Gas exchange and breathing pattern in women with postmenopausal bone fragility

Polverino, Francesca; de-Torres, Juan P.; Santoriello, Carlo; Capuozzo, Antonio; Mauro, Immacolata; Rojas, Joselyn; D’Agostino, Bruno; Celli, Bartolomé R.; Polverino, Mario; Owen, Caroline A.

doi:10.1016/j.rmed.2018.03.006

Cited by 3 publications

(3 citation statements)

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“…The authors hypothesized that the metabolic demand, coming from the central and peripheral chemosensors and muscular mechanoreceptors, sends a signal to the cortex in order to produce a grater stimulus to counterbalance the albeit minimal (and subclinical) muscular weakness of the very early stages of the disease, and the P 0.1 tends to be stronger. A similar mechanism has been described in osteoporosis [ 8 ]. To better highlight this alteration the authors normalized the drive to the inspiratory muscle strength (P 0.1 /MIP): this ratio was significantly different between group A and controls and between group B and controls, while there was no statistical difference between group A and group B.…”

Section: Literature Analysissupporting

confidence: 62%

“…In this paper we analyze studies about the usefulness of PFT in diagnosis of ALS, focusing our attention especially in early diagnosis, similarly to what has emerged in other diseases [ 8 ]. In fact, little or nothing is reported in the literature about respiratory function parameters that may be useful in a very early stage of disease, when yet neurological tests do not allow for a diagnosis of probability.…”

Section: Literature Analysismentioning

confidence: 99%

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Diagnosis of amyotrophic lateral sclerosis by respiratory function test

Polverino,

Sampaolo,

Capuozzo

et al. 2023

Multidis Res Med

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The diagnostic criterion for amyotrophic lateral sclerosis (ALS) based on the findings of concomitant clinical and electrophysiological evidence of upper and lower motor neuron involvement may remain unsatisfied for months and in some patients, even for years in the early stage of the disease. Since respiratory involvement is an onset symptom of ALS in only 1-3% of patients, pulmonary assessment has never been considered useful in the early diagnosis of ALS. However, studies on pulmonary function are lacking, especially in those early stages where neurologic tests are also inconclusive. In contrast to the scarcity of data in the early stages, as the disease progresses, it is increasingly enriched by a rich set of symptoms and positive respiratory tests until respiratory failure occurs, which represents the main cause of death in ALS. Hereby we analyze the main pulmonary function tests (PFT) in the various stages of the disease, up to the recent evidence for the possibility of an early diagnosis.

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Section: Literature Analysissupporting

confidence: 62%

Section: Literature Analysismentioning

confidence: 99%

Diagnosis of amyotrophic lateral sclerosis by respiratory function test

Polverino,

Sampaolo,

Capuozzo

et al. 2023

Multidis Res Med

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“…We show that, early in the onset of ALS, subtle weakening of the muscles is sufficient to induce increases in the P 0.1 , reflecting the increased metabolic demand coming from the central and peripheral chemosensors and muscular mechanoreceptors, as it occurs in osteoporosis [11]. Even after normalizing P 0.1 for the inspiratory muscle strength, we still found it to be higher in patients with pre-ALS versus controls, confirming that this parameter has high sensitivity, specificity, and positive predicted value to detect ALS in preclinical stages.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Function Changes as Early Signs of Amyotrophic Lateral Sclerosis

Polverino,

Sampaolo,

Capuozzo

et al. 2023

Respiration

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Background: The current diagnostic criteria for amyotrophic lateral sclerosis (ALS) may remain unsatisfactory for months or years in the early disease. Pulmonary assessment has never been considered useful in the early diagnosis of ALS, and studies of pulmonary function in this patient category are lacking. Objectives: The objective of this study was to assess the pulmonary function in subjects with unspecific symptoms of ALS in whom an ALS diagnosis cannot be reached based on the current available guidelines. Methods: We performed pulmonary function tests, arterial gas analysis, maximal inspiratory (MIP) and expiratory (MEP) pressure, and respiratory drive (P0.1) assessment in 35 patients with unspecific neurological symptoms at the time of the visit and those were subsequently diagnosed with ALS 2 years after the initial visit (“pre-ALS”); we compared these patients with 29 patients with established ALS and with 28 control subjects. Results: Spirometric parameters were not different between the three groups. However, MIP was significantly lower and P0.1 was significantly increased (with the ratio P0.1/MIP significantly higher) in both established and pre-ALS patients compared to controls, while both MIP and P0.1 were similar between established ALS and pre-ALS. Conclusions: Changes in MIP, P0.1, and P0.1/MIP ratio are highly suggestive of preclinical ALS when the spirometry and neurodiagnostic tests are still inconclusive. MIP and P0.1 are noninvasive measurements that can be easily assessed in an ambulatory setting. Future studies on larger cohorts are needed to validate the use of these parameters in the preclinical diagnosis of ALS as well as in other neuromuscular diseases.

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