Breathing Issues Research Articles

Home birth is unsafe: FOR: The safety of planned homebirths: a clinical fiction.

Patient safety measures and a culture of safety improve obstetric outcomes (Grunebaum A. et al. Am J Obstet Gynecol 2011; 204: 97–105). The tools of obstetric patient safety include teamwork, team training, emergency drills, audits, best-practice protocols, safety checklists, outside review of performance, caesarean delivery, and access to specialised care. It takes a clinical village to improve safety in childbirth—that clinical village is absent in homebirths. Birth at home without advanced equipment or breadth of well trained personnel and essential clinical services leads to inadequate patient safety and unacceptable preventable adverse outcomes such as increased neonatal and delivery related perinatal deaths, and low Apgar scores (Grunebaum et al. Am J Obstet Gynecol 2014; 211: e1–7; Evers et al. BMJ 2010;341;c5639; Grunebaum et al. Am J Obstet Gynecol. 2013;209:323; e1–6). Consider the striking range of clinically significant conditions that cannot be adequately addressed in homebirths. In emergencies such as cord prolapse, cord compression, abruptio placentae, ruptured uterus, and fetal heart decelerations, transport from home to a medical facility to manage such emergencies is delayed. Timely caesarean delivery within the standard of care, an intervention maligned by some homebirth advocates, saves women and newborns daily in hospitals worldwide and is unavailable at homebirths. Pre-eclampsia can occur without warning and requires immediate treatment to prevent adverse outcomes. Magnesium sulphate, the main agent to treat pre-eclampsia and prevent eclampsia, requires intensive monitoring of the pregnant and fetal patient and cannot be appropriately administered at homebirths. Shoulder dystocia occurs often without apparent risks and requires an experienced team to perform the right manoeuvres and to resuscitate the newborn. This team is unavailable in homebirths. Homebirth midwives in the USA sometimes attempt breech presentations, twin deliveries, and trial of labour after caesarean. These and other conditions with potentially adverse outcomes require teamwork, extensive expertise, neonatal and anaesthesia support, and equipment such as ultrasonography. None of these is available in homebirths. Postdate pregnancies constitute about 25% of homebirths in the USA and often require electronic intrapartum fetal monitoring unavailable in homebirths. Neonatal complications, breathing issues, meconium aspiration, and previously undiagnosed fetal anomalies can occur unexpectedly and may require immediate resuscitation, intubation and mechanical ventilation usually by paediatricians or neonatologists, who are unavailable in homebirths. Maternal complications, extensive cervical lacerations, sidewall lacerations, retained placenta, and excessive postpartum haemorrhage may require equipment, positioning, adequate anaesthesia and personnel as well as access to blood products that are unavailable at homebirths. Despite an increase in unacceptable preventable adverse outcomes, homebirth proponents nevertheless claim that planned homebirth is safe because of the supposed selection of low-risk pregnancies. This claim of safe homebirths requires the adoption of clinical fiction—the existence of no-risk pregnancies. Such clinical fiction has no place in professionally responsible obstetric care (Chervenak FA et al. Am J Obstet Gynecol 2013;208:31-8).

April 2015 pulmonary case of the month: get down

History of Present Illness A 59 year old woman was admitted with hypercapnic respiratory failure and an altered mental state. She had progressive “breathing issues” for the last year and was increasingly error prone with decreased mental acuity at the end of her work shift for the last 6 months. She was on oxygen at 2 L by nasal cannula at home and has had several admissions over the last 3 months for hypercapnic respiratory failure.

Australian training for contemporary airway management of obstructive sleep apnoea in ENT surgery: current status and future recommendations.

The identification and treatment of adult obstructive sleep apnoea and other sleep-related breathing issues demands nuanced clinical judgement to determine if surgery is appropriate and which surgery should be performed. No study to date has evaluated the sleep medicine curriculum from the perspective of the Australian ENT surgical trainee, or addressed potential strategies for improving levels of surgical skill and knowledge in this field. A cross-sectional survey was used to assess knowledge of sleep surgery in trainees enlisted with the Australian Society of Otolaryngology Head and Neck Surgery. After a cadaver dissection workshop on the latest reconstructive surgical techniques in adult OSA, a second survey was used to assess changes in the likelihood of applying techniques. Overall, trainee confidence, knowledge and exposure to sleep-disordered breathing cases averaged below 50 per cent. The cadaver dissection workshop achieved consistent improvements in all areas assessed. Low confidence and lack of exposure to sleep surgery cases for ENT trainees supports a broadening of the Australian Society of Otolaryngology Head and Neck Surgery curriculum. This paper outlines possible ways to improve this situation.

Aortopexy for Innominate Artery Compression of the Trachea

Tracheomalacia is a rare congenital condition that results from improper formation of the cartilaginous tracheal rings, but is often seen in children who have esophageal atresia with/without trachea-esophageal fistula. This causes the trachea, which is the main airway, to be floppy, and as the child grows, can result in breathing difficulties. These difficulties are usually manifested as breathing noises that may change with position and improve during sleep, or that get worse with coughing, crying, or feeding. Upper respiratory infections can also be more common. While most cases of tracheomalacia resolve by 18 to 24 months of age, a small percentage either continue or cause such severe breathing or feeding issues that surgical intervention is warranted. In cases where the innominate artery is the cause of compression of the weakened trachea, an aortopexy to elevate the vessel up to the sternum and away from the trachea is performed.

Prader-Willi Syndrome and Sleep-Disordered Breathing

Prader-Willi Syndrome is a complex neurogenetic disorder characterized by appetite dysregulation, obesity with decreased muscle mass and increased fat mass, behavioral problems, various endocrinopathies, and sleep and respiratory abnormalities. Respiratory issues include both central and obstructive sleep apnea, excessive daytime sleepiness, narcolepsy, and impaired ventilatory control. There is some controversy as to whether growth hormone treatment, which is the standard of care for patients with Prader-Willi Syndrome, exacerbates or ameliorates the sleep-disordered breathing issues associated with this syndrome. The natural history of sleep and breathing issues and the issues surrounding growth hormone treatment on sleep-disordered breathing are discussed.

Analyzing Urban Green Space Function Emphasizing Green Space Features in District 2 of Tabriz metropolis in Iran

Urban green spaces can be a comprehensive tool for long term protection of environmental sustainability through improving the quality of life. With urban areas development, population growth and activities increase, urban planners prioritized green spaces and breathing issues in the top of their studies; time lapse and outbreak of respiratory illnesses, resulting from pollution and population density, necessitated deep studies of these phenomena. By the appearance of sustainable development theory the plan of developing green spaces achieved a great importance. Nowadays, developing green spaces, especially parks, is a substantial element of urban development plans which reveals the importance of such spaces in human centers. Land price increase and owners' attempts for converting gardens and farms into inhabitable areas have decreased green spaces. From the other hand, the concept of city without green spaces in their different forms is not imaginable. Urban development repercussions and environmental complexities have necessitated the existence of green spaces. Cities have to accept the structure and functions resulting from natural systems to guaranty their own survival. Referring to green spaces as the lungs of the city seems reasonable; thus, this study aims to examine the status of green spaces, focusing on District 2 of Tabriz and its strengths and weaknesses.

Travellers' tales: spirometry training in Nepal

In Nepal there is very little functioning governmental healthcare at the hospital level for a population of around 29 million people. Most hospitals are private initiatives and patients have to pay cash for their treatment. The remote Amppipal Hospital in Gorkha district (fig. 1) is run by a local committee of villagers with the support of non-governmental organisations, like Nepalmed Germany. Nepalmed is a Germany-based group of volunteers from all over the world supporting Nepalese activities in the field of healthcare. The report on the World Spirometry Day 2012 event in the Nepalese capital Kathmandu in the September issue of Breathe [1] inspired me to write about my training sessions in Nepal. In Germany, I worked as a respiratory physician in private practice for 5 years, after a 10-year period spent working in teaching hospitals. In my spare time, I am chairman of Nepalmed and for 4 years have organised medical surveys in Amppipal, Nepal to learn more about the medical needs of the local population. This helps with planning of medication and equipment supplies. It also helps provide specialised physicians to teach the hospital personnel efficient diagnostic and therapeutic procedures. Figure 1 Map of Nepal showing the locations of the hospitals. There has been no dedicated spirometry curriculum in Germany for doctors or nurses. A small group of German respiratory physicians, called The Doctor's Group for Diagnostic Lung Function, has promoted a standardised approach to teaching. This comprised a half-day session in two parts: a lecture on basic principles, followed by practical training using spirometers provided by the respiratory physician as well as the general practitioner's own spirometers. The event ended with case discussions and a written test, which is discussed after completion with all participants. After 1–2 years, an advanced course or a refresher course can be taken. …

Breathe has a new Chief Editor

2012 has been the year of the Games of the XXX Olympiad with more than 10,000 athletes from 204 countries competing in London. One of the highlights of the memorable summer was the men's 4×100 metre relay competition in which Usain Bolt powered Jamaica to a world-record time of 36.84 seconds, winning his third gold medal of the games. Most journals run their own slower version of a relay race, with the Editors changing every few years. The September issue of Breathe was Prof. Leif Bjermer's last before he passed on the Editorial baton. He leaves Breathe very well placed. At present, each edition of Breathe goes out to ∼15,000 subscribers with two-thirds of the readership in Europe and one-third in the USA and the rest of the world. Testament to Breathe 's wide reach, the website has had visits from 162 countries. So the journal has a truly global …

Solitary giant neurofibroma of the neck subjected to photodynamic therapy: case study

Photodynamic therapy (PDT) - the fourth modality - has been successfully used in the management of early and advanced pathologies of the head and neck. We studied the effect of this modality on a giant solitary neurofibroma of the neck. A 70-year-old Caucasian female presented with left neck pain and disfigurement associated with slight shortness of breath and dysphagia. Examination revealed a large mass in the neck with no neurovascular compromise. Magnetic resonance imaging (MRI) reported a heterogeneously enhancing mass extending from the left angle of the mandible to the base of the neck. A core biopsy was performed and histopathological examination revealed a disorganised array of peripheral nerve fascicles. The patient elected to receive photodynamic therapy as the primary intervention. The multi-disciplinary meeting approved the treatment plan. The photosensitizing agent was mTHPC (0.15 mg/kg), which was systemically administered 96-hours prior to ultrasound (US)-guided light delivery to the mass, which was undertaken under general anaesthesia. Recovery was uneventful.Post-PDT follow-up showed that the patient’s pain, dysphagia and shortness of breath issues had improved. The disfigurement of the neck caused by the mass was no longer a problem. Three months post-PDT, MRI revealed a significant reduction in the neurofibroma size. PDT was proven as a successful primary intervention for this pathology. However, higher evidence-based studies are required before this therapy can be proposed as a replacement to any of the other conventional therapies.

The changing perspectives of respiratory diseases in infancy and childhood

In this issue of Breathe , we highlight paediatric respiratory medicine with four reviews on diseases that are common and/or for which there has been an increase in knowledge and an improvement in care during the last decade, with possible long-term consequences. Awareness has markedly grown that respiratory problems at birth, during the neonatal period and/or in early infancy very often have consequences into adult age [1, 2]. The fact that children born prematurely are at …

A boy with recurrent pneumonia

In the previous issue of Breathe , the case of a 6-yr-old boy who had been admitted to the paediatric department of the University of Heraklion was introduced. After diagnosis of pneumonia and treatment, he was discharged and returned to normal life. 12 months later, the patient was readmitted with fever (38.5°C), dyspnoea and cough for 2 days. He appeared ill. His body temperature was 36.7°C, respiratory rate was 26 breaths·min−1, pulse was 108 beats·min−1 and O2 saturation was 93%. On chest auscultation, he had decreased breath sounds over the right hemi-thorax. S1 and S2 cardiac sounds were normal with no murmur and …

Practical issues about sleep disorders and the diagnosis of chronic cough

This issue of Breathe has two main topics. On the one hand, three articles deal with sleep disorders and, on the other hand, one article discusses important clinical issues in chronic cough. Sleep disorders have a significant clinical impact, with both health and socially relevant importance. The high number of patients suffering from these problems (in some cases with life-threatening symptoms) and the burden on healthcare organisations related to the impact of long-term cost justify the interest in sleep respiratory disorders. The social impact relates to traffic, domestic and workplace accidents that are directly related to sleep disorders. Continuous positive airway pressure (CPAP) is one of the fundamental bases for sleep disorder treatment in adults. Closing the circle of detection, diagnosis, degree of pressure and compliance is sometimes very complex. The variability across different European countries probably responds to the different solutions adopted in …

Successful implementation of a family and patient activated rapid response team in an adult level 1 trauma center

Background When cardiac arrests occur in hospitalized patients, delays in treatment are associated with lower survival and poorer outcomes. Patients often show a physiological deterioration hours before cardiac or pulmonary arrest. As a result, many hospitals have implemented a rapid response team (RRT) as part of their involvement in the 100,000 Lives Campaign sponsored by the Institute for Healthcare Improvement. Method In conjunction with the University Health System Consortium (UHC) Patient- and Family-Centered Care Implementation Collaborative, Shands Jacksonville Medical Center (SJMC) launched a pilot RRT program in October 2006 followed by campus-wide implementation in July 2007. The program was enhanced to allow patient and family activation of the RRT in October 2007. Results A review of the first 2 years of data indicates that the SJMC RRT received 25 patient or family activated calls. Forty-eight percent of the calls were initiated by a family member and 52% by the actual patient. Reasons for the calls have varied but the most frequent reason identified by the patient or family member was “something just doesn’t feel right” with the patient. Other leading reasons for calls were similar to criteria that are used by staff-initiated calls, such as shortness of breath and pain issues. Conclusion This is one of the first initiations of a family activated component of the RRT in an adult hospital that has led to improvements in outcomes such as reduction in mortality rates and non-ICU codes, without an overload of false positive calls.

TRPA1 ion channels: a gateway to airway irritation and reflex responses induced by inhaled oxidants

TRPA1 ion channels: a gateway to airway irritation and reflex responses induced by inhaled oxidants

Smoking bans, politics and respiratory medicine

Exposure to environmental tobacco smoke (ETS) - so-called “passive smoking” - remains a major source of excess morbidity and mortality in Europe and places a significant burden on society. A comprehensive and coordinated effort towards a “smoke-free Europe” should be one of the major priorities in public health and is considered as such by the European Commission (EC), which committed itself in its Environmental and Health Action Plan (2004–2005) to “develop work on improving indoor air quality in particular by encouraging the restriction of smoking in all workplaces by exploring both legal mechanisms and health promotion initiatives at both European and member state level”. There have been significant steps in the EU to promote smoke-free environments, and in this issue of Breathe , the experience of the legislation against smoking in public places in Ireland provides information on how this can be achieved and the impacts of such a ban. A further article in this issue on tobacco control in central and eastern Europe indicates the need for further efforts in this area.

Be Prepared

Be Prepared

Breathe– the present issue – Issue 3

The present third issue of Breathe presents, as previous issues have, a combination of educational Review articles, Hot topic summaries of papers published in other journals with comments from senior pulmonologists and paediatric pulmonologists, material from ERS School courses and educational Case presentations.

Breathe: the second issue

We are proud to present the second issue of Breathe , the new educational journal from the European Respiratory Society (ERS). Following its launch during the Annual ERS congress in Glasgow, Breathe will now be produced four times per year. As in the first issue, each edition will consist of a number of Review articles, several Hot Topic evaluations of important articles from other scientific journals, and Case Studies and Image Case Presentations.

A new “breath” from the European Respiratory Society School

We are proud to present the first issue of Breathe , a new initiative from the European Respiratory Society (ERS) and the ERS School. The objective of Breathe is to bring educational material of high quality to the members of the ERS, as well as to other interested readers. For the respiratory physician whose work is mainly clinical, for allied health professionals and for respiratory paediatricians working mainly in the clinical field, Breathe will try to help keep you updated on the different fields of respiratory medicine. Breathe will bring review articles of high quality, interesting and intriguing case reports, reviews of recently published scientific articles in the manner of the former European Respiratory Topic , and material for self study and self-evaluation. All of this will be presented quarterly, with an easy and colourful layout with many illustrations, in order to be easily readable and accessible.