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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 (FEV 1), 1,892±701 mL and 59.2%±18.2%; FEV 1/FVC, 62.9%±5.5%; peak expiratory flow, 53%±19%. The pre-bronchodilator MIP value was 62.1±36.9 cmH 2O. The reversibility test was found to be positive in 61.9% of patients with salbutamol. The absolute change and percentage of change in FEV 1 were 318±223 mL and 19.8%±16.7%, respectively. The MIP value was increased by 5.5 cmH 2O (8.8%) and was 67.7±30.3 cmH 2O after bronchodilation. There was no significant relationship between age, FEV 1, 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 FEV 1, 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.

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          Most cited references 14

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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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              Relationship between respiratory muscle strength and lean body mass in men with COPD.

              It has been suggested that low body weight may be associated with decreased respiratory muscle function in COPD, but the precise mechanism is not known. Since body compositional change inevitably accompanies body weight change, we decided to study the possible relationship between respiratory muscle strength and body composition in patients with COPD. We studied respiratory muscle strength, pulmonary function, and body composition in 24 Japanese male patients with COPD. Patients were divided into two groups according to their body weight (group A, body weight lower than 80% of ideal body weight vs group B, 80% or more) and a comparison was made together with age-matched controls (group C). Maximal inspiratory mouth pressure (PImax) and maximal expiratory mouth pressure (PEmax) were measured by a previously reported method. Body compositional analysis was performed using dual energy x-ray absorptiometry (DXA; Norland XR26). It showed significantly lower fat body mass (FAT), FAT/body weight%, and lean body mass (LEAN) in group A than those in group B. The PImax in group A was significantly lower than that in group B and C (44.2 +/- 13.8, 76.4 +/- 29.9, and 88.6 +/- 18.1 cm H2O, respectively). PEmax in group A was also significantly lower than that in group B and group C (61.9 +/- 20.1, 86.7 +/- 26.8, and 90.4 +/- 17.6 cm H2O, respectively). Both PImax and PEmax were significantly correlated with LEAN (r = 0.656, r = 0.591, p < 0.01, respectively) in patients with COPD. These results show that respiratory muscle strength is closely associated with body weight and lean body mass in patients with COPD. The present approach to compare respiratory muscle strength with lean body mass should be useful for studying the mechanism of respiratory muscle weakness in patients with COPD.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2014
                05 May 2014
                : 9
                : 453-456
                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
                Author notes
                Correspondence: Sevket Ozkaya, Samsun Medicalpark Hospital, Department of Pulmonary Medicine, Samsun, PO 55200, Turkey, Tel +90 532 474 13 09,Fax +90 362 311 40 50, Email ozkayasevket@ 123456yahoo.com
                Article
                copd-9-453
                10.2147/COPD.S58584
                4015719
                © 2014 Ozkaya et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                salbutamol, asthma, reversibility test, mip, maximal inspiratory pressure, copd

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