Expiratory flow maneuvers in patients with neuromuscular diseases

John R. Bach, Miguel R. Gonçalves, Sylvia Páez, João Carlos Winck, Sandra Leitão, Paulo Abreu

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objectives: To compare cough peak flows (CPF), peak expiratory flows (PEF), and potentially confounding flows obtained by lip and tongue propulsion (dart flows, DF) for normal subjects and for patients with neuromuscular disease/restrictive pulmonary syndrome and to correlate them with vital capacity and maximum insufflation capacity. Design: A cross-sectional analytic study of 125 stable patients and 52 normal subjects in which CPF, PEF, and DF were measured by peak flow meter and vital capacity and maximum insufflation capacity by spirometer. Results: In normal subjects and in patients, the DF significantly exceeded PEF and CPF (P ≤ 0.001). For normal subjects, PEF and CPF were not significantly different. For patients with neuromuscular disease/restrictive pulmonary syndrome, the CPF significantly exceeded PEF (P < 0.05). No normal subjects but 14 patients had DF lower than CPF. Thirteen of these 14 had the ability to air stack (maximum insufflation capacity greater than vital capacity), indicating greater compromise of mouth and lip than of glottic muscles. For 14 of 88 patients, maximum insufflation capacity values did not exceed vital capacity, mostly because of inability to close the glottis (inability to air stack). Nonetheless, for 11 of these 14 patients, the DF were within a standard deviation of the whole patient group; thus, bulbar-innervated muscle dysfunction was not uniform. CPF and PEF correlated with vital capacity (r = 0.85 and 0.86, respectively), and with maximum insufflation capacity (r = 0.76 and 0.72, respectively). Conclusions: Measurements of CPF, PEF, and DF are useful for assessing bulbar-innervated, inspiratory, and expiratory muscle function. Care must be taken to not confuse them.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number2
StatePublished - Feb 2006

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


  • Amyotrophic Lateral Sclerosis
  • Cough Peak Flows
  • Dart Flows
  • Duchenne Muscular Dystrophy
  • Glottic Muscles
  • Maximum Insufflation Capacity
  • Neuromuscular Disease
  • Peak Expiratory Flows
  • Respiratory Muscles
  • Vital Capacity


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