Ventilatory Disorders Research Articles

PREOPERATIVE AND POSTOPERATIVE PULMONARY REHABILITATION IN PATIENTS WITH LUNG CANCER AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study was to analyze the world experience in the objective assessment of the functional state of the bronchopulmonary system in lung cancer patients with chronic obstructive pulmonary disease (COPD) using modern diagnostic tools and techniques as well as correction of ventilation disorders in the perioperative period using long-acting inhaled bronchodilators. Material and methods. A literature search was conducted using the Medline, Elibrary etc. databases. Out of 112 publications concerning the study of the incidence of lung cancer and COPD, external respiration function and rehabilitation of patients, 37 were included in this review. R esults. COPD was shown to be the major cause of postoperative non-surgical complications and the main predictor of perioperative mortality in lung cancer patients. Modern techniques for studying the function of external respiration, such as bodyplethysmography, spirography, high-resolution computed tomography, ventilation and perfusion lung scintigraphy, were highlighted. It was shown that preoperative correction of obstructive syndrome and postoperative pulmonary rehabilitation, including drug therapy with long-acting bronchodilators in combination with smoking cessation, eradication of foci of chronic infection and respiratory gymnastics were necessary to detect functional respiratory disorders in lung cancer patients with COPD. Conclusion. To date, there are no standards clinical practice guidelines for diagnostic testing and the correction of ventilation disorders in lung cancer patients with COPD in the pre- and postoperative periods. Therefore, further studies aimed at developing a diagnostic algorithm to improve the accuracy of detecting bronchial obstructive syndrome, especially in the early stages of COPD, as well as compensation for respiratory disorders using modern bronchodilator therapy are needed.

Study of oxidative stress parameters in patients with chronic obstructive pulmonary disease exacerbation

The purpose of the study was to perform comparative assessment of circulating diene conjugant (DC, rel. u.) and Schiff's bases (SB, rel. u.) levels, intensity of chemiluminescence (I max , rel. lum. u.) in serum and antioxidant activity (AOA) in patients with chronic obstructive pulmonary disease (COPD) exacerbation taking into consideration broncho-obstructive disorder severity. Materials and Methods. Patients ( n = 119; mean age – 62.0 ± 4.8 years) with COPD were studied. Forced expiratory volume in 1st second (FEV 1 ) in subjects, randomized in group 1 ( n = 31), was ³ 80%, in group 2 ( n = 43) – 79-50%, in group 3 ( n = 45) – < 49%. The control group ( n = 21) comprised of healthy non-smoking volunteers of matching age. Results. It was established that changes in oxidative stress (OS) parameters in patients with COPD could be bidirectional depending on ventilation disorder severity. The level of SB was increased in association with disease severity increasing. High level of DC and I max in all studied subjects was progressively decreased in association with increasing bronchial obstruction severity. There was 2-times increase of AOA at COPD exacerbation in patients of group 2 and significant decrease of this parameter in association with severe bronchial obstruction (FEV 1 < 49%) compared to controls. Conclusion. The associations between levels of studied OS parameters and bronchial obstruction degree in patients with moderate and severe broncho-obstructive disorders.

Lung Function of Traditional Bakers and Pastry Makers Expsosed to Flour Dust in the City of Thies, Senegal

Introduction: Cases of restrictive and obstructive diseases have been reported in workers exposed to flour dust. In Senegal, studies on the lung function of bakery-pastry employees are rare. The purpose of our study was to evaluate the clinical respiratory manifestations and ventilatory disorders (VD) related to flour dust exposure among traditional bakers and pastry makers in the city of Thies, Senegal. Materials and Method: A descriptive cross-sectional study was conducted. Forty subjects were recruited. Subjects received a basic and post-bronchodilator spirometry. The targeted respiratory functional disorders were bronchial obstruction, functional restriction and mixed syndrome. Results: The average length of service at the workplace was 7±6,7 years. Smokers represented 17,5%. A respiratory symptoms were found in 65% of our subjects. Coughing, sneezing and rhinorrhea were more frequent with 50%, 24% and 17% respectively. The most common ventilatory disorders among exposed bakers were of the mixed type (22,5%). On the other hand, 12,5% had an isolated obstructive ventilatory disorder (OVD) and a restrictive functional disorder (RFD) was found in 10%. The obstructive ventilatory disorders were dominated by obstruction of the small airways (80%). The severity of ventilatory disorders was of a moderate deficit type (87% and 62% respectively). Respiratory function abnormalities were more common in the smokers with a prevalence of ventilatory disorders that increased with age of employment. However, the effect of exposure appears to be clear because among non-smokers, 12,13 % of the exposed patients had respiratory functional abnormalities with isolated restrictive functional disorder type. Conclusion: This study showed that bakery and pastry workers have various respiratory symptoms and ventilatory disorders. Smoking and job tenure remain factors that increase these flour dust-related risks.

Impact of Fuel Exposure on Ventilatory Function among Petrol Pump Attendants in Thies, Senegal

Introduction: Petrol pump attendants are exposed to toxic substances in fuels. The release of petrol fumes during fuel refuelling is a repeated and often harmful source of exposure for petrol pump attendants. The purpose of our study was to evaluate the ventilatory disorders related to fuel exposure among petrol pump attendants. Materials and Method: Forty petrol pump attendants have been recruited. The study included a medical survey with a questionnaire that examined anthropometric characteristics, seniority, smoking habits and working conditions. The study included a medical survey with a questionnaire that examined anthropometric characteristics, seniority, smoking habits and working conditions. All our subjects received a basic and post-bronchodilator spirometry. The targeted respiratory functional disorders were bronchial obstruction, restrictive syndrome and mixed syndrome. Obstructive syndrome has been reported on the basis of: FEV1/ FVC and/or FEF25-75% less than 80%. Functional restriction was defined on the basis of a decrease in FVC <80% and the normal FEV1/FVC ratio. The mixed syndrome was retained firstly before the combination of the two obstructive and restrictive spirometric anomalies. Results: We noted 20% of active smokers and 25% of ex-smokers. The average length of service was 9.4 ± 7.05 years. All of the petrol pump attendants used incomplete means of protection. No employee was receiving medical follow-up. Most subjects (52.5%) were unaware of the risks associated with fuel exposure. Respiratory functional disorders were dominated by isolated obstructive ventilatory disorder (OVD) in 45% of subjects and were mainly located in the distal bronchi (65%). Besides, 12.5% of subjects had an isolated restrictive functional disorder (RFD) and a mixed syndrome in 27.5% of cases. Obstructive and mixed ventilatory disorders were more important according to smoking status. The different ventilatory disorders (VD) appeared from the beginning of exposure with a predominance of obstructive ventilatory disorders. Mixed ventilatory disorders increased significantly after 10 years of exposure. Conclusion: Exposure to petrol / diesel fumes has harmful effects on the ventilatory function of petrol pump attendants.

Verticalization of frontal P axis on electrocardiography in patients with acute exacerbation of chronic obstructive pulmonary disease and asthma

Objective To investigate the clinical significance of verticalization of frontal P axis on electrocardiagraphy (ECG) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma. Methods Thirty five COPD patients and 20 asthma patients with acute exacerbation admitted in Jing′an District Central Hospital were enrolled and 20 health subjects served as a control group. The 12 lead ECG examination, pulmonary function test and high resolution CT (HRCT) scan of lung were performed. The P axis in ECG, pulmonary function and CT emphysema score were compared among three groups. The correlation of P axis verticalization with pulmonary function and CT emphysema score was analyzed. Results There were significant differences in P axis(F=24.36), FEV1/FVC(F=39.36), FEV1(F=28.82), FEV1%(F=30.64), FVC%(F=3.45), PEF%(F=13.22), RV/TLC(F=10.46) and total emphysema score (F=50.60) among the three groups (all P 60 ° as cut-off value for screening COPD, the sensitivity was 0.933, specificity was 0.667, positive predictive value was 0.833 and negative predictive value was 0.857. Conclusion The verticalization of frontal P axis on ECG is significantly associated with obstructive ventilation disorder and CT emphysema score, which can be used as a preliminary screening index for COPD. Key words: Pulmonary disease, chronic obstructive; Respiratory function test; Electrocardiography; Vectorcardiography; Pulmonary emphysema

Risk factors affecting postoperative pulmonary function in congenital diaphragmatic hernia.

PurposeIt is well known that congenital diaphragmatic hernia (CDH) in infants impacts pulmonary function rehabilitation after surgery. However, the risk factors of postoperative pulmonary function are still unclear. In this research, we analyzed the potential risk factors of postoperative pulmonary function in CDH patients in order to improve the clinical management of CDH patients.MethodsThirty-three cases CDH infants followed were enrolled from November 2016 to September 2018. Clinical data were reviewed. Tidal breathing pulmonary function testing was performed after surgery. Correlation between pulmonary function and clinical characteristics was evaluated using multivariate analysis of variance.ResultsPulmonary dysfunction was detected in 87.9% patients (29 of 33). The defect size was found to be significantly larger in patients with obstructed and mixed ventilatory disorders (P = 0.001). Diagnosis of gestational age (GA) was also significantly earlier compared to restrictive ventilatory disorders (P = 0.001). Larger defect size, and earlier prenatal diagnosis of GA were detected in severe obstructive ventilatory disorders (P = 0.007, P = 0.001, retrospectively).ConclusionMost patients had various degrees of pulmonary dysfunction after surgery. Patients with larger defect size and earlier diagnosis time might be vulnerable to severe obstructive and mixed ventilatory disorders.

Ventilation and diffusion lung capacity dynamics in destructive pulmonary tuberculosis patients with endobronchial valve treatment

The endobronchial valve block (EVB) improves the treat-ment results of destructive pulmonary tuberculosis (PT), but is accompanied by exclusion of the correspon ding lung part from the breathing act. Data on the lung func-tion against the EVB background in PT patients are scarce. Objective: to evaluate the ventilation and diffusion lung capacity in patients requiring EVB and the dynamics of functional parameters against the endobronchial occlu-sion background. Materials and methods: 78 patients (from 18 to 81 years of age) with destructive pulmonary tuberculosis were observed (spirometry, diffusion lung capacity DLCO, and body plethysmography) before EVB. 28 patients have undergone lung function tests against the background of endobronchial occlusion. Results: Lung function testing before the endoscopic stage of treatment showed that in patients with destruc-tive pulmonary tuberculosis, the obstructive variant of ventilation disorders prevailed (63%); while restrictive (6%) and mixed (9%) variants were less common. Ventila-tion disorders were not detected in 22% of the examined patients. Decrease in pulmonary gas exchange was seen in the absolute majority of the examined patients (86%), including patients with normal lung ventilation. Against the background of endobronchial occlusion, there was a significant decrease in airway parameters (FEV1 de-creased to 0.3l, Rtot was 25% higher than the predicted value), decrease in vital capacity (to 0.2l), increase in the residual volume of the total lung capacity (+ 5.1% of pre-dicted va lue). Only 28.6% of the examined patients had a decrease of DLCO, 60.7% had no significant changes in the pulmonary gas exchange, and 10.7% had an increase of DLCO. The dynamics of most parameters of ventilation and gas exchange in the early (up to 6 weeks) and late periods of EVB (6–8 months) did not differ significantly.Conclusion: Endobronchial occlusion leads to up to a 10% decrease of airway patency and vital capacity com-pared to baseline. A decrease in the main ventilation characteristics was observed both in the early and later stages of EVB, without significantly affecting the diffu-sion lung capacity

The Impulse oscillometry in the diagnosis of respiratory mechanics defects in elderly patients with lung cancer

Traditional pulmonary function tests (PFTs) (spirometry, body plethysmography, diffusion test) are quite time-consuming and difficult to perform methods, especially in the elderly patients. Impulse oscillometry (IOS) is advantageous in that all measurements are carried out with quiet breathing for 30–60 s and do not require the active participation of the patient. Objective: to compare IOS with traditional PFTs and to study its capabilities in the diagnosis of respiratory disorders in patients with lung cancer in the elderly patients. Materials and methods: an observational cross-sectional cohort study was performed. The study included 57 patients (55 (97%) male and 2 (3%) female, median age 69 (65–73) years). Smokers or ex-smokers accounted for 93% (39% and 54%, respectively), non-smokers — 7%. Central lung cancer was diagnosed in 22 (39%), peripheral lung cancer — in 35 (61%) patients. Results: ventilation disorders were detected in 54 (95%) patients, including 52 (96%) of obstructive, 1 — restrictive and 1 — mixed respiratory defects. Lung diffusion capacity was reduced in 30 (53%) patients. According to IOS data, deviations from the norm of R5, X5, AX (R5–R20) were detected in 43 (75%) patients. There was a statistically significant correlation between the parameters of the IOS with para­meters of spirometry and most of the parameters of body plethysmography. Conclusion: IOS can be used to assess respiratory mechanics in elderly lung cancer patients.

A Case Of Ventilatory Disorder Due To Subcutaneous Emphysema After Elevated EtCO&lt;sub&gt;2&lt;/sub&gt; During Total Laparoscopic Hysterectomy

A Case Of Ventilatory Disorder Due To Subcutaneous Emphysema After Elevated EtCO&lt;sub&gt;2&lt;/sub&gt; During Total Laparoscopic Hysterectomy

Un cas clinique de syndrome d’hyperplasie neuroendocrine pulmonaire diffuse idiopathique (DIPNECH)

DIPNECH is a strictly histological entity according to the WHO 2015 classification and is considered to be at pre-neoplastic risk. It has been proposed that DIPNECH syndrome should be used to describe patients have clinical symptoms, an obstructive ventilatory disorder and compatible radiological abnormalities. The diagnosis is histological and usually based on a surgical lung biopsy. We report the case of a 58-year-old woman with a chronic cough for over 20years who had an obstructive airway pattern on spirometry. Diagnoses of asthma and COPD had been discussed. After 7years of follow-up, the DIPNECH hypothesis was evoked on the scanning aspect of mosaic attenuation, expiratory trapping and micronodules, which was subsequently confirmed by surgical pulmonary biopsy. It is necessary to consider the possibility of this rare disease in order to avoid inappropriate treatments and in the hope that future therapeutic advances (somatostatin analogs, mTOR inhibitors) improve patients' experience and the progression of respiratory function.

Assessment of selected parameters of the circulatory system in patients undergoing oral aspirin challenge.

IntroductionIt is known that the administration of the drug during the oral aspirin challenge (OAC) can cause hypersensitivity symptoms not only from the respiratory system or skin, but also from the cardiovascular system.AimTo assess the occurrence and nature of cardiovascular adverse events during the OAC in patients suspected of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs).Material and methodsThe study included 52 patients with symptoms of hypersensitivity to aspirin (ASA) or other NSAIDs in the form of skin reactions or respiratory response in anamnesis. Patients were treated with OAC and simultaneously were subject to monitoring of clinical manifestations of hypersensitivity to ASA/NSAIDs, ventilation disorders and cardiovascular functions.ResultsThe most common reaction of the cardiovascular system during OAC was tachycardia or supraventricular and ventricular extrasystoles, regardless of the day of the study and the result of OAC. Supraventricular and ventricular tachycardia was recorded incidentally. Atrial or ventricular fibrillation or flutter was not observed. There was no evidence of any ischemic heart disease. In 2 patients, hypotension was registered, but only 1 of them required typical treatment of anaphylaxis.ConclusionsNo clinically significant cardiac arrhythmias were recorded during OAC. The changes observed in the records of blood pressure and ECG monitoring show that OAC performed in accordance with the current guidelines does not pose a high risk to the patient’s health and life as a result of cardiovascular reactions.

Pediatric sleep disordered breathing: a narrative review

Pediatric sleep disordered breathing is a spectrum of ventilatory disorders associated with multisystem complications. In this literature review, we are discussing the impact of obstructive sleep apnea (OSA) in pediatric patients, the presentation and phenotypic variations, sleep disordered breathing in special populations, screening for suspected sleep apnea, diagnosis and management of pediatric OSA.

Autopneumonektomie. Ein vergessenes Krankheitsbild

An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. Acarotid endarterectomy was also performed without any complication. After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.

Competing mechanisms of plasticity impair compensatory responses to repetitive apnoea.

Intermittent reductions in respiratory neural activity, a characteristic of many ventilatory disorders, leads to inadequate ventilation and arterial hypoxia. Both intermittent reductions in respiratory neural activity and intermittent hypoxia trigger compensatory enhancements in inspiratory output when experienced separately, forms of plasticity called inactivity-induced inspiratory motor facilitation (iMF) and long-term facilitation (LTF), respectively. Reductions in respiratory neural activity that lead to moderate, but not mild, arterial hypoxia occludes plasticity expression, indicating that concurrent induction of iMF and LTF impairs plasticity through cross-talk inhibition of their respective signalling pathways. Moderate hypoxia undermines iMF by enhancing NR2B-containing NMDA receptor signalling, which can be rescued by exogenous retinoic acid, a molecule necessary for iMF. These data suggest that in ventilatory disorders characterized by reduced inspiratory motor output, such as sleep apnoea, endogenous mechanisms of compensatory plasticity may be impaired, and that exogenously activating respiratory plasticity may be a novel strategy to improve breathing. Many forms of sleep apnoea are characterized by recurrent reductions in respiratory neural activity, which leads to inadequate ventilation and arterial hypoxia. Both recurrent reductions in respiratory neural activity and hypoxia activate mechanisms of compensatory plasticity that augment inspiratory output and lower the threshold for apnoea, inactivity-induced inspiratory motor facilitation (iMF) and long-term facilitation (LTF), respectively. However, despite frequent concurrence of reduced respiratory neural activity and hypoxia, mechanisms that induce and regulate iMF and LTF have only been studied separately. Here, we demonstrate that recurrent reductions in respiratory neural activity ('neural apnoea') accompanied by cessations in ventilation that result in moderate (but not mild) hypoxaemia do not elicit increased inspiratory output, suggesting that concurrent induction of iMF and LTF occludes plasticity. A key role for NMDA receptor activation in impairing plasticity following concurrent neural apnoea and hypoxia is indicated since recurrent hypoxic neural apnoeas triggered increased phrenic inspiratory output in rats in which spinal NR2B-containing NMDA receptors were inhibited. Spinal application of retinoic acid, a key molecule necessary for iMF, bypasses NMDA receptor-mediated constraints, thereby rescuing plasticity following hypoxic neural apnoeas. These studies raise the intriguing possibility that endogenous mechanisms of compensatory plasticity may be impaired in some individuals with sleep apnoea, and that exogenously activating pathways giving rise to respiratory plasticity may be a novel pharmacological strategy to improve breathing.

Effects of PM2.5 on Cardio-Pulmonary Function Injury in Open Manganese Mine Workers.

Exposure to fine particulate matter 2.5 (PM2.5) is associated with adverse health effects, varying by its components. The health-related effects of PM2.5 exposure from ore mining may be different from those of environment pollution. The aim of this study was to investigate the effects of different concentrations of PM2.5 exposure on the cardio-pulmonary function of manganese mining workers. A total of 280 dust-exposed workers who were involved in different types of work in an open-pit manganese mine were randomly selected. According to the different concentrations of PM2.5 in the working environment, the workers were divided into an exposed group and a control group. The electrocardiogram, blood pressure, and multiple lung function parameters of the two groups were measured and analyzed. The PM2.5 exposed group had significantly lower values in the pulmonary function indexes of forced expiratory volume in one second (FEV1.0), maximum mid expiratory flow (MMEF), peak expiratory flow rate (PEFR), percentage of peak expiratory flow out of the overall expiratory flow volume (PEFR%), forced expiratory flow at 25% and 75% of forced vital capacity (FEF 25, FEF75), forced expiratory flow when 25%, 50%, and 75% of forced vital capacity has been exhaled (FEF25%,FEF50%, FEF75%), and FEV1.0/FVC% (the percentage of the predicted value of forced vital capacity) than the control group (all p < 0.05). Both groups had mild or moderate lung injury, most of which was restrictive ventilatory disorder, and there was significant difference in the prevalence rate of restrictive respiratory dysfunction between the two groups (41.4% vs. 23.6%, p = 0.016). Electrocardiogram (ECG) abnormalities, especially sinus bradycardia, were shown in both groups, but there was no statistical difference of the prevalence rate between the two groups (p > 0.05). Also, no significant difference of the prevalence rate of hypertension was observed between the PM2.5 exposure and control groups (p > 0.05). PM2.5 exposure was associated with pulmonary function damage of the workers in the open-pit manganese mine, and the major injury was restrictive ventilatory disorder. The early effect of PM2.5 exposure on the cardiovascular system was uncertain at current exposure levels and exposure time.

Faal Paru Dinamis

Pulmonary function is an examination to measure lung volume function using spirometry. Tests with spirometry to detect abnormalities associated with respiratory distress. Spirometry examination is not only to determine the diagnosis but also to assess the severity of obstruction, restriction, and the effects of treatment. Spirometry examination is a test to measure the volume of a person’s static and dynamic lungs with a spirometer tool. Dynamic lung spirometry consists of Forced vital capacity (FVC), Forced expiratory volume (FEVT), Forced expiratory flow200-1200 / FEF 200-1200, Forced expiratory flow25% -75% / FEF 25% -75%, Peak expiratory flow rate / PEFR, Maximum voluntary ventilation / MVV / MBC, FEV1 / FVC Ratio. Ventilation disorders consist of: restriction and obstruction disorders. Restriction is a disorder of lung development by any cause. In obstruction disorder, it shows a decrease in velocity of expiratory flow and normal vital capacity. FEV values, which are widely used are FEV1 / FVC, abnormal when &lt;80%, FEV1 / FVC ratio &lt;80%. This parameter is very important because the accuracy level for obstruction in the central airway is quite large. In obstructive disorder there is generally a decrease in pulmonary dynamic volume. Significant parameters are FEV 1 / FVC, PEFR, and FEF 25-75. The FEV1 / FVC ratio is important because the accuracy level for obstruction in the central airway is considerable, whereas FEF 25-75 indicates obstruction in the small airway.

Ventilatory Support via Mouthpiece to Facilitate Ambulation.

The aim of the study was to evaluate the efficacy of noninvasive ventilatory assistance/support via mouthpiece to improve performance in 6-min walk tests for individuals with severe restrictive ventilatory disorders. Each subject performed the 6-min walk test breathing spontaneously and again while using mouthpiece noninvasive ventilatory assistance/support at full ventilatory support. Oxyhemoglobin saturation (O2 sat), heart rate, Borg scale, distance walked, and ambulation duration were recorded. Eighteen patients using nocturnal nasal noninvasive ventilatory assistance/support, median (interquartile range) age of 58.5 (20) yrs, were studied. Their median baseline forced vital capacity and PaCO2 were 940 (385) ml and 54.1 (6) mm Hg, respectively. All used noninvasive ventilatory assistance/support for at least overnight hours for 36 (111) mos. Because of the progression of ventilatory impairment and hypercapnia, daytime mouthpiece noninvasive ventilatory assistance/support was initiated. All the 6-min walk test parameters improved significantly by using noninvasive ventilatory assistance/support. Both initial and final values of O2 saturation significantly increased (92% [6] vs 96% [2], P < 0.001) and (80% [19] vs 85.50% [13], P = 0.001), respectively. The median distance walked increased by 43% with noninvasive ventilatory assistance/support (175 [218] m vs 250 [113] m, P = 0.017), and the total ambulation time also increased with noninvasive ventilatory assistance/support (5.45 [3] mins vs. 6 [0] mins, P = 0.008). The exercise tolerance of patients with severe ventilatory impairment can improve by using noninvasive ventilatory support.

Respiratory muscles dysfunction and respiratory diseases.

This review presents an analysis of the literature on the topic of respiratory muscle (RM) dysfunction in various forms of respiratory pathology: chronic obstructive pulmonary disease (COPD), asthma, community-acquired pneumonia, idiopathic pulmonary fibrosis (IPF), sarcoidosis and interstitial lung diseases (ILD), associated with systemic connective tissue diseases (polymyositis, dermatomyositis and systemic lupus erythematosus - SLE). Various clinical and pathophysiological aspects of RM dysfunction and general patterns of its pathogenesis were examined. It was proved that the role of RM in the development of respiratory failure depends on the form and stage of the pulmonary pathology and the severity of systemic manifestations of these diseases: excessive proteolysis, oxidative stress, hypoxia, chronic systemic inflammation. These factors modify the morphofunctional status of RM, worsens their contractile function, which is contributed to the development of respiratory failure. In some cases, the primary weakness of RM precedes the clinical manifestation of pulmonary pathology, which is distinctive for some variants of myositis-associated ILD and SLE. Endogenous intoxication syndrome plays a significant role in the development of RM dysfunction during community-acquired pneumonia. It is noted that sarcoid pulmonary ventilation disorders associate with the RM weakness, but not with the degree of lung damage. In most cases, secondary RM dysfunction predominates that contributes to respiratory failure progression, which is especially noticeable in case of COPD, asthma and IPF.

Pulmonary ventilation and gases exchange disorders in workers engaged into refractory materials production

Introduction.Occupational exposure to dust in concentrations sometimes exceeding allowable norms, infl uence of associated hazards (irritating gases, toxic chemicals, unfavorable microclimate at workplace, heavy physical work) cause occupational and occupationally conditioned bronchopulmonary diseases and lower work capacity in workers with main occupations of refractory materials production.Objective.To study functional state of respiratory system for diagnosis of early disorders of pulmonary ventilation and gases exchange in workers of moulded refractory materials production.Materials and methods.Prospective randomized study included apparently healthy male workers (n = 61) of refractory materials plant producing chamott e-silica and spinel-periclase-carbon refractories. Clinic of Ekaterinburg medical research center in 2017–2018 provided examination of carriers (n=21) in spinel-periclase-carbon refractories production shop and pressmen (n=40) of moulding area in chamott e-silica refractories production, aged 27 to 60 years, with length of service in hazardous conditions from 4 to 37 years. Bodyplethysmography helped to assess general lung capacity (GLC), residual lung volume, ratio of residual lung volume to general lung capacity, functional residual lung capacity, bronchial resistance and diff usion lung ability by carbon oxide via single inspiration method. For nonventilated lung volume, the authors used ∆ GLC value that is a diff erence between GLC values measured via bodyplethysmography and via helium dilution in single inspiration maneuver.Results.Obstructive syndrome (6.5%) was a main type of ventilation disorders among the examinees, and equally frequent among the workers engaged into spinel-periclase-carbon refractories production (9.5%) and in those engaged into chamott esilica refractories production (5%). Th e workers engaged into spinel-periclase-carbon refractories production had obstructive syndrome associated with lung hyperinfl ation, and those engaged into chamott e-silica refractories production had also a tendency to restrictive disorders. Lung gases exchange disorders were seen in one third of the examinees, equally frequent in both workers engaged into spinel-periclase-carbon refractories production and those engaged into chamott e-silica refractories production, manifested in 2 variants: lower diff usion lung capacity (fi rst variant) and lower diff usion lung capacity with increased ∆ GLC (second variant).Conclusion.Th e study results prove necessity of bodyplethysmography and diff usion lung capacity diagnosis to reveal perfusion and ventilation disorders at early stages in workers engaged into spinel-periclase-carbon refr actories production over 8 years and in those engaged into chamott e-silica refr actories production over 12 years.

Spirometry in selected clinical situations

Spirometry is the most frequently performed functional test of the respiratory system. In pulmonological practice it is a basic tool used to diagnose ventilation disorders and to monitor treatment. The results obtained during the test are compared to predicted values, that is, assumed parameter values, computed on the basis of anthropometrical data such as: age, gender and height, with the use of complex equations. The use of additional variables including, e.g. an ethnic group or a race as well as corrective factors, enables a more exact determination of their values. Spirometry can be conducted in a sitting or standing position; however, for the subject safety reasons it is usually performed in a sitting position. It allows to eliminate the risk of fall as a result of syncope or impaired balance. Spirometry in a standing position should be considered in measurably obese patients or in patients with a wide abdominal circumference caused by other reasons. Patients with normal body weight obtain equivalent or slightly higher spirometric values in a standing position. In the selected clinical situations some problems with the measurement of the actual hight of patients in a standard way (measurement without shoes, feet together, upright position, eyes straight ahead) and with correct calculation of predicted values occur. They are, among others, silhouette-disturbing disorders or diseases causing changes in body proportions, from the less often occurring, like Marfan syndrome or achondroplasia, to more frequent posture defects and mobility impairments. These diseases influence the change of the predictive functional parameter values which are used to compare with the obtained results. The aim of the study is to demonstrate the methods of height and predicted values determination on the basis of measurements of ranges between different body points with the use of simple and complex equations in a group of patients in whom the application of standard measurement methods is impossible.