Evaluation of respiratory muscle strength in mouth breathers: clinical evidences.
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ABSTRACT:
SUBMITTER: Andrade da Cunha R
PROVIDER: S-EPMC4297026 | biostudies-other | 2014 Jul
REPOSITORIES: biostudies-other
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Project description:ObjectiveTo investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population.MethodsA randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up.ImpactThe results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice.Trial registrationNCT05608941. Registered on November 8, 2022.
| S-EPMC10490961 | biostudies-literature
Project description:BackgroundLittle is known about the response of the equine respiratory muscles to training.ObjectivesTo measure an index of inspiratory muscle strength (IMSi) before and after a period of conventional exercise training (phase 1) and inspiratory muscle training (IMT), comparing high-load (treatment) and low-load (control) groups (phase 2).Study designProspective randomised controlled trial.MethodsPhase 1: Twenty National Hunt Thoroughbred racehorses performed an inspiratory muscle strength test (IMST) twice on two occasions; when unfit at timepoint A (July), and when race fit at timepoint B (October). Phase 2: Thirty-five Thoroughbred racehorses at race fitness were randomly assigned into a high-load (treatment, n = 20) or low-load (control, n = 15) IMT group. The high-load group followed an IMT protocol that gradually increased the inspiratory pressure applied every 4 days. The low-load group underwent sham IMT with a low training load. The IMT was performed 5 days/week for 10 weeks. The IMST was performed twice on two occasions, timepoint B (October) and timepoint C (January). Conventional exercise training and racing continued during the study period. The peak IMSi values obtained from the different groups at timepoints A, B and C were compared using a Wilcoxon Signed Rank Test.ResultsPhase 1: There was a significant increase in IMSi from timepoint A: 22.5 cmH2 O (21-25) to timepoint B: 26 cmH2 O (24-30) (p = 0.015). Phase 2: From timepoint B to C there was a significant increase in IMSi for the high-load group 34 cmH2 O (28-36) (p = 0.001) but not the low-load group 26 cmH2 O (24-30) (p = 0.929). The peak IMSi at timepoint C was significantly higher for the high-load than low-load group (p = 0.019).Main limitationsSingle centre study with only National Hunt horses undergoing race-training included.ConclusionsIn horses undergoing race training there is a significant increase in IMSi in response to conventional exercise training and high-load IMT.
| S-EPMC10084158 | biostudies-literature
Project description:Background and purposeEvaluating respiratory function is important in neuromuscular diseases. This study explored the reference ranges of the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) in healthy adults, and applied them to amyotrophic lateral sclerosis (ALS) patients.MethodsMIP, MEP, and SNIP were measured in 67 healthy volunteers aged from 21 to 82 years. Reference ranges were evaluated by multivariate regression analysis using the generalized additive modeling of location, scale, and shape method. Thirty-six ALS patients were reviewed retrospectively, and abnormal values of MIP, MEP, and SNIP were determined according to the reference ranges.ResultsMIP, MEP, and SNIP were abnormal in 57.1%, 51.4%, and 25.7% of the ALS patients, respectively. MIP and SNIP were significantly correlated with the degree of restrictive pattern and respiratory symptoms. The ALS Functional Rating Scale-Revised score was correlated with SNIP.ConclusionsThis study has provided the reference range of respiratory muscle strength in healthy adults. This range is suitable for evaluating respiratory function in ALS patients.
| S-EPMC4960222 | biostudies-literature
Project description:BackgroundBerardinelli-Seip Congenital Generalized Lipodystrophy (BSCL) is an ultra-rare metabolic disease characterized by hypertriglyceridemia, hyperinsulinemia, hyperglycemia, hypoleptinemia, and diabetes mellitus. Although cardiovascular disturbances have been observed in BSCL patients, there are no studies regarding the Respiratory Muscle Strength (RMS) in this type of lipodystrophy. This study aimed to evaluate RMS in BSCL subjects compared with healthy subjects.MethodsEleven individuals with BSCL and 11 healthy subjects matched for age and gender were included in this study. The Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), and Peripheral Muscle Strength (PMS) were measured for three consecutive years. BSCL subjects were compared to healthy individuals for MIP, MEP, and PMS. Correlations between PMS and MIP were also analyzed. The genetic diagnosis was performed, and sociodemographic and anthropometric data were also collected.ResultsBSCL subjects showed significantly lower values for MIP and MEP (p < 0.0001 and p = 0.0002, respectively) in comparison to healthy subjects, but no changes in handgrip strength (p = 0.15). Additionally, we did not observe changes in MIP, MEP, and PMS two years after the first analysis, showing maintenance of respiratory dysfunction in BSCL subjects (p = 0.05; p = 0.45; p = 0.99). PMS and MIP were not correlated in these subjects (r = 0.56; p = 0.18).ConclusionBSCL subjects showed lower respiratory muscle strength when compared with healthy subjects; however, PMS was not altered. These findings were maintained at similar levels during the two years of evaluation. Our data reveal the first association of BSCL with the development of respiratory muscle weakness.
| S-EPMC6134719 | biostudies-literature
Project description:BackgroundIn patients with multiple sclerosis (MS), there is a decline in muscle strength and physical capacity due to demyelination and axonal loss in the central nervous system. In patients with advanced MS or in a later stage of the disease, also respiratory impairment may occur. The degree of pulmonary dysfunction in the earlier stages of MS has not been thoroughly described. Therefore, the primary aims of this study are to describe pulmonary function and respiratory muscle strength in patients with a moderate disease course and to identify associations between respiratory muscle strength and functional capacity.MethodsA sample of 48 patients with a diagnosis of MS and mean age 56 ± 11 years was studied using a descriptive cross-sectional design. The patients had a disease duration of 24 ± 11 years and a median Expanded Disability Status Scale (EDSS) score of 4.5 (interquartile range 4.0-6.5). Pulmonary function assessed by spirometry, respiratory muscle strength, peak cough flow and peripheral oxygen saturation, subjective breathing and coughing ability, and physical capacity measured using the 6MWT were evaluated.ResultsThe patients had normal pulmonary function with no significant abnormalities in dynamic spirometry (vital capacity 103 ± 16% predicted, forced expiratory volume in 1 second 95 ± 15% predicted). Peak expiratory flow rate 89 ± 17% predicted was in the lower limit of normal. Respiratory muscle strength, determined by maximal inspiratory (MIP) and expiratory (MEP) static pressures, was normal but with large differences between individuals. MIP ranged from 26 to 143 cmH2O (98 ± 31% predicted); the MEP values ranged from 43 to 166 cmH2O (104 ± 29% predicted), with two patients having values below the lower limit of normal. Significant positive associations between MIP as well as MEP were found in several pulmonary function variables. A significant negative association was found between EDSS score and MEP (r = -0.312, p = 0.031). Mean peak cough flow was 389 ± 70 L/min, which is comparable with the values reported for healthy adults. The patients did not experience a severely decreased ability to take deep breaths or cough. There was a moderate correlation between MEP and physical capacity, as assessed by the 6MWT (r = 0.399, p = 0.010) and between peak expiratory flow (PEF) and the 6MWT (r = 0.311, p = 0.048).ConclusionRespiratory muscle strength, pulmonary function assessed by spirometry, and peak cough flow were normal in patients with mild to moderate MS; however, there were large individual differences demonstrating low respiratory muscle strength in some patients. Significant associations between MEP and functional capacity and between MEP and disease severity were found, indicating that patients with impaired respiratory muscle strength have lower functional capacity and more severe disease.
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Project description:OBJECTIVE:Respiratory muscle weakness frequently develops during mechanical ventilation, although in children there are limited data about its prevalence and whether it is associated with extubation outcomes. We sought to identify risk factors for pediatric extubation failure, with specific attention to respiratory muscle strength. DESIGN:Secondary analysis of prospectively collected data. SETTING:Tertiary care PICU. PATIENTS:Four hundred nine mechanically ventilated children. INTERVENTIONS:Respiratory measurements using esophageal manometry and respiratory inductance plethysmography were made preextubation during airway occlusion and on continuous positive airway pressure of 5 and pressure support of 10 above positive end-expiratory pressure 5?cm H2O, as well as 5 and 60 minutes postextubation. MEASUREMENTS AND MAIN RESULTS:Thirty-four patients (8.3%) were reintubated within 48 hours of extubation. Reintubation risk factors included lower maximum airway pressure during airway occlusion (aPiMax) preextubation, longer length of ventilation, postextubation upper airway obstruction, high respiratory effort postextubation (pressure rate product, pressure time product, tension time index), and high postextubation phase angle. Nearly 35% of children had diminished respiratory muscle strength (aPiMax ? 30 cm H2O) at the time of extubation, and were nearly three times more likely to be reintubated than those with preserved strength (aPiMax > 30 cm H2O; 14% vs 5.5%; p = 0.006). Reintubation rates exceeded 20% when children with low aPiMax had moderately elevated effort after extubation (pressure rate product > 500), whereas children with preserved aPiMax had reintubation rates greater than 20% only when postextubation effort was very high (pressure rate product > 1,000). When children developed postextubation upper airway obstruction, reintubation rates were 47.4% for those with low aPiMax compared to 15.4% for those with preserved aPiMax (p = 0.02). Multivariable risk factors for reintubation included acute neurologic disease, lower aPiMax, postextubation upper airway obstruction, higher preextubation positive end-expiratory pressure, higher postextubation pressure rate product, and lower height. CONCLUSIONS:Neuromuscular weakness at the time of extubation was common in children and was independently associated with reintubation, particularly when postextubation effort was high.
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Project description:Temporal muscle thickness (TMT) was investigated as a novel surrogate marker on MRI examinations of the brain, to detect patients who may be at risk for sarcopenia. TMT was analyzed in a retrospective, normal collective cohort (n = 624), to establish standard reference values. These reference values were correlated with grip strength measurements and body mass index (BMI) in 422 healthy volunteers and validated in a prospective cohort (n = 130) of patients with various neurological disorders. Pearson correlation revealed a strong association between TMT and grip strength (retrospective cohort, ? = 0.746; p < 0.001; prospective cohort, ? = 0.649; p < 0.001). A low or no association was found between TMT and age (retrospective cohort, R2 correlation coefficient 0.20; p < 0.001; prospective cohort, ? = -0.199; p = 0.023), or BMI (retrospective cohort, ? = 0.116; p = 0.042; prospective cohort, ? = 0.227; p = 0.009), respectively. Male patients with temporal wasting and unintended weight loss, respectively, showed significantly lower TMT values (p = 0.04 and p = 0.015, unpaired t-test). TMT showed a high correlation with muscle strength in healthy individuals and in patients with various neurological disorders. Therefore, TMT should be integrated into the diagnostic workup of neurological patients, to prevent, delay, or treat sarcopenia.
| S-EPMC7288067 | biostudies-literature
Project description:The striated muscles of breathing play a critical role in respiratory homeostasis governing blood oxygenation and pH regulation. Upper airway dilator and thoracic pump muscles retain a remarkable capacity for plasticity throughout life, both in health and disease states. Hypoxia, whatever the cause, is a potent driver of respiratory muscle remodeling with evidence of adaptive and maladaptive outcomes for system performance. The pattern, duration, and intensity of hypoxia are key determinants of respiratory muscle structural-, metabolic-, and functional responses and adaptation. Age and sex also influence respiratory muscle tolerance of hypoxia. Redox stress emerges as the principal protagonist driving respiratory muscle malady in rodent models of hypoxic disease. There is a growing body of evidence demonstrating that antioxidant intervention alleviates hypoxia-induced respiratory muscle dysfunction, and that N-acetyl cysteine, approved for use in humans, is highly effective in preventing hypoxia-induced respiratory muscle weakness and fatigue. We posit that oxygen homeostasis is a key driver of respiratory muscle form and function. Hypoxic stress is likely a major contributor to respiratory muscle malaise in diseases of the lungs and respiratory control network. Animal studies provide an evidence base in strong support of the need to explore adjunctive antioxidant therapies for muscle dysfunction in human respiratory disease.
| S-EPMC5529115 | biostudies-other
Project description:Background: Long-term effects of lung volume reduction surgery (LVRS) on respiratory muscle strength and effects of age, sex, and emphysema pattern on these changes are unknown. Therefore, we aimed to determine the long-term effect of LVRS on respiratory muscle strength changes in severe emphysema. Methods: The National Emphysema Treatment Trial was a prospective controlled multicentered trial, comparing LVRS to optimal medical treatment on survival and maximal exercise capacity. We examined percentage change in maximum inspiratory pressure (MIP) from baseline to 36 months follow-up to determine impact of LVRS as well as age, sex, emphysema pattern and exercise capacity on changes in MIP compared to medical treatment. Results: LVRS individuals had significantly greater increases in MIP from baseline compared to medical individuals at all follow-ups (LVRS 19.8 ± 42.3%, medical 3.2 ± 29.3%, p<0.0001, 12 months). The LVRS group had significant decreases in total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC) and RV/TLC compared to the medical arm at all follow-up periods. Males and individuals 65-70 years of age had significantly greater increases in MIP following LVRS compared to the medical arm at all follow-ups; this same relationship was seen at up to 24 months for low exercise capacity, upper lobe predominant emphysema. Conclusions: LVRS significantly increases inspiratory muscle strength up to 3 years post-operatively, with male sex, age 65-70 years and low exercise capacity, upper lobe predominant emphysema especially associated with increased MIP. Inspiratory muscle strength increases were associated with decreases in non-invasive markers of dynamic hyperinflation, suggesting that LVRS allows inspiratory muscles to return to their optimal length-tension relationship.
| S-EPMC6373585 | biostudies-literature
Project description:The purpose of this study was to evaluate the inspiratory and expiratory muscle strength of individuals affected by stroke and to compare it with the predicted values in the literature considering their corresponding age. Respiratory muscle strength was evaluated in 22 elderly people who had sequels of stroke, four with right hemiparesis, 16 with left hemiparesis and two with bilateral, of ages ranging from 34 to 82 years. The collected data were submitted to statistical analysis using a Mann-Whitney test to evaluate if there was a significant difference in the average data collected when compared with a mean of the predicted data in the literature. Fourteen men and eight women were evaluated, who obtained mean values of 71.85 cmH2O and 57.75 cmH2O, respectively, for a maximal inspiratory pressure (MIP), and when compared to the predicted values for men and women, 105.41 cmH2O (p-value 0.0019) and 80.57 cmH2O (p-value 0.00464) were significantly lower. For a maximal expiratory pressure (MEP), the mean value obtained for men was 62.28 cmH2O and 49.5 cmH2O for women, whereas the predicted values in the literature were 114.79 cmH2O (p-value < 0.0001) and 78, 46 cmH2O (p-value 0.0059), respectively. In the statistical analysis, it was possible to notice that the studied population did not reach the predicted age indexes and that there was a significant difference between the median columns. In conclusion, there is a weakness in the respiratory muscles of hemiparetic men and women due to stroke.
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