Respiratory Function Parameters Research Articles

The effect of inhalation of Citrus sinensis flowers and Mentha spicata leave essential oils on lung function and exercise performance: a quasi-experimental uncontrolled before-and-after study.

BackgroundRecently, there has been an increased interest in the effects of essential oils on athletic performances and other physiological effects. This study aimed to assess the effects of Citrus sinensis flower and Mentha spicata leaves essential oils inhalation in two different groups of athlete male students on their exercise performance and lung function.MethodsTwenty physical education students volunteered to participate in the study. The subjects were randomly assigned into two groups: Mentha spicata and Citrus sinensis (ten participants each). One group was nebulized by Citrus sinensis flower oil and the other by Mentha spicata leaves oil in a concentration of (0.02 ml/kg of body mass) which was mixed with 2 ml of normal saline for 5 min before a 1500 m running tests. Lung function tests were measured using a spirometer for each student pre and post nebulization giving the same running distance pre and post oils inhalation.ResultsA lung function tests showed an improvement on the lung status for the students after inhaling of the oils. Interestingly, there was a significant increase in Forced Expiratory Volume in the first second and Forced Vital Capacity after inhalation for the both oils. Moreover significant reductions in the means of the running time were observed among these two groups. The normal spirometry results were 50 %, while after inhalation with M. spicata oil the ratio were 60 %.ConclusionOur findings support the effectiveness of M. spicata and C. sinensis essential oils on the exercise performance and respiratory function parameters. However, our conclusion and generalisability of our results should be interpreted with caution due to small sample size and lack of control groups, randomization or masking. We recommend further investigations to explain the mechanism of actions for these two essential oils on exercise performance and respiratory parameters.Trial registrationISRCTN10133422, Registered: May 3, 2016.

PECULIARITIES OF EXTERNAL RESPIRATION FUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH DEFICIT OF ALPHA-1-ANTITRYPSIN

Chronic obstructive pulmonary disease (COPD) is one of the leading reasons of mortality in the whole world. The insufficiency of alpha-1-antitrypsin (А1АТ) protein is an important factor of genetic predisposition to COPD development. А1АТ deficit can be diagnosed with the help of phenotyping. Detection of PiZZ phenotype of А1АТ preconditions 95% of А1АТ deficit cases whereas PiMM phenotype testifies about the conservation function of the protein. Detection of A1AT in case of COPD might be accompanied by a graver course of the diseases, it is characterized by peculiarities of complex study parameters of the external respiratory function and densitometric values of the pulmonary tissue determined by computer tomography. The objective of this study is comparison of external respiratory function in COPD patients with PiZZ and PiMM phenotype of А1АТ. Materials and methods: COPD patients with PiZZ phenotype of А1АТ (N = 6) and PiMM phenotype of A1AT (N = 75) were studies. The following spirometric values were evaluate: forced expiratory volume per 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, maximum expiratory flow rate (MEFR), peak flow rates (PFR50 and PFR75), mean flow rate (MFR), as well as the total lung capacity (TLC) etc. Spiral computer tomography was performed with application of the densitometric analysis software. Evaluation of the intensity of dyspnoe and effect of symptoms on the quality of life was done. Results. Comparison of spirometric values showed that for patients at PiZZ phenotype of А1АТ showed lower values of FEV1/ FVC, PFR50, PFR75, MFR, DLco, va and higher parameters of MEFR, FVC and TLC than in PiMM phenotype of А1АТ (p < 0,05*). Conclusions: in COPD patients with PiZZ phenotype of А1АТ more intense deviations of bronchial obstruction, reduction of elastic properties of the pulmonary tissues, hyperinflation, reduction of the capillary bed due to emphysematous pulmonary involvement are observed.

Effect of Nasal Continuous Positive Airway Pressure Therapy on the Functional Respiratory Parameters and Cardiopulmonary Exercise Test in Obstructive Sleep Apnea Syndrome

Effect of Nasal Continuous Positive Airway Pressure Therapy on the Functional Respiratory Parameters and Cardiopulmonary Exercise Test in Obstructive Sleep Apnea Syndrome

Smart Care™ versus respiratory physiotherapy-driven manual weaning for critically ill adult patients: a randomized controlled trial.

IntroductionA recent meta-analysis showed that weaning with SmartCare™ (Dräger, Lübeck, Germany) significantly decreased weaning time in critically ill patients. However, its utility compared with respiratory physiotherapist–protocolized weaning is still a matter of debate. We hypothesized that weaning with SmartCare™ would be as effective as respiratory physiotherapy–driven weaning in critically ill patients.MethodsAdult critically ill patients mechanically ventilated for more than 24 hours in the adult intensive care unit of the Albert Einstein Hospital, São Paulo, Brazil, were randomly assigned to be weaned either by progressive discontinuation of pressure support ventilation (PSV) with SmartCare™. Demographic data, respiratory function parameters, level of PSV, tidal volume (VT), positive end-expiratory pressure (PEEP), inspired oxygen fraction (FiO2), peripheral oxygen saturation (SpO2), end-tidal carbon dioxide concentration (EtCO2) and airway occlusion pressure at 0.1 second (P0.1) were recorded at the beginning of the weaning process and before extubation. Mechanical ventilation time, weaning duration and rate of extubation failure were compared.ResultsSeventy patients were enrolled 35 in each group. There was no difference between the two groups concerning age, sex or diagnosis at study entry. There was no difference in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity or rapid shallow breathing index at the beginning of the weaning trial. PEEP, VT, FiO2, SpO2, respiratory rate, EtCO2 and P0.1 were similar between the two groups, but PSV was not (median: 8 vs. 10 cmH2O; p =0.007). When the patients were ready for extubation, PSV (8 vs. 5 cmH2O; p =0.015) and PEEP (8 vs. 5 cmH2O; p <0.001) were significantly higher in the respiratory physiotherapy–driven weaning group. Total duration of mechanical ventilation (3.5 [2.0–7.3] days vs. 4.1 [2.7-7.1] days; p =0.467) and extubation failure (2 vs. 2; p =1.00) were similar between the two groups. Weaning duration was shorter in the respiratory physiotherapy–driven weaning group (60 [50–80] minutes vs. 110 [80–130] minutes; p <0.001).ConclusionA respiratory physiotherapy–driven weaning protocol can decrease weaning time compared with an automatic system, as it takes into account individual weaning difficulties.Trial registrationClinicaltrials.gov Identifier: NCT02122016. Date of Registration: 27 August 2013.

Physiological and subjective responses to breathing resistance of N95 filtering facepiece respirators in still-sitting and walking

The objective of this study was to assess the impact of breathing resistance on physiological and subjective responses to N95 filtering facepiece respirators (N95 FFRs) during still-sitting and walking. Fifteen subjects sat for 5 min and walked for 5 min while wearing 2 different models of N95 FFRs, 1 model of which was equipped with exhalation valves (N95 FFR/EV). The subjects were monitored by a modified monitoring garment for respiratory signals (RSP) and surface electromyography (sEMG). Subjects also were asked to complete subjective ratings of overall breathing resistance. The results of the physiological measurements in this study have shown that compared with no respirator, wearing N95 FFR had a direct effect on increasing respiratory amplitude, muscle activity and fatigue of abdominal, and fatigue of scalene; The use of N95 FFR/EV conferred limited physiological benefit over N95 FFR in walking; Compared with sitting still, walking significantly decreased respiratory amplitude, but increased respiratory rate, the muscle activity of sternomastoid, scalene, diaphragm and abdominal, the fatigue of scalene and intercostal. The subjective survey showed that wearing respirators and walking had a direct effect on improving the subjective overall breathing resistance. Significantly low to moderate correlation coefficients were shown between physiological values (respiratory amplitude, the muscle activity of diaphragm, the muscle activity and fatigue of scalene and abdominal), and the subjective breathing resistance. This is the first reported study that combines RSP, sEMG and subjective overall breathing resistance to evaluate breathing resistance on the use of N95 FFR in sitting still and walking. The physiological responses to breathing resistance of wearing a N95 FFR for 5 min in still-sitting and walking are relatively small and should generally be well tolerated by healthy persons. Relevance to industryThis paper's findings can be readily employed by respirator manufactures and administrations for evaluating the respiratory muscle function (activity, fatigue) and breathing parameters of wearing N95 FFRs. Observations of present study are in support of issuing new regulations to raise the limit for breathing resistance over short periods at low-moderate exertion tasks. Thus, the manufacturers could easily fulfill the requirements for collection efficiency by adding more filter media while still meeting the requirements for air resistance.

Progression of obstructive sleep apnoea syndrome in Japanese patients.

The aggravation of obstructive sleep apnoea syndrome (OSAS) is reportedly associated with weight gain. The present study investigated the factors associated with worsening of respiratory functional parameters in Japanese OSAS patients who showed no body weight change during the follow-up period. A follow-up polysomnography (PSG) was performed in 82 patients with a mean of 7.5years after the diagnostic PSG, and the apnoea-hypopnoea index (AHI), respiratory event duration, minimum percutaneous oxygen saturation (SpO2), baseline SpO2, and 3% oxygen desaturation index (ODI) during sleep were compared between the two PSGs. Furthermore, factors associated with worsened AHI, respiratory event duration, and minimum SpO2 were investigated using logistic regression analysis. No significant differences were observed in AHI, baseline SpO2, and 3% ODI between the two PSGs. However, there was a significantly increased respiratory event duration and decreased minimum SpO2 observed. In addition, 17 patients had a ≥25% AHI increase, and the age of 40-60years and initial OSAS severity (mild and moderate) were the significantly associated factors. Age of ≥60years and a baseline body mass index (BMI) of ≥25kg/m(2) were significantly associated with prolonged respiratory event duration. The age of 40-60years was significantly associated with decreased minimum SpO2. Untreated middle-aged patients may be at a high risk for worsened AHI and SpO2 even without weight gain.

Investigating lung responses with functional hyperpolarized xenon-129 MRI in an ex vivo rat model of asthma.

PurposeAsthma is a disease of increasing worldwide importance that calls for new investigative methods. Ex vivo lung tissue is being increasingly used to study functional respiratory parameters independent of confounding systemic considerations but also to reduce animal numbers and associated research costs. In this work, a straightforward laboratory method is advanced to probe dynamic changes in gas inhalation patterns by using an ex vivo small animal ovalbumin (OVA) model of human asthma.MethodsHyperpolarized (hp) 129Xe was actively inhaled by the excised lungs exposed to a constant pressure differential that mimicked negative pleural cavity pressure. The method enabled hp 129Xe MRI of airway responsiveness to intravenous methacholine (MCh) and airway challenge reversal through salbutamol.ResultsSignificant differences were demonstrated between control and OVA challenged animals on global lung hp 129Xe gas inhalation with P < 0.05 at MCh dosages above 460 μg. Spatial mapping of the regional hp gas distribution revealed an approximately three‐fold increase in heterogeneity for the asthma model organs.ConclusionThe experimental results from this proof of concept work suggest that the ex vivo hp noble gas imaging arrangement and the applied image analysis methodology may be useful as an adjunct to current diagnostic techniques. Magn Reson Med 76:1224–1235, 2016. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Dose Optimization Study of AEOL 10150 as a Mitigator of Radiation-Induced Lung Injury in CBA/J Mice.

AEOL 10150 is a catalytic metalloporphyrin superoxide dismutase mimic being developed as a medical countermeasure for radiation-induced lung injury (RILI). The efficacy of AEOL 10150 against RILI through a reduction of oxidative stress, hypoxia and pro-apoptotic signals has been previously reported. The goal of this study was to determine the most effective dose of AEOL 10150 (daily subcutaneous injections, day 1-28) in improving 180-day survival in CBA/J mice after whole-thorax lung irradiation (WTLI) to a dose of 14.6 Gy. Functional and histopathological assessments were performed as secondary end points. Estimated 180-day survival improved from 10% in WTLI alone to 40% with WTLI-AEOL 10150 at 25 mg/kg (P = 0.065) and to 30% at 40 mg/kg (P = 0.023). No significant improvement was seen at doses of 5 and 10 mg/kg or at doses between 25 and 40 mg/kg. AEOL 10150 treatment at 25 mg/kg lowered the respiratory function parameter of enhanced pause (Penh) significantly, especially at week 16 and 18 (P = 0.044 and P = 0.025, respectively) compared to vehicle and other doses. Pulmonary edema/congestion were also significantly reduced at the time of necropsy among mice treated with 25 and 40 mg/kg AEOL 10150 compared to WTLI alone (P < 0.02). In conclusion, treatment with AEOL 10150 at a dose of 25 mg/kg/day for a total of 28 days starting 24 h after WTLI in CBA/J mice was found to be the optimal dose with improvement in survival and lung function. Future studies will be required to determine the optimal duration and therapeutic window for drug delivery at this dose.

Prevention of Morbidity in sickle cell disease--qualitative outcomes, pain and quality of life in a randomised cross-over pilot trial of overnight supplementary oxygen and auto-adjusting continuous positive airways pressure (POMS2a): study protocol for a randomised controlled trial.

BackgroundSickle cell anaemia (SCA) is an inherited disorder of haemoglobin. Patients experience long-term health care problems, affecting quality of life (QOL) including frequent acute pain, which is difficult to document in trials except as hospital admissions. Pilot data suggests that overnight respiratory support, either supplementary oxygen or auto-adjusting continuous positive airways pressure (APAP), is safe and may have clinical benefit. This pilot trial aims to determine which intervention is more acceptable to participants and whether there are other advantages of one over the other, e.g. in respiratory function or haematological parameters, before conducting the Phase 2 trial of overnight respiratory support funded by the National Institutes of Health Research.Methods/DesignThis is a pilot cross-over interventional trial with the order of interventions decided by simple randomization. Ten adults (age over 18 years) and 10 children (aged between 8 and 18 years) with homozygous sickle cell disease (haemoglobin SS, HbSS), recruited regardless of symptoms of sleep-disordered breathing, will undergo overnight pulse oximetry and will have two interventions, overnight oxygen and APAP, for a week each in randomised order with a washout week between interventions. Participants will complete online diaries via an iPad throughout the 29 days of the study and will complete QOL questionnaires and have measurement of haematology, biochemistry, spirometry and lung volumes (adults only) at 3 time points, at baseline and after each intervention, as well as in-depth semi-structured qualitative interviews after each intervention, carried out by an experienced psychologist. Both qualitative and statistical methods will be used to analyze the data. The primary outcome is qualitative data looking at participant experience from the transcribed interviews after each intervention. The participant’s view on feasibility, acceptability and preference will specifically be explored. The QOL, laboratory and lung function data will be compared with baseline for each arm.DiscussionPatient and public involvement is an integral part of this trial and the key outcome is the qualitative result, which is dependent on obtaining good quality data to advise on participant feasibility, acceptability and preference. This is being addressed by using a standard interview. The development of a pain endpoint is another important outcome and collecting daily measurements is likely to be challenging. Research results will be used to inform design of the Phase 2 trial.Trial registration ISRCTN46078697 18 July 2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0883-y) contains supplementary material, which is available to authorized users.

Correlation of respiratory pump function with symptomatology in COPD

Staging criteria for COPD include symptoms and lung function parameters, but the role of respiratory pump function parameters in determining disease severity remains unclear.This study aimed to assess the correlation of respiratory pump functions including respiratory center drive (P0.1), inspiratory muscle strength (PImax) and respiratory muscle fatigue (P0.1/P0.1max%) and symptomatology in COPD patients.This study was carried out on 80 COPD patients recruited from the outpatient clinic of Chest Department, Tanta Faculty of Medicine. They had obstructive airflow limitation with FEV1/FVC% <70% and their reversibility tests were lower than 12%. All patients were classified according to GOLD 2015 into 4 grades (A–D).Respiratory center drive (P0.1), respiratory muscle strength (PImax), respiratory muscle fatigue (P0.1/P0.1max%) were assessed in all patients and correlated to COPD symptomatology.The results of this study showed that P0.1 and P0.1/P0.1max% were significantly higher in grade B&D compared to grade A&C (p<0.01) and significantly higher in grade D compared to grade B (p<0.05), while PImax was significantly lower in grade B&D compared to grade A&C (p<0.01) and significantly higher in grade D compared to grade B (p<0.05).P0.1, PImax and P0.1/P0.1max% and resting arterial carbon dioxide tension showed a significant positive correlation with disease symptomatology (CAT and mMRC scales) in COPD patients (p<0.05) while there was an insignificant correlation between FEV1% of predicted and disease symptoms in the studied patients.It was concluded that, respiratory pump functions as reliably assessed by P0.1. PImax and P0.1/P0.1max% can be considered as an important factor in rating disease severity and correlate significantly with symptomatology in COPD patients.

No relation between sympathetic outflow to muscles and respiratory function in amyotrophic lateral sclerosis

ObjectiveIn amyotrophic lateral sclerosis (ALS), not only impairment of motor neurons but also impairment of the autonomic nervous system has been demonstrated by previous physiological studies. Several investigators have reported a correlation between autonomic dysfunction and respiratory dysfunction in ALS. This study analyzed the relation between parameters of respiratory function and muscle sympathetic nerve activity (MSNA) in a large number of ALS patients. MethodsIn 50 patients with ALS (mean age (SD): 62.1 (11.7) years), MSNA, heart rate (HR), and blood pressure (BP) were recorded simultaneously. The arterial oxygen content (PaO2), arterial carbon dioxide content (PaCO2), and forced vital capacity expressed as a percentage of the predicted value for healthy controls (%VC) were determined as parameters of respiratory function. ResultsThere were no significant correlations between MSNA and PaO2, PaCO2, %VC, or the disability score. Analysis of chronological changes in 14 patients examined twice showed that the disability score and PaCO2 were significantly increased, and %VC was significantly more decreased at the second examination compared with the first examination (p<0.01 and p<0.05, respectively). In contrast, HR, BP, burst rate of MSNA, and age-adjusted MSNA exhibited no significant changes between the first and second examinations. ConclusionsThese findings show that gradual deterioration of respiratory function in ALS patients is not associated with changes of quantitative MSNA parameters, which may suggest that abnormality of the autonomic nervous system is a primary feature of ALS.

Cineradiographic analysis of respiratory movements in a mouse model for early Parkinson's disease

Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system known to cause a typical pattern of motor symptoms. In its later stages, PD is known to cause respiratory alterations including shortening of operational volumes and reduced velocity of respiratory-muscle contraction. It has been proposed that such changes are secondary to changes in posture and osteoarticular degeneration, leading to an alteration in the spinal axis that in turn could affect breathing mechanics. In this study, we examined respiratory movements by using cineradiography on a murine (C57BL/6J) model of mild hemi-PD. Under surgical anesthesia, PD mice received an injection of 6-OHDA solution to the right striatum, and were compared to control mice, which received an injection of saline solution. Two weeks after surgery, all mice had their respiratory movements recorded by video X-ray without any restraint. Behavioral tests were performed to assess the severity of the 6-OHDA lesion. As a result, behavioral tests confirmed mild motor impairments in PD mice as compared to controls. Parameters of respiratory function showed mild alterations in the PD group, suggestive of a restrictive-type respiratory disorder. These results suggest that respiratory alterations in PD may emerge simultaneously to other motor symptoms, and not as a consequence of the latter.

Mitochondrial Morphology and Fundamental Parameters of the Mitochondrial Respiratory Chain Are Altered in Caenorhabditis elegans Strains Deficient in Mitochondrial Dynamics and Homeostasis Processes.

Mitochondrial dysfunction has been linked to myriad human diseases and toxicant exposures, highlighting the need for assays capable of rapidly assessing mitochondrial health in vivo. Here, using the Seahorse XFe24 Analyzer and the pharmacological inhibitors dicyclohexylcarbodiimide and oligomycin (ATP-synthase inhibitors), carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone (mitochondrial uncoupler) and sodium azide (cytochrome c oxidase inhibitor), we measured the fundamental parameters of mitochondrial respiratory chain function: basal oxygen consumption, ATP-linked respiration, maximal respiratory capacity, spare respiratory capacity and proton leak in the model organism Caenhorhabditis elegans. Since mutations in mitochondrial homeostasis genes cause mitochondrial dysfunction and have been linked to human disease, we measured mitochondrial respiratory function in mitochondrial fission (drp-1)-, fusion (fzo-1)-, mitophagy (pdr-1, pink-1)-, and electron transport chain complex III (isp-1)-deficient C. elegans. All showed altered function, but the nature of the alterations varied between the tested strains. We report increased basal oxygen consumption in drp-1; reduced maximal respiration in drp-1, fzo-1, and isp-1; reduced spare respiratory capacity in drp-1 and fzo-1; reduced proton leak in fzo-1 and isp-1; and increased proton leak in pink-1 nematodes. As mitochondrial morphology can play a role in mitochondrial energetics, we also quantified the mitochondrial aspect ratio for each mutant strain using a novel method, and for the first time report increased aspect ratios in pdr-1- and pink-1-deficient nematodes.

Mitochondrial respiratory dysfunctions of blood mononuclear cells link with cardiac disturbance in patients with early-stage heart failure.

Patients with cardiometabolic risk factors and asymptomatic cardiac hypertrophy are hallmarks of early-stage heart failure (HF). We hypothesized that mitochondrial respiratory dysfunctions of peripheral blood mononuclear cells (PBMCs) may be associated with inflammation and oxidative stress in early-stage HF patients complicated with cardiometabolic risk factors. Totally 49 subjects were enrolled with 25 early-stage HF patients (stages A and B) having cardiac hypertrophy and dysfunction and 24 healthy controls. It showed that excessive inflammation and reduced antioxidant capacity were closely associated with cardiac abnormalities in early-stage HF patients. Furthermore, the values of mitochondrial respiratory functional parameters R, CIOXPHOS, CIIOXPHOS, CI+IIOXPHOS, CI+IIETS and CIIETS were significantly lowered in early-stage HF patients. Interestingly, these respiratory parameters were correlated with inflammation and antioxidant capacity in participants. Finally, cardiometabolic risk factors such as salt intake and blood pressure were related to the mitochondrial respiratory dysfunctions, which were further validated by in vitro experiments. Our study indicated that cardiometabolic risk factor-mediated mitochondrial respiratory dysfunctions of PBMCs link with the cellular inflammation / oxidative stress and cardiac disturbance in early-stage HF.

OP40 – 2251: Idebenone as a new therapy to treat respiratory function loss in Duchenne muscular dystrophy: from preclinical studies to phase III trial outcome

Based on its dual mode of action (reducing oxidative stress and improving mitochondrial respiratory chain function), we hypothesized idebenone as a potential therapeutic strategy for DMD. Here we summarize the development program which was executed between 2004 and 2014. A preclinical observer-blinded and placebo-controlled study in the mdx mouse model of DMD showed a significant cardioprotective and voluntary exercise performance effect for presymptomatic-initiated and long-term idebenone treatment. Next, a phase 2 randomized placebo-controlled clinical trial (DELPHI) was performed in 21 DMD boys aged 8–16 years, demonstrating trends for beneficial effects of idebenone on early functional cardiac and respiratory parameters. An important finding was that patients treated for 12 months with idebenone stabilized in peak expiratory flow percent predicted (PEF%p, marker of expiratory muscle strength), compared to patients receiving placebo who declined. Next we investigated the efficacy and tolerability of idebenone in a multicenter phase 3 trial (DELOS) in 64 DMD patients aged 10–18 years not taking concomitant glucocorticoid steroids. The majority of patients (92%) were non-ambulatory at baseline. The primary endpoint was change in PEF%p over the 12 month treatment period. Other respiratory outcome measures included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), weekly home-based PEF measurements, peak cough flow (PCF) and maximal static airway pressures. Idebenone significantly reduced the decline in PEF%p. A significant treatment effect was also observed in PEF (L/min), weekly home-based PEF as well as analyses of FVC and FEV1. The outcomes were comparable between patients with previous glucocorticoid steroid use and steroid naive patients. Results of respiratory function analyses were supported by responder analyses and clinical observations. In conclusion, our data consistently demonstrated that Idebenone was safe and well tolerated, significantly preserved respiratory function, and represents a new treatment option for patients with DMD.

Chaotic Dynamics of Long-term Prevention of Disorders of Central Hemodynamic Parameters and Parameters of Respiratory Function in Patients with Chronic Obstructive Pulmonary Disease with Comorbid Conditions in the North

Chaotic Dynamics of Long-term Prevention of Disorders of Central Hemodynamic Parameters and Parameters of Respiratory Function in Patients with Chronic Obstructive Pulmonary Disease with Comorbid Conditions in the North

G141(P) Monitoring respiratory function parameters in ventilated infants during inter-hospital emergency neonatal transport

Introduction Volume targeted ventilation (VTV) has been shown to decrease the incidence of hypocarbia, air leaks, bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH) and periventricular leukomlacia (PVL). As a result it has now become the predominant mode of ventilation in the NICU. Within the setting of a UK neonatal transport service, ventilation is more commonly non-triggered pressure limited and time cycled. End tidal Carbondioxide (ETCO) monitoring is used as a surrogate marker of ventilation and minute volume and has demonstrable effectiveness. There is a paucity of data however evaluating the use of additional respiratory function parameters, particularly tidal volume and tube leak during inter-hospital emergency neonatal transport. Aim We aimed to assess current use of supplementary respiratory function monitoring within a UK neonatal transport setting. Methods We carried out a telephonic survey of all UK neonatal transport teams to ascertain current practice with regards to monitoring of the following respiratory function parameters in ventilated infants during emergency neonatal transport: PIP, PEEP, MAP, minute volumes, flow, tidal volumes, ETCO and leaks around the ETT. Method of carbon dioxide monitoring was also recorded. Results 21/22 (95%) of UK neonatal transport teams responded to the survey. Currently, during inter-hospital neonatal transport, 9/21(42%) teams monitor tidal volumes and 8/21(38%) teams monitor delivered airway pressures, flow, minute volumes and leaks around ETT. 18/21(85%) teams use ETCO monitoring. Of these, 14/18(77%) use side stream/micro stream and 4/18(23%) use mainstream ETCO monitoring. Conclusions Our survey shows that currently, mechanical ventilation is mainly assessed using heart rate, respiratory rate, oxygen saturations, blood gas, chest rise, auscultation and ETCO monitoring. Hypocapnia is a well-known complication of mechanical ventilation and rates vary significantly between UK neonatal transport teams. Although the vast majority of teams use ETCO monitoring only 40% of services are using a measure of tidal volume. Continuous monitoring of ventilator parameters in an emergency situation and assessment of minute ventilation would allow clinicians to evaluate changes in pulmonary mechanics allowing short-term modifications, potential reductions in key outcome measures such as hypocarbia and possible reduction in medium to long-term adverse respiratory outcomes. Further studies of the potential benefits of enhanced monitoring are required in this high-risk area.

Ultrafine particle content in exhaled breath condensate in airways of asthmatic children

Air pollution triggers and exacerbates airway inflammation. Particulate material (PM) in ambient is characterized as being coarse (PM 10, aerodynamic diameter range 2.5–10 µm), fine (PM 2.5, 2.5–0.1 µm) and ultrafine (UFP, nano-sized, <0.1 µm). It is known that smaller inhaled PM produced more inflammation than larger ones. Most data on human exposure to PM are based on environmental monitoring. We evaluated the effect of individual exposure to UFP on functional respiratory parameters and airway inflammation in 52 children aged 6–18 years referred to the Pulmonary and Allergic Diseases Laboratory due to respiratory symptoms. Spirometry, bronchial provocation challenge, induced sputum (IS), exhaled breath condensate (EBC) and franctional exhaled nitric oxide evaluations were performed by conventional methods. UFP content in EBC was analyzed by using a NanoSight Light Microscope LM20. The total EBC UFP content correlated with wheezing (r = 0.28, p = 0.04), breath symptom score (r = 0.3, p = 0.03), and sputum eosinophilia (R = 0.64, p = 0.005). The percent of EBC particles in the nano-sized range also correlated with wheezing (r = 0.36, p = 0.007), breath symptom score (r = 0.33, p ≤ 0.02), and sputum eosinophilia (r = 0.72, p = 0.001). Respiratory symptoms and airway inflammation positively correlated to UFP content in EBC of symptomatic children.

Ghrelin ameliorates catabolic conditions and respiratory dysfunction in a chronic obstructive pulmonary disease model of chronic cigarette smoke-exposed rats

Cigarette smoking, which is a well-known major risk factor for chronic obstructive pulmonary disease (COPD), causes both pulmonary and extrapulmonary abnormalities. Ghrelin is a gastric peptide that regulates energy homeostasis. In the present study, we investigated the effects of ghrelin on the catabolic changes, respiratory function and emphysema in an animal model of COPD induced by chronic exposure to cigarette smoke. Rats were exposed to cigarette smoke, and they were administered human ghrelin (0.1 or 1 mg/kg, subcutaneous, twice daily) for 12 weeks. Compared with air-exposed rats, body weight gain, food intake, food efficiency, tidal volume, peak expiratory flow rate, and forced expiratory volume at 100 ms were significantly lower, while functional residual capacity, lung capacity, and neutrophils in bronchoalveolar lavage fluid were significantly higher in cigarette smoke-exposed rats. These indicated that the systemic abnormalities associated with COPD developed after the exposure to cigarette smoke. Ghrelin significantly and dose-dependently increased the body weight gain and food efficiency in cigarette smoke-exposed rats. In ghrelin-treated rats, skeletal muscle strength, which tended to be lowered by cigarette smoke exposure, was improved. Ghrelin ameliorated respiratory function and emphysema in a dose-dependent manner, but did not inhibit the increase in neutrophils in the bronchoalveolar lavage fluid. The respiratory functional parameters and lung capacity were significantly correlated with body weight gain. These results suggest that ghrelin inhibited the development of the catabolic changes, respiratory dysfunction, and emphysema that were induced by cigarette smoke exposure in rats, at least in part, through the amelioration of nutritional status.

Взаимосвязь респираторной функции легких и структурно-функционального состояния миокарда у пациентов с сахарным диабетом 2-го типа и ишемической болезнью сердца

To analyze main parameters of respiratory dysfunction in patients with type 2 diabetes mellitus (DM) with and without concomitant ischemic heart disease (IHD).We examined 104 patients with DM without (n = 64, 61.5%) and with (n = 40, 38.5%) concomitant IHD. Examination included taking medical history, registration of parameters of myocardial and respiratory function and lung diffusion capacity.Respiratory dysfunction in patients with DM was related to disease duration and glycose level. Presence of IHD and chronic heart failure of high functional class was associated with more pronounced reduction of forced expiratory volume in 1 sec and lung diffusion capacity.Revealed association between respiratory parameters and characteristics of the state of myocardium evidence for possible contribution of the latter in development of respiratory dysfunction in patients with DM.