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One of the variations is the lung volume from which point the maximum inspiratory force maneuver is initiated&#46; Some authors perform it from functional residual capacity &#40;FRC&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;9&#44;10</span></a> while others do it from residual volume &#40;RV&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> There are also methodological differences with respect to leaving the contralateral nostril open or occluding it&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study&#44; then&#44; was to analyze the effect of 3 different methodological factors &#40;occlusion&#47;opening of the opposite nostril&#44; lung volume from which the maneuver is performed&#44; and graphical incentive&#41; on SNIP values&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This was a cross-sectional&#44; blinded study in healthy volunteers &#40;health workers&#41;&#46; The study was conducted with the approval of the ethics committee of the hospital&#44; and all subjects signed informed consent&#46; Individuals with symptoms of nasal obstruction or history of smoking&#44; any chronic drug use&#44; and alterations in forced spirometry were excluded&#46; SNIP was measured with the subject seated and using a modified device inserted into the nostril and connected to a pressure gauge &#40;TSD 104&#44; Biopac Systems&#44; Goleta&#44; CA&#44; USA&#41;&#44; the signal of which was recorded by a digital polygraph &#40;Biopac Systems&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Ten SNIP measurements were made with each of the methodological variants&#44; and the best value was selected&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> First&#44; the influence of opening or occlusion of the nostril contralateral to the one being measured was studied&#46; The influence of the expiratory lung volume from which the maneuver was performed was then studied&#44; first from RV and then from FRC&#46; Finally&#44; the influence of the graphical incentive was studied&#44; first without and then with visual stimulus &#40;graphics on the computer screen&#41;&#46; Each subject performed the same complete assessment twice at intervals of 24<span class="elsevierStyleHsp" style=""></span>h between each procedure&#46; Results are presented as mean value&#177;standard deviation&#46; Variables were compared using the Student&#39;s <span class="elsevierStyleItalic">t</span> test&#46; Data were analyzed using SPSS version 25&#46;0 &#40;IBM&#44; Armonk&#44; NY&#44; USA&#41;&#44; setting statistical significance at a <span class="elsevierStyleItalic">P</span> value &#8804;&#46;05&#46; A total of 35 volunteers &#40;24 women&#47;11 men&#41;&#44; aged 28&#177;11 years&#44; were included&#44; giving 70 assessments overall&#46; The effect on SNIP values of the 3 methodological factors analyzed is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; SNIP performed with occlusion of the contralateral nostril produced better values than those performed with the opposite nostril open &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;01&#41;&#46; There were no statistically significant differences between SNIPs performed from FRC or RV &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;1&#41;&#46; SNIP performed with visual stimulus showed better values than SNIP performed without visual stimulus &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;04&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">This study shows that&#44; in healthy subjects&#44; some of the variations in the SNIP maneuver technique influence the values obtained and therefore would not provide a true picture of the strength of the inspiratory muscles&#46; SNIP normal values have been defined by performing inspiration from FRC&#44; without occlusion of the contralateral nostril or graphical incentive&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Some authors&#44; mainly when assessing patients with neuromuscular diseases&#44; perform SNIP measurements by beginning the maneuver from RV&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> We did not find that this alternative SNIP maneuver influenced SNIP values&#46; However&#44; the ease of performing the forced inspiratory maneuver when starting from FRC or from RV should also be evaluated&#46; Although this was not assessed in our study&#44; logically the maneuver would be easier to perform from FRC&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Another of the methodological modifications is occlusion of the nostril contralateral to the one in which SNIP is measured&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> Studies in patients with neuromuscular diseases have reported that the determination of SNIP with the opposite nostril occluded produces higher values&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Indeed&#44; an improvement in SNIP values when performed with the occlusion of the other nostril was also detected in our study&#46; This improvement in SNIP values in patients with neuromuscular diseases following occlusion of the opposite nostril might fail to correctly show the strength of the inspiratory muscles&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> which is a prognostic factor for these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; in some pulmonary function tests&#44; mainly spirometry&#44; graphical incentives have been used for several years to facilitate the performance of the maneuver&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The use of graphical incentives impacts on SNIP by helping the subject achieve higher values&#46; Therefore&#44; use of this methodological modification during the measurement of SNIP should be reported&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; changes in the methodology of measuring the strength of inspiratory muscles by SNIP have an effect on the values obtained&#46; Therefore&#44; the values obtained using these variations in the accepted methodology would not correctly reflect the strength of the inspiratory muscles&#44; causing problems for patient control&#46; The SNIP measurement should be systematic&#44; standardized&#44; and as described&#44; and if modifications are introduced&#44; normal values should be found&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Bala&#241;&#225; Corber&#243; A&#44; Admetllo M&#44; Sancho-Mu&#241;oz A&#44; Alvarado M&#44; Gea J&#44; Ausin P&#44; et al&#46; Estudio descriptivo sobre la influencia de la metodolog&#237;a en la medici&#243;n de la fuerza inspiratoria m&#225;xima en nariz &#40;SNIP&#41; en poblaci&#243;n sana&#46; Arch Bronconeumol&#46; 2020&#59;56&#58;398&#8211;399&#46;</p>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">n&#46;s&#46;&#58; not significant&#59; SNIP&#58; nasal pressure during maximum inhalation&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95&#177;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91&#177;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No graphical incentive&nbsp;\t\t\t\t\t\t\n
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