Thoracoabdominal asynchrony and paradoxical motion in middle stage amyotrophic lateral sclerosis

Aim: To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (VT,cw), breathing pattern and cough peak flow (CPF). Methods: Phase angle (0) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IPnca) and abdomen (IPAB) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of 0 and IP, obtained in twelve age and sex matched healthy persons. Results: During quiet breathing, significantly higher RCa and AB 0 (p <.05), IPBca (p = 0.001) and IPAB (p < 0.05) were observed in ALS patients as compared to controls. In ALS patients, correlations between RCa and AB 0 with forced vital capacity (FVC) (r=-0.773, p < 0.01), vital capacity (r=-0.663, p < 0.05) and inspiratory capacity (IC) (r=-0.754, p < 0.01), as well as between RCp and RCa 0 with FVC (r=-0.608, p < 0.05) and CPF (r=-0.601, p < 0.05) were found. During coughing, correlations between RCp and AB 0 with CPF (r =-0.590, p < 0.05), IC (r = 0.748,p < 0.01) and VT,cw (r = -0.608, p < 0.05), as well as between RCa and AB 0 with CPF (r=-0.670, p < 0.05), IC (r=-0.713, p < 0.05) and peak expiratory flow (r=-0.727, p < 0.05) were also observed in ALS patients. ALS patients with paradoxical motion presented lower vital capacity and FVC%pred (p < 0.05) compared to those without paradoxical motion. Conclusions: Middle stage ALS patients exhibit TAA and paradoxical motion during quiet spontaneous breathing and coughing. In addition, diaphragmatic weakness (i.e. decrease in excursion of the RCa and AB compartments) was observed earlier in the lower ribcage rather than the abdominal compartment in this population.