Restrictive Ventilatory Disorder Research Articles

The Effect of the Cheneau Brace on Respiratory Function in Girls with Adolescent Idiopathic Scoliosis Participating in a Schroth Exercise Program

Objectives: The aim of this study was to evaluate the effect of brace use application and the Schroth intervention on lung ventilation and respiratory muscle strength in patients treated long-term with a Chaneau brace and the Schroth method. Methods: A total of 26 post-menarche females aged 15.7 ± 1.5 years, with a Cobb angle of 18–48° and a diagnosis of AIS in inpatient rehabilitation were examined. All participants received brace treatment for a minimum of 3 months with a dosage of 20–22 h/day. This study protocol was performed three times: 1—brace intervention—first day of the present study; 2—without the brace—second day of the present study; and 3—Schroth intervention on the same day. Results: During the period of brace use, girls treated with a long-term therapy showed significantly reduced values for VC, FVC, and FEV1 and significantly higher values for inspiratory muscle strength PImax compared to values obtained in studies without the brace and after single exercises. Expiratory muscle strength did not differ significantly. Conclusions: The majority showed restrictive lung ventilation disorders and decreased respiratory muscle strength in relation to norms. There was a significant correlation of PImax with the duration of wearing the brace and the duration of therapy.

Association between Ventilation Disorder and Masticatory Dysfunction in the Korean Adult Population: A Cross-Sectional Study Using Data from the 2019 Korea National Health and Nutrition Examination Survey.

Background and Objectives: Respiratory and periodontal diseases are among the most common diseases affecting humans worldwide. Periodontal disease is a risk factor for aspiration pneumonia and other respiratory diseases. However, the evidence supporting the link between respiratory and periodontal disease is inconclusive and insufficient. Therefore, this study aimed to investigate the relationship between oral disease symptoms and respiratory diseases. Materials and Methods: Adults who underwent oral examinations and lung disease tests were recruited from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 14,956 individuals participated in the 2019 KNHANES. Among the 6846 participants who underwent oral examinations, 1320 children and adolescents were excluded. Additionally, of the 4119 adults aged ≥40 years who underwent dual lung function tests, those who did not respond to key independent confounding variables were excluded. The final sample consisted of 2988 adults. Results: Complex sample multivariate logistic regression analysis revealed that the risk of restrictive ventilation disorder was lower in individuals without chewing discomfort compared to individuals with chewing discomfort (odds ratio, 0.68; 95% confidence interval, 0.479-0.996), and the difference was statistically significant. Only one significant difference was observed between the two groups. Conclusions: Chewing discomfort is a major periodontal health-related factor associated with chronic obstructive pulmonary disease (COPD). Although the exact mechanism underlying the relationship between masticatory discomfort and COPD remains unclear, masticatory discomfort is an early symptom of oral diseases. The findings from this study provide additional basic data for the prevention of oral diseases and COPD in Korea.

Lung function and quality of life one year after severe COVID-19 in Brazil.

To evaluate symptoms, lung function, and quality of life of a cohort of patients hospitalized for severe COVID-19 12 months after hospital admission. This was a cross-sectional study. We included severe COVID-19 survivors hospitalized in one of three tertiary referral hospitals for COVID-19 in the city of Belo Horizonte, Brazil. Participants were submitted to lung function and six-minute walk tests and completed the EQ-5D-3L questionnaire. The whole sample comprised 189 COVID-19 survivors (mean age = 59.6 ± 13.4 years) who had been admitted to a ward only (n = 96; 50.8%) or to an ICU (n = 93; 49.2%). At 12 months of follow-up, 43% of patients presented with dyspnea, 27% of whom had a restrictive ventilatory disorder and 18% of whom presented with impaired DLCO. There were no significant differences in FVC, FEV1, and TLC between the survivors with or without dyspnea. However, those who still had dyspnea had significantly more impaired DLCO (14.9% vs. 22.4%; p < 0.020) and poorer quality of life. After one year, survivors of severe COVID-19 in a middle-income country still present with high symptom burden, restrictive ventilatory changes, and loss of quality of life. Ongoing follow-up is needed to characterize long COVID-19 and identify strategies to mitigate its consequences.

Updated national guidelines for spirometry. Part 2. An Approach to Interpreting Spirometry

The second part of the article discusses the spirometry interpretation using the latest international and national recommendations. Different systems of predicted values were considered, attention was paid to the GLI‑2012 reference equations advantages and the z-score assessment. The severity classification, obstructive disorders, extrathoracic and intrathoracic airway obstruction and possible spirometry indications of restrictive and mixed ventilation disorders were considered. The algorithm for spirometry evaluation was also presented, and the most common errors in the spirometry interpretation were discussed.

REHABILITATION OF SPINAL DEFORMITIES IN ADOLESCENTS – THE FAMILY DOCTOR'S POINT OF VIEW

The spinal deformities that are commonly detected in the adolescent years has a significant impact on public health. In recent years, additional risk factors have been identified such as the modern lifestyle, sedentary lifestyle, online school during the Covid 19 pandemic. The spinal deformities that are commonly detected in the teenagers are scoliosis - with the special form adolescent idiopathic scoliosis and kyphosis – the special form Scheuermann kyphosis. The risk for spinal deformity among teenagers whose parents had a spinal deformity is higher in most situations. The family physician usually monitors both parents and children. Considering this, the family physician performs targeted screening on teenagers whose parents suffer from a spinal deformity, due to their genetic predisposition. Teenagers with spinal deformities without further limitations or pain have to be treated according to the indication guidelines. Kinetotherapy alone or in combination with medical massage, orthopaedic approaches, are approach to correct of posture, improve and maintain flexibility, to reduce the pain, the pulmonary dysfunction. Adolescents and adults with restrictive ventilation disorders can only be addressed in specialized centres for rehabilitation of breathing. The role of the family physician is to identify spinal deformities early, to intervene through physical therapy in order to correct the posture and reduce complications. Keywords: spinal deformities, rehabilitation, adolescent, family physician.

Trajectory of lung function in diabetic adults: A 16-year follow-up study of community-based prospective cohorts.

To investigate the difference in lung function according to diabetes status in a community-based prospective study. Individuals aged 40-69 years from two community-based cohorts were followed prospectively for 16 years. A spirometer was used to evaluate lung function at baseline, and lung function tests were carried out biennially thereafter. Multivariable linear regression analysis was performed for the cross-sectional and longitudinal analyses based on diabetes status. Among the 6483 subjects, 2114 (32.6%) had prediabetes and 671 (10.4%) had diabetes. The prediabetes and diabetes groups had lower baseline % predicted values of forced expiratory volume in 1 s (FEV1) (mean, -1.853; 95% confidence interval [CI] -2.715 to -0.990 for prediabetes and mean, -4.088; 95% CI -5.424 to -2.752 for diabetes) and forced vital capacity (FVC) (mean, -2.087; 95% CI -2.837 to -1.337 for prediabetes and mean, -4.622; 95% CI -5.784 to -3.460 for diabetes) compared to the normoglycemia group after adjusting for relevant covariates. The rate of decline in FEV1% predicted (mean, -0.227; 95% CI -0.366 to -0.089) and FVC % predicted (mean, -0.232; 95% CI -0.347 to -0.117) during follow-up were faster in the diabetes group than in the normoglycemia group. The diabetes group had a lower proportion of normal ventilation (ptrend = 0.048) and higher proportions of restrictive (ptrend = 0.001) and mixed (ptrend = 0.035) ventilatory disorders at the last follow-up. Diabetes is associated with a lower baseline lung function and a faster rate of deterioration.

Hypersensitivity pneumonitis from Diagnosis to Treatment: A Cases Series with Literature Review

Hypersensitivity pneumonitis (HP) classified as an interstitial lung disease is characterized by a complex immunological reaction of the lung parenchyma in response to repetitive inhalation of a sensitized allergen. The estimated worldwide incidence of hypersensitivity pneumonitis is extremely rare and highly dependent on climatic, geographical, occupational and industrial factors. It might be secondary to a domestic or professional exposure, usually occurs in people who work in places where there are high levels of dust, fungus, or molds. Long-term exposure can lead to lung inflammation and acute lung disease. Over time, the acute condition turns into long-lasting (chronic) lung disease. Thus, we distinguish 2 mains aspects fibrotic HP and Nonfibrotic HP. The diagnosis of HP maybe sophisticated especially in fibrotic form. The prognosis of this disease depends on early diagnosis with complete antigen avoidance and most often corticosteroid therapy. This work aims to study the epidemiological, clinical, paraclinical aspects of hypersensitivity pneumonitis as well as therapeutic management, through a series of eight cases of HP carried out at the Pulmonology Department 20 August 1953, University Hospital Center IBN ROCHD, between January 2020 and January 2022, analyzed using a pre-established exploitation sheet. The average age of the patients studied was 51 years with a female predominance (sex-ratio M/F= 0.34). Domestic and occupational exposures of our patients were equal. The clinical symptomatology is dominated by almost constant dyspnea in all patients. Physical signs increased by crackles, objectified in 75% of patients. Computed tomography (CT) remains a great diagnostic contribution. Thus, allowing to have two categories of patients, depending on the presence or absence of signs of pulmonary fibrosis. In our study, five patients had fibrotic HP, and three cases had non- fibrotic HP. Precipitins were positive. Plethysmography objectified a restrictive ventilatory disorder in 62.5%. All patients benefited from antigenic eviction with long-term corticosteroid therapy. The evolution was favorable in 87.5% of cases.

Longitudinal Relationship Between Physical Activity Levels and Respiratory Function in Older Individuals : A Longitudinal Study

Aging causes various physical changes, including decreased respiratory function characterized by decreased lung elasticity, reduced chest wall compliance, and weakened respiratory muscles. This study explored the longitudinal impact of daily physical activity (PA) on respiratory function in elderly individuals aged ≥50 years in England. Using data from Waves 2 (2004–2005), 4 (2008–2009), and 6 (2012–2013), we examined the influence of different levels of PA on forced expiratory volume (FEV), forced vital capacity (FVC), and other respiratory measures. Participants were classified based on self-reported PA into three categories; “hard” (vigorous activity at least 1–3 times monthly), “middle” (moderate activity 1–3 times monthly), and “nothing” (no PA). The inclusion criteria required participants to be ≥50 years and to have valid respiratory measures. The exclusion criterion was the presence of significant respiratory or cardiovascular disease at baseline. We applied the Sequential Doubly Robust Estimator and SuperLearner ensemble methods in the analysis using inverse probability weighting to address follow up bias and found that vigorous PA significantly reduced the risk of FVC by 4.10-fold compared with no exercise. In addition, vigorous exercise was associated with a 0.63-fold reduction in the risk of restrictive ventilation disorders while moderate exercise approached significance for FVC (p = 0.08). No significant effects were found with obstructive ventilation impairment (FEV). Overall, vigorous PA appears to be crucial for maintaining respiratory function in older individuals, highlighting the importance of regular exercise in preventing respiratory decline and potentially extending a healthy lifespan. These results underscore the need to promote regular PA to improve quality of life and reduce the risk of respiratory disease.

External Respiratory Function, Inflammation Markers, and Life Quality Depending on the Volume of Tuberculosis Lung Lesion

Tuberculosis is a common disease in many countries, so understanding of its impact on life quality and respiratory function as well as study of correlations of these parameters with biochemical markers of tuberculosis course and treatment effectiveness is important in evaluating new methods of treatment and prevention. Objective — to investigate the relationships between the function of external respiration, the level of Human-beta-defensin-1, ferritin, interleukin-6, quality of life and the volume of tuberculosis lung lesions. Materials and methods. 100 patients with pulmonary tuberculosis were included in the study. Patients were divided into groups depending on the volume of tuberculous lesions: Group 1 (n = 36) had lesions within one lung, Group 2 (n = 64) had lesions of both lungs. Examination of patients was carried out according to the current standards of providing medical care to tuberculosis patients. In addition, patients underwent determination of ferritin, interleukin-6 (IL-6), and Human-beta-defensin-1 (HBD-1) levels in the blood by ELISA test. Spirography was performed to determine the parameters of the function of external breathing. Interviews were provided using SF-36 questionnaire with the determination of the main indicators of quality of life. Statistical data processing was carried out using the Statistica 8.0. Results and discussion. Comparison of spirometry parameters between groups showed significantly lower respiratory function parameters in patients with bilateral tuberculous lesions compared to patients with unilate­ral lesions. A decrease in external respiratory function indicators was accompanied by a corresponding significant decrease in the quality of life, which was more pronounced in Group 2. The described changes occurred against the background of a significant increase in the studied biochemical markers in Group 2 compared to Group 1. Thus, the level of HBD-1 in Group 1 was (8.11 ± 1.78) pg/ml, in Group 2 it was (30.14 ± 3.89) pg/ml (p &lt; 0.05). Ferritin level in Group 1 was (94.19 ± 1.18) ng/ml, in Group 2 — (113.45 ± 4.77) ng/ml (p &lt; 0.05). The level of IL-6 in Group 1 was (81.43 ± 1.14) pg/ml, in Group 2 — (103.34 ± 3.46) pg/ml (p &lt; 0.05). When investigating the correlations between the levels of HBD-1, ferritin, IL-6 and quality of life indicators according to the SF-36 scale, reliable inverse relationships were found between all quality of life parameters and the levels of HBD-1 and ferritin. When investigating the correlations between the levels of HBD-1, ferritin, IL-6 and parameters of the function of external respiration, it was found that HBD-1 demonstrates negative reliable correlations with both volume and speed indicators (– 0.24…– 0.32). IL-6 shows negative relationships only in FVC (rs = – 0.42) and FEV1 (rs = – 0.41), however, these correlations are stronger compared to HBD-1. Conclusions. An increase in the volume of tuberculous lesions of the lungs leads to a more pronounced violation of the function of external breathing and, as a result, a decrease in the patients life quality. The described changes are accompanied by an increase in the levels of HBD-1, ferritin and IL-6, which makes the studied biomarkers promising predictors of deterioration of external respiratory function and quality of life. HBD-1 and ferritin demonstrated more pronounced correlations with parameters of life quality. The investigated markers have negative correlations with indicators of both restrictive and obstructive ventilation disorders.

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.

Clinical, radiological and evolutionary aspects of non-specific interstitial Pneumonia

Introduction: Non-specific interstitial pneumonia (NSIP) is an interstitial lung disease that may be idiopathic or secondary to connective tissue disease, toxins or numerous other causes. Materials and methods: This is a retrospective study of 30 cases of non-specific interstitial lung disease collected in the radiology and pneumology departments of the Hassan II University Hospital of Fez, spread over a period of 4 years. Results: We collected 30 cases followed for NSIP. The mean age was 49.5 years, with extremes ranging from 26 to 70 years. A clear female predominance was noted (83%). Smoking intoxication was found in 13% of cases. Clinical symptoms were dominated by dyspnea in 26 cases, cough in 19 patients, chest pain in 4 cases and fever in only 1 patient. A restrictive ventilatory disorder was present in 87% of cases. The radiological appearance was in favor of cellular NSIP in 10 patients and fibrosing NSIP in 20 cases. Elemental scanographic lesions were dominated by intralobular reticulations in 97% of cases, presence of ground glass in 83% of cases, bronchiectasis in 87% and septal lines in 80% of cases. Honeycomb and micronodules were present in 20%. Abnormalities were bilateral with basal topography predominant in 26 cases (87%). Lung biopsy was performed in 4 patients. NSIP was idiopathic in 11 cases and associated with a connective tissue disease in 19 cases. The etiologies were dominated by systemic scleroderma found in 11 cases, followed by anti-synthetase syndrome (4 cases), rheumatoid arthritis (3 cases), Gougerot Sjogren's syndrome (2 cases), systemic lupus erythematosus (1 case). Systemic corticosteroid therapy was prescribed in 26 patients and immunosuppressants in second intention in 21 cases, 4 patients were lost to follow-up and did not receive treatment. The evolution under treatment was marked by a clear clinical improvement in 14 patients, a stability in 8 patients and an aggravation in 4 patients. Conclusion: The final diagnosis of NSIP relies on a multidisciplinary discussion between clinicians, radiologists and expert pathologists; it is essential to make the differential diagnosis with UIP as the majority of patients with NSIP have a better prognosis and respond well to corticosteroid treatment.

Respiratory function of workers at some wood factories in Bac Tu Liem district, 2022

Objectives: This study aimed to assess the respiratory function status and associated factors among workers in wood factories in Bac Tu Liem district. Methods: A total of 80 workers from six woodworking establishments participated in this cross-sectional study. Respiratory symptom questionnaires based on ECCS-87 and ATS-DLD-78a were used to collect data on symptoms experienced within the past 12 months. Respiratory function measurements were also conducted during breaks and at the end of shifts. Results: Workers with 3-5 years of experience accounted for 63.8% of the total sample. The majority (92.5%) were exposed to harmful workplace factors for more than 8 hours per day. Only 13.8% reported using full personal protective equipment. Concentrations of respiratory particles and Total Suspended Particulate (TSP) in wood facilities exceeded allowable standards. Cough was the most commonly reported respiratory symptom, with a prevalence of 28.8%. Approximately 66.3% of subjects had normal respiratory function, while restrictive ventilation disorder accounted for the highest proportion of respiratory disorders at 21.3%. Statistical analysis revealed significant associations between respiratory dysfunction and work experience (OR=2.56, p&lt;0.01), duration of exposure to hazardous factors (OR=1.8, p&lt;0.05), use of personal protective equipment (OR=7.12, p&lt;0.05), and the occurrence of respiratory symptoms (OR=1.73, p&lt;0.01). Conclusions: workers in furniture manufacturing facilities in Bac Tu Liem district face exposure to high concentrations of total particles, respiratory particles, and toxic gases that surpass permissible standards. The study also found a significant relationship between respiratory dysfunction and employee characteristics. Keywords: Respiratory function, wood workers, wood factories.

Investigation of newly diagnosed pneumoconiosis from artificial quartz stone manufacturers

Artificial quartz dust exposure may cause associated pneumoconiosis. From November 2019 to July 2020, a total of 27 cases of silicosis associated with artificial quartz stone manufacturers were diagnosed and treated in the Occupational disease Department of Suzhou Fifth People's Hospital. The average age of onset was (46.8±6.6) years, and the average working age of dust exposure was (5.7±1.7) years.The main feature of high KV chest radiography is P/S shadow with strip shadow. CT imaging findings showed diffuse small nodules and ground glass shadows with band shadows. The lesions were mainly distributed in the upper lung, accompanied by pleural thickening, lymphadenopathy and calcification. The pulmonary function impairment was mainly mild restrictive ventilation disorder, and the bronchial mucosa longitudinal plica was the main manifestation under tracheoscopy. The age of silicosis of workers in artificial quartz stone production enterprises is younger, the working age of dust exposure is short, the lung function and bronchial mucosa have a certain degree of damage, and effective preventive measures should be taken in time.

Functional changes in the respiratory system after COVID-19-associated lung injury

Since the beginning of the pandemic, COVID-19 (COronaVIrus Disease-2019) has been viewed as a respiratory disease with characteristic symptoms including cough, shortness of breath, and difficulty breathing. However, some patients still have respiratory complaints and post-inflammatory changes in the lung tissue according to high-resolution computed tomography of the chest organs (CT scan) even after discharge from the hospital.The aim. To assess the functional changes in the respiratory system in patients who had COVID-19-associated lung injury using a comprehensive testing of the respiratory function (spirometry, body plethysmography and diffusion test) in the first 6 months after discharge from the hospital.Methods. The study included 434 patients (252 men and 182 women, aged 20 to 79 years), who were divided into 3 groups depending on the time interval between discharge from the hospital and the respiratory function test: Group 1 – 15 – 45 days; Group 2 – 46 – 93 days; Group 3 – 94 – 183 days. All patients underwent a comprehensive testing of respiratory function.Results. The average pulmonary ventilation indicators remained within the normal range both in the general group and in separate groups. A decrease in DLCO was found in most patients: in 53% of people in the general group, in 54, 54 and 51% of cases in Groups 1, 2 and 3, respectively. Restrictive ventilation disorders (reduction of TLC below the lower limit of normal (LLN)) were detected in 29 % of people in the general group, 33, 27 and 26% in Groups 1, 2 and 3, respectively. Obstructive ventilation disorders (decrease in FEV1/FVC below LLN) were detected in 2 % in the general group, and in 3, 1 and 1% in groups 1, 2 and 3, respectively. Statistically significant correlations were found between the maximum volume of lung tissue damage in the acute period of COVID-19, the age of the patients, and the respiratory function indicators.Conclusion. The pulmonary ventilation indicators normalized within 6 months after COVID-19, while a decrease in lung diffusion capacity persisted in most patients and required further active follow-up.

Clinical characteristics, radiological features, and disease severity of bronchiectasis according to the spirometric pattern

Bronchiectasis show various ventilatory disorders in pulmonary function. The characteristics and severity of patients with bronchiectasis according to these pulmonary dysfunctions are still very limited. This study aimed to evaluate the clinical, radiologic feature and the disease severity of patients with bronchiectasis according to spirometric patterns. We retrospectively evaluated 506 patients with bronchiectasis who underwent pulmonary lung function test (PFT) at a referral hospital between 2014 to 2021. The results showed that cylindrical type was the most common (70.8%) type of bronchiectasis on chest Computed tomography (CT), and 70% of patients had bilateral lung involvement. On the other hand, obstructive ventilatory disorder was the most common (51.6%), followed by normal ventilation (30%) and restrictive ventilatory disorder (18.4%). The modified Medical Research Council (mMRC) was highest in patients with obstructive ventilatory disorders, Modified Reiff score [median (interquartile range)] [6 (3–10), P < 0.001], FACED (FEV1, Age, Chronic colonization, Extension, and Dyspnea) score [3 (1–4), P < 0.001], and Bronchiectasis Severity (BSI) score [8 (5–11), P < 0.001] showed significantly highest values of obstructive ventilatory disorder rather than restrictive ventilatory disorder and normal ventilation. More than half of patients with bronchiectasis had obstructive ventilatory disorder. Bronchiectasis with obstructive ventilatory disorders has more dyspnea symptom, more disease severity and more radiologic severity. There was no significant association between spirometric pattern and radiologic type, but the more severe the radiologic severity, the more severe the lung function impairment.

Função pulmonar e força muscular respiratória na alta hospitalar em pacientes com COVID-19 pós internação em Unidade de Terapia Intensiva

ABSTRACT This study describes the pulmonary function and respiratory muscle strength (RMS) at hospital discharge of severe COVID-19 patients, correlating them with peripheral muscle strength, duration of mechanical ventilation (MV), length of hospital stay, and use of medication. A cross-sectional study was conducted with COVID-19 patients admitted to the Intensive Care Unit. Assessment at hospital discharge included the following variables: RMS, pulmonary function, and peripheral muscle strength (Medical Research Council score [MRC] and handgrip dynamometry). A total of 25 patients with mean age of 48.7±12.3 years were assessed. Out of these, 72% presented restrictive ventilatory disorder, in addition to reduced RMS (maximum inspiratory pressure [MIP] of 74% and maximum expiratory pressure [MEP] of 78% of the predicted value). RMS (MIP and MEP, respectively) correlated negatively with duration of MV (r=−0.599, p=0.002; r=−0.523, p=0.007) and length of hospital stay (r=−0.542, p=0.005; r=−0.502, p=0.01); and positively with FVC (r=0.825, p=0.000; r=0.778, p=0.000), FEV1 (r=0.821, p=0.000; r=0.801, p=0.000), PEF (r=0.775, p=0.000; r=0.775, p=0.000), and handgrip strength (r=0.656, p=0.000; r=0.589, p=0.002). At hospital discharge, severe COVID-19 patients presented: reduced RMS; changes in lung function; negative correlation between RMS and duration of invasive mechanical ventilation (IMV), and length of hospital stay; and a positive correlation with lung function and hand grip strength.

Spirometric profile of patients in the chronic phase of Covid-19

Introduction: The SARS-CoV-2 virus that generates COVID-19 was the protagonist of the most impacting pandemic experienced by humanity. Responsible for thousands of infections, deaths and multisystem sequelae. The respiratory system, being the main route of viral contamination, was also the most compromised, with chronic repercussions regardless of the severity of the acute condition. Therefore, this article aims to critically review the studies that evaluated lung function through spirometry in the chronic phase of COVID-19. Methods: This is a systematic review carried out in six databases, where, through the PICO strategy in English, Spanish and Portuguese, articles that used spirometry as a pulmonary assessment instrument in patients in the post-acute phase of COVID-19 between the years 2020 and 2022. Four reviewers independently analyzed the works regarding data, methodology used and quality of publication. Results: Initially, a total of 2,205 articles related to the topic were searched, after careful selection 50 works were evaluated in full text, leaving 15 studies included in the review at the end. The data pointed to a higher prevalence of restrictive ventilatory disorders as the main pulmonary impairment after COVID-19.

Long-term personal PM2.5 exposure and lung function alternation: A longitudinal study in Wuhan urban adults

BackgroundThe effect of long-term PM2.5 exposure on lung function has not been well established. ObjectivesTo investigate the effects of long-term personal PM2.5 exposure on lung function decline, obstructive, and restrictive ventilatory disorders. MethodPersonal PM2.5 concentrations were evaluated using an estimation model. Lung function parameters including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) were measured in 3053 Wuhan participants from the Wuhan-Zhuhai cohort and were repeated every 3 years. Participants were classified into persistently high exposure group, persistently low exposure group and inconsistent exposure group according to the median of PM2.5 concentration of each visit. Mixed linear models with subject-specific random intercept were used to assess the association of 3-year change of lung function with personal PM2.5 exposure, and generalized linear models were used to assess the association of 6-year change of lung function with personal PM2.5 exposure. Cox regression models were applied to assess the associations of PM2.5 with obstructive and restrictive ventilatory disorders. ResultsThe medians of personal PM2.5 concentrations at baseline and two follow-ups were 153.18, 209.57 and 83.78 μg/m3, respectively. Compared with participants in the persistently low exposure group, participants in the persistently high exposure group showed a 2.99 % (95 % CI: 0.91, 5.08), a 380.15 mL/s (95 % CI: 32.82, 727.48) and a 5.98 % (95 % CI: 0.84, 11.11) additional decline in FEV1/FVC, PEF and PEFpred after 6 years, respectively. Stratified analyses showed that age, gender, body mass index, smoking status and drinking status had no significant modification effect on the associations. The associations of PM2.5 exposure with obstructive and restrictive ventilatory disorders were not significant, except for a positive association between persistently high PM2.5 exposure and restrictive ventilatory disorder among ever drinkers. ConclusionLong-term high PM2.5 exposure was associated with FEV1/FVC, PEF and PEFpred declines.

Indicators of lung function in children with chronic nonspecific lung diseases with pulmonary fibrosis

Introduction. The pathogenesis of most chronic nonspecific lung diseases (CNSLD) in children is based on a long-term inflammatory process, often leading to the formation of pulmonary fibrosis in the structurally altered tissue, which requires dynamic monitoring of patients, including the study of lung function.Aim. To assess the indicators of the lung function in children with chronic bronchopulmonary pathology accompanied by pulmonary fibrosis.Materials and methods. 84 children with CNSLD were examined. The main group consisted of 45 children with CNSLD with pulmonary fibrosis (bronchopulmonary dysplasia, congenital malformations of the lungs, chronic bronchitis, and post pneumonia fibrosis). The comparison group consisted of 39 children with CNSLD without pulmonary fibrosis. The average age of children in the study groups was 9,3±0,48 years. The patients underwent multispiral computed tomography of the lungs with a virtual bronchoscopy program and intravenous bolus contrast enhancement. Evaluation of lung function was carried out by spirometry.Results. In patients in remission, the average values of the ventilation capacity of the lungs in both groups were within the predicted values. However, in patients with fibrotic changes, pulmonary dysfunction was detected 2 times more often than in children with CNSLD without pulmonary fibrosis (35.5% and 15.4%, respectively, p&lt;0.05). Restrictive ventilation disorders were diagnosed only in the group of patients with pulmonary fibrosis. In children with pulmonary fibrosis, the risk of reduced ventilation capacity is significantly higher than in children with CNSLD without pulmonary fibrosis (OR=3.04, 95% CI 1.049–8.78).Conclusion. The data obtained can serve as a prerequisite for further development of predicting the nature of the course of the disease, identifying “risk groups” for the development of fibrotic changes for a personalized approach to the treatment and follow-up of patients with CNSLD.

Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma?

IntroductionManagement of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Not every rib fracture needs to be stabilized, but conservative treatment by internal splinting and analgesia is not effective for all patients. Deformities of the chest wall with reduced thoracic volume and restrictive ventilation disorders must be avoided. Intraoperative assessment of fractures and chest stability plays a central role.Material and methodsFrom 07/2016 to 07/2021, a total of 121 chest wall stabilizations were performed (m:f = 2:1, age 65 ± 14.5 a). Indications for surgery were the following criteria: (1) palpatory instability of the chest wall, (2) dislocated fracture endings, (3) concomitant injuries, (4) uncontrollable pain symptoms. In all patients, a computed tomography scan of the thorax was performed before the osteosynthetic treatment to assess dislocation of the fracture endings and possible concomitant injuries of intrathoracic organs.ResultsVideo-assisted thoracoscopy was performed in all patients. Hemothorax and concomitant injuries of the lung, diaphragm and mediastinum could be assessed. This was followed by an intraoperative assessment of the rib fractures, in particular penetration of fracture endings and resulting instability and deformity. Relevant fractures could be identified and subsequent incisions for rib osteosynthesis precisely defined. 6.3 (±2.7) rib fractures were detected, but 2.4 (±1.2) ribs treated osteosynthetically. Bilateral rib fractures were present in 26 patients (21.5%). Post-operative bleeding occurred in seven patients (5.8%), a breakage of the osteosynthetic material in two patients (1.7%).DiscussionIntraoperative assessment of relevant fractures and dislocation is the decisive criterium for osteosynthesis. Thoracoscopy is mandatory for this purpose – also to identify accompanying injuries. Not every fracture has to be approached osteosynthetically. Even with serial rib fractures or multiple fractures in a single rib, the thoracic contour can be restored by stabilizing only relevant fractures. Intraoperative palpation can adequately assess the stability and thus the result of the osteosynthesis. Even after surgical treatment of thoracic trauma, adequate analgesia and respiratory therapy are important to the healing process.