Restrictive Pulmonary Disorders Research Articles

Spo2 Analysis on Development of IoT-Based Lung Function and Spo2 Measuring Device

Pulmonary dysfunction is a widespread issue, particularly in developing nations. It encompasses restrictive, obstructive, and mixed pulmonary function disorders that lead to a decrease in vital lung capacity, an increase in functional residual capacity, and a decline in blood oxygen concentration and saturation. This study aims to combine oximetry and spirometry into a single device, using the Internet of Things (IoT) technology to display results via a smartphone app. The focus is on analyzing oxygen saturation, with normal levels ranging from 96% to 100% in adults, alongside a heart rate of 60-100 beats per minute. The MAX30102 sensor measures oxygen saturation, and the Arduino Pro Mini and D1 Mini ESP32 microcontrollers process data. The Android-based app, developed using Kodular platform, integrates a MySQL database and connects to the device module via Wi-Fi. Ten respondents underwent five measurements, revealing an average error of ±0.88% for oxygen saturation (SpO2) and ±2.82% for heart rate measurements. The average data loss rate during transmission was ±0.66% for SpO2 and ±0.89% for heart rate. These findings highlight existing errors in the module. The research aims to facilitate remote health monitoring for healthcare professionals, improving accessibility and healthcare provision.

Impact of Type 2 Diabetes Mellitus on Pulmonary Function Tests

Background: Diabetes mellitus is a chronic metabolic disorder that may affect different organs including the lungs. Different studies have been published on the effects of diabetes mellitus on pulmonary function. A restrictive pattern of lung disorder was reported in some studies, whereas an obstructive pattern was suggested in others. The study aims to determine the impact of type 2 diabetes on pulmonary function tests (PFTs) and the type of respiratory disorder. Material and Methods: This observational study was conducted in Basrah City, Iraq. One hundred and eighty-two participants were enrolled and divided into 2 groups: 100 healthy (group1) and 82 patients with type2 diabetes mellitus (group 2).PFTs were estimated by a medical spirometer and measurements of several hematological tests were done for each individual. Results: We found a significant decline (p >0.05) in each of FEV1, FVC, PEF, and MVV and a significant increase in ELA in group 2. The restrictive pulmonary disorder was a higher percentage (24.39%) than obstruction (10.9%) and combined (2.43%). Conclusion: Pulmonary function tests were significantly affected by type2 DM and the percentages of different respiratory disorders were higher among group 2 than in group 1, with an increase in restrictive pattern.

Dynamics of functional changes in the respiratory system after COVID-19-associated lung injury at one year after hospital discharge

Morphological examination reveals microcirculation disorders in combination with small areas of lung damage in the long term after COVID-19. Therefore, the function of the respiratory system should be assessed after COVID-19. Aim of this study was to evaluate the dynamics of respiratory dysfunction in patients with COVID-19-associated lung injury using a complex examination of lung function (spirometry, body plethysmography, and lung diffusion testing) one year after hospital discharge. Methods. 60 patients (38 men/22 women, aged 39 to 80 years) with a diagnosis of “COVID-19-associated interstitial process in the lungs” were examined. Lung function (spirometry, body plethysmography, and lung diffusion capacity testing) was examined in all patients twice, at 1 – 6 months (visit 1) and at 12 – 24 months (visit 2) after hospital discharge. Results. At visit 1, 60% of patients had restrictive pulmonary ventilation disorders. Obstructive ventilation disorders were detected in only 1 patient. Decreased lung diffusion capacity (D CO corr.) was found in 78% of patients. At visit 2, obstructive disorders were detected in 1 patient, and the frequency of restrictive ventilation disorders was 29%. Decreased DLCO corr. was noted in 57% of cases. The parameters of pulmonary ventilation and pulmonary gas exchange function differed significantly between visits. Significant correlations were found between changes in the functional parameters of the respiratory system and disorders identified at visit 1 after hospital discharge. Conclusion. Thus, there is a decrease in the lung diffusion capacity and the rate of restrictive ventilation disorders even one year after severe COVID-19-associated lung injury. However, our results suggest a marked improvement in respiratory system function over time.

Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation.

Home mechanical ventilation (HMV) is an effective treatment for patients with chronic hypercapnic respiratory failure caused by restrictive or obstructive pulmonary disorders. Traditionally, HMV is initiated in the hospital, nowadays usually on a pulmonary ward. The success of HMV, and especially non-invasive home mechanical ventilation (NIV), has led to a steep and ongoing increase in the incidence and prevalence of HMV, in particular for patients with COPD or obesity hypoventilation syndrome. Consequently, the number of available hospital beds to accommodate these patients has become insufficient, and models of care that minimize the use of (acute) hospital beds need to be developed. At present, the practices for initiation of NIV vary widely, reflecting the limited research on which to base model-of-care decisions, local health system features, funding models, and historical practices. Hence, the opportunity to establish outpatient and home initiation may differ between countries, regions, and even HMV centres. In this narrative review, we will describe the evidence regarding the feasibility, effectiveness, safety, and cost savings of outpatient and home initiation of NIV. In addition, the benefits and challenges of both initiation strategies will be discussed. Finally, patient selection and execution of both approaches will be examined.

Relevance of serum levels of the endoplasmic reticulum stress protein GRP78 (glucose-regulated protein 78 kDa) as biomarker in pulmonary diseases

Cellular stress and inflammation contribute to the initiation and progression of a variety of pulmonary diseases. Endoplasmic reticulum (ER) stress and its main regulator GRP78 (glucose-regulated protein 78 kDa) appear to be involved in the pathogenesis of pulmonary diseases, and GRP78 was found to be a biomarker in a wide range of inflammatory diseases. The aim of this study was to investigate the relevance of serum GRP78 in pulmonary disorders.In this prospective cohort study, 78 consecutive patients with chronic obstructive pulmonary disease (COPD, n = 28), asthma (n = 38) or interstitial lung disease (ILD, n = 12) underwent measurement of serum GRP78 levels by ELISA.The mean age of patients was 59.8 ± 12.4 years, 48.7% were female. Patients with elevated GRP78 levels (> median) offered a significantly better oxygenation status (capillary pO2: 75.3 ± 11.7 mmHg vs. 67.8 ± 15.9 mmHg, p = 0.02). Significant correlations were observed between GRP78, on the one hand, and haemoglobin, high-sensitivity C-reactive protein (hs-CRP) and eosinophil counts, on the other hand (haemoglobin: Pearson’s r = −0.25, hs-CRP: r = 0.30, eosinophils: r = 0.63).Subsequently, we evaluated GRP78 measurements in function of severity stratifiers of the specific underlying pulmonary disease. ILD patients with a severe diffusion impairment (DLCO< 40% of predicted), exhibited a significant decrease in GRP78 levels (p = 0.01). In COPD and asthma, both characterized by obstructive ventilatory defects, a forced expiratory volume in one second (FEV1) <30% of predicted was accompanied by significantly lower GRP78 (p = 0.0075).In both obstructive and restrictive pulmonary disorders, GRP78 protein concentrations were reduced with increasing disease severity. These data suggest a prevalent role of GRP78 in the presently studied pulmonary disorders.

Monitoring of pregnancies with successful deliveries in a Niemann-Pick disease type B patient - case report and literature review

Introduction. Niemann?Pick disease type B is an autosomal recessive disease caused by sphingomyelinase deficiency resulting in sphingomyelin accumulation in macrophages of various organs. Visceral involvement includes spleen enlargement, thrombocytopenia, dyslipidemia, sphingomyelin deposition in lung and liver, and bleeding risk. This is a rare disease and literature data about pregnancy in this setting are scarce. We present two favorable pregnancy outcomes in a patient with Niemann?Pick disease type B along with the review of the literature. Case outline. At the time of the first intended pregnancy, the patient was 34 years old. She had an extremely enlarged spleen, mild restrictive pulmonary disorder, hyperlipoproteinemia type IIb, thrombocytopenia with impaired aggregation tests. Cesarean section was indicated. She was prepared for delivery with platelet concentrates and prophylactic use of antibiotics. In the 36th week of gestation, a Cesarean section without complications was performed. The newborn?s anthropometric parameters were BW 2490, BL 47 cm, HC 32 cm, and Apgar score was 7/8. The infant?s development was normal. Three years later, in the second wanted pregnancy, the same examinations were done. The planned Cesarean section was done without complication after the same procedures, including prophylactic use of antibiotics and platelet concentrates, and a healthy female child was born. Conclusion. A multidisciplinary approach in female patients who suffer from lysosomal storage disease such as Niemann?Pick disease type B is essential and a favorable course is possible despite all risks.

Assessment Tools for Pulmonary Involvement in Patients with Ankylosing Spondylitis: Is Diaphragmatic Ultrasonography Correlated to Spirometry?

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease that can lead to spinal ankylosis and consequently, restrictive pulmonary dysfunction. Thus, the present study aimed to assess the accuracy of diaphragm ultrasound compared to spirometry in the screening of restrictive pulmonary disorders in radiographic SpA patients. We conducted a cross-sectional study of 50 patients with radiographic SpA, over six months. Sociodemographic data, clinical characteristics of the disease, as well as biological, radiological, and therapeutic data, were collected. Spirometry and diaphragm ultrasound were performed. The mean age of the study participants (N= 50) was 42.7±11 years [range: 25-66] with male predominance (N= 41). Spirometry showed a restrictive disorder in 32% of cases. The mean chest expansion (CE) value was 3.9±1.81cm [range: 1-9] with a median of 4 cm. A pathological value (<5cm) was observed in 72% of cases. A significant positive correlation was found between the right inspiratory diaphragmatic thickness and forced vital capacity (FVC) (r= 0.36; p = 0.02) and the supine FVC (r=0.29; p = 0.04). The left inspiratory diaphragmatic thickness was correlated with the percentage of the FVC decrease (r= 0.35; p = 0.01) defined as the percentage of difference between FVC and supine FVC. The right expiratory diaphragmatic thickness was associated with the FVC (r=0.32; p = 0.02). A significant positive correlation was found between the CE and the presence of B lines (r=0.32; p = 0.02), but not between the CE and the FVC. The present study showed that diaphragm ultrasonography is correlated with spirometric findings in radiographic SpA patients. Further studies are required to assess its reliability, specificity, and sensitivity in this pathology.

Retrospektivna procjena učinka nintedaniba u mišjem modelu plućne fibroze

Pulmonary function tests (PFTs) routinely implemented in clinics are the first step in the diagnosis of idiopathic pulmonary fibrosis. Evaluation of PFTs in the mouse model of pulmonary fibrosis accompanied by histological readouts may improve the clinical predictability of new therapeutic candidates. Forced vital capacity (FVC) is considered the most predictive of restrictive pulmonary disorders. This study aimed to test the improvement of PFT in mice lung fibrosis induced by treatment with an approved substance nintedanib, considered the gold standard. The hypothesis that treatment in animal models will demonstrate similar effects as in humans in the most relevant clinical outcomes was tested. Two experimental designs were enrolled in this study, a preventive regimen, with treatment initiation from the day of the challenge; and a therapeutic regimen, starting on day 7 postchallenge when fibrotic changes are present in the lungs. Experiments were terminated at two different time points, at 14 and 21 days postchallenge. C57BL/6 mice were administered with bleomycin (BLM) intranasally and treated with nintedanib from day 0 to day 14 or from day 7 until day 21. Fourteen or 21 days after the BLM challenge, PFTs were assessed using the in vivo invasive lung function measurement system Buxco® Pulmonary Function Test (PFT) (DSI™, New Brighton, USA). Histological evaluation was performed as a modified Ashcroft score. The bleomycin challenge induced a significant decrease of FVC in both experiments. However, nintedanib treatment given in both regimens significantly improved lung functionality. These findings were confirmed with histological analysis of the Ashcroft scoring system, modified by Matsuse. In conclusion, a good correlation between functional test parameters and the clinical effect of nintedanib was shown in both experiments: the preventive regimen was sampled 14 days post-challenge and the therapeutic regimen 21 days post-challenge. Based on these findings, the implementation of PFTs could be a good platform to increase the translational value of the model and potential new treatments.

Value of pulmonary rehabilitation in interstitial lung diseases

Background Interstitial lung diseases (ILDs) are restrictive pulmonary disorders that make lungs unable to expand on inhalation. Persistent symptoms and/or limitation in usual efforties make pulmonary rehabilitation (PR) very helpful. Aim To assess the purpose of PR in improvement of dyspnea, quality of life, and functional capacity in patients with ILDs. Patients and methods A total of 20 adult patients with ILDs were selected from the ward of the Chest Diseases Department at Al-Maamora Chest Hospital. They were subjected to PR program (three sessions per week for 6 weeks). The program is composed of endurance, strengthening, and breathing exercises. Spirometry, arterial blood gas analysis, 6-min walking distance, aerobic capacity (VO2 peak) using Rockport formula, peripheral muscle strength assessment, dyspnea assessment (modified Medical Research Council), and health-related quality of life (HRQL) score using St George’s Respiratory Questionnaire were assessed before and after the sixth week of the program. Results There was crucial influence in modified Medical Research Council (P=0.001), 6-min walk test (P≤0.001), maximal inspiratory pressure (P=0.003), maximal expiratory pressure (P=0.003), VO2 peak (P=0.005), and HRQL (P≤0.001). However, arterial blood gas and spirometry showed no important advancement after the program. Conclusion PR improves exercise capacity, dyspnea, peripheral muscle strength, and HRQL in patients with ILD.

Gambaran fungsi paru pengrajin kayu di Desa Petulu Gianyar, Bali-Indonesia Asshiddiqie Chirac Sepakat Purba1, Luh Made Indah Sri Handari Adiputra2, I Made Muliarta2

Introduction: The woodworking industry is experiencing very rapid growth. Petulu Village is a village famous for its wood crafts. The working environment in Petulu village has risk factors in the form of physical factors (dust, noise, heat, lighting), chemical factors, and the most important is Dust. The purpose of this study was to describe the description of lung function of wood craftsmen including (Gender, Age, Nutritional Status, Working Period, Smoking History and Use of Personal Protective Equipment) in Petulu Village, Gianyar, Bali.Method: This study is a descriptive study with a Cross-Sectional approach which aims to describe the lung function of woodworkers in Petulu Gianyar Village. The sample in this study was taken using the simple random sampling method. The number of samples in this study consisted of 31 respondents. Primary data collection using a questionnaire and measuring lung function using spirometry.Results: The results of this study indicate that the respondents were 16 men (51.61%) and 15 women (48.39%). Respondents aged over 30 years were 25 people (80.65%) and aged under 30 years as many as 6 people (19.35%). Respondents with underweight nutritional status 1 person (3.23%), normal 15 people (48.39%) and fat 15 people (48.39%). Respondents with a working period of more than 5 years were 25 people (80.65%) and tenure under 5 years was 6 people (19.35%). Respondents who have smoking habits as many as 12 people (38.71%) and do not have smoking habits as many as 19 people (61.29%). Respondents who did not use personal protective equipment were 6 people (19.35%) and respondents who used personal protective equipment were 25 people (80.65%). The results of lung function measurements found that respondents who experienced restrictive pulmonary function disorders were 18 people (58.06%) and respondents with normal pulmonary function were 13 people (41.94%).Conclusion: Based on the results of the study showed that as many as 18 people (58.06%) wood craftsmen in Petulu Gianyar Village experienced restrictive lung function disorders.

Improvement of VO2 max in Patient with Restrictive Pulmonary Disorder after Deep Breathing Exercise

Introduction: Restrictive pulmonary disorder is reducing VO2 max values. It can be caused by lung can’t take oxygen from outside air freely. Pulmonary rehabilitation is known to increase the VO2 max. One of the pulmonary rehabilitation is deep breathing exercise. In this study aimed to know the improvement VO2 max after deep breathing exercise. Methods: This was an experimental without control pre and post-experimental study. The Six Minutes Walking Test (6MWT) was measured in patients with restrictive pulmonary disorder, after deep breathing exercise two times a day, for four weeks in May 2018. Results: Fifteen subjects were recruited, with the mean age was 70,76 ± 5,33 years old, 6MWT was 375,13 ± 44,19 m and VO2 Max 31,61±0,86 ml/kg/minute. After four weeks intervention, 6MWT value was 401±44,57 m (p=0.000) and VO2 Max score was 32,11±0,87 ml/kg/minute (p=0.000).

Improvement of VO2 max in Patient with Restrictive Pulmonary Disorder after Deep Breathing Exercise

Introduction: Restrictive pulmonary disorder is reducing VO2 max values. It can be caused by lung can’t take oxygen from outside air freely. Pulmonary rehabilitation is known to increase the VO2 max. One of the pulmonary rehabilitation is deep breathing exercise. In this study aimed to know the improvementVO2 max after deep breathing exercise.Methods: This was an experimental without control pre and post-experimental study. The Six Minutes Walking Test (6MWT) was measured in patients with restrictive pulmonary disorder, after deep breathing exercise two times a day, for four weeks in May 2018.Results: Fifteen subjects were recruited, with the mean age was 70,76 ± 5,33 years old, 6MWT was 375,13 ± 44,19 m and VO2 Max 31,61±0,86 ml/kg/minute. After four weeks intervention, 6MWT value was 401±44,57 m (p=0.000) and VO2 Max score was 32,11±0,87 ml/kg/minute (p=0.000).Conclusion: Four weeks of deep breathing exercise can improve the VO2 max in restrictive lung disorder.Keywords: Deep breathing exercise, Restrictive pulmonary disorder, VO2 max.

Cardiorespiratory repercussions of the chest physical therapy in men with abdominal obesity and restrictive pulmonary disorders

Purpose: This study aimed to compare cardiorespiratory effects in men with restrictive lung disorders, according to the abdominal circumference (AC), undergoing respiratory physical therapy.Materials and methods: Quasi-experimental study with a sample 26 men with forced vital capacity (FVC)pred <80%, who were divided into two groups: AC (cm) < 102 (ACfree_risk) and ≥ 102 (ACrisk). Heart rate variability (HRV), peripheral oxygen saturation (SpO2), blood pressure (BP), lung capacities and maximal expiratory pressure (PEmax) were measured at rest (T1), immediately after physical therapy intervention (T2), which consisted of breathing exercises for pulmonary expansion, active kinesiotherapy to lower and upper limbs, and after 30 min (T3). The statistical tests used were ANOVA and independent t tests (p < .05).Results: ACrisk had the highest values for slow vital capacity (SVC), inspiratory capacity (IC), PEmax and systolic BP (p < .05); there was an increase in HRV (T2), SpO2 (%) [95.0 (2.5) to 96.6 (1.4)] and IC (l) [2.4 (0.5) to 2.7 (0.6)] (T3).Conclusions: Men with restrictive respiratory disorders and AC ≥102 has higher values in the inspiratory capacities and arterial pressure level, and benefit from respiratory physiotherapy by differential increase in IC.

Improvement of VO2 max in Patient with Restrictive Pulmonary Disorder after Deep Breathing Exercise

ABSTRACT Introduction: Restrictive pulmonary disorder is reducing VO2 max values. It can be caused by lung can’t take oxygen from outside air freely. Pulmonary rehabilitation is known to increase the VO2 max. One of the pulmonary rehabilitation is deep breathing exercise. In this study aimed to know the improvement VO2 max after deep breathing exercise. Methods: This was an experimental without control pre and post-experimental study. The Six Minutes Walking Test (6MWT) was measured in patients with restrictive pulmonary disorder, after deep breathing exercise two times a day, for four weeks in May 2018. Results: Fifteen subjects were recruited, with the mean age was 70,76 ± 5,33 years old, 6MWT was 375,13 ± 44,19 m and VO2 Max 31,61±0,86 ml/kg/minute. After four weeks intervention, 6MWT value was 401±44,57 m (p=0.000) and VO2 Max score was 32,11±0,87 ml/kg/minute (p=0.000). Conclusion: Four weeks of deep breathing exercise can improve the VO2 max in restrictive lung disorder. Keywords: Deep breathing exercise, Restrictive pulmonary disorder, VO2 max.

Voluntarily induced vomiting – A yoga technique to enhance pulmonary functions in healthy humans

Vomiting is a complex autonomic reflex orchestrated by several neurological centres in the brain. Vagus, the cranial nerve plays a key role in regulation of vomiting. Kunjal Kriya (Voluntarily Induced Vomiting), is a yogic cleansing technique which involves voluntarily inducing vomiting after drinking saline water (5%) on empty stomach. This study was designed with an objective to understand the effect of voluntary induced vomiting (ViV) on pulmonary functions in experienced practitioners and novices and derive its possible therapeutic applications. Eighteen healthy individuals volunteered for the study of which nine had prior experience of ViV while nine did not. Pulmonary function tests were performed before and after 10 min of rest following ViV. Analysis of Covariance was performed adjusted for gender and baseline values. No significant changes were observed across genders. The results of the present study suggest a significant increase in Slow Vital Capacity [F(1,13) = 5.699; p = 0.03] and Forced Inspiratory Volume in 1st Second [p = 0.02] and reduction in Expiratory Reserve Volume [F(1,13) = 5.029; p = 0.04] and Respiratory Rate [F(1,13) = 3.244, p = 0.09]. These changes suggest the possible role of ViV in enhancing the endurance of the respiratory muscles, decreased airway resistance, better emptying of lungs and vagal predominance respectively. We conclude that ViV when practiced regularly enhances the endurance of the respiratory muscles and decreases airway resistance. These findings also indicate need for scientific understanding of ViV in the management of motion sickness and restrictive pulmonary disorders like bronchitis and bronchial asthma.

A study to assess the pulmonary functions in a cement ware house workers near railway station, Nishatpura, Bhopal

Background: It is unfortunate enough that cement industry workers despite of so many awareness campaigns, unable to seek protection against dust of cement and thus bound to face respiratory problems. In developing countries no legitimate bindings regarding protection of such workers though cement industry is one of the largest industries. Methods: Non probability sampling done in which cases taken from cement workers and control taken from nearby residents matched for age gender and smoking status of participants. Results: When studied for the restrictive and obstructive respiratory problems it was found 2.82 times and 4.71 times higher in cases respectively. When cases studied for duration of working against disease developed, it was found that 61.81% developed obstructive pulmonary disorder and proportion increased from 23.63% to 30.80 as the work span increased from 0-5 years to 5-15 years respectively. When it has been observed for restrictive pulmonary disorder, it has been increased from 3.6% to 5.4%. Conclusions: It has been observed that workers have either obstructive pulmonary dysfunction or normal pulmonary functions and on increasing the duration, number of workers with restrictive pulmonary function increases proportionately.

SC13.03 Limitation by COPD for Diagnostic Procedures

Limitation by COPD for Diagnostic Procedures Ostoros, Gy. Varga, J. and Kerpel-Fronius A. National “Korányi” Institute for Pulmonology Hungary, Budapest Lung cancer and COPD are smoking dependent diseases. Smoking cessation is crucial before and during the diagnostic procedures because of the consequences of smoking (e.g. sputum retention, mucociliary dysfunction and potential other more serious complications after the procedures). Severe obstructive or restrictive pulmonary disorders limit the diagnostic possibilities in patients with malignant pulmonary diseases. The screening of lung cancer with low-dose CT has become the gold standard in the past decade. The two imaging-based phenotypes of COPD can be well distinguished by this technique. CT screening can also help to identify non-diagnosed emphysema patients and may lead to early treatment of the disease. It has been showed that non-smoker emphysema patients have a similar risk of lung cancer as smokers with emphysema. Thus, patients with emphysema may be an eligible subgroup for a more intensive lung cancer screening program. However, once a suspicious lesion is found severe COPD, it can limit the choices available for differential diagnosis seriously - CT guided lung biopsies in COPD patients carry a higher risk of hemorrhage and pneumothorax. Patients with severe COPD and respiratory failure with decreased oxygen saturation limit the indication of diagnostic bronchoscopic procedures as well. The examination of exhaled breath condensate (EBC) is a noninvasive process. There are efforts to discriminate lung cancer and COPD with EBC. Lung tumors have influence on lung function. Besides the severity of COPD, the result of the lung function test (LFT) depends on the size and position of the pulmonary tumor as well. In the case of a big central tumor or a huge amount of pleural fluid, the LFT will show rather restrictive than obstructive character. A small peripheral malignancy will not change the shape and volume of the LFT. If the tumor is in the trachea or compresses it's wall, the inspiratory phase of the flow-volume chart could be flat. Sometimes the lung tumors could lead a misdiagnosis of COPD. A centrally located small tumor which is not visible on the chest X-ray but compresses the trachea or any of the pulmonary vessels can cause breathlessness, fatigue and decreased oxygen saturation. A mediastinal conglomerate of lymph nodes can cause similar symptoms. Low physical activity, obesity, smoking and comorbidities are significant negative factors for risk stratification before any pulmonary diagnostic procedure as well. Pulmonary rehabilitation can improve functional reserves if functional capacity is at borderline. Pulmonary rehabilitation has positive effect on cardiovascular function, metabolism, muscle-function and lung mechanics. As for lung function parameters, we need to focus on forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO). We can follow the common agreement of minimum criteria of the European Society of Chest Surgeon and European Respiratory Society for risk stratification before a diagnostic pleuroscopy. Based on this protocol, FEV1 and DLCO need to be >35%pred. In the case of 35%pred< FEV1 and DLCO<75%pred, we need to consider VO2/kg during a cardiopulmonary exercise test. If VO2 is <10 ml/kg/min, the patient need a pulmonary rehabilitation program to improve functional reserves. Regarding lung function, we need to focus on lung mechanics and lung kinematics as well. Lung mechanics can be monitored by resting functional reserve capacity (FRC) and residual volume (RV). Lung kinematics can be monitored by chest expansion. Improved resting or dynamic hyperinflation and lung kinematics of the patients with chest physiotherapy and complex pulmonary rehabilitation is also suggested. As a general effect of rehabilitation, training programs can improve the cardiovascular response, oxygen uptake and the metabolism. We may also focus on physical activity, which is a general prognostics marker. Physical activity can be monitored by pedometer. Obesity can influence the complications of the surgical procedure and it has some effect on lung mechanics as well. If we have time, in case of an obese patient we may also consider improving their body composition before the invasive procedure. To sum up, comorbidities have to be considered before an invasive diagnostic procedure of lung cancer. Patients with impaired pulmonary hemodynamics, ischemic heart disease, diabetes or obesity have to be carefully evaluated. de Torres JP. Casanova C. et al.: Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: A pilot study. Respiratory Medicine, 107, 5, 702-707. 2013. Wiener RS. Schwarcz LM. et al. Population-Based Risk of Complications Following Transthoracic Needle Lung Biopsy of a Pulmonary Nodule. Annals of Internal Medicine, 155, 3, 137-144. 2011. GOLD-www.goldcopd.org Brunelli, A. Charloux, A. et al.: ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients Eur. Resp. J., 34, 1, 2009. diagnosis, copd, lung cancer

Flow versus pressure triggering in mechanically ventilated acute respiratory failure patients

The effects of flow triggering (FT) compared with pressure triggering (PT) on breathing effort have been the focus of several studies, and discrepant results have been reported; yet, it remains an area of conflict that warrants further studies. The aim of this work is to compare flow versus PT in ventilating patients with acute respiratory failure. One hundred patients with acute respiratory failure of pulmonary origin were assigned randomly to two groups: 50 patients ventilated with PT and 50 patients ventilated with FT. The primary end points were weaning duration, evaluation of patient/machine synchronization, total duration of ventilation and ICU stay as well time under sedation and occurrence of complications. Mortality was considered the secondary end point. Patients were categorized into those with obstructive, restrictive, and combined pulmonary disease according to their medical history, and clinical and radiological assessment, and also more and less severe disease according to the APACHE II score level (cut-off point). In all the patients studied, including those with restrictive pulmonary disorder and more severe disease (APACHE II score ≥32.5), there was a statistically significantly shorter duration of weaning, duration of ventilation, and duration of ICU stay in the FT group than the PT group. The pre-extubation oxygenation index was highly statistically significantly better in the FT group than the PT group (P < 0.001). In patients with obstructive pulmonary disorders, combined pulmonary disorders, and less severe disease (APACHE II <32.5), there was no significant difference between both PT and FT groups in these parameters. FT may be considered to be better than PT in ventilating acute respiratory failure patients with a restrictive pattern and those with higher severity scoring. In obstructive and mixed ventilatory impairment, use of either of them does not make a difference.

The evaluation of the dust-related occupational respiratory disorders of dental laboratory technicians working in Denizli Province.

INTRODUCTION:Dental laboratory technicians (DLTs) get exposed to fibrinogen dusts that are very risky dusts in terms of health. In this study, respiration complaints, pneumoconiosis frequencies and working conditions of the dental technicians in Denizli were investigated.METHODS:All of the registered DLTs working in Denizli were included in the study. A 30-item questionnaire was used to gather data about the participants and their working environments. Then, pulmonary function tests (PFTs) were carried out and standard chest X-rays were taken in order to detect how much the respiratory systems of the workers were affected. Standard chest X-rays were evaluated according to International Labour Organizations classification. Depending on the screening results, technicians who were found to have had pathologies and suspected cases were examined. “High-resolution computerized tomography (HRCT)” was taken from those who were found to have pathology in their chest X-rays and they were evaluated according to the classification of Hering et al.RESULTS:There are a total of 166 DLTs working in Denizli Province participated in the study. One hundred and forty-three (86.1%) of the participants were male, and 23 of them were female. The mean age of the participants is 33.5 ± 8.1. Average working time of the workers is 16 years. Total exposure time was calculated 36,177 h. Approximately, 56% of workers were smokers. When the working conditions were considered, it was found that 98.8% of laboratories had a ventilation system. Technicians’ use of personal protective equipment is low. Participants’ often or continuous use of masks, gloves, goggles, and vacuum device was found 69%, 36%, 47%, and 63% respectively while working. About 21.2% of the technicians have respiratory symptoms while 15.2% of them have eye complaints. At the analysis of PFT results, 27.7% restrictive type pulmonary disorder was determined. At the analysis of chest X-rays; 1/0 profusion sub-category was 25.5%, and the large opacity rate was 16.9%. Ten pneumoconiosis cases (6%) were diagnosed after the analysis of the HRCT results. The ratio of pneumoconiosis was found much higher among male technicians, particularly those who have been working for a long time in the profession and those working at the town hospitals and Department of metal leveling.DISCUSSION:Technicians’ use of personal protective tools is not enough and ratio of smoking is rather high. Pneumoconiosis cases clearly show this exposure. It is necessary to adopt comprehensive work health and safety precautions considering the determined risk factors.

Efficacy of Mechanical Insufflation-Exsufflation in Extubating Unweanable Subjects With Restrictive Pulmonary Disorders

Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to study MIE-associated changes in breathing tolerance, pulse oximetry, and vital capacity (VC) for consecutive unweanable subjects. A retrospective chart review was performed for consecutively referred intubated subjects with single-organ (respiratory muscle) failure. At presentation, CO2 was normalized by adjusting ventilator settings and VC was measured (point 1). Then, MIE was used via the tube up to every h until oximetry remained ≥ 95% on ambient air and VC was remeasured (point 2) immediately before extubation. Subjects who could not meet ventilator weaning criteria and had no ventilator-free breathing ability upon extubation to CNVS were enrolled. Post-extubation, the MIE was used to maintain oximetry ≥ 95% in room air. VC and breathing tolerance were remeasured within 3 weeks (point 3). Ninety-seven of 98 subjects were successfully extubated despite 45 having been CNVS-dependent for 4 months to 18 y before being intubated. Sixty-nine of the 98 were intubated for 24.9 ± 22 (range 1-158) d and failed 0-6 (mean 1.7) extubation attempts before being transferred and successfully extubated in 2.24 ± 1.78 (range < 1-8) d to CNVS. VC increased by 270% (P < .001) from points 1 to 3. Weaning from CNVS to part-time NVS was achieved by all 52 subjects who had not been CNVS-dependent before intubation. One subject underwent tracheotomy. Many unweanable subjects can be extubated to CNVS and MIE. The latter can normalize O2 saturation, increase VC, and facilitate extubation.