Mullers Manoeuvre, an Autonomic Approach to the Treatment of Bronchoconstriction Relevance in Clinical Trials

Abstract

Khalid Abou Farha

Background: Many respiratory clinical trials include sputum induction to evaluate airway inflammation and monitor treatment response. This may cause airway autonomic dysregulation and induces bronchoconstriction necessitating discontinuation of the procedure and administration of β2 adrenergic receptor agonists such as salbutamol. Müller’s manoeuvre is a technique that has been proposed for the diagnosis of sleep apnoea syndrome. The manoeuvre induces an autonomic response consisting of increased sympathetic flow and withdrawal of parasympathetic activity. It is therefore, conceivable that Müller’s manoeuvre may exhibit a bronchodilator effect.

Patients and Methods: The potential bronchodilator effect of Müller’s manoeuvre has been assessed in 9 healthy subjects and 11 patients with moderate to severe COPD. All patients had undergone sputum induction procedure. Thereafter, patients were asked to perform Müller’s manoeuvre. Pre- sputum, post -sputum and post- manoeuvre assessment of 3 spirometry parameters, FVC, FEV1 and FEV1/ FVC ratio, has been performed. In healthy subjects, spirometry testing was done at 2 time points, before and after Müller’s manoeuvre.

Results: Ten COPD patients out of 11 completed Müller’s manoeuvre. The manoeuvre was poorly tolerated in one subject. In the remaining 10 patients, the manoeuvre led to clinically relevant improvement in the declined spirometry parameters and obviated the need to use pharmacological bronchodilator. In healthy subjects, Müller’s manoeuvre caused increase in FEV1 and FVC however, less pronounced than in COPD patients.

Conclusion: Müller’s Manoeuvre showed a potential bronchodilator effect and produced clinically meaningful improvement in post-sputum induction bronchoconstriction. It obviated the requirement to use bronchodilator therapy in all 10 patients. The data in this report suggest that Müller’s Manoeuvre might be used as a first aid measure to treat bronchoconstriction and may serve as a potential alternative to B2 agonists in COPD patients participating in clinical trials. Further investigations to confirm this finding are still warranted.

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