Neural Respiratory Drive During Different Dyspnea Relief Positions and Breathing Exercises in Individuals With COPD.

BACKGROUND: When the work load of the respiratory muscles increases and/or their capacity decreases in individuals with COPD, respiratory muscle activation increases to maintain gas exchange and respiratory mechanics, and perception of dyspnea occurs. The present study aimed to compare diaphragm and accessory respiratory muscle activation during normal breathing, pursed-lip breathing, and breathing control in different dyspnea relief positions, supine and side lying. METHODS: A cross-sectional study design was used. Sixteen individuals with COPD age between 40-75 y were included. Pulmonary function was evaluated by spirometry, muscle activation by surface electromyography, and dyspnea by the modified Borg scale. Muscle activation was measured in the diaphragm, scalene, sternocleidomastoid, and parasternal muscles. The evaluation was made in the dyspnea relief positions (sitting leaning forward, sitting leaning forward at a table, leaning forward with back against a wall, standing leaning forward, and high lying), seated erect, supine, and side lying. RESULTS: There were significant differences between the 8 positions (P < .001). There was no significant difference in muscle activation between sitting leaning forward and sitting leaning forward at a table position with analyzing post hoc test results (P > .99 for each muscle). However, muscle activation was lower in these 2 positions than in the other positions (P < .001 for each muscle). Muscle activation was greater in the supine position than in the other positions (P < .001 for each muscle). No difference was observed in muscle activation between the seated erect, leaning forward with back against a wall, standing leaning forward, high-lying, or side-lying positions (P > .05 for each muscle with a minimum P value of .09). CONCLUSIONS: The use of sitting leaning forward and sitting leaning forward at a table positions together with breathing control may help people with COPD to achieve more effective dyspnea relief and greater energy efficiency.

Comparison of the effects of high and low-moderate load lower limb resistance training on muscle strength and exercise capacity in individuals with COPD: A systematic review and meta-analysis.

BACKGROUND: Extrapulmonary changes also occur in COPD. Resistance training can increase muscle strength and exercise capacity. OBJECTIVE: The objective of this systematic review was to examine and compare the effectiveness of high and low-moderate load lower limb resistance training on muscle strength and exercise capacity in individuals with stable chronic obstructive pulmonary disease (COPD). METHODS: The PubMed/Medline, Scopus, Cochrane Library, ClinicalTrials.gov, Web of Science, EBSCO, and CINAHL databases were searched to identify the articles published in English between January 1970 and July 2023. RESULTS: Seven randomized controlled trials with a total of 188 individuals with COPD (RT: 100, CG: 88) met the inclusion criteria. A significant difference was revealed (favoring high load) in the change in knee extensor muscle strength and leg press strength in the high load resistance training group compared to the low-moderate load resistance training group (MD 21.90 Nm, 95 % CI 17.46-26.34 Nm, p < 0.00001; MD 5.80 kg, 95 % CI 3.87-7.73 kg, p < 0.00001). A significant difference was observed in the change in 6 MWT (six minute walk test) distance (favoring low-moderate load) and VO2peak (peak oxygen uptake) (favoring high load) in the high load resistance training group compared to the low-moderate load resistance training group (MD -16.90 m, 95 % CI -29.76- -4.04 m, p < 0.010; MD 3.10 ml/kg/min, 95 % CI 2.65-3.55 ml/kg/min, p < 0.00001). CONCLUSION: This systematic review and meta-analysis demonstrated that both high-load and low-moderate load resistance training increased muscle strength and might increase exercise capacity.

The Symptom Experience and Functioning of Non-Hospitalized COVID-19 Patients Within the First 20 days.

The adverse physical, psychological, and mental health consequences associated with COVID-19 illness are well-documented. However, how specific symptoms change over time and how COVID-19 affects one's day-to-day activities of daily living (ADL), Quality of Life (QoL), sleep quality, and fatigue severity are not well described. This longitudinal and descriptive study examined the changes in COVID-19 symptoms, ADL, QoL, sleep quality, and fatigue severity within the first 20 days. A convenience sample (n = 41) of non-hospitalized SARS-CoV-2 positive patients were recruited and followed for 20 days. Participants completed self-report measures: COVID-19 symptoms, ADL, QoL, sleep quality, and fatigue severity at days: 1, 10, and 20 following a diagnosis. Findings revealed that symptoms decreased over 20 days (p < .001). In parallel with the decrease in symptoms, QoL and ADL improved over 20 days (p < .05). However, sleep quality and fatigue severity did not improve within 20 days (p > .05). Our findings contribute to the growing evidence that COVID-19 symptoms can linger, especially fatigue and sleep quality, that affect overall day-to-day functioning for at least 20 days after diagnosis. To mitigate the effect of COVID-19 on QOL and ADL, findings underscore the need for clinicians to work collaboratively with patients to develop a symptom management plan for a variety of symptoms including fatigue and sleep quality. Beginning to repurpose existing self-management strategies for the longer term COVID-19 symptoms could be beneficial and help to optimize patient outcomes. Future work should examine these variables over a longer timeframe and among different samples of non-hospitalized patients.

Examination of diaphragm thickness, mobility and thickening fraction in individuals with COPD of different severity.

BACKGROUND: Diaphragm thickness and mobility assessed by ultrasound in individuals with Chronic Obstructive Pulmonary Disease (COPD) reflect the function of the diaphragm. The aim of this study is to compare the diaphragm thickness, mobility, and thickening fraction in individuals with COPD of different severity and healthy individuals and examine the relationship between these parameters and pulmonary function test parameters. METHODS: A cross-sectional observational study design was used. Thirty individuals (mild = 11; moderate = 13; severe = 6) with COPD and 29 healthy male individuals aged between 40-75 years were included in the study. The individuals included in the study were evaluated between October 2020/May 2021. Pulmonary functions were measured with a spirometer, while diaphragm thickness, mobility, and thickening fraction were measured by ultrasound. RESULTS: The right and left diaphragm thickness, mobility, thickness variation, thickening fraction, and mobility were lower in individuals with COPD than in healthy individuals (p < 0.05). The left Functional Residual Capacity (FRC) diaphragm thickness, right Total Lung Capacity (TLC), and FRC diaphragm thickness were higher in mild COPD than moderate COPD and moderate COPD than severe COPD (p < 0.05). The right diaphragmatic thickening fraction and rate were higher in mild COPD than in moderate and severe COPD (p < 0.05). The left mobility was lower in severe COPD than in mild COPD (p < 0.05). DISCUSSION: Diaphragm ultrasound parameters decrease as disease severity increases in individuals with COPD. We think that adding diaphragm ultrasound parameters together with pulmonary function test to the evaluation of individuals with COPD will provide additional contributions to determining the course of the disease.