Differences of ventilatory muscle recruitment and work of breathing in COPD and interstitial lung disease during exercise: a comprehensive evaluation

Autor: Jeferson George Ferreira, Vinícius Carlos Iamonti, Mayra Caleffi Pereira, Renata Pletsch-Assunção, Marcelo Ceneviva Macchione, Pauliane Vieira Santana, Letícia Zumpano Cardenas, Pedro Caruso, Carlos R.R. de Carvalho, André L.P. de Albuquerque
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: ERJ Open Research, Vol 10, Iss 4 (2024)
Druh dokumentu: article
ISSN: 2312-0541
23120541
DOI: 10.1183/23120541.00059-2023
Popis: Introduction COPD and interstitial lung disease (ILD) are significant chronic respiratory disorders, impacting quality of life. Respiratory muscle roles and differences remain not entirely clear. The objective of the present study was to evaluate the degree of recruitment of the respiratory muscles and the work of breathing in COPD and ILD during exercise. Methods We compared the sensory–mechanical relationships in COPD, ILD and healthy controls (n=20 each). They performed pulmonary function, noninvasive and invasive respiratory muscle strength, surface electromyography and work-of-breathing assessments. Results COPD and ILD did not show lower static muscle strength compared to controls, but did show poor performance in the exercise test with increased transdiaphragmatic pressure (Pdi). In ILD, there was a higher increase in oesophageal pressure and a lower gastric pressure (Pga) on inspiration; in COPD, there was a significant increase in Pga on inspiration. In ILD, there is greater recruitment of accessory inspiratory muscles, whereas in COPD, there is marked use of both inspiratory and expiratory muscles. The neuromechanical inefficiency (increased neural respiratory drive without the corresponding tidal volume) was found in both diseases. In COPD, there is a considerable increase in elastic work to overcome intrinsic positive end-expiratory pressure (PEEPi) and expiratory work of breathing, whereas in ILD, non-PEEPi elastic work of breathing is the highest part of the total work of breathing. Conclusions Early and increased activity of the respiratory muscles and work-of-breathing components significantly contribute to dyspnoea, exercise intolerance and neuromechanical inefficiency of ventilation in COPD and ILD. The mechanisms of Pdi generation were different between diseases.
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