{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:08:51Z","timestamp":1791212931940,"version":"4.1.0"},"reference-count":106,"publisher":"American Physiological Society","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Applied Physiology"],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:p>Inspiratory muscles are uniquely adapted for endurance, but their function is compromised in chronic obstructive pulmonary disease (COPD) due to increased loads, reduced mechanical advantage, and increased ventilatory requirements. The hyperinflation of COPD reduces the flow and pressure-generating capacity of the diaphragm. This is compensated by a threefold increase in neural drive, adaptations of the chest wall and diaphragm shape to accommodate the increased volume, and adaptations of muscle fibers to preserve strength and increase endurance. Paradoxical indrawing of the lower costal margin during inspiration in severe COPD (Hoover's sign) correlates with high inspiratory drive and severe airflow obstruction rather than contraction of radially oriented diaphragm fibers. The inspiratory muscles remain highly resistant to fatigue in patients with COPD, and the ultimate development of ventilatory failure is associated with insufficient central drive. Sleep is associated with reduced respiratory drive and impairments of lung and chest wall function, which are exaggerated in COPD patients. Profound hypoxemia and hypercapnia can occur in rapid eye movement sleep and contribute to the development of cor pulmonale. Inspiratory muscles adapt to chronic loading with an increased proportion of slow, fatigue-resistant fiber types, increased oxidative capacity, and reduced fiber cross-sectional area, but the capacity of the diaphragm to increase ventilation in exercise is compromised in COPD. In COPD, neural drive to the diaphragm increases to near maximal levels in exercise, but it does not develop peripheral muscle fatigue. The improvement in exercise capacity and dyspnea following lung volume reduction surgery is associated with a substantial reduction in neural drive to the inspiratory muscles.<\/jats:p>","DOI":"10.1152\/japplphysiol.00163.2009","type":"journal-article","created":{"date-parts":[[2009,4,23]],"date-time":"2009-04-23T21:40:57Z","timestamp":1240522857000},"page":"621-629","source":"Crossref","is-referenced-by-count":114,"title":["Respiratory muscle function and activation in chronic obstructive pulmonary disease"],"prefix":"10.1152","volume":"107","author":[{"given":"David K.","family":"McKenzie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Butler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon C.","family":"Gandevia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"24","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2008.07.025"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1997.83.4.1256"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.90745.2008"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.90336.2008"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.2003.011494"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(93)90065-I"},{"key":"R7","doi-asserted-by":"crossref","unstructured":"Aubier M\n                      , Murciano D, Fournier M, Milic-Emili J, Pariente R, Derenne JP.\n                      Central respiratory drive in acute respiratory failure of patients with chronic obstructive pulmonary disease.\n                      Am Rev Respir Dis\n                      122\n                      : 191\u2013199, 1980.","DOI":"10.1164\/arrd.1980.122.5.747"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(84)90003-3"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.6.1898"},{"key":"R10","unstructured":"Berthon-Jones M\n                      , Sullivan CE.\n                      Ventilatory and arousal responses to hypoxia in sleeping humans.\n                      Am Rev Respir Dis\n                      125\n                      : 632\u2013639, 1982."},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1164\/arrd.1986.134.5.920"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.58.3.691"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2007.145789"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1136\/thx.51.5.490"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1152\/jn.1997.78.1.170"},{"key":"R16","unstructured":"Byrd RB\n                      , Hyatt RE.\n                      Maximal respiratory pressures in chronic obstructive lung disease.\n                      Am Rev Respir Dis\n                      98\n                      : 848\u2013856, 1968."},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.5.2006055"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.156.2.9612089"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2008.09.010"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00173.2009"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1970.sp009188"},{"key":"R22","doi-asserted-by":"crossref","unstructured":"De Troyer A\n                      .\n                      Effect of hyperinflation on the diaphragm.\n                      Eur Respir J\n                      10\n                      : 708\u2013713, 1997.","DOI":"10.1183\/09031936.97.10030708"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2002.028696"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00007.2004"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.155.4.9105076"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.150.1.8025770"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.91472.2008"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2005.12.015"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/142.5.1041"},{"key":"R30","doi-asserted-by":"crossref","unstructured":"Douglas NJ\n                      , Calverley PM, Leggett RJ, Brash HM, Flenley DC, Brezinova V.\n                      Transient hypoxaemia during sleep in chronic bronchitis and emphysema.\n                      Lancet\n                      1\n                      : 1\u20134, 1979.","DOI":"10.1016\/S0140-6736(79)90451-3"},{"key":"R31","unstructured":"Druz WS\n                      , Sharp JT.\n                      Electrical and mechanical activity of the diaphragm accompanying body position in severe chronic obstructive pulmonary disease.\n                      Am Rev Respir Dis\n                      125\n                      : 275\u2013280, 1982."},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.59.2.528"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1986.61.1.220"},{"key":"R34","unstructured":"Farkas GA\n                      , Roussos C.\n                      Acute diaphragmatic shortening: in vitro mechanics and fatigue.\n                      Am Rev Respir Dis\n                      130\n                      : 434\u2013438, 1984."},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.2001.81.4.1725"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.5.9904023"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2005.101915"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.2.8564108"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1985.sp015813"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1986.60.4.1420"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(83)90015-4"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1987.sp016445"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1136\/thx.39.4.264"},{"key":"R44","unstructured":"Gilmartin JJ\n                      , Gibson GJ.\n                      Mechanisms of paradoxical rib cage motion in patients with chronic obstructive pulmonary disease.\n                      Am Rev Respir Dis\n                      134\n                      : 683\u2013687, 1986."},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.1378\/chest.98.5.1179"},{"key":"R46","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200412-1695OC"},{"key":"R47","doi-asserted-by":"publisher","DOI":"10.1016\/S0034-5687(99)00010-9"},{"key":"R48","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200111-087OC"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1136\/thx.35.10.732"},{"key":"R50","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1984.56.1.133"},{"key":"R51","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2007.137240"},{"key":"R52","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/139.2.522"},{"key":"R53","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1984.57.4.1011"},{"key":"R54","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00093408"},{"key":"R55","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/146.6.1378"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1967.sp008274"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.2.8564133"},{"key":"R58","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.6.2188"},{"key":"R59","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00739.2005"},{"key":"R60","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00869.2002"},{"key":"R61","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1988.65.2.888"},{"key":"R62","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00116.2001"},{"key":"R63","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199712183372503"},{"key":"R64","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01607.2005"},{"key":"R65","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00008.2009"},{"key":"R66","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1991.sp018681"},{"key":"R67","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.1.9903010"},{"key":"R68","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/142.2.276"},{"key":"R69","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4899-1016-5_32"},{"key":"R70","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(91)90018-E"},{"key":"R71","unstructured":"McKenzie DK\n                      , Gandevia SC.\n                      Skeletal muscle properties: diaphragm and chest wall. In:\n                      The Lung: Scientific Foundations\n                      , edited by Crystal R, West JB, Weibel ER, Barnes PJ. Philadelphia, PA: Lippincott Raven, 1997, p. 981\u2013991."},{"key":"R72","doi-asserted-by":"publisher","DOI":"10.1016\/S0034-5687(00)00172-9"},{"key":"R73","doi-asserted-by":"crossref","unstructured":"McNicholas WT\n                      .\n                      Impact of sleep in respiratory failure.\n                      Eur Respir J\n                      10\n                      : 920\u2013933, 1997.","DOI":"10.1183\/09031936.97.10050969"},{"key":"R74","unstructured":"Mizuno M\n                      .\n                      Human respiratory muscles: fibre morphology and capillary supply.\n                      Eur Respir J\n                      4\n                      : 587\u2013601, 1991."},{"key":"R75","doi-asserted-by":"publisher","DOI":"10.1136\/thx.44.11.903"},{"key":"R76","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/146.1.16"},{"key":"R77","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2201003"},{"key":"R78","doi-asserted-by":"crossref","unstructured":"Orozco-Levi M\n                      .\n                      Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation?\n                      Eur Respir J Suppl\n                      46\n                      : 41s\u201351s, 2003.","DOI":"10.1183\/09031936.03.00004607"},{"key":"R79","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.99.13237199"},{"key":"R80","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1960.15.6.1101"},{"key":"R81","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1990.68.2.484"},{"key":"R82","unstructured":"Phillipson EA\n                      .\n                      Control of breathing during sleep.\n                      Am Rev Respir Dis\n                      118\n                      : 909\u2013939, 1978."},{"key":"R83","doi-asserted-by":"publisher","DOI":"10.1152\/jn.1987.57.1.274"},{"key":"R84","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.152.3.7663810"},{"key":"R85","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2003.009894"},{"key":"R86","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.2.132"},{"key":"R87","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1966.21.2.497"},{"key":"R88","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2006.120246"},{"key":"R89","unstructured":"Rochester DF\n                      , Braun NM.\n                      Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease.\n                      Am Rev Respir Dis\n                      132\n                      : 42\u201347, 1985."},{"key":"R90","doi-asserted-by":"crossref","unstructured":"Roussos C\n                      , Koutsoukou A.\n                      Respiratory failure.\n                      Eur Respir J Suppl\n                      47\n                      : 3s\u201314s, 2003.","DOI":"10.1183\/09031936.03.00038503"},{"key":"R91","unstructured":"Sharp JT\n                      , Danon J, Druz WS, Goldberg NB, Fishman H, Machnach W.\n                      Respiratory muscle function in patients with chronic obstructive pulmonary disease: its relationship to disability and to respiratory therapy.\n                      Am Rev Respir Dis\n                      110\n                      : 154\u2013168, 1974."},{"key":"R92","unstructured":"Sharp JT\n                      , Goldberg NB, Druz WS, Fishman HC, Danon J.\n                      Thoracoabdominal motion in chronic obstructive pulmonary disease.\n                      Am Rev Respir Dis\n                      115\n                      : 47\u201356, 1977."},{"key":"R93","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1989.66.6.2539"},{"key":"R94","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199109263251304"},{"key":"R95","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1998.85.6.2146"},{"key":"R96","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.7.2007033"},{"key":"R97","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1997.82.4.1370"},{"key":"R98","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.2001.91.5.1913"},{"key":"R99","doi-asserted-by":"crossref","unstructured":"Sorli J\n                      , Grassino A, Lorange G, Milic-Emili J.\n                      Control of breathing in patients with chronic obstructive lung disease.\n                      Clin Sci Mol Med\n                      54\n                      : 295\u2013304, 1978.","DOI":"10.1042\/cs0540295"},{"key":"R100","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1522-2586(199910)10:4<510::AID-JMRI3>3.0.CO;2-G"},{"key":"R101","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00165.2009"},{"key":"R102","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.01.00014101"},{"key":"R103","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1977.43.4.600"},{"key":"R104","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1993.74.4.1475"},{"key":"R105","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(75)90059-6"},{"key":"R106","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.156.3.9702104"}],"container-title":["Journal of Applied Physiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.physiology.org\/doi\/pdf\/10.1152\/japplphysiol.00163.2009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T18:42:37Z","timestamp":1684953757000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.physiology.org\/doi\/10.1152\/japplphysiol.00163.2009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8]]},"references-count":106,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2009,8]]}},"alternative-id":["10.1152\/japplphysiol.00163.2009"],"URL":"https:\/\/doi.org\/10.1152\/japplphysiol.00163.2009","relation":{},"ISSN":["8750-7587","1522-1601"],"issn-type":[{"value":"8750-7587","type":"print"},{"value":"1522-1601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,8]]}}}