Acute effects of Expiratory Positive Airway Pressure (EPAP) on different levels in ventilation and electrical activity of sternocleidomastoid and parasternal muscles in Chronic Obstructive Pulmonary Disease (COPD) patients: a randomized controlled trial

作者：Cardoso Dannuey M^*; Fregonezi Guilherme A F; Jost Renan T; Gass Ricardo; Alberton Cristine L; Albuquerque Isabella M; Paiva Dulciane N; Barreto Sergio S M

来源：Brazilian Journal of Physical Therapy, 2016, 20(6): 525-534.

DOI：10.1590/bjpt-rbf.2014.0190

• chronic obstructive pulmonary disease
• electromyography
• intercostal muscles
• positive-pressure respiration
• respiratory muscles
• physical therapy

Objective: To investigate the acute effects of EPAP on the activity of sternocleidomastoid (SCM), parasternal muscles and ventilatory parameters in COPD patients. Method: Twenty-four patients with COPD were studied using surface electromyography (sEMG) and a ventilometer. Patients were randomly assigned to EPAP 10 cmH(2)O-EPAP(10) or 15 cmH(2)O-EPAP(15) for 20 minutes. Results: The parasternal muscle sEMG activity increased during EPAP(10) and EPAP(15); however, a greater and significant increase was observed with EPAP(10) (mean between-group difference: 12.5% RMS, 95% CI: 9.5 to 15.4, p<0.001). In relation to the baseline, at 10 and 20 minutes and upon recovery, respectively parasternal activity increased by 23.9%, 28.9% and 19.1% during EPAP(10) and by 10.7% at 10 and 20 minutes and upon recovery, respectively, 11.4% and 6.9% during EPAP(15) at 10 and 20 minutes and upon recovery, respectively. The sEMG activity of SCM muscle showed an opposite pattern, increasing with EPAP15 and decreasing with EPAP10 (mean between-group difference: 15.5% RMS, 95% CI: 12.6 to 18.4, p<0.001). SCM muscle activity during EPAP15, increased by 4.8% and 6.1% at 10 and 20 minutes and decreased by -4.0% upon recovery compared to decreases of -5.6%, -20.6% and -21.3% during EPAP10 at 10, 20 minutes, and recovery. Ventilation at both EPAP intensities promoted significant reductions in respiratory rate (RR) and dyspnea, more pronounced in EPAP15: RR (mean between-group difference: -3,8bpm, 95% CI: -7,5 to -0,2, p=0,015) and dyspnea (mean between-group difference: -1.01, 95% CI: -1.4 to -0.53, p=0.028). Conclusion: In COPD patients, the use of EPAP10 was more effective in reducing accessory inspiratory activity and increasing parasternal activity, which was accompanied by an improvement in ventilation and a reduction in dyspnea.

• 出版日期2016-12