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Unexplained dyspnea could be ascribable to postural changes
Full text linkHere we present the cases of 3 females referred to our outpatient clinic complaining dyspnea during daily activity, in particular during walking. A careful history enabled us to determine that dyspnea was significantly reduced when they walked with upper-limb support. Subjects underwent respiratory function tests (FEV1, FVC, DLCO), chest X-ray, echocardiogram with non-invasive PAPs measurement, blood sample testing and ventilatory evaluation by means of portable respiratory inductive plethysmography (LifeShirt System, LS). LS accurately
estimates ventilation, ventilatory pattern and the
synchrony of rib cage-abdominal motion (phase angle, PhA) at rest and during exercise both in patients and in healthy subjects. Subjects performed six-minute walking tests (6MWT) with and without a rollator while equipped with LS.
All exams were normal. LS evaluation during 6MWT showed an higher PhA during 6MWT without rollator: 26±11° and 17±3° without and with rollator respectively. During 6MWT without upper-limb support an evident increase in PhA was observed.
This is an indicator of rib cage-abdominal motion
asynchrony, which in turn could induce dyspnea. We suggest that postural change during walking without upper-limb support may occur in otherwise elderly subjects and this could explain the dyspnea
Long-term (1-year) effects of two methods of exercise training (ET) in COPD patients
No full textIntroduction: the success of long-term ET programs resides in the integration between exercise prescription and patients' compliance with home training.
Aim: to evaluate two methods to help understanding and maintaining the exercise (walking) intensity.
Methods: 36 COPD patients (9F,27M) participated to the ET program (age 72 ±8; FEV1% 48±12). T0= first evaluation: 6MWD, tests on treadmill to evaluate walking distance covered in twenty minutes (20MWD) and maximal speed, monitoring of physical activity (Armband). Patients were then divided in 2 groups for the home ET program: A1= speed walking marked by a metronome; A2=covering a known distance in a fixed time. Test were repeated after 5 and 12 months (T5;T12). Control group: 23 well matched COPD not partecipating in ET (8F,15M,age 69±7,FEV1% 52±11)
Results: Group A1-A2.
Daily METs Physical activity > 3 METs (hours) 6MWD (m) Max speed (Km/h) 20MWD (m)
A1 T0 1,22±0,13 0,39±0,38 299±87 3,7±1,1 790±292
A2 T0 1,29±0,21 0,66±0,56 261±94 3,6±1,2 726±250
A1 T5 1,31±0,16* 0,95±0,86* n.a. 4,0±1,2* 970±363*
A2 T5 1,36±0,22* 1,11±0,77* n.a. 3,9±0,3 868±334*
A1 T12 1,39±0,16*^ 0,96±0,64* 369±80* 4,5±1,2*^ 1028±335*^
A2 T12 1,33±0,25 0,97±0,67^ 315±92* 4,2±1,4* 840±320*
* vs T0 ; ^ vs T5
Control group: no significant change.Conclusions: ET performed at a metronome-marked speed allows the patient to better understand the intensity of exercise and is more effective with time, as shown by the mantaining of higher physical activity and performance after 12 months in A1 compared to A2. ^*=p<0,0
A simple method for home exercise training in patients with chronic obstructive pulmonary disease: One-year study
No full textPURPOSE: The success of long-term exercise training (ExT) programs resides in the integration between exercise prescription and patient compliance with home training. One of the crucial issues for the patients is the understanding of appropriate exercise intensity. We compared 2 methods of home ExT, based on walking. METHODS: Forty-seven patients with chronic obstructive pulmonary disease were recruited and underwent respiratory function, exercise capacity evaluation with a 6-minute walk test, and treadmill tests. Physical activity was monitored by a multisensor Armband (SenseWear, Body Media, Pittsburgh, PA). Patients were randomly assigned to 2 different home training methods and assessed again after 6 and 12 months; group A1: speed walking paced by a metronome, and group A2: walking a known distance in a fixed time. RESULTS: Thirty-six patients completed the study. All subjects showed a significant improvement in the 6-minute walk test after 1 year but the improvement was higher in A1 than in A2 (P < .05). Physical activity levels were significantly higher at T12 versus baseline only in group A1 (P < .05). CONCLUSIONS: The use of a metronome to maintain the rate of walking during home ExT seems to be beneficial, allowing patients to achieve and sustain the optimal exercise intensity, and resulting in greater improvement compared to simply using a fixed time interval exercise. © 2012 Lippincott Williams & Wilkins, Inc
Long-term monitoring of oxygen saturation at altitude can be useful in predicting the subsequent development of moderate to severe Acute Mountain Sickness
No full textThe use of pulse oximetry (SpO2) to identify subjects susceptible to AMS is the subject of debate. To obtain more reliable data, we monitored SpO2 for 24 hours at altitude to investigate the ability to predict impending AMS. Methods The study was conducted during the climb from Alagna (1154m) to Capanna Regina Margherita (4559m) with an overnight stay in Capanna Gnifetti (3647m). Sixty-two subjects (11F) were recruited. Each subject was fitted with a 24-hr recording finger pulse oximeter. The subjects rode a cable car to 3275m and climbed to 3647m, where they spent the night. Results In the morning, 24 (4F) had a Lake Louise Questionnaire score (LLS) ≥3 (AMS+), and 15 (4F) exhibited moderate to severe disease (LLS ≥5 = AMS++). At Alagna, SpO2 did not differ between the AMS- and AMS+. At higher stations, all AMS+ exhibited a significantly lower SpO2 than did the AMS-: at 3275m, 85.4% vs 87.7%; resting at 3647m, 84.5% vs 86.4%. The ROC curve analysis resulted in a rather poor discrimination between the AMS– and all of the AMS+. With the cut-off LLS ≥5, the sensitivity was 86.67%, the specificity was 82.5%, the AUC was 0.88 (p <0.0001) for SpO2≤84% at 3647m. Conclusions We conclude that AMS+ exhibit a more severe and prolonged oxygen desaturation than do AMS- starting from the beginning of altitude exposure, but the predictive power of SpO2 is accurate only for AMS++
Respiratory Muscle Endurance Training Improves Breathing Pattern in Triathletes.
No full textRecent studies show that endurance training of respiratory muscle (RMET) improves exercise performance and decreases ventilation (VE) during exercise. Purpose: To evaluate the effect of RMET with normocapnic hyperpnoea (Spirotiger®) on respiratory function, ventilatory efficiency, cycling and running performance in triathletes. Methods: 20M triathletes (age 21-45) were randomly allocated to two groups: RMT group (10) and control group (10). At baseline (T0) athletes underwent respiratory function tests and maximal incremental cardiopulmonary tests performed with both cycle ergometer and treadmill; the same protocol was repeated after five weeks (T1). The RMT group trained at home for five weeks for 20 min daily, seven days a week. Between T0-T1 the daily training program didn’t change. Results: In the RMT group maximal inspiratory pressure (MIP) significantly increased (T0: 8.9±2.4, T1: 9.4±2.1 kPa; P < 0.05) and an improvement of maximum workload (T0: 389±106 T1: 429±119W
Inspiratory muscle training (IMT) with normocapnic hyperventilation (NH) improves respiratory muscle strength, exercise performance and ventilatory pattern in COPD patients
No full textIntroduction: IMT by means of normocapnic hyperventilation is effective in improving exercise endurance in healthy subject but few data are available for COPD subjects Aim: to evaluate the effect of 4 weeks NH training by means of Spirotiger on respiratory parameters and exercise capacity in 21 moderate/severe COPD patients. Materials and Methods: 19 M, 2 F, aged 42-80. Respiratory function tests (FEV1, FVC, Pimax), QoL (St George’s Questionnaire), 6MWT and endurance exercise (75-80% of peak-work rate measured during an incremental test and performed to the limit of tolerance, tLIM). 7 of 21 patients were instrumented with a portable inductive plethysmografhy (Lifeshirt System) to evaluate breathing pattern during tLIM. After 1 month of weekly supervised training, the patients trained at home for 6 weeks: 10 min twice a day at a breathing rate 12-24/min with a volume equal to 50% of CV. Result: 6 patients dropped out (poor compliance). IMT significantly improved Pimax, QoL, exercise capacity (table1). Ventilatory pattern after IMT is characterized by a significantly higher TV with no change in VE (table2). Conclusion: after a short IMT, COPD patients show a higher exercise capacity and an intriguing change in ventilatory pattern which improves oxygen saturation.
Table1
FEV1% FVC% Pimax(KPa) QoL(total) tLIM(min) 6MWD(m)
Pre IMT 55,216,9 82,322,8 8,873 22,716,6 6,38 3,4 43674,5
Post IMT 57,615,8 82,724,1 9,582,8* 17,512,2* 10,297,4* 466,279,7*
Table2
SpO2mean(%) VE(L/min) TV (L/min) Br(b/min)
Pre IMT 912,2 28,616,1 0,80,4 334,2
Post IMT 92,31,5* 2916,4 0,90,4* 30,86,5
*p<0,05(statistical analysis by T test and Wilcoxon signed rank test
Prevalence of airflow obstruction (AO) in Nepal rural population exposed to indoor but not outdoor pollution
No full textBiomass fuel (BMF) is the major energy source in developing country as a cooking and heating fuel. Its use causes indoor air pollution due to inefficient burning on open fire and traditional stove. This fact plays a main role in development of chronic obstructive respiratory disease (COPD). Aim: To evaluate the impact of BMF on the respiratory health of people living in a mountain village of Nepal not exposed to traffic and industrial pollution. Methods: All the dwellers with an age > 14 years were selected, 105 subjects (51F, 54M), aged 14-82 years were evaluated by spirometry (due to technical problems, the reversibility test was not performed), and a questionnaire about smoke habits, kitchen detail and energy sources. Results: Only 4,8% (2F, 2M) of subjects were smokers, 92,5% (49F, 51M) were never smokers. The prevalence of AO (ERS criterion, FEV1/FVC % of predicted value 10 years) and most of them were women (61%) working at home.
Conclusions: A high percentage of AO is demonstrated in non smokers not exposed to traffic and industrial pollution but with a long term exposure to domestic BMF smoke. The percentage is higher in householder women living in traditional houses. In these subjects the probability of COPD is higher than expected in the general population (4-10%). To the best of our knowledge this is the first study on respiratory health in no smoker subjects with different degrees of indoor pollution exposure, living in an area free from outdoor pollution. In fact in the previous studies the subjects were also exposed to other risk factors such as cigarette smoking and/or traffic exhaust fumes
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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