Effect of respiratory muscles training in weaning of mechanically ventilated COPD patients

Background: Inspiratory muscle weakness is common in patients receiving mechanical ventilation, especially COPD patients with prolonged duration of mechanical ventilation. Inspiratory muscle training could limit or reverse these unhelpful sequelae and facilitate more rapid and successful weaning. Objective: Assessment of the effect of respiratory muscle training in weaning of mechanically ventilated COPD patients admitted in respiratory ICU in the Abbassia chest hospital. Patients and methods: The study was conducted on 40 COPD patients admitted to the respiratory intensive care unit in the Abbassia chest hospital in the period between October-2011 and March-2013. All patients were diagnosed as having acute exacerbation of COPD with acute respiratory failure necessitating mechanical ventilatory support and difficult weaning; patients were subdivided into 2 groups: GROUP (A): (20 patients) include patients who received respiratory muscle training and GROUP (B): (20 patients) include patients who did not receive inspiratory muscle training. Results: There was a significant difference between the 2 groups as regards the primary outcomes including weaning success rate, duration of mechanical ventilation, length of stay in ICU, length of stay in hospital. Also there was a significant improvement of secondary outcomes in group (A) including PO2, O2 saturation, TV, RR, MIP over the 5 days of IMT; while there was a significant difference between the 2 groups regarding the above secondary outcomes in favor to group (A). Conclusion: Inspiratory muscle training increases muscle strength and endurance as well as it assists in weaning from mechanical ventilation in COPD patients with difficult weaning

Effect of inhaled corticosteroids on small airways in asthmatics using impulse oscillometry

Background The abnormalities in the small airways contribute to the symptoms of asthma. The small airways dysfunction may be attributed to many factors; mainly inflammation, remodeling, and changes in the surrounding tissue. Small airways affection associates with worse control of asthma, more frequent exacerbations, presence of nocturnal symptoms, more severe bronchial hyper-responsiveness, exercise-induced asthmatic symptoms, and the late-phase allergic response. Forced oscillation technique (FOT) was found to have higher sensitivity to inhaled corticosteroid (ICS) or to β-agonist inhalation than spirometry. Both ICS and β-agonists improve small-airway function, and FOT responses manifest eminent changes in indices of peripheral airway obstruction. In contrast, spirometric sensitivity to small-airway function is less eminent. Accordingly, it is expected that FOT might provide useful indices of peripheral airway change in response to therapeutic interventions. Aim The aim of this study was to evaluate the effect of regular use of ICS on small-airway function of asthmatic patients using impulse oscillometry (IOS). Patients and methods The study was carried out at Kobry El-Qobba Military Chest Hospital on 30 patients newly diagnosed as having mild and moderate bronchial asthma. Spirometric lung functions and IOS were done at baseline and then after 1 and 3 months of regular use of proper dosage of ICS to assess the effect on small-airway function. Results Results revealed that there was highly statistically significant improvement regarding changes in forced expiratory volume in 1 s, forced vital capacity, forced expiratory volume in 1 s/forced vital capacity, and maximum mid-expiratory flow (MMEF) 25–75 when comparing 1 day, 1 month, and 3 months. Moreover, there was statistically significant improvement regarding the R5, R20, and X5 when comparing 1 day, 1 month, and 3 months. Regular ICS use provides progressive improvement over time in both spirometry and IOS parameters. Both spirometric and IOS parameters were equally sensitive in detecting change of small-airway function. Conclusion Small-airway involvement in the pathogenesis of asthma will no longer be missed as it can be measured either qualitatively, as the presence or absence of high peripheral resistance values, or quantitatively through measuring the reactance. The more the patient is adherent to his or her daily recommended dose of ICS, the more evident is the improvement in his or her IOS and spirometric parameters including parameters that measure the small airways affection, starting from the very first few weeks of proper treatment. Using IOS is equally sensitive as spirometry in diagnosis and follow-up of adult asthmatic patients