Inspiratory muscle training (IMT) with normocapnic hyperpnea improves respiratory muscle strenght and exercise performance in COPD patients.

IMT by means of normocapnic hyperventilation (NH) is effective in improving exercise endurance in healthy subjects but few data are availabale for COPD patients. We aimed to assess the effect of 4 weeks NH training by means of Spirotiger® on: Pimax, spirometry, exercise capacity (6MWD and CPET endurance), physical activity (Armband®), quality of life (St George Questionnaire) in 14 moderate/severe COPD patients (13M, 1F, age 42-80, FEV1 58.1%±6). After 1 month of weekly supervised training, the patients trained at home for 1 month: 10 minutes twice a day at a breathing rate of 28/min with a volume equal to 50% of Vital Capacity. 6 patients (42.8%) dropped out due to poor tolerance to the instrument (2), poor compliance to the training (3),excessive fatigue due to a very severe respiratory function (1). Results. Results FEV1 % FVC% Pimax (KPa) 6MWD (m) QoL (total) Endurance (min) pre 57.9±7.6 82±10 8.5±0.7 370±13 28.5±5.7 7.1±0.6 post 58.9±6.8 81.7±9.9 9.3±0.8 * 387±19 16.2±3.5 * 10.5±0.5 * * p<0.05 The ventilatory pattern shows a trend of increase in tidal volume rather than breathing rate during exercise but the values do not reach the statistical significance.We conclude that a short IMT by means of NH is effective in improving Pimax,quality of life and exercise endurance in COPD patients. The high withdrawal rate suggests that a careful recruitment of subjects in term of compliance and motivation is needed to avoid early dropout

Ventilazione ed esercizio

Relazione tra esercizio fisico e ventilazione .Descrizione del pattern ventilatorio e del lavoro della mucolatura respiratoria durante esercizio

Ventilatory pattern and oxygen saturation(SpO2) in Lowlanders (LL) and Highlanders (HL) during exercise at high altitude (HA)

none4Ventilatory response is a hallmark of HA acclimatization. We aimed to compare ventilation in LL and HL at rest and during a standardized exercise. Methods: 2 groups of healthy subjects were studied at Shigatse (4200m, Tibet) : 6 HL, M (age 17-19yrs); 6 acclimatized LL (3M,3F) (age 26-35 yrs). All were monitored by means of portable respiratory inductive plethysmography (LifeShirt, VivoMetrics, CA, USA) both at rest and during strenuous walking on a slope with a 50m difference in height. Results: Ventilatory parameters at rest, at 50% and 80% of the predicted maximal heart rate(HRmax) are reported. In HL the breathing rate( RR) was 22.4(1.3), 36.0 (2.6)*°, 47.2(3.2)* br/min; the tidal volume (TV) was 381(56), 703(104)*°, 1264(122) * mL; the ventilation (VE) was 10.1(1.2), 24.2(2.4)*° , 58.4(4.2) * L/min; SaO2% was 85.3(1.1) , 85.3(1.5) °, 81.0(1.4) *. In LL , RR was 18.4 (1,7), 24.3(2.4)*°, 35.1(1.9) * br/min; TV was 445(67), 778(129)*°, 1316(127)* mL; VE was 7.6(0.6), 17.3(2.9)*°, 44.5(3.0)* L/min; SaO2% was 83.3(0.8) ,79.9(1.1)*°, 74.6(1.5)*. HL vs LL show a significantly higher RR at each point [22.4(1.3) vs 18.4 (1,7); 36.0 (2.6) vs 24.3(2.4); 47.2(3.2) vs 35.1(1.9) p<0.01], a significantly higher VE at 80%HRmax [58.4(4.2) vs 44.5(3.0) p=0.02] and a significantly higher SaO2% during exercise (at 50% and 80% HRmax ): [ 85.3(1.5) vs 79.9(1.1); 81.0(1.4) vs 74.6(1.5) p<0.05]. The % increase in VE, RR and TV was not different in the 2 groups. We conclude that acclimatized LL and HL have the same increase in ventilation during exercise at HA but highlanders’ ventilation is characterized by higher RR in all condition and a higher VE during strenuous exercise. This different ventilatory pattern in the HL is accompanied by lower oxygen desaturation during exercise. This fact suggests the adaptation of body’s ability to cope with strenuous exercise and hypoxic stress.noneL. Pomidori; L. Bernardi; E. Paolucci ; A.CogoPomidori, Luca; L., Bernardi; Paolucci, Elisa; Cogo, Annaluis

High-Altitude Exposure Reduces Inspiratory Muscle Strength

It was the aim of the study to assess the maximal pressure generated by the inspiratory muscles (MIP) during exposure to different levels of altitude (i.e., hypobaric hypoxia). Eight low-landers (2 females and 6 males), aged 27-46 years, participated in the study. After being evaluated at sea level, the subjects spent seven days at altitudes of more than 3000 metres. On the first day, they rode in a cable car from 1200 to 3200 metres and performed the first test after 45-60 minutes rest; they then walked for two hours to a mountain refuge at 3600 metres, where they spent three nights (days 2-3); on day 4, they walked for four hours over a glacier to reach Capanna Regina Margherita (4559 m), where they spent days 5-7. MIP, flow-volume curve and SpO2% were measured at each altitude, and acute mountain sickness (Lake Louise score) was recorded. Increasing altitude led to a significant decrease in resting SpO 2% (from 98% to 80%) and MIP (from 134 to 111 cmH2O) (baseline to day 4: p < 0.05); there was an improvement in SpO2% and a slight increase in MIP during the subsequent days at the same altitude. Expiratory (but not inspiratory) flows increased, and forced vital capacity and FEF75 decreased at higher altitudes. We conclude that exposure to high altitude hypoxia reduces the strength of the respiratory muscles, as demonstrated by the reduction in MIP and the lack of an increase in peak inspiratory flows. This reduction is more marked during the first days of exposure to the same altitude, and tends to recover during the acclimatisation process

La risposta ventilatoria e le modificazioni spirometriche in alpinisti d'élite durante acclimatazione a 5200m.

Vengono descritti i risultati ottenuti nel corso di un progetto di ricerca svolto durante la spedizione italiana all'Everest ed al K2 nel 2004 in occasione del cinquantesimo anniversario della salita all'Everest. In particolare viene descritta la risposta ventilatoria degli alpinisti saliti in vetta senza ossigeno rispetto a quelli che lo hanno usato dimostrando come un respiro profondo e lento avvantaggi nell'esposizione all'ipossia. Vengono inoltre analizzati alcuni parametri respiratori che evidenziano modificazioni suggestive per la presenza di edema interstiziale che colpirebbe quindi anche gli alpinisti d'èlite ma non pregiudicherebbe la salita a quote estreme

Long-term (1-year) effects of two methods of exercise training (ET) in COPD patients

Introduction: the success of long-term ET programs resides in the integration between exercise prescription and patients' compliance with home training. Aim: to evaluate two methods to help understanding and maintaining the exercise (walking) intensity. Methods: 36 COPD patients (9F,27M) participated to the ET program (age 72 ±8; FEV1% 48±12). T0= first evaluation: 6MWD, tests on treadmill to evaluate walking distance covered in twenty minutes (20MWD) and maximal speed, monitoring of physical activity (Armband). Patients were then divided in 2 groups for the home ET program: A1= speed walking marked by a metronome; A2=covering a known distance in a fixed time. Test were repeated after 5 and 12 months (T5;T12). Control group: 23 well matched COPD not partecipating in ET (8F,15M,age 69±7,FEV1% 52±11) Results: Group A1-A2. Daily METs Physical activity > 3 METs (hours) 6MWD (m) Max speed (Km/h) 20MWD (m) A1 T0 1,22±0,13 0,39±0,38 299±87 3,7±1,1 790±292 A2 T0 1,29±0,21 0,66±0,56 261±94 3,6±1,2 726±250 A1 T5 1,31±0,16* 0,95±0,86* n.a. 4,0±1,2* 970±363* A2 T5 1,36±0,22* 1,11±0,77* n.a. 3,9±0,3 868±334* A1 T12 1,39±0,16*^ 0,96±0,64* 369±80* 4,5±1,2*^ 1028±335*^ A2 T12 1,33±0,25 0,97±0,67^ 315±92* 4,2±1,4* 840±320* * vs T0 ; ^ vs T5 Control group: no significant change.Conclusions: ET performed at a metronome-marked speed allows the patient to better understand the intensity of exercise and is more effective with time, as shown by the mantaining of higher physical activity and performance after 12 months in A1 compared to A2. ^*=p<0,0

Efficacy and tolerability of yoga breathing in COPD patients: a pilot study.

Purpose: Yoga-derived breathing has been reported to improve gas exchange in chronic heart failure patients and in subjects exposed to high altitude hypoxia. We aimed to investigate the tolerability and the effect of yoga breathing on ventilatory pattern and oxygenation in COPD patients. Methods: 11 COPD (3 females) without previous yoga practice and assuming only short acting beta2adrenergic drugs, were enrolled. Ventilatory pattern and oxygen saturation were monitored by means of inductive plethysmography during 30 minutes spontaneous breathing at rest (sb) and during a 30 minute yoga lesson (y). During the yoga lesson the patients were requested to mobilise in sequence the diaphragm, the lower chest, and the upper chest adopting a slower and deeper breathing. We evaluated: oxygen saturation (SaO2%), tidal volume (VT), minute ventilation (VE), respiratory rate (f), inspiratory time, total breath time, fractional inspiratory time, an index of thoraco-abdominal coordination and an index of rapid shallow breathing. Changes in dyspnoea during yoga lesson were assessed with the Borg scale. Results show during the yoga lesson the adoption of a deeper and slower breathing (VTsb L 0,54(0.04), VTy L 0,74(0.08)*; fsb 20.8(1.3),fy 13.8(0.2)*) and a significant improvement in SaO2% with no change in VE (SaO2%sb 91.5%(1.13), SaO2%y 93.5%(0.99)*; VEsb L/min 11.2(1.1), VEy L/min 10.2(0.9)). All the subjects reported to be comfortable during the yoga lesson with no increase in dyspnoea index. Conclusion: We conclude that short-term training in yoga is well tolerated and induces favourable respiratory changes in COPD patients

Respiratory function in subjects living in mountain villages in Nepal exposed to indoor but not traffic or industrial pollution

A risk factors for the development of COPD is exposure to the smoke of biomass fuels used to heat and cook in poorly ventilated homes. We measured respiratory function in healthy dwellers of 2 villages in the Everest region of Nepal, where indoor pollution is rampant, due to the lack of chimney, but which are free of traffic or industrial pollution. Methods: 232 subjects (80F, 152M) performed spirometry (Spirojet, GMbH, Niederlauer, D). No F smoked. 19 M (12.5%) smoked <10 packs/year. Age years FEV1/VC % pred. FEV1 %pred FEF50 %pred F (80) 36 (15-87) 102.6 (79-139) 102.5 (51-133) 91.3 (25-173) M no smokers (133) 31 (14-75) 81.4 (52-104) 97.9 (58-144) 103.7 (25-178) M smokers (19) 27.5 (16-40) 102.3 (83-128) 100.7 (82-136) 111 (64-166) Results: 17F (21.2%) and 19M (12.5%, 1 smoker) had bronchial obstruction (FEV1/VC ≤88%): 15F and 11M mild obstruction; 1M moderate; 2F, 7M moderately severe. 11F (17.5%) and 13M (9.8%) without bronchial obstruction had the typical concave shape of a mild obstructive pattern with FEF50% ≤75%.This slowing in the terminal portion of the spirogram, even when the initial part is not affected is thought to be the earliest change associated with airflow obstruction in the peripheral airways (Pellegrino et al 2005). In total, 35% of F and 21% of M show evidence of either clear or early bronchial obstruction. Conclusion: in this mountain population, living in an area free of traffic or industrial pollution, the exposure to indoor pollution, but not the smoke habit, is the main risk factor for the development of COPD. This is true especially for women who spend much of their time near a fireplace

Home-Based, Moderate-Intensity Exercise Training Using a Metronome Improves the Breathing Pattern and Oxygen Saturation During Exercise in Patients With COPD.

PURPOSE: One of the well-known but less-investigated effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is the change in breathing pattern toward a more efficient one (higher tidal volume [VT], lower breathing frequency). Evidence suggests this change can be obtained only with supervised, high-intensity exercise training (ExTr). However, some patients either do not have such programs available or are unable to exercise at higher intensity. We evaluated the effects of a 12-wk, moderate-intensity, home-monitored ExTr program using a metronome on the breathing pattern, oxygen saturation (SpO2), and dyspnea during exercise in patients with COPD. METHODS: Twenty-one patients with COPD (7 female, aged 64-85 yr) performed spirometry, incremental, and endurance walking tests (at 60% of maximal walking speed) on a treadmill before and after training. During the endurance test, patients were equipped with an instrument that continuously monitored ventilation (VE), breathing pattern, and SpO2. Patients trained at home for 12 wk, 30 min/d for at least 4 d/wk at moderate intensity. A metronome paced the walking speed. RESULTS: Sixteen patients completed the program. After training, a significant change was observed in breathing pattern (lower VE and VE/VT ratio; P < .001), a higher SpO2 (P < .001), and a lower dyspnea perception at the same work intensity (P < .01). The VE/VT ratio and SpO2 during exercise were significantly related (r = 0.56, P = .001). CONCLUSION: A change in breathing pattern towards more efficient ventilation can be obtained with a moderate, home-monitored ExTr program with a pace that is controlled by a metronome. Decreased VE/VT was associated with an improved SpO2 during exercis