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2. Standardization of Air Stacking as Lung Expansion Therapy for Patients With Restrictive Lung Disease: A Pilot Study

Author

Cho, Han Eol, Choi, Won Ah, Lee, Sang-Yoep, and Kang, Seong-Woong

Subjects
Lung diseases -- Care and treatment -- Patient outcomes, Breathing exercises -- Complications and side effects -- Patient outcomes
Abstract

Objective. Although air stacking is a widely used lung expansion therapy essential for restrictive lung diseases, important details such as peak insufflation pressure (PIP) and number of squeezes have not been investigated. The purpose of this study was to standardize a method of air stacking to minimize problems with its application by identifying the optimal pressure and number of squeezes performed by professional physicians and investigating the current status of routine air stacking implementation in patients. Methods. This prospective cross-sectional test-retest study involved individuals who had neuromuscular disorders and had performed air stacking exercise for longer than 1 year. PIP and number of squeezes were measured to identify the differences between caregivers and physicians. Cases of incorrectly performed air stacking were investigated and categorized. The problems associated with air stacking were evaluated. Results. A total of 45 participants were included. PIP was 41.4 (SD = 4.2; range = 34.8-50.0) cm [H.sub.2]O, and optimal number of squeezes was 3.1 (SD = 0.5; range = 2-4). When the air stacking methods used by caregivers were evaluated, 19 of 45 caregivers (42.2%) used methods inappropriately. Higher PIP and larger number of squeezes were observed with caregiver implementation. Thirty caregivers (66.7%) experienced finger or wrist pain; this problem was observed especially in female caregivers, who tended to incorrectly perform air stacking. Conclusions. This pilot study showed that the optimal pressure of air stacking was 35 to 50 cm [H.sub.2]O. Caregivers often perform air stacking inappropriately, leading to complications without achieving the purpose of air stacking. The introduction of a new method, such as manometry, can be helpful for achieving optimal air stacking. Impact. Optimal pressure of air stacking can be measured with inexpensive, simple, and commercially available digital manometry. This approach enables air stacking to be performed and taught more accurately and efficiently and reduces complications in both patients and caregivers. Keywords: Breathing Exercises, Lung Compliance, Neuromuscular Diseases, Pulmonary Rehabilitation, Respiratory Mechanics, Introduction Atelectasis is a common and serious complication for individuals who have difficulty taking deep breaths. Lung expansion therapy is the treatment of choice for such individuals. Lung expansion therapy [...]

Published
2022
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13. The association between cardiac involvement and long‐term clinical outcomes in patients with Duchenne muscular dystrophy

Author

Cha, Jung‐Joon, primary, Kim, In‐Soo, additional, Kim, Jong‐Youn, additional, Choi, Eui‐Young, additional, Min, Pil‐Ki, additional, Yoon, Young Won, additional, Lee, Byoung Kwon, additional, Hong, Bum‐Kee, additional, Kwon, Hyuck Moon, additional, Cho, Han Eol, additional, Choi, Won Ah, additional, Kang, Seong‐Woong, additional, and Rim, Se‐Joong, additional

Published
2022
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14. Precise Pulmonary Function Evaluation and Management of a Patient With Freeman-Sheldon Syndrome Associated With Recurrent Pneumonia and Chronic Respiratory Insufficiency

Author

Park, Jihyun, Kang, Seong-Woong, Choi, Won Ah, Lee, Yewon, and Cho, Han Eol

Subjects
030506 rehabilitation, Pediatrics, medicine.medical_specialty, lcsh:Medicine, Case Report, Scoliosis, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, respiratory insufficiency, medicine, Freeman–Sheldon syndrome, Restrictive lung disease, business.industry, freeman-sheldon syndrome, respiratory function tests, Rehabilitation, lcsh:R, medicine.disease, Pulmonary hypertension, Pneumonia, Respiratory failure, 0305 other medical science, business, 030217 neurology & neurosurgery, Respiratory care
Abstract

Freeman-Sheldon syndrome (FSS) is a rare distal arthrogryposis syndrome. There are few reports on the respiratory insufficiency of FSS. Additionally, there is no detailed information on pulmonary functional evaluation. A 17-year-old male patient with FSS developed respiratory failure, leading him to be admitted to hospital several times for evaluation and treatment. Of those times he was admitted, two were due to pneumonia. His pulmonary functions were indicative of a restrictive lung disease potentially caused by severe scoliosis. After a non-invasive ventilatorwas applied correctly to the patient, pulmonary hypertension was normalized. His pulmonary function has been maintained for 13 years. Since receiving proper respiratory care, which includes assisted coughing methods, the patient has not developed pneumonia. It is important to properly evaluate the pulmonary function of patients who have FSS and scoliosis to eliminate the risk of long-term respiratory complications.

Published
2020

18. Response

Author

Cho, Han Eol, primary, Choi, Won Ah, additional, and Kang, Seong-Woong, additional

Published
2021
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19. Improvement of Peak Cough Flow After the Application of a Mechanical In-exsufflator in Patients With Neuromuscular Disease and Pneumonia: A Pilot Study

Author

Jung, Ji Ho, Oh, Hyeon Jun, Lee, Jang Woo, Suh, Mi Ri, Park, Jihyun, Choi, Won Ah, and Kang, Seong-Woong

Subjects
Neuromuscular disease, business.industry, Rehabilitation, lcsh:R, Statistical difference, lcsh:Medicine, Pneumonia, Sitting, medicine.disease, 03 medical and health sciences, Neuromuscular diseases, 0302 clinical medicine, Mechanical in-exsufflator, 030228 respiratory system, Anesthesia, Hyperventilation, Medicine, Original Article, In patient, medicine.symptom, Peak cough flow, business, 030217 neurology & neurosurgery
Abstract

Objective To investigate and demonstrate persistent increase of peak cough flow after mechanical in-exsufflator application, in patients with neuromuscular diseases and pneumonia. Methods A mechanical in-exsufflator was applied with patients in an upright or semi-upright sitting position (pressure setting, +40 and -40 cmH2O; in-exsufflation times, 2-3 and 1-2 seconds, respectively). Patients underwent five cycles, with 20-30 second intervals to prevent hyperventilation. Peak cough flow without and with assistive maneuvers, was evaluated before, and 15 and 45 minutes after mechanical in-exsufflator application. Results Peak cough flow was 92.6 L/min at baseline, and 100.4 and 100.7 L/min at 15 and 45 minutes after mechanical in-exsufflator application, respectively. Assisted peak cough flow at baseline, 15 minutes, and 45 minutes after mechanical in-exsufflator application was 170.7, 179.3, and 184.1 L/min, respectively. While peak cough flow and assisted peak cough flow increased significantly at 15 minutes after mechanical in-exsufflator application compared with baseline (p=0.030 and p=0.016), no statistical difference was observed between 15 and 45 minutes. Conclusion Increased peak cough flow after mechanical in-exsufflator application persists for at least 45 minutes.

Published
2018

31. Safety of Gastrostomy Tube Placement in Patients with Advanced Amyotrophic Lateral Sclerosis With Noninvasive Ventilation.

Author

Kim, Eun Young, Kang, Seong Woong, Suh, Mi Ri, Jung, Jiho, Park, Jihyun, and Choi, Won Ah

Subjects
POSITIVE pressure ventilation, NONINVASIVE ventilation, AMYOTROPHIC lateral sclerosis, GASTROSTOMY, VITAL capacity (Respiration), TUBE feeding, ENTERAL feeding
Abstract

Background: In patients with amyotrophic lateral sclerosis (ALS), bulbar muscle dysfunction can occur, which eventually requires the initiation of enteral tube feeding. However, there is no consensus on the optimal timing for the gastrostomy or the proper ventilator support method during the procedure. We aimed to investigate the safe range of gastrostomy according to respiratory support status and forced vital capacity (FVC) % of predicted values classification and to compare the safety of noninvasive and invasive mechanical ventilation during the procedure in ALS patients with FVC < 30% of predicted. Methods: A total of 477 patients diagnosed with ALS at our institution from January 1, 2009, to December 31, 2018, were evaluated, and 105 patients were enrolled in this study. All medical records covering ventilation status and complications within 6 months to 1 year after the initial gastrostomy were gathered and reviewed. Results: The gastrostomy procedure was considered safe regardless of FVC status or modality of respiratory support. There were complications related to the gastrostomy procedure in 6 of 105 patients and all were managed through conservative care. The incidence of complications, including respiratory ones, for noninvasive and invasive positive pressure ventilation was 5.5% and 9.6%, respectively, which were not statistically significantly different (P =.294). Conclusion: The procedure and tube placement of a gastrostomy can be safely performed in ALS patients with minimal FVC regardless of ventilation invasiveness. We suggest that there should be a new standard for FVC % of predicted to facilitate performing gastrostomy in ALS patients. [ABSTRACT FROM AUTHOR]

Published
2021
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32. Correlation of Bone Mineral Density with Pulmonary Function in Advanced Duchenne Muscular Dystrophy.

Author

Lee, Jang Woo, Cho, Han Eol, Kang, Seong‐Woong, Choi, Won Ah, Suh, Mi Ri, Kim, Bitnarae, and Kang, Seong-Woong

Subjects
BONE density, DUCHENNE muscular dystrophy, LUMBAR vertebrae, MECHANICAL ventilators, RESPIRATORY muscles, RESEARCH, LUNGS, RESEARCH methodology, RESPIRATORY measurements, MEDICAL cooperation, EVALUATION research, COMPARATIVE studies, PULMONARY function tests, DISEASE complications
Abstract

Background: A relationship between bone mineral density (BMD) and physical function has been revealed in the general population and various diseases. However, there is a lack of research investigating the correlation between BMD and respiratory function, one of few measurable physical parameters in patients with advanced Duchenne muscular dystrophy (DMD).Objective: To determine whether pulmonary function parameters, including respiratory muscle strength, are related to BMD.Design: Retrospective observational study.Setting: A tertiary university hospital.Patients: DMD patients who were over 20 years of age, nonambulatory, and supported by mechanical ventilators.Methods: The patients' age, weight, and pulmonary function as well as the BMD of the first and the fourth lumbar vertebra were assessed. Pulmonary function includes forced vital capacity (FVC), unassisted and assisted peak cough flow (UPCF and APCF), maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP).Main Outcome Measures: A bivariate correlation for BMD and other pulmonary parameters was calculated, and hierarchical regression analysis was used to determine predictors of spine Z-score.Results: It was observed that the decrease in the spine BMD was not significantly correlated with age. However, the body mass index (BMI) and all parameters of pulmonary function were correlated with BMD. Partial correlation analysis adjusted by BMI showed that UPCF and APCF were powerful predictors of spine BMD.Conclusions: The BMD of the lumbar spine correlated with BMI and PCF in patients with DMD at an advanced stage. [ABSTRACT FROM AUTHOR]

Published
2021
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