Expiratory Flow Limitation and Orthopnea in Massively Obese Subjects

Ferretti, Anna Maria; Giampiccolo, Pietro; Cavalli, A; Milic–Emili, J.; Tantucci, Claudio

doi:10.1378/chest.119.5.1401

Cited by 177 publications

(159 citation statements)

References 31 publications

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“…4 A decline of EELV below resting values is typical of grossly obese subjects upon assumption of the supine posture, 36 but has not been shown specifically for mild-to-moderately obese men. In the supine posture, all static mechanical forces of the rib cage and abdomen are expiratory in nature (ie, pushes the diaphragm upward) and drives EELV to its lowest static position.…”

Section: Lung Mechanics In Obese Menmentioning

confidence: 99%

Mild-to-moderate obesity: implications for respiratory mechanics at rest and during exercise in young men

2005

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OBJECTIVE:To investigate the effect of mild-to-moderate obesity on respiratory mechanics at rest and during exercise in obese men. We hypothesized that the simple mass loading of obesity would alter both end-expiratory lung volume (EELV) and respiratory pressures (gastric, P ga and transpulmonary, P TP ) in resting body positions and during graded cycle ergometry to exhaustion. SUBJECTS: A total of 10 obese (3875% body fat; mean7s.d.) and nine lean (1874%) men were studied. METHODS: Body composition (by body circumferences and hydrostatic weighing) and pulmonary function were measured at rest. Breathing mechanics were measured at rest in the upright-seated position, supine, and during cycling exercise. Data were analyzed by independent t-test. RESULTS: EELV was significantly lower in the obese men in the supine (3074 vs 3776% total lung capacity (TLC)) and seated (3976 vs 4775%TLC) positions and at ventilatory threshold (3575 vs 4577%TLC) (Po0.01). In contrast, at peak exercise, EELV was not different between groups. Respiratory pressures (P ga and P TP ) were elevated (Po0.05) during one or more phases of the breathing cycle at rest and during exercise in obese men.CONCLUSION: These data demonstrate that mild-to-moderate obesity in young men results in reduced lung volumes and alterations in respiratory mechanics when supine, seated at rest, and during exercise. During moderate exercise, obesity does not appear to limit changes in EELV; however, the regulation of EELV during heavy exercise appears to be affected.

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Section: Lung Mechanics In Obese Menmentioning

confidence: 99%

Mild-to-moderate obesity: implications for respiratory mechanics at rest and during exercise in young men

2005

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“…The decrease in FVC has been shown to be associated with a decrease in the maximal available ventilation, which is a strong predictor of dyspnoea [5]. Obesity is also known to contribute to symptoms of dyspnoea [29,30]. The increase in BMI and the reduction in FVC by enhancing respiratory limitation may thus be determinants of dyspnoea in the elderly, even in the absence of associated cardiopulmonary disease.…”

Section: Elda Groupmentioning

confidence: 99%

Expiratory flow limitation and obstruction in the elderly

Bisschop

Marty²,

Tessier³

et al. 2005

Eur Respir J

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Elderly people commonly suffer from dyspnoea, which may stem from expiratory flow limitation (EFL). The relationship between EFL, as assessed by the negative expiratory pressure method and spirometric indices, was investigated in an elderly French population. Subjects, aged 66-88 yrs, filled in socio-demographic and standardised questionnaires, which dealt with: medical history, smoking status and respiratory symptoms. EFL measurements and forced expiratory manoeuvres were performed.Validated measurements were obtained in 750 out of 1,318 subjects: 47% were EFL+ (EFL .0), with a higher prevalence in females than in males. EFL and forced expiratory volume in one second (FEV1) were correlated with age. A total of 116, from the 750 subjects, with no medical history and no symptoms, served as a healthy group. The prevalence of EFL+ subjects increased with the grade of dyspnoea and was highest in respiratory and cardiac patients when compared with the healthy subjects. EFL did not correlate with FEV1/forced vital capacity (FVC), the usual index of obstruction. Some elderly subjects (15%) with dyspnoea but with no medical history, mainly females with small FVC and normal FEV1/FVC, had a greater EFL than the healthy subjects.In elderly people, expiratory flow limitation measurements, along with the usual forced expiratory volume in one second/ forced vital capacity ratio, may be of value for the interpretation of dyspnoea.

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“…In some patients with normal FEV 1 and FEV 1 /VC values, we have observed an overlap between the tidal volume expiratory flow and the maximal forced expiratory flow, a pattern that suggests expiratory flow limitation (EFL) [1]. EFL has been reported in obese patients without bronchial obstruction [2] and it is not surprising that some of our obese patients may be flow limited at rest.…”

Section: Background Aims and Methodsmentioning

confidence: 88%

“…The NEP (negative expiratory pressure) technique is widely used to diagnose EFL. It does however require a specific device, and in obese patients has some drawbacks [2,7,8]. PSCs do not require specific devices, but the patient must be very cooperative [4].…”

Section: Brief Commentmentioning

confidence: 99%