Dyspnoea and pulmonary dysfunction have recently been associated with Type I (insulin-dependent) diabetes mellitus. The putative role of altered pulmonary mechanics and of performance of inspiratory muscles in inducing dyspnoea has not been yet assessed in Type I diabetes. To better focus on this topic we evaluated nine patients with Type I diabetes mellitus, aged 19 to 48 years with good and stable metabolic control, without a history of smoking and microvascular complications, alongside a group of 14 healthy control subjects. In each subject, pulmonary volumes, static and dynamic compliance, pleural pressure swings (Pplsw), maximal inspiratory pressures (Pplsn), Pplsw(%Pplsn), a measure of respiratory muscle effort, and tension–time index [TTI = TI/TTOT×Pplsw(%Pplsn)] were measured (TI = inspiratory time;TTOT = total time of the respiratory cycle). All subjects were studied at baseline and during hypoxic rebreathing. Patients had normal pulmonary volumes. During hypoxic rebreathing, a normal change in respiratory muscle effort [ΔPplsw(%Pplsn)/ΔSaO2] and ΔTTI/ΔSaO2, and a lower change in tidal volume versus change in oxygen saturation [ΔVT(% vital capacity)/ΔSaO2], resulted in a higher ratio of respiratory effort to tidal volume [Pplsw(%Pplsn)/VT(% vital capacity)], a measure of neuroventilatory dissociation of the respiratory pump. Hypoxic dyspnoea, assessed by a modified Borg scale, showed a greater rate of rise (ΔBorg/ΔSaO2) and a greater increase for a given level of respiratory effort in patients. Moreover, neuroventilatory dissociation related to the expression of peripheral airway involvement, as assessed in terms of low dynamic compliance, and to concurrent change in dyspnoea sensation. Patients with Type I diabetes mellitus under good metabolic control and with normal lung volumes may have abnormal peripheral airway function. The latter is thought to be responsible for the association between dyspnoea sensation and neuroventilatory dissociation.
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Research Article|
April 14 1999
Dyspnoea, peripheral airway involvement and respiratory muscle effort in patients with Type I diabetes mellitus under good metabolic control
Giorgio SCANO;
*Fondazione Don C. Gnocchi, Pozzolatico ONLUS, Florence, Italy
†Section of Respiratory Disease, Department of Internal Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy
Correspondence: Dr G. Scano, Section of Respiratory Disease, Department of Internal Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
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Giuseppe SEGHIERI;
Giuseppe SEGHIERI
‡Diabetes Unit and Section of Respiratory Disease, Department of Internal Medicine, General Hospital, Pistoia, Italy
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Marco MANCINI;
Marco MANCINI
*Fondazione Don C. Gnocchi, Pozzolatico ONLUS, Florence, Italy
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Mario FILIPPELLI;
Mario FILIPPELLI
†Section of Respiratory Disease, Department of Internal Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy
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Roberto DURANTI;
Roberto DURANTI
*Fondazione Don C. Gnocchi, Pozzolatico ONLUS, Florence, Italy
†Section of Respiratory Disease, Department of Internal Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy
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Alessandro FABBRI;
Alessandro FABBRI
‡Diabetes Unit and Section of Respiratory Disease, Department of Internal Medicine, General Hospital, Pistoia, Italy
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Fabio INNOCENTI;
Fabio INNOCENTI
‡Diabetes Unit and Section of Respiratory Disease, Department of Internal Medicine, General Hospital, Pistoia, Italy
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Iacopo IANDELLI;
Iacopo IANDELLI
*Fondazione Don C. Gnocchi, Pozzolatico ONLUS, Florence, Italy
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Gianni MISURI
Gianni MISURI
*Fondazione Don C. Gnocchi, Pozzolatico ONLUS, Florence, Italy
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Publisher: Portland Press Ltd
Received:
September 09 1998
Revision Received:
December 04 1998
Accepted:
January 08 1999
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society and the Medical Research Society © 1999
1999
Clin Sci (Lond) (1999) 96 (5): 499–506.
Article history
Received:
September 09 1998
Revision Received:
December 04 1998
Accepted:
January 08 1999
Citation
Giorgio SCANO, Giuseppe SEGHIERI, Marco MANCINI, Mario FILIPPELLI, Roberto DURANTI, Alessandro FABBRI, Fabio INNOCENTI, Iacopo IANDELLI, Gianni MISURI; Dyspnoea, peripheral airway involvement and respiratory muscle effort in patients with Type I diabetes mellitus under good metabolic control. Clin Sci (Lond) 1 May 1999; 96 (5): 499–506. doi: https://doi.org/10.1042/cs0960499
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