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The present study set out 1) to evaluate which voluntary respiratory maneuvers provide high and reproducible diaphragm electromyogram root-mean-square (RMS) values and 2) to determine the relative diaphragm activation and mechanical and ventilatory outputs during breathing at rest in healthy subjects ( n = 5), in patients with severe chronic obstructive pulmonary disease (COPD, n = 5), and in restrictive patients with prior polio infection (PPI, n = 6). In all groups, mean voluntary maximal RMS values were higher during inspiration to total lung capacity than during sniff inhalation through the nose ( P = 0.035, ANOVA). The RMS (percentage of voluntary maximal RMS) during quiet breathing was 8% in healthy subjects, 43% in COPD patients, and 45% in PPI patients. Despite the large difference in relative RMS ( P = 0.012), there were no differences in mean transdiaphragmatic pressure ( P= 0.977) and tidal volumes ( P = 0.426). We conclude that voluntary maximal RMS is reliably obtained during an inspiration to total lung capacity but a sniff inhalation could be a useful complementary maneuver. Severe COPD and PPI patients breathing at rest are characterized by increased diaphragm activation with no change in diaphragm pressure generation.<\/jats:p>","DOI":"10.1152\/jappl.1998.85.6.2146","type":"journal-article","created":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T13:31:34Z","timestamp":1513949494000},"page":"2146-2158","source":"Crossref","is-referenced-by-count":187,"title":["Voluntary activation of the human diaphragm in health and disease"],"prefix":"10.1152","volume":"85","author":[{"given":"Christer","family":"Sinderby","sequence":"first","affiliation":[{"name":"Guy-Bernier Research Center, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec H3C 3J7;"},{"name":"Institution of Clinical Neuroscience, University of G\u00f6teborg, G\u00f6teborg S-41346; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Beck","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Pavillion Notre Dame, University of Montreal, Montreal, Quebec H1T 2M4;"},{"name":"Department of Physiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadranka","family":"Spahija","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Pavillion Notre Dame, University of Montreal, Montreal, Quebec H1T 2M4;"},{"name":"School of Physical Therapy, McGill University, Montreal, Quebec, Canada H3A 2B2;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Huddinge Hospital, Huddinge S-14186, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Grassino","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Pavillion Notre Dame, University of Montreal, Montreal, Quebec H1T 2M4;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"24","reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1976.40.3.345"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-0813.1984.tb15535.x"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1995.79.3.975"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1996.81.3.1434"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1998.85.3.1123"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1998.85.2.451"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(84)90003-3"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/137.6.1395"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1993.74.2.688"},{"key":"B10","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S0272-5231(21)00623-7","volume":"10","author":"Burki N. 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