[The possibilities of impulse oscillometry in the diagnosis of the lung function disorders after COVID-19]

BACKGROUND

Impulse oscillometry (IOS) is an effort independent method of studying lung mechanics.

AIM

To study the diagnostic significance of IOS in assessing lung mechanics after COVID-19.

MATERIALS AND METHODS

Spirometry, body plethysmography, diffusion test (DLco), IOS parameters were analyzed in 315 patients (the median age 48 years), the median period from the beginning of COVID-19 to the study was 50 days. Statistical analysis included descriptive statistics, correlation analysis and one-dimensional logistic regression analysis with an assessment of odds ratios.

RESULTS

In general group, spirometry and body plethysmography parameters were in normal values, while DLCO was reduced in 61% of patients. Parameters of IOS were analyzed in the general group and between the groups, depending on the value of DLco and total lung capacity (TLC): normal or reduced. In general group, reactance area (AX), hererogeneity of resistance Rrs5-Rrs20, resistance at 5 Hz (Rrs5), reactance at 5 Hz (ΔXrs5) were increased in 29.8%, 17.8%, 6%, 4.8% of patients, respectively, and were statistically significantly higher in the group with reduced TLC, whereas in the group with reduced DLco AX, Rrs5-Rrs20 were statistically significantly higher. Logistic regression analysis showed that patients with Rrs5-Rrs20>0.07 kPa×sec/l or AX>0.32 kPa/l had a 1.99-fold and 2.24-fold increased risk for decrease DLco, respectively, while the risk of decrease in TLC was 2.25-fold (p=0.012) and 3.16-fold (p<0.001) higher, respectively.

CONCLUSION

IOS allow to detect both dysfunction of small airways (if AX or Rrs5-Rrs20 are increased) and the risk of restrictive pattern and lung diffusion impairment after COVID-19.

[Triple combination therapy with macitentan, riociguat, and selexipag in a patient with idiopathic pulmonary arterial hypertension (functional class III)]

The article presents a clinical case of successful triple combination therapy in a female patient with functional class III idiopathic pulmonary arterial hypertension. Supplementing the previous macitentan and riociguat treatment with selexipag reduced the severity of clinical manifestations of pulmonary hypertension. Also, the treatment efficacy was demonstrated by improvement of laboratory and instrumental indexes. Time-related changes were evaluated at 3 months after initiation of the selexipag treatment.

Possibilities of ultrasound research of the diaphragm

The ultrasound method is a non-invasive and safe diagnostic method. Ultrasound examination (ultrasound) of the diaphragm allows you to conduct a direct study of its structure and function. Using stationary and portable ultrasound scanners, the study of the diaphragm can be carried out in specialized laboratories, in outpatient departments, in various departments of the clinic, including in intensive care units, in patients in different clinical conditions. Ultrasound of the diaphragm can be implemented on devices of different technical levels. Despite the fact that at present the diaphragm ultrasound method is not standardized, nevertheless, it provides clinically important information for solving various clinical studies, including when conducting dynamic observation.