Maximal Inspiratory Pressure Values Research Articles

Maximal Inspiratory Pressure and Maximal Expiratory Pressure in Healthy Korean Children

ObjectiveTo evaluate respiratory muscle strength in healthy Korean children in order to establish the criteria for normal reference values for future applications. In contrast with the other parameters for testing pulmonary function, normal values for respiratory muscle strength in healthy Korean children have not been assessed to date.MethodsWe conducted a complete survey of 263 students at Sinmyung Elementary School in Yangsan, Gyeongsangnam-do, and measured their height and body weight, performed pulmonary function tests, and evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as measures of respiratory muscle strength. We excluded the subjects with respiratory or cardiovascular diseases that could affect the results. The subjects were children aged 8–12 years, and they consisted of 124 boys and 139 girls.ResultsThe MIP and MEP values (mean±standard deviation) for the entire subject group were 48.46±18.1 cmH2O and 47.95±16 cmH2O, respectively. Boys showed higher mean values for MIP and MEP in every age group. Korean children showed lower mean values for MIP and MEP compared to those in previous studies conducted in other countries (Brazil and USA).ConclusionOur results showed that boys generally have greater respiratory muscle strength than girls. We found a significant difference between the results of our study and those of previous studies from other countries. We speculate that this may be attributed to differences in ethnicity, nutrition, or daily activities.

P.67 - Effect of enzyme replacement therapy with alglucosidase alfa (Myozyme®) in 12 patients with advanced late-onset Pompe disease

Glycogen storage disease type II (Pompe disease) is a lysosomal disorder caused by deficiency in acid α-glucosidase. Enzyme replacement therapy (ERT) with recombinant human alglucosidase alfa (Myozyme®, Genzyme) is available since 2006. So far, treatment benefit in adults has been mostly evaluated in patients who maintained ability to walk, and without permanent ventilator assistance. The aim of this study is to evaluate ERT efficacy in twelve patients with advanced Pompe disease, identified from the French Pompe registry. Inclusion criteria were wheelchair dependency and ventilation support (>12 h/24) upon ERT initiation. Home mechanical ventilation hours, forced vital capacity (FVC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), ability to walk a few steps and motor function measure (MFM) scale prior and after ERT were studied, where available. Age at ERT initiation ranged from 20 to 73 years (mean = 49.3) and disease duration from 13 to 40 years (mean = 23.9). Years on ventilation varied from 4 to 40 (mean = 15.4) and of wheelchair use from 1 to 20 (mean = 9). ERT duration ranged from 9 to 111 months (mean 54.4). During follow-up, one patient reduced his daily time of ventilatory support, 9 remained fully dependant (24 h/24) and two became fully dependant of assisted ventilation. Values of FVC, MIP and MEP did not change significantly. At ERT initiation, 3 patients could walk a few meters with aid. Two of them increased their walking distance, while a decrease was observed in the third one. There were no significant changes of MFM values between start of ERT and last follow-up. Moreover, 5 patients died, after a treatment period ranging from 9 to 64 months (mean = 33.4). In our series of 12 patients who started ERT in an advanced stage of Pompe disease, we observed a clinically meaningful improvement of respiratory or muscle functions in two patients. Five patients died and five remained wheelchair bound and fully dependant of ventilatory support.

Maximal inspiratory pressure is influenced by intensity of the warm-up protocol

The aim of the study was to compare the effect of inspiratory muscle warm-up protocols with different intensities and breathing repetitions on maximal inspiratory pressure (MIP). Ten healthy and recreationally active men (183.3±5.5cm, 83.7±7.8kg, 26.4±4.1years) completed four different inspiratory muscle (IM) warm-up protocols (2×30 inspirations at 40% MIP, 2×12 inspirations at 60% MIP, 2×6 inspirations at 80% MIP, 2×30 inspirations at 15% MIP) on separate, randomly assigned visits. Pre-post values of MIP using MicroRPM (Micro Medical, Kent, UK) showed a significant increase in the mean values after the IM warm-up (POWERbreathe® K1, Warwickshire, UK) with 40% MIP and 60% MIP warm-up protocols, when MIP increased by 7cm H2O (95% CI: 0.10…13.89) (p=0.047) and by 6.4cm H2O (95% CI: 2.98…13.83) (p=0.027), respectively. In conclusion, a higher intensity inspiratory muscle warm-up protocol (2×12 breaths at 60% of MIP) can increase IM strength.

Comparison of Pulmonary Functions at Onset of Ventilatory Insufficiency in Patients With Amyotrophic Lateral Sclerosis, Duchenne Muscular Dystrophy, and Myotonic Muscular Dystrophy.

ObjectiveTo evaluate pulmonary functions of patients with amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), and myotonic muscular dystrophy (MMD) at the onset of ventilatory insufficiency.MethodsThis retrospective study included ALS, DMD, and MMD patients with regular outpatient clinic follow-up in the Department of Rehabilitation Medicine at Gangnam Severance Hospital before the application of non-invasive positive pressure ventilation (NIPPV). The patients were enrolled from August 2001 to March 2014. If patients experienced ventilatory insufficiency, they were treated with NIPPV, and their pulmonary functions were subsequently measured.ResultsNinety-four DMD patients, 41 ALS patients, and 21 MMD patients were included in the study. The mean SpO2 was lower in the MMD group than in the other two groups. The mean forced vital capacity (FVC) in the supine position was approximately low to mid 20% on average in DMD and ALS patients, whereas it was 10% higher in MMD patients. ALS patients showed a significantly lower FVC in the supine position than in the sitting position. Maximal insufflation capacity, unassisted peak cough flow, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were significantly higher in MMD group than in the other groups. MEP was significantly the lowest in DMD patients, followed by in ALS, and MMD patients, in order.ConclusionDisease-specific values of pulmonary function, including FVC, MEP, and MIP, can be accurately used to assess the onset of ventilatory insufficiency in patients with ALS, DMD, and MMD.

Reference Range of Respiratory Muscle Strength and Its Clinical Application in Amyotrophic Lateral Sclerosis: A Single-Center Study.

Background and PurposeEvaluating respiratory function is important in neuromuscular diseases. This study explored the reference ranges of the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) in healthy adults, and applied them to amyotrophic lateral sclerosis (ALS) patients.MethodsMIP, MEP, and SNIP were measured in 67 healthy volunteers aged from 21 to 82 years. Reference ranges were evaluated by multivariate regression analysis using the generalized additive modeling of location, scale, and shape method. Thirty-six ALS patients were reviewed retrospectively, and abnormal values of MIP, MEP, and SNIP were determined according to the reference ranges.ResultsMIP, MEP, and SNIP were abnormal in 57.1%, 51.4%, and 25.7% of the ALS patients, respectively. MIP and SNIP were significantly correlated with the degree of restrictive pattern and respiratory symptoms. The ALS Functional Rating Scale-Revised score was correlated with SNIP.ConclusionsThis study has provided the reference range of respiratory muscle strength in healthy adults. This range is suitable for evaluating respiratory function in ALS patients.

Respiratory Muscle Strength in Chronic Stroke Survivors and Its Relation With the 6-Minute Walk Test

ObjectivesTo compare respiratory muscle strength in stroke survivors (SS) with that in a control group (CG) of healthy people matched by age and sex, as well as to investigate any relation between respiratory muscle strength and the distance walked during the 6-minute walk test (6MWT). DesignCross-sectional study. SettingThis study comprised patients from a private neurological rehabilitation center and a public association for patients with acquired brain injury. ParticipantsChronic SS with a diagnosis of hemiplegia/hemiparesis who were able to walk (n=30) and healthy individuals matched by sex and age (n=30) (N=60). InterventionsNot applicable. Main Outcome MeasuresRespiratory muscle strength was assessed using maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) with a pressure transducer and a diver nozzle. The distance walked during the 6MWT was also registered for both groups. The motricity index and the Scale Impact of Stroke version 16.0 were also measured in SS. ResultsThe Student t test revealed significantly lower values of MIP and MEP in SS than in the CG (MEP, 95.93±43.12cmH2O in SS vs 158.43±41.6cmH2O in the CG; MIP, 58.7±24.67cmH2O in SS vs 105.7±23.14cmH2O in the CG; P<.001). Moreover, these findings were clinically relevant because both MIP and MEP in SS were <60% of the predicted values. A positive correlation between the 6MWT and MIP was found using the Pearson coefficient (r=.43; P<.018). ConclusionsRespiratory muscle weakness should be considered in a holistic approach to stroke rehabilitation.

Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway.

IntroductionMaximal Inspiratory Pressure (MIP) is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway.ObjectivesThis study aimed to compare the MIP values assessed by standard method (MIPsta) and by unidirectional expiratory valve method (MIPuni) in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated.MethodsThis was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B) at two moments (Tests 1 and 2) to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1]) was used to determine intraobserver and interobserver reproducibility.ResultsThe mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O) than the mean values for MIPsta (-102.5 ± 23.9 cmH2O) (p<0.001). Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91), and high correlation for Test 2 (ICC[2,1] = 0.88). The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86) and evaluator B (ICC[2,1] = 0.77).ConclusionsMIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway.

Effects of bariatric surgery on inspiratory muscle strength.

BackgroundThe respiratory function is affected by obesity due to an increased deposition of fat on the chest wall. The objective of this study was to investigate the strength of the inspiratory respiratory muscles of obese individuals and the possible influence of bariatric surgery on it by measuring the maximum inspiratory pressure (MIP).MethodsPatients referred to a bariatric centre between the 3rd of October 2011 and the 3rd of May 2012 were screened preoperatively by a multidisciplinary team. Their MIP was measured at screening and 3, 6 and 9 months postoperative. In case of a preoperative MIP lower than 70% of predicted pressure training was provided supervised by a physiotherapist.ResultsThe mean age of 124 included patients was 42.9 ± 11.0 years and mean BMI was 43.1 ± 5.2 kg/m2. The mean predicted MIP preoperatively was 127 ± 31 in cm H2O and the mean measured MIP was 102 ± 24 in cm H2O. Three patients (2.4%) received training. Three months after surgery the MIP was 76 ± 26 cm H2O, after 6 months 82 ± 28 cm H2O and after 9 months 86 ± 28 cm H2O. All postoperative measurements were significant lower than preoperatively (P < 0.05). The only influencing factor for the preoperative MIP was age (p = 0.014).ConclusionThe preoperative MIP values were significantly lower than the predicted MIP values, probably due to altered respiratory mechanics.

Time-Trend Analysis of Pulmonary and Diaphragmatic Functionality in Patients with Diaphragmatic Palsy or with Chronic Diaphragmatic Hernia after Surgical Treatment.

Background The aim of this study was to assess long-term pulmonary and diaphragmatic function in two cohorts of patients: the first one affected by diaphragmatic palsy (DP) who underwent plication reinforced by rib-fixed mesh and the second one affected by chronic diaphragmatic hernia (TDH) who underwent surgical reduction and direct suture. Materials and Methods From 1996 to 2011, 10 patients with unilateral DP and 6 patients with TDH underwent elective surgery. Preoperative and long-term (12 months) follow-up assessments were completed in all patients, including pulmonary function tests (PFTs) with diffusion of the lung for carbon monoxide (DLCO), measure of maximum inspiratory pressure (MIP) assessed both in standing and in supine positions, blood gas analysis, chest computed tomographic (CT) scan, and dyspnea score. The Pearson chi-square test, Fisher exact test, and Student t-test were applied when indicated. Results At long-term (12 months) postoperative follow-up, patients operated for DP showed a significant improvement in terms of forced expiratory volume in 1 second (FEV1%) (+ 18.2%, p < 0.001), forced vital capacity (FVC%) (+ 12.8%, p < 0.001), DLCO% (+ 8.3%, p = 0.04), and Po 2 (+ 9.86 mm Hg, p < 0.001) when compared with baseline values. Conversely, when considering the TDH group, only the levels of Po 2 were found to be significantly higher in the postoperative assessment (+ 8.3 mm Hg, p = 0.04). Although MIP increased in both the groups after surgery, a persistent and significant decrease of MIP was detected in TDH group when comparing the levels assessed in supine position with those measured in the standing position (p < 0.001). Medical Research Council dyspnea scale improved in the DP group by a factor of 0.80 (p < 0.001) and in the TDH group by a factor of 0.33 (p = 0.175). Conclusion In patients who underwent surgery for DP, good long-term results may be predicted in terms of pulmonary flows, volumes, and DLCO. Conversely, in patients who underwent elective surgery for chronic TDH, a persistent overall restrictive pattern, lower MIP values in supine position, and paradoxical motion could be expected.

High prevalence of respiratory muscle weakness in hospitalized acute heart failure elderly patients.

IntroductionRespiratory Muscle Weakness (RMW) has been defined when the maximum inspiratory pressure (MIP) is lower than 70% of the predictive value. The prevalence of RMW in chronic heart failure patients is 30 to 50%. So far there are no studies on the prevalence of RMW in acute heart failure (AHF) patients.ObjectivesEvaluate the prevalence of RMW in patients admitted because of AHF and the condition of respiratory muscle strength on discharge from the hospital.MethodsSixty-three patients had their MIP measured on two occasions: at the beginning of the hospital stay, after they had reached respiratory, hemodynamic and clinical stability and before discharge from the hospital. The apparatus and technique to measure MIP were adapted because of age-related limitations of the patients. Data on cardiac ejection fraction, ECG, brain natriuretic peptide (BNP) levels and on the use of noninvasive ventilation (NIV) were collected.ResultsThe mean age of the 63 patients under study was 75 years. On admission the mean ejection fraction was 33% (95% CI: 31–35) and the BNP hormone median value was 726.5 pg/ml (range: 217 to 2283 pg/ml); 65% of the patients used NIV. The median value of MIP measured after clinical stabilization was -52.7 cmH2O (range: -20 to -120 cmH2O); 76% of the patients had MIP values below 70% of the predictive value. On discharge, after a median hospital stay of 11 days, the median MIP was -53.5 cmH2O (range:-20 to -150 cmH2O); 71% of the patients maintained their MIP values below 70% of the predictive value. The differences found were not statistically significant.ConclusionElderly patients admitted with AHF may present a high prevalence of RMW on admission; this condition may be maintained at similar levels on discharge in a large percentage of these patients, even after clinical stabilization of the heart condition.

Força Muscular Respiratória de Universitários Saudáveis

Objective: This study aimed to perform a comparative analysis of obtained and predicted values of maximal inspiratory and expiratory pressure in healthy university students. Material and Methods: This was a quantitative, cross-sectional and comparative study including 12 students aged between 20 and 39 years, sedentary, and with body mass index between 18 and 29.9. The evaluation of respiratory muscle strength was performed using the manometer apparatus according to protocols established in the literature. Categorical variables were analyzed using descriptive statistics in single frequency. Data normality was checked by Shapiro-Wilk test and then Wilcoxon test was applied for both sexes separately. The findings were considered statistically significant at p<0.05. Results: Of the 12 university students, 8 (66.7%) were male and presented higher means for weight (74.04), height (1.75) and BMI (23.82) compared to females. The maximum inspiratory pressure values (p<0.109 female; p <0.351 male) and maximum expiratory pressure values (p <0.109 women; p <0.463 men) obtained were found to be lower than the predicted ones in both sexes. Conclusion: Although with no statistical significance, the values obtained were found to be lower than the predicted ones in university students. DESCRIPTORS Respiratory Muscles; Students; Lung.

Inspiratory muscle strength in subjects with tetraplegia: viability of evaluation through the measurement of maximal inspiratory pressure

Objective To analyze the values of maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP) and to verify the existence of concordance between the two evaluation methodologies, in subjects with tetraplegia. Materials and methods Cross-sectional study with 17 tetraplegic men, aged 30.42 ± 7.67 years, who underwent MIP and SNIP evaluation using a respiratory pressure meter. Results The MIP and SNIP values obtained showed no difference when compared to each other (88.42 ± 29.39 vs. 86.68 ± 25.40 cmH2O, respectively). They were, however, significantly lower compared to the predicted values (MIP = 128.92 ± 7.18; SNIP = 114.11 ± 3.19 cmH2O), with the MIP values presenting correlation (r2 = 0.94; p &lt; 0.0001) and concordance with those of the SNIP. Conclusions Both the MIP and SNIP values obtained were lower than the predicted values, indicating a reduction in inspiratory muscle strength (IMS). Both techniques showed correlation and concordance, suggesting that MIP can be used as a noninvasive method for IMS evaluation in this population.

Correlação entre as pressões inspiratória máxima e inspiratória nasal em pacientes acometidos por AVC

Objetivo. Avaliar a correlação entre medidas de pressão inspiratória máxima e de pressão inspiratória nasal, e comparar valores médios de força muscular respiratória entre diferentes dias de internação hospi­talar em pacientes acometidos por acidente vascular cerebral (AVC). Método. Foram estudados 13 pacientes acometidos por AVC inter­nados na Unidade de Cuidados Especiais II (UCE II) do Hospital Geral Dr. Waldemar Alcântara, Fortaleza-CE. A ficha de avaliação contemplou medidas referentes à força muscular respiratória em D1 (1º dia de internação) e D5 (5º dia de internação): pressão inspirató­ria máxima (PImáx), pressão expiratória máxima (PEmáx) e pressão inspiratória nasal (SNIP). Resultados. A média de idade dos partici­pantes foi de 69,1±7,2 anos. Quando comparados no 1º e no 5º dia de internação (p≤0,05), houve diferença dos valores médios de PImáx (61,5±32 para 76±13,2), PEmáx (62,9±26 para 69,8±26,1) e SNIP (33,3±12 para 39,4±12,2). Foi obtida correlação positiva moderada (r=0,60, p=0,001) entre PImáx e SNIP. Conclusão. Observou-se au­mento significativo da força muscular respiratória durante a interna­ção e os valores de PImáx e SNIP pareceram assemelhar-se em pacien­tes acometidos por AVC.

Correlação entre as pressões inspiratória máxima e inspiratória nasal em pacientes acometidos por AVC

Objective. To evaluate the correlation between measures of maximal inspiratory pressure and nasal inspiratory pressure, and compare aver­age values of respiratory muscle strength between different days of hospitalization in stroke patients. Method. 13 stroke patients admit­ted to the Unit of Special Care II (UCE II) of Hospital Geral Dr. Waldemar Alcântara, Fortaleza-CE, were studied. The evaluation sheet contemplated measures regarding respiratory muscle strength in D1 (1st day of hospitalization) and D5 (5nd day of hospitalization): maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and nasal inspiratory pressure (SNIP). Results. The average of age of the participants of the study was of 69.1±7.2 years. When compared at 1st and 5nd day of hospitalization (p≤0.05), there was a difference in average values of MIP (61.5±32 to 76±13.2), MEP (62.9±26 to 69.8±26.1) and SNIP (33.3±12 to 39.4±12.2). Was ob­tained positive moderate correlation (r=0.60, p=0.001) between MIP and SNIP. Conclusion. It was observed a significant increase in re­spiratory muscle strength and the values of MIP and SNIP seemed resemble in stroke patients.

The relationship between early reversibility test and maximal inspiratory pressure in patients with airway obstruction.

Maximal inspiratory pressure (MIP) is a marker for assessing the degree of respiratory muscle dysfunction. Muscle dysfunction represents a pathophysiological feature of chronic obstructive pulmonary disease. We aimed to determinate the MIP value in patients with airway obstruction, to evaluate the change in MIP with bronchodilator drug, and to show the relationship between the changes in MIP and disease characteristics. We evaluated 21 patients with airway obstruction at the Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun, Turkey. We performed pulmonary function tests, measurement of MIP values, and reversibility tests with salbutamol. The baseline spirometry results were: mean forced vital capacity (FVC), 3,017±1,020 mL and 75.8%±20.8%; mean forced expiratory volume in 1 second (FEV1), 1,892±701 mL and 59.2%±18.2%; FEV1/FVC, 62.9%±5.5%; peak expiratory flow, 53%±19%. The pre-bronchodilator MIP value was 62.1±36.9 cmH2O. The reversibility test was found to be positive in 61.9% of patients with salbutamol. The absolute change and percentage of change in FEV1 were 318±223 mL and 19.8%±16.7%, respectively. The MIP value was increased by 5.5 cmH2O (8.8%) and was 67.7±30.3 cmH2O after bronchodilation. There was no significant relationship between age, FEV1, reversibility, and change in MIP with bronchodilator. However, the increase in MIP with bronchodilator drug was higher in patients with low body mass index (<25 kg/m2). We noted a 13.1% increase in FVC, a 19.8% increase in FEV1, a 20.2% increase in peak expiratory flow, and an 8.8% increase in MIP with salbutamol. In conclusion; MIP increases with bronchodilator therapy, regardless of changes in lung function, in patients with airway obstruction. The reversibilty test can be used to evaluate change in MIP with salbutamol.

Reference values for maximal inspiratory pressure: a systematic review.

Maximal inspiratory pressure (MIP) is the most commonly used measure to evaluate inspiratory muscle strength. Normative values for MIP vary significantly among studies, which may reflect differences in participant demographics and technique of MIP measurement. To perform a systematic review with meta-analyses to synthesize MIP values that represent healthy adults. A systematic literature search was conducted using Medline, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health (CINAHL) and Sport Discus databases. Two reviewers identified and selected articles, and abstracted data. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. A random-effects model was used to calculate overall means and 95% CIs. Of 22 included articles, MIP data were synthesized according to age group and sex from six reports (n=840) in the meta-analyses. The mean QUADAS score was 3.5 of 7. The age range was between 18 and 83 years (426 men, 414 women). MIP began to decrease with age in the 40 to 60 years age range and continued to fall progressively with age. For the same age group, men tended to have higher MIPs than women. Sensitivity analysis of withdrawing studies from the meta-analysis identified one study that contributed more to heterogeneity in some age groups. MIP was higher in men and decreased with age, which was initially apparent in middle age. Several characteristics of participants and MIP technique influence values in healthy individuals. The present meta-analysis provides normative MIP values that are reflective of a large sample (n=840) and likely represents the broadest representation of participant characteristics compared with previous reports of normative data.

Effects of respiratory muscle training (RMT) in children with infantile-onset Pompe disease and respiratory muscle weakness.

Respiratory muscle weakness is a primary therapeutic challenge for patients with infantile Pompe disease. We previously described the clinical implementation of a respiratory muscle training (RMT) regimen in two adults with late-onset Pompe disease; both demonstrated marked increases in inspiratory and expiratory muscle strength in response to RMT. However, the use of RMT in pediatric survivors of infantile Pompe disease has not been previously reported. We report the effects of an intensive RMT program on maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) using A-B-A (baseline-treatment-posttest) single subject experimental design in two pediatric survivors of infantile Pompe disease. Both subjects had persistent respiratory muscle weakness despite long-term treatment with alglucosidase alfa. Subject 1 demonstrated negligible to modest increases in MIP/MEP (6% increase in MIP, d=0.25; 19% increase in MEP, d=0.87), while Subject 2 demonstrated very large increases in MIP/MEP (45% increase in MIP, d=2.38; 81% increase in MEP, d=4.31). Following three-month RMT withdrawal, both subjects maintained these strength increases and demonstrated maximal MIP and MEP values at follow-up. Intensive RMT may be a beneficial treatment for respiratory muscle weakness in pediatric survivors of infantile Pompe disease.

Predictive equations for respiratory muscle strength according to international and Brazilian guidelines.

Background: The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT). Objective:To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT. Method:We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect. Results:We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%. Conclusion: In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population.

Effect of thyroid function on COPD exacerbation frequency: a preliminary study

Background: Frequent exacerbations of chronic obstructive pulmonary disease (COPD) have negative effects on quality of life and survival. Thus, factors related to exacerbations should be determined. We aimed to evaluate the effects of thyroid function on quality of life and exacerbation frequency in COPD patients. Methods: The study population (n = 128) was divided into 3 groups (Group 1: COPD patients with hypothyroidism (n = 44); Group 2: COPD patients with normal thyroid function tests (n = 44); Group 3: Healthy subjects (n = 40)). Pulmonary function tests, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measurements were performed. Quality of life questionnaire (Short Form 36, SF-36) was carried out. Patients were followed up for one year and number of exacerbations was recorded. Results: FVC, FEV1/FVC, and FEF 25–75% measurements were statistically different between group 1 and 2 (p = 0.041, p = 0.001, p = 0.009 respectively). Although MEP values were significantly different between group 1 and 2 (p = 0.006), there was no significant difference in MIP values between groups (p = 0.77). Quality of life scores in group 1 and 2 were significantly lower than control group. Exacerbation frequency was significantly higher in group 1 than in group 2 (p = 0.017). TSH values and exacerbation frequency had positive correlation (p &lt; 0.0001; r = 0.82). Conclusions: The results of the present study suggest that thyroid function has an effect in exacerbation frequency of COPD. Decrease in exacerbation numbers with early detection of impairment in thyroid function will have positive contribution on quality of life in COPD patients.

Effect of thyroid function on COPD exacerbation frequency: a preliminary study

BackgroundFrequent exacerbations of chronic obstructive pulmonary disease (COPD) have negative effects on quality of life and survival. Thus, factors related to exacerbations should be determined. We aimed to evaluate the effects of thyroid function on quality of life and exacerbation frequency in COPD patients.MethodsThe study population (n = 128) was divided into 3 groups (Group 1: COPD patients with hypothyroidism (n = 44); Group 2: COPD patients with normal thyroid function tests (n = 44); Group 3: Healthy subjects (n = 40)). Pulmonary function tests, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measurements were performed. Quality of life questionnaire (Short Form 36, SF-36) was carried out. Patients were followed up for one year and number of exacerbations was recorded.ResultsFVC, FEV1/FVC, and FEF 25–75% measurements were statistically different between group 1 and 2 (p = 0.041, p = 0.001, p = 0.009 respectively). Although MEP values were significantly different between group 1 and 2 (p = 0.006), there was no significant difference in MIP values between groups (p = 0.77). Quality of life scores in group 1 and 2 were significantly lower than control group. Exacerbation frequency was significantly higher in group 1 than in group 2 (p = 0.017). TSH values and exacerbation frequency had positive correlation (p < 0.0001; r = 0.82).ConclusionsThe results of the present study suggest that thyroid function has an effect in exacerbation frequency of COPD. Decrease in exacerbation numbers with early detection of impairment in thyroid function will have positive contribution on quality of life in COPD patients.