The Influence of Lung Function and Respiratory Muscle Strength on Quadriceps Muscle Fatigability in COPD Patients Under Long-term Oxygen Therapy

Mara Paneroni; Alessandro Cavicchia; Salvi Beatrice; Laura Bertacchini; Massimo Venturelli; Michele Vitacca

doi:10.1016/j.arbres.2024.04.004

The Influence of Lung Function and Respiratory Muscle Strength on Quadriceps Muscle Fatigability in COPD Patients Under Long-term Oxygen Therapy

Arch Bronconeumol. 2024 Apr 23:S0300-2896(24)00111-X. doi: 10.1016/j.arbres.2024.04.004. Online ahead of print.

[Article in English, Spanish]

Authors

Mara Paneroni¹, Alessandro Cavicchia², Salvi Beatrice², Laura Bertacchini², Massimo Venturelli³, Michele Vitacca²

Affiliations

¹ Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy. Electronic address: mara.paneroni@icsmaugeri.it.
² Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy.
³ Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

PMID: 38719676
DOI: 10.1016/j.arbres.2024.04.004

Abstract

Background: This research investigates quadriceps muscle fatigability (MF) in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure (CRF) at different levels of lung obstruction [severe obstruction (SO)=FEV₁ <50% and >30% versus very severe obstruction (VSO)=FEV₁ ≤30%]. It explores the relationships between quadriceps MF and lung function, respiratory muscles, and oxygenation status.

Methods: A post hoc cross-over analysis in 45 COPD patients (20 SO and 25 VSO) undergoing long-term oxygen therapy was performed. Delta change in quadriceps maximum voluntary contraction (MVC) (absolute value and percentage) before and after a constant workload was calculated. Associations between quadriceps MF and lung function, respiratory muscles, and gas exchange were examined using Pearson's correlation and multivariate linear regression analysis.

Results: SO patients experience a more substantial reduction in MVC compared to VSO (-15.15±9.13% vs -9.29±8.90%, p=0.0357), despite comparable resting MVC. Dyspnea is more pronounced in VSO at the beginning and end of the exercise. Correlations were found between MF and maximal inspiratory pressure (MIP) (r=-0.4412, p=0.0056), maximal expiratory pressure (MEP) (r=-0.3561, p=0.0282), and a tendency for FEV₁% (r=-0.2931, p=0.0507). The regression model (R²=0.4719) indicates that lower MIP and FEV₁ and high total lung capacity are significant factors in reducing quadriceps muscle fatigability after a fatiguing task.

Conclusion: COPD patients with more severe pulmonary obstruction and hyperinflation and lower respiratory muscle strength have lower quadriceps MF but higher dyspnea both at rest and during exercise.

Keywords: COPD; Exercise; Fatigability; Muscle fatigability; Rehabilitation.