Chronic Obstructive Lung Disease

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Rik Gosselink presented this research as part of his PhD in the Vrije University of Amsterdam. The work was directed by Professor Anthony J Sargeant and Professor Marc Decramer.

Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease

R A Gosselink

R C Wagenaar

H Rijswijk

Anthony J Sargeant

and M L Decramer

American Journal of Respiratory and Critical Care Medicine
Am J Respir Crit Care Med. 1995 Apr;151(4):1136-42
The effects of diaphragmatic breathing learning on chest wall motion, mechanical efficiency of the respiratory muscles, breathing pattern, and dyspnea sensation were studied in seven patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 34 +/- 7% of the predicted value) during loaded and unloaded breathing. Chest wall motion was studied focusing on amplitude and phase relation of rib cage and abdominal motion. Mechanical efficiency was defined as the ratio of added external power output and added oxygen consumption during inspiratory threshold loading (40% maximal inspiratory pressure [Plmax]). After 2 wk run-in, all subjects participated in a diaphragmatic breathing program for 3 wk. Variables obtained during diaphragmatic breathing were compared with those obtained during natural breathing. During diaphragmatic breathing the ratio of rib cage to abdominal motion decreased significantly during unloaded (0.86 versus 0.37; p < 0.01) as well as during loaded breathing (0.97 versus 0.50; p < 0.01). Chest wall motion became more asynchronous during diaphragmatic breathing in the unloaded conditions (mean phase difference for natural breathing 3.5 versus 10.4% for diaphragmatic breathing; p < 0.02) and loaded conditions (mean phase difference for natural breathing 6 versus 11.4% for diaphragmatic breathing; p < 0.02). Surprisingly, mechanical efficiency decreased significantly during diaphragmatic breathing (2.57 +/- 0.76%) in comparison with natural breathing (3.35 +/- 1.48%; p < 0.01). Tidal volume, respiratory frequency, and duty cycle did not change significantly during diaphragmatic breathing. Dyspnea sensation tended to increase during diaphragmatic breathing.
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What physiological signals drive breathing during human exercise?

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This research was carried out by Professor Anthony J Sargeant while working at McMaster University Medical Centre in Hamilton, Ontario, Canada. He had been awarded a Medical Research Council (UK) Travelling Fellowship on the basis of his PhD research and other studies.
The research in this publication looked at an issue first systematically addressed by Krogh and Lindhard in 1915 and later by Erling Asmussen in Denmark in the 1940s.
Using one of the first breath by breath systems created by Professor Norman L Jones Tony Sargeant and Michel Rouleau blocked the blood flow from exercising leg muscles returning to the central circulation. In this way it was possible to delay CO2 generated by the exercising muscles from reaching central receptors.
The main part of the study was conducted on healthy male volunteers but an additional interesting observation was made on a patient with absent ventilatory response to CO2 and reduced ventilatory response to exercise (Ondine’s Syndrome).The patient showed normal hyperventilatory response to cuffing (caused due to increase in the signal from mechanoreceptors in the contracting muscle) but did not show an increase in ventilation associated with the arrival of CO2 in the lungs, following release of occlusion. The studies confirmed the importance of CO2 in mediating rapid changes in ventilation during exercise.
Journal of Applied Physiology
J Appl Physiol Respir Environ Exerc Physiol. 1981 Apr;50(4):718-23

Five male subjects exercised on a cycle ergometer (100 W) for 8 min; circulation to the legs was occluded by cuffs during the first 2 and last 2 min. Ventilation (VE), oxygen intake (VO2), and carbon dioxide output (VCO2) were measured breath by breath. Repeat studies were used to follow arterial PCO2 (PaCO2) and rebreathing mixed venous PCO2 (PVCO2).

The results were compared to studies without cuffing, but which were otherwise identical. The initial period of cuffing was associated with marked hyperpnea, high VE/VCO2 ratio, and low PaCO2 and PVCO2. Following release of occlusion at the end of the first 2 min, there was an immediate fall in VE, followed by an increase after an average of 12 s. VE/VCO2 fell and end-tidal PCO2 rose after 4-5 s and reached control values after 12 s. Studies during rebreathing established that CO2 reached the lungs from the legs 4-5 s after release of occlusion, and control PVCO2 was reached after 12 s. Repeated occlusion for the final 2 min of exercise was associated with hyperpnea of similar degree to the initial occlusion. An identical study performed in a patient with absent ventilatory response to CO2 and reduced ventilatory response to exercise showed normal hyperventilatory response to cuffing but did not show an increase in ventilation associated with the arrival of CO2 in the lungs, following release of occlusion. The studies confirmed the importance of CO2 in mediating rapid changes in ventilation during exercise