Maximum Voluntary Ventilation: Spirometric Determinants in Chronic Obstructive Pulmonary Disease Patients and Normal Subjects

Dillard, Thomas A.; Hnatiuk, Oleh W.; McCumber, Thomas R.

doi:10.1164/ajrccm/147.4.870

Cited by 55 publications

(35 citation statements)

References 13 publications

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“…27 Our data show that FIVC was 94.4% of the FEVC, which is within the range of these suggestions. Additionally, we found that FIF50 was 80.7 AE 17% of PIF, which was lower than suggested for adults.…”

Section: Quality Controlsupporting

confidence: 90%

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Forced inspiratory flow volume curve in healthy young children

Vilozni

Efrati

Barak

et al. 2009

Pediatric Pulmonology

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Summary. Introduction: Spirometry testing should include both expiratory and inspiratory measurements. Inspiratory forced maneuvers can demonstrate extrathoracic airway abnormalities, of which various symptoms may suggest asthma. However, the inspiratory portion of the forced flow/volume maneuver in young healthy children has not yet been described. Objectives: To document and analyze the forced inspiratory flow volume curve indices in healthy young children. Settings and Participants: Healthy preschool children (age 2.5-6.5 years) from community kindergartens around Israel. Methods: The teaching method included multi-target, interactive spirometry games and accessory games for inspiration (e.g., inspiratory whistle). Results: One hundred and fourteen out of a total of 157 children performed duplicate full adequate inspiratory maneuvers. Repeatability between two maneuvers was 5.6%, 4.0%, 5.1%, 7.3% for inspiratory capacity (IC), forced inspiratory vital capacity (FIVC), peak inspiratory flow (PIF), and mid inspiratory flow (FIF50). Inspiratory flow indices were significantly lower than the expiratory flow indices. The time to reach PIF was significantly longer (mean AE SD; 229 AE 21 msec) than the time to reach peak expiratory flow (92 AE 8 msec; P < 0.0001). The shape of the inspiratory curve was parabolic and did not vary with age. The formed predicted equations were in agreement with the extrapolated values for older healthy children. Conclusions: The majority of healthy young children can perform reliable maximum inspiratory flow volume curves. Our results provide a framework of reference equations for maximum inspiratory flow volume curve in the young children. The clinical applications of these equations have to be explored.

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Section: Quality Controlsupporting

confidence: 90%

“…Another recommendation is to select the best curve for interpretation from the largest sum of FIVC þ FIF50 þ PIF. 24,26,27 We used FIVC þ PIF only because we did not find any advantage for choosing the sum of three parameters over the sum of two parameters in the young children.…”

Section: Quality Controlmentioning

confidence: 99%

Forced inspiratory flow volume curve in healthy young children

Vilozni

Efrati

Barak

et al. 2009

Pediatric Pulmonology

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“…It has been shown that maximal minute ventilation measurement is influenced by both inspiratory and expiratory flow rates. 27 Moreover, subjects' motivation and effort can affect the maneuver. 19 ITL is a more specific test to evaluate inspiratory muscle performance.…”

Section: Discussionmentioning

confidence: 99%

Physiologic correlates of dyspnea in patients with morbid obesity

et al. 2006

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Objective: Mechanisms of dyspnea in obesity remain unclear. This study was undertaken to determine the relationships between dyspnea and pulmonary function including inspiratory muscle endurance (IME) in morbidly obese patients before bariatric surgery. Research methods and procedures: Fifty-five patients with a mean7s.d. body mass index (BMI) of 49.477.0 kg/m 2 were included. Dyspnea was evaluated by the Baseline Dyspnea Index (BDI; 0-12, 0 ¼ maximal dyspnea). Pulmonary function tests included a plethysmography, maximal inspiratory pressure (PImax) and IME was assessed by the incremental threshold loading test, determining the maximal pressure sustained for 2 min (Plim 2 ) and Plim 2 /PImax ratio. Patients were classified according to their BMI in two groups: BMI p49 (n ¼ 27) and 449 kg/m 2 (n ¼ 28

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“…fixed, variable extrathoracic or variable intrathoracic) because this will markedly influence the ratio of maximal expiratory over inspiratory flows [8]. Therefore, the measured MBC (MBCm) and not MBCc appears to be the appropriate MBC index in UAO, because it also reflects inspiratory besides expiratory flow rates, in contrast to MBCc [14][15][16][17]. The relationship between MBCm, MBCc, V 'Emax and exercise capacity is, however, not well established in UAO.…”

mentioning

confidence: 99%

Relationship between external resistances, lung function changes and maximal exercise capacity

Melissant¹,

Lammers²,

Demedts³

1998

Eur Respir J

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The relationship between the abnormalities in the different routine lung function tests and the degree of functional limitation during exercise is not well established in upper airway obstruction (UAO). On the contrary, in chronic obstructive pulmonary disease (COPD), for instance, a forced expiratory volume in one second (FEV1) of 60% predicted is generally associated with a peak expiratory flow (PEF) of 60-70% pred and corresponds with a moderate physical impairment of ~20-30% [1,2]. Yet, in UAO, FEV1 will still be 70-80% pred when PEF is only 40-50% pred and it is not established what the clinical relevance is of each of these changes in terms of exercise limitation, although it is generally accepted that FEV1 is an insensitive test for UAO [3][4][5].In several respiratory disorders the maximal breathing capacity (MBC) is considered a useful index of the degree of ventilatory impairment because the exercise limitation shows a good relationship with the reduction in MBC [6,7]. In instances of ventilatory limitation the maximal exercise ventilation (V 'Emax) will often be more than 70% MBC, which is the normal ratio in healthy individuals. In addition, it has been claimed that MBC is a sensitive index of the ventilatory limitation in UAO [3,[8][9][10][11][12][13]. It seems, however, very probable that the calculated MBC (MBCc), derived from FEV1 (e.g. FEV1 ×37.5) will overestimate the actual ventilatory reserve in UAO, because of the already mentioned underestimation of the obstruction by FEV1. The relationship between FEV1 or MBCc and exercise capacity will, in addition, vary depending on the type of obstruction (i.e. fixed, variable extrathoracic or variable intrathoracic) because this will markedly influence the ratio of maximal expiratory over inspiratory flows [8]. Therefore, the measured MBC (MBCm) and not MBCc appears to be the appropriate MBC index in UAO, because it also reflects inspiratory besides expiratory flow rates, in contrast to MBCc [14][15][16][17]. The relationship between MBCm, MBCc, V 'Emax and exercise capacity is, however, not well established in UAO. Yet LINDSTEDT et al. [18] Therefore, we investigated in nine healthy subjects (age 36±9 yrs) the effects of two added resistances at the mouth (R1 = added resistance with 7.8 mm diameter; R2 = 5.7 mm) on forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), airway resistance (Raw) and maximal breathing capacity (measured during 15 s = measured maximum breathing capacity (MBCm); calculated as FEV1×37.5 = calculated maximum breathing capacity (MBCc)) on the one hand, and maximum exercise capacity (W 'max), minute ventilation (V 'E) and CO 2 elimination (V 'CO 2 ) on the other.We found that R1 had almost no influence on FEV1 but decreased PEF by ~35% and increased Raw by almost 300%; it decreased W 'max by merely ~10% while maximal exercise ventilation (V 'Emax) was only 65% of control and only reached ~40% MBCc and ~70% MBCm; yet V 'E and V 'CO 2 were significantly reduced at high exercise levels indicating hypoventilat...

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Maximum Voluntary Ventilation: Spirometric Determinants in Chronic Obstructive Pulmonary Disease Patients and Normal Subjects

Cited by 55 publications

References 13 publications

Forced inspiratory flow volume curve in healthy young children

Forced inspiratory flow volume curve in healthy young children

Physiologic correlates of dyspnea in patients with morbid obesity

Relationship between external resistances, lung function changes and maximal exercise capacity

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