Management Of Respiratory Diseases Research Articles

Management of respiratory disorders in childhood neurological disorders

Management of respiratory disorders in childhood neurological disorders

Efficacy and safety of a new acoustic device, the lung flute, for sputum induction and lung physiotherapy

Introduction Induction of sputum by noninvasive methods from lower respiratory tract has evolved as an important tool for diagnosis and management of different respiratory diseases. Aim of the study To assess the efficacy and safety of lung flute compared with the standard methods. Patients and methods The study was conducted at Chest Department, Clinical Pathology Department, and Respiratory ICU Unit at Zagazig University Hospitals. A total of 85 patients were included in this study (20 healthy controls, 20 patients with chronic bronchitis, 20 asthmatic patients, 20 patients with chronic obstructive pulmonary disease, and five patients with myopathy). Serial measurements of forced expiratory volume in 1 s % predicted were done. Induced sputum by lung flute and hypertonic saline was obtained. Sputum and saliva samples were processed and examined. Results The age of the studied patients ranged from 18 to 66 years. Duration of illness ranged from 1 to 44 years. By comparing samples obtained by lung flute and salivary samples, it was confirmed that sputum samples were from the lower respiratory tract as it higher in purulent score, fibrinogen, elastase levels, and cellular components. Comparison of samples obtained by lung flute and hypertonic saline showed significant difference in weight of samples and cellular components. Reported complications were more frequent with hypertonic saline. There was significant improvement in lung function and exercise performance in patients using lung flute. Conclusion The lung flute presents a safe, convenient, effective, easy, and rapid method for sputum induction with both diagnostic and therapeutic applications.

In vitro drug sensitivity and therapeutic management of respiratory diseases in lambs of Kashmir

<i>In vitro</i> drug sensitivity and therapeutic management of respiratory diseases in lambs of Kashmir

The use of nebulized pharmacotherapies during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19), caused by the highly contagious novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a worldwide pandemic and currently represents a major public health issue. COVID-19 has highlighted the need for clear and accurate guidance on the use of aerosol-generating procedures, such as nebulization, for the treatment of patients with respiratory diseases with or without COVID-19. Despite the lack of evidence, there is heightened concern about the potential risk of transmission of SARS-CoV-2 in the form of aerosolized respiratory droplets during the nebulized treatment of patients with COVID-19. Consequently, the use of metered-dose inhalers (MDIs) has risen considerably as an alternative to nebulized therapy, which has led to inadequate supplies of MDIs in some parts of the United States. In this article, we review and discuss the role of nebulization in patients with SARS-CoV-2 and the treatment of noninfected patients with chronic respiratory diseases. The following two important questions are addressed: (1) should nebulized therapy be used in hospital or home settings by patients infected with SARS-CoV-2; and (2) should nebulized therapy be continued in patients already using it for chronic respiratory disease management in hospital or home settings? The reviews of this paper are available via the supplemental material section.

The first state-level public health program for obstructive airway disease in India: An early field-level evaluation.

Background:Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India; however, there are no programs for COPD in India at primary care level. Kerala became the first state in India to implement a program at primary care for COPD, called the Step Wise Approach to Airway Syndrome program.Objective:The objective of the study was to evaluate and document the implementation status of a program for obstructive airway disease (OAD) in Trivandrum district of Kerala state in India and compare the treatment characteristics of patients with OAD seeking care from the centers implementing and not implementing this program for OADs.Methods:A cross-sectional study was done as early evaluation of a program for OAD implemented in Kerala state, India, from October 2018 to February 2019.Results:A reflection of the health-seeking behavior due to better facilities at the FHCs. There was no difference in the hospital visits or emergency department visits between the two groups. However, there was a statistically significant difference in the average number of visits per patient to health center for taking injectable drugs and visits for nebulization. Forty-nine (94%) of the COPD and 36 (100%) of the asthma patients underwent spirometry from implementing center itself. A higher proportion of patients receiving care from implementing centers (30.9%) never had to buy inhalers from outside.Conclusion:This is the first time that a public health programme for chronic respiratory disease management at primary care level was evaluated in India. The study has provided valuable insights on the need for strengthening the training for health care providers as well as patient education in bringing about a change in patient attitudes.

Pediatric pulmonary rehabilitation program at a Chilean public hospital.

Pediatric pulmonary rehabilitation is relevant in the management of chronic respiratory diseases. In Chile, it is provided only at certain hospitals. Objective. To describe the outcomes of a pediatric pulmonary rehabilitation program after 3 months of rehabilitation. Retrospective study of patients with chronic lung disease, neuromuscular disease, and other chronic conditions admitted to the program between June 2011 and June 2017. Assessments included general physical and respiratory muscle examination, and spirometry. General physical training and respiratory muscle training were planned according to facilitybased, mixed and home protocols. A total of 156 patients (11.45 ± 3.55 years old) were included, 68 had chronic lung disease (11.56 ± 4.6 years old, 43.5 %); 45, neuromuscular disease (11.4 ± 3.7 years old, 28.8 %); and 43, various chronic conditions (11.31 ± 3.9 years old). Out of all patients, 102 (65.4 %) followed training protocols; targeted (n = 27), mixed (n = 23), and home (n = 50); compliance was 69 %, 87.5 %, and 70 %, respectively. Peak inspiratory pressure increased by 19.3 % (p = 0.001); peak expiratory pressure, 14.5 % (p = 0.001); forced vital capacity, 12.9 % (p = 0.001); forced expiratory volume in 1 second, 11.6 % (p = 0.004); and the six-minute walk test, 17.6 meters (p = 0.036) after 3 months of rehabilitation. The intervention protocol improved cardiorespiratory functional capacity. Compliance was over 65 %.

Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients

Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients Abstract. Pulmonary rehabilitation (PR) is a comprehensive treatment method in the non-drug management of chronic respiratory diseases. Most evident data exists for COPD patients. However, the effect of PR is no longer detectable after 6 to 12 months, unless the patient participates in a kind of maintenance program following PR. But the contents of such a maintenance program are still unclear in terms of duration, location, methods and intensity. They are still subject of current research. Therefore concrete recommendations are still missing and further studies are necessary. This review aims to give an overview of the existing results in this field.

A Comparative Study of Pulmonary Function Test in School Children of Industrial Area and Non Industrial Area

Background&#x0D; Pulmonary function test is an important tool in the diagnosis, assessment and management of respiratory diseases in adults and older children. The main objective was to study the pulmonary function test in school children of industrial and Non industrial area.&#x0D; Method&#x0D; The study was carried out in a school of industrial area i.e., Advani Arlicon Higher secondary School, Urla Road, Birgaon and a school of Non Industrial area i.e., Vivekananda Higher Secondary School, Mana Camp of Raipur city from April to August 2012.. The subjects were evaluated through pulmonary function test by using Spirometry method. A total of 400 subjects aged between 11–18 years were included. For the study Permission from Institutional Ethics Committee was obtained. Initially informed individual consent was taken from all the patients included in the study.&#x0D; Results&#x0D; When Mean FEV1 (in liters) for Males in Cases was compared with Controls, p value was found to be &lt;0.0001. When Mean FEV1 (in liters) for Females in Cases was compared with Controls, p value was found &lt;0.0001. When PEFR (in liters/Sec) for Males in Cases was compared with Controls, p value was found to be 0.0290. When PEFR (in liters/Sec) for Females in Cases was compared with Controls, p value was found to be 0.3117.&#x0D; Conclusion&#x0D; To conclude, the problems are diverse, but it is important to keep close control over pollutants. Some preventable strategies need to be taken for acceptable environment for the future generations.

Occupational therapy-led pulmonary rehabilitation: A practice analysis

Statement of context:Pulmonary rehabilitation is accepted as an essential strategy for the management of respiratory disease. However, there is wide variation in models of service delivery, and evi...

The Geriatric Patient: The Ideal One for Chest Ultrasonography? A Review From the Chest Ultrasound in the Elderly Study Group (GRETA) of the Italian Society of Gerontology and Geriatrics (SIGG)

ObjectivesTo investigate the current evidence on the use of point-of-care chest ultrasonography in older patients and geriatric settings and present the current state of the art of chest ultrasound applications. DesignSpecial article based on a literature review with narrative analyses and expert clinical knowledge. Setting and participantsAll studies performed in a geriatric setting were included. Observational and intervention studies and meta-analyses including participants aged ≥70 years were also considered, even if not specifically focused on a geriatric setting. MeasuresData on participant characteristics, diagnostic accuracy of chest ultrasonography, and outcomes were collected for each considered study. Data were analyzed and discussed with a particular focus on the possible applications and advantages of chest ultrasonography in geriatric medicine, underlining the possible areas of future research. ResultsWe found only 5 studies on the diagnostic accuracy and prognostic relevance of chest ultrasonography in geriatrics. However, several studies performed in emergency departments, intensive care units, and internal medicine wards included a large number of participants ≥70 years old; they suggest that chest ultrasonography may represent a valid aid to the diagnostics of acute dyspnea, pneumonia, acute heart failure, pneumothorax, and pleural diseases, with an accuracy in some cases superior to standard x-rays, especially when mobility limitation is present. Diaphragm ultrasonography may also represent a valid tool to guide mechanical ventilation weaning in older patients with acute respiratory failure. Conclusions and implicationsChest ultrasonography may represent a valid bedside diagnostic aid to the management of acute respiratory diseases in older patients. However, specific evidence is lacking for geriatric patients. Future research will need to focus on defining the reference standards and the diagnostic accuracy for older patients with frailty and multimorbidity, cost-efficacy and cost-effectiveness of the technique, its impact for clinical outcomes, and role for follow-up in the post-acute care.

Interventions for management of respiratory disease in young people with cerebral palsy: A systematic review.

Respiratory disease is a leading cause of hospitalizations and deaths in young people with cerebral palsy (CP). It is insidious and multifactorial. Clinical management can be complex. This systematic review describes effects of interventions for the prevention and management of respiratory disease in young people with CP. Nine databases (Cochrane, CINAHL, Embase, EMCare, MEDLINE, PEDro, OpenGrey, ScienceDirect, and SpeechBITE) were searched. Eligibility criteria were as follows: the population included at least 50% individuals with CP aged under 26years, the intervention was for chronic respiratory illness, the outcomes were any measurable indicators of respiratory health or morbidity; the study design could be any original study reporting effects of an intervention on measurable outcomes, and the study was published January 1998 or later. The American Academy for Cerebral Palsy and Developmental Medicine methodology guided study appraisal and synthesis. The review was registered with PROSPERO (reference number CRD42018086314). The search yielded 3,347 papers; 37 papers (reporting 34 studies) of these met the eligibility criteria. They included 582 participants with CP (ranging from 1 to 77 across studies) with ages from 5months to 25years. Interventions were diverse and included: airway clearance techniques, exercise, positioning, mealtime management, salivary management, upper airway interventions, antibiotics, gastro-intestinal interventions, and spinal surgery. There were no interventions aimed at prevention of respiratory disease in this population. Research designs were classified as Levels 2 (n=3), 3 (n=2), 4 (n=25), and 5 (n=4). Evidence for most respiratory interventions for young people with CP is absent or weak. No controlled trials demonstrated significant effects on respiratory morbidity, owing to their scarcity, weak designs, and inadequate power. There is an urgent need for well-designed prospective controlled studies investigating prevention and management of respiratory disease in young people with CP.

Health Benefits of Heat-Killed (Tyndallized) Probiotics: An Overview.

Nowadays, the oral use of probiotics is widespread. However, the safety profile with the use of live probiotics is still a matter of debate. Main risks include: Cases of systemic infections due to translocation, particularly in vulnerable patients and pediatric populations; acquisition of antibiotic resistance genes; or interference with gut colonization in neonates. To avoid these risks, there is an increasing interest in non-viable microorganisms or microbial cell extracts to be used as probiotics, mainly heat-killed (including tyndallized) probiotic bacteria (lactic acid bacteria and bifidobacteria). Heat-treated probiotic cells, cell-free supernatants, and purified key components are able to confer beneficial effects, mainly immunomodulatory effects, protection against enteropathogens, and maintenance of intestinal barrier integrity. At the clinical level, products containing tyndallized probiotic strains have had a role in gastrointestinal diseases, including bloating and infantile coli—in combination with mucosal protectors—and diarrhea. Heat-inactivated probiotics could also have a role in the management of dermatological or respiratory allergic diseases. The reviewed data indicate that heat-killed bacteria or their fractions or purified components have key probiotic effects, with advantages versus live probiotics (mainly their safety profile), positioning them as interesting strategies for the management of common prevalent conditions in a wide variety of patients´ characteristics.

PDG74 DRUG UTILIZATION OF PATIENTS WITH RESPIRATORY DISEASE AT COMMUNITY PHARMACIES IN CHINA: AN ANALYSIS OF CHEMICAL DRUGS (2014-2017)

This study aimed to explore the situation of chemical drugs used for patients with respiratory disease at community pharmacies in China. Using the data from the China Health Industry Intelligence System Database from 2014 to 2017, which collected data from community pharmacies (n = 11,450) in 185 cities over China. Comprehensive analysis of the utilization of chemical drugs in respiratory disease in community pharmacies from the perspectives of market share, indications, and prescription. The sales of chemical drugs in the community pharmacies raised from 11.4 billion yuan in 2014 to 13.9 billion yuan in 2017 with the compound annual growth rate is 6.58%. The market share of prescription drugs increased from 24.99% in 2014 to 32.20% in 2017.The market concentration rate of chemical drugs is gradually decreasing, which the concentration of TOP10 reduced from 51.53% in 2014 to 47.64% in 2017. The nature of prescriptions and indication of the Top 10 chemical drugs in 2017 were: (1)Pediatric paracetamol, atificial cow-bezoar and chlorphenamine maleate granules(OTC, cold); (2)Compound paracetamol capsule(OTC, cold); (3) Compound paracetamol tablets(OTC, cold); (4)Pediatric paracetamol granules(OTC, cold); (5)Loratadine tablets(OTC, allergic rhinitis); (6)Salmeterol xinafoate and fluticasone propionate powder for inhalation(prescription ,asthma); (7)Montelukast sodium chewable tablets(prescription, asthma); (8) Ambroxol hydrochloride and clenbuterol hydrochloride oral solution(prescription, bronchitis); (9)Ibuprofen suspension(OTC, cold), (10)Budesonide formoterol powder inhalation(prescription, asthma). At community pharmacies in China, the chemical drugs for patients with respiratory disease, especially the OTC, are mainly used to treat colds, and the prescription drugs for asthma treatment increase rapidly. More interventions are needed to enhance drug therapy management of respiratory disease.

Mobile health tools for the management of chronic respiratory diseases.

The market of mobile health (mHealth) technology is rapidly evolving, making new mobile technologies potentially available for healthcare systems. Patient empowerment through self-monitoring of symptoms, shared decision making with the physician, and easily accessible education are importantfeatures extending the reach of mHealth technology beyond traditional care. Two digital distribution platforms (Apple App Store and Google Play Store) were searched for currently available mobile applications (apps) for patients with chronic respiratory diseases (CRDs). A new index (score ranging from 0 to 10) was developed to assess the potential of apps as a tool to empower patients through mobile technology (based on self-monitoring, personalized feedback, and patient education app features). One hundred and twelve apps were retained for analysis and could be classified in 5 categories: Asthma (n=71), COPD (n=15), Asthma and COPD (n=15), Rhinitis and Asthma (n=5), and Rhinosinusitis (n=6). Eighty percent were developed by medical technology companies compared to 18% by medical doctors and 2% by pharmaceutical companies. Two-thirds of apps allow disease self-monitoring, whereas over half of apps provide patient feedback through graphs. Sixty percent of apps contain easily accessible patient education material. Only three percent of apps reach a score of ≥7 on the newly designed patient empowerment index. A variety of apps are available for patients with CRDs of which only few were developed by or jointly with medical doctors. The majority of these apps include self-monitoring tools, but only few also provide personalized feedback, which is needed to adopt these apps into daily care.

Obstructive Sleep Apneu (OSA), Obesitas Hypoventilation Syndrome (OHS) dan Gagal Napas

Background: Obstructive sleep apnea (OSA) is a state of the occurrence of upper airway obstruction periodically during sleep that causes breathing to stop intermittently, either complete (apnea) or partial (hipopnea). Obesity hypoventilation syndrome (OHS) is generally defined as a combination of obesity (BMI ≥ 30 kg / mc) with arterial hypercapnia while awake (PaCO2 &gt; 45 mmHg) in the absence of other causes of hypoventilation. Purpose: In order for the pulomonologis can understand the pathogenesis and pathophysiology of OSA and its complications. Literature review: Several studies have been expressed about the link between OSA, OHS with respiratory failure disease. Pathophysiology of OSA, OHS in respiratory failure were difficult to detect, can cause respiratory failure disease management becomes less effective. Conclusion: A good understanding can help with the diagnosis and management of the appropriate conduct to prevent complications of respiratory failure associated with OSA.

Interaction between the respiratory system and cerebral blood flow regulation.

This review summarizes the interaction between the regulatory system of respiration and cerebral vasculature. Some clinical reports provide evidence for the association between these two physiological regulatory systems. Physiologically, arterial carbon dioxide concentration is mainly regulated by two feedback control systems: respiration and cerebral blood flow. In other words, both of these systems are sensitive to the same mediator, i.e., carbon dioxide, at a set point. In addition, respiratory dysfunction alters various physiological factors that affect the cerebral vasculature. Therefore, it is physiologically plausible that these systems are closely linked. The regulation of arterial carbon dioxide concentration affected by respiration and cerebral blood flow may be a key factor for a rise in the risk of brain disease in the patients with respiratory dysfunction. For example, the management of respiratory disease (e.g., patients with chronic obstructive pulmonary disease) and the use of prophylactic therapy are essential to reduce the risk of stroke.

A role for psychosocial support in the management of respiratory disorders

A role for psychosocial support in the management of respiratory disorders

The importance of obtaining a sputum sample and how it can aid diagnosis and treatment.

Respiratory disease has a major impact on the NHS and continues to be a growing problem as each year passes. However, through improving diagnosis and management of respiratory disease the problem could be lessened. Taking a sputum sample is common practice within respiratory medicine especially for patients with chronic obstructive pulmonary disease (COPD) and helps to diagnose, confirm infection and offer correct treatment. It is important that the multidisciplinary team are aware of how to appropriately obtain sputum samples and when to request them. It is important as a respiratory health professional to understand the patient's usual sputum history including colour, amount and viscosity. Antibiotic stewardship aims to reduce antibiotic resistance through offering the most appropriate antibiotics for those with a bacterial infection and to discourage antibiotic prescribing for those that have not. This should result in better patient outcomes and lower healthcare costs.

Oscillating positive expiratory pressure (OPEP) device therapy in Canadian respiratory disease management: Review, care gaps and suggestion for use

Oscillating positive expiratory pressure (OPEP) devices are a non-pharmacologic therapy that can increase mobilization and elimination of airway mucus hypersecretions. In respiratory diseases such as chronic obstructive pulmonary disease, cystic fibrosis and others, mucus clearance can improve pulmonary mechanics and facilitate gas exchange, reduce breathlessness, prevent recurring infection, reduce exacerbations and hospitalization and improve quality of life. Several OPEP devices are available, although only a few have published evidence of efficacy, cost effectiveness and benefit to patients. We review the evidence and provide suggestions on inclusion of some OPEP devices in mucus clearance therapy regimens.

Smart capnometry: Personalising the diagnosis and management of respiratory disease

To develop a connected, portable, point-of-care medical device (capnometer) for the diagnosis, monitoring and management of acute and chronic cardiorespiratory diseases at home and in primary and secondary care environments, facilitating timely, evidence-based treatment interventions and