Immediate effect of respiratory muscle stretch gymnastics and diaphragmatic breathing on respiratory pattern. Respiratory Muscle Conditioning Group.

We investigated the immediate effect of respiratory muscle stretch gymnastics (RMSG) and diaphragmatic breathing (DB) on the respiratory pattern in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with COPD (age, 71.3 +/- 3.9 year) were entered in the study. DB was performed for 10 minutes in supine position. For RMSG, 5 patterns were repeated 10 times each. Respiratory variables were measured in sitting position before and after both RMSG and DB, performed in random order, patient to patient, with a 20-minute washout period in-between. After RMSG, but not after DB, there was a significant overall prolongation in expiratory time. After DB, but not after RMSG, there was an overall decrease in minute ventilation, carbon dioxide output, respiratory gas exchange ratio, end tidal O2 fraction, end tidal CO2 fraction and tidal diaphragmatic volume. The results suggest that RMSG may have a beneficial effect on the respiratory pattern. On the other hand, DB may provoke post-hyperventilation hypoxemia.

[Analysis of inspiratory flow-volume curve].

Inhaled antiasthmatic agents can be effective, but their efficacy depends on the delivery system and on inhalation technique, especially in metered-dose inhalers (MDI). To find out whether inhalation therapy for asthmatics had been performed correctly, we studied inspiratory flow in the slow matter in healthy subjects and bronchial asthma patients. About half of 30 patients studied inspired more than 1 L/sec inspiratory flow rate, especially in male. Inspiratory flow in the fast matter (peak inspiratory flow; PIF) is important in the use of dry powder inhaler, so we studied the correlationship between PIF and expiratory flow and volume parameters. PIF correlated with PEFR, FEV1 and FEV1% in female, FVC and %FVC in male, respectively. In summary, we must recognize slow inspiratory flow can not be gotten easily, and asthmatic patients always have to use MDI carefully in inspiratory flow. Some expiratory parameters of spirometry can accurately predict PIF. The analysis of inspiratory flow-volume curve gives us beneficial data in inhalation therapy.

[Clinical effects of four weeks of respiratory muscle stretch gymnastics in patients with chronic obstructive pulmonary disease].

We developed a program of respiratory muscle stretch gymnastic (RMSG), and measured lung function, exercise capacity, dyspnea, and quality of life before and after 4 weeks of training with this program. Thirteen patients with chronic obstructive pulmonary disease (mean FEVi, 1.24 liters) began the program. They participated in three sessions of RMSG each day. Twelve patients completed all 4 weeks. RMSG significantly (p < 0.01) decreased functional residual capacity (from 4.19 +/- 1.27 to 3.88 +/- 1.03 liters), total lung capacity (from 5.98 +/- 1.35 to 5.66 +/- 1.20 liters), residual volume (from 3.29 +/- 1.16 to 2.89 +/- 0.89 liters), and residual volume as a percent of total lung capacity (from 53.9 +/- 11.2% to 50.6 +/- 9.74%). The distance walked in 6 min increased by an average of 43 +/- 30 meters (+ 15%, p < 0.01). Dyspnea after a 6-minute walk (measured with a 150-mm visual analog scale) decreased significantly (from 65.1 +/- 40.8 to 36.1 +/- 36.8, p < 0.05). Quality of life was measured with the Chronic Respiratory Disease Questionnaire of Guyatt, et al., and was found to have improved significantly. Respiratory muscle stretch gymnastics may be useful in pulmonary rehabilitation.

[Prevention of stomatitis in patients with acute myelogenous leukemia using PVP-iodine (Isodine) gargle].

From November 1987 to October 1990, we investigated the efficacy of povidine iodine gargle solution (Isodine Gargle) for preventing stomatitis in 26 patients (19 males and 7 females; mean age 53.2 years) with acute myelogenous leukemia (AML). The patients were given a concentrated preparation of the gargle solution which they had to dilute 50 times, and were asked to use it 8 times/day for one year. Twenty patients (76.9%) frequently suffered from stomatitis despite the gargling. Therefore, in the second year they were instructed to use the gargle solution at a higher concentration (30-fold dilution). On the third year, they were asked to increase the frequency of gargling to 10 times/day; this resulted in a significant decrease in frequency of the episodes of stomatitis. Severe and painful stomatitis no longer occurred. Gargling with povidine iodine gargle solution was thus considered effective for preventing stomatitis in AML patients.