Mechanical loading and control of breathing in patients with severe chronic obstructive pulmonary disease

R. Duranti, G. Misuri, M. Gorini, P. Goti, F. Gigliotti, G. Scano

Research output: Contribution to journalArticle

Abstract

Background - High neural drive to the respiratory muscles and rapid and shallow breathing are frequently observed in patients with chronic obstructive pulmonary disease (COPD), and both mechanical and chemical factors are thought to play a part. However, the interrelation between these factors and the modifications in the control of breathing are not clearly defined. The effects of an acute decrease in mechanical load by the administration of a high dose of a β2 agonist were studied. Methods - Nine spontaneously breathing patients with severe COPD took part in the study. Criteria for entry were FEV1 of 1 of 2), end tidal carbon dioxide pressure (PETCO2), and the electrocardiogram were also monitored. Each variable was measured under control conditions and 20 and 40 minutes after the inhalation of 800 μg fenoterol. In five patients the effects of placebo were also studied. Results - Fenoterol resulted in an increase in FEV1 and decrease in FRC. SaO2 did not change, while PETCO2 fell and heart rate increased. The VT increased, and Rf decreased, PPLsw fell and PPLmax increased, thus the PPLsw/PPLmax ratio fell. Both RL and RL/PPLmax also fell, and a substantial decrease in EDI and EPS was observed. Changes in PPLsw were related to changes in FEV1 and RL. Changes in VT and Rf, and EDI/TI and EPS/TI were also related to changes in PPLsw and RL/PPLmax ratio, but not to changes in FEV1. No variation was observed with placebo. Conclusions - In patients with severe COPD a decrease in inspiratory muscle loading relative to the maximal available strength, as expressed by the RL/PPLmax and PPLsw/PPLmax ratios, appears to be the major determinant of changes in breathing pattern and inspiratory muscle activity (decrease in EMG).

Original languageEnglish
Pages (from-to)127-133
Number of pages7
JournalThorax
Volume50
Issue number2
Publication statusPublished - 1995

Keywords

  • Breathing pattern Respiratory muscles
  • Chronic obstructive pulmonary disease
  • Mechanical load

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Duranti, R., Misuri, G., Gorini, M., Goti, P., Gigliotti, F., & Scano, G. (1995). Mechanical loading and control of breathing in patients with severe chronic obstructive pulmonary disease. Thorax, 50(2), 127-133.