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Published ahead of print on July 11, 2003, doi:10.1164/rccm.200303-334BC

Am. J. Respir. Crit. Care Med., Volume 168, Number 6, September 2003, 714-717

A more recent version of this article appeared on September 15, 2003
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Submitted on March 6, 2003
Accepted on July 9, 2003

COUGH GASTRIC PRESSURE AND MAXIMUM EXPIRATORY MOUTH PRESSURE IN HUMANS

William D-C Man1*, Dimitris Kyroussis2, Tracey A Fleming1, Alfredo Chetta1, Farzaneh Harraf1, Naveed Mustfa1, Gerrard F Rafferty1, Michael I Polkey2, and John Moxham1

1 Respiratory Medicine, King's College Hospital, London, United Kingdom, 2 Respiratory Muscle Laboratory, Royal Brompton Hospital, London, United Kingdom

* To whom correspondence should be addressed. E-mail: william.man{at}kcl.ac.uk.

Maximal expiratory mouth pressure is a well-established test used to assess expiratory muscle strength. However low values are difficult to interpret as they may result from technical difficulties in performing the test, particularly in patients with facial muscle weakness or bulbar dysfunction. We hypothesized that measuring the gastric pressure during a cough, a natural maneuver recruiting the expiratory muscles, might prove to be a useful additional test in the assessment of expiratory muscle function. Mouth expiratory and cough gastric pressures were measured in 99 healthy volunteers to obtain normal values, and in 293 patients referred for respiratory muscle assessment, to compare the two measurements. Between-occasion within-subject coefficient of variation, assessed in 24 healthy volunteers, was 10.3% for mouth pressure and 6.9% for cough. Mean±standard deviation cough gastric pressure for normal males was 214.4±42.2cmH2O, and 165.1±34.8cmH2O for females. In 171 patients deemed weak by a low mouth expiratory pressure, 42% had a normal cough gastric pressure. In 105 patients deemed weak by a low cough gastric pressure, 5.7% had a normal expiratory mouth pressure. Low maximal expiratory mouth pressures do not always indicate expiratory muscle weakness. Cough gastric pressure provides a useful complementary test for the assessment of expiratory muscle strength.
Key words: neuromuscular disease, expiratory muscle strength




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