Rib cage dimensions in hyperinflated patients with severe chronic obstructive pulmonary disease.

This study examines structural changes of the thorax in hyperinflated subjects with chronic obstructive pulmonary disease (COPD). Age-matched normal subjects were used for comparison. Thoracic dimensions were determined using anteroposterior and lateral chest radiographs performed at total lung capacity, functional residual capacity, and residual volume. Rib cage dimensions (lateral diameter, rib angle, anteroposterior diameter) and diaphragm position were determined at each lung volume. There were no significant differences in rib cage dimension between the COPD and normal subjects for all lung volumes. In contrast, the diaphragm was significantly lower in the COPD subjects. The change of rib cage dimensions in the COPD subjects (for a similar volume change) was not different from that in normal subjects, whereas the change of diaphragm position in the COPD subjects (for a similar volume change) was reduced. In conclusion, the primary structural change of the thorax in COPD with chronic hyperinflation is confined to the diaphragm, with no appreciable structural change in the rib cage.

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Accessory muscle activity during sleep in chronic obstructive pulmonary disease

Journal of Applied Physiology ◽

10.1152/jappl.1984.57.4.1011 ◽

1984 ◽

Vol 57 (4) ◽

pp. 1011-1017 ◽

Cited By ~ 62

Author(s):

M. W. Johnson ◽

J. E. Remmers

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Minute Ventilation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Rib Cage ◽

Inspiratory Muscles ◽

Inspiratory Activity ◽

Increased Activity ◽

Severe Copd

Hypoventilation contributes to oxyhemoglobin desaturation during rapid-eye-movement (REM) sleep in patients with severe chronic obstructive pulmonary disease (COPD). Due to hyperinflated lungs these patients have mechanically impaired diaphragms and increased activity of other inspiratory muscles while awake. We speculated that rib cage (RC) inspiratory muscles might lose activity during REM, thereby contributing to hypoventilation. We therefore recorded scalene (SCA) and sternocleidomastoid (SCM) electromyorgrams in six subjects with severe COPD. SCA activity decreased 76% (P less than 0.001), from non-REM (NREM) to tonic REM and decreased an additional 17% during phasic REM. SCM activity was much more variable during NREM but when present also decreased during REM. SCA activity correlated strongly with RC excursion. SCA and SCM activity, RC excursion, estimates of minute ventilation, and oxyhemoglobin saturation all decreased in parallel. Expiratory activity of the SCA and SCM, present during wakefulness and NREM, disappeared during REM. We conclude that loss of inspiratory activity of rib cage muscles during REM causes chest wall distortion and hypoventilation in patients with severe COPD. Loss of expiratory activity of these muscles may contribute to a decrease in end-expiratory volume and thereby to a deterioration of pulmonary gas exchange.

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Oral and Oropharyngeal Sensory Function in Adults With Chronic Obstructive Pulmonary Disease

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00095 ◽

2020 ◽

Vol 29 (2) ◽

pp. 864-872

Author(s):

Fernanda Borowsky da Rosa ◽

Adriane Schmidt Pasqualoto ◽

Catriona M. Steele ◽

Renata Mancopes

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Oral Cavity ◽

Pulmonary Disease ◽

Thermal Sensation ◽

Sensory Function ◽

Control Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Age Related ◽

Copd Patients

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years ( SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years ( SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups (“≤ 65 years” and “> 65 years”) within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications ( p < .001) and xerostomia ( p = .003) in the COPD cohort. Oral cavity thermal sensation ( p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group ( p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.

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