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Q J Med 2001; 94: 497-502
© 2001 Association of Physicians

Commentary

Respiratory muscle assessment in motor neurone disease

N. Mustfa and J. Moxham

From the Respiratory Muscle Laboratory, Guy's, King's and St Thomas' School of Medicine, King's College Hospital, London, UK


   Introduction
 
In this issue, Hadjikoutis and Wiles correctly identify that respiratory failure is the commonest cause of death in Motor Neurone Disease (MND)1 and discuss the use of venous bicarbonate and chloride to assess respiratory function.2 The study's finding that this domiciliary investigation can provide prognostic information regarding the respiratory status of MND patients is interesting, and it is useful to consider its place amongst the many tests of respiratory muscle and ventilatory function that are available.

Respiratory muscle weakness is a common feature of MND and is often present at diagnosis.3 Although such weakness is usually asymptomatic at this stage, respiratory failure can be the presenting feature of MND.4,5 Respiratory muscle strength continues to deteriorate during the course of the disease,6,7 with symptoms developing insidiously, eventually leading to respiratory failure and, if untreated, death. Due to the impaired mobility of the patients, symptoms of hypoventilation are initially subtle and depend . . . [Full Text of this Article]


   Non-invasive volitional tests
 
Vital capacity and routine lung function
Static mouth pressures
Sniff nasal pressure (SNIP)
Peak cough expiratory flow (PCEF)

   Non-invasive non-volitional tests
 

   Invasive volitional tests
 
Sniff Poes and sniff Pdi
Cough Pgas

   Invasive non-volitional tests
 
Magnetic stimulation of the phrenic nerves
Magnetic stimulation of T10
Earlobe blood gases (ELBG)
Sleep studies

   Conclusion
 

   Notes
 

   References
 

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