Biphasic (Subtherapeutic) Levodopa-induced Respiratory Dysfunction in Parkinson Disease

2021 ◽  
pp. 10.1212/CPJ.0000000000001043
Author(s):  
Veerle A. van de Wetering - van Dongen ◽  
Alberto J. Espay ◽  
Luca Marsili ◽  
Andrea Sturchio ◽  
Susanne Ten Holter ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Respiratory Muscle ◽  
Forced Expiratory Volume ◽  
Muscle Control ◽  
Related Complication ◽  
Levodopa Dose ◽  
Respiratory Dysfunction ◽  
Continuous Dopaminergic Stimulation ◽  
Before And After ◽  
Dopaminergic Stimulation

ABSTRACTObjectiveTo evaluated three cases illustrating a rarely recognized phenotype of Parkinson disease (PD), namely biphasic levodopa-induced respiratory dysfunction manifesting as dyspnea.MethodsTo appreciate the nature of the fluctuations of respiratory function in response to levodopa, we measured changes in respiratory muscle control before and after the best therapeutic response to levodopa in three PD patients with fluctuating dyspnea.ResultsEpisodes of breathlessness were accompanied by shallow tachypnea and reduced respiratory muscle control, as measured by maximal expiratory pressure (MEP), peak cough flow (PCF), and Forced Expiratory Volume in 1 second (FEV1).ConclusionsThe spectrum of respiratory dysfunction in PD includes a biphasic reduced respiratory muscle control accompanying periods when the effect of levodopa is subtherapeutic. This biphasic levodopa-related complication represents a rarely recognized non-motor phenomenon in PD. Management requires increasing the levodopa dose, shortening the interdose interval, or implementing a program of continuous dopaminergic stimulation.

scholarly journals Respiratory Muscle Performance and the Perception of Dyspnea in Parkinson's Disease

2002 ◽  
Vol 29 (1) ◽  
pp. 68-72 ◽  
Author(s):  
Paltiel Weiner ◽  
Rivka Inzelberg ◽  
Avi Davidovich ◽  
Puiu Nisipeanu ◽  
Rasmi Magadle ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Muscle Strength ◽  
Respiratory Muscle ◽  
Respiratory Muscles ◽  
Normal Subjects ◽  
Forced Expiratory Volume ◽  
Muscle Performance ◽  
Respiratory Muscle Strength ◽  
Before And After

Background:Pulmonary and respiratory muscle function impairment are common in patients with Parkinson's disease (PD). However, dyspnea is not a frequent complaint among these patients, although it is well documented that the intensity of dyspnea is related to the activity and the strength of the respiratory muscles.Patients and Methods:We studied pulmonary function, respiratory muscle strength and endurance and the perception of dyspnea (POD) in 20 patients with PD (stage II and III Hoehn and Yahr scale) before and after their first daily L-dopa dose. Respiratory muscle strength was assessed by measuring the maximal inspiratory and expiratory mouth pressures (PImax and PEmax), at residual volume (RV) and total lung capacity (TLC) respectively. The POD was measured while the subject breathed against progressive load and dyspnea was rated using a visual analog scale.Results:Respiratory muscle strength and endurance were decreased and the POD was increased during the off medication period compared to normal subjects. There was a nonsignificant trend to an increase in PImax, PEmax and endurance after L-dopa intake. The POD of PD patients decreased (p<0.05) following medication, although, it remained increased (p<0.01) as compared to the normal subjects. Even if patients had spirometry data showing a mild restrictive pattern, before medication, both forced vital capacity (FVC) and forced expiratory volume (FEV)1 remained almost identical after L-dopa intake.Conclusions:Patients with PD have higher POD, compared to normal subjects and this increased perception is attenuated when the patients are on dopaminergic medication. The change in the POD is not related to changes in respiratory muscle performance or pulmonary functions. A central effect or a correction of uncoordinated respiratory movements by L-dopa may contribute to the decrease in POD following L-dopa treatment.

scholarly journals Omalizumab reduces bronchial mucosal IgE and improves lung function in non-atopic asthma

2016 ◽  
Vol 48 (6) ◽  
pp. 1593-1601 ◽  
Author(s):  
Prathap Pillai ◽  
Yih-Chih Chan ◽  
Shih-Ying Wu ◽  
Line Ohm-Laursen ◽  
Clare Thomas ◽  
...  
Keyword(s):  
Mast Cells ◽  
Lung Function ◽  
Plasma Cells ◽  
Placebo Treatment ◽  
Forced Expiratory Volume ◽  
Atopic Asthma ◽  
Before And After ◽  
Bronchial Biopsies ◽  
Withdrawal Of Therapy ◽  
Therapy Reduction

Omalizumab therapy of non-atopic asthmatics reduces bronchial mucosal IgE and inflammation and preserves/improves lung function when disease is destabilised by staged withdrawal of therapy.18 symptomatic, non-atopic asthmatics were randomised (1:1) to receive omalizumab or identical placebo treatment in addition to existing therapy for 20 weeks. Bronchial biopsies were collected before and after 12–14 weeks of treatment, then the patients destabilised by substantial, supervised reduction of their regular therapy. Primary outcome measures were changes in bronchial mucosal IgE+ cells at 12–14 weeks, prior to regular therapy reduction, and changes in lung function (forced expiratory volume in 1 s) after destabilisation at 20 weeks. Quality of life was also monitored.Omalizumab but not placebo therapy significantly reduced median total bronchial mucosal IgE+ cells (p<0.01) but did not significantly alter median total mast cells, plasma cells, B lymphocytes, eosinophils and plasmablasts, although the latter were difficult to enumerate, being distributed as disperse clusters. By 20 weeks, lung function declined in the placebo-treated patients but improved in the omalizumab treated patients, with significant differences in absolute (p=0.04) and % predicted forced expiratory volume in 1 s (p=0.015).Omalizumab therapy of non-atopic asthmatics reduces bronchial mucosal IgE+ mast cells and improves lung function despite withdrawal of conventional therapy.

scholarly journals Effect of respiratory muscle training on pulmonary function in preoperative preparation of tobacco smokers

2007 ◽  
Vol 22 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Carrie Chueiri Ramos Galvan ◽  
Antônio José Maria Cataneo
Keyword(s):  
Pulmonary Function ◽  
Respiratory Muscle ◽  
Vital Capacity ◽  
Peak Flow ◽  
Respiratory Muscles ◽  
Forced Expiratory Volume ◽  
Respiratory Muscle Training ◽  
Specific Training ◽  
Muscle Training ◽  
Respiratory Exercises

PURPOSE: To evaluate the effect of utilization of a specific training program of respiratory muscles on pulmonary function in tobacco smokers. METHODS: Fifty asymptomatic tobacco smokers with age superior to 30 years were studied, at the moments: A0 - initial evaluation followed by protocol of respiratory exercises; A1 - reevaluation after 10 minutes of protocol application; and A2 - final reevaluation after 2 weeks of training utilizing the same protocol 3 times per week. The evaluation was realized through measures of maximum respiratory pressures (PImax and PEmax), respiratory peak flow (IPF and EPF), maximum voluntary ventilation (MVV), forced vital capacity (FVC) and forced expiratory volume at the 1st second (FEV1). RESULTS: There was no improvement from initial to final evaluation in FVC and FEV1. But there were significant increases in the variables IPF, EPF, MVV and PImax at evaluations A1 and A2. The PEmax variable increased only at evaluation A2. CONCLUSION: The application of the protocol of respiratory exercises with and without additional load in tobacco smokers produced immediate improvement in the performance of respiratory muscles, but this gain was more accentuated after 2 weeks of exercise.

Parkinson disease: A systemic review of pain sensitivities and its association with clinical pain and response to dopaminergic stimulation

2018 ◽  
Vol 395 ◽  
pp. 172-206 ◽  
Author(s):  
Simon Sung ◽  
Nirosen Vijiaratnam ◽  
Daniela Wan Chi Chan ◽  
Michael Farrell ◽  
Andrew H. Evans
Keyword(s):  
Parkinson Disease ◽  
Systemic Review ◽  
Clinical Pain ◽  
Dopaminergic Stimulation

scholarly journals Monitoring respiratory muscle strength assists in early diagnosis of respiratory dysfunction as opposed to the isolated use of pulmonary function evaluation in amyotrophic lateral sclerosis

2013 ◽  
Vol 71 (3) ◽  
pp. 146-152 ◽  
Author(s):  
Guilherme Fregonezi ◽  
Palomma Russelly Saldanha Araújo ◽  
Tathiana Lindemberg Ferreira Macêdo ◽  
Mario Emilio Dourado Junior ◽  
Vanessa Regiane Resqueti ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Muscle Strength ◽  
Early Diagnosis ◽  
Pulmonary Function ◽  
Healthy Subjects ◽  
Respiratory Muscle ◽  
Function Evaluation ◽  
Respiratory Muscle Strength ◽  
Respiratory Dysfunction ◽  
Lateral Sclerosis

ObjectiveIt was study the relationship between respiratory muscle strength and forced vital capacity (FVC) in patients with amyotrophic lateral sclerosis (ALS) versus healthy subjects.MethodsPulmonary function and respiratory muscle strength [maximal inspiratory (PImax), maximal expiratory (PEmax) and sniff nasal inspiratory pressure (SNIP)] were assessed in patients with ALS and healthy subjects, matched using cutoffs established in the literature for impaired pulmonary function and respiratory muscle weakness.ResultsTwenty-eight ALS patients and 28 healthy subjects were studied. We found sensitivity and specificity for PImax, PEmax and SNIP of 75/58%, 81/67% and 75/67%. The Receiver Operating Characteristic curve (ROC curve) indicated that the variables PImax, PEmax and SNIP can identify differences in respiratory muscle strength between ALS and healthy individuals at 0.89, 0.9 and 0.82, respectively. A positive correlation was recorded between FVC (%) versus SNIP, PImax and PEmax.ConclusionIn ALS, monitoring respiratory muscle strength assists in early diagnosis of respiratory dysfunction as opposed to the isolated use of FVC.

Respiratory Muscle Control in Patients with Parkinson's Disease

1983 ◽  
Vol 64 (2) ◽  
pp. 31P-32P
Author(s):  
M.C.P. Apps ◽  
D.W. Empey ◽  
C. Kennard
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Respiratory Muscle ◽  
Muscle Control

Impact of Lung Biopsy on Lung Function in Idiopathic Pulmonary Fibrosis

Respiration ◽  
2020 ◽  
pp. 1-8
Author(s):  
Pierre-Henri Aussedat ◽  
Nader Chebib ◽  
Kais Ahmad ◽  
Jean-Charles Glerant ◽  
Gabrielle Drevet ◽  
...  
Keyword(s):  
Lung Function ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Forced Vital Capacity ◽  
Lung Biopsy ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Surgical Lung Biopsy ◽  
Before And After ◽  
The Impact

<b><i>Background:</i></b> Video-assisted surgical lung biopsy (SLB) is performed in 10–30% of cases to establish the diagnosis of idiopathic pulmonary fibrosis (IPF). <b><i>Objectives:</i></b> The aim of the study was to analyze the impact of SLB on lung function in patients eventually diagnosed with IPF. <b><i>Methods:</i></b> This is an observational, retrospective, monocentric study of all consecutive patients eventually diagnosed with IPF in multidisciplinary discussion who underwent SLB over 10 years in a specialized center. The primary end point was the variation in forced vital capacity (FVC) before and after the SLB. The secondary end points were the variations in forced expiratory volume in one second (FEV1), total lung capacity (TLC), carbon monoxide diffusion capacity (DLCO), and morbidity and mortality associated with the SLB. <b><i>Results:</i></b> In 118 patients who underwent SLB and were diagnosed with IPF, a relative decrease in FVC of 4.8% (<i>p</i> &#x3c; 0.001) was found between measurements performed before and after the procedure. The mean FVC decrease was 156 ± 386 mL in an average period of 185 days, representing an annualized decline of 363 ± 764 mL/year. A significant decrease was also observed after SLB in FEV1, TLC, and DLCO. Complications within 30 days of SLB occurred in 14.4% of patients. Two patients (1.7%) died within 30 days, where one of them had poor lung function. Survival at 1 year was significantly poorer in patients with FVC &#x3c;50% at baseline. <b><i>Conclusion:</i></b> In this uncontrolled study in patients ultimately diagnosed with IPF, SLB was followed by a significant decline in FVC, which appears to be numerically greater than the average decline in the absence of treatment in the literature. <b><i>Summary at a Glance:</i></b> This study evaluated the change in lung function in 118 consecutive patients diagnosed with idiopathic pulmonary fibrosis by surgical lung biopsy. Forced vital capacity decreased by 156 ± 386 mL in a mean of 185 days between the last measurement before and first measurement after biopsy, representing an annualized decline of 363 ± 764 mL/year.

scholarly journals Expiration Training Maneuver for Chronic Obstructive Pulmonary Disease with Congestive Heart Failure Grade II: A Case Report

2019 ◽  
Vol 7 (01) ◽  
pp. 28
Author(s):  
Nury Nusdwinuringtyas ◽  
Siti Chandra Widjanantie
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Muscle Strength ◽  
Pulmonary Disease ◽  
Respiratory Muscle ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Respiratory Muscle Strength ◽  
Obstructive Pulmonary Disease ◽  
Before And After ◽  
Grade Ii

Introduction: Chronic Obstructive Pulmonary Disease (COPD) was characteristic by the inflammatory process in the airway which causes air trapping and hyperinflation, then followed by decreasing the respiratory muscle strength. Breathing training using the positive expiratory pressure (PEP) increasing respiratory muscle strength.Methods: A case presentation of a male, age was 60 years old diagnosed as COPD by The Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade 4 group D, and Chronic Heart Failure (CHF) grade II, with complication of excessive phlegm, underweight, and weakness of respiratory muscle, have PEP for 8 weeks.Results: Spirometry evaluation before and after eight week of PEP have found; FEV1 22.12 and 22.42%, FVC 34.24 and 56%, FEV1/FVC 76.8 and 64%. Respiratory muscle strength before and after PEP showed the Muscle Inspiratory Pressure (MIP) 46 and 71 cmH2O, Muscle Expiratory Pressure (MEP) 48 and 104 cmH2O.The values of Six Minute Walk Test (6MWT) evaluation by BORG modified scale before and after PEP were 11 and 13 ( efforts), 2 and 3 (dyspnea), 0 and 1 (Leg Fatigue). The six-minute walking distance (6MWD) before and after PED were 170 and 190 m, equation reference with Nury’s formula showed percentage prediction before and after PEP respectively 29.2 and 32%, VO2Max; 4.96 and 6L, METs; 1.41 and 1.7. The St GeorgeRespiratory Questionnaire (SGRQ) before and after PEP were 20.6 and 49.5% (symptom), 86.6 and 45.1% (activity), 45.5 and 18.4% (impact) and 53.6 and 42% for total.Conclusion: Positive airway pressure exercise had beneficial effect on reducing air-trapping process in COPD and increasing the respiratory muscle strength for both expiratory and inspiratory muscle strength.Keywords: Chronic obstructive pulmonary disease, positive expiratory pressure device, respiratory muscle strength, six minutes walking distance

scholarly journals Impact of Permissive Hypoxia and Hyperoxia Avoidance on Clinical Outcomes in Septic Patients Receiving Mechanical Ventilation: A Retrospective Single-Center Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Kota Nishimoto ◽  
Takeshi Umegaki ◽  
Sayaka Ohira ◽  
Takehiro Soeda ◽  
Natsuki Anada ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
University Hospital ◽  
Icu Mortality ◽  
Respiratory Dysfunction ◽  
Mechanically Ventilated ◽  
Icu Stay ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration ◽  
Before And After ◽  
Clinical Records

Background. Septic patients often require mechanical ventilation due to respiratory dysfunction, and effective ventilatory strategies can improve survival. The effects of the combination of permissive hypoxia and hyperoxia avoidance for managing mechanically ventilated patients are unknown. This study examines these effects on outcomes in mechanically ventilated septic patients. Methods. In a retrospective before-and-after study, we examined adult septic patients (aged ≥18 years) requiring mechanical ventilation at a university hospital. On April 1, 2017, our mechanical ventilation policy changed from a conventional oxygenation target (SpO2: ≥96%) to more conservative targets with permissive hypoxia (SpO2: 88-92% or PaO2: 60 mmHg) and hyperoxia avoidance (reduced oxygenation for Pa O 2 > 110   mmHg ). Patients were divided into a prechange group (April 2015 to March 2017; n = 83 ) and a postchange group (April 2017 to March 2019; n = 130 ). Data were extracted from clinical records and insurance claims. Using a multiple logistic regression model, we examined the association of the postchange group (permissive hypoxia and hyperoxia avoidance) with intensive care unit (ICU) mortality after adjusting for variables such as Sequential Organ Failure Assessment (SOFA) score and PaO2/FiO2 ratios. Results. The postchange group did not have significantly lower adjusted ICU mortality (0.67, 0.33-1.43; P = 0.31 ) relative to the prechange group. However, there were significant intergroup differences in mechanical ventilation duration (prechange: 11.0 days, postchange: 7.0 days; P = 0.01 ) and ICU stay (prechange: 11.0 days, postchange: 9.0 days; P = 0.02 ). Conclusions. Permissive hypoxia and hyperoxia avoidance had no significant association with reduced ICU mortality in mechanically ventilated septic patients. However, this approach was significantly associated with shorter mechanical ventilation duration and ICU stay, which can improve patient turnover and ventilator access.

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