Bronchial Mucus Hypersecretion in Acute Quadriplegia: Macromolecular Yields and Glycoconjugate Composition

Abstract

In acute quadriplegia we have noted that about one in five patients develops unexplained production of markedly excessive and tenacious bronchial mucus. Spontaneous recovery from mucus hypersecretion usually occurs within weeks to months. Mucus samples collected from 12 patients have been found to be abnormal. Macromolecular contents of single aspirates yielded as much as 500 mg. Analytical ultracentrifuge analysis showed the mucus to contain considerable epithelial glycoprotein (GP) of typical buoyant density; its amino acid and carbohydrate compositions were characteristic of the GP from hypersecretory bronchial mucus such as in chronic bronchitis and cystic fibrosis. In five patients studied after recovery from hypersecretion, there tended to be relatively less GP. The mucus samples contained a high density glycoconjugate (GC): this had sugars of GP but also reacted positively with a monoclonal antibody to keratan sulfate. Its amino acid composition was different from that of GP: threonine was lower and glycine was higher than in GP. In mucus from one patient who died, chondroitin sulfate ABC and hyaluronic acid were identified as well. This suggests proteoglycans are involved in the pathophysiology of mucus hypersecretion. The sudden onset and spontaneous recovery of hypersecretion suggests that it is not due to gland hypertrophy. We speculate that in acute quadriplegia it is due to disturbed neuronal control of bronchial mucus gland secretion, perhaps related to initial disappearance and later reappearance of peripheral sympathetic nervous system tone.

Breathing patterns during breathing exercises in persons with tetraplegia

“…In some of the SCL patients, V T decreased gradually during the manoeuvre, indicating that IR-PEP acted restrictively on respiratory function. Earlier studies by Bhaskar et al 7 and Liaw et al 21 have shown positive effects on static lung volumes and maximum inspiratory pressure after respiratory training with resistive breathing during inspiration only, which is a different method from IR-PEP. Future studies should also involve this type of training.…”

“…6 In complete lesions above the Th6 level, the autonomic nervous system is injured, and bronchial hypersecretions occur, which further aggravates problems regarding secretions. 7 To prevent pulmonary complications such as atelectasis and pneumonia, intensive respiratory training is given routinely during the first weeks after the injury.…”

Effects of abdominal binding on breathing patterns during breathing exercises in persons with tetraplegia

“…1 Loss of innervations of abdominal and intercostal respiratory muscles in these patients causes a reduced ability to cough, hypersecretions, accumulation of secretion in the airways, which in combination with immobilisation, increases the risk of respiratory complications. 2,3 Deep breathing exercises and resistive expiratory breathing are commonly practised to prevent respiratory complications in the acute phase of SCL since they are thought to enhance mucus clearance. Although scientific evidence for such effects is essentially lacking, 4 this does not necessarily imply that such effects do not exist.…”

Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

“…The lungs in individuals with acute complete cervical SCI have decreased lung expansion, a highly impaired cough due to the weakness of expiratory muscles, impairment of the elastic recoil of the diaphragm and lung, increased secretion production due to an unopposed parasympathetic stimulation, and decreased surfactant production. 6,7 Therefore, interventions to aid secretion mobilization are crucial in preventing mucus plugging, atelectasis, pneumonia, and ventilatory failure following injury. Because the cough flow and effectiveness are greatly reduced with a cervical SCI, the ability to clear secretions is profoundly affected.…”