Article

OBJECTIVE: To evaluate the long-term effect on measures of forced vital capacity
(FVC) before and after the introduction of regular lung volume recruitment (LVR)
maneuvers (breath-stacking) in individuals with Duchenne muscular dystrophy
(DMD). DESIGN: Retrospective cohort study of pulmonary function data, including
FVC, cough peak flow (CPF), maximum inspiratory pressure (MIP), and maximum
expiratory pressure (MEP). Data were collected for 33 months prior to and 45
months after LVR introduction. SETTING: Ambulatory care in a tertiary level
regional rehabilitation center in Canada. PARTICIPANTS: All individuals (N=22)
with DMD (mean age +/- SD, 19.6+/-2.4y), who were prescribed LVR and reported
adherence with therapy. INTERVENTIONS:
Introduction of regular LVR
(breath-stacking); 3 to 5 maximal lung inflations (maximum insufflation capacity
[MIC]) using a hand-held resuscitation bag and mouthpiece, twice daily. MAIN
OUTCOME MEASURES: Measures included the rate of decline of FVC in
percent-predicted, before and after the introduction of regular LVR. Changes in
maximum pressures (MIP, MEP), MIC, and cough peak flows were also measured.
RESULTS: At LVR initiation, FVC was 21.8+/-16.9 percent-predicted, and cough peak
flows were <270L/min (144.8+/-106.9L/min). Annual decline of FVC was 4.7
percent-predicted a year before LVR and 0.5 percent-predicted a year after LVR
initiation. The difference, 4.2 percent-predicted a year (95% confidence
interval, 3.5-4.9; P<.000), represents an 89% improvement in the annual rate of
FVC decline. CONCLUSIONS: The rate of FVC decline in DMD patients improves
dramatically with initiation of regular LVR.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS