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Whistle mouth pressure as test of expiratory muscle strength

¹ Dept of Respiratory Medicine & Allergy, Guy's, King's & St. Thomas' School of Medicine, King's College Hospital, London, UK. ² Dept of Respiratory Diseases, University of Parma, Italy. ³ Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK

CORRESPONDENCE: A. Chetta, Istituto di Malattie Respiratoire, Azienda Ospedaliera e Università di Parma, Viale G. Rasori 10, Parma, Italy. Fax: 39 0521292615

Keywords: expiratory muscle strength, respiratory muscles, respiratory pressures, whistle mouth pressure test

Received: June 19, 2000
Accepted November 13, 2000

Expiratory muscle strength is a determinant of cough function. Mouth pressures during a maximal static expiratory effort (P_E,max) are dependent on patient motivation and technique and low values are therefore difficult to interpret. This study hypothesized that a short, sharp and maximal expiration through a narrow aperture, a "whistle", might provide a complementary test of expiratory muscle strength.

To obtain a maximal whistle, subjects (27 healthy volunteers and 10 patients with amyotrophic lateral sclerosis) were asked to perform a short, sharp blow as hard as possible, from total lung capacity, through a reversed paediatric inhaler whistle, connected to a flange-type mouthpiece.

In both healthy subjects and patients, whistle mouth pressure (P_mo,W) was closely related to the pressure measured in the oesophagus and stomach during the same manoeuvre. In healthy subjects, P_mo,W and P_E,max correlated with wide limits of agreement, although P_mo,W values were significantly higher than P_E,max (131±31 cmH₂O versus 101±27 cmH₂O, p<0.0001). In patients, it was also found that P_mo,W and P_E,max values were strongly related (r=0.937, p<0.0001). In healthy subjects, the intraclass correlation coefficient and the variation coefficient for P_mo,W repeated measurements were respectively 0.88 and 7.0%. However P_mo,W and P_E,max were always smaller than the gastric pressure generated by a maximal cough.

It is concluded that mouth whistle pressure, a noninvasive, reproducible and simple test, provides a reliable measure of expiratory muscle strength in healthy subjects that is acceptable to patients and can be used in a complementary fashion to maximal static expiratory effort.

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