Restrictive Respiratory Disease Research Articles

Assessment of Lung Health Status by Analyzing Cough Sound Using Swaasa Artificial Intelligence Technology

ABSTRACT Introduction: The crucial function of the respiratory system is the facilitation of blood gas exchange process. Spirometry is the diagnostic tool to detect and differentiate obstructive and restrictive respiratory diseases that impair this vital function. The need for a clinical setup, technical expertise, and patient compliance are certain limitations for utilizing spirometry in remote areas. Swaasa® artificial intelligence (AI) platform, which has a Class B manufacturing license from India’s Central Drugs Standard Control Organization, is a validated “software as a medical device,” which aids in screening and diagnosis of respiratory diseases, unbounded by location, equipment and technical expertise. Objectives: The objectives of the study were to determine the “lung health index” and the “pattern of lung health” conditions among nursing students. Materials and Methods: A cross-sectional study was conducted utilizing the Swaasa® AI platform among students of a nursing college in Central Karnataka in June 2023. Based on audiometric analysis of cough sounds, parameters such as underlying respiratory condition, cough count values, and respiratory symptoms experienced, ‘Swaasa’ AI platform derives pattern of respiratory condition (normal/obstructive/restrictive/mixed), ‘Lung Health Index,’ and presence or absence of lung health risk. Data collected in the Swaasa app were downloaded and analyzed using SPSS.v. 20. Results: Lung health risk was present in 58.2% of participants. Abnormal lung pattern was noted in 21.3% of participants (obstructive: 14.8%, restrictive: 2.5%, and mixed pattern: 4.1%). Conclusion: The Swaasa AI platform was utilized in this study to self-test lung health in real time without the need for a clinical setting. A high lung health index was found among 18% of participants. Studies adopting such cough sound analysis involving a larger population from wider geographic areas have to be conducted to detect and monitor respiratory diseases to increase its usage among the medical community in everyday clinical practice and also in remote areas.

Respiratory homeostasis features in female students with idiopathic arterial hypotension and hyperventilation syndrome

Aim. To assess the condition of pulmonary ventilation and diaphragmatic excursion in female students with idiopathic arterial hypotension in the context of hyperventilation syndrome and excessive anxiety. Materials and methods. In total, 62 female students aged 18–24 diagnosed with idiopathic arterial hypotension were examined. The patients were randomly assigned to three groups based on clinical symptoms. Group 1 consisted of 34 students with idiopathic arterial hypotension accompanied by excessive anxiety and hyperventilation syndrome. Group 2 comprised 28 students with arterial hypotension without signs of neurogenic hyperventilation. Group 3, the control one, included 11 apparently healthy age-matched students. The manifestations of hyperventilation syndrome were determined using the Nijmegen Questionnaire. The level of anxiety was assessed using the Spielberger–Hanin scale. Primary indicators of pulmonary ventilation were examined using a Spirolab spirometer (Italy). The diaphragm dynamic function was evaluated by assessing the excursion of its right dome using a Chison QBIT 5 apparatus (China). Results. Through the survey, signs of neurogenic hyperventilation syndrome and excessive anxiety have been identified in the students of Group 1 showing changes in pulmonary ventilation parameters, such as significantly decreased vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1), compared to the results obtained in Groups 2 and 3, indicating restrictive respiratory disorders. It has been found that diaphragmatic excursion values (18.29 ± 3.26 mm) at rest in Group 1 were significantly lower compared to those obtained in the control group (26.82 ± 2.32 mm) (p ˂ 0.05). During forced breathing, diaphragmatic excursion (56.86 ± 4.35 mm) in Group 1 was lower than that (80.18 ± 3.19 mm) in the control group (p < 0.05). In Group 2, a significant initial decrease in diaphragmatic excursion was revealed only in 26.67 % of the girls. Conclusions. In female students with idiopathic arterial hypotension accompanied by hyperventilation syndrome and excessive anxiety, restrictive pattern of decreased pulmonary ventilation parameters and reduced diaphragmatic excursion were observed.

The impact of lung transplantation on esophageal motility and inter-relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease.

For many patients with lung disease the only proven intervention to improve survival and quality of life is lung transplantation (LTx). Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, and often associate with worse prognosis following LTx. Which, if any patients, should be excluded from LTx based on esophageal concerns remains unclear. Our aim was to understand the effect of LTx on esophageal motility diagnosis and examine how this and the other physiological and mechanical factors relate to GER and clearance of boluses swallowed. We prospectively recruited 62 patients with restrictive (RLD) and obstructive (OLD) lung disease (aged 33-75 years; 42 men) who underwent high resolution impedance manometry and 24-h pH-impedance before and after LTx. RLD patients with normal motility were more likely to remain normal (p = 0.02), or if having abnormal motility to change to normal (p = 0.07) post-LTx than OLD patients. Esophageal length (EL) was greater in OLD than RLD patients' pre-LTx (p < 0.001), reducing only in OLD patients' post-LTx (p = 0.02). Reduced EL post-LTx associated with greater contractile reserve (r = 0.735; p = 0.01) and increased likelihood of motility normalization (p = 0.10). Clearance of reflux improved (p = 0.01) and associated with increased mean nocturnal baseline impedance (p < 0.001) in RLD but not OLD. Peristaltic breaks and thoraco-abdominal pressure gradient impact both esophageal clearance of reflux and boluses swallowed (p < 0.05). RLD patients are more likely to show improvement in esophageal motility than OLD patients post-LTx. However, the effect on GER is more difficult to predict and requires other GI, anatomical and pulmonary factors to be taken into consideration.

Tracheostomy for the pediatric patient with fibrodysplasia ossificans progressiva: a case report

BackgroundFibrodysplasia ossificans progressiva (FOP) is an extremely rare connective tissue disease characterized by subsequent ossification of skeletal muscles, tendons, ligaments, and other fibrous tissues. The ossification of these tissues progresses during childhood and leads to limb and trunk deformities. Since any surgery may trigger subsequent ossification, it is relatively contraindicated for patients with FOP. In this report, we describe our experience in performing tracheostomy in a pediatric patient with FOP who developed a restrictive respiratory disorder due to progressive deformity of the trunk.Case presentationA 12-year-old boy, diagnosed with FOP at the age of one, was referred for a tracheotomy after requiring 2 months of oral intubation and mechanical ventilation due to severe deformity-induced dyspnea. After changing from oral intubation to nasal intubation, we carefully considered the indications and benefits of tracheostomy in patients with FOP. Eventually, tracheostomy was successfully performed using our surgical design: creating a skin incision at the level of the cricoid cartilage that can always be identified, creating inverted U-shaped incision on the anterior tracheal wall to make a flap, and suturing the entire circumference of the tracheotomy and skin. One month after the surgery, he regained normal breathing and pronunciation and returned to school. The patient showed no unfavorable postoperative outcomes over a 4-year follow-up period.ConclusionsTracheostomy in our pediatric case of FOP required careful perioperative management. However, it could effectively improve the patient’s quality of life.

Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks

BackgroundAquaporin-4 immunoglobulin G Neuro Myelitis Optica spectrum disorders attacks (NMOSD-AQP4-IgG+ attacks) can cause respiratory failure requiring orotracheal intubation (OTI), but the risk factors and outcomes of OTI during attacks remain unclear. Our primary objective was to identify the clinical and radiological risk factors for OTI in NMOSD-AQP4-IgG+ attacks. As a secondary objective, we aimed to evaluate the prognosis of OTI-attacks.MethodsWe retrospectively analyzed NMOSD-AQP4-IgG+ attacks at the Pitié-Salpêtrière Hospital (Jan 2010–Jan 2021), excluding isolated optic neuritis. The primary outcome was the need for OTI due to neurological dysfunction an attack (OTI-attack). The secondary outcome was attack’s poor recovery after 12 months, defined as a modified Rankin score (mRS) > 2 in patients with an initial mRS ≤ 2, or an increase ≥ 1 point in mRS in other patients. Analyses were performed using a binomial generalized linear mixed model, with a random intercept for the patient ID to account for within-patient correlations.ResultsSeventy-three attacks in 44 patients NMOSD-AQP4-IgG+ were analyzed. Of 73 attacks, 8 (11%) required OTI during the attack, related to acute restrictive respiratory failure (n = 7) and/or severe swallowing disorder (n = 2). None of the OTI-attacks occurred in patients previously treated with active disease-modifying treatment (DMT), while 36 (55.4%) of the non-OTI-attacks occurred in patients who were already on active DMT. On admission, OTI-attacks were more likely to have upper limbs motor paresis of (75.0% versus 29.2%, p = 0.366) and dyspnea (3 [50.0%] versus 4 [6.6%], p = 0.002) compared to non-OTI-attacks. MRI analysis showed that OTI-attacks had edematous lesions in the cervical spinal cord, mainly at levels C1 (75% versus 0% in non-OTI-attacks), C2 (75% versus 1.9%), C3 (62.5% versus 1.9%), and C4 and C5 levels (50% versus to 3.9%). One OTI-attack resulted in the death of one patient. Five patients with OTI-attack had mRS ≤ 2 one year after OTI-attack. Two (25%) OTI-attacks had poor recovery compared to 15 (24.2%) non-OTI-attacks (p = 0.468).ConclusionOTI-attacks occurred in untreated NMOSD-AQP4-IgG+ patients and were associated with edematous upper cervical lesions. The prognosis of these attacks may be favorable, and warrant maximal medical and supportive treatment.Trial registration This was a retrospective observational monocentric cohort study nested in the NOMADMUS cohort (ClinicalTrials.gov Identifier: NCT02850705)Graphical

Large fenestrated atrial septal occluder to treat an elderly female in her seventh decade

Atrial septal defect (ASD) is one of the common congenital heart anomalies presenting in the geriatric group. It presents with symptoms such as progressive effort intolerance, arrhythmias, and palpitations. Sometimes, associated obstructive and restrictive respiratory diseases can contribute significantly to the symptoms masked by cardiac disease. A female in her seventh decade, presenting with dyspnea, had a large ASD with diastolic dysfunction and moderate pulmonary hypertension. She had persistence of symptoms after initial treatment for cardiac elements. On detailed evaluation, she was found to have mixed obstructive and restrictive respiratory disease. She was treated for respiratory elements under expert pulmonology guidance with significant improvement. The ASD was occluded with a custom-made fenestrated 40 mm LifeTech atrial septal occluder in view of diastolic dysfunction and initial pulmonary arterial hypertension. She remained symptomatically better on her short-term follow-up. The index case highlights the importance of detailed evaluation of elderly patients with large ASDs and individualized care to treat.

Frequency of peripheral blood eosinophilia and obstructive airway disease in sarcoidosis

There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma. The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded. A total of 84 patients were included of which 26 (31%) had a PBE level of ≥300 μL with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients. Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis.

Frequency of peripheral blood eosinophilia and obstructive airway disease in sarcoidosis.

There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma. The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded. A total of 84 patients were included of which 26 (31%) had a PBE level of ≥300 µL with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients. Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis.

Фізична терапія та легенева реабілітація у пацієнтів із COVID-19

The global pandemic of the novel coronavirus disease COVID-19 is continueing for the second year, despite tremendous progress in the development and implementation of vaccinations to prevent this disease. The incidence is increasing all over the world, affecting people of different age groups. The inability to predict the severe course of the disease, the development of complications or the so-called "long-COVID" remain one of the most important problems. In patients with COVID-19, damage to the respiratory and cardiovascular systems prevails, manifests itself in the progression of shortness of breath, decrease in blood oxygen saturation and respiratory failure and requires the use of intensive methods of respiratory support, mainly in patients with concomitant diseases such as diabetes mellitus, obesity, coronary heart disease, cancer, chronic obstructive pulmonary disease. COVID-19 reconvalescents, who had significant lung and airway damage, suffer from respiratory complications for a long time due to massive fibrosis of the lung tissue, the development of restrictive respiratory disorders, which significantly impairs the quality of life of such patients. The purpose of the study was to discuss the feasibility and effectiveness of pulmonary rehabilitation and its recommended strategies in patients with COVID-19, based on data from modern literature. The evidence-based rehabilitation process is governed by a functional assessment using the International Classification of Functioning, Disability and Health. The rehabilitation process is based on the strategy of the rehabilitation cycle and consists of sequential stages: assessment, appointment, intervention, quality estimation. Rehabilitation is provided by the multidisciplinary team and begins with a specialized rehabilitation examination, determining the presence or risk of a functional limitation, quantifying them and creating an individual rehabilitation plan. Continuous monitoring of patients' respiratory and hemodynamic parameters before, during and after a physical therapy session is essential to ensure patient safety and assess cardiorespiratory stress in order to optimize an individualized plan and rehabilitation program. Conclusion. Taking into account the phased use of physical therapy and pulmonary rehabilitation, depending on the severity of COVID-19, existing complications and comorbid pathology, a maximally individual syndromic-pathogenetic approach is proposed that realizes the maximum effectiveness of each rehabilitation technique, depending on the patients’ pathological changes, the level of fitness and exercise tolerance

Ventilation heterogeneity imaged by multibreath wash-ins of hyperpolarized 3 He and 129 Xe in healthy rabbits.

Multibreath imaging to estimate regional gas mixing efficiency is superior to intensity-based single-breath ventilation markers, as it is capable of revealing minute but essential measures of ventilation heterogeneity which may be sensitive to subclinical alterations in the early stages of both obstructive and restrictive respiratory disorders. Large-scale convective stratification of ventilation in central-to-peripheral directions is the dominant feature of observed ventilation heterogeneity when imaging a heavy/less diffusive xenon gas mixture; smaller-scale patchiness, probably originating from asymmetric lung function at bronchial airway branching due to the interaction of convective and diffusive flows, is the dominant feature when imaging a lighter/more diffusive helium gas mixture. Since detecting low regional ventilation is crucial for characterizing diseased lungs, our results suggest that dilution with natural abundance helium and imaging at higher lung volumes seem advisable when imaging with hyperpolarized 129 Xe; this will allow the imaging gas to reach slow-filling and/or non-dependent lung regions, which might otherwise be impossible to distinguish from total ventilation shunt regions. The ability to differentiate these regions from those of total shunt is worse with typical single-breath imaging techniques. The mixing of freshly inhaled gas with gas already present in the lung can be directly assessed with heretofore unachievable precision via magnetic resonance imaging of signal build-up resulting from multiple wash-ins of a hyperpolarized (HP) gas. Here, we used normoxic HP 3 He and 129 Xe mixtures to study regional ventilation at different spatial scales in five healthy mechanically ventilated supine rabbits at two different inspired volumes. To decouple the respective effects of density and diffusion rates on ventilation heterogeneity, two additional studies were performed: one in which 3 He was diluted with an equal fraction of natural abundance xenon, and one in which 129 Xe was diluted with an equal fraction of 4 He. We observed systematic differences in the spatial scale of specific ventilation heterogeneity between HP 3 He and 129 Xe. We found that large-scale, central-to-peripheral convective ventilation inhomogeneity is the dominant cause of observed heterogeneity when breathing a normoxic xenon gas mixture. In contrast, small-scale ventilation heterogeneity in the form of patchiness, probably originating from asymmetric lung function at bronchial airway branching due to interactions between convective and diffusive flows, is the dominant feature when breathing a normoxic helium gas mixture, for which the critical zone occurs more proximally and at an imageable spatial scale. We also showed that the existence of particular underventilated non-dependent lung regions when breathing a heavy gas mixture is the result of the density of that mixture - rather than, for example, its diffusion rate or viscosity. Finally, we showed that gravity-dependent ventilation heterogeneity becomes substantially more uniform at higher inspired volumes for xenon gas mixtures compared to helium mixtures.

Comparison of Consistency, Feasibility, and Convenience of a Novel Compact System for Assessing Lung Volumes and Carbon Monoxide Diffusing Capacity versus Whole Body Plethysmography.

BackgroundThe MiniBox+™ is an innovative technique for assessing lung volumes (LVs) and the diffusing capacity of the lung for carbon monoxide (DLco). Differently from the equipment needed for whole body plethysmography (WBP), the MiniBox+ is a small, transportable instrument, which derives total lung capacity (TLC) during tidal breathing by analyzing gas pressures and airflows immediately preceding and immediately following airway occlusions.AimTo compare the consistency and the feasibility of LV and DLco measurements between the two instruments in different lung function disorders, and their cost of execution.MethodsConsecutive patients of both genders with obstructive and restrictive respiratory disorders were randomly recruited. LVs and DLco were measured by a randomized sequence. The failure risk, number of attempts to achieve the first reliable measurement, corresponding time spent, and costs per patient were compared.ResultsA total of 134 patients were enrolled: 42 asthmatics (32.1%), and 47 patients with obstructive (35.1%) and 44 with restrictive respiratory disorders (32.8%). The overall failure risk was 19.4% for WBP and 8.2% for the MiniBox+ (risk ratio=0.417, 95% CI 0.242 to 0.72). LVs and DLco values proved equal with both techniques, regardless of the patients’ age, sex, schooling level, and initial lung disorder. Number of attempts and total time spent in achieving the first reliable measurement were significantly lower with the MiniBox+. Mean cost per patient was €87.58 with WBP and €75.11 with the MiniBox+, with a mean saving of €12.33 (95% CI 5.93 to 18.73), mainly due to the saving in productivity loss.ConclusionLV and DLco measurements with the MiniBox+ were highly consistent with those obtained with WBP. The MiniBox+ proved easier to use (lower failure risk) and more convenient (lower execution costs) than WBP.

Quantitative assessment of the posttreatment lung volume changes in patients with flail chest on computed chest tomography images

Complications encountered in the chronic phase in flail chest patients are a decrease in lung volume due to chest wall deformities and secondary restrictive respiratory function disorders. The aim of the study was to determine the differences in lung volume changes between flail chest patients who were treated non-surgically and those who were treated with surgical stabilisation. The study was conducted on twenty patients who applied to our clinic and were diagnosed with flail chest. There were ten patients in the non-surgically treated group and ten in the surgical stabilisation group. Computed tomography (CT) images of the patients were received before the treatment and in the third post-operative month. Total lung volumes were estimated on CT images using the planimetry method of the Cavalieri principle. The relationship between the treatment method and volume changes was analysed. While the total lung volume increased 12.9% post-operatively in the non-surgically treated group, it increased 36.9% in the surgical stabilisation group (p&lt;0.05). In those cases of hemithorax affected by trauma, the increase in volume in the surgical stabilisation group was 41.6 (34.6%), but it was 7.7 (10%) in the non-surgically treated group (p&lt;0.05). In the contralateral hemithorax, the increase observed in the stabilisation group was 42.6 (39.2%) while the increase in the non-surgical treated group was 19.6 (13.9%) (p&gt;0.05). Our findings showed that the post-operative total lung volume increase in the surgically treated group of patients was greater than that of the conservative group. If there are no preventive factors for the surgical approach, surgical rib stabilisation could be the primary choice of treatment in flail chest patients.

Selected Morbidities among Workers of an Adhesive Plaster Industry in Goa

Background: The toxic nature of chemicals &amp; pollutants associated with an adhesive plaster industry is well established. A disastrous health sequel would occur among workers of these industries due to exposure to pollution, created &amp; stored wastes, and constant noise &amp; bright light. Objective:To describe selected morbidities among workers in an ad-hesive plaster industry in Goa. Methodology:The study was conducted over a period of two months during which, the data of 135 workers was obtained from an Occupa-tional Health and Safety (OHS) Centre catering to an adhesive plaster industry in North Goa which conducted periodic medical check-ups of these workers. The data included socio-demographic characteristics and details regarding selected morbidities among the workers of the adhesive plaster industry. Result: Among 135 workers, the mean age was 40.96 ± 11.1 years. Majority of the participants were males. It was observed that 5 (3.7 %) had a known history of diabetes and 48 (35.6 %) were hypertensive. Near-vision abnormalities were seen among 66 (48.9 %), whereas 60 (44.4 %) had uncorrected far-vision abnormalities. Obesity was detected among 6 (4.4 %) whereas 40 (29.6 %) were overweight. Obstructive &amp; restrictive respiratory diseases were seen in 3 (2.2 %) &amp; 40 (29.6 %) persons respectively. Audiometry reports revealed 4 (3%) workers had mild to moderate hearing loss. Conclusion: Workers in the adhesive plaster industry suffered from several lifestyle diseases like diabetes, hypertension, obesity, as well as occupational diseases like audio-visual impairment and lung diseases. This study emphasizes the importance of periodic medical examinations for timely detection &amp; appropriate treatment of the health conditions among such workers.

Merosin-deficient muscular dystrophy: pathogenesis, clinical manifestations and therapeutic strategies

Merosin-deficient muscular dystrophy is the most common form of congenital muscular dystrophies (СMD), characterized by genetic heterogeneity and a severe course in most cases. CMD pathogenesis is associated with a partial or complete absence of laminin 2 chains in the basal membrane of muscle fiber caused by a mutation in theLAMA2gene. The clinical manifestations of LAMA2-associated muscular dystrophy vary from severe СMD (СMD 1A) with an early onset to a relatively mild course with a late onset and phenotype of limb-girdle muscular dystrophy. CMD type 1A is characterized by a delay in motor development from the first months of the life (while the vast majority of children do not master the ability to walk independently), facial muscles weakness, ptosis, ophthalmoplegia, spine rigidity, early occurrence of contractures in the shoulder, elbow, hip and knee joints, restrictive respiratory disorders, nutritional problems, such as disorders of swallowing and chewing, gastroesophageal reflux, low body weight; some children suffer from mental retardation and epilepsy.

Evaluation of Dynamic Respiratory Mechanical Abnormalities During Conventional CPET.

Assessment of the ventilatory response to exercise is important in evaluating mechanisms of dyspnea and exercise intolerance in chronic cardiopulmonary diseases. The characteristic mechanical derangements that occur during exercise in chronic respiratory conditions have previously been determined in seminal studies using esophageal catheter pressure-derived measurements. In this brief review, we examine the emerging role and clinical utility of conventional assessment of dynamic respiratory mechanics during exercise testing. Thus, we provide a physiologic rationale for measuring operating lung volumes, breathing pattern, and flow–volume loops during exercise. We consider standardization of inspiratory capacity-derived measurements and their practical implementation in clinical laboratories. We examine the evidence that this iterative approach allows greater refinement in evaluation of ventilatory limitation during exercise than traditional assessments of breathing reserve. We appraise the available data on the reproducibility and responsiveness of this methodology. In particular, we review inspiratory capacity measurement and derived operating lung volumes during exercise. We demonstrate, using recent published data, how systematic evaluation of dynamic mechanical constraints, together with breathing pattern analysis, can provide valuable insights into the nature and extent of physiological impairment contributing to exercise intolerance in individuals with common chronic obstructive and restrictive respiratory disorders.

Differential diagnosis of asthma and restrictive respiratory diseases by combining forced oscillation measurements, machine learning and neuro-fuzzy classifiers.

To design machine learning classifiers to facilitate the clinical use and increase the accuracy of the forced oscillation technique (FOT) in the differential diagnosis of patients with asthma and restrictive respiratory diseases. FOT and spirometric exams were performed in 97 individuals, including controls (n = 20), asthmatic patients (n = 38), and restrictive (n = 39) patients. The first experiment of this study showed that the best FOT parameter was the resonance frequency, providing moderate accuracy (AUC = 0.87). In the second experiment, a neuro-fuzzy classifier and different supervised machine learning techniques were investigated, including k-nearest neighbors, random forests, AdaBoost with decision trees, and support vector machines with a radial basis kernel. All classifiers achieved high accuracy (AUC ≥ 0.9) in the differentiation between patient groups. In the third and fourth experiments, the use of different feature selection techniques allowed us to achieve high accuracy with only three FOT parameters. In addition, the neuro-fuzzy classifier also provided rules to explain the classification. Neuro-fuzzy and machine learning classifiers can aid in the differential diagnosis of patients with asthma and restrictive respiratory diseases. They can assist clinicians as a support system providing accurate diagnostic options.

Intensive care of a complicated form of asthmatic status (clinical case)

The article presents a clinical case of successful treatment of a patient with prolonged asthmatic status. The pathogenesis of purulent-septic and other life-threatening complications developing as a result of the above critical condition is described. The positive effect of a differentiated approach in conducting respiratory support depending on the stage of the disease is justified: at the beginning, when airway obstruction is in the foreground, and in the future, when restrictive respiratory disorders develop. When conducting respiratory support, the most reasonable methods for ensuring airway patency were selected. The necessity of neurovegetative blockade and myoplegia for the prevention of pulmonary barotrauma during respiratory support by aggressive ventilation modes and with the goal of antihypoxic protection of the brain is emphasized. During the treatment of the patient, it was confirmed that the optimal regime for obstruction of the bronchi is forced volume-cyclic ventilation of the lungs to provide the necessary minute volume of breathing, and in severe pneumonia, in the case of relief of bronchial obstruction, respiratory support is carried out in pressure control mode for better air-oxygen mixture distribution in the airways. The need for early tracheostomy and daily therapeutic fibrobronchoscopy to ensure airway patency and treat pneumonia has been confirmed.

Chest wall volume and asynchrony in stroke and Parkinson's disease subjects: A case-control study.

BackgroundThe expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals.MethodsTotal and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis.ResultsIn both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (VRCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05).ConclusionOur study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.

The Spinal Structure and Lung Function Relationship in an Untreated Nonambulatory Myelomeningocele Group of Patients.

The relationship between spinal structure and respiratory function has been coined as thoracic insufficiency syndrome and is defined as the inability of the thorax to support normal respiratory function or lung growth. Little is known about what supports this relationship in untreated nonambulatory myelomeningocele patients. A prospective cross-sectional study of nonambulatory myelodysplasia patients was performed. Anatomic, radiographic, and functional parameters were evaluated to validate the respiratory-spinal structure relationship. Thirty-one patients diagnosed with nonambulatory myelomeningocele fulfilled the inclusion criteria. The imaging study confirmed the spinal deformity. Lung functions measured in this patient population describe reduced lung volumes by CT lung volume reconstruction, reduced vital capacity by spirometry, and reduced total lung capacity by the nitrogen washout method. Together, these findings suggest moderate restrictive respiratory disease. The blood count study did not show evidence of anemia or other blood disturbances. Echocardiogram analysis did not show pulmonary hypertension in any patient. The data validate the relationship between spinal structure and lung function. However, there is no simple structural feature that could help to diagnose thoracic insufficiency syndrome. Thus, the diagnosis continues to be based on a combination of clinical findings and radiological and respiratory function evaluations. Level III.

Epidemiologic characteristics of allergic manifestations in food industry sector

Introduction Food industry is a thriving sector in Tunisia, meeting the increasing demand of our population. A variety of substances are used, from organic to chemical, exposing workers in these manufactories to multiple pathologies, essentially allergic and respiratory diseases. The aim of this study was to describe allergic manifestations among food industry employees. Methods A descriptive cross-sectional study including 90 workers in a biscuit factory carried out from January to May 2016. It included workplace description and medical study. The employees answered a standardized questionnaire and benefited from a physical exam followed by a spirometry for all participants. Results The participation rate was 95.5 %. Sex-ratio male/female was 0.18. Average age was 36 ± years old. Smokers represented 49 %. Average professional seniority was 9 ± years. Family atopy was found in 41 %. Collective and individual protective measures at workplace were not satisfactory. Nasal pruritus was reported in 11.6 % and allergic rhinitis in 19 %, ocular pruritus described in 7 %, erythemato-vesicular and pruritic lesions of hands in 10.5 %. Asthma was found in 3.5 % with no significant correlation with age, sex nor professional seniority. Spirometry showed abnormalities in 17.5 % of the participants. An obstructive respiratory disorder was found in 7 %, it was reversible after administration of salbutamol in 50 %. A restrictive respiratory disorder was suspected in 10.5 % and it had a significant link to the existence of allergic rhinitis history (P = 0.05). Conclusion Food industry exposes workers to multiple allergenic high molecular and chemical substances that can be incriminated in allergic manifestations. Periodic medical consultation and adequate preventive measures to reduce allergenic substances concentration are recommanded.