ABSTRACT
Background: Spirometry may be used as a surrogate marker of respiratory muscle strength in patients with neuromuscular disorders. However, it is an aerosol-generating procedure, not readily conducted during remote consultation, and its use has been limited by infection control guidance during the COVID-19 pandemic. Single breath counting (SBC) has been reported to predict vital capacity (VC). We aimed to evaluate the utility of SBC in our clinic. Method(s): We conducted an evaluation to compare SBC and VC measurements in healthy volunteers and patients with respiratory muscle weakness. To perform SBC, individuals were asked to maximally inhale and then count every second in time with a metronome from 1 to the highest number they could manage in a single breath. SBC was repeated 3 times and the mean and maximum results were recorded. Individuals performed spirometry for slow VC in accordance with ERS guidelines. Results were compared using Spearman's rank correlation coefficient. Result(s): 31 healthy controls and 18 cases were included. The correlation between VC and SBC were rho=0.697 (p<0.001) and rho=0.694 (p<0.001) for mean and maximal efforts respectively (Figure). Conclusion(s): Primary findings highlight the potential usefulness of SBC for respiratory muscle function assessment. This promising technique is simple and feasible with current infection control guidelines and may be useful in remotely conducted appointments.
ABSTRACT
BackgroundContinuous Positive Airway Pressure (CPAP) therapy is the standard treatment for patients with Obstructive Sleep Apnoea (OSA). Significant recent challenges have affected CPAP supply worldwide: increased CPAP demand, interrupted logistics during the COVID pandemic, worldwide Field Safety Notice (2021), plus CPAP component shortages.MethodsTo understand the issues around CPAP delivery and supply, the OSA Alliance sent an email survey to all UK-based Sleep Centres listed on the Sleep Apnoea Trust database in February and again in June 2022.ResultsWe received replies from 22 (February) and 15 (June) UK centres, with 8 centres represented in both surveys.91% (February) and 67% (June) of respondents confirmed ongoing CPAP machine supply shortages. In February, centres were receiving on average 50% usual delivery versus 73% in June. In June, centres described CPAP supply during the past 6 months as: improved 47%, worsened 47%, same in 6%. In free text comments, humidifier shortage was also mentioned by some.Patients on the waiting list for CPAP varied between UK centres from 0–400 (February) and 0–260 (June). All centres with CPAP shortages were using the BTS Clinical Risk Stratification.1In February, patients with high clinical priority according to the risk stratification requiring urgent CPAP therapy could start this quickly (1–2 weeks) in all centres, but the average wait time to start routine CPAP was 13 weeks (range 2 to 40 weeks). In June, the average wait for routine CPAP was 13.3 weeks (range 2–52 weeks). In both surveys, the majority of centres (86% February and 67% June) said delays were due to CPAP supply, not staff shortages.ConclusionsOngoing CPAP supply issues have led to self-reported sleep centre delays in treatment for patients with OSA. CPAP supply appears highly variable between centres, meaning centres have searched for alternative suppliers;a time consuming task with teams not being trained on the respective CPAP models. A humidifier shortage contributes to difficulties that may impact on CPAP adherence. Specific resource allocation towards CPAP provision for patients with OSA is required to address these issues and improve compliance NICE evidence-based therapeutic guidance in the UK.The authors have produced this abstract on behalf of the OSA Alliance, UK.Referencehttps://www.brit-thoracic.org.uk/news/2021/national-patient-safety-alert/