Ventilatory Disorders Research Articles

Trends and Clinical Implications of Pediatric Pulmonary Function After Hematopoietic Stem Cell Transplantation: A Systematic Review.

Hematopoietic stem cell transplantation (HSCT) is a key therapeutic approach for pediatric patients with hematologic and non-hematologic disorders. However, post-transplant pulmonary complications remain a significant cause of morbidity and mortality. Pulmonary Function Tests (PFTs) are essential for the early detection of pulmonary dysfunction, yet their application in pediatric HSCT recipients has yielded inconsistent results. This review aims to assess the variations in pulmonary function post-HSCT and explore their clinical implications for pediatric patients. A systematic review was conducted by analyzing studies published between 2000 and 2024, sourced from PubMed, Web of Science, CNKI, and Wan Fang databases. The review included cohort studies, randomized controlled trials, and case-control studies that assessed pulmonary function using standardized PFTs. Pulmonary dysfunction, particularly obstructive and restrictive ventilatory disorders, is common in pediatric HSCT recipients. Significant changes in PFT parameters, such as FEV1/FVC ratio and FEF25-75%, were observed. However, trends in post-transplant pulmonary function vary due to factors such as pre-transplant lung conditions, patient age, and treatment protocols. Innovative diagnostic methods, such as parametric response mapping (PRM) and multiple breath washout (MBW), show promise in enhancing early detection and management of pulmonary complications. Monitoring pulmonary function is critical for the early identification of complications in pediatric HSCT recipients. Although standardized clinical guidelines are available, variability in PFT trends underscores the need for more refined diagnostic tools. Advanced diagnostic methods, like PRM and MBW, may improve early detection and help optimize the management of pulmonary dysfunction, ultimately improving long-term outcomes for pediatric patients.

Key spirometric parameters for post-tuberculosis sequelae in patients after new coronavirus infection

The study evaluated key spirometric parameters in patients with post-tuberculosis (post-TB) lung sequelae after recovery from a new coronavirus infection. The main group incliuded 14 patients with clinically cured respiratory tuberculosis who had recovered from the new coronavirus infection and, after recovery, were sent to the Glukhovskaya tuberculosis sanatorium for treatment in 2020-2021. The control group included 52 patients with residual post-TB sequelae, who did not have a new coronavirus infection and who were treated at the sanatorium during the same period. The groups were comparable in terms of epidemiological and clinical criteria, except for post-TB sequelae: the main group included 13 cases (92.9%) of minor post-TB sequelae, 1 case (7.1%) of major post-TB sequelae, and the control group included 36 (69.2%) and 16 (30.8%) cases, respectively. Pulmonary function tests included vital capacity, forced vital capacity, forced expiratory volume in 1 second, and forced expiratory volume in 1 second/forced vital capacity. Tests were performed at admission to the sanatorium and after 1 month. At stage 1 in the main group, vital capacity, forced vital capacity and forced expiratory volume in 1 second were on average below the predicted level (80%) compared with the control group, and after sanatorium treatment the same parameters improved slightly. In the control group, the initial indicators were significantly higher, the rates of recovery of vital capacity of the lungs and forced vital capacity of the lungs were comparable with the main group, during the 2nd examination, the average levels of recovery of vital capacity of the lungs and forced vital capacity of the lungs approached, and in terms of forced expiratory volume in the 1st second, they reached the norm. At baseline, low ventilatory lung capacity correlated with clinical symptoms, as 42.8% of patients in the main group and 55.7% of controls reported shortness of breath. However, after sanatorium treatment, the control group more often showed parameters below 60%: 7.7% of cases for vital capacity, 17.3% for forced vital capacity, 11.5% for forced expiratory volume in 1 second, while the main group showed mostly slight or moderate decrease of these parameters. Therefore, the new coronavirus infection has a negative impact on the functional capacity of the respiratory system, but major post-TB sequelae also contribute to the development of ventilatory disorders.

Prediction of restrictive ventilation disorders after COVID-19

Introduction. The effect of SARS-COV-2 on the lung function remains relevant at the present time.Aim. Determination of the most important predictors of the restrictive ventilation disorder after COVID-19.Materials and methods. The retrospective study included 341 patients without underlying lung diseases (median age 48 years) survivors after COVID-19 with bilateral pneumonia. The median of the greatest extent of parenchymal involvement in the acute phase of COVID-19 (CTmax) was 50%. Spirometry, body plethysmography, and diffusion test were performed. Descriptive statistics, correlation analysis, one-dimensional logistic regression analysis with an assessment of odds ratios (OR) and multivariate logistic regression analysis were applied. ROC analysis was used to assess the quality of the binary classifier model.Results. The initial model for predicting reduced total lung capacity (TLC) (criterion 1: TLC < 80% predicted, criterion 2: TLC<predicted-1.645SD) included predictors: CTmax, time interval from the COVID-19 onset (TI), gender, age, body mass index. Backward stepwise regression was applied and a binary classifier model that includes CTmax and TI was obtained. Applying criterion 1 for reducing TLC, the sensitivity and specificity of the model were 70,5% and 89.3%, respectively, and criterion 2 - 96.6% and 67.3%, respectively. The analysis of OR for the obtained binary classifier models showed that OR>1 is observed at CTmax > 70%.Conclusions. The restrictive ventilation disorder after COVID-19 is caused by CTmax and TI. The risk of reducing TLC after COVID-19 increases significantly with CTmax 70% or more. The criterion of the low level of normal of TLC affects the sensitivity and specificity of the obtained models.

CARACTERIZAÇÃO DA CAPACIDADE VITAL FORÇADA E DO VOLUME EXPIRATÓRIO FORÇADO NO PRIMEIRO SEGUNDO EM ACADÊMICOS FUMANTES E NÃO FUMANTES

INTRODUCTION: It is known that smoking is a major public health problem, causal factor of disabling and fatal diseases, the nicotine present in cigarette composition cause addiction similar to drugs. In this context, one of the safest tests to measure the damage done to the lungs by smoking is spirometric testing, helping to prevent and allowing the diagnosis and quantification of respiratory disorders in patients with respiratory symptoms or known respiratory disease. OBJECTIVE: To evaluate the FVC and FEV1 in young smokers and nonsmokers population. METHODS: A spirometric test of the quantitative type was conducted with 20 students’ smokers and nonsmokers, with a minimum age of 18 years and maximum 35 years and not practicing regular physical activity, in March 2016. It is characterized the FVC, FEV1 and Tiffeneau index for evaluation of pulmonary function, with subsequent analysis and comparison between groups. RESULTS: There were no significant differences between the groups and found literature since the ventilatory disorders in smokers give will see to 20 years / sheaf. CONCLUSION: It is believed that the smoker group was within that normal range, due to smoking time being insufficient to cause changes in the respiratory system.

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.

Anti-NMDA receptor autoimmune encephalitis associated with ovarian teratoma: A case series and literature review.

Autoimmune encephalitis is a group of disorders characterized by symptoms of dysfunction of the limbic and extra-limbic systems that occur in association with antibodies against intracellular antigens, synapses, or proteins located on the surface of nerve cells. Anti-NMDA (N-methyl-D-aspartate) receptor encephalitis was first described in 2007 and has become one of the most commonly recognized autoimmune encephalitides. The disease is predominantly female (81%) and affects young patients (37% <18 years old, 95% <45 years old), with up to 58% of women over 18 years old having ovarian teratoma. Clinical symptoms of anti-NMDA receptor encephalitis include psychiatric disorders (anxiety, agitation, bizarre behavior, hallucinations, delusions, and memory impairment); seizures and epileptic states; and other neurologic symptoms (muscle tone abnormalities, eye movement disorders, and central ventilatory disorders). Diagnosis of this condition can be difficult due to the non-specific nature of the symptoms, often leading to delays in appropriate treatment. Early diagnosis and timely treatment of anti-NMDA receptor encephalitis, especially in young women with ovarian teratoma, has significantly improved the chances of full recovery and improved reproductive health outcomes for patients.

3 cases of obstructive ventilation disorder caused by chronic butanedione exposure

This paper analyzed and discussed 3 cases of the occupational diseases diagnosis and identification of obstructive ventilation disorder caused by chronic butanedione exposure. 3 patients developed recurrent cough 3 months to 2 years after occupational exposure to butanedione. After the activity, the chest tightness and shortness of breath were the main symptoms. Pulmonary function tests presented with ventilatory dysfunction. And the patients were diagnosed as obstructive pulmonary disease caused by occupational chronic butanedione poisoning. It is suggested that butanedione could cause lung ventilation function injury, and provided a basis for the formulation of butanedione occupational exposure limit value and occupational disease diagnosis standard in China.

Post-COVID-19 pneumonia: Long-term radiographic and spirometric outcomes

Objectives: This study aimed to evaluate the long-term radiographic and spirometric outcomes in patients who survived Coronavirus Disease 2019 (COVID-19) pneumonia in Brazzaville, with a focus on identifying the prevalence and contributing factors to persistent pulmonary sequelae. Materials and Methods: A cross-sectional study was conducted in multiple COVID-19 treatment centers in Brazzaville. A total of 52 patients, with a median age of 49.5 years, were assessed at least six months after recovery. Thoracic computed tomography (CT) scans were used to evaluate radiographic abnormalities, while spirometry assessed ventilatory function. Factors contributing to these abnormalities were analyzed, including age, comorbidities, and the severity of the acute illness. Results: Radiographic analysis revealed that 42.3% of patients had abnormal thoracic CT scans, with common findings including ground-glass opacities (52.2%), atelectasis (39.1%), and traction bronchiectasis (13%). Spirometric analysis revealed that 71.1% of patients had ventilatory disorders and predominantly restrictive patterns (51.4%). Advanced age, comorbidities (such as diabetes and hypertension), and the use of mechanical ventilation were significantly associated with radiographic abnormalities. Persistent respiratory symptoms, including chronic cough and dyspnea, were reported by 32.7% of patients, and 44.2% experienced impaired quality of life. Conclusion: These findings underscore the importance of long-term follow-up for COVID-19 pneumonia survivors, particularly those with persistent symptoms or comorbidities. Regular monitoring of respiratory function through spirometry and imaging is essential to managing long-term sequelae and improving patients’ quality of life.

Respiratory virus infections and adenovirus characteristics during acute exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease globally, characterized by obstructive ventilatory disorder under pulmonary function tests. Recent years have witnessed a yearly increase in the prevalence of COPD. To investigate the impact of respiratory virus infections on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to perform sequencing typing and mutation analysis of viruses with high detection rate. A total of 1523 inpatients with AECOPD admitted to our hospital from April 1,2020 to March 30,2022 were collected and divided into two groups: the infected group (n= 532) and the non-infected group (n= 991). The related indexes between the two groups were collected and compared (including clinical characteristics and laboratory tests that blood cell count, PCT, CRP, adenovirus, respiratory syncytial virus, rhinovirus, influenza A virus, influenza B virus, etc.). In the infected group, the proportion of patients with palpitations (49.44% VS 8.07%, P< 0.001), lipid metabolism abnormalities (18.42% VS 39.96%, P< 0.001), heart failure (39.85% VS 29.87%, P< 0.001), disease duration (17.48 ± 7.47 VS 12.45 ± 11.43 d, P< 0.001), and poor prognosis (69.55% VS 17.15%, P< 0.001) were higher than those in the non-infected group; Adenovirus (ADV) accounted for 75.94% (404/532) of all infected viruses. 31 virus strains could be categorized into 16 ADV-C1, one ADV-C5, two ADV-B3, three ADV-B7, two ADV-D17, two ADV-D19, and five ADV-D27, which were similar to the serotypes reported in severe pneumonia. Furthermore, three strains of C1 adenovirus were found to be highly homologous to the original strain AF534906 by sequencing, and the phylogenetic trees of the three main structural genes were all on the same branch as the original strain. Base mutations and amino acid variants were found in each structural gene segment. In clinical data, it's found that patients with mutations are worse than those without mutations. Respiratory viruses are common in patients with poor prognosis of AECOPD, especially adenovirus, respiratory syncytial virus. Respiratory virus infections will lead to the deterioration of patients with AECOPD, accompanied by longer treatment cycles and poor prognosis.

REABILITAÇÃO FISIOTERAPÊUTICA CARDIORRESPIRATÓRIA EM PACIENTES COM DOENÇA DE PARKINSON

Introduction: Parkinson's disease (PD) is a neurodegenerative disorder that affects motor function and often leads to a number of secondary complications, including cardiorespiratory impairments. The importance of cardiorespiratory physical therapy rehabilitation as a vital component of comprehensive care for individuals with PD is emphasized. This study highlights approaches and outcomes associated with cardiorespiratory physiotherapy in Parkinson's disease. Physical inactivity associated with PD may be linked to the appearance of obstructive ventilatory disorders, potentiated by the clinical worsening of the patient. In conclusion, the findings delimit promising results of physical therapy treatment on pulmonary parameters in PD, and sentence the need for further longitudinal studies of the clinical trial type to prove the cause-and-effect relationship of the variables in question. Parkinson's disease (PD) has a chronic and progressive characteristic and affects, in general, the elderly population in the age group between 50 and 70 years, reaching a peak between 60 years and increasing both the prevalence and incidence of PD. Approximately 1 to 2% of the Brazilian population over 65 years of age has PD. Objective: To provide an insight into the role of physical therapy rehabilitation in addressing the cardiorespiratory challenges faced by individuals with PD. Methods: Through a systematic review of existing literature on evidence-based practices, using the PICO strategy. Results and Discussion: 19 articles were found in the main databases, only 04 met the inclusion criteria. Conclusion: The articles studied tend to indicate that cardiorespiratory physiotherapy plays an important role in the treatment of cardiorespiratory complications in Parkinson's.

Pulmonary hypertension in patients carrying FLNA loss-of-function variants.

Pulmonary hypertension (PH) is an unusual complication of X-linked disease caused by loss-of-function (LOF) variants in the filamin A (FLNA) gene. Patients with FLNA LOF may also present dysmorphic facial features, aortic dilation, thrombopenia, and periventricular nodular heterotopia (PVNH). We reported clinical, functional, radiologic, and hemodynamic characteristics of patients with FLNA LOF variants and PH from the French PH Network. Nine patients were identified with a female to male ratio of 8:1. PH was diagnosed at a median age of 36 [0-69] years. Associated conditions included epilepsy (n=5), PVNH (n=7), valvular heart disease (n=8), congenital heart diseases (n=4), thrombocytopenia (n=4), and hyperlaxity (n=4). Right heart catheterisation confirmed moderate-to-severe precapillary PH with a median mPAP of 33 [22-49] mmHg and PVR of 4.7 [2.4-8.0] WU. The DLCO was markedly decreased (48 [22-64] %pred) and five patients had obstructive ventilatory disorder. High-resolution CT showed heterogeneous parenchyma (n=8), emphysema (n=3), presence of a peripheral hyperclear band (n=3) and aortic ectasia (n=4). Pathologic assessment available in one patient revealed significant remodelling of small pulmonary arteries, interstitial edema, and irregular alveoli shapes. During follow-up, three patients died, including two from right heart failure. No patient died from aortic rupture. Precapillary PH, likely due to multiple mechanisms, may complicate the course of patients with LOF FLNA variants and may be the presenting symptom leading to diagnosis. The combination of PH with parenchymal involvement and extrapulmonary symptoms (epilepsy, congenital heart diseases, valvular and aortic involvement, thrombocytopenia) should prompt genetic screening for FLNA.

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.

Взаимосвязь уровня неконьюгированного билирубина и спирометрических показателей у подростков с бронхиальной астмой

Either a high-to-normal or slightly elevated total bilirubin level may have external respiration protective effect in patients with bronchial asthma (BA). However, Authors have searched but not found any studies related to the connection between the unconjugated bilirubin level and spirometric parameters in adolescents. The purpose of this research was to study the connection between unconjugated bilirubin level and spirometric parameters in adolescents with BA. Materials and methods used: a single-center observational cross-sectional pilot study of 74 adolescents aged 10 to 17 y/o with BA was conducted. All participants had undergone measurements of anthropometric and spirometric parameters, hematological parameters, both total and unconjugated bilirubin level. Results: elevated total bilirubin (17.1 mmol/l and higher) occurred in 40.5% (30) being the highest in homozygous carriers of UGT1A1 gene polymorphisms with an increased number of TA repeats, the differences were statistically insignificant. The unconjugated bilirubin level and such spirometric indicators as z-ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity of the lungs (FVC) and z-criterion of the mean forced expiratory flow during the 25-75% of FVC (MEF25-75) had statistically significant direct correlation (R=0,42, p&lt;0,001, R=0,37, p=0,001, respectively). Patients with obstructive lung ventilation disorders at the time of examination (zFEV1/FVC less than -1.645) had lower levels of both total and unconjugated bilirubin, the differences were statistically significant (p=0.002 and p=0.004, respectively). Conclusion: statistically significant correlations between unconjugated bilirubin level and such spirometric parameters as zFEV1/FVC and zMEF25-75 as well as unconjugated bilirubin low level identification in patients with spirometric indicators of bronchial obstruction suggest a protective effect of unconjugated bilirubin on the development of bronchial obstruction in adolescents with BA.

Proportion and risk factors for hospital-acquired venous thromboembolism in children: a systematic review and meta-analysis of data from 20 million individuals in 22 countries

BackgroundHospital-acquired venous thromboembolism (HA-VTE) in children has been widely regarded. ObjectivesWe aimed to analyze the proportion and risk factors for HA-VTE in hospitalized children. MethodsWe conducted a comprehensive systematic search across 4 databases from 1990 to 2023. Cochran Q test was used to evaluate the heterogeneity of the effect sizes of study, and I2 statistic was used to quantify the heterogeneity. Pooled estimates were calculated by the inverse-variance weighted method in a fixed-effect model or a random-effect model when heterogeneity was low (I2 < 25%) or high (I2 > 25%), respectively. ResultsIn total, 105 original papers and 20,718,294 patients were included in the study, and the proportion of HA-VTE in children was 4.1% (95% CI, 2.9%-5.2%). Although the proportion of venous thromboembolism increased over the various research periods, the differences were not statistically significant. In the subgroup analysis based on country, the proportion of pediatric HA-VTE was lowest in the United Kingdom and highest in Spain, whereas when based on region, the proportion was lowest in Asia and highest in North America. Multiple HA-VTE risk factors were identified, including central venous catheter use, age of >10 years, surgery, injury, infection, obesity, mechanical ventilation, blood transfusion, malignancy, coagulation and hemorrhagic disorders, and length of hospital stay. ConclusionIn this study, we systematically analyzed the proportion and risk factors of HA-VTE in hospitalized children. Our findings provide valuable insights for the prevention and treatment of HA-VTE in pediatric patients.

Long-Term Preclinical Evaluation of a Permanent Stent Developed for the Human Eustachian Tube.

The Eustachian tube (ET) is a bottleneck when it comes to middle ear (ME) health. If its function is impaired, this can lead to serious consequences for the patient, such as hearing problems or deafness. Therefore, this study investigated a tapered nitinol stent (3-5 mm × 14 mm) for the human ET as a potential new permanent treatment for chronic Eustachian tube dysfunction (ETD) and thus ME ventilation disorders. The self-expanding stent was inserted unilaterally into the ET of 24 sheep with observation periods of 3, 6, and 12 months. Local tissue effects and the safety of the stent insertion were analyzed based on regular endoscopic checks, weekly tympanometry measurements, final imaging, and histological examinations. The animals showed no stent-related health restrictions. However, the individual anatomy and stenting procedure had an influence on the results. The tissue reaction in the endoscopic examinations was mild even though no concomitant antibiotics were administered. After all three monitoring periods, stented ETs had a significantly larger ET lumen than the non-stented contralateral ETs. However, tissue growth was detected in the stent. Overall, the first long-term study on an ET stent showed that the tapered ET stent could be a promising treatment option for ETD.

Improvement of pulmonary function parameters in female patients with adolescent idiopathic scoliosis by Schroth rehabilitative therapy

ObjectiveThis study investigates if an inpatient rehabilitation therapy (brace therapy and Schroth therapy) for six weeks contributes to an improvement in lung function of the patients. DesignRetrospective study. SettingScoliosis rehabilitation clinic “Asklepios Katharina-Schroth-Klinik” (Bad Sobernheim, Germany). ParticipantsIn 253 female patients a lung function examination was performed at entry and at the end of their inpatient rehabilitation stay. Of these, 61 patients underwent Schroth therapy (group 1); 192 patients underwent the combination of brace and Schroth therapy (group 2). InterventionLung function parameters under the influence of Schroth and Schroth and brace therapy within a rehabilitative stay. Main measuresThe parameters of IVC (inspiratory vital capacity), FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 s) and the Tiffeneau index (FEV/FVC) related to patient-specific reference values were evaluated with regard to potential ventilation disorders. ResultsThere were significant improvements for IVC +2.56 %, FVC +3.99 %, FEV1 +2.36 % for the first stay (IVC and FVC 2nd, 3rd stay). The comparison of patients with vs. without additional brace therapy showed no significances. For the long-term analysis the parameters approached the reference values of age-matched, healthy female subjects. The greater the Cobb angle in the thoracic region, the significantly worse almost each of the measured parameters are. ConclusionAn inpatient rehabilitation therapy contributes to an improvement in lung function (IVC, FVC and FEV1). A second, and even a third, follow-up stay still led to a measurable improvement in lung function, albeit to a lesser extent.

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.

Differences in the elastic work of breathing of the pulmonary parenchyma in patients with bronchial asthma and COPD

To determine and compare the work of breathing to overcome elastic resistance (Ael) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) with similar changes in the elastic properties of the parenchyma in the same settings of ventilation disorders (grade 1). Differences in the manifestations of similar changes in the elastic properties of the lungs in patients with BA and COPD were evaluated. To identify differences, a comparative study was conducted on Аel overcome in BA patients with positive bronchodilator (with salbutamol) and bronchoconstrictor (with methacholine) tests, with reduced and preserved bronchial conductance (groups 1 and 2, respectively), and in COPD patients with negative bronchodilator and bronchoconstrictor tests (group 3). All study patients showed a grade 1 lung ventilation disorder (a decrease in the one-second forced expiratory volume by 15-35%). The results were compared with each other and with the control group (group 4, healthy non-smokers). All study patients were comparable by age and sex. The respiration mechanics was studied using simultaneous registration of spirogram and transpulmonary pressure, and the parameters of bronchial conductance and ventilation were determined using body plethysmopressography using the Jager software and hardware system. In COPD patients, Ael was significantly increased (p>0.05), whereas in both BA groups, it was unchanged. Increased elastic work of breathing in patients with COPD may be associated with the involvement of certain types of contractile elements, which are preserved in patients with BA at the initial stages of the disease.