Maximum Rate of Pressure Development and Maximal Relaxation Rate of Respiratory Muscles in Patients with Cystic Fibrosis

Abstract

BACKGROUND:

Respiratory muscle function in patients with cystic fibrosis (CF) has been studied by measurement of maximal inspiratory pressure (P_Imax), maximal expiratory pressure (P_Emax), and the pressure-time index of the respiratory muscles (PTI_mus). The maximum rate of pressure development (MRPD) during P_Imax (MRPD-P_Imax), MRPD during P_Emax (MRPD-P_Emax), maximal relaxation rate (MRR) during P_Imax (MRR-P_Imax), and MRR during P_Emax (MRR-P_Emax) have not been studied in CF. Our aim was to study MRPD and MRR and investigate their possible application as accessory indices of respiratory muscle function in patients with CF.

METHODS:

FEV₁, FVC, and maximal expiratory flow between 25% and 75% of vital capacity, body mass index (BMI), upper arm muscle area, P_Imax, P_Emax, PTI_mus, MRPD-P_Imax, MRPD-P_Emax, MRR-P_Imax, and MRR-P_Emax were assessed in 123 CF patients and in a control group of 123 healthy subjects matched for age and sex.

RESULTS:

MRR-P_Emax was significantly increased and MRPD-P_Emax was significantly decreased in the CF patients, compared to the healthy controls. In the CF patients MRR-P_Imax was significantly related to PTI_mus (P = .02), FEV₁ (P = .03), FVC (P = .001), BMI (P < .001), and upper arm muscle area (P < .001). In the CF patients, MRPD-P_Imax and MRPD-P_Emax were significantly related to upper arm muscle area (P < .001), BMI (P < .001 and P = .01, respectively), P_Imax (P < .001), and P_Emax (P < .001).

CONCLUSIONS:

The CF patients exhibited increased MRR and decreased MRPD during maximal respiratory effort, compared to controls. The differences in MRR-P_Imax and MRPD-P_Imax between the controls and the complete group of CF patients were not significant. MRPD and MRR were significantly related to nutritional and pulmonary function impairment in CF patients. MRPD strongly correlated to maximal respiratory muscle pressures, and MRR strongly correlated to PTI_mus in patients with CF. These findings suggest that CF patients are at increased risk of respiratory muscle fatigue. Regular determination of MRPD and MRR may be clinically useful in CF patients and help to initiate inspiratory muscle training and noninvasive ventilation.

Keywords

cystic fibrosis respiratory muscles spirometry nutritional deficiency

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