Maximal Voluntary Breath-Holding Tele-Inspiratory Test in Patients with Chronic Obstructive Pulmonary Disease.

Maximal voluntary inspiratory breath-holding time (MVIBHT) has proved to be of clinical utility in some obstructive ventilatory defects. This study aims to correlate the breath-holding time with pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD) and to determine the feasibility of using a breath-holding test in assessing the severity of COPD.A cross-sectional study including male patients with stable COPD were conducted. Patients with respiratory comorbidities and severe or unstable cardiac diseases were excluded. Patients were interviewed and examined. Six-minute walk test (6MWT) and plethysmography were performed.For MVIBHT collection, the subject was asked to inspire deeply and to hold the breath as long as possible at the maximum inspiratory level. This maneuver was repeated three times. The best value was used for further analysis.A total of 79 patients (mean age: 64.2 ± 8) were included in this study. The mean value of MVIBHT was 24.2 ± 8.5 s. We identified a positive and significant correlations between MVIBHT and forced vital capacity (r = .630; p < .001) as well as MVIBHT and forced expiratory volume in 1 s (FEV1%) (r = .671; p < .001). A significant inverse correlation with total lung capacity (r = -.328; p = .019) and residual volume to total lung capacity ratio (r = -.607; p < .001) was noted. MVIBHT was significantly correlated to the distance in the 6MWT (r = .494; p < .001). The mean MVIBHT was significantly different within spirometric grades (p < .001) and GOLD groups (p = .002). At 20.5 s, MVIBHT had a sensitivity of 72% and specificity of 96% in determining COPD patients with FEV1 <50%.Our results provide additional evidence of the usefulness of MVIBHT in COPD patients as a pulmonary function parameter.

Sit-to-stand test and 6-min walking test correlation in patients with chronic obstructive pulmonary disease.

BACKGROUND: The 6-min walking test (6MWT) is one of the most commonly used tests to assess exercise capacity during chronic obstructive pulmonary disease (COPD). However, it is a relatively time-consuming test. Many authors assessed the usefulness of simpler methods, as the sit-to-stand test (STST), to estimate exercise capacity. PURPOSE: To demonstrate the feasibility of STST, in comparison to 6MWT, for the evaluation of functional status in Tunisian COPD patients and evaluate its correlation to the severity of the disease. METHODS: We studied patients with COPD (Global Initiative for Chronic Obstructive Lung Disease A-D). All patients had plethysmography and manual quadriceps femoris muscle strength evaluation. Each patient completed a 6MWT and a STST. During the tests, dyspnea severity (Borg scale), heart rate, pulsed oxygen saturation, and blood pressure were measured. RESULTS: In 49 patients with stable COPD (mean age 67.06 ± 8.4 years, mean forced expiratory volume in the first second 46.25% ± 19.64%), 6MWT and STST were correlated with each other (r = 0.47, P = 0.001). During 6MWT and STST, the rise in heart rate, systolic blood pressure, and severity of dyspnea were statistically significant compared to baseline (P < 0.05). However, cardiorespiratory stress was lower after STST than after 6MWT (P < 0.05). A statistically significant positive correlation was noted between the 6MWT distance and forced vital capacity (r = 0.357, P < 0.05). The 6MWT was negatively correlated with dyspnea severity at baseline (r = -0.289, P < 0.05) and with BODE index (r = -0.672, P < 0.01). STST was correlated only with age (r = 0.377, P < 0.01). No correlation was found between both tests and quadriceps femoris strength. CONCLUSION: As like as 6MWT, STST can determine functional status during COPD. In addition, it is less time consuming and produces less hemodynamical stress compared to 6MWT. STST can be used as an alternative for 6MWT in patients with COPD.

[Infuenzae A (H1N1): about 189 cases]. / Grippe A (H1N1): à propos de 189 cas.

BACKGROUND: Influenza A (H1N1) is a contagious acute respiratory infection caused by a subtype influenza virus A (H1N1). The later had caused a pandemic in 2009. Despite its low mortality, the disease was more severe in some subgroups. OBJECTIVES: Describe confirmed cases of influenza A (H1N1) addressed to the pulmonary department of the Rabta hospital and identify risk factors. METHODS: During the pandemic influenza A (H1N1), pulmonary department of Rabta hospital was identified among the centers to receive and detect new cases in addition to hospitalization of severe ones. All subjects had nasal and pharyngeal swabs. The authors distinguished non-severe and severe cases; hospitalization was indicated for severe forms. RESULTS: From September 2009 to March 2010, influenza A (H1N1) has been confirmed in 189 patients. The average age was 27.3 years [2-72 years]. Sex ratio was 1.2. Contagion was found in all patients. Twenty-two patients were hospitalized for the severe form. Mean age was 56 years, sex ratio was 0.47. Among them, 20 patients had at least one co-morbidity. Most frequently found risk factors were diabetes (9 cases), chronic respiratory disease (9 cases) and pregnancy (6 cases). All patients received ozeltamivir. The dose was doubled in severe cases. Nonspecific antibiotic therapy was prescribed in 11 cases. Seven patients were hospitalized in intensive care unit, among whom 4 died. Mortality in severe forms was 18% and overall mortality 2.1%. CONCLUSIONS: Through this Tunisian series, we emphasize the potential severity of influenza A (H1N1). This justifies a systematic vaccination of subjects at risk even away from pandemic period.