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Tests of respiratory muscle strength

Author
John Moxham, MD
Section Editor
James K Stoller, MD, MS
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Respiratory muscle strength can be assessed by measuring the maximal inspiratory pressure (MIP or PImax), and the maximal expiratory pressure (MEP or PEmax). The MIP reflects the strength of the diaphragm and other inspiratory muscles, while the MEP reflects the strength of the abdominal muscles and other expiratory muscles. An alternative or additional test of inspiratory muscles strength is maximal sniff nasal inspiratory pressure (SNIP). Common indications for measurement of the MIP, SNIP, and MEP include:

Respiratory muscle weakness is suspected, such as a patient with unexplained dyspnea, a weak cough, or known neuromuscular disease

Lung function tests show reduced vital capacity (VC) or an increased diffusion capacity of unknown etiology

Evaluation of whether known respiratory muscle weakness has improved, remained stable, or worsened

Measurement, interpretation, quality assurance, and clinical applications of the MIP, SNIP, and MEP are discussed in this topic review. Assessments of other aspects of respiratory function (eg, airflow, lung volumes, gas exchange) are described separately. (See "Overview of pulmonary function testing in adults" and "Diffusing capacity for carbon monoxide" and "Reference values for pulmonary function testing" and "Flow-volume loops" and "Office spirometry".)

                 

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Literature review current through: Jun 2015. | This topic last updated: Jul 13, 2015.
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References
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  1. Hamnegård CH, Wragg S, Kyroussis D, et al. Portable measurement of maximum mouth pressures. Eur Respir J 1994; 7:398.
  2. Watson, L. A method for measuring sniff nasal inspiratory pressure using the PK Morgan Pm meter. Inspire, the Official J Assoc Respir Technicians Physiologists 1997; 1:14.
  3. Enright PL, Kronmal RA, Manolio TA, et al. Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group. Am J Respir Crit Care Med 1994; 149:430.
  4. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care 2009; 54:1348.
  5. American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166:518.
  6. Wen AS, Woo MS, Keens TG. How many maneuvers are required to measure maximal inspiratory pressure accurately. Chest 1997; 111:802.
  7. Fiz JA, Carreres A, Rosell A, et al. Measurement of maximal expiratory pressure: effect of holding the lips. Thorax 1992; 47:961.
  8. Héritier F, Rahm F, Pasche P, Fitting JW. Sniff nasal inspiratory pressure. A noninvasive assessment of inspiratory muscle strength. Am J Respir Crit Care Med 1994; 150:1678.
  9. Uldry C, Janssens JP, de Muralt B, Fitting JW. Sniff nasal inspiratory pressure in patients with chronic obstructive pulmonary disease. Eur Respir J 1997; 10:1292.
  10. Lyall RA, Donaldson N, Polkey MI, et al. Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis. Brain 2001; 124:2000.
  11. Rafferty GF, Leech S, Knight L, et al. Sniff nasal inspiratory pressure in children. Pediatr Pulmonol 2000; 29:468.
  12. Rochester DF. Tests of respiratory muscle function. Clin Chest Med 1988; 9:249.
  13. Orozco-Levi M. Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation? Eur Respir J Suppl 2003; 46:41s.
  14. Morrison NJ, Richardson J, Dunn L, Pardy RL. Respiratory muscle performance in normal elderly subjects and patients with COPD. Chest 1989; 95:90.
  15. Steier J, Kaul S, Seymour J, et al. The value of multiple tests of respiratory muscle strength. Thorax 2007; 62:975.
  16. Moxham J. Lung function tests: physiological principles and clinical applications. In: Respiratory Muscles, Hughes JB, Pride NB, Saunders WB (Eds), London 1999.
  17. Aldrich TK, Spiro P. Maximal inspiratory pressure: does reproducibility indicate full effort? Thorax 1995; 50:40.
  18. Hughes PD, Polkey MI, Kyroussis D, et al. Measurement of sniff nasal and diaphragm twitch mouth pressure in patients. Thorax 1998; 53:96.
  19. Celli BR. Clinical and physiologic evaluation of respiratory muscle function. Clin Chest Med 1989; 10:199.
  20. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1:307.
  21. Maillard JO, Burdet L, van Melle G, Fitting JW. Reproducibility of twitch mouth pressure, sniff nasal inspiratory pressure, and maximal inspiratory pressure. Eur Respir J 1998; 11:901.
  22. Keenan SP, Alexander D, Road JD, et al. Ventilatory muscle strength and endurance in myasthenia gravis. Eur Respir J 1995; 8:1130.
  23. Goswami R, Guleria R, Gupta AK, et al. Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy. Eur J Endocrinol 2002; 147:299.
  24. Nava S, Crotti P, Gurrieri G, et al. Effect of a beta 2-agonist (broxaterol) on respiratory muscle strength and endurance in patients with COPD with irreversible airway obstruction. Chest 1992; 101:133.
  25. Larson JL, Covey MK, Vitalo CA, et al. Maximal inspiratory pressure. Learning effect and test-retest reliability in patients with chronic obstructive pulmonary disease. Chest 1993; 104:448.
  26. American Thoracic Society. Pulmonary Function Laboratory Management and Procedure Manual, Wanger J, Crapo RO, Irvin CG (Eds), 2005.
  27. Koulouris N, Mulvey DA, Laroche CM, et al. Comparison of two different mouthpieces for the measurement of Pimax and Pemax in normal and weak subjects. Eur Respir J 1988; 1:863.
  28. Wohlgemuth M, van der Kooi EL, Hendriks JC, et al. Face mask spirometry and respiratory pressures in normal subjects. Eur Respir J 2003; 22:1001.
  29. Harik-Khan RI, Wise RA, Fozard JL. Determinants of maximal inspiratory pressure. The Baltimore Longitudinal Study of Aging. Am J Respir Crit Care Med 1998; 158:1459.
  30. Carpenter MA, Tockman MS, Hutchinson RG, et al. Demographic and anthropometric correlates of maximum inspiratory pressure: The Atherosclerosis Risk in Communities Study. Am J Respir Crit Care Med 1999; 159:415.
  31. Lechtzin N, Wiener CM, Shade DM, et al. Spirometry in the supine position improves the detection of diaphragmatic weakness in patients with amyotrophic lateral sclerosis. Chest 2002; 121:436.
  32. Polkey MI, Lyall RA, Green M, et al. Expiratory muscle function in amyotrophic lateral sclerosis. Am J Respir Crit Care Med 1998; 158:734.
  33. Teixeira A, Cherin P, Demoule A, et al. Diaphragmatic dysfunction in patients with idiopathic inflammatory myopathies. Neuromuscul Disord 2005; 15:32.
  34. Hughes PD, Polkey MI, Harrus ML, et al. Diaphragm strength in chronic heart failure. Am J Respir Crit Care Med 1999; 160:529.
  35. Ker JA, Schultz CM, Ker J. Respiratory muscle endurance in heart failure--the effect of clinical severity. S Afr Med J 1998; 88 Suppl 1:C20.
  36. Polkey MI, Kyroussis D, Hamnegard CH, et al. Diaphragm strength in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 154:1310.
  37. Moore AJ, Soler RS, Cetti EJ, et al. Sniff nasal inspiratory pressure versus IC/TLC ratio as predictors of mortality in COPD. Respir Med 2010; 104:1319.
  38. Lemos A, de Souza AI, Figueiroa JN, et al. Respiratory muscle strength in pregnancy. Respir Med 2010; 104:1638.
  39. Morgan RK, McNally S, Alexander M, et al. Use of Sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis. Am J Respir Crit Care Med 2005; 171:269.
  40. Man WD, Kyroussis D, Fleming TA, et al. Cough gastric pressure and maximum expiratory mouth pressure in humans. Am J Respir Crit Care Med 2003; 168:714.
  41. Szeinberg A, Tabachnik E, Rashed N, et al. Cough capacity in patients with muscular dystrophy. Chest 1988; 94:1232.
  42. van der Palen J, Rea TD, Manolio TA, et al. Respiratory muscle strength and the risk of incident cardiovascular events. Thorax 2004; 59:1063.
  43. Mier A. Respiratory muscle weakness. Respir Med 1990; 84:351.
  44. Jackson CE, Rosenfeld J, Moore DH, et al. A preliminary evaluation of a prospective study of pulmonary function studies and symptoms of hypoventilation in ALS/MND patients. J Neurol Sci 2001; 191:75.
  45. Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis 1988; 137:877.
  46. Laroche CM, Mier AK, Moxham J, Green M. The value of sniff esophageal pressures in the assessment of global inspiratory muscle strength. Am Rev Respir Dis 1988; 138:598.
  47. Miller JM, Moxham J, Green M. The maximal sniff in the assessment of diaphragm function in man. Clin Sci (Lond) 1985; 69:91.
  48. Mills GH, Kyroussis D, Hamnegard CH, et al. Unilateral magnetic stimulation of the phrenic nerve. Thorax 1995; 50:1162.
  49. Mills GH, Kyroussis D, Hamnegard CH, et al. Bilateral magnetic stimulation of the phrenic nerves from an anterolateral approach. Am J Respir Crit Care Med 1996; 154:1099.
  50. Watson AC, Hughes PD, Louise Harris M, et al. Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med 2001; 29:1325.
  51. Hopkinson NS, Dayer MJ, Moxham J, Polkey MI. Abdominal muscle fatigue following exercise in chronic obstructive pulmonary disease. Respir Res 2010; 11:15.
  52. Luo YM, Moxham J, Polkey MI. Diaphragm electromyography using an oesophageal catheter: current concepts. Clin Sci (Lond) 2008; 115:233.