Telemonitoring systems for respiratory patients: technological aspects.

Abstract This review introduces the reader to the available technologies in the field of telemonitoring, with focus on respiratory patients. In the materials and methods section, a general structure of telemonitoring systems for respiratory patients is presented and the sensors of interest are illustrated, i.e., respiratory monitors (wearable and non-wearable), activity trackers, pulse oximeters, environmental monitors and other sensors of physiological variables. Afterwards, the most common communication protocols are briefly introduced. In the results section, selected clinical studies that prove the significance of the presented parameters in chronic respiratory diseases are presented. This is followed by a discussion on the main current issues in telemedicine, in particular legal aspects, data privacy and benefits both in economic and health terms

Environmental toxicity, redox signaling and lung inflammation:the role of glutathione

Glutathione (γ-glutamyl-cysteinyl-glycine, GSH) is the most abundant intracellular antioxidant thiol and is central to redox defense during oxidative stress. GSH metabolism is tightly regulated and has been implicated in redox signaling and also in protection against environmental oxidant-mediated injury. Changes in the ratio of the reduced and disulfide form (GSH/GSSG) can affect signaling pathways that participate in a broad array of physiological responses from cell proliferation, autophagy and apoptosis to gene expression that involve H(2)O(2) as a second messenger. Oxidative stress due to oxidant/antioxidant imbalance and also due to environmental oxidants is an important component during inflammation and respiratory diseases such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, acute respiratory distress syndrome, and asthma. It is known to activate multiple stress kinase pathways and redox sensitive transcription factors such as Nrf2, NF-κB and AP-1, which differentially regulate the genes for pro-inflammatory cytokines as well as the protective antioxidant genes. Understanding the regulatory mechanisms for the induction of antioxidants, such as GSH, versus pro-inflammatory mediators at sites of oxidant-directed injuries may allow for the development of novel therapies which will allow pharmacological manipulation GSH synthesis during inflammation and oxidative injury. This article features the current knowledge about the role of GSH in redox signaling, GSH biosynthesis and particularly the regulation of transcription factor Nrf2 by GSH and downstream signaling during oxidative stress and inflammation in various pulmonary diseases. We also discussed the current therapeutic clinical trials using GSH and other thiol compounds, such as N-acetyl-L-cysteine, fudosteine, carbocysteine, erdosteine in environment-induced airways disease

The effects of lung volume on swallowing in chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD), a respiratory disease that leads to reduced airflow, may result in difficulty swallowing with disease progression. The coordination between the respiratory and swallowing systems decouple and they may experience increased risk of aspiration. This study aimed to determine the effects of lung volume on swallowing in individuals with COPD compared with older healthy. Specifically, the study examined if altering lung volume at the time of the swallow changed swallowing timing, specifically pharyngeal swallow duration, and impacted the respiratory-swallow pattern in individuals with COPD. Measurement of estimated lung volume (ELV), pharyngeal swallow duration, and respiratory-swallow patterning in individuals with COPD was compared with older healthy at varying lung volume conditions. Participants completed seven 20 ml water bolus swallows by medicinal cup across 4 lung volumes: non-cued volume (NC), and in order of increasing volume, resting expiratory level (REL), tidal volume (TV), and total lung capacity (TLC) . ELV was determined using respiratory inductive plethysmography (RIP) and spirometry. Swallow timing was measured by events during the swallow with pharyngeal manometry. Individuals with COPD had lower lung volumes at the time of the swallow than older healthy individuals. A moderate to strong negative relationship between estimated lung volume at the time of the swallow and pharyngeal swallow duration was found in individuals with COPD that was not present in the healthy participants. They had a longer pharyngeal duration when swallowing at lower lung volumes. The percentage of swallows resuming on inspiration post-swallow were significantly greater in individuals with COPD than the healthy. In the COPD group, resumption of respiration in inspiration occurred significantly less often at the higher lung volumes (TLC and TV) than the lower volume condition, REL. In conclusion lower lung volumes at the time of the swallow in individuals with COPD were associated with longer pharyngeal swallow duration and increased resumption of respiration in inspiration post-swallow

A Differential Inertial Wearable Device for Breathing Parameter Detection: Hardware and Firmware Development, Experimental Characterization

Breathing monitoring is crucial for evaluating a patient’s health status. The technologies commonly used to monitor respiration are costly, bulky, obtrusive, and inaccurate, mainly when the user moves. Consequently, efforts have been devoted to providing new solutions and methodologies to overcome these limitations. These methods have several uses, including healthcare monitoring, measuring athletic performance, and aiding patients with respiratory diseases, such as COPD (chronic obtrusive pulmonary disease), sleep apnea, etc. Breathing-induced chest movements can be measured noninvasively and discreetly using inertial sensors. This research work presents the development and testing of an inertia-based chest band for breathing monitoring through a differential approach. The device comprises two IMUs (inertial measurement units) placed on the patient’s chest and back to determine the differential inertial signal, carrying out information detection about the breathing activity. The chest band includes a low-power microcontroller section to acquire inertial data from the two IMUs and process them to extract the breathing parameters (i.e., RR—respiration rate; TI/TE—inhalation/exhalation time; IER—inhalation-to-exhalation time; V—flow rate), using the back IMU as a reference. A BLE transceiver wirelessly transmits the acquired breathing parameters to a mobile application. Finally, the test results demonstrate the effectiveness of the used dual-inertia solution; correlation and Bland–Altman analyses were performed on the RR measurements from the chest band and the reference, demonstrating a high correlation (r = 0.92) and low mean difference (MD = -0.27 BrPM (breaths per minute)), limits of agreement (LoA = +1.16/-1.75 BrPM), and mean absolute error (MAE = 1.15%). Additionally, the experimental results demonstrated that the developed device correctly measured the other breathing parameters (TI, TE, IER, and V), keeping an MAE of <=5%. The obtained results indicated that the developed chest band is a viable solution for long-term breathing monitoring, both in stationary and moving users