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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 September;67(9):653-8

language: English

Respiratory muscles in chronic obstructive pulmonary disease and asthma

Barbarito N., Ceriana P., Nava S.

From the Divisione di Pneumologia Riabilitativa IRCCS Fondazione “S. Maugeri” Centro Medico di Pavia - Pavia

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Chronic obstruc­tive pul­mo­nary dis­ease (­COPD) and asth­ma are char­ac­ter­ized by air­flow obstruc­tion and sig­nif­i­cant ­increase of res­pir­a­to­ry mus­cle work­load, ­with con­crete ­risk of ven­til­a­to­ry ­pump fail­ure. Respiratory mus­cles, the ­main com­po­nent of ­this ­pump, under­go struc­tu­ral and func­tion­al chang­es dur­ing the ­course of ­these dis­eas­es. Aim of the ­present ­paper is to ana­lyze mod­ifi­ca­tions of res­pir­a­to­ry mus­cles in ­COPD and asth­ma. An analysis of the ­most impor­tant con­trolled clin­i­cal stud­ies ­released dur­ing the ­past ­years was car­ried out.
The ­patients suf­fered ­from chron­ic obstruc­tive pul­mo­nary dis­ease and asth­ma. In ­COPD, res­pir­a­to­ry mus­cles ­have to ­cope ­with an ­increased ­load, an intrin­sic weak­ness and a mechan­i­cal dis­ad­van­tage, expe­cial­ly in the dia­phrag­mat­ic ­lenght-­force rela­tion­ship; in ­patients ­with ­acute asth­ma, the ­main fea­tures are a mas­sive hyper­in­fla­tion and a per­sis­tent inspir­a­to­ry mus­cle activ­ity dur­ing expi­ra­tion. Modifications of res­pir­a­to­ry mus­cles ­deserve ­great con­sid­er­a­tion not ­only for the com­plete com­pre­hen­sion of the under­ly­ing phys­io­pat­o­log­ic ­aspects of ­these dis­eas­es, but ­also for the opti­mal clin­i­cal man­age­ment: a ­reduced pul­mo­nary hyper­in­fla­tion in ­COPD ­place the res­pir­a­to­ry mus­cles in a bet­ter posi­tion of the ­force-­lenght ­curve ­while ­great ­care ­must be ­payed to the meta­bol­ic and nutri­tion­al ­aspects. During asth­mat­ic cri­sis res­pir­a­to­ry mus­cles are sub­ject­ed to a ­sort of ­intense train­ing but any­way per­sis­tence of bron­chos­pasm in ­most ­severe ­attacks can ­lead to exhaus­tion of the ven­til­a­to­ry ­pump and ­need of mechan­i­cal ven­til­a­to­ry sup­port.

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