Respiratory Exercise Research Articles

The effects of breathing exercises on respiratory functions, functional capacity and quality of life in vehicle spray painters

Background/aims Workers engaged in vehicle spray painting are at a risk of developing respiratory problems because of the solvents in the spray paints. Changes in respiratory functions and functional capacities caused by spray painting can be improved with respiratory exercises. The aim of this study was to examine the effects of respiratory exercises on the respiratory functions, functional capacity and quality of life in vehicle spray painters. Methods A total of 70 volunteers with similar characteristics participated in the study. The groups were divided into two groups randomly (35 study group, 35 control group). Respiratory functions (value of forced expiratory volume percentage in 1 second [FEV1]), forced vital capacity percentage [FVC], FEV1/FVC percentage, peak expiratory flow percentage [PEF (%)] and maximum voluntary ventilation percentage [MVV (%)]), functional capacity (6-Minute Walk Test) and quality of life (Short Form Health Survey [SF-36]) were evaluated. The study group undertook supervised breathing exercises 3 days a week for 6 weeks. The same exercises were given to the control group as a home programme. Home programmes were followed up by telephone calls. Evaluations were performed again after 6 weeks. Results In the study group, FEV1 (%) increased more than in the control group (P<0.05). The increase in PEF (%) was similar in both groups (P>0.05). In the study group, FEV1/FVC (%) and MVV (%) were significantly different before and after the intervention (P<0.05), but there was no difference in the control group (P>0.05). There was a greater increase in the study group than in the control group (P<0.05). 6-Minute Walk Test distance (m) before and after the intervention in both groups were similar (P>0.05). Before and after the intervention, a significant difference was found in the vitality and the social function domains of the SF-36 in the study group. In the comparisons of groups, a significant difference was found in the study group in the role-emotional, social function and bodily pain domains of the SF-36 after the intervention (P<0.05). Conclusions Breathing exercises can be recommended for vehicle spray painters to avoid an increase in respiratory resistance and to improve their quality of life.

The comparison of the effectiveness of respiratory muscle exercises (RME) and incentive spirometry exercises (ISE) on improvement of lung function post mechanical ventilation: A literature review

To compare the effectiveness of respiratory muscle exercise (RME) and incentive spirometry exercises (ISE) to improve lung function after mechanical ventilation. This was a systematic literature review by searching through a database; PubMed, Cochrane, Science Direct, Google Scholar, and DOAJ. Nine articles were identified according to eligibility criteria, and all of them evaluated the effectiveness of breathing exercises with ISE. Such exercise has been significant in improving lung function; three articles that evaluate related to the direct title, namely RME with diaphragmatic breathing and ISE, the results are significant for improvement in lung function. Several studies have concluded that breathing exercises (BE) by training diaphragmatic breathing muscles include RME and ISE, significantly improve lung function.

Comparison of the Effectiveness of Cognitive Behavioral Therapy and Training of Diaphragmatic Respiratory Exercises on Panic Symptoms in Women with Asthma

Comparison of the Effectiveness of Cognitive Behavioral Therapy and Training of Diaphragmatic Respiratory Exercises on Panic Symptoms in Women with Asthma

To Assess the Effectiveness of Breathing Exercise on Labour Pain and Behavioral Response of Primi Gravida Mothers during First Stage of Labour, at Selected Maternity Hospitals

Background of the Study: Labour is tough and headaches occur, however mother's our bodies are designed to supply birth. The shape of the pelvis, hormones, effective muscle mass and further all paintings collectively that may help mother to convey her child into the globe - before, within the course of and after childbirth.
 Objectives: 1. To assess pain intensity level among the Primi gravida mothers during first stage of labour in experimental and control group.2. To assess the behavioral response of primi gravid mothers during 1st stage of labour in control and Experimental group. 3. To determine the effectiveness of breathing exercise on labour pain among primi gravida mothers during first stage of labour.4. To determine the effectiveness of breathing exercise on behavioral response among primi gravida mothers during first stage of labour. 5. To determine the association between selected demographic variables and pain of primi gravida mothers during first stage of labour.6. To determine the association between selected demographic variables and behavioral response of prim gravid mothers during first stage of labour.
 Material and Methods: The design of this research study was based on a True Experimental research design with a pre-test and post-test control group. A total of 400 mothers were included in the study (200 in experimental group and 200 in control group). The samples were chosen using the probability simple random sampling technique. The data will be gathered using Baseline Proforma and an observational check list.
 Expected Results: At selected Maternity hospitals, this study will assess the effects of respiratory exercise on Childbirth pain and behavioral responses of primi gravida moms during the early stage of childbirth. After intervention, the degree of discomfort in primi gravida women should be reduced, and their behavioral reaction should improve.
 Conclusion: Final conclusion is drawn from the ultimate results of the statistical review.

Beneficial Effect of Water-Based Exercise Training on Exercise Capacity in COPD Patients-a Pilot Study.

Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable condition, characterized by persistent airflow limitation. Exercise training is a core component of pulmonary rehabilitation in people with COPD. Water-based exercise has been studied, but it remains unclear whether water-based exercise program leads to the improvement in respiratory function, muscle strength, balance ability, and exercise capacity. We aim to study the effect of an 8-week water-based exercise program on respiratory function, muscle strength, balance ability, and exercise capacity in people with COPD.Methods: Fourteen stable COPD participants (FEV1 56.8 ± 24.6%pred) were recruited and randomized into a water-based exercise or a land-based exercise group. Both groups were trained for 8 weeks, two sessions per week. Pulmonary function, respiratory muscle strength, peripheral muscle strength, balance ability, exercise capacity [6-min walking test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT)] were assessed at baseline and at the end of the program. ANCOVA was used to conduct between-group comparisons of outcomes after adjusting for pre-intervention values.Results: Baseline characteristics of participants were not significantly different between the two groups (p ≥ 0.05). After the 8-week training program, participants in the intervention group achieved larger gains in ESWT (Δ663.4 ± 279.5 vs. Δ45.4 ± 93.2 s, p = 0.001). In addition, maximal inspiratory pressure (MIP) was significantly increased more in the intervention group (Δ11.1 ± 7.8 vs. Δ1.1 ± 5.7 cmH2O, p = 0.026). However, no significant differences in pulmonary function, peripheral muscle strength, balance ability variables, 6MWD (p = 0.248), and ISWT (p = 0.506) were observed between the two groups.Conclusions: The water-based exercise program could be recommended to the COPD rehabilitation program for improving the endurance exercise capacity and inspiratory muscle strength.Clinical Trial Registration: www.thaiclinicaltrials.org, identifier: TCTR20210125005.

Extracorporeal membrane oxygenation and rehabilitation in patients with COVID-19: A scoping review.

Background and purposeThe coronavirus diseases 2019 (COVID‐19) pandemic posed severe difficulties in managing critically ill patients in hospital care settings. Extracorporeal membrane oxygenation (ECMO) support has been proven to be lifesaving support during the SARS‐CoV‐2 outbreak. The purpose of this review was to describe the rehabilitative treatments provided to patients undergoing ECMO support during the COVID‐19 pandemic.MethodsWe searched PubMed and Scopus for English‐language studies published from the databases’ inception until June 30, 2021. We excluded editorials, letters to the editor, and studies that did not describe rehabilitative procedures during ECMO support. We also excluded those articles not written in English.ResultsA total of 50 articles were identified. We ultimately included nine studies, seven of which were case reports. Only two studies had more than one patient; an observational design analyzing the clinical course of 19 patients and a case series of three patients. Extracorporeal support duration varied from 9 to 49 days, and the primary indication was acute respiratory distress syndrome COVID‐19‐related. Rehabilitative treatment mainly consisted of in‐bed mobilization, postural transfers (including sitting), and respiratory exercises. After hospital discharge, patients were referred to rehabilitation facilities. Physiotherapeutic interventions provided during ECMO support and after its discontinuation were feasible and safe.ConclusionThe physiotherapeutic treatment of patients undergoing ECMO support includes several components and must be provided in a multidisciplinary context. The optimal approach depends on the patient’s status, including sedation, level of consciousness, ECMO configuration, types of cannulas, and cannulation site.

The Role of Regional Block and Sedation Accompanıed Thoracoscopy on the Diagnosis and Treatment of Post-Trauma Patients Chest Tube Inserted

Traumatic hemothorax/pneumothorax; is a pathological condition seen in blunt and sharp thoracic traumas and can generally be treated by tube thoracostomy. While patients are being followed up with tube thoracotomy, analgesics support, and respiratory exercise support; emergency thoracotomy is usually not required. Early thoracoscopy is a method that has come to the fore in recent years. This thoracoscopy is known to have therapeutic and diagnostic benefits. In our study; the files of 40 patients who underwent tube thoracostomy after traumatic hemothorax/pneumothorax were reviewed retrospectively. Twenty of these patients, whose radiological and clinical improvement could not be achieved after tube thoracostomy, underwent thoracoscopy with sedo-analgesia on the first day after the procedure. The remaining 20 patients were followed up without any additional procedures. Patients' age, gender, trauma type, tube thoracostomy indication, presence of additional trauma, length of chest tube stay, length of hospital stay, WBC, RDW, %Neu, pO2, pCO2, SO2, presence of tube malposition, and complications were recorded from patient files. Demographic data of the two groups were similar. While tube withdrawal time was 4.7±1.5 days in the thoracoscopy group, it was 6.9±1.9 days in the control group. This difference was statistically significant (p < 0.001). The mean hospital stay was 7.1±2.0 days in the first group, while it was 9.3±3.3 days in the control group. This difference was statistically significant (p=0.014). In both groups, there was a 1 (5%) patient who developed a need for thoracotomy. Thoracoscopy with sedo-analgesia in early period is a safe method for patients who have undergone tube thoracostomy due to trauma. This method reduces the duration of chest tube removal and hospital stay of patients. The need for thoracotomy after follow-up was similar in both groups..

Breathing and Cardiovascular Patterns: What can we Learn from Respiratory Exercises?

Breathing and Cardiovascular Patterns: What can we Learn from Respiratory Exercises?

Impact of Combined Corrective &amp; Home Respiratory Exercises on Kyphosis Angle &amp; Respiratory Capacity in Asthmatic Children

Background and Aims: Asthma is a chronic disease causing morbidity and reduced quality of life. Asthmatics are less active than their peers, inducing a more sedentary lifestyle for the patient. Asthma can cause postural changes in the spine. Shoulder girdles are suitable options for their correction and prevention. Another possible solution is corrective breathing exercises. Hence, this study’s objective was to investigate and assess the impact of combined corrective and home respiratory exercises on kyphosis angle and respiratory capacity in asthmatic children. Methods: The present study was a clinical trial with a pretest and posttest design. For this purpose, with the approval of a pediatric pulmonologist, 30 mildly asthmatic children living in Rasht were voluntarily included in the study. The subjects were randomly divided into two groups: experimental (15 individuals with a mean age of 10.53±2.09 years) and control (15 kids with a mean age of 11.40±2.13 years). Written informed consent forms were obtained from the children’s parents. Respectively, a flexible ruler, spirometry, and bone caliper were deployed to evaluate the curvature of the thoracic spine, respiratory capacity, and the chest’s anthropometric indices. To analyze the study’s results, a dependent t-test and analysis of covariance were utilized (significance level: P&lt;0.05). Results: The findings revealed a significant difference between the thoracic spine curvature (P=0.004), forced expiratory volume in 1 second (FEV1) (P=0/001), (FEV1)/ forced vital sapacity (FVC) (P=0/02), and chest anthropometric indices (P=0.001). Conclusion: In line with the findings, it appears that combined corrective and respiratory exercises can positively influence the chest’s extensor muscles inducing improvements in lung function and postural correction in asthmatic children. Therefore, it is hereby recommended that therapists, coaches, and exercise teachers utilize combined corrective and respiratory exercises to improve the physical, postural, and respiratory conditions of asthmatic children.

Six-month respiratory outcomes and exercise capacity of COVID-19 acute respiratory failure patients treated with continuous positive airway pressure.

ABSTRACTBackgroundCOVID‐19 long‐term sequelae are ill‐defined since only a few studies have explored the long‐term consequences of this disease so far.AimsTo evaluate the 6‐month respiratory outcome and exercise capacity of COVID‐19 acute respiratory failure (ARF) patients treated with continuous positive airway pressure (CPAP) during the first wave of the ongoing COVID‐19 pandemic.MethodsA retrospective observational study included COVID‐19 patients with ARF. Interventions included CPAP during hospitalisation and 6‐month follow up. Frailty assessment was carried out through frailty index (FI), pO2/FiO2 during hospitalisation and at follow up, respiratory parameters, 6‐min walking test (6MWT) and the modified British Medical Research Council (mMRC) and Borg scale at follow up.ResultsMore than half of the patients had no dyspnoea according to the mMRC scale. Lower in‐hospital pO2/FiO2 correlated with higher Borg scale levels after 6MWT (ρ 0.27; P 0.04) at the follow‐up visit. FI was positively correlated with length of hospitalisation (ρ 0.3; P 0.03) and negatively with the 6MWT distance walked (ρ −0.36; P 0.004).ConclusionsRobust and frail patients with COVID‐19 ARF treated with CPAP outside the intensive care unit setting had good respiratory parameters and exercise capacity at 6‐month follow up, although more severe patients had slightly poorer respiratory performance compared with patients with higher PaO2/FiO2 and lower FI.

Development and pilot testing of novel game-based respiratory rehabilitation exercise devices for patients with tetraplegia.

BACKGROUND: Individuals with spinal cord injuries (SCI) show restricted breathing patterns with reduced lung volumes and capacities.OBJECTIVE: To improve breathing in such individuals, we aimed to develop breathing exercise devices using a user-centered design (UCD) and then assess the effects of these devices on breathing.METHODS: Patients with SCI were involved in the device development. Preliminary online survey participants were recruited from the community, and interview and pilot test participants were recruited from a patient self-help group. The four UCD phases were repeatedly performed. Users required fun, easy, multi-player, and safe exercise devices.RESULTS: Seven breathing exercise devices were developed, and 10 different game-based exercises were performed. Two individuals participated in a pilot test involving a respiratory rehabilitation exercise program conducted twice weekly for 60 min/session over 8 weeks. Lung function was assessed using a spirometer. Forced vital capacity, forced expiratory volume in 1 s, and vital capacity showed minimal changes, whereas maximum inspiratory and expiratory pressures improved. Participants reported that the exercises were entertaining and that the competitive nature of the game-like exercises encouraged further participation.CONCLUSION: Breathing exercise programs using our developed devices can improve breathing and positively affect the psychological states and sociability of users.

123 Reduction of asthma hospitalizations in children in a tertiary care center in Quebec during the early confinement period of the COVID-19 pandemic

Primary Subject areaRespirologyBackgroundAsthma in children and adolescents is a major cause of urgent visits and hospitalizations. In preschoolers, viral infections remain the main cause of these exacerbations, although environmental factors may also play a role. In older children and adolescents, many other risk factors are present including respiratory allergies, exercise, strong emotions, active and passive smoking and poor adherence to recommended treatments. In the context of the COVID-19 pandemic, clinicians have been concerned about the possibility of a significant increase in urgent consultations for asthma in children. However, due to the confinement imposed on a large part of the population from March 2020, we have suspected a reduction in the number of viral infections leading to urgent visits and hospitalizations in pediatric patients.ObjectivesOur hypothesis was that the number of children hospitalized with asthma exacerbations during the pandemic lockdown declined significantly. Our objective was to determine if the number and severity of hospitalizations at the CME of the CHU de Québec for asthma exacerbations in children aged 1 to 17 had significantly decreased during the confinement period from April 1 to July 1, 2020 and to what extent, according to various clinical features.Design/MethodsRetrospective study reviewing episodes of care in medical records in children aged 1 to 17 and hospitalized on all wards at the CME-CHU de Québec. All patients with primary diagnosis of asthmatic exacerbation according to the summary sheets between April 1 to July 1, 2020 for the study group and from April 1 to July 1, 2019 for the control group were included. We aimed to determine the number of hospitalizations for this diagnosis for each period and determine the length of stay on the various pediatric wards for each episode of care according to the established criteria. We have determined the presence of risk factors (asthma diagnosis, underlying condition, regular asthma medication, allergies, and other factors relevant to asthma).We have further determined the presence of gravity markers during the course of hospitalization (need for: IV corticosteroids, Mg sulfate, IV bronchodilators, non-invasive ventilation, intubation, ICU stay and radiological pneumonia) for each episode of care. The data was denominated and collated in an encoded file, and shareable only between the investigators.ResultsAfter exclusions, a total of 97 charts were analyzed. Between April 1 and July 1 2019, a total of 89 patients were admitted with a diagnosis of asthma exacerbation while only eight patients were admitted during the same period in 2020. The median age of patients admitted in 2020 was higher than in 2019 (53 vs 25 months). In 2019, 40 children (48%) had a previous diagnosis of asthma, of whom 28 used regular controller medications compared to 2 children (25%) in 2020, both taking regular controller medications. More patients had an associated diagnosis of upper respiratory tract infection in 2019 than in 2020 (92% vs 63%). Nine patients required intensive care in 2019 compared to none in 2020.ConclusionCompared to 2019, hospital admissions for asthma exacerbations in our tertiary care centre in Quebec City were significantly lower during the early phase of the 2020 pandemic. More research is required to determine the exact causes of this significant reduction.

Optimizing phase variability threshold for automated synchrogram analysis of cardiorespiratory interactions in amateur cyclists.

We propose a procedure suitable for automated synchrogram analysis for setting the threshold below which phase variability between two marker event series is of such a negligible amount that the null hypothesis of phase desynchronization can be rejected. The procedure exploits the principle of maximizing the likelihood of detecting phase synchronization epochs and it is grounded on a surrogate data approach testing the null hypothesis of phase uncoupling. The approach was applied to assess cardiorespiratory phase interactions between heartbeat and inspiratory onset in amateur cyclists before and after 11-week inspiratory muscle training (IMT) at different intensities and compared to a more traditional approach to set phase variability threshold. The proposed procedure was able to detect the decrease in cardiorespiratory phase locking strength during vagal withdrawal induced by the modification of posture from supine to standing. IMT had very limited effects on cardiorespiratory phase synchronization strength and this result held regardless of the training intensity. In amateur athletes training, the inspiratory muscles did not limit the decrease in cardiorespiratory phase synchronization observed in the upright position as a likely consequence of the modest impact of this respiratory exercise, regardless of its intensity, on cardiac vagal control. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.

Do not forget the lungs: preliminary feasibility study on I/E mode physiotherapy for people recovering from COVID-19

Early chest physiotherapy is recommended for patients with post-COVID syndrome to improve dyspnea, relieve anxiety, minimize disability, preserve lung function and improve Quality of Life. However, there is still no consensus on the best treatments to manage respiratory symptoms. We aimed to test a method based on a guided in/expiratory (I/E) modulation to treat the lung inhomogeneity. Twenty patients with post-COVID syndrome and mild-to-moderate obstructive syndrome performed 3 15-min sessions/day using the I/E mode of the T-PEP®4 device (Medical Products Research Srl, Legnano, Milan, Italy), for 15 consecutive days. Lung function parameters, dyspnea, and Quality of Life scores, as well as exercise capacity were assessed before and after treatment. All patients concluded the treatment and showed significant improvements in symptoms (chest pain during deep inspiration, chest tightness, inability to yawn, fatigue during activities of daily living [ADL], desaturation ≥4% during ADL) and in health status (BCSS -1.75, P=0.0003; CAT -5.2, P=0.0001). Lung function (FVC +10.9%, P=0.0002; FEV<inf>1</inf> +8%, P=0.0001) and respiratory muscle strength (MIP +13.8%, P<0.0001; SNIP +13.6%, P=0.0122; MEP +7.6%, P=0.0045) improved. Exercise capacity also improved (6MWT +14.2%, P=0.005). At the end of treatment, only 2 patients reported symptoms and ADL-induced desaturation, while 14 still had fatigue during ADL. This study shows that chest physiotherapy using an I/E device to actively recruit peripheral lungs in COVID-19 patients early after hospital discharge improved lung function tests as well as respiratory muscle strength, exercise capacity and Quality of Life.

Respiratory muscle strength and exercise capacity of children and adolescents with chronic liver diseases Exercise capacity in liver disease

Introdution: Chronic liver diseases are characterized by inflammatory and fibrotic lesions of the liver that cause systemic complications. These complications can negatively interfere with the respiratory muscle strength and exercise capacity of developing children and adolescents. Objectives: To compare respiratory muscle strength and exercise capacity in children and adolescents with chronic hepatopathy, using reference values from healthy individuals of the same age. Methods: A cross-sectional study was performed. Children and adolescents from 6 to 16 years old with chronic hepatopathies were included. For the evaluation of respiratory muscle strength, the maximal respiratory pressures were measured through manovacuometry. A six-minute walk test was used to assess exercise capacity. The Wilcoxon test was used to verify the difference between the evaluated and predicted values of the distance traveled. Results: In total, 40 subjects were analyzed; 57.5% of the subjects were female, and the subjects had a mean age of 11.68±2.82 years. In the comparison between the measured and predicted maximal respiratory pressures, a difference of -17.71 cmH2O (p&lt; 0.001) was found for the maximal inspiratory pressure, and a difference of -30.68 cmH2O (p&lt; 0.001) was found for the maximal expiratory pressure. Regarding exercise capacity, the measured average distance traveled was 346.46±49.21 m, which was 185.54m (p&lt; 0.001) less than the predicted value. Conclusions: Children and adolescents with chronic liver disease have reduced respiratory muscle function and exercise capacity.

The Effect of Telerehabilitation on Quality of Life, Exercise Capacity, and Spirometry Indexes in Patients with Chronic Obstructive Pulmonary Disease in Masih Daneshvari Hospital

Background: Chronic Obstructive Pulmonary Disease (COPD) leads to limited activity and reduced quality of life. Treatment of this disease is a long-term process that requires the cooperation of patients in monitoring and treatment. Methods: In the present study which was conducted from April 2019 to March 2021 in Masih Daneshvari Hospital, Tehran, Iran, 75 patients were randomly divided into telerehabilitation and control groups. Patients in the control group received pulmonary rehabilitation including respiratory, isometric, and aerobic exercises for 8 weeks, three times per week. In the second group, patients were given a lung rehabilitation booklet and asked to repeat the exercises three times a week for four weeks according to a specific schedule. In addition, patients installed Behzee care application on the mobile phone that recorded various indicators such as heart rate, SpO2, dyspnea, fatigue, and daily activities. This application reminded the patient of the program every day and at a specific time. Finally, the patients’ conditions were compared in the two groups after 8 weeks using CAT and mMRC questionnaires and 6-Minute Walk (6MW) exercise indices as well as spirometry tests. Results: In all four indicators (6MW, CAT, and mMRC questionnaires as well as spirometry), patients showed improvement after rehabilitation (p&lt;0.001). This improvement was significantly higher in the telemedicine group compared to the other group (p&lt;0.01). Conclusion: The use of telerehabilitation in COPD patients is effective in improving spirometry indices, quality of life, as well as activity and sports indices.

742 INITIAL RESULTS OF THE ‘TUBELESS’ OESOPHAGUECTOMY: LESS IS MORE

Abstract Oesophageal cancer surgery is a complex procedure with high morbidity and mortality rate. High volume centres, complete multidisciplinary support and clear clinical guidelines are required to obtain adequate results. One of the objectives of multimodal rehabilitation programs in this field is to reduce surgical aggression. Initial experience with the tubeless oesophagectomy technique is described. Methods Description of the technique and perioperative management of tubeless oesophagectomy. We performed a 3-stage esophagectomy with a minimally invasive approach, without NGT placement or any type of drainage. The procedure includes the so-called phantom jejunostomy, which require of fixing the first jejunal loop to the parietal peritoneum in order to position a percutaneous catheter if necessary. All patients were extubated at the end of the surgery, remaining in the ICU with high-flow glasses for the first 24–48 hours. Also in the first 2 days, the urinary catheter and the epidural catheter were removed, sitting and fluid tolerance began. Results Beteween June–November 2020 6 patients were operated on. Median age was 60 years (range: 52–70), 83.3% were squamous cell carcinoma located in the middle oesophagus, 4 patients received neoadjuvant CROSS treatment. No intraoperative complications reported and a median stay of 7 days (range: 6–28). There was no anastomotic leak, nor need to place a jejunostomy, nor need to place a nasogastric tube and neither reoperation. A thoracic tube was necessary for chylothorax and another for pneumothorax (in a patient with acute respiratory distress). There was no mortality at 30 and 90 days after the procedure. Conclusion Tubeless oesophagectomy is a feasible concept that can improve postoperative recovery in selected cases, reducing pain associated with drains and tubes, facilitating early mobilization and correct performance of respiratory physiotherapy exercises. Improving functional recovery and quality of life during the postoperative period. Studies with a greater number of cases and well designed are necessary to strongly evaluate this type of procedure.

The Age, Sex, and Geographical Distribution of Self-Reported Asthma Triggers on Children With Asthma in China.

Background: Asthma can be exacerbated by many triggers, and the heterogeneity of asthma triggers is clear among children with asthma. This study describes asthma triggers using a large-scale electronic dataset from the smartphone-based Chinese Children's Asthma Action Plan (CCAAP) app and aims to examine the difference in asthma triggers among different subgroups of children with asthma.Methods: Data from the smartphone-based CCAAP app between February 22, 2017, and November 23, 2020, were reviewed, and children with asthma who reported their asthma triggers were enrolled. Eight common asthma triggers were listed in the software: upper respiratory infection (URI), allergen sensitization, exercise, emotional disturbances, pungent odors, air pollution/smog, weather change, and tobacco smoke. We compared the incidence of asthma triggers among different subgroups (<6 years vs. 6–17 years; boy vs. girl; eastern region vs. central region vs. western region).Results: We enrolled 6,835 patients with self-reported asthma triggers. When compared by sex, boys had a higher proportion of exercise-triggered asthma than girls (boys vs. girls, 22.5 vs. 19.7%, p < 0.05). The proportion of patients <6 years of age with URI-triggered asthma was higher than that of patients 6–17 years of age (<6 vs. 6–17 years, 80.9 vs. 74.9%, p < 0.001). Patients 6–17 years of age were more likely than patients <6 years of age to report five of the asthma triggers: allergen sensitization (<6 vs. 6–17 years, 26.6 vs. 35.8%, p < 0.001), exercise (<6 vs. 6–17 years, 19.3 vs. 23.7%, p < 0.001), pungent odors (<6 vs. 6–17 years, 8.8 vs. 12.7%, p < 0.001), air pollution/smog (<6 vs. 6–17 years, 9.4 vs. 16.2%, p < 0.001), and tobacco smoke (<6 vs. 6–17 years, 3.5 vs. 5.3%, p < 0.001). In subgroups based on geographical distribution, asthma triggering of allergen sensitization was reported to be the most common in patients from the eastern region (eastern region vs. central region vs. western region, 35.0 vs. 24.6 vs. 28.0%, p < 0.001). Exercise-triggered asthma was found to be the most prevalent among patients from the central region (eastern region vs. central region vs. western region, 21.6 vs. 24.8 vs. 20.4%, p < 0.05). However, the proportion of patients with air pollution/smog as an asthma trigger was the lowest among those from the western region (eastern region vs. central region vs. western region, 14.1 vs. 14.1 vs. 10.8%, p < 0.05).Conclusion: Children with asthma present different types of asthma triggers, both allergenic and nonallergenic. Age, sex, and geographical distribution affect specific asthma triggers. Preventive measures can be implemented based on a patient's specific asthma trigger.

Left ventricular concentric remodeling and impaired cardiorespiratory fitness in patients with heart failure and preserved ejection fraction.

Left ventricular (LV) concentric remodeling refers to a process by which increased LV relative wall thickness alters myocardial geometry, resulting in reduced LV end-diastolic volume (LVEDV) and stroke volume (SV). While the degree of concentric remodeling is a negative prognostic factor in heart failure with preserved ejection fraction (HFpEF), it is not known how it contributes to cardiorespiratory fitness (CRF). We performed a retrospective analysis of patients with HFpEF who underwent treadmill single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and cardiopulmonary exercise testing (CPX). From exercise SPECT-MPI, we recorded postexercise LVEDVi, LVESVi, SVi, LVEF, the presence and extent of perfusion defects, and perfusion reversibility. Peak oxygen consumption (VO<inf>2</inf>), the oxygen uptake efficiency slope (OUES), oxygen (O<inf>2</inf>) pulse, ventilatory efficiency (V<inf>E</inf>/VCO<inf>2</inf> slope), ventilatory anaerobic threshold, respiratory exchange ratio, exercise time, and maximum heart rate were obtained from CPX. Data are expressed as mean (±standard deviation). Univariate and multivariate linear regression was performed. We identified 23 subjects who had completed both an exercise SPECT-MPI and a CPX. Patients were more commonly women (83%), black (65%), middle age (50 [±7.3] years), and obese (Body Mass Index [BMI] 39.7 [±6.0] kg/m2). Greater LVEDVi and LVESVi correlated positively with peak VO<inf>2</inf> (R=+0.648, P=0.001; R=+0.601, P=0.002), O<inf>2</inf> pulse (R=+0.686, P<0.001; R=+0.625, P=0.001) and OUES (R=+0.882, P<0.001; R=+0.779, P<0.001). The LVEF correlated inversely with peak VO<inf>2</inf> and OUES (R=-0.450, P=0.031; R=-0.485, P=0.035). Perfusion defect area, grade of severity, and presence of reversibility were not associated with CRF variables. Postexercise reduced LV volumes correlate with measures of impaired CRF in patients with HFpEF, thus supporting a pathophysiologic role of concentric remodeling in impaired CRF in HFpEF.

Effect of electroacupuncture on small airway function in patients with stable chronic obstructive pulmonary disease

To observe the regulatory effect of electroacupuncture (EA) on small airway function and exercise tolerance in patients with stable chronic obstructive pulmonary disease (COPD). A total of 62 patients with stable COPD were randomized into an observation group (31 cases, 1 case dropped off) and a control group (31 cases, 5 cases dropped off). On the base of routine medication and aerobic exercise, the patients of the two groups all received EA at Danzhong (CV 17), Rugen (ST 18), Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25) and Yingchuang (ST 16). In the observation group, filiform needles were used and inserted perpendicularly, 3 mm in depth. In the control group, the placebo needling method was performed, in which the needle was not inserted through skin at each point. In both groups, electric stimulation with low-frequency electronic pulse instrument was exerted, with continuous wave, 2 Hz in frequency, lasting 30 min each time in the two groups. The treatment was given once every other day, 3 times a week, for 14 treatments totally. Before and after treatment, the following indexes were compared in patients between the two groups, i.e. the lung function indexes (forced expiratory volume in first second [FEV1], forced vital capacity [FVC], the ratio of FEV1 to FVC [FEV1/FVC], maximal voluntary ventilation [MVV], the percentage of maximal expiratory flow [MEF] at 25% of FVC exhaled [MEF25], MEF50 and MEF75 in predicted value), cardiopulmonary exercise test indexs (metabolic equivalent [METS], oxygen uptake per kg body weight [VO2/kg], minute ventilation [VE], the percentage of oxygen pulse [VO2/HR] in predictd value, maximal minute ventilation [VEmax], ventilatory equivalent for oxygen [VE/VO2], ventilatory equivalent for carbon dioxide [VE/VCO2]), 6-minute walk distance (6MWD), the total score of COPD assessment test (CAT), the modified British Medical Research Council (mMRC) score and COPD comprehensive grade. After treatment, FVC%, MVV%, MEF75%, MEF50%, VO2/kg%, METs%, VEmax, VO2/HR%, 6MW and the total CAT score were all improved as compared with those before treatment in the observation group (P<0.05, P<0.01). After treatment, MEF75% and the total CAT score were reduced as compared with those before treatment in the control group (P<0.05). After treatment, MVV%, MEF50%, VO2/kg%, METs%, VEmax and 6MWD in the observation group were all better than those in the control group (P<0.05, P<0.01). Electroacupuncture can improve the respiratory function and exercise tolerance in COPD patients through removing small airway obstruction and increasing ventilation.