Chest
Volume 104, Issue 4, October 1993, Pages 1097-1100
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Clinical Investigations: COPD/Asthma
The Ventilatory Response to Arm Elevation of Patients With Chronic Obstructive Pulmonary Disease

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Although arm activity is poorly tolerated by patients with COPD, the ventilatory response to arm elevation alone is not well understood. We therefore studied the ventilatory response to arm elevation using a customized arm support sling to eliminate the effect of an increase in metabolic activity that might be attributable to independent arm elevation and used leg exercise to increase metabolic activity. During arm elevation at rest, there was a significant decrease in vital capacity (180 ml) and a small decrease in functional residual capacity (120 ml) as measured by body plethysmography. Minute ventilation was unchanged. When supported arm elevation (SAE) was compared with the control arm position (CAP), minute ventilation was unchanged although the pattern of breathing became more rapid and shallow (mean±SD, SAE vs CAP: fb = 17.9±5.3 vs 16.2 ±4.8 breaths·min−1; vt = 533 ± 126 vs 579± 142 ml; p<0.05). During steady-state leg exercise, the increase in v˙o2,v˙co2 and v˙E did not differ between SAE and CAP; however, both fb and vt changed toward a more rapid, shallow pattern of breathing (SAE vs CAP: fb = 24.3±3.0 vs 22.8±3.5 breaths·min−1; vt = 990 ±293 vs 1,081 ±309 ml; p<0.05). During unsupported arm elevation v˙o2,v˙co2, and v˙E, and fb were significantly greater than during the CAP. Approaches that train arm muscles and strategies that either support arm muscles or allow for frequent rests during upper arm activity may improve the endurance and the quality of life for COPD patients.

Section snippets

Subjects

Subjects with severe but stable COPD were recruited on an ongoing basis from the hospitals Respiratory Rehabilitation Program. Informed consent was obtained from those patients who volunteered for the study. Patients selected did not require supplemental oxygen at rest or during exercise. Each subject completed Standard measurements of pulmonary function.8, 9, 10 Arterial blood gases were measured with the patient resting in the supine position and breathing room air.

Protocol

Effects of Arm Position on

Results

Pulmonary function tests measured in each of the three protocols are summarized in Table 1. Results of the baseline pulmonary function tests among these groups were similar. The patients all had severe airflow obstruction as reflected by a mean FEV1 of less than 1 L and a mean FEV1/FVC of less than 40 percent.

Effect of Arm Position on Pulmonary Function

The results of arm elevation on static lung volumes are shown in Table 2. During arm elevation there was a small but significant decrease (180

Discussion

Altered ventilatory responses have been observed during arm elevation in healthy volunteers and in subjects with COPD.1, 2, 3, 46,7 The extent to which these altered ventilatory responses are due to an increase in the metabolic demand that results from arm elevation alone remains unclear. When the arms are elevated, some muscles such as the pectorals will expand the rib cage by passive stretching, whereas others, such as serratus anterior will do so by active contraction. When expanded, the rib

Acknowledgment

The authors wish to acknowledge the assistance of D. Mills in the preparation of this manuscript.

References (16)

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This work is supported by the West Park Hospital Foundation, the Ontario Rehabilitation Technology Research and Development Consortium and the Respiratory Health Network of Centres of Excellence.

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