Ventilatory muscle strength and endurance in myasthenia gravis

Keenan, SP; Alexander, David; Jd, Road; Ryan, C. Frank; Oger, Joél; Wilcox, P. H.

doi:10.1183/09031936.95.08071130

Cited by 37 publications

(36 citation statements)

References 15 publications

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“…subjects and 27 subjects (100%) lower P Imax values, so determining high values of P Emax /P Imax . Our results are apparently in partial disagreement with those of Weiner et al 17 and Keenan et al, 18 who studied subjects with severe and moderate generalized MG, and found that both P Emax and P Imax were lower than normal. However, our group of MG subjects included those with only mild/moderate, and not severe, generalized MG.…”

Section: Discussioncontrasting

confidence: 57%

Muscle Impairment in Neuromuscular Disease Using an Expiratory/Inspiratory Pressure Ratio

et al. 2015

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BACKGROUND: Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (P Imax ) and maximum static expiratory pressure (P Emax ), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate P Emax /P Imax ratio for these groups. METHODS: Seventy (35 males) subjects with NMDs (amyotrophic lateral sclerosis, myasthenia gravis, and myotonic dystrophy), and 93 (47 males) healthy individuals 20 -80 y of age were evaluated for anthropometry, pulmonary function, P Imax , and P Emax , respectively. RESULTS: Healthy individuals showed greater values for P Imax and P Emax when compared with subjects with NMDs. P Emax /P Imax ratio for healthy subjects was 1.31 ؎ 0.26, and P Emax %/P Imax % was 1.04 ؎ 0.05; for subjects with NMDs, P Emax /P Imax ratio was 1.45 ؎ 0.65, and P Emax %/P Imax % ratio was 1.42 ؎ 0.67. We found that P Emax %/P Imax % for myotonic dystrophy was 0.93 ؎ 0.24, for myasthenia gravis 1.94 ؎ 0.6, and for amyotrophic lateral sclerosis 1.33 ؎ 0.62 when we analyzed them separately. All healthy individuals showed higher P Emax compared with P Imax . For subjects with NMDs, the impairment of P Emax and P Imax is different among the 3 pathologies studied (P < .001). CONCLUSIONS: Healthy individuals and subjects with NMDs showed higher P Emax in comparison to P Imax regarding the P Emax /P Imax ratio. Based on the ratio, it is possible to state that NMDs show different patterns of respiratory muscle strength loss. P Emax /P Imax ratio is a useful parameter to assess the impairment of respiratory muscles in a patient and to customize rehabilitation and treatment.

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Section: Discussioncontrasting

confidence: 57%

Muscle Impairment in Neuromuscular Disease Using an Expiratory/Inspiratory Pressure Ratio

et al. 2015

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“…Indeed, in our series as well as in the literature [3], most MG patients presented with PFT values in the range of normal, and MG-induced restrictive ventilatory patterns or low vital capacity were rarely observed. Surprisingly, in our study, we found that the first cause of dyspnea not related to MG was asthma (14% of our 63 patients), followed by obesity and tobacco-induced PFT abnormalities, while in the general adult population, tobacco-induced chronic obstructive pulmonary disease prevalence (10%) and obesity prevalence (16%) are higher than asthma prevalence (6%) [2].…”

Section: Discussionmentioning

confidence: 80%

Asthma as a Cause of Persistent Dyspnea in Treated Myasthenia Gravis Patients

Echaniz‐Laguna

Pistea²,

Philippi³

et al. 2012

Eur Neurol

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Aims: The aim of this study was to evaluate the proportion of patients with treated myasthenia gravis (MG) who present with dyspnea not related to MG. Methods: We analyzed the files of 63 consecutive adult patients with treated MG and persistent dyspnea who had been referred to our Pulmonary Function Test (PFT) Department between 2000 and 2010. Results: We observed that asthma was the first cause of MG-unrelated dyspnea in MG patients, with 9 patients (14%) presenting with asthma-related PFT abnormalities. Six patients had asthma for several years before developing MG, and 3 patients (4%) developed asthma a few months after MG was diagnosed, suggesting a non-coincidental association between the two conditions. In all 3 cases, asthma appeared in elderly patients with severe late-onset AchR-Ab- positive MG, treated with pyridostigmine and corticosteroids and/or intravenous immunoglobulins. In all 3 patients, β₂-adrenergic agonist treatment allowed only partial control of dyspnea. In one case, respiratory symptoms were alleviated when pyridostigmine dosage was reduced. Conclusions: Patients with treated MG and persistent dyspnea should be investigated for asthma using PFT before being diagnosed with refractory MG. If asthma is diagnosed, a bronchodilator treatment should be instituted and a reduction in pyridostigmine dosage should be proposed.

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“…Bu nedenlerin başlıcaları, "amyotrophic lateral sclerosis (ALS)", myastenia gravis, polymyozitis, Guillain-Barré sendromu gibi nöromusküler hastalıklar ya da kalp yetmezliği, tirotoksikoz, malnütrisyon, yoğun bakım sonrası sendromu gibi durumlardır (35,51,52,(57)(58)(59)(60).…”

Section: Kli̇ni̇k Kullanimunclassified

Solunum Kas Fi̇zyoloji̇si̇ Ve Kas Gücü Ölçümü

Ulubay¹

2017

Bulletin of Thoracic Surgery

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Respiratory muscle strength can be assessed noninvasively by measuring the forced vital capacity (FVC), vital capacity (VC), maximal inspiratory pressure (MIP or PImax), the maximal expiratory pressure (MEP or PEmax) and maximal sniff nasal inspiratory pressure (SNIP) tests. The MIP and SNIP reflect the strength of the diaphragm and other inspiratory muscles, while the MEP reflects the strength of the expiratory muscles including abdominal muscles and other expiratory muscles. Respiratory muscle strength can also be assessed invasively by Sniff esophageal pressure (Sniff Pe), Sniff transdiaphragmatic pressure (Sniff Pdi), gastric pressure measurement methods. Common indications for measurement of the MIP, MEP, and SNIP include clinically suspected respiratory muscle weakness, lung function consistent with respiratory muscle weakness (e.g., unexplained restrictive pattern, low vital capacity), and evaluation of whether respiratory muscle weakness has improved, remained stable, or worsened. In this topic, the anatomy, physiology of respiratory muscles, and the methods for the evaluation of muscle strength by invasive and noninvasive methods will be reviewed. Keywords: Respiratory muscles, respiratory function tests, muscle weakness ÖzetSolunum kas gücü, zorlu vital kapasite (FVC), vital kapasite (VC), maksimal inspiratuvar basınç (MIP ya da PImax), maksimal ekspiratuvar basınç (MEP ya da PEmax) ve maksimal sniff nazal inspiratuvar basınç (SNIP) testleri ile invaziv olmayan şekilde ölçülebilir. MIP ve SNIP testler, diyafragma ve diğer inspiratuvar kasların gü-cünü yansıtırken, MEP karın ve diğer ekspiratuvar kasların gücünü yansıtır. Solunum kas gücü ayrıca Sniff özefageal basınç (Sniff Pe), Sniff trans diyafragmatik basınç (Sniff Pdi) ve gastrik basınç öl-çüm yöntemleriyle invaziv olarak da ölçülebilir. MIP, MEP ve SNIP ölçümleri için en sık endikasyonlar, klinik olarak solunum kas güç-süzlüğü şüphesi, solunum kas güçsüzlüğü ile uyumlu solunum fonksiyon testi bulguları (örn. açıklanamayan restriktif patern, düşük vital kapasite gibi) ve solunum kas gücünde iyileşme, kö-tüleşme, stabil seyir durumlarının değerlendirmesidir. Bu bölüm-de, solunum kaslarının anatomisi, fizyolojisi ve invaziv, noninvaziv yöntemlerle solunum kaslarının değerlendirilme yöntemleri göz-den geçirilecektir.Anahtar kelimeler: Solunum kasları, solunum fonksiyon testleri, kas güçsüzlüğü SOLUNUM KASLARININ ANATOMİSİSolunum yolları burun ile başlar ve arka arkaya birbirini takip ederek burun boşlukları, farenks, larenks, trakea ve bronşlarla devam eder. Bronşlar akciğer içinde giderek incelerek dallara ayrılır ve sonrasında solunumsal yüzeyi meydana getiren alveolleri oluşturarak sonlanır. Dinlenme durumunda inspirasyon; diyafragma, eksternal interkostal ve skalen kasların kasılmasıyla gerçekleştirilir. Sakin solunumda görev yapan bu kaslar, primer inspirasyon kasları olarak adlandırılır. Primer inspirasyon kaslarının kasılmasıyla toraks genişler ve hacmi artar (1). Üst Hava YollarıFarenks kavitesi üç kısımdan oluşur; 1. Nazofarenks: Buru...

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Ventilatory muscle strength and endurance in myasthenia gravis

Cited by 37 publications

References 15 publications

Muscle Impairment in Neuromuscular Disease Using an Expiratory/Inspiratory Pressure Ratio

Muscle Impairment in Neuromuscular Disease Using an Expiratory/Inspiratory Pressure Ratio

Asthma as a Cause of Persistent Dyspnea in Treated Myasthenia Gravis Patients

Solunum Kas Fi̇zyoloji̇si̇ Ve Kas Gücü Ölçümü

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