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Evaluation of breath-by-breath measurement of respiratory gas exchange in pediatric exercise testing.

In adults, breath-by-breath analysis has been used for measuring respiratory gas exchange during exercise. The present study evaluates the validity and reproducibility of this method in children. In 21 patients with various types of congenital heart disease, steady state exercise testing was performed on a motor-driven treadmill. Based on simultaneous measurements of VO2, VCO2, VE and R, comparisons were made between the breath-by-breath and Douglas bag methods. No significant differences were found between both methods for any of the variables. In seven other patients the reproducibility of cardiorespiratory variables during exercise was assessed. No significant difference was found for the cardiorespiratory variables during any of the tests and the coefficients of variation were comparable to data obtained in adults. It is concluded that the breath-by-breath method for measuring respiratory values can be applied in children with an acceptable degree of validity and reproducibility.

Adolescent↗

Computerized breath-by-breath analysis of respiratory variables during exercise.

An on-line analysis of respiration with a breath-by-breath method during exercise is presented. Special emphasis is given to the computer processing of signals for gas flow rate and for O2 and CO2 concentrations. The validity and reliability of the method to measure oxygen uptake (VO2) was tested by ten subjects in repeated tests. Mean oxygen uptake was 2.3% less with the computerized breath-by-breath method than with the Douglas-bag method which was used as reference. The breath-by-breath method is planned to be used primarily for evaluating the work capacity of healthy and disabled persons. However, in addition to being suitable for such routine uses, the method described also yields respiratory data whose analysis can be valuable in a variety of clinical and research work.

Adult↗

Clinical study of yoga techniques in university students with asthma: a controlled study.

Adult asthmatics, ranging from 19 to 52 years from an asthma and allergy clinic in a university setting volunteered to participate in the study. The 17 students were randomly divided into yoga (9 subjects) and nonyoga control (8 subjects) groups. The yoga group was taught a set of breathing and relaxation techniques including breath slowing exercises (pranayama), physical postures (yogasanas), and meditation. Yoga techniques were taught at the university health center, three times a week for 16 weeks. All the subjects in both groups maintained daily symptom and medication diaries, collected A.M. and P.M. peak flow readings, and completed weekly questionnaires. Spirometry was performed on each subject every week. Analysis of the data showed that the subjects in the yoga group reported a significant degree of relaxation, positive attitude, and better yoga exercise tolerance. There was also a tendency toward lesser usage of beta adrenergic inhalers. The pulmonary functions did not vary significantly between yoga and control groups. Yoga techniques seem beneficial as an adjunct to the medical management of asthma.

Adult↗

Alveolar gas exchange during exercise: a single-breath analysis.

Changes in expired alveolar O2 and CO2 were measured breath-by-breath in six healthy male subjects (mean age 30 yr, mean weight 80 kg) at rest, 600 kpm/min, and 1,200 kpm/min. Changes were expressed in relation to expired volume (liters) and time (s) and separated into an initial dead-space component using the Fowler method applied to expired CO2 and O2, and alveolar slope. The alveolar slopes with respect to time (dPACO2, dPAO2, Torr/s) increased in relation to CO2 output (VCO2, 1/min, STPD) and O2 intake (VO2, 1/min, STPD) but were reduced by increasing tidal volume (VT, liters, BTPS): dPACO2 = 2.7 + 4.6(VCO2) - 1.9(VT) (r = 0.97); and dPAO2 = 2.3 + 5.5(VO2) - 1.9(VT) (r = 0.96). From the alveolar slopes, tidal volume, and airway dead-space volume, mean expired alveolar PO2 and PCO2 (PAO2, PACO2) were calculated. There was no change in arterialized capillary PCO2 (PaCO2) between rest (38.9 +/- 0.66 Torr) and heavy exercise (38.2 +/- 2.18 Torr), but mean PACO2 rose from 36.7 +/- 0.55 to 40.8 +/- 1.67 Torr during heavy exercise. There was no change in arterialized capillary (mean = 84.3 +/- 0.7 Torr) or alveolar (mean = 107.2 +/- 1.03 Torr) PO2. Exercise increases the fluctuations in alveolar gas composition leading to discrepancies between the PCO2 in mean alveolar gas and arterial blood to an extent that is dependent on VCO2 and VT.

Adult↗

[Clinical and functional course of a group of patients with COPD under controlled medical-rehabilitative treatment over a 6-year period].

Functional and clinical tests were performed on a group of 36 patients with COPD for 6 years. During this period they had medical treatment as well as cycles of respiratory rehabilitation (diaphragmatic breathing and exercise training). After this period the resistance to muscular work was greatly enhanced in 9 subjects (25%), enhanced in 25 (69%), little enhanced in 2. Functional respiratory parameters did not change in a significant way, thus indicating the stability of the disease, which did not worsen. One interesting feature was the mean reduction in residual volume (-32%, p less than 0.001). This may indicate that a better coordination of the diaphragm can reduce pulmonary hyperinflation. The ventilatory pattern spontaneously changed towards a stability of ventilation, with increased respiratory frequency and reduced tidal volume.

Breathing Exercises↗

Impact of laryngeal paralysis and its treatment on the glottic aperture and upper airway flow characteristics during exercise.

Patients with unilateral vocal fold paralysis occasionally report shortness of breath during exercise. This symptom may persist in some patients after medialization thyroplasty. A review of the literature revealed no study that objectively evaluated laryngeal dynamics or airway flow characteristics during exercise after medialization thyroplasty for unilateral laryngeal paralysis. This study evaluates glottic aperture size and configuration as well as upper airway flow characteristics during exercise in 16 subjects. Six patients who underwent medialization thyroplasty for unilateral vocal fold paralysis were compared with 10 healthy control subjects. During a standardized exercise protocol on an incremental ergometer (bicycle type), real-time videolaryngoscopy was obtained and correlated in a synchronized fashion with maximum-effort respiratory efforts at the beginning, midpoint, and end of the exercise period. Direct calculations of glottic size during various phases of the exercise period were performed from digitized images. These data were correlated with inspiratory flow data for each patient. Patients with laryngeal paralysis demonstrated smaller mean glottic areas and lower peak inspiratory flow rates than controls both at rest and during all phases of the exercise period. This study suggests that after treatment of unilateral laryngeal paralysis with medialization thyroplasty, inspiratory flow rate and glottic area are significantly less than in normal controls.

Adolescent↗

Delay time adjustments to minimize errors in breath-by-breath measurement of Vo2 during exercise.

If the delay time between gas concentration and flow signals is not adequately corrected during breath-by-breath analysis of expired gas, an error in calculation of oxygen consumption (Vo2) will result. To examine the frequency and delay time dependences of errors in Vo2 measurement, six healthy men exercised at 100, 200, and 250 W on a cycle ergometer while breath-by-breath assessment of Vo2 was made simultaneously with collection of expired air. Subjects breathed first at normal rates (15-30 breaths/min) and then at 70 breaths/min. Each subject performed each level of exercise twice by using erroneous values for the delay time between gas concentration and flow signals. At normal breathing frequencies, errors in Vo2 measurement were +/- 10% over the full range of delay times used, and the errors were not tightly correlated with variations in delay times from optimum. However, at 70 breaths/min, errors approached +/- 30% as the variations in delay times deviated +/- 0.1 s from the optimal, and the errors were highly correlated with the variations in delay times. We conclude that there is greater potential for errors in Vo2 measurement with incorrect delay time at higher breathing frequencies. These findings suggest that the optimal delay time for breath-by-breath systems should be adjusted by using high breathing frequencies.

Adult↗

Stability of total respiratory resistance under multiple baseline conditions, isometric arm exercise and voluntary deep breathing.

Little is known about total respiratory resistance (TRR) as a psychophysiological parameter in normal subjects. Therefore, we investigated TRR in 45 healthy students under multiple baseline conditions, isometric arm muscle tension and voluntary deep breathing (VDB). TRR was measured by the forced oscillation technique. In addition, heart rate (HR) as well as volume and time components of the respiratory cycle, respiratory timing and respiratory drive were monitored. Subjects repeated the protocol 14 days later. Coefficients of stability and dependability were calculated for 20 s measurement epochs within and between both sessions. Increases of HR and shortening of time components of the respiratory cycle were found during muscle tension, prolongation of time components and increases in volume were found for deep breathing. During both experimental tasks TRR increased significantly. Short-term as well as long-term stability of absolute TRR scores proved to be comparable or even better than reliability of other physiological parameters, however, difference scores from baseline revealed only low coefficients.

Adult↗

A treatment for vocal cord dysfunction in female athletes: an outcome study.

OBJECTIVES: This article reports the outcome of a speech pathology treatment program for vocal cord dysfunction (VCD) in 20 adolescent female athletes. STUDY DESIGN: A retrospective, nonrandomized group design was used to collect the outcome data. METHODS: Twenty consecutive referrals of female athletes diagnosed as having symptoms of VCD during exercise were assessed, treated, and followed for at least 6 months after treatment. RESULTS: Ninety-five percent of the participants reported the ability to control symptoms of VCD during exercise up to 6 months after treatment. Asthma medications were no longer used by 80% of the athletes. All of the females continued to participate in athletics. CONCLUSION: Speech pathology intervention focusing on respiratory control of VCD in adolescent female athletes is an effective treatment resulting in the athletes' ability to control the symptoms of VCD in exercise for at least 6 months after treatment.

Adolescent↗

Comparison of cardiac output during exercise by single-breath and CO2-rebreathing methods.

Cardiac output (Q) was estimated in supine rest and in upright cycling at several work rates up to 200 W in five male and one female subjects. At least four repetitions of both the CO2-rebreathing plateau method (Collier, J. Appl. Physiol. 9:25-29, 1956) and the Kim et al. (J. Appl. Physiol. 21: 1338-1344, 1966) single-breath method were performed at each work rate, in a steady state of O2 consumption and heart rate. At supine rest and low work rates, estimates of Q were similar by the two methods. However, at higher work rates, the single-breath method significantly (P less than 0.05) underestimated the value obtained by CO2 rebreathing. The reason for the difference in estimates of Q by the two methods was traced to the determination of arterial partial pressure of CO2 (PaCO2) and mixed venous partial pressure of CO2 (PvCO2). The estimate of PaCO2 from the single-breath method was approximately 88.5% of the estimate from end-tidal PCO2 used with the rebreathing method (P less than 0.001). The oxygenated PvCO2 calculated from the single-breath Q averaged approximately 92.5% of the PvCO2 from CO2 rebreathing (P less than 0.0001). The difference in estimates of Q was not eliminated by using a logarithmic form of the CO2 dissociation curve with the single-breath method.

Adult↗