Questions and Answers about C. P. S

Several patients with poliomyelitic paralysis of the muscles used in normal breathing learned a method of breathing consisting of pumping air into the lungs by action of the mouth, cheeks, tongue, pharynx and larynx. The advantages of the method are that the patient can be out of the respirator and on a conventional bed for longer periods, can talk longer and louder, is more easily cared for, and is better able to engage in interesting occupations.     

Single motor unit activity in the diaphragm of cat during pressure breathing

In this study we analyzed the breath-by-breath activity of single motor units in the diaphragm slip of allobarbital-anesthetized cats during quiet breathing and during continuous positive- and negative-pressure breathing. Our objective was to determine whether single motor units, on the basis of their activities, can be separated into discrete subpopulations or whether they fall on a continuum analogous to that of motor units of hindlimb muscles. The firing profiles of each unit were characterized for each pressure level by the onset and peak firing frequencies, onset latency, duration of firing, number of impulses per breath, and minimal frequency, when appropriate. Units with shorter onset latencies had higher peak frequencies, longer firing durations, and increased firing frequencies than did units with longer onset latencies. These comparative relationships persisted even though the activity of every motor unit was altered during pressure breathing. During positive-pressure breathing onset latencies were lengthened, and durations of firing were shortened with little change in onset or peak frequencies. Late units might be silenced. During negative-pressure breathing onset latencies were shortened, and durations of firing were lengthened, sufficiently in some cases to fill the expiratory pause. In addition, previously inactive units were recruited late in inspiration for short, relatively high frequency bursts during inspiration. The results support the concept that the phrenic motoneuron pool is comprised of three discrete subpopulations.     

The effect of breathing technique on sticking region during maximal bench press

The intrathoracic pressure and breathing strategy on bench press (BP) performance is highly discussed in strength competition practice. Therefore, the purpose of this study was to analyze whether different breathing techniques can influence the time and track characteristics of the sticking region (SR) during the 1RM BP exercise. 24 healthy, male adults (age 23 ± 2.4 yrs., body mass 85 ± 9.2 kg, height 181 ± 5.4 cm) performed a 1 repetition BP using the breathing technique of Valsalva maneuver (VM), hold breath, lung packing (PAC), and reverse breathing (REVB), while maximum lifted load and concentric phase kinematics were recorded. The results of ANOVA showed that the REVB breathing decreased absolute (p < 0.04) and relative lifted load (p < 0.01). The VM showed lower (p = 0.01) concentric time of the lift than the other breathing techniques. The VM and PAC showed lower SR time than other breathing techniques, where PAC showed a lower SR time than VM (p = 0.02). The PAC techniques resulted in shorter SR and pre-SR track than other breathing techniques and the REVB showed longer SR track than the other considered breathing techniques (p = 0.04). Thus, PAC or VM should be used for 1RM BP lifting according to preferences, experiences and lifting comfort of an athlete. The hold breath technique does not seem to excessively decrease the lifting load, but this method will increase the lifting time and the time spend in the sticking region, therefore its use does not provide any lifting benefit. The authors suggest that the REVB should not be used during 1 RM lifts.     

Individual differences in respiratory sinus arrhythmia

To investigate the interindividual differences in respiratory sinus arrhythmia (RSA), recordings of ventilation and electrocardiogram were obtained from 12 healthy subjects for five imposed breathing periods (T(TOT)) surrounding each individual's spontaneous breathing period. In addition to the spectral analysis of the R-R interval signal at each breathing period, RSA characteristics were quantified by using a breath-by-breath analysis where a sinusoid was fitted to the changes in instantaneous heart rate in each breath. The amplitude and phase (or delay = phase x T(TOT)) of this sinusoid were taken as the RSA characteristics for each breath. It was found that for each subject the RSA amplitude-T(TOT) relationship was linear, whereas the delay-T(TOT) relationship was parabolic. However, the parameters of these relationships differed between individuals. Linear correlation between the slopes of RSA amplitude versus T(TOT) regression lines and 1) mean breathing period and 2) mean R-R interval during spontaneous breathing were calculated. Only the correlation coefficient with breathing period was significantly different from zero, indicating that the longer the spontaneous breathing period the lesser the increase in RSA amplitude with increasing breathing period. Similarly, only the correlation coefficient between the curvature of the RSA delay-T(TOT) parabola and mean breathing period was significantly different from zero; the longer the spontaneous breathing period the larger the curvature of RSA delay. These results suggest that the changes in RSA characteristics induced by changing the breathing period may be explained partly by the spontaneous breathing period of each individual. Furthermore, a transfer function analysis performed on these data suggested interindividual differences in the autonomic modulation of the heart rate.     

Doppler ultrasound method for detecting human fetal breathing in utero.

An audible Doppler ultrasound method for detecting human fetal breathing movements in utero has been developed. The frequencies synchronous with fetal breathing movements probably originate from the lung rather than the chest wall. This method is much cheaper and simpler than the ultrasound A-scan method and is suitable for screening large numbers of people.     

Pattern of breathing in the rat.

The basic ventilation values - tidal volume (VT), breathing frequency (f), minute ventilation (VE) and the duration of inspiration (TI) and expiration (TE) -- were determined in adult male rats. The range of these values is given and the pattern of breathing is defined as the relationship between VE and VT, which in the rat is linear throughout its entire range. The role of TI and TE in changing f in the rat were evaluated. The breathing pattern of the rat was compared with data for the rabbit and man, using percentual expression of the basic values. A shift of the breathing pattern to higher f values was observed in rats with experimental lung diseases. In these rats, the inhalation of 100% O2 shifted the pattern of breathing markedly to lower VE values, though not to values comparable with the controls. Bilateral cervical vagotomy was followed by a pronouced decrease in f, an increase in VT and T1 persisted even after vagotomy, however; it can be assumed that this relationship is effected either by means of receptors in the chest muscles, or by the direct action of CO2 which is used to stimulate breathing, on the bulbopontine pacemaker.     

Fetal and neonatal breathing movements in man after betamethasone.

Nineteen women in the last trimester of pregnancy were treated with betamethasone 12 mg daily for three consecutive days. The fetal breathing movements were monitored by an ultrasonic method before and after the treatment and the patterns of movements were compared to those in controls. In seven treated cases the recording of breathing was performed also in the neonatal period. Betamethasone in the given dose, which causes pronounced alterations in the fetal corticosteroid balance, does not influence the pattern of breathing movements in the fetus and newborn. Although corticosteroids are known to affect several functions of CNS, the maturation of mechanisms regulating breathing movements in the perinatal period is apparently not accelerated by betamethasone.     

Temporal effects in the estimation of pulmonary diffusing capacity

Steady state estimates of the pulmonary diffusing capacity for carbon monoxide (DLCO) require measurement of the uptake and the average alveolar partial pressure of carbon monoxide (PACO). The expired alveolar sample obtained by different experimental methods and/or breathing patterns rarely represents the actual PACO. It is widely accepted that nonuniform distribution of ventilation, diffusion and perfusion causes discrepancies in the measurement of diffusing capacity. tan additional source of error in choosing PACO arises in the sampling time chosen by the experimental method. A theoretical study of a ramp-with-pause and a square breathing pattern demonstrates that the sample-time error exists even in the homogeneous lung. The study shows for the homogeneous lung that the correct fractional concentration of alveolar carbon monoxide (FAV) occurs at a time (TAV), one-half of a breathing period after the effective inspiration time (TI) for the two very different breathing patterns. TI is well-defined in relation to any breathing pattern which can be approximated by ramps and pauses. If TAV and the sample time chosen by the experimental method are known, then the measured DLCO can be corrected to the actual diffusing capacity (DL). The theory agrees with experimental results and computer simulations of inhomogeneous lungs from the literature. This agreement suggests that the theory for the homogeneous lung is also relevant to the inhomogeneous lung.     

High density respiratory syndrome: I. Oscillations of flow-volume curves during forced respiration in dense gas media]

33 divers exposed to high pressure have been examined in three series. The dynamics of the forced breathing parameters has been studied: I--helio or neon-oxygen medium under pressure of 1.078-3.53 MPa (11-36 kg/m2) with density to 32.7 kg/m3; II--nitrogen-oxygen medium under 0.274-0.882 MPa (2.8-9.0 kg/m2) with density of 11.7 kg/m3; III--under the same conditions, as II, but using bronchospasmolytics (stimulators of 2-adrenoreceptors: astompent, salbutamol, berotec) under hyperbaria. A new phenomenon: high-density breathing syndrome is revealed. It includes appearance of oscillations of respiratory flows against the background of a decrease of forced breathing rate in dense gas medium and has a common mechanism of appearance both during inhale and exhale. High hydrostatic pressure and narcotic qualities of inert gases can have a modulating effect. Evidences are obtained that tremor phenomena observed during high pressure nervous syndrome can influence the biomechanics of forced breathing at hyperbaria. A high correlation between amplitude modulation of electromyograms of breathing muscles and pneumotachogram oscillations within the range, corresponding to the frequency of physiological tremor, allowed assuming that tremor of breathing muscles induced by high-density gas medium action is one of factors responsible for appearance of respiratory flows oscillations.     

Effects of industrial respirators on breathing pattern at different work levels

The effects of a filtering device and an air-line apparatus on breathing pattern were studied in healthy men with different physical characteristics and work capacity. The subjects comprised nine construction workers aged 35-44, and nine firemen aged 21-35. The construction workers' mean maximal oxygen consumption (VO2max) was 34.5 ml min-1 kg-1, the firemen's 66.9 ml min-1 kg-1. Breathing pattern was analyzed for its components, inspiratory time, expiratory time, breathing frequency, tidal volume, and pulmonary ventilation at rest, during two submaximal treadmill walks when the subjects' absolute work load was equal, and during recovery. Neither the filtering device nor the air-line apparatus had a significant effect on breathing pattern when compared with the control values measured twice with a low-resistance breathing valve. A significantly longer expiratory time, lower breathing frequency, and smaller pulmonary ventilation were found for the firemen with the breathing valve and the industrial respirators. The breathing pattern of the construction workers and the firemen differed, but the alterations were not induced by the use of the filtering device or the air-line apparatus when studied at aerobic work levels up to 60% VO2max.     

Acute effects of acrolein on breathing: role of vagal bronchopulmonary afferents.

Spontaneous inhalation of acrolein vapor (350 ppm, 1 ml/100 g body wt) elicited an immediate and transient inhibitory effect on breathing in anesthetized rats, characterized by a prolongation of expiratory duration and accompanied by a bradycardia; ventilation was reduced by 47 +/- 6%, which returned to baseline after three to seven breaths. When both vagi were cooled to 6.6 +/- 0.1 degrees C, the reflex apneic response to lung inflation was completely abolished but the bradypneic response to acrolein was not affected. After perineural capsaicin treatment of both cervical vagi to selectively block the capsaicin-sensitive C-fiber afferents, acrolein no longer evoked an inhibitory effect on breathing; conversely, an augmented inspiration was consistently elicited with the first breath of acrolein inhalation, which was subsequently abolished by cooling both vagi to 6.5 degrees C. The inhibitory effect of inhaling acrolein at a lower concentration (200 ppm) was not detectable, whereas that of a higher concentration (600 ppm) was more intense and prolonged. All these responses were completely eliminated by bilateral vagotomy. These results suggest that inhaled acrolein activated both vagal C-fiber endings and rapidly adapting irritant receptors in the airways, but the acrolein-induced inhibitory effect on breathing was elicited primarily by the C-fiber afferent stimulation.     

Bradykinin stimulates respiratory drive by activating pulmonary sympathetic afferents in the rabbit.

We recently identified a vagally mediated excitatory lung reflex by injecting hypertonic saline into the lung parenchyma (Yu J, Zhang JF, and Fletcher EC. J Appl Physiol 85: 1485-1492, 1998). This reflex increased amplitude and burst rate of phrenic (inspiratory) nerve activity and suppressed external oblique abdominal (expiratory) muscle activity. In the present study, we tested the hypothesis that bradykinin may activate extravagal pathways to stimulate breathing by assessing its reflex effects on respiratory drive. Bradykinin (1 microg/kg in 0.1 ml) was injected into the lung parenchyma of anesthetized, open-chest and artificially ventilated rabbits. In most cases, bradykinin increased phrenic amplitude, phrenic burst rate, and expiratory muscle activity. However, a variety of breathing patterns resulted, ranging from hyperpnea and tachypnea to rapid shallow breathing and apnea. Bradykinin acts like hypertonic saline in producing hyperpnea and tachypnea, yet the two agents clearly differ. Bradykinin produced a higher ratio of phrenic amplitude to inspiratory time and had longer latency than hypertonic saline. Although attenuated, bradykinin-induced respiratory responses persisted after vagotomy. We conclude that bradykinin activates multiple afferent pathways in the lung; portions of its respiratory reflexes are extravagal and arise from sympathetic afferents.     

The role of air breathing in the resistance of bimodally respiring fish to waterborne toxins

The bimodally respiring catfish Clarias macrocephalus Günther responded to a toxic extract of Croton tiglium (Euphorbiaceae) seeds by increased air breathing under both normoxic (8.1 ± 0.4 mgO₂ l⁻¹) and hypoxic (0.7 ± 0.1 mgO₂l⁻¹) conditions. Fish in hypoxia survived longer than those in normoxia when surface access was provided. When air breathing was prevented, survival time in toxin was greatly reduced at both levels of dissolved oxygen, and fish in normoxia survived longer than those in hypoxia. Non-toxin controls without surface access survived in normoxia but in hypoxia died at the same time as the fish in toxin. These results suggest that air breathing increases the resistance offish to toxins by permitting a decrease in the rate of gill ventilation and hence the rate at which toxins are absorbed.     

Effects of maternal indomethacin administration on fetal breathing movements in sheep

To determine the role of prostaglandins in the control of fetal breathing movements, we infused indomethacin (5 mg/ml; 25 mg/kg per day) into the maternal femoral vein for 70 h in 5 pregnant ewes. There was a significant increase in the incidence and amplitude of fetal breathing movements beginning within 2 h reaching a peak at 8-10 h. It then diminished and was no longer present by 20-70 h despite continued indomethacin infusion. Maternal glucose concentrations were increased at 8 and 16 h following the initiation of indomethacin infusion. The data suggested that the previously reported effects of cyclo-oxygenase inhibitor on fetal breathing movements are transient and do not continue beyond 20 h.     

Fetal breathing, sleep state, and cardiovascular responses to adenosine in sheep

The possibility that adenosine mediates hypoxic inhibition of fetal breathing and eye movements was tested in nine chronically catheterized fetal sheep (0.8 term). Intracarotid infusion of adenosine (0.25 +/- 0.03 mg.min-1.kg-1) for 1 h to the fetus increased heart rate and hemoglobin concentration but did not significantly affect mean arterial pressure or blood gases. As with hypoxia, adenosine decreased the incidence of rapid eye movements by 55% and the incidence of breathing by 77% without significantly affecting the incidence of low-voltage electrocortical activity. However, with longer (9 h) administration, the incidence of breathing and eye movements returned to normal during the adenosine infusion. Intravenous infusion of theophylline, an adenosine receptor antagonist, prevented most of the reduction in the incidence of breathing and eye movements normally seen during severe hypoxia (delta arterial PO2 = -10 Torr). It is concluded that 1) adenosine likely depresses fetal breathing and eye movements during hypoxia and 2) downregulation of adenosine receptors may contribute to the adaptation of breathing and eye movements during prolonged hypoxia.     

Continuous non-invasive blood pressure monitoring in patients with sleep disorders.

Sleep related breathing disorders are of high prevalence and are often associated with essential hypertension. It is therefore necessary to study blood pressure continuously in all patients with sleep related breathing disorders and arterial hypertension as well as in all patients with essential hypertension and suspected sleep apnoea. To investigate the usefulness of a non-invasive continuous volume-clamp method during sleep we used this technique in parallel with 130 sleep recordings and performed a validation study of the Finapres instrument on a subgroup where continuous invasive blood pressure recordings were available. Absolute pressure values of Finapres are valid when the position and the movement of the sensor were carefully observed and only appropriate segments of the recordings were taken for further evaluation. The high beat to beat resolution of the systolic and diastolic pressure is the main advantage of this non-invasive technique because it reflects rapid blood pressure variations as they occur in sleep related breathing disorders. This could be investigated only invasively until now.     

Breathing patterns during varied activities.

The level of ventilation attained and breathing patterns adopted during activity have important implications for the distribution and deposition of particles that are inhaled. However, breathing patterns and levels of ventilation adopted during specific physical activities are unknown. We used a noninvasive means of measuring ventilation in subjects performing a variety of activities (bicycling, arm ergometry, lifting, and pulling) during unencumbered (no mouthpiece) breathing and while breathing through a mouthpiece. Minute ventilation (VE), tidal volume (VT), inspiratory time (TI), and total breathing cycle time (TT) were measured initially both spirometrically and from body surface displacements. When a mouthpiece was used, VE and breathing patterns were significantly altered during all activities such that VE, VT, and TT increased by 16, 34, and 20%, respectively. This mouthpiece effect was attenuated at the higher levels of VE. A task dependency of breathing pattern was also noted such that there was much greater variability of VT and TI for a given VE during the lifting activity compared with bicycling (coefficient of variation for VT of 0.39 +/- 0.09 vs. 0.20 +/- 0.07, P less than 0.01; and for TI of 0.38 +/- 0.08 vs. 0.21 +/- 0.08, P less than 0.01). We conclude that a mouthpiece significantly alters breathing pattern during varied types and intensities of activities, and breathing patterns may differ significantly from one activity to another. When the total dose of particulates inhaled in the lung are assessed, the mouthpiece effect and activity effect on breathing pattern must be considered.     

Analysis of breathing via optoelectronic systems: comparison of four methods for computing breathing volumes and thoraco-abdominal motion pattern

Breathing parameters can be measured by motion capture systems by placing photo-reflective markers on the chest wall. A computational model is mandatory to compute the breathing volume and to calculate temporal and kinematical features by the gathered markers trajectories. Despite different methods based on different geometrical approaches can be adopted to compute volumes, no information about their differences in the respiratory evaluation are available. This study investigated the performances of four methods (conventional, prism-based, convex hull with boundary condition, based on Delaunay triangulation) using an optoelectronic motion capture system, on twelve healthy participants during 30 s of breathing. Temporal trends of volume traces, tidal volume values, and breathing durations were compared between methods and spirometry (used as reference instrument). Additionally, thoraco-abdominal motion patterns were compared between methods by analysing the compartmental contributions and their variability. Results shows comparable similarities between the volume traces obtained using spirometry, prism-based and conventional methods. Prism-based and convex hull with boundary condition methods show lower bias in tidal volumes estimation up to 0.06 L, compared to the conventional and Delaunay triangulation methods. Prism-based method shows maximum differences of 30 mL in the comparison of compartmental contributions to the total volume, by resulting in a maximum deviation of 1.6% in the percentage contribution analysis. In conclusion, our finding demonstrated the accuracy of the non-invasive MoCap-based breathing analysis with the prism-based method tested. Data provided in this study will lead researchers and clinicians in the computational method choice for temporal and volumetric breathing analysis.     

Estimation of respiratory impedance and source pressure using a Thévenin equivalent circuit model

The objective of this paper is to present a new technique which can provide both active respiration source pressure and lung impedance in a single noninvasive test. The method is based upon a Thévenin equivalent circuit model of respiratory mechanics. Using this model, the equivalent source pressure and source impedance can be computed from the measured changes of respiratory pressures and flows in two consecutive cycles before and after addition of purely resistive loads to the mouth. In maximal breathing the source parameters were reproducible in six normal human subjects. The total respiratory resistance during maximal breathing had an average value of 3.46 cmH2O l-1 s-1, and the total dynamic compliance had an average value of 0.078 l cmH2O-1. The airway resistances measured using a plethysmographic method were within the range of 45-65% of the estimated total respiratory resistances. These two resistances were related with a correlation coefficient of 0.98. An average value of the magnitudes of the fundamental components of the source pressure was 6.73 cmH2O during maximal breathing and 2.09 cmH2O during spontaneous breathing.     

Smooth muscle length adaptation and actin filament length: a network model of the cytoskeletal dysregulation

Length adaptation of the airway smooth muscle cell is attributable to cytoskeletal remodeling. It has been proposed that dysregulated actin filaments may become longer in asthma, and that such elongation would prevent a parallel-to-series transition of contractile units, thus precluding the well-known beneficial effects of deep inspirations and tidal breathing. To test the potential effect that actin filament elongation could have in overall muscle mechanics, we present an extremely simple model. The cytoskeleton is represented as a 2-D network of links (contractile filaments) connecting nodes (adhesion plaques). Such a network evolves in discrete time steps by forming and dissolving links in a stochastic fashion. Links are formed by idealized contractile units whose properties are either those from normal or elongated actin filaments. Oscillations were then imposed on the network to evaluate both the effects of breathing and length adaptation. In response to length oscillation, a network with longer actin filaments showed smaller decreases of force, smaller increases in compliance, and higher shortening velocities. Taken together, these changes correspond to a network that is refractory to the effects of breathing and therefore approximates an asthmatic scenario. Thus, an extremely simple model seems to capture some relatively complex mechanics of airway smooth muscle, supporting the idea that dysregulation of actin filament length may contribute to excessive airway narrowing.