高齢者の咳の強さと活動レベル

高齢者の咳の強さと活動レベルの関係をみた論文を紹介します。

Freitas FS, Ibiapina CC, Alvim CG, Britto RR, Parreira VF.　Relationship between cough strength and functional level in elderly.　Rev Bras Fisioter. 2010 Nov-Dec;14(6):470-6.

下記のHPで全文PDFで見れます。

http://www.scielo.br/pdf/rbfis/v14n6/en_a04v14n6.pdf

リサーチクエスチョンは以下の通りです。

P：健常高齢者で
E：活動レベルが高い方は（Human Activity Profileで評価）
C：活動レベルが低い方と比較して
O：呼吸筋の筋力が強い
D：横断研究

結果ですが、活動レベルが高い高齢者はより呼吸筋の筋力が強かったです。加齢とともに最大呼気圧は徐々に低下していました（1年で1 cmH₂O）。活動レベルと咳嗽時の最大呼気流量、最大吸気圧、最大呼気圧に正の相関を認めました。以上より、活動レベルと加齢は呼吸筋の筋力と関係するという結論です。

呼吸筋に加齢による筋萎縮・サルコペニアを認めることは、今回の結果からも示唆されます。活動レベルと呼吸筋の筋力の関係には、全身の筋肉量や栄養状態、サルコペニアが関与している可能性があると考えます。このくらいの臨床研究なら、栄養評価も追加して実現可能ではと感じます。

Abstract

BACKGROUND:

Respiratory muscle strength is influenced by aging.

OBJECTIVES:

To assess, in a healthy elderly population, the influence of physical activity and functional performance on the pulmonary function parameters, on respiratory muscle strength and on coughing.

METHODS:

Observation study that sixty one elderly with age equal or more than 60 years (72.3 ± 7.2 years), with normal spirometry were included. Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP), Peak Expiratory Flow (PEF), Peak Cough Flow (PCF) and Human Activity Profile (HAP) were evaluated. The elderly were separated in two groups (active and moderately active) according to HAP. Student`s test was used for univariate analysis and regression analysis models was used for multivariate analysis.

RESULTS:

Elderly participants who were classified as active presented on average 13.5 cmH₂O higher MEP (88 ± 21.4 cmH₂O), and 16.2 cmH₂O higher MIP (76 ± 17.7 cmH₂O). Maximal respiratory pressure decreases 1 cmH₂O per year. The PEF and PCF were higher for male (p < 0.001) and active elderly (p = 0.046 e p = 0.004 respectively). A positive correlation was observed between HAP and the following variables: MEP MIP and PCF (r = 0.527, p < 0.001; r = 0.498, p < 0.001 and r = 0.365, p = 0.004, respectively).

CONCLUSIONS:

The active life style can positively affect the respiratory muscle strength and PCF values. Aging is associated to respiratory muscle strength reduction (both inspiratory and expiratory). Women showed lower PEmax.