Peak Flow and Peak Cough Flow in the Evaluation of Expiratory Muscle Weakness and Bulbar Impairment in Patients with Neuromuscular Disease

Suárez, Adrián A; Pessolano, Fernando Augusto; Monteiro, Sergio G; Ferreyra, Gabriela; Capria, Maria Esther; Mesa, L.; Dubrovsky, Alberto; Vito, Eduardo L De

doi:10.1097/00002060-200207000-00007

Cited by 157 publications

(126 citation statements)

References 7 publications

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“…During an effective cough, the expiratory flow rate increases and secretions in the airway are moved towards the buccal cavity 13,18,21) . Alone, isometric training of the pelvis elevator muscles is unlikely to improve cough force, since in addition to expiratory muscle strength, factors that determine cough effectiveness include: the ability to instantaneously increase intrathoracic pressure 22) ; contraction of the expiratory muscles to increase this pressure 13) ; timing of glottis opening 23) ; and bulbar function 6,20,24) .…”

Section: Discussionmentioning

confidence: 99%

The Effects of Strength Training of Pelvis Elevator Muscles on Exhalation Capacity in Healthy Men

2007

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Abstract. The effects on expiratory muscle strength and exhalation capacity of increased pelvis elevator muscles strength caused by strength training are not known. Twenty-six male students were randomized to either a training group or a control group. The training group had pelvis elevator muscles strength training twice daily for 4 weeks. At the beginning and end of the study, pelvis elevator muscle strength, maximum expiratory muscle strength (PE max ), and peak cough flow (PCF) were measured, and pulmonary function testing (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1.0 ), peak expiratory flow rate (PFR)) was performed. In the training group, significant increases were seen in pelvis elevator muscles strength, PE max , and FEV 1.0 ; no changes were seen in FVC, PFR, or PCF. No significant correlation was seen between change in pelvis elevator muscles strength and changes in exhalation capacity parameters in the training group. Strength training of the pelvis elevator muscles increases respiratory muscle strength, which would suggest that such training could increase exhalation capacity. However, the increase in pelvis elevator muscles strength that occurred as a result of training could not fully account for the changes in expiratory muscle strength or other parameters of exhalation capacity noted after training.

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Section: Discussionmentioning

confidence: 99%

The Effects of Strength Training of Pelvis Elevator Muscles on Exhalation Capacity in Healthy Men

2007

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“…If air cannot be held behind a closed glottis, then coordinating expulsion of air with a thrust from a carer is more difficult and if coordination is not ideal, the effectiveness of the assisted cough diminishes. 9,32 In a group of eight patients with neuromuscular weakness and without scoliosis, the assisted cough resulted in a PCF increase to 185l ⁄ min (93)355) from an unassisted PCF of 104l ⁄ min (43)188) p<0.01. 31 The assisted cough can also be used with air stacking techniques, where air is stacked by the use of glossopharyngeal breathing, a manual resuscitator bag, or a ventilator (non-invasive or invasive) to stack air before performing the assisted cough.…”

Section: Augmenting Expirationmentioning

confidence: 98%

“…3 Cough is a major mechanism used to expel secretions from the airways. [9][10][11] The muscles of inspiration and expiration are required to generate an effective cough. 1,4,8,9 Neuromuscular disorders involving the thoracic cage lead to a reduction in chest wall muscle contraction.…”

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confidence: 99%

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Airway clearance in neuromuscular weakness

Gauld

2009

Developmental Medicine &Amp; Child Neurology

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FVC Forced vital capacity IVC Inspiratory vital capacity PCF Peak cough flowImpaired airway clearance leads to recurrent chest infections and respiratory deterioration in neuromuscular weakness. It is frequently the cause of death. Cough is the major mechanism of airway clearance. Cough has several components, and assessment tools are available to measure the different components of cough. These include measuring peak cough flow, respiratory muscle strength, and inspiratory capacity. Each is useful in assessing the ability to generate an effective cough, and can be used to guide when techniques of assisting airway clearance may be effective for the individual and which are most effective. Techniques to assist airway clearance include augmenting inspiration by air stacking, augmenting expiration by assisting the cough, and augmenting both inspiration and expiration with the mechanical insufflator-exsufflator or by direct suctioning via a tracheostomy. Physiotherapists are invaluable in assisting airway clearance, and in teaching patients and their families how to use these techniques. Use of the mechanical insufflator-exsufflator has gained popularity in recent times, but several simpler, more economical methods are available to assist airway clearance that can be used effectively alone or in combination. This review examines the literature available on the assessment and management of impaired airway clearance in neuromuscular weakness.

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“…Patients with a peak cough flow < 180 L/min are unable to independently clear secretions (Bach, 1995). In myasthenics, peak cough flow has been shown to be useful in monitoring expiratory muscle strength (Suárez et al, 2002;Wilson et al, 2005). It must be realized that although this test indicates expiratory muscle performance the pressure and force generated depends on lung volumes and coordinated bulbar function to rapidly open and close the glottis during cough pressure generation and release.…”

Section: Peak Cough Flowmentioning

confidence: 99%

Respiratory Care for Myasthenic Crisis

Kuo¹,

Fan²

2012

A Look Into Myasthenia Gravis

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Peak Flow and Peak Cough Flow in the Evaluation of Expiratory Muscle Weakness and Bulbar Impairment in Patients with Neuromuscular Disease

Abstract: These results suggest that peak cough flow-peak expiratory flow is useful to monitor expiratory muscle weakness and bulbar involvement and to assess its evolution in these patients.

Cited by 157 publications

References 7 publications

The Effects of Strength Training of Pelvis Elevator Muscles on Exhalation Capacity in Healthy Men

The Effects of Strength Training of Pelvis Elevator Muscles on Exhalation Capacity in Healthy Men

Airway clearance in neuromuscular weakness

Respiratory Care for Myasthenic Crisis

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