Effects of air stacking maneuver on cough peak flow and chest wall compartmental volumes of amyotrophic lateral sclerosis subjects

Publication date: Available online 17 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Antonio Sarmento, Vanessa Regiane Resqueti, Mario Emílio Teixeira Dourado-Júnior, Lailane Saturnino, Andrea Aliverti, Guilherme Augusto de Freitas Fregonezi, Armele de Fátima Dornelas de Andrade
ObjectivesTo assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy controls positioned at 45° body inclination.DesignCross-sectional study with a matched-pair design.SettingUniversity hospital.ParticipantsTwelve persons with ALS and twelve age-matched healthy.Main outcomesCPF, chest wall compartmental inspiratory capacity (ICCW), vital capacity (VCCW), tidal volume (VTCW) and operational volumes, breathing pattern and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography.ResultsCompared to controls, significant lower CPF (P=.007), ICCW (P<.001), VCCW (P<.001) and VTCW (P<.001) were found in ALS. Immediately after air stacking, CPF (P<.001) and ICCW (P<.001) significantly increased in both groups with values returning to basal only in controls. After air stacking, the abdominal compartment (P=.004) was determined to be the most responsible for the inspired volume in ALS. Significant higher VCCW (P=.05) was observed in ALS five minutes after air stacking, with the ribcage compartment (P=.049) the main responsible for volume change. No differences were found in VCCW and compartmental volumes of control subjects. VTCW (P<.001) significantly increased during the protocol in controls, mainly due to end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume as well as end-expiratory volume of both groups. No significant differences were found in VTCW, operational volumes and breathing pattern in persons with ALS.ConclusionAir stacking is effective in increasing CPF, ICCW and VCCW of persons with ALS with no hyperinflation. Differences in compartmental volume contributions are probably due to lung and chest wall physiological changes.



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