Preserved Ratio Impaired Spirometry (PRISm): A Global Epidemiological Overview, Radiographic Characteristics, Comorbid Associations, and Differentiation from Chronic Obstructive Pulmonary Disease.

Preserved Ratio Impaired Spirometry (PRISm) manifests notable epidemiological disparities across the globe, with its prevalence and influential factors showcasing pronounced diversities among various geographical territories and demographics. The prevalence of PRISm fluctuates considerably among regions such as Latin America, the United States, and Asian nations, potentially correlating with a myriad of determinants, including socioeconomic status, environmental factors, and lifestyle modalities. Concurrently, the link between PRISm and health risks and other disorders, especially its distinction and interrelation with chronic obstructive pulmonary disease (COPD), has become a pivotal subject of scientific enquiry. Radiographic anomalies, such as perturbations in the pulmonary parenchyma and structural alterations, are posited as salient characteristics of PRISm. Furthermore, PRISm unveils intricate associations with multiple comorbidities, inclusive of hypertension and type 2 diabetes, thereby amplifying the intricacy in comprehending and managing this condition. In this review, we aim to holistically elucidate the epidemiological peculiarities of PRISm, its potential aetiological contributors, its nexus with COPD, and its association with radiographic aberrations and other comorbidities. An integrative understanding of these dimensions will provide pivotal insights for the formulation of more precise and personalised preventative and therapeutic strategies.

Comparing the Effect of Incentive Spirometry and Deep Breathing Exercises on the Level of Shoulder Pain and Nausea Following Laparoscopic Cholecystectomy Surgery: A Clinical Trial Study.

Cholecystitis treated by laparoscopy results in patients experiencing shoulder pain and nausea. Thus, the aim of the present study was to compare the effect of incentive spirometry and deep breathing exercises on the level of shoulder pain and nausea following laparoscopy. In this clinical trial, 105 patients were enrolled into three groups: use of incentive spirometry, deep breathing exercises, and control. Data were collected using a checklist and a visual analog scale and analyzed through the χ2, the Kruskal-Wallis, the Friedman, and the paired t test by SPSS Version 25. In the deep breathing exercise, incentive spirometry, and control groups, mean pain scores immediately after surgery but within 24 hours following the intervention were 3.8, 2.6, and 4.4, respectively. The mean score of severity of nausea for patients in the deep breathing exercise and incentive spirometry groups showed a significant difference immediately after the procedure, as well as at 12 and 24 hours post-intervention. Breathing exercises and incentive spirometry can be effective in reducing pain and nausea in patients undergoing cholecystectomy through laparoscopy. Because of the effectiveness of the two methods, nurses can use incentive spirometery and deep breathing exercises to diminish patients' pain post-cholecystectomy.

Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial.

BACKGROUND AND OBJECTIVE: Hemodynamic changes are among the common complications after coronary artery bypass graft (CABG) surgery. Incentive spirometry (IS) and deep breathing exercises (DBEs) are widely used in patients undergoing CABG surgery. The aim of the present study was to compare the effect of IS and DBEs on hemodynamic and oxygenation parameters of patients undergoing CABG surgery. METHODS: This is a clinical trial that was performed on 40 patients with heart disease who were candidates for coronary artery bypass graft surgery. Participants were selected using convenience sampling and then randomly divided into two groups. One day before surgery, one group was taught how to perform DBE and the other group was taught how to use IS in practice. Hemodynamic and oxygenation indices were measured and recorded before the intervention, the first, second, and the third day after the intervention. Data analysis was carried out using SPSS ver.16 and descriptive and inferential statistical tests. RESULTS: The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the first day after the intervention in patients undergoing the IS group was significantly higher than the DBE group (p<0.05). On the third day after the intervention, the mean arterial oxygen saturation (SaO2) in patients of the IS group was significantly higher than the DBE group and the mean respiratory rate (RR) in patients in the IS group was significantly lower than the DBE group (p <0.05). However, there was no significant difference between the two groups in terms of other indices (p> 0.05). CONCLUSION: The results showed that IS has a greater effect on hemodynamic and oxygenation indices of patients undergoing CABG compared to DBE, so, it is recommended to use IS to improve hemodynamic and oxygenation indices in these patients.

Effects of three pulmonary ventilation regimes in patients undergoing coronary artery bypass graft surgery: a randomized clinical trial.

The aim was to compare the effect of diaphragmatic breathing exercise (DBE), flow- (FIS) and volume-oriented incentive spirometry (VIS) on pulmonary function- (PFT), functional capacity-6-Minute Walk Test (6 MWT) and Functional Difficulties Questionnaire (FDQ) in subjects undergoing Coronary Artery Bypass Graft surgery (CABG). The purpose of incorporating pulmonary ventilator regimes is to improve ventilation and avoid post-operative pulmonary complications. CABG patients (n = 72) were allocated to FIS, VIS and DBE groups (n = 24 each) by block randomization. Preoperative and postoperative values for PFT were taken until day 7 for all three groups. On 7th postoperative day, 6 MWT and FDQ was analyzed using ANOVA and post-hoc analysis. PFT values were found to be decreased on postoperative day 1(Forced Vital Capacity (FVC) = FIS group-65%, VIS group-47%, DBE group-68%) compared to preoperative day (p < 0.001). PFT values for all 3 groups recovered until postoperative day 7 (FVC = FIS group-67%, VIS group-95%, DBE group-59%) but was found to reach the baseline in VIS group (p < 0.001). When compared between 3 groups, statistically significant improvement was observed in VIS group (p < 0.001) in 6 MWT and FDQ assessment. In conclusion, VIS was proven to be more beneficial in improving the pulmonary function (FVC), functional capacity and FDQ when compared to FIS and DBE.

Impact of breath-hold level on positional error aligned by stent/Lipiodol in Hepatobiliary radiotherapy with breath-hold respiratory control.

BACKGROUND: Respiratory motion management with breath hold for patients with hepatobiliary cancers remain a challenge in the precise positioning for radiotherapy. We compared different image-guided alignment markers for estimating positional errors, and investigated the factors associated with positional errors under breath-hold control. METHODS: Spirometric motion management system (SDX) for breath holds was used in 44 patients with hepatobiliary tumor. Among them, 28 patients had a stent or embolized materials (lipiodol) as alignment markers. Cone-beam computed tomography (CBCT) and kV-orthogonal images were compared for accuracy between different alignment references. Breath-hold level (BHL) was practiced, and BHL variation (ΔBHL) was defined as the standard deviation in differences between actual BHLs and baseline BHL. Mean BHL, ΔBHL, and body-related factors were analyzed for the association with positional errors. RESULTS: Using the reference CBCT, the correlations of positional errors were significantly higher in those with stent/lipiodol than when the vertebral bone was used for alignment in three dimensions. Patients with mean BHL > 1.4 L were significantly taller (167.6 cm vs. 161.6 cm, p = 0.03) and heavier (67.1 kg vs. 57.4 kg, p = 0.02), and had different positional error in the craniocaudal direction (- 0.26 cm [caudally] vs. + 0.09 cm [cranially], p = 0.01) than those with mean BHL < 1.4 L. Positional errors were similar for patients with ΔBHL< 0.03 L and > 0.03 L. CONCLUSION: Under rigorous breath-hold respiratory control, BHL correlated with body weight and height. With more accurate alignment reference by stent/lipiodol, actual BHL but not breath-hold variation was associated with craniocaudal positional errors.

Iron deficiency in non-anemic chronic obstructive pulmonary disease in a predominantly male population: an ignored entity.

Non-anemic iron deficiency has been studied in heart failure, but studies are lacking in chronic obstructive pulmonary disease (COPD). The potential clinical implications of association of iron deficiency with the severity of COPD warrant research in this direction. This was an observational, cross-sectional study on patients with COPD to compare disease severity, functional status and quality of life in non-anemic patients with COPD between two groups - iron deficient and non-iron deficient. Stable non-anemic COPD with no cause of bleeding were evaluated for serum iron levels, ferritin levels, TIBC, 6MWD, SGRQ, spirometry, and CAT questionnaire. The study patients were divided into iron replete (IR) and iron deficient (ID) groups. A total of 79 patients were studied, out of which 72 were men and seven were women. The mean age was 61.5±8.42 years. Of these, 36 (45.5%; 95% CI, 34.3-56.8%) had iron deficiency. Mean 6-minute-walk distance was significantly shorter in ID (354.28±82.4 meters vs 432.5±47.21 meters; p=0.001). A number of exacerbations in a year were more in ID group (p=0.003), and more patients in ID had at least two exacerbations of COPD within a year (p=0.001). However, the resting pO2, SaO2, and SpO2 levels did not differ significantly between the two groups (p=0.15 and p=0.52, respectively). Also, there was no significant difference in the distribution of patients of a different class of airflow limitations between the two groups. Non-anemic iron deficiency (NAID) is an ignored, yet easily correctable comorbidity in COPD. Patients with iron deficiency have a more severe grade of COPD, had lesser exercise capacity and more exacerbations in a year as compared to non-iron deficient patients. So, foraying into the avenue of iron supplementation, which has shown promising results in improving functional capacity in heart failure and pulmonary hypertension, may well lead to revolutionary changes in the treatment of COPD.

Desempenho muscular respiratório após 12 sessões de treinamento utilizando o aparelho Reformer do método Pilates / Rendimiento muscular respiratorio después de 12 sesiones de entrenamiento utilizando el aparato Reformer del método Pilates / Respiratory muscle performance after 12 sessions of training using the apparatus Reformer of Pilates method

RESUMO Analisar o desempenho muscular respiratório em praticantes de exercícios utilizando o aparelho Reformer do Método Pilates após um treinamento de 12 sessões. O estudo foi realizado com 24 voluntárias, adultas jovens, saudáveis, não tabagistas e não praticantes de exercício físico regular, divididas em Grupo Controle (GC) e Grupo Treinado (GT). Os dois grupos foram submetidos às avaliações inicial e final para análise do desempenho dos músculos respiratórios por meio da manovacuometria e da eletromiografia do músculo reto abdominal. Utilizou-se o teste de Shapiro-Wilk para verificar a normalidade dos dados. A análise de variância two-way foi empregada para as comparações entre os grupos (GT e GC) e os momentos (inicial e final). Para comparações múltiplas, utilizou-se o teste post-hoc de Scheffé. Os GC e GT foram pareados para idade e IMC e, para verificação de diferenças entre os grupos, utilizou-se o teste t pareado. Considerou-se p<0,05 para significância. Houve diferença significante (p=0,039) entre os valores iniciais (116,6 ± 12,8) e finais (120 ± 12,8) de PImáx no GT, assim como entre os valores iniciais (75,3 ± 12,4) e finais (89,3 ± 13,7) de PEmáx nesse mesmo grupo (p=0,0005). Para a eletromiografia houve diferença significante (p=0,03) entre o momento inicial (42,1 ± 15,8) e final (76,7 ± 37,1) do GT para o músculo reto abdominal esquerdo. Conclui-se que as doze sessões de Pilates utilizando o aparelho Reformer melhoraram o desempenho muscular respiratório, aumentando a força da musculatura inspiratória e expiratória.

RESUMEN Evaluar el rendimiento de los músculos respiratorios en practicantes de ejercicios utilizando el método Reformer de Pilates después de un entrenamiento de 12 sesiones. Este estudio se realizó con 24 voluntarios, adultos jóvenes, sanos, no fumadores y no deportistas regulares, siendo divididos en grupo control (GC) y grupo entrenado (GE). El GE participó en un programa de entrenamiento ejecutando 6 ejercicios en el aparato Reformer. Ambos grupos se sometieron a evaluaciones iniciales y finales para analizar el rendimiento de los músculos respiratorios mediante la manovacuometría y la electromiografía del músculo recto abdominal. La prueba de Shapiro-Wilk se utilizó para verificar la normalidad de los datos. Se utilizó el análisis de varianza two-way para las comparaciones entre los grupos (GE y GC) y los momentos (inicial y final). Para comparaciones múltiples, se utilizó la prueba post-hoc de Scheffé. El GC y el GE se emparejaron por edad e IMC mediante la prueba t pareada. Se consideró el valor de significación p<0,05. Se observó una diferencia significativa (p=0,039) entre los valores iniciales (116,6 ± 12,8) y finales (120 ± 12,8) de PImax en el grupo entrenado, así como entre los valores de iniciales (75,3 ± 12,4) y finales (89,3 ± 13,7) de PEmax en el mismo grupo (p=0,0005). En la electromiografía, se observó una diferencia significativa (p=0,03) entre los momentos inicial (42,1 ± 15,8) y final (76,7 ± 37,1) del GE para el músculo recto abdominal izquierdo. Se concluye que las 12 sesiones de Pilates utilizando el aparato Reformer mejoran el rendimiento de los músculos respiratorios, aumentando la fuerza muscular inspiratoria y espiratoria.

ABSTRACT To analyze respiratory muscle performance in exercise practitioners using the Reformer of Pilates method after a 12-session training. This study was carried out with 24 volunteers, healthy young adults, non-smokers and non-regular exercisers, divided into control group (CG) and trained group (TG). The TG participated in a training program executing 6 exercises in the Reformer apparatus. Both groups were submitted to the initial and final evaluations to analyze the performance of the respiratory muscles through the manovacuometry and electromyography of the rectus abdominis muscle. The Shapiro-Wilk test was used to verify the data normality. Two-way analysis of variance was used for the comparisons between the groups (TG and CG) and moments (Initial and Final). For multiple comparisons, the Scheffé post hoc test was used. The groups Control and Trained were paired by age and BMI by paired t test. P <0.05 was considered for significance. A significant difference (p=0039) was observed between the initial (116.6 ± 12.8) and final (120 ± 12.8) values of MIP in the trained group, as well as between baseline values (75.3 ± 12.4) and final (89.3 ± 13.7) of MEP in the same group (p=0.0005). For electromyography, a significant difference (p=0.03) was observed between the initial (42.1 ± 15.8) and final (76.7 ± 37.1) moments of the TG for the left rectus abdominis muscle. The conclusion is that the 12 Pilates sessions using the Reformer apparatus improve respiratory muscle performance, increasing the inspiratory and expiratory muscle strength.

Sustained maximal inspiration has similar effects compared to incentive spirometers.

PURPOSE: To compare the effects of flow incentive spirometer (FIS), volume incentive spirometer (VIS), and sustained maximal inspiration exercise (SMI) on breathing pattern, chest wall motion, and thoracoabdominal asynchrony. METHODS: Sixteen healthy adults aged 27.63 ± 5.26 years were evaluated by optoelectronic plethysmography in the supine position with trunk inclination of 45° during quiet breathing and during exercise performance. RESULTS: In the comparisons among exercises, VIS promoted a significantly higher inspiratory time and lower mean inspiratory flow compared with FIS. The rating of perceived exertion according to the Borg Scale was significantly higher after the performance of FIS compared with VIS. Regarding asynchrony, none of the exercises caused changes in thoracoabdominal synchrony between the rib cage and abdomen. However, both devices significantly reduced the asynchrony between the pulmonary and abdominal rib cage compared with quiet breathing. CONCLUSION: SMI exercise was equivalent to incentive spirometers and may be an interesting alternative for clinical use in cases in which it is not possible to acquire the devices.

Protocol for a multicentre randomised controlled trial to investigate the effect on asthma-related quality of life from breathing retraining in patients with incomplete asthma control attending specialist care in Denmark.

INTRODUCTION AND AIM: Uncontrolled asthma is a global health challenge with substantial impact on quality of life (QoL) and overall healthcare costs. Unrecognised and/or unmanaged comorbidities often contribute to presence of uncontrolled asthma. Abnormalities in breathing pattern are termed dysfunctional breathing and are not only common in asthma but also lead to asthma-like symptoms and reduced QoL, and, in keeping with this, improvement with breathing normalisation. Evidence-based guidelines recommend breathing retraining interventions as an adjuvant treatment in uncontrolled asthma. Physiotherapy-based breathing pattern modification interventions incorporating relaxation have been shown to improve asthma-related QoL in primary care patients with impaired asthma control. Despite anecdotal reports, effectiveness of breathing retraining in patients referred to secondary care with incomplete asthma control has not been formally assessed in a randomised controlled trial (RCT). We aim to investigate the effect of breathing exercises on asthma-related QoL in patients with incomplete asthma control despite specialist care. METHODS AND ANALYSIS: This two-armed assessor-blinded multicentre RCT will investigate the effect of physiotherapist-delivered breathing retraining on asthma QoL questionnaire (MiniAQLQ) in addition to usual specialist care, recruiting from seven outpatient departments and one specialised clinic representing all regions of Denmark during 2017-2019. We will include 190 consenting adults with incomplete asthma control, defined as Asthma Control Questionnaire 6-item score ≥0.8. Participants will randomly be allocated to either breathing exercise programme in addition to usual care (BrEX +UC) or UC alone. BrEX compiles three physiotherapy sessions and encouragement to perform home exercise daily. Both groups continue usual secondary care management. Primary outcome is between-group difference in MiniAQLQ at 6 months. Secondary outcomes include patient-reported outcome measures, spirometry and accelerometer. ETHICS AND DISSEMINATION: Ethics Committee, Region Zealand (SJ-552) and Danish Data Protection Agency (REG-55-2016) approved the trial. Results will be reported in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT03127059; Pre-results.

The impact on health status in short- and long-terms of a novel and non-orthodox real-world COPD rehabilitation effort in rural India: an appraisal.

BACKGROUND: Rehabilitation has been an integral part of management of COPD. Since the implementation of the standard rehabilitation protocol is hardly possible in the rural developing world, aiming to make a feasible alternate effort may be worthwhile. METHODS: COPD patients diagnosed through spirometry were first stabilized with 6 weeks of uniform pharmacotherapy. Subsequently, they were subjected to a curriculum-based intensive single-session intervention with education, bronchial hygiene, and exercise training. The latter involved whole body exercise, pursed lip breathing, and diaphragmatic exercise. The participants continued to practice the exercises under real-world encouragement and supervision from trained volunteers. The impact was appraised in terms of change in health status through COPD assessment test (CAT) score measurements at stabilization, and after 6 weeks and 1 year of the intensive training and education. RESULTS: At stabilization, 70 out of 96 selected COPD subjects (73%) turned up (with mean age 62±9 years and mean FEV1 as 1.16±0.39 L) showing improvement as per CAT score (p=0.0001) from pharmacotherapy. After practicing the imparted education and training for 6 weeks, all these 70 participants had further significant improvement in the health status (n=70, p=0.00001). This improvement, been reinforced and supervised, continued to last even at 1 year (n=54, p=0.0001). CONCLUSION: The self-managed practice of a single-session education and training under real-world supervision can bring forth significant long-term improvement in the health status of COPD sufferers. Such simple and feasible intervention may substitute formal COPD rehabilitation programs in resource constraint situations.

Validity of ICD9-CM codes to diagnose chronic obstructive pulmonary disease from National Health Insurance claim data in Taiwan.

PURPOSE: Claim data from Taiwan's National Health Insurance (NHI) database have previously been utilized in the study of COPD. However, there are limited data on the positive predictive value of claim data for COPD diagnosis. Therefore, this study aimed to characterize and validate the COPD cohort identified from the NHI research database. METHODS: This cross-sectional study compared records from claim data with those from a medical center. From 2007 to 2014, a COPD cohort was constructed from claim data using ICD9-CM codes for COPD. The diagnostic positive predictive value of these data was assessed with reference to physician-verified COPD. In addition, a multivariate logistic regression model was built to identify independent factors associated with the positive predictive value of COPD diagnosis by claim data. RESULTS: During the 8-year study period, a total of 12,127 subjects met the criterion of having two or more outpatient codes in 1 year or one or more inpatient COPD codes in their claim data. Of this total, the diagnosis of COPD was verified by physicians in 7,701 (63.5%) subjects. Applying a more stringent criterion - three or more outpatient codes or two or more inpatient codes - improved the diagnostic positive predictive value to 72.2%. Age ≥65 years and a claim for spirometry were the two most important factors associated with the positive predictive value of claim-data-defined COPD. Adding spirometry testing to diagnostic ICD9-CM codes for COPD increased the positive predictive value to 84.6%. CONCLUSION: This study emphasizes the importance of validation of disease-specific diagnosis prior to applying an administrative database in clinical studies. It also indicates the limitation of ICD9-CM codes alone in recognizing COPD patients within the NHI research database.

Characteristics of COPD phenotypes classified according to the findings of HRCT and spirometric indices and its correlation to clinical characteristics.

INTRODUCTION: In recent years, there has been increasing interest in diagnosing various components of chronic obstructive pulmonary disease (COPD) using high-resolution computed tomography (HRCT). The present study was undertaken to evaluate HRCT features in patients with COPD. MATERIALS AND METHODS: Fifty patients of COPD (confirmed on Spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. The Philips computer program for lung densitometry was used with these limits (-800/-1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes. RESULTS: There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). A mild linear correlation of pre-forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. CONCLUSION: HRCT may be an important additional tool in the holistic evaluation of COPD.

Breath-stacking and incentive spirometry in Parkinson's disease: Randomized crossover clinical trial.

Patients with Parkinson's disease often exhibit respiratory disorders and there are no Respiratory Therapy protocols which are suggested as interventions in Parkinson's patients. The aim of this study is to evaluate the effects of Breathing-Stacking (BS) and incentive spirometer (IS) techniques in volume variations of the chest wall in patients with Parkinson's Disease (PD). 14 patients with mild-moderate PD were included in this randomized cross-over study. Volume variations of the chest wall were assessed before, immediately after, then 15 and 30 min after BS and IS performance by optoelectronic plethysmography. Tidal volume (VT) and minute ventilation (MV) significantly increased after BS and IS techniques (p < 0.05). There was greater involvement of pulmonary and abdominal compartments after IS. The results suggest that these re-expansion techniques can be performed to immediately improve volume.

Diagnosing COPD and supporting smoking cessation in general practice: evidence-practice gaps.

OBJECTIVES: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers' experiences with and preferences for smoking cessation. DESIGN, SETTING AND PARTICIPANTS: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. RESULTS: 1050 patients attended baseline interviews (February 2015 - April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1-20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0% of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. CONCLUSIONS: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

Pilates en pacientes con espondilitis anquilosante: repercusión en la función pulmonar / Pilates physiotherapy for ankylosing spondylitis patients: Impact on lung function

Objetivo: Evaluar el impacto de la fisioterapia basada en el método de Pilates en la función pulmonar de pacientes con espondilitis anquilosante (EA). Material y método: Se realiza un ensayo clínico aleatorizado (ECA) con 49 pacientes diagnosticados de EA según los criterios de Nueva York modificados. Se establecen al azar 2 grupos de trabajo. Se aplicó ejercicio terapéutico en 26 pacientes, 17 semanas, días alternos y 1h de duración, supervisado por un fisioterapeuta. El grupo control (23 pacientes) realizó un programa de ejercicios convencionales en el domicilio. Terminan el estudio 45 de los 49 pacientes que iniciaron el ECA. Las variables analizadas son: expansión costal, capacidad vital forzada (CVF), volumen espirado forzado (FEV1) y el cociente FEV1/CVF. Resultados: No hay diferencias significativas en los valores de expansión costal entre ambos grupos (p valor=0,686) ni diferencias en el grupo experimental antes y después de la intervención (p valor=0,780). Los valores de la espirometría se comportan de forma similar. La CVF aumenta de forma discreta en el grupo experimental no de forma significativa (p valor = 0,122). Conclusiones: El impacto de los ejercicios basados en pilates sobre los valores espirométricos y la expansión costal es escaso, a pesar de la tendencia del grupo experimental a mejorar su CVF después de la intervención. Se debe considerar, para su aplicación clínica, implementar este tipo de protocolos con fisioterapia respiratoria específica

Aim: To evaluate the impact of physiotherapy, based on the Pilates Method, on the lung function of patients with Ankylosing Spondylitis (AS). Material and methods: A randomised clinical trial (RCT) was performed with 49 patients diagnosed with AS according to the modified New York criteria. Two groups were randomly established. Therapeutic Pilates-based exercise was performed by 26 patients for 17 weeks, in 90minute sessions on alternative days, supervised by a physiotherapist. The control group (23 patients) used a conventional exercise program at home. The variables analysed were: rib cage expansion, forced vital capacity (FVC), forced expiratory volume (FEV1), and the FEV1/FVC ratio. Results: No significant differences were found in the values of rib cage expansion between control and experimental groups (P=.686), while there were differences before and after intervention in the experimental group (P=.780). The values of spirometry were similar in both control and experimental groups. No-significant increase in FVC was observed in the experimental group (P=.122). Conclusions: The impact of Pilates-based exercises on spirometry values and rib cage expansion is limited, although there was a tendency to improve FVC after Pilates exercises. These types of exercise protocols should be considered, for their clinical application, in specific respiratory physiotherapy

Utilidad del índice FEV1/FEV6 en pacientes pluripatológicos hospitalizados para detectar la prevalencia de obstrucción pulmonar / Usefulness of the FEV1/FEV6 ratio to detect the prevalence of lung obstruction in hospitalised patients with multiple morbidities

Introducción. La prevalencia de obstrucción pulmonar aumenta con la edad y la presencia de comorbilidades. Aunque para confirmar su diagnóstico es necesario completar una espirometría, esta puede ser difícil de realizar en ancianos con deterioro cognitivo o dependencia funcional. Recientemente el uso de dispositivos portátiles que utilizan el índice FEV1/FEV6 han demostrado su utilidad para evaluar la presencia de obstrucción pulmonar, con una mayor facilidad de uso, aunque su utilidad en población anciana con pluripatología no ha sido establecida. Metodología. Estudio transversal, realizado en pacientes ingresados en la Unidad de pacientes crónicos complejos del Hospital Universitario Mútua de Terrassa. A todos ellos se les realizó un cuestionario que incluía -entre otras- medidas de dependencia funcional y deterioro cognitivo y se intentaron completar previamente al alta 3 maniobras válidas de FEV1/FEV6 con el aparato Piko-6, considerándose criterio de obstrucción un FEV1/FEV6≤0,75. Se analizaron las características de la población que fue capaz de realizar las pruebas, y la prevalencia de obstrucción pulmonar. Resultados. Se estudiaron 54 pacientes, de los cuales 35 (64,81%) realizaron las maniobras correctamente. Los pacientes que no completaron las maniobras tenían más dependencia funcional (Barthel 19 vs. 72, p<0,0001) y más deterioro cognitivo (Pfeiffer 1 vs. 9, p<0,0001; MEC 3/35 vs. 28/35, p<0,010). La prevalencia de obstrucción fue del 71,43%, con un 72% de infradiagnóstico. Conclusiones. En un 35,18% de los pacientes no se consiguió determinar el FEV1/FEV6, por deterioro cognitivo o dependencia funcional. Tanto la prevalencia de obstrucción como el infradiagnóstico superaron el 70% (AU)

Background. The prevalence of lung obstruction increases with age and the presence of comorbidities. Although a complete spirometry is necessary to confirm the diagnosis, this may be impractical in elderly patients with cognitive impairment or functional dependence. Recently, the use of portable devices using the FEV1/FEV6 ratio have shown to be useful for assessing the presence of lung obstruction, with greater ease of use, but its usefulness has not been established in the elderly population with multiple morbidities. Methods. A cross-sectional study was conducted on patients hospitalised in the complex chronic patients Unit of the University Hospital Mútua de Terrassa. All of them completed a questionnaire that included -among other things- measurements of functional dependence and cognitive impairment. Three manoeuvres validated with the Piko-6 device were attempted before discharge, and considering an FEV1/FEV6<0.75 as criteria for obstruction. An analysis was performed on the characteristics of the population that was able to perform the tests, as well as the prevalence of pulmonary obstruction. Results. A total of 54 patients were included in the study, of which 35 (64.81%) performed the manoeuvres correctly. Patients who were unable to complete the manoeuvres of the Piko-6 had more functional dependence (Barthel 19 vs. 72, P<.0001) and cognitive impairment (Pfeiffer 1 vs. 9, P<.0001; MEC 28/35 vs. 3/35, P<.010). The prevalence of obstruction was 71.43%, with an underdiagnosis of 72%. Conclusions. The FEV1/FEV6 ratio was not determined in 35.18% of the patients due to cognitive impairment or functional dependence. The prevalence of obstruction and underdiagnosis exceeded 70% (AU)

Combined spiroergometry and 31 P-MRS of human calf muscle during high-intensity exercise.

Simultaneous measurements of pulmonary oxygen consumption (VO2 ), carbon dioxide exhalation (VCO2 ) and phosphorus magnetic resonance spectroscopy (31 P-MRS) are valuable in physiological studies to evaluate muscle metabolism during specific loads. Therefore, the aim of this study was to adapt a commercially available spirometric device to enable measurements of VO2 and VCO2 whilst simultaneously performing 31 P-MRS at 3 T. Volunteers performed intense plantar flexion of their right calf muscle inside the MR scanner against a pneumatic MR-compatible pedal ergometer. The use of a non-magnetic pneumotachograph and extension of the sampling line from 3 m to 5 m to place the spirometric device outside the MR scanner room did not affect adversely the measurements of VO2 and VCO2 . Response and delay times increased, on average, by at most 0.05 s and 0.79 s, respectively. Overall, we were able to demonstrate a feasible ventilation response (VO2 = 1.05 ± 0.31 L/min; VCO2 = 1.11 ± 0.33 L/min) during the exercise of a single calf muscle, as well as a good correlation between local energy metabolism and muscular acidification (τPCr fast and pH; R2 = 0.73, p < 0.005) and global respiration (τPCr fast and VO2 ; R2  = 0.55, p = 0.01). This provides improved insights into aerobic and anaerobic energy supply during strong muscular performances.

Physical Therapy Treatment of Impaired Chest Mobility in Patients with Airway Sensory Hyperreactivity.

BACKGROUND AND PURPOSE: In sensory hyperreactivity (SHR), patients have symptoms from the airways and the chest induced by environmental irritants like scenting products and cigarette smoke. They are characterized by increased cough reaction to inhaled capsaicin compared with healthy controls. Lung function tests are normal, and asthma medications have no or little effect. In a recent published article, patients with SHR were found to have impaired chest mobility and increased pain sensitivity. The purpose of this study was to evaluate if a physiotherapeutic intervention can increase chest mobility in SHR, influence these patients' symptoms and reduce capsaicin cough sensitivity. METHODS: Forty-one SHR patients were initially randomized in to groups, one for training and one for symptom registration in this controlled training study. It consisted of a daily training programme containing simple movements to increase the flexibility of the chest, a breathing exercise and a relaxation session as well as symptom registration. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using pressure algometry and a standardized capsaicin inhalation threshold provocation-evaluated cough sensitivity. RESULTS: Twenty seven patients were left for analyses after 12 weeks and 26 patients after 24 weeks. Chest mobility and upper thoracic respiratory movements improved (p < 0.01), feeling of chest pressure and the capsaicin cough sensitivity decreased (p < 0.01). The patients also showed of significantly lowered pain pressure thresholds measured with algometry, compared with healthy controls (p < 0.001). CONCLUSION: Improvement of chest mobility after physiotherapeutic intervention indicates that these patients may have acquired a dysfunctional breathing pattern. The regular use of a training programme and structural breathing instructions can be used to improve chest mobility, chest symptoms and capsaicin cough sensitivity in patients with SHR and signs of dysfunctional breathing. Copyright © 2016 John Wiley & Sons, Ltd.