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Identification of peripheral chemoreceptor stimuli.

This short review considers the essential structure and stimulus-response characteristics of the carotid body chemoreceptors and attempts to relate the latter to their role in the generation of exercise hyperpnea. It shows that the arterial chemoreceptors do contribute substantially to the drive to breathe in exercising man and it suggests that this extra drive results from an increase in discharge which occurs in spite of the fact that the classical stimuli to its discharge, do not change. The possibility that in exercise the carotid body is excited by activation of its sympathetic innervation, and by raised arterial potassium, is considered. The idea that breath-by-breath oscillations of arterial blood gas tension convey accurate information about the whole body rate of carbon dioxide production is described and found wanting.

Animals↗

Respiratory muscle dynamics and control during exercise with externally imposed expiratory flow limitation.

To determine how decreasing velocity of shortening (U) of expiratory muscles affects breathing during exercise, six normal men performed incremental exercise with externally imposed expiratory flow limitation (EFLe) at approximately 1 l/s. We measured volumes of chest wall, lung- and diaphragm-apposed rib cage (Vrc,p and Vrc,a, respectively), and abdomen (Vab) by optoelectronic plethysmography; esophageal, gastric, and transdiaphragmatic pressures (Pdi); and end-tidal CO2 concentration. From these, we calculated velocity of shortening and power (W) of diaphragm, rib cage, and abdominal muscles (di, rcm, ab, respectively). EFLe forced a decrease in Uab, which increased Pab and which lasted well into inspiration. This imposed a load, overcome by preinspiratory diaphragm contraction. Udi and inspiratory Urcm increased, reducing their ability to generate pressure. Pdi, Prcm, and Wab increased, indicating an increased central drive to all muscle groups secondary to hypercapnia, which developed in all subjects. These results suggest a vicious cycle in which EFLe decreases Uab, increasing Pab and exacerbating the hypercapnia, which increases central drive increasing Pab even more, leading to further CO2 retention, and so forth.

Abdominal Muscles↗

Effect of breathing pattern on dead space ventilation VD/VT during exercise.

In order to assess the effect of breathing pattern on measurements of dead space ventilation (VD/VT) during exercise, we studied 6 patients with the complaint of exertional dyspnea. They had essentially normal resting pulmonary function studies and the only abnormality noted during an initial exercise study was an elevated VD/VT associated with a rapid respiratory rate. A second exercise study was then performed during which they were coached to breathe at a slower rate and larger tidal volume. During the exercise study with coaching, the VD/VT response was normal. We conclude that breathing pattern during exercise influences VD/VT and that an increase in total minute ventilation which is accomplished by a preferential increase in respiratory rate may result in an abnormally high VD/VT.

Aged↗

A human physiological model describing acetone kinetics in blood and breath during various levels of physical exercise.

Physiologically based toxicokinetic (PBTK) modeling of human experimental data suggests difficulties to simultaneously describe the time courses of inhaled polar solvents in blood and breath, especially if exposures occur during physical exercise. We attribute this to the washin-washout effect in the airways. The aim was to develop a PBTK-model that explains the behavior of acetone in blood and exhaled air at different levels of physical exercise. The model includes exchange of inhaled solvent vapor with the blood flow via the mucosa and separate compartments to describe working and resting muscles. The developed model was contrasted to a traditional PBTK-model where the conducting airways were regarded as an inert tube. Our model predictions agrees well with experimentally observed acetone levels in both arterial blood and end- and mixed-exhaled air from 26 inhalation experiments conducted with 18 human volunteers at 0, 50, 100 and 150 W workload. In contrast, the inert-tube model was unable to describe the data. The developed model is to our knowledge the first which explains the toxicokinetics of acetone at such various levels of physical exercise. It may be useful in breath monitoring and to obtain more accurate estimates of absorbed dose during inhalation of polar volatiles.

Acetone↗

Myocardial blood flow and lactate metabolism at rest and during exercise with reduced arterial oxygen content.

The effect of a reduction in arterial oxygen content, equivalent to acute exposure to an altitude of 2300 metres above sea level, on myocardial blood flow and oxygen and lactate exchange was studied by coronary sinus catheterization in 12 healthy men. Measurements were made at rest, during atrial pacing and during submaximal and maximal exercise both breathing air and breathing 15% oxygen (hypoxia). Coronary sinus blood flow was measured by thermodilution and the possibility of a simultaneous uptake and release of lactate by the heart was calculated using intravenous infusion of 14C lactate. At all levels of cardiac power output myocardial oxygen consumption was the same during hypoxia as during air breathing. At rest this was achieved entirely by a more complete extraction of oxygen from the coronary blood, during maximal exercise entirely by a greater coronary sinus blood flow, while at intermediate levels of cardiac power output a combination of these mechanisms prevailed. At rest and during submaximal work myocardial lactate extraction was lower with hypoxia than air breathing suggesting a change in myocardial redox state, while the 14C lactate data suggested no significant lactate release or possibly limited areas with some lactate production. During maximal exercise, however, there was no difference in myocardial lactate net extraction between hypoxia and air breathing, which together with the greater blood flow suggests that the heart has a 'coronary flow reserve' permitting maximal exercise at moderate altitude without anaerobic myocardial metabolism.

Adult↗

[Evolution of breathing pattern and ventilation at maximal exercise during growth. Definition of reference values].

The aim of the study was to define the changes of parameters of breathing pattern and ventilation (VE) as a function of age during maximal exercise in children. A multi-longitudinal survey was conducted in forty four untrained schoolboys, divided in three groups with initial age of 11.2 years for group I, 12.9 years for group II, and 14.9 for group III. These children were subsequently followed three years ago at the same period. The range age was thus 11.2 to 16.9 years. This study showed that, during growth, ventilation (VE max), tidal volume (VT max) and mean inspiratory flow (VT/TI max) increased significantly with age, that inspiratory frequency (f max) decreased, that inspiratory, expiratory and total time of the respiratory cycle (TI max, TE max, TTOT max) increased slightly and that the inspiration fraction (TI/TTOT max) was identical at 11 and 17 years. Furthermore we observed that the peak height velocity and peak tidal volume velocity took place at the same age, i.e., 14 years and that those of weight and VT/TI at the same age of 15 years. In conclusion, this study allowed us to define reference values for breathing pattern at maximal exercise in sedentary boys and to specify the relation between growth and parameters of breathing pattern in these children.

Adolescent↗

Exercise performance during inspiratory resistance breathing under exhaustive constant load work.

The purpose of this study was to determine the effects of different inspiratory resistances on exercise performance and to describe physiological and subjective responses during constant load work of an intensity that elicits the maximum sensitivity to respiratory factors of respirator wear. Nine subjects (mean age 25.8 +/- 4.8 years) performed exhaustive treadmill exercise during constant load work of 80% of maximal aerobic capacity while inspiring against one of five randomly assigned inspiratory resistance conditions. For inspiratory resistances of 0.20 kPa (R1), 0.29 kPa (R2), 0.39 kPa (R3), and 0.49 kPa (R4), measured at a steady air flow rate of 85 L min-1, average performance times were 84, 75, 54, and 30% of the control condition. Performance time reductions were significant for R3 and R4 trials. Results also indicated a significantly reduced mean respiration rate, minute ventilation, and oxygen ventilatory equivalent (VE/VO2) for the R4 condition at exercise breakpoint compared to control. For resistances R1-R4, mean VE/VO2 were significantly reduced from control by approximately 12, 17, 19, and 31%. At breakpoint, mean ratings of perceived exertion were similar for control, R1, R2, and R3 conditions but were significantly lower for R4 versus control. Breathing comfort did not differ significantly between resistances below the R3 level, but discomfort was significantly greater for conditions R3 and R4. These findings suggest that the impact of the respiratory limitations of respirators can be diminished by employing respirators with inspiratory resistances below the R3 level.

Adult↗

Enhancement of exercise-induced asthma by cold air.

To study the possibility that the inhalation of cold air accentuates the bronchoconstrictor response to exercise in asthma, eight subjects exercised while breathing air at ambient or subfreezing temperatures. On a separate day, cold air was breathed at rest so as to isolate the effects of this stimulus. Pulmonary mechanics were measured before and after each experiment. In all subjects acute bronchoconstriction followed the control exercise challenge. With cold-air breathing, however, the magnitude of the response was markedly enhanced. Residual volume increased 158 per cent more than it did previously, and specific conductance and one-second forced expiratory volumes changed an additional 85 and 100 per cent, respectively. The effects of cold air at rest were very small. The results demonstrate a positive interaction of two common naturally occurring stimuli in the induction of asthmatic attacks, and constitute objective verification of a frequent clinical complaint.

Adult↗

Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation.

Idiopathic hyperventilation (IH) is a poorly understood condition of sustained hypocapnia and controversial etiology. Although behavioral/emotional factors may contribute, it is uncertain whether chemosensitivity is altered, hyperventilation is maintained during exercise, and the associated breathlessness reflects the hyperventilation. In 39 patients with IH and 23 control subjects, we described ventilatory responses to isocapnic-hypoxia, hyperoxic-hypercapnia, and exercise; breath-hold tolerance; breathlessness; and psychologic status. Patients demonstrated hyperventilation at rest, with hypocapnia (28 +/- 3.8 mm Hg), a normal (slightly alkaline) arterial pH and [H(+)]a, and a significant base excess (-4.5 +/- 2.7 mEq/L), consistent with compensated respiratory alkalosis. Hyperventilation was sustained during exercise, despite hyperoxic-hypercapnic ventilatory responsiveness being normal and isocapnic-hypoxic ventilatory responsiveness being low relative to control (but exceeding control [2.4 +/- 1.0 vs. 1.6 +/- 0.5 L/min/%, p < 0.05] with acute restoration to normocapnia). Hyperventilation was maintained during exercise, at the resting CO(2) "setpoint." Relative to control, the breath-hold tolerance was attenuated, and dyspnea during exercise was significantly greater and not simply ascribable to the high ventilation. These observations suggest that patients with IH have a sustained hyperventilatory and dyspneic drive that, although not attributable to central chemosensitivity, may possibly have peripheral chemoreflex contributions. The nature and etiology of this chronic hyperventilatory drive remain unclear.

Administration, Inhalation↗

Evidence that circulatory oscillations accompany ventilatory oscillations during exercise in patients with heart failure.

Periodic breathing (PB) during exercise in patients with congestive heart failure (CHF) is associated with prominent oscillations (OSC) of O2 uptake (VO2). We hypothesized that the VO2 OSC represent OSC in true O2 exchange, resulting from concomitant cardiac output fluctuations and are not merely due to OSC of lung O2 stores. We compared the amplitude of the OSC of VO2, ventilation (VE), and end-expiratory lung volume (EELV) in 17 patients with CHF and PB and in seven healthy control subjects who volitionally simulated PB. Subjects underwent an incremental and/or a constant work-rate exercise test. VE and VO2 were measured breath by breath. EELV change was estimated by summing the difference between inspiratory and expiratory tidal volumes for each breath. The amplitude of the OSC, delta, is expressed as the ratio of the difference between the peak and nadir of the oscillating variable divided by its mean [delta = (peak - nadir)/mean]. In CHF, during incremental testing, the amplitude of the VE OSC was smaller than that of the VO2 OSC (delta VE = 49 +/- 15% [SD], delta VO2 = 63 +/- 25%, p less than 0.01). In contrast, during volitional PB in the control subjects, VE OSC were larger than VO2 OSC (delta VE = 48 +/- 12%, delta VO2 = 25 +/- 11%, p less than 0.01). This suggests that changing VE itself cannot account for the marked VO2 OSC seen in CHF. In the patients, EELV showed no systematic OSC, did not correlate with delta VO2, and was not significantly different from zero.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Inspiratory pressure threshold training in a case of congenital bilateral abductor vocal fold paralysis.

We present a non-surgical treatment option to decrease symptoms of dyspnea in a 6 year-old child with congenital bilateral abductor vocal fold paralysis. A respiratory muscle strength-training program was used to strengthen her inspiratory muscles for 8 months, 3 to 5 days per week. Inspiratory muscle strength increased over the course of training, resulting in reported decreases in dyspnea by both the child and parents during speech and exercise.

Breathing Exercises↗

Effect of breathing techniques on blood pressure response to resistance exercise.

Twenty novice male weight lifters performed resistance exercises using three different breathing techniques to determine the effects on blood pressure. Systolic and diastolic blood pressures were measured by an automated non-invasive method while subjects performed the single arm curl and double knee extension using the different breathing techniques. Performing the Valsalva manoeuvre (breath-holding) during either the single arm curl or double knee extension produced the highest blood pressure responses. Inhaling during the concentric phase of the exercise was associated with blood pressure elevations that were similar to the elevations observed with exhaling during the concentric phase. The heart rate response was slightly higher with inhalation. These results suggest that performing the Valsalva manoeuvre exaggerates the blood pressure response to resistance exercise. In addition, coupling inhalation with the concentric phase of the lift offers no cardiovascular advantage over coupling exhalation with the concentric phase of the lift.

Adolescent↗

Respiratory sinus arrhythmia versus neck/trapezius EMG and incentive inspirometry biofeedback for asthma: a pilot study.

This pilot study compared biofeedback to increase respiratory sinus arrhythmia (RSA) with EMG and incentive inspirometry biofeedback in asthmatic adults. A three-group design (Waiting List Control n = 5, RSA biofeedback n = 6, and EMG biofeedback n = 6) was used. Six sessions of training were given in each of the biofeedback groups. In each of three testing sessions, five min. of respiratory resistance and EKG were obtained before and after a 20-min biofeedback session. Additional five-min epochs of data were collected at the beginning and end of the biofeedback period (or, in the control group, self-relaxation). Decreases in respiratory impedance occurred only in the RSA biofeedback group. Traub-Hering-Mayer (THM) waves (.03-.12 Hz) in heart period increased significantly in amplitude during RSA biofeedback. Subjects did not report significantly more relaxation during EMG or RSA biofeedback than during the control condition. However, decreases in pulmonary impedance, across groups, were associated with increases in relaxation. The results are consistent with Vaschillo's theory that RSA biofeedback exercises homeostatic autonomic reflex mechanisms through increasing the amplitude of cardiac oscillations. However, deep breathing during RSA biofeedback is a possible alternate explanation.

Adolescent↗