Abstract
Background: It is not known whether respiratory muscle fatigue occurs as a consequence of exercise in patients with interstitial lung disease (ILD) and, if so, to what extent it is related to changes in dynamic lung volumes. Objectives: To assess the development of respiratory muscle fatigue in patients with ILD and relate it to the respiratory pattern during exercise. Methods: Sixteen ILD patients (11 women) performed incremental, symptom-limited cycle ergometry with inspiratory capacity manoeuvres used to measure changes in end-expiratory lung volume (EELV). Twitch transdia-phragmatic pressure (TwPdi) and twitch gastric pressure (TwT10Pga), in response to magnetic stimulation, were used to assess the development of fatigue. Results: TwPdi did not differ significantly before and after exercise (21.8 ± 8 vs. 20.2 ± 8 cm H2O; p = 0.10), while TwT10Pga fell from 28.6 ± 18 to 25.2 ± 14 cm H2O (p = 0.02). EELV fell from 2.18 ± 0.65 to 1.91 ± 0.59 liters following exercise (p = 0.04). The fall in TwT10Pga correlated with peak oxygen uptake at peak of exercise (r = -0.52, p = 0.041), increase in heart rate (r = 0.53, p = 0.032) and with the decrease of EELV during exercise (r = 0.57, p = 0.021). Abdominal muscle fatiguers (n = 9, 56%), defined as having a ≥10% fall in TwT10Pga, had a fall in EELV of 22 ± 22% compared to 0.7 ± 8% in non-fatiguers (p = 0.016). Conclusion: Abdominal muscle fatigue develops during exercise in some ILD patients in association with increased expiratory muscle activity manifested by reduced EELV.
Journal Section:
Editor's choice
References
1.
Hansen JE, Wasserman K: Pathophysiology of activity limitation in patients with interstitial lung disease. Chest 1996;109:1566-1576.
[PubMed]
2.
Holland AE: Review series: aspects of interstitial lung disease: exercise limitation in interstitial lung disease - mechanisms, significance and therapeutic options. Chronic Res Dis 2010;7:101-111.
[PubMed]
3.
Holland AE, Hill CJ, Conron M, Munro P, McDonald CF: Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax 2008;63:549-554.
[PubMed]
4.
Kozu R, Senjyu H, Jenkins SC, Mukae H, Sakamoto N, Kohno S: Differences in response to pulmonary rehabilitation in idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Respiration 2011;81:196-205.
[PubMed]
5.
Baydur A, Alsalek M, Louie SG, Sharma OP: Respiratory muscle strength, lung function, and dyspnea in patients with sarcoidosis. Chest 2001;120:102-108.
[PubMed]
6.
NHLBI Workshop: Respiratory muscle fatigue. Report of the Respiratory Muscle Fatigue Workshop Group. Am Rev Respir Dis 1990;142:474-480.
[PubMed]
7.
Bellemare F, Grassino A: Effect of pressure and timing of contraction on human diaphragm fatigue. J Appl Physiol 1982;53:1190-1195.
[PubMed]
8.
Hamnegard CH, Wragg S, Kyroussis D, Mills GH, Polkey MI, Moran J, Road J, Bake B, Green M, Moxham J: Diaphragm fatigue following maximal ventilation in man. Eur Respir J 1996;9:241-247.
[PubMed]
9.
Renggli AS, Verges S, Notter DA, Spengler CM: Development of respiratory muscle contractile fatigue in the course of hyperpnoea. Respir Physiol Neurobiol 2008;164:366-372.
[PubMed]
10.
Mador MJ, Magalang UJ, Rodis A, Kufel TJ: Diaphragmatic fatigue after exercise in healthy human subjects. Am Rev Respir Dis 1993;148:1571-1575.
[PubMed]
11.
Johnson BD, Babcock MA, Suman OE, Dempsey JA: Exercise-induced diaphragmatic fatigue in healthy humans. J Physiol 1993;460:385-405.
[PubMed]
12.
Babcock MA, Pegelow DF, Johnson BD, Dempsey JA: Aerobic fitness effects on exercise-induced low-frequency diaphragm fatigue. J Appl Physiol 1996;81:2156-2164.
[PubMed]
13.
Polkey MI, Kyroussis D, Hamnegard C-H, Mills GH, Hughes PD, Green M, Moxham J: Diaphragm performance during maximal voluntary ventilation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;155:642-648.
[PubMed]
14.
Polkey MI, Kyroussis D, Keilty SEJ, Hamnegard CH, Mills GH, Green M, Moxham J: Exhaustive treadmill exercise does not reduce twitch transdiaphragmatic pressure in patients with COPD. Am J Respir Crit Care Med 1995;152:959-964.
[PubMed]
15.
Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky P, Choi YS, Tobin MJ: Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 2003;167:120-127.
[PubMed]
16.
Levine S, Kaiser L, Leferovich J, Tikunov B: Cellular adaptations in the diaphragm in chronic obstructive pulmonary disease. N Engl J Med 1997;337:1799-1806.
[PubMed]
17.
Stubbings AK, Moore AJ, Dusmet M, Goldstraw P, West TG, Polkey MI, Ferenczi MA: Physiological properties of human diaphragm muscle fibres and the effect of chronic obstructive pulmonary disease. J Physiol 2008;586:2637-2650.
[PubMed]
18.
Fitch S, McComas AJ: Influence of human muscle length on fatigue. J Physiol 1985;362:205-213.
[PubMed]
19.
Hopkinson NS, Dayer MJ, Moxham J, Polkey MI: Abdominal muscle fatigue following exercise in chronic obstructive pulmonary disease. Respir Res 2010;11:15.
[PubMed]
20.
Marciniuk DD, Sridhar G, Clemens RE, Zintel TA, Gallagher CG: Lung volumes and expiratory flow limitation during exercise in interstitial lung disease. J Appl Physiol 1994;77:963-973.
[PubMed]
21.
Bradley B, Branley HM, Egan JJ, Greaves MS, Hansell DM, Harrison NK, Hirani N, Hubbard R, Lake F, Millar AB, et al: Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 2008;63(suppl 5):v1-v58.
[PubMed]
22.
Baydur A, Pangiotis K, Behrakis K, Zin W, Milic-Emili J: A simple method of assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 1982;126:788-791.
[PubMed]
23.
Wilson SH, Cooke NT, Edwards RH, Spiro SG: Predicted normal values for maximal respiratory pressures in Caucasian adults and children. Thorax 1984;39:535-538.
[PubMed]
24.
Miller JM, Moxham J, Green M: The maximal sniff in the assessment of diaphragm function in man. Clin Sci (Lond) 1985;69:91-96.
[PubMed]
25.
Man WD, Hopkinson NS, Harraf F, Niko-letou D, Polkey MI, Moxham J: Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease. Thorax 2005;60:718-722.
[PubMed]
26.
Mills GH, Kyroussis D, Hamnegard CH, Polkey MI, Green M, Moxham J: Bilateral magnetic stimulation of the phrenic nerves from an anterolateral approach. Am J Respir Crit Care Med 1996;154:1099-1105.
[PubMed]
27.
Kyroussis D, Mills GH, Polkey MI, Hamnegard CH, Koulouris N, Green M, Moxham J: Abdominal muscle fatigue after maximal ventilation in humans. J Appl Physiol 1996;81:1477-1483.
[PubMed]
28.
Stubbing DG, Pengelly LD, Morse JL, Jones NL: Pulmonary mechanics during exercise in subjects with chronic airflow obstruction. J Appl Physiol 1980;49:511-515.
[PubMed]
29.
Duranti R, Filippelli M, Bianchi R, Roma-gnoli I, Pellegrino R, Brusasco V, Scano G: Inspiratory capacity and decrease in lung hyperinflation with albuterol in COPD. Chest 2002;122:2009-2014.
[PubMed]
30.
Reilly CC, Ward K, Jolley CJ, Frank LA, Elston C, Moxham J, Rafferty GF: Effect of endurance exercise on respiratory muscle function in patients with cystic fibrosis. Respir Physiol Neurobiol 2012;180:316-322.
[PubMed]
31.
Abraham KA, Feingold H, Fuller DD, Jenkins M, Mateika JH, Fregosi RF: Respiratory-related activation of human abdominal muscles during exercise. J Physiol 2002;541:653-663.
[PubMed]
32.
Martin JG, De Troyer A: The behaviour of the abdominal muscles during inspiratory mechanical loading. Respir Physiol 1982;50:63-73.
[PubMed]
33.
O'Donnell DE, Chau LKL, Webb KA: Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. J Appl Physiol 1998;84:2000-2009.
[PubMed]
34.
Wilkens H, Weingard B, Lo Mauro A, Schena E, Pedotti A, Sybrecht GW, Aliverti A: Breathing pattern and chest wall volumes during exercise in patients with cystic fibrosis, pulmonary fibrosis and COPD before and after lung transplantation. Thorax 2010;65:808-814.
[PubMed]
35.
Babcock MA, Johnson BD, Pegelow DF, Suman OE, Griffin D, Dempsey JA: Hypoxic effects on exercise-induced diaphragmatic fatigue in normal healthy humans. J Appl Physiol 1995;78:82-92.
[PubMed]
36.
Keens TG, Bryan AC, Levison H, Ianuzzo CD: Developmental pattern of muscle fiber types in human ventilatory muscles. J Appl Physiol 1978;44:909-913.
[PubMed]
37.
Suzuki J, Tanaka R, Yan S, Chen R, Macklem PT, Kayser B: Assessment of abdominal muscle contractility, strength, and fatigue. Am J Respir Crit Care Med 1999;159:1052-1060.
[PubMed]
38.
Johnson BD, Saupe KW, Dempsey JA: Mechanical constraints on exercise hyperpnea in endurance athletes. J Appl Physiol 1992;73:874-886.
[PubMed]
39.
Sacco P, McIntyre DB, Jones DA: Effects of length and stimulation frequency on fatigue of the human tibialis anterior muscle. J Appl Physiol 1994;77:1148-1154.
[PubMed]
40.
Polkey MI, Luo Y, Guleria R, Hamnegard C-H, Green M, Moxham J: Functional magnetic stimulation of the abdominal muscles in humans. Am J Respir Crit Care Med 1999;160:513-522.
[PubMed]
41.
Polkey MI, Hamnegard C-H, Hughes PD, Rafferty GF, Green M, Moxham J: Influence of acute lung volume change on contractile properties of the human diaphragm. J Appl Physiol 1998;85:1322-1328.
[PubMed]
42.
Chonan T, Altose MD, Cherniack NS: Effects of expiratory resistive loading on the sensation of dyspnea. J Appl Physiol 1990;69:91-95.
[PubMed]
43.
Kyroussis D, Polkey MI, Hamnegard CH, Mills GH, Green M, Moxham J: Respiratory muscle activity in patients with COPD walking to exhaustion with and without pressure support. Eur Respir J 2000;15:649-655.
[PubMed]
44.
Derchak PA, Sheel AW, Morgan BJ, Dempsey JA: Effects of expiratory muscle work on muscle sympathetic nerve activity. J Appl Physiol 2002;92:1539-1552.
[PubMed]
45.
Taylor BJ, Romer LM: Effect of expiratory muscle fatigue on exercise tolerance and locomotor muscle fatigue in healthy humans. J Appl Physiol 2008;104:1442-1451.
[PubMed]
46.
Man WD, Luo YM, Mustfa N, Rafferty GF, Glerant JC, Polkey MI, Moxham J: Postprandial effects on twitch transdiaphragmatic pressure. Eur Respir J 2002;20:577-580.
[PubMed]
47.
Watson AC, Hughes PD, Louise Harris M, Hart N, Ware RJ, Wendon J, Green M, Moxham J: Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med 2001;29:1325-1331.
[PubMed]
48.
Guleria R, Lyall R, Hart N, Harris ML, Hamnegard CH, Green M, Moxham J, Polkey MI: Central fatigue of the diaphragm and quadriceps during incremental loading. Lung 2002;180:1-13.
[PubMed]
49.
Luo YM, Lyall RA, Lou Harris M, Rafferty GF, Polkey MI, Moxham J: Quantification of the esophageal diaphragm electromyogram with magnetic phrenic nerve stimulation. Am J Respir Crit Care Med 1999;160:1629-1634.
[PubMed]
50.
Mador MJ, Khan S, Kufel TJ: Bilateral anterolateral magnetic stimulation of the phrenic nerves can detect diaphragmatic fatigue. Chest 2002;121:452-458.
[PubMed]
51.
Lin VWH, Hsieh C, Hsiao IN, Canfield J: Functional magnetic stimulation of expiratory muscles: a non-invasive and new method for restoring cough. J Appl Physiol 1998;84:1144-1150.
[PubMed]
© 2012 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2012
You do not currently have access to this content.
