scholarly journals Exertional dyspnea associated with chest wall strapping is reduced when external dead space substitutes for part of the exercise stimulus to ventilation

2017 ◽  
Vol 122 (5) ◽  
pp. 1179-1187
Author(s):  
Luke A. Garske ◽  
Ravin Lal ◽  
Ian B. Stewart ◽  
Norman R. Morris ◽  
Troy J. Cross ◽  
...  
Keyword(s):  
Lung Disease ◽  
Chest Wall ◽  
Dead Space ◽  
Exercise Intensity ◽  
Rating Scale ◽  
Exertional Dyspnea ◽  
Restrictive Lung Disease ◽  
Muscle Work ◽  
Leg Muscle ◽  
Exercise Stimulus

Chest wall strapping has been used to assess mechanisms of dyspnea with restrictive lung disease. This study examined the hypothesis that dyspnea with restriction depends principally on the degree of reflex ventilatory stimulation. We compared dyspnea at the same (iso)ventilation when added dead space provided a component of the ventilatory stimulus during exercise. Eleven healthy men undertook a randomized controlled crossover trial that compared four constant work exercise conditions: 1) control (CTRL): unrestricted breathing at 90% gas exchange threshold (GET); 2) CTRL+dead space (DS): unrestricted breathing with 0.6-l dead space, at isoventilation to CTRL due to reduced exercise intensity; 3) CWS: chest wall strapping at 90% GET; and 4) CWS+DS: chest strapping with 0.6-l dead space, at isoventilation to CWS with reduced exercise intensity. Chest strapping reduced forced vital capacity by 30.4 ± 2.2% (mean ± SE). Dyspnea at isoventilation was unchanged with CTRL+DS compared with CTRL (1.93 ± 0.49 and 2.17 ± 0.43, 0–10 numeric rating scale, respectively; P = 0.244). Dyspnea was lower with CWS+DS compared with CWS (3.40 ± 0.52 and 4.51 ± 0.53, respectively; P = 0.003). Perceived leg fatigue was reduced with CTRL+DS compared with CTRL (2.36 ± 0.48 and 2.86 ± 0.59, respectively; P = 0.049) and lower with CWS+DS compared with CWS (1.86 ± 0.30 and 4.00 ± 0.79, respectively; P = 0.006). With unrestricted breathing, dead space did not change dyspnea at isoventilation, suggesting that dyspnea does not depend on the mode of reflex ventilatory stimulation in healthy individuals. With chest strapping, dead space presented a less potent stimulus to dyspnea, raising the possibility that leg muscle work contributes to dyspnea perception independent of the ventilatory stimulus. NEW & NOTEWORTHY Chest wall strapping was applied to healthy humans to simulate restrictive lung disease. With chest wall strapping, dyspnea was reduced when dead space substituted for part of a constant exercise stimulus to ventilation. Dyspnea associated with chest wall strapping depended on the contribution of leg muscle work to ventilatory stimulation. Chest wall strapping might not be a clinically relevant model to determine whether an alternative reflex ventilatory stimulus mimics the intensity of exertional dyspnea.

Respiratory sensation during chest wall restriction and dead space loading in exercising men

2000 ◽  
Vol 88 (5) ◽  
pp. 1859-1869 ◽  
Author(s):  
Denis E. O'Donnell ◽  
Harry H. Hong ◽  
Katherine A. Webb
Keyword(s):  
Tidal Volume ◽  
Chest Wall ◽  
Dead Space ◽  
Exercise Performance ◽  
Pulmonary Function Tests ◽  
Normal Subjects ◽  
Exercise Intolerance ◽  
Exercise Tests ◽  
Exertional Dyspnea ◽  
Ventilatory Drive

We mimicked important mechanical and ventilatory aspects of restrictive lung disorders by employing chest wall strapping (CWS) and dead space loading (DS) in normal subjects to gain mechanistic insights into dyspnea causation and exercise limitation. We hypothesized that thoracic restriction with increased ventilatory stimulation would evoke exertional dyspnea that was similar in nature to that experienced in such disorders. Twelve healthy young men [28 ± 2 (SE) yr of age] completed pulmonary function tests and maximal cycle exercise tests under four conditions, in randomized order: 1) control, 2) CWS to 60% of vital capacity, 3) added DS of 600 ml, and 4) CWS + DS. Measurements during exercise included cardiorespiratory parameters, esophageal pressure, and Borg scale ratings of dyspnea. Compared with control, CWS significantly reduced the tidal volume response to exercise, increased dyspnea intensity at any given work rate or ventilation, and thus limited exercise performance. DS stimulated ventilation but had minimal effects on dyspnea and exercise performance. Adding DS to CWS further increased dyspnea by 1.7 ± 0.6 standardized Borg units ( P = 0.012) and decreased exercise performance (total work) by 21 ± 6% ( P = 0.003) over CWS alone. Across conditions, increased dyspnea intensity correlated best with decreased resting inspiratory reserve volume ( r = −0.63, P < 0.0005). Dyspnea during CWS was described primarily as “inspiratory difficulty” and “unsatisfied inspiration,” similar to restrictive disorders. In conclusion, severe dyspnea and exercise intolerance were provoked in healthy normal subjects when tidal volume responses were constrained in the face of increased ventilatory drive during exercise.

scholarly journals Qualitative aspects of exertional dyspnea in patients with restrictive lung disease

2010 ◽  
Vol 5 ◽  
Author(s):  
Pierantonio Laveneziana
Keyword(s):  
Interstitial Lung Disease ◽  
Activities Of Daily Living ◽  
Lung Disease ◽  
Clinical Manifestation ◽  
Daily Living ◽  
Effective Management ◽  
Exertional Dyspnea ◽  
Lung Volumes ◽  
Restrictive Lung Disease ◽  
Broad Term

Restrictive lung disease is a broad term encompassing a num- ber of conditions in which lung volumes are reduced. Dyspnea is a common clinical manifestation of restrictive lung disease and frequently becomes a prominent and disabling symptom that undermines patients’ ability to function and engage in activities of daily living (especially in those with more advanced restriction). Effective management of this disabling symptom awaits a better understanding of its underlying physiology. In recent decades, our understanding of the mechanisms of dyspnea in restrictive lung disease has been improved by a small, but significant, body of research. One approach to the study of dyspnea is to identify the major qualitative dimensions of the symptom in an attempt to uncover different underlying neurophysiologic mechanisms. This article will review the existing literature on the intensity and qualitative dimensions of dyspnea during exercise in patients with restrictive lung disease. The main focus will be on interstitial lung disease (ILD), since it is the prototypical restrictive disease.

Effects of Industrial Respirator Wear During Exercise in Subjects With Restrictive Lung Disease

AIHAJ ◽  
1986 ◽  
Vol 47 (3) ◽  
pp. 176-180 ◽  
Author(s):  
THOMAS K. HODOUS ◽  
T CONNIE BOYLES ◽  
JOHN HANKINSON
Keyword(s):  
Lung Disease ◽  
Restrictive Lung Disease

Chest wall muscle atrophy as a contributory factor for forced vital capacity decline in systemic sclerosis-associated interstitial lung disease

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 250-255
Author(s):  
Takashi Nawata ◽  
Yuichiro Shirai ◽  
Mikito Suzuki ◽  
Masataka Kuwana
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Chest Wall ◽  
Muscle Atrophy ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Pulmonary Function Tests ◽  
Potential Contribution ◽  
Muscle Area ◽  
Chest Wall Muscle

Abstract Objective To investigate the potential contribution of accessory respiratory muscle atrophy to the decline of forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (ILD). Methods This single-centre, retrospective study enrolled 36 patients with SSc-ILD who underwent serial pulmonary function tests and chest high-resolution CT (HRCT) simultaneously at an interval of 1–3 years. The total extent of ILD and chest wall muscle area at the level of the ninth thoracic vertebra on CT images were evaluated by two independent evaluators blinded to the patient information. Changes in the FVC, ILD extent, and chest wall muscle area between the two measurements were assessed in terms of their correlations. Multiple regression analysis was conducted to identify the independent contributors to FVC decline. Results Interval changes in FVC and total ILD extent were variable among patients, whereas chest wall muscle area decreased significantly with time (P=0.0008). The FVC change was negatively correlated with the change in ILD extent (r=−0.48, P=0.003) and was positively correlated with the change in the chest wall muscle area (r = 0.53, P=0.001). Multivariate analysis revealed that changes in total ILD extent and chest wall muscle area were independent contributors to FVC decline. Conclusion In patients with SSc-ILD, FVC decline is attributable not only to the progression of ILD but also to the atrophy of accessory respiratory muscles. Our findings call attention to the interpretation of FVC changes in patients with SSc-ILD.

scholarly journals Galectin-3 Is Associated with Restrictive Lung Disease and Interstitial Lung Abnormalities

2016 ◽  
Vol 194 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Jennifer E. Ho ◽  
Wei Gao ◽  
Daniel Levy ◽  
Rajalakshmi Santhanakrishnan ◽  
Tetsuro Araki ◽  
...  
Keyword(s):  
Lung Disease ◽  
Restrictive Lung Disease ◽  
Lung Abnormalities ◽  
Galectin 3
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