An internet-based system for home monitoring of respiratory muscle disorders

Brazilian studies on pulmonary function in COPD patients: what are the gaps?

BACKGROUND

COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on sensitive methods for lung-function testing. A wide body of knowledge has been accumulated in recent years showing that these methods have been significantly refined and seems promising for detection of early disease.

OBJECTIVES

This review focuses on research on pulmonary function analysis in COPD performed in Brazil during this century.

MATERIALS AND METHODS

The literature was searched using a systematic search strategy limited to English language studies that were carried out in Brazil from the year 2000 onward, with study objectives that included a focus on lung function.

RESULTS

After we applied our inclusion and exclusion criteria, 94 articles addressed our stated objectives. Among the new methods reviewed are the forced-oscillation technique and the nitrogen-washout test, which may provide information on small-airway abnormalities. Studies investigating the respiratory muscles and thoracoabdominal motion are also discussed, as well as studies on automatic clinical decision-support systems and complexity measurements. We also examined important gaps in the present knowledge and suggested future directions for the cited research fields.

CONCLUSION

There is clear evidence that improvements in lung-function methods allowed us to obtain new pathophysiological information, contributing to improvement in our understanding of COPD. In addition, they may also assist in the diagnosis and prevention of COPD. Further investigations using prospective and longitudinal design may be of interest to elucidate the use of these new methods in the diagnosis and prevention of COPD.

Effects of an animated diagram and video-based online breathing program for dyspnea in patients with stable COPD

BACKGROUND

Breathing programs have been reported to have positive effects in alleviating symptoms and optimizing pulmonary function in patients with chronic obstructive pulmonary disease (COPD). However, patients with stable disease may drop out of such programs if they are not modified to the individual's exercise tolerance level, or if they are not easy to perform in the home. Little is known about the effectiveness of web-based home breathing programs for dyspnea. The purpose of this study was to evaluate the effectiveness of an online breathing program which included an animated diagram and video-guided instruction on pulmonary function, exercise capacity, and health-related quality of life in patients with COPD.

METHODS

Sixty patients with stable COPD were randomized 1:1 to an experimental group (n = 30) or a control group (n = 30). Subjects in the experimental group trained for four months using an online program which included an animated diagram and video-guided instruction while the control group received conventional patient education on discharge from hospital. Forced expiratory volume, forced expiratory volume in one second (FEV1)/forced vital capacity (%), peak expiratory volume, six-minute walking distance test, and responses to the St George's Respiratory Questionnaire were assessed before and after the intervention.

RESULTS

Patients in the two groups were well matched for demographic and clinical characteristics at baseline. All outcome measures showed significant improvement in the experimental group but not in the control group.

CONCLUSION

The online training program resulted in improved pulmonary function, exercise capacity, and health status. Therefore, it is strongly recommended that patients with stable COPD be trained with such programs.

Detection and classification of hypovolaemia during anaesthesia

In recent years, there has been a rapid growth in patient monitoring and medical data analysis using decision support systems, smart alarm monitoring, expert systems and many other computer aided protocols. The main goal of this study was to enhance the developed diagnostic alarm system for detecting critical events during anaesthesia. The proposed diagnostic alarm system is called Fuzzy logic monitoring system-2 (FLMS-2). The performance of the system was validated through a series of off-line tests. When detecting hypovolaemia a substantial level of agreement was observed between FLMS-2 and the human expert and it is shown that system has a better performance with sensitivity of 94%, specificity of 90% and predictability of 72%.