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• W2057632685 abstract "The majority of patients with severe diffuse obstructive pulmonary emphysema develop right heart failure, and, in some cases as a later event, failure of the left heart as well. Measures which are useful in the treatment of the pulmonary disease itself are naturally of importance in the prevention of cardiac insufficiency, and this discussion could be terminated here were it not that some of the major factors which increase cardiorespiratory reserve are frequently ignored or, in one instance, misinterpreted as a hazard. It is my intention to discuss two of these factors, restoration of diaphragmatic function, and increased capacity for exercise resulting from inhalation of oxygen during a walking regimen. Ascent of the diaphragm by deliberate contraction of the abdominal musculature has been taught to patients as a breathing exercise by investigators who followed the original regimen of Hofbauer.’ This consciously directed procedure was frequently abandoned by the patient during exertion when it was most needed. We, therefore, developed instead a training program in which the natural process of diaphragmatic respiration was encouraged by the head-down position and pressuure of the operator’s hand on the patient’s chest and abdomen.2’3’4 Heckscher,5 emphasizing the difficulty of the patient making a habit of breathing exercises that required his deliberate attention, i.e., synchronization of abdominal muscle contraction and expiration, reported remarkably favorable results from the use of the leaning forward posture to facilitate upward movement of the diaphragm. Additional aids to breathing consist of development of the diaphragmatic muscle so that no conscious effort is required to breathe against a weight of 15 to 30 pounds, applied to the abdomen and the use of an emphysema belt with an elastic recoil mechanism to increase the expiratory ascent of the diaphragm.4 The substitution of diaphragmatic for upper costal respiration in these cases resulted in a 20 to 30 per cent decrease in pulmonary ventilation, an enhanced efficiency of exchange of both oxygen and carbon dioxide, and a decrease in energy expended as shown by decrease in 02 consumption; a substantial dcrease in the work of the circulation and the respiration was accomplished by measures which lower the minute volume of breathing without the development of hypoxia or uncompensated respiratory acidosis.2’3 4 Restoration of diaphragmatic function may therefore be considered a method of preventing cardiac failure in cases in which better alveolar diffusion of oxygen and carbon dioxide is produced. The value of a program of this kind depends on the degree of elastic recoil of the diaphragm which can be restored by persistent training as well as by the use of measures which decrease bronchial constriction and alveolar overdistention." @default.
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• W2057632685 date "1960-06-01" @default.
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• W2057632685 title "SUMMARY OF CURRENT THERAPY" @default.
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• W2057632685 doi "https://doi.org/10.1378/chest.37.6.687" @default.
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