BACKGROUND: Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. METHODS: Sixteen elderly subjects (9 women, mean ؎ SD age 70.6 ؎ 3.9 y, mean ؎ SD body mass index 23.8 ؎ 2.5 kg/ m 2 ) and 16 healthy adults (8 women, mean ؎ age 25.9 ؎ 4.3 y, mean ؎ body mass index 23.6 ؎ 2.4 kg/ m 2 ) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). RESULTS: In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. CONCLUSIONS: Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

BackgroundThoracoabdominal asynchrony is the nonparallel motion of the ribcage and abdomen. It is estimated by using respiratory inductive plethysmography and, recently, using optoelectronic plethysmography; however the agreement of measurements between these 2 techniques is unknown. Therefore, the present study compared respiratory inductive plethysmography with optoelectronic plethysmography for measuring thoracoabdominal asynchrony to see if the measurements were similar or different.Methods27 individuals (9 healthy subjects, 9 patients with interstitial lung disease, and 9 with chronic obstructive pulmonary disease performed 2 cycle ergometer tests with respiratory inductive plethysmography or optoelectronic plethysmography in a random order. Thoracoabdominal asynchrony was evaluated at rest, and at 50% and 75% of maximal workload between the superior ribcage and abdomen using a phase angle.ResultsThoracoabdominal asynchrony values were very similar in both approaches not only at rest but also with exercise, with no statistical difference. There was a good correlation between the methods and the Phase angle values were within the limits of agreement in the Bland-Altman analysis.ConclusionThoracoabdominal asynchrony measured by optoelectronic plethysmography and respiratory inductive plethysmography results in similar values and has a satisfactory agreement at rest and even for different exercise intensities in these groups.

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Objective: To compare two methods of respiratory inductive plethysmography (RIP) calibration in three different positions. Methods: We evaluated 28 healthy subjects (18 women and 10 men), with a mean age of 25.4 ± 3.9 years. For all of the subjects, isovolume maneuver calibration (ISOCAL) and qualitative diagnostic calibration (QDC) were used in the orthostatic, sitting, and supine positions. In order to evaluate the concordance between the two calibration methods, we used ANOVA and Bland-Altman plots. Results: The values of the constant of proportionality (K) were significantly different between ISOCAL and QDC in the three positions evaluated: 1.6 ± 0.5 vs. ResumoObjetivo: Comparar dois métodos de calibração da pletismografia respiratória por indutância (PRI) em três posturas diferentes. Métodos: Foram avaliados 28 indivíduos saudáveis (18 mulheres e 10 homens), com média de idade de 25,4 ± 3,9 anos. Todos os indivíduos foram submetidos a isovolume maneuver calibration (ISOCAL, calibração por manobra de isovolume) e qualitative diagnostic calibration (QDC, calibração diagnóstica qualitativa) em ortostatismo, sedestação e decúbito dorsal. Foi utilizada ANOVA e a disposição gráfica de Bland-Altman para a avaliação da concordância dos métodos de calibração. Resultados: Os valores da constante de proporcionalidade (K) foram significativamente distintos entre ISOCAL e QDC nas três posturas avaliadas: 1,6 ± 0,5 vs. 2,0 ± 1,2, em decúbito dorsal; 2,5 ± 0,8 vs. 0,6 ± 0,3, em sedestação; e 2,0 ± 0,8 vs. 0,6 ± 0,3, em ortostatismo (p < 0,05 para todos). Conclusões: Nossos resultados sugerem que QDC não é um método acurado para a calibração da PRI. Os valores de K obtidos por ISOCAL mostram que a PRI deve ser calibrada para cada postura avaliada.Descritores: Pletismografia; Mecânica respiratória; Postura; Calibragem. where SD(∆ U V AB ) and SD(∆ U V CT ) are the standard deviations of the electrical signals related to the abdomen and rib cage, respectively. (4,8,9) Although ISOCAL is considered the gold standard for RIP calibration, the vast majority of studies employ QDC because the method requires no specific respiratory maneuvers. (10)(11)(12)(13) We are unaware of any studies comparing the two methods of RIP calibration regarding the values of the constant K when different positions are employed.