Breathing pattern and muscle activity using different inspiratory resistance devices in children with mouth breathing syndrome

Aim The aim of this study was to evaluate the acute effects of different inspiratory resistance devices and intensity of loads via nasal airway on the breathing pattern and activity of respiratory muscles in children with mouth breathing syndrome (MBS). Methods Children with MBS were randomised into two groups based on inspiratory load intensity (20% and 40% of the maximal inspiratory pressure). These subjects were assessed during quiet breathing, breathing against inspiratory load via nasal airway and recovery. The measurements were repeated using two different devices (pressure threshold and flow resistance). Chest wall volumes and respiratory muscle activity were evaluated by optoelectronic plethysmography and surface electromyography, respectively. Results During the application of inspiratory load, there was a significant reduction in respiratory rate (p<0.04) and an increase in inspiratory time (p<0.02), total time of respiratory cycle (p<0.02), minute ventilation (p<0.03), tidal volume (p<0.01) and scalene and sternocleidomastoid muscles activity (root mean square values, p<0.01) when compared to quiet spontaneous breathing and recovery, regardless of load level or device applied. The application of inspiratory load using the flow resistance device showed an increase in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02). Conclusion For both devices, the addition of inspiratory loads using a nasal interface had a positive effect on the breathing pattern. However, the flow resistance device was more effective in generating volume and, therefore, has advantages compared to pressure threshold

Relación entre función pulmonar y calidad de vida relacionada con la salud en la miastenia gravis generalizada

Objetivo: Estudiar las alteraciones de la función pulmonar y de la calidad de vida relacionada con la salud (CVRS), así como las relaciones entre ambas áreas, en un grupo de pacientes diagnosticados de miastenia gravis generalizada. Pacientes y métodos: Se ha realizado un estudio prospectivo en 20 pacientes diagnosticados de miastenia gravis generalizada. Se evaluaron la espirometría, los volúmenes pulmonares estáticos, el patrón respiratorio, las presiones respiratorias máximas y la ventilación voluntaria máxima. La CVRS se valoró con el cuestionario general de salud SF-36. Resultados: La edad media (± desviación estándar) de los pacientes fue de 64 ± 11 años. Se clasificaron en IIa (12 pacientes) y IIb (8 pacientes). Se observaron una leve disminución de la capacidad pulmonar total (86%) y una ligera reducción de la presión inspiratoria máxima (88%) y de la ventilación voluntaria máxima (un 63% en el grupo IIb). Los dominios más afectados de la CVRS fueron los relacionados con la actividad física y la percepción general de la salud en todos los grupos, pero con mayor intensidad en el sexo femenino. Se observaron relaciones estadísticamente significativas entre las áreas de vitalidad y actividad física, la capacidad vital forzada y los volúmenes pulmonares. También se encontraron relaciones entre la presión inspiratoria máxima, la presión espiratoria máxima, la ventilación voluntaria máxima, la capacidad inspiratoria con volumen circulante y el índice volumen circulante. Conclusiones: Se observaron un patrón restrictivo muy ligero y reducción de la fuerza muscular inspiratoria. Los ámbitos de la CVRS más afectados fueron los relacionados con la actividad física y la percepción general de la salud. La afectación muscular respiratoria contribuye a una alteración en las variables de la función pulmonar y al deterioro de la calidad de vida relacionada con la salud

Effects of inspiratory load on chest wall kinematics, breathing pattern, and respiratory muscle activity of mouth-breathing children

BACKGROUND: We sought to evaluate the acute effects of different inspiratory loads using nasal and oral interfaces on the volumes of the chest wall and its compartments, breathing pattern, and respiratory muscle activation in children with mouth-breathing syndrome. METHODS: Children with mouth-breathing syndrome were randomized into 2 groups, one with an inspiratory load intensity 20% of maximum inspiratory pressure (n = 14), and the other with an inspiratory load intensity 40% of maximum inspiratory pressure (n = 15). The chest wall volumes and electromyography of sternocleidomastoid, rectus abdominis, scalene, and internal intercostal muscles were used to analyze respiration against the 2 load intensities and using 2 interfaces (ie, nasal and oral). RESULTS: A total of 72 children with mouth-breathing syndrome were recruited, and 29 were evaluated in this study. The use of inspiratory load promoted improvement in the components of the breathing pattern: breathing frequency (P =.039), inspiratory time (P =.03), and total respiratory time (P =.043); and increases in tidal volume (P <.001), end-inspiratory volume (P <.001), and electrical activity of scalene muscles and sternocleidomastoid muscles (P <.001) when compared to quiet breathing. The load imposed via a nasal interface versus an oral interface provided an increase in tidal volume (P =.030), end-inspiratory volume (P =.02), and electrical activity of scalene muscles (P <.001) and sternocleidomastoid muscles (P =.02). CONCLUSIONS: The use of acute inspiratory loads improved the breathing pattern and increased lung volume and electrical activity of inspiratory muscles. This work brings new perspective to the investigation of using nasal interfaces during the application of inspiratory loads. The nasal interface was more effective compared to the oral interface com-monly used in clinical practice

Chest wall volume and asynchrony in stroke and Parkinson’s disease subjects: A case-control study

BackgroundThe expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson's disease and post-Stroke in comparison to healthy individuals.MethodsTotal and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson's disease subjects). Post-stroke and Parkinson's disease subjects were also grouped according to the length of diagnosis.ResultsIn both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (V-RCp) volume is reduced when compared to healthy subjects (p<0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson's subjects with less than three years of diagnosis p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson's disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05).ConclusionOur study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson's disease individuals. Half of the subjects with post-Stroke and Parkinson's disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis