help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by POLKEY, M. I.
Right arrow Articles by MOXHAM, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by POLKEY, M. I.
Right arrow Articles by MOXHAM, J.

Am. J. Respir. Crit. Care Med., Volume 158, Number 3, September 1998, 734-741

Expiratory Muscle Function in Amyotrophic Lateral Sclerosis

MICHAEL I. POLKEY, REBECCA A. LYALL, MALCOLM GREEN, P. NIGEL LEIGH, and JOHN MOXHAM

Respiratory Muscle Laboratory and Department of Clinical Neurosciences, King's College School of Medicine and Dentistry; and Respiratory Muscle Laboratory, Royal Brompton Hospital, London, United Kingdom

Few data exist concerning expiratory muscle function in amyotrophic lateral sclerosis (ALS). We studied 26 patients with ALS (16 with respiratory symptoms and 10 without) and measured the maximal static expiratory mouth pressure (MEP), the gastric pressure during a maximal cough (Cough Pga), and the gastric pressure after magnetic stimulation of the lower thoracic nerve roots (Tw Pga). These measurements were related to the ability to generate transient supramaximal flow during a cough (cough spikes), to arterialized capillary blood gases, and to inspiratory muscle strength. Vocal cord motion was examined endoscopically in 11 of the 16 symptomatic patients. Expiratory muscle weakness was related to inability to generate cough spikes with a threshold effect such that spikes were absent for Cough Pga < 50 cm H2O (p = 0.009) or Tw Pga < 7 cm H2O (p = 0.006) and was usually associated with inspiratory muscle weakness. However, in multivariate analysis, PaCO2 was only significantly associated with the maximal sniff esophageal pressure (p = 0.02). Symptomatic patients had significantly lower inspiratory muscle strength, whereas, of the expiratory muscle tests, only Tw Pga was significantly lower (p = 0.0009) in symptomatic patients. Abnormal vocal cord motion was observed in two of the 11 patients examined. We conclude that abdominal muscle weakness in ALS, when substantial, results in an inability to generate transient supramaximal flow during a cough. However, the primary determinant of both ventilatory failure and respiratory symptoms seems to be inspiratory muscle weakness.




This article has been cited by other articles:


Home page
 Arch NeurolHome page
M. M. van der Graaff, W. Grolman, E. J. Westermann, H. C. Boogaardt, H. Koelman, A. J. van der Kooi, M. A. Tijssen, and M. de Visser
Vocal Cord Dysfunction in Amyotrophic Lateral Sclerosis: Four Cases and a Review of the Literature
Arch Neurol, November 1, 2009; 66(11): 1329 - 1333.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
N. Ambrosino, N. Carpene, and M. Gherardi
Chronic respiratory care for neuromuscular diseases in adults
Eur. Respir. J., August 1, 2009; 34(2): 444 - 451.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
F. Harraf, K. Ward, W. Man, G. Rafferty, K. Mills, M. Polkey, J. Moxham, and L. Kalra
Transcranial magnetic stimulation study of expiratory muscle weakness in acute ischemic stroke
Neurology, December 9, 2008; 71(24): 2000 - 2007.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. Sancho, E. Servera, J. Diaz, and J. Marin
Predictors of Ineffective Cough during a Chest Infection in Patients with Stable Amyotrophic Lateral Sclerosis
Am. J. Respir. Crit. Care Med., June 15, 2007; 175(12): 1266 - 1271.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
J. Lim, R. B. Gorman, J. P. Saboisky, S. C. Gandevia, and J. E. Butler
Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles
J Appl Physiol, April 1, 2007; 102(4): 1612 - 1617.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
C. G. Tankersley, C. Haenggeli, and J. D. Rothstein
Respiratory impairment in a mouse model of amyotrophic lateral sclerosis
J Appl Physiol, March 1, 2007; 102(3): 926 - 932.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
D Lasserson, K Mills, R Arunachalam, M Polkey, J Moxham, and L Kalra
Differences in motor activation of voluntary and reflex cough in humans
Thorax, August 1, 2006; 61(8): 699 - 705.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
W.D-C. Man, J. Moxham, and M.I. Polkey
Magnetic stimulation for the measurement of respiratory and skeletal muscle function
Eur. Respir. J., November 1, 2004; 24(5): 846 - 860.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
W. D-C. Man, D. Kyroussis, T. A. Fleming, A. Chetta, F. Harraf, N. Mustfa, G. F. Rafferty, M. I. Polkey, and J. Moxham
Cough Gastric Pressure and Maximum Expiratory Mouth Pressure in Humans
Am. J. Respir. Crit. Care Med., September 15, 2003; 168(6): 714 - 717.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
F. Laghi and M. J. Tobin
Disorders of the Respiratory Muscles
Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 10 - 48.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
M. Chatwin, E. Ross, N. Hart, A.H. Nickol, M.I. Polkey, and A.K. Simonds
Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness
Eur. Respir. J., March 1, 2003; 21(3): 502 - 508.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
N. Hart, D. Cramer, S.P. Ward, A.H. Nickol, J. Moxham, M.I. Polkey, and N.B. Pride
Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes
Eur. Respir. J., October 1, 2002; 20(4): 996 - 1002.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
ATS/ERS Statement on Respiratory Muscle Testing
Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 518 - 624.
[Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
M D Bradley, R W Orrell, J Clarke, A C Davidson, A J Williams, D M Kullmann, N Hirsch, and R S Howard
Outcome of ventilatory support for acute respiratory failure in motor neurone disease
J. Neurol. Neurosurg. Psychiatry, June 1, 2002; 72(6): 752 - 756.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
M.B. Chaudri, C. Liu, R. Hubbard, D. Jefferson, and W.J. Kinnear
Relationship between supramaximal flow during cough and mortality in motor neurone disease
Eur. Respir. J., March 1, 2002; 19(3): 434 - 438.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
N. Lechtzin, C. M. Wiener, D. M. Shade, L. Clawson, and G. B. Diette
Spirometry in the Supine Position Improves the Detection of Diaphragmatic Weakness in Patients With Amyotrophic Lateral Sclerosis
Chest, February 1, 2002; 121(2): 436 - 442.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
R. A. Lyall, N. Donaldson, M. I. Polkey, P. N. Leigh, and J. Moxham
Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis
Brain, October 1, 2001; 124(10): 2000 - 2013.
[Abstract] [Full Text] [PDF]

Home page
 QJMHome page
N. Mustfa and J. Moxham
Respiratory muscle assessment in motor neurone disease
QJM, September 1, 2001; 94(9): 497 - 502.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
A. Chetta, M.L. Harris, R.A. Lyall, G.F. Rafferty, M.I. Polkey, D. Olivieri, and J. Moxham
Whistle mouth pressure as test of expiratory muscle strength
Eur. Respir. J., April 1, 2001; 17(4): 688 - 695.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. I. Polkey and J. Moxham
Clinical Aspects of Respiratory Muscle Dysfunction in the Critically Ill
Chest, March 1, 2001; 119(3): 926 - 939.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. ESTENNE, C. PINET, and A. DE TROYER
Abdominal Muscle Strength in Patients with Tetraplegia
Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 707 - 712.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
I. ARNULF, T. SIMILOWSKI, F. SALACHAS, L. GARMA, S. MEHIRI, V. ATTALI, V. BEHIN-BELLHESEN, V. MEININGER, and J.-P. DERENNE
Sleep Disorders and Diaphragmatic Function in Patients with Amyotrophic Lateral Sclerosis
Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 849 - 856.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. I. POLKEY, Y. LUO, R. GULERIA, C.-H. H. ÅRD, M. GREEN, and J. MOXHAM
Functional Magnetic Stimulation of the Abdominal Muscles in Humans
Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 513 - 522.
[Abstract] [Full Text]

Home page
 ThoraxHome page
M. I Polkey, R. A Lyall, A C. Davidson, P N. Leigh, and J. Moxham
Ethical and clinical issues in the use of home non-invasive mechanical ventilation for the palliation of breathlessness in motor neurone disease
Thorax, April 1, 1999; 54(4): 367 - 371.
[Full Text]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
M. I Polkey, R. A Lyall, J. Moxham, and P N. Leigh
Respiratory aspects of neurological disease
J. Neurol. Neurosurg. Psychiatry, January 1, 1999; 66(1): 5 - 15.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 1998 American Thoracic Society 		  Tobacco