Chest
Volume 118, Issue 1, July 2000, Pages 61-65
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Clinical Investigations: Pulmonary Function
Maximum Insufflation Capacity

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Objective

To investigate the effect of deep lung insufflations on maximum insufflation capacities (MICs) and peak cough flows (PCFs) for patients with neuromuscular disease.

Method

Forty-three patients with neuromuscular disease were trained in stacking delivered volumes of air to deep lung insufflation and were prescribed a program of air stacking once their vital capacities (VCs) were noted to be < 2,000 mL. VC, MIC, and unassisted and assisted PCF were monitored. The initial data were compared with the highest MICs subsequently achieved. For those patients whose MICs only decreased, we compared the initial data with the most recent data.

Results

The MICs increased from (mean ± SD) 1,402 ± 530 mL to 1,711 ± 599 mL (p < 0.001) for 30 patients and only decreased for 13 patients. Patients for whom the MICs increased also had a significant increase in assisted PCF from 3.7 ± 1.4 to 4.3 ± 1.6 L/s (p < 0.05) despite having somewhat decreasing VCs and unassisted PCFs.

Conclusion

With training, the capacity to stack air to deep insufflations can improve despite progressive neuromuscular disease. This can result in increased cough effectiveness.

Section snippets

Materials and Methods

All patients with neuromusculoskeletal disease diagnosed by standard criteria15 and monitored in a Jerry Lewis Muscular Dystrophy Association clinic were candidates for this study, provided that they were old enough to cooperate. The exclusion criteria for taking part in the deep insufflation program were the following: VC > 2,000 mL; the presence of concomitant intrinsic lung disease to the extent of necessitating oxygen therapy; bulbar muscle dysfunction so severe that glottic closure could

Results

One hundred eight patients with neuromuscular weakness underwent initial evaluations. Forty-three patients returned for reevaluation and satisfied the inclusion criteria. The 108 patients had the following diagnoses: DMD, 32 patients; amyotrophic lateral sclerosis (ALS), 30 patients; SMA, 15 patients; post-poliomyelitis syndrome, 12 patients; non-DMD myopathies, 14 patients; and miscellaneous, 5 patients. Two of the 108 patients had tracheostomy tubes. One patient did not return to clinic.

Discussion

Extremity ROM therapy is a cornerstone of physical medicine and rehabilitation interventions to maintain limb mobility (joint mobilization) for patients with muscular weakness. The loss of limb function results from weakness as well as from musculotendinous tightness or contractures.16 Contracture prevention or correction can help to maintain function.16,17 Lung and chest wall ROM can be provided by giving deep insufflations. By contrast with ROM therapy for the extremities, the ROM of the lung

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