open access

Vol 88, No 4 (2020)
ORIGINAL PAPERS
Published online: 2020-07-15
Submitted: 2020-01-07
Accepted: 2020-04-18
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The threshold for detecting a rise in airflow resistance during tidal breathing is lower in older patients with COPD than in healthy people of similar age

Stephen Charles Allen, Alex Tanner, Ahmed Khattab
DOI: 10.5603/ARM.a2020.0126
·
Pubmed: 32869264
·
Adv Respir Med 2020;88(4):313-319.

open access

Vol 88, No 4 (2020)
ORIGINAL PAPERS
Published online: 2020-07-15
Submitted: 2020-01-07
Accepted: 2020-04-18

Abstract

Introduction: To investigate whether or not the threshold for subjectively detecting an increase in the resistance to airflow (LDT) during tidal breathing at rest rises in older age in patients with COPD, as it does in healthy people and asthmatics in remission. Material and methods: We conducted an open cross-sectional study of 31 older patients (age 55–89) with COPD and 60 healthy volunteers (age 55–86). Inspiratory and expiratory resistive load detection thresholds (ILDT and ELDT respectively) and spirometry were measured.
Results: The mean (SD) ILDT was 5.93 (7.02) kPa.s/L in COPD patients, compared to 11.11 (8.47) in healthy people (P < 0.001) in the same age range. There was no significant correlation between ILDT and age in the COPD group (r = -0.182, P = 0.326), though significant correlation with age was found in healthy people (r = 0.591, P < 0.001). ILDT and ELDT in COPD patients correlated significantly with the FEV1/FVC ratio (r = 0.367, P = 0.048 and r = 0.481, P = 0.007 respectively) but not with other spirometry indices, height, weight, BMI, oxygen saturation or smoking pack-years.
Conclusion: LDT during tidal breathing appears to be sensitized, and thereby lower, in older COPD patients, possibly due to altered central regulation of the threshold or as a consequence of the effect lung compliance, recoil and volume changes have on afferent input from mechano-receptors in COPD. Older COPD patients with good cognition are therefore likely to be as aware of changing airways resistance as younger patients and take appropriate therapeutic action.

Abstract

Introduction: To investigate whether or not the threshold for subjectively detecting an increase in the resistance to airflow (LDT) during tidal breathing at rest rises in older age in patients with COPD, as it does in healthy people and asthmatics in remission. Material and methods: We conducted an open cross-sectional study of 31 older patients (age 55–89) with COPD and 60 healthy volunteers (age 55–86). Inspiratory and expiratory resistive load detection thresholds (ILDT and ELDT respectively) and spirometry were measured.
Results: The mean (SD) ILDT was 5.93 (7.02) kPa.s/L in COPD patients, compared to 11.11 (8.47) in healthy people (P < 0.001) in the same age range. There was no significant correlation between ILDT and age in the COPD group (r = -0.182, P = 0.326), though significant correlation with age was found in healthy people (r = 0.591, P < 0.001). ILDT and ELDT in COPD patients correlated significantly with the FEV1/FVC ratio (r = 0.367, P = 0.048 and r = 0.481, P = 0.007 respectively) but not with other spirometry indices, height, weight, BMI, oxygen saturation or smoking pack-years.
Conclusion: LDT during tidal breathing appears to be sensitized, and thereby lower, in older COPD patients, possibly due to altered central regulation of the threshold or as a consequence of the effect lung compliance, recoil and volume changes have on afferent input from mechano-receptors in COPD. Older COPD patients with good cognition are therefore likely to be as aware of changing airways resistance as younger patients and take appropriate therapeutic action.

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Keywords

airflow resistance sensing; ageing; spirometry; chronic obstructive pulmonary disease

About this article
Title

The threshold for detecting a rise in airflow resistance during tidal breathing is lower in older patients with COPD than in healthy people of similar age

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 4 (2020)

Pages

313-319

Published online

2020-07-15

DOI

10.5603/ARM.a2020.0126

Pubmed

32869264

Bibliographic record

Adv Respir Med 2020;88(4):313-319.

Keywords

airflow resistance sensing
ageing
spirometry
chronic obstructive pulmonary disease

Authors

Stephen Charles Allen
Alex Tanner
Ahmed Khattab

References (27)
  1. Allen SC, Vassallo M, Khattab A, et al. The threshold for sensing airflow resistance during tidal breathing rises in old age: implications for elderly patients with obstructive airways diseases. Age and Ageing. 2009; 38(5): 548–552.
  2. Allen SC, Khattab A, Allen SC, et al. The airflow resistance sensing threshold during tidal breathing rises in old age in patients with asthma. Age and Ageing. 2012; 41(4): 557–560.
  3. Akiyama Y, Nishimura M, Kobayashi S, et al. Effects of aging on respiratory load compensation and dyspnea sensation. American Review of Respiratory Disease. 1993; 148(6_pt_1): 1586–1591.
  4. Bijl-Hofland ID, Folgering H, Hoogen Hv, et al. Perception of bronchoconstriction in asthma patients measured during histamine challenge test. European Respiratory Journal. 1999; 14(5): 1049–1054.
  5. Bijl-Hofland I, Cloosterman S, Schayck Cv, et al. Perception of respiratory sensation assessed by means of histamine challenge and threshold loading tests. Chest. 2000; 117(4): 954–959.
  6. Connolly MJ, Crowley JJ, Charan NB, et al. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax. 1992; 47(6): 410–413.
  7. Allen SC, Khattab A, Allen SC, et al. The tendency to altered perception of airflow resistance in aged subjects might be due mainly to a reduction in diaphragmatic proprioception. Medical Hypotheses. 2006; 67(6): 1406–1410.
  8. Burdon JG, Killian KJ, Campbell EJ, et al. Effect of ventilatory drive on the perceived magnitude of added loads to breathing. Journal of Applied Physiology. 1982; 53(4): 901–907.
  9. Cherniak NS, Altose MD. Mechanisms of dyspnoea. Chest Med. 1987; 8: 207–14.
  10. Burki NK, Burki NK. Detection of added respiratory loads in patients with restrictive lung disease. Am Rev Respir Med. 1985; 132: 1210–1213.
  11. Robbins S, Waked E, McClaran J, et al. Proprioception and stability: foot position awareness as a function of age and footware. Age and Ageing. 1995; 24(1): 67–72.
  12. Petrella RL, Lattanzio PJ, Nelson MG, et al. Effect of age and activity on knee joint proprioception. Am J Phys Med Rehabil. 1997; 276: 235–41.
  13. Guan J, Wadw MG, Guan J, et al. The effect of aging on adaptive eye-hand coordination. J Gerontol B Psychol Soc Sci. 2000; 55: 151–62.
  14. Proudlock F, Shekhar H, Gottlob I, et al. Age-related changes in head and eye coordination. Neurobiology of Aging. 2004; 25(10): 1377–1385.
  15. Hurley M, Rees J, Newham D, et al. Quadriceps function, proprioceptive acuity and functional performance in healthy young, middle-aged and elderly subjects. Age and Ageing. 1998; 27(1): 55–62.
  16. Gill J, Allum J, Carpenter MG, et al. Trunk sway measures of postural stability during clinical balance tests: effects of age. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001; 56(7): M438–M447.
  17. NICE Guideline NG115. Chronic obstructive pulmonary disease in over 16s: diagnosis and management, December 2018. Available at: nice.org.uk/guidance/ng115/chapter/Recommendations#diagnosing-copd. [Last accessed at 01.09.2019].
  18. Hodkinson HM. Mental impairment in the elderly. J Roy Coll Physicians Lond. 1973; 7: 305–17.
  19. Bellia V, Pistelli F, Giannini D, et al. Questionnaires, spirometry and PEF monitoring in epidemiological studies on elderly respiratory patients. European Respiratory Journal. 2003; 21(Supplement 40).
  20. MRC Dyspnoea scale. Available at: mrc.ukri.org/research/facilities-and-resources-for-researchers./mrc-scales/ [Last accessed at: 03.09.2019].
  21. Ferguson GT, Ferguson GT. Why does the lung hyperinflate? Proceedings of the American Thoracic Society. 2006; 3(2): 176–179.
  22. Moy M, Weiss WJ, Sparrow D, et al. Quality of dyspnea in bronchoconstriction differs from external resistive loads. American Journal of Respiratory and Critical Care Medicine. 2000; 162(2): 451–455.
  23. Lansing RW, Banzett RB, Brown R, et al. Tidal volume perception in a C1-C2 tetraplegic subject is blocked by airway anaesthesia. J Spinal Cord Med. 1998; 21: 137–141.
  24. Undem BJ. The role of vagal afferent nerves in chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society. 2005; 2(4): 355–360.
  25. Peiffer C, Silbert D, Cerrina J, et al. Respiratory sensation related to resistive loads in lung transplant recipients. American Journal of Respiratory and Critical Care Medicine. 1996; 154(4): 924–930.
  26. DiMarco AF, Wolfson DA, Gottfried SB, et al. Sensation of inspired volume in normal subjects and quadriplegic patients. Journal of Applied Physiology. 1982; 53(6): 1481–1486.
  27. Burki NK, Davenport PW, Safdar F, et al. The effect of airway anaesthesia on the magnitude estimation of added inspiratory resistive and elastic loads. Am Rev Respir Med. 1983; 127: 2–4.

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