[Respiratory muscle disorders in chest wall diseases]

Vector-Field dynamic X-ray (VF-DXR) using Optical Flow Method

OBJECTIVES

To explore the feasibility of Vector-Field DXR (VF-DXR) using optical flow method (OFM).

METHODS

Five healthy volunteers and five COPD patients were studied. DXR was performed in the standing position using a prototype X-ray system (Konica Minolta Inc., Tokyo, Japan). During the examination, participants took several tidal breaths and one forced breath. DXR image file was converted to the videos with different frames per second (fps): 15 fps, 7.5 fps, five fps, three fps, and 1.5 fps. Pixel-value gradient was calculated by the serial change of pixel value, which was subsequently converted mathematically to motion vector using OFM. Color-coding map and vector projection into horizontal and vertical components were also tested.

RESULTS

Dynamic motion of lung and thorax was clearly visualized using VF-DXR with an optimal frame rate of 5 fps. Color-coding map and vector projection into horizontal and vertical components were also presented. VF-DXR technique was also applied in COPD patients.

CONCLUSION

The feasibility of VF-DXR was demonstrated with small number of healthy subjects and COPD patients.

ADVANCES IN KNOWLEDGE

A new Vector-Field Dynamic X-ray (VF-DXR) technique is feasible for dynamic visualization of lung, diaphragms, thoracic cage, and cardiac contour.

Nonpharmacological interventions for respiratory health in Parkinson's disease: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Respiratory dysfunction in Parkinson's disease (PD) is often an underdiagnosed and untreated impairment associated with the disease. Clinically, a reactive approach to respiratory morbidity is taken, rather than preventative approaches that address underlying impairment/s. This systematic review identifies the current evidence to support nonpharmacological interventions to improve respiratory impairments in individuals with PD.

METHODS

The relevant literature was searched using a customised and systematic strategy. Randomised and nonrandomised control trials of nonpharmacological interventions targeting respiratory outcome measures in PD were included. Outcomes of interest were respiratory morbidity and mortality, respiratory muscle strength, spirometry measures, lung volumes, peak cough flow, and perception of dyspnoea.

RESULTS

Nonpharmacological interventions included: functional training, generalised strength training, respiratory muscle strength training, aerobic exercise, qigong, yoga, breath stacking, incentive spirometry and singing. Methodological quality of included studies varied. Meta-analyses of nonpharmacological interventions demonstrated significant effects for inspiratory muscle strength (mean difference [MD] 19.68; confidence interval [CI] 8.49, 30.87; z = 3.45; p = 0.0006; I²  = 2%), expiratory muscle strength (MD 18.97; CI 7.79, 30.14; z = 3.33; p = 0.0009; I²  = 23%) and peak expiratory flow (MD 72.21; CI 31.19, 113.24; z = 3.45; p = 0.0006; I²  = 0%). Best-evidence synthesis identified level 1 evidence supporting nonpharmacological interventions for improving peak cough flow and perceived dyspnoea. No studies were identified reporting outcomes of respiratory rate, inspiration:expiration ratio or respiratory morbidity or mortality in PD.

CONCLUSIONS

Nonpharmacological interventions improved respiratory muscle strength and peak expiratory flow in PD. Additional trials targeting respiratory dysfunction and longitudinal studies examining the relationship between respiratory dysfunction and morbidity and mortality rates in PD are required.

Cardiorespiratory fitness among adults with fibromyalgia

This review presents and addresses the conflicting results on cardiorespiratory fitness among adults with fibromyalgia. The heterogeneity in study designs, symptom severity and the assessment protocols might partly explain these conflicting results. It also presents the possible relationship between cardiorespiratory fitness and exercise prescription, attrition from exercise/rehabilitation programmes and independence with activities of daily living. Cardiorespiratory fitness might impact aerobic exercise and independence in daily activities of patients with fibromyalgia, which is often concomitantly diagnosed in patients with sleep disordered breathing, including patients with obstructive sleep apnoea. Therefore, cardiorespiratory fitness evaluation should be considered by general and respiratory physicians as well as physiotherapists who treat patients diagnosed with fibromyalgia for more accurate diagnosis, exercise prescription and monitoring of patients' status.

Key points

Adults with fibromyalgia often present with reduced cardiorespiratory fitness.Reduced cardiorespiratory fitness might have an important impact on functional capacity and quality of life.Adults with fibromyalgia who have a secondary condition affecting their ventilatory anaerobic threshold and/or V'_O2peak, for example chronic obstructive pulmonary disease, might present with a greater reduction of their cardiorespiratory fitness which may not be entirely related to their lung disease.

Educational aims

To better understand the cardiorespiratory fitness results among adults with fibromyalgia in general, and when taking into account differences in assessment protocol (maximal versus submaximal testing protocol; cycle ergometer versus treadmill testing protocol) and symptom severity (fibromyalgia severity level).To better understand how cardiorespiratory fitness among adults with fibromyalgia could: 1) assist in exercise prescription; 2) minimise dropout rates from exercise/rehabilitation programmes; and 3) promote independence with activities of daily living.To learn why fibromyalgia might be important to consider in adults who have concurrent fibromyalgia and lung disease.

Effect of idiopathic thoracic scoliosis on the tracheobronchial tree

Introduction

High prevalence of obstructive lung disease has been reported in patients undergoing surgical correction of thoracic scoliosis. Airway narrowing due to spine morphology is analysed as a contributing factor.

Methods

Preoperative surgical planning CTs of 34 patients with right-sided thoracic scoliosis (age: 17.6±9.0) were retrospectively analysed and compared with 15 non-scoliotic controls (age: 16.3±5.1). Three-dimensional models of spine and airway lumen were reconstructed. Based on thoracic sagittal profile, patients were divided into hypokyphosis (HypoS: <10°), normal kyphosis (NormS: ≥10° and <40°) and hyperkyphosis (HyperS: ≥40°) groups. Lumen area of bronchi, bifurcation angles and minimum spine–airway distance were measured. Pulmonary function tests were correlated to scoliosis, kyphosis and lumen area.

Results

Loss of kyphosis led to proximity between bronchus intermedius (BI) and spine. HypoS (NormS) had lumen area reductions in the right main bronchus of 29% (19%), BI of 45% (23%), right middle lobar bronchus of 46% (32%) and right lower lobe bronchus (RLL7) of 66% (37%), respectively (P<0.05). The lower right superior segmental bronchus was reduced across all scoliotic groups (P<0.05). Airways were displaced caudal by 0.65±0.45 vertebra in patients with scoliosis. Loss of kyphosis correlated negatively with forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC), FVC/(FVC predicted) and FEV₁/(FEV₁ predicted) (P<0.01). Lumen area of trachea, right upper lobar bronchus, BI and RLL7 correlated negatively with FEV₁/FVC. BI and RLL7 narrowing were strong predictors of FVC and FEV₁ loss (P<0.001).

Conclusions

Right-sided main stem airways are narrowed in HypoS and NormS. Loss of kyphosis leads to narrowing of BI and its trifurcation. FEV₁/FVC correlated negatively with airway narrowing, implying an obstructive element to lung function impairment in patients with scoliosis and hypokyphosis.

Measuring Respiratory Pressures with Mercury Manometer in Low Economic Health Care Settings- An Analytical Study

INTRODUCTION

Health care economics restricts many health centers from using hi-tech diagnostics equipment. Mercury manometers are used for calibration of pressure transducers. If standardized it would be a cost effective, simple alternative to transducers in low economic settings.

AIM

To analyse the feasibility of mercury manometer usage in respiratory pressure measurement.

MATERIALS AND METHODS

The experimental study was conducted with 30 healthy volunteers of age group 17-19 yrs. They were recruited by using simple random sampling method. The volunteers were made familiarized to lab environment, instrument and techniques of maximum inspiratory (Pimax) and expiratory pressures (Pemax). Then parameters were recorded using mercury manometer connected to different syringes as mouth piece (2.5 ml, 10 ml, and 20 ml) and with sphygmomanometer. Statistical analysis was done by using IBM SPSS statistics version 21.

RESULTS

The Pimax was 111.07 ± 6.53 with a 2.5 ml syringe as mouth piece. With 20 ml syringe it was 61.47 ± 9.98. PEmax with 2.5 ml syringe was 70.33 ± 8.19 with a confidence limit of 2.93 and with sphygmomanometer was 99.33 ± 8.16 with a confidence limit of 2.92. There was a change in recorded pressure and the correlation analysis result showed a significant difference from both above and below 10 ml mouth piece range.

CONCLUSION

Mercury manometers could be used for recording respiratory pressures in low economic facilities once standardized. Size of syringe to be used as mouth piece needs further more works although this study finds 10 ml syringe as suitable.