Skip to main content
SpringerLink
Log in

Respiratory Muscle Function and Other Pulmonary Function Studies

  • Chapter
  • First Online:
Pulmonary Function Tests in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

  • 1636 Accesses

Abstract

This chapter reviews testing for respiratory muscle dysfunction and other miscellaneous pulmonary function studies including airways resistance, lung compliance, and shunt testing. This includes maximal inspiratory and expiratory pressure. We also review upright and supine spirometry assessing for diaphragmatic weakness. A new addition to this chapter discusses ultrasonographic assessment of diaphragmatic function.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    MIP and MEP are sometimes referred to as PImax and PEmax, respectively.

  2. 2.

    There is a wide range of normal values in the same age and sex; the normal values vary significantly with age and sex. For more details refer to [2].

  3. 3.

    Bilateral tetanic stimulation can give maximal Pdi but is uncomfortable and only used for research.

  4. 4.

    This reduction is caused by the effect of the increasing frequency of breathing on the lung units that are recruited. As the frequency of breathing increases, the lung units with more rapid frequency response, i.e., shorter time constant, are recruited and these units are less compliant.

References

  1. Malcolm ATS, Gary C. Respiratory muscle testing: tests of respiratory muscle strength. Am J Respir Crit Care Med. 2002;166:518–624.

    Article  Google Scholar 

  2. Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969;99:696–702.

    CAS  PubMed  Google Scholar 

  3. Koulouris N, Mulvey DA, Laroche CM, Green M, Moxham J. Comparison of two different mouthpieces for the measurement of Pimax and Pemax in normal and weak subjects. Eur Respir J. 1988;1:863–7.

    CAS  PubMed  Google Scholar 

  4. Enright PL, Kronmal RA, Manolio TA, Schenker MB, Hyatt RE. Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group. Am J Respir Crit Care Med. 1994;149:430–8.

    Article  CAS  PubMed  Google Scholar 

  5. Sclauser Pessoa IMB, Parreira VF, Fregonezi GAF, Sheel AW, Chung F, Reid WD. Reference values for maximal inspiratory pressure: a systematic review. Can Respir J. 2014;21:43–50.

    Article  PubMed  Google Scholar 

  6. Hyatt RE, Scanlon PD, Nakamura M. Interpretation of pulmonary function tests, a practical guide. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.

    Google Scholar 

  7. Hancox B, Whyte K. Bob pocket guide to lung function tests. 1st ed. Sydney: McGraw-Hill; 2001.

    Google Scholar 

  8. Clanton TL, Ameredes BT. Fatigue of the inspiratory muscle pump in humans: an isoflow approach. J Appl Physiol. 1988;64:1693–9.

    Article  CAS  PubMed  Google Scholar 

  9. Mador MJ, Rodis A, Magalang UJ, Ameen K. Comparison of cervical magnetic and transcutaneous phrenic nerve stimulation before and after threshold loading. Am J Respir Crit Care Med. 1996;154:448–53.

    Article  CAS  PubMed  Google Scholar 

  10. Heritier F, Rahm F, Pasche P, Fitting J. W. Sniff nasal pressure. Anon ivasive assess inspiratory muscle strength. Am J Respir Crit Care Med. 1994;150:1678–83.

    Article  CAS  PubMed  Google Scholar 

  11. Bellemare F, Grassino A. Evaluation of human diaphragm fatigue. J Appl Physiol. 1982;53:1196–206.

    Article  CAS  PubMed  Google Scholar 

  12. Capozzo R, Quaranta VN, Pellegrini F, et al. Sniff nasal inspiratory pressure as a prognostic factor of tracheostomy or death in amyotrophic lateral sclerosis. J Neurol. 2015;262:593. https://doi.org/10.1007/s00415-014-7613-3.

    Article  PubMed  Google Scholar 

  13. Laaroche CM, Mier AK, Moxham J, Green M. The value of sniff esophageal pressure in the assessment of global inspiratory muscle strength. Am Rev Respir Dis. 1988;138:598.

    Article  Google Scholar 

  14. Hughes JM, Pride NB. Lung function tests: physiological principles and clinical applications. Philadelphia, PA: W. B. Saunders; 2000.

    Google Scholar 

  15. Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis. 1988;137:877–83.

    Article  CAS  PubMed  Google Scholar 

  16. Allen SM, Hunt B, Green M. Fall in vital capacity with posture. Br J Dis Chest. 1995;79:267–71.

    Article  Google Scholar 

  17. Green M. Respiratory muscle testing. Bull Eur Physiopathol Respir. 1984;20:433–5.

    CAS  PubMed  Google Scholar 

  18. Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C, Kiran J. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med. 2001;20(6):597–604.

    Article  CAS  Google Scholar 

  19. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest. 2009;135(2):391–400.

    Article  PubMed  Google Scholar 

  20. Houston JG, Angus RM, Cowan MD, McMillan NC, Thomson NC. Ultrasound assessment of normal hemidiaphragmatic movement: relation to inspiratory volume. Thorax. 1994;49(5):500–3.

    Article  CAS  PubMed  Google Scholar 

  21. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve. 2013;47:319–29.

    Article  PubMed  Google Scholar 

  22. Wait JL, Nahormek PA, Yost WT, Rochester DP. Diaphragmatic thickness-lung volume relationship in vivo. J Appl Physiol. 1989;67(4):1560–8.

    Article  CAS  PubMed  Google Scholar 

  23. Mccool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med. 2012;366:932–42.

    Article  CAS  PubMed  Google Scholar 

  24. Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med. 1997;155(5):1570–4.

    Article  CAS  PubMed  Google Scholar 

  25. Zifko U, Hartmann M, Girsch W, Zoder G, Rokitansky A, Grisold W, Lischka A. Diaphragmatic paresis in newborns due to phrenic nerve injury. Neuropediatrics. 1995;26(5):281–4.

    Article  CAS  PubMed  Google Scholar 

  26. Ayoub J, Cohendy R, Dauzat M, Targhetta R, Coussaye JE, Bourgeois JM, Ramonatxo M, Prefaut C, Pourcelot L. Non-invasive quantification of diaphragm kinetics using m-mode sonography. Can J Anaesth. 1997;44(7):739–44.

    Article  CAS  PubMed  Google Scholar 

  27. Kantarci F, Mihmanli I, Demirel MK, Harmanci K, Akman C, Aydogan F, Mihmanli A, Uysal O. Normal diaphragmatic motion and the effects of body composition: determination with M-mode sonography. J Ultrasound Med. 2004;23(2):255–60.

    Article  PubMed  Google Scholar 

  28. Cohen E, Mier A, Heywood P, Murphy K, Boultbee J, Guz A. Excursion-volume relation of the right hemidiaphragm measured by ultrasonography and respiratory airflow measurements. Thorax. 1994;49(9):885–9.

    Article  CAS  PubMed  Google Scholar 

  29. Targhetta R, Chavagneux R, Ayoub J, Lemerre C, Prefaut C, Bourgeois JM, Balmes P. Right diaphragmatic kinetics measured by TM-mode ultrasonography with concomitant spirometry in normal subjects and asthmatic patients. Rev Med Interne. 1995;16(11):819–26.

    Article  CAS  PubMed  Google Scholar 

  30. Scott S, Fuld JP, Carter R, McEntegart M, MacFarlane NG. Diaphragm ultrasonography as an alternative to whole-body plethysmography in pulmonary function testing. J Ultrasound Med. 2006;25(2):225–32.

    Article  PubMed  Google Scholar 

  31. Alexander C. Diaphragm movements and the diagnosis of diaphragmatic paralysis. Clin Radiol. 1966;17:79–83.

    Article  CAS  PubMed  Google Scholar 

  32. Sanchez de Toledo J, Munoz R, Landsittel D, Shiderly D, Yoshida M, Komarlu R, Wearden P, Morell VO, Chrysostomou C. Diagnosis of abnormal diaphragm motion after cardiothoracic surgery: ultrasound performed by a cardiac intensivist vs. fluoroscopy. Congenit Heart Dis. 2010;5:565–72.

    Article  PubMed  Google Scholar 

  33. Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO. An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg. 2010;110(5):1349–54.

    Article  PubMed  Google Scholar 

  34. Punzal PA, Ries AL, Kaplan RM, Prewitt LM. Maximum intensity exercise training in patients with chronic obstructive pulmonary disease. Chest. 1991;100:618–23.

    Article  CAS  PubMed  Google Scholar 

  35. Franciosa JA, Park M, Levine TB. Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am J Cardiol. 1981;47:33–9.

    Article  CAS  PubMed  Google Scholar 

  36. Weber KT, Janicki JS. Cardiopulmonary exercise testing: physiologic principles and clinical applications. Philadelphia: W B Saunders; 1986.

    Google Scholar 

  37. Szlachcic J, Massie BM, Kramer BL, Topic N, Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol. 1985;55:1037–42.

    Article  CAS  PubMed  Google Scholar 

  38. Dillard TA, Hnatiuk OW, McCumber TR. Maximum voluntary ventilation. Spirometric determinants in chronic obstructive pulmonary disease patients and normal subjects. Am Rev Respir Dis. 1993;147:870–5.

    Article  CAS  PubMed  Google Scholar 

  39. Dillard TA, Piantadosi S, Rajagopal KR. Prediction of ventilation at maximal exercise in chronic air-flow obstruction. Am Rev Respir Dis. 1985;132:230–5.

    CAS  Google Scholar 

  40. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.

    Article  CAS  Google Scholar 

  41. Pride NB, Macklem PT. Lung mechanics in disease. In: Macklem PT, Mead J, editors. Handbook of physiology. The respiratory system. Mechanics of breathing. Section 3, vol. 3, Part 2. Bethesda, MD: American Physiological Society; 1986. p. 659–92.

    Google Scholar 

  42. Chiang ST. A nomogram for venous shunt (Q̇s/Q̇t) calculation. Thorax. 1968;23:563–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Prince Sultan Military Medical City, Riyadh, Saudi Arabia

    Ali Altalag

  2. University of British Columbia, Vancouver, BC, Canada

    Jeremy Road & Pearce Wilcox

  3. University of British Columbia, Victoria, BC, Canada

    Kewan Aboulhosn

Authors
  1. Ali Altalag
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy Road
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pearce Wilcox
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kewan Aboulhosn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali Altalag .

Editor information

Editors and Affiliations

  1. Prince Sultan Military Medical City, Riyadh, Saudi Arabia

    Ali Altalag

  2. University of British Columbia, Vancouver, BC, Canada

    Jeremy Road

  3. University of British Columbia, Vancouver, BC, Canada

    Pearce Wilcox

  4. University of British Columbia, Victoria, BC, Canada

    Kewan Aboulhosn

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Altalag, A., Road, J., Wilcox, P., Aboulhosn, K. (2019). Respiratory Muscle Function and Other Pulmonary Function Studies. In: Altalag, A., Road, J., Wilcox, P., Aboulhosn, K. (eds) Pulmonary Function Tests in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-93650-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-93650-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-93649-9

  • Online ISBN: 978-3-319-93650-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation