Respiratory Muscle Weakness as a Risk Factor for Pneumonia in Older People

Introduction: The respiratory muscle strength regulates the effectiveness of coughing, which clears the airways and protects people from pneumonia. Sarcopenia is an aging-related loss of muscle mass and function, the worsening of which is associated with malnutrition. The loss of respiratory and swallowing muscle strength occurs with aging, but its effect on pneumonia is unclear. This study aimed to determine the risks of respiratory muscle weakness on the onset and relapse of pneumonia in older people in conjunction with other muscle-related factors such as malnutrition. Methods: We conducted a longitudinal study with 47 pneumonia inpatients and 35 non-pneumonia controls aged 70 years and older. We evaluated the strength of respiratory and swallowing muscles, muscle mass, and malnutrition (assessed by serum albumin levels and somatic fat) during admission and confirmed pneumonia relapse within 6 months. The maximal inspiratory and expiratory pressures determined the respiratory muscle strength. Swallowing muscle strength was evaluated by tongue pressure. Bioelectrical impedance analysis was used to evaluate the muscle and fat mass. Results: The respiratory muscle strength, body trunk muscle mass, serum albumin level, somatic fat mass, and tongue pressure were significantly lower in pneumonia patients than in controls. Risk factors for the onset of pneumonia were low inspiratory respiratory muscle strength (odds ratio [OR], 6.85; 95% confidence interval [CI], 1.56–30.11), low body trunk muscle mass divided by height2 (OR, 6.86; 95% CI, 1.49–31.65), and low serum albumin level (OR, 5.46; 95% CI, 1.51–19.79). For the relapse of pneumonia, low somatic fat mass divided by height2 was a risk factor (OR, 20.10; 95% CI, 2.10–192.42). Discussion/Conclusions: Respiratory muscle weakness, lower body trunk muscle mass, and malnutrition were risk factors for the onset of pneumonia in older people. For the relapse of pneumonia, malnutrition was a risk factor.

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Pneumonien bei älteren Menschen: Risikofaktor Atemmuskelschwäche

Karger Kompass Pneumologie ◽

10.1159/000518544 ◽

2021 ◽

pp. 1-2

Author(s):

Helmut Frohnhofen

Keyword(s):

Muscle Strength ◽

Serum Albumin ◽

Muscle Mass ◽

Fat Mass ◽

Respiratory Muscle ◽

Serum Albumin Level ◽

Albumin Level ◽

Trunk Muscle ◽

Tongue Pressure ◽

Respiratory Muscle Strength

Introduction: The respiratory muscle strength regulates the effectiveness of coughing, which clears the airways and protects people from pneumonia. Sarcopenia is an aging-related loss of muscle mass and function, the worsening of which is associated with malnutrition. The loss of respiratory and swallowing muscle strength occurs with aging, but its effect on pneumonia is unclear. This study aimed to determine the risks of respiratory muscle weakness on the onset and relapse of pneumonia in older people in conjunction with other muscle-related factors such as malnutrition. Methods: We conducted a longitudinal study with 47 pneumonia inpatients and 35 non-pneumonia controls aged 70 years and older. We evaluated the strength of respiratory and swallowing muscles, muscle mass, and malnutrition (assessed by serum albumin levels and somatic fat) during admission and confirmed pneumonia relapse within 6 months. The maximal inspiratory and expiratory pressures determined the respiratory muscle strength. Swallowing muscle strength was evaluated by tongue pressure. Bioelectrical impedance analysis was used to evaluate the muscle and fat mass. Results: The respiratory muscle strength, body trunk muscle mass, serum albumin level, somatic fat mass, and tongue pressure were significantly lower in pneumonia patients than in controls. Risk factors for the onset of pneumonia were low inspiratory respiratory muscle strength (odds ratio [OR], 6.85; 95% confidence interval [CI], 1.56–30.11), low body trunk muscle mass divided by height2 (OR, 6.86; 95% CI, 1.49–31.65), and low serum albumin level (OR, 5.46; 95% CI, 1.51–19.79). For the relapse of pneumonia, low somatic fat mass divided by height2 was a risk factor (OR, 20.10; 95% CI, 2.10–192.42). Discussion/Conclusions: Respiratory muscle weakness, lower body trunk muscle mass, and malnutrition were risk factors for the onset of pneumonia in older people. For the relapse of pneumonia, malnutrition was a risk factor.

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Abstract 2395: Respiratory Muscle Weakness in Acute Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a2395 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Ross Pollock ◽

Ged Rafferty ◽

John Moxham ◽

Lalit Kalra

Keyword(s):

Systematic Review ◽

Muscle Strength ◽

Acute Stroke ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Mean Difference ◽

Respiratory Muscle Strength ◽

Inclusion Criteria ◽

Stroke Patients ◽

Respiratory Muscle Weakness

Background: Increased frequency of chest infections in acute stroke patients may be the result of respiratory muscle weakness contributing to a weak cough and poor airway clearance. We undertook a systematic review of studies comparing respiratory muscle strength in acute stroke patients with age-matched controls. Method: A systematic review of literature was performed using the electronic databases Medline, EMBASE, ISI web of knowledge and the Scopus. The key words searched were stroke or cerebrovascular accident in combination with cough, inspiratory, expiratory or respiratory and strength or weakness. Studies were included if they compared stroke patients with age matched controls and measured maximum inspiratory or expiratory mouth pressure (PImax and PEmax) for inspiratory and expiratory muscle strength respectively. Results: The initial search identified 136 articles, 14 of which remained after screening for pre-defined inclusion criteria and removal of duplicates. Eleven were excluded after reviewing abstracts (5 did not assess muscle strength, 5 did not include healthy control group, 1 absolute values could not be obtained). A further study was identified from the reference lists of screened articles. The 4 studies that met inclusion criteria included 121 subjects. Mean PImax ranged from 75-99 cmH 2 O in controls and 37-74 cmH 2 O in stroke patients. (mean difference 41 cmH 2 O, 95% CI 54 to 29 cm H 2 O; P<0.0001). Mean PEmax ranged from 52-89 cm H 2 O in stroke patients and was also reduced compared with age matched controls (mean difference 55 cmH 2 O, 95% CI 61 to 48 cmH 2 O; P<0.0001). ( Fig 1 ). Conclusion: Individual studies and pooled data suggest that respiratory muscle strength is impaired in acute stroke patients. However, these studies are limited by small samples and design heterogeneity. Larger studies are needed to assess the relationship of respiratory muscle weakness with chest infections and clinical outcomes in the acute phase.

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Volitional assessment of respiratory muscle strength

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2012.162 ◽

2015 ◽

Vol 77 (1) ◽

Cited By ~ 5

Author(s):

J.W. Fitting

Keyword(s):

Muscle Strength ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Neuromuscular Disorders ◽

Ventilatory Support ◽

Neuromuscular Diseases ◽

Respiratory Muscle Strength ◽

Respiratory Muscle Weakness ◽

Complete Evaluation ◽

Non Invasive

Respiratory muscle weakness may induce dyspnoea, secretion retention and respiratory failure. Assessing respiratory muscle strength is mandatory in neuromuscular diseases and in case of unexplained dyspnoea. A step by step approach is recommended, starting with simple volitional tests. Using spirometry, respiratory muscle weakness may be suspected on the basis of an abnormal flowvolume loop or a fall of supine vital capacity. When normal, maximal inspiratory and expiratory pressures against a near complete occlusion exclude significant muscle weakness, but low values are more difficult to interpret. Sniff nasal inspiratory pressure is a useful alternative because it is easy and it eliminates the problem of air leaks around the mouthpiece in patients with neuromuscular disorders. The strength available for coughing is easily assessed by measuring peak cough flow. In most cases, these simple non invasive tests are sufficient to confirm or to eliminate significant respiratory muscle weakness and help the timely introduction of ventilatory support or assisted cough techniques. In a minority of patients, a more complete evaluation is necessary using non volitional tests like cervical magnetic stimulation of phrenic nerves.

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How Respiratory Muscle Strength Correlates with Cough Capacity in Patients with Respiratory Muscle Weakness

Yonsei Medical Journal ◽

10.3349/ymj.2010.51.3.392 ◽

2010 ◽

Vol 51 (3) ◽

pp. 392 ◽

Cited By ~ 64

Author(s):

Jung Hyun Park ◽

Seong-Woong Kang ◽

Sang Chul Lee ◽

Won Ah Choi ◽

Dong Hyun Kim

Keyword(s):

Muscle Strength ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Respiratory Muscle Strength ◽

Respiratory Muscle Weakness

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Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2012.618 ◽

2012 ◽

Vol 7 ◽

Author(s):

Baykal Tulek ◽

Fikret Kanat ◽

Sule Tol ◽

Mecit Suerdem

Keyword(s):

Muscle Strength ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Patient Characteristics ◽

Flexible Bronchoscopy ◽

High Dose ◽

Complication Rates ◽

Respiratory Muscle Strength ◽

Respiratory Muscle Weakness ◽

Post Procedure

Background: Flexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures. Methods: One hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated. Results: Significant decreases in both MIP and MEP values were observed following FB (p < 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups. Conclusions: It was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.

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Assessment of Peripheral and Respiratory Muscle Strength in ICU

10.1093/med/9780199653461.003.0047 ◽

2014 ◽

Cited By ~ 1

Author(s):

Gerrard Rafferty ◽

John Moxham

Keyword(s):

Muscle Strength ◽

Critically Ill ◽

Muscle Weakness ◽

Nerve Stimulation ◽

Critically Ill Patients ◽

Phrenic Nerve ◽

Respiratory Muscle ◽

Respiratory Muscle Strength ◽

Phrenic Nerve Stimulation ◽

Icu Patients

Skeletal muscle weakness affecting the respiratory and peripheral muscles is common in critically ill patients and can lead to difficulties in weaning, prolonged ICU admission, and significant morbidity in survivors. A number of techniques can be used to assess muscle strength. In the peripheral muscles, volitional techniques employing scoring systems or portable hand dynamometers are relatively simple and quick to use, requiring little or no specialist equipment. Such techniques can, however, only be applied to conscious and cooperative patients, preventing assessment of muscle weakness in many ICU patients. The volitional requirement also limits the ability to distinguish poor motivation and impaired cognition from true loss of muscle function. Non-volitional techniques involving motor nerve stimulation provide measures of muscle force production in non-cooperative patients but require specialist equipment. Normative data for comparative purposes are limited. Also, it is not clear which peripheral muscle best reflects generalized muscle weakness. Measurements of maximal inspiratory and expiratory pressures are widely used to assess respiratory muscle strength in ICU patients and are applicable to patients who can make some respiratory effort. As with all tests requiring patient cooperation, reliability is limited. Phrenic nerve stimulation allows direct, non-volitional assessment of diaphragm and phrenic nerve function, and normative values for comparative purposes are available. Magnetic phrenic nerve stimulation is well tolerated, can be performed in the presence of vascular catheters, and is used to document respiratory muscle weakness and track progression in critically ill patients.

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Muscle weakness, functional capacities and recovery for COVID-19 ICU survivors

BMC Anesthesiology ◽

10.1186/s12871-021-01274-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Clément Medrinal ◽

Guillaume Prieur ◽

Tristan Bonnevie ◽

Francis-Edouard Gravier ◽

Denys Mayard ◽

...

Keyword(s):

Muscle Strength ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Tertiary Hospital ◽

Limb Muscle ◽

Respiratory Muscle Weakness ◽

Limb Weakness ◽

Cross Sectional ◽

Icu Discharge ◽

Walking Capacity

Abstract Background Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. Method We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. Results Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. Conclusion The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.

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The Relationship between Sarcopenia and Respiratory Muscle Weakness in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413257 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13257

Author(s):

Tomoyuki Morisawa ◽

Yota Kunieda ◽

Shingo Koyama ◽

Mizue Suzuki ◽

Yuma Takahashi ◽

...

Keyword(s):

Older Adults ◽

Skeletal Muscle ◽

Muscle Mass ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Skeletal Muscle Mass ◽

Community Dwelling ◽

Respiratory Muscle Weakness ◽

Skeletal Muscle Index ◽

Community Dwelling Older Adults

An association between respiratory muscle weakness and sarcopenia may provide a clue to the mechanism of sarcopenia development. We aimed to clarify this relationship among community-dwelling older adults. In total, 117 community-dwelling older adults were assessed and classified into 4 groups: robust, respiratory muscle weakness, sarcopenia, and respiratory sarcopenia. The respiratory sarcopenia group (12%) had a significantly higher percentage of males and had lower BMI, skeletal muscle index, skeletal muscle mass, phase angle, and oral function than the robust group (32.5%). All physical functions were significantly lower. The respiratory muscle weakness group (54.7%) had a significantly lower BMI and slower walking speed, compared with the robust group. The sarcopenia group (0.8%) was excluded from the analysis. The percent maximum inspiratory pressure was significantly lower in both the respiratory muscle weakness and respiratory sarcopenia groups, compared with the robust group. Almost all participants with sarcopenia showed respiratory muscle weakness. In addition, approximately 50% had respiratory muscle weakness, even in the absence of systemic sarcopenia, suggesting that respiratory muscle weakness may be the precursor of sarcopenia. The values indicating physical function and skeletal muscle mass in the respiratory muscle weakness group were between those in the robust and the respiratory sarcopenia groups.

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Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis

Physical Therapy ◽

10.1093/ptj/pzaa171 ◽

2020 ◽

Vol 100 (12) ◽

pp. 2099-2109

Author(s):

Aline de Cassia Meine Azambuja ◽

Luma Zanatta de Oliveira ◽

Graciele Sbruzzi

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Muscle Strength ◽

Muscle Weakness ◽

Functional Capacity ◽

Respiratory Muscle ◽

Meta Analysis ◽

Inspiratory Muscle ◽

Respiratory Muscle Weakness

Abstract Objective The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients benefit from this intervention are not clear. The purpose of this study was to review the effects of IMT on respiratory muscle strength, functional capacity, pulmonary function, quality of life, and dyspnea in patients with HF; IMT isolated or combined with another intervention (combined IMT), the presence of inspiratory muscle weakness, training load, and intervention time were considered. Methods The search included the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and LILACS database through September 2019. The review included randomized studies that assessed IMT in isolation or combined with another intervention—in comparison with a control group, a placebo, or another intervention—in patients with HF. Fourteen studies were included, 13 for meta-analysis (10 for isolated IMT and 3 for combined IMT). Results Isolated IMT demonstrated an increase in maximal inspiratory pressure (MIP) (25.12 cm H2O; 95% CI = 15.29 – 34.95), 6-Minute Walk Test (81.18 m; 95% CI = 9.73 – 152.63), maximum oxygen consumption (12 weeks: 3.75 mL/kg/min; 95% CI = 2.98 to 4.51), and quality of life (−20.68; 95% CI = −29.03 to −12.32). The presence of inspiratory muscle weakness, higher loads, and longer intervention times resulted in greater increases in MIP. IMT combined with another intervention demonstrated an increase only in MIP. Conclusions Isolated IMT resulted in an increase in inspiratory muscle strength, functional capacity, and quality of life. IMT combined with another intervention resulted only in a small increase in inspiratory strength. Isolated IMT with higher loads can be considered an adjuvant intervention, especially for those who do not adhere to conventional rehabilitation and who have respiratory muscle weakness. Impact A systematic review was necessary to review the effects of IMT on respiratory muscle strength, lung function, functional capacity, quality of life, and dyspnea in patients with HF. Various clinical issues important for a better training prescription were considered; these included whether the performance of the training IMT as a form of isolated training benefits patients with HF, whether the combination of IMT with another intervention has additional effects, whether any patient with HF can benefit from IMT (alone or combined with another intervention), and whether only patients who already have respiratory muscle weakness benefit. Also important was establishing which training load provides the best result and the best intervention time, so that health care can be provided more efficiently. Lay Summary For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise.

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