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Effect of Systemic Inflammation on Inspiratory and Limb Muscle Strength and Bulk in Cystic Fibrosis

¹ Chest Service, ³ Department of Physiotherapy, and ⁴ Department of Radiology, Erasme University Hospital; ² Cystic Fibrosis Clinic, UZ-Brussels; ⁵ Department of Pneumology, HUDERF; and ⁶ Laboratory of Immunology, Brugmann University Hospital, Brussels, Belgium

Correspondence and requests for reprints should be addressed to Marc Estenne, M.D., Chest Service, Erasme University Hospital 808, Route de Lennik B-1070, Brussels, Belgium. E-mail: mestenne{at}ulb.ac.be

Rationale: Diaphragm thickness is increased in cystic fibrosis (CF), but it shows a marked variability between patients. The variable response of the diaphragm to loading may reflect the combined and opposite effects of training by the respiratory disease and systemic inflammation.

Objectives: To assess the impact of systemic inflammation on diaphragm and limb muscle strength and bulk in adult patients with CF.

Methods: In 38 stable patients with CF and 20 matched control subjects, we measured fat-free mass (FFM), inspiratory muscle strength, diaphragm thickness, quadriceps and biceps strength and cross-sectional area, and circulating levels of leukocytes, C-reactive protein, IL-6, IL-8, IL-17, tumor necrosis factor-, tumor necrosis factor- soluble receptors, and immunoglobulin G.

Measurements and Main Results: Patients had increases in several inflammatory markers that correlated with the severity of lung disease and nutritional depletion. Compared with control subjects, patients with CF had increased diaphragm thickness and inspiratory muscle strength and showed a trend toward a reduction in limb muscle strength and bulk. Multiple regression analyses identified FFM and airway resistance as independent predictors of diaphragm thickness, but systemic inflammation had no (or only a minor) predictive effect on FFM, inspiratory muscle strength, diaphragm thickness, and limb muscle strength and bulk.

Conclusions: In patients with CF, the intensity of systemic inflammation does not account significantly for the variance of FFM and diaphragm or limb muscle strength and bulk. Training of the diaphragm in CF occurs despite the presence of systemic inflammation.

Key Words: skeletal muscles • airway obstruction • acute phase reaction • lung infection

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Several studies suggest that systemic inflammation may contribute to muscle wasting in respiratory and nonrespiratory chronic diseases. However, studies of chronic obstructive pulmonary disease have not established a causal link between systemic inflammation and skeletal muscle dysfunction. What This Study Adds to the Field The potential impact of several inflammatory markers on fat-free mass and on the strength and bulk of the diaphragm and two limb muscles in stable patients with cystic fibrosis is very limited. Continued inflammation does not impede the response of the diaphragm to loading.