Early Midlife Pulmonary Function and Dementia Risk.

BACKGROUND: Poor pulmonary function (PPF) is associated with increased risk of dementia, yet it is unclear if PPF in early adulthood to midlife increases risk, independent of smoking and subsequent vascular disease. OBJECTIVE: This study evaluated the association between multiple markers of PPF in early adulthood to midlife and long-term risk of dementia. METHODS: We evaluated 27,387 members of an integrated health care system with forced expiratory volume in 1, 2 seconds, and vital capacity collected from 1964 to 1973 (mean age=41.8±4.2 y). Associations of PPF with dementia diagnoses from January 1, 1996 to September 30, 2015 were evaluated with Cox proportional hazards models adjusted for demographics, height, body mass index, hypertension, smoking status, diabetes, stroke, and heart failure. RESULTS: In total, 7519 individuals (27%) were diagnosed with dementia. In fully adjusted Cox proportional hazards models, for all PPF measures each liter decrease was associated with a 13% to 14% higher risk of dementia. Compared with the highest quintile, the first quintile of PPF measures were associated with a 24% to 28% increased risk of dementia; second to fourth quintiles showed strong dose-dependent associations. Results were similar when stratified by smoking status. CONCLUSIONS: In this large, diverse cohort, multiple measures of PPF in early adulthood to midlife were associated with dementia risk independent of smoking and vascular comorbidities.

Augmenting breath regulation using a mobile driven virtual reality therapy framework.

This paper presents a conceptual framework of a virtual reality therapy to assist individuals, especially lung cancer patients or those with breathing disorders to regulate their breath through real-time analysis of respiration movements using a smartphone. Virtual reality technology is an attractive means for medical simulations and treatment, particularly for patients with cancer. The theories, methodologies and approaches, and real-world dynamic contents for all the components of this virtual reality therapy (VRT) via a conceptual framework using the smartphone will be discussed. The architecture and technical aspects of the offshore platform of the virtual environment will also be presented.

Improved air trapping evaluation in chest computed tomography in children with cystic fibrosis using real-time spirometric monitoring and biofeedback.

BACKGROUND: The quality of chest Computed Tomography (CT) images in children is dependent upon a sufficient breath hold during CT scanning. This study evaluates the influence of spirometric breath hold monitoring with biofeedback software on inspiratory and expiratory chest CT lung density measures, and on trapped air (TA) scoring in children with cystic fibrosis (CF). This is important because TA is an important component of early and progressive CF lung disease. METHODS: A cross sectional comparison study was completed for chest CT imaging in two cohorts of CF children with comparable disease severity, using spirometric breath hold monitoring and biofeedback software (Copenhagen (COP)) or unmonitored breath hold manoeuvres (Gothenburg (GOT)). Inspiratory-expiratory lung density differences were calculated, and TA was scored to assess the difference between the two cohorts. RESULTS: Eighty-four chest CTs were evaluated. Mean (95%CI) change in inspiratory-expiratory lung density differences was 436 Hounsfield Units (HU) (408 to 464) in the COP cohort with spirometric breath hold monitoring versus 229 HU (188 to 269) in the GOT cohort with unmonitored breath hold manoeuvres (p<0.0001). The Mean TA (95%CI) score was 6.93 (6.05 to 7.82) in COP patients and 3.81 (2.89 to 4.73) in GOT (p<0.0001) patients. CONCLUSIONS: In children with comparable CF lung disease, spirometric breath hold monitoring during examination yielded a large difference in lung volume between inhalation and exhalation, and allowed for a significantly greater measured change in lung density and TA score, compared to unmonitored breath hold maneuvers. This has implications to the clinical use of chest CT, especially in children with early CF lung disease.

El estudio de instrumentos de viento se asocia con un patrón obstructivo en la espirometría de adolescentes con buena capacidad de resistencia aeróbica / Playing of wind instruments is associated with an obstructive pattern in the spirometry of adolescents with a good aerobic resistance capacity

ObjetivoExiste controversia en la literatura médica respecto al efecto beneficioso o perjudicial de la práctica con instrumentos musicales de viento sobre el sistema respiratorio. El objetivo de este estudio es analizar esta relación en sujetos jóvenes en periodo de aprendizaje, ponderando su nivel de condición física.DiseñoEstudio observacional transversal.EmplazamientoCentro Integrado de Enseñanzas Artísticas y Musicales (estudios musicales reglados de Grado Medio) y de Educación Primaria y Secundaria, de titularidad pública.ParticipantesJóvenes estudiantes de entre 13–17 años.Mediciones principalesSe recogieron parámetros epidemiológicos básicos (sexo, edad, peso, talla, estado de salud) y a cada sujeto se le realizó un test de condición física (prueba de aptitud cardiorespiratoria de «course navette»), y una espirometría forzada.ResultadosSe incluyeron 90 alumnos, 53 mujeres y 37 varones, de los cuales 32 eran instrumentistas de viento y 58 de otros instrumentos. Los 2 grupos fueron homogéneos respecto a sexo, edad e índice de masa corporal. El consumo máximo de oxígeno no mostró diferencias significativas (p=0,255), manifestando además un adecuado nivel de condición física respecto a la población general. La CVF fue normal y comparable en ambos grupos (p=0,197). El VEMS porcentual y el cociente VEMS/CVF fueron significativamente menores (p<0,0005) en el grupo de viento. La práctica con instrumentos de viento se comportó como variable predictora de VEMS/CVF patológico (<70%) en el análisis multivariante (p<0,0005).ConclusionesEl estudio de instrumentos de viento se asoció con un patrón espirométrico obstructivo en músicos jóvenes con un nivel normal de condición física(AU)

ObjectiveThere is controversy in the medical literature regarding the beneficial or detrimental effects of playing wind musical instruments on the respiratory system. The aim of this study is to analyse this relationship, taking the physical condition of the subjects into consideration.DesignCross-sectional observational study.SettingPublic institution with coordinated medium grade musical instruction and primary and secondary education.ParticipantsYoung performers (between 13 and 17 years).DataWe collected basic epidemiological parameters (gender, age, weight, size, heath status), and each subject underwent a fitness test (“course navette” cardiorespiratory fitness test) and a forced spirometry.ResultsWe included 90 students, 53 females and 37 males. Thirty two were wind instrument players and 58 studied other instruments. The two groups were homogeneous with respect to gender, age and body mass index. The maximum oxygen uptake showed no significant difference (P=0.255), further demonstrating an adequate level of fitness compared to the general population. FVC was normal and similar in both groups (P=0.197). The FEV1 percentage and the FEV1/FVC ratio were significantly lower (P<0.0005) in the “wind” group. Practice with wind instruments behaved as a predictor of pathological FEV1/FVC (<70%) in the multivariate analysis (P<0.0005).ConclusionThe study of wind instruments was associated with an obstructive spirometric pattern in young musicians with a normal level of physical fitness(AU)

Rehabilitación respiratoria en pediatría / Pulmonary rehabilitation in children

La rehabilitación respiratoria se ha consolidado como parte fundamental del manejo y tratamiento de muchos enfermos pulmonares crónicos en edad adulta. La literatura reporta constante información de los múltiples beneficios que tiene el ejercicio practicado de manera sistemática, tanto en sujetos enfermos como sanos, sean estos niños o adultos; siempre considerando una acabada evaluación inicial que permita detectar aquellos en quienes el ejercicio produzca efectos deletéreos en su salud. En nuestro país, el concepto de rehabilitación respiratoria en pediatría está escasamente desarrollado. Sólo existen esfuerzos aislados, que solucionan problemas individuales y no colectivos. El Programa Nacional de Asistencia Ventilatoria no Invasiva en Domicilio (AVNI), es probablemente el primer esfuerzo sistemático en aplicar los principios de la rehabilitación pulmonar en pediatría, en donde un equipo trans-disciplinario le ofrece a los pacientes pediátricos portadores de una patología neuromuscular un enfoque integral que mejore su condición de calidad de vida. Este artículo resume algunos conceptos en torno a los principios de entrenamiento muscular en niños, el concepto de presión inspiratoria y la introducción de válvulas de entrenamiento.

Velocity and attenuation of sound in the isolated fetal lung as it is expanded with air.

We measured the velocity and attenuation of audible sound in the isolated lung of the near-term fetal sheep to test the hypothesis that the acoustic properties of the lung provide a measure of the volume of gas it contains. We introduced pseudorandom noise (bandwidth 70 Hz-7 kHz) to one side of the lung and recorded the noise transmitted to the surface immediately opposite, starting with the lung containing only fetal lung liquid and making measurements after stepwise inflation with air until a leak developed. The velocity of sound in the lung fell rapidly from 187 +/- 28.2 to 87 +/- 3.7 m/s as lung density fell from 0.93 +/- 0.01 to 0.75 +/- 0.01 g/ml (lung density = lung weight/gas volume plus lung tissue volume). For technical reasons, no estimate of velocity could be made before the first air injection. Thereafter, as lung density fell to 0.35 +/- 0.01 g/ml, there was a further decline in velocity to 69.6 +/- 4.6 m/s. High-frequency sound was attenuated as lung density decreased from 1.0 to 0.5 g/ml, with little change thereafter down to a density of 0.35 +/- 0.01 g/ml. We conclude that both the velocity of audible sound through the lung and the degree to which high-frequency sound is attenuated in the lung provide information on the degree of inflation of the isolated fetal lung, particularly at high lung densities. If studies of sound transmission through the lung in the intact organism were to confirm these findings, the acoustic properties of the lung could provide a means for monitoring lung aeration during mechanical ventilation of newborn infants.

Respiratory functions in Kalaripayattu practitioners.

Kalaripayattu, an ancient traditional martial art form of Kerala, is considered as the basis for all martial arts viz. Karate, Kungfu, etc. physiological studies are more concentrated on Karate, Kungfu and other martial arts due to their global acceptance. Considering the limited knowledge available regarding the physiological profiles of Kalaripayattu practitioners, the present study was taken up for filling the lacunae in the field. Lung function tests were carried out in ten Kalari practitioners. Residual volume was measured by indirect method. Higher lung volumes and flow rates were achieved in Kalari practitioners compared to age and height-matched controls. Better mechanical factors and lower airway resistance influenced during Kalari practice might have benefited in improving hung volumes and flow rates.

Breathing patterns during breathing exercises in persons with tetraplegia.

STUDY DESIGN: Cross-sectional, observational, controlled study. OBJECTIVES: To survey breathing patterns during breathing at rest, ordinary deep breathing (DB), positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) among individuals with a cervical spinal cord lesion (SCL) compared with able-bodied controls. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. METHOD: Participants consisted of 20 persons with a complete SCL at the C5-C8 level (at least 1 year postinjury) and 20 matched, able-bodied controls. Breathing patterns and static lung volumes were measured using a body plethysmograph. RESULTS: Compared to the controls, breathing patterns at rest among the people with tetraplegia were characterised by a decreased tidal volume, stable respiratory rate and total cycle duration resulting in decreased mean inspiratory and expiratory flow, and alveolar ventilation. All volume and flow parameters increased except respiratory rate, which decreased during DB and PEP. During IR-PEP, tidal volume increased less compared to PEP, and combined with a decreased respiratory rate the alveolar ventilation was lower than during breathing at rest. The functional residual capacity increased during PEP and IR-PEP in people with tetraplegia. CONCLUSION: DB exercises with or without resistance during expiration or the whole breathing cycle affect the breathing pattern in persons with tetraplegia. DB was superior in increasing volumes and flow. PEP and IR-PEP increased FRC but IR-PEP decreased volumes and flows. However, large interindividual differences in the SCL group indicate the need for caution in generalising the results. SPONSORSHIP: This work was supported in part by grants from the Memorial Foundation of the Swedish Association of registered Physiotherapists and the Association of Cancer and Road Accident Victims.

Transpulmonary speed of sound input into the supraclavicular space.

The transpulmonary speed of sound input at the mouth has been shown to vary with lung volume. To avoid the disadvantages that exist in certain clinical situations in inputting sound at the mouth, we input sound in the supraclavicular space of 21 healthy volunteers to determine whether similar information on the relationship of sound speed to lung volume could be obtained. We measured the transit time at multiple microphones placed over the chest wall using a 16-channel lung sound analyzer (Stethographics). There was a tight distribution of transit times in this population of subjects. At functional residual capacity, it was 9 +/- 1 (SD) ms at the apical sites and 13 +/- 1 ms at the lung bases. The sound speed at total lung capacity was 24 +/- 2 m/s and was 22 +/- 2 m/s at residual volume (P < 0.001). In all subjects, the speed of sound was faster at higher lung volume. This improved method of studying the mechanism of sound transmission in the lung may help in the development of noninvasive tools for diagnosis and monitoring of lung diseases.

The management of neuromuscular ventilatory failure.

All patients with respiratory impairment have either primarily ventilatory or primarily oxygenation impairment. Patients with neuromuscular conditions fall into the former category but are all too often managed as though they had the latter with oxygen therapy, bronchodilators, chest physical therapy, intermittent positive pressure breathing, and so on. This approach can only hasten respiratory failure and management by tracheostomy-However, it has been reported that with the use of noninvasive respiratory muscle aids, respiratory morbidity and mortality can be prevented for most patients with neuromuscular disease without resort to tracheostomy or even hospitalization.

Central alveolar hypoventilation in a child: an evaluation using a whole body plethysmograph.

A disorder in the central nervous system control of breathing is thought to be responsible for the clinical syndrome of "primary" or central alveolar hypoventilation. Only 2 of the 7 reported cases in children have included any functional evaluation of this control system disorder. We report the case of a 2-year-old girl with central alveolar hypoventilation attributed to an abnormality in be central nervous system of unknown etiology. In evaluating her ventilatory control system, we used a method (whole body pleildren and small animals but has since received little clinical use. The findings included an irregular respiratory rhythm and a diminished ventilatory response to inhaled CO2, which suggested a functional abnormality of brainstem neurons responsible for rhythmic effective breathing and the CO2 response. A relatively normal change in breathing with sleep and exercise as well as qualitively normal peripheral chemoreceptor function suggested that these aspects of the control system were undisturbed. These findings are contrasted to those in other children; it is suggested that the syndrome of central alveolar hypoventilation may reflect a variety of functional abnormalities in the nervous system control of ventilation.