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Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

Introduction Dry powder inhalers (DPIs), a commonly prescribed inhaler type for respiratory diseases, require patients to generate sufficient peak inspiratory flow (PIF) to ensure optimal drug delivery to the airways. Effectiveness of therapy also requires a good inhalation technique and adequate medication adherence. For patients with chronic obstructive pulmonary disease (COPD), recent studies conducted in tertiary care suggest that DPI users with suboptimal PIF have poorer COPD-related health status and increased exacerbation risk versus those with optimal PIF. The PIFotal study will investigate the impact of PIF, inhalation technique and medication adherence on patient-reported outcomes in patients with COPD in primary care using a DPI for their maintenance therapy. Methods and Analysis This cross-sectional observational study will assess 1200 patients (aged ≥ 40 years, diagnosed with COPD and using a DPI for COPD maintenance therapy for ≥ 3 months) from the Netherlands, Spain, Portugal, Poland, Greece and Australia. Assessments will consist of (1) PIF measurements (usual patient inhalation manoeuvre, maximal PIF against resistance of own inhaler, and maximal PIF against low resistance); (2) Clinical COPD Questionnaire (CCQ), COPD Assessment Test and Test of Adherence to Inhalers scores; and (3) video recordings of patient inhalation technique. Dependent variables include health status (CCQ score), number of self-reported exacerbations in previous 12 months, and healthcare resource utilisation in previous 6 months. Independent variables include PIF values, inhalation technique errors, medication adherence, and demographic and clinical characteristics. In the primary analysis, the mean difference in CCQ score between patients (1) with optimal/suboptimal PIF, (2) exhibiting/not exhibiting inhalation technique errors, and (3) adhering/not adhering to medication will be examined in a multivariable linear mixed model. Ethics The study protocol was approved by ethics committees/institutional review boards of all participating sites prior to enrolment; written informed consent was obtained from all study participants. Trial Registration Number ClinicalTrials.gov: NCT04532853. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00172-7.

Introduction: Pulmonary TB is a contagious disease in the respiratory system caused by the bacterium Mycobacteria tuberculosis. The purpose of this research is to analyze the difference in the effectiveness of breathing exercise and effective cough to increase lung expansion of pulmonary tuberculosis patients. Objectives: the purpose of this research is to analyze the difference in the effectiveness of breathing exercise and effective cough to increase lung expansion of pulmonary tuberculosis patients. Methods: The research design used Quasy experiment with a Pre-postes approach with a control group design. The population of this research was pulmonary TB patients at Perak Timur Surabaya Public Health Center amounting to 33 people. The sampling technique used Probability Sampling with Simple Random Sampling got a sample of 30 people. Independent variables were aromatherapy eucalyptus oil and breathing exercises. The dependent variable was pulmonary expansion in pulmonary tuberculosis patients. Instrumen in this research used Peak Flow Meter and an observation sheet. Data analysis used the One Way Annova Test. One Way Annova test results showed that breathing exercise was more effective when compared with aromatherapy eucalyptus oil in influencing the process of increasing pulmonary expansion in patients with pulmonary tuberculosis. Results: Results of aromatherapy analysis of eucalyptus oil with pulmonary expansion ρ = 0,530 (ρ ˃ α = 0,05), and breathing exercise with pulmonary expansion ρ = 0.026 (ρ < α = 0,05. Conclusions: The implications of the study show that breathing exercise is more effective for non pharmacology therapy to help increase lung expansion in patients with pulmonary tuberculosis so as to reduce shortness of breath.

Background: Benign tracheal stenosis may relapse after management. Objectives: This study aimed to assess the value of dyspnea and spirometry in detecting relapse of benign tracheal stenosis. Methods: Patients with benign tracheal stenosis were evaluated post-management, at regular follow-up and emergency visits, with the Medical Research Council (MRC) dyspnea scale, spirometry, and flexible bronchoscopy. Patient visits were categorized and compared, in terms of change in clinical and functional parameters, in 2 groups: visits with relapse (case group) and visits with no relapse (control group). The ability of the MRC dyspnea scale and spirometry to predict relapse was evaluated. Results: Thirty-five patients with benign tracheal stenosis were included. Mean follow-up duration was 3.2 years (standard deviation = 3.3). Spirometry data were analyzed from 43 relapse visits (23 patients) versus 90 nonrelapse visits. The MRC dyspnea score and most spirometric indices were associated with relapse. In the receiver operating characteristic analysis, forced expiratory volume in 1 s, forced expiratory flow when 25% of forced vital capacity has been expired, peak expiratory flow (PEF), and total peak flow were superior to the MRC dyspnea score in predicting relapse. Among spirometric indices, >10.8% of PEF reduction has been very sensitive and specific. Conclusions: This study supports the role of dyspnea and spirometry in monitoring benign tracheal stenosis, with spirometry predicting relapse even in clinically stable patients. PEF being a very sensitive index has the additional advantage of being assessed by peak flow meter and could potentially be used for remote monitoring.

The roles of endothelial nitric oxide synthase (eNOS) in the ventilatory responses during and after a hypercapnic gas challenge (HCC, 5% CO2, 21% O2, 74% N2) were assessed in freely-moving female and male wild-type (WT) C57BL6 mice and eNOS knock-out (eNOS-/-) mice of C57BL6 background using whole body plethysmography. HCC elicited an array of ventilatory responses that were similar in male and female WT mice, such as increases in breathing frequency (with falls in inspiratory and expiratory times), and increases in tidal volume, minute ventilation, peak inspiratory and expiratory flows, and inspiratory and expiratory drives. eNOS-/- male mice had smaller increases in minute ventilation, peak inspiratory flow and inspiratory drive, and smaller decreases in inspiratory time than WT males. Ventilatory responses in female eNOS-/- mice were similar to those in female WT mice. The ventilatory excitatory phase upon return to room-air was similar in both male and female WT mice. However, the post-HCC increases in frequency of breathing (with decreases in inspiratory times), and increases in tidal volume, minute ventilation, inspiratory drive (i.e., tidal volume/inspiratory time) and expiratory drive (i.e., tidal volume/expiratory time), and peak inspiratory and expiratory flows in male eNOS-/- mice were smaller than in male WT mice. In contrast, the post-HCC responses in female eNOS-/- mice were equal to those of the female WT mice. These findings provide the first evidence that the loss of eNOS affects the ventilatory responses during and after HCC in male C57BL6 mice, whereas female C57BL6 mice can compensate for the loss of eNOS, at least in respect to triggering ventilatory responses to HCC.

Biomarkers in COPD may be clinical (prior exacerbation history), physiologic (FEV1), or blood based (eosinophil count or fibrinogen level). Recent interest in using biomarkers to predict response to therapy in clinical practice has emerged. The benefits of inhaled therapy depend on the correct use of the inhaler, including an appropriate inspiratory flow. Of the available delivery systems, dry powder inhalers are unique because they have an internal resistance, are breath actuated, and are flow dependent. Ideally, the user inhales "forcefully" to generate turbulent energy (determined by an individual's inspiratory flow and the resistance of the device) within the device that disaggregates the powder so that the individual inhales the medication particles into the lower respiratory tract. Because of specific features of dry powder inhalers and the required optimal inspiratory flow, an unmet need exists to identify individuals who are likely or unlikely to benefit from dry powder medications. Peak inspiratory flow, defined as the maximum airflow generated during inhalation against the simulated resistance of a dry powder inhaler, is a physiologic measure that has biological plausibility, has good test characteristics (repeatability and reliability), and is generalizable. Current evidence supports peak inspiratory flow as a predictive therapeutic biomarker to optimize therapy in both outpatients with COPD as well as those hospitalized for an exacerbation before discharge. This approach is consistent with the precepts of precision medicine, which considers differences in a person's biological features, exposure, and lifestyle to prevent and treat disease.

Suryanamaskar or Sun Salutation is a mostly practiced Yoga pose by most yoga practitioners all around the world. It consists of synchronizing body flow movements which alternatively contracts and stretches the body musculature, with continuous alteration of the Inhalation & Exhalation. Most of the Indians or ancient Yoga practitioners as well as various health professionals always keep advising for the practice of suryanamaskar. Previous literature has shown its effects on different systems of the body. Primarily the ethical approval was taken for the study to conduct from the ethical board. The consent from the parents of the school-going children was taken. The Purpose of the Research was explained to the children as well as the parent to improve the compliance towards study results. The study is conducted with 65 samples of school-going children with 4 weeks of intervention of slow Suryanamaskar practice. The purposive sampling method has been used to sort the samples as per the requirements. The whole study was conducted between 6 months of period. The finding of this study shows the significant improvement of the mean values of the Peak Expiratory Flow Rate at the end of the study duration. This study concludes that slow Suryanamaskar has a great impact on the improvement of pulmonary functions.

Purpose Upper airway patency is crucial in a patient's ability to tolerate a one-way speaking valve (SV). Traditional assessment of airway patency is mainly subjective. We developed four noninvasive methods to assess patency (leak volume, transtracheal pressure [TTP], end-tidal CO 2 , and Mallampati score) in our institution. This study was aimed to evaluate the effectiveness of the four methods and explore the relationship between the patient's upper airway patency and SV trial tolerance. Method A retrospective cohort study was conducted to enroll adult patients with tracheostomies eligible for an SV trial from April 2019 through January 2020. An in vitro study was also implemented to explore the relationship between upper airway patency and noninvasive measurements. Results Forty patients (22 men and 18 women) were included; 16 used SV in-line with mechanical ventilation. Twenty-four patients tolerated an SV trial of > 10 min; they had lower TTP (3.0 [2.0–9.0] vs. 15.0 [9.3–21.3] cm H 2 O, p < .001), higher leak volume (268.5 ± 177.2 vs. 88.6 ± 99.6 ml, p = .038), and lower percentage of patients with Mallampati Classification IV (16.7 vs. 50.0%, p = .035), compared to the 16 patients who did not tolerate an SV trial. Twenty-two patients with a TTP of ≤ 9 cm H 2 O had higher percentage tolerating an SV trial than those with a TTP of > 9 cm H 2 O (86.4 vs. 35.3%, p = .002). The in vitro study demonstrated a strong correlation between upper airway patency and TTP, peak inspiratory flow, and tidal volume inhaled from the upper airway. Conclusions TTP, Mallampati classification, and leak volume can be used to assess upper airway patency for adult patients with tracheostomies undergoing an SV trial. A TTP of ≤ 9 cm H 2 O might indicate adequate upper airway patency to tolerate the SV trial.

The aim. To compare three respiratory physical therapy techniques and their impact on pulmonary function restoration among cardiac surgery patients in hospital settings. Materials and methods. The study involved 126 patients of both sexes who were admitted for cardiac surgery. All the procedures were performed by sternotomy with cardiopulmonary bypass and cardioplegic arrest. The patients were randomly divided (with a ratio of 1:1:1 by envelope method) into the control group (CG, n = 42), incentive spirometry group (ISG, n = 42) and іnspiratory muscle training group (IMTG, n = 42). The examined patients underwent standardized physical therapy (early mobilization; therapeutic exercises; coughing). The groups varied in respiratory therapy. Patients of the ISG group performed additional respiratory exercises using a Tri-Ball respiratory exerciser (three repetitions of 10 forced, full and rapid inspirations through the respiratory exerciser under the supervision of a physical therapist; besides, they were recommended to perform 3 repetitions with 10 inspirations each hour). Patients of the IMTG group performed additional respiratory exercises using Respironics Threshold IMT breathing exerciser, received explanations and recommendations like patients of the ISG group. The pulmonary function test (PFT) was performed for the patients of all groups before the surgery and on the 7 postoperative day. Results. PFT scores did not differ statistically between the groups of patients before the surgery. The three groups of patients had a negative dynamic of all test indicators, except Tiffeneau index. The analysis of PFT final scores did not confirm a significant difference in the studied indicators among the groups: vital capacity (P = 0.599), forced vital capacity (P = 0.393), forced expiratory volume in one second (P = 0.589), peak expiratory flow (P = 0.326), forced inspiratory vital capacity (P = 0.258), peak inspiratory flow (P = 0.569). Conclusions. Statistical analysis of PFT indicators did not reveal any significant differences among the groups of cardiac surgery patients at the preoperative examination and on the 7 postoperative day, despite the differences in postoperative respiratory physical therapy.

Nan Ding,1,&ast; Wei Zhang,2,&ast; Zhuo Wang,1 Chong Bai,3 Qian He,4 Yuchao Dong,3 Xiumin Feng,5 Jingxi Zhang,3 Shen Gao1 1Department of Pharmacy, First Affiliated Hospital of Naval Medical University (Changhai Hospital), Shanghai, People’s Republic of China; 2Department of Pharmacy, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Naval Medical University (Changhai Hospital), Shanghai, People’s Republic of China; 4Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Xinjiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shen GaoDepartment of Pharmacy, First Affiliated Hospital of Naval Medical University (Changhai Hospital), No. 168 Changhai Road, Shanghai, 200433, People’s Republic of ChinaTel +86(021)31162331Fax +86(021)31162304Email liullk@126.comJingxi ZhangDepartment of Respiratory and Critical Care Medicine, First Affiliated Hospital of Naval Medical University (Changhai Hospital), No. 168 Changhai Road, Shanghai, 200433, People’s Republic of ChinaEmail jingxizhang2000@126.comPurpose: The present study aimed to investigate the prevalence and associated factors of suboptimal daily peak inspiratory flow (PIF) and technical misuse of three commonly used dry powder inhalers (DPIs) in outpatients with stable chronic airway diseases.Patients and Methods: Included in this study were 85 outpatients with stable asthma, chronic obstructive pulmonary disease (COPD), or asthma-COPD Overlap (ACO) and had previously used any of Turbuhaler® (TUR), Diskus® (DIS), HandiHaler® (HAN) between December 2018 and September 2019. The patient’s daily PIF against the resistance of a specific DPI and operation technique was investigated by two pharmacists by using In-Check DIAL G16 and a checklist.Results: Of the 85 patients, the proportion of patients with a suboptimal daily PIF and technical misuse was 38.8% and 65.9%, respectively. In logistic regression, we observed that the factors that increase the risk for suboptimal daily PIF were age (OR=1.06) and combination with respiratory diseases (OR = 6.59). The factor that decreases the risk for misuse was the higher education level (OR =0.63).Conclusion: Even if patients have received training at the time of initial prescription, the standardization of the use of DPIs by patients in our center was still unoptimistic. Age and combined with respiratory diseases were associated with suboptimal PIF. Higher education level decreased the incidence of technique misuse.Keywords: dry powder inhaler, inhalation technique, peak inspiratory flow rate, pharmacist, risk factors

We have identified thiolesters that reverse the negative effects of opioids on breathing without compromising antinociception. Here we report the effects of d-cystine diethyl ester (d-cystine diEE) or d-cystine dimethyl ester (d-cystine diME) on morphine-induced changes in ventilation, arterial-blood gas chemistry, A-a gradient (index of gas-exchange in the lungs) and antinociception in freely moving rats. Injection of morphine (10 mg/kg, IV) elicited negative effects on breathing (e.g., depression of tidal volume, minute ventilation, peak inspiratory flow, and inspiratory drive). Subsequent injection of d-cystine diEE (500 μmol/kg, IV) elicited an immediate and sustained reversal of these effects of morphine. Injection of morphine (10 mg/kg, IV) also elicited pronounced decreases in arterial blood pH, pO2 and sO2 accompanied by pronounced increases in pCO2 (all indicative of a decrease in ventilatory drive) and A-a gradient (mismatch in ventilation-perfusion in the lungs). These effects of morphine were reversed in an immediate and sustained fashion by d-cystine diME (500 μmol/kg, IV). Finally, the duration of morphine (5 and 10 mg/kg, IV) antinociception was augmented by d-cystine diEE. d-cystine diEE and d-cystine diME may be clinically useful agents that can effectively reverse the negative effects of morphine on breathing and gas-exchange in the lungs while promoting antinociception. Our study suggests that the d-cystine thiolesters are able to differentially modulate the intracellular signaling cascades that mediate morphine-induced ventilatory depression as opposed to those that mediate morphine-induced antinociception and sedation.

Introduction Peak expiratory flow measurement is a simple measure of respiratory capacity to diagnose airflow obstruction and monitor treatment response in patients with pulmonary diseases. But there is wide diurnal variability in its values. The objectives of this study was to determine the diurnal variability of peak expiratory flow rate in healthy adults. MethodsThis cross-sectional study was done in employees of Kathmandu Medical College, Duwakot between March to August 2020. A total of 74 subjects of 30-45 years were included in the study. After adequate training, subjects were asked to record their own peak expiratory flow five times a day by Mini-Wright peak flow meter. Diurnal variability was expressed as amplitude percent mean and standard deviation percent mean. Data analysis was done by student’s unpaired t-test and one-way ANOVA. ResultsThe mean peak expiratory flow rate (in L/min) were lowest in morning (male: 478.75±45.91; female: 362.86±20.51) followed by progressive rise throughout the day and highest at evening (male: 531.88 ±43.95; female: 415.71±20.97) with slight fall at bedtime (male: 486.88±46.38; female: 362.86±20.51). The difference in peak expiratory flow rate at different time periods was statistically significant in both males and females (p

Rain Jõgi,1 Leena Mattila,2 Mikko Vahteristo,3 Aino Takala,2 Satu Lähelmä,4 Ville A Vartiainen,2 Ari Lindqvist5 1Tartu University Hospital, Lung Clinic, Tartu, Estonia; 2Medical Affairs, Orion Corporation, Espoo, Finland; 3Research Unit of Pulmonary Diseases, Helsinki University Hospital and Helsinki University, Helsinki, Finland; 4Inhalation Platform, Orion Corporation, Espoo, Finland; 5Biostatistics and Data Analytics, Orion Corporation, Espoo, FinlandCorrespondence: Rain JõgiTartu University Hospital, Lung Clinic, Riia 167, Tartu, 50104, EstoniaTel +372 5331 8918Email Rain.Jogi@kliinikum.eeIntroduction: Achieving correct inhalation technique through an inhaler to ensure effective drug delivery is key to managing symptoms in patients with chronic obstructive pulmonary disease (COPD). However, many patients struggle to use their inhalers correctly, with the resultant reduction in therapeutic benefit. Consequently, appropriate inhaler choice is important to maximize clinical benefit. The primary objective of this study was to characterize inspiratory flow parameters across two Easyhaler® inhalers and the HandiHaler® inhaler in patients with COPD and healthy volunteers.Methods: In this randomized, open-label, crossover study, subjects (100 patients with COPD; 100 healthy volunteers) were trained to perform inhalations of placebo powder via two variants of Easyhaler and placebo capsules via the HandiHaler inhalers. Subjects then performed three placebo inhalations through each inhaler in a random sequence. Inspiratory flow parameters were assessed, including peak inspiratory flow (PIF), for each inhaler. A parallel sub-study was conducted in patients with COPD from the main study to assess correct use of the inhalers, patient’s preference, ability to learn to use the inhalers, and the feasibility of the In-Check Dial device to measure PIF values.Results: Mean PIF rates and inspiratory volumes through the three inhalers were similar between patients with COPD and healthy volunteers, and all subjects achieved the 30 L/min PIF required for effective use of Easyhaler. Almost 70% of the 88 patients enrolled in the sub-study used the Easyhaler and HandiHaler inhalers without errors. The Easyhaler was preferred by 51% of patients, while 25% favored the HandiHaler. Teaching the use of both inhalers to almost 70% of patients was very easy. The In-Check Dial PIF values and those obtained via spirometry were strongly correlated (p< 0.0001) for all three inhalers.Conclusion: The respiratory performance of patients with COPD does not appear to be a limiting factor in the use of Easyhaler.Keywords: COPD, crossover study, Easyhaler, HandiHaler, dry powder inhaler, peak inspiratory flow

Martin Anderson,1 Kathryn Collison,2 M Bradley Drummond,3 Melanie Hamilton,4 Renu Jain,2 Neil Martin,5,6 Richard A Mularski,7 Mike Thomas,8 Chang-Qing Zhu,9 Gary T Ferguson10 1Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; 2Respiratory Therapy Area, GSK, Research Triangle Park, NC, USA; 3Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 4R&D, GSK, Ware, Hertfordshire, UK; 5Global Medical Affairs, GSK, Brentford, Middlesex, UK; 6Institute for Lung Health, University of Leicester, Leicester, Leicestershire, UK; 7Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA; 8Primary Care Research, University of Southampton, Southampton, UK; 9Biostatistics, GSK, Stockley Park West, Uxbridge, Middlesex, UK; 10Pulmonary Research, Institute of Southeast Michigan, Farmington Hills, MI, USACorrespondence: Gary T FergusonPulmonary Research, Institute of Southeast Michigan, Farmington Hills, MI, USATel +1 248-478-6561Email garytferguson@msn.comBackground: The influence of peak inspiratory flow (PIF) on dose delivery from dry powder inhalers (DPIs) and association with treatment efficacy in patients with chronic obstructive pulmonary disease (COPD) has not been fully determined. In vitro studies have demonstrated adequate dose delivery through ELLIPTA DPI at PIF ≥ 30 L/min. This analysis of two clinical trials and a real-world population of COPD patients determined spirometric PIF distribution, and explored the relationship between PIF and outcomes in the trials.Methods: The replicate Phase IV, 12-week, randomized, double-blind 207608/207609 (NCT03478683/NCT03478696) trials evaluated fluticasone furoate/umeclidinium/vilanterol via ELLIPTA DPI versus budesonide/formoterol+tiotropium in COPD patients. This post hoc analysis assessed spirometric PIF distribution at screening and relationship between PIF and lung function outcomes in the pooled 207608/207609 population. Spirometric PIF distributions in a real-world population of COPD patients were evaluated by retrospective analysis of the Kaiser Permanente Northwest (KPNW) database to assess similarities between clinical trial and real-world populations.Results: A total of 1460 (207608/207609) and 3282 (KPNW) patients were included. There was considerable overlap between spirometric PIF distributions for both populations. Overall, 99.7% and 99.8% of the 207608/207609 and KPNW populations, respectively, reported spirometric PIF ≥ 50 L/min, estimated as equivalent to ELLIPTA PIFR ≥ 30 L/min. In the 207608/207609 combined analysis, there was no significant interaction between spirometric PIF and treatment for lung function endpoints, indicating treatment effect is independent of PIF.Conclusion: Nearly all COPD patients in the 207608/207609 and KPNW populations achieved spirometric PIF values estimated as equivalent to PIFR of ≥ 30 L/min through the ELLIPTA DPI. Lack of correlation between spirometric PIF at screening and treatment efficacy aligns with consistent dose performance from the ELLIPTA DPI across a wide range of PIFs, achieved by patients with COPD of all severities.Keywords: COPD, inhaled triple therapy, patient outcomes, real-world studies, peak inspiratory flow rate, DPI

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a heterogeneous disease that poses a challenge when ventilating premature infants. The purpose of this study was to determine how inspiratory pressure rise time (IRT), different ventilators, and their software updates affect the balance of ventilation among 2 heterogeneous lung units. METHODS: A passive dual-chamber lung model was constructed using the IngMar ASL5000 to approximate moderate BPD. One chamber had a short time constant, and the other had a long time constant. Three ventilators were used to provide pressure control intermittent mandatory ventilation: the Servo-i, an Avea ventilator with the volume guarantee software update, and an Avea ventilator without the volume guarantee software update. Using the same settings for pressure control intermittent mandatory ventilation, the IRT was adjusted between minimum and maximum settings. Data from 100 consecutive breaths/IRT were obtained. Inspiration time to 90% of plateau pressure was used as a surrogate for IRT; this was defined as the time needed to achieve a pressure of 18 cm H2O at the simulated trachea and was measured in 5 random breaths using ImageJ for each ventilator at each IRT. Outcome variables were tidal volume, peak inspiratory flow, mean inspiratory pressure, and volume balance (%) defined as the difference in chamber tidal volumes divided by total tidal volume. Linear regression was used to assess the impact of the IRT and ventilators on the different variables. RESULTS: In this model, increasing IRT decreased peak inspiratory flow, mean inspiratory pressure, chamber-specific tidal volume, and volume balance. Furthermore, different ventilator hardware and software influenced the waveforms in pressure control intermittent mandatory ventilation, which independently affected the measured variables. CONCLUSIONS: In a lung model of BPD with 2 very heterogeneous lung units, prolonging IRT without any volume balancing measures improved volume balance between the chambers at the expense of total tidal volume. Furthermore, the different ventilators acted as independent factors from the measured inspiration time to 90% of plateau pressure.

Background: To evaluate whether patients of varying ages and lung function with asthma or those with chronic obstructive pulmonary disease (COPD) can achieve sufficient inspiratory flows for effective use of the fixed-dose combination of salmeterol-fluticasone propionate and budesonide-formoterol dispensed with the Easyhaler (R) (EH) device-metered, multi-dose dry powder inhaler (DPI). Methods: A pooled analysis of two randomized, multicenter, crossover, open-label studies (NCT01424137; NCT009849061) was conducted to characterize inspiratory flow parameters across the EH, Seretide Diskus (DI) and Symbicort Turbuhaler (TH) inhalers in patients with asthma and/or COPD of varying severity. The primary endpoint was peak inspiratory flow (PIF) rate through the EH. Results: The intent-to-treat population comprised 397 patients; 383 patients were included in the per protocol (PP) population. The mean PIF (standard deviation) values through the EH in patients = 18 years of age with asthma and in those with COPD, were similar: 61.4 (11.5), 69.7 (13.5), and 61.9 (13.2) L/min, respectively. These flow rates correspond to pressure drops of 5.05 (1.80), 6.52 (2.34) and 5.19 (2.07) kPa, respectively. In total, 380 (99.2%) of patients in the PP population were able to generate a PIF rate through the EH of >= 30 L/min, which is required to enable consistent dose delivery from the DPI; there was a moderate direct association between age and PIF in younger patients with asthma, but this was inverse and less apparent in adult patients with asthma and/or those with COPD. Height and weight were also moderately correlated with PIF. Stronger associations with PIF were observed for some lung function parameters, particularly native PIF and forced inspiratory vital capacity. Conclusions: Over 99% of patients with asthma and/or COPD were able to inhale through the EH with an adequate PIF rate, irrespective of age, or severity of airway obstruction. This confirms that patients with asthma and/or COPD can achieve inspiratory flows via the EH DPI that are sufficient for its effective use.

BACKGROUND: Daily evaluation of peak expiratory flow rate (PEFR) is quite useful for monitoring and adjusting an asthmatic patient’s treatment. Many factors including geography, ethnicity, socio-economic conditions, gender, and anthropometric play a role in lung function differences studies have found. The aim of this study is to present normal PEFR and to establish a PEFR equation for Thai children living in a suburban environment. METHODS: This study includes a cross-section of healthy children aged 6 to 18. It was conducted in Phitsanulok Province in the lower north of Thailand. The children were chosen to participate from five primary and secondary schools over the period from February 2014 to January 2015. The children were instructed on how to use the Wright peak flow meter (Clement Clarke International Ltd.). All of the participants performed PEFR 3 times and the highest value was recorded. RESULTS: A total of 2,000 students were initially examined; 80 students were excluded from the study. A total of 1,920 healthy children were recruited between the ages of 6 and18 years. Among them, 719 (37.4%) were males and 1,201 (62.6%) were females. The median age was 18 [12–18] years old, mean height, weight, body mass index (BMI) and PEFR were 155.98±14.99 cm, 51.38±16.95 kg, 20.62±4.79 kg/m(2) and 339.31±113.55 L/min, respectively. PEFR has a linear relationship in regards age, weight, height and BMI. For males, age was the strongest factor associated with PEFR (r=0.838, P

Exposure to atmospheric fine particulate matter has short-term and long-term adverse effects on pulmonary function, especially PM2.5; however, early lung function impairment is not easily detected in time. Notably, microRNAs (miRNAs) have been classified as novel biomarkers for diseases related to PM. Thus, the purpose of this study was to investigate whether miR-146 was related to the decline of lung function after exposure to air pollution. Thirty BALB/c mice were subjected to different concentrations of PM2.5 by noninvasive tracheal instillation for 56 days (two times one week), after which we detected the histopathological changes of mice lung, pulmonary functions, pro-inflammatory factors levels in bronchoalveolar lavage fluid (BALF) and lung tissue homogenate, and the relative expression of microRNA-146a and -146b. When BALB/c mice were exposed to 10 mg/kg PM2.5, severe changes such as widened alveolar interval and diffuse infiltration of macrophages with engulfed PM2.5 particles (dust cells) were found. Peak inspiratory flow (PIF) and peak expiratory flow (PEF) were decreased significantly. Expiratory resistance (Re) and inspiratory resistance (Ri) were increased significantly in the 5 mg/kg and 10 mg/kg PM2.5 groups, meanwhile lung resistance increased and MVV (maximum minute ventilation) decreased from the general tendency; however, pro-inflammatory factors interleukin-6 (IL-6), interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) were increased dramatically. MiR-146a and miR-146b were elevated remarkably in the PM2.5 groups compared to the NS group. We also found miR-146 had negative relationships with PIF and PEF, especially miR-146b. Thus, elevated miR-146a and miR-146b may have a relationship with pulmonary dysfunction after PM2.5 chronic exposure.

Asthma is a chronic inflammatory disorder in the airway. The peak expiratory flow rate is one of the human lung function tests used to assess the ability of lung function and provide an image of the airway disorder. This study aims to determine the effect of Buteyko’s respiratory technique on peak expiratory flow rate in asthma patients. The type of research is Pre-Experimental Design with One-Group Pretest-Posttest using purposive sampling. The sample size is 22 people. The patient's peak expiratory flow rate is measured using a peak flow meter. The results of peak expiratory flow rate of the patient tested using paired t- test. The results showed that the peak expiratory flow rate prior to Buteyko’s respiratory technique of 75.764%, and after given breathing Buteyko's breathing techniques, peak expiratory flow rate of patients showed an increase to equal to 79.986%. Based on the results of the research, the value of ρ-value = 0.000

Respiratory problems are significant gathering of ailment influencing kids particularly in India and are the significant reasons for youth horribleness and mortality. Specifically, obstructive aviation route illnesses ascend in youngsters because of natural contamination and different causes. In this way, evaluation of aspiratory work test in such kids is significant. Henceforth the current investigation focused on to evaluate the adequacy of strelinikova breathing activity on respiratory signs and boundaries among younger students with respiratory parcel infection. The research configuration utilized was semi exploratory pre-test post-test plan. Purposive examining strategy was utilized to choose the 60 sample. The demographic data was collected by using the structured questionnaire and the oxygen level was measured by using the Pulse Oximeter. The peak flow rate was measured by using the Peak Flow Meter. The findings of the study revealed that there was significant difference in the measurement of oxygen saturation and respiratory rate between the experimental and control group which infers that Strelinikova Breathing Exercise on respiratory signs and parameters administered to the school age children with lower respiratory tract infection in the experimental group was found to be effective in maintaining the respiratory parameters among school age children and the current findings suggests that more extensive studies can be done at different settings and also as comparative studies.

Introduction: PEFR is a simple bedside tool to assess the degree of airway obstruction in asthmatic children. As it is influenced by age, anthropometric data, racial and ethnic differences, region specific nomograms have been advocated for use. This study has been undertaken with a view to establish reference values for PEFR and develop nomograms in Vizianagaram district. Material and Methods: The present study was undertaken at MIMS medical college, Vizianagaram. The main aim of this school based, cross-sectional, descriptive study was to establish standard nomograms of PEFR for healthy school going children between 5-15 years age group. A total of 2684 students were included in the study after meeting the inclusion criteria. PEFR values were recorded with mini-Wright peak flow meter. Body surface area and body mass index were calculated from height and weight. Statistical analysis was carried out using R version 3.4.2. Results:PEFR showed high positive correlation with respect to Height, Weight, Age, Body Surface area and moderate positive correlation with BMI. Separate regression models were developed for boys and girls. Conclusions:PEFR had positive correlation with height, age, weight, BMI and BSA.PEFR values of children in Vizianagaram district were lesser than those of other south Indian, north Indian and western children. Keywords: PEFR, mini-Wright peak flow meter, linear regression equations, asthma morbidity, nomograms

The Peak flow meter is a device used to measure the amount of airflow in the human airway or often referred to as PFR (Peak Flow Rate). Peak Flow Rate (PFR) measurement is a simple and reliable way to detect airway obstruction. PFR measurement is a simple, non-invasive, fast and economic method to assess the strength and speed of expiration in L / min, through maximum expiration of capacity total lung. The results of peak flow data can illustrate early warning signs for an illness that in some cases may show a decrease in lung function 1-3 days before other respiratory symptoms become apparent. This module is designed using MPX5100GP sensor. This sensor has a pressure range of 0-100 Kpa. The Nature module is also equipped with data storage facilities using an SD Card so that the measurement data can be processed using Ms. Excel to find out graph data for further diagnostic purposes. The inspection results can be directly viewed on the display and also automatically stored in the SD Card storage that has been available. This module has the highest error rate of 4.41% and the lowest error value of 0.42% compared to the original device. From the data collection that has been done, it can be concluded that this module can be used for the inspection process.

Air pollution is regarded as a significant global public health risk factor in cities around the world. It is considered as one of the highest-ranking environmental health challenges in the world, particularly in developing countries like India. Air pollution is a significant risk factor for the development of various lung disorders. World Health Organization (WHO) defined air pollution as the impurity in the environment in and around by the physical, chemical, or biological agent, which has changed the natural characteristics of the atmosphere. The environmental factors related to air pollution induces the risk of allergic asthmatic reaction and emergency intervention. According to the respiratory health investigation people who are exposed to vehicular pollution for a longer duration, are in a risk to develop asthma. The air pollutants rates were measured by using the application real-time air quality index in which the air quality rate is evaluated. We piloted ten children with DCD of age about 5 - 10 years were analysed with wrights’ peak flow meter. Results of the study predicted that there is a decrease in peak expiratory flow rate with the predicted value (.000) and increase in the shortness of breath questionnaire with the predicted value (.077) on comparing over air quality index. This study concludes that there is an impact of air pollution among children with DCD.

Background: Inhalation therapy is a cornerstone of treating patients with chronic obstructive pulmonary disease (COPD). Inhaler types and through-device inhalation parameters influence airway drug delivery. We aimed to measure the repeatability of inhalation performance through four different commercially available inhalers. Methods: We recruited control subjects (n = 22) and patients with stable COPD (S-COPD, n = 16) and during an acute exacerbation (AE-COPD, n = 15). Standard spirometry was followed by through-device inhalation maneuvers using Ellipta(®), Evohaler(®), Respimat(®), and Genuair(®). Through-device inspiratory vital capacity (IVC(d)) and peak inspiratory flow (PIF(d)), as well as inhalation time (t(in)) and breath hold time (t(bh)), were recorded and all measurements were repeated in a random manner. Results: There was no difference in forced expiratory volume in 1 second (FEV(1)) between patients (S-COPD: 39 ± 5 vs. AE-COPD: 32% ± 5% predicted, p > 0.05). In controls, the IVC(d) was significantly reduced by all four devices in comparison with the slight reduction seen in COPD patients. In all subjects, PIF was lowered when inhaling through the devices in order of decreasing magnitude in PIF(d): Evohaler, Respimat, Ellipta, and Genuair. The Bland-Altman analysis showed a highly variable coefficient of repeatability for IVC(d) and PIF(d) through the different inhalers for all COPD patients. Based on the intermeasurement differences in patients, Respimat and Genuair showed the highest repeatability for IVC(d), while Genuair and Ellipta performed superior with regard to PIF(d). Conclusions: Our study is the first to compare repeatability of inhalation performances through different inhalers in COPD patients, showing great individual differences for parameters influencing lung deposition of inhaled medication from a given device. Our data provide new insight into the characterization of inhaler use by patients with COPD, and might aid the selection of the most appropriate devices to ensure the adequate and consistent delivery of inhaled drugs.

Background Peak inspiratory flow (PIF) has been proposed as a measure to assess a patient’s ability to use dry powder inhalers (DPIs). However, robust quality criteria to determine a repeatability limit for measuring PIF are lacking. Research Questions What are the repeatability limits for measuring PIF? What is the relationship between PIF measured using the In-Check DIAL device at Diskus (GlaxoSmithKline; PIFD) and HandiHaler (Boehringer Ingelheim; PIFHH) resistances? Study Design and Methods Data from a randomized, controlled, phase 3 trial (study 0149; see Clinical Trial Registration data) were used to define repeatability limits for PIF. In addition, a model to characterize the relationship between PIF measured with the In-Check DIAL device at PIFD and PIFHH was defined using data from two randomized, controlled, phase 3 trials (studies 0128 and 0149). Results In study 0128, the mean values (SD) for PIF at zero resistance and PIFHH were 84.6 (33.4) and 57.3 (26.1) L/min, respectively. In study 0149, the mean values (SD) for PIFD and PIFHH were 42.4 (11.2) and 29.0 (8.3) L/min, respectively. At the mean level, the mean difference between measurement attempts for PIFD and PIFHH was small, Interpretations This analysis demonstrated that the two highest values of PIF using the In-Check DIAL device among three inspiratory efforts, met the repeatability limit. Altogether, these data provide guidance for measuring PIF against the simulated resistance of a specific DPI in clinical practice and research studies. Clinical Trial Registration ClinicalTrials.gov; Nos.: NCT02518139 (study 0128) and NCT03095456 (study 0149); URL: www.clinicaltrials.gov .

BACKGROUND The Indian hair and beauty salon industry is growing rapidly due to the demand for beauty and personal care services and products. Workers in the industry are vulnerable to several occupational factors such as chemicals, confined space, and poor ventilation. Chemicals in the products used are known or suspected to cause allergies, respiratory, neurological and reproductive health problems and cancer. METHODS The present study was carried out to determine the factors associated with the occurrence of respiratory morbidity among hair and beauty salon workers of Udupi taluk, Karnataka, India. A total of 240 salon workers were recruited for the study. A semistructured, interviewer-led questionnaire was used to collect data. Peak expiratory flow rate (PEFR) was done using a JSB peak flow meter. RESULTS The frequency of respiratory morbidity among participating beauty salon workers was 19%. Men reported respiratory symptoms more frequently than women. Receiving training on work materials and practices was a significant protective factor (odds ratio = 0.3; 95% confidence interval: 0.1-0.7) for the occurrence of respiratory morbidity. The mean observed PEFR in these workers was significantly lower than their predicted values. While 61.2% of the workers were using some form of personal protective equipment, only 4% of workers used a mask or respiratory protection. CONCLUSION Hair and beauty salon workers are at risk of developing respiratory morbidity potentially from harmful exposures and lack of effective control measures at the workplace.

Many controlled studies and neurological studies demonstrate that men and women are physically and mentally different. The purpose of this study is to find out whether there is any gender difference in respiratory capacity between trained athletes of both gender. This study was conducted at Kolkata (Serampore area), West Bengal, India. The subject was trained table tennis players of age group was 14 – 17 years. Significant differences have been found in height (cm), W/H ratio and PIF (l/s) between male and female lawn tennis players and all these values are significantly higher (P

Pesticides exposure affects respiratory system. The study of peak expiratory flow rate (PEFR) as a parameter of lung function changes due to limited pesticide among farmers. This cross-sectional study aims to analyze factors affecting PEFR and formulate a model for predicting PEFR among 76 vegetable farmers using pesticides in Tlogolele Village, Boyolali Regency. Data were collected through questionnaire-based interview and clinical examination. PEFR test was conducted using a peak flow meter while cholinesterase level was investigated using Deutsche Gessellschaftfur Klinische Chemie method. The data were analyzed using unpaired T-test and Pearson test continued by multivariate regression models. The examination showed 75% of subjects had abnormal PEFR. Cholinesterase, body mass index, smoking habits, personal protective equipment usage, pesticide dosage, length of work per day, and last time of spraying did not show a significant correlation with PEFR. On the other hand, age, height, weight, frequency of spraying, and spraying duration showed a significant correlation with PEFR and a prediction equation for PEFR model was obtained as R 2 =0.268 (p

OBJECTIVES Tracheostomy is commonly used in intensive care units and in head and neck departments. Airway obstruction due to occluded cuffless tracheostomy tubes themselves remains unknown, although capping trials are commonly used before decannulation. The aim of this study was to evaluate the extent to which airway obstruction can be caused by occluded cuffless tubes in patients who underwent head and neck surgery. DESIGN Prospective Research Outcome. SETTINGS University teaching hospital. PARTICIPANTS Fifty patients requiring transient tracheostomy after head and neck surgery. MAIN OUTCOME MEASURES A flow-volume loop (FVL) through the mouth using a portable spirometer, with the occluded fenestrated cuffless tube, was measured before and immediately after decannulation, by obstructing the orifice of tracheostomy tube. The measurement of FVL recorded the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1 ), peak expiratory flow (PEF), forced expiratory flow at 50% of FVC, peak inspiratory flow (PIF) and forced inspiratory flow at 50% of FVC. RESULTS A statistically significant difference between all spirometric parameters was found. Mean PEF and PIF, respectively, increased from 2.8 to 4.5 L/s (P

Background: The Queens College Step Test is used to determine aerobic fitness. Peak Expiratory Flow Rate (PEFR) is the maximum rate of forceful exhalation following full inspiration. PEFR primarily reflects bronchial airflow and depends on the voluntary effort and muscular strength of the individual. Studies that correlate ventilatory capacity with body fat percentage are rare in published literature in Nepalese settings. Body fat percentage is regarded as a better indicator of obesity recently. Hence, this study aims to find an association between post-exercise change in PEFR and body adiposity in the context of Nepal. Methods: A cross-sectional study was carried out from 20th July 2019 to 15th November in the laboratory of Clinical Physiology of Maharajgunj Medical Campus. Body fat percentage was measured by using OMRON BF 214. Pre-exercise PEFR of each subject was recorded by using Wright’s peak flow meter. Post-exercise PEFR was also recorded after three minutes of Queen’s College step test, which is the submaximal exercise test, and change in PEFR was calculated and correlated with body fat percentage. Result: The study showed a negative correlation of change in PEFR with body fat percentage (r=-0.324; P

Objective: Teenage is the time of shaping health behavior and preventing postural defects and improving respiratory fitness. The teenagers possess insufficient knowledge of their respiratory system. Postural defects are commonly seen among teenagers due to lack of physical activity and poor postural habits which can lead to non-harmonious development of organs and affect respiratory system as well. For efficient respiratory function, moderate-intensity exercises with posture correction would be useful. There is a paucity of literature showing the effect of posture correction and moderate-intensity exercises on respiratory system in teenagers, hence, this study would be helpful to analyze the same. The objectives of the study were to find out the effect of posture correction exercise on respiratory system in teenagers and to find out the effect of moderate-intensity exercises on respiratory system in teenagers. Materials and Methods: The study was carried out in Karad area. The subjects were selected according to the inclusion and exclusion criteria. A total of 35 subjects were participated in this study. Prior consent and assent form was taken. The aim and procedure were explained to the subjects in their preferred language before data collection. Pre- and post-assessment was done by 6 min walk test for respiratory function and flexicurve was measured using flexible ruler to recognize spinal postural defect. Peak flow meter was used to measure lung function. Results: In a conducted study, 6 min walk test, peak flow meter, and flexicurve showed statistically significant difference between pre- and post-treatment values. Conclusion: On the basis of the result of the study, it can be concluded that posture correction and moderate- intensity exercises help in improving respiratory function in teenagers.

Introduction: The Peak Expiratory Flow Rate (PEFR) is a person maximum expiratory airflow measurement. The active cycle breathing technique is a breathing exercise focus on release the abnormal lung secretion by increase the expiration power. The aim of this study was to analyze the effectiveness of the active cycle breathing technique on the PEFR in asthma patient. Methods: Design of this study was quasi-experimental with single pre-post test group. Study was conducted in the Kedungkandang Primary Health Care, Malang City, East Java Province, Indonesia. In total 25 asthma patients recruited into a single group. The participant asked to practice the breathing exercise for three times a week and being evaluated after one month. The PEFR was measured by Peak Flow Meter. Results: The Wilcoxon test showed p grade < 0.05, which means there is a significant effect of the active cycle breathing technique on the PEFR grade. The increase of PEFR grade in asthma patients start to appear at the week third to the end of week fourth. Continuous treatment may increase the PEFR grade, however it was influenced by several factors such as age (years) and educational background. Conclusion: The active cycle breathing technique increase PEFR in asthma patients. The PEFR expected to be evaluated simultaneously, to assess the stages of improvement for asthma patient.

Asthma is a common disease in children, and obtaining basic knowledge and skills to manage asthma symptoms is critically important. This study examined the effectiveness of a theoretically based school nurse–led asthma intervention on asthma symptoms, self-management, peak flow meter usage, daily activities, and school absences in children 7–12 years old. A randomized controlled, two-group, repeated measures design was conducted in eight public schools. Data collection occurred at three time points. The treatment group had statistically significant differences in reported symptoms ( p < .001), asthma control with a peak flow meter usage ( p < .001), and daily activities ( p < .001) at 6 weeks and at 12 weeks. Although difference in school absences was not statistically significant, the treatment group missed fewer school days than the control group. Self-management is a complex process, and school nurses can provide essential learning steps and continuity of care for school-age children living with asthma.

Objectives To investigate the effects of ventilation mode and manual chest compression (MCC) application on the flow bias generated during positive end-expiratory pressure–zero end-expiratory pressure (PEEP-ZEEP) in mechanically ventilated patients. PEEP-ZEEP is an airway clearance manoeuvre with the potential to exceed the flow bias required to remove secretions. However, the ventilation mode applied during the manoeuvre has not been standardised. Design Randomised crossover trial. Participants Nineteen mechanically ventilated patients. Interventions Patients were randomised to receive PEEP-ZEEP in volume-controlled and pressure-controlled modes, and with or without MCC. Main outcome measures The difference in flow bias – assessed by the peak expiratory flow (PEF) and peak inspiratory flow (PIF) ratio and difference – between PEEP-ZEEP applied in both ventilation modes, and with and without MCC. Results The expiratory flow bias was significantly higher in the volume-controlled mode than the pressure-controlled mode. This result was caused by a lower PIF in the volume-controlled mode. PEEP-ZEEP applied in the pressure-controlled mode did not achieve the PEF-PIF difference threshold to clear mucus. Moreover, in the majority of cycles of PEEP-ZEEP applied in the pressure-controlled mode, an inspiratory flow bias was generated, which might embed mucus. PEF was 8 l/minute higher with MCC compared with without MCC, which increased the PEF-PIF difference by the same amount. No haemodynamic or respiratory adverse effects were found. Conclusions If applied in the volume-controlled mode, PEEP-ZEEP can achieve the flow bias needed to expel pulmonary secretions. However, this is not the case in the pressure-controlled mode. MCC can augment the flow bias generated by PEEP-ZEEP, but its application may be dispensable. Clinical trial registration http://www.ensaiosclinicos.gov.br/rg/RBR-223xv8/ .

Peak Flow Meter (PFM) is a tool to measure the Peak Flow of Air Expiration in the road (PFR) or commonly referred to as Peak Expiration Flow (PEF) and to connect asthma. The value of PEF can help a number of factors in age, respiratory muscle strength, height and gender. Airway measurements are used to measure patients suffering from asthma. This peak flow meter tool works based on the air pressure produced from the patient's puff using the MPX5100GP pressure sensor in the range of 0 to 100 kPa and the voltage output is 0.2 to 4.7 VDC to increase wind pressure in the patient. From the pressure converted to voltage and enter the 0 from the Arduino nano minimum system circuit to be processed into analog data and then put into units of liters / second, the value of the flow meter is sent and replaced to a PC with the Delphi7 application. The measurement results of PEF values at peak flow meters have an error value of less than 5% This peak flow meter tool also has a consideration value of 0.095475 so that this tool can be said to be very certain to be used as asthma. Then it can be concluded that the peak flow meter is feasible and meets the specified requirements

Introduction Expiratory flow is important to minimize the risk of infection by expelling foreign substances from the lungs. Abdominal muscle activities primarily produce expiratory flow. However, data on the association of abdominal muscle activity during expiratory effort and abdominal exercise posture with expiratory flow rate is limited. This study aimed to assess the correlation between expiratory flow and abdominal muscle activity while holding maximum expiration and performing the side bridge exercise in elderly women. Methods Rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscle activity was measured using electromyography in 14 elderly women (82.8 ± 6.7 years), who could walk independently while performing 2 tasks: holding their breath after maximum expiration in the crook-lying position (maximum expiration), and performing the side bridge exercise on their knees without breathing instruction (side bridge). Peak expiratory flow (PEF) was obtained using a peak flow meter. Correlations between PEF and the abdominal muscle activity were determined using the Spearman rank correlation coefficient. Results The correlation coefficients between PEF and RA, EO, and IO activity while holding maximum expiration were 0.407 (p = 0.149), −0.345 (p = 0.227), and 0.732 (p = 0.003), respectively. The correlation coefficients between PEF and RA, EO, and IO activity while performing the side bridge exercise were −0.297 (p = 0.303), −0.552 (p = 0.041), and 0.147 (p = 0.615), respectively. Conclusions Higher IO activity while holding maximum expiration or lower EO activity while performing the side bridge exercise was related to higher PEF. Thus, maximum expiration and abdominal exercise might be effective in the improvement or prevention of the decrease of expiratory flow.

Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. Objective To analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. Materials and methods Breathing, swallowing and phonation were analyzed in 37 patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1 year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. Results The rate of primary surgery without tracheotomy was 64.9% (13 patients), with rapid resumption of oral feeding (mean intubation time, 13 days). Mean VHI score was 28.3 and mean DHI 30 score 2.7. Mean peak inspiratory flow was 203.3 mL/min. Conclusion Supracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.

Background The objective of this study was to evaluate the effects of three single-limb heated wired circuits (SLHWC) for NIV, on ventilatory parameters and humidification performance in a simulation lung model. Methods Three SLHWC compatible with the MR-850 Heated Humidifier (HH) (Fisher & Paykel, Auckland, New Zealand) were tested: RT-319 (FP) (Fisher & Paykel, Auckland, New Zealand), Respironics 1045770 (RP) (DEAS, Castel Bolognese, Italy) and Intersurgical B/SYS 5809001 (IT) (Intersurgical, Wokingham, UK). A Bipap Vision ventilator (Philips Respironics, Murrysville, PA, USA) in pressure control ventilation (PCV) connected to a test lung was used for simulation. Each SHWC performance was evaluated in four ventilatory conditions: IPAP of 15 cm H2O with FiO2 0.3 and 1, respectively; and, IPAP of 25 cm H2O with FiO2 0.3 and 1, respectively. EPAP was set at 5 cm H2O. Hygrometric and ventilatory measurements including: relative humidity (RH), temperature (T), Pplat, PIP, PEEP, peak inspiratory flow (PIF), and tidal volume (Vt) were measured. Results In each FiO2 group absolute humidity (AH) was similar with FP regardless of the IPAP level employed compared to IT and RP (P Conclusions Humidification performance varied significantly among the three circuits, being FP the only one able to maintain stable AH values during the study with no influence on ventilatory parameters.

The purpose of this study was to compare the effect of two types of cervical collars (Philadelphia and Miami-J) on pulmonary function and ventilation in healthy volunteers through spirometry, peak flow meter, and capnograph.Initially, subjects were randomized into two groups in which the sequence of collars' fixation was reversed. Afterward, we assessed the pulmonary parameters without a cervical collar in all participants. Each group underwent two additional test conditions, including measurements after wearing a Philadelphia and Miami-J cervical collar. In any case, we took the measurements half an hour after the collar fixation.The mean age of participants was 48.34 ± 1.35 years. Following either type of collars application, there was a statistically significant decrease in FEV1, FEV1/FVC, FEF25-75%, and PEF (p .001). However, FVC was not significantly changed (p = .157).In summary, we noted a statistically significant expiratory flow obstruction after both the Philadelphia and Miami-J cervical collar. These changes were not clinically significant in healthy volunteers, albeit may have ramifications in patients with pre-existing respiratory compromise.

Background Optimal flow settings during high-flow nasal cannula (HFNC) therapy are unknown. We investigated the optimal flow settings during HFNC therapy based on breathing pattern and tidal inspiratory flows in patients with acute hypoxemic respiratory failure (AHRF). Methods We conducted a prospective clinical study in adult hypoxemic patients treated by HFNC with a fraction of inspired oxygen (FIO2) ≥ 0.4. Patient’s peak tidal inspiratory flow (PTIF) was measured and HFNC flows were set to match individual PTIF and then increased by 10 L/min every 5–10 min up to 60 L/min. FIO2 was titrated to maintain pulse oximetry (SpO2) of 90–97%. SpO2/FIO2, respiratory rate (RR), ROX index [(SpO2/FIO2)/RR], and patient comfort were recorded after 5–10 min on each setting. We also conducted an in vitro study to explore the relationship between the HFNC flows and the tracheal FIO2, peak inspiratory and expiratory pressures. Results Forty-nine patients aged 58.0 (SD 14.1) years were enrolled. At enrollment, HFNC flow was set at 45 (38, 50) L/min, with an FIO2 at 0.62 (0.16) to obtain an SpO2/FIO2 of 160 (40). Mean PTIF was 34 (9) L/min. An increase in HFNC flows up to two times of the individual patient’s PTIF, incrementally improved oxygenation but the ROX index plateaued with HFNC flows of 1.34–1.67 times the individual PTIF. In the in vitro study, when the HFNC flow was set higher than PTIF, tracheal peak inspiratory and expiratory pressures increased as HFNC flow increased but the FIO2 did not change. Conclusion Mean PTIF values in most patients with AHRF were between 30 and 40 L/min. We observed improvement in oxygenation with HFNC flows set above patient PTIF. Thus, a pragmatic approach to set optimal flows in patients with AHRF would be to initiate HFNC flow at 40 L/min and titrate the flow based on improvement in ROX index and patient tolerance. Trial registration: ClinicalTrials.gov (NCT03738345). Registered on November 13th, 2018. https://clinicaltrials.gov/ct2/show/NCT03738345?term=NCT03738345&draw=2&rank=1

Objective The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects. Study design Prospective cohort study. Setting Tertiary referral center. Method Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements. Results The Cotton-Myer classification correlated weakly with peak expiratory flow (r = -0.35, P = .012), expiratory disproportion index (r = 0.32, P = .022), peak inspiratory flow (r = -0.32, P = .022), and total peak flow (r = -0.36, P = .01). The DI showed an excellent area under the curve (0.99, P Conclusion Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI.

Background: The emitted dose (ED) from most dry powder inhalers (DPIs) is almost independent of peak inspiratory flow (PIF) above a certain value, which is specific to the individual DPI. However, ...

Respiratory insufficiency and pulmonary health are important considerations in equine neonatal care. As the majority of foals are bred for athletic pursuits, strategies for respiratory support of compromised foals are of particular importance. The administration of supplementary oxygen is readily implemented in equine practice settings, but does not address respiratory insufficiency due to inadequate ventilation and is no longer considered optimal care for hypoxia in critical care settings. Non-invasive ventilatory strategies including continuous or bi-level positive airway pressure are effective in human and veterinary studies, and may offer improved respiratory support in equine clinical practice. The current study was conducted to investigate the use of a commercial bi-level positive airway pressure (BiPAP) ventilator, designed for home care of people with obstructive respiratory conditions, for respiratory support of healthy foals with pharmacologically induced respiratory insufficiency. A two sequence (administration of supplementary oxygen with, or without, BiPAP), two phase, cross-over experimental design was used in a prospective study with six foals. Gas exchange and mechanics of breathing (increased tidal volume, decreased respiratory rate and increased peak inspiratory flow) were improved during BiPAP relative to administration of supplementary oxygen alone or prior studies using continuous positive airway pressure, but modest hypercapnia was observed. Clinical observations, pulse oximetry and monitoring of expired carbon dioxide was of limited benefit in identification of foals responding inappropriately to BiPAP, and improved methods to assess and monitor respiratory function are required in foals.

Background: Children with neuromuscular diseases (NMD) are at risk of morbidity and mortality because of progressive respiratory muscle weakness and ineffective cough. Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength, thereby reducing morbidity and improving health-related quality of life (HRQoL). Objectives: To describe the safety and feasibility of a 6-week IMT programme using an electronic threshold device (Powerbreathe®). Any adverse events and changes in functional ability, spirometry, peak expiratory cough flow (PECF), inspiratory muscle strength and HRQoL (Pediatric Quality of Life [PedsQL]) were recorded. Methods: A convenience sample of eight participants ( n = 4 boys; median [interquartile range {IQR}] age: 12.21 [9.63–16.05] years) with various NMD were included in a pre-experimental, observational pre-test post-test feasibility study. Training consisted of 30 breaths, twice daily, 5 days a week, for 6 weeks. Results: There were significant pre- to post-intervention improvements in upper limb function and coordination ( p = 0.03) and inspiratory muscle strength: maximum inspiratory mouth pressure (Pimax) ( p = 0.01); strength-index ( p = 0.02); peak inspiratory flow (PIF) ( p = 0.02), with no evidence of change in spirometry, PECF or HRQoL. No adverse events occurred and participant satisfaction and adherence levels were high. Conclusion: Inspiratory muscle training (at an intensity of 30% Pimax) appears safe, feasible and acceptable, in a small sample of children and adolescents with NMD and was associated with improved inspiratory muscle strength, PIF and upper limb function and coordination. Clinical implications: Larger, longer-term randomised controlled trials are warranted to confirm the safety and efficacy of IMT as an adjunct respiratory management strategy in children with NMD.

(1) Background: Aerosol delivery via high-flow nasal cannula (HFNC) has attracted increasing clinical interest. In vitro studies report that the ratio of HFNC gas flow to patient inspiratory flow (GF:IF) is a key factor in the efficiency of trans-nasal aerosol delivery. (2) Methods: In a randomized controlled trial, patients with a history of COPD or asthma and documented positive responses to inhaled bronchodilators in an outpatient pulmonary function laboratory were recruited. Subjects were randomized to receive inhalation at gas flow ratio settings of: GF:IF = 0.5, GF:IF = 1.0, or GF = 50 L/min. Subjects were assigned to inhale saline (control) followed by salbutamol via HFNC with cumulative doses of 0.5 mg, 1.5 mg, 3.5 mg, and 7.5 mg. Spirometry was performed at baseline and 10–12 min after each inhalation. (3) Results: 75 subjects (49 asthma and 26 COPD) demonstrating bronchodilator response were enrolled. Per the robust ATS/ERS criteria no difference was observed between flows, however using the criteria of post-bronchodilator forced expiratory volume in the first second (FEV1) reaching the screening post-bronchodilator FEV1 with salbutamol, a higher percentage of subjects receiving GF:IF = 0.5 met the criteria at a cumulative dose of 1.5 mg than those receiving GF:IF = 1.0, and GF = 50 L/min (64% vs. 29% vs. 27%, respectively, p = 0.011). Similarly at 3.5 mg (88% vs. 54% vs. 46%, respectively, p = 0.005). The effective dose at GF:IF = 0.5 was 1.5 mg while for GF = 50 L/min it was 3.5 mg. (4) Conclusions: During salbutamol delivery via HFNC, cumulative doses of 1.5 mg to 3.5 mg resulted in effective bronchodilation. Applying the robust ATS/ERS criteria no difference was observed between the flows, however using the more sensitive criteria of subjects reaching post screening FEV1 to salbutamol via HFNC, a higher number of subjects responded to the doses of 0.5 mg and 1.5 mg when HFNC gas flow was set at 50% of patient peak inspiratory flow.

Asthma could affect quality of life and decrease productivity. The worsening of asthma symptoms also affected lung function. Symptoms of asthma could be control by self-management. The patient's behavior in self-management influenced by his perception of asthma. This research aims to determine effect of perception of disease on health function of parents in asma patients in surabaya. Research using observational methods with cross sectional design. Research Subjects were outpatient asthma patients aged 17-25 years. Data collection was conducted from June 2015 to January 2016 in Surabaya, to 27 people. Assessment of asthma perception use Illness Perception Questionnaire (IPQ) and health condition of lung function with peak flow meter to assess PEF (peak expiratory flow). The results of this study indicate that both groups have a PEF value 0.05) between disease perceptions based on the number of asthma-related symptoms with lung function (PEF), with the greatest answer as the cause of asthma that is genetic. Therefore, the perception of asthma does not affect lung function (PEF) in adult asthma patients in Surabaya.

Jamie R Chua,1 Albert B Albay Jr,1 Michael L Tee2 1Division of Pulmonary Medicine, Department of Medicine, Philippine General Hospital, College of Medicine, University of the Philippines Manila, Manila, Philippines; 2Associate Professor, Department of Physiology and Division of Rheumatology, Department of Medicine, College of Medicine, University of the Philippines Manila, Manila, PhilippinesCorrespondence: Jamie R ChuaDivision of Pulmonary Medicine, Department of Medicine, Philippine General Hospital, College of Medicine, University of the Philippines Manila 25 Caimito Street, South Caloocan City, Metro Manila 1400, PhilippinesTel +63 224164308Email jrchua6@up.edu.phBackground and objectives: The loss of muscle or fat free mass (FFM) as a result of systemic inflammation and poor nutrition in Chronic Obstructive Pulmonary Disease (COPD), is recognized as an important factor that influences symptoms and disease-related outcomes. To date, there are no data on body composition among Filipino COPD patients and how it impacts COPD disease severity. This paper examined the relationship of Fat Free Mass Index (FFMI = FFM/height) and sarcopenia with COPD disease severity variables.Methods: This was a cross-sectional analytic study comparing low and normal FFMI, sarcopenic and nonsarcopenic COPD patients, in terms of lung function, exercise capacity, and quality of life score. Filipino COPD patients older than 40 years were included. Patients performed six minute walking distance (6MWD), handgrip strength (HGS), and quality of life status evaluation using Filipino version of COPD Assessment Test (CAT). Body composition was measured using bioelectrical impedance analysis (BIA).Results: A total of 41 patients were included. The mean age was 69.22 years. The prevalence of being underweight and having sarcopenia was 32% and 46%, respectively. Point biserial correlation showed that COPD patients with low FFMI had a statistically significant reduction in peak inspiratory flow (r= −0.5791, P value 0.0002), peak expiratory flow (r= −0.4475, P value 0.0055), and handgrip strength (r= −0.4560, P value 0.0027); and lower CAT score (r= −0.3422, P value 0.0285). Similar findings were observed among sarcopenic COPD patients.Conclusion: The prevalence of being underweight and having sarcopenia was high. Low FFMI results in reduction of lung function and upper limb muscle strength among Filipino COPD patients.Keywords: chronic obstructive pulmonary disease, nutrition, body composition, sarcopenia, lung function