Benefits of chest wall mobilization on respiratory efficiency and functional exercise capacity in people with severe chronic obstructive pulmonary disease (COPD): A randomized controlled trial.

BACKGROUND: Coexistence of chest wall hypomobility and lung hyperinflation compromises respiratory muscle function and respiratory efficiency in people with severe chronic obstructive pulmonary disease (COPD). This study aimed to investigate the effect of chest wall mobilization on functional exercise capacity, respiratory muscle activity and respiratory muscle tissue oxygen saturation for people with severe COPD. METHODS: Thirty male adults (age: 75 ± 6) diagnosed with severe COPD completed a 6-week programme (twice/week) according to intervention randomization (chest wall mobilization group, CWMG, n = 15; control group, CG, n = 15). Both groups received standardized education and walking exercise, while CWMG also received chest wall and thoracic spine mobilization. Electromyography of the essential and accessory respiratory muscles and tissue oxygen saturation of the intercostal muscle (StO2, measured by near-infrared spectroscopy) during incremental cycle exercise test were measured and compared between the two groups at pre-programme, post-programme and 3-month follow-up. RESULTS: Patients in CWMG demonstrated a significant increase in exercise tolerance from <3 METS to 4-6 METS (p = 0.000) after intervention. A significant decrease in activity of scalene, sternocleidomastoids and intercostal muscle during exercise test (p < 0.01) was found in CWMG, as compared to CG. A significant decrease in StO2 (p < 0.05) and greater decline in the slope of oxygenation dissociation (p = 0.000) were seen in CWMG during exercise test. These positive results were maintained at 3-month follow-up in CWMG. CONCLUSION: Improvements in exercise tolerance, respiratory muscle efficiency and oxygenation extraction ability in CWMG suggest a potential clinical benefit of integrating chest wall and thoracic spine mobilization for rehabilitation of people with severe COPD.

Recurrent respiratory papillomatosis (RRP) of tracheobronchial tree presenting as lung collapse with malignant transformation after a decade.

Recurrent respiratory papillomatosis is a rare disease caused by HPV infection. We hereby report a patient with recurrent respiratory papillomatosis of the tracheobronchial tree with no laryngeal involvement who remained clinically stable for more than 10 years but then developed malignant transformation with metastases. A 61-year-old lady with good past health presented to our department in 2010 because of chronic cough for years. Chest X-ray showed reduced left lung volume. Bronchoscopy showed multiple nodules over left main bronchus and left upper lobe progressing to involve the posterior trachea and left lower lobe. Biopsy revealed squamous papilloma with mild dysplasia. She refused surgical intervention. She remained relatively stable until November 2022 when she developed left chest pain. CT showed features of malignant transformation with local invasion and metastases. Fine needle aspiration suggested squamous cell carcinoma. She succumbed in December 2022. Bronchoscopy should be considered in the investigation of unexplained chronic cough so that this rare disease can be detected at an early stage. The disease may not require intervention if uncomplicated. Despite clinical stability for a prolonged period, close monitoring for malignant transformation is warranted indefinitely.

Reference values of diffusing capacity of non-smoking Chinese in Hong Kong.

BACKGROUND AND OBJECTIVE: This study was conducted to define normal reference values and lower limits of normal (LLN) for single-breath carbon monoxide diffusing capacity (DLco) and DLco per unit of alveolar volume (Kco) for Chinese adults in Hong Kong. METHODS: Healthy non-smoking men and women aged 18-80 years were recruited by random digit dialing. DLco and Kco were measured according to American Thoracic Society standards. Reference equations were obtained by multiple linear regression; LLN were derived by distribution-free method for estimation of age-related centiles. RESULTS: Tests from 568 subjects (259 men, 309 women) were analysed. DLco declined with age in both genders, and increased with height and the interaction term of height and age in men and women, respectively. Considering Hb values did not improve the reference equations. Kco declined with age and increased with weight in both genders, while height and its interaction term with age were additional determinants in women. The reference DLco was lower than some Caucasian values, and was only explained partially by a smaller body size and alveolar volume in Chinese. The distribution-free method yielded better overall approximation to the fifth percentile compared with the traditional method of determining LLN. CONCLUSIONS: The equations for reference values and LLN of diffusing capacity derived in this study are of clinical relevance to Chinese subjects.