1
|
Bhandari SK, Bist A, Ghimire A. Single breath count test and its applications in clinical practice: a systematic review. Ann Med Surg (Lond) 2024; 86:2130-2136. [PMID: 38576972 PMCID: PMC10990392 DOI: 10.1097/ms9.0000000000001853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Background Single breath count test (SBCT) may be a reproducible, rapid, easy to perform and easy to interpret substitute to spirometry especially in low resource settings for certain conditions. Its interest has been rekindled with the recent COVID-19 pandemic and it can be done as a part of tele-medicine as well. Objectives The objective of this review was to summarize the evidence of SBCT in clinical practice. Methods The authors searched EMBASE, PubMed and Google Scholar for all the relevant articles as per exclusion and inclusion criteria. Two authors independently screened all the studies. Newcastle Ottawa Scale was used to assess the quality of the studies. The systematic review was carried following the PRISMA guidelines. Results After the rigorous process of screening, a total of 13 articles qualified for the systematic review. SBCT greater than 25 had sensitivity of greater than 80% in diagnosing myasthenia gravis exacerbation and SBCT less than or equal to 5 predicted the need for mechanical ventilation in Guillain-Barre syndrome (GBS) patients with 95.2% specificity. Also, Single breath count correlated significantly with forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) in children with pulmonary pathology and in patients with COVID-19 it was used to rule out the need for noninvasive respiratory support. Conclusion SBCT will undoubtedly be an asset in low resource settings and in tele-medicine to assess the prognosis and guide management of different respiratory and neuromuscular diseases.
Collapse
Affiliation(s)
| | - Anil Bist
- Tribhuvan University Institute of Medicine, Maharajgunj Medical Campus, Internal Medicine, Maharajgunj, Nepal
| | | |
Collapse
|
2
|
Delmondes GMB, Couto NFS, Correia Junior MGA, Bonifácio ABDS, Freitas Dias RD, Bezerra J, Santos MADM, Gomes de Barros MV, Costa EC, Correia Junior MADV. Single breath counting technique to assess pulmonary function: a systematic review and meta-analysis. J Breath Res 2023; 18:014001. [PMID: 37875103 DOI: 10.1088/1752-7163/ad0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/24/2023] [Indexed: 10/26/2023]
Abstract
Pulmonary function is usually assessed by measuring Vital Capacity (VC) using equipment such as a spirometer or ventilometer, but these are not always available to the population, as they are relatively expensive tests, difficult to transport and require trained professionals. However, the single breath counting technique (SBCT) appears as a possible alternative to respiratory function tests, to help in the pathophysiological understanding of lung diseases. The objective is to verify the applicability of the SBCT as a parameter for evaluating VC. This is a systematic review registered in the International Prospective Register of Systematic Reviews (CRD42023383706) and used for PubMed®, Scientific Electronic Library Online, LILACS, EMBASE, and Web of Science databases of articles published until January 2023. Methodological quality regarding the risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and National Institutes of Health tools. Eleven of a total of 574 studies were included, of these, nine showed a correlation between VC and SBCT (weak in healthy, moderate in neuromuscular and strong in hospitalized patients). One study of hospitalized patients accurately identified a count value of 21 for a VC of 20 ml kg-1(Sensitivity = 94% and Specificity = 77%), and another estimated a count lower than 41 for a VC below 80% of predicted in patients with neuromuscular dystrophy (Sensitivity = 89% and Specificity = 62%), and another showed good intra and inter-examiner reproducibility in young, adult, and elderly populations. A meta-analysis of three studies showed a moderate correlation in subjects with neuromuscular diseases (r= 0.62, 95% CI = 0.52-0.71,p< 0.01). A high risk of bias was identified regarding the justification of the sample size and blinding of the evaluators. SBCT has been presented as an alternative to assess VC in the absence of specific equipment. There is a clear relationship between SBCT and VC, especially in neuromuscular and hospitalized individuals. New validation studies conducted with greater control of potential bias risks are necessary.
Collapse
Affiliation(s)
| | - Nathália Ferreira Santos Couto
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | | | | | | | - Jorge Bezerra
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | - Marcos André de Moura Santos
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | - Mauro Virgílio Gomes de Barros
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | - Emília Chagas Costa
- Centro Acadêmico de Vitória da Universidade Federal de Pernambuco, Vitoria de Santo Antao, Pernambuco, Brazil
| | - Marco Aurélio de Valois Correia Junior
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| |
Collapse
|
3
|
Sharma D, Saini AK, Jha DK, Tyagi A, Bisht SS. Single Breath Counting for Diagnosis and Prediction of Severity of Acute Asthma Exacerbation in Children. Indian J Pediatr 2023; 90:776-780. [PMID: 35648308 DOI: 10.1007/s12098-022-04154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To find correlation between single breath counting (SBC) and spirometry in acute exacerbation of asthma in children. METHODS A cross-sectional observational study including all children aged 6-12 y age, who presented in outpatient department or emergency room with acute exacerbation of asthma, not fitting in exclusion criteria were enrolled. SBC and spirometry parameters were obtained before treatment and 1 h after initiating treatment (GINA 2017 Guidelines). RESULTS Significant correlation was observed in SBC and FVC (r = 0.349), FEV1 (r = 0.439), FEF25-75 (r = 0.424), and PEF (r = 0.593). Cutoff value of SBC of 23 was found to be suggestive of severe/life-threatening asthma with sensitivity of 83.3% and specificity of 84.4%. No significant association was found between percent change in SBC and spirometry parameters in response to treatment. CONCLUSIONS SBC can be used to predict PEF, FEV1, FVC, and FEF25-75 of a patient aged between 6 and 12 y during acute asthma exacerbation. The observed cutoff value of 23 of SBC score has a good sensitivity and specificity to identify life-threatening/severe exacerbation. SBC score significantly increases in response to therapy.
Collapse
Affiliation(s)
- Devansh Sharma
- Department of Pediatrics, Swami Dayanand Hospital, New Delhi, India
| | - Anil Kumar Saini
- Department of Pediatrics, Swami Dayanand Hospital, New Delhi, India
| | - Deo Kumar Jha
- Department of Pediatrics, Swami Dayanand Hospital, New Delhi, India
| | - Amita Tyagi
- Department of Pediatrics, Swami Dayanand Hospital, New Delhi, India
| | - Surender Singh Bisht
- Department of Pediatrics, Swami Dayanand Hospital, New Delhi, India.
- , B-83, Sector 36, Noida, Uttar Pradesh, 201303, India.
| |
Collapse
|
4
|
Nakka S, Das RR. Single Breath Counting: Is it a Reliable, Tool Independent Measure to Predict Asthma Exacerbation? Indian J Pediatr 2023; 90:750-751. [PMID: 37162732 DOI: 10.1007/s12098-023-04638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Swathi Nakka
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, India.
| |
Collapse
|
5
|
Dishnica N, Vuong A, Xiong L, Tan S, Kovoor J, Gupta A, Stretton B, Goh R, Harroud A, Schultz D, Malycha J, Bacchi S. Single count breath test for the evaluation of respiratory function in Myasthenia Gravis: A systematic review. J Clin Neurosci 2023; 112:58-63. [PMID: 37094510 DOI: 10.1016/j.jocn.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Myasthenia gravis (MG) can have a variety of respiratory presentations, ranging from mild symptoms through to respiratory failure. The evaluation of respiratory function in MG can be limited by accessibility to testing facilities, availability of medical equipment, and facial weakness. The single count breath test (SCBT) may be a useful adjunct in the evaluation of respiratory function in MG. METHOD A systematic review of the databases PubMed, EMBASE, and the Cochrane Library was conducted from inception to October 2022 in accordance with PRISMA guidelines and was registered on PROSPERO. RESULTS There were 6 studies that fulfilled the inclusion criteria. The described method of evaluating SCBT involves inhaling deeply, then counting at two counts per second, in English or Spanish, sitting upright, with normal vocal register, until another breath needs to be taken. The identified studies support that the SCBT has a moderate correlation with forced vital capacity. These results also support that SCBT can assist the identification of MG exacerbation, including via assessment over the telephone. The included studies support a threshold count of ≥ 25 as consistent with normal respiratory muscle function. Although further analysis is needed, the included studies describe the SCBT as a quick bedside tool that is inexpensive and well tolerated. CONCLUSIONS The results of this review support the clinical utility of the SCBT in assessing respiratory function in MG and describe the most current and effective methods of administration.
Collapse
Affiliation(s)
- Noel Dishnica
- Flinders University, Bedford Park, SA 5042, Australia.
| | - Alysha Vuong
- Flinders University, Bedford Park, SA 5042, Australia
| | - Lucy Xiong
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, SA 5005, Australia; Gold Coast University Hospital, Southport, QLD 4215, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Adil Harroud
- McGill University, Montreal, Quebec H3A 0G4, Canada
| | - David Schultz
- Flinders University, Bedford Park, SA 5042, Australia
| | - James Malycha
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Stephen Bacchi
- Flinders University, Bedford Park, SA 5042, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| |
Collapse
|
6
|
Klein E, Dräger B, Boentert M. Validation of the Single Breath Count Test for Assessment of Inspiratory Muscle Strength in Healthy Subjects and People with Neuromuscular Disorders. J Neuromuscul Dis 2023; 10:251-261. [PMID: 36617788 DOI: 10.3233/jnd-221530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to validate the single breath count test (SBCT) against volitional measures of respiratory muscle function in healthy subjects and people with neuromuscular disorders (NMD; n = 100 per group). METHODS Testing comprised upright and supine SBCT, forced vital capacity (FVC), maximum inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP). Predictability of FVC by SBCT was assessed using logarithmic regression analysis. Receiver operating characteristics curves were used to identify SBCT thresholds for lung restriction (FVC < 80% predicted), inspiratory muscle weakness (MIP < 60 cmH2O), and indication for non-invasive ventilation (NIV) in NMD patients. RESULTS In both groups, SBCT showed moderate correlation with FVC. In patients, SBCT values were also correlated with MIP and SNIP. Strength of correlations was similar with supine and upright SBCT which accounted for 23.7% of FVC variance in healthy individuals (44.5% in patients). Predictive thresholds of upright SBCT were < 27 for MIP < 60 cmH2O (sensitivity 0.61/specificity 0.86), <39 for NIV indication (0.92/0.46), and <41 for FVC < 80% predicted (0.89/0.62). CONCLUSION The SBCT is positively correlated with spirometry. It predicts both lung restriction and NIV indication in NMD patients. The SBCT allows for remote monitoring and may substitute for spirometry/manometry if appropriate devices are unavailable.
Collapse
Affiliation(s)
- Eike Klein
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Bianca Dräger
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| |
Collapse
|
7
|
Jain BK, Songara A, Chandrakantham UM, Nagwanshi J. Effect of smoking on vital hemodynamic parameters and lipid profile of young smokers. IMC JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.55010/imcjms.17.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objectives: Tobacco use is associated with cardiovascular, respiratory and peripheral vascular diseases. The short term effects of tobacco smoking on vital hemodynamic parameters and lipid profile of young smoker with increased quantity of smoking is still debatable. The objective of this study was to evaluate the effect of smoking on vital hemodynamic parameters and lipid profile of young smokers.
Materials and methods: The current study was an observational cross sectional study conducted in a tertiary care hospital over a period of 18 months and included smokers and non-smokers. Data on vital hemodynamic parameters like blood pressure, heart rate, oxygen saturation (SPO2) and lipid profile were collected. Chi-square and analysis of variance (ANOVA) tests were used to analyze the data.
Results: A total of 80 smokers and 80 non-smokers were enrolled in the study. Blood pressure, heart rate and mean SpO2 were significantly (p<0.001) lower in non-smokers compared to smokers. Breath holding time (BHT) and single breath count (SBC) were higher in non-smokers. Mean values of total cholesterol (T-chol), low density lipoprotein (LDL) and triglyceride (TG) were significantly (p<0.001) higher in smokers than non-smokers, while high density lipoprotein (HDL) was significantly low in smokers. SBP, T -chol and TG significantly (p<0.05) increased as the quantity of smoking increased.
Conclusion: Smoking is associated with derangement of vital hemodynamic parameters and lipid profile across the age. Anti-smoking campaign should be organized to discourage both personal smoking and smoking in public places.
IMC J Med Sci. 2023. 17(1): 007. DOI : https://doi.org/10.55010/imcjms.17.007
*Correspondence: Bhupendra Kumar Jain, Department of Pulmonary Medicine, School of Chhindwara Institute Of Medical Sciences, Jabalpur Medical University, Chhindwara, Madhya Pradesh, India. Email: drbhupendrakjain@gmail.com
Collapse
Affiliation(s)
- Bhupendra Kumar Jain
- Department of Pulmonary Medicine, School of Chhindwara Institute of Medical Sciences, Chhindwara, Jabalpur Medical University, Madhya Pradesh, India
| | - Ashwin Songara
- Department of Pulmonary Medicine, Amaltas Institute of Medical Sciences, Dewas, Jabalpur Medical University, Madhya Pradesh, India
| | - U Maheshwar Chandrakantham
- Department of Pulmonary Medicine, School of Chhindwara Institute of Medical Sciences, Chhindwara, Jabalpur Medical University, Madhya Pradesh, India
| | - Jyoti Nagwanshi
- Department of Medicine, School of Chhindwara Institute of Medical Sciences, Chhindwara, Jabalpur Medical University, Madhya Pradesh, India
| |
Collapse
|
8
|
The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Reeducation Exercises, in Patients with Non-Specific Chronic Neck Pain: Protocol for Development of Outcome Measures and a Randomized Controlled Trial. Diagnostics (Basel) 2022; 12:diagnostics12112690. [DOI: 10.3390/diagnostics12112690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Until now, non-specific chronic neck pain has mainly been considered as a musculoskeletal system dysfunction, with associated psychological involvement due to its prolonged or recurrent nature. However, patients with non-specific chronic neck pain frequently additionally exhibit respiratory dysfunction. Emerging evidence suggests that addressing the respiratory dysfunction in these patients will provide additional therapeutic benefits in musculoskeletal and respiratory-related outcomes for several reasons (biomechanical, biochemical, and psychological). Motor control dysfunction of the muscles surrounding the spine (diaphragm included) negatively affects the mechanics and biochemistry of breathing (pH-homeostasis). An impaired and ineffective breathing pattern has been recognized as the primary source of many unexplained symptoms (anxiety, depression, confusion, chest pain, hypocapnia, and breathlessness) in patients with non-specific chronic neck pain. The proposed protocol’s purpose is dual: to assess the relative effectiveness of manual therapy in the cervical spine and the diaphragm, in combination with breathing reeducation exercises, along with cervical spine manual therapy or usual physical therapy care on the underlying dysfunctions in patients with non-specific chronic neck pain via a randomized controlled clinical trial, and to validate part of the outcome measures. Several musculoskeletal and respiratory dysfunction outcomes will be employed to delimit the initial extent and level of dysfunction and its resolution with the treatments under study.
Collapse
|
9
|
Aguirre F, Fernández RN, Arrejoría RM, Manin A, Cores VE, Sivori M, Villa AM. Peak expiratory flow and the single-breath count test as markers of respiratory function in patients with myasthenia gravis. NEUROLOGÍA (ENGLISH EDITION) 2022:S2173-5808(22)00076-1. [PMID: 35842128 DOI: 10.1016/j.nrleng.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/19/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. METHODS We performed an observational study of patients with MG. All cases were evaluated with the single-breath count test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). RESULTS The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath count test scores and FVC values (r = 0.57, P = .000), and between PEF and FVC values (r = 0.76, P = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, P = .03). PEF also showed a significant correlation with MEP (r = 0.51, P = .002). CONCLUSIONS PEF, the single-breath count test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.
Collapse
Affiliation(s)
- F Aguirre
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
| | - R N Fernández
- Unidad Neumotisiología, Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - R M Arrejoría
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - A Manin
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - V E Cores
- Hospital Interzonal General de Agudos (HIGA) Eva Perón, CONICET, Buenos Aires, Argentina
| | - M Sivori
- Unidad Neumotisiología, Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - A M Villa
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| |
Collapse
|
10
|
Single-Breath Counting Test to Start Non-Invasive Respiratory Support in COVID-19 Patients: Early Detection and the Eternal Dilemma. Comment on Longhitano et al. Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia. J. Clin. Med. 2022, 11, 179. J Clin Med 2022; 11:jcm11133588. [PMID: 35806874 PMCID: PMC9267701 DOI: 10.3390/jcm11133588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/20/2022] [Indexed: 12/04/2022] Open
|
11
|
Alzuhaily H, Khashaneh E, Albkhetan S, Abbas F. An unusual occurrence of opsoclonus and liver enzymes elevation in a patient with acute motor and sensory axonal neuropathy subtype of Guillain-Barré syndrome. BMC Neurol 2022; 22:102. [PMID: 35303829 PMCID: PMC8932169 DOI: 10.1186/s12883-022-02599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Acute motor and sensory axonal neuropathy (AMSAN) is a subtype of Guillain-Barré syndrome (GBS) differentiated by nerve conduction studies (NCS) and characterized by symmetric ascending paralysis often involving respiratory muscles. While opsoclonus, which is involuntary chaotic rapid eye movements, is not a common manifestation of GBS. Moreover, little published data are available on the relation between liver enzymes elevation and GBS. Case presentation A 42-year-old man presented to Al Mouwassat University Hospital with weakness in all limbs and dyspnea. Examination showed an elevated respiratory rate, hyporeflexia, and decreased strength of upper and lower limbs. Analysis of cerebrospinal fluid revealed an albuminocyto-dissociation suggesting the diagnosis of GBS and subsequent plasmapheresis. NCS confirmed a diagnosis of AMSAN. Elevation in liver enzymes was noticed prompting further exploration with no positive findings. Despite treatment efforts, the patient developed severe dyspnea, deterioration in cognitive abilities, and opsoclonus with a normal brain MRI. Unfortunately, he developed respiratory failure which lead to his death. Conclusion In this case, we highlight the occurrence of opsoclonus which is a rarely-encountered manifestation of GBS, in addition to an unexplained elevated liver enzyme, the thing that could contribute to larger research to further comprehend the pathophysiology of GBS. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02599-0.
Collapse
Affiliation(s)
| | - Eman Khashaneh
- Department of Neurology, Damascus University, Damascus, Syria
| | | | - Fatima Abbas
- Department of Internal Medicine, Damascus University, Damascus, Syria
| |
Collapse
|
12
|
Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neuron, peripheral nerve, and neuromuscular junction disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:259-270. [PMID: 36031308 DOI: 10.1016/b978-0-323-91532-8.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly.
Collapse
Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gian Luca Vita
- Unit of Neurology, Emergency Department, P.O. Piemonte, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, Messina University Hospital, Messina, Italy.
| |
Collapse
|
13
|
Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia. J Clin Med 2021; 11:jcm11010179. [PMID: 35011920 PMCID: PMC8745879 DOI: 10.3390/jcm11010179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 01/08/2023] Open
Abstract
The use of non-invasive respiratory strategies (NIRS) is crucial to improve oxygenation in COVID-19 patients with hypoxemia refractory to conventional oxygen therapy. However, the absence of respiratory symptoms may delay the start of NIRS. The aim of this study was to determine whether a simple bedside test such as single-breath counting test (SBCT) can predict the need for NIRS in the 24 h following the access to Emergency Department (ED). We performed a prospective observational study on 120 patients with COVID-19 pneumonia. ROC curves were used to analyze factors which might predict NIRS requirement. We found that 36% of patients had normal respiratory rate and did not experience dyspnea at rest. 65% of study population required NIRS in the 24 h following the access to ED. NIRS-requiring group presented lower PaO2/FiO2 (235.09 vs. 299.02), SpO2/FiO2 ratio (357.83 vs. 431.07), PaCO2 (35.12 vs. 40.08), and SBCT (24.46 vs. 30.36) and showed higher incidence of dyspnea at rest (57.7% vs. 28.6%). Furthermore, SBCT predicted NIRS requirement even in the subgroup of patients without respiratory symptoms (AUC = 0.882, cut-off = 30). SBCT might be a valuable tool for bedside assessment of respiratory function in patients with COVID-19 pneumonia and might be considered as an early clinical sign of impending respiratory deterioration.
Collapse
|
14
|
Ranjan Y, Althobiani M, Jacob J, Orini M, Dobson RJ, Porter J, Hurst J, Folarin AA. Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study. JMIR Res Protoc 2021; 10:e28873. [PMID: 34319235 PMCID: PMC8500349 DOI: 10.2196/28873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. OBJECTIVE The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. METHODS Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. RESULTS The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. CONCLUSIONS The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. TRIAL REGISTRATION ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/28873.
Collapse
Affiliation(s)
- Yatharth Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Malik Althobiani
- Royal Free Campus, University College London Respiratory, University College London, London, United Kingdom
| | - Joseph Jacob
- Department of Radiology, University College London Hospital, London, United Kingdom
- Centre for Medical Image Computing, University College London Respiratory, University College London, London, United Kingdom
| | - Michele Orini
- Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, University College London Hospitals, London, United Kingdom
| | - Richard Jb Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Joanna Porter
- Respiratory Medicine, Division of Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - John Hurst
- Royal Free Campus, University College London Respiratory, University College London, London, United Kingdom
| | - Amos A Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
15
|
Kumar M, Kalita J, Kant Misra U, Dhar N. Prediction models for mechanical ventilation and outcome in Guillain-Barré syndrome. J Clin Neurosci 2021; 92:131-135. [PMID: 34509240 DOI: 10.1016/j.jocn.2021.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Various prediction models have been formulated to predict the need for mechanical ventilation (MV). In this study, we compare the sensitivity and specificity of Erasmus GBS Respiratory Insufficiency Score (EGRIS) and Sharshar score with single breath count (SBC) at 2 Hz to assess their usefulness in predicting MV and functional outcome. The primary outcome was prediction of MV and relative usefulness of all three models based on sensitivity and specificity. The secondary outcome was functional recovery at 6 months using the cut off points for MV and functional outcome at 6months was assessed using Hughes scale and categorized as good (<2) and poor (≥2). The median age was 30 years, and 64 (69.6%) were males. The sensitivity and specificity of EGRIS score was 78.1% and 67.2%, Sharshar score was 75.0% and 64.1%, and SBC at 2 Hz was 78.1% and 75.0%. The area under the receiver operating curves was maximum for SBC at 2 Hz (0.86) compared to other models, although insignificant. EGRIS score < 5 had better functional recovery compared to those with score ≥ 5 (66% vs 34%, p = 0.001). Similarly, in Sharshar score, 23/59 (39%) with score ≥ 4 had good recovery compared to 36 (61%) with score < 4 (p = 0.01). All the three models have comparable predictive values for MV. Outcome prediction is the best with EGRIS.
Collapse
Affiliation(s)
- Mritunjai Kumar
- Department of Neurology, AIIMS, Rishikesh, Uttarakhand, India
| | - Jayantee Kalita
- Ex-HOD, Department of Neurology, Sanjay Gandhi PGIMS, Lucknow 226014, Uttar Pradesh, India.
| | - Usha Kant Misra
- Ex-HOD, Department of Neurology, Sanjay Gandhi PGIMS, Lucknow 226014, Uttar Pradesh, India; Apollo Medics Super-specialty Hospitals and Senior Consultant Neurologist, Vivekanand Polyclinic, and Institute of Medical Science, Lucknow 22600, India.
| | - Nikita Dhar
- Department of Neurology, AIIMS, Rishikesh, Uttarakhand, India
| |
Collapse
|
16
|
Paneroni M, Simonelli C, Saleri M, Bertacchini L, Venturelli M, Troosters T, Ambrosino N, Vitacca M. Muscle Strength and Physical Performance in Patients Without Previous Disabilities Recovering From COVID-19 Pneumonia. Am J Phys Med Rehabil 2021; 100:105-109. [PMID: 33181531 DOI: 10.1097/phm.0000000000001641] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT In this cross-sectional study, we evaluated skeletal muscle strength and physical performance (1-min sit-to-stand and short physical performance battery tests), dyspnea, fatigue, and single-breath counting at discharge from a postacute COVID department, in patients recovering from COVID-19 pneumonia who had no locomotor disability before the infection.Quadriceps and biceps were weak in 86% and 73% of the patients, respectively. Maximal voluntary contraction for quadriceps was 18.9 (6.8) kg and for biceps 15.0 (5.5) kg (i.e., 54% and 69% of the predicted normal value, respectively). The number of chair rises in the 1-min sit-to-stand test was 22.1 (7.3 corresponding to 63% of the predicted normal value), whereas the short physical performance battery score was 7.9 (3.3 corresponding to 74% of the predicted normal value). At the end of the 1-min sit-to-stand test, 24% of the patients showed exercise-induced desaturation. The single-breath counting count was 35.4 (12.3) corresponding to 72% that of healthy controls. Mild-to-moderate dyspnea and fatigue were found during activities of daily living (Borg scale score, median value = 0.5 [0-2] and 1 [0-2]) and after the 1-min sit-to-stand (Borg scale score, median value = 3 [2-5] and 1 [0-3]). Significant correlations were observed between muscle strength and physical performance indices (R = 0.31-0.69).The high prevalence of impairment in skeletal muscle strength and physical performance in hospitalized patients recovering from COVID-19 pneumonia without previous locomotor disabilities suggests the need for rehabilitation programs after discharge.
Collapse
Affiliation(s)
- Mara Paneroni
- From the Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy (MP, CS, MS, LB, M. Vitacca); Department of Neurosciences, Biomedicine and Movement Sciences, Università di Verona, Verona, Italy (M. Venturelli); Department of Rehabilitation Sciences, University Hospitals Gasthuisberg, Leuven, Belgium (TT); Respiratory Division, KU Leuven, Leuven, Belgium (TT); and Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy (NA)
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Aguirre F, Fernández RN, Arrejoría RM, Manin A, Cores VE, Sivori M, Villa AM. Peak expiratory flow and the single-breath counting test as markers of respiratory function in patients with myasthenia gravis. Neurologia 2020; 38:S0213-4853(20)30432-1. [PMID: 33317968 DOI: 10.1016/j.nrl.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/08/2020] [Accepted: 09/19/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. METHODS We performed an observational study of patients with MG. All cases were evaluated with the single-breath counting test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). RESULTS The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath counting test scores and FVC values (r = 0.57, p = .000), and between PEF and FVC values (r = 0.76, p = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, p = .03). PEF also showed a significant correlation with MEP (r = 0.51, p = .002). CONCLUSIONS PEF, the single-breath counting test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.
Collapse
Affiliation(s)
- F Aguirre
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI). Facultad de Medicina. Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
| | - R N Fernández
- Unidad Neumotisiología, Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - R M Arrejoría
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - A Manin
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI). Facultad de Medicina. Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - V E Cores
- Hospital Interzonal General de Agudos (HIGA) Eva Perón. CONICET, Buenos Aires, Argentina
| | - M Sivori
- Unidad Neumotisiología, Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - A M Villa
- Sección de Enfermedades Neuromusculares y Neurofisiología, División Neurología. Hospital José María Ramos Mejía, Buenos Aires, Argentina; Centro Argentino de Neuroinmunología (CADENI). Facultad de Medicina. Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| |
Collapse
|
18
|
Lopes N, Vernuccio F, Costantino C, Imburgia C, Gregoretti C, Salomone S, Drago F, Lo Bianco G. An Italian Guidance Model for the Management of Suspected or Confirmed COVID-19 Patients in the Primary Care Setting. Front Public Health 2020; 8:572042. [PMID: 33330317 PMCID: PMC7732472 DOI: 10.3389/fpubh.2020.572042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
An outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 started in China's Hubei province at the end of 2019 has rapidly become a pandemic. In Italy, a great number of patients was managed in primary care setting and the role of general practitioners and physicians working in the first-aid emergency medical service has become of utmost importance to coordinate the network between the territory and hospitals during the pandemic. Aim of this manuscript is to provide a guidance model for the management of suspected, probable, or confirmed cases of SARS-CoV-2 infection in the primary care setting, from diagnosis to treatment, applying also the recommendations of the Italian Society of General Medicine. Moreover, this multidisciplinary contribution would analyze and synthetize the preventive measures to limit the spread of SARS-CoV-2 infection in the general population as well as the perspective for vaccines.
Collapse
Affiliation(s)
- Noemi Lopes
- Provincial Health Authority of Palermo, Palermo, Italy
| | - Federica Vernuccio
- Centro Neurolesi Bonino Pulejo Istituto di Ricovero e Cura a Carattere Scientifico - Scientific Institutes of Hospitalization and Care (IRCCS), Messina, Italy.,Department of Science for Health Promotion and Mother to Child Care, University of Palermo, Palermo, Italy.,Section of Radiology - Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Claudia Imburgia
- Infectious Disease Unit, National Relevance Hospital Trust, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina e Benfratelli, Palermo, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological, and Stomatological Sciences, University of Palermo, Palermo, Italy.,Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Salvatore Salomone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Giuliano Lo Bianco
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| |
Collapse
|
19
|
Margus C, Sondheim SE, Peck NM, Storch B, Ngai KM, Ho HE, She T. Discharge in Pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission. Am J Emerg Med 2020; 45:185-191. [PMID: 33046303 PMCID: PMC7434326 DOI: 10.1016/j.ajem.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (Covid-19) has led to unprecedented healthcare demand. This study seeks to characterize Emergency Department (ED) discharges suspected of Covid-19 that are admitted within 72 h. METHODS We abstracted all adult discharges with suspected Covid-19 from five New York City EDs between March 2nd and April 15th. Those admitted within 72 h were then compared against those who were not using descriptive and regression analysis of background and clinical characteristics. RESULTS Discharged ED patients returning within 72 h were more often admitted if suspected of Covid-19 (32.9% vs 12.1%, p < .0001). Of 7433 suspected Covid-19 discharges, the 139 (1.9%) admitted within 72 h were older (55.4 vs. 45.6 years, OR 1.03) and more often male (1.32) or with a history of obstructive lung disease (2.77) or diabetes (1.58) than those who were not admitted (p < .05). Additional associations included non-English preference, cancer, heart failure, hypertension, renal disease, ambulance arrival, higher triage acuity, longer ED stay or time from symptom onset, fever, tachycardia, dyspnea, gastrointestinal symptoms, x-ray abnormalities, and decreased platelets and lymphocytes (p < .05 for all). On 72-h return, 91 (65.5%) subjects required oxygen, and 7 (5.0%) required mechanical ventilation in the ED. Twenty-two (15.8%) of the study group have since died. CONCLUSION Several factors emerge as associated with 72-h ED return admission in subjects suspected of Covid-19. These should be considered when assessing discharge risk in clinical practice.
Collapse
Affiliation(s)
- Colton Margus
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Samuel E Sondheim
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Nathan M Peck
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Bess Storch
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ka Ming Ngai
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Hsi-En Ho
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Trent She
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| |
Collapse
|
20
|
Kalita J, Kumar M, Misra UK. Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome. J Clin Neurosci 2020; 72:50-56. [DOI: 10.1016/j.jocn.2020.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
|
21
|
Johansson K, Seiger Å, Forsén M, Holmgren Nilsson J, Hartelius L, Schalling E. Assessment of voice, speech and communication changes associated with cervical spinal cord injury. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:761-775. [PMID: 29476590 DOI: 10.1111/1460-6984.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Respiratory muscle impairment following cervical spinal cord injury (CSCI) may lead to reduced voice function, although the individual variation is large. Voice problems in this population may not always receive attention since individuals with CSCI face other, more acute and life-threatening issues that need/receive attention. Currently there is no consensus on the tasks suitable to identify the specific voice impairments and functional voice changes experienced by individuals with CSCI. AIMS To examine which voice/speech tasks identify the specific voice and communication changes associated with CSCI, habitual and maximum speech performance of a group with CSCI was compared with that of a healthy control group (CG), and the findings were related to respiratory function and to self-reported voice problems. METHODS & PROCEDURES Respiratory, aerodynamic, acoustic and self-reported voice data from 19 individuals (nine women and 10 men, aged 23-59 years, heights = 153-192 cm) with CSCI (levels C3-C7) were compared with data from a CG consisting of 19 carefully matched non-injured people (nine women and 10 men, aged 19-59 years, heights = 152-187 cm). OUTCOMES & RESULTS Despite considerable variability of performance, highly significant differences between the group with CSCI and the CG were found in maximum phonation time, maximum duration of breath phrases, maximum sound pressure level and maximum voice area in voice-range profiles (all p = .000). Subglottal pressure was lower and phonatory stability was reduced in some of the individuals with CSCI, but differences between the groups were not statistically significant. Six of 19 had voice handicap index (VHI) scores above 20 (the cut-off for voice disorder). Individuals with a vital capacity below 50% of the expected for an equivalent reference individual performed significantly worse than participants with more normal vital capacity. Completeness and level of injury seemed to impact vocal function in some individuals. CONCLUSIONS & IMPLICATIONS A combination of maximum performance speech tasks, respiratory tasks and self-reported information on voice problems help to identify individuals with reduced voice function following CSCI. Early identification of individuals with voice changes post-CSCI, and introducing appropriate rehabilitation strategies, may help to minimize development of maladaptive voice behaviours such as vocal strain, which can lead to further impairments and limitations to communication participation.
Collapse
Affiliation(s)
- Kerstin Johansson
- Department of Clinical Sciences, Intervention, and Technology (CLINTEC)/Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Åke Seiger
- Rehab Station Stockholm, Solna, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS)/Division of Neurodegeneration, Karolinska Institutet, Huddinge, Sweden
| | - Malin Forsén
- Department of Clinical Sciences, Intervention, and Technology (CLINTEC)/Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Holmgren Nilsson
- Department of Clinical Sciences, Intervention, and Technology (CLINTEC)/Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lena Hartelius
- Speech and Language Pathology Unit, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ellika Schalling
- Department of Clinical Sciences, Intervention, and Technology (CLINTEC)/Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
22
|
Single breath count: a simple pulmonary function test using a mobile app. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
23
|
Elsheikh B, Arnold WD, Gharibshahi S, Reynolds J, Freimer M, Kissel JT. Correlation of single-breath count test and neck flexor muscle strength with spirometry in myasthenia gravis. Muscle Nerve 2016; 53:134-6. [PMID: 26437790 DOI: 10.1002/mus.24929] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Although formal spirometry is the gold standard for monitoring respiratory function in patients with myasthenia gravis (MG), such testing is often delayed or unavailable. There is a need for a simple bedside test that can accurately measure respiratory function. METHODS We conducted a prospective, cross-sectional, single-blind study in adults with acetylcholine receptor antibody positive MG. Participants performed the single breath count test (SBCT) and underwent manual muscle strength testing, and a respiratory therapist performed spirometry blinded to SBCT and strength results. RESULTS Thirty-one patients, aged 57 ± 19 years participated. SBCT showed significant correlations with forced vital capacity (FVC), negative inspiratory force, and neck flexor strength (P < 0.01). FVC showed significant correlation with neck flexor strength (P = 0.02) but no correlation with shoulder abductor strength. CONCLUSIONS These data suggest that the SBCT and neck flexor strength testing are valuable tools for bedside assessment of respiratory function in MG patients.
Collapse
Affiliation(s)
- Bakri Elsheikh
- Neurology, Johns Hopkins Aramco Healthcare, Saudi Aramco, P.O. Box 2614, Dhahran, Saudi Arabia, 31311
| | - W David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Jerold Reynolds
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Miriam Freimer
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John T Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
24
|
Kalita J, Ranjan A, Misra UK. Outcome of Guillain-Barre syndrome patients with respiratory paralysis. QJM 2016; 109:319-23. [PMID: 26475599 PMCID: PMC4888327 DOI: 10.1093/qjmed/hcv190] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS To evaluate the outcome of patients with Guillain -: Barre syndrome (GBS) having respiratory failure treated with modified intubation policy. DESIGN AND METHODS Consecutive patients with GBS having single breath count below 12 and respiratory rate >30/min were included and their clinical details noted. The patients were intubated and mechanically ventilated (MV) if their PaO2 was <60 mmHg on venturi mask, PaCo2 > 50 mmHg or pH < 7.3. Their electrophysiological subtypes and complications were noted. The hospital mortality and 3 months outcome were compared in MV and those could be managed without MV even with respiratory compromise. RESULTS Out of 369 patients, 102 (27.6%) patients had respiratory compromise who were included in this study. Of the patients with respiratory compromise, 44 (43.1%) were intubated and mechanically ventilated after a median of 4 days of hospitalization. The median duration of MV was 21 (range 1-88) days. The patients with autonomic dysfunction (56.8% vs. 19%), facial weakness (78% vs. 36.2%), bulbar weakness (81.8% vs. 31%), severe weakness (63.8% vs. 31%) and high transaminase level (47.7% vs. 25.9%) needed MV more frequently. In our study, 6.8% patients died and 26.6% had poor outcome which was similar between MV and non-MV patients. The MV patients had longer hospitalization and more complications compared with non-MV group. CONCLUSION In GBS patients with respiratory compromise, conservative intubation does not increase mortality and disability.
Collapse
Affiliation(s)
- J Kalita
- From the Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, 226014, India
| | - A Ranjan
- From the Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, 226014, India
| | - U K Misra
- From the Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, 226014, India
| |
Collapse
|
25
|
Kass LE, Putnam K. Single breath counting for the evaluation of pediatric respiratory function: derivation of a "normogram". Intern Emerg Med 2016; 11:225-8. [PMID: 26411522 DOI: 10.1007/s11739-015-1316-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/01/2015] [Indexed: 11/24/2022]
Abstract
Single breath counting (SBC) is the measurement of how far an individual can count in cadence with a metronome set at 2 beats per second in a normal speaking voice following a maximal effort inhalation. Previous work has demonstrated that it correlates well with standard measures of pulmonary function. The objective of this study is to derive a "normogram" of healthy children showing the expected SBC value as a function of easily measured physiologic parameters (age, gender, height, and weight). This was a prospective observational study of a convenience sample of healthy children presenting for well-child checks or non-respiratory complaints at a large tertiary care center. Correlation was determined by the Pearson's product correlation coefficient (r) and r (2) determined as a measure of shared variance. Multiple regression analysis was performed on demographic data to determine a best linear fit with calculation of the coefficient of determination (R (2)). A total of 105 children served as the basis for analysis; 54 (51.4 %) were male and average age was 9.7 (median 10, range 3-15) years. For both males and females, height correlated most strongly with SBC score (r = 0.730 and 0.725, respectively). In both genders, height alone accounted for more than 50 % of the observed variance in the results (r (2) = 0.533 and 0.526, respectively). Breath counting, an easy to perform test that appears to correlate well with standard measures of pulmonary function and shows promise for measuring asthma severity in children. We present an equation for predicting normal results (a "normogram").
Collapse
Affiliation(s)
- Lawrence Edward Kass
- Department of Emergency Medicine, Penn State Hershey Medical Center-H043, PO Box 850, 500 University Drive, Hershey, PA, 17033, USA.
| | - Kristy Putnam
- Department of Emergency Medicine, Rady Children's Hospital, San Diego, CA, USA
| |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW This article discusses the relationship between inhaled corticosteroids and dysphonia, with discussion of the therapeutic use of inhaled steroids in laryngeal disease and a review of negative laryngeal effects of this class of medication in patients with reactive airway disease. RECENT FINDINGS Although prescribed for their anti-inflammatory effects (predominantly for pulmonary disease and less often for laryngeal conditions), corticosteroid inhalers can cause laryngeal inflammation. This may relate to chemical irritation from the inhaler itself as well as fungal inflammation related to opportunistic candidiasis that may accompany inhaler use. Patients who suffer from dysphonia because of inhaler use may improve if switched to another inhaler. Studies suggest that ciclesonide metered-dose inhaler may have less oropharyngeal deposition and therefore be associated with reduced oropharyngeal candidiasis and dysphonia compared with other inhaled corticosteroids. SUMMARY Corticosteroid inhalers are a common cause of dysphonia and their use should be investigated in any patient with laryngeal complaints.
Collapse
|
27
|
Roofe LR, Resha DJ, Abramo TJ, Arnold DH. Noninvasive bedside assessment of acute asthma severity using single-breath counting. Pediatr Emerg Care 2014; 30:8-10. [PMID: 24365723 DOI: 10.1097/pec.0000000000000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The single-breath counting (SBC) method for assessment of asthma exacerbation severity has been evaluated in adults during exacerbations and in pediatric patients during routine settings. Single-breath counting has not been evaluated in children during exacerbations. We sought to assess criterion validity and responsiveness of SBC with percent-predicted FEV1 (%FEV1) and the Pediatric Respiratory Assessment Measure (PRAM), a validated acute asthma severity score. METHODS We prospectively enrolled subjects aged 7 to 17 years with acute asthma exacerbations. Single-breath counting, %FEV1, and PRAM were obtained before treatment and 2 hours after initiating therapy. Multivariable linear regression models were used to examine associations of pretreatment SBC with %FEV1 and PRAM (criterion validity) and 2-hour change of these measures (responsiveness). With a 2-sided α of 0.05, SBC SD of 8.5, and 90% power to detect an adjusted R of greater than 0.36 for SBC with each outcome measure, a minimum sample of 20 participants was necessary. RESULTS From June to November 2011, 51 participants were enrolled, with median (interquartile range) age of 8.46 years (6.92-11.4 years); male sex, n = 40 (78%); and African American race, n = 33 (64%). Before treatment, 42 (92%) were able to successfully perform SBC, and 24 (51%) %FEV1. Median pretreatment SBC obtained was 16 (10-24); %FEV1, 50 (26-71); and PRAM, 5 (1-5). CONCLUSIONS Single-breath counting demonstrates modest criterion validity for predicting the pretreatment PRAM score and a trend for predicting %FEV1. Single-breath counting does not appear to be responsive to change of these measures in response to treatment and has limited validity as a measure of acute asthma severity.
Collapse
Affiliation(s)
- Lindsay R Roofe
- From the Department of Pediatric Emergency Medicine, Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN
| | | | | | | |
Collapse
|
28
|
Simple bedside predictors of mechanical ventilation in patients with Guillain-Barre syndrome. J Crit Care 2013; 29:219-23. [PMID: 24378177 DOI: 10.1016/j.jcrc.2013.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study is to develop and validate a predictor score for assessing the requirement of mechanical ventilation (MV) in patients with Guillain-Barre syndrome (GBS). STUDY DESIGN The study was conducted in patients admitted with GBS in neurointensive care unit in a tertiary care hospital. The demographic, clinical factors, electrophysiological, and spirometric data of all consecutive patients were prospectively collected. The study was undertaken in 2 stages. In the first stage, data were collected for development of a predictor score. In the second stage, the score developed was validated on a separate set of patient data. RESULTS The data collected were compared between the 2 groups (ventilated vs nonventilated). On univariate analysis, time taken to reach maximum deficit, neck weakness, bulbar weakness, facial weakness, single breath count (SBC), forced vital capacity, and phrenic nerve latency predicted the need for MV. On multivariate analysis, only neck weakness, bulbar weakness, SBC, and forced vital capacity were independent predictors of MV. There was a good correlation between SBC and the spirometric tests and phrenic nerve distal motor latency, as reflected in receiver operating characteristics curve. The predictor score developed using the regression coefficient of independent predictors showed that the best cutoff score for prediction of ventilation was 60 (sensitivity, 0.95; 1--specificity, 0.065). Internal cross validation of the neck weakness, SBC, and bulbar palsy (NSB) score showed good correlation (Pearson R = 0.76; P = .00). There was no statistically significant difference between predicted and observed outcomes (sensitivity, 95%; specificity, 93%). CONCLUSION Several independent risk factors were found to predict the requirement for MV in patients with GBS at admission. However, after scoring and analyzing them, it was found that combining a few of them was more useful to predict the need for MV. A model using NSB score, developed using clinical variables, accurately predicted the requirement of MV. In addition, among the NSB score parameters, simple bedside SBC could adequately assess the adequacy of vital capacity.
Collapse
|
29
|
Balali-Mood M, Moshiri M, Etemad L. Medical aspects of bio-terrorism. Toxicon 2013; 69:131-42. [PMID: 23339855 DOI: 10.1016/j.toxicon.2013.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/02/2013] [Accepted: 01/09/2013] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Bioterrorism is a terrorist action involving the intentional release or dissemination of a biological warfare agent (BWA), which includes some bacteria, viruses, rickettsiae, fungi or biological toxins. BWA is a naturally occurring or human-modified form that may kill or incapacitate humans, animals or plants as an act of war or terrorism. BWA is a weapon of choice for mass destruction and terrorism, because of the incubation period, less effective amount than chemical warfare agents, easily distribution, odorless, colorless, difficult to detect, no need of specialized equipment for production and naturally distribution which can easily be obtained. BWA may be disseminating as an aerosol, spray, explosive device, and by food or water. CLASSIFICATION Based on the risk for human health, BWAs have been prioritized into three categories of A, B and C. Category A includes microorganisms or toxins that easily spread, leading to intoxication with high death rates such as Anthrax, Botulism, Plague, Smallpox, Tularemia and Viral hemorrhagic fevers. Category B has lower toxicity with wider range, including Staphylococcal Entrotoxin type B (SEB), Epsilon toxin of Clostridium perfringens, Ricin, Saxotoxins, Abrin and Trichothecene mycotoxins. The C category includes emerging pathogens that could also be engineered for mass spread such as Hanta viruses, multidrug-resistant tuberculosis, Nipah virus, the tick-borne encephalitis viruses, hemorrhagic fever viruses and yellow fever. CLINICAL MANIFESTATIONS OF BIOTOXINS IN HUMAN: Clinical features and severity of intoxication depend on the agent and exposed dose, route of entry, individual variation and environmental factors. Onset of symptoms varies from 2-24 h in Ricin to 24-96 h in Botulism. Clinical manifestations also vary from irritation of the eyes, skin and mucus membranes in T2 toxin to an acute flaccid paralysis of bilateral cranial nerve impairment of descending manner in botulism. Most of the pyrogenic toxins such as SEB produce the same signs and symptoms as toxic shock syndrome including a rapid drop in blood pressure, elevated temperature, and multiple organ failure. MANAGEMENT There is no specific antidote or effective treatment for most of the biotoxins. The clinical management is thus more supportive and symptomatic. Fortunately vaccines are now available for most of BWA. Therefore, immunization of personnel at risk of exposure is recommended. CONCLUSION Biotoxins are very wide and bioterrorism is a heath and security threat that may induce national and international problems. Therefore, the security authorities, health professional and even public should be aware of bioterrorism.
Collapse
Affiliation(s)
- Mahdi Balali-Mood
- Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91735-348, Islamic Republic of Iran.
| | | | | |
Collapse
|
30
|
Ali SS, O'Connell C, Kass L, Graff G. Single-breath counting: a pilot study of a novel technique for measuring pulmonary function in children. Am J Emerg Med 2010; 29:33-6. [PMID: 20825771 DOI: 10.1016/j.ajem.2009.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 07/09/2009] [Accepted: 07/10/2009] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Although peak expiratory flow rate is the conventional way to measure asthma severity in adults, its use is problematic in children because it is effort dependent. Forced expiratory volume in 1 second (FEV₁) and the ratio of FEV₁ to forced vital capacity (FEV₁/FVC) are more accurate, but generally not available in the emergency department (ED). A better test is needed. Single-breath counting (SBC) is the measurement of how far an individual can count in a normal speaking voice after a maximal effort inhalation. The count is in cadence to a metronome set at 2 beats per second. Previous work has suggested that SBC correlates with standard measures of pulmonary function in adults. However, it has never been tested in children. OBJECTIVES The aims of this study are to determine if SBC can be easily performed by children and to assess the correlation between SBC and standard measures of pulmonary function in a pediatric population. METHODS This was a prospective observational study of a convenience sample of children presenting to the pulmonary clinic for scheduled pulmonary function testing (PFT). Peak expiratory flow rate, FEV₁, FVC, forced expiratory flow 25% to 75%, and FEV₁/FVC were measured and recorded. After PFT, subjects were asked to perform SBC. Three attempts were allowed, and the average was recorded. Correlation was determined by the Pearson coefficient. RESULTS Sixty-seven children (ages 5-18 years, 64% male) were enrolled. All were able to understand and complete the testing. Indications for PFT included asthma and/or allergies (n = 44), cystic fibrosis (n = 9), and other chronic diseases (n = 14). The correlations (r) of SBC to peak expiratory flow rate, FEV₁, FVC, forced expiratory flow 25% to 75%, and FEV₁/FVC were 0.55, 0.66, 0.71, 0.44, and -0.29, respectively (P < .05 for all results). CONCLUSION Single-breath counting is easy to perform in children, seems to correlate well with standard measures of pulmonary function, and shows promise for measuring asthma severity in children. Further work to define the range of reference SBC values (as a function of age and/or body size) and an evaluation of the utility of SBC in an ED population of acute asthmatics is indicated.
Collapse
Affiliation(s)
- Syed Sameer Ali
- Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, 17033, USA.
| | | | | | | |
Collapse
|
31
|
Koury TG, Counselman FL, Huff JS, Peebles JS, Kolm P. Comparison of peak expiratory flow rate with speaking time in ED patients presenting with acute exacerbation of asthma. Am J Emerg Med 1998; 16:572-5. [PMID: 9786540 DOI: 10.1016/s0735-6757(98)90221-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Thirty-six patients with a history of asthma who presented to an emergency department (ED) with an acute exacerbation were studied prospectively to determine if a correlation existed between peak expiratory flow rate (PEFR) and speaking time. Each patient listened to an instructional audiotape on the proper method of counting and then maximally inhaled and counted until it became necessary to take a second breath. This represented the patient's "speaking time" in seconds. A PEFR was then obtained using a hand-held peak flow meter. The speaking time and PEFR were measured before and after each nebulized albuterol treatment. A total of 169 pairs of pretreatment and posttreatment PEFR and speaking time measurements were obtained. Regression analysis of the PEFR and speaking time demonstrated the PEFR can be predicted by the speaking time with statistical significance (P < .0001). The regression analysis equation was: peak flow (L/min) = 114.8 +/- (17.6 x speaking time).
Collapse
Affiliation(s)
- T G Koury
- Department of Emergency Medicine, Eastern Virginia Medical School and Emergency Physicians of Tidewater, Norfolk, USA
| | | | | | | | | |
Collapse
|
32
|
Ushkow BS, Bartfield JM, Reicho PR, Raccio-Robak N. Single-breath counting for the assessment of bronchospastic patients in the ED. Am J Emerg Med 1998; 16:100-1. [PMID: 9451330 DOI: 10.1016/s0735-6757(98)90081-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|