Respiratory muscle strength and cough capacity in patients with Duchenne muscular dystrophy

Seong-Woong Kang, Yeoun-Seung Kang, Hong-Seok Sohn, Jung-Hyun Park, Jae-Ho Moon, Seong-Woong Kang, Yeoun-Seung Kang, Hong-Seok Sohn, Jung-Hyun Park, Jae-Ho Moon

Abstract

The function of inspiratory muscles is crucial for effective cough as well as expiratory muscles in patients with Duchenne muscular dystrophy (DMD). However, there is no report on the correlation between cough and inspiratory muscle strength. To investigate the relationships of voluntary cough capacity, assisted cough techniques, and inspiratory muscle strength as well as expiratory muscle strength in patients with DMD (n= 32). The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and three different techniques of assisted PCF were evaluated. The mean value of MICs (1918 +/- 586 mL) was higher than that of VCs (1474 +/- 632 mL) (p < 0.001). All three assisted cough methods showed significantly higher value than unassisted method (212 +/- 52 L/min) (F = 66.13, p < 0.001). Combined assisted cough technique (both manual and volume assisted PCF; 286 +/- 41 L/min) significantly exceeded manual assisted PCF (MPCF; 246 +/- 49 L/ min) and volume assisted PCF (VPCF; 252 +/- 45 L/min) (F = 66.13, p < 0.001). MIP (34 +/- 13 cmH2O) correlated significantly with both UPCF and all three assisted PCFs as well as MEP (27 +/- 10 cmH2O) (p < 0.001). Both MEP and MIP, which are the markers of respiratory muscle weakness, should be taken into account in the study of cough effectiveness.

Figures

Fig. 1
Fig. 1
Relationships between maximal respiratory pressures and UPCF. Both absolute value of MIP and MEP correlated significantly with UPCF. UPCF, Unassisted peak cough flow; MIP, Maximal inspiratory pressure; MEP, Maximal expiratory pressure.
Fig. 2
Fig. 2
Relationships between maximal respiratory pressures and VPCF. Both absolute value of MIP and MEP correlated significantly with VPCF. VPCF, Volume assisted peak cough flow; MIP, Maximal inspiratory pressure; MEP, Maximal expiratory pressure.
Fig. 3
Fig. 3
Relationships between maximal respiratory pressures and MPCF. Both absolute value of MIP and MEP correlated significantly with MPCF. MPCF, Manual assisted peak cough flow; MIP, Maximal inspiratory pressure; MEP, Maximal expiratory pressure.
Fig. 4
Fig. 4
Relationships between maximal respiratory pressures and CPCF. Both absolute value of MIP and MEP correlated significantly with CPCF. CPCF, Combined peak cough flow; MIP, Maximal inspiratory pressure; MEP, Maximal expiratory pressure.

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