Acute effects of different intensities of positive expiratory pressure on chest wall volumes in Parkinson

Aim: To evaluate acute effects of different intensities of Positive Expiratory Pressure (PEP)on chest wall kinematics in patients with Parkinson disease (PD). Methods: 15 subjects with PD (PG) (59.1±9.3 years; FEV 1 %: 85±16.5; FEV 1 /FVC: 0.84±0.1) and 15 age-matched healthy controls with normal lung function (CG) were included in the study. All subjects were evaluated by Optoelectronic Plethysmography. Volumes of chest wall (CW) and its compartments (abdominal, abdominal rib cage and pulmonary rib cage) were measured during 3 random PEPintensities(10, 15 and 20 cmH 2 O) in 3 different moments: quite breathing (QB), 5 minutes of each PEP with 5 minutes of rest between PEP and recovery. Results: PG significantly increased Vtcw when we compared QB with different PEP intensities (PEP 10 : 1.07±0.4, PEP 15 : 1.19 ± 0.4, PEP 20 : 1.40 ± 0.5L, p<0.001). Compartmental volumes showed the same pattern as CW. Total respiratory time was significantly lower in PG compared to CG at QB (3.61±1.2 vs 4.27 ± 1.1s, p < 0.01) and increased during PEP 10 (6.68±3.6 s) and PEP 20 (7.42±3.4s), (p<0.01). PG respiratory rate was significantly higher compared to CG (18.1±4.6 vs 15.1±3.6 cycles/min, p<0.0001) and significantly decreased in all PEP intensities (PEP 10 : 11.3±4.9, PEP 15 : 11.4±3.7, PEP 20 : 10±4.3 cycles/min, p<0.001). No significant changes were observed in operational volume. Conclusion : The use of PEP in Parkinson disease improves ventilation without important changes in operational volumes. Due to the restrictive characteristic of the disease and the similar changes observed in the three intensities of PEP, caution must be adopted during PEP use at intensities over 10 cmH 2 O.