title: Expiratory muscle endurance in chronic obstructive pulmonary disease.
abstract: 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 (FEV(1) 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 (Tth(80)). 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 H(2)O (mean difference 99, 95% CI 74 to 123); and Tth(80) 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 FEV(1), 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.
authors.affiliation: Servei de Pneumologia and Unitat de Recerca Respiratòria I Ambiental, Hospital del Mar-IMIM, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ramírez-Sarmiento
authors.forename: M
authors.initials: M
authors.lastname: Orozco-Levi
authors.forename: E
authors.initials: E
authors.lastname: Barreiro
authors.forename: R
authors.initials: R
authors.lastname: Méndez
authors.forename: A
authors.initials: A
authors.lastname: Ferrer
authors.forename: J
authors.initials: J
authors.lastname: Broquetas
authors.forename: J
authors.initials: J
authors.lastname: Gea
mesh_terms: D004576:Electromyography; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue / Q000502:physiology; D010807:Physical Endurance / Q000502:physiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012132:Respiratory Muscles / Q000502:physiology*; D014797:Vital Capacity / Q000502:physiology