Chronic Exertional Dyspnea and Respiratory Muscle Function in Patients with Chronic Obstructive Pulmonary Disease

Ferrari, Katia; Goti, P; Misuri, Gianni; Amendola, Marco A.; Rosi, Elisabetta; Grazzini, M; Iandelli, Iacopo; Duranti, Roberto; Scano, Giorgio

doi:10.1007/pl00007577

Cited by 22 publications

(16 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there are several reports showing that ExM strength can be impaired in COPD, [24][25][26][27] it is still unclear whether or not this is associated with an impairment in their endurance, and under which circumstances this may occur. This study shows that the endurance of ExM is significantly decreased in patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

Expiratory muscle endurance in chronic obstructive pulmonary disease

Ramírez-Sarmiento

Orozco-Levi

Barreiro

et al. 2002

Thorax

View full text Add to dashboard Cite

Background: A reduction in expiratory muscle (ExM) endurance in patients with chronic obstructive pulmonary disease (COPD) may have clinically relevant implications. This study was carried out to evaluate ExM endurance in patients with COPD. Methods: Twenty three patients with COPD (FEV 1 35 (14)% predicted) and 14 matched controls were studied. ExM endurance was assessed using a method based on the use of an expiratory threshold valve which includes two steps. In step 1 the load is progressively increased (50 g every 2 minutes) until task failure is reached, and the pressure generated against the highest tolerated load is defined as the maximal expiratory sustainable pressure (Pthmax). In step 2 subjects breathe against a submaximal constant load (80% of Pthmax) and the time elapsed until task failure is termed the expiratory endurance time (Tth 80 ). In addition, the strength of peripheral muscles (handgrip, HGS) and respiratory muscles (maximal inspiratory and expiratory pressures, PImax and PEmax, respectively) was evaluated. Results: Patients with COPD had lower ExM strength and endurance than controls: PEmax 64 (19)% predicted v 84 (14)% predicted (mean difference 20%; 95% confidence intervals (CI) 14 to 39); Pthmax 52 (27) v 151 (46) cm H 2 O (mean difference 99, 95% CI 74 to 123); and Tth 80 9.4 (6.3) v 14.2 (7.4) min (mean difference 4.8, 95% CI 1.0 to 10.4; p<0.01 for all). Interestingly, ExM endurance directly correlated with both the severity of airways obstruction (Pthmax with FEV 1 , r=0.794, p<0.01) and the reduction in strength observed in different muscle groups (Pthmax with HG, PImax or PEmax, r=0.550, p<0.05; r=0.583, p<0.001; and r=0.584, p<0.001, respectively). Conclusions: ExM endurance is decreased in patients with COPD. This impairment is proportional to the severity of the disease and is associated with lower strength in different muscle groups. This suggests that systemic effects are implicated in the impairment observed in ExM function.

show abstract

Section: Discussionmentioning

confidence: 99%

Expiratory muscle endurance in chronic obstructive pulmonary disease

Ramírez-Sarmiento

Orozco-Levi

Barreiro

et al. 2002

Thorax

View full text Add to dashboard Cite

show abstract

“…Change in each component scores from ‐3 (major deterioration) to +3 (major improvement); a TDI focal score is obtained by adding scores for each of the three components (range ‐9– +9). Italian translations of BDI and TDI were administered [25, 26]. Subjective rating of dyspnoea was scored using a visual analogue scale (VAS) [25].…”

Section: Methodsmentioning

confidence: 99%

Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction

Foglio¹,

Bianchi²,

Bruletti³

et al. 1999

Eur Respir J

173

106

View full text Add to dashboard Cite

The aim of this study was to evaluate the long-term outcome of an outpatient pulmonary rehabilitation programme (PRP) in patients with chronic airway obstruction (CAO).In 61 CAO patients (35 asthmatics and 26 chronic obstructive pulmonary disease (COPD)) lung and respiratory muscle function, exercise tolerance (by symptom limited cycloergometer and walking tests), dyspnoea (Borg scale, visual analogue scale (VAS), baseline and transitional dyspnoea index (BDI and TDI, respectively)) and quality of life (St George's Respiratory Questionnaire (SGRQ)) were assessed at baseline (t0), at discharge (t1) and 12 months postdischarge (t2). Preprogramme and postprogramme hospital admissions and exacerbations of disease were also recorded.In comparison with baseline, no significant change was observed in lung function tests in either diagnostic group, either at t1 or at t2. In both groups improvements in respiratory muscle strength, exercise tolerance, Borg scale and VAS reported at t1 were partially reduced at t2. Analysis of variance showed that these changes over time were similar in the two groups. Mean values of SGRQ and BDI/TDI improved at t1, and, unlike exercise tolerance, did not worsen at t2. However, a clinically relevant difference in SGRQ between t2 and t0 was reported only in 56% of asthmatics and 52% of COPD patients. Compared with the preceding 2 yrs, in the year following PRP, hospital admissions and disease exacerbations decreased significantly in both diagnostic groups.Regardless of diagnosis, patients with chronic airway obstruction who underwent an outpatient pulmonary rehabilitation programme maintained an improved quality of life 12 months postdischarge despite a partial loss of the improvement in exercise tolerance. Eur Respir J 1999; 13: 125±132.

show abstract

“…Previous studies of expiratory muscle strength in COPD Several previous studies have measured expiratory muscle strength in COPD, [7][8][9][10][11][12][13][14][15][16][17] but no consensus has been reached over whether weakness is present. Some investigators have described significant expiratory muscle weakness, 8-10 13-16 whereas others have shown normal strength 11 17 or, indeed, increased strength.…”

Section: Patient Selectionmentioning

confidence: 99%

“…6 Hence, evidence of abdominal muscle weakness in conjunction with quadriceps weakness would support the hypothesis that systemic factors are important in causing weakness, whereas preserved abdominal muscle strength would by inference support the notion that reduced use is a necessary condition for the development of quadriceps weakness. Several previous studies have measured expiratory muscle strength in COPD, [7][8][9][10][11][12][13][14][15][16][17] but there is no consensus over whether weakness is present, and few have simultaneously measured quadriceps strength. The differences between studies may reflect patient selection and the matching of appropriate control groups.…”

mentioning

confidence: 99%

Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

Man

Hopkinson²,

Harraf³

et al. 2005

Thorax

View full text Add to dashboard Cite

Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and fibre type distribution to the quadriceps, although they remain active in COPD. Cough gastric pressure is a recently described technique that assesses abdominal muscle (and hence expiratory muscle) strength more accurately than traditional techniques. A study was undertaken to test the hypothesis that more severe weakness exists in the quadriceps than in the abdominal muscles of patients with COPD compared with healthy elderly controls. Methods: Maximum cough gastric pressure and quadriceps isometric strength were measured in 43 patients with stable COPD and 25 healthy elderly volunteers matched for anthropometric variables. Results: Despite a significant reduction in mean quadriceps strength (29.9 kg v 41.2 kg; 95% CI 217.9 to 24.6; p = 0.001), cough gastric pressure was preserved in patients with COPD (227.3 cm H 2 O v 204.8 cm H 2 O; 95% CI 25.4 to 50.6; p = 0.11). Conclusions: Abdominal muscle strength is preserved in stable COPD outpatients in the presence of quadriceps weakness. This suggests that anatomical location and fibre type cannot explain quadriceps weakness in COPD. By inference, we conclude that disuse and consequent deconditioning are important factors in the development of quadriceps muscle weakness in COPD patients, or that activity protects the abdominal muscles from possible systemic myopathic processes.

show abstract

Chronic Exertional Dyspnea and Respiratory Muscle Function in Patients with Chronic Obstructive Pulmonary Disease

Cited by 22 publications

References 23 publications

Expiratory muscle endurance in chronic obstructive pulmonary disease

Expiratory muscle endurance in chronic obstructive pulmonary disease

Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction

Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

Contact Info

Product

Resources

About