Mean Peak Expiratory Flow Rate Research Articles

The home-based breathing and chest mobility exercise improves cardiorespiratory functional capacity in long COVID with cardiovascular comorbidities: a randomized study

BackgroundBeyond the acute phase, a considerable proportion of patients recovering from the coronavirus disease 2019 (COVID-19) experience long-term sequelae that profoundly impact their quality of life, particularly their physical fitness. This study aims to assess the effect of home-based breathing and chest mobility exercise on the cardiorespiratory functional capacity of long COVID with cardiovascular comorbidity.MethodsIn this randomized, controlled, single-blind clinical trial, 46 long COVID with cardiovascular comorbidities were randomly assigned to either intervention or control group. The intervention group (n = 23) received additional home-based breathing and chest mobility exercise 3x/week for 12 weeks supervised by attending physicians, whereas the control group only received a home-based cardiac rehabilitation program. Baseline and post-intervention assessments consisted of laboratory (D-Dimer and CRP levels) and functional capacity, assessed through 6-minute walking test (6-MWT), exercise stress test’s metabolic equivalents (METS), and predicted peak oxygen consumption (VO2 peak), peak expiratory flow rate (PEFR), peak cough flow (PCF), chest expansion, and EuroQoL’s quality of life. Intention to treat analysis was performed.ResultsAt the 12th week, intervention subjects had significantly greater functional capacity with higher mean PEFR (p = .031) and PCF (p = .016). Similarly, 6-MWT was higher in the group receiving home-based breathing and chest mobility training (p = .032). The bottom part of the chest circumference was statistically different between the two groups (p = .01). METS and predicted VO2 peak were also higher in the intervention group. However, laboratory parameters and quality of life did not differ markedly (p > .05).ConclusionsHome-based respiratory and chest mobility exercise could be an adjunct to cardiac rehabilitation in long COVID with cardiovascular comorbidities for improving cardiorespiratory functional capacity.Trial registrationThe study protocol was registered at http://ClinicalTrial.gov.id NCT05077943 (14/10/2021).

Peak Expiratory Flow Rate in Healthy Urban School Children (6 to 17 Years) and Its Correlation with Anthropometric Measurements

Background: The predictive normal value of peak expiratory flow rate (PEFR), in children, is correlated with height and other anthropometric measurements, however, it shows ethnic Differences. The present study was conducted to establish the normal value of PEFR in healthy school children and to know the effect of various anthropometric factors on PEFR.
 Methodology: This study was conducted among 2200 students to assess their Peak Expiratory Flow Rate (PEFR) using Mini-Wright peak flow meter. PEFR values correlated with age, gender and various anthropometric measurements.
 Results: Out of total 2200 students, 1122 were boys which accounted for 51%. Mean PEFR for boys was 282.53 L/min and for girls was 270/.79 L/min. In boys and girls PEFR value increase as the age advances.
 Multiple regression modeling with PEFR as dependent variable and MUAC, BMI, Age, CC, Height, Weight and BSA as independent variables shows that Height, Weight, BMI, BSA, Age and chest circumference are independently associated with PEFR value. However, MUAC is not independently associated with PEFR values.
 Conclusion: From this study we conclude that in children between 6 to 17 year of age group the PEFR value in higher in boys compared to girls at any age. Height has strongest association with PEFR then the other variables.

Impact of Volume-Oriented Incentive Spirometry on Lung Volume and Peak Expiratory Flow Rate in Patients With Tracheostomy.

Background The volume-oriented incentive spirometer is a specialized device designed to facilitate maximal inspiration, promote deep breathing exercises, and enhance lung function. The use of spirometry is challenging and not proven in patients with tracheostomy. Therefore, this study aimed to assess the impact of volume-oriented incentive spirometry on lung volume and peak expiratory flow rate (PEFR) in patients with tracheostomy. Methodology All adult patients with cuffed tracheostomy tubes with a Medical Research Council (MRC) score of more than 48 were studied. Volume-oriented incentive spirometry was performed and the PEFR was measured before and after the spirometry session. All patients underwent 28 sessions in seven days with initial few training sessions. Patient demographic information, such as age, gender, reasons for tracheostomy, MRC at the beginning of the session, volume (volume per breath, mL), and PEFR, was documented. Results Thirty patients were studied, consisting of 18 males and 12 females with initial MRC scores ranging from 48 to 60. The mean lung volume and mean PEFR at the end of seven days were 950 ± 330.9and 134.7 ± 63.3, respectively, demonstrating safety with minimal complications, including four cases of pain at the tracheostomy site, three cases of hypotension, one case of abdominal pain, and 22 cases with no reported complications. Conclusion Volume-oriented incentive spirometry improves lung volumeand PEFRin patients with a tracheostomy tube. Additionally, spirometry proved to be both feasible and effective in this patient population.

PULMONARY FUNCTION IN RHEUMATOID ARTHRITS: A CROSS-SECTIONAL STUDY

Objective: Rheumatoid arthritis (RA) is an autoimmune disease with many extraarticular manifestations. Pulmonary involvement is seen in 60-80% cases with and without symptoms. This research studies the pattern of PFT (Pulmonary Function Test) in RA and find the correlation between PFT and Disease activity. Secondary objectives were to evaluate the effect of use of Methotrexate (MTx) on disease activity and PFT.
 Methods: An outpatient-based descriptive cross-sectional study was conducted in General Medicine department at a tertiary centre among 100 eligible patients. Disease activity score was recorded using DAS-28 (Disease Activity Score-28) and CDAI (Clinical Disease Activity Index). Patients underwent PFT by Spirometry thereafter.
 Results: 45 % patients had restrictive pattern and 55% had normal PFT. None had an obstructive pattern. The mean FVC (Forced Vital Capacity), FEV1 (Forced Expiratory Volume in the first second), FEV1/FVC ratio, PEFR (Peak Expiratory Flow Rate) and FEF 25-75% (Forced mid expiratory flow) were 78.83±14.37, 79.24±16.96, 103.56±11.03, 71.73±22.39 and 76.56±23.72 respectively. Both FVC and FEV1 were found to be significantly associated with age, disease duration, CDAI score, MTx dose and duration (P<0.05). Age, ESR(erythrocyte sedimentation rate) and MTx dose were significantly associated with FEV1/FVC ratio (P<0.05). Age, duration of disease, ESR. MTx dose and duration were significantly associated with PEFR (P<0.05). Lastly age, CDAI score, MTx dose and duration were significantly associated with FEF 25-75% (P<0.05).
 Conclusion: Restrictive pattern (45%) was the most common defect on PFT among RA patients. Severity of lung disease depends on age, MTx dose, disease activity (ESR, CDAI), duration of disease and MTx duration.

Continuous Analgesia through an Extrapleural Catheter: Ropivacaine Alone versus Ropivacaine with Fentanyl

Introduction: Thoracotomy incision causes severe debilitating pain. Local anesthetic infusion in extrapleural paravertebral space via a catheter is a good alternative for postoperative analgesia for such patients. The addition of fentanyl to the local anesthetic infusion may further augment the analgesic efficacy of this technique. The aim was to compare the analgesic efficacy of 0.375% ropivacaine with fentanyl and without fentanyl via extrapleural paravertebral catheter (EPVC) for continuous postoperative analgesia. Materials and Methods: This prospective comparative study included 40 patients aged 18–60 years belonging to the American Society of Anesthesiologists (ASA) Grade I, II, and III posted for thoracic surgery. All the patients received general anesthesia as per the standard institutional protocol, and intubation was done with an appropriate size double-lumen endotracheal tube after giving muscle relaxant. An extrapleural catheter was inserted by the surgeon under direct vision external to the parietal pleura just before thoracotomy closure. Patients were randomly allocated to receive an infusion of 0.375% ropivacaine at 0.15 ml/kg/h in Group R or 0.375% ropivacaine with fentanyl 2 mcg/ml at 0.15 ml/kg/h in Group R.F. The dose or rate of infusion was decreased after 2 days or chest drain removal as the pain subsided. Postoperatively, the pain was assessed using a Visual Analog Scale (VAS) at 1, 6, 12, 18, 24, 48, and 72 h after the surgery. Patients who complained of pain with a VAS score of more than or equal to 4 were given injection tramadol 1 mg/kg as rescue analgesic. The peak expiratory flow rates (PEFRs), hemodynamic parameters, and incidence of any adverse effect were compared between groups. Results: The analgesia duration was comparable in the two groups (3.46 h in Group R vs. 4.60 h in Group R.F, P = 0.091). The mean VAS score at rest as well as during cough was comparable between the two groups (P > 0.05). There was no statistically significant difference in the mean PEFRs between the two groups. Conclusion: Fentanyl 2 μg/ml does not increase the duration of analgesia when combined with ropivacaine 0.375% for continuous EPVC infusion.

The effect of body weight on peak expiratory flow rate (pefr) among the adolescent rural school children, an observational study

Background: The increasing prevalence of childhood obesity in developing countries is a growing public health concern. Obesity has been linked to pulmonary dysfunction, including reduced peak expiratory flow rate (PEFR). This study aimed to investigate the effect of body weight on PEFR among rural adolescent school children. Methods: A cross-sectional observational study was conducted in schools located in and around Nagamangala Taluk, with a study duration of 18 months. The sample size was determined using a formula based on the prevalence of obesity in school-going children. Anthropometric measurements, including height, weight, waist circumference (WC), and waist-to-height ratio (WHtR), were recorded. PEFR was measured using a peak flow meter. Statistical analysis, including correlation coefficient, t-test, and linear regression analysis, was performed using SPSS version 26. Results: The study included 573 rural adolescent school children, with a majority aged between 13 and 15 years and a higher proportion of female participants. The prevalence of overweight based on WHtR was 29.7%. There was no significant difference in mean age between overweight and normal WHtR groups. However, a higher prevalence of overweight was observed among boys compared to girls. Higher consumption of sweets, soft drinks, and fast food was significantly associated with overweight, while a higher frequency of exercise showed an inverse association. Longer duration of TV viewing was also associated with overweight. Overweight children had a significantly higher mean BMI and lower mean PEFR compared to children with a normal WHtR. There was a significant inverse correlation between PEFR and both BMI and WHtR. Conclusion: The present study observed a significant inverse correlation between PEFR and both BMI and WHtR. The study findings support the negative impact of excess body weight on lung function, as evidenced by reduced PEFR among overweight rural adolescent school children. The results emphasize the need for interventions to address childhood obesity and promote healthy lifestyle behaviors. Awareness among healthcare professionals, parents, and educators is crucial for early detection and management of pulmonary dysfunction associated with excess body weight in children.

Diurnal variation of peak expiratory flow rate in adolescents

Lung functions exhibit a circadian rhythm. Peak Expiratory Flow Rate (PEFR) is an easily measured and reproducible parameter for measuring lung functions. Limited information is available on the circadian variations in lung functions in south Indian adolescents. Hence, this study was undertakento evaluate the diurnal variation of PEFR in adolescents.This longitudinal study was conducted among 30 adolescent girls in the age group of 18-19 years recruited from a hostel in Chirala, Andhra Pradesh. Smokers, pregnant women and subjects with history of tuberculosis were excluded from the study. PEFR was measured using the Mini — Wright s, peak flow meter, four times a day (5.30 – 6.00 am, 12.00-1.00 pm, 5.00-6.00 pm, 9-10.00pm) and the diurnal variation of lung function was calculated. The PEFR values at different time points were analyzed using analysis of variance. Statistical significance was taken at 5% level of significance. Amplitude % Mean and Standard deviation % Mean were used to estimate diurnal variation of PEFR. The mean PEFR recorded at 5.30 am, 12.00 noon, 5.00 pm and 9.00 pm were 340, 347, 349 and 348 respectively. The mean of amplitude % mean and standard deviation % mean obtained in this study were 8.42 ± 3.65and 3.87±1 respectively.C The results of this study indicate that PEFR in adolescents exhibits a definite circadian rhythm, it being lowest early in the morning, progressively rises till late afternoon following which there is a slight fall in the night.

Analysis of lung function and respiratory symptoms in brass/metal industrial workers of Moradabad, Uttar Pradesh, India.

The job demands of some of the industries have been reported to be hazardous to the health and safety of workers. Workplace environmental hazards or occupational hazards are a globally major cause of disability and mortality among the working population. The present study was done to analyze the effect of exposure to metal dust on pulmonary function and respiratory symptoms. The study population selected as cases were 200 male mill workers working for at least 1-year duration (direct exposure) in the age group of 20-50 years, and controls were 200 age- and gender-matched male participants without any history of occupational or environmental exposure. A complete history was taken. Spirometry was done. Spirometric parameters studied were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), ratio of FEV1 and FVC, and peak expiratory flow rate (PEFR). The spirometry data and baseline characteristics of the participants were compared using unpaired t-test. The mean age of the participants of the study group and the control group was 42.3 years and 44.1 years, respectively. The majority of the study population belonged to the age group of 41-50 years. The mean FEV1 value among participants of the study group and control group was 2.69 and 2.13, respectively. The mean FVC value among participants of the study group and control group was 3.18 and 3.63, respectively. The mean FEV1/FVC value among participants of the study group and control group was 84.59% and 86.22%, respectively. The mean PEFR value among the study group and control group was 7.78 and 8.67, respectively. While analyzing statistically, mean lung functional tests were significantly lowered among the study group. About 69.5% of the participants of the study group thought it to be essential for making safety measures a necessity. The present study concluded that mean lung functional tests were significantly lowered among the study group. Despite the use of face mask, lung function abnormality was present in mill workers.

DIURNAL VARIATION OF PEAK EXPIRATORY FLOW RATE IN HEALTHY YOUNG ADULTS

Background: Peak expiratory flow rate is an indicator of respiratory capacity and bronchial responsiveness which can be useful in diagnosing respiratory diseases. However, a circadian rhythm has been observed in its values. The aim of this study was to determine the diurnal variation of peak expiratory flow rate in healthy young adults. Methods: A total of 160 subjects of age 18-24 years were studied in this cross-sectional study done on students of Manipal College of Medical Sciences between March to September 2021. Subjects were asked to record their peak expiratory flow rates five times a day using Mini-Wright peak flow meter after adequate training. Diurnal variability was expressed as amplitude percent mean and standard deviation percent mean. Data analysis was done in SPSS version 25 by Kruskal Wallis test and Mann Whitney U test. Results: Lowest mean peak expiratory flow rate (L/min) was observed in morning in both males (564.21 ± 57.10) and females (320.68 ± 17.05) with progressive rise throughout the day thus reaching highest value in evening (males: 583.16 ± 64.45; females: 349.13 ± 36.32). Statistically significant (<0.005) difference in mean peak expiratory flow rate at different time intervals was found in the overall population. Diurnal variation calculated as amplitude percent mean and standard deviation percent mean was found to be significantly higher in females than males (<0.005). Conclusions: Significant diurnal variation of peak expiratory flow rate was seen in healthy young adults.

Association of obesity markers and peak expiratory flow rate in healthy students of a medical campus of Kathmandu, Nepal

Background: Obesity is a major health problem worldwide in the developed as well as in developing countries like Nepal. It has been linked with different co-morbidities that are known to increase the incidence of cardiopulmonary problems. The study aims to find the association of obesity markers with peak expiratory flow rate in young healthy participants. Methods: A cross-sectional analytical study was performed in 114 students of Maharajgunj Medical Campus in between the age group of 18-25 years. Subject’s body mass index, waist circumference, waist hip ratio, body fat percentage and peak expiratory flow rate were assessed. Peak expiratory flow rate was correlated separately with obesity markers using Pearson’s correlation test. Results: The mean peak expiratory flow rates for male and female were 524.18±87.30 L/min and 355.78±77.89 L/min respectively. A negative correlation was found between peak expiratory flow rate and body mass index (r=-0.082, p=0.50), and also with waist circumference (r=-0.148, p=0.21), waist hip ratio (r=-0.095, p=0.42) and body fat percentage (r=-0.061, p=0.61) in males. In females, peak expiratory flow rate had a negative correlation with body mass index (r=-0.237, p=0.13) and body fat percentage (r=-0.227, p=0.15) whereas, it had a positive correlation with waist circumference (r=0.031, p=0.84) and waist hip ratio (r=0.023, p=0.89). Conclusion: All the obesity markers were negatively correlated with peak expiratory flow rate in males, whereas body mass index and body fat percentage were negatively correlated but waist circumference and waist hip ratio were positively correlated with peak expiratory flow rate in females. PEFR may not be affected by obesity both in males and females as all the correlations are weak.

Assessment of peak expiratory flow rate of bakers in Osun, Lagos and Oyo States, Nigeria

Bakers are exposed to flour dust; thence, they face various tremendous health problems such as asthma and some other respiratory illnesses, which may be aggravated when combined with improper awareness of ways of protection and ignorance by bakery employers and employees. This study focused on bakers' speed of expiration in the selected geographical locations by assessing the Peak Expiratory Flow Rate (PEFR) of the bakers and also establishing equations involving their anthropometric parameters. A total of 435 subjects were considered for each group, classified as a test group and a control group. The PEFR and anthropometric data which includes age, height, weight, and length of chest of bakers and non-bakers were collected using a Mini-Wright peak flow meter and Detecto PD300MDHR column scale. A self-reporting questionnaire was administered to each of the bakers. SPSS (version 21) and MS Excel (version 2016) were used to analyze the data. Descriptive and inferential statistics, as well as T-test analysis, were used to compare the data of the two groups. The study showed that bakers in Agege, Osogbo, and Ibadan have mean PEFR of 372.37, 386.44, and 389.31l/min, respectively, while non-bakers in Agege, Osogbo, and Ibadan have mean PEFR of 487.50, 473.32, and 473.80l/min, respectively. It was observed that some of the factors that affect the low level of PEFR are lack of personal protective equipment, negligence to health tips, carefree attitude to guides, and the principle of safety in bakery industries. It is therefore recommended that require training/retraining, awareness creation, and use of personal protective equipment should be employed as safety interventions highly necessary in the baking industry.

Evaluation of Peak Expiratory Flow Rates (Pefr) among Healthy Children of Khairpur Mir’s City of Pakistan: A Cross-Sectional Study

Aim:To assess the peak expiratory flow rates (PEFR) among healthy children aged 6 to 12 years Study design: A cross-sectional study Place and Duration: This Study was conducted at Gambat Medical College Khairpur Mir’s, Pakistan from April 2019 to March 2020. Methodology: A study using a random sampling technique was conducted in primary schools. Healthy school children of either gender ages 6 to 12 years were enrolled in the study. An EU scale peak flow meter measured PEFR (60-800 l/min). While standing, their PEFR was determined. A total of three readings were taken, with the highest value being recorded. SPSS version 21 was used for statistical analysis. Results: Boys made up 56.15 percent (n=278) of the 495 participants. PEFR was measured at a minimum of 6 years old and a maximum of 12 years old in both genders. Boys aged 6 to 12 years had a PEFR of 179.71 ± 30.67 (L/Min), whereas girls had a PEFR of 159.15 ± 25.77 (L/Min). There was no discernible difference between genders and age categories (t=0.912, P=0.189). Conclusion: Mean PEFR values may vary between gender and age. PEFR results from this study can be utilized as a clinical reference for children aged 6 to 12 years of age. Clinicians can use these PEFR values to measure lung function and airway obstruction in this population subset. Keywords: Age, Gender, Lung Function Test, Peak Expiratory Flow Rates

Anthropometric Variables and PEFR

Peak expiratory flow rate (PEFR) varies with anthropometric variables like calendar age, body height, body weight, and body surface area in different regions. The present study aims at analyzing the relationship of PEFR with anthropometric variables to know a reference value in this region. We conducted the present study on healthy adult males aged eighteen to forty-five years engaged in works where they were un-exposed to pollutants in Patiala, India. Subgroups were made in each anthropometric variable category. PEFR recording was done using Mini Wright Peak Flow Meter. Results are expressed as mean PEFR ± standard deviation (mean ± S.D.), while the students' t-test was used to determine the differences between the means. We observed a linear increase in PEFR with all anthropometric variables. The correlation of PEFR with anthropometric variables was determined. PEFR is positively correlated with body height and body surface area (r =+0.20) and negatively correlated with calendar age (r = - 0.24) and body weight (r = - 0.02). We conclude that PEFR correlates best with body height (r = +0.48), and the result is highly significant (p < 0.01).

Ketamine for Adults with Severe Asthma Exacerbation: A Systematic Review and Meta-analysis

BACKGROUND: Severe asthma mandates careful attention and timely management, and the benefit of ketamine in severe asthma exacerbations in adult patients require further exploration. METHODS: We conducted a systematic review and meta-analysis of the use of ketamine in cases of acute asthma exacerbation in adults. We searched PubMed, Google Scholar, Cochrane databases, and gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform); we also searched the reference lists of included articles and any systematic reviews and meta-analyses identified therein. Our search covered the period from 1963 to August 20, 2021. Search terms were “ketamine” AND “asthma”. RESULTS: Of 25 540 articles, two studies were included in the analysis. The total number of patients included in the studies was 136 (68 in the ketamine groups and 68 in the placebo group). The pooled effect size was 0.30 (95% CI: -0.04, 0.63) favouring ketamine over placebo, p=0.08, (I2=0%, p=0.39). A paired t-test revealed that ketamine improved the mean peak expiratory flow rate (PEFR) from 242.4 (SD=146.23) to 286.95 (SD=182.22), p=0.33, representing an 18.38% improvement. CONCLUSION: Ketamine can induce a 30% improvement in PEFR, representing a small positive effect in the treatment of acute severe asthma exacerbation in the emergency department (ED). The improvement was not statistically significant; nonetheless, since the improvement could be as great as 63% versus only a 4% possibility of no benefit/harm, the benefit appears to considerably outweigh any harm.

Impact of biomass fuels on the respiratory functions of women in Rural India.

In India, about 90% of the rural population relied upon biomass fuels like animal dung, crop residues and wood. Women generally being involved in cooking are at higher risk of developing respiratory diseases following use of unclean fuels. Objective: The objective of the study is to assess the association of respiratory morbidity with different fuels and the duration of exposure in the women residing in the rural area of Maharashtra. A community-based cross-sectional study was conducted in field practice area of the Department of Community Medicine of Government Medical College in Maharashtra. Total of 994 eligible subjects were included in the study and data was collected using predesigned structured questionnaire. Abnormal pulmonary function of the study subjects was assessed by the measurement of peak expiratory flow rate (PEFR). Statistical tests such as ANOVA, bivariate and multivariate analysis were used. Out of 994 subjects, 725 (72.9%) subjects were using only biomass fuel and 120 (12.1%) were using only LPG for domestic purposes. Lowest mean PEFR was seen in mixed fuel users, that is, 284.09 (SD ± 64.83), followed by biomass fuel users, that is, 287.88 (SD ± 61.47). Respiratory morbidity was seen in 369 (38.1%) subjects with maximum morbidity in biomass users, that is, 262 (p < 0.001). Occurrence of respiratory symptoms like dyspnoea, cough and rhinitis was significantly higher amongst the subjects using biomass fuel, with P < 0.001. Bivariate and multivariate analysis showed that use of biomass fuel, age above 60 years and EI more than 90 had higher odds of having respiratory morbidity. The risk of developing respiratory morbidities is high in subjects using biomass fuel. Also, the occurrence of such morbid conditions depends on the higher age and longer duration of exposure to biomass smoke.

Estimation of peak expiratory flow rate in young Indians.

INTRODUCTION: Peak expiratory flow rate (PEFR) is commonly used to monitor the progression of respiratory diseases as it gives good information about the status of airways. A good amount of research is going across the world to establish a local prediction equation. The joint task force of the American thoracic society and European Respiratory Society has promoted research in this regard. In India, data derived from the Caucasian population are still used for PEFR. OBJECTIVE: To verify the relationship between PEF levels and the variables age, sex, anthropometric and body surface area, and establish the regression equation for young Indian adults. METHODS: A cross-sectional observational study was conducted in 15-25 years aged 1000 subjects from the Metropolitan region of Mumbai. Pearson’s correlation coefficient was used to understand the relation of anthropometric parameters and PEFR. Multivariate regression analysis was done for establishing a prediction equation (Alpha 5%). RESULTS: Age and all anthropometric parameters were correlated with PEFR. The mean PEFR of the male population was 515 ml/sec, whereas, for females, it was 399 ml/sec, for PEFR highest correlation was observed with BSA (.696) followed by weight (.667), height (.630), age (.504) whereas BMI shown lowest correlation coefficient (.445). PEFR had the best significance with age, BSA, Height, and BMI. It had less significance with weight. In females, PEFR had the best significance with Height, weight, BMI, and Age. CONCLUSION: Gender-wise differences exist in PEFR. Hence gender-specific equations are needed for the estimation of PEFR.

Dexmedetomidine as an adjunctive treatment for acute asthma.

ObjectiveThis study aimed to compare the efficacy of using dexmedetomidine with salbutamol and salbutamol nebulization alone in patients with acute exacerbation of asthma presenting to the emergency department.MethodsThis clinical trial included 60 patients, in the age range of 18 to 55 years, with signs of bronchospasm presenting to the emergency department. In the intervention group, dexmedetomidine 0.5 µg/kg was injected intravenously and three doses of salbutamol nebulization were administered over 60 minutes. In the control group, salbutamol nebulization was administered for 60 minutes three times. The patient’s clinical status, based on clinical symptoms, consciousness, speech, breathing rate, heart rate, and blood pressure were recorded before the intervention, and peak expiratory flow rate and forced expiratory volume in 1 second were measured at 20, 40, and 60 minutes after intervention. Patients who did not respond to the intervention were excluded from the study within 60 minutes. ResultsThe increased mean forced expiratory volume in 1 second and mean peak expiratory flow rate were found to be similar in both groups during the treatment (P=0.304). The mean systolic and diastolic blood pressure recorded at 40 and 60 minutes were significantly lower in the intervention group. During this study, no patient was excluded before 60 minutes.ConclusionAdministration of dexmedetomidine in addition to standard salbutamol treatment has no beneficial effect in patients with acute asthma attacks and merely causes hypotension in patients.

Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status

BackgroundThe aim of this study was to investigate differences in reflexive and volitional cough airflows in advanced stage head and neck cancer survivors as it relates to aspiration status and time since treatment. The hypothesis is that those who aspirate several years after treatment completion would demonstrate reduced airflows for all cough parameters compared to those recently status post treatment completion given the known progressive deterioration associated with radiotherapy. MethodsDemographic and airflow data during both reflexive and volitional cough tasks and aspiration status as determined during fiberoptic endoscopic evaluation of swallow function were collected from 33 Head and Neck Cancer (HNC) survivors. ResultsOmnibus MANOVA for dependent airflow variables and independent variables aspiration status, time since treatment and cough type (reflex or volitional) was significant (F(3,1) = 184, p < 0.000) indicating that peak expiratory flow rates (PEFR) were reduced under reflex (mean PEFR 1.88 SD 0.7) versus volitional (mean PEFR 2.3, SD 0.7) cough types; reduced for aspirators versus non-aspirators (F(2,1) = 4.1, p = 0.04) and reduced for those in the subacute versus chronic phase status post Intensity Modulated Radiotherapy (IMRT) (F(2,1) = 10.05, p = 0.002). ConclusionFindings of reduced reflexive compared to volitional cough airflows in head and neck cancer survivors are consistent with those from both healthy and other diseased populations. Additional findings that aspirators demonstrate reduced cough airflows compared to non-aspirators supports the hypothesis. Surprisingly, those recently status post treatment completion show worse cough airflows compared to those remotely status post treatment completion.

Evaluation of efficacy of nebulized low molecular weight heparin as an adjunctive extra treatment for acute mild-moderate asthma attack; a randomized clinical trial study

BackgroundAsthma is the most common chronic disorders of the respiratory tract. This study aimed to evaluate the effect of low-molecular-weight heparins (LMWHs) in the treatment of acute asthma. MethodsIn this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the intervention group received nebulized LMWH (1 mg/kg) with albuterol (2.5 mg) every 20 min for 10 min. The patients in the control group received nebulized albuterol with the same dose. Then peak expiratory flow rates (PEFR) and forced expiratory volume in 1 s (FEV1), and hemodynamic parameters in both groups were assessed for every 20 min. ResultsIn total 70 patients enrolled in this study. We found that the mean PEFR at 40 min was higher in the LMWH group than the control group (202.51 L/min and 180.2 L/min) (p = 0.001). Moreover, this difference remains significant in the 60th minute (p < 0.001). Further, FEV1 was significantly higher in the LMWH group after 60 min (1.82 L/min vs 1.48 L/min, p < 0.001). Moreover, we found that the hemodynamic parameters were sustainable in the intervention group. ConclusionThe study suggests that LMWH in mild-moderate asthma attacks may be beneficial in the short term and could be prescribed in addition to standard albuterol therapy.

Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study

Introduction: Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation. Methods: It was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) &lt;300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes. Results: The mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant. Conclusion: Nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality.