Abdominal muscle recruitment and PEEPi during bronchoconstriction in chronic obstructive pulmonary disease
Open accessAbstract
BACKGROUND: It has been recently shown that, when breathing at rest, many patients with severe chronic obstructive pulmonary disease (COPD) contract abdominal muscles during expiration, and that this contraction is an important determinant of positive end expiratory alveolar pressure (PEEPi). In this study the effects of acute bronchoconstriction on abdominal muscle recruitment in patients with severe COPD were studied, together with the consequence of abdominal muscle action on chest wall mechanics. METHODS: Breathing pattern, pleural (PPL) and gastric (PGA) pressures, and changes in abdomen anteroposterior (AP) diameter were studied in 14 patients with COPD (mean forced expiratory volume in one second (FEV1) 1.06 (0.08) 1) under control conditions and during histamine-induced bronchoconstriction. RESULTS: The analysis of plots of PGA versus the AP diameter of the abdomen revealed that during maximal broncho-constriction (decrease in FEV1 of 34.8% (95% confidence intervals (CI) 29.9 to 39.7)) the expiratory rise in PGA increased significantly whereas end expiratory abdomen AP diameter decreased, indicating marked abdominal muscle recruitment. As a consequence, the rib cage compartment accounted for all of the volume of hyperinflation during bronchoconstriction (mean value 0.66 I, 95% CI 0.49 to 0.83). Positive end expiratory alveolar pressure during progressive bronchoconstriction was related directly to the expiratory rise in PGA and inversely to the expiratory time. CONCLUSIONS: The results indicate that, in patients with severe COPD, the abdominal muscles are recruited during acute bronchoconstriction. This recruitment probably preserves diaphragm length at the beginning of inspiratory muscle contraction despite the hyperinflation, and contributes significantly to positive end expiratory alveolar pressure. The degree of dynamic pulmonary hyperinflation during bronchoconstriction can be overestimated if abdominal muscle contraction is not assessed.
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Forced abdominal expiration is linked to COPD.
“| Forced abdominal expiration | 2 | [50, 51] | COPD |”
From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [51]
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- De Troyer A, Estenne M, Ninane V, Van Gansbeke D, 31 Marini JJ. Should PEEP be used in airflow obstruction? Am Gorini M. Transversus abdominis muscle function in humans. J Appl Physiol 1990;68:1010-6. Rev Respir Dis 1989;140:1-3. on July 11, 2023 by guest. Protected by copyright. http://thorax.bmj.com/ Thorax: first published as 10.1136/thx.52.4.355 on 1 April 1997. Downloaded from
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Dysfunctional breathing: a review of the literature and proposal for classification
Boulding, R., Stacey, R., Niven, R., & Fowler, S. J. (2016) · European Respiratory Review · doi:10.1183/16000617.0088-2015 · Cited by 372 · see citing works
- Authors
- Gorini, M., Misuri, G., Duranti, R., Iandelli, I., Mancini, M., & Scano, G.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 1997-04-01
- Volume
- 52
- Issue
- 4
- Pages
- 355-361
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC1758533
- OpenAlex
- W2075122321
- Cited by
- 34
- References
- 0
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 3 · 2012: 1
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- chronic obstructive pulmonary disease, bronchoconstriction, histamine challenge, gastric pressure, pleural pressure, chest wall mechanics, lung hyperinflation, expiration
- MeSH terms
- Abdominal Muscles, Aged, Carbon Dioxide, Histamine, Humans, Lung Diseases, Obstructive, Male, Middle Aged, Oxygen, Regression Analysis, Respiration, Respiratory Function Tests, Bronchoconstriction, Positive-Pressure Respiration, Intrinsic
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