Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, United States; Pulmonary Section, Department of Medicine, Cincinnati Veteran Affairs Medical Center, United States.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, United States; Pulmonary Section, Department of Medicine, Cincinnati Veteran Affairs Medical Center, United States.
Respir Med. 2017 Oct;131:179-183. doi: 10.1016/j.rmed.2017.08.023. Epub 2017 Aug 26.
Positive expiratory pressure(PEP) breathing modalities are commonly prescribed in obstructive lung diseases, however practical methods of airway pressures(AP) quantification for therapeutic efficacy are lacking. Excessive dynamic airway collapse(EDAC) is characterized by expiratory central airway collapse leading to dyspnea and poor quality of life(QoL), with limited therapeutic options.
To measure AP and exertional dyspnea in EDAC patients during normal breathing and with use of pursed-lip breathing(PLB), nasal PEP device(nPEP), and oral-PEP valve(oPEP) during rest and exercise using an Esophageal Manometer.
EDAC patients exercised on a bicycle ergometer sequentially using normal breathing, PLB, nPEP, and oPEP for five-minute intervals. AP's were measured by continuous topographic upper airway manometry. Pre- and post-exercise BORG dyspnea scores were recorded and QoL measured with the St. George's respiratory questionnaire(SGRQ-C). The most effective and patient-preferred PEP modality was prescribed for daily activities and SGRQ-C repeated after one week.
Three women with symptomatic EDAC participated. Expiratory laryngopharyngeal AP's during exercise with normal breathing, PLB, nPEP and oPEP in patient-1 were 1.7, 14, 4.5, and 7.3 mmHg, in patient-2; 2.3, 8, 8.3, and 12 mmHg, and in patient-3; 1, 15, unobtainable, and 9 mmHg, respectively. Maximal reduction in BORG scores occurred with PLB in patient 1 and with oPEP in patients 2 and 3. After 1 week mean SGRQ-C scores declined by 17-points.
Upper airway manometry directly measures laryngopharyngeal pressures during rest and exercise and can be used to select and optimize PEP breathing techniques to improve respiratory symptoms in EDAC patients.
正压呼气（PEP）呼吸模式常用于阻塞性肺疾病，但缺乏治疗效果的气道压力（AP）定量的实用方法。过度动态气道塌陷（EDAC）的特征是呼气中央气道塌陷，导致呼吸困难和生活质量（QoL）差，治疗选择有限。
使用食管测压仪在休息和运动期间测量 EDAC 患者在正常呼吸以及使用缩唇呼吸（PLB）、鼻 PEP 装置（nPEP）和口腔 PEP 阀（oPEP）时的 AP 和运动性呼吸困难。
EDAC 患者在自行车测力计上依次使用正常呼吸、PLB、nPEP 和 oPEP 进行 5 分钟的间隔运动。AP 通过连续的上气道拓扑测压仪测量。记录运动前后 BORG 呼吸困难评分，并使用圣乔治呼吸问卷（SGRQ-C）测量 QoL。为日常活动开出最有效和患者首选的 PEP 模式，并在一周后重复 SGRQ-C。
3 名有症状的 EDAC 女性患者参与了研究。患者 1 在正常呼吸、PLB、nPEP 和 oPEP 运动时的呼气咽腔 AP 分别为 1.7、14、4.5 和 7.3mmHg，患者 2 分别为 2.3、8、8.3 和 12mmHg，患者 3 分别为 1、15、无法测量和 9mmHg。PLB 在患者 1 中、oPEP 在患者 2 和 3 中使 BORG 评分最大程度降低。1 周后，SGRQ-C 评分平均下降 17 分。
上气道测压仪可直接测量休息和运动时的咽腔压力，并可用于选择和优化 PEP 呼吸技术，以改善 EDAC 患者的呼吸症状。
