Respiratory Muscles in Chronic Obstructive Pulmonary Disease, Softcover reprint of the original 1st ed. 1988 Current Topics in Rehabilitation Series

While emphysema and chronic bronchitis are primarily lung di­ seases, one of their major consequences is to deeply affect the function of the respiratory muscles. Lung hyperinflation shortens the inspiratory muscles due to increased airways resistance, more of their effort is demanded and changes in nutritional status wea­ ken them further. Their malfunction can lead to severe dyspnea and to failure of the ventilatory pump. Over the last 10 years we have witnessed an explosion of information of how respiratory muscles function in health and disease, new techniques for their evaluation have been created, the concept of fatigue, weakness, and failure was developed, and their rest or training was attemp­ ted. The implication of respiratory muscles malfunction in respi­ ratory medicine has reached a prominent place. It seems remarkable that while some aspect of skeletal muscles function requires molecular biology techniques to find new an­ swers, we still know little on respiratory muscles interaction, stra­ tegies of coordination, their role in dyspnea, chronic hypercapnia or how to effectively improve their function in patients. This workshop was organized and held at the Medical Center of Rehabilitation in Montescano and represents an attempt to focus on how the newly adquired wealth of information can eventually be trasformed into medical care. The particpants in this workshop brought forward challenging thoughts and we are most grateful for their participation. This book represents a report of the proceedings and also provides the most updated information in this field.

Aspects of Respiratory Muscles Physiology.- Some old concepts in respiratory muscle mechanics.- Inspiratory muscle physiology, with particular regard to the diaphragm.- Respiratory muscle physiology with particular regard to rib cage muscles.- Patterns of inspiratory muscle activation with changing levels of ventilatory demand.- Chest wall and diaphragmatic afferents: their role during external mechanical loading and respiratory muscle ischemia.- The oxygen cost of respiratory and non-respiratory muscles.- EMG evaluation of respiratory muscles.- Aspects of Respiratory Muscles Pathophysiology.- Pathways leading to skeletal muscle fatigue.- Efficiency of breathing during hyperinflation.- Effect of lung volume on in vivo contraction characteristics of the human diaphragm.- Nutritional and metabolic aspects of COPD.- Inspiratory muscles and dyspnea.- Respiratory muscle weakness.- Intrinsic PEEP and its ramifications in patients with respiratory failure.- Early Changes in respiratory mechanics in acute respiratory failure.- The respiratory muscles in acute respiratory failure.- Therapeutical Approaches.- Respiratory muscle training in COPD.- Treatment of patients with respiratory failure during wakefulness and sleep: use of tank ventilator.- Rest in the treatment of respiratory muscle fatigue.- Key words.