and expressed as a fat fraction (FF). How does abdominal expiratory muscle fatty infiltration change over time in DMD and relate to clinical expiratory function? Individuals with DMD underwent longitudinal MRI of the abdomen to determine FF in the internal oblique, external oblique, and rectus abdominis expiratory muscles. FF data were used to estimate a model of expiratory muscle degeneration by using nonlinear mixed effects and a cumulative distribution function. FVC, maximal inspiratory and expiratory pressures, and peak cough flow were collected as clinical correlates to MRI. Forty individuals with DMD (aged 6-18 years at baseline) participated in up to five visits over 36months. Modeling estimated the internal oblique progresses most quickly and reached 50%replacement by fat at a mean patient age of 13.0 years (external oblique, 14.0 years; rectus abdominis, 16.2 years). Corticosteroid-untreated individuals (n= 4) reached 50%muscle replacement by fat 3 to 4 years prior to treated individuals. Individuals with mild clinical dystrophic phenotypes (n= 3) reached 50%muscle replacement by fat 4 to 5 years later than corticosteroid-treated individuals. Internal and external oblique FFs near 50%were associated with maximal expiratory pressures< 60cm H2O and peak cough flows< 270 L/min. These data improve understanding of the early phase of respiratory compromise in DMD, which typically presents as airway clearance dysfunction prior to the onset of hypoventilation, and links expiratory muscle fatty infiltration to pulmonary function measures.

Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: A randomized-controlled trial.

Objectives This study aims to investigate how exercise programs not directly applied to the cervical spine affect office workers with forward head posture (FHP). Patients and methods Between March 2018 and June 2018, a total of 32 office workers with FHP (13 males, 19 females; mean age 36.63 years; range, 23 to 57 years) were randomized either to experimental (n=16) or control groups (n=16). Scapular stabilization and thoracic extension exercises were applied to the experimental group and cervical stabilization and stretching exercises to the control group. The results of the pre-intervention and after six weeks measurement of the craniovertebral angle (CVA), respiration, pain, and disability were compared and analyzed. Results For intra-group comparison, both groups showed significant differences (p<0.05) in CVA, forced expiratory volume at 1 sec (FEV1), Visual Analog Scale (VAS), and neck disability index at pre- and post-intervention, while only the experimental group showed a significant difference (p<0.05) in maximum inspiratory pressure, maximum expiratory pressure, and forced vital capacity. For inter-group comparison, a significant difference (p<0.05) between FEV1 and VAS was observed. Conclusion The combination of scapular stabilization and thoracic extension exercises, not directly applied to the cervical spine, has an effect on improving the posture, respiration, neck pain, and disability in office workers with FHP.

Исследование силы дыхательных мышц у больных, перенесших COVID-19

Respiratory muscles (RM) are a very important part of the respiratory system that enables pulmonary ventilation. This study aimed to assess the post-COVID-19 strength of RM by estimating maximum static inspiratory (MIP or PImax) and expiratory (MEP or PEmax) pressures and to identify the relationship between MIP and MEP and the parameters of lung function. We analyzed the data of 36 patients (72% male; median age 47 years) who underwent spirometry, and body plethysmography, diffusion test for carbon monoxide (DLCO) and measurement of MIP and MEF. The median time between the examinations and onset of COVID-19 was 142 days. The patients were divided into two subgroups. In subgroup 1, as registered with computed tomography, the median of the maximum lung tissue damage volume in the acute period was 27%, in subgroup 2 it reached 76%. The most common functional impairment was decreased DLCO, detected in 20 (55%) patients. Decreased MIP and MEP were observed in 5 and 11 patients, respectively. The subgroups did not differ significantly in MIP and MEP values, but decreased MIP was registered in the second subgroup more often (18%). There were identified no significant dependencies between MIP/MEP and the parameters of ventilation and pulmonary gas exchange. Thus, in patients after COVID-19, MIP and MEP were reduced in 14 and 31% of cases, respectively. It is reasonable to add RM tests to the COVID-19 patient examination plan in order to check them for dysfunction and carry out medical rehabilitation.

End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation.

The role of end-expiratory lung volume (EELV) during a spontaneous breathing trial (SBT) in patients who were tracheostomized and on prolonged mechanical ventilation is unclear. This study aimed to assess EELV during a 60-min SBT and its correlation with weaning success. Enrolled subjects admitted to a weaning unit were measured for EELV and relevant parameters before and after the SBT. Of the 44 enrolled subjects, 29 (66%) were successfully liberated, defined as not needing mechanical ventilation for 5 d. The success group had fewer subjects with chronic kidney disease (41% vs 73%, P = .044), stronger mean ± SD maximum inspiratory pressure (41.6 ± 10.4 vs 34.1 ± 7.1 cm H2O; P = .02) and mean ± SD maximum expiratory pressure (46.9 ± 11.7 vs 35.3 ± 16.9 cm H2O; P = .01) versus the failure group. Toward the end of the SBT, the success group had a significant increase in the mean ± SD EELV (before vs after: 1,278 ± 744 vs 1,493 ± 867 mL; P = .040) and a decrease in the mean ± SD rapid shallow breathing index (83.8 ± 39.4 vs 66.3 ± 29.4; P = .02), whereas there were no significant changes in these 2 parameters in the failure group. The Cox regression analysis showed that, at the beginning of SBT, a greater difference between EELV with a PEEP of 0 cm H2O and with a PEEP of 5 cm H2O was significantly correlated to a higher likelihood of weaning success. Toward the end of the SBT, a greater EELV level at a PEEP of 0 cm H2O was also correlated with weaning success. Also, the greater difference of EELV at a PEEP of 0 cm H2O between the beginning and the end of the SBT was also correlated with a shorter duration to weaning success. The change in EELV during a 60-min SBT may be of prognostic value for liberation from prolonged mechanical ventilation in patients who had a tracheostomy. Our findings suggest a model to understand the underlying mechanism of failure of liberation from mechanical ventilation in these patients.

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

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

Low-Cost Open-Source Device to Measure Maximal Inspiratory and Expiratory Pressures.

The measurement of maximal inspiratory (MIP) and maximal expiratory (MEP) pressures is a widely used technique to non-invasively evaluate respiratory muscle strength in clinical practice. The commercial devices that perform this test range from whole body plethysmographs to portable spirometers, both expensive and include a wide range of other respiratory tests. Given that a portable, low-cost, and specific option for MIP and MEP measuring device is not currently available in the market. A high-performance and easy-to-build prototype has been developed and the detailed technical information to easily reproduce it is freely released. A novel device is based on an Arduino microcontroller with a digital display, an integrated pressure transducer, and three-dimensional (3D) printed enclosure (total retail cost €80). The validation of the device was performed by comparison with a laboratory reference setting, and results showed accuracy within ±1%. As the device design is available according to the open-source hardware approach, measuring MIP/MEP can greatly facilitate easily available point-of-care devices for the monitoring of patients and, most important, for making this lung function measurement tool affordable to users in low- and middle-income countries.

Predictors of Successful Weaning from Noninvasive Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Single-Center Retrospective Cohort Study.

PurposeNoninvasive ventilation (NIV) is often required for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and it can significantly reduce the need for endotracheal intubation. Currently, there is no standard method for predicting successful weaning from NIV. Therefore, we aimed to evaluate whether a weaning index can predict NIV outcomes of patients with AECOPD.MethodsThis study was conducted at a single academic public hospital in northern Taiwan from February 2019 to January 2021. Patients with AECOPD admitted to the hospital with respiratory failure who were treated with NIV were included in the study. Univariate and multivariate logistic regression analyses were used to identify independent predictors of successful weaning from NIV. Receiver operating characteristic curve methodology was used to assess the predictive capacity.ResultsA total of 85 patients were enrolled, 65.9% of whom were successfully weaned from NIV. The patients had a mean age of 75.8 years and were mostly men (89.4%). The rapid shallow breathing index (RSBI) (P < 0.001), maximum inspiratory pressure (P = 0.014), and maximum expiratory pressure (P = 0.004) of the successful group were significant while preparing to wean. The area under the receiver operating characteristic curve for the RSBI was 0.804, which was considered excellent discrimination.ConclusionThe RSBI predicted successful weaning from NIV in patients with AECOPD with hypercapnic respiratory failure. This index may be useful for selecting patients with AECOPD that are suitable for NIV weaning.

Pulmonary function, muscle strength, and quality of life have differed between chronic kidney disease patients and healthy individuals

Chronic kidney disease (CKD) patients have lower pulmonary function, respiratory and peripheral muscle strength values when compared to the general population, which reflects negatively in the quality of life (QoL). The aim of this study was to compare the pulmonary function, respiratory and peripheral muscle strength, and QoL between CKD patients and healthy individuals. Cross-sectional study with a consecutive sample of 39 individuals separated into three groups: nondialysis-dependent CKD in stage 5 (CKD-5), HD group (CKD-HD), and healthy individuals. The tests performed were spirometry, manovacuometry, handgrip strength (HGS), and Medical Outcomes Short-Form Health Survey (SF-36). A significant difference between groups was observed in forced expiratory volume in 1second (FEV1 ) and its predicted value (p=0.004 and p < 0.001, respectively), forced vital capacity (FVC), and its predicted value (p=0.008 and p < 0.001, respectively), peak expiratory flow (PEF) and its predicted value (p=0.004 and p < 0.001, respectively), maximal inspiratory pressure (MIP) and its predicted value (p=0.022), maximal expiratory pressure (MEP) and its predicted value (p=0.030 and p=0.009, respectively) in which CKD-5 presented the worst values, followed by CKD-HD and healthy group. The CKD-5 had worse pulmonary function, respiratory muscle strength, and QoL. Moreover, CKD-HD also showed some impairment in pulmonary function and QoL when compared with healthy individuals. Even with the peripheral muscle strength preserved, its decrease is proportional to the pulmonary impairment in the evaluated CKD patients.

Severely disabled multiple sclerosis patients can achieve the performance of healthy subjects after expiratory muscle strength training

BackgroundThe efficacy of expiratory muscle strength training (EMST) in patients with multiple sclerosis (MS) is controversial. The current study's primary objective was to test the effects of a progressive and intensive 12 week home based EMST program on expiratory muscle strength and voluntary cough strength. The secondary objective was to determine the retention of EMST benefits. MethodsThirty-five severely disabled MS patients (relapsing-remitting MS, n = 15; primary progressive MS, n = 5; secondary progressive MS, n = 15) with Expanded Disability Status Scale (EDSS) 5.0 − 7.0 were included in the study. Within 36 weeks, patients completed 12 weeks of a non-training period, 12 weeks of EMST and 12 weeks of a detraining period. Maximal expiratory pressure (PEmax) and voluntary peak cough flow (vPCF) were assessed 4 times: at week 0 (baseline), week 12 (pre-training), week 24 (post-training), and week 36 (post-detraining). MS patients included in the study were compared to age- and sex-matched healthy subjects. In the healthy controls, the PEmax and vPCF were assessed once to obtain normative data. ResultsTwenty-six patients completed the training period (mean age 52.7 ± 10.2, EDSS 5.9 ± 0.6) and were compared to 26 sex- and age-matched healthy subjects (mean age 53.5 ± 5.8). Patients with MS had a lower PEmax (p = 0.002) and vPCF (p = 0.022) at baseline than the healthy control group. In training period, the PEmax and vPCF increased (p = 0.0000; effect size: d = 0.94 and p = 0.0036; d = 0.57 respectively) in comparison with the non-training period (p = 0.0692; d = -0.36 and p = 0.5810; d = 0.11 respectively). Following the 12 weeks detraining period, the PEmax and vPCF declined but remained 16.7% and 5.5% respectively above the pre-training values. No differences were observed in the PEmax and vPCF between the MS group at the post-training and post-detraining timepoint and the healthy control group normative values. ConclusionsEMST improves expiratory muscle strength and voluntary cough strength in severely disabled MS patients.

Expiratory Muscle Strength Training in Patients with Parkinson's Disease: A Pilot Study of Mobile Monitoring Application.

Expiratory muscle strength training (EMST) studies have reported significant improvements in maximum expiratory strength, cough efficacy, and swallowing function in patients with Parkinson's disease (PD).1 Currently, EMST is usually performed in short and intensive training periods.1 However, information about detraining outcomes highlights the need for the development of long-term maintenance home-based programs to sustain training gains following intensive periods of EMST, especially considering the progressive nature of PD.2 Nevertheless, low long-term adherence to home exercise is an important issue in many patient groups and may compromise treatment outcomes.3 Therefore, we developed a mobile phone-based visual feedback (MPVF) application to keep patients motivated to continue EMST following intensive periods of training. With the help of a specially developed algorithm, the application can evaluate real-time data using a microphone attached to an expiratory handheld device (Fig. 1). Supplement S1 provides detailed information about the algorithm. The first step in the research process of examining whether the feedback application is effective in long-term EMST adherence is to find out whether a MPVF application is suitable for patients with PD who may experience difficulties in using a smartphone due to motor and cognitive problems related to age and PD itself. Therefore, we conducted a pilot study to investigate the usability of MPVF in EMST in patients with PD. A total of 12 patients (Table S1) with PD performed an intensive home-based EMST with MPVF for 2 weeks. Peak cough flow, maximum expiratory pressure, and maximum inspiratory pressure were measured. The usability of the MPVF was also assessed using a semistructured interview. Supplement S2 provides detailed information about the methods. The median of adherence for completing the prescribed exercises in the training period was 90.5% (between 174 and 431 completed EMST maneuvers). A total of 2 weeks of intensive EMST were sufficient to significantly improve the participants' maximum expiratory pressure and voluntary peak cough flow (Table S2). The improvement is quantitatively comparable with the results of other intensive EMST studies with longer durations, for example.4, 5 When interpreting such rapid improvement, the impact of visual feedback should be considered. It can be assumed that visual feedback increased training effort compared with regular training without immediate control. All participants appreciated EMST with MPVF (12/12). They found it motivating (11/12), comprehensible (11/12), and user friendly (10/12). Even participants (n = 3) with mild cognitive impairment (Montreal Cognitive Assessment scores 24–25) who coincidentally had no previous experience with smartphones were able to use the application without difficulties or help from another person. With respect to the suggestions for improvement from a semistructured interview, the patients might be divided into 2 groups. The first group proposed simplifying the application as much as possible. The second group preferred more advanced options of presenting training data, such as in overview graphs and charts. To meet the needs of both groups, the application should be able to work in basic and advanced modes in the future. These findings indicate that EMST coupled with MPVF is feasible and potentially useful in patients with PD. We thank Tomas Sieger, PhD, from the Czech Technical University in Prague for his advice on the method of instantaneous sound level calculation. We also thank Ota Gal, PhD, from the Department of Neurology and Centre of Clinical Neuroscience, General University Hospital in Prague for manuscript review and critique. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique. M.S.: 1A, 1B, 1C, 2A, 2B, 2C, 3A R. Korteová: 1A, 1B, 1C, 2C R. Kliment: 1A, 3A R.J.: 3B E.R.: 1A, 2C, 3B M.H.: 1A, 3B This study was approved by the Ethics Committee of the General University Hospital in Prague (No. 1613/19 S-IV). All participants signed an informed consent. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. This work was supported by The EU Joint Programme–Neurodegenerative Disease Research 8F19003iCARE-PD and Ministry of Health of the Czech Republic Grants No NV19-04-00233 and NU20-04-0337. The authors declare that there are no conflicts of interest relevant to this work. The authors declare that there are no additional disclosures to report. Supplement S1 The MPVF algorithm. Supplement S2 The methods. Table S1 Demographic and clinical characteristics. Table S2 Median and interquartile range (IQR) of maximum respiratory pressure and voluntary cough values across pre- and posttesting time points. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Effects of yogic intervention on pulmonary function and respiratory muscle strength parameters: A systematic literature review and meta-analysis

The aim of this systematic review and meta-analysis is to investigate the efficacy of yogic intervention (YI) on pulmonary functions (PFs) and respiratory muscle strength parameters in healthy individuals. PubMed/Medline, Embase, Google Scholar, SPORTdiscus databases as well as manual searches carried out until March 2020 on yoga AND pulmonary function were included based on Prisma guidelines. Twenty studies were identified potentially relevant. They were systematically reviewed and summarized in tabular form, listing yogic intervention (YI) significant improved forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1); FEV1/FVC; peak expiratory flow rate (PEFR), maximum voluntary volume (MVV), respiratory muscle strength parameters like maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP or PEmax). There are encouraging results elucidated that yogic intervention improves pulmonary functions and respiratory muscle strength parameters of healthy physically fit individuals significantly.

Respiratory Muscle Strength in Healthy Indian Children of Age 7-17 Years: A Cross-Sectional Study.

PurposeAs the values of respiratory muscle strength vary according to race, ethnicity, and geographical area, there is a wide-ranging difference among different populations. Thus, the available reference values may not have an application for use in the Indian paediatric population, creating a need for generating values which will be appropriate for the Indian paediatric context.Materials and MethodsAssessment of respiratory muscle strength was carried out by assessing maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and synthesising predictive formulas using anthropometric variables like height, gender and age, which will be suitable for Indian children.ResultsWe calculated MIP and MEP of 320 (boys=160 and girls= 160) children in the age range of 7 years to 17 years of Mangaluru city, India. Results stated that mean MIP and MEP for boys were 72.5±32.8 cm H2O and 73±33.2 cm H2O, while for the girls it was 67±30.2 cm H2O and 68±30.1 cm H2O, respectively.ConclusionThis study concluded that there is a difference in respiratory pressure values of Indian children with respect to those of other countries. Age, gender, height and BMI have a significant role in determining respiratory muscle strength. Boys demonstrated higher MIP and MEP. As age, height, weight and BMI increases, so does MIP and MEP.

Pulmonary function decline in amyotrophic lateral sclerosis

Background: There has been no comprehensive longitudinal study of pulmonary functions (PFTS) in ALS determining which measure is most sensitive to declines in respiratory muscle strength. Objective: To determine the longitudinal decline of PFTS in ALS and which measure supports Medicare criteria for NIV initiation first. Methods: Serial PFTs (maximum voluntary ventilation (MVV), maximum inspiratory pressure measured by mouth (MIP) or nasal sniff pressure (SNIP), maximum expiratory pressure (MEP), and Forced Vital Capacity (FVC)) were performed over 12 months on 73 ALS subjects to determine which measure showed the sentinel decline in pulmonary function. The rate of decline for each measure was determined as the median slope of the decrease over time. Medicare-based NIV initiation criteria were met if %FVC was ≤ 50% predicted or MIP was ≤ 60 cMH2O. Results: 65 subjects with at least 3 visits were included for analyses. All median slopes were significantly different than zero. MEP and sitting FVC demonstrated the largest rate of decline. Seventy subjects were analyzed for NIV initiation criteria, 69 met MIP criteria first; 11 FVC and MIP criteria simultaneously and none FVC criteria first. Conclusions: MEP demonstrated a steeper decline compared to other measures suggesting expiratory muscle strength declines earliest and faster and the use of airway clearance interventions should be initiated early. When Medicare criteria for NIV initiation are considered, MIP criteria are met earliest. These results suggest that pressure-based measurements are important in assessing the timing of NIV and the use of pulmonary clearance interventions.

Functional State of Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease

The objective: to assess the strength of respiratory muscles (RM) in patients with chronic obstructive pulmonary disease (COPD) and determine the role of certain pathogenetic factors of COPD in the development of respiratory muscle dysfunction.Subjects and methods. In in-patient settings, the strength characteristics of respiratory muscles were studied in 85 men aged 39-78 years suffering fromCOPD exacerbation. MicroRPM (CareFusion, UK) was used to determine the levels of maximum inspiratory and expiratory pressures in the oral cavity, maximum rate of their rise during inspiration and expiration as well as the level of intranasal pressure before and after the test with salbutamol.Results. Significant variability in strength characteristics of respiratory muscles was observed depending on the stage of COPD, its phenotype, and the presence of hypoxemia or hypercapnia. In patients at early stage of COPD, only expiratory respiratory muscle dysfunction was documented; at moderate and severe stages, inspiratory and expiratory muscle dysfunction was observed, and at very severe stage – diaphragm dysfunction prevailed. The results of the salbutamol test demonstrated the maximum increase in the strength of respiratory in early and moderate COPD and the minimum increase in extremely severeCOPD indicating the role of the irreversible component of bronchial obstruction in the development of respiratory muscle dysfunction. The emphysematous phenotype of COPD was characterized by inspiratory respiratory muscle dysfunction, while the bronchitic phenotype was characterized by expiratory respiratory muscle dysfunction. In patients with hypoxemia and hypercapnia, the strength of inspiratory respiratory muscle was lower versus normoxemia.

Impact of drains positioning on pulmonary function after coronary artery bypass grafting: an observational study

IntroductionCoronary artery bypass grafting (CABG) is a procedure associated with a decline in pulmonary function. Among the main causes is the presence of the drain that is usually positioned in the intercostal or subxiphoid region. ObjectiveTo measure the interference of drains positioning on pulmonary function in patients undergoing CABG. MethodsObservational study that assessed preoperative pulmonary function through vital capacity (VC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF). These variables were evaluated in three different moments: in the presence of two drains, when removing one, and after removing all drains. ResultsWe evaluated 45 patients with a mean age of 62 ± 7 years with male prevalence of 29 (64%) individuals. The insertion of drains caused a decline in pulmonary function after surgery by reducing MIP by 48%, MEP by 11%, VC by 39%, and PEF by 6%. ConclusionThis study has demonstrated that drains positioning after CABG surgery may produce weakness of the respiratory muscles, change ventilatory mechanics, and impair normal pulmonary function postoperatively.

A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis.

BackgroundIsolated diaphragmatic palsy in the absence of progressive neuromuscular disease is uncommon. It poses diagnostic challenges and limited data are available regarding prognosis. We present retrospective cohort data from two large teaching hospitals in the United Kingdom.Method60 patients who were assessed either as inpatients or outpatients were included in this study. Patients with progressive neuromuscular disease were excluded. Clinical presentation, tests of respiratory muscle function (sitting/supine vital capacity, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP)) and outcomes were recorded.ResultsFor patients with diaphragmatic palsy, mean±sd seated and supine vital capacity pre-noninvasive ventilation (NIV) were reduced at 1.7±1.2 L and 1.1±0.9 L, respectively, with a mean±sd postural fall in vital capacity of 42±0.16%. The mean MEP/MIP and MEP/SNIP ratios for diaphragmatic palsy were 3 and 3.5, respectively. After a year of treatment with NIV, mean±sd upright and supine vital capacity had increased to 2.1±0.9 L and 1.8±1 L, respectively, and the mean±sd fall in vital capacity from sitting to supine reduced to 29±0.17%. MEP/MIP and MEP/SNIP ratios reduced to 2.6 and 2.9, respectively, from the pre-NIV values. The values of postural fall in vital capacity correlated (p<0.05) with MEP/MIP and MEP/SNIP ratio (r2=0.86 and r2=0.7, respectively).ConclusionTests of respiratory muscle strength are valuable in the diagnostic workup of patients with unexplained dyspnoea. A triad of 1) orthopnoea, with 2) normal lung imaging and 3) MEP/MIP and/or MEP/SNIP ratio ≥2.7 points towards isolated diaphragmatic palsy. This needs to be confirmed by prospective studies.

Increased Maximal Expiratory Pressure, Abdominal and Thoracic Respiratory Expansibility in Healthy Yoga Practitioners Compared to Healthy Sedentary Individuals

Abstract Background Increasing thoracic expansion is effective at reducing blood pressure in hypertensive subjects. Yoga prescribes many respiratory techniques with a growing number of practitioners. However, very little is known whether sedentary or yoga practitioners show measurable differences in their respiratory patterns. Objective This study aims to demonstrate differences between healthy sedentary individuals and healthy yoga practitioners regarding maximal respiratory pressures and thoracic and abdominal respiratory expansibility. Methods Maximal inspiratory and expiratory pressures (MIP and MEP, respectively) were evaluated by [...]

The effect of oropharyngeal exercise in patients with moderate and severe obstructive sleep apnea using CPAP: a randomized controlled study.

Obstructive sleep apnea (OSA) is an important public health problem. Beyond common treatment options, solution-oriented options are needed. Oropharyngeal exercise training may be a research area in this respect. This study aimed to evaluate the effects of oropharyngeal exercise (OPE) in addition to continuous positive airway pressure (CPAP) therapy in patients diagnosed with OSA. Patients with moderate and severe OSA were screened from the electronic database of our hospital and 41 patients (20: exercise group; 21: control group) were included in the study. Each patient was assessed with CPAP usage time, maximal voluntary ventilation (MVV), maximum inspiratory and expiratory pressure (MIP-MEP), neck circumference, body mass index (BMI), waist-hip ratio, Epworth sleepiness score, Pittsburgh sleep quality index (PSQI), and short-form health survey (SF-36) in the first visit. The OPE was prescribed in addition to CPAP for the exercise group and performed by the patients for 3months. At the end of the third month, groups were re-assessed with the same parameters. Most of the patients were men, and the mean age of the study population was 51.9 ± 7.4; the mean apnea-hypopnea index (AHI) in the last polysomnography report was 53.3 ± 27.4. In the exercise group, MVV (p = 0.003), MIP (p = 0.002), MEP (p = 0.024), and SF-36 energy/fatigue (p = 0.020) were observed to increase while the total PSQI score (p = 0.036) decreased. The neck circumference (p = 0.006) and BMI (p = 0.013) were found to be significantly decreased in the exercise group. We found that OPE training may have improved respiratory muscle strength as well as sleep quality and health-related quality of life in the exercise group. OPE along with CPAP therapy may be recommended in moderate and severe OSA patients who are willing to participate.