目的评估并比较茚达特罗和噻托溴铵单药治疗对慢性阻塞性疾病(简称"慢阻肺")患者气流限制和呼吸阻抗的影响。方法选取2014年3月至2015年1月于我院诊断为慢阻肺患者78例(平均年龄为72.4岁,平均FEV1预计值为61.6%),随机分为两组...目的评估并比较茚达特罗和噻托溴铵单药治疗对慢性阻塞性疾病(简称"慢阻肺")患者气流限制和呼吸阻抗的影响。方法选取2014年3月至2015年1月于我院诊断为慢阻肺患者78例(平均年龄为72.4岁,平均FEV1预计值为61.6%),随机分为两组,每组各39例,分别接受茚达特罗或噻托溴铵治疗。在药物治疗开始及治疗8周后,对患者进行肺功能测试、慢阻肺评估测试(CAT)和多频强迫振荡技术测试。在全呼吸、吸气和呼气阶段测定5 Hz和20 Hz振动频率时的粘性阻力(R_5和R-20),5 Hz时电抗(X——5)和共振频率(Fres)及低频电抗面积(ALX)。结果茚达特罗与噻托溴铵均可改善慢阻肺患者的气流受限情况,平均FEV1值分别提高170 m L和90 m L。患者接受茚达特罗药物治疗后CAT得分由11.2±4.3降为7.5±2.3,治疗前后具有显著性差异(P<0.001)。与噻托溴铵相比,茚达特罗可明显改善患者的FEV1值,FEV1百分比预计值及CAT得分(P分别为0.042,0.008和0.027)。对于呼吸阻抗,两种药物在全呼吸、吸气和呼气阶段都可改变患者的R_5、X_5、Fres及ALX值。茚达特罗组R_5、R_5-R_20、X_5、Fres及ALX值的变化与FEV1变化显著相关。结论茚达特罗可显著改善慢阻肺患者的气流受限情况和症状。对于呼吸阻抗,茚达特罗和噻托溴铵两种支气管扩张药物改善强迫振荡技术参数的程度相似,均可用于慢阻肺患者的临床治疗。展开更多
Respiratory diseases, especially asthma, are common in children. While spirometry contributes to asthma diagnosis and management in older children, it has a limited role in younger children whom are often unable to pe...Respiratory diseases, especially asthma, are common in children. While spirometry contributes to asthma diagnosis and management in older children, it has a limited role in younger children whom are often unable to perform forced expiratory manoeuvre. The development of novel diagnostic methods which require minimal effort, such as forced oscillation technique(FOT) is, therefore, a welcome and promising addition. FOT involves applying external, small amplitude oscillations to the respiratory system during tidal breathing. Therefore, it requires minimal effort and cooperation. The FOT has the potential to facilitate asthma diagnosis and management in preschool children by faciliting the objective measurement of baseline lung function and airway reactivity in children unable to successfully perform spirometry. Traditionally the use of FOT was limited to specialised centres. However, the availability of commercial equipment resulted in its use both in research and in clinical practice. In this article, we review the available literature on the use of FOT in childhood asthma. The technical aspects of FOT are described followed by a discussion of its practical aspects in the clinical field including the measurement of baseline lung function and associated reference ranges, bronchodilator responsiveness and bronchial hyperresponsiveness. We also highlight the difficulties and limitations that might be encountered and future research directions.展开更多
Importance:The forced oscillation (FOT) and multiple breath washout (MBW) techniques are passive tests of lung function,and are reliable for preschool-age children.There has not been comparison testing to determine wh...Importance:The forced oscillation (FOT) and multiple breath washout (MBW) techniques are passive tests of lung function,and are reliable for preschool-age children.There has not been comparison testing to determine which test could more accurately differentiate between healthy controls and poorly controlled asthmatics,or differentiate a response to bronchodilator administration.Objective:To determine whether the MBW and/or FOT could differentiate between healthy controls and poorly controlled asthmatics,and whether the two tests could detect a response to bronchodilator administration.Methods:Twenty-eight healthy controls and 23 poorly controlled asthmatics 3-6 years of age participated.All subjects were administered the MBW followed by the FOT.A bronchodilator was then administered and testing was repeated.Wilcoxon Rank Sum tests were used to compare the difference between healthy controls and poorly controlled asthmatics.Wilcoxon Signed Rank tests were used to compare the pre-and post-bronchodilator values.Results:Neither MBW nor FOT differentiated healthy controls from poorly controlled asthmatics (pre-bronchodilator data);both groups had similar baseline gas mixing and airway mechanics.There was no improvement in any MBW outcomes post-bronchodilator administration.FOT detected a significant and similar degree of improvement in the airway mechanics in both groups.Interpretation:Neither MBW nor FOT differentiated between poorly controlled asthmatics (when well) and healthy controls.MBW did not detect a significant bronchodilator response in either subject group,whereas FOT detected a similar degree of bronchodilator responsiveness in both groups.This discrepancy may reflect differential changes in airway mechanics and gas mixing properties in response to bronchodilators.展开更多
Rulmonary function tests provide an objective means to verify ventilatory dysfunction and to estimate its severity in respiratory disorders. Measurement of forced expiratory volume in 1 second （FEV1） and forced vita...Rulmonary function tests provide an objective means to verify ventilatory dysfunction and to estimate its severity in respiratory disorders. Measurement of forced expiratory volume in 1 second （FEV1） and forced vital capacity （FVC） is considered to be the basic tests for the assessment of airway obstruction. Although they are useful diagnostically and prognostically, the results of FEV1 and FVC are strongly dependent on the cooperation of the patient. Lack of collaboration is particularly present in elderly patients because of mood alterations, fatigability or cognitive impairment. The forced oscillation technique （FOT） and the interrupter resistance technique are the two methods of measuring respiratory resistance during tidal breathing, they are of special interest because both of them are noninvasive, requires minimal cooperation, takes little time and can be easily repeated, especially in children and elderly subjects who cannot accomplish forced expiratory maneuvers in a reproducible manner.展开更多
This paper presents the design of a novel oscillometry device for the measurement of respiratory mechanics based on piezoelectric bimorph actuator technology. To predict performance for measurement of human respirator...This paper presents the design of a novel oscillometry device for the measurement of respiratory mechanics based on piezoelectric bimorph actuator technology. To predict performance for measurement of human respiratory mechanics, a dynamic model was developed based on a bimorph piezoelectric actuator driving a linear resistance mesh screen including subject’s respiratory impedance loads, and realistic breathing noise. Model performance was also validated in a prototype device. We found that while breathing noise substantially lowered SNR, the model could produce sufficient pressure and flow for acceptable SNRs exceeding 35 dB, and accuracies exceeding 99%. Satisfactory accuracy could be achieved with load impedance errors less than 3%. Maintaining the air-gap around the oscillating mesh with a resistance against the leak greater than 0.38 cmH2O/L/s maintained good performance, with an acceptable 4 dB decrease to SNR. Moreover, this work provides multiple solutions to host higher amounts of noise and nonlinearities. These results indicate that the development of an accurate lightweight portable single frequency FOT device is feasible.展开更多
文摘目的评估并比较茚达特罗和噻托溴铵单药治疗对慢性阻塞性疾病(简称"慢阻肺")患者气流限制和呼吸阻抗的影响。方法选取2014年3月至2015年1月于我院诊断为慢阻肺患者78例(平均年龄为72.4岁,平均FEV1预计值为61.6%),随机分为两组,每组各39例,分别接受茚达特罗或噻托溴铵治疗。在药物治疗开始及治疗8周后,对患者进行肺功能测试、慢阻肺评估测试(CAT)和多频强迫振荡技术测试。在全呼吸、吸气和呼气阶段测定5 Hz和20 Hz振动频率时的粘性阻力(R_5和R-20),5 Hz时电抗(X——5)和共振频率(Fres)及低频电抗面积(ALX)。结果茚达特罗与噻托溴铵均可改善慢阻肺患者的气流受限情况,平均FEV1值分别提高170 m L和90 m L。患者接受茚达特罗药物治疗后CAT得分由11.2±4.3降为7.5±2.3,治疗前后具有显著性差异(P<0.001)。与噻托溴铵相比,茚达特罗可明显改善患者的FEV1值,FEV1百分比预计值及CAT得分(P分别为0.042,0.008和0.027)。对于呼吸阻抗,两种药物在全呼吸、吸气和呼气阶段都可改变患者的R_5、X_5、Fres及ALX值。茚达特罗组R_5、R_5-R_20、X_5、Fres及ALX值的变化与FEV1变化显著相关。结论茚达特罗可显著改善慢阻肺患者的气流受限情况和症状。对于呼吸阻抗,茚达特罗和噻托溴铵两种支气管扩张药物改善强迫振荡技术参数的程度相似,均可用于慢阻肺患者的临床治疗。
文摘Respiratory diseases, especially asthma, are common in children. While spirometry contributes to asthma diagnosis and management in older children, it has a limited role in younger children whom are often unable to perform forced expiratory manoeuvre. The development of novel diagnostic methods which require minimal effort, such as forced oscillation technique(FOT) is, therefore, a welcome and promising addition. FOT involves applying external, small amplitude oscillations to the respiratory system during tidal breathing. Therefore, it requires minimal effort and cooperation. The FOT has the potential to facilitate asthma diagnosis and management in preschool children by faciliting the objective measurement of baseline lung function and airway reactivity in children unable to successfully perform spirometry. Traditionally the use of FOT was limited to specialised centres. However, the availability of commercial equipment resulted in its use both in research and in clinical practice. In this article, we review the available literature on the use of FOT in childhood asthma. The technical aspects of FOT are described followed by a discussion of its practical aspects in the clinical field including the measurement of baseline lung function and associated reference ranges, bronchodilator responsiveness and bronchial hyperresponsiveness. We also highlight the difficulties and limitations that might be encountered and future research directions.
文摘Importance:The forced oscillation (FOT) and multiple breath washout (MBW) techniques are passive tests of lung function,and are reliable for preschool-age children.There has not been comparison testing to determine which test could more accurately differentiate between healthy controls and poorly controlled asthmatics,or differentiate a response to bronchodilator administration.Objective:To determine whether the MBW and/or FOT could differentiate between healthy controls and poorly controlled asthmatics,and whether the two tests could detect a response to bronchodilator administration.Methods:Twenty-eight healthy controls and 23 poorly controlled asthmatics 3-6 years of age participated.All subjects were administered the MBW followed by the FOT.A bronchodilator was then administered and testing was repeated.Wilcoxon Rank Sum tests were used to compare the difference between healthy controls and poorly controlled asthmatics.Wilcoxon Signed Rank tests were used to compare the pre-and post-bronchodilator values.Results:Neither MBW nor FOT differentiated healthy controls from poorly controlled asthmatics (pre-bronchodilator data);both groups had similar baseline gas mixing and airway mechanics.There was no improvement in any MBW outcomes post-bronchodilator administration.FOT detected a significant and similar degree of improvement in the airway mechanics in both groups.Interpretation:Neither MBW nor FOT differentiated between poorly controlled asthmatics (when well) and healthy controls.MBW did not detect a significant bronchodilator response in either subject group,whereas FOT detected a similar degree of bronchodilator responsiveness in both groups.This discrepancy may reflect differential changes in airway mechanics and gas mixing properties in response to bronchodilators.
文摘Rulmonary function tests provide an objective means to verify ventilatory dysfunction and to estimate its severity in respiratory disorders. Measurement of forced expiratory volume in 1 second （FEV1） and forced vital capacity （FVC） is considered to be the basic tests for the assessment of airway obstruction. Although they are useful diagnostically and prognostically, the results of FEV1 and FVC are strongly dependent on the cooperation of the patient. Lack of collaboration is particularly present in elderly patients because of mood alterations, fatigability or cognitive impairment. The forced oscillation technique （FOT） and the interrupter resistance technique are the two methods of measuring respiratory resistance during tidal breathing, they are of special interest because both of them are noninvasive, requires minimal cooperation, takes little time and can be easily repeated, especially in children and elderly subjects who cannot accomplish forced expiratory maneuvers in a reproducible manner.
文摘This paper presents the design of a novel oscillometry device for the measurement of respiratory mechanics based on piezoelectric bimorph actuator technology. To predict performance for measurement of human respiratory mechanics, a dynamic model was developed based on a bimorph piezoelectric actuator driving a linear resistance mesh screen including subject’s respiratory impedance loads, and realistic breathing noise. Model performance was also validated in a prototype device. We found that while breathing noise substantially lowered SNR, the model could produce sufficient pressure and flow for acceptable SNRs exceeding 35 dB, and accuracies exceeding 99%. Satisfactory accuracy could be achieved with load impedance errors less than 3%. Maintaining the air-gap around the oscillating mesh with a resistance against the leak greater than 0.38 cmH2O/L/s maintained good performance, with an acceptable 4 dB decrease to SNR. Moreover, this work provides multiple solutions to host higher amounts of noise and nonlinearities. These results indicate that the development of an accurate lightweight portable single frequency FOT device is feasible.
