RT Journal Article
SR Electronic
T1 Inefficient cough in Duchenne muscular dystrophy (DMD)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1393
VO 40
IS Suppl 56
A1 Antonella LoMauro
A1 Marianna Romei
A1 Grazia D'Angelo
A1 Andrea Aliverti
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/1393.abstract
AB In DMD, impaired cough secondary to muscle weakness leads to serious respiratory complications, namely atelectasis, ineffective airway clearance, pneumonia and tracheal intubations. In order to study which factors influence and determine inefficient cough in DMD we studied 36 DMD patients and 15 healthy controls (C,age:16.3±5.4 yrs). Peak cough flow (PCF) was measured at the mouth while rib cage (RC), abdominal (AB) and total chest wall (CW) volume variations were measured by opto-electronic plethysmography during quite breathing and maximal cough (supine position). PCF was <160 L/min in 15 patients (inefficient cough, I:age:17.6±5 yrs,FVC:33.7±20 %predicted) and>270 L/min in 9 (efficient cough, E:age:16.1±4 yrs,FVC:70.8±34 %predicted). Tidal volume (VT) was similar in I, E and C. In I, RC, AB and CW inspired volumes preceding cough were significantly lower than controls and inspired AB volume was lower than E (panel A). Thoraco-abdominal asynchrony during cough, quantified by labored breathing index (LBI), and percentage abdominal contribution to VT (%ΔVAB) were respectively higher and lower in I group (panel B and C). In conclusion, in DMD inefficient cough is characterized by impaired inspiration, thoracoabdominal asynchony and lower abdominal contribution to volume variations due to diaphragmatic weakness. %ΔVAB, that does not require patient's collaboration, seems to be a good predictor of inefficient cough.