Respiratory Exercise Research Articles

Using RQA for evaluating heart rate patterns under controlled breathing

In this work, the variation of time and amplitude of the electrical stimulation of the heart muscle is analyzed during respiratory control exercise, effect of the autonomic nervous system. The specifics are verified by recurrence plot, and recurrence quantification analysis. The analysis revealed distinguished behavior of the electrical stimulation of the heart. And, the cross recurrence between the variations of amplitude and time demonstrated the equilibrium relationship in the cardiac cycles, which are accentuated in the exercise of concentration.

Evaluating pulmonary function, aerobic capacity, and pediatric quality of life following a 10-week aerobic exercise training in school-aged asthmatics: a randomized controlled trial.

BackgroundIt has been documented that aerobic exercise may increase pulmonary functions and aerobic capacity, but limited data has evaluated a child’s satisfaction and pediatric quality of life (PQoL) with exercise training.ObjectivesThis study aimed to investigate the effects of moderate-intensity exercise training on asthmatic school-aged children.Subjects and methodsThis study included 38 school-aged children with asthma (23 males and 15 females) aged between 8–12 years. They were randomly assigned to two groups, aerobic exercise (AE) and conventional treatment (Con ttt) groups. The AE group received a program of moderate-intensity aerobic exercise for 10 weeks with asthma medications and the Con ttt group received only asthma medications without exercise intervention. A home respiratory exercise was recommended for the two groups. Aerobic capacity was investigated using maximal oxygen uptake (VO2max), 6-minute walk test (6MWT), and fatigue index. PQoL was evaluated using Pediatric Quality of Life Questionnaire (PQoLQ). Also, pulmonary function tests were performed, and the results recorded.ResultsThe findings of this study showed significant improvements in pulmonary functions and VO2max in the two groups; however, this improvement was significantly higher in the AE group than in the Con ttt group (p<0.05). The 6MWT and fatigue index improved in the AE group (p<0.05) but not in the Con ttt group (p>0.05). All dimensions of PQoL significantly improved in the AE group (p<0.05), but there was no significant improvement in the Con ttt group after the 10-week intervention period (p>0.05).ConclusionTen weeks of physical exercise had beneficial effects on pulmonary functions, aerobic capacity, and PQoL in school-aged children with asthma. Effort and awareness should be dedicated to encouraging the active lifestyle among different populations, especially asthmatic children.

Respiratory muscle training for cystic fibrosis.

Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. To determine the effectiveness of respiratory muscle training on clinical outcomes in people with cystic fibrosis. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of most recent search: 17 April 2018.A hand search of the Journal of Cystic Fibrosis and Pediatric Pulmonology was performed, along with an electronic search of online trial databases up until 07 May 2018. Randomised controlled studies comparing respiratory muscle training with a control group in people with cystic fibrosis. Review authors independently selected articles for inclusion, evaluated the methodological quality of the studies, and extracted data. Additional information was sought from trial authors where necessary. The quality of the evidence was assessed using the GRADE system MAIN RESULTS: Authors identified 19 studies, of which nine studies with 202 participants met the review's inclusion criteria. There was wide variation in the methodological and written quality of the included studies. Four of the nine included studies were published as abstracts only and lacking concise details, thus limiting the information available. Seven studies were parallel studies and two of a cross-over design. Respiratory muscle training interventions varied dramatically, with frequency, intensity and duration ranging from thrice weekly to twice daily, 20% to 80% of maximal effort, and 10 to 30 minutes, respectively. Participant numbers ranged from 11 to 39 participants in the included studies; five studies were in adults only and four in a combination of children and adults.No significant improvement was reported in the primary outcome of pulmonary function (forced expiratory volume in one second and forced vital capacity) (very low-quality evidence). Although no change was reported in exercise capacity as assessed by the maximum rate of oxygen use, a 10% improvement in exercise duration was found when working at 60% of maximal effort in one study (n = 20) (very low-quality evidence). In a further study (n = 18), when working at 80% of maximal effort, health-related quality of life improved in the mastery and emotion domains (very low-quality evidence). With regards to the review's secondary outcomes, one study (n = 11) found a significant change in intramural pressure, functional residual capacity and maximal inspiratory pressure following training (low-quality evidence). A further study (n = 22) reported that respiratory muscle endurance was significantly longer in the training group (P < 0.01). No studies reported on any other secondary outcomes. Meta-analyses could not be performed due to a lack of consistency and insufficient detail in reported outcome measures. There is insufficient evidence to suggest whether this intervention is beneficial or not. Healthcare practitioners should consider the use of respiratory muscle training on a case-by-case basis. Further research of reputable methodological quality is needed to determine the effectiveness of respiratory muscle training in people with cystic fibrosis. Researchers should consider the following clinical outcomes in future studies; respiratory muscle function, pulmonary function, exercise capacity, hospital admissions, and health-related quality of life. Sensory-perceptual changes, such as respiratory effort sensation (e.g. rating of perceived breathlessness) and peripheral effort sensation (e.g. rating of perceived exertion) may also help to elucidate mechanisms underpinning the effectiveness of respiratory muscle training.

Nonintubated Subxiphoid Bilateral Redo Lung Volume Reduction Surgery

This report describes a nonintubated, bilateral thoracoscopic redo lung volume reduction surgery procedure through a single subxiphoid access in a patient who previously underwent one-stage bilateral volume reduction for upper lobe-predominant heterogeneous emphysema 19 years earlier. The patient was uneventfully discharged on postoperative day 2, and meaningful improvement in respiratory function and exercise tolerance occurred at 3 months postoperatively. This novel surgical approach may merge the potential benefits of a subxiphoid incision for bilateral treatment, nonintercostal passage of chest drains, and adoption of a nonintubated anesthesia protocol.

Cardiopulmonary rehabilitation in pulmonary arterial hypertension

Cardiopulmonary rehabilitation is a promising therapy for Pulmonary arterial hypertension (PAH) whose survival does not exceed 65% at five years. We performed a literature search about rehabilitation on PAH in MEDLINE, LILACS and COCHRANE databases, considering articles from 2005 to 2017. Fifteen articles were incorporated in the final analysis. We obtained information about safety parameters, type of exercises applied, duration and frequency of sessions. The interventions included aerobic, resistance and respiratory muscle training exercises. The results showed improvements in peak oxygen uptake, six minutes walking test, quality of life and inspiratory muscle strength, among others. We conclude that the evidence supports the recommendation of physical rehabilitation in selected patients with stable PAH as a complementary strategy to the available pharmacological therapy.

Effect of Breathing Exercises on Fatigue Dimensions in Patients with COPD

Objective: Fatigue is known as an important and multidimensional symptom in patients with chronic obstructive pulmonary disease (COPD). Pulmonary Rehabilitation (PR) is one of the effective ways to reduce fatigue and improve the quality of life in patients with COPD. However, equal recovery to all dimensions of fatigue is unclear after the rehabilitation program. This study aims to determine the effect of breathing exercises on the fatigue dimensions in patients with COPD Method: This study aimed to determine the effect of breathing exercises on fatigue dimensions in patients with COPD. The population in this clinical-trial research included 70 COPD patients who had been hospitalized in the Thorax Ward of Razi Hospital in Rasht. The samples were divided into two groups of 35 subjects, by which the control group was tried to be in a separate room from the experimental group. The experimental group participated in the breathing exercises program where the patients were asked to perform their respiratory exercises 4 times a day for 10 days. The control group received the routine care. Dimensions of fatigue (physical, general, mental, reduced activity, and reduced motivation) were measured and compared in both groups. SPSS (version 21) was used to analyze the data and descriptive and inferential tests were used. Results: There were significant statistical improvements in mean score of fatigue dimensions after breathing exercises, general fatigue (p=0.0001), physical exhaustion (p=0.0001), reduced activity (p=0.0001) and reduced motivation (p=0.0001), but there was no significant difference in mental fatigue. Predictors of changes in total fatigue score, breathing exercises (p<0.0001) and Salbutamol spray (p<0.013) were considered as two factors affecting fatigue score changes in multiple analysis. Conclusion: According to the obtained findings, breathing exercises are effective in many dimensions of fatigue as a non-pharmacological, low-cost, and safe method in care-and-treatment process in patients with COPD, but their effect on mental fatigue, as an important dimension, requires different plans and designs in doing breathing exercises.

Brachycephalic obstructive airway syndrome

Brachycephalic breeds are often in the news due to the challenges and ethical issues surrounding conformation-related disease in these breeds. An exponential rise in ownership of brachycephalic breeds has occurred...

A Simplified Approach to Select Exercise Endurance Intensity for Interventional Studies in COPD

ABSTRACTTime to exercise limitation (Tlim) in response to constant work rate (CWR) is sensitive to interventions in chronic obstructive pulmonary disease (COPD). This is particularly true when the pre-intervention test lasts between 3 and 8 min (Tlim3′–8′). There is, however, no simple method to select a work rate which is consistently associated with Tlim3′–8′ across the spectrum of COPD severity.We assessed 59 GOLD stages II–IV patients who initially cycled to Tlim at 75% peak. In case of short (<3 min, low-endurance) or long (>8 min, high-endurance) tests, patients exercised after 60 min at 50% or 90%, respectively (CWR50%⇐75%⇒90%).Critical mechanical constraints and limiting dyspnea at 75% were reached within the desired timeframe in 27 “mid-endurance” patients (46%). Increasing work rate intensity to 90% hastened the mechanical-ventilatory responses leading to Tlim3′–8′ in 23/26 (88%) “high-endurance” patients; conversely, decreasing exercise intensity to 50% slowed those responses leading to Tlim3′–8′ in 5/6 (83%) “high-endurance” patients. Repeating the tests at higher (60%) or lower (80%) intensities fail to consistently produce Tlim3′–8′ in “low-” and “high-endurance”, respectively (p > 0.05). Compared to a fixed work rate at 75%, CWR50%⇐75%⇒90% significantly decreased Tlim's coefficient of variation; consequently, the required N to detect 100 s or 33% improvement in Tlim decreased from 82 to 26 and 41 to 14, respectively.This simplified approach to individualized work rate adjustment (CWR50%⇐75%⇒90%) might allow greater sensitivity in evaluating interventional efficacy in improving respiratory mechanics and exercise tolerance while simultaneously reducing sample size requirements in patients with COPD.

Study of Decannulation Problems Following Tracheostomy in Quadriplegics

Aim: Decannulation of tracheostomy in cases of traumatic quadriplegia is always a challenge due to respiratory muscle paralysis, chest infections, aspiration and need to care for sacral sores. Aim of this study was to identify and overcome the difficulties in decannulation of tracheostomy in cases of quadriplegia due to cervical spinal cord injury. Material and methods: This prospective observational study was carried out in a tertiary care Spinal Cord Injury Center of a Military Hospital. Ten cases of tracheostomized traumatic quadriplegics were evaluated over 3years. Decannulation was considered once there was normal gag reflex, effective cough, manageable aspiration, oxygen saturation above 90%, no serious pulmonary compromise and no need for bed sores surgery. The cases were followed up for further one year post-decannulation. Results: Eight cases could be decannulated successfully. Only two cases could not be decannulated due to feeble chest movement, ineffective Cough, lack of motivation and occasional aspiration. Conclusion: Cervical cord injury patients have difficult decannulation due to weak respiratory muscles, ineffective cough, aspiration, pulmonary pathology and bed sores. Respiratory muscle exercise, quantified peak cough pressure, assisted coughing, risk benefit approach in aspiration, healing of bed sores and team work are keys to successful decannulation

Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial)

BackgroundThere is a need for evidence of the effectiveness of pre-operative exercise for patients undergoing major cancer surgery; however, recruitment to such trials can be challenging. The PrE-operative Physical Activity (PEPA) Trial will establish the feasibility and acceptability of a pre-operative exercise programme aimed to improve patient outcomes after cytoreductive surgery and pelvic exenteration. The secondary aim is to obtain pilot data on the likely difference in key outcomes (post-operative complications, length of hospital stay, post-operative functional capacity and quality of life) to inform the sample size calculation for the substantive randomised clinical trial.Methods/designTwenty patients undergoing cytoreductive surgery and pelvic exenteration at the Royal Prince Alfred Hospital, Sydney will be recruited and randomly allocated (1:1 ratio) to either 2 to 6 weeks’ pre-operative exercise programme (intervention group) or usual care (control group). Those randomised to the intervention group will receive up to six individualised, 1-h physiotherapy sessions (including aerobic and endurance exercises, respiratory muscle exercises, stretching and flexibility exercises), home exercises (instruction and recommendations on how to progress the exercises at home) and encouragement to be more active by using an activity tracker to measure the number of steps walked daily. Patients allocated to the control group will not receive any specific advice about exercise training. Feasibility will be assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the exercise programme. Acceptability of the exercise programme will be assessed with a semi-structured questionnaire. The following measures of the effectiveness of the intervention will be collected at baseline (2 to 6 weeks pre-operative), a week before surgery, during hospital stay and pre hospital discharge: post-operative complication rates (Clavien-Dindo), post-operative functional capacity (Six-minute Walk Test) and quality of life (SF-36v2®) and length of hospital stay. Functional status will be additionally measured using Cardiopulmonary Exercise Testing (CPET), at baseline and within a week before surgery.DiscussionThe PEPA Trial will provide important information about the feasibility and acceptability of a pre-operative exercise programme for patients undergoing major cancer surgery. Data from the PEPA Trial will be used to inform the design, methodology and to calculate sample size required for a larger, definitive trial.Trial registrationAustralian New Zealand Clinical Trials Registry, ID: ACTRN12617001129370. Registered on 1 August 2017.

Respiratory characteristics of individuals with non-specific low back pain: A cross-sectional study.

Non-specific low back pain (NS-LBP) is known to cause respiratory dysfunction. In this study, we investigated alterations in breathing, respiratory strength and endurance, core stability, diaphragm mobility, and chest expansion among patients with NS-LBP and healthy individuals. The specific aim of the study was to correlate between respiratory function and other variables among NS-LBP patients. Thirty four patients with NS-LBP were matched with 34 healthy participants before undergoing total faulty breathing scale, spirometer, respiratory pressure meter, chest expansion, ultrasound, and pressure biofeedback measurements. There were signs of faulty breathing in the NS-LBP patients when compared to the healthy participants. Diaphragmatic mobility and respiratory muscle endurance were lower in the NS-LBP group. Chest expansion exhibited a significant decrease at the level of the fourth intercostal space in the NS-LBP group, but respiratory muscle strength and core stability were not significant between the two groups. Positive correlations were found to be fairly significant regarding respiratory muscle strength. The findings of this study indicated altered respiratory characteristics in the NS-LBP patients, and suggested that they would improve through respiratory exercises.

Abstract TMP87: Non-Invasive Respiratory Impedance Enhances Cerebral Perfusion in Acute Stroke Patients

Introduction: Optimization of cerebral blood flow is a cornerstone of clinical management in a number of neurologic diseases, most notably acute ischemic stroke. Intra-thoracic pressure influences cardiac output and has the potential to impact cerebral blood flow (CBF). We aimed to quantify cerebral hemodynamic changes in acute ischemic stroke patients during increased respiratory impedance using a non-invasive oral device. Methods: Cerebral perfusion was measured during low (6cm H 2 0) and high (12cm H 2 0) levels of respiratory impedance in 20 patients within 72 hours of acute ischemic stroke. Microvascular CBF was measured by optical diffuse correlation spectroscopy, and middle cerebral artery mean flow velocity (MFV) was assessed by transcranial Doppler ultrasound. Results: High level respiratory impedance resulted in a 10% increase in MFV. Low level respiratory impedance resulted in a smaller (4%) non-significant change in MFV. Changes in cortical CBF were non-significant (figure). MFV varied across all studied levels (baseline vs low vs high, p=0.0017) with a significant test of trend (p=0.001), but this was not seen with microvascular CBF (p=0.33). Heart rate, cardiac output, and end tidal CO 2 remained stable during all levels of respiratory impedance. There was a small increase in mean arterial blood pressure at the low and high level of respiratory impedance, 4% (p=0.013) and 6% (p=0.017) respectively. All patients completed the protocol in its entirety, and the respiratory impedance exercise was well tolerated. Conclusions: Manipulating intrathoracic pressure via non-invasive respiratory impedance was safe and produced a small but measurable increase in cerebral blood flow in acute stroke patients. Future studies are warranted to assess whether respiratory impedance is feasible during hyperacute stroke management, and to determine the effect of volume status on the hemodynamic response to respiratory impedance.

Effect of preoperative respiratory exercise on pulmonary function and complications in elderly patients after abdominal operation

Objective To compare and analyze the effects of preoperative respiratory function exercise on postoperative pulmonary function and complications in elderly patients who undergoing abdominal surgery. Methods A total of 92 elderly patients who underwent abdominal surgery were recruited. They were randomly divided into observation group(46 cases) and control group(46 cases) according to the random number table method. The control group was treated with routine preoperative care methods, the observation group was given preoperative respiratory exercise on the basis of the control group. The pulmonary function tests were performed pre and post surgery. Then, the postoperative pulmonary complications, VC, FEV1, FVC, MVV and the average length of hospital stay of the two groups were recorded and compared. Results After operation, the levels of VC, FEV1, FVC and MVV in the control group were (2.48±0.71)L, (51.40±10.10)L, (1.79±0.17)L, (62.40±13.00)L/min, respectively, which in the observation group were (2.89±0.72)L, (63.20±9.60)L, (2.21±0.16)L and(73.30±12.70)L/min, respectively, the differences between the two groups were significant(t=2.750, 5.743, 12.202, 4.068, all P<0.05). The average hospitalization time in the observation group was (11.62±1.41)d, which was significantly shorter than (15.56±6.23)d in the control group(t=4.163, P<0.001). The incidence rate of pulmonary infection in the control group was 26.09%, which was significantly higher than 8.69% in the observation group(χ2=4.842, P<0.05). Conclusion The respiratory function training can effectively reduce the incidence of postoperative pulmonary complications in elderly patients with abdominal surgery, improve the patients’ postoperative pulmonary function, and shorten the patients’ hospital recovery time. Respiratory function exercise is a simple method, and is worthy of promotion in related fields. Key words: Breathing exercises; Respiratory function tests; Postoperative complications; Aged

Treatment of fatigue in amyotrophic lateral sclerosis/motor neuron disease.

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is terminal, progressive neurological condition for which there are no curative treatments. Among people with ALS/MND, fatigue is a common and debilitating symptom, which is characterised by reversible motor weakness and whole-body tiredness that is only partially relieved by rest. The effectiveness of pharmacological or non-pharmacological treatments for fatigue in ALS/MND is not yet established. To assess the effects of pharmacological and non-pharmacological interventions for fatigue in ALS/MND. We searched the following databases on 5 September 2017: Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL Plus, and ERIC. We also searched two clinical trials registries. We selected randomised and quasi-randomised controlled trials of any intervention which sought to reduce fatigue for people with ALS/MND. We included studies if reduction in fatigue was a primary or secondary outcome of the trial. We used the standard methodological procedures expected by Cochrane. We included one pharmacological (modafinil) study and three non-pharmacological studies (resistance exercise, respiratory exercise, and repetitive transcranial magnetic stimulation (rTMS)), involving a total of 86 participants with ALS/MND. None of the included studies were free from risk of bias. Since there was only one trial for each intervention, no meta-analysis was possible. All studies assessed fatigue using the Fatigue Severity Scale (FSS; scale from 9 to 63, higher scores indicate more fatigue). Information for assessing bias was often lacking in study reports, making the risk of bias unclear across several domains in all trials. Blinding of participants was not possible in exercise trials, but the outcome assessment was blinded.We found very low-quality evidence suggesting possible improvements in fatigue for modafinil treatment versus placebo (MD -11.00, 95% CI -23.08 to 1.08), respiratory exercise versus a sham intervention (MD -9.65, 95% CI -22.04 to 2.73), and rTMS versus sham rTMS (data not provided), which warrant further investigation to clarify the efficacy of these treatments for fatigue in ALS/MND. We found no clear improvements in fatigue for resistance exercise versus usual care (MD 0.20, 95% CI -10.98 to 11.38; very low-quality evidence).Three participants in the modafinil group dropped out of the modafinil study, two citing issues with headache and one with chest tightness; other adverse effects were anxiety, nausea, dizziness, and sialorrhoea (probably ALS-related). The trials reported no adverse effects of exercise or rTMS.We cannot be certain about the effects of any of the interventions studied because of imprecision (small numbers of participants, wide CI), and possible study limitations. It is impossible to draw firm conclusions about the effectiveness of interventions to improve fatigue for people with ALS/MND as there are few randomised studies, and the quality of available evidence is very low.

Effect of respiratory exercise on pulmonary function, balance, and gait in patients with chronic stroke.

[Purpose] This study investigated the effect of respiratory exercise on pulmonary function, balance, and gait in chronic stroke patients. [Participants and Methods] Twenty patients with chronic stroke were randomly assigned to experimental and control groups (n=10 each). The patients in both groups underwent neurodevelopmental treatment. Moreover, the experimental group performed respiratory exercise. Pulmonary function was measured using a pneumatometer. Balance was measured using a Berg Balance Scale and Functional Reach Test. Gait was measured with a 10-m walk test and Timed Up-and-Go Test. [Results] Intragroup comparison showed significant differences in forced vital capacity, forced expiratory volume in one second, Berg Balance Scale, Functional Reach Test, 10-meter walk test, and Timed Up-and-Go Test. Intergroup comparison showed that the differences in forced vital capacity, forced expiratory volume in one second, Berg Balance Scale, Functional Reach Test, 10-meter walk test, and Timed Up-and-Go Test for the experimental group were significantly related to those for the control group. [Conclusion] Based on these results it was concluded that respiratory exercise effectively improves the pulmonary function, balance, and gait in patients with chronic stroke.

The effect of respiratory exercise on trunk control, pulmonary function, and trunk muscle activity in chronic stroke patients.

[Purpose] This study aims to identify the effect of respiratory exercise on trunk control, pulmonary function, and trunk muscle activity in chronic stroke patients. [Subjects and Methods] The study included 24 chronic stroke patients who were randomly assigned, 12 each, to the experimental and control groups, and received neurodevelopmental treatment. Moreover, the experimental group underwent respiratory exercise. In each patient, the trunk control was measured using the Trunk Impairment Scale (TIS); muscle activity of the trunk, through the surface electromyogram; and pulmonary function, using the pneumatometer. [Results] The intragroup comparison showed significant differences in TIS, Forced vital capacity (FVC), Forced expiratory volume at one second (FEV1), Rectus Abdominis (RA), Internal Oblique (IO) and External Oblique (EO) in the experimental group. The intergroup comparison showed that the differences in TIS, FVC, FEV1, RA, IO and EO within the experimental group appeared significant relative to the control group. [Conclusion] Based on these results, this study proved that respiratory exercise was effective in improving trunk control, pulmonary function, and trunk muscle activity in patients with chronic stroke.

Impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer.

ABSTRACTObjective:To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. Methods:Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose. Results:The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis. Conclusions:In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.

Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial.

Background:Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test.Methods:A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ClinicalTrials.gov identifier: NCT02939625].Results:A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height (z score: −2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group.Conclusion:Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.

Effect of a Respiratory Training Program Using Wind Instruments on Cardiopulmonary Function, Endurance, and Quality of Life of Elderly Women

BackgroundPhysical changes due to aging lead to weakening of respiratory muscles and decreased lung functions that result in increasing risk of chronic respiratory disease. A complex respiratory rehabilitation program is needed to prevent respiratory diseases and improve lung functions and quality of life. The purpose of the present study was to examine the effects of respiratory training programs on pulmonary functions, cardiovascular endurance, and quality of life in elderly women.Material/MethodsThe program was structured with respiration exercise and playing wind musical instruments for 10 weeks (n=13) and 5 weeks (n=16), respectively, for elderly women in 2 different community welfare centers. The program consisted of breathing exercises twice a week, 20 min per session, and 40 min of wind instrumentation. Effects were assessed using forced vital capacity (FVC), forced expiratory volume-one second (FEV1), FEV1/FVC ratio (FEV1%), maximum voluntary ventilation (MVV), 6-minute walk test (6MWT), modified Borg scale (MBS), and life satisfaction scale (LSS).ResultsThe 10-week program group (10WPG) showed significant differences in FVC, MVV, 6MWT, MBS, and LSS before and after interventions (p<.05), and the 5-week program group (5WPG) showed significant differences in FVC and 6MWT. MVV, MBS, and LSS were not significantly different between the 2 groups (p<.05).ConclusionsThis study confirms that the long-term respiration training program has positive effects on pulmonary functions, cardiopulmonary endurance, and quality of life. Various respiratory training programs and long-term implementations are needed to prevent respiratory illness and to improve lung functions and quality of life of respiratory patients.

Changes in exercise tolerance and quality of life are unrelated in lung cancer survivors who undergo video-assisted thoracic surgery.

[Purpose] The associations between changes in respiratory function, exercise tolerance, and quality of life (QOL) in patients with lung cancer who undergo lobectomy using video-assisted thoracoscopic surgery (VATS) are unclear. This study aimed to investigate the relationships between exercise tolerance and QOL in patients who underwent VATS. [Subjects and Methods] Thirty-six patients with lung cancer were followed for 3 months after VATS. Patients were evaluated before and 1, 4, and 12 weeks after surgery. Respiratory function, grip strength, and knee extension strength, as well as the results of timed up and go, 6-minute walk, and cardiopulmonary exercise tests, were evaluated using the 36-item short-form health survey. Longitudinal changes in physical performance and QOL were analyzed, as was the relationship between the change in physical function and QOL. [Results] The physical and social aspects of QOL significantly decreased at week 4 post-surgery, but recovered to pre-surgical levels by week 12. In contrast, physical (non-respiratory) function recovered to pre-surgical levels by week 4. There was no correlation between the percentages of change in QOL and those related to physical function. [Conclusion] Our preliminary study highlights the fact that early recovery of physical function is possible after VATS, but does not necessarily correlate with early QOL recovery. It is therefore necessary to perform perioperative interventions to promptly restore QOL after surgery.