Abstract
Objective
To investigate whether the decrease in dyspnea in neuromuscular diseases after air
stacking (AS) occurs mostly in patients with decreased inspiratory muscle force and
ensuing chest wall restriction or heterogeneous ventilation across the lungs.
Design
Interventional, before-after study.
Setting
A neurorehabilitation inpatient and outpatient center.
Participants
Fifteen consecutive adult patients affected by neuromuscular diseases (N=15).
Interventions
AS treatment.
Main Outcome Measures
Patients had vital capacity (VC) and sniff nasal inspiratory pressure (SNIP) measured.
We measured Borg score, oxygen saturation, and ventilation heterogeneity across the
lung as estimated from the difference between respiratory resistance at 5 and 19 Hz
(R5-19) with the forced oscillation technique before and 5, 30, 60, and 120 minutes after
applying AS.
Results
Before AS, Borg score was significantly related to R5-19 (r2 0.46, P<.05) but not to VC % predicted, SNIP % predicted, and time since symptom onset. After
AS, average Borg score gradually decreased (P=.005), whereas inspiratory flow resistance at 5 Hz, R5-19, and inspiratory reactance at 5 Hz tended to improve, despite not reaching statistical
significance. The decrease in dyspnea at 60 and 120 minutes after AS significantly
correlated with baseline R5-19 (r2 0.49, P<.01 and r2 0.29, P<.05, respectively), but not with VC % predicted, SNIP % predicted, time since symptom
onset, and clinical severity score for patients affected by amyotrophic lateral sclerosis.
Conclusions
These findings suggest that dyspnea in neuromuscular diseases is related to heterogeneous
ventilation rather than inspiratory muscle force and/or lung volumes decrease. Restoring
ventilation distribution across the lungs with AS appears to improve dyspnea.
Keywords
List of Abbreviations:
ALS (amyotrophic lateral sclerosis), AS (air stacking), FOT (forced oscillation technique), SNIP (sniff nasal inspiratory pressure), VC (vital capacity), R5 (inspiratory flow resistance at 5 Hz), R19 (inspiratory flow resistance at 19 Hz), R5-19 (difference in respiratory resistance between 5 and 19 Hz), SaO2 (oxygen saturation), X5 (inspiratory reactance at 5 Hz)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 08, 2021
Accepted:
January 19,
2021
Received in revised form:
January 15,
2021
Received:
December 31,
2020
Footnotes
Disclosures: Dr Dellaca has a patent on the detection of expiratory flow limitation (EFL) by forced oscillation technique outside the submitted work. Royalties are paid to Philips Respironics and Restech srl. Dr Dellaca also has a patent on monitoring lung volume recruitment by forced oscillation technique outside the submitted work, with royalties paid to Restech and Philips. Dr Pompilio reports a financial relationship with Restech srl outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The American Congress of Rehabilitation Medicine.
