TY - JOUR
T1 - Effects of Air Stacking on Dyspnea and Lung Function in Neuromuscular Diseases
AU - Pellegrino, Giulia Michela
AU - Corbo, Massimo
AU - Di Marco, Fabiano
AU - Pompilio, Pasquale
AU - Dellacà, Raffaele
AU - Banfi, Paolo
AU - Pellegrino, Riccardo
AU - Sferrazza Papa, Giuseppe Francesco
N1 - Funding Information:
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.
Publisher Copyright:
© 2021
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - Cough
KW - Dyspnea
KW - Neuromuscular diseases
KW - Rehabilitation
KW - Respiratory muscles
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U2 - 10.1016/j.apmr.2021.01.092
DO - 10.1016/j.apmr.2021.01.092
M3 - Article
C2 - 33711277
AN - SCOPUS:85107052740
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
ER -