Abstract
Respiratory muscle dysfunction is a cardinal feature of acute and chronic respiratory failure in COPD. Diaphragm and accessory inspiratory muscles face increased load due to increased lung resistance and elastance, as well as increased ventilatory demands. Concomitantly, the capacity of the inspiratory muscles to generate pressure is decreased due to mechanical disadvantage imposed by hyperinflation. Additionally, inflammation and oxidative stress impair muscle fiber specific force generation and increase diaphragm susceptibility to sarcomere disruption during acute inspiratory loading. In response to this increased load, diaphragm presents unique adaptations in its cellular structure and passive and contractile mechanical properties, and displays a more efficient metabolic armamentarium. A shift of muscle fiber type towards slow-twitch, oxidative type I fibers, which are more fatigue-resistant, increases diaphragmatic endurance but protein degradation and a significant reduction in myosin content decrease its force generating capacity. Furthermore, diaphragm adapts to chronic hyperinflation by sarcomere deletion so that its overall length is shortened, in an attempt to preserve optimum force-length relationship. Adaptation however may not be complete, or may be overwhelmed by pathophysiologic derangements during exercise or acute exacerbations, leading to obvious “dysfunction” of the respiratory muscles, and if sustained, ultimately to muscle fatigue and respiratory pump failure.
Keywords: Diaphragm, respiratory pump failure, weakness, endurance, load/capacity imbalance, structure, metabolism, adaptation, exacerbation, COPD, inflammation
Current Drug Targets
Title: Respiratory Muscle Dysfunction in COPD: From Muscle to Cell
Volume: 12 Issue: 4
Author(s): M. Klimathianaki, K. Vaporidi and D. Georgopoulos
Affiliation:
Keywords: Diaphragm, respiratory pump failure, weakness, endurance, load/capacity imbalance, structure, metabolism, adaptation, exacerbation, COPD, inflammation
Abstract: Respiratory muscle dysfunction is a cardinal feature of acute and chronic respiratory failure in COPD. Diaphragm and accessory inspiratory muscles face increased load due to increased lung resistance and elastance, as well as increased ventilatory demands. Concomitantly, the capacity of the inspiratory muscles to generate pressure is decreased due to mechanical disadvantage imposed by hyperinflation. Additionally, inflammation and oxidative stress impair muscle fiber specific force generation and increase diaphragm susceptibility to sarcomere disruption during acute inspiratory loading. In response to this increased load, diaphragm presents unique adaptations in its cellular structure and passive and contractile mechanical properties, and displays a more efficient metabolic armamentarium. A shift of muscle fiber type towards slow-twitch, oxidative type I fibers, which are more fatigue-resistant, increases diaphragmatic endurance but protein degradation and a significant reduction in myosin content decrease its force generating capacity. Furthermore, diaphragm adapts to chronic hyperinflation by sarcomere deletion so that its overall length is shortened, in an attempt to preserve optimum force-length relationship. Adaptation however may not be complete, or may be overwhelmed by pathophysiologic derangements during exercise or acute exacerbations, leading to obvious “dysfunction” of the respiratory muscles, and if sustained, ultimately to muscle fatigue and respiratory pump failure.
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Cite this article as:
Klimathianaki M., Vaporidi K. and Georgopoulos D., Respiratory Muscle Dysfunction in COPD: From Muscle to Cell, Current Drug Targets 2011; 12 (4) . https://dx.doi.org/10.2174/138945011794751474
DOI https://dx.doi.org/10.2174/138945011794751474 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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