Breathing Lung Research Articles

Optimising CPAP and oxygen levels to support spontaneous breathing in preterm rabbits

Abstract Background Very preterm infants often require respiratory support after birth with current recommendations suggesting the use of continuous positive airway pressure (CPAP) of 4–8 cmH2O and an initial fraction of inspired oxygen (FiO2) of 0.21–0.3. We have examined the interaction of high and low CPAP and FiO2 levels on breathing rates and lung aeration in preterm rabbits. Methods Prematurely delivered rabbits (29/32 days gestation) received CPAP of either 5cmH2O (5CPAP; n = 12) or 15 cmH2O (15CPAP; n = 14), and a FiO2 of either 0.3 (5CPAP/0.3, n = 6 or 15CPAP/0.3, n = 7) or 0.6 (5CPAP/0.6, n = 6 or 15CPAP/0.6, n = 7). Breathing rates, lung aeration (functional residual capacity; FRC), lung bulging and air accumulation in the stomach were measured using phase-contrast X-ray imaging. Results Kittens receiving 0.6 FiO2 had higher breathing rates (5CPAP/0.6: 32.6±6.4 breaths/min; p = 0.0064 and 15CPAP/0.6: 36.9±3.5breaths/min; p = 0.0010) than 5CPAP/0.3 kittens (11.8±4.1breaths/min). Kittens receiving 15CPAP/0.6 tended to have higher FRC volumes (34.9±4 mL/kg) than kittens receiving 5 cmH2O CPAP (5CPAP/0.3: 13.1±6mL/kg; p = 0.0675 and 5CPAP/0.6: 13.5±6 mL/kg; p = 0.1720) and 15CPAP/0.3 (22.5 ± 6.6 mL/kg; p = 0.4245). Lung bulging and air accumulation in the stomach were not different between groups. Conclusion Preterm rabbits supported with both 15 cmH2O CPAP and 0.6 FiO2 increased spontaneous breathing rates and lung aeration without increasing the risk of air in the stomach or lung bulging. Impact While current guidelines recommend the use of low CPAP (4–8 cmH2O) and low FiO2 levels (0.21–0.3 FiO2) to support preterm infants at birth, the optimum levels are unknown. This study has shown that 15 cmH2O of CPAP and FiO2 of 0.6 improved lung aeration and breathing in preterm rabbits, compared with a CPAP of 4 cmH2O and FiO2 of 0.3. These results add to the evidence indicating that initial high CPAP and high FiO2 levels, followed by titration of both, enhance respiratory support for preterm newborns.

A Dynamic Breathing Lung Chip for Precise Evaluation of Inhaled Drug Efficacy and Airway Epithelial Responses.

Inhaled therapy has become a crucial treatment option for respiratory diseases like asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD), delivering drugs directly to bronchial and alveolar tissues. However, traditional static in vitro cell models, while valuable for studying pharmacokinetics (PK) and pharmacodynamics (PD), fall short in replicating the dynamic nature of physiological breathing. In this study, we present a breathing lung chip model that integrates a dynamic breathing mechanism with an air-liquid interface (ALI) culture environment to overcome these limitations. The platform replicates key aspects of lung physiology, including a functional airway interface, cyclic breathing motion, and medium circulation. Using the Calu-3 cell line to model airway epithelium, our experiments show that the incorporation of breathing motion significantly enhances the efficacy of inhaled drug delivery and cellular uptake, resulting in improved treatment outcomes compared to direct exposure of the drug. While further research is needed to explore its full potential, this platform holds promise for advancing inhaled drug screening and respiratory disease research.

Assessment of pulmonary function and respiratory symptoms among INDIAN textile sizing mill workers.

Textile-sizing mill workers are exposed to various hazards in the sizing units during their working hours and are at risk of acquiring lung impairments due to the usage of sizing chemicals in the sizing process. The main aim of this study is to assess the influence of cotton dust and sizing agents on lung function and breathing difficulties among Indian textile sizing mill workers. This cross-sectional study was carried out at a textile-sizing mill from August 2022 to September 2022. A modified questionnaire based American Thoracic Society's standard was used to assess respiratory symptoms among sizing mill workers and the pulmonary function test was conducted Spirometry. The chi-square test was used to find the difference between respiratory symptoms and the t-test was used to find the difference between spirometric parameters. Textile sizing mill workers showed significant (P < 0.0001) decline in peak expiratory flow rate, forced vital capacity (FVC), ratio of FEV1 and forced vital capacity, and forced expiratory volume in 1 s (FEV1). There was an association between symptoms and duration of exposure to pulmonary abnormality. Sizing mill workers showed a significant decline in lung functions and an increase in pulmonary symptoms. As the service duration of exposure in terms of years increased, respiratory symptoms increased and spirometric abnormality also increased. This study confirms that sizing agents such as polyvinyl alcohol (PVA), emulsifier, wax, carboxymethyl cellulose (CMC), and starch used in sizing mills are also responsible for respiratory illness and lung impairment among textile workers.

Design and Analysis of a Contact Piezo Microphone for Recording Tracheal Breathing Sounds.

Analysis of tracheal breathing sounds (TBS) is a significant area of study in medical diagnostics and monitoring for respiratory diseases and obstructive sleep apnea (OSA). Recorded at the suprasternal notch, TBS can provide detailed insights into the respiratory system's functioning and health. This method has been particularly useful for non-invasive assessments and is used in various clinical settings, such as OSA, asthma, respiratory infectious diseases, lung function, and detection during either wakefulness or sleep. One of the challenges and limitations of TBS recording is the background noise, including speech sound, movement, and even non-tracheal breathing sounds propagating in the air. The breathing sounds captured from the nose or mouth can interfere with the tracheal breathing sounds, making it difficult to isolate the sounds necessary for accurate diagnostics. In this study, two surface microphones are proposed to accurately record TBS acquired solely from the trachea. The frequency response of each microphone is compared with a reference microphone. Additionally, this study evaluates the tracheal and lung breathing sounds of six participants recorded using the proposed microphones versus a commercial omnidirectional microphone, both in environments with and without background white noise. The proposed microphones demonstrated reduced susceptibility to background noise particularly in the frequency ranges (1800-2199) Hz and (2200-2599) Hz with maximum deviation of 2 dB and 2.1 dB, respectively, compared to 9 dB observed in the commercial microphone. The findings of this study have potential implications for improving the accuracy and reliability of respiratory diagnostics in clinical practice.

DeepBreath: Breathing Exercise Assessment with a Depth Camera

Practicing breathing exercises is crucial for patients with chronic obstructive pulmonary disease (COPD) to enhance lung function. Breathing mode (chest or belly breathing) and lung volume are two important metrics for supervising breathing exercises. Previous works propose that these metrics can be sensed separately in a contactless way, but they are impractical with unrealistic assumptions such as distinguishable chest and belly breathing patterns, the requirement of calibration, and the absence of body motions. In response, this research proposes DeepBreath, a novel depth camera-based breathing exercise assessment system, to overcome the limitations of the existing methods. DeepBreath, for the first time, considers breathing mode and lung volume as two correlated measurements and estimates them cooperatively with a multitask learning framework. This design boosts the performance of breathing mode classification. To achieve calibration-free lung volume measurement, DeepBreath uses a data-driven approach with a novel UNet-based deep-learning model to achieve one-model-fit-all lung volume estimation, and it is designed with a lightweight silhouette segmentation model with knowledge transferred from a state-of-the-art large segmentation model that enhances the estimation performance. In addition, DeepBreath is designed to be resilient to involuntary motion artifacts with a temporal-aware body motion compensation algorithm. We collaborate with a clinical center and conduct experiments with 22 healthy subjects and 14 COPD patients to evaluate DeepBreath. The experimental result shows that DeepBreath can achieve high breathing metrics estimation accuracy but with a much more realistic setup compared with previous works.

Determining the optimum high-flow nasal cannula flow rate to achieve the desired fraction of inspired oxygen: A bench study

BackgroundPurpose: High-flow nasal cannula (HFNC) has many benefits in various clinical conditions. The original hypothesis suggests that the high and constant fraction of inspired oxygen (FiO2) is one of the main physiological effects. However, increasing evidence shows that there is a gap between the actual FiO2 and administered FiO2. We aimed to determine the actual FiO2 under different respiratory conditions and develop a regression model using a spontaneous breathing lung model. MethodsA spontaneous breathing simulation model was built using an airway manikin and a model lung. The FiO2 was measured under different respiratory conditions with varying tidal volumes and respiratory and HFNC flow rates. The relationships between the respiratory parameters and actual FiO2 were determined and used to build the predictive model. ResultsThe actual FiO2 was negatively correlated with respiratory rate and tidal volume and positively correlated with HFNC flow. The regression model could not be developed using simple respiratory parameters. Therefore, we introduced a new variable, defined as flow ratio, which equaled the HFNC flow divided by inspiratory flow. Our equation demonstrated that the actual FiO2 was mainly determined by the flow ratio in a non-linear relationship. Accordingly, a flow ratio greater than 1 did not ensure a constant high FiO2, whereas a flow ratio >1.435 could produce FiO2 >0.9. ConclusionThe FiO2 during HFNC was not constant even at sufficiently high oxygen flow compared with inspiratory flow. The predictive model showed that the actual FiO2 was mainly determined by the flow ratio.

Predictors of radiographic pneumonia in febrile children with cancer presenting to the emergency department

BackgroundFever is a common presenting complaint to the pediatric emergency department (PED), especially among oncology patients. While bacteremia has been extensively studied in this population, pneumonia has not. Some studies suggest that chest X-ray (CXR) does not have a role in the investigation of neutropenic fever in the absence of respiratory symptoms, yet non-neutropenic pediatric oncology patients were excluded from these studies. ObjectiveWe aimed to determine the incidence of CXRs ordered for febrile pediatric oncology patients, irrespective of their absolute neutrophil count (ANC), and to evaluate the rates of radiographic pneumonia as well as predictors of the latter in this group. MethodThis study was conducted in the PED at the American University of Beirut Medical Center (AUBMC), an Eastern Mediterranean tertiary-care hospital. We conducted a retrospective cohort study of acutely febrile pediatric cancer patients, younger than 18 years, presenting to a tertiary center from 2014 to 2018. We included one randomly selected febrile visit per patient. Fever was defined as a single oral temperature ≥38 °C within 24 h of presentation. We collected data on patient characteristics and outcomes. Our primary outcome was radiographic pneumonia; our secondary outcome was whether a CXR was done or not. We defined radiographic pneumonia as a consolidation, pleural effusion, infiltrate, pneumonia, “infiltrate vs. atelectasis,” or possible pneumonia mentioned by the radiologist. SPSS was used for the statistical analysis. ResultsWe reviewed a total of 664 medical charts and included data from 342 febrile pediatric patients in our analysis. Of these, 64 (18.7%) had a CXR performed. Overall, 16 (25%) had radiographic pneumonia while 48 (75%) did not. Patients were significantly more likely to have a CXR performed if they presented with upper respiratory tract symptoms, cough (p < 0.001 for both), or abnormal lung auscultation at the bedside (p = 0.004). Patients were also less likely to have a CXR done if they were asymptomatic upon admission to the PED (p < 0.001). However, neither cough nor shortness of breath nor abnormal lung examinations were significant predictors of a positive CXR (p = 0.17, 0.43, and 0.669, respectively). Patients with radiographic pneumonia were found to be significantly younger (4.29 vs. 6 years, p = 0.03), with a longer time since their last chemotherapy (15 vs. 7 days, p = 0.005), and were given intravenous (IV) bolus in the PED (87.5% vs. 56.3%, p = 0.02). Interestingly, patients with higher white blood cell (WBC) counts were more likely to have radiographic pneumonia (4850 vs. 1750, p = 0.01). Having a cough and an abnormal lung examination on presentation increased the odds of having a CXR (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI]: 3.4–12.8 and aOR: 4.5; 95% CI: 1.1–18.3, respectively). Returning to the PED for the same complaint within 2 weeks was associated with lower odds of a CXR at the index visit (aOR: 0.3; 95% CI: 0.1–0.6). For every year the child is older, the odds of having radiographic pneumonia decreased by 0.8 (95% CI: 0.6–0.98). However, for every day since the last chemotherapy session, the odds increased by 1.1 (95% CI: 1.01–1.12). ConclusionIn our sample, CXR was not commonly performed in the initial assessment of febrile cancer patients in the PED, unless respiratory symptoms or an abnormal lung examination was noted. However, these were not significant predictors of radiographic pneumonia. Further studies are needed to identify better predictors of pneumonia in this high-risk population.

Aerosol Delivery Efficiency With High-Flow Nasal Cannula Therapy in Neonatal, Pediatric, and Adult Nasal Upper-Airway and Lung Models.

High-flow nasal cannula (HFNC) systems employ different methods to provide aerosol to patients. This study compared delivery efficiency, particle size, and regional deposition of aerosolized bronchodilators during HFNC in neonatal, pediatric, and adult upper-airway and lung models between a proximal aerosol adapter and distal aerosol circuit chamber. A filter was connected to the upper airway to a spontaneously breathing lung model. Albuterol was nebulized using the aerosol adapter and circuit at different clinical flow settings. The aerosol mass deposited in the upper airway and lung was quantified. Particle size was measured with a laser diffractometer. Regional deposition was assessed with a gamma camera at each nebulizer location and patient model with minimum flow settings. Inhaled lung doses ranged from 0.2-0.8% for neonates, 0.2-2.2% for the small child, and 0.5-5.2% for the adult models. Neonatal inhaled lung doses were not different between the aerosol circuit and adapter, but the aerosol circuit showed marginally greater lung doses in the pediatric and adult patient models. Impacted aerosols and condensation in the non-heated HFNC and aerosol delivery components contributed to the dispersion of coarse liquid droplets, high deposition (11-44%), and occlusion of the supine neonatal upper airway. In contrast, the upright pediatric and adult upper-airway models had minimal deposition (0.3-7.0%) and high fugitive losses (∼24%) from liquid droplets leaking out of the nose. The high impactive losses in the aerosol adapter (56%) were better contained than in the aerosol circuit, resulting in less cannula sputter (5% vs 22%), fewer fugitive losses (18% vs 24%), and smaller inhaled aerosols (5 µm vs 13 µm). The inhaled lung dose was low (1-5%) during HFNC. Approaches that streamline aerosol delivery are needed to provide safe and effective therapy to patients receiving aerosolized medications with this HFNC system.

Improving breathing effort estimation in mechanical ventilation via optimal experiment design

Estimation of the breathing effort and relevant lung parameters of a ventilated patient is essential to keep track of a patient’s clinical condition. The aim of this paper is to increase estimation accuracy through experiment design. The main method is an experiment design approach across multiple breaths within a linear regression framework to accurately identify the patient’s condition. Identifiability and persistence of excitation are used to formulate an estimation problem with a unique solution. Furthermore, Fisher information is used for assessing the parameters sensitivity to slight changes of the ventilator settings to improve the variance of the estimation. The estimation method is applied to simulated patients who breathe regularly but also to patients who have variable breathing patterns. A virtual experiment is conducted for both situations to generate estimation results. The results are analyzed using mathematical tools and show that uniquely estimating the lung parameters and breathing effort over multiple breaths for both regularly and variably breathing patients is possible in the presented framework. The proposed estimation method obtains clinically relevant estimates for a large set of breathing disturbances from the simulation case-study.

Respiratory and chest wall mechanics in very preterm infants.

Data on static compliance of the chest wall (Ccw) in preterm infants are scarce. We characterized the static compliance of the lung (CL) and Ccw to determine their relative contribution to static compliance of the respiratory system (Crs) in very preterm infants at 36 wk postmenstrual age (PMA). We also aimed to investigate how these compliances were influenced by the presence of bronchopulmonary dysplasia (BPD) and impacted breathing variables. Airway opening pressure, esophageal pressure, and tidal volume (VT) were measured simultaneously during a short apnea evoked by the Hering-Breuer reflex. We computed tidal breathing variables, airway resistance (R), and dynamic lung compliance (CL,dyn), inspiratory capacity (IC), and Crs, CL, and Ccw. Functional residual capacity was assessed by the multiple breath washout technique (FRCmbw). Breathing variables, compliances, and lung volumes were adjusted for body weight. Twenty-three preterm infants born at 27.2 ± 2.0 wk gestational age (GA) were studied at 36.6 ± 0.6 wk PMA. Median and interquartile range (IQR) Crs/kg is 0.69 (0.6), CL/kg 0.95 (1.0), and Ccw/kg 3.0 (2.4). Infants with BPD (n = 11) had lower Crs/kg (P = 0.013), CL/kg (P = 0.019), and Ccw/kg (P = 0.027) compared with infants without BPD. Ccw/CL ratio was equal between groups. FRCmbw/kg (P = 0.044) and IC/kg (P = 0.005) were decreased in infants with BPD. Infants with BPD have reduced static compliance of the respiratory system, the lungs, and chest wall. Decreased Crs, CL, and Ccw in infants with BPD explain the lower FRC and IC seen in these infants.NEW & NOTEWORTHY Data on chest wall compliance in very preterm infants in the postsurfactant era are scarce. To our knowledge, we are the first group to report data on static respiratory system compliance (Crs), lung compliance (CL), and chest wall compliance (Ccw) in preterm infants with and without bronchopulmonary dysplasia (BPD) in the postsurfactant era.

Impairment of lung volume perception and breathing control in hypermobile Ehlers-Danlos syndrome

Breathing difficulties and exertional dyspnea are frequently reported in hypermobile Ehlers-Danlos syndrome (hEDS); however, they are not clearly explained. An impaired proprioception or the addition of a cognitive task could influence ventilatory control. How can the perception of lung volume be measured? Is lung volume perception impaired in hEDS patients? Is the breathing control impaired during a cognitive task in hEDS patients? A device was developed to assess the accuracy of lung volume perception in patients with hEDS and matched control subjects. In the second step, ventilation was recorded in both groups with and without a cognitive task. Two groups of 19 subjects were included. The accuracy of lung volume perception was significantly (P < 0.01) lower at 30% of inspired vital capacity in patients with hEDS in comparison to the control group, and they showed erratic ventilation (based on spatial and temporal criteria) when performing a cognitive task. These data support the influence of the proprioceptive deficit on ventilatory control in hEDS patients. These elements may help to understand the respiratory manifestations found in hEDS. Future research should focus on this relationship between lung volume perception and ventilation, and could contribute to our understanding of other pathologies or exercise physiology.Trial registration number: ClinicalTrials.gov, NCT05000151.

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Profile of individuals diagnosed with obstructive sleep apnea who use non-invasive ventilation

Introduction: Obstructive Sleep Apnea (AOS) can be characterized as a disorder of total or partial obstruction of the upper airways, causing symptoms such as non-restorative sleep, snoring, choking and fatigue associated with cardiovascular diseases, where the VNI uses positive pressures to reduce the work of breathing and increase oxygenation and lung compliance. Objective: To know the profile of CPAP users as a form of treatment for AOS. Methods: This was a descriptive research, carried out in a digital environment, based on validated questionnaires specific for each proposed objective, with data presented as mean and standard deviation or raw data, through SPSS 23.0 with the significance level adopted p&lt;0.05. Results: A total of 82 individuals participated, considering that there were three exclusions for not meeting the inclusion criteria, 79 were evaluated using the PSQI and ESE questionnaires, which evaluated the presence of poor quality sleep without changes in daytime sleepiness of the individuals. Conclusion: it was observed that the use of CPAP for the treatment of OSA improved the users' sleep; even though most of them had a poor quality of sleep, their daytime sleepiness was considered normal.

Correlation between diaphragmatic-rapid shallow breathing index and lung ultrasound score in elderly patients with mechanical ventilation and its predictive value for weaning results

To investigate the correlation between diaphragmatic-rapid shallow breathing index (D-RSBI) and lung ultrasound score (LUS) in elderly patients with mechanical ventilation and its predictive value for weaning results. A retrospective study was conducted. The clinical data of elderly patients (age > 60 years old) with invasive positive pressure ventilation (IPPV) admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from January 2021 to June 2022 were enrolled. According to the outcome of withdrawal, the patients were divided into successful and failed groups. The differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), D-RSBI and LUS before weaning and extubation were compared between the two groups. Pearson correlation was used to analyze the correlation between D-RSBI and LUS. The predictive value of D-RSBI and LUS on weaning results of elderly patients with IPPV was analyzed by receiver operator characteristic curve (ROC curve). A total of 398 elderly patients with IPPV were enrolled, including 300 successful weaning patients and 98 failed weaning patients. There were no significant differences in gender and age between the failed group and successful group [male: 55.1% (54/98) vs. 59.0% (177/300), age (years old): 67.02±5.03 vs. 66.96±4.99, both P > 0.05]. APACHE II score in the failed group was significantly higher than that in the successful group (17.09±3.30 vs. 16.06±3.81, P < 0.05), and the D-RSBI and LUS score before extubation were significantly higher than those in the successful group [D-RSBI (time×min-1×mm-1): 2.19±0.33 vs. 1.60±0.22, LUS: 17.30±3.04 vs. 11.97±3.20, both P < 0.01]. All patients showed a significant positive correlation between D-RSBI and LUS score (r = 0.406, P = 0.000). ROC curve analysis showed that the area under the curve (AUC) of D-RSBI for predicting weaning outcomes in elderly IPPV patients was 0.920, with a 95% confidence interval (95%CI) of 0.881-0.958 and P = 0.000. When the cut-off value was 1.85 times×min-1×mm-1, the sensitivity was 88.7% and the specificity was 86.7%. The AUC of LUS score for predicting weaning outcome in elderly IPPV patients was 0.875, with a 95%CI of 0.839-0.912 and P = 0.000. When the cut-off value was 14.50, the sensitivity was 75.7% and the specificity was 84.7%. There is a significant correlation between D-RSBI and LUS score in elderly mechanically ventilated patients, both of them can predict weaning outcome in elderly patients with mechanical ventilation.

Validated respiratory drug deposition predictions from 2D and 3D medical images with statistical shape models and convolutional neural networks.

For the one billion sufferers of respiratory disease, managing their disease with inhalers crucially influences their quality of life. Generic treatment plans could be improved with the aid of computational models that account for patient-specific features such as breathing pattern, lung pathology and morphology. Therefore, we aim to develop and validate an automated computational framework for patient-specific deposition modelling. To that end, an image processing approach is proposed that could produce 3D patient respiratory geometries from 2D chest X-rays and 3D CT images. We evaluated the airway and lung morphology produced by our image processing framework, and assessed deposition compared to in vivo data. The 2D-to-3D image processing reproduces airway diameter to 9% median error compared to ground truth segmentations, but is sensitive to outliers of up to 33% due to lung outline noise. Predicted regional deposition gave 5% median error compared to in vivo measurements. The proposed framework is capable of providing patient-specific deposition measurements for varying treatments, to determine which treatment would best satisfy the needs imposed by each patient (such as disease and lung/airway morphology). Integration of patient-specific modelling into clinical practice as an additional decision-making tool could optimise treatment plans and lower the burden of respiratory diseases.

Qualitative analysis and chaotic behavior of respiratory syncytial virus infection in human with fractional operator

Respiratory syncytial virus (RSV) is the cause of lung infection, nose, throat, and breathing issues in a population of constant humans with super-spreading infected dynamics transmission in society. This research emphasizes on examining a sustainable fractional derivative-based approach to the dynamics of this infectious disease. We proposed a fractional order to establish a set of fractional differential equations (FDEs) for the time-fractional order RSV model. The equilibrium analysis confirmed the existence and uniqueness of our proposed model solution. Both sensitivity and qualitative analysis were employed to study the fractional order. We explored the Ulam–Hyres stability of the model through functional analysis theory. To study the influence of the fractional operator and illustrate the societal implications of RSV, we employed a two-step Lagrange polynomial represented in the generalized form of the Power–Law kernel. Also, the fractional order RSV model is demonstrated with chaotic behaviors which shows the trajectory path in a stable region of the compartments. Such a study will aid in the understanding of RSV behavior and the development of prevention strategies for those who are affected. Our numerical simulations show that fractional order dynamic modeling is an excellent and suitable mathematical modeling technique for creating and researching infectious disease models.

Rehabilitation in children with home invasive mechanical ventilation.

Children with home invasive mechanical ventilation need special health care and rehabilitation services due to complications caused by both the pulmonary system and physical inactivity. Children who are dependent on invasive mechanical ventilators due to breathing difficulties and lung problems can benefit from rehabilitation programs. Rehabilitation requires a close relationship between the child, parents and/or caregivers, and healthcare professionals. The main goal of rehabilitation is to improve breathing, lung function and overall quality of life. In this review, although full standard approaches have not been determined yet, rehabilitation approaches for children dependent on home-type invasive mechanical ventilator will be discussed.

Prevalence of respiratory morbidities and lung function outcome in Traffic Police in eastern Nepal

Introduction: Outdoor air pollution is a cause for occupational lung disease. A community vulnerable to lung health hazards of outdoor air pollutants from vehicle emissions is traffic police, whose long duration of outdoor work, with no proper protective equipment, predisposes them to respiratory symptoms such as cough, dryness of nose, throat irritation and wheezing due to the air pollutants causing inflammation of the airways. The risks to lung function and development of respiratory disease are not known in traffic police in eastern Nepal. Objectives: To determine respiratory morbidities and lung function values of traffic police working in eastern Nepal. Methodology: This cross-sectional study was conducted for 6 months, from 1st January to 30th June 2022, in traffic police using a structured questionnaire adapted from American Thoracic Society and National Heart &amp; Lung Institute and portable spirometry, at the duty posts or office. Data were represented using descriptive statistics. Results: The study enrolled 129 traffic police in eastern Nepal, 109 (84.50%) were male and 20 (15.50%) females, mean age 34.50 (±8). Mean duration of active duty was 9.76 years (±6.19). Cough was present in 33 (25.58%), 50 (38.76%) phlegm, 37 (28.68%) dyspnea, and 28 (21.71%) noisy breathing. Mean FEV1% in ≤ 5 years exposure was 76.75 (±17.28), and 65.26 (±18.88) in &gt; 15 years. Mean FVC% in ≤ 5 years exposure was 81.81 (±20.56) and 76.18 (±19.77) in those working &gt;15 years. Mean FEF25-75% in ≤ 5 years was 73.69 (±23.73), which was 62.04 (±33.97) in those &gt; 15 years. The spirometry analysis suggested obstructive airways disease in 90 personnel (69.8%), restrictive disease in 80 (62%), mixed airways disease in 72 (55.8%), and small airways disease in 52 (40.3%). Conclusion: There was increased burden of respiratory problems such as cough with sputum production, noisy breathing, and dyspnea and lower lung volumes and flows among traffic police working in different parts of eastern Nepal. Long duration of exposure to traffic environments resulted in spirometry analyses suggestive of obstructive and restrictive airways diseases.

Endobronchial Valves for the Management of Severe Emphysema

What Is the Issue?&#x0D; &#x0D; People with severe emphysema who do not experience relief with non-invasive therapies such as medication, physical activity, and smoking cessation may need advanced treatments.&#x0D; Endobronchial valves are an alternative therapy that may improve exercise capacity and quality of life, and are less invasive compared to lung reduction surgery or transplants.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; A 2019 CADTH report summarized clinical effectiveness evidence for valves compared to standard care. CADTH sought to update this evidence with new clinical research and include information on cost-effectiveness, which was not part of the previous report.&#x0D; A research information specialist conducted a literature search of the peer-reviewed and grey literature with a search strategy focused on emphysema and endobronchial valves. The search was limited to English-language documents published since 2018. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; We did not find systematic reviews or health technology assessments published since 2018 that contained clinical evidence not already captured in the 2019 CADTH report. Two RCTs provide updated clinical evidence for endobronchial valves compared to standard care, and 1 RCT contains evidence on valves compared to lung surgery.&#x0D; The evidence suggests that valves may improve lung function, breathing ability, and physical activity in middle-aged and older adults with emphysema compared to standard care; the effect on quality of life and safety is unclear. The previous CADTH report showed lung function, breathing ability, physical activity, and quality of life were favourable for valve treatment compared to standard care.&#x0D; The previous CADTH report showed that valves resulted in harmful outcomes compared to standard care; however, in the current review, safety was difficult to assess due to poor reporting.&#x0D; When comparing valves to lung surgery, lung surgery may improve quality of life compared to valves; other outcomes did not favour one therapy over another.&#x0D; For cost-effectiveness, valves may be favourable compared to standard medical care, while their cost-effectiveness compared to lung volume reduction surgery is unclear.&#x0D; One study was conducted in Canada, and no studies were conducted in children and younger adults.&#x0D; &#x0D; What Does it Mean?&#x0D; &#x0D; Endobronchial valves are a potential therapy for people with severe emphysema with some favourable clinical and cost outcomes, but the evidence for their safety is unclear.&#x0D; Decision-makers may wish to consider the balance of favourable and harmful effects in existing evidence before more high-quality evidence in Canada, especially for safety, is available.&#x0D;

HIDROPNEUMOTHORAKS ET CAUSA TB PARU

Hydropneumothorax is a condition where there is air and fluid in the pleural cavity resulting in the collapse of lung tissue. The exact incidence is unknown but it is found that the incidence of pneumothorax ranges from 2.4 to 17.8/100,000 population per year. In this case, a 42-year-old man with complaints of chest pain since 2 weeks before admission to the hospital. The complaints included shortness of breath and continuous coughing. From the examination results obtained BP 120/80, HR: 135x/I, RR: 18 x/I, and temperature: 37oC. Physical examination found asymmetrical chest movements, chest tube in the sinistra thorax, weak vocal fremitus in the basal part of the left hemithorax at the level of posterior ICS XI, hypersonor in the right lung at the level of ICS II-IV and dimmed in the left basal part at the level of ICS V and a decrease in left lung breath sounds. X-ray examination showed an area of lusensi without pulmonary scars in the lateral aspect of the sinistral hemithorax with a ridge in the basal aspect of the sinistral hemithorax accompanied by an air fluid level in the left hemithorax. The patient was diagnosed with hydropneumothorax ec pulmonary tuberculosis with water seal drainage.