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Respiratory Muscle Performance and the Perception of Dyspnea in Parkinson's Disease

  • Paltiel Weiner (a1), Rivka Inzelberg (a2), Avi Davidovich (a1), Puiu Nisipeanu (a2), Rasmi Magadle (a1), Noa Berar-Yanay (a1) and Ralph L. Carasso (a2)...

Abstract

Background:

Pulmonary and respiratory muscle function impairment are common in patients with Parkinson's disease (PD). However, dyspnea is not a frequent complaint among these patients, although it is well documented that the intensity of dyspnea is related to the activity and the strength of the respiratory muscles.

Patients and Methods:

We studied pulmonary function, respiratory muscle strength and endurance and the perception of dyspnea (POD) in 20 patients with PD (stage II and III Hoehn and Yahr scale) before and after their first daily L-dopa dose. Respiratory muscle strength was assessed by measuring the maximal inspiratory and expiratory mouth pressures (PImax and PEmax), at residual volume (RV) and total lung capacity (TLC) respectively. The POD was measured while the subject breathed against progressive load and dyspnea was rated using a visual analog scale.

Results:

Respiratory muscle strength and endurance were decreased and the POD was increased during the off medication period compared to normal subjects. There was a nonsignificant trend to an increase in PImax, PEmax and endurance after L-dopa intake. The POD of PD patients decreased (p<0.05) following medication, although, it remained increased (p<0.01) as compared to the normal subjects. Even if patients had spirometry data showing a mild restrictive pattern, before medication, both forced vital capacity (FVC) and forced expiratory volume (FEV)1 remained almost identical after L-dopa intake.

Conclusions:

Patients with PD have higher POD, compared to normal subjects and this increased perception is attenuated when the patients are on dopaminergic medication. The change in the POD is not related to changes in respiratory muscle performance or pulmonary functions. A central effect or a correction of uncoordinated respiratory movements by L-dopa may contribute to the decrease in POD following L-dopa treatment.

RÉSUMÉ: Introduction:

L'altération de la fonction pulmonaire et des muscles respiratoires est fréquente chez les patients atteints de la maladie de Parkinson (MP). Cependant, ces patients se plaignent rarement de dyspnée, bien qu'il soit bien connu que l'intensité de la dyspnée est reliée à l'activité et à la force des muscles respiratoires. Patients et

Méthodes:

Nous avons étudié la fonction pulmonaire, la force des muscles respiratoires, ainsi que l'endurance et la perception de la dyspnée (PD) chez 20 patients atteints de MP (stage II et III à l'échelle de Hoehn et Yahr) avant et après la première prise de L-dopa de la journée. La force des muscles respiratoires a été évaluée par la mesure buccale des pressions inspiratoires et expiratoires maximales (Plmax et PEmax), au VR et à la CT respectivement. La PD a été mesurée pendant que le sujet respirait contre une charge progressive. Il évaluait sa dyspnée au moyen d'une échelle visuelle analogue.

Résultats:

La force des muscles respiratoires et l'endurance étaient diminuées et la PD était augmentée pendant la période sans effet médicamenteux par rapport à des sujets normaux. On a observé une tendance non significative à l'augmentation des Plmax, PEmax et de l'endurance après la prise de L-dopa. La PD a diminué (p(0.05), tout en demeurant plus élevée comparée à celle des sujets normaux (p(0.01). Même si on observait un patron légèrement restrictif à la spirométrie des patients avant la prise du médicament, le CVF et la VEMS sont demeurés presque inchangés après.

Conclusions:

Les patients atteints de la MP ont plus de PD comparés aux sujets normaux et cette perception augmentée est atténuée quand les patients sont sous médication dopaminergique. Le changement de la PD n'est pas relié aux changements de performance des muscles respiratoires ou à la fonction pulmonaire. Un effet central ou une correction des mouvements respiratoire incoordonnés par la L-dopa peuvent contribuer à la diminution de la PD suite à l'administration de L-dopa.

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References

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Respiratory Muscle Performance and the Perception of Dyspnea in Parkinson's Disease

  • Paltiel Weiner (a1), Rivka Inzelberg (a2), Avi Davidovich (a1), Puiu Nisipeanu (a2), Rasmi Magadle (a1), Noa Berar-Yanay (a1) and Ralph L. Carasso (a2)...

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