Activity of latissimus dorsi muscle during inspiratory threshold loads

Orozco-Levi, Mauricio; Gea, J; Monells, J.; Arán, X.; Aguar, María Carmen; Broquetas, J.M.

doi:10.1183/09031936.95.08030441

Cited by 30 publications

(9 citation statements)

References 7 publications

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“…Located in the posterior region of the thorax, this muscle participates fundamentally in the adduction of the arm. In contrast, electrophysiological [59] and structural [60] studies demonstrate that this muscle participates in the ventilatory efforts in healthy and COPD patients. Activation of the muscle linearly increases in the face of inspiratory loads.…”

Section: Adaptive Changes In the Latissimus Dorsi Musclementioning

confidence: 87%

Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation?: Fig. 1.—

Orozco-Levi¹

2003

Eur Respir J

131

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Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation?. M. Orozco-Levi. #ERS Journals Ltd 2003. ABSTRACT: Respiratory muscles are essential to alveolar ventilation. These muscles work against increased mechanical loads due to airflow limitation and geometrical changes of the thorax derived from pulmonary hyperinflation. Respiratory muscle fibres show several degrees of impairment in cellular and subcellular structures which, in many cases, are proportional to the severity of the disease and accompanying conditions (ageing, deconditioning, starvation, comorbidity). This structural impairment translates, from the functional point of view, to a loss of strength (capacity to generate tension) and an increased susceptibility to failure in the face of a particular load (early onset of fatigue).On the other hand, there is accumulating evidence that the diaphragm and other respiratory muscles are also able to express adaptive changes in response to the chronic mechanical load imposed by the disease. In most cases, impairment and adaptation of the respiratory muscles reaches a balance that permits enough ventilation for patients9 survival. However, this balance can be altered for additional increments of the mechanical or metabolic load on the muscles (e.g. abdominal or thoracic surgeries, pneumonia, pulmonary embolism, etc.). Moreover, loss of balance is not always associated with extreme situations. Many patients develop ventilatory failure and require hospital admission even if the cause of the exacerbation is less dramatic (bronchial infections, pain of any nature, electrolyte disturbances, etc.).Although the physiopathology of chronic obstructive pulmonary disease exacerbations is multifactorial, the above-mentioned fragility suggests the existence of a "fragile balance" between respiratory muscle overload and respiratory muscle adaptations. Assessment of respiratory muscle function through specific tests evaluating the strength and endurance could offer valuable information about this particular susceptibility to muscle imbalance. Identification of patients possessing a fragile respiratory muscle balance could have important implications for the application of specific strategies such as respiratory muscle training, nutrition, or anabolic treatment. Dyspnoea, decrease of exercise capacity and impairment of quality of life are common in patients with chronic obstructive pulmonary disease (COPD). Recently, it has been demonstrated that the decrease in exercise capacity is associated with mortality of these patients. Depending on the individual, the imbalance between the functional capacity of the respiratory muscles and the load they are chronically facing plays an important role in the genesis of dyspnoea [1] and hypercapnia [2,3]. It has also been described that respiratory muscle dysfunction could be an important determinant of increased use of health resources and survival in hospitalised patients with severe COPD [4][5][6][7][8][9].Respiratory muscles are skeletal musc...

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Section: Adaptive Changes In the Latissimus Dorsi Musclementioning

confidence: 87%

Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation?: Fig. 1.—

Orozco-Levi¹

2003

Eur Respir J

131

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“…The most important expiratory muscles are those located in the abdominal wall and the internal intercostals (6,7). In addition, many other muscles of the upper chest and shoulder girdle can also contribute to the breathing effort (6,10,11). In turn, limb muscles are essential for ambulation and other important activities of daily life, and therefore, their functional loss will entail significant limitations to patient physical activity and social life, impacting negatively on quality of life (5,6).…”

Section: Respiratory and Limb Muscle Dysfunctionmentioning

confidence: 99%

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

et al. 2016

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Muscle dysfunction is frequently observed in chronic obstructive pulmonary disease (COPD) patients, contributing to their exercise limitation and a worsening prognosis. The main factor leading to limb muscle dysfunction is deconditioning, whereas respiratory muscle dysfunction is mostly the result of pulmonary hyperinflation. However, both limb and respiratory muscles are also influenced by other negative factors, including smoking, systemic inflammation, nutritional abnormalities, exacerbations and some drugs. Limb muscle weakness is generally diagnosed through voluntary isometric maneuvers such as handgrip or quadriceps muscle contraction (dynamometry); while respiratory muscle loss of strength is usually recognized through a decrease in maximal static pressures measured at the mouth. Both types of measurements have validated reference values. Respiratory muscle strength can also be evaluated determining esophageal, gastric and transdiaphragmatic maximal pressures although there is a lack of widely accepted reference equations. Non-volitional maneuvers, obtained through electrical or magnetic stimulation, can be employed in patients unable to cooperate. Muscle endurance can also be assessed, generally using repeated submaximal maneuvers until exhaustion, but no validated reference values are available yet. The treatment of muscle dysfunction is multidimensional and includes improvement in lifestyle habits (smoking abstinence, healthy diet and a good level of physical activity, preferably outside), nutritional measures (diet supplements and occasionally, anabolic drugs), and different modalities of general and muscle training.

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“…Therefore, these changes occurring in the diaphragm and the external intercostal muscles, which can be seen as both opposite and complementary, can supply the system with additional strength and endurance in order more effectively to deal with harmful geometrical conditions and increases in respiratory loads. Other contractile elements occasionally contributing to the respiratory effort, such as latissimus dorsi (Orozco-Levi, 1995a), also show signs of remodelling in COPD patients (Orozco-Levi, 1995b).…”

Section: Copdmentioning

confidence: 99%