Literature Review
Discuss about the COPD patients and the relationship between COPD patients, MMG signals and EMG signals.
Chronic obstructive pulmonary disease (COPD) is a lung obstructive disease that is branded by long-standing breathing difficulties and poor respiratory functions. The patient experiences difficulties in breathing, a productive cough and shortness of breath (Brij, Chatterji & Marquette, 2016 p245). The disease is a progressive condition hence the symptoms worsen with time. Therefore, the daily activities become difficult such as dressing, walking, and other simple tasks. There are various causes of COPD that include genetics, tobacco smoking, and pollution. However, the most common cause of this disease is the smoking of tobacco while the other factors play a smaller role. Air pollution that causes this condition is due to poorly ventilated heating and also cooking fires that have not undergone complete combustion (Brij, Chatterji & Marquette, 2016 p250). The long-term exposure to these agents leads to the development of an inflammatory response in the respiratory systems, especially in the lungs. The airways become smaller and narrower while the lung tissues are destroyed. Diagnosis of COPD is based on the determination of inefficient air flow measured by tests on lung functions. Prevention is done by improving the outdoor and indoor air quality. Treatment is through stopping smoking, lung transplant and rehabilitating the respiratory system. COPD is treated using bronchodilators, steroids and oxygen therapy and there is also a vaccination that is given to prevent this condition (Amal et al. 2017 p250).
In this article I will do a literature review for the patients that have COPD and the relationship that exists between diaphragm and wall mechanomyography (MMG), EMG muscle signals in patients that have COPD while comparing it with the lung functions of healthy subjects and the identification of the muscles which will be affected by COPD during quiet breathing due to the severity of COPD (Chlif et al. 2016 p228). Mechanomyography has been applied for detecting signals in the respiratory system to quantify the diaphragm muscle and the coastal wall muscles functions and performance. This mechanism has been favored since it is efficient and its intrinsic mechanical nature and the ability to assess muscle activity and function non-invasively and at the same time preserving the muscular neuropathologic information. MMG is used together with electromyogram (EMG) to determine diaphragmatic muscle efficiency and respiratory power in patients with COPD (Sarlabous et al. 2017 p434).
Experiments
Respiratory muscle dysfunction is the major problem that is experienced by patients with chronic obstreperous respiratory conditions and has been connected to the pulmonic hyperinflation (Sarlabous et al. 2017 p434). This condition is associated with diaphragm shortening and other harmful changes that occur in the muscle force-size relationship hence leading to reduced muscle ability to generate pressure hence they have a mechanical disadvantage. Inspiratory muscle mechanical efficiency and strength may be reduced in patients with this condition (Sarlabous et al. 2017 p434). However, at isovolume, the contracting force of the diaphragmatic muscle in patients with COPD may be conserved or even enhanced in some few instances. By the use of the MMG, the ratio between the electrical diaphragm activity and the trans-diaphragmatic pressure can be used to measure the efficiency of the respirational muscles which include the diaphragm muscle and the intercostal muscles which aid in respiration during the periods of quiet breathing.
The gold standards in the assessment of diaphragm contractility in patients with respirational illnesses such as chronic obstructive pulmonic disease involve the invasive measures of the trans-diaphragmatic pressure. The surface MMG is a non-invasive method used to assesses muscle fiber vibration during contraction. There is a great correlation between inspiratory mouth pressure which is taken to be a measure of respiratory muscle function and diaphragm amplitude (Sarlabous et al. 2009 p3927). The MMG assesses the mechanical activation of the diaphragm which is one of the inhalational muscles and the muscles of the inferior rib cage wall in patients with COPD and also in healthy people to determine the relationship that is present between the pulmonary function parameters and the inspiratory muscle activation (Ottenheijm, Heunks & Dekhuijzen, 2008 p12).
A propose System
The researches were carried out on the mechanomyography (MMG) which is a noninvasive technique used to detect the effects of COPD on various respiratory muscles. COPD has an adverse effect on the respiratory muscular efficiency and effort. The experiments will involve the measurement of the lung muscle function by use of the MMG. The experiments involve patients with COPD and healthy subjects used as control. Then results for all the experiments will be recorded and discussed.
Procedures
The MMG involves the measurement of inspiratory pressure and the activities of the diaphragm and the chest wall muscles in those with a pulmonic problem and in well subjects to determine muscle activation and pulmonary function limitations (Ottenheijm, Heunks & Dekhuijzen, 2008 p14). During the contraction periods, respiratory muscle fibers usually vibrate laterally and these sensations are linked to the mechanical initiation of respirational muscles and can be documented noninvasively. These parameters were then simultaneously recorded under two different respiratory conditions, quiet breathing and increased ventilatory efforts. In one of the experiments carried out, the MMG signal of the diaphragm was assessed so as to determine the respiratory muscular function in COPD patients. The MMG signals from both right and left parts of the diaphragm muscle were recorded using the two accelerometers that were placed on both sides of the coastal wall surface. The respiratory pressure indications and MMG signals were recorded while these COPD patients carried out the inspiratory capacity respiratory tests. These procedures were also repeated on healthy individuals who were set to be the control subjects (Macintyre, 2006 p850).
Results Of The Experiments
Results Of The Experiments
The results showed that the COPD patients had a severe condition hence showed abnormally high positive correlation coefficients that were obtained from the maximum inspiratory pressure (Pmax) that was developed during the respiratory cycle. There were different limitations to the amplitude of the left and right MMG signals. (RMS, on the right side: 0.69±0.12, and on the left: 0.68±0.11; Rényi entropy of the right: 0.77±0.08 and left side: 0.73±0.10; Multistate Lempel- Ziv, left: 0.73±0.17 while on the right hemidiaphragm: 0.74±0.08). These patients, therefore, showed a negative association between the highest MMG frequency signal spectrum and the Pmax. These results from the MMG consequently was used to evaluate the diaphragm muscle efficiency and the respiratory efforts in the patient with COPD. COPD patients have reduced diaphragmatic muscle efficiency as well as decreased respiratory power hence they have to put more efforts in the respiratory process. To validate the relationship between Pmax and the MMG, this technique was done on the healthy individuals. There was a close relationship between MMG and Pmax in the healthy subjects. During a forced respiratory threshold loading protocol, the results were recorded and analyzed by the use of fixed sample entropy (Motamedi-Fakhr, Wilson & Iles, 2017 p8).
Discussion
From the above studies, it is clear that the MMG is an important, non-invasive indicator of diaphragm and chest wall muscle functions of experimental and clinical significance used in patients with COPD. This is done through the exploration of frequency and amplitude of the signal of these muscles especially during muscle contractions for the optimal application. The signals that are obtained with the MMG in patients with respiratory conditions is a feasible complementary substitute to the conservative muscle assessment tools such as the EMG (Torres, Galdiz, Gea, Morera & Jane, 2006 p5735). This technique also generates mechanical information about the physiological facets of diaphragm and chest wall muscular activities hence help in therapy such as exercises (Chlif et al. 2016 p228).
The Mechanical Of The Respiratory System And Diaphragm Muscle Assessment Function
To determine the function ability of the respiratory system and the diaphragm muscle, both the diaphragm and the intercostal muscle function should be evaluated. During the breathing activity, these two organs contract hence expanding the chest cavity. The diaphragm should become flat and move downwards while the intercostal muscles are expected to move the ribcage upwards and outwards. Therefore, due to these changes in size, the internal pressure decreases hence air from the outside which has a higher pressure than that of inside the thorax rushes into the lungs to ensure that the pressures are at equilibrium (Crisafulli, Costi, Fabbri & Clini, 2007 p20). In patients with COPD, the functions of the diaphragm and chest wall are decreased since the diaphragm muscles and the chest wall contractility in individuals with COPD is reduced. These patients also have reduced diaphragmatic mobility and reduced functions of the chest wall hence this is the basis of the mechanism of action of the disease.
Discussion
Conclusion
The literature review and the experiments done above shows that the patients with reduced respiratory abilities due to COPD have reduced diaphragmatic mobility and reduced functions of the chest wall (Ottenheijm et al. 2005 p200). The solid relationship that exists between the measures of Pdi and sMMGdi in the healthy patient shows that MMG provides a clinically appropriate noninvasive index of the diaphragm muscles and the chest wall contractility in individuals with long-lasting obstreperous pulmonic disease (Numis et al. 2014 p6). Therefore, it is evident that the use of MMG to determine the severity of COPD improves the evaluation of the inspiratory muscle activation in the clinical setup. This technique has led to a well understanding of the continuing obstructive lung disease. The measurements of the diaphragmatic function and performance have a role in the early assessment of the exacerbation of COPD and can be used to predict the response to therapy (Crisafulli, Costi, Fabbri & Clini, 2007 p21).
References
Amal A. Abd El Aziz, Rabab A. Elwahsh, Gehan A. Abdelaal, Mohammed S. Abdullah, Rehab A. Saad,( 2017). Diaphragmatic assessment in COPD patients by different modalities, Egyptian Journal of Chest Diseases and Tuberculosis, Volume 66, Issue 2, , Pages 247-250,
Brij, S.O., Chatterji, S. and Marquette, M., 2016. Chronic Obstructive Pulmonary Disease (COPD). In Clinical Pathways in Emergency Medicine (pp. 245-257). Springer, New Delhi.
Chlif, Mehdi, Keochkerian, David, Temfemo, Abdou , Choquet, Dominique & Ahmaidi, Said. (2016). Inspiratory muscle performance in endurance-trained elderly males during incremental exercise. Respiratory Physiology & Neurobiology. 228. 10.1016/j.resp.2016.03.008.
Crisafulli E, Costi S, Fabbri LM, Clini EM.; . (2007). Respiratory muscles training in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease;2(1):19-25.
Macintyre, N.R., 2006. Muscle dysfunction associated with chronic obstructive pulmonary disease. Respiratory care, 51(8), pp.840-852.
Motamedi-Fakhr, S., Wilson, R. C., & Iles, R. (2017). Tidal breathing patterns derived from structured light plethysmography in COPD patients compared with healthy subjects. Medical Devices (Auckland, N.Z.), 10, 1–9. https://doi.org/10.2147/MDER.S119868
Numis, F. G., Morelli, L., Bosso, G., Masarone, M., Cocozza, S., Costanzo, A., & Schiraldi, F. (2014). Diaphragmatic motility assessment in COPD exacerbation, early detection of Non-Invasive Mechanical Ventilation failure: a pilot study. Critical Ultrasound Journal, 6(Suppl 2), A6. https://doi.org/10.1186/2036-7902-6-S2-A6
Ottenheijm, C. A. C., Heunks, L. M. A., Sieck, G. C., Zhan, W.-Z., Jansen, S. M., Degens, H., … Dekhuijzen, P. N. R. (2005). Diaphragm Dysfunction in Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 172(2), 200–205. https://doi.org/10.1164/rccm.200502-262OC
Ottenheijm, C. A., Heunks, L. M., & Dekhuijzen, R. P. (2008). Diaphragm adaptations in patients with COPD. Respiratory Research, 9(1), 12. https://doi.org/10.1186/1465-9921-9-12
Sarlabous, L., Torres, A., Fiz, J.A., Gea, J., Martínez-Llorens, J.M. and Jané, R., 2015. Efficiency of mechanical activation of inspiratory muscles in COPD using sample entropy. European Respiratory Journal, pp.ERJ-00434.
Sarlabous, L., Torres, A., Fiz, J.A., Martínez-Llorens, J.M., Gea, J. and Jané, R., 2017. Inspiratory muscle activation increases with COPD severity as confirmed by non-invasive mechanomyographic analysis. PloS one, 12(5), p.e0177730.
Torres, A, Galdiz, J.B., Gea, J., Morera, J. and Jane, R., 2006, August. Inspiratory pressure evaluation by means of the entropy of respiratory mechanomyographic signals. In Engineering in Medicine and Biology Society, 2006. EMBS’06. 28th Annual International Conference of the IEEE (pp. 5735-5738). IEEE
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