Respiratory Response to Arm Elevation in Patients with Chronic Airflow Obstruction

Martínez, Fernando J.; Couser, James I.; Celli, Bartolomé R.

doi:10.1164/ajrccm/143.3.476

Cited by 68 publications

(45 citation statements)

References 11 publications

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“…This is in accordance with earlier studies [5,8], although the percentage increases in V'O 2 , V'CO 2 , V'E and HR in these studies were much higher than reported here. Instead of calculating peak metabolic and ventilatory response in these earlier studies, we calculated the mean increase of the total period of arm elevation and recovery.…”

Section: Discussionsupporting

confidence: 94%

“…This was confirmed in a study by DOLMAGE et al [4], who found that even arm positioning only (arms elevated but supported by a sling) changed breathing pattern in COPD patients (decrease in VT, increase in f R). In addition, MARTINEZ et al [8] found that except for an increased diaphragmatic recruitment, COPD patients probably also recruite expiratory muscles during arm elevation.…”

Section: Discussionmentioning

confidence: 99%

“…In all studies, arm elevation resulted in a significant increase in metabolic and ventilatory requirements [3,4,5,8]. Possible differences in metabolic and ventilatory response pattern following arm elevation between COPD patients and healthy persons, however, have not yet been specified.…”

mentioning

confidence: 97%

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Metabolic and ventilatory response pattern to arm elevation in patients with COPD and healthy age-matched subjects

Baarends¹,

Schols²,

Slebos³

et al. 1995

Eur Respir J

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M Me et ta ab bo ol li ic c a an nd d v ve en nt ti il la at to or ry y r re es sp po on ns se e p pa at tt te er rn n t to o a ar rm m e el le ev va at ti io on n i in n p pa at ti ie en nt ts s w wi it th h C CO OP PD D a an nd d h he ea al lt th hy y a ag ge e--m ma at tc ch he ed d s su ub bj je ec ct ts s Each subject consecutively performed three types of arm elevation for 2 min, with 3 min rest periods in between. Breath-by-breath metabolic and ventilatory parameters and heart rate (HR) were registered during a 3 min baseline period and throughout the measurement period.Adjusted for significantly greater baseline test results in COPD patients, it was found that AE (arm elevation including recovery) tended to be more demanding with respect to metabolic and ventilatory response for patients with COPD than for the age-matched healthy subjects. Arm elevation resulted in an increase in oxygen consumption (V ' 'O 2 ) (COPD 12%; healthy 6%), carbon dioxide elimination V ' 'CO 2 (COPD 15%; healthy 10%), minute ventilation V ' 'E (COPD 13%; healthy 7%) and heart rate (COPD 2%; healthy 5%). A pronounced difference was found in the pattern of metabolic and ventilatory response to arm elevation, i.e. there was an earlier but sluggish V ' 'O 2 onset in COPD patients, whereas the healthy subjects demonstrated a sudden peak approximately 30 s after arm elevations. Mutual comparison of the three different types of arm elevation demonstrated a comparable response pattern.Knowledge of the specific response to arm elevations in COPD patients seems essential for interpretation of arm elevation tests in upper extremity rehabilitation programmes. Eur Respir J., 1995Respir J., , 8, 1345Respir J., -1351 Patients with severe chronic obstructive pulmonary disease (COPD) often complain of dyspnoea during activities of daily living, such as combing their hair, brushing their teeth or shaving [1][2][3]. These activities mainly involve (unsupported) movements of arm and shoulder muscles.Several factors may contribute to impairment of unsupported arm activities in COPD patients, such as a dual activity of shoulder muscles in breathing as well as movement [4,5], and peripheral [6] and respiratory [7] skeletal muscle weakness.In order to examine the possible limitations of (unsupported) arm activities in patients with COPD, other investigators have studied the metabolic and ventilatory requirements of simple arm elevation. In all studies, arm elevation resulted in a significant increase in metabolic and ventilatory requirements [3,4,5,8]. Possible differences in metabolic and ventilatory response pattern following arm elevation between COPD patients and healthy persons, however, have not yet been specified. Furthermore, it may be hypothesized that the response pattern depends on the type of arm elevation due to different muscle recruitment.In this study, the metabolic and ventilatory requirements of three basic arm elevations were compared between COPD patients and healthy age-matched control subjects. Material and methods Study popula...

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metabolic and ventilatory response pattern to arm elevation in patients with COPD and healthy age-matched subjects

Baarends¹,

Schols²,

Slebos³

et al. 1995

Eur Respir J

View full text Add to dashboard Cite

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“…A possible cause of dyspnea is the change in lung volumes (decreased FVC and inspiratory capacity, and increased functional residual capacity) during upper-limb activities. 12,33 Also, reduction of blood flow during elevation of the upper limbs increases the production of lactate, which increases ventilation demand and, consequently, dyspnea. 34,35 One of the most common measures of muscle fatigue is the decline in maximum strength.…”

Section: Discussionmentioning

confidence: 99%

Upper and Lower Limb Muscles in Patients With COPD: Similarities in Muscle Efficiency But Differences in Fatigue Resistance

et al. 2013

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BACKGROUND: Peripheral muscle dysfunction is a common finding in patients with COPD; however, the structural adaptation and functional impairment of the upper and lower limb muscles do not seem to be homogenous. We compared muscle fatigue and recovery time between 2 representative muscles: the middle deltoid and the quadriceps femoris. METHODS: Twenty-one subjects with COPD (FEV 1 46.1 ؎ 10.3% of predicted) underwent maximal voluntary isometric contraction and an endurance test (60% of maximal voluntary isometric contraction, to the limit of tolerance). The maximal voluntary isometric contraction test was repeated after 10 min, 30 min, 60 min, and 24 hours for both the quadriceps femoris and middle deltoid. Surface electromyography was recorded throughout the endurance test. RESULTS: Maximal voluntary isometric contraction significantly decreased only for the middle deltoid between 10 and 60 min after the endurance test. A significant increase of the root mean square and a greater decline in median frequency throughout the endurance test occurred for the middle deltoid, compared with the quadriceps femoris. When dyspnea and fatigue scores were corrected by endurance time, higher values were observed for the middle deltoid (0.07 and 0.08, respectively) in relation to the quadriceps femoris (0.02 and 0.03, respectively). CONCLUSIONS: Subjects with COPD had a higher fatigability of a representative upper limb muscle (middle deltoid) than a lower limb muscle (quadriceps femoris).

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“…Thus, it is unlikely that IPV decreased dyspnea by decreasing vagal afferent signals. In COPDpatients, upper inspiratory intercostal muscles are suggested to be tonically active during AE (9), and may contribute to the increase in functional residual capacity (FRC) (19). Increasing hyperinflation during leg exercise has been indicated to be related to dyspnea in COPDpatients (20).…”

Section: Central Motor Commandmentioning

confidence: 99%

In-phase Chest Wall Vibration Decreases Dyspnea During Arm Elevation in Chronic Obstructive Pulmonary Disease Patients.

et al. 1998

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In-phase chest wall vibration (IPV) is knownto decrease dyspnea in patients with chronic obstructive pulmonary disease (COPD) at rest and during leg exercise. In the present study, the effects of IPV (100 Hz) on dyspnea and arm fatigue during upper extremity activity were studied in 9 patients with COPD(mean FEV1? 0.95 /). Dyspnea and arm fatigue (modified Borg scale) and ventilatory variables were measured during arm elevation (AE) with weights lifted straight above the head with and without IPV. Mean dyspnea during AE was 3.3 without IPV and 2.1 with IPV (p<0.05), but, arm fatigue, oxygen saturation and end-tidal Fco2 were not affected by IPV. Minute ventilation during AEwas significantly increased with IPV in 5 of 9 patients. The results suggest that IPV decreases dyspnea during AE.

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Respiratory Response to Arm Elevation in Patients with Chronic Airflow Obstruction

Cited by 68 publications

References 11 publications

Metabolic and ventilatory response pattern to arm elevation in patients with COPD and healthy age-matched subjects

Metabolic and ventilatory response pattern to arm elevation in patients with COPD and healthy age-matched subjects

Upper and Lower Limb Muscles in Patients With COPD: Similarities in Muscle Efficiency But Differences in Fatigue Resistance

In-phase Chest Wall Vibration Decreases Dyspnea During Arm Elevation in Chronic Obstructive Pulmonary Disease Patients.

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