title: Lung inflation training using a positive end-expiratory pressure valve in neuromuscular disorders.
abstract: OBJECTIVE
  Respiratory muscle weakness causes alveolar hypoventilation and reduced lung compliance in neuromuscular disorders. Lung inflation is important to prevent secondary pulmonary complications however respiratory and laryngeal dysfunction often hamper lung inflation. There is a need for a convenient and low-cost device that enables effective lung inflation. We tested a lung inflation training method using a positive end-expiratory pressure (PEEP) valve.
  
  
  METHODS
  Vital capacity (VC), maximum insufflation capacity (MIC) and peak cough flow (PCF) as well as PEEP lung inflation capacity (PIC) were assessed in 93 neuromuscular patients. Consecutive PIC training was done for 4 months in six tracheostomized Duchenne muscular dystrophy (DMD) patients and PIC was assessed before and after training.
  
  
  RESULTS
  PIC training was practicable in all participants and no serious adverse events were detected. PIC was significantly higher than VC or MIC in all disorders, although MIC was higher than VC in DMD only. Patients with dysphagia showed lower MIC and PCF compared with non dysphagic patients. PIC was as low as 345±77 mL in tracheostomized DMD patients; however consecutive training increased it up to 619±205 mL.
  
  
  CONCLUSIONS
  The PEEP valve enabled effective lung inflation regardless of laryngeal function. Consecutive training can improve lung condition even in advanced cases. Early introduction of PIC training could be effective at preventing respiratory complications in patients with neuromuscular disorders.
authors.affiliation: Department of Neurology, National Hospital Organization Toneyama National Hospital, Japan. matumura@toneyama.hosp.go.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Matsumura
authors.forename: Toshio
authors.initials: T
authors.lastname: Saito
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Fujimura
authors.forename: Susumu
authors.initials: S
authors.lastname: Shinno
authors.forename: Saburo
authors.initials: S
authors.lastname: Sakoda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity; D008297:Male; D008875:Middle Aged; D020388:Muscular Dystrophy, Duchenne / Q000503:physiopathology / Q000628:therapy; D009223:Myotonic Dystrophy / Q000503:physiopathology / Q000628:therapy; D009468:Neuromuscular Diseases / Q000503:physiopathology / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012138:Respiratory Therapy / Q000379:methods*; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult