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Observational Study
. 2017 Mar 2:12:773-781.
doi: 10.2147/COPD.S126354. eCollection 2017.

Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease

Weiliang Wu  1 , Xianming Zhang  2 , Lin Lin  1 , Yonger Ou  1 , Xiaoying Li  1 , Lili Guan  1 , Bingpeng Guo  1 , Luqian Zhou  1 , Rongchang Chen  1
Affiliations
Observational Study

Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease

Weiliang Wu et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Inspiratory muscle training (IMT) is a rehabilitation therapy for stable patients with COPD. However, its therapeutic effect remains undefined due to the unclear nature of diaphragmatic mobilization during IMT. Diaphragmatic mobilization, represented by transdiaphragmatic pressure (Pdi), and neural respiratory drive, expressed as the corrected root mean square (RMS) of the diaphragmatic electromyogram (EMGdi), both provide vital information to select the proper IMT device and loads in COPD, therefore contributing to the curative effect of IMT. Pdi and RMS of EMGdi (RMSdi%) were measured and compared during inspiratory resistive training and threshold load training in stable patients with COPD.

Patients and methods: Pdi and neural respiratory drive were measured continuously during inspiratory resistive training and threshold load training in 12 stable patients with COPD (forced expiratory volume in 1 s ± SD was 26.1%±10.2% predicted).

Results: Pdi was significantly higher during high-intensity threshold load training (91.46±17.24 cmH2O) than during inspiratory resistive training (27.24±6.13 cmH2O) in stable patients with COPD, with P<0.01 for each. Significant difference was also found in RMSdi% between high-intensity threshold load training and inspiratory resistive training (69.98%±16.78% vs 17.26%±14.65%, P<0.01).

Conclusion: We concluded that threshold load training shows greater mobilization of Pdi and neural respiratory drive than inspiratory resistive training in stable patients with COPD.

Keywords: diaphragmatic electromyogram; inspiratory resistive training; inspiratory threshold load training; pulmonary rehabilitation; respiratory physiological detection.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Respiratory resistance device (PFLEX; Respironics Inc; Pittsburgh, PA, USA).
Figure 2
Figure 2
Respiratory threshold load device (Threshold Inspiration Muscle Trainer; Respironics Inc; Pittsburgh, PA, USA).
Figure 3
Figure 3
Multipair esophageal electrode with esophageal and gastric pressure balloons.
Figure 4
Figure 4
The waveforms of mouth pressure, diaphragmatic pressure, respiratory flow rate, tidal volume, and EMGdi of COPD patients during spontaneous breathing, respiratory resistance, and threshold load training. Abbreviations: EMGdi, diaphragmatic electromyogram; Pm, mouth pressure; Pdi, transdiphragmatic pressure; Vt, total volume.
Figure 5
Figure 5
Pdi in 12 COPD patients during low-, moderate-, and high-intensity inspiratory resistance training and inspiratory threshold load training. Abbreviations: Pdi, transdiaphragmatic pressure; SB, spontaneous breathing; L, low intensity; M, moderate intensity; H, high intensity.
Figure 6
Figure 6
RMSdi% in 12 COPD patients in low-, moderate-, and high-intensity inspiratory resistance training and inspiratory threshold load training. Abbreviations: RMSdi, root mean square of diaphragmatic electromyogram; SB, spontaneous breathing; L, low intensity; M, moderate intensity; H, high intensity.
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