5 research outputs found
Volitional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity
Pursed lips breathing (PLB) is used by a proportion of patients with chronic obstructive pulmonary disease (COPD) to alleviate dyspnea. It is also commonly used in pulmonary rehabilitation. Data to support its use in patients who do not spontaneously adopt PLB are limited. We performed this study to assess the acute effects of PLB on exercise capacity in nonspontaneously PLB patients with stable COPD. We performed a randomized crossover study comparing 6 - min walk test (6MWT) at baseline without PLB with 6WMT using volitional PLB. Spirometry, maximal inspiratory and expiratory mouth pressures, and diaphragmatic excursion during tidal and vital capacity breathing using B-mode ultrasonography were measured at baseline and after 10 min of PLB. A Visual Analog Scale (VAS) assessed subjective breathlessness at rest, after 6MWT and after 6MWT with PLB. p \u3c = 0.01 was considered significant. Mean + / - SD age of patients was 53.1 + / - 7.4 years. Forced expiratory volume in 1second was 1.1 + / - 0.4 L / min (38.4 + / - 13.2% predicted). Compared with spontaneous breathing, all but one patient with PLB showed a significant increment in 6MWdistance (+ 34.9 + / - 26.4 m; p = 0.002). There was a significant reduction in respiratory rate post 6MWT with PLB compared with spontaneous breathing (-4.4 + / - 2.8 per minute; p = 0.003). There was no difference in VAS scores. There was a significant correlation between improvement in 6MWT distance and increase in diaphragmatic excursion during forced breathing. The improvement was greater in patients who had poorer baseline exercise performance. PLB has an acute benefit on exercise capacity. Sustained PLB or short bursts of PLB may improve exercise capacity in stable COPD
Non-pharmacological management of hypertension
Hypertension is a silent killer. Indians are racially predisposed to
cardiovascular disease, and the increasing burden of hypertension has
only added to the problem. Economic constraints and the allure of
additional benefits without adverse effects have made lifestyle
modifications an attractive proposition in developing and developed
countries alike. Blood pressure is a continuum and any increase above
optimal confers additional independent risk of vascular disease, even
in ranges previously considered normal. While antihypertensive agents
have been used for those patients with blood pressure above the
traditional cutoff, there has been increasing emphasis on the
prevention and treatment of hypertension by non-pharmacological means,
termed ′lifestyle modifications.′ A MEDLINE search was done
for relevant references with emphasis on original studies, randomized
controlled trials and meta-analyses. Lifestyle modifications that
effectively lower blood pressure are increased physical activity,
weight loss, limited alcohol consumption, reduced sodium intake and the
Dietary Approaches to Stop Hypertension diet. Lifestyle modification is
recommended as initial therapy in stage 1 hypertension before
initiation of drug therapy and as an adjunct to medication in persons
already on drug therapy. In pre-hypertensives, it can reduce the
incidence of hypertension and lower end-organ damage. It is emphasized
that simple advice from physicians can have a positive influence on
patients′ motivation to make lifestyle changes
Comparison of bronchoscopic and non-bronchoscopic techniques for diagnosis of ventilator associated pneumonia
Background: The diagnosis of ventilator associated pneumonia (VAP)
remains a challenge because the clinical signs and symptoms lack both
sensitivity and specificity and the selection of microbiologic
diagnostic procedure is still a matter of debate. Aims and Objective:
To study the role of various bronchoscopic and non-bronchoscopic
diagnostic techniques for diagnosis of VAP. Settings and Design: This
prospective comparative study was conducted in a medical ICU of a
tertiary care center. Materials and Methods: Twenty-five patients,
clinically diagnosed with VAP, were evaluated by bronchoscopic and
non-bronchoscopic procedures for diagnosis. The sensitivity,
specificity, positive predictive value (PPV) and negative predictive
value (NPV) of various bronchoscopic and non-bronchoscopic techniques
were calculated, taking clinical pulmonary infection score (CPIS) of
656 as reference standard. Results: Our study has shown that for
the diagnosis of VAP, bronchoscopic brush had a sensitivity,
specificity, PPV and NPV of 94.9% [confidence interval (CI):
70.6-99.7], 57.1% (CI: 13.4-86.1), 85% (CI: 61.1-96) and 80% (CI:
21.9-98.7), respectively. Bronchoscopic bronchoalveolar lavage (BAL)
had a sensitivity, specificity, PPV and NPV of 77.8% (CI: 51.9-92.6),
71.8% (CI: 24.1-94), 87.3% (CI: 60.4-97.8) and 55.5% (CI: 17.4-82.6),
respectively. Sensitivity, specificity, PPV and NPV for
non-bronchoscopic BAL (NBAL) were 83.3% (CI: 57.7-95.6), 71.43% (CI:
24.1-94), 88.2% (CI: 62.3-97.4) and 62.5% (CI: 20.2-88.2),
respectively. Endotracheal aspirate (ETA) yield was only 52% and showed
poor concordance with BAL (k-0.351; P-0.064) and NBAL (k-0.272;
P-0.161). There was a good microbiologic concordance among different
bronchoscopic and non-bronchoscopic distal airway sampling techniques.
Conclusion: NBAL is an inexpensive, easy, and useful technique for
microbiologic diagnosis of VAP. Our findings, if verified, might
simplify the approach for the diagnosis of VAP