The Relation Between the Inspiratory Muscle Strength, the Perception of Dyspnea and Inhaled 2Agonists in Patients with Asthma
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Slide 1 :
The Relation Between the Inspiratory Muscle Strength, the Perception of Dyspnea and Inhaled ?2-Agonists in Patients with AsthmaPaltiel Weiner M.D., Rasmi Magadle M.D., Marinella Beckerman M.D. , Noa Berar-Yanay M.D., Department of Medicine A, Hillel-Yaffe Medical Center, Hadera, Israel
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Background It is well documented that, in patients with asthma, there is a considerable variation in the severity of breathlessness for any particular degree of airflow obstruction. Studies investigating dyspnea suggest that dyspnea, at least in part, is perceived as respiratory muscle effort. The degree of breathlessness, is related to the activity and the strength of the inspiratory muscles
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Background (cont) The perception of dyspnea (POD) is very important in patients with asthma. It serves as one of the most important indexes used to guide treatment, and it regulates the use of ”as needed” ?2-agonists. In a recent study we have shown that in mild asthmatic patients, with high ?2-agonist consumption, specific inspiratory muscle training (SIMT) was associated with a decrease in perception of dyspnea and a decrease in ?2-agonist consumption.
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Hypothesis There is relationship between the: Inspiratory muscle strength (IMS) The perception of dyspnea The ?2-agonist consumption Specific inspiratory muscle training will result in increased inspiratory muscle strength that will be associated with decreased POD and ?2-agonist consumption.
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Specific Aim To investigate the relation between the perception of dyspnea, the inspiratory muscle strength and the ?2-agonists consumption before and following specific inspiratory muscle training in patients with mild persistent-moderate asthma.
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Patients 30 consecutive asthmatic patients (13 F and 17 M), with mild-persistent to moderate asthma (FEV1>60% of pred.), were recruited for the study. All satisfied the American Thoracic Society definition of asthma. All subjects were treated by their primary physician only with inhaled corticosteroids (Budesonide 400-800 µg/d or Fluticasone dipropionate 200-500 µg/d) and ?2-agonists, as required.
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2 weeks Diary (daily) PEFR ?2-agonists consumption SIMT Sham training Study design PImax>5 cm H20 PImax>10 cm H20 PImax>15 cm H20 PImax>20 cm H20
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Tests All tests were performed after the 2-weeks run-in and before each stage during the training period Spirometry The FVC and the FEV1 were measured 3 times on a computerized spirometer and the best trial is reported. Respiratory muscle strength As were assessed by the PImax at RV. The value obtained from the best of at least 3 efforts was used. POD Was measured while the subject breathed against progressive resistance, at 1-min intervals, in order to achieve mouth pressure of 0, 5, 10, 20, and 30 cm H2O. After breathing for 1 minute in each load the subjects rated the sensation of dyspnea using a modified Borg scale.
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There was no good correlation between the baseline PImax and the POD, and between the baseline PImax and the mean daily ?2-agonist consumption. However, there was a significant correlation between the POD and the mean daily ?2-agonist consumption
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Following SIMT there was a close correlation between the increase in the IMS and the decrease in POD
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The decrease in the POD was associated with a decrease in the BD consumption
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Conclusions In mild persistent-moderate asthmatic patients: There is a close correlation between the POD and the mean daily ?2-agonist consumption. The inspiratory muscles can be trained in these patients with significant increase in IMS. The increase in the IMS is in close correlation with the decrease in the POD and the decrease in ?2-agonist consumption.
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