Lung hyperinflation: foe or friend?

Eichinger, Monika; Walterspacher, Stephan; Scholz, Tobias; Tetzlaff, Kay; Röcker, Kai; Cm, Muth; Puderbach, Michael; Hu, Kauczor; Sorichter, Stephan

doi:10.1183/09031936.00118807

Cited by 28 publications

(26 citation statements)

References 16 publications

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“…Indeed, maximal expiratory and inspiratory pressure did not change after any form of training (Nygren-Bonnier et al 2007b;Tetzlaff et al 2008). This was expected, as the GI maneuvers were aimed at stretching the chest wall alone (Eichinger et al 2008;Nygren-Bonnier et al 2007a, b). GI increases thoracic circumference.…”

Section: Pulmonary Volumesmentioning

confidence: 71%

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Ventilatory function in breath-hold divers: effect of glossopharyngeal insufflation

Lemaître

Clua²,

Andréani³

et al. 2009

Eur J Appl Physiol

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This study was conducted to determine whether ventilatory parameters would change in breath-hold divers (BHDs) after they performed the glossopharyngeal technique for lung insufflation. Fifteen elite BHDs, 16 non-expert BHDs and 15 control subjects participated in this cross-sectional study. Volumes and expiratory flow rates were measured twice, before and after the glossopharyngeal technique performed at rest. Before the technique, greater forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) and lower FEV(1)/FVC were noted in the elite and non-expert BHDs compared with controls. No difference was noted regarding the other pulmonary parameters. After the technique, increases were noted in FVC, FEV(1) and maximal voluntary ventilation in the elite BHDs (P < 0.001, respectively). The FEF(25-75%)/FVC ratios were lower in the BHDs both before and after the technique, indicating possible dysanapsis. The ventilatory parameters observed after the glossopharyngeal technique indicated (1) higher lung volumes in expert BHDs and (2) a correlation with BHD performance (maximal dynamic BH performance). This correlation became more significant after the technique, indicating a positive effect of glossopharyngeal insufflation on performance.

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Section: Pulmonary Volumesmentioning

confidence: 71%

“…BHDs able to insufflate large volumes thus expand the chest significantly, giving them a barrel chest appearance. It is possible that they have increased joint mobility and stretch their respiratory muscles so they can increase the chest volume to whatever is anatomically possible (Eichinger et al 2008;Whittaker and Irvin 2007). …”

Section: Pulmonary Volumesmentioning

confidence: 98%

Ventilatory function in breath-hold divers: effect of glossopharyngeal insufflation

Lemaître

Clua²,

Andréani³

et al. 2009

Eur J Appl Physiol

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“…The consistency of change is reassuring. A previous case report, based on dynamic magnetic resonance imaging, suggested that there was a symmetrical expansion in the thorax [10]. A second case report also demonstrated cardiac and vascular mediastinum configurational changes [9].…”

Section: Discussionmentioning

confidence: 84%

“…While some of this increase could be from displacement of structures within the thorax (heart, vessels or oesophagus) most of the increase may be related to the change in the configuration of the chest wall and diaphragm. Individual case reports on breath-hold divers have described pulmonary hyperinflation with cardiac compression, aortic stretch and reduction in blood flow using magnetic resonance imaging [9,10].…”

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confidence: 99%

Lung perfusion and chest wall configuration is altered by glossopharyngeal breathing

et al. 2009

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Glossopharyngeal insufflation is used by competitive breath-hold divers to increase lung gas content above baseline total lung capacity (TLC) in order improve performance. Whilst glossopharyngeal insufflation is known to induce hypotension and tachycardia, little is known about the effects on the pulmonary circulation and structural integrity of the thorax.Six male breath-hold divers were studied. Exhaled lung volumes were measured before and after glossopharyngeal insufflation. On two study days, subjects were studied in the supine position at baseline TLC and after maximal glossopharyngeal insufflation above TLC. Tc 99 m labelled macro-aggregated albumin was injected and a computed tomography (CT) scan of the thorax was performed during breath-hold. Single photon emission CT images determined flow and regional deposition. Registered CT images determined change in the volume of the thorax.CT and perfusion comparisons were possible in four subjects. Lung perfusion was markedly diminished in areas of expanded lung. 69% of the increase in expired lung volume was via thoracic expansion with a caudal displacement of the diaphragm. One subject who was not proficient at glossopharyngeal insufflation had no change in CT appearance or lung perfusion.We have demonstrated areas of hyperexpanded, under perfused lung created by glossopharyngeal insufflation above TLC.KEYWORDS: Breath-hold diving, glossopharyngeal insufflation, hyperinflation, perfusion imaging, pulmonary perfusion B reath-hold diving, or freediving, is a highly organised, increasingly popular extreme sport. Many competitive breathhold divers perform glossopharyngeal breathing both as a training exercise and just prior to a dive or submersed breath-hold. Glossopharyngeal breathing, a pump-like action involving the glossopharyngeal structures and larynx that forces air into the airways [1], was originally developed as a therapeutic technique for neuromuscular patients to help expand tidal volume and cough effectiveness [2,3]. The increase in expired lung volume above baseline total lung capacity (TLC) using glossopharyngeal breathing is achieved by a combination of an increase in the Euclidian size of the lung and gas compression [4,5]. Participants refer to this technique as lung packing; however this is described in the literature as glossopharyngeal insufflation (GI) [1,5,6].In theory, GI above TLC has the potential to assist breath-hold diving performance by increasing available oxygen stores and providing a volume buffer against the compressive effects of hyperbaria. Improvements in both static apnoea duration and breath-hold diving performance have been shown [7]. The potential for adverse cardiocirculatory effects is also clear. The extremely high transpulmonary pressures achieved, of up to 80 cmH 2 O [5], are associated with tachycardia, hypotension and biventricular systolic dysfunction [8]. In keeping with these observations, adverse neurological symptoms (e.g. presyncopal episodes and light-headedness) have been associated with this manoe...

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“…BH divers employ glossopharyngeal mus cle contractions (= glossopharyngeal pistoning; buccal pumping; lung packing) to increase the volume of air in the lungs above TLC [35]. They thereby increase the volume of gas available for pressure equalization during descent [36, 37] and enhance the amount of oxygen available in the lungs [38].…”

Section: Breathing Techniquesmentioning

confidence: 99%

Effects of Breath-Hold Deep Diving on the Pulmonary System

Schipke¹,

Lemaître²,

Cleveland³

et al. 2019

Respiration

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This short review focuses on pulmonary injury in breath-hold (BH) divers. When practicing their extreme leisure sport, they are exposed to increased pressure on pulmonary gas volumes, hypoxia, and increased partial gas pressures. Increasing ambient pressures do present a serious problem to BH deep divers, because the semi-rigid thorax prevents the deformation required by the Boyle-Mariotte law. As a result, a negative-pressure barotrauma (lung squeeze) with acute hemoptysis is not uncommon. Respiratory maneuvers such as glossopharyngeal insufflation (GI) and glossopharyngeal exsufflation (GE) are practiced to prevent lung squeeze and to permit equalizing the paranasal sinuses and the middle ear. GI not only impairs venous return, thereby provoking hypotension and even fainting, but also produces intrathoracic pressures likely to induce pulmonary barotrauma that is speculated to induce long-term injury. GE, in turn, further increases the already negative intrapulmonary pressure, thereby favoring alveolar collapse (atelectasis). Finally, hypoxia seemingly not only induces brain injury but initiates the opening of intrapulmonary shunts. These pathways are large enough to permit transpulmonary passage of venous N₂ bubbles, making stroke-like phenomena in deep BH divers possible.

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Lung hyperinflation: foe or friend?

Cited by 28 publications

References 16 publications

Ventilatory function in breath-hold divers: effect of glossopharyngeal insufflation

Ventilatory function in breath-hold divers: effect of glossopharyngeal insufflation

Lung perfusion and chest wall configuration is altered by glossopharyngeal breathing

Effects of Breath-Hold Deep Diving on the Pulmonary System

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