Breathing In Patients Research Articles

The Effect of Treatment Adherence on Health Status of Outpatients with Chronic Obstructive Pulmonary Disease

Adherence to COPD treatment plays a crucial role in patient health outcomes. Understanding the correlation between treatment adherence and health status is vital for clinicians to develop effective disease management strategies. This study aimed to examine treatment adherence and its impact on the health status of COPD patients, specifically focusing on the effects of adhering to inhaled medications and breathing exercises. A cross-sectional study involving 420 outpatients diagnosed with COPD was conducted. The study encompassed administering questionnaires, observing patient breathing exercises, and measuring ventilatory function. Results showed that only 36.9% of participants adhered to treatment, with 44.7% following inhaler protocols and 36.9% regularly engaging in breathing exercises. The patients who were non-adherent exhibited a 0.3-fold increase in disease severity compared to the adherent group (p = .002). These findings suggest that consistent adherence to treatment, including inhaled medications and breathing exercises, may positively affect health status by reducing disease severity and airway obstruction in COPD patients. To address this, we recommend that home care clinicians implement a post-discharge assessment and intervention program. This program should focus on educating patients about the importance of treatment adherence and promoting behaviors that reinforce adherence to prescribed therapies.

Prevalence and characteristics of dysfunctional breathing in patients with asthma in the Japanese population

BackgroundDysfunctional breathing (DB) is a major asthma comorbidity; however, it is not well recognized in Japan. Moreover, it has rarely been reported in the asthma population, and its clinical characteristics are unclear. We aimed to clarify the clinical characteristics of DB as a comorbidity in patients with asthma in Japan. Questionnaire surveys were conducted among patients with asthma at medical facilities in three regions of Japan (Niigata, Kumamoto, and Tokyo). MethodsThis cross-sectional questionnaire survey targeting patients with asthma who had regularly visited medical institutions and their doctors was conducted from September to November 2021. The questionnaire addressed the control status and method of treatment. The diagnosis of DB was evaluated using the Nijmegen questionnaire (NQ). ResultsThere were 2087 eligible participants. Based on their NQ scores, 217 patients were classified into the DB group (NQ ≥ 19). There were significant differences with respect to sex, disease duration, Asthma Control Test (ACT) scores, Patient Health Questionnaire-9 (PHQ-9) scores, type-2 biomarkers, pulmonary function indices, treatment methods, severity, and asthma exacerbations in the previous year between the DB and non-DB groups. In the multivariate analysis, there were significant differences in sex, disease duration (≥15 y), ACT scores (<20), and PHQ-9 scores (≥10). The cluster analysis of cases with DB classified the population into four clusters. ConclusionsThe asthma population with DB exhibited several characteristics, including depression and poorly controlled asthma. Further large-scale interventional investigations with longer follow-up periods are necessary to verify these findings.

Validation of a sleep-disordered breathing screening questionnaire during pregnancy and comparison between mothers and bedpartners prediction of risk

BackgroundSleep Disordered Breathing (SDB) in pregnant patients ranges from 3 to 27% and varies depending on gestational age and method used to diagnose. SDB increases the risk of advanced pregnancy complications such as gestational diabetes mellitus, pregnancy-induced hypertension, and preeclampsia. Screening and diagnosis of SDB during pregnancy remains a challenge, with existing screening tools underperforming during pregnancy. This study aimed to validate a previously developed model for predicting SDB during late pregnancy and compare the predictive value of bedpartner responses.MethodsNinety-six women in the third trimester of pregnancy underwent polysomnography and completed the Berlin Questionnaire (BQ), with 81 bedpartners completing the BQ about their pregnant partner. A subset of BQ items (snoring volume and tiredness upon awakening) along with BMI > 32 kg/m2was utilised to calculate the Wilson Optimized Model (WOM), which demonstrated strong predictive properties in development.ResultsSDB (RDI/hr ≥ 5) was detected in 43.8% of women. BQ identified 72% of pregnant mothers as high risk for SDB (Sensitivity = 83%, Specificity = 37%), compared to 29% of mothers identified by the WOM (Sensitivity = 45%, Specificity = 83%). At RDI of ≥ 15, the WOM correctly classified more women according to SDB risk than the BQ (76.0% vs. 41.7% cases correct,X2(1) = 23.42,p < .001), with no difference at RDI ≥ 5. Bedpartners were more likely to report high risk for SDB on the WOM than pregnant women themselves (38.3% vs. 28.4%), however predictive ability was not improved by bedpartner input (RDI ≥ 5 bedpartner AUC = 0.69 v mother AUC = 0.73).ConclusionBQ largely overestimates the prevalence of SDB in pregnancy compared to the WOM which underestimates. Utilising bedpartner responses didn’t improve screening for SDB in late pregnancy. More work is needed to develop a pregnancy-specific tool for quick and accurate screening for SDB.

Advances in the Study of Patient Self-inflicted Lung Injury

Patient self-inflicted lung injury (P-SILI) is caused by excessive expansion of the lungs caused by excessive spontaneous breathing and the shear force caused by repeated alveolar atrophy and re-dilation in the gravity-dependent area. There are some benefits of keeping spontaneous breathing in patients with acute respiratory distress syndrome: 1. Reduce the need for sedation; 2. Exercise diaphragm function; 3. Improve the cardiopulmonary function of the patient. However, if the respiratory drive is too high, even with ventilator support, the patient will develop self-induced lung injury. In this review, the current pathophysiology of P-SILI and the indicators of monitoring respiratory drive and measures to reduce respiratory drive are systematically reviewed.

Factors Affecting the Effectiveness of DIBH (Deep Inspiratory Breath Hold) in Patients with Left Breast Cancer: A Narrative Review

Deep Inspiratory Breath Hold (DIBH) has become a valuable technique in left-breast cancer radiotherapy, offering the possibility to reduce radiation exposure to organs at risks (OARs) and minimize the risk of cardiac complications. This treatment method involves stopping the breathing of patients during irradiation in order to temporarily distance the heart from the radiation field, which reduces potential cardiac risks and other complications. To identify factors that may affect the effectiveness of DIBH treatment, we analyzed the most important 5-year studies published in the PubMed database. Research shows that DIBH reduces the radiation dose to the heart and lungs. However, the effectiveness of DIBH is determined by a variety of factors, including the patient’s training, cooperation, anatomical features, age, and choice of radiotherapy technique. Additionally, cardiovascular risk factors, such as diabetes, smoking, and hypertension, can be impactful to the effectiveness and potential complications of DIBH. Moreover, if a patient has a substantial level of depression or anxiety, then they may be potentially disqualified from the DIBH treatment method. In addition to this, a lack of consent and/or fear may also disqualify a patient from DIBH treatment. Careful patient selection, comprehensive training, and optimization of treatment parameters are essential to maximize the benefits of DIBH whilst minimizing any potential side effects. DIBH enhancement techniques, such as IMRT and VMAT, also have an important role to play. The purpose of this narrative review article is to summarize the factors affecting the efficacy and side effects of DIBH in radiation therapy for left-breast cancer, with the aim of optimizing its clinical application while minimizing side effects. Patients who are likely to benefit most from DIBH are young women in good medical condition, able to cooperate with the procedure, and with smaller breasts. The increase in the estimated 10-year patient survival is significantly influenced by cardiovascular problems, so patients without diabetes and metabolic syndrome, and non-smokers, will benefit the most. An estimated 50–70% of breast cancer patients are likely to benefit from DIBH, and in the best case, it can result in a 50% reduction in the risk of cardiac problems after photodynamic therapy (PDT).

Exploring the Relationship between Inhaled Corticosteroid Usage, Asthma Severity, and Sleep-Disordered Breathing: A Systematic Literature Review.

(1) Background: Sleep-disordered breathing and asthma are often interrelated. Children and adults with asthma are more susceptible to sleep apnea. Inhaled corticosteroids effectively reduce inflammation and prevent structural changes in the airways. Objective: to explore the existing literature to determine whether inhaled corticosteroids play a role in sleep-disordered breathing in patients with asthma. (2) Methods: We conducted a thorough search of the PubMed, Scopus, and Web of Science databases for English-language articles published up to 12 May 2024. We utilized the ROBINS-E tool to assess the risk of bias. (4) Conclusions: 136 articles were discerned upon conducting the literature search. A total of 13 articles underwent exhaustive full-text scrutiny, resulting in 6 being considered non-relevant. The remaining seven articles, assessed for eligibility, were incorporated into the final analysis. Five studies were identified in adults and two in children. In adult patients, inhaled corticosteroids, especially at high doses, appear to increase the risk of sleep apnea in a dose-dependent manner. Moreover, the properties of inhaled corticosteroids, such as particle size, may impact the risk of developing sleep apnea. In children, the severity of asthma is a key factor affecting the prevalence of sleep apnea, whereas inhaled corticosteroids appear to be a less significant risk factor compared to adults. All of the studies reviewed were classified as having a high risk of bias or some concerns regarding bias. Each study revealed at least one type of bias that raised notable concerns. This research highlights a complex interaction between the use of inhaled corticosteroids, the severity of asthma, and the onset of sleep apnea. Additional research is necessary to investigate these relationships further.

(Invited) Multi-Modal Solid-State Gas Sensors-Based Breath Analysis System with Convolutional Neural Network (CNN) for Early Detection of Lung Cancer

Currently, digital healthcare technologies based on Internet of Things (IOT) are emerging, and the market for digital healthcare was estimated to be 151.5 billion dollars by 2020. Among the digital healthcare technologies, disease diagnosis is attracting maximum attention. Traditional diagnostic methods, such as radiology and human biological material analysis, have limitations of long study time, high cost, radiation exposure, and pain. Therefore, non-invasive diagnostics methods, for early diagnosis of specific diseases and personal healthcare management, have attracted attention.Breath sensors are one of the promising candidates for the realization of non-invasive diagnosis owing to their ease of use, safety, and cost effectiveness. The exhaled breath analysis technique holds great promise as a non-invasive method for diagnosing lung cancer. In the breath of lung cancer patients, various volatile organic compounds (VOCs) markers are generated during metabolic processes. Analyzing these VOCs markers presents a compelling avenue for early and non-invasive lung cancer diagnosis. Solid state gas sensors capable of measuring specific VOCs are currently being researched and utilized as commercial gas sensors for this purpose. However, the concentration of lung cancer VOCs markers in exhaled breath is commonly very low, and individual commercial gas sensors often lack the necessary sensitivity and selectivity to accurately diagnose lung cancer. In this study, we propose a multimodal solid state electronic biosensor system designed to differentiate lung cancer VOCs characteristics among multiple VOCs, enabling exhalation-based lung cancer diagnosis. Initially, we developed multimodal biosensors using more than 20 gas sensors, consisting of metal oxide semiconductor sensors, electrochemical sensors, photoionized detectors, metalorganic frame sensors and so on. And each exhibiting varying sensitivity profiles for complex gas mixtures. Additionally, we designed a classification algorithm based on convolutional neural networks (CNN) and multi-layered perceptron (MLP) to distinguish between lung cancer patients and healthy individuals using the output from these diverse multimodal gas sensors. To evaluate the system's performance, we collected exhaled air samples from 74 lung cancer patients and 107 normal subjects, conducting clinical trials with our developed system. We did model evaluation with confusion matrix and ROC curve. The results of these tests confirmed that our system achieved a high predictive accuracy of over 95% in classifying lung cancer patients. The simplicity of the sensor configuration in our developed system makes it suitable for large-scale screening tests to identify potential candidates for precise lung cancer diagnosis. This technology has the potential to contribute to reduced national welfare costs and improved patient survival rates through early diagnosis.

Improved exercise ventilatory efficiency with nasal compared to oral breathing in cardiac patients.

Objectives: To assess whether nasal breathing improves exercise ventilatory efficiency in patients with heart failure (HF) or chronic coronary syndromes (CCS). Background: Exercise inefficient ventilation predicts disease progression and mortality in patients with cardiovascular diseases. In healthy people, improved ventilatory efficiency with nasal compared to oral breathing was found. Methods: Four study groups were recruited: Patients with HF, patients with CCS, old (age≥45years) and young (age 20-40years) healthy control subjects. After a 3-min warm-up, measurements of 5min with once nasal and once oral breathing were performed in randomized order at 50% peak power on cycle ergometer. Ventilation and gas exchange parameters measured with spiroergometry were analysed by Wilcoxon paired-sample tests and linear mixed models adjusted for sex, height, weight and test order. Results: Groups comprised 15 HF, CCS, and young control and 12 old control. Ventilation/carbon dioxide production ( E/ CO2), ventilation ( E), breathing frequency (fR), and end-tidal oxygen partial pressure (PETO2) were significantly lower and tidal volume and end-tidal carbon dioxide partial pressure (PETCO2) significantly higher during nasal compared to oral breathing in all groups, with large effect sizes for most parameters. For patients with HF, median E/ CO2 was 35% lower, fR 26% lower, and PETCO2 10% higher with nasal compared to oral breathing, respectively. Exercise oscillatory ventilation (EOV) was present in 6 patients and markedly reduced with nasal breathing. Conclusion: Nasal breathing during submaximal exercise significantly improved ventilatory efficiency and abnormal breathing patterns (rapid shallow breathing and EOV) in 80% of our patients with HF and CCS.

Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan

BackgroundAutomated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes.MethodsThis is a multicenter observational cohort study in spontaneously breathing patients with COVID-19 respiratory failure exposed to early lung CT within 7 days of admission. We explored lung CT images using deep learning approaches to quantitative and qualitative analyses; latent class analysis (LCA) by using clinical, laboratory and lung CT variables; regional differences between subphenotypes following 3D spatial trajectories.ResultsComplete datasets were available in 559 patients. LCA identified two subphenotypes (subphenotype 1 and 2). As compared with subphenotype 2 (n = 403), subphenotype 1 patients (n = 156) were older, had higher inflammatory biomarkers, and were more hypoxemic. Lungs in subphenotype 1 had a higher density gravitational gradient with a greater proportion of consolidated lungs as compared with subphenotype 2. In contrast, subphenotype 2 had a higher density submantellar–hilar gradient with a greater proportion of ground glass opacities as compared with subphenotype 1. Subphenotype 1 showed higher prevalence of comorbidities associated with endothelial dysfunction and higher 90-day mortality than subphenotype 2, even after adjustment for clinically meaningful variables.ConclusionsIntegrating lung-CT data in a LCA allowed us to identify two subphenotypes of COVID-19, with different clinical trajectories. These exploratory findings suggest a role of automated imaging characterization guided by machine learning in subphenotyping patients with respiratory failure.Trial registration: ClinicalTrials.gov Identifier: NCT04395482. Registration date: 19/05/2020.

OTMorph: Unsupervised Multi-domain Abdominal Medical Image Registration Using Neural Optimal Transport.

Deformable image registration is one of the essential processes in analyzing medical images. In particular, when diagnosing abdominal diseases such as hepatic cancer and lymphoma, multi-domain images scanned from different modalities or different imaging protocols are often used. However, they are not aligned due to scanning times, patient breathing, movement, etc. Although recent learning-based approaches can provide deformations in real-time with high performance, multi-domain abdominal image registration using deep learning is still challenging since the images in different domains have different characteristics such as image contrast and intensity ranges. To address this, this paper proposes a novel unsupervised multi-domain image registration framework using neural optimal transport, dubbed OTMorph. When moving and fixed volumes are given as input, a transport module of our proposed model learns the optimal transport plan to map data distributions from the moving to the fixed volumes and estimates a domain-transported volume. Subsequently, a registration module taking the transported volume can effectively estimate the deformation field, leading to deformation performance improvement. Experimental results on multi-domain image registration using multi-modality and multi-parametric abdominal medical images demonstrate that the proposed method provides superior deformable registration via the domain-transported image that alleviates the domain gap between the input images. Also, we attain the improvement even on out-of-distribution data, which indicates the superior generalizability of our model for the registration of various medical images. Our source code is available at https://github.com/boahK/OTMorph.

SEQUELAE OF RADIOTHERAPY IN THE ORAL CAVITY

The article addresses the consequences caused by radiotherapy in the oral cavity, which involves ionizing radiation to combat tumor cells. Radiotherapy can be associated with other methods, such as surgery and chemotherapy, and aims to eliminate the tumor without affecting nearby normal structures and functions. However, radiotherapy can also generate side effects on normal cells, especially in the oral cavity, causing oral sequelae. Oral sequelae are changes that harm patients' health, nutrition, speech, chewing, swallowing, breathing, aesthetics and self-esteem, in addition to interfering with treatment, causing infections, bleeding, osteoradionecrosis, necrosis, fibrosis, trismus, cavities, tooth loss, among other complications. Therefore, the text proposes a literature review on the oral sequelae of radiotherapy in the oral cavity, to identify the main oral changes, evaluate patient satisfaction and suggest strategies for preventing and controlling oral sequelae.

Pursed-Lips Breathing and High Fowler Position in Pleural Effusion Patient: Case Report

Pleural effusion is a collection of fluid in the pleura caused by the impact of another disease. Treatment for pleural effusion can be provided through the nursing care process with airway management interventions to help minimize shortness of breath in patients. There are nursing actions that can be carried out independently by nurses, namely the semi-fowler or fowler position, administering additional oxygen, and other therapies such as pursed lips breathing. The aim of this research is to determine the effectiveness of the combination of pursed lips breathing and high fowler position in the nursing care process for patients with ineffective airway clearance nursing problems in patients with pleural effusion using the case report method and nursing care approach. The results of the study showed that the combination of pursed lips breathing and the use of the selected high fowler position as high as 90 degrees for 3 days provided comfort and reduced shortness of breath with pleural effusion while being balanced by the provision of pharmacological therapy. Providing pursed lips breathing therapy and high fowler position has the potential to reduce shortness of breath in patients with pleural effusion

Nurses’ perception of thirst in patients within palliative home care: a qualitative study

BackgroundThirst is the body’s natural urge to replenish fluids in response to a deficiency in hydration. Patients at the end of life gradually lose their independence and reach a point where they become unable to express their needs and can no longer drink on their own. In palliative care, the main advice is to provide regular oral care to relieve symptoms such as dry mouth and thirst. However, according to previous studies the prevalence of thirst and dry mouth remains.AimThe aim of this study was to describe palliative care, nurses’ views and experiences of thirst in end-of-life care in specialist palliative care units.MethodsA qualitative interview study with an inductive approach was conducted. Eighteen nurses working in six different specialist palliative care units in different hospitals in Sweden were interviewed. The interviews were transcribed and analysed with a content analysis approach according to Graneheim and Lundman.ResultsWhen nurses discuss thirst, they perceive thirst as a problem for the patient. This is attributable to various factors, including the patient breathing with an open mouth, a reduced level of awareness, and negligence on the part of the nursing staff. Signs of thirst are dry mouth, and frequently and intense sucking on the oral care stick during oral care. It also emerged that not all nurses perceived that dying patients experienced thirst. They believe that thirst is something that is reduced in the dying patient in the same way as hunger. The most important thing to them is to relieve the dry mouth by providing good oral care. Several issues, such as a lack of guidelines paired with the patient’s reduced consciousness and hence his/her lack of communication, make assessing thirst problematic.ConclusionNurses have different thoughts and experiences about thirst, where some perceive patients as thirsty while others perceive them as having a dry mouth. Nurses expressed that both evidence and guidelines are lacking.

Expiratory Velopharyngeal Obstruction: Sleep Endoscopy-Guided Treatment Strategies to Prevent Oral Breathing During Sleep.

Obstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug-induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE. Case series. Tertiary Medical Center. Seventy-two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO. The results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs35.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01-1.06). However, no other baseline characteristics were significantly associated the odds of EVO. Our study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.

DIFFERENCE BETWEEN PURSED LIP BREATHING AND DISTRACTIVE AUDITORY STIMULI REGARDING ANXIETY IN COPD PATIENTS

Anxiety of COPD patients is related to perceived clinical depression such as fear of acute dyspnea attacks with a sense of suffocation and fear of death. Anxiety can be treated by providing non-pharmacological therapies, namely Pursed lip breathing and distractive auditory stimuli. Pursed lip breathing is a breathing technique that helps more effectively in increasing oxygen saturation, which trains to exhale more slowly so that breathing will feel easy and more comfortable both when resting or doing activities. Distractive auditory stimuli (DAS) using classical music with a tempo of 60-80 beats/minute so as to increase patient calmness and control patient breathing patterns. This study was conducted to determine the difference between Pursed lip breathing and distractive auditory stimuli on the anxiety of COPD patients. Experimental research method two group pre-posttest design with 40 respondents taken using purposive sampling technique which each group consists of 20 respondents. Anxiety measurement tools using beck anxiety inventory. Bivariate analysis using man-whitney test . The results showed that the p-value of the Mann-Whitney test was 0.006. Conclusion: there is a difference in Pursed lip breathing and distractive auditory stimuli, indicating a decrease in the anxiety level of COPD patients

Highly Sensitive Room-Temperature Detection of Ammonia in the Breath of Kidney Disease Patients Using Fe2Mo3O8/MoO2@MoS2 Nanocomposite Gas Sensor.

A novel Fe2Mo3O8/MoO2@MoS2 nanocomposite is synthesized for extremely sensitive detection of NH3 in the breath of kidney disease patients at room temperature. Compared to MoS2, α-Fe2O3/MoS2, and MoO2@MoS2, it shows the optimal gas-sensing performance by optimizing the formation of Fe2Mo3O8 at 900°C. The annealed Fe2Mo3O8/MoO2@MoS2 nanocomposite (Fe2Mo3O8/MoO2@MoS2-900°C) sensor demonstrates a remarkably high selectivity of NH3 with a response of 875% to 30ppm NH3 and an ultralow detection limit of 3.7 ppb. This sensor demonstrates excellent linearity, repeatability, and long-term stability. Furthermore, it effectively differentiates between patients at varying stages of kidney disease through quantitative NH3 measurements. The sensing mechanism is elucidated through the analysis of alterations in X-ray photoelectron spectroscopy (XPS)signals, which is supported by density functional theory (DFT) calculations illustrating the NH3 adsorption and oxidation pathways and their effects on charge transfer, resulting in the conductivity change as the sensing signal. The excellent performance is mainly attributed to the heterojunction among MoS2, MoO2, and Fe2Mo3O8 and the exceptional adsorption and catalytic activity of Fe2Mo3O8/MoO2@MoS2-900°C for NH3. This research presents a promising new material optimized for detecting NH3 in exhaled breath and a new strategy for the early diagnosis and management of kidney disease.

The complex link between sleep-disordered breathing and asthma control in pediatric patients: A cross-sectional study

BackgroundIn children, asthma and sleep-disordered breathing (SDB) may affect quality of life (QoL), and SDB may complicate asthma management. ObjectiveTo evaluate the prevalence of SDB, its association with asthma control, and risk factors associated with SDB in a cohort of asthmatic children. The effects of asthma control and SDB on QoL were also investigated. MethodsWe consecutively recruited asthmatic children referred to our Pulmonology Service from December 1, 2022 to May 31, 2023. Data on anthropometrics, respiratory function, and allergies were collected. The prevalence of SDB was assessed by the Pediatric Sleep Questionnaire (PSQ). Asthma control status was assessed by the Childhood Asthma Control Test (C-ACT), while QoL was evaluated by the Pediatric Quality of Life Inventory (PedsQL) questionnaire. Factors associated with SDB were analyzed. ResultsA total of 78 asthmatic children aged 5–12 years were included. SDB was found in 37.2% of them, with a higher prevalence in children with uncontrolled versus well-controlled asthma (60.1% vs. 27.3%; p-value = 0.005). The C-ACT score was significantly lower in SDB-positive versus SDB-negative group, and uncontrolled asthma (C-ACT ≤19) was associated with a 4.15-fold increased risk of SDB. The PedsQL score was significantly lower in asthmatic children with than without SDB and was associated with lower SDB risk. SDB increased the risk of uncontrolled asthma in children, and asthmatic children with SDB had lower QoL. ConclusionIn asthmatic children, SDB affects both asthma control and QoL. Children with uncontrolled asthma should be referred for polysomnography to identify a possible underlying SDB.

Sedation Techniques for Drug-induced Sleep Endoscopy in Adult Patients with Sleep-disordered Breathing

Drug-induced sleep endoscopy emerged and developed as an essential alternative diagnosis tool in sleep-disordered breathing patients. Accurate identification and dynamic characteristics of upper respiratory airway obstruction are paramount in establishing an adequate therapeutic plan and selecting for particular surgical or non-surgical strategies. This article reviews the current aspects of intravenous sedation for drug-induced sleep endoscopy (DISE) in adults, emphasizing its implications for patients with sleep apnea. The ideal sedative agent for DISE should replicate natural sleep patterns while maintaining upper airway dynamics. The clinical practice exhibits a significant variability in drug selection, with midazolam and propofol often being preferred. The review presents emerging trends and advancements in DISE, emphasizing its role in optimizing surgical indications, predicting outcomes, and screening patients for alternative therapeutic strategies for OSA. Future research is needed to understand better the impact of specific sedative drugs on DISE findings, contributing to the development of standardized protocols and the evolution of new sedative drugs with improved effects and optimized techniques for delivering sedation.

Comparing the Effect of Pursed Lip Breathing and Diaphragmatic Breathing on Pulmonary Function and Exercise Frequency in COPD Patients

Background: COPD is a disease having both pulmonary and extra-pulmonary consequences , a curable but avoidable condition that frequently results in serious difficulties for patients. Its hallmark is a progressive and permanent limiting of airflow brought on by long-term lung inflammation brought on by a variety of dangerous particles or gases. The GOLD strategy highlights the importance of a post-bronchodilator FEV1/FVC ratio &lt; 0.7 and stresses spirometry as the cornerstone for diagnosis. With the help of this criteria-driven method, COPD can be accurately identified and managed in accordance with medical recommendations. Objectives: The aim of study was to investigate the effect of pursed lip breathing exercise and effect of diaphragmatic breathing in COPD patients and also to check improvement of pulmonary function and exercise frequency. Methods: The study was Quasi experimental in which purposive sampling technique was done from COPD patients from DHQ and General hospital, Faisalabad after meeting inclusion criteria. The study duration was 6 months.Forty individuals with COPD wasdivided into two groups: group 1 and group 2. Group 1 received pursed lip breathing exercise and group 2 receiveddiaphragmatic breathing exercise for 8 weeks. To check the normality of data distribution shiparo wilk test was applied. FVC and FEV1 by FVC at baseline shows p values more than 0.05. Data was normally distributed so parametric tests were applied. Paired sample T test for comparison within group which shows p values less than 0.05. Independent sample T Test for comparison between groups which shows p values greater than 0.05. Evaluation of exercise frequency and pulmonary function was measured by counting the number of exercises performed, modifiedborg scale and spirometry (FVC,FEV1, FEV1/FVC) Data was analyzed by SPSS version 24 for this study. Results: there was no significant difference between the effects of pursed lip breathing and diaphragmatic breathing exercises on pulmonary function and exercise frequency. Conclusion: Both interventions were equally effective. Keywords: Pulmonary, Obstructive, Breathing Exercise, Tolerance, Rehabilitation, Respiratory mechanics.

Combination of Tripod Position and Pursed Lip Breathing to Reduce Shortness of Breathing in Patients with Respiratory System Disorders

Background: Shortness of breath that is not treated immediately will result in several other health problems and threaten death. There are non-pharmacological treatments, namely tripod position techniques and pursed lip breathing. To determine the effectiveness of tripod position and pursed lip breathing on reducing shortness of breath in patients with impaired systems and respiration. Methods: The study design used in this case study is based on evidence-based practice of nursing (EBN) with sampling according to inclusion criteria of 5 respondents—ameasuring instrument used for the assessment of shortness of breath using oxygen saturation observation sheets. Respondents' intervention used SOPs for tripod position and pursed lip breathing. Results: Based on interventions that have been performed on patients, most oxygen saturation &lt; 95% to 80%. Then, after the intervention, there was an increase in oxygen saturation to 96-100% as much as 100%, from the results of the spss test using the Wilcoxon test, p values (0.04) &lt; (0.05) were obtained, which means that there is an effect of the application of tripod position and pursed lip breathing on reducing shortness of breath in patients. Conclusion: Tripod position and pursed lip breathing techniques can reduce shortness of breath in patients. This application can be done independently for 10-15 minutes, as much as two times, to reduce shortness of breath if you experience a recurrence.