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Experimental Physiology Jan 2021What is the central question of the study? The aim was to determine the effects of duration of acceleration in the cranial-caudal direction (+Gz) on acceleration...
NEW FINDINGS
What is the central question of the study? The aim was to determine the effects of duration of acceleration in the cranial-caudal direction (+Gz) on acceleration atelectasis and identify measurement techniques that can be used to assess it. What is the main finding and its importance? Non-invasive measurement of acceleration atelectasis using electrical impedance tomography and estimates of pulmonary shunt provide more detailed assessment of acceleration atelectasis than traditional forced vital capacity measures. Using these techniques, it was found that as little as 30 s of exposure to +Gz acceleration can cause acceleration atelectasis. The results of the present study will allow a more accurate and detailed assessment of acceleration atelectasis in the future.
ABSTRACT
Recently, there have been reports of acceleration atelectasis during fast jet flight despite the use of systems designed to minimize this. Before further investigation of this, indices suitable for use in applied settings and identification of acceleration durations that elicit it are required. Fifteen non-aircrew subjects underwented five centrifuge exposures lasting 15, 30, 60 and 2 × 90 s with a plateau of +5 Gz (acceleration in the cranial-caudal direction) while breathing 94% O during all but one control exposure (21% O ). Lung volumes and gas exchange limitation were assessed after each exposure. Regional lung impedance and compliance were measured after Gz exposure using electrical impedance tomography and the forced oscillatory technique, respectively. The presence of acceleration atelectasis was confirmed by reductions of 10-17% in vital and inspiratory capacity after 60 and 90 s Gz exposures (P < 0.05) and resulted in reduced regional lung impedance and a gas exchange limitation of 8.1 and 12.5%, respectively (P < 0.05). There was also a small but significant decrease in regional lung impedance after 30 s exposures. Functional residual capacity and lung compliance were unchanged in atelectatic lungs (P > 0.05). In the majority of individuals, >60 s of Gz exposure while breathing 94% O causes acceleration atelectasis. Electrical impedance tomography and the measurement of gas exchange limitation provide useful indicators of acceleration atelectasis. Acceleration atelectasis exerts its effects primarily through basal lung closure and reflex inspiratory limitation, both of which can be reversed by performing three maximal inspiratory breathing manoeuvres.
Topics: Acceleration; Adult; Female; Humans; Hypergravity; Lung; Male; Oxygen; Pulmonary Atelectasis; Respiration; Vital Capacity; Young Adult
PubMed: 32281162
DOI: 10.1113/EP088495 -
Advances in Experimental Medicine and... 2020Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor...
Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor control of the disease is low patient compliance with treatment plan. The aim of the study was to investigate sociodemographic and health status factors that may have an influence on adherence to treatment. There were 106 inpatients (F/M, 42/64; mean age 70 ± 6 years) with COPD enrolled into this retrospective study. Patients completed the Adherence to Refills and Medications Scale (ARMS) to assess adherence to therapy. We found that the mean ARMS score was 23.1 ± 6.8. About 86% of patients had low adherence, and 14% had good adherence (mean score 3.2 ± 2.4). The low-adherence patients were more likely to be older (p = 0.020), female (p = 0.011), single (p = 0.019), not professionally active (p = 0.049), hospitalized more often (p = 0.005) and for a longer time (p = 0.046), feel worse (p = 0.023), experience a greater impact of the disease on sleep quality (p = 0.008) and daily activities (p = 0.001), and had a higher GOLD stage of COPD when compared to patients with good adherence patients (p = 0.012). Multiple factor analysis demonstrates that independent adverse predictors of the ARMS score included the following: being single (OR = 3.18), having had more than eight hospitalizations (OR = 1.18), and experiencing dysfunction in daily activities (OR = 1.79). Male gender (OR = 0.77) and longer than 21-day hospitalizations (OR = 0.93) were independent positive predictors of adherence. In conclusion, COPD patients demonstrate a low level of adherence to pharmacotherapy. Adherence is adversely affected by sociodemographic (older age, female gender, being single, and professionally inactive) and clinical factors (more frequent hospitalizations, perception of poor well-being, disordered sleep and daily functioning, and a higher GOLD stage).
Topics: Aged; Female; Health Status; Hospitalization; Humans; Male; Medication Adherence; Pulmonary Disease, Chronic Obstructive; Retrospective Studies
PubMed: 32239444
DOI: 10.1007/5584_2020_508 -
Current Medicinal Chemistry 2023Nowadays, lungs are the most common organs affected by diseases due to climate change, tobacco smoking, pollution and genetic factors. Conventional pharmacotherapy (oral... (Review)
Review
Nowadays, lungs are the most common organs affected by diseases due to climate change, tobacco smoking, pollution and genetic factors. Conventional pharmacotherapy (oral medication or injection) is poorly selective; this causes toxicity problems and numerous systemic side effects. Furthermore, although pulmonary administration is an interesting drug administration route for treating lung diseases, inhalation therapy is complex mainly due to the lung defense mechanisms leading to rapid drug elimination. Pulmonary drug delivery using nanocarriers appears to be the best therapeutic strategy to overcome these issues. In fact, these nanosystems can reduce both drug therapeutic dose and side effects, improving patient compliance, avoiding alveolar macrophage clearance, protecting the drug from degradation processes, and providing a controlled and targeted drug release. Therefore, this review aims to analyze the scientific literature regarding the use of nanocarriers to treat the main lung diseases (cancer, asthma, infections). In particular, attention was devoted to liposomes and polymer- and lipid-based nanoparticles, being the topic of most published articles in the last decade.
Topics: Humans; Drug Delivery Systems; Lung; Lung Diseases; Nanoparticles; Asthma; Neoplasms; Drug Carriers; Administration, Inhalation
PubMed: 36043745
DOI: 10.2174/0929867329666220829092323 -
Minerva Medica Oct 2021The benefits of inhaled medication for the treatment of respiratory diseases are immense. Inhalers are unquestionably the most important medical devices for the... (Review)
Review
The benefits of inhaled medication for the treatment of respiratory diseases are immense. Inhalers are unquestionably the most important medical devices for the treatment of asthma and in Europe today there are more than 230 different device and drug combinations of inhaled therapies many of which are available for the treatment of asthma. They are designed to alleviate the symptoms of asthma by controlling inflammation and minimizing exacerbations and are intended to be simple enough to operate by all patients regardless of their age and education. However, it is still a huge challenge for patients to use their inhaler correctly and consistently and achieving asthma control continues to be an elusive goal for most patients worldwide. The reality is that despite advances in the diagnosis of asthma, the availability of comprehensive asthma management guidelines and potent asthma medications combined with efficient delivery systems, uncontrolled disease is still linked to substantial morbidity and mortality. Despite the enormous benefits of delivering topically acting medication directly to the site of disease in the lungs adherence to treatment still remains one of the biggest challenges in asthma control. This current review looks at why patients have difficulty in using their inhalers and why adherence is so poor and how this may be improved through the use of innovation in inhaler design.
Topics: Administration, Inhalation; Anti-Asthmatic Agents; Asthma; Humans; Lung; Medication Adherence; Medication Errors; Nebulizers and Vaporizers
PubMed: 33438386
DOI: 10.23736/S0026-4806.20.07276-6 -
Expert Opinion on Drug Delivery Feb 2020: Aerosolized medications are commonly prescribed for the treatment of patients with pulmonary diseases, and there has been an increased interest in the development of... (Review)
Review
: Aerosolized medications are commonly prescribed for the treatment of patients with pulmonary diseases, and there has been an increased interest in the development of aerosol delivery devices over the years. Technical innovations have advanced device design, novel features such as breath actuation, dose tracking, portability, and feedback mechanism during treatment that improved the performance of aerosol devices, and effectiveness of inhalation therapy.: The purpose of this paper is to review recent advances in aerosol devices for delivery of inhaled medications.: Drug formulations and device designs are rapidly evolving to make more consistent dosing across a broad range of inspiratory efforts, to maximize dose and target specific areas of the diseased lung.
Topics: Administration, Inhalation; Aerosols; Humans; Nebulizers and Vaporizers; Patient Compliance
PubMed: 31959028
DOI: 10.1080/17425247.2020.1712356 -
The Clinical Respiratory Journal Mar 2023Patients with overlap syndrome (OS), that is obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), are at increased risk of acute exacerbations...
Effect of compliance to continuous positive airway pressure on exacerbations, lung function and symptoms in patients with chronic obstructive pulmonary disease and obstructive sleep apnea (overlap syndrome).
INTRODUCTION
Patients with overlap syndrome (OS), that is obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), are at increased risk of acute exacerbations related to COPD (AECOPD). We assessed the effect of CPAP compliance on AECOPD, symptoms and pulmonary function in OS patients.
METHODS
Consecutive OS patients underwent assessment at baseline and at 12 months under treatment with CPAP of: AECOPD and hospitalizations, COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) questionnaires, pulmonary function testing and 6-min walking test (6MWT).
RESULTS
In total, 59 patients (54 males) with OS were followed for 12 months and divided post hoc according to CPAP compliance into: group A with good (≥4 h CPAP use/night, n = 29) and group B with poor (<4 h CPAP use/night, n = 30) CPAP compliance. At 12 months, group A showed improvements in FEV (p = 0.024), total lung capacity (p = 0.024), RV/TLC (p = 0.003), 6MWT (p < 0.001) and CAT (p < 0.001). COPD exacerbations decreased in patients with good CPAP compliance from baseline to 12 months (17 before vs. 5 after, p = 0.001), but not in those with poor compliance (15 before vs. 15 after, p = 1). At multivariate regression analysis, COPD exacerbations were associated with poor CPAP compliance (β = 0.362, 95% CI: 0.075-0.649, p = 0.015).
CONCLUSIONS
When compared to poorly compliant patients, OS patients with good CPAP compliance had a lower number of AECOPD and showed improved lung function and COPD related symptoms.
Topics: Male; Humans; Continuous Positive Airway Pressure; Pulmonary Disease, Chronic Obstructive; Sleep Apnea, Obstructive; Connective Tissue Diseases; Autoimmune Diseases; Patient Compliance; Lung
PubMed: 36635888
DOI: 10.1111/crj.13580 -
Journal of Biomechanical Engineering Sep 2022Pulmonary function is tightly linked to the lung mechanical behavior, especially large deformation during breathing. Interstitial lung diseases, such as idiopathic...
Pulmonary function is tightly linked to the lung mechanical behavior, especially large deformation during breathing. Interstitial lung diseases, such as idiopathic pulmonary fibrosis (IPF), have an impact on the pulmonary mechanics and consequently alter lung function. However, IPF remains poorly understood, poorly diagnosed, and poorly treated. Currently, the mechanical impact of such diseases is assessed by pressure-volume curves, giving only global information. We developed a poromechanical model of the lung that can be personalized to a patient based on routine clinical data. The personalization pipeline uses clinical data, mainly computed tomography (CT) images at two time steps and involves the formulation of an inverse problem to estimate regional compliances. The estimation problem can be formulated both in terms of "effective", i.e., without considering the mixture porosity, or "rescaled," i.e., where the first-order effect of the porosity has been taken into account, compliances. Regional compliances are estimated for one control subject and three IPF patients, allowing to quantify the IPF-induced tissue stiffening. This personalized model could be used in the clinic as an objective and quantitative tool for IPF diagnosis.
Topics: Humans; Idiopathic Pulmonary Fibrosis; Lung; Tomography, X-Ray Computed
PubMed: 35292805
DOI: 10.1115/1.4054106 -
Minerva Anestesiologica Feb 2021Protective ventilation includes a strategy with low tidal volume, Plateau pressure, driving pressure, positive end-expiratory pressure (PEEP), and recruitment maneuvers...
Protective ventilation includes a strategy with low tidal volume, Plateau pressure, driving pressure, positive end-expiratory pressure (PEEP), and recruitment maneuvers on the ventilated lung. The rationale for the application of PEEP during one-lung ventilation (OLV) is that PEEP may contribute to minimize atelectrauma, preventing airway closure and alveolar collapse and improving the ventilation/perfusion to the ventilated lung. However, in case of high partial pressure of oxygen the application of PEEP may cause increased pulmonary vascular resistance, thus diverting blood flow to the non-ventilated lung, and worsening ventilation/perfusion. Further, PEEP may be associated with higher risk of hemodynamic impairment, increased need for fluids and vasoactive drugs. Positive effects on outcome have been reported by titrating PEEP according to driving pressure, targeted to obtain the optimum respiratory as well as pulmonary system compliance. This may vary according to the method employed for titration and should be performed individually for each patient. In summary, the potential for harm combined with the lack of evidence for improved outcome suggest that PEEP must be judiciously used during OLV even when titrated to a safe target, and only as much as necessary to maintain an appropriate gas exchange under low protective tidal volumes and driving pressures.
Topics: Anesthesia; Humans; Lung; One-Lung Ventilation; Positive-Pressure Respiration; Tidal Volume
PubMed: 33300325
DOI: 10.23736/S0375-9393.20.14797-7 -
Journal of Ultrasound Mar 2022Many patients with chronic pulmonary diseases, such as interstitial lung disease, cystic fibrosis, and non-cystic fibrosis bronchiectasis, suffer from dyspnea and...
PURPOSE
Many patients with chronic pulmonary diseases, such as interstitial lung disease, cystic fibrosis, and non-cystic fibrosis bronchiectasis, suffer from dyspnea and exercise intolerance. Reduced lung compliance is the main cause of the patients' dyspnea, but weak respiratory muscles could be an additional factor. The diaphragm is considered the major respiratory muscle. Our study aimed to detect diaphragmatic thickness and excursion by ultrasound in pediatric patients with chronic pulmonary diseases to assess respiratory muscle weakness in these patients.
METHODS
A case-control study was conducted on 130 patients with pediatric chronic pulmonary diseases (childhood interstitial lung diseases, cystic fibrosis, and non-cystic fibrosis bronchiectasis) and 100 control subjects. Ultrasound was used to detect diaphragmatic excursion and thickness, which were correlated with the severity of the disease, both clinically and functionally.
RESULTS
The right and left diaphragmatic excursions were significantly lower in the patients (19.469 ± 9.984 and 18.5 ± 10.131, respectively) than in the control subjects (29.6 ± 14.131 and 25.6 ± 12.827, respectively) (p values of 0.002 and 0.019). In contrast, the difference in the right and left diaphragmatic thicknesses between the patients and the controls was statistically insignificant (p values of 0.884 and 0.344). The left diaphragmatic excursion was positively correlated with the patients' age and weight, while both the right and the left diaphragmatic excursion significantly correlated with the patients' height, FEV1/FVC ratio, and heart rate.
CONCLUSION
The diaphragmatic excursion is lower in children and adolescents with chronic pulmonary diseases than in healthy control subjects. The diaphragmatic excursion is positively correlated with patients' age, weight, height, FEV1/FVC ratio, and heart rate.
Topics: Adolescent; Case-Control Studies; Child; Diaphragm; Humans; Lung; Lung Diseases, Interstitial; Ultrasonography
PubMed: 33604840
DOI: 10.1007/s40477-021-00570-2 -
European Respiratory Review : An... Sep 2019Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared... (Review)
Review
Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared with the growing needs for OSA diagnosis and management, and alternative strategies need to be developed to optimise the OSA clinical pathway. In this review, we propose a management strategy for OSA, and in general for sleep-disordered breathing, to be implemented from diagnosis to follow-up. For this purpose, the best current options seem to be: 1) networking at different levels of care, from primary physicians to specialised sleep laboratories; and 2) use of telemedicine. Telemedicine can contribute to the improved cost-effectiveness of OSA management during both the diagnostic and therapeutic phases. However, although the technology is already in place and different commercial platforms are in use, it is still unclear how to use telemedicine effectively in the sleep field. Application of telemedicine for titration of positive airway pressure treatment, follow-up to improve compliance to treatment through early identification and solution of problems, and teleconsultation all appear to be promising areas for improved OSA management.
Topics: Delivery of Health Care, Integrated; Health Services Needs and Demand; Humans; Lung; Needs Assessment; Patient Compliance; Predictive Value of Tests; Recovery of Function; Respiration; Respiratory Therapy; Sleep; Sleep Apnea Syndromes; Telemedicine; Treatment Outcome
PubMed: 31511256
DOI: 10.1183/16000617.0059-2019