Prolonged Expiration Research Articles

Effect of a prolonged slow expiration technique on 24-h food intake in children hospitalized for moderate bronchiolitis: a randomized controlled trial

BackgroundChest physiotherapy for airway clearance is not recommended in children hospitalized with bronchiolitis. The updated Cochrane meta-analysis suggests that slow expiratory techniques could slightly improve clinical severity, but the evidence certainty is low and the clinical significance of this change is unknown. We investigated whether the prolonged slow expiration technique (PSET) would impact the 24-h food intake of these children.MethodsWe conducted a two-arm double-blind randomized controlled trial. Hospitalized children aged from 1 to 12 months, bottle-fed or diversified and referred for airway clearance were included. Both groups received upper airway clearance at inclusion and standard treatments. The experimental group received PSET including rhinopharyngeal unclogging and targeted unprovoked cough. The primary outcome was the 24-h food intake. Clinical severity, vomit episodes and sleep quality were also recorded. An ordinary least squares linear regression for quantitative variables was modelled for between-group comparisons.ResultsFrom January 9, 2019, to December 1, 2022, 42 children were randomized with a 1:1 ratio (mean age: 5.0 (± 2.9) months). The 24-h food intake did not differ between groups (estimate: 1.8% (95%CI -7.0 to 10.6); p = 0.68). PSET had no effect on SpO2, clinical severity, RR and HR at the follow-up assessments (5 min, 30 min and 24 h after intervention), nor on the number of vomit episodes, total sleep time and SpO2 during sleep.ConclusionsPSET did not affect food intake or the 24-h course of bronchiolitis more than standard treatment in children hospitalized for moderate bronchiolitis.Trial registrationNCT03738501 registered on 13/11/2018, Slow Expiratory Technique to Improve Alimentation in Children With Bronchiolitis (BRONCHIOL-EAT); https://classic.clinicaltrials.gov/ct2/show/NCT03738501.

Vagally Mediated Heart Rate Variability and Mood States in Patients with Chronic Pain Receiving Prolonged Expiration Regulated Breathing: A Randomized Controlled Trial.

Reduced vagally mediated heart rate variability (VmHRV) has been reported in patients with chronic pain. In healthy persons, breathing with longer expiration relative to inspiration increases VmHRV at 12 breaths per minute. The present study aimed to determine the immediate effect of breathing with longer expiration relative to inspiration on VmHRV and mood states in patients with chronic pain. Fifty patients with chronic pain aged between 20 and 67years were prospectively randomized as two groups with an allocation ratio of 1:1. The interventional group practiced breathing with metronome based visual cues, maintaining an inspiration to expiration ratio of 28:72 (i/e ratio, 0.38) at a breath rate of 12 breaths per minute. The average i/e ratio they attained based on strain gauge respiration recording was 0.685 (SD 0.48). The control group, which looked at the metronome without conscious breath modification had an average i/e ratio of 0.745 (SD 0.69). The VmHRV, respiration and self-reported mood states (using the Brief Mood Introspection Scale (BMIS)) were assessed. There was a significant increase in HF-HRV and RMSSD during low i/e breathing (repeated measures ANCOVA, Bonferroni adjusted post-hoc test, p < 0.05; in all cases). Self-reported mood states changed as follows: (i) following low i/e breathing positive-mood states increased while the aroused mood state decreased whereas (ii) following the control intervention the aroused mood state increased (repeated measure ANOVA, p < 0.05; in all cases). Hence breathing with prolonged expiration is possibly useful to increase VmHRV and improve self- reported mood states in patients with chronic pain.

Wearing surgical face mask has no significant impact on auscultation assessment.

During the COVID-19 pandemic, universal mask-wearing became one of the main public health interventions. Because of this, most physical examinations, including lung auscultation, were done while patients were wearing surgical face masks. The aim of this study was to investigate whether mask wearing has an impact on pulmonologist assessment during auscultation of the lungs. This was a repeated measures crossover design study. Three pulmonologists were instructed to auscultate patients with previously verified prolonged expiration, wheezing, or crackles while patients were wearing or not wearing masks (physician and patients were separated by an opaque barrier). As a measure of pulmonologists' agreement in the assessment of lung sounds, we used Fleiss kappa (K). There was no significant difference in agreement on physician assessment of lung sounds in all three categories (normal lung sound, duration of expiration, and adventitious lung sound) whether the patient was wearing a mask or not, but there were significant differences among pulmonologists when it came to agreement of lung sound assessment. Clinicians and health professionals are safer from respiratory infections when they are wearing masks, and patients should be encouraged to wear masks because our research proved no significant difference in agreement on pulmonologists' assessment of auscultated lung sounds whether or not patients wore masks.

Comparison of Prolonged Slow Expiration Technique and Lung Squeezing Technique on Saturation of Peripheral Oxygen (SpO2) and Respiratory Rate (RR) in Infants with Acute Respiratory Distress Syndrome: An Experimental Study

Comparison of Prolonged Slow Expiration Technique and Lung Squeezing Technique on Saturation of Peripheral Oxygen (SpO2) and Respiratory Rate (RR) in Infants with Acute Respiratory Distress Syndrome: An Experimental Study

Differences in Polysomnographic and Craniofacial Characteristics of Catathrenia Phenotypes: A Cluster Analysis.

Catathrenia is a rare sleeping disorder characterized by repetitive nocturnal groaning during prolonged expirations. Patients with catathrenia had heterogeneous polysomnographic, comorbidity, craniofacial characteristics, and responses to treatment. Identifying phenotypes of catathrenia might benefit the exploration of etiology and personalized therapy. Sixty-six patients diagnosed with catathrenia by full-night audio/video polysomnography seeking treatment with mandibular advancement devices (MAD) or continuous positive airway pressure (CPAP) were included in the cohort. Polysomnographic characteristics including sleep architecture, respiratory, groaning, and arousal events were analyzed. Three-dimensional (3D) and 2D craniofacial hard tissue and upper airway structures were evaluated with cone-beam computed tomography and lateral cephalometry. Phenotypes of catathrenia were identified by K-mean cluster analysis, and inter-group comparisons were assessed. Two distinct clusters of catathrenia were identified: cluster 1 (n=17) was characterized to have more males (71%), a longer average duration of groaning events (18.5±4.8 and 12.8±5.7s, p=0.005), and broader upper airway (volume 41,386±10,543 and 26,661±6700 mm3, p<0.001); cluster 2 (n=49) was characterized to have more females (73%), higher respiratory disturbance index (RDI) (median 1.0 [0.3, 2.0] and 5.2 [1.2, 13.3]/h, p=0.009), more respiratory effort-related arousals (RERA)(1 [1, 109] and 32 [13, 57)], p=0.005), smaller upper airway (cross-sectional area of velopharynx 512±87 and 339±84 mm2, p<0.001) and better response to treatment (41.2% and 82.6%, p=0.004). Two distinct phenotypes were identified in patients with catathrenia, primary catathrenia, and catathrenia associated with upper airway obstruction, suggesting respiratory events and upper airway structures might be related to the etiology of catathrenia, with implications for its treatment.

Effect of Volitional Modification of Breath Frequency on Attention and Mood States: An Exploratory Randomized Crossover Study.

Previously, yoga breathing improved mood states and attention but the effect of varying breath frequency on mood and attention was not clear. The objective of this study was to determine the effects of changes in breath frequency on attention, mood, vigor, and affect states. Thirty participants (mean age ± standard deviation, 27.3 ± 4.2 years) were assessed on 2 separate days practicing either high-frequency yoga breathing (HFYB, breath frequency 54.23/min) or bumblebee yoga breathing (BBYB, breath frequency 3.97/min) in random order. Assessments included blood pressure (BP), cancellation test scores, Nijmegen (to check for hyperventilation), respiration (rate, height of the breath wave [depth], and duration of inhalation relative to exhalation), mood states, vigor, and affect states. Diastolic BP increased after HFYB, whereas systolic BP decreased after BBYB, after both sessions scores in a cancellation test increased (changes in cancellation test performance suggest alertness and test-directed attention), also global vigor (signifying mental energy) and global affect (related to being "happy" and "calm") scores increased, whereas negative mood decreased after HFYB session (P < 0.05, Wilcoxon signed-rank test). Both HFYB and BBYB increased attention test scores, possibly due to cortical activation (HFYB) or relaxation (BBYB). In HFYB, breath frequency and inspiration duration increased suggestive of increased sympathetic activity, accounting for increased vigor, positive affect, and diastolic BP. In contrast in BBYB, low breath frequency, higher breath amplitude, and prolonged expiration suggestive of parasympathetic activity may account for the decreased systolic BP after BBYB.

Medical Management of Acute Spinal Cord Injury with Aspiration pneumonia in a Kid

A two-month-old, non-descript female goat kid was brought to the Veterinary Clinical Complex, Veterinary College and Research Institute, Orathanadu, with a history of continuous high-pitched bleating, respiratory distress, and forelimb paresis over the past two days. The animal has appeared lethargic with an abnormal gait. Neurological examination revealed sluggish sensory and motor reflexes in the forelimbs and palpation elicited pain in the thoracic and dorsal spinal areas (C7-T2). Auscultation revealed exaggerated heart sounds and prolonged expiration. Radiographic examination ruled out spinal involvement but revealed left lung consolidation with pulmonary infiltration. Cerebrospinal fluid analysis showed an increase in neuron-specific enolase (NSE). The condition was tentatively diagnosed as acute spinal cord injury with aspiration pneumonia. Inj. Progesterone and intranasal Budesonide were administered along with a Progesterone patch applied to the lateral neck region. Successful medical management led to gradual clinical improvement observed from the seventh day and completely recovered after 15 days of treatment.

Effect of Prolonged Slow Expiration Technique on Oxygen Saturation and Blood Pressure Among Neonates with Pneumonia

Effect of Prolonged Slow Expiration Technique on Oxygen Saturation and Blood Pressure Among Neonates with Pneumonia

Bronchodilator-responsive bronchiolar obstruction in term neonates: a case series

BackgroundBronchiolar obstruction, which causes airway obstruction in hyperresponsive airways, often results from the contraction of the airway's smooth muscles, increased viscid mucous secretions, and mucosal oedema consequent upon a reduced cyclic 3,5-adenosine monophosphate (c-AMP). These processes respond to bronchodilators. The six cases presented to us, in Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia, in the newborn period with clinical features suggesting obstruction with airway reactivity with response to bronchodilator treatment are presented here. Our capacity-limited literature search did not show any such report in neonates. This report highlights the need for this condition to be sought in neonates, medically managed in resource-poor countries without resorting to high-cost equipment use, and for its possible future classification.Case presentationWe report six cases of Gambian neonates consisting of four males and two females ages 2–27 days who presented to us with histories of fast breathing of a few hours duration and expiratory respiratory distress. All were term babies with rhonchi and demonstrable prolonged expiration with terminal effort. They all had a diagnosis of hyperreactive airway disease with bronchiolar obstruction. Five cases were first-time wheezers, while one was a recurrence. All were eventually treated with bronchodilators and steroids with good results. The median duration for resolution of most symptoms with treatment was two days, with a range of 1–5 days.ConclusionClinically determined bronchiolar obstructions in term neonates can be relieved with bronchodilators and steroids, and this treatment modality, if employed where the pathological process can be established, can reduce the demand on scarce resources in resource-poor countries.

Rebounds of sevoflurane concentration during simulated trigger-free pediatric and adult anesthesia

BackgroundIn trigger-free anesthesia a volatile anesthetic concentration of 5 parts per million (ppm) should not be exceeded. According to European Malignant Hyperthermia Group (EMHG) guideline, this may be achieved by removing the vapor, changing the anesthetic breathing circuit and renewing the soda lime canister followed by flushing with O2 or air for a workstation specific time. Reduction of the fresh gas flow (FGF) or stand-by modes are known to cause rebound effects. In this study, simulated trigger-free pediatric and adult ventilation was carried out on test lungs including ventilation maneuvers commonly used in clinical practice. The goal of this study was to evaluate whether rebounds of sevoflurane develop during trigger-free anesthesia.MethodsA Dräger® Primus® was contaminated with decreasing concentrations of sevoflurane for 120 min. Then, the machine was prepared for trigger-free anesthesia according to EMHG guideline by changing recommended parts and flushing the breathing circuits using 10 or 18 l⋅min− 1 FGF. The machine was neither switched off after preparation nor was FGF reduced. Simulated trigger-free ventilation was performed with volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) including various ventilation maneuvers like pressure support ventilation (PSV), apnea, decreased lung compliance (DLC), recruitment maneuvers, prolonged expiration and manual ventilation (MV). A high-resolution ion mobility spectrometer with gas chromatographic pre-separation was used to measure sevoflurane in the ventilation gas mixture in a 20 s interval.ResultsImmediately after start of simulated anesthesia, there was an initial peak of 11–18 ppm sevoflurane in all experiments. The concentration dropped below 5 ppm after 2–3 min during adult and 4–18 min during pediatric ventilation. Other rebounds of sevoflurane > 5 ppm occurred after apnea, DLC and PSV. MV resulted in a decrease of sevoflurane < 5 ppm within 1 min.ConclusionThis study shows that after guideline-compliant preparation for trigger-free ventilation anesthetic machines may develop rebounds of sevoflurane > 5 ppm during typical maneuvers used in clinical practice. The changes in rate and direction of internal gas flow during different ventilation modes and maneuvers are possible explanations. Therefore, manufacturers should provide machine-specific washout protocols or emphasize the use of active charcoal filters (ACF) for trigger-free anesthesia.

Design of a wearable device for respiratory rate monitoring and detection of anomalous values

Abstract Chronic obstructive pulmonary disease (COPD) is characterized by a persistent reduction in airflow. Symptoms gradually worsen and shortness of breath, dyspnea, increases over time to even appear at rest. Regarding measurement technology, spirometry is the reference standard for the diagnosis and evaluation of the severity of said condition. This test requires specialized equipment that does not allow it to be performed on an outpatient basis or for constant monitoring. For this reason, the doctor must systematically look for the presence of symptoms that may go unnoticed by the patient and that can be attributed to age, sedentary lifestyle, or the fact of smoking. Also, prolonged expiration in the trachea during a maximum forced effort can be useful in the early diagnosis of obstruction or when spirometry is not available, which is why it would be important to be able to constantly monitor breathing in order to increase the probability of identifying possible COPD at an early stage. The solution proposed in this article is focused on the design and implementation of a wearable device that allows the monitoring of the respiratory rate. This device will allow this biometric variable to be identified and will notify when it is outside the normal ranges to suggest an airflow test (spirometry) at a possible early stage of the disease. This instrumentation system will be integrated into the frame of a pair of glasses, specifically positioning the sensor on the nasal platelets.

A CLINICAL STUDY TO EVALUATE THE EFFECT OF KULATTHA GUDA IN TAMAK SHWASA

Background: Tamak Shwasa is one of the varieties among the five types of Shwasa roga characterized by prolonged expiration, wheeze, and dyspnoea. In modern science, it can be correlated with bronchial asthma. It is a yapya vyadhi. shodhana and shaman chikitsa are the important line of treatment described in Ayurvedic classics. Aim: To evaluate the effect of Kulattha guda with and without nitya virechana karma in the management of Tamak Shwasa. Method: In the present study Kulattha guda and Kulattha guda after nitya virechana karma with Trivrit avaleha were selected for a clinical trial in Tamak Shwasa. The clinical study was done on 40 patients and divided randomly into two groups. In Group A, Kulattha guda 5 gm BD with lukewarm water was given for 45 days, and in Group B, firstly, nitya virechana was done with Trivrit avaleha 5-15 gm at night for 3-7 days according to the kostha of the patient, after that Kulattha guda 5 gm BD with lukewarm water were given for 45 days. Result: In the trial, 10.53% of patients in Group A and 50% in Group B showed marked improvement, 68.42% in Group A and 38.89% in Group B showed moderate improvement and 21.05% in Group A and 11.11% in Group B showed mild improvement. Conclusion: In the present study Group A showed significant results, and Group B showed highly substantial in all subjective parameters. Thus, the synergetic effect of nitya virechana with Trivrit avaleha and Kulattha guda were more than only Kulattha guda.

Ayurvedic Management of Tamaka Swasa w.s.r to Bronchial Asthma

Bronchial asthma is one of the most distressing chronic illness in all socio- economic status people, affecting all age groups. Changing in lifestyle, demographic factors, urbanization, environmental charges are the triggering factors of bronchial asthma. Tamaka swasa is characterized by paraoxysmal attacks of breathlessness, cough, coryza, due to chest tightness, rapid respiration, distress inability to expectorate and prolonged expiration. Methods: This is a single case study of a 34 year male patient, came with the complaints of difficulty in Breathing since 5 years. He also complaints of abdominal distension and decreased appetite. According to patient, he was apparently well before 5 years. Gradually he developed breathing difficulty because of his smoking habit. Patient also c/o abdominal distension and decreased appetite at that time. In the case study patient was given Sadhyo vaman first followed by Snehapana with Brahmi ghrta was given along with Internal medications. Result: Patient showed remarkable improvement in severity of symptoms and as well as time period between 2 successive episodes of dyspnea is increased. During this course we observed that the patient had partial relief of symptoms. Lesser the chronicity greater the relief and improvement in chronic condition was observed. Interpretations and Conclusion: The patient was given Sadhyovamana, followed by Snehapana with Brahmi ghrtam for Virechana. The contents of Brahmi ghrtham are Ghee, Brahmi, Shankapushpi, Trikatu, Shweta trivrt, Krishna Trivrt, Vidanga, Nipadruma, Saptala, Danti, followed by Virechana with Trivrt lehaya. Tamake tu virechana In this condition Virechana is advised as the best line of treatment, and in the above mentioned case after Virechana patient feels better and got much more relief from symptoms.

Экспериментальные исследования проливов криогенных жидкостей (топлив)

Experimental studies were carried out, the analysis of the processes of spillage, spreading and evaporation of the cryogenic liquids (fuels) on a solid surface were carried out. It is shown that the intensity of evaporation of the cryogenic liquids during spills is influenced by many factors: the type of surface on which the spill occurred (concrete, steel, soil, sand, etc.), its penetrating ability, temperature, thickness of the receiving layer, humidity, atmospheric mobility, and, etc. The evaporation rate is determined by the total heat flow coming to the liquid from the external sources. In this case, the heat flow coming from the underlying surface is dominant. Studies of the evaporation of cryogenic liquids during spills on various surfaces showed that the evaporation process has a non-stationary character. This is especially evident at the initial stage of evaporation when its intensity decreases 5֪–6 times in the first 1.5 minutes. After 6–8 minutes, the process goes into a quasi-stationary mode, and the evaporation rate decreases slowly. In case of spills on the solid surfaces, the evaporation process is satisfactorily described (depending on the nature of the surface) by the calculated ratios obtained. Seepage of liquid deep into the sand increases the intensity of evaporation by 2–3 times. Presence of moisture in the ground, on the one hand, reduces the seepage of liquid due to its freezing, and on the other hand, additional heat is released during freezing to vaporize the liquid. Presence of moisture in the ground can increase the evaporation rate by up to 50 % at a non-stationary evaporation site. Based on two scenarios of cryogenic liquids spilling (instantaneous or prolonged expiration) onto a limited or unlimited surface, physicomathematical models of their spreading during leakage were developed. These models, in turn, are implemented as methods for assessing the hazardous factors of fires under various scenarios of their occurrence and explosions on the territory of the facility and in the residential area near the facility.

Performance Evaluation of Amplitude and Phase Respiratory Gating Methods on Continuous-Bed-Motion Whole-Body PET Studies

Positron emission tomography (PET) scanners with the feature of continuous-bed-motion (CBM) that allows efficient whole-body dynamic scans and customized imaging protocols have been made commercially available in recent years. As the bed motion has to be reasonably slow in order to achieve sufficient count statistics, the blurring effect induced by respiratory motion is inevitable, and adequate gating methods should be applied. The aim of this study is to identify a relatively reliable gating method for CBM whole-body scans with respect to breathing pattern variability. Two methods: 1) equal amplitude gating (EAG) and 2) phase gating (PG) initially developed for the single-bed imaging protocol are evaluated using CBM data for subjects with a regular breathing pattern, irregular breathing pattern with baseline shift, and irregular breathing pattern with prolonged end expiration. The potential influence of the scan duration on the performance of the applied gating methods is taken into account as well. Based on the results, we suggest that the PG method is relatively reliable for all studied breathing patterns, while the EAG method could introduce severe artifacts in the presence of the baseline shift.

ASSESSMENT OF CASES ADMITTED TO THE NEONATAL INTENSIVE CARE UNIT WITH LOWER RESPIRATORY TRACT INFECTION

OBJECTIVE: The purpose of this study is to assess the clinical features, laboratory findings, diagnosis and treatments of neonates in the neonatal intensive care unit with a diagnosis of lower respiratory tract infection (LRTI).MATERIAL AND METHODS: The data of neonates hospitalized in the neonatal intensive care unit of our hospital between 2017 and 2019 with a diagnosis of LRTI was retrospectively obtained from the file records. Demographical features, diagnosis and treatments were analyzed.RESULTS: A total of 57 patients diagnosed with LRTI were included in the study. The mean gestational age of the patients was 36.8 ± 3 weeks and their mean birth weight was 2864 ± 787 g. The 67% (n = 38) of them were term infants and the 33% (n = 19) of them were preterm infants. When the symptoms, examination findings and chest radiographs of the cases were examined at the time of admission, tachypnea, prolonged expiration, and nutritional difficulty in 67% of cases (n = 38), cough in 26% (n = 15) of the cases, fever in 20% (n = 12) of the cases, vomiting in 12% (n = 7) of the cases, apnea in 7% (n = 4)of the cases, and increased aeration in lung imaging in 21% (n = 12) of the cases were detected. Respiratory panel using Polymenase Chain Reaction (PCR) method was investigated in nasopharyngeal swab samples of 61% (n = 35) of the patients, respiratory syncytial virus (RSV) in 57% (n = 20), rhinovirus in 14% (n = 5), and metapneumovirus in 3% (n = 1) of the cases were observed. The 47% of the patients (n = 27) received high-flow oxygen, 26% (n= 15) nasal CPAP, 58% (n=33) antibiotics, 63% (n= 36) inhaler bronchodilator and hypertonic saline treatment.CONCLUSIONS: In accordance with the literature, a high rate of RSV infection was detected in neonates with LRTI in the neonatal intensive care unit of our hospital. Early diagnosis is important to prevent unnecessary use of antibiotics and to prevent nosocomial infections.

Clinical and radiologic manifestations of Mycoplasma pneumoniae infection in children

Mycoplasma pneumoniae (MP) is one of the most important etiological agents of communityacquired pneumonia in children. The medical records of children with an MP infection between 2008 and 2015 were reviewed for their clinical, laboratory radiological features. This study included 244 patients (male 57.4%) with a median age of 80.5 months (IQR, 46.5-120 months). A total of 78 (32%) patients were < 5 years old, and 166 (68%) were ≥ 5 years old. The most common complaints before admission to the hospital were cough (84.8%), fever (57.4%), and weakness (18.9%). In the < 5 years old age group, oxygen saturation was lower, and tachypnea was more common than in the ≥ 5 years old age group (p=0.02 and p=0.05, respectively). Similarly, the physical findings such as the prolonged expiration, presence of retractions, and rhonchi were more frequent in the < 5 years old age group (p=0.001, p=0.000, p=0.02, respectively). Extrapulmonary manifestations were present in 45 (18.4%) patients, and skin involvement was the most common one (7.7%). Two hundred-thirty-eight (97.5%) patients had chest radiographs, and 45 (18.4%) had normal radiography. The most common radiological involvement was peribronchial infiltration (n=70, 28.7%). Of the patients, 147 (60.2%) were hospitalized, and 97 (39.7%) were followed up as outpatients. It was determined that 156 (63.9%) patients had commenced macrolide empirically, and 61 (25%) patients were treated with positive serology results. The prolonged fever, cough and expiration time, wheezing and rhonchi in younger children, and segmental-lober consolidation in chest radiography could be clues for MP infection. Further studies in different age groups can facilitate an understanding of MP infection`s epidemic characteristics and clinical features that will provide early diagnosis and appropriate treatment.

Review of Previous Research Works Done on Tamak ShwasaConducted Across India and Role of Different Treatment Modalities in Tamak Shwasa

At present era, many chronic recurrent airway disorders are increasingly seen all over the global population. Tamak Shwasais one of such disorder described in Ayurveda. It is one of the variety among five types of Shwasa rogacharacterized by prolonged expiration, wheeze, dyspnoea of exceedingly deep velocity, which is immensely injurious to life. In modern science, it can be correlated with bronchial asthma. According to Ayurveda Tamak shwasais a Yapya vyadhi. It is not serious as Maha, Urdhvaand Chhinna shwasabut it is a very troublesome disease and long lasting with frequent episodes (attacks) difficult to bring under control unless quick and prompt treatment is not provided. Shodhanaand Shaman chikitsaare the important line of treatment described in Ayurvedicclassics. Shodhana karmais studied to be a necessary prerequisite in managing Shwasa roga, particularly in patients with sufficient strength, because the disease is manifested by the aggravated Prana vayuand by the obstruction of Kapha. Similary there are lots of herbal drugs and rasapreparation having Vatakaphashamak, Ushna, Vatanulomana, Shwasaharand Kasaharaproperties which seems to be very effective in the treatment of Tamak shwasa. So there are many research studies were done by various previous scholars on Shodhana karma, rasapreparation and herbal drugs to analyse their efficacy and effectiveness on the disease Tamak shwasa.

Safety of airway clearance combined with bronchodilator and hypertonic saline in non-hospitalized infants with acute bronchiolitis

Background: Acute viral bronchiolitis (AVB) is associated with significant morbidity and no study has addressed the safety of airway clearance techniques (ACT) for non-hospitalized infants. This study aimed to evaluate the safety of the use of ACT combined with bronchodilator and hypertonic saline in non-hospitalized children with the first episode of AVB. Methods: A quasi-experimental study of infants aged 2–12 months, with a clinical diagnosis of AVB (mild to moderate), was performed. The Wang score, breathing frequency, oxygen saturation (SpO2), heart rate (HR), and the presence of adverse events were evaluated before, 10 and 20 min after the application of a protocol including ACT (nasal irrigation, prolonged slow expiration, and provoked cough), bronchodilator and hypertonic saline inhalation. A total of 265 infants, mean age 6.86±3.01 months, were included. Results: A reduction (p<0.001) in the Wang score and in the breathing frequency as well as an increase in SpO2 were found. There was also a transient HR increment at 10 min followed by a reduction at 20 min (p<0.05). The proportion of patients presenting with chest retraction and wheezing decreased (p<0.001) after treatment. Most of the children (88.3%) did not experience adverse events. A post-treatment increment (p<0.001) of patients classified as having normal values, as well as a decrease in those with mild and moderate AVB, was found for the Wang score levels. Conclusion: The use of ACT combined with bronchodilator and hypertonic saline was safe, immediately after treatment, for non-hospitalized children with mild to moderate AVB. No clinically important deterioration or adverse events were identified in the follow-up period.

Prolonged Slow Expiration Technique and Gastroesophageal Reflux in Infants Under the Age of 1 Year.

Background: The Prolonged Slow Expiration Technique (PSE) is an airway clearance technique (ACT) carried out in newborn children with bronchial obstruction and hypersecretion to clear away the mucus from the respiratory tract. Evidence about the effect of PSE on gastroesophageal reflux (GER) is currently lacking in the literature. This study aimed to evaluate the influence of PSE on GER in infants under the age of 1 year.Methods: Infants were observed using multichannel intraluminal impedance-pH monitoring (MII-pH) over 24 h. During monitoring, the participants were treated with one 20 min intervention of PSE in supine position, 2 h after feeding. In this controlled trial with intra-subject design, the number of reflux episodes (REs) during PSE were compared to 20 min before and after PSE.Results: Fifty infants younger than 1 year were screened of whom 22 had a pathological GER. For the entire group, no significant difference was seen in the total number of REs between before, during, or after the PSE treatment (P = 0.76). No significant difference in total REs was found between the three measuring points (P = 0.59) in the group of infants with an abnormal MII-pH (n = 22).Conclusion: PSE does not cause a significant difference in REs in infants younger than 1 year.Registration number: NCT03341585.