BACKGROUND: Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (P Imax ) and maximum static expiratory pressure (P Emax ), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate P Emax /P Imax ratio for these groups. METHODS: Seventy (35 males) subjects with NMDs (amyotrophic lateral sclerosis, myasthenia gravis, and myotonic dystrophy), and 93 (47 males) healthy individuals 20 -80 y of age were evaluated for anthropometry, pulmonary function, P Imax , and P Emax , respectively. RESULTS: Healthy individuals showed greater values for P Imax and P Emax when compared with subjects with NMDs. P Emax /P Imax ratio for healthy subjects was 1.31 ؎ 0.26, and P Emax %/P Imax % was 1.04 ؎ 0.05; for subjects with NMDs, P Emax /P Imax ratio was 1.45 ؎ 0.65, and P Emax %/P Imax % ratio was 1.42 ؎ 0.67. We found that P Emax %/P Imax % for myotonic dystrophy was 0.93 ؎ 0.24, for myasthenia gravis 1.94 ؎ 0.6, and for amyotrophic lateral sclerosis 1.33 ؎ 0.62 when we analyzed them separately. All healthy individuals showed higher P Emax compared with P Imax . For subjects with NMDs, the impairment of P Emax and P Imax is different among the 3 pathologies studied (P < .001). CONCLUSIONS: Healthy individuals and subjects with NMDs showed higher P Emax in comparison to P Imax regarding the P Emax /P Imax ratio. Based on the ratio, it is possible to state that NMDs show different patterns of respiratory muscle strength loss. P Emax /P Imax ratio is a useful parameter to assess the impairment of respiratory muscles in a patient and to customize rehabilitation and treatment.

SUMMARY The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic shows a rapid increase in cases and deaths. The World Health Organization (WHO) has shown that more than 200.000 confirmed cases have been identified in more than 166 countries/territories. Public health authorities in Brasil have reported 532 confirmed cases by March 19. Approximately 5% of the patients will require intensive care unit treatment with oxygen therapy and mechanical ventilation. Limited data are available about rehabilitation protocols for severe illness and intensive care treatment of COVID-19 increase. Thus, we aim to show current information about COVID-19, describing symptoms and the respiratory management for critical patients and preventive care. Physical therapists and all health care professionals need to recognize the challenges they will face in the coming months.

OM-85, administered in early life in mice in human-equivalent doses, does not inhibit the development of allergic pulmonary response in mice.

ObjectiveTo evaluate sensitivity/specificity of the maximum relaxation rate (MRR) of inspiratory muscles, amplitude of electromyographic activity of the sternocleidomastoid (SCM), scalene (SCA), parasternal (2ndIS) and rectus abdominis (RA) muscles; lung function and respiratory muscle strength in subjects with Myotonic dystrophy type 1 (DM1) compared with healthy subjects.Design and methodsQuasi-experimental observational study with control group. MRR of inspiratory muscles, lung function and amplitude of the electromyographic activity of SCM, SCA, 2ndIS and RA muscles during maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and sniff nasal inspiratory pressure (SNIP) tests were assessed in eighteen DM1 subjects and eleven healthy.ResultsMRR was lower in DM1 group compared to healthy (P = 0.001) and was considered sensitive and specific to identify disease in DM1 and discard it in controls, as well as SNIP% (P = 0.0026), PImax% (P = 0.0077) and PEmax% (P = 0.0002). Contraction time of SCM and SCA was higher in DM1 compared to controls, respectively, during PImax (P = 0.023 and P = 0.017) and SNIP (P = 0.015 and P = .0004). The DM1 group showed lower PImax (P = .0006), PEmax (P = 0.0002), SNIP (P = 0.0014), and higher electromyographic activity of the SCM (P = 0.002) and SCA (P = 0.004) at rest; of 2ndIS (P = 0.003) during PEmax and of SCM (P = 0.02) and SCA (P = 0.03) during SNIP test.ConclusionsMD1 subjects presented restrictive pattern, reduced respiratory muscle strength, muscular electrical activity and MRR when compared to higher compared to controls. In addition, the lower MRR found in MD1 subjects showed to be reliable to sensitivity and specificity in identifying the delayed relaxation of respiratory muscles.