The objective assessment of cough frequency: accuracy of the LR102 device

BACKGROUND: The measurement of cough frequency is problematic and most often based on subjective assessment. The aim of the study was to assess the accuracy of the automatic identification of cough episodes by LR102, a cough frequency meter based on electromyography and audio sensors. METHODS: Ten adult patients complaining of cough were recruited in primary care and hospital settings. Participants were asked to wear LR102 for 4 consecutive hours during which they were also filmed. RESULTS: Measures of cough frequency by LR102 and manual counting were closely correlated (r = 0.87 for number of cough episodes per hour; r = 0.89 for number of single coughs per hour) but LR102 overestimated cough frequency. Bland-Altman plots indicate that differences between the two measurements were not influenced by cough frequency. CONCLUSIONS: LR102 offers a useful estimate of cough frequency in adults in their own environment, while significantly reducing the time required for analysi

Effects of helium-oxygen on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in a porcine model of stable methacholine-induced bronchospasm

Objective: To explore the consequences of helium/oxygen (He/O2) inhalation on respiratory mechanics, gas exchange, and ventilation-perfusion (VA/Q) relationships in an animal model of severe induced bronchospasm during mechanical ventilation. Design: Prospective, interventional study. Setting: Experimental animal laboratory, university hospital. Interventions: Seven piglets were anesthetized, paralyzed, and mechanically ventilated, with all ventilator settings remaining constant throughout the protocol. Acute stable bronchospasm was obtained through continuous aerosolization of methacholine. Once steady-state was achieved, the animals successively breathed air/O2 and He/O2 (FIO2 0.3), or inversely, in random order. Measurements were taken at baseline, during bronchospasm, and after 30min of He/O2 inhalation. Results: Bronchospasm increased lung peak inspiratory pressure (49±6.9 vs 18±1cmH2O, P<0.001), lung resistance (22.7±1.5 vs 6.8±1.5cmH2O.l−1.s, P<0.001), dynamic elastance (76±11.2 vs 22.8±4.1cmH2O.l−1, P<0.001), and work of breathing (1.51±0.26 vs 0.47±0.08, P<0.001). Arterial pH decreased (7.47±0.06 vs 7.32±0.06, P<0.001), PaCO2 increased, and PaO2 decreased. Multiple inert gas elimination showed an absence of shunt, substantial increases in perfusion to low VA/Q regions, and dispersion of VA/Q distribution. He/O2 reduced lung resistance and work of breathing, and worsened hypercapnia and respiratory acidosis. Conclusions: In this model, while He/O2 improved respiratory mechanics and reduced work of breathing, hypercapnia and respiratory acidosis increased. Close attention should be paid to monitoring arterial blood gases when He/O2 is used in mechanically ventilated acute severe asthm

Usage of inhalation devices in asthma and chronic obstructive pulmonary disease: a Delphi consensus statement.

peer reviewedOBJECTIVES: The study aimed to assess usage of inhalation devices in asthma and chronic obstructive pulmonary disease (COPD). METHODS: In this two-round Delphi survey, 50 experts in asthma and COPD completed a 13-item, Internet-based, self-administered questionnaire about choice of inhalation device, training and monitoring of inhalation techniques, the interchangeability and the role of costs in the selection of inhalation devices. For each item, the median (central tendency) and interquartile ranges (degree of consensus) were calculated. RESULTS: Experts considered that the choice of inhalation device was as important as that of active substance (very good consensus) and should be driven by ease of use (good to very good consensus) and teaching (very good consensus). Experts recommended giving oral and visual instructions (good consensus) and systematic monitoring inhalation techniques. Pulmonologists and paramedics have predominantly educational roles (very good consensus). Experts discouraged inhalation device interchangeability (good consensus) and switching for cost reasons (good to very good consensus) without medical consultation (good consensus). CONCLUSIONS: The results of this survey thus suggested that inhalation devices are as important as active substances and training and monitoring are essential in ensuring effective treatment of asthma and COPD. Inhalation device switching without medical consultation should be avoided

Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease

Objective: To compare the effects of He/O2 and external PEEP (PEEPe) on intrinsic PEEP (PEEPi), respiratory mechanics, gas exchange, and ventilation/perfusion (V̇A/Q̇) in mechanically ventilated COPD patients. Design and setting: Prospective, interventional study in the intensive care unit of a university hospital. Interventions: Ten intubated, sedated, paralyzed, mechanically ventilated COPD patients studied in the following conditions: (a) baseline settings made by clinician in charge, air/O2, ZEEP; (b) He/O2, ZEEP; (c) air/O2, ZEEP; (d) air/O2, PEEPe 80% of PEEPi. Measurements at each condition included V̇A/Q̇ by the multiple inert gas elimination technique (MIGET). Results: PEEPi and trapped gas volume were comparably reduced by He/O2 (4.2±4 vs. 7.7±4cmH2O and 98±82 vs. 217±124ml, respectively) and PEEPe (4.4±1.3 vs. 7.8±3.6cmH2O and 120±107 vs. 216±115ml, respectively). He/O2 reduced inspiratory and expiratory respiratory system resistance (15.5±4.4 vs. 20.7±6.9 and 19±9 vs. 28.8±15cmH2Ol−1s−1, respectively) and plateau pressure (13±4 vs. 17±6cmH2O). PEEPe increased airway pressures, including total PEEP, and elastance. PaO2/FIO2 was slightly reduced by He/O2 (225±83 vs. 245±82) without significant V̇A/Q̇ change. Conclusions: He/O2 and PEEPe comparably reduced PEEPi and trapped gas volume. However, He/O2 decreased airway resistance and intrathoracic pressures, at a small cost in arterial oxygenation. He/O2 could offer an attractive option in COPD patients with PEEPi/dynamic hyperinflatio

Observational study on efficacy of negative expiratory pressure test proposed as screening for obstructive sleep apnea syndrome among commercial interstate bus drivers - protocol study

<p>Abstract</p> <p>Background</p> <p>Obstructive sleep apnea (OSA) is a respiratory disease characterized by the collapse of the extrathoracic airway and has important social implications related to accidents and cardiovascular risk. The main objective of the present study was to investigate whether the drop in expiratory flow and the volume expired in 0.2 s during the application of negative expiratory pressure (NEP) are associated with the presence and severity of OSA in a population of professional interstate bus drivers who travel medium and long distances.</p> <p>Methods/Design</p> <p>An observational, analytic study will be carried out involving adult male subjects of an interstate bus company. Those who agree to participate will undergo a detailed patient history, physical examination involving determination of blood pressure, anthropometric data, circumference measurements (hips, waist and neck), tonsils and Mallampati index. Moreover, specific questionnaires addressing sleep apnea and excessive daytime sleepiness will be administered. Data acquisition will be completely anonymous. Following the medical examination, the participants will perform a spirometry, NEP test and standard overnight polysomnography. The NEP test is performed through the administration of negative pressure at the mouth during expiration. This is a practical test performed while awake and requires little cooperation from the subject. In the absence of expiratory flow limitation, the increase in the pressure gradient between the alveoli and open upper airway caused by NEP results in an increase in expiratory flow.</p> <p>Discussion</p> <p>Despite the abundance of scientific evidence, OSA is still underdiagnosed in the general population. In addition, diagnostic procedures are expensive, and predictive criteria are still unsatisfactory. Because increased upper airway collapsibility is one of the main determinants of OSA, the response to the application of NEP could be a predictor of this disorder. With the enrollment of this study protocol, the expectation is to encounter predictive NEP values for different degrees of OSA in order to contribute toward an early diagnosis of this condition and reduce its impact and complications among commercial interstate bus drivers.</p> <p>Trial registration</p> <p><it>Registro Brasileiro de Ensaios Clinicos </it>(local acronym RBEC) [Internet]: Rio de Janeiro (RJ): <it>Instituto de Informaçao Cientifica e Tecnologica em Saude </it>(Brazil); 2010 - Identifier RBR-7dq5xx. Cross-sectional study on efficacy of negative expiratory pressure test proposed as screening for obstructive sleep apnea syndrome among commercial interstate bus drivers; 2011 May 31 [7 pages]. Available from <url>http://www.ensaiosclinicos.gov.br/rg/RBR-7dq5xx/</url>.</p

A Qualitative Exploration of the Use of Contraband Cell Phones in Secured Facilities

Offenders accepting contraband cell phones in secured facilities violate state corrections law, and the possession of these cell phones is a form of risk taking behavior. When offenders continue this risky behavior, it affects their decision making in other domains where they are challenging authorities; and may impact the length of their incarceration. This qualitative phenomenological study examined the lived experience of ex-offenders who had contraband cell phones in secured correctional facilities in order to better understand their reasons for taking risks with contraband cell phones. The theoretical foundation for this study was Trimpop\u27s risk-homeostasis and risk-motivation theories that suggest an individual\u27s behaviors adapt to negotiate between perceived risk and desired risk in order to achieve satisfaction. The research question explored beliefs and perceptions of ex-offenders who chose to accept the risk of using contraband cell phones during their time in secured facilities. Data were collected anonymously through recorded telephone interviews with 8 male adult ex-offenders and analyzed using thematic content analysis. Findings indicated participants felt empowered by possession of cell phones in prison, and it was an acceptable risk to stay connected to family out of concern for loved ones. The study contributes to social change by providing those justice system administrators, and prison managers responsible for prison cell phone policies with more detailed information about the motivations and perspectives of offenders in respect to using contraband cell phones while imprisoned in secured facilities

Conservative and non surgical treatments for the sleep disordered breathing adult.

Obstructive sleep apnoea (OSA) syndrome is a chronic disease characterised by repetitive obstructive apnoeas and hypopnoeas during sleep leading to sleep fragmentation. The treatment of OSA consists of general and specific measures. The aim of this article is to review the different non surgical approaches to treat OSA in adults. The different therapeutical options can be used in combination, which underlines that the OSA patient needs a careful and multidisciplinary management

Conservative and non surgical treatments for the sleep disordered breathing adult.

Obstructive sleep apnoea (OSA) syndrome is a chronic disease characterised by repetitive obstructive apnoeas and hypopnoeas during sleep leading to sleep fragmentation. The treatment of OSA consists of general and specific measures. The aim of this article is to review the different non surgical approaches to treat OSA in adults. The different therapeutical options can be used in combination, which underlines that the OSA patient needs a careful and multidisciplinary management