It is established that during tidal breathing the rib cage expands more than the abdomen in the upright posture, whereas the reverse is usually true in the supine posture. To explore the reasons for this, we studied nine normal subjects in the supine, standing, and sitting postures, measuring thoracoabdominal movement with magnetometers and respiratory muscle activity via integrated electromyograms. In eight of the subjects, gastric and esophageal pressures and diaphragmatic electromyograms via esophageal electrodes were also measured. In the upright postures, there was generally more phasic and tonic activity in the scalene, sternocleidomastoid, and parasternal intercostal muscles. The diaphragm showed more phasic (but not more tonic) activity in the upright postures, and the abdominal oblique muscle showed more tonic (but not phasic) activity in the standing posture. Relative to the esophageal pressure change with inspiration, the inspiratory gastric pressure change was greater in the upright than in the supine posture. We conclude that the increased rib cage motion characteristic of the upright posture owes to a combination of increased activation of rib cage inspiratory muscles plus greater activation of the diaphragm that, together with a stiffened abdomen, acts to move the rib cage more effectively.

Diaphragmatic force-length behavior was assessed in anesthetized dogs using two techniques. One employed measurements in a diaphragm strip with intact nerve and blood supply; the second related transdiaphragmatic pressure (Pdi) to direct estimates of diaphragmatic tension from strain gauge arches during bilateral, tetanic, supramaximal phrenic nerve stimulation. In strip preparations the diaphragm exerted active force at lengths as short as 40% of resting in situ length (Lo), and maximal force was registered at a length averaging 25% greater than Lo. This suggested a broader effective length range for the diaphragm as compared to other skeletal muscles. In the intact preparation both Pdi and directly measured diaphragmatic tension were inversely related to lung volume and when they were used to calculate the diaphragm's effective radius of curvature (r), r was found to change little or decrease at large lung volumes rather than increase as theory would predict. These findings suggest that length tension characteristics outweigh geometric considerations in explaining the diaphragm's function in normal dogs and probably normal men.

With a linearized respiratory magnetometer, measurements of anteroposterior and lateral diameters of both the rib cage and the abdomen were made at functional residual capacity and continuously during tidal breathing. Twenty-five subjects with normal respiratory systems were studied in the sitting, supine, lateral decubitus, and prone body positions. When subjects changed from sitting to supine position anteroposterior diameters of both rib cage and abdomen decreased while their lateral diameters increased. Both anteroposterior and lateral tidal excursions of the rib cage decreased; those of the abdomen increased. When subjects turned from supine to lateral decubitus position both anteroposterior diameters increased and the lateral diameters decreased. This was associated with an increase in both lateral excursions and a decrease in the abdominal anteroposterior excursions. Diameters and tidal excursions in the prone position resembled those in the supine position. Diameter changes could be explained by gravitational effects. Differences in tidal excursions accompanying body position change were probably related to 1) differences in the distribution of respiratory muscle force, 2) differences in the activity or mechanical advantage of various inspiratory muscles, and 3) local compliance changes in parts of the rib cage and abdomen.

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Patients with severe obesity and obstructive sleep apnea (OSA) have been shown to have abnormalities in respiratory muscle function and respiratory control. The present study was done to evaluate diaphragmatic function and the diaphragm fiber-length-compensating reflex in morbidly obese patients with OSA (1). Twelve normal subjects and 13 morbidly obese patients with OSA were studied in recumbent and upright positions. In the normal subjects, the diaphragm fiber-length-compensating reflex operated normally causing the diaphragm's inspiratory EMG to increase when the diaphragm's fibers shortened with assumption of the upright position. However, 8 of the 13 obese patients with OSA showed a decrease rather than an increase in the inspiratory diaphragmatic EMG on assuming the upright posture. Further data indicate greater diaphragmatic efficiency in the upright than in the supine position in a majority of the obese patients, a reversal of the normal response. Two possible explanations of these observations are: an abnormality of central respiratory control in obese patients with OSA and overstretching of the diaphragm in the recumbent obese patient. The observation of reduced maximal transdiaphragmatic pressures in the recumbent position in some of the obese patients with OSA supports the second explanation. Diaphragmatic overstretching may be an important mechanism in the development of hypoventilation in the morbidly obese.

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This study sought answers to 2 questions: (1) Is severe dyspnea to the point of exhaustion regularly accompanied by diaphragmatic fatigue in patients with moderately severe chronic obstructive pulmonary disease (COPD)? (2) When diaphragmatic fatigue occurs in such patients, does theophylline prevent or delay its onset? Eight eucapnic patients with moderately severe COPD were subjected to 2 different stresses to the point of severe dyspnea requiring cessation of the stress. The stresses were cycle exercise and inspiratory resistive breathing, the latter requiring a tidal Pdi equal to 60% of Pdimax. Despite incapacitating dyspnea, objective evidence of diaphragmatic fatigue was not encountered during cycle exercise. During inspiratory resistive breathing, diaphragmatic fatigue was encountered in all patients as defined by consistent inability to attain a target Pdi during final moments of the resistance run. Patients were uniformly extremely dyspneic at this point. In neither stressful maneuver did oral sustained-release theophylline show a convincing or significant advantage over placebo when administered in a randomized double-blind crossover protocol. These results suggest that the diaphragmatic fatigue encountered in this sort of COPD patient may be of predominantly central rather than peripheral (myogenic) origin and that theophylline may not be effective in this type of fatigue.