Inspiratory drive is related to dynamic pulmonary hyperinflation in COPD patients
Diego Gatta,1 Marco Fredi,2 Giovanni Aliprandi,2 Laura Pini,1 Claudio Tantucci1
1Respiratory Medicine Unit, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy; 2Respiratory Rehabilitation Unit, Hospital Domus Salutis, Brescia, Italy
Background: Baseline high neuromuscular drive is present in chronic obstructive pulmonary disease (COPD). In moderate-to-very severe COPD patients, both static and/or dynamic pulmonary hyperinflation have been demonstrated at rest.
Aim: To assess the influence of dynamic hyperinflation on neuromuscular drive at rest.
Methods: We recruited 22 patients with severe-to-very severe COPD showing resting dynamic pulmonary hyperinflation, as assessed by the baseline reduction of inspiratory capacity (IC) (<80% of predicted). IC, occlusion pressure (P0.1), maximal inspiratory pressure (MIP), and their ratio were measured at end-expiratory lung volume (EELV) before and after acute inhalation of 400 mcg of albuterol (metered-dose inhaler plus spacer). In these patients the bronchodilator response was assessed also as lung volume changes.
Results: Only in COPD patients with a marked increase in IC (>12% of baseline and at least 200 mL) after bronchodilator, resting P0.1 showed a clinically significant decrease, despite the EELV diminution (P < 0.001). MIP was augmented following EELV reduction and therefore the P0.1/MIP ratio was markedly decreased (P < 0.001). In contrast, no changes in these indices were found after bronchodilator in COPD patients with insignificant variations of IC. Breathing pattern parameters did not vary in both sub-groups after albuterol.
Conclusion: Following bronchodilator, significant P0.1 decrease, MIP increase, and reduction of the P0.1/MIP ratio were found only in COPD patients with a marked IC increase and these changes were closely related. These findings suggest that bronchodilators, by decreasing dynamic hyperinflation, may control exertional and/or chronic dyspnea partly through a reduction of central neuromuscular drive.
Keywords: chronic obstructive pulmonary disease, control of breathing, inspiratory muscles, dynamic hyperinflation, bronchodilators
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]
Other article by this author:
Pini L, Pinelli V, Modina D, Bezzi M, Tiberio L, Tantucci C
Published Date: 1 September 2014
Readers of this article also read:
Subbiah R, Jeon SB, Park K, Ahn SJ, Yun KS
Published Date: 27 August 2015
Ongel EA, Karakurt Z, Salturk C, Takir HB, Burunsuzoglu B, Kargin F, Ekinci GH, Mocin O, Gungor G, Adiguzel N, Yilmaz A
Published Date: 17 October 2014
Hospital readmissions following initiation of nebulized arformoterol tartrate or nebulized short-acting beta-agonists among inpatients treated for COPD
Bollu V, Ernst FR, Karafilidis J, Rajagopalan K, Robinson SB, Braman SS
Published Date: 6 December 2013
Price D, Small M, Milligan G, Higgins V, Garcia Gil E, Estruch J
Published Date: 27 November 2013
The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data
Kim JH, Rhee CK, Yoo KH, Kim YS, Lee SW, Park YB, Lee JH, Oh YM, Lee SD, Kim Y, Kim KJ, Yoon HK
Published Date: 19 November 2013
Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial
Dias FD, Sampaio LMM, da Silva GA, Dantas Gomes ELF, Nascimento ESP, Santos Alves VL, Stirbulov R, Costa D
Published Date: 5 November 2013
Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis
Yawn BP, Li YF, Tian HJ, Zhang J, Arcona S, Kahler KH
Published Date: 27 June 2013
Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure
Titlestad IL, Lassen AT, Vestbo J
Published Date: 26 April 2013
Chronic obstructive pulmonary disease as a cardiovascular risk factor: results of a case-control study (CONSISTE study)
Published Date: 21 February 2013
Improving the quality of life in patients with chronic obstructive pulmonary disease: focus on indacaterol
Published Date: 14 February 2013