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      International Journal of COPD (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on pathophysiological processes underlying Chronic Obstructive Pulmonary Disease (COPD) interventions, patient focused education, and self-management protocols. Sign up for email alerts here.

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      The relationship between early reversibility test and maximal inspiratory pressure in patients with airway obstruction.

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          Abstract

          Maximal inspiratory pressure (MIP) is a marker for assessing the degree of respiratory muscle dysfunction. Muscle dysfunction represents a pathophysiological feature of chronic obstructive pulmonary disease. We aimed to determinate the MIP value in patients with airway obstruction, to evaluate the change in MIP with bronchodilator drug, and to show the relationship between the changes in MIP and disease characteristics. We evaluated 21 patients with airway obstruction at the Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun, Turkey. We performed pulmonary function tests, measurement of MIP values, and reversibility tests with salbutamol. The baseline spirometry results were: mean forced vital capacity (FVC), 3,017±1,020 mL and 75.8%±20.8%; mean forced expiratory volume in 1 second (FEV1), 1,892±701 mL and 59.2%±18.2%; FEV1/FVC, 62.9%±5.5%; peak expiratory flow, 53%±19%. The pre-bronchodilator MIP value was 62.1±36.9 cmH2O. The reversibility test was found to be positive in 61.9% of patients with salbutamol. The absolute change and percentage of change in FEV1 were 318±223 mL and 19.8%±16.7%, respectively. The MIP value was increased by 5.5 cmH2O (8.8%) and was 67.7±30.3 cmH2O after bronchodilation. There was no significant relationship between age, FEV1, reversibility, and change in MIP with bronchodilator. However, the increase in MIP with bronchodilator drug was higher in patients with low body mass index (<25 kg/m(2)). We noted a 13.1% increase in FVC, a 19.8% increase in FEV1, a 20.2% increase in peak expiratory flow, and an 8.8% increase in MIP with salbutamol. In conclusion; MIP increases with bronchodilator therapy, regardless of changes in lung function, in patients with airway obstruction. The reversibilty test can be used to evaluate change in MIP with salbutamol.

          Most cited references14

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          Skeletal muscle dysfunction in chronic obstructive pulmonary disease

          It has become increasingly recognized that skeletal muscle dysfunction is common in patients with chronic obstructive pulmonary disease (COPD). Muscle strength and endurance are decreased, whereas muscle fatigability is increased. There is a reduced proportion of type I fibers and an increase in type II fibers. Muscle atrophy occurs with a reduction in fiber cross-sectional area. Oxidative enzyme activity is decreased, and measurement of muscle bioenergetics during exercise reveals a reduced aerobic capacity. Deconditioning is probably very important mechanistically. Other mechanisms that may be of varying importance in individual patients include chronic hypercapnia and/or hypoxia, nutritional depletion, steroid usage, and oxidative stress. Potential therapies include exercise training, oxygen supplementation, nutritional repletion, and administration of anabolic hormones.
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            Assessment of respiratory muscle function and strength.

            N Syabbalo (1998)
            Measurement of respiratory muscle strength is useful in order to detect respiratory muscle weakness and to quantify its severity. In patients with severe respiratory muscle weakness, vital capacity is reduced but is a non-specific and relatively insensitive measure. Conventionally, inspiratory and expiratory muscle strength has been assessed by maximal inspiratory and expiratory mouth pressures sustained for 1 s (PImax and PEmax) during maximal static manoeuvre against a closed shutter. However, PImax and PEmax are volitional tests, and are poorly reproducible with an average coefficient of variation of 25%. The sniff manoeuvre is natural and probably easier to perform. Sniff pressure, and sniff transdiaphragmatic pressure are more reproducible and useful measure of diaphragmatic strength. Nevertheless, the sniff manoeuvre is also volition-dependent, and submaximal efforts are most likely to occur in patients who are ill or breathless. Non-volitional tests include measurements of twitch oesophageal, gastric and transdiaphragmatic pressure during bilateral electrical and magnetic phrenic nerve stimulation. Electrical phrenic nerve stimulation is technically difficult and is also uncomfortable and painful. Magnetic phrenic nerve stimulation is less painful and transdiaphragmatic pressure is reproducible in normal subjects. It is a relatively easy test that has the potential to become a widely adopted method for the assessment of diaphragm strength. The development of a technique to measure diaphragmatic sound (phonomyogram) during magnetic phrenic nerve stimulation opens the way for noninvasive assessment of diaphragmatic function.
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              Portable measurement of maximum mouth pressures.

              We have compared a small portable mouth pressure meter (MPM) to our laboratory standard (LS) pressure recording equipment in order to evaluate this new device. The mouth pressure meter measures and displays as a digital read-out peak pressure for inspiratory and expiratory efforts. It samples the signal at 16 Hz, and an integral microprocessor is programmed to determine and display the maximum pressure averaged over one second both during inspiratory and expiratory manoeuvres (PImax and PEmax, respectively). A fine bore catheter connecting the mouthpiece of the mouth pressure meter to a Validyne pressure transducer enabled simultaneous measurement of pressure, which was analysed by LabVIEW, running on a Macintosh Quadra 700 computer. We studied 13 normal subjects and 11 patients with respiratory disease. Each subject performed inspiratory and five expiratory efforts. The values displayed from the mouth pressure meter were manually recorded. The mouth pressure meter reliably and accurately measured peak pressure and maximal pressure both for inspiratory and expiratory efforts in normals and patients. The mean +/- SD difference when compared with the Validyne method was 0.19 +/- 0.12 and -0.04 +/- 0.12 kPa, for PImax and PEmax, respectively. This portable device should be useful to measure mouth pressures, not only in the routine lung function laboratory but also at the bedside and in the clinic.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                International journal of chronic obstructive pulmonary disease
                Informa UK Limited
                1178-2005
                1176-9106
                2014
                : 9
                Affiliations
                [1 ] Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey.
                [2 ] Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun, Turkey.
                [3 ] Department of Physical Therapy and Rehabilitation Clinic, Samsun Medicalpark Hospital, Samsun, Turkey.
                [4 ] Department of Pulmonary Medicine, Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey.
                [5 ] Academy of Sports, Ondokuzmayis University, Samsun, Turkey.
                Article
                copd-9-453
                10.2147/COPD.S58584
                4015719
                24833899
                e722c697-168a-4a58-9515-0fff41f5b48c
                History

                COPD,MIP,asthma,maximal inspiratory pressure,reversibility test,salbutamol

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