Respiratory Movements of Patients with Severe Chronic Obstructive Lung Disease and Emphysema in Supine and Forward Standing Leaning

Asdis Kristjansdottir^1*, Magdalena Asgeirsdottir¹, Hans Beck¹, Petur Hannesson², Maria Ragnarsdottir³

¹Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland.
²Department of Radiology, Landspitali National and University Hospital, Reykjavik, Iceland.
³Department of Physiotherapy, Landspitali National and University Hospital, Reykjavik, Iceland.

DOI: 10.4236/ojrd.2015.51001                

Abstract

Objective: To investigate respiratory movements in supine and forward standing leaning position among patients with emphysema and severe chronic obstructive pulmonary disease (COPD) during rest and dyspnea. Methodology: Nineteen patients with emphysema and severe COPD underwent lung function measurement and positional assessment of diaphragm. Respiratory movements during quiet and deep breathing were measured in supine and standing forward leaning using the Respiratory Movement Measuring Instrument (RMMI) (MTT, Arleyni 8, Reykjavik, Iceland). Patients then bicycled with the work rate 87% of the peak work rate tolerated in a pre-program incremental exercise test. Immediately after dismounting the bicycle, respiratory movements were measured in forward leaning. Results: For participants with mean age of 61 ± 7 years and mean body mass index of 23.59 ± 4.63, respiratory movements during quiet breathing in supine were significantly (abdominal p = 0.025, lower- and upper-thoracic p = 0.020) greater than in forward leaning. In the case forward leaning during dyspnea, lower- and upper-thoracic movements were significantly (p = 0.001; p = 0.005, respectively) less than abdominal. Conclusion: This study indicates that the diaphragm of patients with severe COPD and emphysema is active in forward leaning position during rest and dyspnea.

Keywords

Respiratory Movements, Dyspnea, Pulmonary Rehabilitation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Nici, L., Raskin, J., Rochester, C.L., Bourbeau, J.C., Carlin, B.W., Casaburi, R., et al. (2009) Pulmonary Rehabilitation: What We Know and What We Need to Know. Journal of Cardiopulmonary Rehabilitation and Prevention, 29, 141-151. http://dx.doi.org/10.1097/HCR.0b013e3181a3324a
[2]	Griffiths, T.L., Burr, M.L., Campbell, I.A., Lewis-Jenkins, V., Mullins, J., Shiels, K., et al. (2000) Results at 1 Year of Outpatient Multidisciplinary Pulmonary Rehabilitation: A Randomised Controlled Trial. Lancet, 355, 362-368. http://dx.doi.org/10.1016/S0140-6736(99)07042-7
[3]	Gibson, G.J. (1996) Pulmonary Hyperinflation: A Clinical Overview. European Respiratory Journal, 9, 2640-2649. http://dx.doi.org/10.1183/09031936.96.09122640
[4]	Blanch, L., Bernabé, F. and Lucangelo, U. (2005) Measurement of Air Trapping, Intrinsic Positive End-Expiratory Pressure, and Dynamic Hyperinflation in Mechanically Ventilated Patients. Respiratory Care, 50, 110-124.
[5]	Rubini, A., Paoli, A. and Parmagnani, A. (2012) Body Meatabolic Rate and Electromyographic Activities of Antigravitational Muscles in Supine and Standing Postures. European Journal of Applied Physiology, 112, 2045-2050. http://dx.doi.org/10.1007/s00421-011-2180-0
[6]	O’Neill, S. and McCarthy, D. (1983) Postural Relief of Dyspnoea in Severe Chronic Airflow Limitation. Thorax, 38, 595-600. http://dx.doi.org/10.1136/thx.38.8.595
[7]	Sharp, J.T., Druz, W.S., Moisan, T., Foster, J. and Machnach, W. (1980) Postural Relief of Dyspnoea in Severe Chronic Obstructive Pulmonary Disease. American Review of Respiratory Disease, 122, 201-211.
[8]	Druz, W.S. and Sharp, J.T. (1982) Electrical and Mechanical Activity of the Diaphragm Accompanying Body Position in Severe Chronic Obstructive Pulmonary Disease. American Review of Respiratory Disease, 125, 275-280.
[9]	Delgado, H.R., Braun, S.R., Skatrud, J.B., Reddan, W.G. and Pegelow, D.F. (1982) Chest Wall and Abdominal Motion during Exercise in Patients with Chronic Obstructive Pulmonary Disease. American Review of Respiratory Disease, 126, 200-205.
[10]	Gosselink, R. (2003) Controlled Breathing in Patients with Chronic Obstructive Pulmonary Disease [COPD]. Journal of Rehabilitation Research and Development, 40, 25-34. http://dx.doi.org/10.1682/JRRD.2003.10.0025
[11]	Heijdra, Y. (1994) Effects of Body Position, Hyperinflation, and Blood Gas Tensions on Maximal Respiratory Pressures with Chronic Obstructive Pulmonary Disease. Thorax, 49, 453-458. http://dx.doi.org/10.1136/thx.49.5.453
[12]	Suwatanapongeched, T., Gierada, D.S., Slone, R.M., Pilgram, T.K. and Tuteur, P.G. (2003) Variation in Diaphragm Position and Shape in Adults with Normal Pulmonary Function. Chest, 123, 2019-2027. http://dx.doi.org/10.1378/chest.123.6.2019
[13]	Gunnerson, I.L. and Olsén, M.F. (2011) Validity in Measuring Breathing Movements with the Respiratory Movement Measuring Instrument. Clinical Physiology and Functional Imaging, 31, 1-4. http://dx.doi.org/10.1111/j.1475-097X.2010.00970.x
[14]	Fagevik Olsén, M. and Romberg, K. (2010) Reliability of the Respiratory Movement Measuring Instrument, RMMI. Clinical Physiology and Functional Imaging, 30, 349-353.
[15]	Ragnarsdóttir, M., Kristjánsdóttir, á., Ingvarsdóttir, I., Hannesson, P., Torfason, B. and Cahalin, L. (2004) Short-Term Changes in Pulmonary Function and Respiratory Movements after Cardiac Surgery via Median Sternotomy. Scandinavian Cardiovascular Journal, 38, 46-52. http://dx.doi.org/10.1080/14017430310016658
[16]	Kristjánsdóttir, á., Ragnarsdóttir, M., Hannesson, P., Beck, H. and Torfason, B. (2004) Respiratory Movements Are Altered Three Months and One Year Following Cardiac Surgery. Scandinavian Cardiovascular Journal, 38, 98-103. http://dx.doi.org/10.1080/14017430410028492
[17]	Kristjánsdóttir, á., Ragnarsdóttir, M., Hannesson, P., Beck, H. and Torfason, B. (2004) Chest Wall Motion and Pulmonary Function Are More Diminished Following Cardiac Surgery When the Internal Mammary Artery Retractor Is Used. Scandinavian Cardiovascular Journal, 38, 1-6. http://dx.doi.org/10.1080/14017430410016396
[18]	Ragnarsdottir, M. and Kristinsdottir, E.K. (2006) Breathing Movements and Breathing Patterns among Healthy Men and Women 20-69 Years of Age. Respiration, 73, 48-54. http://dx.doi.org/10.1159/000087456
[19]	Ragnarsdottir, M., Malmberg, E., Strandberg, E. and Indridason, O. (2011) Increased Physical Fitness among Patients Following Endurance Training during Haemodialysis. Scandinavian Journal of Urology and Nephrology, 46, 54-57.
[20]	Fagevik Olsén, M., Pazooki, D. and Granhed, H. (2013) Recovery after Stabilising Surgery for “Flail Chest”. European Journal of Trauma and Emergency Surgery, 39, 501-506. http://dx.doi.org/10.1007/s00068-013-0293-3
[21]	Borg, G. (1982) Psychophysical Bases of Perceived Exertion. Medicine Science in Sports Exercise, 14, 377-381. http://dx.doi.org/10.1249/00005768-198205000-00012
[22]	Rochester, C.L. and Mohsenin, V. (2002) Respiratory Complications of Stroke. Seminars in Respiratory and Critical Care Medicine, 23, 248-260. http://dx.doi.org/10.1055/s-2002-33033
[23]	Ropper, A.H. and Brown, R.H. (2005) Adams & Victors Principles of Neurology. 8th Edition, McGraw-Hill, New York.
[24]	Gorman, R., McKenzie, D., Pride, N., Tolman, J. and Gandevia, S. (2002) Diaphragm Length during Tidal Breathing in Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 166, 1461-1469. http://dx.doi.org/10.1164/rccm.200111-087OC
[25]	Kleinman, B., Frey, K., VanDuren, M., Sheikh, T., DiPinto, D., Mason, R., et al. (2002) Motion of the Diaphragm in Patients with Chronic Obstructive Pulmonary Disease While Spontaneously Breathing versus during Positive Pressure Breathing after Anaesthesia and Neuromuscular Blockage. Anaesthesiology, 97, 298-305. http://dx.doi.org/10.1097/00000542-200208000-00003
[26]	Bhatt, S., Guleria, R., Luqman-Arafath, T., Gupta, A., Mohan, A., Nanda, S., et al. (2009) Effect of Tripod Position on Objective Parameters of Respiratory Function in Stable Chronic Obstructive Pulmonary Disease. Indian Journal of Chest Disease and Allied Science, 51, 83-85.