• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.798-803
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• 2018

Objective To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke. Methods This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups. Results The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups. Conclusion Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.23-31
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• 2021

Purpose : To compare the immediate effects of air stacking maneuver using resuscitator bags and balloons. Methods : Twenty healthy young adults participated in this study. Forced vital capacity (FVC) and peak cough flow (PCF) tests were performed at pre-intervention, and then, the maximum insufflation capacity (MIC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF), and peak cough flow (PCF) were measured using the air stacking maneuver via resuscitator bags and balloons. Interventions were randomly performed, and a 40-min break was provided between interventions. The evaluation process in this study was conducted in accordance with the guidelines of the American Thoracic Society (ATS) 2019. To compare the three outcomes measured at pre-and post-interventions, repeated measures analysis of variance was performed. Results : A significant difference was found in the MIC, FEV1, PEF, and PCF after the air stacking maneuver using resuscitator bags and balloons, whereas no significant difference was observed between resuscitator bags and balloons. Conclusion : No significant difference was found in the immediate effect of the air stacking maneuver using resuscitator bags and balloons in this study. Air stacking maneuver using balloons can increase the success rate of the techniques by providing visual feedback on the amount of air insufflation when performed with balloon blowing exercise. Balloons are cheaper and easier to buy compared to manual resuscitator bags; therefore, education on the air stacking maneuver using balloons will have a positive effect on pulmonary rehabilitation.

• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.201-209
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• 1996

Background : Auto-PEEP which develops when expiratory lung emptying is not finished until the beginning of next inspiration is frequently found in patients on mechanical ventilation. Its presence imposes increased risk of barotrauma and hypotension, as well as increased work of breathing (WOB) by adding inspiratory threshold load and/or adversely affecting to inspiratory trigger sensitivity. The aim of this study is to evaluate the relationship of auto-PEEP with WOB and to evaluate the effect of PEEP applied by ventilator (external PEEP) on WOB in patients with auto-PEEP. Method : 15 patients, who required mechanical ventilation for management of acute respiratory failure, were studied. First, the differences in WOB and other indices of respiratory mechanics were examined between 7 patients with auto-PEEP and 8 patients without auto-PEEP. Then, we applied the 3 cm $H_2O$ of external PEEP to patients with auto-PEEP and evaluated its effects on lung mechanics as well as WOB. Indices of respiratory mechanics including tidal volume ($V_T$), repiratory rate, minute ventilation ($V_E$), peak inspiratory flow rate (PIFR), peak expiratory flow rate (PEFR), peak inspiratory pressure (PIP), $T_I/T_{TOT}$, auto-PEEP, dynamic compliance of lung (Cdyn), expiratory airway resistance (RAWe), mean airway resistance (RAWm), $p_{0.1}$, work of breathing performed by patient (WOB), and pressure-time product (PTP) were obtained by CP-100 Pulmonary Monitor (Bicore, USA). The values were expressed as mean $\pm$ SEM (standard error of mean). Results : 1) Comparison of WOB and other indices of respiratory mechanics in patients with and without auto-PEEP : There was significant increase in WOB ($l.71{\pm}0.24$ vs $0.50{\pm}0.19\;J/L$, p=0.007), PTP ($317{\pm}70$ vs $98{\pm}36\;cm$ $H_2O{\cdot}sec/min$, p=0.023), RAWe ($35.6{\pm}5.7$ vs $18.2{\pm}2.3\;cm$ H2O/L/sec, p=0.023), RAWm ($28.8{\pm}2.5$ vs $11.9{\pm}2.0cm$ H2O/L/sec, p=0.001) and $P_{0.1}$ ($6.2{\pm}1.0$ vs 2.9+0.6 cm H2O, p=0.021) in patients with auto-PEEP compared to patients without auto-PEEP. The differences of other indices including $V_T$, PEFR, $V_E$ and $T_I/T_{TOT}$ showed no significance. 2) Effect of 3 cm $H_2O$ external PEEP on respiratory mechanics in patients with auto-PEEP : When 3 cm $H_2O$ of external PEEP was applied, there were significant decrease in WOB ($1.71{\pm}0.24$ vs $1.20{\pm}0.21\;J/L$, p=0.021) and PTP ($317{\pm}70$ vs $231{\pm}55\;cm$ $H_2O{\cdot}sec/min$, p=0.038). RAWm showed a tendency to decrease ($28.8{\pm}2.5$ vs $23.9{\pm}2.1\;cm$ $H_2O$, p=0.051). But PIP was increased with application of 3 cm $H_2O$ of external PEEP ($16{\pm}2$ vs $22{\pm}3\;cm$ $H_2O$, p=0.008). $V_T$, $V_E$, PEFR, $T_I/T_{TOT}$ and Cdyn did not change significantly. Conclusion : The presence of auto-PEEP in mechanically ventilated patients was accompanied with increased WOB performed by patient, and this WOB was decreased by 3 cm $H_2O$ of externally applied PEEP. But, with 3 cm $H_2O$ of external PEEP, increased PIP was noted, implying the importance of close monitoring of the airway pressure during application of external PEEP.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.4
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• pp.29-37
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• 2017

PURPOSE: This study investigated the immediate effect of inspiratory muscle training with whole-body vibration on the pulmonary function of subacute stroke patients. METHODS: All participants (n=30) were allocated to the following groups: (1) the inspiratory muscle training group with whole-body vibration (n=10), wherein the patients received inspiratory muscle training with whole-body vibration comprising 3minutes of vibration per session and respiratory training of 30 times and 2 sessions for one day. (2) the inspiratory muscle training group with visual feedback (n=10), wherein the patients received inspiratory muscle training with visual feedback. (3) the inspiratory muscle training group (n=10), wherein the patients received inspiratory muscle training. RESULTS: After the experiment, the inspiratory muscle training group with whole-body vibration exhibited significantly higher forced vital capacity, forced expiratory volume at 1 second, peak inspiratory flow rate, maximal inspiratory pressure, and chest expansion (p<.05), compared to the other groups. Inspiratory muscle training group with whole-body vibration had significantly higher peak expiratory flow rate and maximal voluntary ventilation than the other groups (p<.05). CONCLUSION: These results show that pulmonary function, maximal inspiratory pressure, and chest expansion were significantly better in the inspiratory muscle training group with whole-body vibration than in the other groups. Thus, this treatment will help recovery of pulmonary function in stroke patients.

• Tuberculosis and Respiratory Diseases
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• v.56 no.2
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• pp.144-150
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• 2004

Background : An assessment of the presence and the degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. However, the time responses of spirometric parameters in response to bronchodilator have not been well investigated. Methods: We studied 15 patients with asthma. Spirometric and mini-Wright peak expiratory flow measurements were performed at 15, 30, 45, and 60 minutes after using single dose($200{\mu}g$) of inhaled bronchodilator, salbutamol. Results : The mean values of forced expiratory volume in one second($FEV_1$) and forced vital capicaty(FVC) were significantly increased at 60 minutes after using bronchodilator in comparison to 15 minutes. And peak expiratory flow rate measured by either mass flow sensor or mini-Wright peak flow meter were significantly increased at 45 minutes after using bronchodilator in comparison to 15 minutes. Conclusions : To appropriate evaluation of the bronchodilator response in patients with reversible airflow limitation, it would be useful measuring either $FEV_1$ or PEF at the later time point 60 or 45 minutes in comparison to 15 minutes after using bronchodilator.

• Journal of Environmental Health Sciences
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• v.30 no.2
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• pp.140-148
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• 2004

To evaluate the acute effects of fine particles on pulmonary function, a longitudinal study was conducted. This study was carried out for the schoolchildren (3rd and 6th grades) living in Beijing, China. Each child was provided with a mini-Wright peak flow meter and a preformatted health symptom diary for 40 days, and was trained on their proper use. Participants were instructed to perform the peak flow test three times in standing position, three times a day (9 am, 12 pm, and 8 pm), and to record all the readings along with the symptoms (cold, cough, and asthmatic symptoms) experienced on that day. Daily measurement of fine particles (PM$_{10}$ and PM$_{2.5}$) was obtained in the comer of the playground of the participating elementary school for the same period of this longitudinal study. The relationship between daily peak expiratory flow rate (PEFR) and fine particle levels was analyzed using a mixed linear regression models including gender, height, the presence of respiratory symptoms, and daily average temperature and relative humidity as extraneous variables. The total number of students participating in this longitudinal study was 87. The range of daily measured PEFR was 253-501$\ell$/min. In general, the PEFR measured in the morning was lower than the PEFR measured in the evening (or afternoon) on the same day. The daily mean concentrations of PM$_{10}$ and PM$_{2.5}$ over the study period were 180.2$\mu\textrm{g}$/㎥ and 103.2$\mu\textrm{g}$/㎥, respectively. The IQR (inter-quartile range) of PM$_{10}$ and PM$_{2.5}$ were 91.8$\mu\textrm{g}$/㎥ and 58.0$\mu\textrm{g}$/㎥. During the study period, the national ambient air quality standard of 150$\mu\textrm{g}$/㎥ (for PM$_{10}$) was exceeded in 23 days (57.5%). The analysis showed that an increase of 1$\mu\textrm{g}$/㎥ of PM$_{10}$ corresponded to 0.59$\mu\textrm{g}$/㎥ increment of PM$_{2.5}$. Daily mean PEFR was regressed with the 24-hour average PM$_{10}$ (or PM$_{2.5}$) levels, weather information such as air temperature and relative humidity, and individual characteristics including gender, height, and respiratory symptoms. The analysis showed that the increase of fine particle concentrations was negatively associated with the variability in PEFR. The IQR increments of PM$_{10}$ or PM$_{2.5}$ (at 1-day time lag) were also shown to be related with 1.54 $\ell$/min (95% Confidence intervals: 0.94-2.14) and 1.56$\ell$/min (95% CI: 0.95-2.16) decline in PEFR.R.ine in PEFR.ine in PEFR.

• Journal of Korean Physical Therapy Science
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• v.30 no.3
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• pp.49-58
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• 2023

Background: This study aims to examine the useful- ness of the portable spirometer "The Spirokit" as a clinical diagnostic device through technology introduction, precision test, and correction. Design: Technical note Methods: "The Spirokit" was developed using a propeller-type flow rate and flow rate measurement method using infrared and light detection sensors. The level of agreement between the Pulmonary Waveform Generator and the measured values was checked to determine the precision of "The Spirokit", and the correction equation was included using the Pulmonary Waveform Generator software to correct the error range. The analysis was requested using the ATS 24/26 waveform recognized by the Ministry of Food and Drug Safety and the American Thoracic Society for the values of Forced Voluntary Capacity (FVC), Forced Expiratory Volume in 1second (FEV1), and Peak Expiratory Flow (PEF), which are used as major indicators for pulmonary function tests. All tests were repeated five times to derive an average value, and FVC and FEV1 presented accuracy and PEF presented accuracy as the result values. Results: FVC and FEV1 of 'The Spirokit' developed in this study showed accuracy within ± 3% of the error level in the ATS 24 waveform. The PEF value of 'The Spirokit' showed accuracy within the error level ± 12% of the ATS 26 waveform. Conclusion: Through the results of this study, the precision of 'The Spirokit' as a clinical diagnosis device was identified, and it was confirmed that it can be used as a portable pulmonary function test that can replace a spirometer.

• Physical Therapy Rehabilitation Science
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• v.12 no.3
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• pp.229-239
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• 2023

Objective: Patients with chronic obstructive pulmonary disease (COPD) may experience reduced physical activity and quality of life (QoL) due to decreased pulmonary function. The purpose of this study was to investigate the level of pulmonary function, physical activity, and QoL of COPD patients. Design: Cross-sectional observational study. Methods: This study examined the published data of the Korea National Health and Nutrition Examination Survey in 2015-2019. Among 39,759 subjects who participated for 5 years, data from 151 patients diagnosed with COPD were analyzed separately. For the pulmonary function, the results of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV6, forced expiratory flow 25-75%, and peak expiratory flow were observed. Physical activity was identified as frequency and duration. For the QoL, EQ-5D-3L evaluation results were examined, and the frequency and index of the Korean version were investigated. Results: In pulmonary function, all variables were found to be lower than age and weighted matched normal values. COPD patients showed to perform very low levels of high/medium physical activity and sitting time was confirmed to be more than 8 hours a day. In QoL, it was found that the highest reporting rate of some problems was the "pain and discomfort" and "mobility". Conclusions: It was found that COPD patients showed that the prevalence of circulatory disease was relatively high, lowered pulmonary function, and QoL. These can be improved through regular physical activity, and it is thought that this can be achieved through optimization of pulmonary rehabilitation.

• Journal of Environmental Health Sciences
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• v.33 no.5
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• pp.365-371
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• 2007

To evaluate the effect of air pollution on respiratory health in children, We conducted a longitudinal study in which children were asked to record their daily levels of Peak Expiratory Flow Rate(PEFR) using potable peak flow meter(mini-Wright) for 4 weeks. The relationship between daily PEFR and ambient air particle levels was analyzed using a mixed linear regression models including gender, age in year, weight, the presence of respiratory symptoms, and relative humidity as an extraneous variable. The daily mean concentrations of $PM_{10}$ and $PM_{2.5}$ over the study period were $64.9{\mu}g/m^3$ and $46.1{\mu}g/m^3$, respectively. The range of daily measured PEFR in this study was $182{\sim}481\;l/min$. Daily mean PEFR was regressed with the 24-hour average $PM_{10}(or\;PM_{2.5})$ levels, weather information such as air temperature and relative humidity, and individual characteristics including sex, weight, and respiratory symptoms. The analysis showed that the increase of air particle concentrations was negatively associated with the variability in PEFR. We estimated that the IQR increment of $PM_{10}$ or $PM_{2.5}$ were associated with 1.5 l/min (95% Confidence intervals -3.1, 0.1) and 0.8 l/min(95% CI -1.8, 0.1) decline in PEFR. Even though this study showed negative findings on the relationship between respiratory function and air particles, it was worth noting that the findings must be interpreted cautiously because exposure measurement based on monitoring of ambient air likely resulted in misclassification of true exposure levels and this was the first Korean study that $PM_{2.5}$ measurement was applied as an index of air quality.

• Tuberculosis and Respiratory Diseases
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• v.42 no.3
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• pp.342-350
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• 1995

Background: Although there are improvements of clinical symtoms after bronchodilator inhalation in COPD patients, it has been noted that there was no increase of $FEV_1$ in some cases. $FEV_1$ did not reflect precisely the improvement of ventilatory mechanics after bronchodilator inhalation in these COPD patients. The main pathophysiology of COPD is obstruction of airway in expiratory phase but in result, the load of respiratory system is increased in inspiratory phase. Therefore the improvement of clinical symptoms after bronchodilator inhalation may be due to the decrease of inspiratory load. So we performed the study which investigated the effect of bronchodilator on inspiratory response of vetilatory mechanics in COPD patients. Methods: In 17 stable COPD patients, inspiratory and expiratory forced flow-volume curves were measured respectively before bronchodilator inhalation. 10mg of salbutamol solution was inhaled via jet nebulizer for 4 minutes. Forced expiratory and inspiratory flow-volume curves were measured again 15 minutes after bronchodilator inhalation. Results: $FEV_1$, FVC and $FEV_1$/FVC% were $0.92{\pm}0.34L$($38.3{\pm}14.9%$ predicted), $2.5{\pm}0.81L$($71.1{\pm}21.0%$ predicted) and $43.1{\pm}14.5%$ respectively before bronchodilator inhalation. The values of increase of $FEV_1$, FVC and PIF(Peak Inspiratory Flow) were $0.15{\pm}0.13L$(relative increase: 17.0%), $0.58{\pm}0.38\;L$(29.0%) and $1.0{\pm}0.56L$/sec(37.5%) respectively after bronchodilator inhalation. The increase of PIF was twice more than $FEV_1$ in average(p<0.001). The increase of PIF in these patients whose $FEV_1$ was not increased after bronchodilator inhalation were 35.0%, 44.0% and 55.5% respectively. Conclusion: The inspiratory parameter reflected improvement of ventilatory mechanics by inhaled bronchodilater better than expiratory parameters in COPD patients.