Increase In Peak Expiratory Flow Research Articles

Breath-by-breath assessment of acute pulmonary edema using electrical impedance tomography, spirometry and volumetric capnography in a sheep (Ovis Aries) model.

The bedside diagnosis of acute pulmonary edema is challenging. This study evaluated the breath-by-breath information from electrical impedance tomography (EIT), respiratory mechanics and volumetric capnography (VCap) to assess acute pulmonary edema induced by xylazine administration in anesthetized sheep. To determine the ability and efficiency of each monitoring modality in detecting changes in lung function associated with onset of pulmonary edema. Twenty healthy ewes were anesthetized, positioned in sternal (prone) recumbency and instrumented. Synchronized recordings of EIT, spirometry and VCap were performed for 60 s prior to start of injection, during xylazine injection over 60 s (0-60 s) and continuously for 1 min (60-120 s) after the end of injection. After visual assessment of the recorded mean variables, statistical analysis was performed using a mixed effect model for repeated measures with Bonferroni's correction for multiple comparisons, to determine at which breath after start of injection the variable was significantly different from baseline. A significant change over time was defined as an adjusted p < 0.05. All statistics were performed using GraphPad Prism 0.1.0. Electrical impedance tomography showed significant changes from baseline in all but two variables. These changes were observed simultaneously during xylazine injection at 48 s and were consistent with development of edema in dependent lung (decreased end-expiratory lung impedance, ventilation in centro-ventral and ventral lung region) and shift of ventilation into non-dependent lung (decreased non-dependent silent spaces and increased center of ventilation ventral to dorsal and increased ventilation in centro-dorsal and dorsal lung region). All changes in lung mechanics also occurred during injection, including decreased dynamic respiratory system compliance and increased peak expiratory flow, peak inspiratory pressure and airway resistance at 48, 54 and 60 s, respectively. Changes in VCap variables were delayed with all occurring after completion of the injection. In this model of pulmonary edema, EIT detected significant and rapid change in all assessed variables of lung function with changes in regional ventilation indicative of pulmonary edema. Volumetric capnography complemented the EIT findings, while respiratory mechanics were not specific to lung edema. Thus, EIT offers the most comprehensive method for pulmonary edema evaluation, including the assessment of ventilation distribution, thereby enhancing diagnostic capabilities.

Восстановительная терапия больных бронхиальной астмой: в фокусе дыхательная гимнастика с экспираторным сопротивлением

Aim: to evaluate the effectiveness of high-resistance breathing exercises using flutter as a method of rehabilitation therapy for asthma. Patients and Methods: the patients with asthma were divided into two groups. Group 1 (n=40) received breathing exercises as part of their treatment, which consisted of quiet inhalation through the nose and exhalation into the flutter for 3–5 minutes daily, for a total of 14 procedures per course, in addition to their baseline therapy. In group 2 (n=40), patients received similar drug therapy without performing breathing exercises. The control group (n=40) consisted of healthy volunteers who performed breathing exercises as in group 1. We analyzed changes in clinical and functional parameters over time after a single application of the rehabilitation technique, as well as at baseline and after completing treatment (after 14 days). Results: showed a significant increase (p&lt;0.05) in external respiration indices, specifically forced expiratory volume in the 1st second, forced vital capacity (FVC), and expiratory reserve volume in groups 1 and 2. Furthermore, group 1 reported a significant increase (p&lt;0.05) in the time to hold breath, as well as an increase in peak expiratory flow, peak expiratory flow rate (PEFR), and a decrease in the daily variation of PEFR and minute ventilation. After two weeks of treatment, group 1 showed significant improvement. The study showed a decrease in choking incidents, reduced need for bronchodilators, and improvement in symptoms such as cough, dyspnea, expectoration of sputum, its character, and wheezing. Additionally, there was an improvement in disease control and exercise tolerance as demonstrated by the results of the 6-minute walk test. Group 2 showed a stable disease course during the follow-up, but no significant changes in clinical manifestations or pharmacological therapy were reported. In this study, it was found that flutter therapy had a significant and moderate favorable effect on 80% and 20% of patients with asthma, respectively. However, this effect was only maintained in patients who regularly practiced high-resistance breathing exercises. No adverse events were reported. Conclusion: high-resistance breathing exercises can reduce hyperventilation and improve bronchial patency in patients with asthma. Additionally, flutter therapy can decrease the doses of bronchodilators, improve FVC, and positively impact the disease course. KEYWORDS: asthma, breathing exercises, expiratory resistance, flutter therapy. FOR CITATION: Alekseenko S.N., Churyukina E.V., Ukhanova O.P., Kas'yanova T.R., Kotieva I.M., Kokova L.N., Dodokhova M.A., AndreevaV.O., Puzikova O.Z., Popova V.A., Sozaeva D.I. Rehabilitation therapy in asthma: focus on high-resistance breathing exercises. Russian Medical Inquiry. 2024;8(3):143–149 (in Russ.). DOI: 10.32364/2587-6821-2024-8-3-4.

STUDI LITERATUR TENTANG : TEKNIK BUTEYKO DAN TEKNIK LATIHAN PERNAPASAN DIAFRAGMA TERHADAP PUNCAK LAJU ALIRAN PERNAPASAN PASIEN ASMA

Asthma is a disease that is often found in the community, based on data from the World Health Organization in 2018, as many as 300 million asthma sufferers and 225 thousand sufferers died of asthma worldwide. Buteyko technique and diaphragmatic breathing exercise technique can be one of the non-pharmacological adjunct therapies to reduce asthma symptoms also can increase peak expiratory flow. Besides, both of these techniques are still rare people who know that the buteyko technique and diaphragmatic breating exercise can reduce the frequency of asthma symptoms. The purpose of this literature review study is to determine the effectiveness of the Buteyko technique and diaphragmatic breathing exercise on peak expiratory flow rates in asthma patients. In this literature study Journal searches were traced nationally and internationally through Google Schoolar, Pubmed, and DOAJ published from 2010-2020 using selected keywords namely: ((((asthma) AND buteyko) AND diaphragmatic breating exercise) OR breathing exercise) OR muscle training. Based on the literature search results through publication in the database and using keywords that have been adapted to MeSH, researchers get 21 articles that match these keywords. An assessment based on the eligibility of the inclusion and exclusion criteria was found as many as 10 articles that could be used in the literature review. Based on the analysis and synthesis of the article, it can be concluded that the effectiveness of the Buteyko technique and diaphragmatic breathing exercise on peak expiratory flow rates it can be concluded that there is no significant difference between the two interventions in increasing peak expiratory flow rate.&#x0D;

THE EFFECT OF BUTEYKO BREATHING EXERCISE ON INCREASING PEAK EXPIRATIONAL FLOW IN THE ELDERLY AT THE TRESNA WERDHA BUDI MULIA III SOCIAL HOME

Background: Aging is the cause of widespread progressive changes in all aspects of biology that result in susceptibility to various diseases. The changes seen in the decrease in peak expiratory flow due to age often cause less air to enter the body. A decrease in peak expiratory flow will result in hypoxemia and hypercapnia which will lead to respiratory failure.. Buteyko Breathing Exercise is an intervention that supports increasing peak expiratory flow so that it can open the breathing path. Objective: Knowing the Effect of Buteyko Breathing Exercise on Increasing Peak Expiratory Flow in the Elderly. Method: This study uses the type of experimental research with one group pretest - posttest which is carried out at the Tresna Budi Mulia III Social Institution. In this study using 13 respondents who were selected using the Random Sampling Technique. Measurement of Peak Expiratory Flow using a Peak Flow Meter on baseline and final data after intervention for 4 weeks with a frequency of 2 times a week. Results: Changes in the increase in peak expiratory flow before and after the intervention obtained a value of p = 0.000 (p &lt; 0.05). Conclusion: There is an effect of Buteyko Breathing Exercise on Increasing Peak Expiratory Flow in the Elderly at Tresna Werdha Budi Mulia III Social Home.

“PEEP-ZEEP” Maneuver for Airway Clearance in Mechanically Ventilated Patients: A Scoping Review

Abstract A mechanical ventilator is the standard care to manage airways in intensive care unit (ICU). The inherent complications associated with mechanical ventilation are easy to prevent and control. Ventilator events, including ventilator-associated pneumonia, are crucial issues to manage in critically ill patients. Secretion retention due to compromised mucociliary function and altered lung internal milieu plays a significant concern in ICU outcomes. Physiotherapy involved in ICU plays an essential role in maintaining lung hygiene. Conventional chest physiotherapy is an extrapulmonary technique to remove secretion and maintain bronchial hygiene. Manual hyperinflation and suctioning are the methods that are highly at risk of transmitting lung infection. Generating flow bias through modification in various ventilator parameters is recently in trend to prevent bronchial hygiene-related complications. PEEP-ZEEP maneuver causes the expiratory flow bias by increasing peak expiratory flow. The present scoping review explores the safety and efficacy of the PEEP-ZEEP maneuver for airway clearance in mechanically ventilated patients. The current scoping review aims to identify the use and safety of the PEEP-ZEEP maneuver applied in mechanically ventilated patients for airway clearance. The five databases, i.e., PubMed, PEDro, Google Scholar, Cochrane, and Web of Science, have been searched till October 2022. The published experimental studies included in the review was searched using Boolean operators (“AND” and “OR”) and keywords, i.e., PEEP-ZEEP, Mechanical Ventilator, and Airway Clearance technique. PEEP-ZEEP is a safe and efficient for airway clearance in mechanically ventilated patients, with the need to explore further with a larger sample size and more defined outcomes and population.

Evaluating the Safety and Efficacy of Ketamine as a Bronchodilator in Pediatric Patients With Acute Asthma Exacerbation: A Review.

Ketamine has emerged as a potential treatment option for pediatric patients with acute asthma exacerbation who do not respond to standard therapy. This review aims to evaluate the safety and efficacy of ketamine in this population and provide an overview of the current literature. A comprehensive search was conducted in PubMed and Google Scholar, resulting in the identification of four relevant studies. The studies demonstrated that ketamine administration led to improvements in respiratory parameters, including a decrease in clinical asthma scores (CASs) and respiratory rates, and an increase in peak expiratory flow and oxygen saturation. Ketamine infusion also showed promise in obviating the need for intubation in patients with severe wheezing due to bronchiolitis. The most common side effects observed were increased tracheobronchial secretions and hallucinations, which were manageable through discontinuation or additional medication. No significant changes in heart rate and blood pressure were reported, indicating hemodynamic stability. Long-term complications of ketamine use were minimal, with no reports of nightmares or dysphoria. In conclusion, ketamine shows potential as a bronchodilator for pediatric patients with acute asthma exacerbation, although further research is needed to fully evaluate its effectiveness and long-term effects. The use of ketamine should be considered in carefully selected cases and closely monitored for adverse events.

Literature Review: Benefits of Balloon Blowing Breathing Exercises on Lung function in Astma Patients

Chronic inflammation that occurs in asthmatic patients results in recurrent episodic symptoms such as shortness of breath, chest tightness, coughing, and wheezing breath sounds. This indicates that there is impaired lung function which can be seen from the results of the Peak Expiratory Flow (APE) examination. The purpose of compiling a literature review is to analyze the benefits of breathing exercise therapy using the balloon blowing technique on lung function in asthma patients. The method used in this literature study is the PICOS framework. Article searches were carried out using the science database from Science Direct, Pub Med and Google Scholar. The keywords used are breathing exercises, Balloon Blowing and asthma or asthma. Results have been literature found 7 articles analyzed. A total of 5 articles discussed the effect of breathing exercises using the balloon blowing technique on lung function, namely in terms of Peak Expiratory Flow (APE) values ​​and 2 journals discussed the effect of balloon blowing on improving clinical symptoms, namely shortness of breath and increased oxygen saturation. Based on the results of the literature review, it can be concluded that the Balloon Blowing breathing exercise can be applied to asthma patients. This exercise, when performed according to correct and regular procedures, can improve lung function which can be seen from several indicators, namely increasing Peak Expiratory Flow (APE), oxygen saturation and decreasing complaints of shortness of breath.

Combination of diaphragmatic breathing with therapeutic walking exercise to increase peak expiratory flow rate in asthma patients

Abstract Objective: This study aimed to determine the effect of combined diaphragmatic breathing and therapeutic walking exercise on peak expiratory flow in asthma patients. Methods: The research design used a quasi-experiment nonequivalent pretest and posttest design. The research sample contained 38 respondents divided into intervention and control groups, selected by simple random sampling. The control group received standard drug therapy, while the intervention group received standard drug therapy and a combination of diaphragmatic breathing and therapeutic walking exercise for 2 weeks. This exercise was carried out in the morning, 6 times a week, with 5 diaphragmatic breathing and exhalations per exercise. After that, a 1-min break was followed by a therapeutic walking exercise of 5–15 min, with an increased duration. Both groups measured the peak expiratory flow before and after the intervention using a peak flow meter. The data analysis used central tendency and t-test. Results: The results showed that the mean peak expiratory flow in the intervention group was 306.84, while in the control group, it was 232.63, with the value of the t-test being −14.17 (P &lt; 0.0001). Conclusions: Diaphragmatic breathing and therapeutic walking exercise significantly increased the peak expiratory flow in asthma patients.

Nebulized budesonide combined with systemic corticosteroid vs systemic corticosteroid alone in acute severe asthma managed in the emergency department: a randomized controlled trial

BackgroundThe additive benefit of inhaled corticosteroid when used with systemic corticosteroid in acute asthma is still unclear. The objective of this study was to assess the effect of high and repeated doses of inhaled budesonide when combined with the standard treatment of adult acute asthma.MethodsIt was a prospective double-blind randomized controlled study performed in the emergency department (ED) from May 1, 2010 to February 28, 2011 (ClinicalTrials.gov, NCT04016220). Fifty patients were included and were randomized to receive intravenous hydrocortisone hemisuccinate in association with nebulized budesonide (n = 23, budesonide group) or normal saline (n = 27, control group). Nebulization of budesonide or saline was done in combination with 5 mg of terbutaline every 20 min the first hour, then at 2 h (H2), and 3 h (H3). All patients received standard treatment. Efficacy and safety of inhaled budesonide were evaluated every 30 min for 180 min.ResultsA significant increase in peak expiratory flow (PEF) was observed in both treatment groups at evaluation times. The increase in PEF persisted significantly compared to the previous measurement in both groups. There was no significant difference in the PEF between the two groups at evaluation times. There was no significant difference between the two groups in the evolution in the respiratory rate and heart rate. There was also no statistically significant difference between the two groups in the rate of hospitalization, the discharge criteria before the end of the protocol.ConclusionsConsidering its limited power, our study suggests that the association of nebulized budesonide with hydrocortisone hemisuccinate has no additional effect over the use of hydrocortisone alone in adults’ acute asthma managed in the ED.

Efficacy of a rehabilitation protocol on pulmonary and respiratory muscle function and ultrasound evaluation of diaphragm and quadriceps femoris in patients with post-COVID-19 syndrome: a series of cases.

This study assessed the efficacy of a pulmonary rehabilitation (PR) on pulmonary and respiratory muscle function and thickness of quadriceps femoris and diaphragm of patients with post-COVID-19 syndrome. This series of cases followed nine patients who performed PR twice a week for six weeks. Patients received the following PR program: lung expansion therapy; respiratory muscle training; upper limb strength exercises; aerobic exercises on a treadmill. After the program, we observed increased peak expiratory flow (26.03%), forced vital capacity (FVC) (7.14%), forced expiratory volume in the first second (FEV1) (9.55%), and ratio between FEV1/FVC (6.19%). All parameters of respiratory muscle strength and endurance were improved. Diaphragmatic thickening fraction and thickness of quadriceps femoris also improved, whereas echo intensity of quadriceps reduced. Thus, RP protocol improved pulmonary function, respiratory muscle strength and endurance, and thickness of diaphragm and quadriceps femoris, and reduced echo intensity of quadriceps in patients with post-COVID-19 syndrome.

Longitudinal Examination of the Shape of the Maximum Expiratory Flow‐Volume Curve in Young Adults Following SARS‐CoV‐2 Infection

Examination of the shape of the maximum expiratory flow‐volume curve represents a method to noninvasively describe lung and airway function in health and disease. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can result in pulmonary dysfunction and may result in changes to the shape of the maximum expiratory flow‐volume curve during the recovery period following SARS‐CoV‐2 infection.PurposeThe purpose of this study was to quantitatively examine the shape and the area of the maximum expiratory flow volume curve in otherwise healthy, young adults during the three months following SARS‐CoV‐2 infection.MethodsOtherwise healthy, young adults (4M/3F, age: 21 ± 1 y, height: 174.9 ± 11.2 cm, body mass index: 23.6 ± 1.6 kgᐧm‐2) who tested positive for SARS‐CoV‐2 completed spirometry testing on three occasions. The first visit (BL) took place three‐to‐four weeks after positive test confirmation. Approximately four weeks separated each subsequent visit (1M and 2M, respectively). Following each spirometry test, the flow‐volume loop with the greatest sum of forced vital capacity (FVC) and forced expiratory volume in one second was chosen for analysis. The angle beta (β°) and flow ratio were calculated using standard pulmonary function parameters. Slope ratios at increments of 5% of FVC were determined from 80% to 20% FVC. Additionally, the area under the maximum expiratory flow‐volume curve was calculated. Data were compared using repeated measures analysis of variance. Statistical significance was set at p = 0.05.ResultsFVC remained similar over the study period (p > 0.05). The β° was significantly reduced at 2M compared with BL (BL: 188.8 ± 15.7°, 1M: 180.9 ± 6.9°; 2M: 176.8 ± 5.0°, p = 0.012). Flow ratios were similar between visits (BL: 20.3 ± 11.7%, 1M: 13.0 ± 6.4%, 2M: 18.1 ± 5.9%; p = 0.53). Additionally, the slope ratios at each lung volume were similar between visits. However, while not statistically different, the slope ratio at 80% FVC approached significance (BL: 1.22 ± 0.98, 1M: 2.37 ± 1.00, 2M: 2.13 ± 0.86; p = 0.07). The total area under the maximum flow‐volume curve was not different between visits (BL: 21.0 ± 5.1 L2∙s‐1, 1M: 21.5 ± 4.5 L2∙s‐1; 2M: 21.9 ± 4.7 L2∙s‐1; p = 0.49). The percentages of the total area under the curve that were contained between peak expiratory flow (PEF) and 75% FVC and between 50% FVC and 25% FVC were altered at 1M and 2M compared with BL (p < 0.05). PEF tended to be greater during 2M compared with BL (BL: 8.49 ± 1.34 L2∙s‐1, 1M: 9.34 ± 1.92 L2∙s‐1, 2M: 9.44 ± 1.53 L2∙s‐1; p = 0.056) and the changes in PEF from BL to 2M were significantly correlated with the changes in β° and area under the curve subdivisions over the same time period (p < 0.05).ConclusionThese data demonstrate that the shape of the maximum expiratory flow‐volume curve changes marginally during the initial three months following SARS‐CoV‐2 infection. Yet, the changes appear to be largely driven by increases in peak expiratory flow and suggests that SARS‐CoV‐2 infection is acutely involved in large airway dysfunction.

Effect of 2-Hz Electroacupuncture Stimulation on Respiratory Function: A Randomized Controlled Trial.

Objective: The autonomic nervous system is involved in the regulation of airway smooth muscle. This study examined the effect of acupuncture stimulation in the vicinity of the cervical-sympathetic ganglion on respiratory function in humans. Materials and Methods: Twenty-four healthy adults (19 males and 5 females) were randomly assigned to a no-treatment group, a leave-needle group, and an electroacupuncture (EA) group in a crossover trial. In all groups, respiratory function was initially tested. In both acupuncture groups, after 5 minutes of rest, a 5-minute acupuncture stimulus was delivered, followed by 5 minutes of rest. Thereafter, respiratory function was again tested in all groups. Acupuncture was delivered in the vicinity of the cervical ganglia at the height of the sixth cervical vertebra on the left side and the vertebral artery node; the EA stimulus was set to 2 Hz, and the stimulation intensity was set to a level at which no pain was felt by the participants. Results: The EA group had significant increases in peak expiratory flow (PEF) and vital capacity (VC) after the intervention, compared to before intervention. Additionally, the EA group had significant increases in these parameters, compared to the no-treatment group. Conclusions: These results indicated that stimulation with 2-Hz EA in the vicinity of the cervical-sympathetic trunk causes an increase in PEF and VC, and increased bronchial dilation.

Pengaruh Incorporating Progressive Muscle Relaxation dan Diaphragm Breathing Exercise terhadap Aliran Puncak Ekspirasi Pasien Asma

adalah suatu kelainan berupa inflamasi kronik saluran napas yang mengakibatkan penyempitan saluran napas, sehingga meningkatkan resistensi aliran udara dan menurunkan laju aliran ekspirasi. Selain terapi farmakologis, penatalaksanaan asma juga dapat dilakukan secara non farmakologis, diantaranya dengan latihan incorporating progressive muscle relaxation dan diaphragm breathing exercise yang dapat meningkatkan aliran puncak ekspirasi. Tujuan penelitian ini adalah untuk mengetahui pengaruh incorporating progressive muscle relaxation dan diaphragm breathing exercise terhadap peningkatan aliran puncak ekspirasi (APE) pasien asma. Metode penelitian adalah quasy experimental pre-test dan post-test with control group. Jumlah responden penelitian adalah 80 orang yang dibagi menjadi 2 kelompok yaitu 60 orang kelompok intervensi dan 20 orang kelompok kontrol. Hasil uji beda paired sample t-test pada kelompok intervensi menunjukkan perbedaan yang signifikan APE sebelum dan sesudah intervensi (65,05% vs 81,17%, p=0,00). Hasil uji independen t-test menunjukkan perbedaan yang signifikan APE kelompok intervensi dengan kelompok kontrol (81,17% vs 65,10%, p=0,00). Penelitian ini menyimpulkan bahwa latihan incorporating progressive muscle relaxation dan diaphragm breathing exercise berpengaruh pada peningkatan APE.

Comparação das técnicas de facilitação neuromuscular proprioceptiva na função respiratória de indivíduos com doença de Parkinson

Introdução: A Doença de Parkinson (DP) é uma patologia crônica e neurodegenerativa, caracterizada pelo tremor, bradicinesia, rigidez e instabilidade postural, através da progressão da doença, de caráter multifatorial, o sistema respiratório apresenta disfunções. Objetivo: Comparar o efeito imediato da facilitação neuromuscular proprioceptiva (FNP) respiratória e de escápula e pelve na função respiratória de indivíduos com doença de Parkinson. Materiais e métodos: Ensaio clínico randomizado, simples cego, realizado na Clínica Escola de Fisioterapia da Universidade Luterana do Brasil-ULBRA/Canoas, com uma amostra de 12 indivíduos, com diagnóstico de Doença de Parkinson. Os mesmos assinaram o Termo de Consentimento Livre e Esclarecido e foram avaliados através do Miniexame do Estado Mental (MEEM), da escala de Hoehn e Yahr Modificada, capacidade inspiratória, pico de fluxo expiratório e pressões inspiratória e expiratória máximas. Após, foram alocados por sorteio em Grupo A (FNP respiratório) e Grupo B (FNP de escápula e pelve). Resultados: O FNP respiratório se mostrou eficaz nos parâmetros respiratórios avaliados, sendo estatisticamente significativo (p&lt;0,05), assim como o FNP de escápula e pelve para a capacidade inspiratória (p=0,041). Já a comparação entre os dois grupos mostrou que o FNP respiratório foi mais eficaz, apesar de não apresentar significância estatística. Conclusão: As duas técnicas foram eficazes no aumento da capacidade inspiratória, porém a técnica de FNP respiratória mostrou-se efetiva também no aumento do pico de fluxo expiratório e pressões inspiratória e expiratória máximas.

Variability of Voluntary Cough Airflow in Healthy Adults and Parkinson's Disease.

Cough is an important airway protective behavior responsible for ejecting material from the airway to prevent pneumonia, a leading cause of death in older adults and individuals with Parkinson's disease (PD). Variability of motor performance for both spinal and bulbar functions has been documented; however, there are no studies examining variability of cough motor control in PD and healthy controls. The present study examined the effects of age and PD on variability of voluntary cough performance. Twenty-five healthy younger adults (HYA), 26 healthy older adults (HOA), and 16 participants with PD completed three trials of sequential voluntary cough with spirometry. Coefficients of variation were used to examine variability between groups. Increased variability of cough expired volume (p = 0.012) and inspiratory volume (p = 0.006) was appreciated in HOAs compared to HYAs. Participants with PD demonstrated increased variability of cough expired volume (p = 0.029), peak expiratory flow rise time (p = 0.016), and cough volume acceleration (p = 0.034) compared to HOAs. Though participants with PD descriptively demonstrated increased peak expiratory flow rate compared to HOAs, this finding was statistically nonsignificant after adjusting for multiple comparisons (p = 0.072). This study identified that variability in cough airflow increases in healthy aging and Parkinson's disease. These motor control impairments may be attributed to age and disease-related sensorimotor changes in the peripheral and central nervous system. Future research will be necessary to examine the relationship between inconsistent cough motor output, airway invasion, and aspiration pneumonia in PD.

Inhaled Albuterol Increases Forced Mid-expiratory Flows In Non-asthmatic Children With And Without Obesity

PURPOSE: The effect of albuterol on β2-adrenoceptor activation is usually assessed by a significant increase in forced expiratory volume in one second (FEV1). However, even without a significant increase in FEV1, an increase in isovolume forced expiratory flow between 25% and 75% (isoFEF25-75) of forced vital capacity (FVC) would allow for greater exercise tidal flow rates thus increasing ventilatory capacity (V̇Ecap). This could be particularly important in children with obesity, who breathe at low lung volumes and have limited expiratory reserves. We examined if isoFEF25-75 and V̇Ecap increase with albuterol in non-asthmatic prepubescent children with and without obesity. METHODS: A total of 46 obese (n=29 boys) and 29 nonobese (n=14 boys) children, ages 8-12yr, performed spirometry according to the American Thoracic Society guidelines before and after 360μg of albuterol. Subjects who displayed ≥12% and ≥200mL increase in FEV1 after albuterol were excluded. For each individual, V̇Ecap was determined using an estimated tidal volume at maximal exercise (‘VTmax’ = FVC/2) and forced expiratory time between 25% and 75% of FVC (FET25-75) to estimate an individualized maximum breathing frequency (fbmax), where V̇Ecap = VTmax*fbmax. A two-way ANOVA with repeated measures (obese x nonobese; pre- x post-inhaler) was conducted. RESULTS: No significant group by treatment interaction was detected. No significant differences were detected in spirometry parameters between children with and those without obesity. From pre- to post-inhaler in the total cohort of children (n=75), FVC significantly decreased (-0.70%, p = 0.04). While there was a statistically significant increase in peak expiratory flow (+3.0%, p = 0.02), FEV1 (+2.6%, p < 0.01) and FEV1/FVC (+3.0%, p < 0.01), there were more meaningful increases in isoFEF25-75 (+17.1%, p < 0.01) and V̇Ecap (+15.5%, p < 0.01).CONCLUSIONS: Administration of albuterol can increase isoFEF25-75 despite a relatively small nonclinical increase in FEV1. The remarkable increase in flow rates along the effort-independent portion of a forced expiration yields a large increase in V̇Ecap, which could potentially change breathing mechanics and ventilatory output during heavy exercise in non-asthmatic prepubescent children with and without obesity.

The effects of doxapram on time to tracheal extubation and early recovery in young morbidly obese patients scheduled for bariatric surgery: A randomised controlled trial.

Bariatric surgery is a well established treatment of the obese. Postoperative respiratory failure and airway obstruction after bariatric surgery can often be attributed to the residual depressant effects of anaesthetics, sedatives and opioids. Peri-operative management of morbidly obese patients is still a concern for operating room professionals. The evaluation of the effects of doxapram on the outcomes of general anaesthesia following bariatric surgical procedures in the morbidly obese. A single-blind randomised controlled trial with two parallel arms. A tertiary care teaching hospital, Tehran, Iran, from 2017 to 2018. In total, 100 patients (69 women) with at least class two obesity were included in two groups of equal sizes and underwent bariatric surgery. The primary outcome was the time from the administration of doxapram to tracheal extubation. Secondary outcomes included vital signs and variables including peak expiratory flow rate, time to return to spontaneous breathing, time to eye-opening and hand-squeezing on the commands, and time to recovery. Both groups underwent general anaesthesia. The intervention group received a single dose of doxapram 1 mg kg ideal body weight, immediately after reversal of neuromuscular blockade and after discontinuation of all anaesthetics. Doxapram decreased time to extubation, time to eye-opening and hand-squeezing, shortened recovery time and lowered end-tidal CO2 significantly (all P < 0.001). Moreover, it increased peak expiratory flow rate, oxygen saturation, temperature, heart rate and blood pressure (all P < 0.001). The two groups were similar in the bispectral index and mean arterial pressure (both P > 0.05). None of our participants had complications attributable to doxapram. The postoperative use of doxapram improves peak expiratory flow rate, and decreases respiratory complications of anaesthesia during recovery in the morbidly obese undergoing bariatric surgery. Doxapram is well tolerated in young ASA physical status classes 1 to 2 morbidly obese patients; however, the anaesthesiologist should cautiously evaluate the vital signs for at least half an hour following the administration of doxapram. Iranian Registry of Clinical Trials (IRCT) http://www.irct.ir/ number IRCT2017060712203N9.

Associations Between Bioaerosol Exposures and Lung Function Changes Among Dairy Workers in Colorado.

Limited studies have examined effects of bioaerosols on the respiratory health of dairy workers; previous findings have been inconsistent across populations. Using a repeated measures design, exposures to dust, bioaerosols, and ozone were assessed and pre- and post-shift spirometry was performed for dairy workers (n = 36). Workers completed 1 to 8 visits. Linear mixed effect models estimated associations between air pollutant constituents and changes in spirometry. There was an association between higher dust exposures and increased peak expiratory flow rate. However, for all other outcomes there was no association with the exposures considered. Relationships between bioaerosol exposures and respiratory health in dairy workers remain unclear. Future studies should increase sample sizes, include repeated measures designs, vary the timing of spirometry measurements, and include markers for Gram positive bacteria such as muramic acid or peptidoglycan.

The Effect of Pursed Lips Breathing Technique on Increasing Peak Expiratory Flow Rate (PEFR) in Medium Classification of Chronic Obstructive Pulmonary Disease Patients

Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that attacks the respiratory system caused by inflammation and pollutants that are sucked in the respiratory tract which will cause bronchial stiffness resulting in dyspnea or gasping breath. West Java itself has a prevalence of 3% including Ciamis. Dyspnea will reduce the ability of lung physiology which is marked by a decrease of peak expiratory flow rate<150 L which will eventually cause the death. The purpose of this study is to reduce dyspnea in COPD patients seen from the increase ofPEFR. The sample of this study was 25 medium classifications of COPD patients who were given the technique of Purse Lips Breathing 2 times a day in 7 days. The method of this research is one group pre-post test design with a sample of 25 COPD patients. The results of the study were tested by paired T-test where the results showed a P value of 0.00 <0.05, which means that there was a clear and significant increase in PEFR after given the Pursed lips breathing technique. Discussion of increasing PEFR requires consistency of COPD patients so that complementary therapy or even collaboration can be used to reduce dyspnea symptoms. As the conclusion, the increase of PEFR as a sign of reducing dyspnea does not stand alone but requiring a comprehensive examination, it can be used as the first measure of emergency breathing.

Short-Term Appraisal of the Effects and Safety of Manual Versus Ventilator Hyperinflation in an Animal Model of Severe Pneumonia.

In patients on mechanical ventilation, lung hyperinflation is often performed to reverse atelectasis and clear retained mucus. We evaluated the effects of manual hyperinflation and ventilator hyperinflation on mucus clearance, gas exchange, pulmonary mechanics, and hemodynamics. Six mechanically ventilated pigs with severe Pseudomonas aeruginosa pneumonia randomly received either 12 manual hyperinflation breaths over a period of 2 min (through a gradual manual compression of a resuscitation bag within 4 s to achieve 40 cm H2O of airway pressure), or 12 ventilator hyperinflation over 2 min to achieve the same ventilatory end points as in manual hyperinflation. Mucus clearance rate was measured through fluoroscopic tracking of tracheal markers. Prior to each maneuver and 15 min thereafter, we assessed arterial and mixed gas exchange, pulmonary mechanics, and hemodynamics. Both manual hyperinflation and ventilator hyperinflation significantly decreased inspiratory flow by approximately 16 L/min (P < .001) and increased peak expiratory flow by roughly 44 L/min (P < .001). The median (interquartile range) mucus clearance rate was 1.31 (0.84-2.30) prior to the interventions, and 0.70 (0.00-2.58) and 0.65 (0.45-1.47) during manual hyperinflation and ventilator hyperinflation, respectively (P = .09). Hyperinflations, whether delivered manually or through the ventilator, did not significantly modify pulmonary or hemodynamic parameters. In an animal model of severe P. aeruginosa pneumonia, neither manual hyperinflation nor ventilator hyperinflation improved mucus clearance. If confirmed in comprehensive clinical experimentations, these findings should promote reappraisal of indications for both manual hyperinflation and ventilator hyperinflation as a therapeutic technique for mucus clearance and atelectasis reversal.