Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction

Emil S. Walstead; Azmy Faisal; Caroline J. Jolley; Laura L. Swanton; Matthew J. Pavitt; Yuan-Ming Luo; Vibeke Backer; Michael I. Polkey; James H. Hull

doi:10.1152/japplphysiol.00691.2017

Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction

Emil S. Walstead, Azmy Faisal, Caroline J. Jolley, Laura L. Swanton, Matthew J. Pavitt, Yuan-Ming Luo, Vibeke Backer, Michael I. Polkey, James H. Hull

Centre for Human & Applied Physiological Sciences

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

176 Downloads (Pure)

Abstract

Rationale: Exercise induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. Objectives: To evaluate exercise related changes in laryngeal aperture on ventilation, pulmonary mechanics and respiratory neural drive. Methods: We prospectively evaluated 12 subjects (six with EILO and six healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video, gastric-, esophageal- and transdiaphragmatic pressures, diaphragm electromyography and respiratory airflow. Results: The EILO and control groups had similar peak work rates and minute ventilation (V̇E) (work rate: 227±35 vs. 237±35W; V̇E: 103±20 vs. 98±23 L/min; p>0.05). At submaximal work rates (140-240W) subjects with EILO demonstrated increased work of breathing (p<0.05) and respiratory neural drive (p<0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (p<0.05). Unexpectedly, a ventilatory increase (p<0.05), driven by augmented tidal volume (p<0.05), was seen in subjects with EILO, before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Conclusion: Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation.

Original language	English
Journal	Journal of Applied Physiology
Volume	124
Issue number	2
Early online date	8 Feb 2018
DOIs	https://doi.org/10.1152/japplphysiol.00691.2017
Publication status	Published - Feb 2018

Access to Document

10.1152/japplphysiol.00691.2017

Increased respiratory neural drive_WALSTED_Accepted26October2017Publishedonline8February2018_GREEN AAMAccepted author manuscript, 13.2 MB

Cite this

@article{803ce4d84c15482baff60f9e13e750a9,

title = "Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction",

abstract = "Rationale: Exercise induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. Objectives: To evaluate exercise related changes in laryngeal aperture on ventilation, pulmonary mechanics and respiratory neural drive. Methods: We prospectively evaluated 12 subjects (six with EILO and six healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video, gastric-, esophageal- and transdiaphragmatic pressures, diaphragm electromyography and respiratory airflow. Results: The EILO and control groups had similar peak work rates and minute ventilation ({\.V}E) (work rate: 227±35 vs. 237±35W; {\.V}E: 103±20 vs. 98±23 L/min; p>0.05). At submaximal work rates (140-240W) subjects with EILO demonstrated increased work of breathing (p<0.05) and respiratory neural drive (p<0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (p<0.05). Unexpectedly, a ventilatory increase (p<0.05), driven by augmented tidal volume (p<0.05), was seen in subjects with EILO, before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Conclusion: Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation.",

author = "Walstead, {Emil S.} and Azmy Faisal and Jolley, {Caroline J.} and Swanton, {Laura L.} and Pavitt, {Matthew J.} and Yuan-Ming Luo and Vibeke Backer and Polkey, {Michael I.} and Hull, {James H.}",

year = "2018",

month = feb,

doi = "10.1152/japplphysiol.00691.2017",

language = "English",

volume = "124",

journal = "Journal of Applied Physiology",

issn = "8750-7587",

publisher = "American Physiological Society",

number = "2",

}

TY - JOUR

T1 - Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction

AU - Walstead, Emil S.

AU - Faisal, Azmy

AU - Jolley, Caroline J.

AU - Swanton, Laura L.

AU - Pavitt, Matthew J.

AU - Luo, Yuan-Ming

AU - Backer, Vibeke

AU - Polkey, Michael I.

AU - Hull, James H.

PY - 2018/2

Y1 - 2018/2

N2 - Rationale: Exercise induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. Objectives: To evaluate exercise related changes in laryngeal aperture on ventilation, pulmonary mechanics and respiratory neural drive. Methods: We prospectively evaluated 12 subjects (six with EILO and six healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video, gastric-, esophageal- and transdiaphragmatic pressures, diaphragm electromyography and respiratory airflow. Results: The EILO and control groups had similar peak work rates and minute ventilation (V̇E) (work rate: 227±35 vs. 237±35W; V̇E: 103±20 vs. 98±23 L/min; p>0.05). At submaximal work rates (140-240W) subjects with EILO demonstrated increased work of breathing (p<0.05) and respiratory neural drive (p<0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (p<0.05). Unexpectedly, a ventilatory increase (p<0.05), driven by augmented tidal volume (p<0.05), was seen in subjects with EILO, before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Conclusion: Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation.

AB - Rationale: Exercise induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. Objectives: To evaluate exercise related changes in laryngeal aperture on ventilation, pulmonary mechanics and respiratory neural drive. Methods: We prospectively evaluated 12 subjects (six with EILO and six healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video, gastric-, esophageal- and transdiaphragmatic pressures, diaphragm electromyography and respiratory airflow. Results: The EILO and control groups had similar peak work rates and minute ventilation (V̇E) (work rate: 227±35 vs. 237±35W; V̇E: 103±20 vs. 98±23 L/min; p>0.05). At submaximal work rates (140-240W) subjects with EILO demonstrated increased work of breathing (p<0.05) and respiratory neural drive (p<0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (p<0.05). Unexpectedly, a ventilatory increase (p<0.05), driven by augmented tidal volume (p<0.05), was seen in subjects with EILO, before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Conclusion: Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation.

U2 - 10.1152/japplphysiol.00691.2017

DO - 10.1152/japplphysiol.00691.2017

M3 - Article

SN - 8750-7587

VL - 124

JO - Journal of Applied Physiology

JF - Journal of Applied Physiology

IS - 2

ER -

Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction

Abstract

Access to Document

Fingerprint

Cite this