Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • For authors
    • Instructions for authors
    • Submit a manuscript
    • ERS author centre
  • Journal club
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • For authors
    • Instructions for authors
    • Submit a manuscript
    • ERS author centre
  • Journal club
  • Alerts
  • Subscriptions

A case of unexplained dyspnoea: when lung function testing matters!

Pierantonio Laveneziana, Marie-Cécile Niérat, Antonella LoMauro, Andrea Aliverti
Breathe 2018 14: 325-332; DOI: 10.1183/20734735.025018
Pierantonio Laveneziana
Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, FranceAP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département R3S, Paris, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: pierantonio.laveneziana@aphp.fr
Marie-Cécile Niérat
Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Antonella LoMauro
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Antonella LoMauro
Andrea Aliverti
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    a) Maximal (outer black loop) and tidal (inner purple loop) flow–volume loops at rest in our patient. The predicted values loop is shown as a dashed profile. b) SNIP traces at rest in our patient. c) MIP traces at rest in our patient. Please refer to the text for more details.

  • Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2

    Current practice on the suspicion of respiratory muscle dysfunction (especially of the diaphragm), outside the intensive care setting. The figure describes how a clinician or physiologist suspects and treats respiratory muscle dysfunction (especially unilateral and bilateral diaphragm weakness), outside the intensive care setting. PImax: maximal inspiratory pressure; TF: thickening fraction of the diaphragm; PSG: polysomnography; CPAP: continuous positive airway pressure; NPPV: noninvasive positive pressure ventilation; PaCO2: arterial carbon dioxide tension; SpO2: arterial oxygen saturation measured by pulse oximetry. Please refer to the text for more details.

Tables

  • Figures
  • Table 1

    Resting PFT in an upright sitting and supine position

    Upright sitting positionSupine position
    MeasuredLLNULNReference (mean value)% of referenceMeasured% of reference
    VC L4.134.336.175.2579%2.7051%
    TLC L5.796.078.377.2280%4.1758%
    FRC L2.392.434.413.4270%1.6548%
    IC L3.403.4798%2.5273%
    RV L1.651.242.581.9187%1.4777%
    ERV L0.731.7342%0.1810%
    RV/TLC %29193728102%35126%
    FEV1 L3.073.325.004.1674%
    FVC L4.044.036.035.0380%
    FEV1/VC %#7469928194%
    PEF L·s−18.117.5911.579.5885%
    FEF25% L·s−16.935.4411.068.2584%
    FEF50% L·s−13.523.147.485.3166%
    FEF75% L·s−10.911.113.672.3938%

    LLN: lower limit of normality; ULN: upper limit of normality; VC: vital capacity; TLC: total lung capacity; FRC: functional residual capacity; IC: inspiratory capacity; RV: residual volume; ERV: expiratory reserve volume; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; PEF: peak expiratory flow; FEFx%: forced expiratory flow measured after x% of the FVC has been exhaled. #: spirometric evidence of an obstructive ventilatory defect as defined by a reduced FEV1/VC ratio less than the fifth percentile of the predicted value [1].

    • Table 2

      Respiratory muscle pressure assessment

      MeasuredLLNULNReference (mean value)#% of reference
      MIP sustained for 1 s (at RV) cmH2O688016812455%
      MIP at peak value (at RV) cmH2O70
      MEP sustained for 1 s (at TLC) cmH2O16614931723371%
      MEP at peak value (at TLC) cmH2O
      Maximum SNIP cmH2O528112910550%

      MIP: maximal inspiratory pressure; MEP: maximal expiratory pressure; SNIP: sniff nasal inspiratory pressure. #: reference values taken from [2, 3].

      • Table 3

        Main differences between unilateral and bilateral diaphragmatic paralysis

        Unilateral diaphragmatic paralysisBilateral diaphragmatic paralysis
        SymptomsUsually asymptomatic
        Possible dyspnoea on exertion and limited ability to exercise
        Occasionally dyspnoea when supine
        Unexplained dyspnoea or recurrent respiratory failure
        Considerable dyspnoea at rest, when supine, with exertion, or when immersed in water above their waist
        Fatigue, hypersomnia, depression, morning headaches and frequent nocturnal awakenings
        Subsegmental atelectasis and infections of the lower respiratory tract
        PFTVC ∼75% predicted
        VC ∼55–65% predicted when supine
        FRC usually preserved
        TLC usually preserved
        VC ∼50% predicted
        VC ∼30–50% predicted when supine
        TLC ∼70–79% predicted (mild restriction)
        TLC ∼30–50% predicted (moderate-to-severe restriction)
        RV >predicted
        RMEMIP ∼30–60% predicted
        SNIP ∼30–60% predicted
        MIP <30% predicted
        SNIP <30% predicted
        Threshold values to suspect diaphragmatic weakness:
        MIP or sniff Pdi or Pdi,max ≤80 cmH2O in men, ≤70 cmH2O in women
        SNIP ≤70 cmH2O in men, ≤60 cmH2O in women

        RME: respiratory muscles evaluation. Please refer to the text for more details.

        PreviousNext
        Back to top
        Vol 14 Issue 4 Table of Contents
        Breathe: 14 (4)
        • Table of Contents
        • Index by author
        Email

        Thank you for your interest in spreading the word on European Respiratory Society .

        NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

        Enter multiple addresses on separate lines or separate them with commas.
        A case of unexplained dyspnoea: when lung function testing matters!
        (Your Name) has sent you a message from European Respiratory Society
        (Your Name) thought you would like to see the European Respiratory Society web site.
        Print
        Alerts
        Sign In to Email Alerts with your Email Address
        Citation Tools
        A case of unexplained dyspnoea: when lung function testing matters!
        Pierantonio Laveneziana, Marie-Cécile Niérat, Antonella LoMauro, Andrea Aliverti
        Breathe Dec 2018, 14 (4) 325-332; DOI: 10.1183/20734735.025018

        Citation Manager Formats

        • BibTeX
        • Bookends
        • EasyBib
        • EndNote (tagged)
        • EndNote 8 (xml)
        • Medlars
        • Mendeley
        • Papers
        • RefWorks Tagged
        • Ref Manager
        • RIS
        • Zotero

        Share
        A case of unexplained dyspnoea: when lung function testing matters!
        Pierantonio Laveneziana, Marie-Cécile Niérat, Antonella LoMauro, Andrea Aliverti
        Breathe Dec 2018, 14 (4) 325-332; DOI: 10.1183/20734735.025018
        del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
        Full Text (PDF)

        Jump To

        • Article
          • Abstract
          • Case history
          • Questions
          • Answers
          • State of the art and controversial issues
          • Points to emphasise
          • Conclusions and future directions
          • Footnotes
          • References
        • Figures & Data
        • Info & Metrics
        • PDF

        Subjects

        • Respiratory clinical practice
        • Mechanisms of lung disease
        • Tweet Widget
        • Facebook Like
        • Google Plus One

        More in this TOC Section

        • ERS International Congress 2018: highlights from best-abstract awardees
        • Respiratory training in Turkey
        • Α 78-year-old female who presents with a non-resolving pneumonia
        Show more Expert opinion

        Related Articles

        Navigate

        • Home
        • Current issue
        • Archive

        About Breathe

        • Journal information
        • Editorial board
        • CME
        • Press
        • Permissions and reprints
        • Advertising

        The European Respiratory Society

        • Society home
        • myERS
        • Privacy policy
        • Accessibility

        ERS publications

        • European Respiratory Journal
        • ERJ Open Research
        • European Respiratory Review
        • Breathe
        • ERS books online
        • ERS Bookshop

        Help

        • Feedback

        For authors

        • Intructions for authors
        • Submit a manuscript
        • ERS author centre

        For readers

        • Alerts
        • Subjects
        • Collections
        • RSS

        Subscriptions

        • Accessing the ERS publications

        Contact us

        European Respiratory Society
        442 Glossop Road
        Sheffield S10 2PX
        United Kingdom
        Tel: +44 114 2672860
        Email: journals@ersnet.org

        ISSN

        Print ISSN: 1810-6838
        Online ISSN: 2073-4735

        Copyright © 2019 by the European Respiratory Society