Objective: The objective of this research was to compare measured metrics of respiratory function – Spirometry, Respiratory Muscle Strength and Peak Cough Flow – with predicted values to identify deficits in an Irish PD population.

Background: Non-motor impairments in PD including respiratory disorders are a frequent cause of diminished quality of life1, with respiratory disorders including pneumonia the most common cause of death in PD.2 A 2016 Irish study highlighted the worrying trend of increased hospital admission rates in Ireland for diseases of the respiratory system for people with Parkinson’s disease.3 The top two principal diagnoses on acute hospital admission were noted as respiratory tract infections and pneumonias.3 Controversy on the aetiology of PD respiratory dysfunction exists with central, restrictive, obstructive causes cited. Clinically however, respiratory function is not routinely assessed.

Method: Functional respiratory measures tested included: Spirometry (ATS/ERS criteria compliant), identifying lung volume (FVC) and flow rates (FEV1 and FEV1/FVC ratio); Respiratory muscle strength, identifying Inspiratory Muscle Strength (MIP), Expiratory Muscle Strength (MEP) and Sniff nasal inspiratory pressure (SNIP); Peak Cough Flow (PCF), a measure of gross respiratory function, measured via PCF meter and face mask. Age and gender matched normative values were identified  from the published literature4,5,6,thresholds for normal PCF and impaired mucocillary clearance identified as 360 l/min and 270l/min7. Statistical analysis comparing results with age/gender matched normative data was performed using independent t-tests (SPSS software).

Results: Fourteen male and 9 female (N=23) participants were recruited with mean age 65.5(+/-7.5) years; disease duration from 1-19 years and H&Y scores ranging from 0-3. When compared to predicted values, statistically significant differences were found in all respiratory strength measures (MIP, MEP and SNIP), p< 0.001. 74% of participants had a PCF<360 l/min and 35% of participants had a PCF<270l/min. No significant differences in spirometry volume FVC (p=0.325) or flow rates FEV1 (p=0.158), FEV1/FVC (p=0.612) were observed.

Conclusion: Measures of respiratory muscle strength and PCF were reduced in the PD participants when compared to predicated measures. No deficits in ventilation volume or flow rates were observed.

References: 1. Schrag A., Jahanshahi M., and Quinn N. What contributes to quality of life in patients with Parkinson’s disease? Journal of Neurology, Neurosurgery & Psychiatry 2000;69:308-312. 2. Pennington S., Snell K., Lee M. and Walker R. The cause of death in idiopathic Parkinson’s disease, Parkinsonism Related Disorders, 2010;16(7), pp. 434-7. 3. Kelly, B., Blake, C. and Lennon, O. Acute Hospital Admissions of Individuals with a Known Parkinson’s Disease Diagnosis in Ireland 2009-2012: A Short Report, Journal of Parkinsons Disease, 2016;6(4), pp. 709-716 4. Quanjer PH, Stanojevic S, Cole TJ et al. and the ERS Global Lung Function Initiative. Multi-ethnic reference values for spirometryfor the 3–95-yr age range: the global lungfunction 2012 equations. European Respiratory Journal 2012;40: 1324–1343 5. Evans JA and Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respiratory Care 2009;54(10):1348-59. 6. Uldry C and Fitting JW. Maximal values of sniff nasal inspiratory pressure in healthy subjects. Thorax. 1995;50(4):371-5. 7. Kang SW and Bach JR. Maximum insufflation capacity: vital capacity and cough flows in neuromuscular disease. American Journal of Physicial Medicine and Rehabilitation 2000;79:222–227.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-comparative-study-of-measured-and-predicted-metrics-of-respiratory-function-in-people-with-parkinsons-disease-pd/