Respiratory muscle performance and the Perception of dyspnea in Parkinson's disease.
BACKGROUND
Pulmonary and respiratory muscle function impairment are common in patients with Parkinson's disease (PD). However, dyspnea is not a frequent complaint among these patients, although it is well documented that the intensity of dyspnea is related to the activity and the strength of the respiratory muscles.


METHODS
We studied pulmonary function, respiratory muscle strength and endurance and the perception of dyspnea (POD) in 20 patients with PD (stage II and III Hoehn and Yahr scale) before and after their first daily L-dopa dose. Respiratory muscle strength was assessed by measuring the maximal inspiratory and expiratory mouth pressures (PImax and PEmax), at residual volume (RV) and total lung capacity (TLC) respectively. The POD was measured while the subject breathed against progressive load and dyspnea was rated using a visual analog scale.


RESULTS
Respiratory muscle strength and endurance were decreased and the POD was increased during the off medication period compared to normal subjects. There was a nonsignificant trend to an increase in Plmax, PEmax and endurance after L-dopa intake. The POD of PD patients decreased (p<0.05) following medication, although, it remained increased (p<0.01) as compared to the normal subjects. Even if patients had spirometry data showing a mild restrictive pattern, before medication, both forced vital capacity (FVC) and forced expiratory volume (FEV)1 remained almost identical after L-dopa intake.


CONCLUSIONS
Patients with PD have higher POD, compared to normal subjects and this increased perception is attenuated when the patients are on dopaminergic medication. The change in the POD is not related to changes in respiratory muscle performance or pulmonary functions. A central effect or a correction of uncoordinated respiratory movements by L-dopa may contribute to the decrease in POD following L-dopa treatment.
Weiner
Paltiel
P
Department of Medicine A, Hillel Yaffe Medical Center, Hadera, Israel.
Inzelberg
Rivka
R
Davidovich
Avi
A
Nisipeanu
Puiu
P
Magadle
Rasmi
R
Berar-Yanay
Noa
N
Carasso
Ralph L
RL
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015259:Dopamine Agents / Q000627:therapeutic use*; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology*
D015259:Dopamine Agents; D007980:Levodopa