Restrictive Ventilatory Patterns in Residents of Continuing Care Retirement Communities.

Restrictive ventilatory patterns (RVPs) in older adults may contribute to morbidity and decreased quality of life. The purpose of this study was to begin to understand (a) the number of older adults residing in Continuing Care Retirement Communities with RVPs, (b) factors associated with RVP, and (c) whether RVP is associated with ambulation level. This descriptive study was conducted at three sites. RVP was evident in 34 of the 65 participants (52%), and 33 (97%) of these were either moderate or severely restricted. Dementia, dyspnea, kyphosis, and lower muscle strength were significant predictors of RVP. Eighty percent of the nonambulatory participants had RVP and 38% of the ambulatory participants had RVP. Designing interventions to address modifiable factors associated with RVP may prevent respiratory infections, help people to achieve better lung health, and increase physical activity tolerance.

Interpretando la función pulmonar. Una perspectiva para el siglo XXI desde la Neumología pediátrica / No disponible

Las pruebas de función pulmonar son básicas para el diagnóstico y seguimiento del paciente respiratorio. Su correcta interpretación es fundamental para distinguir lo normal de lo patológico. La aparición de las primeras ecuaciones globales para todas las edades (Global Lung Initiative [GLI]-2012) supone un reto para cualquier médico encargado de interpretar una espirometría, no solo por los cambios "numéricos" esperables al utilizar otros patrones de referencia, sino por la necesidad de expresar los resultados como desviaciones de la media (z-scores) y abandonar el clásico porcentaje sobre el valor predicho. La visión de los pediatras neumólogos, acostumbrados a trabajar con pacientes en constante cambio, puede ayudar a entender la necesidad de este tipo de ecuaciones. Este artículo pretende revisar el concepto de normalidad, los parámetros necesarios para interpretar una espirometría, las características ideales de una ecuación de referencia y las bondades y defectos de las nuevas ecuaciones GLI-2012

Pulmonary function tests are basic in the diagnosis and monitoring of respiratory patients. The proper interpretation of these tests is essential to distinguish normal from pathological. The first global equations for all ages (Global Lung Initiative [GLI]-2012) poses a challenge for any physician responsible for interpreting spirometry, not only due to the "numerical" changes expected when using a new reference equation, but also because of the need to express the results as deviations from the mean (z-scores) and leave the classical percentage of the predicted value. The view of the paediatric pulmonologists, who are used to working with patients in constant evolution, can help to understand the need for this type of equations. This article reviews the concept of normality, the parameters required to interpret a spirometry, the ideal characteristics of a reference equation and the virtues and defects of the new GLI-2012 equations

Avaliação da função pulmonar e de fatores associados em indivíduos com insuficiência cardíaca / Evaluation of pulmonary function and associated factors in individuals with heart failure / Evaluación de la función pulmonar en pacientes con insuficiencia cardíaca

Introdução: A Insuficiência Cardíaca (IC) é uma enfermidade de prevalência e morbimortalidade elevada, sendo uma síndrome clínica complexa. Dentre suas repercussões sistêmicas, as manifestações respiratórias são proeminentes, sendo a dispneia uma das mais observadas, refletindo-se em alterações na função pulmonar e impacto na qualidade de vida. Objetivo: Avaliar a função pulmonar, a intensidade de dispneia, a qualidade de vida e os fatores associados em indivíduos com insuficiência cardíaca, em classes funcionais I, II e III. Metodologia: estudo transversal, realizado em ambulatório de referência para indivíduos com IC em Salvador-BA. Incluídos 50 indivíduos, em classe funcional I, II e III. Os dados foram analisados por meio de medidas de tendência central e de dispersão, as relações entre variáveis testadas por correlação de Pearson ou Spearman e por regressão linear multivariada. O teste de Kruskal-Wallis foi procedido para testar diferença entre grupos. Foram considerados estatisticamente significantes valores com intervalo de confiança maior que 95% (p ˂ 0,05). Resultados: Predominaram sexo masculino (52%), renda familiar de aproximadamente dois salários mínimos, afrodescendentes; aposentados ou inativos, casados ou em relação estável. A idade média foi de 57 anos (± 13,3), a média de estudo foi de 8 anos (±14,6) e a média de acompanhamento ambulatorial, diagnóstico da IC e início da dispneia foi de 4 anos. Prevaleceu IC de origem ventricular esquerda, classe funcional II, etiologia chagásica, comorbidades como HAS, dislipidemia e diabetes mellitus tipo II. Os medicamentos mais utilizados foram os diuréticos, betabloqueadores, IECAs e digitálicos. Observou-se excesso de peso em 64% dos indivíduos. A avaliação da função pulmonar sugere a presença de distúrbio respiratório restritivo, leve (%VEF1 = 68,3; %CVF = 67,8; VEF1/CVF = 0,8). O escore total do Índice de Dispneia Basal de Mahler não indicou incapacidades devido à sensação de dispneia. O escore total do MLHFQ não demonstrou redução significativa na qualidade de vida da amostra. Não foi encontrada significância estatística para a relação entre a função pulmonar e o escore de dispneia. Identificou-se que quanto piores os resultados dos volumes pulmonares (%VEF1 e %CVF), pior a percepção de qualidade de vida dos indivíduos. Não houve significância estatística para os parâmetros da função pulmonar, qualidade de vida e intensidade de dispneia quando comparados pelas classes funcionais da IC, mas os valores absolutos demonstraram que a percepção de qualidade de vida, o impacto da dispneia e os percentuais de VEF1 e CVF foram piores entre os indivíduos na CF III. Conclusão: a função pulmonar encontra-se reduzida nos indivíduos com IC, aproximando-se de valores característicos de distúrbios restritivos. A caracterização socioeconômica e clínica desses indivíduos é importante para uma melhor definição de seus prognósticos e no planejamento de seus cuidados pela equipe de enfermagem e multidisciplinar. Recomenda-se o monitoramento dos parâmetros de função pulmonar e dispneia nos indivíduos com IC, não só como indicadores prognósticos, mas também como indicadores de qualidade de vida.(AU)

Wheelchair positioning and breathing in children with cerebral palsy: study methods and lessons learned.

In children with cerebral palsy (CP), poor trunk control can lead to spinal deformity, pulmonary compromise (Canet, Praud, & Bureau, 1998), and increased health risks and costs of long-term care (Braddock, 2002). Evidence links posture and pulmonary function, but the influence of wheelchair components on pulmonary function is unknown. This article reports on a study evaluating pulmonary measurement in wheelchairs and how it affected children with CP. The objectives of the study were to (a) describe recruitment and retention of school-aged children with CP and (b) discuss participants'response to the protocol. Using a wheelchair simulator, participants experienced five seating parameters while pulmonary mechanics measures were recorded. A process log captured participant recruitment and retention challenges and response to the protocol. Recruitment was challenging; retention was 50%. The protocol was feasible for 50% of participants, none of whom could participate in conventional pulmonary function testing. Among the study's participants, facemask and seating simulator acceptability were 75%, improving with participants'increased verbal communication abilities (verbal children tolerated the procedure best). The facemask was vulnerable to tilt; 75% of participants experienced fatigue.

Pain and quality of life with chronic obstructive pulmonary disease.

BACKGROUND: Pain as a symptom may be underrecognized in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study is to explore the prevalence and intensity of pain, its location, how demographic and clinical variables may be related to pain, and how pain is associated with quality of life (QOL). METHODS: In this cross-sectional study, 154 patients with COPD answered the Brief Pain Inventory, Respiratory Quality of Life Questionnaire, and Quality of Life Scale, and performed spirometry. RESULTS: Seventy-two percent of the patients indicated the location of pain on a body diagram. Lower lung function, higher score of pain intensity, and pain interference were associated with lower disease QOL. A higher score of pain interference was associated with lower global QOL. When controlling for disease QOL in the equation of global QOL, pain interference was no longer significant. CONCLUSION: The experience of pain is related to disease QOL in patients with COPD.

Interpretation and evaluation of pulmonary function tests.

Evaluation of pulmonary function is essential for the diagnosis and management of respiratory disease and other conditions. Various tests are available. Some, such as spirometry and pulse oximetry, are widely used in a variety of healthcare settings; others, such as those that measure diffusing capacity and static lung volumes, are performed in specialist pulmonary function laboratories. This article examines some of the pulmonary function tests available.

Screening for asthma: results from a rural cohort.

BACKGROUND: Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management. PURPOSE: The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF(25-75)); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma. FRAMEWORK: The Vulnerable Populations Framework (Flaskerud and Winslow, 1998) was used to organize this study. METHODOLOGY: A prospective descriptive design was utilized for this research. RESULTS: Approximately 12% of the children screened were referred to their primary care provider (PCP) for follow-up care. Of these approximately half of the children were seen by their PCP. Barriers to seeking follow-up care were: a) the child was not symptomatic all the time, b) reluctance to be diagnosed with asthma, and c) others, such as cost and time. Children who were not well controlled identified that they ran out of medicine and their parents did not refill their prescription. CONCLUSION: Results from this descriptive study indicate that screening for asthma in school may be a way to identify those children who are at risk for asthma, and who are not diagnosed as well as those who are diagnosed with asthma but are not optimally managed. While many parents wanted their children to be screened, follow-up care was not critical to them. IMPLICATIONS: Nurses working in a school setting are in a prime position to help identify those children with signs and symptoms of asthma. In addition, use of written screenings with or without spirometry may be helpful in identifying children at risk for asthma. Further studies need to be undertaken to determine if written screening is as efficacious as spirometry for school and other ambulatory care settings.

Current management of status asthmaticus in the pediatric ICU.

Status asthmaticus (SA) in the pediatric ICU (PICU) can progress to a life-threatening emergency. The goal of management is to improve hypoxemia, improve bronchoconstriction, and decrease airway edema through the administration of continuous nebulized beta2 adrenergic agonist with intermittent anticholinergics, corticosteroids, and oxygen. Adjunctive therapies, such as magnesium, methylxanthines, intravenous beta-agonists, heliox, and noninvasive ventilation should be considered in the child who fails to respond to initial therapies. The restoration of adequate pulmonary functions, resolution of airway obstruction, and avoidance of mechanical ventilation should guide management. This article reviews the pathophysiology, assessment, and management of the child who has SA in the PICU to provide the critical care nurse with current information to facilitate optimal care.

Diagnostic measures to evaluate oxygenation in critically ill adults: implications and limitations.

Accurate assessment and treatment of disturbances in oxygenation are crucial to optimal outcomes in critically ill patients. Oxygenation is dependent upon adequate pulmonary gas exchange, oxygen delivery, and oxygen consumption. Each of these physiologic processes may vary independently in response to pathophysiologic conditions and therapeutic interventions. The author reviews diagnostic measures available to evaluate pulmonary gas exchange, oxygen delivery, and oxygen consumption in critically ill patients. Currently available tools and their potential value as well as key methodological limitations are addressed. Failure on behalf of clinicians to fully appreciate these limitations can lead to misdiagnoses and inappropriate treatment. The aim of this article is to help advanced practice nurses more fully understand the implications and limitations of these diagnostic measures to ensure accurate assessment and treatment of disturbances in oxygenation.

Does screening for loss of lung function help smokers give up?

One-fifth of smokers show accelerated decline in lung function. These are the patients that go on to develop chronic obstructive pulmonary disease (COPD), an illness characterized by cough, production of sputum, shortness of breath and premature death (Sethi and Rochester, 2000). If this group of smokers stopped smoking, their decline would slow and they might avoid developing COPD. This pilot study aimed to discover whether those with accelerated decline in lung function would quit if presented with the facts about their situation. Known smokers in their 50s were screened for signs of accelerated respiratory decline. Those with an accelerated decline in lung function were identified and given tailored smoking cessation advice. Of 141 eligible patients, 22 responded and six gave up smoking and remained non-smokers 1 year later. The results of this pilot suggest that screening smokers for accelerated respiratory decline by practice nurses is feasible and acceptable to those patients that respond. Further research is needed to discover whether such an intervention would be cost-effective.

Distinguishing chronic obstructive pulmonary disease from asthma.

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases in the UK. Good management of both diseases results in better symptom control and improved quality of life for the patient, but will rely on all members of the primary healthcare team sharing the aims of management as well as helping to implement those goals. The two diseases share many clinical features and similar drugs can be used to treat them both. However there are important clinical differences which help to distinguish them from each other. The management of the two diseases differs in drug regimens and in the long-term aims of management. This article clarifies the important features that distinguish asthma from COPD and which allow patients to receive the best specific management.

Noninvasive respiratory monitoring.

Advances in technology now permit a variety of noninvasive respiratory monitoring options for clinicians. Perhaps a more complex issue is determining how much monitoring is needed as part of routine patient care. Often, practitioners take a "more is better" approach. This reasoning is justified in critical care, because, in theory, the more information clinicians have available to them, the more likely they are to make accurate assessments and proper therapeutic interventions. If one fails to properly understand the physiologic significance and clinical limitations of the numbers or waveforms from the monitor, however, patient care may not improve and, even worse, may be compromised. Therefore, proper training in all aspects of respiratory monitoring should be a basic and fundamental component of any critical care nurse training program. There are important cost considerations to be taken into account with continuous respiratory monitoring. The financial impact as it relates to care of the critically ill patient is often difficult to assess. Issues of cost-effectiveness are often justified because of the complex nature of caring for these patients and their need for intensive clinical observation and evaluation. The fact that many aspects of cardiopulmonary assessment can now be determined noninvasively is an important advantage over more invasive technologies and their associated risks. Clearly, monitoring techniques such as pulse oximetry and capnography do not eliminate the need for arterial blood gases and other invasive cardiopulmonary monitoring techniques. Rather, when appropriately applied, noninvasive monitoring has the potential to reduce the frequency of certain invasive procedures and still provide valuable information to nurses and other health care practitioners.

Home monitoring of pulmonary function.

The use of healthcare technology in homes is increasing. This article details an electronic home spirometry unit used by lung transplant patients. The unit can also be used with other populations including persons with asthma or cystic fibrosis, or persons awaiting transplants. Home health nurses are in a prime position to assist patients in using technology that provides direction for the treatment regimen.

Respiratory monitoring in critical care.

The assessment of pulmonary function, from a clinical perspective, can be performed accurately only if the clinician understands the concept ventilation/perfusion ratios of the lung. The major categories of ventilation/perfusion ratios are intrapulmonary shunting and physiologic deadspace. Virtually all pulmonary assessments and interventions are aimed to address Qs/Qt or Vd/Vt. This chapter provides background information useful to the clinician in the assessment of intrapulmonary shunting and deadspace analysis. From this information, more thorough assessments of pulmonary function are possible.