Diagnostic differences in respiratory breathing patterns and work of breathing indices in children with Duchenne muscular dystrophy

Abstract

Rationale Pulmonary function testing (PFT) provides diagnostic information regarding respiratory physiology. However, many forms of PFT are time-intensive and require patient cooperation. Respiratory inductance plethysmography (RIP) provides thoracoabdominal asynchrony (TAA) and work of breathing (WOB) data. pneuRIPTM is a noninvasive, wireless analyzer that provides real-time assessment of RIP via an iPad. In this study, we show that pneuRIPTM can be used in a hospital clinic setting to differentiate WOB indices and breathing patterns in children with DMD as compared to age-matched healthy subjects. Methods RIP using the pneuRIPTM was conducted on 9 healthy volunteers and 7 DMD participants (ages 5 18) recruited from the neuromuscular clinic, under normal resting conditions over 3 5 min during routine outpatient visits. The tests were completed in less than 10 minutes and did not add excessive time to the clinic visit. Variables recorded included laboredbreathing index (LBI), phase angle (π) between abdomen and rib cage, respiratory rate (RR), percentage of rib cage input (RC%), and heart rate (HR). The data were displayed in histogram plots to identify distribution patterns within the normal ranges. The percentages of data within the ranges (0π30 deg.; median RC % 10%; median RR 5%; 1 LBI 1.1) were compared. Unpaired t-tests determined significance of the data between groups. Results 100% patient compliance demonstrates the feasibility of such testing in clinical settings. DMD patients showed a significant elevation in π, LBI, and HR averages (P<0.006, P<0.002, P<0.046, respectively). Healthy subjects and DMD patients had similar BPM and RC% averages. All DMD data distributions were statistically different from healthy subjectsbased on analysis of histograms. The DMD patients showed significantly less data within the normal ranges, with only 49.7%, 48.0% RC%, 69.2% RR, and 50.7% LBI. Conclusion In this study, noninvasive pneuRIPTM testing provided instantaneous PFT diagnostic results. As compared to healthy subjects, patients with DMD showed abnormal results with increased markers of TAA, WOB indices, and different breathing patterns. These results are similar to previous studies evaluating RIP in preterm infants. Further studies are needed to compare these results to other pulmonary testing methods. The pneuRIPTM testing approach provides immediate diagnostic information in outpatient settings.