Document Detail

Expiratory flow limitation and orthopnea in massively obese subjects.
MedLine Citation:
PMID:  11348945     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Morbidly obese subjects, who often complain about breathlessness when lying down, breathe at low lung volume with a reduced expiratory reserve volume (ERV). Therefore, during tidal breathing the expiratory flow reserve is decreased, promoting expiratory flow limitation (EFL), which is more likely to occur in the supine position, when the relaxation volume of the respiratory system, and hence the functional residual capacity (FRC), decrease because of the gravitational effect of the abdominal contents. PURPOSE: The aim of the study was to assess EFL and orthopnea in massively obese subjects and to evaluate whether orthopnea was associated with the development of supine EFL. METHODS: In 46 healthy obese subjects (18 men) with a mean (+/- SD) age of 44 +/- 11 years and a mean body mass index (BMI) of 51 +/- 9 kg/m(2), we assessed EFL in both the seated and the supine positions by the negative expiratory pressure method and assessed postural changes in FRC by measuring the variations in the inspiratory capacity (IC) with recumbency. Simultaneously, dyspnea was evaluated in either position using the Borg scale dyspnea index (BSDI) to determine the presence of orthopnea, which was defined as any increase of the BSDI in the supine position. RESULTS: Partial EFL was detected in 22% and 59%, respectively, of the overall population in seated and supine position. The mean increase in the supine IC amounted to 120 +/- 200 mL (4.1 +/- 6.4%), indicating a limited decrease in FRC with recumbency in these subjects. Orthopnea, although mild (mean BSDI, 1.7 +/- 1.3), was claimed by 20 subjects, and in 15 of them EFL occurred or worsened in the supine position. Orthopnea was associated with lower values of seated ERV (p < 0.05) and was marginally related to supine EFL values (p = 0.07). No significant effect of age, BMI, obstructive sleep apnea-hypopnea syndrome, FEV(1), and forced expiratory flow at 75% of vital capacity was found on either orthopnea or EFL. CONCLUSION: In morbidly obese subjects, EFL and dyspnea frequently occur with the subject in the supine position, and both supine EFL and low-seated ERV values are related to orthopnea, suggesting that dynamic pulmonary hyperinflation and intrinsic positive end-expiratory pressure may be partly responsible for orthopnea in massively obese subjects.
A Ferretti; P Giampiccolo; A Cavalli; J Milic-Emili; C Tantucci
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  119     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-11     Completed Date:  2001-07-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1401-8     Citation Subset:  AIM; IM    
Divisione di Pneumologia, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
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MeSH Terms
Obesity, Morbid / complications*,  physiopathology*
Peak Expiratory Flow Rate
Respiration Disorders / etiology*,  physiopathology*

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