Diagnosis Of Respiratory Disorders Research Articles

Current approaches to respiratory pathology in late preterm infants

Late preterm babies are those born between 340/7 and 366/7 weeks of gestation, constituting the largest subgroup of preterm infants. Despite the relative morphofunctional maturity, these children remain at a high risk of damage to various organs and systems, and there is also a high mortality rate. One of the top places in the structure of morbidity in late preterm is occupied by respiratory disorders. Quite often there is transient tachypnea, respiratory distress syndrome of the newborn, pulmonary hypertension, and congenital pneumonia. Currently, there are various approaches to prevention, treatment, and diagnosis of respiratory disorders in late preterm children. Until now, the issue of the advisability of prenatal prevention of respiratory distress syndrome with corticosteroids after the 34th week of gestation has not been resolved. Non-invasive methods of respiratory support are more popular along with minimally invasive administration of surfactant preparations when indicated. The trend towards an annual increase in late preterm births determines the need to improve the methods of their nursing. The control over respiratory disorders and hypoxia is crucial in the prevention of adverse outcomes in late preterm children.

The optimal gestational age to deliver patients with chronic hypertension on antihypertensive therapy

Objective To identify the optimal gestational age of planned delivery in pregnancies complicated by chronic hypertension requiring antihypertensive medications that minimizes the risk of adverse perinatal events and maternal morbidity. Methods Retrospective cohort study of singleton pregnancies after 37 weeks of gestation complicated by chronic hypertension on antihypertensive medication, delivered at 7 hospitals within an academic health system in New York from 12/1/2015 to 9/3/2020. Two comparisons were made (1) planned deliveries at 37–376/7 weeks versus expectant management, (2) planned deliveries at 38–386/7 weeks versus expectant management. Patients with other maternal or fetal conditions were excluded. The primary outcome was a composite of adverse perinatal outcomes including stillbirth, neonatal death, assisted ventilation, cord pH < 7.0, 5-minute Apgar ≤5, diagnosis of respiratory disorder, and neonatal seizures. The secondary outcomes included preeclampsia, eclampsia, primary cesarean delivery, postpartum readmission, and infant stay greater than 5 days. Odds ratios were estimated with multiple logistic regression and adjusted for confounding effects. Results A total of 555 patients met inclusion criteria. Patients who underwent planned delivery at 37 weeks compared to expectant management did not appear to be at higher risk of adverse perinatal outcomes (14.9% vs 10.4%, aOR 1.49, 95% CI: 0.77–2.88). Similarly, we did not find a difference in the primary outcome in patients who underwent planned delivery at 38 weeks versus those expectantly managed (9.7% vs 10.1%, (aOR 0.84, 95% CI: 0.39–1.76). There were no differences in the rates of primary cesarean or preeclampsia at 37 and 38 weeks. Conclusion Our findings suggest that there is no difference in neonatal or maternal outcomes for chronic hypertensive patients on medication if delivery is planned or expectantly managed at 37 or 38 weeks’ gestation.

The potential of impulse oscillometry in lung function assessment in children after allogeneic hematopoietic stem cell transplantation

The article analyzes the potential of using impulse oscillometry in the diagnosis of respiratory disorders in children with oncological and hematological diseases after allogeneic hematopoietic stem cell transplantation (HSCT). The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. A comparative analysis of parameters of impulse oscillometry and spirometry before and on Days 30, 90, 180 and 360 after HSCT was carried out. It was revealed that pulmonary ventilation function impairments are quite common in this group of patients, worsening significantly by month 3 of follow-up. An increase in reactance at a frequency of 5 Hz is one of the earliest signs of impaired respiratory function, which can be used for timely diagnosis of pulmonary complications after allogeneic HSCT.

Conditional GAN based augmentation for predictive modeling of respiratory signals

Respiratory illness is the primary cause of mortality and impairment in the life span of an individual in the current COVID–19 pandemic scenario. The inability to inhale and exhale is one of the difficult conditions for a person suffering from respiratory disorders. Unfortunately, the diagnosis of respiratory disorders with the presently available imaging and auditory screening modalities are sub-optimal and the accuracy of diagnosis varies with different medical experts. At present, deep neural nets demand a massive amount of data suitable for precise models. In reality, the respiratory data set is quite limited, and therefore, data augmentation (DA) is employed to enlarge the data set. In this study, conditional generative adversarial networks (cGAN) based DA is utilized for synthetic generation of signals. The publicly available repository such as ICBHI 2017 challenge, RALE and Think Labs Lung Sounds Library are considered for classifying the respiratory signals. To assess the efficacy of the artificially created signals by the DA approach, similarity measures are calculated between original and augmented signals. After that, to quantify the performance of augmentation in classification, scalogram representation of generated signals are fed as input to different pre-trained deep learning architectures viz Alexnet, GoogLeNet and ResNet-50. The experimental results are computed and performance results are compared with existing classical approaches of augmentation. The research findings conclude that the proposed cGAN method of augmentation provides better accuracy of 92.50% and 92.68%, respectively for both the two data sets using ResNet 50 model.

The Impulse oscillometry in the diagnosis of respiratory mechanics defects in elderly patients with lung cancer

Traditional pulmonary function tests (PFTs) (spirometry, body plethysmography, diffusion test) are quite time-consuming and difficult to perform methods, especially in the elderly patients. Impulse oscillometry (IOS) is advantageous in that all measurements are carried out with quiet breathing for 30–60 s and do not require the active participation of the patient. Objective: to compare IOS with traditional PFTs and to study its capabilities in the diagnosis of respiratory disorders in patients with lung cancer in the elderly patients. Materials and methods: an observational cross-sectional cohort study was performed. The study included 57 patients (55 (97%) male and 2 (3%) female, median age 69 (65–73) years). Smokers or ex-smokers accounted for 93% (39% and 54%, respectively), non-smokers — 7%. Central lung cancer was diagnosed in 22 (39%), peripheral lung cancer — in 35 (61%) patients. Results: ventilation disorders were detected in 54 (95%) patients, including 52 (96%) of obstructive, 1 — restrictive and 1 — mixed respiratory defects. Lung diffusion capacity was reduced in 30 (53%) patients. According to IOS data, deviations from the norm of R5, X5, AX (R5–R20) were detected in 43 (75%) patients. There was a statistically significant correlation between the parameters of the IOS with para­meters of spirometry and most of the parameters of body plethysmography. Conclusion: IOS can be used to assess respiratory mechanics in elderly lung cancer patients.

Diagnostic significance of volume capnography in examination of patients with bronchial asthma

Aim: to study the diagnostic significance of volume capnography in examination of patients with severe and moderate bronchial asthma (BA).&#x0D; Materials and Methods. 171 patents were examined, of them 43 patients with severe BA and 45 patients with moderate BA. The control group included 83 relatively healthy volunteers. In all the participants, along with clinical examination, parameters of spirometry and volume capnography were determined using ultrasound computer spirograph SpiroScout (Ganshorn, Germany) equipped with a volume capnography function.&#x0D; Results. Volume capnography revealed the following changes in patients with BA in comparison with the control group: increase in the slope of phase III (indicates non-uniformity of ventilation and perfusion in the lung periphery due to pathology of the small airways) and increase in emphysema index (indicates hyperinflation of lung). The above indices had statistically significant differences in severe and moderate asthma. Based on the results of examination of healthy individuals, the normal values for the slope of phase III (&lt;0.31 g/mol·L) and emphysema index (&lt;43) were calculated. Diagnostic sensitivity and specificity of volume capnography were studied with subsequent construction of ROC-curves and calculation of AUC for the slope angle of phase III and for emphysema index. It was found that most informative in BA are parameters of specificity of the diagnostic test (slope of phase III – 90.32%, emphysema index – 96.77%). The subsequent construction of ROC-curves showed that the AUC value for slope of phase III and emphysema index was higher in severe BA compared to the moderate BA (0.74 and 0.86, respectively).&#x0D; Conclusion. The obtained data demonstrate the significance of volume capnography in the functional diagnosis of respiratory disorders in BA.

Remote monitoring of breathing dynamics using infrared thermography.

An atypical or irregular respiratory frequency is considered to be one of the earliest markers of physiological distress. In addition, monitoring of this vital parameter plays a major role in diagnosis of respiratory disorders, as well as in early detection of sudden infant death syndrome. Nevertheless, the current measurement modalities require attachment of sensors to the patient's body, leading to discomfort and stress. The current paper presents a new robust algorithm to remotely monitor breathing rate (BR) by using thermal imaging. This approach permits to detect and to track the region of interest (nose) as well as to estimate BR. In order to study the performance of the algorithm, and its robustness against motion and breathing disorders, three different thermal recordings of 11 healthy volunteers were acquired (sequence 1: normal breathing; sequence 2: normal breathing plus arbitrary head movements; and sequence 3: sequence of specific breathing patterns). Thoracic effort (piezoplethysmography) served as "gold standard" for validation of our results. An excellent agreement between estimated BR and ground truth was achieved. Whereas the mean correlation for sequence 1-3 were 0.968, 0.940 and 0.974, the mean absolute BR errors reached 0.33, 0.55 and 0.96 bpm (breaths per minute), respectively. In brief, this work demonstrates that infrared thermography is a promising, clinically relevant alternative for the currently available measuring modalities due to its performance and diverse remarkable advantages.

Robust remote monitoring of breathing function by using infrared thermography.

An abnormal breathing rate (BR) is one of the strongest markers of physiological distress. Moreover, it plays an important role in early detection of sudden infant death syndrome, as well as in the diagnosis of respiratory disorders. However, the current measuring modalities can cause discomfort to the patient, since attachment to the patient's body is required. This paper proposes a new approach based on infrared thermography to remotely monitor BR. This method allows to (1) detect automatically the nose, (2) track the associate region of interest (ROI), and (3) extract BR. To evaluate the performance of this method, thermal recording of 5 healthy subjects were acquired. Results were compared with BR obtained by capnography. The introduced approach demonstrated an excellent performance. ROIs were precisely segmented and tracked. Furthermore, a Bland-Altman diagram showed a good agreement between estimated BR and gold standard. The mean correlation and mean absolute BR error are 0.92 ± 0.07 and 0.53 bpm, respectively. In summary, infrared thermography seems to be a great, clinically relevant alternative to attached sensors, due to its outstanding characteristics and performance.

Indications for performing flexible bronchoscopy: Trends over 34 years at a tertiary care hospital.

Background and Aim:Due to its easy maneuverability, patient comfort and documented safety as an outpatient procedure, flexible bronchoscopy (FB) has replaced rigid bronchoscopy for routine diagnostic use. Herein, we report our 34-year experience with outpatient performance of FB.Materials and Methods:This was a retrospective analysis of all FB procedures performed between September 1979 and November 2013 (period I: 1979-1990; period II: 1991-2000; period III: 2001-2013) in a tertiary care hospital. Demographic profile of patients, indications for performing FB, and annual and seasonal trends were noted from the records.Results:A total of 24,814 bronchoscopies were performed during the study period. The mean (SD) age of patients (71.6% males) was 48.4 (15.5) years. The number of procedures performed per decade showed an absolute increase by 322%. The most common indication for FB was suspected bronchogenic carcinoma (32.2%) followed by pulmonary infections (18.6%) and interstitial lung diseases (13%). The proportion of annual cases due to interstitial lung diseases (3.9% in period I to 16.2% in period III) increased over the years, whereas disorders such as hemoptysis and pleural effusion showed a declining trend as an indication for FB. A seasonal trend was observed for diseases such as sarcoidosis, bronchogenic carcinoma and pulmonary infections. Six deaths were encountered during the study period in patients undergoing FB.Conclusion:FB is increasingly being performed in the diagnosis of respiratory disorders and is a safe outpatient procedure. Although bronchogenic carcinoma remains a common indication for performing FB, benign conditions such as pulmonary infections and sarcoidosis constitute important indications in the Indian scenario.

Computerized diagnosis of respiratory disorders. SVM based classification of VAR model parameters of respiratory sounds.

This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced METHODS for Studying Cardiovascular and Respiratory Systems". This work proposes an algorithm for diagnostic classification of multi-channel respiratory sounds. 14-channel respiratory sounds are modeled assuming a 250-point second order vector autoregressive (VAR) process, and the estimated model parameters are used to feed a support vector machine (SVM) classifier. Both a three-class classifier (healthy, bronchiectasis and interstitial pulmonary disease) and a binary classifier (healthy versus pathological) are considered. In the binary scheme, the sensitivity and specificity for both classes are 85% ± 8.2%. In the three-class classification scheme, the healthy recall (95% ± 5%) and the interstitial pulmonary disease recall and precision (100% ± 0% both) are rather high. However, bronchiectasis recall is very low (30% ± 15.3%), resulting in poor healthy and bronchiectasis precision rates (76% ± 8.7% and 75% ± 25%, respectively). The main reason behind these poor rates is that the bronchiectasis is confused with the healthy case. The proposed method is promising, nevertheless, it should be improved such that other mathematical models, additional features, and/or other classifiers are to be experimented in future studies.

Mesure et monitorage sans fil des paramètres respiratoires pour des applications diagnostique et de surveillance : le projet ANR-TecSan TeleResp

The TeleResp Project (2007–2011), adopted following the call 2007 ANR-TecSan, was led by RBI firm in partnership with R.-Poincaré hospital of Garches and the Sleep Laboratory of Grenoble hospital. The main objective of the project was to develop a wireless device for measuring and monitoring respiratory signals (impedance plethysmography), oxygen saturation, body position, mouth pressure and limb movements. TeleResp is devoted to be used at home: 1) for monitoring mechanical ventilation in patients with neuromuscular disease and 2) for diagnosis of sleep apnea syndrome. The innovative aspect of this project is its use at home, in a familiar environment with minimal constraints due to measurement devices. The device will be tested and evaluated by the medical teams. The project aims also to build specific softwares starting from signals analysis, data fusion from several sensors and identification of pertinent information. Meeting a real market demand and carrying a strong marketing desire, the main stake of the TeleResp project is the industrial development and the marketing of a new noninvasive medical device using embedded sensors and a wireless technology making it autonomous, easy to use, and innovative in home monitoring and diagnosis of respiratory disorders during sleep which constitute a real problem of public health.

Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study

BackgroundAnthroposophic medicine is a physician-provided complementary therapy system involving counselling, artistic and physical therapies, and special medications. The purpose of this analysis was to identify predictors of symptom improvement in patients receiving anthroposophic treatment for chronic diseases.Methods913 adult outpatients from Germany participated in a prospective cohort study. Patients were starting anthroposophic treatment for mental (30.4% of patients, n = 278/913), musculoskeletal (20.2%), neurological (7.6%), genitourinary (7.4%) or respiratory disorders (7.2%) or other chronic indications. Stepwise multiple linear regression analysis was performed with the improvement of Symptom Score (patients' assessment, 0: not present, 10: worst possible) after 6 and 12 months as dependent variables. 61 independent variables pertaining to socio-demographics, life style, disease status, co-morbidity, health status (SF-36), depression, and therapy factors were analysed.ResultsCompared to baseline, Symptom Score improved by average 2.53 points (95% confidence interval 2.39-2.68, p < 0.001) after six months and by 2.49 points (2.32-2.65, p < 0.001) after 12 months. The strongest predictor for improvement after six months was baseline Symptom Score, which alone accounted for 25% of the variance (total model 32%). Improvement after six months was also positively predicted by better physical function, better general health, shorter disease duration, higher education level, a diagnosis of respiratory disorders, and by a higher therapy goal documented by the physician at baseline; and negatively predicted by the number of physiotherapy sessions in the pre-study year and by a diagnosis of genitourinary disorders. Seven of these nine variables (not the two diagnoses) also predicted improvement after 12 months. When repeating the 0-6 month analysis on two random subsamples of the original sample, three variables (baseline Symptom Score, physical function, general health) remained significant predictors in both analyses, and three further variables (education level, respiratory disorders, therapy goal) were significant in one analysis.ConclusionIn adult outpatients receiving anthroposophic treatment for chronic diseases, symptom improvement after 6 and 12 months was predicted by baseline symptoms, health status, disease duration, education, and therapy goal. Other variables were not associated with the outcome. This secondary predictor analysis of data from a pre-post study does not allow for causal conclusions; the results are hypothesis generating and need verification in subsequent studies.

Reference values of Forced Expiratory Volumes and pulmonary flows in 3–6 year children: a cross-sectional study

BackgroundThe aims of this study were to verify the feasibility of respiratory function tests and to assess their validity in the diagnosis of respiratory disorders in young children.MethodsWe performed spirometry and collected information on health and parents' lifestyle on a sample of 960 children aged 3–6.ResultsThe cooperation rate was 95.3%. Among the valid tests, 3 or more acceptable curves were present in 93% of cases. The variability was 5% within subjects in 90.8% of cases in all the parameters. We propose regression equations for FVC (Forced Vital Capacity), FEV1, FEV0.5, FEV0.75 (Forced Expiratory Volume in one second, in half a second and in 3/4 of a second), and for Maximum Expiratory Flows at different lung volume levels (MEF75, 50, 25). All parameters are consistent with the main reference values reported in literature. The discriminating ability of respiratory parameters versus symptoms always shows a high specificity (>95%) and a low sensitivity (<20%) with the highest OR (10.55; IC95% 4.42–25.19) for MEF75. The ability of FEV0.75 to predict FEV1 was higher than that of FEV0.50: FEV0.75 predicts FEV1 with a determination coefficient of 0.95.ConclusionOur study confirms the feasibility of spirometry in young children; however some of the current standards are not well suited to this age group. Moreover, in this restricted age group the various reference values have similar behaviour.

Usefulness of Plasma Fibrinogen Concentration Measurement in Diagnosis of Respiratory Disorders in Thoroughbred Racehorses

In this study, we determined a physiological standard for fibrinogen (Fbg) concentration in the plasma of clinically healthy thoroughbred racehorses trained under sufficient loads for running in races. Furthermore, we examined the usefulness of Fbg levels by comparing them with the white blood cell (WBC) counts in peripheral blood from thoroughbred racehorses diagnosed as suffering from colds or bacterial pneumonia. The Fbg level in healthy horses was lower (246.0±33.1 mg/dl) than previously reported values. On the other hand, both the Fbg levels at the first medical examination and the maximum Fbg levels reflected the severity of the respiratory disorders; therefore, higher Fbg concentrations tended to be related to longer treatment periods. The results suggest that Fbg measurements, both initially and with the elapse of time, can enable the severity of clinical conditions of respiratory disorders in racehorses to be determined and an estimate to be made of the treatment period needed to cure the disease. Therefore, measurements of not only peripheral WBC counts, which have been previously examined, but also of Fbg concentrations permit a diagnosis, based on clinical conditions, of the severity of inflammation that can provide essential information on the pathological states of respiratory disorders, particularly bacterial pneumonia, in racehorses.

Common respiratory disorders of the newborn.

Respiratory distress is a frequently encountered problem in the first few days of life. The general pediatrician must assess the infant9s condition, make a tentative diagnosis, institute appropriate care, and decide whether to transfer the infant to a neonatal intensive care unit. The decision to transfer an infant should be based on the interest and training of the physician as well as on readily available resources for optimal management. In general, any infant who needs mechanical ventilation for more than a few hours should be transferred to a regional intensive care nursery. An infant who is in respiratory distress of any cause may present with tachypnea, nasal flaring, sternal and intercostal retractions, cyanosis, and even apnea. The differential diagnosis of respiratory disorders in the newborn is extensive and includes disorders of the major airways, diseases of the pulmonary parenchyma, and rib cage abnormalities. Review of the history of pregnancy, labor, delivery, and resuscitation; careful physical examination; analysis of laboratory tests such as blood gases, hematocrit, and blood glucose; and evaluation of a chest radiograph usually permit a tentative diagnosis. Additional challenges arise when an infant who has chronic lung disease is returned to the community hospital for continuing care. This review covers three of the most common forms of neonatal respiratory distress: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and bronchopulmonary dysplasia (BPD).

Common Respiratory Disorders of the Newborn

Respiratory distress is a frequently encountered problem in the first few days of life. The general pediatrician must assess the infant's condition, make a tentative diagnosis, institute appropriate care, and decide whether to transfer the infant to a neonatal intensive care unit. The decision to transfer an infant should be based on the interest and training of the physician as well as on readily available resources for optimal management. In general, any infant who needs mechanical ventilation for more than a few hours should be transferred to a regional intensive care nursery. An infant who is in respiratory distress of any cause may present with tachypnea, nasal flaring, sternal and intercostal retractions, cyanosis, and even apnea. The differential diagnosis of respiratory disorders in the newborn is extensive and includes disorders of the major airways, diseases of the pulmonary parenchyma, and rib cage abnormalities. Review of the history of pregnancy, labor, delivery, and resuscitation; careful physical examination; analysis of laboratory tests such as blood gases, hematocrit, and blood glucose; and evaluation of a chest radiograph usually permit a tentative diagnosis. Additional challenges arise when an infant who has chronic lung disease is returned to the community hospital for continuing care. This review covers three of the most common forms of neonatal respiratory distress: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and bronchopulmonary dysplasia (BPD).

Changes in external respiratory function in severe combined cranial and thoracic trauma

We analyzed case histories and forensic medical examination reports of 247 deceased patients with combined cranial and chest trauma, which allowed us to identify the following difficulties in the differential diagnosis of respiratory disorders.