Publications
314 results found
Lavorini F, Pistolesi M, Usmani OS, 2017, Erratum: Recent advances in capsulebased dry powder inhaler technology (Multidisciplinary Respiratory Medicine (2017) 12 (11) DOI: 10.1186/s40248-017-0092-5), Multidisciplinary Respiratory Medicine, Vol: 12, ISSN: 1828-695X
After publication of the article [1] it was brought to our attention that resistance values of Breezahler (0.15 cmH2O/ L/min) and Handihaler (0.22 cmH2O/L/min) are incorrect. (page 4 right column, lines 14 and 16 from below). The correct resistance values of Breezhaler and Handihaler are 0.07 and 0.16 cmH2O/L.min-1, respectively. We apologise for the inaccuracy.
Hakim A, Usmani OS, 2016, New molecules to treat asthma and COPD, Advances in Pulmonary Drug Delivery, Pages: 49-65, ISBN: 9781498758048
Bonini M, Usmani OS, 2016, Monitoring asthma: current knowledge and future perspectives, Minerva Pneumologica, Vol: 55, Pages: 106-118, ISSN: 0026-4954
Asthma is a heterogeneous chronic respiratory disease. For many years, clinicians have classified and managed it according to severity. However, disease severity is largely affected by several external factors. Therefore, it has been recommended that ideal asthma management should primarily aim to achieve and maintain disease control. However, despite effective therapeutic options, a large proportion of patients do not manage to achieve satisfactory asthma control, often due to lack of adequate compliance. Poorly controlled asthma is associated with a relevant socioeconomic burden in terms of mortality, morbidity, quality of life and healthcare costs, in both adult and pediatric patients. Careful and constant disease monitoring therefore assumes a crucial role in allowing treatment adjustments and ensuring that therapy goals are met. This article provides a review of the currently available outcomes to monitor asthma control, as well as of innovative solutions to improve asthma management in the near future.
Hakim A, Khan Y, Esteban I, et al., 2016, Effects of a single inhaled budesonide/formoterol dose on glucocorticoid receptor activity in sputum of COPD patients, ERS International Congress 2016, Publisher: European Respiratory Society, Pages: OA3313-OA3313, ISSN: 0903-1936
Braido F, Scichilone N, Lavorini F, et al., 2016, Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN), World Allergy Organization Journal, Vol: 9, ISSN: 1939-4551
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases.Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction.In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect t
El-Hilly AA, Iqbal SS, Ahmed M, et al., 2016, Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study, JMIR Serious Games, Vol: 4, ISSN: 2291-9279
BACKGROUND: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. OBJECTIVE: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. METHODS: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. RESULTS: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. CONCLUSIONS: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly
Braido F, Scichilone N, Lavorini F, et al., 2016, Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN), Asthma Research and Practice, Vol: 2, ISSN: 2054-7064
Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonarydisease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the smallairways in these diseases.Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto,which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes theevidence gathered to date and defines and proposes issues on small airway involvement and management in asthmaand COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis ofasthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests areavailable for the assessment of the small airways, and their results must be integrated to confirm a diagnosisof small airway dysfunction.In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes.Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensivedeposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currentlyavailable tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessedusing currently available tools. In patients with subotpimal disease control and/or functional or biological signs ofdisease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choicebetween large- and small-particle inhaled formulations must reflect the physician&r
Fabbri N, Paredi P, Sally M, et al., 2016, Airway resistances deteriorate following spirometry in asthma and COPD patients, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Simpson A, Honkoop P, Sont J, et al., 2016, mHealth systems for asthma self-management: Opinions of people with asthma and healthcare professionals (HCPs) on their use and functions, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Sherwani Y, Muntasir M, Ahmed M, et al., 2016, Smoking cessation using the gamification of mHealth apps: A longitudinal qualitative study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Biddiscombe M, Meah S, Barnes P, et al., 2016, Drug particle size and lung deposition in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Comino RMO, Palacios PJR, Del Castillo JDDL, et al., 2016, Improvement of symptoms, FEV1 and FVC in adolescent elite swimmers during the summer break, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Nousias S, Lalos A, Moustakas K, et al., 2016, Computational modeling methods for simulating obstructive human lung diseases, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Paredi P, Biddiscombe M, Dasaolu M, et al., 2016, Deep inhalation induces bronchodilation in current smokers, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Dekhuijzen PNR, Lavorini F, Usmani OS, 2016, Patients' perspectives and preferences in the choice of inhalers: the case for Respimat® or HandiHaler®, Patient Preference and Adherence, Vol: 10, Pages: 1561-1572, ISSN: 1177-889X
Poor inhaler technique hampers the efficacy of drug therapy in asthma and chronic obstructive pulmonary disease. Not only does this affect individual patient care, but it also impacts on the wider health care economics associated with these conditions. Treatment guidelines recommend a systematic approach to drug class selection; however, standardization of inhaler selection is currently difficult owing to the complexity of the interaction between the inhaler device and the patient. Specifically, individual patient preference can influence how successful a treatment is overall. This article reviews inhaler devices from the patient perspective, with a particular focus on the dry powder inhaler HandiHaler® and Respimat® Soft Mist™ Inhaler. It discusses factors that influence device preference and treatment compliance and reviews tools that can aid health care professionals to better match inhaler devices to individual patients’ needs.
Usmani OS, 2016, Dilemmas, confusion, and misconceptions related to small airways directed therapy, Chest, Vol: 151, Pages: 1345-1355, ISSN: 1931-3543
Over the last decade, there is increasing evidence that the small airways, i. e. airways <2 mm in internal diameter, contribute significantly to the pathophysiology and clinical expression of asthma and chronic obstructive pulmonary disease (COPD). The increased interest in small airways is, at least in part, a result of innovation in small-particle aerosol formulations that better target the distal lung and also advanced physiological methods of assessing small airway responses. Increasing the precision of drug deposition may improve targeting of specific diseases or receptor locations, decrease airway drug exposure and side effects, and thereby increase the efficiency and effectiveness of inhaled drug delivery. The availability of small-particle aerosols of corticosteroid, bronchodilator or their combination, enables a higher total lung deposition, better peripheral lung penetration, and provides added clinical benefit, compared to large-particle aerosol treatment. However, a number of questions remain unanswered on the pragmatic approach relevant in order for clinicians to consider the role of small airways directed therapy in the day-to-day management of their patients with asthma and COPD. We have thus tried to clarify the dilemmas, confusion, and misconceptions related to small airways directed therapy. To this end, we have systematically reviewed all studies on small-particle aerosol therapy in order to address the dilemmas, confusion, and misconceptions related to small airways directed therapy.
Verbanck S, Ghorbaniasl G, Biddiscombe MF, et al., 2016, Inhaled aerosol distribution in human airways: a scintigraphy-guided study in a 3D printed model, Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol: 29, Pages: 525-533, ISSN: 1941-2711
Background: While it is generally accepted that inertial impaction will lead to particle loss as aerosol is being carried into the pulmonary airways, most predictive aerosol deposition models adopt the hypothesis that the inhaled particles that remain airborne will distribute according to the gas flow distribution between airways downstream.Methods: Using a 3D printed cast of human airways, we quantified particle deposition and distribution and visualized their inhaled trajectory in the human lung. The human airway cast was exposed to 6 μm monodisperse, radiolabeled aerosol particles at distinct inhaled flow rates and imaged by scintigraphy in two perpendicular planes. In addition, we also imaged the distribution of aerosol beyond the airways into the five lung lobes. The experimental aerosol deposition patterns could be mimicked by computational fluid dynamic (CFD) simulation in the same 3D airway geometry.Results: It was shown that for particles with a diameter of 6 μm inhaled at flows up to 60 L/min, the aerosol distribution over both lungs and the individual five lung lobes roughly followed the corresponding distributions of gas flow. While aerosol deposition was greater in the main bronchi of the left versus right lung, distribution of deposited and suspended particles toward the right lung exceeded that of the left lung. The CFD simulations also predict that for both 3 and 6 μm particles, aerosol distribution between lung units subtending from airways in generation 5 did not match gas distribution between these units and that this effect was driven by inertial impaction.Conclusions: We showed combined imaging experiments and CFD simulations to systematically study aerosol deposition patterns in human airways down to generation 5, where particle deposition could be spatially linked to the airway geometry. As particles are negotiating an increasing number of airways in subsequent branching generations, CFD predicts marked dev
Levy ML, Dekhuijzen P, Barnes PJ, et al., 2016, CORRIGENDUM: Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT), npj Primary Care Respiratory Medicine, Vol: 26, ISSN: 2055-1010
Levy ML, Dekhuijzen P, Barnes PJ, et al., 2016, Erratum: Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT)., npj Primary Care Respiratory Medicine, Vol: 26, Pages: 16028-16028, ISSN: 2055-1010
[This corrects the article DOI: 10.1038/npjpcrm.2016.17.].
Usmani OS, Singh D, Spinola M, et al., 2016, The prevalence of small airways disease in adult asthma: A systematic literature review, Respiratory Medicine, Vol: 116, Pages: 19-27, ISSN: 1532-3064
BackgroundSmall airways dysfunction and inflammation contribute significantly to the clinical impact of asthma, yet conventional methods of assessing airways function in the clinic cannot reliably evaluate its presence. However, most recently, promising methods of assessment are being utilised.MethodsWe conducted a systematic literature review, using PubMed, with the aim of determining the prevalence of small airways disease in adult patients with asthma. We ascertained how small airways disease prevalence compared between different studies when measured using distinct techniques of small airways assessment.ResultsFifteen publications were identified determining the prevalence of small airways disease in asthma. Methods of assessments included impulse oscillometry, spirometry, body plethysmography, multiple-breath nitrogen washout, and high-resolution computed tomography. These studies used differing inclusion characteristics and recruited patients with a broad range of asthma severity, yet collectively they reported an overall prevalence of small airways disease of 50 to 60%. Small airways disease was present across all asthma severities, with evidence of distal airway disease even in the absence of proximal airway obstruction.ConclusionsSmall airways disease is highly prevalent in asthma, even in patients with milder disease. Given the clinical impact of small airways disease, its presence should not be underestimated or overlooked as part of the daily management of patients with asthma.
Levy ML, Dekhuijzen PNR, Barnes PJ, et al., 2016, Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT), npj Primary Care Respiratory Medicine, Vol: 26, ISSN: 2055-1010
Health professionals tasked with advising patients with asthma and chronic obstructive pulmonary disease (COPD) how to use inhaler devices properly and what to do about unwanted effects will be aware of a variety of commonly held precepts. The evidence for many of these is, however, lacking or old and therefore in need of re-examination. Few would disagree that facilitating and encouraging regular and proper use of inhaler devices for the treatment of asthma and COPD is critical for successful outcomes. It seems logical that the abandonment of unnecessary or ill-founded practices forms an integral part of this process: the use of inhalers is bewildering enough, particularly with regular introduction of new drugs, devices and ancillary equipment, without unnecessary and pointless adages. We review the evidence, or lack thereof, underlying ten items of inhaler ‘lore’ commonly passed on by health professionals to each other and thence to patients. The exercise is intended as a pragmatic, evidence-informed review by a group of clinicians with appropriate experience. It is not intended to be an exhaustive review of the literature; rather, we aim to stimulate debate, and to encourage researchers to challenge some of these ideas and to provide new, updated evidence on which to base relevant, meaningful advice in the future. The discussion on each item is followed by a formal, expert opinion by members of the ADMIT Working Group.
Bonini M, Usmani OS, 2016, Drugs for airway disease, Medicine (United Kingdom), Vol: 44, Pages: 271-280, ISSN: 1357-3039
Asthma is a heterogeneous disease characterized by chronic airway inflammation and variable expiratory airflow limitation. It affects 5-15% of people worldwide and shows an increasing prevalence over the last decade. The treatment of asthma is well established in current guidelines, with the aim of achieving optimal disease control and preventing acute exacerbations using a stepwise medication approach. Drugs are commonly divided into 'relievers', which quickly alleviate airway obstruction, and 'controllers', which suppress the pathophysiology and provide long-term symptom control. β2-Adrenoreceptor agonists are the most effective therapy for reversing bronchial obstruction. Inhaled corticosteroids are recommended as first-line 'controller' therapy for persistent asthma. Acute exacerbations often require systemic corticosteroids. Muscarinic antagonists, methylxanthines, anti-leukotrienes, cromones and macrolides also play a key role in disease management. The use of biological agents has recently received increasing attention, prompting a drive for a so-called 'precision-based medicine' approach, particularly in more severe disease. The only biological drug currently licensed in Europe is the anti-IgE monoclonal antibody omalizumab. Several other antibodies and targeted molecules are under advanced development and are expected to be available on prescription soon, although they will be expensive.
Kikidis D, Konstantinos V, Tzovaras D, et al., 2016, The Digital Asthma Patient: The History and Future of Inhaler Based Health Monitoring Devices, Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol: 29, Pages: 219-232, ISSN: 1941-2711
The wave of digital health is continuously growing and promises to transform healthcare and optimize the patients' experience. Asthma is in the center of these digital developments, as it is a chronic disease that requires the continuous attention of both health care professionals and patients themselves. The accurate and timely assessment of the state of asthma is the fundamental basis of digital health approaches and is also the most significant factor toward the preventive and efficient management of the disease. Furthermore, the necessity of inhaled medication offers a basic platform upon which modern technologies can be integrated, namely the inhaler device itself. Inhaler-based monitoring devices were introduced in the beginning of the 1980s and have been evolving but mainly for the assessment of medication adherence. As technology progresses and novel sensing components are becoming available, the enhancement of inhalers with a wider range of monitoring capabilities holds the promise to further support and optimize asthma self-management. The current article aims to take a step for the mapping of this territory and start the discussion among healthcare professionals and engineers for the identification and the development of technologies that can offer personalized asthma self-management with clinical significance. In this direction, a technical review of inhaler based monitoring devices is presented, together with an overview of their use in clinical research. The aggregated results are then summarized and discussed for the identification of key drivers that can lead the future of inhalers.
Darquenne C, Fleming JS, Katz I, et al., 2016, Bridging the gap between science and clinical efficacy: physiology, imaging, and modeling of aerosols in the lung, Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol: 29, Pages: 107-126, ISSN: 1941-2711
Development of a new drug for the treatment of lung disease is a complex and time consuming process involving numerous disciplines of basic and applied sciences. During the 2015 Congress of the International Society for Aerosols in Medicine, a group of experts including aerosol scientists, physiologists, modelers, imagers, and clinicians participated in a workshop aiming at bridging the gap between basic research and clinical efficacy of inhaled drugs. This publication summarizes the current consensus on the topic. It begins with a short description of basic concepts of aerosol transport and a discussion on targeting strategies of inhaled aerosols to the lungs. It is followed by a description of both computational and biological lung models, and the use of imaging techniques to determine aerosol deposition distribution (ADD) in the lung. Finally, the importance of ADD to clinical efficacy is discussed. Several gaps were identified between basic science and clinical efficacy. One gap between scientific research aimed at predicting, controlling, and measuring ADD and the clinical use of inhaled aerosols is the considerable challenge of obtaining, in a single study, accurate information describing the optimal lung regions to be targeted, the effectiveness of targeting determined from ADD, and some measure of the drug's effectiveness. Other identified gaps were the language and methodology barriers that exist among disciplines, along with the significant regulatory hurdles that need to be overcome for novel drugs and/or therapies to reach the marketplace and benefit the patient. Despite these gaps, much progress has been made in recent years to improve clinical efficacy of inhaled drugs. Also, the recent efforts by many funding agencies and industry to support multidisciplinary networks including basic science researchers, R&D scientists, and clinicians will go a long way to further reduce the gap between science and clinical efficacy.
Vos W, Van Holsbeke C, Van Geffen W, et al., 2016, Lower Lobe Air Trapping Is Linked To Exacerbation Recovery Rate, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Menon A, Hull J, Chung KF, et al., 2015, LOW PREVALENCE OF EXTRA-THORACIC AIRWAY HYPER-RESPONSIVENESS IN UK PATIENTS WITH CHRONIC REFRACTORY COUGH, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A197-A197, ISSN: 0040-6376
van de Kant KDG, Paredi P, Meah S, et al., 2015, The effect of body weight on distal airway function and airway inflammation, Obesity Research and Clinical Practice, Vol: 10, Pages: 564-573, ISSN: 1871-403X
Background/Objectives:Obesity is a global health problem that adversely influences the respiratory system. We assessed the effects of body mass index (BMI) on distal airway function and airway inflammation.Subjects/Methods:Impulse oscillometry (IOS) as a measure of distal airway function, together with spirometry, were assessed in adults with a range of different BMIs. Airway inflammation was assessed with the fraction of exhaled nitric oxide (FeNO) and participants exhaled at various exhalation flows to determine alveolar and bronchial NO.Results:In total 34 subjects were enrolled in the study; 19 subjects had a normal BMI (18.50–24.99), whilst 15 subjects were overweight (BMI 25.00–29.99), or obese (BMI ≥30). All subjects had normal spirometry. However, IOS measures of airway resistance (R) at 5 Hz, 20 Hz and frequency dependence (R5–20) were elevated in overweight/obese individuals, compared to subjects with a normal BMI (median (interquartile range)); 5 Hz: 0.41 (0.37, 0.45) vs. 0.32 (0.30, 0.37) kPa/l/s; 20 Hz: 0.34 (0.30, 0.37) vs. 0.30 (0.26, 0.33) kPa/l/s; R5–20: 0.06 (0.04, 0.11) vs. 0.03 (0.01, 0.05) kPa/l/s; p < 0.05), whereas airway reactance at 20 Hz was decreased in overweight/obese individuals (20 Hz: 0.07 (0.03, 0.09) vs. 0.10 (0.07, 0.13) kPa/l/s, p = 0.009; 5 Hz: −0.12 (−0.15, −0.10) vs. −0.10 (−0.13, −0.09) kPa/l/s, p = 0.07). In contrast, within-breath IOS measures (a sign of expiratory flow limitation) and FeNO inflammatory measures, did not differ between groups (p > 0.05).Conclusions: Being overweight has significant effects on distal and central airway function as determined by IOS, which is not detected by spirometry. Obesity does not influence airway inflammation as measured by FeNO. IOS is a reliable technique to identify airway abnormalities in the presence of normal spirometry in overweight people.
Ahmed M, Sherwani Y, Muntasir M, et al., 2015, Game on? the gamification of mhealth apps in the context of smoking cessation, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ Publishing Group, Pages: A47-A47, ISSN: 1468-3296
Gastaldi AC, Paredi P, Talwar A, et al., 2015, Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion: A Randomized Clinical Trial, Medicine, Vol: 94, ISSN: 0025-7974
Abstract: This study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD).Randomized crossover study: 15 COPD outpatients from Asthma Lab–Royal Brompton Hospital underwent spirometry, impulse oscillometry (IOS) for respiratory resistance (R) and reactance (X), and fraction exhaled nitric oxide (FeNO) measures.Thirty minutes of flutter exercises: a “flutter-sham” procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed.Respiratory system resistance (R): in COPD patients an increase in X5insp (-0.21 to -0.33 kPa/L/s) and Fres (24.95 to 26.16 Hz) occurred immediately after flutter exercises without bronchodilator. Following 20 min of rest, a decrease in the R5, [DELTA]R5, R20, X5, and Ax was observed, with R5, R20, and X5 values lower than baseline, with a moderate effect size; there were no changes in FeNO levels or spirometry.The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions.
Bikov A, Pride NB, Goldman MD, et al., 2015, Glottal Aperture and Buccal Airflow Leaks Critically Affect Forced Oscillometry Measurements, CHEST, Vol: 148, Pages: 731-738, ISSN: 0012-3692
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