Single Breath Count Research Articles

Risk Stratification and Management of Acute Respiratory Failure in Patients With Neuromuscular Disease.

Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) are the most common causes of acute neuromuscular respiratory failure resulting in ICU admission. This synthetic narrative review summarizes the evidence for the prediction and management of acute neuromuscular respiratory failure due to GBS and MG. We searched PubMed for relevant literature and reviewed bibliographies of included articles for additional relevant studies. English-language publications were reviewed. Data regarding study methodology, patient population, evaluation metrics, respiratory interventions, and clinical outcomes were qualitatively assessed. No single tool has sufficient sensitivity and specificity for the prediction of acute neuromuscular respiratory failure requiring mechanical ventilation. Multimodal assessment, integrating history, examination maneuvers (single breath count, neck flexion strength, bulbar weakness, and paradoxical breathing) and pulmonary function testing are ideal for risk stratification. The Erasmus GBS Respiratory Insufficiency Score is a validated tool useful for GBS. Noninvasive ventilation can be effective in MG but may not be safe in early GBS. Airway management considerations are similar across both conditions, but dysautonomia in GBS requires specific attention. Extubation failure is common in MG, and early tracheostomy may be beneficial for MG. Prolonged ventilatory support is common, and good functional outcomes may occur even when prolonged ventilation is required. Multimodal assessments integrating several bedside indicators of bulbar and respiratory muscle function can aid in evidence-based risk stratification for respiratory failure among those with neuromuscular disease. Serial evaluations may help establish a patient's trajectory and to determine timing of respiratory intervention.

Maintaining Physical Health in Individuals with Duchenne Muscular Dystrophy Through Telerehabilitation

Aims To investigate the effects of a telerehabilitation program on walking performance, lower and upper extremity function, fall frequency, respiratory function, and satisfaction in individuals with Duchenne muscular dystrophy (DMD). Methods Thirty children (mean age 8.8 ± 4.2 years) were ambulant (Group 1), and 12 youth (18.5 ± 4.7 years) were non-ambulant (Group 2). The telerehabilitation program was applied by physiotherapists for 24 sessions (3 days/week). The 10-meter walking test, stand up from the supine position test, the modified upper extremity performance test, repetition of Lower and upper extremity movements, and the single breath count (SBC) test were administered. Fall frequency and satisfaction level were also recorded. Results Significant improvement was found after telerehabilitation in upper extremity performance, repetition of lower and upper extremity movements, fall frequency, and SBC scores in Group 1. Changes in the 10-minute Walk and Stand Up from the Supine Position tests were not significant. There was a significant improvement in SBC scores in Group 2. Satisfaction with the service was 88%. Conclusions The 8-week telerehabilitation program was effective in improving aspects of upper and lower extremity function, fall frequency, pulmonary function, and satisfaction levels in individuals with DMD.

A Pilot Study “To Derive the Normal Values of Single Breath Count in Young Healthy Adults”

Introduction: Pulmonary function tests such as spirometer and peak expiratory flow rate are the standard measuresto test lung volumes and capacities; but generally there is a lack of such equipment in emergency departments.Hence there is a need for an easier, quicker and convenient outcome measure in such set-ups. Single breath count(SBC) can be a simple assessment method in such clinical settings. However no studies for normal values of SBCin young Healthy adults were found during the search for literature.Objective: The objective of this study was to estimate normal value of SBC in Healthy young adult population.Results: 100 participants were enrolled from 18-24 years of age in the study. The mean SBC was 39(±7) and 41(±9)in females and males respectively. The SBC had a significant positive correlation with age at r=0.3, p value 0.0051and height at r=0.28, p value 0.0038. The SBC had a non-significant negative correlation with BMI and weight.Discussion: The results show that SBC was influenced significantly by gender (males>females), age and height ofthe individuals. However BMI and weight did not seem to influence the SBC.Conclusion: SBC is a test which is easy to perform and appears to correlate well with standard measures ofpulmonary functions. We estimated the normal values of SBC in young healthy adults which can be used in theclinical set up.

CLINICO- ELECTROPHYSIOLOGICAL AND CSF PROFILE AND PREDICTORS OF FUNCTIONAL OUTCOME IN GUILLAINE-BARRE SYNDROME- A PROSPECTIVE STUDY

BACKGROUND Guillain-Barre syndrome (GBS) is a rare, immune mediated disorder which is associated with demyelination of peripheral nervous system and progressive muscle weakness, with an annual global incidence of approximately 1–2 per 100,000 person-years. GBS has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Recent advances in the eld of critical care has successfully improved the outcome of GBS. Successful management mandates anticipation, prompt recognition of modiable risk factors and optimal treatment of neuromuscular respiratory failure in GBS. There is limited Indian data with regards to the early determinants and outcome of severely affected GBS patients. Knowledge of early predictors can substantially improve patient care and provides essential data for triage at an early stage in the course of the illness. OBJECTIVE 1. To study the clinical, electrophysiological prole, progression and outcome of GBS in a tertiary care hospital. 2. To determine the factors associated with the poor functional outcome, including the need for mechanical ventilation. MATERIALS AND METHODS This was a single centre, prospective study with 50 patients with GB syndrome, conducted from from 1st June 2021 to 30th May 2022 for a period of 1 year at Gauhati Medical College and Hospital. Their clinical, electrophysiological, CSF parameters were analysed. Hughes grading, EGRIS, mEGOS, MRC sum score were used. Any clinical deterioration and need for mechanical ventilation were noted carefully. Patients were followed up at 3 months and 6 months at assess their outcome. The mean age of the patients was 30.5 RESULTS years with a male female ratio of 1.3:1. AIDP was the most prevalent subtype found in 23(46%) patients followed by AMAN in 14(28%), AMSAN in 9(18%) and 4(8%) cases were unclassied. 32(64%) had severe disease with Hughes score ≥ 4 and 28(56%) had MRC score <40 at presentation. Respiratory distress was found in 17(34%) of patients, and out of which 10(20%) required mechanical ventilation. During the study 2(4%) patients died of complications. At 3 months, 30(60%) patients had complete recovery, 12(24%) had partial recovery and 6(12%) had poor recovery. At 6 months, 35(70%) had good recovery, 9(18%) had partial recovery and 4(8%) had poor recovery. Delayed CONCLUSION presentation, early peak of illness, prolonged Hospital stay, bulbar weakness, neck exor weakness, bilateral facial weakness, quadriparesis, respiratory distress, need for mechanical ventilation, autonomic dysfunction; high Hughes grading, low average single breath count along with high EGRIS, mEGOS, MRC sum score, high CSF protein, albumin-cytological dissociation, presence of F-wave abnormalities and Non stimulable nerves or Inexcitable nerves on NCS, AMAN subtype and systemic complications are associated with poor outcome. The overall outcome of GBS is favourable.

Validation of the Single Breath Count Test for Assessment of Inspiratory Muscle Strength in Healthy Subjects and People with Neuromuscular Disorders.

This study aimed to validate the single breath count test (SBCT) against volitional measures of respiratory muscle function in healthy subjects and people with neuromuscular disorders (NMD; n = 100 per group). Testing comprised upright and supine SBCT, forced vital capacity (FVC), maximum inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP). Predictability of FVC by SBCT was assessed using logarithmic regression analysis. Receiver operating characteristics curves were used to identify SBCT thresholds for lung restriction (FVC < 80% predicted), inspiratory muscle weakness (MIP < 60 cmH2O), and indication for non-invasive ventilation (NIV) in NMD patients. In both groups, SBCT showed moderate correlation with FVC. In patients, SBCT values were also correlated with MIP and SNIP. Strength of correlations was similar with supine and upright SBCT which accounted for 23.7% of FVC variance in healthy individuals (44.5% in patients). Predictive thresholds of upright SBCT were < 27 for MIP < 60 cmH2O (sensitivity 0.61/specificity 0.86), <39 for NIV indication (0.92/0.46), and <41 for FVC < 80% predicted (0.89/0.62). The SBCT is positively correlated with spirometry. It predicts both lung restriction and NIV indication in NMD patients. The SBCT allows for remote monitoring and may substitute for spirometry/manometry if appropriate devices are unavailable.

Prediction of Postoperative Pulmonary Complications in Patients Undergoing Functional Endoscopic Sinus Surgery: A Cohort Study

Introduction: Considering the pathophysiology of nasal obstruction, changes in certain parameters such as Peripheral Blood Eosinophil Count (PBEC), bedside pulmonary function test, Peak Expiratory Flow Rate (PEFR), and Electrocardiography (ECG) may have some correlation with postoperative pulmonary complications such as upper airway obstruction, loss of pharyngeal muscle tone, and postobstructive pulmonary oedema. Aim: To observe and analyse the changes in PBEC, bedside pulmonary function test, PEFR, and ECG in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Materials and Methods: A prospective cohort study was conducted at Bharati Hospital, Pune, Maharashtra, India over a two-year duration from December 2020 to October 2022. A total of 50 patients aged above 18 years undergoing FESS surgery were included in the study. The statistical analysis was performed using the Chi-square test and student’s t-test. After thorough preoperative evaluation, the aforementioned predictors were recorded. General anaesthesia management for FESS surgery was done according to the standard protocol. Vigilant intraoperative monitoring of vital parameters including peak airway pressure and plateau pressure was performed. After shifting the patients to the recovery room, they were observed for: 1) Hypoxia; 2) Hypercarbia; 3) Laryngospasm; 4) Bronchospasm; and 5) Pulmonary oedema. Results: A total of 50 patients aged between 18 years and 65 years with the mean age was 41.7±15.4 years were included in the study, with 32 males and 18 females. Only 24% of the study population showed postoperative hypoxia, while the rest of the complications were not observed in any patient. Changes in eosinophil count, PEFR, and ECG did not have any correlation with postoperative hypoxia and were statistically insignificant. Bedside pulmonary function tests, including the Sabrasez breath-holding test and the Sabrasez single breath count test, showed changes in 30% and 76% of patients, respectively. Forced Expiratory test change was seen in 72% of patients. Among these, 19.4% showed hypoxia. Out of the 12 cases showing postoperative hypoxia, seven had a disease duration of less than six months. Conclusion: The Sabrasez breath-holding test and Sabrasez single breath count are good predictors for postoperative hypoxia in patients undergoing FESS surgery. Shorter duration of nasal obstruction also showed postoperative hypoxia.

Effect of smoking on vital hemodynamic parameters and lipid profile of young smokers

Background and objectives: Tobacco use is associated with cardiovascular, respiratory and peripheral vascular diseases. The short term effects of tobacco smoking on vital hemodynamic parameters and lipid profile of young smoker with increased quantity of smoking is still debatable. The objective of this study was to evaluate the effect of smoking on vital hemodynamic parameters and lipid profile of young smokers. Materials and methods: The current study was an observational cross sectional study conducted in a tertiary care hospital over a period of 18 months and included smokers and non-smokers. Data on vital hemodynamic parameters like blood pressure, heart rate, oxygen saturation (SPO2) and lipid profile were collected. Chi-square and analysis of variance (ANOVA) tests were used to analyze the data. Results: A total of 80 smokers and 80 non-smokers were enrolled in the study. Blood pressure, heart rate and mean SpO2 were significantly (p&lt;0.001) lower in non-smokers compared to smokers. Breath holding time (BHT) and single breath count (SBC) were higher in non-smokers. Mean values of total cholesterol (T-chol), low density lipoprotein (LDL) and triglyceride (TG) were significantly (p&lt;0.001) higher in smokers than non-smokers, while high density lipoprotein (HDL) was significantly low in smokers. SBP, T -chol and TG significantly (p&lt;0.05) increased as the quantity of smoking increased. Conclusion: Smoking is associated with derangement of vital hemodynamic parameters and lipid profile across the age. Anti-smoking campaign should be organized to discourage both personal smoking and smoking in public places. IMC J Med Sci. 2023. 17(1): 007. DOI : https://doi.org/10.55010/imcjms.17.007 *Correspondence: Bhupendra Kumar Jain, Department of Pulmonary Medicine, School of Chhindwara Institute Of Medical Sciences, Jabalpur Medical University, Chhindwara, Madhya Pradesh, India. Email: drbhupendrakjain@gmail.com

Peak expiratory flow and the single-breath count test as markers of respiratory function in patients with myasthenia gravis

IntroductionMyasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. MethodsWe performed an observational study of patients with MG. All cases were evaluated with the single-breath count test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). ResultsThe study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath count test scores and FVC values (r = 0.57, P = .000), and between PEF and FVC values (r = 0.76, P = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, P = .03). PEF also showed a significant correlation with MEP (r = 0.51, P = .002). ConclusionsPEF, the single-breath count test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.

Myasthenia Gravis Presenting after Administration of the mRNA-1273 Vaccine.

The mRNA-1273 SARS-CoV-2 vaccine received emergency use authorization in December 2021. We present a case of myasthenia gravis (MG) which became clinically apparent following vaccination against SARS-CoV-2. A 30-year-old man developed acute onset diplopia, 2 days after receiving his first mRNA-1273 vaccination against SARS-CoV-2. He reported blurred vision with horizontally displaced images, which worsened with increased eye strain. Diplopia resolved when one eye was covered. He also had fatigable arm weakness, but denied dysphagia, dysarthria, dysphonia or dyspnoea. On examination, he had left-sided ptosis and esotropia at rest which worsened with sustained upward gaze and prolonged focus. He also had fatigable weakness of neck flexion and extension (4+/5), and generalized, fatigable weakness (4/5). His single-breath count was 38. Cranial nerves, sensory examination and deep tendon reflexes were normal. A 2-min ice-pack test and neostigmine test temporarily improved his diplopia and ptosis. The acetylcholine receptor (AChR) antibody was borderline high and muscle-specific tyrosine kinase (MuSK) antibody was negative. Chest CT and brain MRI with contrast were unremarkable. The patient was diagnosed with MG and oral pyridostigmine and prednisone therapy were initiated.We present a case of newly diagnosed MG after administration of mRNA-1273 vaccination against SARS-CoV-2. Although there has been long-standing discussion regarding the potential for vaccines to exacerbate autoimmune conditions, data remain sparse and consensus has not been reached. Consequently, this case is important to make providers aware of potential side effects of a novel vaccine, and may also help guide the selection of vaccination candidates and monitoring parameters.LEARNING POINTSWe present a case of newly diagnosed myasthenia gravis after administration of the mRNA-1273 SARS-CoV-2 vaccine.mRNA-1273 vaccination against SARS-CoV-2 may exacerbate subclinical cases of myasthenia gravis.Recognition of new vaccine side effects may guide the selection of vulnerable patients.

084 Is there a positive correlation between single breath count and forced vital capacity?

IntroductionMonitoring respiratory function is a critical part of the management of patients with acute neuromuscular disease. Single breath count (SBC) testing is often performed as a surrogate for the Forced Vital Capacity (FVC), especially in resource poor environments. However, equivalence of these two tests has not been formally evaluated.MethodsWe will compare the SBC and FVC in 50 healthy adults. Correlation will be evaluated using linear regression and factors influencing the SBC and FVC will be investigated.ResultsTo date 10 participants have been recruited (4 male, 6 female, mean age 30 years). Provisional analysis has shown a mean best SBC and FVC was 71 (SD 19) and 4.8 Litres (SD 1.3) respectively. In this small sample a significant correlation between SBC and FVC was demonstrated (p=0.03, R-squared=0.47). Recruitment is on schedule to complete by March 2020 and full results will be available for presentation at the conference.DiscussionTo our knowledge no study has directly compared SBC and FVC in healthy adult population. Our study will provide useful data to help understand the appropriateness of interchanging these tests in clinical practice.aram.aslanyan@srft.nhs.uk

Could We Predict Respiratory Failure in Amyotrophic Lateral Sclerosis?

Introduction: Respiratory complications are important in the prognosis of amyotrophic lateral sclerosis (ALS). The aim of this study was to determine the electrophysiological findings that may predict respiratory failure. Methods: According to the Awaji electrodiagnostic criteria, 30 patients with ALS who were diagnosed with definite or probable ALS without respiratory failure were included in the study. Nerve conduction studies, needle electromyography (EMG), and single-breath count tests were performed in all patients. In addition, the pulmonary function tests, swallowing EMG, and arterial blood gas analysis of the patients were recorded and evaluated. The patients were followed until respiratory failure developed. Results: As a result of 18 months of follow-up, 26 of 30 patients developed respiratory failure. When the contribution of the accessory respiratory muscles to the respiratory effort before the development of respiratory failure was evaluated clinically and electrophysiologically, it was observed that the most common muscles involved in the respiratory effort were sternocleidomastoid (SCM), trapezius, and rectus abdominis. Before the development of respiratory failure, the latest neurogenic EMG findings were seen in the SCM (50% cases), trapezius (20% cases), and thoracic paraspinal muscles (17% of cases), respectively. It was thought that this finding could be an important early electrophysiologic marker in predicting the development of respiratory failure in ALS cases. Conclusions: To sum up, the presence of neurogenic changes in certain muscles in needle EMG and demonstration of the contribution of certain accessory respiratory muscles in respiration can be used as an electrophysiological marker to predict the development of respiratory failure.

Physiotherapy interventions facilitating recovery in COVID-19 patient on immunosuppressive therapy and with multiple comorbidities: a case report

&lt;p class="abstract"&gt;The global pandemic of the Coronavirus disease 2019 (COVID-19) has increasingly emerged as a multisystem infection with a wide spectrum of patient presentation, clinical severity and eventual outcomes. Physiotherapy treatment is pivotal to combat the consequences of the viral infection assisting timely functional recovery. Early intervention, routine assessments and tailormade rehabilitation programs aid in the comprehensive management of the patient and reduce further debilitating long COVID sequelae. This case report describes the course of a COVID-19 patient admitted in a COVID dedicated ICU, on immunosuppressive therapy and with multiple comorbidities, receiving daily physiotherapy treatment from admission to discharge. The change in the functional status was assessed using various outcome measures namely single breath count, breath holding time, Medical Research Council sum score, 30 sec sit to stand, timed up and go and 6 min walk test demonstrating a positive effect of physiotherapy interventions in facilitating recovery in the patient. &lt;/p&gt;

Prediction models for mechanical ventilation and outcome in Guillain-Barré syndrome

Various prediction models have been formulated to predict the need for mechanical ventilation (MV). In this study, we compare the sensitivity and specificity of Erasmus GBS Respiratory Insufficiency Score (EGRIS) and Sharshar score with single breath count (SBC) at 2 Hz to assess their usefulness in predicting MV and functional outcome. The primary outcome was prediction of MV and relative usefulness of all three models based on sensitivity and specificity. The secondary outcome was functional recovery at 6 months using the cut off points for MV and functional outcome at 6months was assessed using Hughes scale and categorized as good (<2) and poor (≥2). The median age was 30 years, and 64 (69.6%) were males. The sensitivity and specificity of EGRIS score was 78.1% and 67.2%, Sharshar score was 75.0% and 64.1%, and SBC at 2 Hz was 78.1% and 75.0%. The area under the receiver operating curves was maximum for SBC at 2 Hz (0.86) compared to other models, although insignificant. EGRIS score < 5 had better functional recovery compared to those with score ≥ 5 (66% vs 34%, p = 0.001). Similarly, in Sharshar score, 23/59 (39%) with score ≥ 4 had good recovery compared to 36 (61%) with score < 4 (p = 0.01). All the three models have comparable predictive values for MV. Outcome prediction is the best with EGRIS.

Telemedicine visits in myasthenia gravis: Expert guidance and the Myasthenia Gravis Core Exam (MG-CE).

Telemedicine may be particularly well-suited for myasthenia gravis (MG) due to the disorder's need for specialized care, its hallmark fluctuating muscle weakness, and the potential for increased risk of virus exposure among patients with MG during the coronavirus disease 2019 (COVID-19) pandemic during in-person clinical visits. A disease-specific telemedicine physical examination to reflect myasthenic weakness does not currently exist. This paper outlines step-by-step guidance on the fundamentals of a telemedicine assessment for MG. The Myasthenia Gravis Core Exam (MG-CE) is introduced as a MG-specific, telemedicine, physical examination, which contains eight components (ptosis, diplopia, facial strength, bulbar strength, dysarthria, single breath count, arm strength, and sit to stand) and takes approximately 10 minutes to complete. Pre-visit preparation, remote ascertainment of patient-reported outcome scales and visit documentation are also addressed. Additional knowledge gaps in telemedicine specific to MG care are identified for future investigation.

Clinical Experience with Eculizumab in Treatment-Refractory Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis.

Background:Although established therapies are effective in most patients with generalized myasthenia gravis (gMG), some patients do not respond or they experience intolerable adverse events, highlighting the need for better tolerated, targeted therapies for treatment-refractory gMG.Objective:To describe real-world experience with eculizumab in patients with treatment-refractory acetylcholine receptor antibody-positive (AChR+) gMG.Methods:Retrospective chart review of 15 patients with treatment-refractory AChR+ gMG treated for 12 months with eculizumab (900 mg/week for 4 weeks then 1200 mg every 2 weeks). Outcome measures were Myasthenia Gravis–Activities of Daily Living (MG-ADL) scores, number of exacerbations, single-breath count test (SBCT) score, medication changes, selected Quantitative Myasthenia Gravis (QMG) evaluations, and adverse events. Data collected at 3-monthly intervals for 12 months before and after eculizumab initiation were analyzed.Results:Clinically meaningful reductions in total MG-ADL scores were observed at 3 months following eculizumab initiation and maintained up to 12 months in all patients. After 12 months’ eculizumab treatment, there was a significant reduction in the number of acute exacerbations; mean (SD) SBCT score improved from 28.13 (0.33) to 50.26 (2.86); all patients achieved a ‘none’ or ‘mild’ rating for QMG evaluations; all patients reduced their daily prednisone dose; and nine patients had discontinued pyridostigmine. At the end of treatment, intravenous immunoglobulin was discontinued in all six patients receiving this therapy at eculizumab initiation. Eculizumab was well tolerated.Conclusions:This real-world study demonstrated improvement in outcome measures and decreased concomitant drug requirement within 12 months of eculizumab initiation in patients with treatment-refractory AChR+ gMG.

Sensory symptoms on admission as a predictor of respiratory insufficiency in patients of Guillain-Barre Syndrome (GBS).

To assess sensory symptoms on presentation as a predictor of respiratory insufficiency in patients of Guillain-Barre Syndrome. The descriptive cross-sectional study was conducted from November 2018 to March 2019 at the Neurology Department of King Edward Medical University, Lahore, Pakistan, and comprised patients aged 18-60 years suffering from Guillain-Barre Syndrome as per Brighton criteria. All patients were monitored for respiratory insufficiency by single breath count and arterial blood gases. Data was analysed using SPSS 22. Of the 87 patients, 61(70.1%) were male and 26(29.9%) were female. The overall mean age was 37.51±15.36 years. Sensory symptoms were noted in 27(31%) patients, and respiratory distress in 17(19.5%). Of those who had sensory symptoms, 10(37%) also had sensory symptoms. Respiratory insufficiency in Guillain-Barre Syndrome patients presenting with sensory symptoms was common.

A telephonic single breath count test for screening of exacerbations of myasthenia gravis: A pilot study.

Patients with myasthenia gravis (MG) may experience worsening symptoms outside of a clinical setting. A method of diagnosing and triaging such individuals would be valuable. This study gauged the viability of a nurse-administered single breath count test (SBCT) over the telephone for assessing MG exacerbations. This was a retrospective, single-center review of a pilot study of 45 telephone calls from patients with MG who had worsening baseline symptoms. SBCTs were administered over the telephone to patients by trained nurses. Patients with a breath count of 25 or less were sent to the emergency department. Using a cutoff count of 25, the nurse-administered telephonic SBCT had a positive predictive value of 71%, sensitivity of 80%, and specificity of 60% in diagnosing an MG exacerbation. SBCT administered by trained nurses by means of telephone may be a useful screening tool for assessing decreased respiratory function in patients with MG.

Efficacy of breathing retraining program on bedside assessment of pulmonary function

Breathing retraining alters respiratory muscle recruitment and improves respiratory muscle performance. However, the effectiveness of Pursed Lip Breathing in reducing dyspnoea is controversial. The aims of this study are to determine if breathing retraining is influencing the Single Breath Count performed by dyspneic subjects and to assess the correlation between Single breath Count Test and Snider match test as the standard measures of bedside pulmonary function test in patients with dyspnoea. 100 Patients with dyspnoea were assessed in the baseline with snider match test and they were asked to perform a single breath count. 5 times weekly and for 4 weeks, the participants have been practicing Breathing Retraining. Pursed lip breathing (PLB) and diaphragmatic breathing (DB) are breathing retraining strategies to subjects with dyspnoea; Single Breath Count was measured by asking patients to take a deep breath and count as far as possible in their normal speaking voice without taking another breath. Counting was timed to a metronome set at 2 counts per second. Snider match test was conducted by blowing the matches at increasing the test distance from 3, 6, 9 inches. The result of this study will determine whether breathing retraining is safe and beneficial for people with dyspnoea.

Role of Inpatient Pulmonary Rehabilitation Program in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Case Series

Chronic Obstructive Pulmonary Disease (COPD) defined as a chronic inflammatory lung disease that causes airflow obstruction and limitation of the lungs that primarily affects the airway and lung parenchyma. Pulmonary rehabilitation (PR) in COPD have been shown improvement of respiratory capacity, exercise capacity, self-efficacy, quality of life, and reduce COPD-related hospital admission. The purpose of postural drainage, manual technique, and cough control is to drain the excessive sputum, while breathing control with pursed-lip breathing and breathing exercise with deep breathing exercise and chest expansion exercise are to improve the respiratory capacity and control. The purpose of this study was to investigate the feasibility and outcome of PR in patients with Acute Exacerbation (AE) of COPD. This case report describes 4 patients with of AE of COPD who received PR. The inpatient PR program was 5 consecutive days twice daily of 3 times repetition cough control, 2 sets of 6 repetition pursed lip breathing, 2 sets of 6 repetition deep breathing exercise, postural drainage, and manual clapping. The postural drainage and the manual technique were given according to the chest x-ray result. The result of 5 days PR was: improvement of clean airway, SOB, incentive spirometer, chest expansion, and single breath count test in all subjects. Our findings demonstrate that early inpatient PR in COPD AE is safe, significantly effective and beneficial by improving many aspects of respiratory function

Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome

In this study, we correlate single breath count (SBC) with arterial blood gas (ABG) parameters to derive a cutoff point for intubation and mechanical ventilation (MV) in Guillain-Barré Syndrome (GBS). Ninety-four GBS patients underwent serial SBC at 2 Hz using an audio program. ABG was done at admission, and repeated if SBC declined. The patients were intubated based on “the modified intubation criteria” as follows (a + b or c): (a) hypoxia (PaO2 < 60 mm of Hg on ventimask); (b) hypercarbia (PaCO2 > 50 mm of Hg); (c) acidosis (pH < 7.3). The primary outcome was the absolute SBC at which patients had ABG alteration needing intubation.All the patients maintained a desired ABG without respiratory distress till SBC 7. At SBC 5, need for MV could be predicted with a sensitivity of 90.6% and specificity of 95.2%. Admission SBC cut-off of 13 and relative delta SBC at 24 h cut-off of > 20% had a negative predictive value of 88.5% (95% CI 77.0%–96.0%) and 80.8% (95% CI 60.7%–93.4%) respectively for ruling out need of MV.SBC is a useful non-invasive measure for monitoring respiratory function and guiding ABG analysis. Till SBC 7, repeated ABG may be avoided in GBS.