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Inspiratory Muscle Strength in Acute Asthma^*

^* From the Departments of Accident & Emergency Medicine (Dr. Stell) and Respiratory Medicine (Drs. Polkey and Moxham), King’s College Hospital, London, UK; the Department of Respiratory Medicine (Dr. Rees), Guy’s Hospital, London, UK; and the Department of Respiratory Medicine (Dr. Green), The Royal Brompton Hospital, London, UK.

Correspondence to: Ian M. Stell, MBBS, Accident & Emergency Department, Bromley Hospital, Cromwell Avenue, Bromley, Kent, BR2 9AJ UK; e-mail ian.stell@bromleyh_tr.sthames.nhs.uk

Study objectives: The aim of this study was to measure inspiratory pressure-generating capacity in patients presenting with acute asthma, as it has been suggested that inspiratory muscle fatigue may contribute to breathlessness and acute respiratory failure.

Design: Descriptive study.

Setting: Emergency departments of two inner-city hospitals.

Patients: Fifty-one patients with acute asthma, and 45 patients without respiratory disease who served as control subjects.

Measurements and results: Maximum inspiratory pressure-generating capacity was measured soon after presentation by the sniff nasal inspiratory pressure (SNIP) method. The mean (SD) SNIP was 110 cm H₂O (23 cm H₂O) in men with asthma (mean for control subjects, 126 cm H₂O [25 cm H₂O]; p < 0.05) and 80 cm H₂O [24 cm H₂O] in women with asthma (mean for control subjects, 105 cm H₂O (26 cm H₂O); p < 0.01). In a second study of simultaneous SNIP and intrathoracic pressure measurements in a group of patients with acute asthma (n = 10) and control subjects (n = 11), the effect of airways obstruction on SNIP was assessed. The measurement of sniff esophageal pressure was more negative than SNIP by approximately 16% in asthmatic patients and by 4% in control subjects. Taking account of the likely effect of airways obstruction on SNIP, the reduction in inspiratory pressure-generating capacity that was observed in these patients with moderately severe acute asthma was minor and was consistent with the modest hyperinflation observed.

Conclusions: This study did not find evidence of inspiratory muscle weakness or fatigue in patients with moderately severe acute asthma presenting to the emergency department.

Key Words: asthma • respiratory insufficiency • respiratory muscles • muscle fatigue

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