Respiratory muscle training with normocapnic hyperpnea improves ventilatory pattern and thoracoabdominal coordination, and reduces oxygen desaturation during endurance exercise testing in COPD patients

Background: Few data are available about the effects of respiratory muscle training with normocapnic hyperpnea (NH) in COPD. The aim is to evaluate the effects of 4 weeks of NH (Spirotiger®) on ventilatory pattern, exercise capacity, and quality of life (QoL) in COPD patients. Methods: Twenty-six COPD patients (three females), ages 49-82 years, were included in this study. Spirometry and maximal inspiratory pressure, St George Respiratory Questionnaire, 6-minute walk test, and symptom-limited endurance exercise test (endurance test to the limit of tolerance [tLim]) at 75%-80% of peak work rate up to a Borg Score of 8-9/10 were performed before and after NH. Patients were equipped with ambulatory inductive plethysmography (LifeShirt®) to evaluate ventilatory pattern and thoracoabdominal coordination (phase angle [PhA]) during tLim. After four supervised sessions, subjects trained at home for 4 weeks 10 minutes twice a day at 50% of maximal voluntary ventilation. The workload was adjusted during the training period to maintain a Borg Score of 5-6/10. Results: Twenty subjects completed the study. After NH, maximal inspiratory pressure significantly increased (81.5±31.6 vs 91.8±30.6 cmH2O, P<0.01); exercise endurance time (+150 seconds, P=0.04), 6-minute walk test (+30 meters, P=0.03), and QoL (-8, P<0.01) all increased. During tLim, the ventilatory pattern changed significantly (lower ventilation, lower respiratory rate, higher tidal volume); oxygen desaturation, PhA, and dyspnea Borg Score were lower for the same work intensity (P<0.01, P=0.02, and P<0.01, respectively; one-way ANOVA). The improvement in tidal volume and oxygen saturation after NH were significantly related (R2=0.65, P<0.01). Conclusion: As expected, NH improves inspiratory muscle performance, exercise capacity, and QoL. New results are significant change in ventilatory pattern, which improves oxygen saturation, and an improvement in thoracoabdominal coordination (lower PhA). These two facts could explain the reduced dyspnea during the endurance test. All these results together may play a role in improving exercise capacity after NH training

Primary Pulmonary Epithelioid Hemangioendothelioma: A Rare Cause of PET-Negative Pulmonary Nodules

We report here a case of primary pulmonary epithelioid hemangioendothelioma diagnosed in a 67-year-old Caucasian man, presenting with exertion dyspnoea, dry cough, and multiple bilateral pulmonary nodules revealed by computed tomography. At the 18F-fluorodeoxyglucose positron emission tomography, these nodules were negative. The histopathological diagnosis was made on a pulmonary wedge resection (performed during video-thoracoscopic surgery)

Lung not only heart

Invited editorial hihglighting the role of respiratory system in exercise performanc

Medicina e Salute in Montagna

Condizioni ambientali in altitudine. Risposte fisiologiche dell'organismo all'esposzione all'atitudine, Rispostre patologiche (mal di montagna). Allenamento. Alimentazione. Aspetti pediatrici dell'esposizione all'ipossia. Possibilità di recarsi in altitudine per chi è affetto da patologie croniche

Pro: Rebuttal

We confirm the results of the discussion on lung interstitial edema

Criteri di Valutazione Pneumologica per l'Idoneità all'Attività Sportiva

Vengono esposti i principi di diagnostica funzionale respiratoria; vengono esaminate le patologie respiratorie acute e croniche in relazioni allo svolgimento di diverse tipologie di sport; vengo enunciati i criteri di valutazione pneumologica per l'idoneità alla attività sportiv

Patologie respiratorie d’alta quota: l’edema polmonare.

In questo capitolo viene affrontato il problema dell'edema interstiziale che compare nei soggetti esposti all'alta quota in assenza di evidenza clinica. In particolare si analizzano e si discutono le metodiche di diagnostica funzionale respiratoria che servono a dare un segnale indiretto dell'imbibizione dell'interstizio polmonare. Dopo una breve revisione della letteratura, vengono presentati e discussi i dati raccolti dagli autori nel corso di diversi progetti di ricerca svolti in altitudine

Endothelial Function in COPD Is in an Intermediate Position Between Healthy Subjects and Coronary Artery Disease Patients and Is Related to Physical Activity.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of ischemic heart disease. Endothelial dysfunction may play a role in the onset of cardiovascular event. Previous studies showed an impaired endothelial function (measured by flow-mediated dilation, FMD) in COPD patients compared to healthy subjects. To the best of our knowledge no study has compared FMD in COPD and in cardiac (coronary artery disease, CAD) patients. We aimed to assess FMD in healthy subjects, COPD, CAD, and COPD + CAD. The main result is that FMD in COPD is reduced and is in an intermediate position between healthy subjects and CAD or COPD + CAD; this impairment can contribute to explain the higher prevalence of cardiovascular disease in COPD. The only determinant independently associated with FMD in all subjects is the physical activity level, irrespective of the traditional risk factors (i.e., smoke, dyslipidemia, hypertension)

Field testing of ventilatory responses associated with walking and walking with poles(Nordicwalking)

Nordic walking, (NW) is a healthy physical activity reported to significantly increase O2 consumption and energy expenditure compared to regular walking (W). No information is available about the effect of NW on ventilatory pattern.Aim: to compare the ventilatory responses of NW to W under field-testing conditions in healthy subjects.Methods: 8 NW trainers (M,age 31-49) were studied by means of portable inductive plethysmography (Lifeshirt, Vivometrics, CA) at rest and during both NW and W at 2 speeds: 3km/h and 5km/h.Subjects performed either W or NW in a randomized manner with 1 hour rest in between.Subjects walked on a level, 420-m track with speed paced by a metronome.We measured minute ventilation (VE), tidal volume (VT), respiratory rate (ƒ), contribution of rib cage to ventilation (RC%) an index of thoracoabdominal coordination (phase angle, Φ°) and Borg scale.Anova test was used for statistical evaluation. Ventilatoy variables during W and NW at 2 speeds Rest W 3km/h W 5km/h NW 3km/h NW 5 km/h VE L/min 10,2±6 23,4±8§ 26,99±8°§ 39,6±18§ * 43,76±18 °§* VT mL 444±240 937±367§ 1042±379°§ 1230±448§* 1446±661§* ƒ 20,6±4 24,8±3§ 26±2§ 32±8§* 31±6§* RC% 53,2±19 49,9±19 50,3±21 53,2±18 51,3±21 Φ ° 17,3±9,1 13,8±4,8 11,8±3 20,7±8,9* 12±9° Borg scale 0 0,6±0,5§ 1,8±1§° 2,5±1,5§* 4,6±1,7§°* * = p<0.05 vs W at the same speed; ° p <0.05 vs same condition at different speed; § vs restResults (mean ±SD): VE, VT, ƒ and Borg scale are significantly higher during NW than W at both speeds. Conclusion: the involvement of ventilation and the perceived exertion are significantly higher during NW than during W; NW might be proposed as a suitable method for respiratory training

Device to facilitate the inhalation of medical products

Dispositivo per facilitare l'inalazione di farmaci per via inalatoria, fondamentali nella cura della patologie croniche ostruttiv