OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly improved inspiratory capacity (p<0.001), and singing significantly improved the physical component of QoL, than did the control groups (p<0.001). All BEs did not significantly improve dyspnea, compared to the controls (p>0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).
Bias (Epidemiology) ; Breathing Exercises ; Dyspnea ; Humans ; Inspiratory Capacity ; Pulmonary Disease, Chronic Obstructive ; Quality of Life ; Respiration ; Respiratory Rate ; Singing ; Tidal Volume ; Ventilation

This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCO₂, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaO₂, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.
Animals ; Asthma ; Carbon Dioxide ; Cats ; Eosinophils ; Forced Expiratory Volume ; Glycosylation End Products, Advanced ; Humans ; Hydrogen-Ion Concentration ; Immunoglobulin E ; Immunoglobulins ; Inspiratory Capacity ; Lipocalins ; Lung Diseases, Obstructive ; Neutrophils ; Nitric Oxide* ; Oxygen ; Partial Pressure ; Peroxidase ; Plasma ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Surfactant-Associated Protein A ; Residual Volume ; Sputum ; Total Lung Capacity ; Vital Capacity

PURPOSETo make the capacity model of SMART new-type multi-functional ventilator achieve the capability that the flow can be stable and adjusted accurately.

METHODSTo analysis the problems in the course of development with fluid mechanics principle, find the deficiencies of original design and improve it.

RESULTSThe inspiratory phase waveform of IPPV. SIMV,etc, breathing pattern presented square wave, achieved the goal of adjustable flow.

CONCLUSIONSUsing the fluid mechanics principle guiding the design of ventilator gas circuit can get twice the result with half the effort.

Inspiratory Capacity ; Respiratory Mechanics ; Ventilators, Mechanical

PURPOSE: The purpose of this study is to investigate how respiratory muscle strength correlates to cough capacity in patients with respiratory muscle weakness. MATERIALS AND METHODS: Forty-five patients with amyotrophic lateral sclerosis (ALS), 43 with cervical spinal cord injury (SCI), and 42 with Duchenne muscular dystrophy (DMD) were recruited. Pulmonary function tests including forced vital capacity (FVC) and respiratory muscle strength (maximal expiratory pressure, MEP; maximal inspiratory pressure, MIP) were performed. The correlation between respiratory muscle strength and cough capacity was analyzed. RESULTS: In the SCI group, FVC in a supine position (2,597 +/- 648 mL) was significantly higher than FVC in a sitting position (2,304 +/- 564 mL, p < 0.01). Conversely, in the ALS group, FVC sitting (1,370 +/- 604 mL) was significantly higher than in supine (1,168 +/- 599 mL, p < 0.01). In the DMD group, there was no statistically significant difference between FVC while sitting (1,342 +/- 506 mL) and FVC while supine (1,304 +/- 500 mL). In addition, the MEP and MIP of all three groups showed a significant correlation with peak cough flow (PCF) (p < 0.01, Pearson's correlation analysis). In the SCI group, MIP was more closely correlated with PCF, while in the ALS and DMD groups, MEP was more closely correlated with PCF (p < 0.01, multiple regression analysis). CONCLUSION: To generate cough flow, inspiratory muscle strength is significantly more important for SCI patients, while expiratory muscle function is significantly more important for ALS and DMD patients.
Adult ; Amyotrophic Lateral Sclerosis/*physiopathology ; Cough/*physiopathology ; Female ; Humans ; Inspiratory Capacity ; Male ; Middle Aged ; Muscle Strength/*physiology ; Muscle Weakness/pathology/*physiopathology ; Muscular Dystrophy, Duchenne/*physiopathology ; Respiratory Muscles/pathology/*physiopathology ; Spinal Cord Injuries/*physiopathology

OBJECTIVETo study the relationship of inspiratory capacity (IC) with body mass index (BMI), fat free mass index (FFMI), and fat mass index (FMI) in adults with normal lung function.

METHODSBased on a survey on the Chinese physiological constants conducted in Heilongjiang during 2008, we obtained the data of 2,050 adults (921 men and 1,129 women aged 19-81 years) with normal lung function and grouped them according to the standard of classification of body weight recommended by Working Group on Obesity of China. Statistical analysis was performed using Pearson correlation analysis, one-way analysis of variance,and multi-factor regression analysis.

RESULTSAfter the influences of age and gender were adjusted, IC was positively correlated with BMI, FFMI, and FMI in adults aged 19-81 years (all P= 0.000) (the correlation coefficients were 0.320, 0.303, and 0.204, respectively). The means of IC, FFMI, and FMI in obesity group were significantly higher than those in overweight group normal weight group, and underweight group, were significantly higher in overweight group than in normal weight group and underweight group, were significantly higher in normal weight group than in underweight group (all P = 0.000). Multiple stepwise regression analysis showed that factors including age, gender, height, FFMI, and FMI influenced IC, and while height, FFMI, and FMI were positively correlated with IC, gender and age were negatively correlated with IC.

CONCLUSIONSBMI, FFMI, and FMI are positively correlated with IC in adults with normal lung function. The elevation of IC derived from BMI may attribute to FFMI and FMI, and FFMI has a higher influence on IC than FMI does.

Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Body Composition ; physiology ; Body Mass Index ; China ; Female ; Humans ; Inspiratory Capacity ; Male ; Middle Aged ; Regression Analysis ; Young Adult

OBJECTIVEDry powder inhalers (DPIs) are increasingly being used to deliver drugs for the treatment of asthma. It is known that DPIs require a crucial minimal inspiratory flow. Previous studies have demonstrated that the peak inspiratory flow (PIF, L/min) through a DPI is dependent on the type of device, the age of the patient, and the level of bronchial obstruction. However, the peak inspiratory flow of healthy preschool children in China remains scant in the literature. The present study aimed to analyze the ability of inspiring flow through the resistance state of ordinary use inhaler in Shenzhen healthy preschool children by measuring the peak inspiratory flow through the different analogue dry powder inhalers and go further into the relationship between it and the age, weight and forced expiratory volume of the children.

METHODA survey in 370 healthy preschool children aged 3 to 6 years (75 children aged 3 years, 104 children aged 4 years, 100 children aged 5 years and 91 children aged 6 years) was carried out in Shenzhen. Peak inspiratory flow (PIF) was measured without and with resistances, which mimicked the internal resistances of several inhalers, Diskus, Turbuhaler, Autohaler, Surehaler by PIF meter (In-check DIAL) and then data PIF-N, PIF-D, PIF-T, PIF-A and PIF-S were obtained. Peak expiratory flow (PEF) was measured by PEF meter (MicroPeak, USA). These two measurements were made in a well-controlled setting, and at least three attempts were recorded to establish maximum achievement. Six spirometry parameters forced vital capacity (FVC), forced expiratory volume at 0.5 second (FEV 0.5), forced expiratory volume at 0.75 second (FEV 0.75), forced expiratory volume at one second (FEV1), maximal mid expiratory flow rate (FEF 25 - 75, PEF were measured by using COSMED spirometry of Italy and the FVC measurements should be around the quality control for spirometry in preschool children which we suggested and published in 2005. All data were expressed as mean +/- SD and analyzed with the statistical software SPSS 12.0 for Windows. Pearson's test was used for calculation of the significances of the correlation coefficients. Variance analysis was used for analysing the variability of inspiratory flows through the inhalers.

RESULTSResults were obtained from 295 children aged 3 - 6 years who successfully finished the tests. The PIF-N, PIF-D, PIF-T, PIF-A and PIF-S were significantly different among the groups aged 3 yrs, 4 yrs, 5 yrs and 6 yrs. The peak inspiratory flow significantly increased with age. The PIF-N, PIF-D, PIF-T, PIF-A and PIF-S in the children of 110 cm height and above were significantly higher than those in the children below 110 cm height, so were the parameters between the children of 120 cm height and above and the children below 120 cm. PIF correlated significantly with age, height and weight and the Pearson coefficient was 0.3 - 0.5. The PIFs in different inhalers varied because of the different inner resistances. The minimum and optimum PIFs in resistances of Diskus, Autohaler and Surehaler could be achieved in almost all subjects, but those in resistances of Turbuhaler could be achieved in only 87.5% subjects, most of whom aged 3 yrs or below 100 cm height. There were good correlations between the PIFs in different resistances and main parameters of ventilation function (FVC, FEV 0.5, FEV 0.75, FEV1, FEF 25 - 75, PEF), PEF was the best among them (Pearson correlative coefficient was 0.6).

CONCLUSIONThe inspiratory ability of the children can be predicted and assessed by using routine measurement of lung function of normal pre-school children. As to the pre-school children of varying ages, the variety of inspiratory ability should be considered completely in the selection of inhaler used during the treatment. The best inhaler suitable for them should be selected properly in order to obtain the best efficacy of treatment individually.

Child ; Child, Preschool ; China ; Female ; Humans ; Inspiratory Capacity ; Male ; Maximal Expiratory Flow Rate ; Metered Dose Inhalers

BACKGROUND: Tiotropium is a long acting anticholinergic bronchodilator and it reduces exacerbations and improves the quality of life of patients with stable chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the effect of tiotropium on dyspnea, the quality of life and the pulmonary function in patients with COPD. METHODS: Between April 2005 and April 2006, the patients with moderate to severe COPD, as based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, and who needed to use long-acting bronchodilator were enrolled in this study. They inhaled tiotropium as a dry powder capsule, 18 microgram once daily for six months, with using the Handihaler(R) device. The lung function tests, including lung volume, the St. George's respiratory questionnaire and the MRC dyspnea scale, was measured at baseline and after 6 months treatment with tiotropium. RESULTS: 21 patients with COPD were enrolled. The mean age of the patients was 69 years and the mean baseline FEV1 was 1.0 L (40% predicted). Compared with the baseline, tiotropium produced significant improvement of the FEV1 (1.0+/-0.2 L vs. 1.1+/-0.3 L, respectively, p=0.013), IC (1.65+/-0.3 L vs. 1.7+/-0.3 L, respectively, p=0.037), the RV (4.0+/-0.7 L vs. 3.8+/-0.4, respectively, p=0.003), the SGRQ score (48.7+/-10 vs. 41.3+/-10.4, respectively, p<0.001), and the MRC dyspnea scale (3.4+/-0.6 vs. 3.0+/-0.8, respectively, p=0.009) after 6 months treatment. The dyspnea scale was associated with physical activity, the impact on life, the inspiratory capacity and the residual volume rather than the symptom score or FEV1. The treatment was well tolerated. CONCLUSIONS: Treatment with tiotropium once daily for 6 months improved lung functions, the health related quality of life and dyspnea.
Dyspnea ; Humans ; Inspiratory Capacity ; Lung ; Motor Activity ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Residual Volume ; Respiratory Function Tests ; Tiotropium Bromide ; Surveys and Questionnaires

The function of inspiratory muscles is crucial for effective cough as well as expiratory muscles in patients with Duchenne muscular dystrophy (DMD). However, there is no report on the correlation between cough and inspiratory muscle strength. To investigate the relationships of voluntary cough capacity, assisted cough techniques, and inspiratory muscle strength as well as expiratory muscle strength in patients with DMD (n=32). The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and three different techniques of assisted PCF were evaluated. The mean value of MICs (1918 +/- 586 mL) was higher than that of VCs (1474 +/- 632 mL) (p < 0.001). All three assisted cough methods showed significantly higher value than unassisted method (212 +/- 52 L/min) (F = 66.13, p < 0.001). Combined assisted cough technique (both manual and volume assisted PCF; 286 +/- 41 L/min) significantly exceeded manual assisted PCF (MPCF; 246 +/- 49 L/ min) and volume assisted PCF (VPCF; 252 +/- 45 L/min) (F = 66.13, p < 0.001). MIP (34 +/- 13 cmH2O) correlated significantly with both UPCF and all three assisted PCFs as well as MEP (27 +/- 10 cmH2O) (p < 0.001). Both MEP and MIP, which are the markers of respiratory muscle weakness, should be taken into account in the study of cough effectiveness.
Respiratory Muscles/*pathology ; Pressure ; *Oxygen Consumption ; Muscular Dystrophy, Duchenne/*genetics ; Muscles/pathology ; Muscle Weakness/pathology ; Models, Statistical ; Male ; Inspiratory Capacity ; Humans ; Cough ; Biopsy ; Adult ; Adolescent

The aim of this study was to investigate the factors affecting cough ability, and to compare the assisted cough methods in patients with Duchenne muscular dystrophy (DMD). A total seventy-one male patients with DMD were included in the study. The vital capacity (VC) and maximum insufflation capacity (MIC) were measured. The unassisted peak cough flow (UPCF) and three different techniques of assisted peak cough flow were evaluated. UPCF measurements were possible for all 71 subjects. But when performing the three different assisted cough techniques, peak cough flows (PCFs) could be obtained from only 51 subjects. The mean value of MICs (1801+/-780cc) was higher than that of VCs (1502+/-765cc) (p< 0.01). All three assisted cough methods showed a significantly higher value than the unassisted method (F=80.92, p< 0.01). The manual assisted PCF under MIC (MPCFmic) significantly exceeded those produced by manual assisted PCF (MPCF) or PCF under MIC (PCFmic). The positive correlation between the MIC, VC difference (MIC-VC), and the difference between PCFmic and UPCF (PCFmic-UPCF) was seen (r= 0.572, p< 0.01). The preservation of pulmonary compliance is important for the development of an effective cough as well as assisting the compression and expulsive phases. Thus, the clinical importance of the inspiratory phase and pulmonary compliance in assisting a cough should be emphasized.
Adolescent ; Child ; Cough/*physiopathology ; Humans ; Inspiratory Capacity ; *Lung Compliance ; Male ; Muscular Dystrophy, Duchenne/*physiopathology/*therapy ; Pulmonary Ventilation ; *Respiratory Therapy ; Vital Capacity

BACKGROUND AND OBJECTIVES: The objective of this research was to study the change of lung volume after uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea (OSA) patients. MATERIALS AND METHOD: Eight OSA patients were participated in this study. These patients were treated with UPPP at Seoul adventist hospital. Vital capacity (VC), inspiratory capacity (IC), expiratory residual volume (ERV) and FEV1, FEV1/FVC, FEV25-75% were determined by standard spirometry at the preoperative, at 3 postoperative days and 1 postoperative month. RESULTS: Vital capacity (VC) was significantly larger at 3 post-operative days (3.58+/-0.87 L, mean+/-SD) than those at pre-operative (3.12+/-0.69 L, mean+/-SD) in the patient with OSA (p=0.047). FEV 1 (L) was larger at 3 post-operative days (2.91+/-0.76 L, mean+/-vSD) than those at pre-operative (2.68+/-0.85 L, mean+/-vSD), but was not significantly correlated statically (p=0.249). CONCLUSION: We found significant correlation between preopeative and postoperative VC, IC.
Humans ; Inspiratory Capacity ; Lung* ; Residual Volume ; Respiratory Function Tests ; Seoul ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Spirometry ; Vital Capacity