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

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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), FEV1FVC% 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 FEV1PEF% (expiratory flow peak) > 8.51/min and MEF50MIF50 > 1. Eighteen patients had a central (FEV1 < 80% and FEV1FVC% < 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 FEV1FVC% > 80%. Sixteen patients had air trapping (RV > 120% and RVTLC > 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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      There appears to be no improvement of FEV1 or FEV1/FVC scores after L-Dopa (Polatli et al., 2001; Monteiro et al., 2012). Restrictive airway disease has been observed in most studies, based on significant reductions in FVC and normal or high FEV1/FVC ratios in 30%–85% of IPD patients (Izquierdo-Alonso et al., 1994; Sabaté et al., 1996; Sathyaprabha et al., 2005; Pal et al., 2007), although a few studies report normal FVC (Hovestadt et al., 1989; Seccombe et al., 2011). It may be worse in the “OFF” medication state (reduced FVC in up to 80% of patients) than in the “ON” state (reduced FVC in up to 70% of patients) (Pal et al., 2007).

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