Effects of arm bracing on expiratory flow limitation and lung volume in elderly COPD patients

Physiotherapy ◽  
2015 ◽  
Vol 101 ◽  
pp. e1121-e1122
Author(s):  
T. Ogino ◽  
K. Mase ◽  
M. Nozoe ◽  
T. Wada ◽  
Y. Uchiyama ◽  
...  
Keyword(s):  
Lung Volume ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Copd Patients ◽  
Expiratory Flow

scholarly journals Clinical characteristics of COPD patients with tidal expiratory flow limitation

2017 ◽  
Vol Volume 12 ◽  
pp. 1503-1506 ◽  
Author(s):  
James Dean ◽  
Umme Kolsum ◽  
Paul Hitchen ◽  
Vanadana Gupta ◽  
Dave Singh
Keyword(s):  
Clinical Characteristics ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Copd Patients ◽  
Expiratory Flow

Expiratory flow limitation during exercise in prepubescent boys and girls: prevalence and implications

2010 ◽  
Vol 108 (5) ◽  
pp. 1267-1274 ◽  
Author(s):  
Katherine E. Swain ◽  
Sara K. Rosenkranz ◽  
Bethany Beckman ◽  
Craig A. Harms
Keyword(s):  
Body Composition ◽  
Oxygen Saturation ◽  
Tidal Volume ◽  
Lean Body Mass ◽  
Lung Volume ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Expiratory Flow

The purpose of this study was to compare the prevalence and implications of expiratory flow limitation (EFL) during exercise in boys and girls. Forty healthy, prepubescent boys (B; n = 20) and girls (G; n = 20) were tested. Subjects completed pulmonary function tests and an incremental cycle maximal oxygen uptake (V̇o2max) test. EFL was recorded at the end of each exercise stage using the % tidal volume overlap method. Ventilatory and metabolic data were recorded throughout exercise. Arterial oxygen saturation (SpO2) was determined via pulse oximetry. Body composition was determined using dual-energy X-ray absorptiometry. There were no differences ( P > 0.05) in height, weight, or body composition between boys and girls. At rest, boys had significantly higher lung volumes (total lung capacity, B = 2.6 ± 0.5 liters, G = 2.1 ± 0.5 liters) and peak expiratory flow rates (B = 3.6 ± 0.6 l/s; G = 1.6 ± 0.3 l/s). Boys also had significantly higher V̇o2max (B = 46.9 ± 5.9 ml·kg lean body mass−1·min−1, G = 41.7 ± 6.6 ml·kg lean body mass−1·min−1) and maximal ventilation (B = 49.8 ± 8.8 l/min, G = 41.2 ± 8.3 l/min) compared with girls. There were no sex differences ( P > 0.05) at V̇o2max in VE /Vco2, end-tidal Pco2, heart rate, respiratory exchange ratio, or SpO2. The prevalence (B = 19/20 vs. G = 18/20) and severity (B = 58 ± 7% vs. G = 43 ± 8% tidal volume) of EFL was not significantly different in boys compared with girls at V̇o2max. A significant relationship existed between % EFL at V̇o2max and the change in end-expiratory lung volume from rest to maximal exercise in boys ( r = 0.77) and girls ( r = 0.75). In summary, our data suggests that EFL is highly and equally prevalent in prepubescent boys and girls during heavy exercise, which led to an increased end-expiratory lung volume but not to decreases in arterial oxygen saturation.

scholarly journals Effect of nocturnal EPAP titration to abolish tidal expiratory flow limitation in COPD patients with chronic hypercapnia: a randomized, cross-over pilot study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emanuela Zannin ◽  
Ilaria Milesi ◽  
Roberto Porta ◽  
Simona Cacciatore ◽  
Luca Barbano ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Work Of Breathing ◽  
Lung Mechanics ◽  
Intrinsic Peep ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Copd Patients ◽  
Ineffective Efforts ◽  
Expiratory Flow

Abstract Background Tidal expiratory flow limitation (EFLT) promotes intrinsic PEEP (PEEPi) in patients with chronic obstructive pulmonary disease (COPD). Applying non-invasive ventilation (NIV) with an expiratory positive airway pressure (EPAP) matching PEEPi improves gas exchange, reduces work of breathing and ineffective efforts. We aimed to evaluate the effects of a novel NIV mode that continuously adjusts EPAP to the minimum level that abolishes EFLT. Methods This prospective, cross-over, open-label study randomized patients to one night of fixed-EPAP and one night of EFLT-abolishing-EPAP. The primary outcome was transcutaneous carbon dioxide pressure (PtcCO2). Secondary outcomes were: peripheral oxygen saturation (SpO2), frequency of ineffective efforts, breathing patterns and oscillatory mechanics. Results We screened 36 patients and included 12 in the analysis (age 72 ± 8 years, FEV1 38 ± 14%Pred). The median EPAP did not differ between the EFLT-abolishing-EPAP and the fixed-EPAP night (median (IQR) = 7.0 (6.0, 8.8) cmH2O during night vs 7.5 (6.5, 10.5) cmH2O, p = 0.365). We found no differences in mean PtcCO2 (44.9 (41.6, 57.2) mmHg vs 54.5 (51.1, 59.0), p = 0.365), the percentage of night time with PtcCO2 > 45 mm Hg was lower (62(8,100)% vs 98(94,100)%, p = 0.031) and ineffective efforts were fewer (126(93,205) vs 261(205,351) events/hour, p = 0.003) during the EFLT-abolishing-EPAP than during the fixed-EPAP night. We found no differences in oxygen saturation and lung mechanics between nights. Conclusion An adaptive ventilation mode targeted to abolish EFLT has the potential to reduce hypercapnia and ineffective efforts in stable COPD patients receiving nocturnal NIV. Trial registration: ClicalTrials.gov, NCT04497090. Registered 29 July 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04497090.

Expiratory flow limitation during exercise in competition cyclists

1999 ◽  
Vol 86 (2) ◽  
pp. 611-616 ◽  
Author(s):  
Susana Mota ◽  
Pere Casan ◽  
Franchek Drobnic ◽  
Jordi Giner ◽  
Olga Ruiz ◽  
...  
Keyword(s):  
Lung Volume ◽  
Exercise Test ◽  
Maximal Exercise ◽  
Peak Exercise ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Exercise Ventilation ◽  
Aerobic Exercise Capacity ◽  
Expiratory Flow ◽  
Maximal Voluntary Ventilation

In some trained athletes, maximal exercise ventilation is believed to be constrained by expiratory flow limitation (FL). Using the negative expiratory pressure method, we assessed whether FL was reached during a progressive maximal exercise test in 10 male competition cyclists. The cyclists reached an average maximal O2 consumption of 72 ml ⋅ kg−1 ⋅ min−1(range: 67–82 ml ⋅ kg−1 ⋅ min−1) and ventilation of 147 l/min (range: 122–180 l/min) (88% of preexercise maximal voluntary ventilation in 15 s). In nine subjects, FL was absent at all levels of exercise (i.e., expiratory flow increased with negative expiratory pressure over the entire tidal volume range). One subject, the oldest in the group, exhibited FL during peak exercise. The group end-expiratory lung volume (EELV) decreased during light-to-moderate exercise by 13% (range: 5–33%) of forced vital capacity but increased as maximal exercise was approached. EELV at peak exercise and at rest were not significantly different. The end-inspiratory lung volume increased progressively throughout the exercise test. The conclusions reached are as follows: 1) most well-trained young cyclists do not reach FL even during maximal exercise, and, hence, mechanical ventilatory constraint does not limit their aerobic exercise capacity, and 2) in absence of FL, EELV decreases initially but increases during heavy exercise.

Exacerbation History In COPD Patients With And Without Expiratory Flow Limitation (EFL)

2012 ◽  
Author(s):  
Bernt B. Aarli ◽  
Peter M. Calverley ◽  
Per Bakke ◽  
Tomas M.L. Eagan ◽  
Jon A. Hardie
Keyword(s):  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Copd Patients ◽  
Expiratory Flow

scholarly journals Tidal expiratory flow limitation induces expiratory looping of the alveolar pressure-flow relation in COPD patients

2020 ◽  
Vol 129 (1) ◽  
pp. 75-83
Author(s):  
Matteo Pecchiari ◽  
Dejan Radovanovic ◽  
Camilla Zilianti ◽  
Laura Saderi ◽  
Giovanni Sotgiu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Alveolar Pressure ◽  
Expiratory Flow Limitation ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Expiratory Flow ◽  
Spontaneously Breathing

In stable chronic obstructive pulmonary disease (COPD) patients spontaneously breathing at rest, tidal expiratory flow limitation is the major determinant of the occurrence of expiratory looping in the plethysmographic flow-alveolar pressure diagram. In these patients the magnitude and the characteristics of the loop can be used as predictors of the presence of tidal expiratory flow limitation.

scholarly journals Noninvasive detection of expiratory flow limitation in COPD patients during nasal CPAP

2006 ◽  
Vol 27 (5) ◽  
pp. 983-991 ◽  
Author(s):  
R. L. Dellacà ◽  
M. Rotger ◽  
A. Aliverti ◽  
D. Navajas ◽  
A. Pedotti ◽  
...  
Keyword(s):  
Noninvasive Detection ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Nasal Cpap ◽  
Copd Patients ◽  
Expiratory Flow

Detection of expiratory flow limitation during exercise in COPD patients

1997 ◽  
Vol 82 (3) ◽  
pp. 723-731 ◽  
Author(s):  
Nickolaos G. Koulouris ◽  
Ioanna Dimopoulou ◽  
Päivi Valta ◽  
Richard Finkelstein ◽  
Manuel G. Cosio ◽  
...  
Keyword(s):  
Normal Subjects ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Obstructive Pulmonary Disease ◽  
Normal Limits ◽  
Volume Curve ◽  
Copd Patients ◽  
Flow Volume Curve ◽  
Expiratory Flow

Koulouris, Nickolaos G., Ioanna Dimopoulou, Päivi Valta, Richard Finkelstein, Manuel G. Cosio, and J. Milic-Emili.Detection of expiratory flow limitation during exercise in COPD patients. J. Appl. Physiol. 82(3): 723–731, 1997.—The negative expiratory pressure (NEP) method was used to detect expiratory flow limitation at rest and at different exercise levels in 4 normal subjects and 14 patients with chronic obstructive pulmonary disease (COPD). This method does not require performance of forced expirations, nor does it require use of body plethysmography. It consists in applying negative pressure (−5 cmH2O) at the mouth during early expiration and comparing the flow-volume curve of the ensuing expiration with that of the preceding control breath. Subjects in whom application of NEP does not elicit an increase in flow during part or all of the tidal expiration are considered flow limited. The four normal subjects were not flow limited up to 90% of maximal exercise power output (W˙max). Five COPD patients were flow limited at rest, 9 were flow limited at one-third W˙max, and 12 were flow limited at two-thirdsW˙max. Whereas in all patients who were flow limited at rest the maximal O2 uptake was below the normal limits, this was not the case in most of the other patients. In conclusion, NEP provides a rapid and reliable method to detect expiratory flow limitation at rest and during exercise.

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