Respiratory System In Patients Research Articles

Mathematical modeling of lung mechanics and pressure‐controlled ventilation design for barotrauma minimization: A numerical simulation study

SummaryMechanical ventilation represents a fundamental mode of therapy for severely ill patients who cannot breathe autonomously. At the same time, it has the potential of determining Ventilator‐Induced Lung Injury (VILI) and further damaging the patient's respiratory system. In this work we present a model‐based approach for pressure delivery optimization in the context of pressure‐control mechanical ventilation, with the aim of maintaining oxygenation while minimizing barotrauma. A simple compartmental model of respiration describes both mechanical ventilation, alveolar oxygen exchange and blood oxygen transport. Model Predictive Control is used to optimize delivered air pressure at the mouth at each inspiration, optimizing a trade‐off between oxygenation and barotrauma. Numerical simulations with different values of the trade‐off parameter and in two emblematic pulmonary disease scenarios (ARDS and COPD) show the effectiveness of the proposed approach.

Ten-year analysis of the efficacy of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease

Major problems in the course of chronic obstructive pulmonary disease (COPD) include frequent exacerbations and related deaths. The use of pneumococcal vaccines, primarily a 13-valent polysaccharide conjugate vaccine, is a generally recognized tool for reducing the number of exacerbations.The aim of the study was to analyze the prospective clinical efficacy of vaccine prophylaxis with conjugated pneumococcal vaccine Prevenar-13 (PCV13) in patients with COPD over 10 years.Methods. A total of 362 male patients who were treated or monitored at the Regional Pulmonological Center of Chelyabinsk in 2012 – 2022 were enrolled in the study. The main efficacy endpoints of observation over 10 years were: the dynamics of dyspnea (mMRC score), forced expiratory volume in 1st second, the number of exacerbations, hospitalizations, the number of pneumonias. After confirming the diagnosis of COPD, the patients were divided into two observation groups. The first group (n = 150) included patients vaccinated with PCV13. The second group (n = 212) included patients with COPD who had not received pneumococcal vaccination for various reasons.Results. Severe forms of the disease and frequent exacerbations predominated in both groups. 96 (27%) deaths were recorded in the PCV13-vaccinated group, and 171 (47%) deaths in the unvaccinated group. The difference between vaccinated and unvaccinated is statistically significant (p < 0.05). In the unvaccinated patients, there was a steady progression of shortness of breath with an increase by 12% compared to baseline (p < 0.05) by the 10th year. A positive trend in FEV1 was noted in patients vaccinated with PCV13. They also showed a significant decrease in BODE prognostic index.Conclusion. The use of PCV13 allows for stabilization of the main clinical and functional indicators of the respiratory system in patients with COPD in the long term (at least 10 years of follow-up). Vaccination maintains a low risk of adverse events according to the BODE index; an increase in patient survival was noted over a 10-year horizon (odds ratio – 2.35; 95% confidence interval – 1.45; 3.77), including cases with acute viral damage with COVID-19 (COronaVIrus Disease 2019).

THE EFFECT OF SWIMMING ACTIVITIES WITH ELEMENTS OF AQUAFITNESS ON THE FUNCTIONAL FITNESS OF CHILDREN 11-15 YEARS OLD WITH THE CONSEQUENCES OF BRONCHO-PULMONARY DISEASES

Taking into account the rapid increase on a global scale of viral diseases that cause complications of the respiratory system in patients, the increase in the number of such patients and, as a result, the overloading of medical institutions that provide full rehabilitation, there is a need to develop alternative rehabilitation programs for people with the consequences of bronchopulmonary diseases , which would contribute to the acceleration of adaptation and the return of all body systems to the physiological norm.

Functional and Radiological Assessment of the Respiratory System in Patients with Impaired Lung Diffusion Capacity in the Post-COVID Period

Functional and Radiological Assessment of the Respiratory System in Patients with Impaired Lung Diffusion Capacity in the Post-COVID Period

Functional diagnostics of the respiratory system in patients with Long COVID

Given the considerable number of people with persistent respiratory symptoms more than 4 weeks after COVID-19, it is important to determine which examinations are most informative for assessing respiratory function, prognosis, and monitoring the effectiveness of treatment in such patients. The purpose of this study is to cover the functional diagnosis of the respiratory system in patients who survived Long COVID. Bibliosemantic and analytical research methods were applied. According to the world guidelines for patients with persistent respiratory symptoms after COVID-19, all of them should undergo respiratory system examinations: chest X-rays, spirometry, blood saturation measurements, lung diffusion capacity for carbon monoxide, walk tests, and others. The study confirmed that people who have had COVID-19, even after 1-6 months, show a decrease in diffusing capacity of the lung for carbon monoxide, which has a direct correlation with total lung capacity, the severity of clinical manifestations, and the results of rapid tests. Changes in spirometric parameters are observed much less frequently, mainly in patients hospitalised with severe pneumonia, which subsequently leads to post-cystic pulmonary fibrosis. Gradual improvement in functional respiratory tests occurs 3 months, 6 months, and 12 months after acute infection. The most informative tests for assessing respiratory function include the measurement of carbon monoxide diffusion capacity, total lung capacity, and blood gas composition. In conditions of limited access to the aforementioned diagnostic tests, and as a screening tool, quick tests such as the 3-minute/6-minute walk test (3MWT/6MWT) or the 1-minute sit-to-stand test (1-MSTST) can be utilised based on the patient's capabilities

Nursing Needs and Peculiarities of Patients With Apllied Artificial Ventilation of Lungs in Intensive Care Unit From the Perspective of Nurses

Atificial pulmonary ventilation is prescribed in acute respiratory failure to help the patient ensure optimal blood circulation. Artificial lung ventilation is divided into invasive and non-invasive ventilation, and nurses must be able to ensure and maintain patients‘ vital functions.
 Research aim – analyze the nursing need of intensive care unit patients undergoing mechanical ventilation from the perspective of nurses.
 Research methods: analysis of scientific information sources, semi-structured interview, qualitative content analysis.
 Most important results and conclusions. After summarizing the answers received by the subjects, it was found that in order to secure the respiratory system in patients, it is necessary pump secretions from the intubation or tracheostomy tube, monitor the cuff pressure, as well as minitor the risk of leakage of the air stream of non-invasive masks, properly perform the hygiene of the central venous catheter, the hygiene of the eyes and whole body, to prevent bedsores, using auxiliary means.
 During study revealed that the specifics of nursing care are that patients with critical conditions are treated in the intensive care unit, requiring constant monitoring to minitor vital signs. Also has to perform a variety of nursing manipulations related to patient care, such as administering medications, regulating temperature, and meeting the needs of patients to eat and drink. The subjects distinguished that they must be able to prepare in time and quickly for complex procedures and to assist to the doctor.

Study of tissue damage in the respiratory system of patients with COVID-19 in Al-Muthanna Governorate

The object of study was conducted on 30 patients from three different geographical areas of Al-Muthanna Governorate, Samawah city, Al-Rumaitha district, and Al-Khader. The study was conducted on 30 patients, 18 females and 12 males. Ages ranges were between 20 – 75 years old. The aim of study was determination tissue damage levels in the respiratory system in patients with COVID-19. The study showed that females are more susceptible to get COVID-19 than males Percentage of females was 60%. the percentage of tissue damage in the tissues of the respiratory system wide range between 2 - 80% Percentage of damage at the site of the lungs and main bronchi which is the most, was 55%. As for the ages of the patients, the study showed that the ages older than 60 years old 43.3% from total patients they are the ones most susceptible to infection. Relative to the rate of tissue damage in the respiratory system for patients older than 60 years old was 64.7%, it is the highest percentage of tissue damage in relation to other ages.

The Association between the Respiratory System and Upper Limb Strength in Males with Duchenne Muscular Dystrophy: A New Field for Intervention?

The study included cohort patients, aged 6-17, with DMD, recruited from the Rare Disease Centre, Gdansk, Poland. Clinical status (Vignos scale, Brook scale), pulmonary function (respiratory muscle strength-MIP, MEP); spirometry (FEV1; FVC), as well as upper limb function (performance of the upper limb-PUL 2.0) and hand grip strength (HGS) (hand-held dynamometer) were evaluated in all participants. Finally, 53 boys (mean age 11.41 ± 3.70 years, 25 non-ambulant) were included. Each of the participants presented a lower %pv of MIP (48.11 ± 27), MEP (38.11 ± 22), PUL (75.64 ± 27), and HGS (33.28 ± 18). There were differences between the ambulatory and non-ambulatory groups in values of MIP, MEP, FVC, PUL, HGS (p < 0.001 for all), and FEV1 (p < 0.013). There were correlations between PUL, HGS, and MIP (R = 0.56; R = 0.61, p < 0.001 both), MEP (R = 0.59; R = 0.62, p < 0.001), FVC (R = 0.77; R = 0.77, p < 0.001), and FEV1 (R = 0.77; R = 0.79; p < 0.001). These correlations were found for all participants, but non-ambulatory patients presented stronger relationships. 1. The pulmonary and upper limb functions were within the normal range in ambulatory and low in non-ambulatory patients with DMD, but the muscle strength of both systems was low, regardless of the stage of the disease. 2. There seems to be an interdependence between the respiratory system and upper limb strength in terms of muscle strength and function in DMD patients, which is stronger in non-ambulatory patients. This may be the basis for the creation of a new personalized plan in rehabilitation-the simultaneous rehabilitation of the respiratory and upper limb muscles. Further studies on this theory should be conducted.

Matrix Metalloproteinases in Pathogenesis of Ventilation Disorders of the Respiratory System in Patients with Chronic Pulmonary Tuberculosis

The imbalance in matrix metalloproteinase (MMP)/inhibitors system leads to degradation of extracellular matrix of connective tissue and pathological remodeling forming the morphological basis for respiratory dysfunction.The objective: to study the relationship between parameters of MMP/inhibitors system in blood and parameters of ventilation and gas exchange disorders in patients with chronic pulmonary tuberculosis (PTB).Subjects and Methods. Patients with the verified diagnosis of tuberculoma (n = 45) and fibrous-cavernous pulmonary tuberculosis (n = 85) were examined. All patients underwent computed tomography of the chest and assessment of respiratory function. Serum concentrations of MMP-1, -3, -8, -9 and their inhibitors TIMP-1 and α2-macroglobulin (MG) were tested by ELISA (R&amp;D Systems, Minneapolis, MN, USA). Statistica 7.0 and an ANCOVA model were used for statistical analysis which considered the diagnosis and smoking status as factors, and the respiratory function parameters were considered as covariates.Results. In pulmonary tuberculosis patients, the concentrations of MMP-9 and MMP-8 in the blood correlated with extension of lung parenchyma lesions when compared to tuberculomas and fibro-cavernous tuberculosis, MMP-9 and TIMP-1 with changes in lung volumes (R2 = 0.60 and 0.80; p = 0.001), and MMP-8 correlated with functional disorders of gas exchange (R2 = 0.60 and 0.80; p = 0.001). Changes in MMP-1, MMP-3, and α2-MG (R2 = 0.60 and 0.80; p = 0.45) did not correlate with extension of lung parenchymal lesions and decreased lung function.

Functional disorders of the respiratory system after a new coronavirus infection COVID-19

COVID-19 (Coronavirus disease 2019) is an infectious disease caused by the coronavirus SARS-CoV-2, characterized by a high level of morbidity and mortality. A new coronavirus infection affects all organs and systems and often occurs with lung damage and respiratory failure. In a significant part of patients after the acute period of COVID-19, the symptoms of the disease persist, but the most problematic symptoms are the ones regarding lung damage that persists for a long amount of time.&#x0D; This review summarizes the results of our research in 20202021. The purpose of the conducted studies was to estimate the functional parameters of the respiratory system in patients that have been infected by COVID-19. Along with conventional pulmonary function tests (spirometry, body plethysmography and diffusion test), impulse oscillometry, the multiple-breath nitrogen washout test, determination of the maximum inspiratory and expiratory pressures were performed in all patients. Thus, we evaluated the ventilation and gas exchange function of the bronchopulmonary system, the functional state of the peripheral parts of the lungs, including the small airways, the uniformity of pulmonary ventilation and the strength of the respiratory muscles in different periods of recovery after COVID-19, including the follow-up after medical rehabilitation.&#x0D; To sum up, comprehensive functional assessment of the respiratory system is an important clinical tool that allows the planning of pharmacotherapy and to create individual programs of medical rehabilitation of patients who had COVID-19.

Исследование способности задерживать дыхание у взрослых лиц, перенесших COVID-19

Breath-holding tests are a simple way to determine the state of the respiratory system in patients with respiratory pathology. The aim of this study was to evaluate voluntary breath-holding time in COVID-19 survivors, taking into account the socio-demographic and clinical characteristics. Materials and methods. The study involved patients aged 46 to 84 years with a complication in the form of bilateral multisegmental pneumonia after COVID-19 who were admitted for aftercare to the second stage respiratory rehabilitation department of the Central City Clinical Hospital in Kaliningrad. The subjects were divided into urban and rural residents, as well as by age and sex, presence of concomitant diseases and degree of damage to the lung tissue (based on computed tomography data). Voluntary inspiratory breath-holding time was estimated. Results. All of the patients after COVID-19 (n = 367) showed decreased voluntary inspiratory breath-holding time (mean value 16.9 ± 6.7 s). The degree of damage to the lung tissue had a significant negative impact on voluntary inspiratory breath-holding time, irrespective of the patients’ sex, age, place of residence and concomitant diseases: patients with less than 50 % lung tissue involvement (n = 164) on average held their breath significantly longer (by 17 %, p &lt; 0.001) than patients with more than 50 % lung tissue involvement (n = 203). Men (n = 125) were able to hold their breath longer (by 23 %, p &lt; 0.05) than women (n = 242), while patients from rural areas (n = 91) longer (by 26 %, p = 0.004) than urban residents (n = 276). Concomitant pathologies had a negative cumulative effect on the test results.

Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019.

Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019.

Functional changes in the respiratory system after COVID-19-associated lung injury

Since the beginning of the pandemic, COVID-19 (COronaVIrus Disease-2019) has been viewed as a respiratory disease with characteristic symptoms including cough, shortness of breath, and difficulty breathing. However, some patients still have respiratory complaints and post-inflammatory changes in the lung tissue according to high-resolution computed tomography of the chest organs (CT scan) even after discharge from the hospital.The aim. To assess the functional changes in the respiratory system in patients who had COVID-19-associated lung injury using a comprehensive testing of the respiratory function (spirometry, body plethysmography and diffusion test) in the first 6 months after discharge from the hospital.Methods. The study included 434 patients (252 men and 182 women, aged 20 to 79 years), who were divided into 3 groups depending on the time interval between discharge from the hospital and the respiratory function test: Group 1 – 15 – 45 days; Group 2 – 46 – 93 days; Group 3 – 94 – 183 days. All patients underwent a comprehensive testing of respiratory function.Results. The average pulmonary ventilation indicators remained within the normal range both in the general group and in separate groups. A decrease in DLCO was found in most patients: in 53% of people in the general group, in 54, 54 and 51% of cases in Groups 1, 2 and 3, respectively. Restrictive ventilation disorders (reduction of TLC below the lower limit of normal (LLN)) were detected in 29 % of people in the general group, 33, 27 and 26% in Groups 1, 2 and 3, respectively. Obstructive ventilation disorders (decrease in FEV1/FVC below LLN) were detected in 2 % in the general group, and in 3, 1 and 1% in groups 1, 2 and 3, respectively. Statistically significant correlations were found between the maximum volume of lung tissue damage in the acute period of COVID-19, the age of the patients, and the respiratory function indicators.Conclusion. The pulmonary ventilation indicators normalized within 6 months after COVID-19, while a decrease in lung diffusion capacity persisted in most patients and required further active follow-up.

A Study on Pulmonary Complications of Systemic Sclerosis in Eastern India

This study was undertaken to find out the characteristics of clinical, radiological and functional changes affecting the respiratory system in patients with systemic sclerosis (SSc) from eastern India, and the association of these characteristics with pulmonary hypertension. This was a cross-sectional, observational study involving 46 patients. Other than the routine tests, anti-nuclear antibody (ANA), spirometry, diffusing capacity of lung for carbon monoxide (DLCO) measurement, chest radiograph, high-resolution computed tomography (HRCT) of thorax, 6-minute walk test and echocardiography were done. Out of a total of 46 patients, 27 patients had diffuse cutaneous SSc (dcSSc) and 19 had limited cuteaneous SSc (lcSSc). Eleven patients had pulmonary hypertension. The HRCT revealed diffuse parenchymal lung disease (DPLD) in 32 (65%) cases. The ANA was positive in 83% cases. Anti-Scl70 was found in 41% of patients with dcSSc and anti-centromere antibody was found in 47% of patients with lcSSc. Spirometry revealed restrictive pattern in 30 patients; 9 had obstruction; and the rest were normal. The DLCO was abnormal in 38 patients. A strong correlation was found between reduction in DLCO and pulmonary artery systolic pressure (PASP). Also, a strong association was observed between a drop of > 4% in oxygen saturation on 6-minute walk test and presence of pulmonary arterial hypertension (PAH). Majority of the patients with SSc had restrictive lung disease with abnormal DLCO and features resembling non-specific interstitial pneumonia. Nucleolar ANA was predominantly found in patients having PAH. Presence of DPLD had a negative association with presence of anti-centromere antibody. Reduction in DLCO and a fall of > 4% in oxygen saturation on 6-minute walk test may be used as predictors of PAH in asymptomatic individuals.

Functional disorders of the respiratory system in patients with penetrating lung wounds: study prospective design

Background. Lung function tests should be performed to patients with penetrating wounds of the lungs to identify lung function disorders, and the data obtained should be taken into account when correcting medical treatment and prescribing individual medical rehabilitation programs.&#x0D; The aim was to study the impact of penetrating lung wounds on the lung function in the early recovery period.&#x0D; Materials and methods. 13 patients were enrolled in the study, 100% male, median age 26 [21; 31] years. Spirometry, body plethysmography, and a diffusion test were performed on an average of 14 days from the injury.&#x0D; Results. A prospective cross-sectional study was performed. A moderate decrease in the vital capacity (VC), the forced vital capacity (FVC), the volume of forced exhalation in the first second (FEV1) was revealed while the total lung capacity (TLCpl) and the FEV1/FVC ratio were within normal values. However, in 2 (15.4%) and 3 (23%) patients, a restrictive ventilation disorders (TLC lower limit of normal) was detected when using Global Lung Function Initiative (GLI) and European Community for Steel and Coal (ECSC) 1993 predicted value system, respectively. The residual lung (RV) and RV/TLCpl were increased. Functional residual capacity (FRC), FRCpl/TLCpl, airway resistance remained within normal values. The diffusion lung capacity impairment was detected in 92.3% and 61.5% cases according to the ECSC 1993 and the GLI system, respectively.&#x0D; Conclusion. In the early period of recovery after penetrating lung wounds, a nonspecific pattern of ventilation disorders was the most often abnormality namely a decrease in VC while TLC and FEV1/FVC were within normal values. Less frequently, the classic restrictive pattern of ventilation disorders was diagnosed. Besides, the diffusion lung capacity impairment was detected. The system of predicted values has a significant impact on the frequency of detection of the lung function disorders. The revealed functional disorders should be taken into account for adjusting medical and rehabilitation interventions.

БАЗИСНЫЕ ПРОТИВОВОСПАЛИТЕЛЬНЫЕ ЛЕКАРСТВЕННЫЕ СРЕДСТВА И ИХ ВОЗДЕЙСТВИЕ НА ДЫХАТЕЛЬНУЮ СИСТЕМУ У ПАЦИЕНТОВ СО СПОНДИЛОАРТРИТАМИ И РЕВМАТОИДНЫМ АРТРИТОМ

At present interaction peculiarities of disease-modifying anti-rheumatic drugs and respiratory system in patients with spondyloarthritеs and rheumatoid arthritis are subject to thorough investigation and reassessment. Objective. To assess the impact of disease-modifying anti-rheumatic drugs (methotrexate) on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis. Material and methods. The research involved 172 patients with spondyloarthritеs and rheumatoid arthritis. The patients were interviewed and examined. The multispiral computer tomography of thorax was performed in order to determine the volume and nature of lung affection. Lung function was tested by means of spirometry and body plethysmography. In order to process the data Statistica 10 software package was used. Results. Lung disorders were found in 77,1% of patients with rheumatoid arthritis who were taking methotrexate while the percentage of patients with lung affection who were not taking disease-modifying anti-rheumatic drugs reached 100%. The patients with spondyloarthritеs or rheumatoid arthritis who were taking methotrexate showed significantly higher parameters of vital capacity and forced vital capacity than the patients with spondyloarthritеs or rheumatoid arthritis who were not taking disease-modifying anti-rheumatic drugs. Conclusion. Lung disorders were found more rarely in patients with rheumatoid arthritis who were taking methotrexate as compared to patients with rheumatoid arthritis who were not taking disease-modifying anti-rheumatic drugs. Taking into account the assessment of the lung function, we can talk of absence of the negative impact of methotrexate on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis.

Chapter 12 - The pathophysiology of opioid-induced respiratory depression

Opiates, such as morphine, and synthetic opioids, such as fentanyl, constitute a class of drugs acting on opioid receptors which have been used therapeutically and recreationally for centuries. Opioid drugs have strong analgesic properties and are used to treat moderate to severe pain, but also present side effects including opioid dependence, tolerance, addiction, and respiratory depression, which can lead to lethal overdose if not treated. This chapter explores the pathophysiology, the neural circuits, and the cellular mechanisms underlying opioid-induced respiratory depression and provides a translational perspective of the most recent research. The pathophysiology discussed includes the effects of opioid drugs on the respiratory system in patients, as well as the animal models used to identify underlying mechanisms. Using a combination of gene editing and pharmacology, the neural circuits and molecular pathways mediating neuronal inhibition by opioids are examined. By using pharmacology and neuroscience approaches, new therapies to prevent or reverse respiratory depression by opioid drugs have been identified and are currently being developed. Considering the health and economic burden associated with the current opioid epidemic, innovative research is needed to better understand the side effects of opioid drugs and to discover new therapeutic solutions to reduce the incidence of lethal overdoses.

PHYSICАL THERАPY FOR CHRONIC OBSTRUCTIVE PULMONАRY DISEАSE IN PERSONS OF THE FIRST PERIOD OF АDULTHOOD

The aim is to evaluate the impact of physical therapy on physical development, volume and speed of the respiratory system in patients with COPD in the first period of adulthood. Materials and methods. The study of physicаl development аnd functionаl indicаtors of the respirаtory system wаs conducted in 40 people of the first period of аdulthood (20 men аnd 20 women) who hаve bronchopulmonаry pаthology. The physicаl therаpy progrаm included kinesitherаpy, physiotherаpy procedures, therаpeutic mаssаge аnd spа treаtment. Results. Аfter а course of rehаbilitаtion interventions, there wаs аn improvement in the pаrаmeters of physicаl development, increаsed resistаnce to hypoxiа, improvement of pulmonаry ventilаtion. Аccording to pneumotаchogrаphy аfter rehаbilitаtion meаsures reveаled аn increаse in vitаl cаpаcity of the lungs аnd forced vitаl cаpаcity of the lungs in persons with bronchopulmonаry pаthology. Аnаlysis of the velocity of the respirаtory system indicаtes their improvement аt the end of the study. Conclusions. The obtаined results indicаte а relаtive strengthening of the respirаtory (including musculаr) аppаrаtus of the first period of аdulthood with COPD. Аccording to the indicаtors of the Tifno test, аfter rehаbilitаtion meаsures, а slightly higher efficiency of respirаtory аcts wаs noted, аs 100% of the rаtio of the Tifno test is registered on the third cаlculаted indicаtor.

ПАЦИЕНТЫ С ТЯЖЁЛЫМИ ПОРАЖЕНИЯМИ ЛЁГКИХ НА ФОНЕ СПОНДИЛОАРТРИТА ИЛИ РЕВМАТОИДНОГО АРТРИТА: ФУНКЦИЯ ВНЕШНЕГО ДЫХАНИЯ, ВЛИЯНИЕ БАЗИСНЫХ ПРОТИВОВОСПАЛИТЕЛЬНЫХ ЛЕКАРСТВЕННЫХ СРЕДСТВ

The presence of lung involvement in patients with spondyloarthritеs or rheumatoid arthritis always causes concern with regard to the choice of disease­modifying anti­rheumatic drugs. Objective. To determine clinical and instrumental peculiarities of severe lung disorders and to assess the disease­modifying anti­rheumatic drugs (methotrexate) impact on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis in the presence of severe lung disorders. Material and methods. The research involved 172 patients with spondyloarthritеs and rheumatoid arthritis. The patients were interviewed and examined. The nature of the current medication was specified. The multispiral computer tomography of thorax was performed in order to determine the presence of lung affection. Lung function was tested by means of spirometry and body plethysmography. In order to process the data Statistica 10 software package was used. Results. Lung disorders were found in 77,5 % of patients with spondyloarthritеs and 90,0 % of patients with rheumatoid arthritis. Out of all disorders severe lung disorders were found in 48,4 % of patients with spondyloarthritеs and 70,0 % of patients with rheumatoid arthritis. The patients with severe lung disorders had dyspnea, they also showed a decrease in lung function parameters. The patients with severe lung disorders who were taking methotrexate showed higher parameters of forced vital capacity and vital capacity than the patients with similar lung disorders who were not taking methotrexate. Conclusion. Severe lung disorders in patients with spondyloarthritеs and rheumatoid arthritis can be manifested by respiratory complaints and a decrease in lung function parameters. Methotrexate shows a beneficial effect on the lung function in patients with spondyloarthritеs and rheumatoid arthritis who have severe lung disorders.

Application of Inspiratory Muscle Training to Improve Physical Tolerance in Older Patients with Ischemic Heart Failure.

Regardless of the management regime for heart failure (HF), there is strong evidence supporting the early implementation of exercise-based cardiac rehabilitation (CR). Respiratory therapy is considered to be an integral part of such secondary prevention protocols. The aim of the study was to evaluate the effect of inspiratory muscle training (IMT) on exercise tolerance and the functional parameters of the respiratory system in patients with heart failure involved in cardiac rehabilitation. The study included 90 patients with HF who took part in the second-stage 8-week cycle of cardiac rehabilitation (CR). They were randomly divided into three groups: Group I underwent CR and IMT; Group II only CR; and patients in Group III underwent only the IMT. Before and after the 8-week cycle, participants were assessed for exercise tolerance and the functional parameters of respiratory muscle strength. Significant statistical improvement concerned the majority of the hemodynamic parameters, lung function parameters, and respiratory muscle strength in the first group. Moreover, the enhancement in the exercise tolerance in the CR + IMT group was accompanied by a negligible change in the HRpeak. The results confirm that the addition of IMT to the standard rehabilitation process of patients with heart failure can increase the therapeutic effect while influencing some of the parameters measured by exercise electrocardiography and respiratory function.