Assessment Of Respiratory Diseases Research Articles

Feasibility and value of a domiciliary spirometry programme in the assessment of severe asthma: a real-world evaluation.

Domiciliary spirometry (DS) is a novel tool that is widely employed in the assessment of respiratory disease. We assessed real-world feasibility, effectiveness and value of a physiologist-led home spirometry programme in patients with treatment-refractory severe asthma. Patients were referred and provided with a hand-held DS device. Patients completed baseline measurements in a physiologist-led virtual clinic and were instructed to provide further values during any periods of respiratory symptoms. Outcome measures included prevalence of new obstructed events, DS adherence and uptake of this approach. 112 patients were enrolled from November 2020 to January 2023. 102 individuals, mean±sd age 44±13 years (86% female) with median (IQR) forced expiratory volume in 1 s % predicted 88% (77-97%), successfully recorded baseline spirometry values. During follow-up (24 months), 11 (11%) were identified with new obstructive spirometry and were subsequently able to be commenced on biologic therapy. Patient engagement was poor with median (IQR) of 4 (2-6) attempts of contact made before baseline values were recorded, and 2 (1-3) attempts required to record technically acceptable values. Continued DS use was suboptimal; 34% failed to use their device after baseline and only 10% continued at the end of the study period. The cost of DS measurements was greater than a single hospital-based visit but enables multiple event capture. Overall, DS measurement uptake was poor, with a minority of patients continuing to use the device at the end of the study period. However, for those that engage, DS provides an alternative approach to traditional hospital-based spirometry measurements that can alter clinical management.

Prediction of Pulmonary Function Parameters Based on a Combination Algorithm.

Objective: Pulmonary function parameters play a pivotal role in the assessment of respiratory diseases. However, the accuracy of the existing methods for the prediction of pulmonary function parameters is low. This study proposes a combination algorithm to improve the accuracy of pulmonary function parameter prediction. Methods: We first established a system to collect volumetric capnography and then processed the data with a combination algorithm to predict pulmonary function parameters. The algorithm consists of three main parts: a medical feature regression structure consisting of support vector machines (SVM) and extreme gradient boosting (XGBoost) algorithms, a sequence feature regression structure consisting of one-dimensional convolutional neural network (1D-CNN), and an error correction structure using improved K-nearest neighbor (KNN) algorithm. Results: The root mean square error (RMSE) of the pulmonary function parameters predicted by the combination algorithm was less than 0.39L and the R2 was found to be greater than 0.85 through a ten-fold cross-validation experiment. Conclusion: Compared with the existing methods for predicting pulmonary function parameters, the present algorithm can achieve a higher accuracy rate. At the same time, this algorithm uses specific processing structures for different features, and the interpretability of the algorithm is ensured while mining the feature depth information.

A Patent Review of Lung-airway Modeling with Tangential Digital Twin Technology

Background: The digital twin as an integrated technology has been widely used in the medical field. Currently, the application of digital twin technology in the field of respiratory science is mostly theoretical exploration, with less applied technical research. Therefore, this has greatly limited the development of lung-airway models and devices that cope with digital twin technology in clinical settings and has also hindered the development of digital twin technology. Objective: The aim of this study is to propose an effective physical model to simulate the human environment as an efficient means to develop and improve the digital twin technology. Method: A representative set of patents related to physical models of the respiratory tract and lungs is presented, including methods for model building and ways to assess and predict the diagnosis of respiratory diseases. Results: Current patents are analyzed and compared in three aspects: physical models, model building methods, and respiratory disease assessment and prediction. A digital twin modeling approach, including mechanical effects, biological evolution, physiological tissue changes, and physical entity coupling is proposed based on the hardware support involved in rapid prototyping techniques and method patents. The advantages and disadvantages of the existing models are analyzed, and the systematicity, applicability, modeling techniques, and fidelity of the digital twin physical model are discussed. Conclusion: Lung airway models are already based on complete morphological data, but purely physical models cannot reproduce the real environment of the human body. Therefore, in order to reach the heights of digital twins, the intervention of numerical theory and related auxiliary hardware is often required.

Genetic loci for lung function in Japanese adults with adjustment for exhaled nitric oxide levels as airway inflammation indicator

Lung function reflects the ability of the respiratory system and is utilized for the assessment of respiratory diseases. Because type 2 airway inflammation influences lung function, genome wide association studies (GWAS) for lung function would be improved by adjustment with an indicator of the inflammation. Here, we performed a GWAS for lung function with adjustment for exhaled nitric oxide (FeNO) levels in two independent Japanese populations. Our GWAS with genotype imputations revealed that the RNF5/AGER locus including AGER rs2070600 SNP, which introduces a G82S substitution of AGER, was the most significantly associated with FEV1/FVC. Three other rare missense variants of AGER were further identified. We also found genetic loci with three candidate genes (NOS2, SPSB2 and RIPOR2) associated with FeNO levels. Analyses with the BioBank-Japan GWAS resource revealed genetic links of FeNO and asthma-related traits, and existence of common genetic background for allergic diseases and their biomarkers. Our study identified the genetic locus most strongly associated with airway obstruction in the Japanese population and three genetic loci associated with FeNO, an indicator of type 2 airway inflammation in adults.

Validity of Lung Ultrasound: Is an Image Worth More Than a Thousand Sounds?

Introduction: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). Results: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%; p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%; p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%; p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B-lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. Conclusions: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.

A beginner's guide: practical feline rhinoscopy

Respiratory endoscopy, when performed by an experienced clinician, can be one of the most valuable diagnostic tools available for the evaluation of airway diseases in feline patients. Specific procedures have been developed to allow for the assessment of respiratory diseases affecting both upper (nasal cavity, larynx, nasopharynx, sinuses) and lower airways (tracheobronchial tree). This first part of this article series will focus on the indications, equipment, procedure and visual appearance of the upper airway in cats as viewed using upper airway endoscopy (laryngoscopy, retrograde pharyngoscopy, and rigid anterograde rhinoscopy).The second part of the series will focus on the indications and equipment needed to perform lower airway endoscopy (laryngoscopy and tracheobronchoscopy). As with many procedures, the benefits and results obtained from these procedures will relate to the degree of experience of the endoscopist. 10.12968/coan.2014.19.1.22

HRCT and MRI of the lung in children with cystic fibrosis: Comparison of different scoring systems

Chest imaging is essential in the assessment of respiratory disease in cystic fibrosis (CF). High-resolution computed tomography (HRCT) can detect progressive lung disease but involves significant delivered dose of ionizing radiation. Magnetic resonance imaging (MRI) is radiation-free but is rarely used in CF. Based on the limited information on the potential interest of chest MRI in CF pediatric patients, the aims of our study were: 1) to evaluate and compare the reproducibility of HRCT and MRI scores; and 2) to evaluate the agreement between HRCT and MRI scores using both Helbich and Eichinger scores. In this prospective study, CF children who were having a HRCT for their routine assessment were proposed to perform a chest MRI the same day. 17 patients were included (median age 12.7 years). Two radiologists scored independently HRCT (Helbich score) and MRI (Helbich and Eichinger scores); and established a consensus score. Concordance was assessed using the Intraclass Correlation Coefficient (ICC); and the inter-observer reproducibility between methods was compared using Fisher's Z test for dependent observations. Concordance between readers was almost perfect for HRCT score (ICC = 96%) and MRI-Eichinger score (84%), and substantial for MRI-Helbich score (68%). Correlation was strong between HRCT and MRI (r = 0.86 and 0.91 for HRCT and respectively MRI-Eichinger and MRI-Helbich scores) and the concordance almost perfect and substantial (ICC = 86% and 78% for HRCT and respectively MRI-Eichinger and MRI-Helbich scores). We showed that, in CF children, MRI could adequately visualize lung morphologic changes when compared with the "gold-standard" HRCT. Regarding the potential cancer risks from associated ionizing radiation with HRCT, these results lead us to propose larger intervals of time between two lung HRCTs with realization of lung MRI in the meantime.

Simplified detection of eosinophils in induced sputum

The induction of sputum is a safe, noninvasive method of studying airway inflammation in asthma, but the method of analyzing the samples is laborious and requires well-trained technicians using highly specialized laboratory equipment. We introduce a shorter and simpler modification of the process for identifying eosinophilic inflammation from induced sputum (IS) samples. Samples of 81 patients referred for IS assessment of respiratory diseases were studied. Four different assessment approaches were studied in comparison with the conventional method of selecting plugs proposed by the European Respiratory Society/American Thoracic Society task force. One modification of the conventional method of IS processing emerged as simpler to execute and less technologically demanding than the original one (13.0±18.2 vs. 15.4±22.4% eosinophils, P=0.19). The simpler approach should now encourage the use of IS as a convenient procedure for evaluating eosinophilic inflammation in less sophisticated laboratories.

609 A combined high temporal and high spatial resolution 3 Tesla MR imaging protocol for the assessment of breast lesions: initial results

Chest imaging is essential in the assessment of respiratory disease in cystic fibrosis (CF). High-resolution computed tomography (HRCT) can detect progressive lung disease but involves significant delivered dose of ionizing radiation. Magnetic resonance imaging (MRI) is radiation-free but is rarely used in CF. Based on the limited information on the potential interest of chest MRI in CF pediatric patients, the aims of our study were: 1) to evaluate and compare the reproducibility of HRCT and MRI scores; and 2) to evaluate the agreement between HRCT and MRI scores using both Helbich and Eichinger scores.In this prospective study, CF children who were having a HRCT for their routine assessment were proposed to perform a chest MRI the same day. 17 patients were included (median age 12.7 years). Two radiologists scored independently HRCT (Helbich score) and MRI (Helbich and Eichinger scores); and established a consensus score. Concordance was assessed using the Intraclass Correlation Coefficient (ICC); and the inter-observer reproducibility between methods was compared using Fisher's Z test for dependent observations.Concordance between readers was almost perfect for HRCT score (ICC = 96%) and MRI-Eichinger score (84%), and substantial for MRI-Helbich score (68%). Correlation was strong between HRCT and MRI (r = 0.86 and 0.91 for HRCT and respectively MRI-Eichinger and MRI-Helbich scores) and the concordance almost perfect and substantial (ICC = 86% and 78% for HRCT and respectively MRI-Eichinger and MRI-Helbich scores).We showed that, in CF children, MRI could adequately visualize lung morphologic changes when compared with the “gold-standard” HRCT. Regarding the potential cancer risks from associated ionizing radiation with HRCT, these results lead us to propose larger intervals of time between two lung HRCTs with realization of lung MRI in the meantime.

Measurement of pulmonary function with body plethysmograph in infants

To observe the alterations of pulmonary function in infants with respiratory diseases. A total of 900 infants with respiratory diseases were recruited and pulmonary function measured in 30 healthy infants. The tests were performed in the sleeping infants with sedation. Tidal breathing flow-volume (TBFV) loops were recorded when infants were breathing quietly. Passive flow-volume technique was used to obtain static respiratory system compliance and resistance. Functional residual capacity was measured by body plethysmograph. The TBFV loop showed proximate round or oval curve in healthy infants. The shape and parameters of TBFV loop had significant differences in infants with respiratory diseases as compared with healthy controls. The TBFV loop displayed a concave expiratory curve and ratio of time to reach tidal peak flow to total expiratory time, the expiratory volume till peak flow divided by the total expiratory volume significantly decreased in infants with small airway obstruction. The expiratory or inspiratory curve showed a plateau and the ratio of mid-expiratory to mid-inspiratory flow was less than 60% or over 150% in infants with upper airway obstruction. The TBFV loop turned narrow and lung volume decreased in infants with restrictive diseases. The TBFV loop show proximate round or oval curve in healthy infants. Pulmonary function has significant differences between healthy controls and infants with respiratory diseases. Pulmonary function test is useful in the assessment of respiratory diseases.

The Keokuk County Rural Health Study

ABSTRACT The Keokuk County Rural Health Study is a unique, population-based, prospective study of an agricultural community. The study is expected to continue for twenty years. The research includes systematic assessment of respiratory disease, injury, and other health outcomes in relation to agricultural, occupational, and environmental exposures. The aims of the environmental surveys are: (1) to conduct a systematic assessment of rural households in order to characterize the environmental exposures associated with the resi-dences and properties of the study subjects comparing farm, rural non-farm, and town households; and (2) to characterize occupational exposures associated with activities of the study subjects, particular-ly those related to farming and the rural environment. The environ-mental surveys consist of a combination of personal interviews, walk-through observations, and measurement of a selected number of environmental parameters. The focus of these assessments is on the environment and operations of the household and farm. Four instruments are used to record data: a Home Environmental Ques-tionnaire; a Home/Grounds Environmental Checklist; a Farm Envi-ronmental Questionnaire; and a Farm Environmental Checklist. Pre-liminary results from the first 106 environmental assessments are described, including the first 26 farms. More than half of residences were built before 1950, and they are primarily heated with liquid propane gas, natural gas, or wood. Dangerously high levels of car-bon monoxide were measured in several homes during winter 1995/96. Only 77 of 148 smoke detectors functioned. Farms ranged from 7 to 1,600 acres, with a mean of 324 acres. Eleven raised swine in enclosed systems. The average age of tractors in use was 26 years. Twenty-eight percent of all tractors had cabs, 25% had ROPS, and 39% had PTO shields.

Respiratory disease in systemic lupus erythematosus: correlation with results of laboratory tests and histological appearance of muscle biopsy specimens.

In systemic lupus erythematosus, certain laboratory tests and evidence from muscle biopsy specimens of lymphocytic vasculitis reflect disease activity. A study was designed to determine if such indices predict respiratory lesions, and in particular whether the presence of vasculitis in quadriceps muscle reflects respiratory muscle function. Twenty seven 27 patients with systemic lupus erythematosus were studied, ten of whom were consecutive untreated patients and 17 having clinically active disease and being treated. They were prospectively evaluated on the basis of erythrocyte sedimentation rate, lymphocyte count, C3 degradation products, quadriceps muscle biopsy, spirometry, lung volumes, carbon monoxide transfer factor, and mouth pressure during a maximal sniff. Lung function test results were abnormal in 12 patients. Vital capacity was reduced in seven, carbon monoxide transfer factor capacity in five, and mouth pressure was low (< 70% predicted) in ten. Lymphocytic vasculitis was seen in the muscle biopsy specimens of ten patients. No correlation was found between laboratory tests and lung function or mouth pressure, or between the presence of lymphocytic vasculitis and mouth pressure. In untreated patients, those with lymphocytic vasculitis had lower spirometric values. In systemic lupus erythematosus, evidence from muscle biopsy specimens of lymphocytic vasculitis is not predictive of impaired inspiratory muscle function as measured by mouth pressure. In untreated patients there were relationships between some laboratory test results and respiratory function, but this was not the case for the whole group. In systemic lupus erythematosus, laboratory tests and evidence from muscle biopsy specimens of lymphocytic vasculitis are therefore unlikely to be helpful in the assessment of respiratory disease.

Assessment of respiratory diseases and therapeutic intervention by the forced oscillation technique in feedlot cattle

The forced oscillation technique was used to study pulmonary function in bulls during naturally acquired pulmonary-gastrointestinal disease complex known as shipping fever and as it was treated with two different antibiotics. Fifteen double-muscled bulls of the Belgian White and Blue breed were investigated. Clinical, serological and pulmonary function values were recorded during and after naturally occurring respiratory disease. Total respiratory resistance (R rs) and reactance (X rs) were measured by the forced oscillation technique. The antibiotic ceftiofur (group A, n =10) and oxytetracycline (group B, n = 5) were given over three days. A large increase of R rs at low frequencies with a marked negative frequency dependence, an increase of the resonant frequency, and a decrease of X rs were recorded in the initial stage of the disease. The parameters returned to normal values seven days later. Clinical evidence of recovery was more marked in group A than in group B. These results show that moderate shipping fever induces acute small and large airway obstruction which responds to appropriate antibiotic therapy.

An scanning electron microscopic study of adenocarcinoma cells in pleural effusions

Cytodiagnosis of pleural effusions is very important in the clinical assessment of respiratory diseases. The existence of cancerous cells in effusions is a good evidence of indicating malignant nature of the disease process, and thus determines the treatment and prognosis of the patients. Observation of the cells derived from pleural effusion with light microscopy or transmission electron microscopy can perform detailed analysis of the cytoplasm and the nucleus. It is expected that other useful morphologic data is still contained on the plasmic membrane or cell surface. However, this can only be explored by scanning electron microscopy. In order to understand more comprehensively the surface structure of malignant cells in pleural effusion, specimens obtained from 69 patients including 26 men and 43 women were examined with scanning electron microscope in this study. The clinical diagnosis was primary adenocarcinoma of the lung in 46 patients, breast cancer in 20 patients and ovarian cancer in 3 patients. Pleural metastasis occurred in all of the patients and their chest X-ray films showed pleural effusion.

Respiration in Health and Disease

This book is the latest revision of what has been for many years a valuable textbook for introducing the medical student to respiration and providing the clinician with a concise and helpful source for reviewing this subject. The contents have been gathered, organized, and written essentially by one person, allowing for a clarity, predictability, and readability often lacking in multiauthor texts. The book is generously illustrated with superb, easily understandable drawings. One third of the book covers the basics of pulmonary physiology and pulmonary function testing, replete with the usual formulas, which here lose some of their intimidation because of a lucid and abundantly illustrated text. The sections on the manifestations and the assessment of respiratory disease are an excellent primer for respiratory history and physical diagnosis. The short chapter on radiological assessment should be read and retained by all senior medical students, no matter what their eventual interests. The

Oxygen uptake during maximal treadmill and bicycle exercise.

Oxygen uptake during maximal treadmill and bicycle exercise.