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Effects of Air Stacking Maneuver on Cough Peak Flow and Chest Wall Compartmental Volumes of Subjects With Amyotrophic Lateral Sclerosis

  • Antonio Sarmento
    Affiliations
    PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil

    PneumoCardioVascular Lab, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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  • Vanessa Resqueti
    Correspondence
    Corresponding author Vanessa Resqueti, PhD, Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Campus Universitário Lagoa Nova, Caixa Postal 1524, CEP 59072-970, Natal, Rio Grande do Norte, Brazil.
    Affiliations
    PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil

    PneumoCardioVascular Lab, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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  • Mario Dourado-Júnior
    Affiliations
    Ambulatório de Neurologia, Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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  • Lailane Saturnino
    Affiliations
    PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil

    PneumoCardioVascular Lab, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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  • Andrea Aliverti
    Affiliations
    Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, Italy
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  • Guilherme Fregonezi
    Affiliations
    PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil

    PneumoCardioVascular Lab, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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  • Armele Dornelas de Andrade
    Affiliations
    Departamento de Fisioterapia, Universidade Federal de Pernambuco, Universidade Federal do Pernambuco, Recife, Pernambuco, Brazil
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      Abstract

      Objectives

      To assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy subjects positioned at 45° body inclination.

      Design

      Cross-sectional study with a matched-pair design.

      Setting

      University hospital.

      Participants

      Persons (N=24) with ALS (n=12) and age-matched healthy subjects (n=12).

      Main Outcomes Measures

      CPF, chest wall compartmental inspiratory capacity, chest wall vital capacity, chest wall tidal volume and operational volumes, breathing pattern, and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography.

      Results

      Compared with healthy subjects, significantly lower CPF (P=.007), chest wall compartmental inspiratory capacity (P<.001), chest wall vital capacity (P<.001), and chest wall tidal volume (P<.001) were found in subjects with ALS. Immediately after air stacking, CPF (P<.001) and chest wall compartmental inspiratory capacity (P<.001) significantly increased in both groups, with values returning to basal only in healthy subjects. After air stacking, the abdominal compartment (P=.004) was determined to be responsible for the inspired volume in subjects with ALS. Significantly higher chest wall vital capacity (P=.05) was observed in subjects with ALS 5 minutes after air stacking, with the rib cage compartment (P=.049) being responsible for volume change. No differences were found in chest wall vital capacity and compartmental volumes of healthy subjects. Chest wall tidal volume (P<.001) significantly increased during the protocol in the healthy subjects, mainly because of end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume and end-expiratory volume of both groups. No significant differences were found in chest wall tidal volume, operational volume, and breathing pattern in persons with ALS.

      Conclusions

      Air stacking is effective in increasing CPF, chest wall compartmental inspiratory capacity, and chest wall vital capacity of persons with ALS with no hyperinflation. Differences in compartmental volume contributions are probably because of lung and chest wall physiological changes.

      Keywords

      List of abbreviations:

      ALS (amyotrophic lateral sclerosis), CPF (cough peak flow), CW (chest wall), FVC (forced vital capacity), IC (inspiratory capacity), OEP (optoelectronic plethysmography), RC (rib cage), VT (tidal volume)
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