Obstructive and restrictive pulmonary dysfunctions in Parkinson's disease

doi:10.1016/0022-510X(96)00003-2

Journal of the Neurological Sciences

Volume 138, Issues 1–2, June 1996, Pages 114-119

https://doi.org/10.1016/0022-510X(96)00003-2 Get rights and content

Abstract

Pulmonary dysfunction was investigated in fifty-eight Parkinson's patients. Clinical disability was assessed by the Unified Parkinson's Disease Rating Scale. Pulmonary dysfunction was studied by spirometry with flow-volume loops, body plethysmography with lung volumes computation and maximal inspiratory and expiratory static mouth pressures. Forced vital capacity (FVC), forced expiratory volume in 1 min (FEV1), $FEV 1 FVC %$ and arterial PO2 and PCO2 were significantly below normal values. Residual volume (RV) and total rows were above normal values. Thirty-six had upper airway obstruction as judged by inspiratory flow peaks (PIF) <31/s and $FEV 1 PEF %$ (expiratory flow peak) > 8.51/min and $MEF 50 MIF 50$ > 1. Eighteen patients had a central (FEV1 < 80% and $FEV 1 FVC %$ < 80% of normal values) or peripheral (maximal expiratory flow between 75% and 25% of FVC and maximal expiratory flow after expiration of 50% below 70% of normal values) obstructive pattern. Sixteen patients had a restrictive dysfunction as judged by a total lung capacity < 85% or FVC < 80% with $FEV 1 FVC %$ > 80%. Sixteen patients had air trapping (RV > 120% and $RV TLC$ > 40%) and seven patients had lung insufflation (TLC > 120%). Rigidity, Rx signs of cervical arthrosis and limitations for passive movement of neck were higher in patients with central or peripheral airway obstruction. Bradykinesia and Rx signs of dorsal arthrosis was higher in patients with upper airway obstruction. Restrictive dysfunction was not related to tremor, rigidity or bradykinesia. The present data support the hypothesis that Parkinson patients present a high risk for pneumologic disturbances. These pulmonary dysfunctions are induced by the simultaneous action of a group of factors including the degree of bradykinesia or rigidity and the musculoskeletal limitations of vertebral column probably induced by chronic anomalous posture.

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Citation Excerpt :
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PD patients on stable oral PD therapy and no chronic respiratory disease had spirometry and diffusing capacity of the lungs for carbon monoxide (DL_CO) measured at 3, 6, 9, and 12 months.
106 patients (81.5%) in the observational cohort on no investigational therapy completed the study. Mean FEV₁ declined at 12 months from 2.88L at baseline with a mean change of −0.11L, greater than the −0.030–0.045L/year observed in healthy, non-smokers aged 60–70 years. FVC declined from 3.77L (mean change −0.19L); FEV₁/FVC ratio remained relatively constant. DL_CO mean change was −0.48 mL/min/mmHg from a baseline of 24.24 mL/min/mmHg. This change in DL_CO, while not significant, was similar to that seen in non-smokers aged 60–70 years (DL_CO -0.42–0.63 mL/min/mmHg/year). Decreases in alveolar volume (VA) and inspiratory vital capacity (IVC) rather than the transfer coefficient (DL_CO/VA) were observed.
PD patients had greater declines in FEV₁, and FVC, but not in DL_CO, compared to healthy non-smokers of similar age. Declines in FEV₁ and FVC with little change in FEV₁/FVC, and decline in VA and IVC with little change in DL_CO/VA, suggest these changes were due to decreases in lung volume and are compatible with progressive PD-associated respiratory muscle weakness.
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Research articleObstructive and restrictive pulmonary dysfunctions in Parkinson's disease

Abstract

Lancet

Lancet

Lancet

Chest

Lancet

Parkinsonism: onset, progression and mortality

Neurology

Involvement of upper-airway muscles in extrapyramidal disorders

N. Engl. J. Med.

Pulmonary function in Parkinson's disease

J. Neurol. Neurosurg. Psychiat.

Epidemiology standardization project. III. Recommended standardized procedures for pulmonary function testing

Am. Rev. Respir. Dis.

Site of airway obstruction in asthma as determined by measuring maximal expiratory flow breathing air and helium-oxygen mixture

J. Clin. Invest.

The maximal espiratory flow-volume curve. Normal standards, variability and effects of age

Am. Rev. Respir. Dis.

Normal values and evaluation of forced end-expiratory flow

Am. Res. Respir. Dis.

Maximal respiratory pressures: normal values and relationship to age and sex

Am. Rev. Respir. Dis.

Pleuropulmonary changes during long-term bromocriptine treatment for Parkinson's disease

Lancet

Fibrose pleuropulmonaire et bromocriptine

Bromocriptine-induced pleuropulmonary fibrosis

Thorax

Research article
Obstructive and restrictive pulmonary dysfunctions in Parkinson's disease