Chest
Volume 94, Issue 6, December 1988, Pages 1232-1235
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Clinical Investigations
Cough Capacity in Patients with Muscular Dystrophy

https://doi.org/10.1378/chest.94.6.1232Get rights and content

Cough capacity was evaluated in 22 patients with muscular dystrophy (MD) using subjective cough assessment, cough flow-volume curves, maximum expiratory pressures (MEP), forced vital capacity (FVC), and peak expiratory flow rates (PEFR). In ten of the 22 patients transients of peak flow were generated during cough flow-volume maneuvers, indicating dynamic compression of the airways, which is considered important in the physiology of an efficient cough. Patients who could not generate peak flow transients had significantly reduced PEFR, FVC, and MEP values. Measurement of MEP was the most sensitive predictor of flow transient production during coughing; all of the patients who exhibited transients had MEP values of above 60 cmH2O, whereas the highest value of MEP recorded in patients without transients was 45 cmH2O. Three of the 12 patients who were unable to generate flow transients were considered to have an adequate cough by subjective assessment. We concluded that the measurement of MEP is extremely useful for assessment of cough strength in patients with MD. (Chest 1988; 94:1232-35)

Section snippets

MATERIAL AND METHODS

Twenty-two patients with MD were included in the study. Patient characteristics are summarized in Table 1. The following parameters were evaluated.

RESULTS

The 14 subjects of the control group, six females and eight males, age range 9 to 35 years (median age, 14 years) were all classified as having a strong cough and all generated transients of peak flow during the cough flow-volume maneuver. The range of their spirometric and maximal expiratory pressure measurements were as follows: FVC, 82 to 108 percent predicted; PEFR, 85 to 120 percent predicted; and MEP, 78 to 130 percent predicted (100 to 290 cm H2O). A representative example of peak flow

DISCUSSION

In this study we have shown that 12 of 22 patients with muscular dystrophy were unable to produce transients of peak flow during cough flow-volume maneuvers. In contrast, all of the subjects in the control group exhibited transients. The production of these peak flow transients plays an important role in the efficacy of the cough mechanism.

Cough flow-volume tracings from those patients who could generate transients of peak flow and from the control subjects were similar to those previously

REFERENCES (17)

  • SR Inkley et al.

    Pulmonary function in Duchenne muscular dystrophy related to stage of disease

    Am J Med

    (1974)
  • J Gilroy et al.

    Cardiac and pulmonary complications in Duchenne's progressive muscular dystrophy

    Circulation

    (1963)
  • J. Newsom-Davis

    The respiratory system in muscular dystrophy

    Br Med Bull

    (1980)
  • DE. Leith

    The development of cough

    Am Rev Respir Dis

    (1985)
  • BB Ross et al.

    Physical dynamics of the cough mechanism

    J Appl Physiol

    (1955)
  • RE. Hyatt

    Expiratory flow limitation

    J Appl Physiol

    (1983)
  • RJ Knudson et al.

    Contribution of airway collapse to supramaximal expiratory flows

    J Appl Physiol

    (1974)
  • NS Arora et al.

    Cough dynamics during progressive expiratory muscle weakness in healthy curarized subjects

    J Appl Physiol

    (1981)
There are more references available in the full text version of this article.

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