Evaluation of Breathing Pattern and Dyspnea in Subjects With Tetraplegia

Breathlessness is an extremely common and uncomfortable symptom that is reported in more than two-thirds of persons with tetraplegia. This disordered pulmonary function is due to respiratory muscle paralysis or to sympathetic denervation results in a restrictive impairment and airway hyperreactivity, respectively. These restrictive and obstructive dysfunctions have been associated with the symptom of breathlessness. However, mechanisms contributing to dyspnea in persons who have tetraplegia are not well understood. It has been demonstrated that persons with tetraplegia have an increased prevalence of breathlessness and may have an altered breathing pattern. The purpose of this study is to determine the breathing pattern at rest and measure the changes in breathing after a bronchodilator treatment (a medicine commonly used to treat asthma that relaxes and opens up airways). The determination of breathing pattern is done by measuring the movements in the chest wall while breathing. This design will elucidate differences in breathing patterns between those with tetraplegia and controls, as well as demonstrate the effect of bronchodilatation on motor drive and timing. Knowledge of the intraindividual variability and mean values of the components of the breathing pattern will improve our understanding of breathlessness in these individuals.

Study Overview

• Status: Completed
• Conditions: Dyspnea; Tetraplegia
• Intervention / Treatment: Drug: ipratropium (Atrovent)

Detailed Description

The goal of this study is to evaluate mechanisms of dyspnea in tetraplegia. This goal will be accomplished by completing the following specific objectives:

1. To noninvasively assess dyspnea, motor drive, and respiratory timing during prolonged periods of resting breathing.
2. To determine if relationships exist between these breathing pattern components and dyspnea.
3. To determine if the relationships among respiratory timing, drive, and dyspnea are altered by a bronchodilator and over its duration of action.

These specific objectives will be used to test the hypotheses that:

1. During prolonged periods of resting breathing, respiratory timing will be altered and motor drive will be increased and less variable than in able-bodied controls.
2. There will be a positive association between motor drive and dyspnea.
3. Improving respiratory mechanics by bronchodilator administration will reduce drive, normalize timing and lessen dyspnea over the duration of action of the drug.

Completion of the proposed studies will expand our existing knowledge of ventilatory control in persons with tetraplegia and relate these changes to dyspnea, a common and distressing clinical problem in these individuals. These studies will also provide a better characterization of breathing patterns and their intrasubject variability in persons with tetraplegia. Currently, the only information regarding breathing patterns in tetraplegia are of limited duration (15-30 minutes). If this pilot study reveals significant relationships between motor drive, timing, and dyspnea, compiling "normative" data for breathing patterns from large numbers of individuals with tetraplegia may be useful in evaluating dyspnea in different clinical settings.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Bronx, New York, United States, 10468
      • VA Medical Center, Bronx

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subjects who have cervical spinal cord injury
2. Complaints of dyspnea
3. Healthy non-paralyzed controls

Exclusion Criteria:

1. Active pulmonary infection
2. Current history of chronic pulmonary disease or asthma
3. Current smoker (> 0.5 ppd)
4. Age < 18 or > 60 years
5. Duration of spinal cord injury < 1 year
6. Unable to sit upright in a chair or wheelchair for a full day
7. Persons taking anticholinergic (e.g., ditropan) or gaba (e.g., baclofen) agents

Study Plan

How is the study designed?

Design Details

• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; Spinal Cord Injury: subjects who have cervical spinal cord injury and complaints of dyspnea	Drug: ipratropium (Atrovent); Bronchodilator Treatment: Subjects will inhale 1 unit dose vial of aerosolized ipratropium (500 mcg of ipratropium (Atrovent) mixed in 2.5 ml of saline).
No Intervention: 2; Controls

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The goal of this study is to evaluate ventilatory control during quiet breathing in subjects with tetraplegia by obtaining dyspnea scores and noninvasively measuring indices of motor output (tidal volume / inspiratory time, VT/TI).	2 years

Secondary Outcome Measures

Outcome Measure	Time Frame
The goal of this study is to evaluate ventilatory control during quiet breathing in subjects with tetraplegia by obtaining dyspnea scores and noninvasively measuring indices of timing (inspiratory time/total breath time TI/TTOT).	2 years

Collaborators and Investigators

• Sponsor: US Department of Veterans Affairs
• Investigators: Principal Investigator: Ann M. Spungen, EdD, VA Medical Center, Bronx

Study record dates

Study Major Dates

• Study Start: December 1, 1999
• Primary Completion (Actual): January 1, 2001
• Study Completion (Actual): January 1, 2001

Study Registration Dates

• First Submitted: May 14, 2009
• First Submitted That Met QC Criteria: May 18, 2009
• First Posted (Estimate): May 19, 2009

Study Record Updates

• Last Update Posted (Estimate): May 19, 2009
• Last Update Submitted That Met QC Criteria: May 18, 2009
• Last Verified: May 1, 2009

More Information

Terms related to this study

• Keywords: Dyspnea; Tetraplegia; Breathing Patterns
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Neurologic Manifestations; Signs and Symptoms, Respiratory; Paralysis; Respiratory Aspiration; Dyspnea; Quadriplegia; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Autonomic Agents; Peripheral Nervous System Agents; Cholinergic Antagonists; Cholinergic Agents; Bronchodilator Agents; Anti-Asthmatic Agents; Respiratory System Agents; Ipratropium
• Other Study ID Numbers: B2648C-1