Acute effects of Expiratory Positive Airway Pressure (EPAP) on different levels in ventilation and electrical activity of sternocleidomastoid and parasternal muscles in Chronic Obstructive Pulmonary Disease (COPD) patients: a randomized controlled trial

Abstract

ObjectiveTo investigate the acute effects of EPAP on the activity of sternocleidomastoid (SCM), parasternal muscles and ventilatory parameters in COPD patients. MethodTwenty-four patients with COPD were studied using surface electromyography (sEMG) and a ventilometer. Patients were randomly assigned to EPAP 10 cmH2O-EPAP10 or 15 cmH2O-EPAP15 for 20 minutes. ResultsThe parasternal muscle sEMG activity increased during EPAP10 and EPAP15; however, a greater and significant increase was observed with EPAP10 (mean between-group difference: 12.5% RMS, 95% CI: 9.5 to 15.4, p<0.001). In relation to the baseline, at 10 and 20 minutes and upon recovery, respectively parasternal activity increased by 23.9%, 28.9% and 19.1% during EPAP10 and by 10.7% at 10 and 20 minutes and upon recovery, respectively, 11.4% and 6.9% during EPAP15 at 10 and 20 minutes and upon recovery, respectively. The sEMG activity of SCM muscle showed an opposite pattern, increasing with EPAP15 and decreasing with EPAP10 (mean between-group difference: 15.5% RMS, 95% CI: 12.6 to 18.4, p<0.001). SCM muscle activity during EPAP15, increased by 4.8% and 6.1% at 10 and 20 minutes and decreased by -4.0% upon recovery compared to decreases of –5.6%, –20.6% and –21.3% during EPAP10 at 10, 20 minutes, and recovery. Ventilation at both EPAP intensities promoted significant reductions in respiratory rate (RR) and dyspnea, more pronounced in EPAP15: RR (mean between-group difference: –3,8bpm, 95%CI: –7,5 to –0,2, p=0,015) and dyspnea (mean between-group difference: –1.01, 95%CI: –1.4 to –0.53, p=0.028) . ConclusionIn COPD patients, the use of EPAP10 was more effective in reducing accessory inspiratory activity and increasing parasternal activity, which was accompanied by an improvement in ventilation and a reduction in dyspnea.

Effect of portable noninvasive ventilation on thoracoabdominal volumes in recovery from intermittent exercise in patients with COPD

“…EMG data were recorded during quiet breathing and at the first minute of each recovery period when pNIV or PLB were applied for 30 seconds. Finally, EMG data were recorded at 2000Hz and were filtered at 25-500 Hz during each trial (Spike 2, Cambridge Electronic Design, Cambridge, UK) (8). All EMG was processed using custom written scripts in Matlab (The Mathworks, Inc. Natick, MA, USA).…”

Sternocleidomastoid muscle activation following inspiratory muscle training in patients with chronic obstructive pulmonary disease: a randomized clinical trial

“…Chronic obstructive pulmonary disease (COPD) is a systemic condition characterized by airflow limitation, being not fully reversible 1 . Pulmonary hyperinflation, which is an abnormal increase on functional residual capacity (i.e., lung volume at the end of tidal expiration), induces the recruitment of inspiratory accessory muscle, which can fatigue the muscles involved 2 . The diaphragm is the most affected muscle, as it becomes flattened, reducing its motion and efficiency to contract.…”

Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case–control study

“…Previous studies showed have shown interesting results regarding the impact of PEP in different conditions. 12 , 13 A study conducted by Frazão et al 13 showed a significant increase in chest wall volumes, measured through Optoelectronic Pletismography (OEP), in subjects with Parkinson's disease during the use of three different intensities of PEP compared to quiet breathing. 13 However, subjects with hemiparesis frequently show restrictive ventilatory impairment associated with respiratory muscle weakness.…”