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Measuring inspiratory muscle strength in neuromuscular disease: one test or two?

¹ Intensive Care Unit, Dept of Physiology-Functional Testing and Centre for Technological Innovation, Raymond Poincaré Teaching Hospital, Garches, ² Paediatric Pulmonary Dept and National Institute for Health and Medical Research (INSERM) Mixed Research Unit 719, Armand Trousseau Teaching Hospital, Pierre and Marie Curie University, Paris, and, ³ INSERM Mixed Research Unit 841, Créteil, France.

CORRESPONDENCE: F. Lofaso, Service de Physiologie-Explorations Fonctionnelles, Hôpital Raymond Poincaré, 92380 Garches, France. Fax: 33 147107943. E-mail: f.lofaso{at}rpc.ap-hop-paris.fr

Keywords: Maximal inspiratory pressure, neuromuscular disease, sniff pressure

Received: July 25, 2007
Accepted September 7, 2007

Inspiratory muscle strength monitoring is crucial in patients with neuromuscular disorders. The sniff nasal inspiratory pressure (SNIP) and maximal inspiratory pressure (P_I,max) are usually measured. The present study investigated whether the test yielding the best value at baseline continued to yield the best value during follow-up.

The present study included 25 patients with Duchenne muscular dystrophy (DMD) and 61 with myotonic muscular dystrophy (MMD). SNIP and P_I,max were measured at baseline and then annually.

At baseline, SNIP was lower than P_I,max in 20 (80%) DMD patients and 32 (52%) MMD patients. During follow-up in DMD patients, changes in the best method always occurred from SNIP to P_I,max. In MMD patients, when SNIP was better than P_I,max at baseline, SNIP was usually (88%) better during follow-up, whereas a better P_I,max than SNIP at baseline was frequently (50%) followed by a shift to SNIP.

Maximal inspiratory pressure may be sufficient for monitoring inspiratory muscle function in Duchenne muscular dystrophy adults. In myotonic muscular dystrophy, the marked variability in the test yielding the best value at baseline indicates a need for performance of both tests at baseline. However, when sniff nasal inspiratory pressure measurement yields the best value at baseline, using sniff nasal inspiratory pressure alone during follow-up may be appropriate.