Advertisement

Effects of Air Stacking on Dyspnea and Lung Function in Neuromuscular Diseases

Published:March 08, 2021DOI:https://doi.org/10.1016/j.apmr.2021.01.092

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Andersen PM
        • Abrahams S
        • et al.
        • EFNS Task Force on Diagnosis and Management of Amyotrophic Lateral Sclerosis
        EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)–revised report of an EFNS task force.
        Eur J Neurol. 2012; 19: 360-375
        • Benditt JO
        • Boitano LJ.
        Pulmonary issues in patients with chronic neuromuscular disease.
        Am J Respir Crit Care Med. 2013; 187: 1046-1055
        • Chatwin M
        • Toussaint M
        • Goncalves MR
        • et al.
        Airway clearance techniques in neuromuscular disorders: a state of the art review.
        Respir Med. 2018; 136: 98-110
        • Toussaint M
        • Chatwin M
        • Gonzales J
        • et al.
        228th ENMC International Workshop: airway clearance techniques in neuromuscular disorders Naarden, The Netherlands, 3-5 March, 2017.
        Neuromuscul Disord. 2018; 28: 289-298
        • Bach JR.
        Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques.
        Chest. 1993; 104: 1553-1562
        • Sarmento A
        • Resqueti V
        • Dourado-Junior M
        • et al.
        Effects of air stacking maneuver on cough peak flow and chest wall compartmental volumes of subjects with amyotrophic lateral sclerosis.
        Arch Phys Med Rehabil. 2017; 98 (2237-46.e2231)
        • Lechtzin N
        • Shade D
        • Clawson L
        • et al.
        Supramaximal inflation improves lung compliance in subjects with amyotrophic lateral sclerosis.
        Chest. 2006; 129: 1322-1329
        • Estenne M
        • Gevenois PA
        • Kinnear W
        • et al.
        Lung volume restriction in patients with chronic respiratory muscle weakness: the role of microatelectasis.
        Thorax. 1993; 48: 698-701
        • Bellardine Black CL
        • Hoffman AM
        • Tsai LW
        • et al.
        Relationship between dynamic respiratory mechanics and disease heterogeneity in sheep lavage injury.
        Crit Care Med. 2007; 35: 870-878
        • Kaczka DW
        • Dellaca RL.
        Oscillation mechanics of the respiratory system: applications to lung disease.
        Crit Rev Biomed Eng. 2011; 39: 337-359
        • LaPrad AS
        • Lutchen KR.
        Respiratory impedance measurements for assessment of lung mechanics: focus on asthma.
        Respir Physiol Neurobiol. 2008; 163: 64-73
        • Gillis HL
        • Lutchen KR.
        Airway remodeling in asthma amplifies heterogeneities in smooth muscle shortening causing hyperresponsiveness.
        J Appl Physiol (1985). 1999; 86: 2001-2012
        • Smith HJ RP
        • Goldman MD
        Forced oscillation technique and impulse oscillometry.
        Lung Function Testing. 2005; : 72-105
        • Oostveen E
        • MacLeod D
        • Lorino H
        • et al.
        The forced oscillation technique in clinical practice: methodology, recommendations and future developments.
        Eur Respir J. 2003; 22: 1026-1041
        • Peslin R
        • Felicio da Silva J
        • Duvivier C
        • et al.
        Respiratory mechanics studied by forced oscillations during artificial ventilation.
        Eur Respir J. 1993; 6: 772-784
        • Kaczka DW
        • Hager DN
        • Hawley ML
        • et al.
        Quantifying mechanical heterogeneity in canine acute lung injury: impact of mean airway pressure.
        Anesthesiology. 2005; 103: 306-317
        • Pellegrino R
        • Gobbi A
        • Antonelli A
        • et al.
        Ventilation heterogeneity in obesity.
        J Appl Physiol (1985). 2014; 116: 1175-1181
        • Miller MR
        • Hankinson J
        • Brusasco V
        • et al.
        Standardisation of spirometry.
        Eur Respir J. 2005; 26: 319-338
        • Quanjer PH
        • Stanojevic S
        • Cole TJ
        • et al.
        Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.
        Eur Respir J. 2012; 40: 1324-1343
        • Morgan RK
        • McNally S
        • Alexander M
        • et al.
        Use of sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis.
        Am J Respir Crit Care Med. 2005; 171: 269-274
        • Gobbi A
        • Milesi I
        • Govoni L
        • Pedotti A.
        A new telemedicine system for the home monitoring of lung function in patients with obstructive respiratory diseases.
        in: 2009 International Conference on eHealth, Telemedicine, and Social Medicine. IEEE, Cancun, Mexico2009
        • Kang SW
        • Bach JR.
        Maximum insufflation capacity.
        Chest. 2000; 118: 61-65
        • Killian KJ
        • Watson R
        • Otis J
        • et al.
        Symptom perception during acute bronchoconstriction.
        Am J Respir Crit Care Med. 2000; 162: 490-496
        • Antonelli A
        • Crimi E
        • Gobbi A
        • et al.
        Mechanical correlates of dyspnea in bronchial asthma.
        Physiol Rep. 2013; 1: e00166
        • Pedersen OF
        • Ingram Jr., RH
        Configuration of maximum expiratory flow-volume curve: model experiments with physiological implications.
        J Appl Physiol (1985). 1985; 58: 1305-1313
        • Dubois AB
        • Brody AW
        • Lewis DH
        • et al.
        Oscillation mechanics of lungs and chest in man.
        J Appl Physiol. 1956; 8: 587-594
        • Lutchen KR
        • Gillis H.
        Relationship between heterogeneous changes in airway morphometry and lung resistance and elastance.
        J Appl Physiol (1985). 1997; 83: 1192-1201
        • Coleridge HM
        • Coleridge JCG.
        Reflexes evoked from tracheobronchial tree and lungs.
        in: Fishman AP Handbook of physiology, the respiratory system, mechanics of breathing;. Wiley, Bethesda1986 (p 395–429)
        • Pack AI.
        Sensory inputs to the medulla.
        Annu Rev Physiol. 1981; 43: 73-90
        • Brusasco V
        • Pellegrino R
        • Rodarte JR.
        Airway mechanics.
        Respiratory Mechanics. 1999; : 68-91