Current status of prevention and treatment of respiratory diseases in primary care in China: a cross-sectional study.

BACKGROUND: China launched its new round of health care reform to develop primary care in 2009, establishing 954,390 primary care institutions that employed over 10 million staff by 2019. However, some studies have shown that the prevention and management of respiratory diseases is inadequate in these institutions. METHODS: We conducted a cross-sectional survey of grassroots institutions throughout China between September and December 2020 based on the standardized Prevention and Treatment System and Capacity Building Project of Respiratory Diseases in primary care settings. The operation of the respiratory department in primary health care institutions was evaluated in terms of facilities, drugs, personnel and management of chronic diseases by means of questionnaires. Descriptive analyses were performed to calculate percentages and frequencies of key parameters. RESULTS: A total of 144 primary health care institutions were surveyed, including 51 in the east, 82 in the west, 9 in the central and 2 in the northeast. Approximately 60% of institutions had spirometers and pulse oximeters. The majority had short-acting bronchodilators, theophylline, systemic corticosteroids, antibiotics, and traditional Chinese medicine. More than half had at least one respiratory physician and operator for spirometry. Half of the institutions carried out screening of chronic obstructive pulmonary disease within the jurisdiction. The institutions in the east were superior to those in the west regarding the equipment, common drugs, medical staff, and management of respiratory diseases. CONCLUSIONS: The study reveals that the overall operation of the respiratory department in primary care settings needs to be further strengthened. It is crucial to provide adequate essential equipment, medical professionals, and medicines for proper diagnosis and treatment of chronic respiratory diseases, as well as improving the management of diseases.

Feasibility and Efficacy of Inspiratory Muscle Training in Patients with Head and Neck Cancer receiving Concurrent Chemoradiotherapy.

OBJECTIVES: Patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT) often experience pulmonary symptoms. This study evaluated if a 7-week inspiratory muscle training (IMT) program during CCRT is feasible, adherent, and safe in patients with HNC. This study also evaluated the effect of IMT on diaphragm thickness, mobility, and cardiorespiratory parameters in patients with HNC receiving CCRT. METHODS: Ten participants with advanced stage HNC receiving CCRT were recruited for the study. Feasibility, adherence, and safety of the intervention were the primary outcomes. Changes in diaphragm thickness and mobility, maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, forced expiratory volume in first second and functional capacity using 6-MWT were measured at baseline and post 7 weeks of CCRT. IMT was performed at one session per day for 5 days a week for 7 weeks. Eight sets of two minutes of inspiratory manoeuvres with one minute rest period between them with intensity of 40% MIP were given. RESULTS: Ten participants  were included in this study out of the 13 patients screened, indicating the feasibility to be 76.9%. Participants completed a total of 260 training sessions out of the 350 planned sessions denoting the adherence level as 74%. Diaphragm thickness and MEP remained significantly unchanged while significant decline was seen in diaphragm mobility, MIP,FVC, FEV1 and 6-MWD at the end of 7 weeks. No adverse events were reported following the intervention. CONCLUSION: Inspiratory muscle training did not show significant effect on the diaphragm thickness, mobility, and cardiorespiratory parameters; however, it was feasible, adherent, and safe in patients with HNC receiving CCRT.

Respiratory Muscle Training Improves Strength and Decreases the Risk of Respiratory Complications in Stroke Survivors: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the effects of respiratory muscle training in a population of stroke patients. DATA SOURCES: The following databases were searched for clinical trials through December 2019: PubMed, EMBASE, Cochrane Library, CINAHL, and China National Knowledge Infrastructure. STUDY SELECTION: Randomized controlled trials (N=9) published in English met the inclusion criteria. DATA EXTRACTION: Data were extracted and assessed for accuracy by 2 reviewers. Any disagreements were resolved after discussions with an independent third reviewer. The quality of the included randomized controlled trials was assessed using the Cochrane bias tool. DATA SYNTHESIS: The meta-analysis showed increased maximal inspiratory pressure (standardized mean difference [SMD], 0.88; 95% confidence interval [CI], 0.62-1.15; P<.001; 12-wk follow-up period: SMD, 0.94; 95% CI, 0.42-1.45; P<.001), maximal expiratory pressure (SMD, 0.83; 95% CI, 0.15-1.52; P=.017; 12-wk follow-up period: SMD, 0.99; 95% CI, 0.47-1.51; P<.001), forced expiratory volume in 1 second (SMD, 1.41; 95% CI, 0.57-2.24; P=.001), forced vital capacity (SMD, 1.36; 95% CI, 0.55-2.16; P<.001), peak expiratory flow (SMD, 0.74; 95% CI, 0.16-1.32; P=.013), 6-minute walk test (SMD, 0.67; 95% CI, 0.11-1.23; P=.020), and decreased respiratory complications (odds ratio, 0.55; 95% CI, 0.30-1.00; P=.050) compared with no respiratory intervention or a sham intervention. CONCLUSIONS: Respiratory muscle training improved poststroke muscle strength and the benefits were carried over for up to 12 weeks, including improved lung function, walking capacity, and a reduced risk of respiratory impediments.

Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children.

BACKGROUND: Upper gastrointestinal endoscopies (UGEs) performed under ketamine sedation may increase the risk of respiratory adverse events (RAEs) due to pharyngeal stimulation. Topical lidocaine prevents general anesthesia-induced laryngospasm. OBJECTIVE: Our objective was to determine whether topical lidocaine may reduce the incidence of RAEs induced by pharyngeal stimulation in UGEs performed on children sedated with ketamine. METHODS: We conducted a single-center prospective study. We included every patient admitted for an elective diagnostic UGE under ketamine sedation who received lidocaine prior to the technique. Patients requiring any other medication were excluded. Our main outcome measure was the number of desaturation episodes. We then compared these results with those obtained in an historic group who did not receive topical lidocaine, in which we registered a total of 54 desaturation episodes. RESULTS: In total, 88 children (52.3% boys) were included. The median age was 7 years [interquartile range (IQR) 3-11]. The mean duration of the procedure was 6.5 ± 2.4 min, and the median initial ketamine dose was 1.76 mg/kg (IQR 1.56-2.03). The total number of desaturation episodes was 3 (3.4%), and two of these occurred prior to the introduction of the endoscope. This result represents a lower incidence than in previously reported series, and a significant decrease (p < 0.0001) with respect to the 54 RAEs registered in the historic group of 87 children. CONCLUSIONS: Topical lidocaine premedication significantly reduced the incidence of RAEs in children during UGEs under ketamine sedation. Our findings should be confirmed by a double-blind randomized controlled trial.

Effect of preoperative inspiratory muscle training on physical functioning following esophagectomy.

This study aims to examine the effect of preoperative inspiratory muscle training (IMT) on pre- and postoperative functional exercise performance in patients undergoing esophagectomy. A subcohort of patients recruited to the PREPARE randomized control trial were studied. Following evaluation of respiratory muscle function (spirometry, maximum inspiratory pressure (MIP), and inspiratory muscle endurance), postoperative mobilization (accelerometry) and postoperative physical functioning (6-minute walk test (6MWT)), participants scheduled for esophagectomy were randomly assigned to either 2 weeks of preoperative IMT or a control group. Measures were repeated on the day before surgery and postoperatively. Sixty participants (mean (standard deviation) age 64.13 (7.8) years; n = 42 male; n = 43 transthoracic esophagectomy; n = 17 transhiatial esophagectomy) were included in the final analysis (n = 28 IMT; n = 32 control). There was a significant improvement in preoperative MIP (P = 0.03) and inspiratory muscle endurance (P = 0.04); however preoperative 6MWT distance did not change. Postoperatively, control participants were more active on postoperative day (POD)1, and from POD1-POD5 (P = 0.04). Predischarge, 6MWT distance was significantly lower in the IMT group (305.61 (116.3) m) compared to controls (380.2 (47.1) m, P = 0.03). Despite an increase in preoperative respiratory muscle function, preoperative IMT does not improve pre- or postoperative physical functioning or postoperative mobilization following esophagectomy.

[Respiratory Rehabilitation to Reduce Respiratory Complications after Cardiovascular Surgery].

The number of cardiovascular surgical operations has been increasing, accompanied by an increase in the number of patients with an aging patient and various comorbidities. For this reason, the risk of respiratory complications after cardiovascular surgery is high, and ingenuity to alleviate this is necessary. We evaluated preoperative respiratory function and examined whether there is a difference in the onset of postoperative respiratory complications with or without respiratory rehabilitation from preoperative. As a result, the incidence of respiratory complications was significantly reduced in the group subjected to preoperative respiratory rehabilitation. Also, the intensive care unit stay was significantly shortened. From this, it is important to perform respiratory rehabilitation from preoperative time. And as a breathing exercise method, active cycle breathing technique is safe and highly effective.

Los ejercicios respiratorios postoperatorios reducen el riesgo de complicaciones pulmonares en pacientes sometidos a lobectomía / Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy

Objetivo: Evaluar los efectos de un programa intensivo de fisioterapia postoperatoria basado en ejercicios respiratorios dirigido a pacientes lobectomizados mediante toracotomía abierta. Diseño : Estudio cuasiexperimental. Emplazamiento: Hospital universitario terciario. Participantes: Doscientos ocho (208) pacientes lobectomizados mediante toracotomía abierta. Intervención: Los pacientes del grupo control (n=102) recibieron atención médica/de enfermería estándar y los pacientes del grupo experimental (n=106), además de la atención clínica estándar, se sometieron a un programa de fisioterapia diaria basada en ejercicios respiratorios hasta el momento del alta hospitalaria. Variables de resultado: Las variables de resultado estudiadas incluyeron la frecuencia de complicaciones pulmonares postoperatorias (CPP) más susceptibles de tratamiento fisioterapéutico (neumonía, atelectasias e insuficiencia respiratoria) y la duración de la estancia hospitalaria (DEH). Resultados: Las características preoperatorias y quirúrgicas de ambos grupos fueron comparables. La incidencia de CPP registrada fue de un 20,6% en el grupo control y un 6,6% en el grupo experimental (p = 0,003). La mediana y el RIC de la DEH fue de 14 y 7días, respectivamente (estimador M de Huber 14,21) en el grupo control y de 12 y 6días (estimador M de Huber 12,81) en el grupo experimental. El modelo de regresión logística creado identificó al programa de fisioterapia evaluado (p = 0,017; EXP (B) [IC 95% 0,081-0,780]) y al porcentaje del FEV1 (p = 0,042; EXP (B) [IC 95% 0,941-0,999]) como factores protectores frente al desarrollo de CPP en los pacientes intervenidos de lobectomía. Conclusiones: La implementación de un programa intensivo de fisioterapia postoperatoria basado en ejercicios respiratorios reduce el riesgo de desarrollar CPP y la DEH en pacientes lobectomizados

Objective: To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Design: Quasi-experimental study. Setting: Tertiary referral academic hospital. Participants: 208 patients undergoing lobectomy by open thoracotomy. Interventions: Control group patients (n = 102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Outcomes: Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Results: Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P = .003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P = .017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P = .042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Conclusions: Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy

Efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation in patients undergoing off-pump coronary artery bypass grafting.

BACKGROUND: Postoperative complications after cardiac surgery increase mortality. This study aimed to evaluate the efficacy of cardiopulmonary rehabilitation with adaptive servo-ventilation (ASV) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS AND RESULTS: A total of 66 patients undergoing OPCAB were enrolled and divided into 2 groups according to the use of ASV (ASV group, 30 patients; non-ASV group, 36 patients). During the perioperative period, all patients undertook cardiopulmonary rehabilitation. ASV was used from postoperative day (POD) 1 to POD5. Hemodynamics showed a different pattern in the 2 groups. Blood pressure (BP) on POD6 in the ASV group was significantly lower than that in the non-ASV group (systolic BP, 112.9±12.6 vs. 126.2±15.8 mmHg, P=0.0006; diastolic BP, 62.3±9.1 vs. 67.6±9.3 mmHg, P=0.0277). The incidence of postoperative atrial fibrillation (POAF) was lower in the ASV group than in the non-ASV group (10% vs. 33%, P=0.0377). The duration of oxygen inhalation in the ASV group was significantly shorter than that in the non-ASV group (5.1±2.2 vs. 7.6±6.0 days, P=0.0238). The duration of postoperative hospitalization was significantly shorter in the ASV group than in the non-ASV group (23.5±6.6 vs. 29.0±13.1 days, P=0.0392). CONCLUSIONS: Cardiopulmonary rehabilitation with ASV after OPCAB reduces both POAF occurrence and the duration of hospitalization.

[Cost-consequence analysis of respiratory preventive intervention among institutionalized older people: randomized controlled trial]. / Descripción de los resultados y costes de una intervención preventiva a nivel respiratorio en el anciano institucionalizado: ensayo controlado aleatorizado.

INTRODUCTION: The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment. MATERIAL AND METHODS: A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n=54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective. RESULTS: The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to Euro 21,678. CONCLUSIONS: This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate.

Effectiveness of antenatal corticosteroids in reducing respiratory disorders in late preterm infants: randomised clinical trial.

OBJECTIVES: To determine the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks' gestation. Design Randomised triple blind clinical trial. Setting A large tertiary teaching hospital in northeast of Brazil. Participants Women at 34-36 weeks of pregnancy at risk of imminent premature delivery. Interventions Betamethasone 12 mg or placebo intramuscularly for two consecutive days. Main outcomes measures Primary outcome was the incidence of respiratory disorders (respiratory distress syndrome and transient tachypnoea of the newborn). Secondary outcomes included the need for ventilatory support, neonatal morbidity, and duration of stay in hospital. RESULTS: 320 women were randomised, 163 of whom were assigned to the treatment group and 157 to the controls. Final analysis included 143 and 130 infants, respectively. The rate of respiratory distress syndrome was low (two (1.4%) in the corticosteroid group; one (0.8%) in the placebo group; P = 0.54), while the rate of transient tachypnoea was high in both groups (34 (24%) v 29 (22%); P = 0.77). There was no reduction in the risk of respiratory morbidity with corticosteroid use even after adjustment for subgroups of gestational age (34-34(+6) weeks, 35-35(+6) weeks, and ≥ 36 weeks). The adjusted risk of respiratory morbidity was 1.12 (95% confidence interval 0.74 to 1.70). The need for ventilatory support was around 20% in both groups. There was no difference in neonatal morbidity (88 (62%) v 93 (72%); P = 0.08) or in the duration of stay in hospital between the two groups (5.12 v 5.22 days; P = 0.87). Phototherapy for jaundice was required less often in babies whose mothers received corticosteroids (risk ratio 0.63, 0.44 to 0.91). CONCLUSIONS: Antenatal treatment with corticosteroids at 34-36 weeks of pregnancy does not reduce the incidence of respiratory disorders in newborn infants. Trial registration Clinical Trials NCT00675246.

Respiratory outcomes in early childhood following antenatal vitamin C and E supplementation.

BACKGROUND: Prenatal antioxidant supplementation might influence fetal lung growth and development and reduce infant respiratory morbidity. The aim of this study was to test the hypothesis that infants of mothers at risk of pre-eclampsia who were randomised to receive high-dose vitamins C and E (1000 mg vitamin C and 400 IU RRR α-tocopherol daily) during pregnancy would have better respiratory outcomes than infants whose mothers were randomised to receive placebo. METHODS: Respiratory outcomes to 2 years of age were documented using questionnaires and, in a subset, by recording their healthcare utilisation and calculating the cost of care data. RESULTS: 330 women who had taken vitamin supplementation and 313 who had taken placebo completed the respiratory questionnaire (386 and 366 infants, respectively). There were no significant differences between the two groups in the proportions diagnosed with asthma. 54 women who had taken vitamin supplementation and 45 who had taken placebo took part in the healthcare utilisation study (65 and 53 infants, respectively). On average, infants of mothers receiving vitamin supplementation had 2.6 (99% CI 0.8 to 5.1) times more A&E/outpatient visits and 3.2 (99% CI 0.2 to 6.9) times more GP visits than infants of mothers receiving placebo, and their costs of care were £226 (99% CI £27 to £488) more for outpatient admissions, £57 (99% CI £3 to £123) more for GP visits and £22 (99% CI £3 to £50) more for medications. CONCLUSIONS: High-dose antenatal vitamin C and E supplementation does not improve infant respiratory outcome and is associated with increased healthcare utilisation and cost of care.

Olive oil during pregnancy is associated with reduced wheezing during the first year of life of the offspring.

OBJECTIVE: To test the hypothesis that consuming Mediterranean diet and using olive oil for cooking/dressing salads during pregnancy might be associated with less wheezing during the first year of the offspring's life. METHODS: A study was conducted in 1,409 infants (mean age, 16.6 +/- 2.5 months) attending healthy infant clinics in Spain. Dietary data of mothers' intake during pregnancy was collected by means of a parental food frequency questionnaire. Demographic information and data on wheezing during the first year of the offspring's life were also recorded. Infants were stratified according to any wheezing (42.2%) during the first year of life. RESULTS: In the univariate analysis, adherence to a Mediterranean diet and using olive oil for cooking/dressing salads during pregnancy were both significantly associated with less wheezing during the first year of life. However, after multivariate analysis, only olive oil consumption during pregnancy remained associated with less wheezing in the studied period (aOR = 0.57 [95% CI = 0.4-0.9]); whereas male gender (1.8 [1.4-2.3]), day care attendance (2.15 [1.5-3.1]), maternal asthma (2.16 [1.3-3.6]), maternal smoking during pregnancy (1.83 [1.3-2.2]), infant eczema (1.95 [1.3-2.9]), and mould stains on the household walls (1.72 [1.2-2.5]) remained associated with wheezing. CONCLUSION: Our findings suggest a protective effect (primary prevention) of olive oil use during pregnancy on wheezing during the first year of the offspring's life.

Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery.

BACKGROUND: Respiratory muscles are affected after cardiac surgeries. OBJECTIVE: To verify whether the preoperative conditioning of the inspiratory muscles might help to decrease postoperative respiratory dysfunction. METHODS: Thirty volunteers of both genders and with a minimum age of 50 years, while waiting for myocardial revascularization and/or cardiac valve surgery, were randomly assigned to two groups. Fifteen patients were included in a domiciliary program of at least 2 weeks of preoperative training of the inspiratory muscles, using a device with a load corresponding to 40% of the maximum inspiratory pressure. The other 15 patients received general advice and did not train the inspiratory muscle. Spirometry, before and after the training program, as well as the evolution of the arterial blood gases and of the maximum inspiratory and expiratory pressure, before and after the operation were evaluated in both group. The clinical outcomes of the two groups were also compared. RESULTS: We observed that inspiratory muscle training increased the forced vital capacity, the maximum voluntary ventilation and the ratio between the forced expired volume during the first second and the forced vital capacity. The evolution of the arterial blood gases and of the maximum inspiratory and expiratory pressures before and after the operation was similar in both groups, with the outcomes also being similar. CONCLUSION: We concluded that our domiciliary program of inspiratory muscle training was safe and improved the forced vital capacity and the maximum voluntary ventilation, although the clinical benefits of this program were not clearly demonstrable in the present study.

Efeitos de um programa de reabilitação da musculatura inspiratória no pós-operatório de cirurgia cardíaca / Efectos de un programa de rehabilitación de la musculatura inspiratoria en el postoperatorio de cirugía cardiaca / Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery

FUNDAMENTO: Os músculos respiratórios são afetados pós operações cardíacas. OBJETIVO: Verificar se o condicionamento pré-operatório dos músculos inspiratórios poderia ajudar a diminuir a disfunção respiratória pós-operatória. MÉTODOS: Trinta voluntários de ambos os sexos com idade mínima de 50 anos, aguardando cirurgia de revascularização do miocárdio e/ou cirurgia de válvula cardíaca foram alocados de forma randômica em dois grupos. Quinze pacientes foram incluídos em um programa domiciliar de pelo menos 2 semanas de treinamento pré-operatório dos músculos inspiratórios usando um dispositivo com uma carga correspondente a 40 por cento da pressão inspiratória máxima. Os outros 15 receberam orientações gerais e não treinaram os músculos inspiratórios. A espirometria, antes e depois do programa de treinamento, bem como a evolução dos gases sanguíneos arteriais e das pressões inspiratória e expiratória máximas, foram avaliados em ambos os grupos antes e depois da cirurgia. Os desfechos clínicos dos dois grupos também foram comparados. RESULTADOS: Observamos que o treinamento dos músculos inspiratórios aumentou a capacidade vital forçada, a ventilação voluntária máxima e a relação entre o volume expirado forçado no primeiro segundo e a capacidade vital forçada. A evolução dos gases sanguíneos e das pressões expiratória e inspiratória máximas antes e depois da cirurgia foi similar em ambos os grupos, com desfechos também similares. CONCLUSÃO: Concluímos que nosso programa domiciliar de treinamento dos músculos inspiratórios foi seguro e melhorou a capacidade vital forçada e a ventilação voluntária máxima, embora os benefícios clínicos desse programa não tenham sido claramente demonstrados no presente estudo.

BACKGROUND: Respiratory muscles are affected after cardiac surgeries. OBJECTIVE: To verify whether the preoperative conditioning of the inspiratory muscles might help to decrease postoperative respiratory dysfunction. METHODS: Thirty volunteers of both genders and with a minimum age of 50 years, while waiting for myocardial revascularization and/or cardiac valve surgery, were randomly assigned to two groups. Fifteen patients were included in a domiciliary program of at least 2 weeks of preoperative training of the inspiratory muscles, using a device with a load corresponding to 40 percent of the maximum inspiratory pressure. The other 15 patients received general advice and did not train the inspiratory muscle. Spirometry, before and after the training program, as well as the evolution of the arterial blood gases and of the maximum inspiratory and expiratory pressure, before and after the operation were evaluated in both group. The clinical outcomes of the two groups were also compared. RESULTS: We observed that inspiratory muscle training increased the forced vital capacity, the maximum voluntary ventilation and the ratio between the forced expired volume during the first second and the forced vital capacity. The evolution of the arterial blood gases and of the maximum inspiratory and expiratory pressures before and after the operation was similar in both groups, with the outcomes also being similar. CONCLUSION: We concluded that our domiciliary program of inspiratory muscle training was safe and improved the forced vital capacity and the maximum voluntary ventilation, although the clinical benefits of this program were not clearly demonstrable in the present study.

FUNDAMENTO: Los músculos respiratorios se ven afectados tras operaciones cardíacas. OBJETIVO: Verificar si el condicionamiento preoperatorio de los músculos inspiratorios podría ayudar a disminuir la disfunción respiratoria postoperatoria. MÉTODOS: Se dividieron en dos grupos, y de forma randómica, a 30 voluntarios -de ambos sexos, con edad mínima de 50 año- que aguardaban cirugía de revascularización del miocardio y/o cirugía de válvula cardiaca. Se incluyó a un total de 15 pacientes en un programa domiciliar, de por lo menos 2 semanas de entrenamiento preoperatorio de los músculos inspiratorios, utilizándose un dispositivo con una carga correspondiente al 40 por ciento de la presión inspiratoria máxima. Los otros 15 individuos recibieron orientaciones generales y no entrenaron los músculos inspiratorios. Tanto la espirometría, antes y luego del programa de entrenamiento, así como la evolución de los gases sanguíneos arteriales y de las presiones inspiratoria y espiratoria máximas, se las evaluaron en ambos grupos antes y tras la cirugía. Se compararon también los desenlaces clínicos de los dos grupos. RESULTADOS: Observamos que el entrenamiento de los músculos inspiratorios aumentó la capacidad vital forzada, la ventilación voluntaria máxima y la relación entre el volumen espirado forzado en el primer segundo y la capacidad vital forzada. La evolución de los gases sanguíneos y de las presiones espiratoria e inspiratoria máximas antes y tras la cirugía se mostró similar en ambos grupos, con desenlaces también similares. CONCLUSIÓN: Concluimos que nuestro programa domiciliar de entrenamiento de los músculos inspiratorios fue seguro y produjo la mejora de la capacidad vital forzada y la ventilación voluntaria máxima, aunque los beneficios clínicos de ese programa no han sido claramente demostrados en el presente estudio.

Exacerbations in cystic fibrosis: 2 . prevention.

The life span of people with cystic fibrosis (CF) has increased dramatically over the past 50 years. Many factors have contributed to this improvement. Respiratory exacerbations of CF lung disease are associated with the need for hospitalisation and antibiotic treatment, reduction in the quality of life, fragmented sleep and mortality. A number of preventive treatment strategies have been developed to reduce the frequency and severity of respiratory exacerbations in CF including mucolytic agents, physiotherapy and exercise, antibiotics, nutritional strategies, anti-inflammatory treatments and vaccinations against common respiratory pathogens. The evidence for each of these treatments and their potential impact is discussed.

[Aromaphytotherapy in prevention of acute respiratory diseases in children].

The authors' studies show pathogenetic validity of using aromaphytotherapy in children predisposed to acute respiratory diseases. Courses of essential oils aromaphytotherapy produce a wide spectrum of physiological changes reducing frequency of the respiratory diseases, exacerbations of chronic ENT diseases in children.