Félix Erika, Gimenes Ana Cristina, Costa-Carvalho Beatriz Tavares
Department of Pediatrics, School of Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
Pediatr Pulmonol. 2014 Mar;49(3):238-44. doi: 10.1002/ppul.22828. Epub 2013 Aug 19.
Ataxia telangiectasia (AT) is a genetic syndrome caused by a mutation of chromosome 11. The clinical features are cerebellar ataxia, telangiectasia, and progressive loss of muscular coordination, including an inefficient cough secondary to progression of neurological disease.
To evaluate the effects of inspiratory muscle training (IMT) on ventilation, lung volume, dyspnoea, respiratory muscle strength, and quality of life in patients with AT.
A longitudinal study was conducted with 11 AT patients and nine healthy volunteers. Ventilometry, subjective sensation of dyspnoea, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and quality of life were assessed before and after a 24-week IMT program. The IMT load used was set at 60% of the MIP, and the training was performed for 20 min daily.
Patients with AT had lower height and weight and also had lower respiratory muscle strength and lung volume compared with healthy volunteers. Furthermore, patients with AT showed a significant improvement when pre- and post-IMT were compared for ventilatory pattern: Vt (476.5 ± 135 ml vs. 583.3 ± 66 ml, P = 0.015) and f (23.3 ± 6 rpm vs. 20.4 ± 4 rpm, P = 0.018), and VC (1,664 ± 463 ml/kg vs. 2,145 ± 750 ml/kg, P = 0.002). IMT also significantly improved the sensation of dyspnoea (median 0.5; minimum 0; maximum 1.0; P = 0.022) and respiratory muscle strength: MIP (-22.2 ± 2 cmH2O vs. -38 ± 9 cmH2O, P < 0.001) and MEP (29 ± 7 cmH2O vs. 40 ± 8 cmH2O, P = 0.001). The health and vitality domains of the SF-36 also showed significant improvement (P = 0.009 and P = 0.014, respectively) post-IMT.
IMT was effective in improving ventilatory pattern, lung volume, respiratory muscle strength, and the health and vitality domains for quality of life in patients with AT. IMT may be an effective adjunct therapy to drug treatment for patients with AT.
共济失调毛细血管扩张症(AT)是一种由11号染色体突变引起的遗传综合征。其临床特征为小脑性共济失调、毛细血管扩张以及肌肉协调性逐渐丧失,包括因神经疾病进展导致的无效咳嗽。
评估吸气肌训练(IMT)对AT患者通气、肺容积、呼吸困难、呼吸肌力量及生活质量的影响。
对11例AT患者和9名健康志愿者进行了一项纵向研究。在为期24周的IMT项目前后,评估了通气功能、呼吸困难主观感受、最大吸气压(MIP)、最大呼气压(MEP)和生活质量。所使用的IMT负荷设定为MIP的60%,训练每天进行20分钟。
与健康志愿者相比,AT患者的身高和体重较低,呼吸肌力量和肺容积也较低。此外,比较IMT前后的通气模式时,AT患者有显著改善:潮气量(Vt)(476.5±135毫升对583.3±66毫升,P = 0.015)、呼吸频率(f)(23.3±6次/分钟对20.4±4次/分钟,P = 0.018)和肺活量(VC)(1,664±463毫升/千克对2,145±750毫升/千克,P = 0.002)。IMT还显著改善了呼吸困难感受(中位数0.5;最小值0;最大值1.0;P = 0.022)和呼吸肌力量:MIP(-22.2±2厘米水柱对-38±9厘米水柱,P < 0.001)和MEP(29±7厘米水柱对40±8厘米水柱,P = 0.001)。IMT后,SF-36的健康和活力领域也显示出显著改善(分别为P = 0.009和P = 0.014)。
IMT对改善AT患者的通气模式、肺容积、呼吸肌力量以及生活质量的健康和活力领域有效。IMT可能是AT患者药物治疗的有效辅助疗法。