title: Respiratory function in multiple sclerosis. Utility of clinical assessment of respiratory muscle function.
abstract: OBJECTIVE
  The aim of this study was to assess the utility of clinical assessment of respiratory muscle weakness in MS.
  
  
  METHODS
  We studied 40 MS patients who performed pulmonary function tests using standard procedures and measures of respiratory muscle strength. Descriptive clinical indices included a history of detailed neurologic findings, including upper and lower extremity weakness, cerebellar signs, and evidence of cerebral lesions and other clinical signs including dependence in activities of daily living, shortness of breath, weak voice, dysarthria and dysphagia. We devised an index comprised of four clinical signs: the patient's report of difficulty in clearing pulmonary secretions and his report of a weakened cough, the examiner's observation of the patient's cough, and ability to count on a single exhalation.
  
  
  RESULTS
  Mean values of TLC (95 percent +/- 14) VC (91 percent +/- 19), and RV (106 percent +/- 34) were normal. By contrast, MVV (68 percent +/- 20), PImax (74 percent +/- 27) and PEmax (51 percent +/- 22) were decreased. Stepwise multiple regression indicated that the best single predictor of expiratory muscle weakness was the index score; the combination of index score, upper extremity weakness, and maximal voluntary ventilation accounted for 60 percent of the variance in PEmax.
  
  
  CONCLUSIONS
  We conclude that clinical assessment is a better predictor of respiratory muscle weakness than spirometry and that a systematic clinical assessment supplemented by respiratory muscle assessment and MVV can uncover subtle respiratory muscle weakness in patients with MS.
authors.affiliation: College of Nursing, Rutgers, State University of New Jersey, Newark.
authors.forename: S C
authors.initials: SC
authors.lastname: Smeltzer
authors.forename: J H
authors.initials: JH
authors.lastname: Skurnick
authors.forename: R
authors.initials: R
authors.lastname: Troiano
authors.forename: S D
authors.initials: SD
authors.lastname: Cook
authors.forename: W
authors.initials: W
authors.lastname: Duran
authors.forename: M H
authors.initials: MH
authors.lastname: Lavietes
mesh_terms: D000328:Adult; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008451:Maximal Voluntary Ventilation; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D010366:Peak Expiratory Flow Rate; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology*; D014109:Total Lung Capacity