Article Text

Download PDFPDF

Expiratory muscle endurance in chronic obstructive pulmonary disease
  1. A Ramírez-Sarmiento1,
  2. M Orozco-Levi1,2,
  3. E Barreiro1,
  4. R Méndez1,
  5. A Ferrer1,
  6. J Broquetas1,3,
  7. J Gea1,2
  1. 1Servei de Pneumologia and Unitat de Recerca Respiratòria I Ambiental, Hospital del Mar-IMIM, Barcelona, Spain
  2. 2CEXS, Universitat Pompeu Fabra, Barcelona, Spain
  3. 3Departamente Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
  1. Correspondence to:
    Dr J Gea, Grup de Recerca de Pneumologia, IMIM, Avda Doctor Aiguader 80, 08003 Barcelona, Spain;


Background: A reduction in expiratory muscle (ExM) endurance in patients with chronic obstructive pulmonary disease (COPD) may have clinically relevant implications. This study was carried out to evaluate ExM endurance in patients with COPD.

Methods: Twenty three patients with COPD (FEV1 35 (14)% predicted) and 14 matched controls were studied. ExM endurance was assessed using a method based on the use of an expiratory threshold valve which includes two steps. In step 1 the load is progressively increased (50 g every 2 minutes) until task failure is reached, and the pressure generated against the highest tolerated load is defined as the maximal expiratory sustainable pressure (Pthmax). In step 2 subjects breathe against a submaximal constant load (80% of Pthmax) and the time elapsed until task failure is termed the expiratory endurance time (Tth80). In addition, the strength of peripheral muscles (handgrip, HGS) and respiratory muscles (maximal inspiratory and expiratory pressures, Pimax and Pemax, respectively) was evaluated.

Results: Patients with COPD had lower ExM strength and endurance than controls: Pemax 64 (19)% predicted v 84 (14)% predicted (mean difference 20%; 95% confidence intervals (CI) 14 to 39); Pthmax 52 (27) v 151 (46) cm H2O (mean difference 99, 95% CI 74 to 123); and Tth80 9.4 (6.3) v 14.2 (7.4) min (mean difference 4.8, 95% CI 1.0 to 10.4; p<0.01 for all). Interestingly, ExM endurance directly correlated with both the severity of airways obstruction (Pthmax with FEV1, r=0.794, p<0.01) and the reduction in strength observed in different muscle groups (Pthmax with HG, Pimax or Pemax, r=0.550, p<0.05; r=0.583, p<0.001; and r=0.584, p<0.001, respectively).

Conclusions: ExM endurance is decreased in patients with COPD. This impairment is proportional to the severity of the disease and is associated with lower strength in different muscle groups. This suggests that systemic effects are implicated in the impairment observed in ExM function.

  • expiratory muscles
  • endurance
  • chronic obstructive pulmonary disease
  • threshold loading
  • Pimaxrv, maximal inspiratory pressure
  • Pemaxtlc, maximal expiratory pressure
  • Pthmax, maximal expiratory sustainable pressure
  • Tth80, expiratory endurance time
  • HGS, hand grip dynamometry
View Full Text

Statistics from


  • Antoni Ferrer was a Senior Researcher from the Consorci Hospitalari Parc Tauli, Sabadell. His stage of the study was funded by grant BAE-FIS (Spain).

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.