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J Appl Physiol 85: 2146-2158, 1998;
8750-7587/98 $5.00
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Vol. 85, Issue 6, 2146-2158, December 1998

Voluntary activation of the human diaphragm in health and disease

Christer Sinderby1,2, Jennifer Beck3,4, Jadranka Spahija4,5, Jan Weinberg6, and Alex Grassino4

1 Guy-Bernier Research Center, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec H3C 3J7; 4 Centre Hospitalier de l'Université de Montréal, Pavillion Notre Dame, University of Montreal, Montreal, Quebec H1T 2M4; 3 Department of Physiology and 5 School of Physical Therapy, McGill University, Montreal, Quebec, Canada H3A 2B2; 2 Institution of Clinical Neuroscience, University of Göteborg, Göteborg S-41346; and 6 Department of Neurology, Huddinge Hospital, Huddinge S-14186, Sweden

Intersubject comparison of the crural diaphragm electromyogram, as measured by an esophageal electrode, requires a reliable means for normalizing the signal. The present study set out 1) to evaluate which voluntary respiratory maneuvers provide high and reproducible diaphragm electromyogram root-mean-square (RMS) values and 2) to determine the relative diaphragm activation and mechanical and ventilatory outputs during breathing at rest in healthy subjects (n = 5), in patients with severe chronic obstructive pulmonary disease (COPD, n = 5), and in restrictive patients with prior polio infection (PPI, n = 6). In all groups, mean voluntary maximal RMS values were higher during inspiration to total lung capacity than during sniff inhalation through the nose (P = 0.035, ANOVA). The RMS (percentage of voluntary maximal RMS) during quiet breathing was 8% in healthy subjects, 43% in COPD patients, and 45% in PPI patients. Despite the large difference in relative RMS (P = 0.012), there were no differences in mean transdiaphragmatic pressure (P = 0.977) and tidal volumes (P = 0.426). We conclude that voluntary maximal RMS is reliably obtained during an inspiration to total lung capacity but a sniff inhalation could be a useful complementary maneuver. Severe COPD and PPI patients breathing at rest are characterized by increased diaphragm activation with no change in diaphragm pressure generation.

electromyography; diaphragm activation; motor unit recruitment; motor unit firing rate; neural drive; esophageal electrode


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