{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T02:44:30Z","timestamp":1778035470043,"version":"3.51.4"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["PB-PG-0214-33060"],"award-info":[{"award-number":["PB-PG-0214-33060"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,2,7]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Neural respiratory drive (NRD) measurement, reflecting the balance between respiratory muscle load and capacity, is quantified using surface parasternal electromyography (EMG\n                      <jats:sub>para<\/jats:sub>\n                      ). EMG\n                      <jats:sub>para<\/jats:sub>\n                      tracks recovery from severe exacerbations of chronic obstructive pulmonary disease (COPD). Among stable COPD participants, we hypothesised the existence of a relationship between NRD, breathlessness and airway obstruction. Study aims: (1) assessing the feasibility of measuring EMG\n                      <jats:sub>para<\/jats:sub>\n                      in COPD participants with forced expiratory volume in 1 s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      ) \u226550% predicted in primary care; (2) investigating relationships between NRD measures, self-reported breathlessness, airflow obstruction severity and health-related quality of life (HRQoL).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants with stable mild\/moderate COPD, using inhaled corticosteroid (ICS) therapy, were recruited from 20 general practices. Participants were randomly allocated to continue using ICS (maintenance group) or to withdraw ICS (withdrawal group) over 6 weeks. EMG\n                      <jats:sub>para<\/jats:sub>\n                      , spirometry, self-reported breathlessness (modified Borg dyspnoea scale), COPD Assessment Test and Chronic Respiratory Disease Questionnaire Self-Administered Standardised were measured at baseline, 3- and 6-month follow-up. Bland-Altman plots examined agreement between serial measurements.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty COPD participants were recruited: age 70\u00b19.2 years; body mass index 26\u00b15.3\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; FEV\n                      <jats:sub>1<\/jats:sub>\n                      1.74\u00b10.54\u2009L; and FEV\n                      <jats:sub>1<\/jats:sub>\n                      % pred 69.6\u00b114.0%. High-quality EMG\n                      <jats:sub>para<\/jats:sub>\n                      data were obtained from 35 participants at baseline and 31 participants on three occasions. High intra-rater and inter-rater agreement for EMG\n                      <jats:sub>para<\/jats:sub>\n                      (intraclass correlation coefficient &gt;0.9) and moderate correlation between EMG\n                      <jats:sub>para<\/jats:sub>\n                      and FEV\n                      <jats:sub>1<\/jats:sub>\n                      % predicted (r=\u22120.42; p=0.01) were recorded. No correlation was observed between resting EMG\n                      <jats:sub>para<\/jats:sub>\n                      and breathlessness or HRQoL measures across the three time points.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      EMG\n                      <jats:sub>para<\/jats:sub>\n                      measurement is feasible in primary care. In this group of COPD patients, lung function was stable across the three time points and EMG\n                      <jats:sub>para<\/jats:sub>\n                      was associated with the degree of airflow obstruction. In the resting stable state in mild\/moderate disease, there was no association between EMG\n                      <jats:sub>para<\/jats:sub>\n                      and participant-reported outcomes. Further work should investigate the utility of EMG\n                      <jats:sub>para<\/jats:sub>\n                      in mild\/moderate COPD participants during acute exacerbation and recovery.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003418","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:40:19Z","timestamp":1775842819000},"page":"e003418","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Parasternal electromyography in participants with mild or moderate chronic obstructive pulmonary disease in primary care: cohort study to assess technical and clinical application"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn65344386","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3891-9157","authenticated-orcid":false,"given":"Timothy 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