The place of impulse oscillometry system in the diagnosis of early obstructive disorders associated with asthma

Asthma is one of the most common and socially significant human diseases. To date, spirometry is included in most recommendations as the gold standard for the diagnosis of obstructive disorders. However, in real clinical practice, this procedure does not always reveal signs of bronchial obstruction, not only in the early stages of the disease but also in more severe controlled bronchial asthma. Tests of oscillatory mechanics are increasingly being used to detect early violations of the pulmonary ventilation function. These tests are based on the forced oscillation technique, and the latest modification is impulse oscillometry system. The aim of this study was to investigate the capabilities of impulse oscillometry in diagnosing early changes in the function of the respiratory system in patients with asthma and identifying the most informative parameters of the method. Methods. A total of 146 patients with an established diagnosis of mild and moderate asthma were examined during remission. The patients were divided into 2 groups by the severity of asthma. The comparison group included 40 people with no signs of lung abnormalities. Results. Disorders of the pulmonary ventilation function were found in 23% of patients with asthma by spirometry, in 42% by bodypletismography in 42%, and in 72% of patients by impulse oscillometry. Impulse oscillometry system revealed obstructive changes localized in the central respiratory tract in 11% of patients, and obstruction of mixed localization was found in 6% of respondents. Peripheral respiratory tract disorders were diagnosed in 56 % of patients. Most respiratory tract lesions were located in the small bronchi in both groups. The obstructive disorders in large bronchi and generalized obstruction were observed more often in the 2nd group. Among impulse oscillometry parameters, the increase in Delta (Rrs5 – Rrs20) was most often recorded in both examined groups of patients with asthma. Conclusion. Compared to standard methods, impulse oscillometry system is more sensitive. Therefore, it has advantages in diagnosing respiratory system dysfunctions both in the early stages of asthma and in more severe cases during remission.

Preliminary study of the characteristics of rib fractures and their impact on pulmonary ventilatory function

Background This study aimed to investigate the pulmonary ventilation function (PVF) according to different types of rib fractures and pain levels. Methods This was a retrospective study of patients with thoracic trauma admitted to our ward from May 1, 2015, to February 1, 2017. Vital capacity (VC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were measured on admission. A numerical rating scale (NRS) was used for pain assessment. Results A total of 118 (85 males and 33 females) were included. The location of rib fractures did not affect the PVF. When the number of rib fractures was ≥5, the PVF was lower than in those with ≤4 fractures (VC: 0.40 vs. 0.47, P = 0.009; FEV1: 0.37 vs. 0.44, P = 0.012; PEF: 0.17 vs. 0.20, P = 0.031). There were no difference in PVF values between rib fractures with multiple locations and those with non-multiple locations (VC: 0.41 vs. 0.43, P = 0.202; FEV1: 0.37 vs. 0.39, P = 0.692; PEF: 0.18 vs. 0.18, P = 0.684). When there were ≥ 5 breakpoints, the PVF parameters were lower than those with ≤4 breakpoints (VC: 0.40 vs. 0.50, P = 0.030; FEV1: 0.37 vs. 0.45, P = 0.022; PEF: 0.18 vs. 0.20, P = 0.013). When the NRS ≥ 7, the PVF values were lower than for those with NRS ≤ 6 (VC: 0.41 vs. 0.50, P = 0.003; FEV1: 0.37 vs. 0.47, P = 0.040; PEF: 0.18 vs. 0.20, P = 0.027). Conclusions When the total number of fractured ribs is ≥5, there are ≥5 breakpoints, or NRS is ≥7, the VC, FEV1, and PEF are more affected. Trial registration The trial was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and individual consent for this retrospectively registered analysis was waived.

Control Study of Short-Term Aftereffect in Diving Exposure Related Pulmonary Ventilation Function

Objective: Ventilation attenuation often happened in professional divers due to long-term cumulative effects in diving exercises. By case-control experiments, we observed the immediate effects of pulmonary ventilation before and after the exposure of 12m-depth underwater for 20 min to discuss the relationships between the short-term and long-time effects caused by diving environment. Methods: Participants were randomly assigned into the Experimental Group (EG) who stayed for 20 min under 12-m water environment or the Control Group (CG) who stayed in hyperbaric chamber under the pressure of 2.2ATA. Pulmonary ventilation function parameters including VC, FVC, MVV and MV were detected respectively before and after hyperbaric exposure by the Spirometer. Immediate effects of pulmonary ventilation before and after diving were compared by paired t test to reveal the different influence caused by environmental pressure. Results: The value of VC appears to rise while the MV, MVV were detected decreased after the exposure of 2.2ATA of environment pressure for 20min in the two groups. VC increased more significantly in the CG (t=-1.26, p=0.23) after hyperbaric exposure, that leads to the FEV1.0%t (=FEV1.0/VC %) increase in EG (t=-0.73, p=0.48) while decrease in CG (t=0.42, p=0.17). The same trend in VC, MV and MVV after high pressure exposure in the two groups mainly due to the effect of common factors –the pressure. In addition to the impact of the pressure itself, EG members also face diving related immersion effect, influence of diving equipment load and water under low temperature. The FVC is detected decreased in EG (t=1.21, P =0.25) while it increased in CG (t=-0.42, P =0.68) , but the differences are not significant and couldn’t affect the measured FEV1.0% (=FEV1.0/FVC %) values showed both increasing in EG (t=-1.48, P =0.16) and in CG (t=-0.23, P =0.82). The expiratory flow rate including PEF, FEF25-75, MEF75, MEF50 increased in EG (t are -0.72, -0.69, -0.87 and -0.36 respectively with P all greater than 0.05) while decreased in CG (t are 1.67, 0.50, 1.53 and 0.71 respectively with P all greater than 0.05). MEF25 is the expiratory flow index of not affected by respiratory muscle force and the measured values of MEF25 increased in the EG (t=-0.68, P =0.51) and in the CG (t=-0.36, P =0.72). Conclusion: Water immersion and water temperature during diving exposure could cause and accelerate hemodynamic changes in pulmonary circulation induced pulmonary interstitial edema and led to the increase of external respiratory work. Instant effects of diving exposure in the study are quite consistent with the long-term cumulative effect of professional divers in previous research, which is FVC reduced because small airway become narrower. The results illustrate even the small depth of short-range diving exercise have definite influences on pulmonary ventilation, which mainly comes from the environmental factor but not the pressure increases.

The Effect of Respiratory Rehabilitation Training on the Life Quality of Pneumoconiosis Patients

Objective: To explore the effect of respiratory rehabilitation training on the quality of life of pneumoconiosis patients. Methods: 76 pneumoconiosis patients who were treated in our hospital from April 2017 to December 2019 were selected as the research object, and randomly divided into 2 groups according to the order of admission by coin tossing, 38 cases in each group. The control group carried out health knowledge education on the basis of conventional treatment, and the observation group combined with respiratory rehabilitation training on the basis of the control group to compare the quality of life and lung function of the two groups of patients. Results: After 2 months of nursing care, scores of GQOLI-74 scale and pulmonary ventilation function indexes in the observation group were higher than those in the control group, with statistically significant differences (P<0.05). Conclusion: Respiratory rehabilitation training can improve pulmonary ventilation function of pneumoconiosis patients, improve the quality of life of patients, has good clinical application value.

Control study of short-term after effect in diving exposure related pulmonary ventilation function

Objective: Ventilation attenuation often happened in professional divers due to long-term cumulative effects in diving exercises. By case-control experiments, we observed the immediate effects of pulmonary ventilation before and after the exposure of 12m-depth underwater for 20 min to discuss the relationships between the short-term and long-time effects caused by diving environment. Methods: Participants were randomly assigned into the Experimental Group (EG) who stayed for 20 min under 12-m water environment or the Control Group (CG) who stayed in hyperbaric chamber under the pressure of 2.2ATA. Pulmonary ventilation function parameters including VC, FVC, MVV and MV were detected respectively before and after hyperbaric exposure by the Spirometer. Immediate effects of pulmonary ventilation before and after diving were compared by paired t test to reveal the different influence caused by environmental pressure. Results: The value of VC appears to rise while the MV, MVV were detected decreased after the exposure of 2.2ATA of environment pressure for 20min in the two groups. VC increased more significantly in the CG (t=-1.26, p=0.23) after hyperbaric exposure, that leads to the FEV1.0%t (=FEV1.0/VC %) increase in EG (t=-0.73, p=0.48) while decrease in CG (t=0.42, p=0.17). The same trend in VC, MV and MVV after high pressure exposure in the two groups mainly due to the effect of common factors –the pressure. In addition to the impact of the pressure itself, EG members also face diving related immersion effect, influence of diving equipment load and water under low temperature. The FVC is detected decreased in EG (t=1.21, P =0.25) while it increased in CG (t=-0.42, P =0.68)，but the differences are not significant and couldn’t affect the measured FEV1.0% (=FEV1.0/FVC %) values showed both increasing in EG(t=-1.48, P =0.16) and in CG(t=-0.23, P =0.82). The expiratory flow rate including PEF, FEF25-75, MEF75, MEF50 increased in EG (t are -0.72, -0.69, -0.87 and -0.36 respectively with P all greater than 0.05) while decreased in CG (t are 1.67, 0.50, 1.53 and 0.71 respectively with P all greater than 0.05). MEF25 is the expiratory flow index of not affected by respiratory muscle force and the measured values of MEF25 increased in the EG (t=-0.68, P =0.51) and in the CG (t=-0.36, P =0.72). Conclusion: Water immersion and water temperature during diving exposure could cause and accelerate hemodynamic changes in pulmonary circulation induced pulmonary interstitial edema and led to the increase of external respiratory work. Instant effects of diving exposure in the study are quite consistent with the long-term cumulative effect of professional divers in previous research, which is FVC reduced because small airway become narrower. The results illustrate even the small depth of short-range diving exercise have definite influences on pulmonary ventilation, which mainly comes from the environmental factor but not the pressure increases.