Sport-specific influences on respiratory patterns in elite athletes

OBJECTIVE:

To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows.

METHODS:

This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21 ± 4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry).

RESULTS:

Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV₁, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV₁ (r = −0.386; p < 0.001).

CONCLUSIONS:

Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.

Respiratory parameters in elite athletes--does sport have an influence?

INTRODUCTION

Unlike large population studies about cardiovascular components and how they adapt to intensive physical activity, there is less research into the causes of enlargement of the respiratory system in athletes (e.g. vital capacity, maximum flow rates and pulmonary diffusion capacity). The purpose of this research was to study and compare pulmonary function in different types of sports and compare them with controls in order to find out which sports improve lung function the most.

MATERIALS AND METHOD

Pulmonary functional capacities, vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximum voluntary ventilation (MVV) of 493 top athletes belonging to 15 different sports disciplines and of 16 sedentary individuals were studied. Pulmonary function test was performed according to ATS/ERS guidelines.

RESULTS

Basketball, water polo players and rowers had statistically higher vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) than the healthy sedentary control individuals. Football and volleyball players had lower VC while FVC was higher in the football group compared to controls. Peak expiratory flow was lower in boxing, kayak, rugby, handball, taekwondo and tennis. The maximum voluntary ventilation (MVV) was significantly higher in water polo players and rowers. Boxers had statistically lower MVV than the controls. Players of other sports did not differ from the control group.

CONCLUSION

The study suggests that specific type of training used in basketball, water polo or rowing could have potential for improving pulmonary function and rehabilitation.

Association between walking, dysphoric mood and anxiety in late pregnancy: A cross-sectional study

Relationship between physical activity and mental disorders in late pregnancy is unclear. In this work, we demonstrate that there is a significant association between the time spent on walking and symptoms of depression and anxiety in antenatal period. The cross-sectional study was done on a sample of 200 healthy women in 9th month of physiological pregnancy at Health center Kraljevo, Serbia during 2015. Each participant was given a questionnaire consisting of general questions regarding physical activity, pregnancy, and other parameters. Also, each participant completed a Beck depression inventory (BDI) and Zung anxiety scale (ZAS). There was a statistically significant negative correlation (p<0.05) between the BDI score and the daily time spent on walking. There was also a strong positive connection between the daily time spent on walking and level of anxiety (p<0.01). To our knowledge this is the first study to jointly test the relationship between scores of Beck depression inventory and Zung anxiety scale, and time spent on walking as physical activity in antenatal period. The results represent the basis for further research in the field of gynecological psychology, psychiatry and behavioral physiology.

Inevitable cesarean myomectomy following delivery through posterior hysterotomy in a case of uterine torsion

BACKGROUND

Torsion of the pregnant uterus at term is a very infrequent obstetric event. It is usually associated with the presence of myoma or congenital deformities. Maternal prognosis is good after surgical treatment; however, prenatal mortality is high.

CASE REPORT

We report a case of posterior low transverse hysterectomy in a case of uterine torsion at 38 weeks' gestation, due to a large myoma. At presentation, her cervix was unfavorable and cardiotocography showed spontaneous deceleration demanding delivery by cesarean section. Following delivery, it was realized that the incision had been made on the posterior wall of the uterus and that the uterus was axially rotated by 180 degrees. The mother recovered uneventfully and both mother and the baby were discharged on the fifth postoperative day.

CONCLUSION

Obstetricians must have uterine torsion in mind when performing a cesarean section in patients with myomas.

United in prevention-electrocardiographic screening for chronic obstructive pulmonary disease

CONFLICT OF INTEREST

NONE DECLARED.

INTRODUCTION

P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, "Gothic" P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease.

AIM

We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema.

MATERIAL AND METHOD

1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests.

CONCLUSION

Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema.

Rib-cage-movement measurements as a potential new trigger signal in non-invasive mechanical ventilation

Non-invasive ventilation performed through an oronasal mask is a standard in clinical and homecare mechanical ventilation. Besides all its advantages, inevitable leaks through the mask cause errors in the feedback information provided by the airflow sensor and, hence, patient-ventilator asynchrony with multiple negative consequences. Here we investigate a new way to provide a trigger to the ventilator. The method is based on the measurement of rib cage movement at the onset of inspiration and during breathing by fibre-optic sensors. In a series of simultaneous measurements by a long-period fibre grating sensor and pneumotachograph we provide the statistical evidence of the 200 ms lag of the pneumo with respect the fibre-optic signal. The lag is registered consistently across three independent delay metrics. Further, we discuss exceptions from this trend and identify the needed improvements to the proposed fibre-sensing scheme.

Comparison of lung diffusing capacity in young elite athletes and their counterparts

BACKGROUND

The influence of exercise on the pulmonary function is controverse, some studies have reported no sports influence, while the others have found positive correlation.

AIM

To evaluate and compare the sports influence on pulmonary function: spirometry (VC, FVC, FEV1, FEV1/FVC), lung diffusing capacity (DLCO) and coefficient of the CO gas transfer (KCO) in two elite athletes groups and healthy sedentary controls.

METHOD

Equally divided into aerobic and anaerobic group, 60 elite athletes were recruited, as well as 43 age-matched, healthy sedentary controls. All of the participants performed basic anthropometric measurements, spirometry, DLCO and KCO at rest. Kruskal-Wallis one way ANOVA test was used to determine differences between groups; Mann-Whitney U test was used for inter-groups differences and Pearson coefficient for pulmonary variables and anthropometric parameters correlation. Statistical analyses were performed using the SPSS computer statistic program, version 20.

RESULTS

No differences were found in pulmonary characteristics (spirometric function values, DLCO and KCO) in athletes and non-athletes at rest, as well as between aerobics and anaerobics. There were no correlations between the anthropometric parameters and the investigated respiratory function tests. DLCO (%) correlated positively with height in athletes playing anaerobic type of sport (karate and taekwondo) (p=0.036; r=0.544), and negatively in sedentary control group (p=0.030; r=-0.560). Regarding KCO, no differences were found.

CONCLUSION

Spirometry indices and DLCO are not influenced either by aerobic or anaerobic training type, so benefits of sports on pulmonary indices or DLCO was not confirmed.

Pulmonary aspergilloma

INTRODUCTION

Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. Aspergillus species causes a variety of pulmonary diseases such as saphrophyticus (aspergilloma/mycetoma), hypersensitivity reaction (allergic bronhopulmonary), semi- invasive (chronic necrotizing) and angioinvasive aspergillosis.

CASE REPORT

We report a case of pulmonary aspergilloma (PA) in 38 years old patient who was previously healthy with complaints of fever and hemoptysis. PA was diagnosed radiologically and confirmed by serology.

CONCLUSION

Oral itraconazole was administered. The patient responded well to the treatment with improvement in his systemic symptoms and regression of the pulmonary lesions.

Cytokine Release Syndrome (CRS) in Severe COVID-19 Patients: Two Controversial and Interesting Case Reports and Literature Review

Background

Cytokine release syndrome (CRS) represents a potentially life-threatening and systematic inflammatory response where it is noted an increase of secretion of proinflammatory cytokines from lymphocytes, myeloid cells like macrophages, dendritic cells, and monocytes. This syndrome is characteristic of some conditions such as viral infections, administration of antibody-based therapy, auto immune disease, and immunotherapy, especially in severe COVID-19 patients.

Case reports

We presented two cases of COVID-19 patients in which the clinical picture significantly deteriorated during hospitalization, where the value of CRP, ferritin, LDH, and IL-6 dramatically increased, especially values of IL-6 were recorded over 2000. We treated them with third-generation cephalosporins, carbapenems, glycopeptides, metronidazole, anti-IL-6 inhibitor, low molecular weight heparin (LMWH), glucocorticoids, immunoglobulins (IVIG), and vitamins. Both patients were successfully treated and were discharged from the hospital with a recommendation for oral anticoagulant therapy.

Conclusion

CRS is a complex syndrome. In the future, it is necessary to educate doctors about this syndrome, as well as to develop drugs whose goal would be to reduce the inflammatory response in already developed diseases.

Validation of online version of asthma control questionnaire in pediatric patients

Introduction: The Asthma Control Questionnaire (ACQ) is a seven-item questionnaire assessing symptoms that asthma clinicians consider to be most important for evaluating the adequacy of asthma control. An online version of the ACQ may be able to indicate whether a visit to the physician is warranted to modify therapy to achieve better control of their asthma, ultimately reducing the number of unnecessary visits, particularly during the pandemic. The aim of our study is to compare the paper and online ACQ to validate the online version for use in real-life settings.Methods: Our study included 28 patients who completed both paper and the online ACQ on the same day when they came home. The online version of the questionnaire was prepared to look similar to the paper form, with the same sentences and answers.Results: The correlation between paper and online ACQ questionnaires was very high (r = 0.935; p < 0.001). When comparing each individual item, correlation coefficients ranged from 0.672 to 0.935. The lowest correlation is obtained in activity limitations, while the next one is 0.767, others higher than 0.8. The online form gave small and insignificantly higher scores compared to paper form with mean difference between -0.07 and 0.21. Mean difference of 0.01 (p = 0.986) between paper ACQ and online ACQ is obtained.Conclusion: The online version of the ACQ can be used for asthma control monitoring in pediatric patients in order to minimize unnecessary social contacts as well as hospital patient load, but retain adequate surveillance of disease symptoms by their physician.

Lung and diaphragm ultrasound in noninvasive respiratory support: A real tool or fashion?

Introduction

Over the past few years, there has been an increase in lung and diaphragm ultrasound applications as a tool to evaluate the outcomes and settings of noninvasive respiratory supports. However, actual clinical practices in this field are yet to be known. The aim of this study was to investigate the current clinical utilization of ultrasound for noninvasive respiratory supports on an international level.

Materials and Methods

The study employed an online survey consisting of 32 items, which was sent via email to intensivists, pulmonologists, emergency medicine physicians, and other specialists with expertise in using ultrasound and/or noninvasive respiratory supports.

Result

We collected 52 questionnaires. The ultrasound study of diaphragm dysfunction was well-known by the majority of respondents (57.7%). Diaphragm performance was used as a weaning failure predictor (48.5%), as a predictor of noninvasive ventilation failure (38.5%) and as a tool for the ventilator settings adjustment (30.8%). In patients with acute respiratory failure, 48.1% used ultrasound to assess the damaged lung area to set up ventilatory parameters, 34.6% to monitor it after noninvasive ventilation application, and 32.7% to match it with the ventilatory settings for adjustment purposes. When administering high flow nasal cannula - oxygen therapy, 42.3% of participants used ultrasound to evaluate lung involvement and assess flow parameters.

Conclusions

Lung and diaphragm ultrasound is an established clinical practice to evaluate noninvasive respiratory supports outcomes and settings. Further studies are needed to evaluate the educational aspects to increase confidence and indications for its use.