Am. J. Respir. Crit. Care Med., Volume 162, Number 4, October 2000, 1507-1511

Usefulness of Sniff Nasal Pressure in Patients with Neuromuscular or Skeletal Disorders

DANIELA STEFANUTTI, MARIE-ROSE BENOIST, PIERRE SCHEINMANN, MICHÈLE CHAUSSAIN, and JEAN-WILLIAM FITTING

Laboratoire Explorations Fonctionnelles Respiratoires, Hôpital Necker Enfants Malades, and Laboratoire Explorations Fonctionnelles Respiratoires, Hôpital St-Vincent de Paul, Paris, France; and Division de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Inspiratory muscle strength is an important variable in patients with neuromuscular or skeletal disorders. It is usually assessed by measuring maximal inspiratory pressure (PI_max), but this test may prove difficult for some patients, and low values may originate from incomplete effort or air leaks. We assessed the usefulness of the novel sniff nasal pressure (Pn_sn) test in 126 patients with a neuromuscular or a skeletal disorder, aged 5 to 49 yr. Pn_sn was measured in an occluded nostril during maximal sniffs performed through the contralateral nostril. All patients performed the Pn_sn maneuver easily, whereas 10 young and weak patients with neuromuscular disorders could not perform the PI_max maneuver. Data were analyzed for the 116 patients who could perform both tests (92 patients with neuromuscular and 24 with skeletal disorders). When expressed as percents of the predicted values, Pn_sn was similar to PI_max in patients with neuromuscular disorders (54 ± 25% predicted [mean ± SD] versus 52 ± 24% predicted), and was higher than PI_max in patients with skeletal disorders (70 ± 25% predicted versus 61 ± 27% predicted, p < 0.05). Pn_sn appeared to be the main determinant of VC in patients with neuromuscular disorders, whereas the Cobb angle and PI_max were the main determinants of VC in patients with skeletal disorders. We conclude that inspiratory muscle strength can be easily assessed with Pn_sn in children and adults with various neuromuscular and skeletal disorders. This new muscular parameter appears particularly useful in neuromuscular disorders, in which it represents a major determinant of VC.

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