Respiratory muscle strength during and after hospitalization for COPD exacerbation

• Published in: Respiratory care Vol. 58; no. 12; pp. 2142 - 2149
• Main Authors: Mesquita, Rafael, Donária, Leila, Genz, Isabel C H, Pitta, Fabio, Probst, Vanessa S
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01-12-2013
• Subjects: Admission and discharge; Aged; Complications and side effects; Disease Progression; Female; Hospitalization - statistics & numerical data; Hospitals; Humans; Inspiratory Capacity; Lung diseases, Obstructive; Male; Measurement; Middle Aged; Monitoring, Physiologic; Muscle Strength; Patient Outcome Assessment; Physiological aspects; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Quadriceps Muscle - physiopathology; Respiratory Function Tests - methods; Respiratory muscles; Respiratory Muscles - physiopathology; Severity of Illness Index; Brazil; hospitalization; respiratory muscles; respiratory muscle strength; COPD; exacerbation
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.02393

A more profound investigation of respiratory muscle strength during COPD exacerbation was needed, so we investigated respiratory muscle strength and related factors in patients with COPD during and after hospitalization for COPD exacerbation.
In 19 subjects hospitalized for COPD exacerbation (12 males, mean age 67 ± 11 y, median percent-of-predicted FEV(1) 26% [IQR 19-32%]) we measured lung function and respiratory and quadriceps muscle strength at admission (day 1), at discharge, and 1 month after discharge.
At admission, 68% of the subjects had inspiratory muscle dysfunction (maximum inspiratory pressure < 70% of predicted). Inspiratory muscle strength increased between day 1 (56 cm H(2)O [IQR 45-64 cm H(2)O]) and 1 month after discharge (65 cm H(2)O [IQR 51-74 cm H(2)O], P = .007). Expiratory muscle strength increased between day 1 (99 cm H(2)O [65-117 cm H(2)O]) and discharge (109 cm H(2)O [77-136 cm H(2)O], P = .005), and between day 1 and 1 month after discharge (114 cm H(2)O [90-139 cm H(2)O], P = .001). Inspiratory capacity increased between discharge (1.59 ± 0.44 L) and 1 month after discharge (1.99 ± 0.54 L, P = .02). There was no significant change in other lung function variables or quadriceps strength. At admission the inspiratory muscle dysfunction and reduction in inspiratory capacity (< 80% of predicted) correlated linearly (phi coefficient 0.62, P = .03), whereas the expiratory muscle strength correlated inversely with FEV(1) (Spearman rho -0.61, P = .005) and inspiratory capacity (Spearman rho -0.54, P = .02).
There was a high prevalence of inspiratory muscle dysfunction in patients hospitalized for COPD exacerbation. Inspiratory and expiratory muscle strength increased markedly during and after hospitalization. The degree of air-flow obstruction and hyperinflation were related to inspiratory and expiratory muscle strength.