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Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction.
J Appl Physiol (1985). 2018 02 01; 124(2):356-363.JA

Abstract

Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video and gastric, esophageal, and transdiaphragmatic pressures, diaphragm electromyography, and respiratory airflow. The EILO and control groups had similar peak work rates and minute ventilation (V̇e) (work rate: 227 ± 35 vs. 237 ± 35 W; V̇e: 103 ± 20 vs. 98 ± 23 l/min; P > 0.05). At submaximal work rates (140-240 W), subjects with EILO demonstrated increased work of breathing (P < 0.05) and respiratory neural drive (P < 0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (P < 0.05). Unexpectedly, a ventilatory increase (P < 0.05), driven by augmented tidal volume (P < 0.05), was seen in subjects with EILO before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video, we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation. NEW & NOTEWORTHY Exercise-induced laryngeal obstruction is a prevalent cause of exertional dyspnea in young individuals; yet, how laryngeal closure affects breathing is unknown. In this study we synchronized endoscopic video with respiratory physiological measurements, thus providing the first detailed commensurate assessment of respiratory mechanics and neural drive in relation to laryngeal closure. Laryngeal closure was associated with increased work of breathing and respiratory neural drive preceded by an augmented tidal volume and a rise in minute ventilation.

Authors+Show Affiliations

Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom. Respiratory Research Unit, Bispebjerg Hospital , Copenhagen , Denmark.Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom. Faculty of Physical Education for Men, Alexandria University , Alexandria , Egypt. School of Health, Sport and Bioscience, University of East London , London , United Kingdom.King's College London, Centre of Human and Aerospace Physiological Sciences, King's Health Partners, London , United Kingdom.Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom.Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom.Guangzhou Medical College, National Key Laboratory of Respiratory Disease , Guangzhou , People's Republic of China.Respiratory Research Unit, Bispebjerg Hospital , Copenhagen , Denmark.Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom. National Heart and Lung Institute, Imperial College London , London , United Kingdom.Department of Respiratory Medicine, Royal Brompton Hospital , London , United Kingdom. National Heart and Lung Institute, Imperial College London , London , United Kingdom.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29097629

Citation

Walsted, Emil S., et al. "Increased Respiratory Neural Drive and Work of Breathing in Exercise-induced Laryngeal Obstruction." Journal of Applied Physiology (Bethesda, Md. : 1985), vol. 124, no. 2, 2018, pp. 356-363.
Walsted ES, Faisal A, Jolley CJ, et al. Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction. J Appl Physiol. 2018;124(2):356-363.
Walsted, E. S., Faisal, A., Jolley, C. J., Swanton, L. L., Pavitt, M. J., Luo, Y. M., Backer, V., Polkey, M. I., & Hull, J. H. (2018). Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction. Journal of Applied Physiology (Bethesda, Md. : 1985), 124(2), 356-363. https://doi.org/10.1152/japplphysiol.00691.2017
Walsted ES, et al. Increased Respiratory Neural Drive and Work of Breathing in Exercise-induced Laryngeal Obstruction. J Appl Physiol. 2018 02 1;124(2):356-363. PubMed PMID: 29097629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction. AU - Walsted,Emil S, AU - Faisal,Azmy, AU - Jolley,Caroline J, AU - Swanton,Laura L, AU - Pavitt,Matthew J, AU - Luo,Yuan-Ming, AU - Backer,Vibeke, AU - Polkey,Michael I, AU - Hull,James H, Y1 - 2017/11/02/ PY - 2017/11/4/pubmed PY - 2019/10/28/medline PY - 2017/11/4/entrez KW - dyspnea KW - exercise KW - laryngeal disorders KW - respiratory neural drive KW - work of breathing SP - 356 EP - 363 JF - Journal of applied physiology (Bethesda, Md. : 1985) JO - J. Appl. Physiol. VL - 124 IS - 2 N2 - Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video and gastric, esophageal, and transdiaphragmatic pressures, diaphragm electromyography, and respiratory airflow. The EILO and control groups had similar peak work rates and minute ventilation (V̇e) (work rate: 227 ± 35 vs. 237 ± 35 W; V̇e: 103 ± 20 vs. 98 ± 23 l/min; P > 0.05). At submaximal work rates (140-240 W), subjects with EILO demonstrated increased work of breathing (P < 0.05) and respiratory neural drive (P < 0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (P < 0.05). Unexpectedly, a ventilatory increase (P < 0.05), driven by augmented tidal volume (P < 0.05), was seen in subjects with EILO before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video, we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation. NEW & NOTEWORTHY Exercise-induced laryngeal obstruction is a prevalent cause of exertional dyspnea in young individuals; yet, how laryngeal closure affects breathing is unknown. In this study we synchronized endoscopic video with respiratory physiological measurements, thus providing the first detailed commensurate assessment of respiratory mechanics and neural drive in relation to laryngeal closure. Laryngeal closure was associated with increased work of breathing and respiratory neural drive preceded by an augmented tidal volume and a rise in minute ventilation. SN - 1522-1601 UR - https://www.unboundmedicine.com/medline/citation/29097629/Increased_respiratory_neural_drive_and_work_of_breathing_in_exercise_induced_laryngeal_obstruction_ L2 - http://www.physiology.org/doi/full/10.1152/japplphysiol.00691.2017?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -