Publications by authors named "Giuseppe Liistro"

68 Publications

Follow-up of functional exercise capacity in patients with COVID-19: It is improved by telerehabilitation.

Respir Med 2021 07 30;183:106438. Epub 2021 Apr 30.

Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium; Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address:

Background: The impact of the COVID-19 pandemic on functional exercise capacity seemed quickly clinically evident. The objective of this study was to assess the functional exercise capacity of patients with severe COVID-19 and to evaluate the effect of a telerehabilitation program in the specific context of the COVID-19 pandemic.

Method: Patients hospitalized for severe or critical COVID-19 were recruited. The functional exercise capacity (1-min sit-to-stand test (STST)) was prospectively quantified at discharge. A telerehabilitation program was then proposed. A control group was composed with the patients refusing the program.

Results: At discharge, none of the 48 recruited patients had a STST higher than the 50th percentile and 77% of them were below the 2.5th percentile. SpO2 was 92.6 ± 3.0% after STST and 15 patients had oxygen desaturation. After 3-months of follow-up, the number of repetitions during STST significantly increased either in telerehabilitation (n = 14) (p < 0.001) or in control groups (n = 13) (p = 0.002) but only one patient had a result higher than the 50th percentile (in Telerehabilitation group) and 37% of them were still under the 2.5th percentile for this result. The improvement was significantly and clinically greater after the telerehabilitation program (p = 0.005). No adverse events were reported by the patients during the program.

Conclusions: Patients hospitalized for COVID-19 have a low functional exercise capacity at discharge and the recovery after three months is poor. The feasibility and the effect of a simple telerehabilitation program were verified, this program being able to substantially improve the functional recovery after three months.
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http://dx.doi.org/10.1016/j.rmed.2021.106438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084600PMC
July 2021

Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire.

Muscle Nerve 2021 Apr 23. Epub 2021 Apr 23.

Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.

Introduction/aims: Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia.

Methods: We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia.

Results: Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases.

Discussion: The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.
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http://dx.doi.org/10.1002/mus.27254DOI Listing
April 2021

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.

Respir Med 2021 05 4;181:106383. Epub 2021 Apr 4.

Radiology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Belgium.

Background: COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected.

Research Question: We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging.

Study Design: and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT.

Results: Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea.

Interpretation: Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.
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http://dx.doi.org/10.1016/j.rmed.2021.106383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019490PMC
May 2021

Chest Expansion and Lung Function for Healthy Subjects and Individuals With Pulmonary Disease.

Respir Care 2021 Apr 29;66(4):661-668. Epub 2020 Dec 29.

Service de Pneumologie, Cliniques Universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium.

Background: The purposes of this study were to verify the correlation between chest expansion and lung function within a larger sample of subjects composed of both healthy subjects and subjects affected by pulmonary disease, and to verify the influence of age, body mass index, and gender on chest expansion.

Methods: Adults were recruited prospectively when they visited the lung function lab. Chest expansion was measured with a measuring tape at 2 different levels of the rib cage by 1 blinded examiner. Spirometry was performed for each subject.

Results: Data from 251 subjects between 18 and 88 y old were collected and analyzed. Among the analyzed subjects, mean upper and lower chest expansion were 4.82 ± 1.84 cm and 3.99 ± 2.15 cm, respectively. A significant but poor correlation was found between both chest expansion and all lung function parameters (total lung capacity, FVC, and FEV) ( = .01). Negative significant correlations were found between chest expansion and age as well as body mass index. The difference in upper chest expansion between obese and nonobese subjects was not statistically significant, but the difference in lower chest expansion was significant for these 2 groups. Finally, upper and lower chest expansion were not different between males and females.

Conclusions: Based on these results, one cannot validate the use of chest expansion measurement to define lung function. In centers that have easy access to more precise and complete methods to measure lung function, the measurement of chest expansion for diagnostic purposes seems to be archaic. Additionally, age and body mass index are 2 parameters that can influence chest expansion.
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http://dx.doi.org/10.4187/respcare.08350DOI Listing
April 2021

Impact of an Improvised System on Preserving Oxygen Supplies in Patients With COVID-19.

Arch Bronconeumol 2021 Jan 27;57 Suppl 1:77-79. Epub 2020 Aug 27.

Service de Médecine Interne et Maladies Infectieuses, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Louvain Centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique (IREC), Université Catholique de Louvain, Avenue Hippocrate 55, 1200 Brussels, Belgium.

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http://dx.doi.org/10.1016/j.arbres.2020.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450946PMC
January 2021

Cheyne-Stokes respiration and cardiovascular oscillations ending abruptly when deploying transfemoral aortic valve.

J Appl Physiol (1985) 2020 02 24;128(2):345-349. Epub 2019 Dec 24.

Pôle de Pneumologie, ORL et Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.

A 86-yr-old man was referred for transfemoral aortic valve implantation. Transthoracic echocardiography revealed a severe stenosis (mean gradient: 58 mmHg, aortic valve area: 0.4 cm), and after multidisciplinary discussion, the risk of surgery was judged too high (logistic Euroscore: 51%), and the patient was proposed for a transfemoral aortic valve implantation (TAVI). On arrival in the operating room, the patient, fully conscious, was noted to have Cheyne-Stokes breathing (CSB), which persisted after 40% oxygen administration. TAVI procedure was successful, and the CSB pattern was interrupted within 8 s. To the best of our knowledge, this report is the first to show an acute disappearance of CSB, occurring only seconds after TAVI and restoration of a normal hemodynamic situation. To explain such rapid changes in breathing pattern, we hypothesize a role played by the acute release of pulmonary hypertension and pulmonary volume overload. Acute disappearance of Cheyne-Stokes breathing after transfemoral aortic valve implantation suggests a reflex pathway originating from the fall in pulmonary vessels congestion.
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http://dx.doi.org/10.1152/japplphysiol.00193.2019DOI Listing
February 2020

Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During Active Expiratory Flow.

Respir Care 2020 Apr 19;65(4):492-499. Epub 2019 Nov 19.

Service de Pneumologie, Cliniques universitaires Saint-Luc, and with the Institute of Experimental & Clinical Research - Pole of Pneumology, ENT, and Dermatology, Université catholique de Louvain, Brussels, Belgium.

Background: Air-flow oscillations generated by exhaling through oscillatory positive expiratory pressure (OPEP) devices favor airway clearance. Variations in mechanical properties between different devices may influence therapeutic efficacy. The objective of this study was to assess mechanical properties in vitro and to compare the performance of 6 OPEP devices at different resistance levels under active expiratory flow patterns.

Methods: 4 gravity-dependent OPEP devices (ie, Flutter, Gelomuc, Pari O-PEP, Shaker Medic Plus) and 2 gravity-independent OPEP devices (ie, Acapella Choice and Aerobika) were each tested at low, medium, and high resistance settings. All devices were independently connected to a pulmonary waveform generator that reproduced active exhalation flows. Expiratory flow-volume curves were retrieved from 4 subjects with different stages of obstruction severity and were scaled according to either peak expiratory flow (4, 6, and 8 L/s) or volumes (2, 3 and 4 L), thus amounting to 24 active exhalations. Resulting waveforms were divided into 4 parts and the 2 middle parts were used to extract the following mechanical data: positive expiratory pressure (PEP), maximum expiratory pressure (P), oscillation frequency, and flow oscillation amplitude. The percentage of tests achieving oscillation frequencies ≥ 12 Hz and PEP ≥ 10 cm HO was calculated for each device.

Results: Mechanistic effects of the Acapella, Aerobika, and Shaker devices were not comparable. The Flutter, Gelomuc, and Pari devices behaved similarly and achieved more tests with optimum oscillation frequency and PEP values than the other devices. These 3 devices also produced the highest oscillation amplitudes at the low-resistance level, whereas the Aerobika elicited higher and consistent oscillation amplitudes at medium and high resistance settings.

Conclusions: Operational parameters differed between and within devices, yet the Flutter, Gelomuc, and Pari devices were similar in many aspects. Therapeutic efficacy may depend on the selected OPEP device and set resistance.
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http://dx.doi.org/10.4187/respcare.07271DOI Listing
April 2020

Intrapulmonary percussive ventilation leading to 20-minutes breath-hold potentially useful for radiation treatments.

Radiother Oncol 2019 12 25;141:292-295. Epub 2019 Oct 25.

Pôle de Pneumologie, ORL & Dermatologie (PNEU), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Haute Ecole Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium; Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.

We developed a training protocol based on Intrapulmonary Percussive Ventilation in order to prolong breath-hold while nearly suppressing the thorax motion. This protocol allowed ten subjects to achieve a 20-minutes-breath-hold, while reducing the residual surface motion to 1 mm around its mean position for more than 95% of the breath-hold duration.
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http://dx.doi.org/10.1016/j.radonc.2019.09.024DOI Listing
December 2019

Unexpected pressure swings in a positive airway pressure device: an unknown cause for bad CPAP tolerance?

Sleep Breath 2020 Dec 5;24(4):1665-1667. Epub 2019 Oct 5.

Pneumology Department and Center for Sleep Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av Hippocrate 10, 1200, Brussels, Belgium.

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http://dx.doi.org/10.1007/s11325-019-01938-9DOI Listing
December 2020

Targeted Lung Deposition From Nebulization Is Not Improved in the Lateral Decubitus Position in Healthy Volunteers.

Respir Care 2019 Dec 10;64(12):1537-1544. Epub 2019 Sep 10.

Service de Médecine Nucléaire, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Background: Clinical benefits of inhaled therapies are related to the amount of drug deposited in the targeted area of the lung. Body positions that influence the distribution of lung ventilation should impact lung deposition of the nebulized drug. The aim of this study was to analyze the immediate effect of body position while the subject lies on his side (lateral decubitus) during nebulization on 3-dimensional total and regional lung deposition.

Methods: A randomized crossover trial was performed on healthy male volunteers without cardiovascular or pulmonary disease. A technetium-99m diethylenetriaminepentaacetic acid (Tc-DTPA) solution (4 mL) was nebulized using an individual-controlled inhalation system in left lateral decubitus and sitting positions with a 96-h washout period (43 inspirations of 4 s [ie, drug delivered until second 3] with a tidal volume of 0.8 L and a low inspiratory flow (200 mL/s). Drug deposition was followed with the use of planar images and single-photon-emission computed tomography combined with low-resolution computed tomography. Total and regional depositions were the main outcomes. Penetration index was also considered.

Results: Six participants (26.8 ± 6.9 y old) were included. Total lung deposition tended to be higher in a sitting position than in a lateral decubitus position: 10.2 ± 0.9% of nominal dose (95% CI 9.1-11.3) vs 8.6 ± 1.4% of nominal dose (95% CI 6.8-10.4) ( = .09). The deposition was significantly reduced in the dependent (left) lung in the lateral decubitus position: 3.5 ± 0.7% of nominal dose (95% CI 2.6-4.3) vs 4.7 ± 0.3% of nominal dose (95% CI 4.3-5.0) ( = .03). Penetration index was only influenced by body position for the dependent (left) lung ( = .043).

Conclusions: The total amount of drug delivered to the lungs during nebulization with an individual-controlled inhalation system tended to decrease when performed in the left lateral decubitus position. Moreover, contrary to the initial hypothesis, the deposition of particles in the dependent lung was not improved by the lateral decubitus position in this configuration. (ClinicalTrials.gov registration NCT02451501.).
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http://dx.doi.org/10.4187/respcare.06978DOI Listing
December 2019

Mechanically-assisted non-invasive ventilation: A step forward to modulate and to improve the reproducibility of breathing-related motion in radiation therapy.

Radiother Oncol 2019 04 25;133:132-139. Epub 2019 Jan 25.

Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium. Electronic address:

Background And Purpose: When using highly conformal radiotherapy techniques, a stabilized breathing pattern could greatly benefit the treatment of mobile tumours. Therefore, we assessed the feasibility of Mechanically-assisted non-invasive ventilation (MANIV) on unsedated volunteers, and its ability to stabilize and modulate the breathing pattern over time.

Materials And Methods: Twelve healthy volunteers underwent 2 sessions of dynamic MRI under 4 ventilation modes: spontaneous breathing (SP), volume-controlled mode (VC) that imposes regular breathing in physiologic conditions, shallow-controlled mode (SH) that intends to lower amplitudes while increasing the breathing rate, and slow-controlled mode (SL) that mimics end-inspiratory breath-holds. The last 3 modes were achieved under respirator without sedation. The motion of the diaphragm was tracked along the breathing cycles on MRI images and expressed in position, breathing amplitude, and breathing period for intra- and inter-session analyses. In addition, end-inspiratory breath-hold duration and position stability were analysed during the SL mode.

Results: MANIV was well-tolerated by all volunteers, without adverse event. The MRI environment led to more discomfort than MANIV itself. Compared to SP, VC and SH modes improved the inter-session reproducibility of the amplitude (by 43% and 47% respectively) and significantly stabilized the intra- and inter-session breathing rate (p < 0.001). Compared to VC, SH mode significantly reduced the intra-session mean amplitude (36%) (p < 0.002), its variability (42%) (p < 0.001), and the intra-session baseline shift (26%) (p < 0.001). The SL mode achieved end-inspiratory plateaus lasting more than 10 s.

Conclusion: MANIV offers exciting perspectives for motion management. It improves its intra- and inter-session reproducibility and should facilitate respiratory tracking, gating or margin techniques for both photon and proton treatments.
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http://dx.doi.org/10.1016/j.radonc.2018.12.026DOI Listing
April 2019

Artificial intelligence outperforms pulmonologists in the interpretation of pulmonary function tests.

Eur Respir J 2019 04 11;53(4). Epub 2019 Apr 11.

Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.

The interpretation of pulmonary function tests (PFTs) to diagnose respiratory diseases is built on expert opinion that relies on the recognition of patterns and the clinical context for detection of specific diseases. In this study, we aimed to explore the accuracy and interrater variability of pulmonologists when interpreting PFTs compared with artificial intelligence (AI)-based software that was developed and validated in more than 1500 historical patient cases.120 pulmonologists from 16 European hospitals evaluated 50 cases with PFT and clinical information, resulting in 6000 independent interpretations. The AI software examined the same data. American Thoracic Society/European Respiratory Society guidelines were used as the gold standard for PFT pattern interpretation. The gold standard for diagnosis was derived from clinical history, PFT and all additional tests.The pattern recognition of PFTs by pulmonologists (senior 73%, junior 27%) matched the guidelines in 74.4±5.9% of the cases (range 56-88%). The interrater variability of κ=0.67 pointed to a common agreement. Pulmonologists made correct diagnoses in 44.6±8.7% of the cases (range 24-62%) with a large interrater variability (κ=0.35). The AI-based software perfectly matched the PFT pattern interpretations (100%) and assigned a correct diagnosis in 82% of all cases (p<0.0001 for both measures).The interpretation of PFTs by pulmonologists leads to marked variations and errors. AI-based software provides more accurate interpretations and may serve as a powerful decision support tool to improve clinical practice.
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http://dx.doi.org/10.1183/13993003.01660-2018DOI Listing
April 2019

Validation and Reliability of the French Version of the Sydney Swallow Questionnaire.

Dysphagia 2019 08 1;34(4):556-566. Epub 2019 Feb 1.

Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.

Oropharyngeal dysphagia is frequently under-reported and early detection may lead to adapt strategies of rehabilitation and management decisions. The Sydney Swallow Questionnaire (SSQ), a self-reported questionnaire for the detection and quantification of oropharyngeal dysphagia, was previously adapted and validated in other languages but not in French. The purposes of this study were to develop and validate a French version of SSQ (SSQ-f) and to assess its psychometric properties. This SSQ-f, obtained by back-translation and cross-cultural adaptation, was validated in 27 patients with impaired swallowing and 27 healthy controls. After inclusion, patients filled in the SSQ-f and performed a videofluoroscopic swallow study. The penetration aspiration scale (PAS) and Dysphagia outcome and severity scale (DOSS) were assigned to assess construct validity. Sensitivity and specificity of cut-off scores for the SSQ-f were assessed by the receiver operating characteristic (ROC) curves. Moreover, the SSQ-f was repeated after 2 weeks to evaluate its test-retest reliability. The results supported that SSQ-f was considered understandable. Its total score was strongly correlated to the DOSS (r = - 0.873) and to the PAS (r = 0.738). It demonstrated acceptable internal consistency, with Cronbach's alpha values ranging from 0.744 to 0.956. The test-retest reliability was excellent. According to the ROC curve, cut-off scores of 118.5 or 218.5 were proposed for determining oropharyngeal dysphagia using DOSS as a reference and 755.0, using PAS as reference. No ceiling or floor effects were observed. In conclusion, the SSQ-f is a valid and reliable instrument to measure and detect oropharyngeal dysphagia in French-speaking subjects and can be used in a clinical setting.
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http://dx.doi.org/10.1007/s00455-019-09978-9DOI Listing
August 2019

Comparison of ERS'93 to the newly published GLI'17 reference values for carbon monoxide transfer factor.

Respir Med 2019 01 15;146:113-115. Epub 2018 Dec 15.

Université Catholique de Louvain (UCL), Institute of Experimental & Clinical Research - Pole of Pneumology, ENT and Dermatology, Brussels, Belgium; Department of Pneumology, Cliniques Universitaires St-Luc, Brussels, Belgium. Electronic address:

Background: The new predicted values for the carbon monoxide transfer factor (TL,CO) for Caucasians by the Global Lung Function Initiative are available since September 2017. Several authors have previously shown that the predicted values of Cotes et al. (ERS'93), overestimated TL,CO. However, the GLI'17 authors omitted to compare their predicted values with the ERS'93 equations, still in use throughout Europe. We present the differences between the two sets of predicted values, and in an attempt to improve the readability, used the contour plots instead of the classical 2-dimensional representations.

Methods: Predicted values were computed for males and females for ages between 18 and 70 years and heights between 155 and 180 cm using Matlab software with increments of one unit (1 yr, 1 cm).

Results: We demonstrate that GLI-'17 predicted values of TL,CO are systematically lower than those of ERS-'93, but also that the magnitude of the differences varies according to age, height and sex. More specifically, differences increase in both males and females by decreasing age and height, reaching up to 16% in males and 24% in females.

Conclusion: The predicted values of TL,CO by Cotes at al. are systematically larger than the new GLI'17 values. Plotting all the possible differences between predicted variables using contour graphs allows to identify the groups of subjects in whom significant changes in their predicted values will occur. Our findings should prompt physicians to investigate how switching to GLI-17 equations affects the clinical interpretation of TL,CO measurements in a real-live setting.
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http://dx.doi.org/10.1016/j.rmed.2018.12.005DOI Listing
January 2019

Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers-Danlos syndrome: A randomized controlled trial.

Am J Med Genet A 2019 03 20;179(3):356-364. Epub 2018 Dec 20.

Laboratory of Human Molecular Genetics (GEHU), de Duve Institute (DDUV), Université catholique de Louvain (UCLouvain), Belgium.

As exertional inspiratory dyspnea is a common disabling complaint in hypermobile Ehlers-Danlos syndrome (hEDS) often also known as joint hypermobility syndrome (JHS), we investigated inspiratory muscle (IM) strength in patients with hEDS, and we assessed the effects of IM training (IMT) on IM strength, lung function, and exercise capacity. A prospective evaluation of IM strength followed by a randomized controlled trial of IMT was performed in women with hEDS. Sniff nasal inspiratory pressure (SNIP) was used to routinely measure IM strength and IMT was carried out using a pressure threshold device. IM strength (main outcome), cardiopulmonary function, exercise capacity, and emotional distress of both the treated and control groups were evaluated at the start and at the end of the 6-week training period. IM strength was reduced (<80% of predicted) in 77% of patients (80/104). Lung function was normal, although 24% of patients had a higher forced expiratory vital capacity (FVC) than normal and 12% of patients had a higher total lung capacity (TLC) than normal. Both the IMT and control groups (n = 20) had similar baseline characteristics. Significant changes were noted only in the IMT group after IMT. At the end of the program, IMT improved SNIP (20%) (before: 41 ± 17 cm H O [28, 53] vs. after: 49 ± 18 cm H O [34;65]), six-minute walking distance (6MWD) (60 m) (455 ± 107 m [379,532] vs. 515 ± 127 m [408, 621]), and forced expiratory volume in one second (FEV1) (285 mL) (94 ± 14% pred [84,104] vs. 103 ± 11% pred [94, 112]). IM strength is significantly reduced in patients with hEDS. IMT improved IM strength, lung function, and exercise capacity. Our findings suggest that IMT should be added to usual care.
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http://dx.doi.org/10.1002/ajmg.a.61016DOI Listing
March 2019

Launching Global Lung Function Initiative reference values in Belgium: tips and tricks.

Eur Respir J 2018 08 2;52(2). Epub 2018 Aug 2.

Dept of Chronic Diseases, Metabolism and Ageing (CHROMETA), University Hospital Leuven, KU Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1183/13993003.00922-2018DOI Listing
August 2018

Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice.

Int J Chron Obstruct Pulmon Dis 2018 5;13:2089-2099. Epub 2018 Jul 5.

Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium.

Evidence and guidelines are becoming increasingly clear about imbalance between the risks and benefits of inhaled corticosteroids (ICSs) in patients with COPD. While selected patients may benefit from ICS-containing regimens, ICSs are often inappropriately prescribed with - according to Belgian market research data - up to 70% of patients in current practice receiving ICSs, usually as a fixed combination with a long-acting β-adrenoreceptor agonist. Studies and recommendations support withdrawal of ICSs in a large group of patients with COPD. However, historical habits appear difficult to change even in the light of recent scientific evidence. We have built a collaborative educational platform with chest physicians and primary care physicians to increase awareness and provide guidance and support in this matter.
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http://dx.doi.org/10.2147/COPD.S164259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039066PMC
January 2019

Sleep-disordered breathing in patients with neuromuscular disease.

Sleep Breath 2018 05 12;22(2):277-286. Epub 2017 Jul 12.

Department of Neurology-Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.

Sleep-disordered breathing (SDB) is relatively common in general population as well as in patients with neuromuscular disease. SDB comprises a wide spectrum of disorders varying from simple snoring to complete closure of the upper airway as seen in obstructive sleep apnoea (OSA). It includes also other disorders like prolonged hypoxemia, hypoventilation, and central sleep apnoea (CSA). Neuromuscular diseases (NMD) form a group of disorders that can cause significant reduction in the quality and span of life. The involvement of respiratory system in the context of these disorders is the most serious complication, and it is considered as the leading cause of death in those patients. NMD can affect ventilation, cough, swallowing, and phonation. The involvement of respiratory muscles makes NMD patients vulnerable to sleep-disordered breathing with a significant prevalence of SDB among such patients.
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http://dx.doi.org/10.1007/s11325-017-1538-xDOI Listing
May 2018

Pulmonary Drug Delivery Following Continuous Vibrating Mesh Nebulization and Inspiratory Synchronized Vibrating Mesh Nebulization During Noninvasive Ventilation in Healthy Volunteers.

J Aerosol Med Pulm Drug Deliv 2018 02 6;31(1):33-41. Epub 2017 Jul 6.

6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, 1200 Brussels, Belgium .

Background: A breath-synchronized nebulization option that could potentially improve drug delivery during noninvasive positive pressure ventilation (NIPPV) is currently not available on single-limb circuit bilevel ventilators. The aim of this study was to compare urinary excretion of amikacin following aerosol delivery with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes.

Materials And Methods: A crossover clinical trial involving 6 noninvasive ventilated healthy volunteers (mean age of 32.3 ± 9.5 y) randomly assigned to both vibrating mesh nebulization modes was conducted: Inspi-Neb delivered aerosol during only the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. All subjects inhaled amikacin solution (500 mg/4 mL) during NIPPV using a single-limb bilevel ventilator (inspiratory positive airway pressure: 12 cm HO, and expiratory positive airway pressure: 5 cm HO). Pulmonary drug delivery of amikacin following both nebulization modes was compared by urinary excretion of drug for 24 hours post-inhalation.

Results: The total daily amount of amikacin excreted in the urine was significantly higher with Inspi-Neb (median: 44.72 mg; interquartile range [IQR]: 40.50-65.13) than with Conti-Neb (median: 40.07 mg; IQR: 31.00-43.73), (p = 0.02). The elimination rate constant of amikacin (indirect measure of the depth of drug penetration into the lungs) was significantly higher with Inspi-Neb (median: 0.137; IQR: 0.113-0.146) than with Conti-Neb (median: 0.116; IQR: 0.105-0.130), (p = 0.02). However, the mean pulmonary drug delivery rate, expressed as the ratio between total daily urinary amount of amikacin and nebulization time, was significantly higher with Conti-Neb (2.03 mg/min) than with Inspi-Neb (1.09 mg/min) (p < 0.01).

Conclusions: During NIPPV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization may improve pulmonary drug delivery compared with conventional continuous vibrating mesh nebulization.
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http://dx.doi.org/10.1089/jamp.2016.1339DOI Listing
February 2018

One minute sit-to-stand test is an alternative to 6MWT to measure functional exercise performance in COPD patients.

Clin Respir J 2018 Mar 15;12(3):1247-1256. Epub 2017 Jun 15.

Pulmonary rehabilitation unit, Morlaix Hospital Centre, France.

Introduction: Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise performance. Even if this parameter is routinely evaluated using 6-minute walking test (6MWT), new field tests are regularly investigated as alternative tests. The aim of this study was to compare functional exercise performance evaluation by sit-to-stand test (STST) and 6MWT and to evaluate reliability and repeatability of the STST in COPD patients.

Method: Forty-two COPD patients performed randomly two tests: 6MWT and STST. Each test was repeated two times. Distance (6MWD) and number of repetitions were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded before and after the tests.

Results: Sit-to-stand repetitions (19 ± 6) and 6MWD (441 ± 104 m) were correlated (r = .716; P < .001). Good repeatability was found for STST and 6MWT. Good reliability was observed for STST (ICC = 0.902). Variations of heart rate and pulsed oxygen saturation were significantly different between these two tests (23% ± 17% vs 13% ± 11%; P = .022 and -7.6% ± 4.6% vs -0.7% ± 2.7%; P < .001 for 6MWT and STST, respectively). Variations of dyspnea and lower limb fatigue were similar between both tests (P = .827 and P = .467).

Conclusion: The one minute sit-to-stand test is a valuable alternative to 6MWT to estimate functional exercise performance in COPD patients. The cardiorespiratory demand is different between both tests although the variation of dypsnea is similar. No learning effect was observed for STST.
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http://dx.doi.org/10.1111/crj.12658DOI Listing
March 2018

In Vitro and In Vivo Comparison of Two Nebulizers Used for Inhaled Pentamidine Delivery.

Arch Bronconeumol 2017 Dec 3;53(12):697-698. Epub 2017 Jun 3.

Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.

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http://dx.doi.org/10.1016/j.arbres.2017.05.001DOI Listing
December 2017

In Vitro and In Vivo Evaluation of the Combination of Oscillating Positive Expiratory Pressure and Nebulization: A Randomized Cross-Over Study.

Arch Bronconeumol 2017 Dec 27;53(12):695-697. Epub 2017 May 27.

Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Belgium.

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http://dx.doi.org/10.1016/j.arbres.2017.04.011DOI Listing
December 2017

Inhaled treatment of COPD: a Delphi consensus statement.

Int J Chron Obstruct Pulmon Dis 2017 6;12:793-801. Epub 2017 Mar 6.

Medical Department, Novartis Pharma, Vilvoorde, Belgium.

Background: Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification.

Objectives: To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories.

Methods: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts.

Results: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting β2-agonist (LABA) and LABA/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV)<50%, a very good consensus was reached for LAMA/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA/LAMA/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA/LAMA and LABA/LAMA/ICS could be the first choice for these patients.

Conclusion: Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV<50% and ≥2 moderate exacerbations or 1 severe exacerbation/year.
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http://dx.doi.org/10.2147/COPD.S125564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345984PMC
August 2017

Short-Term Effect of Autogenic Drainage on Ventilation Inhomogeneity in Adult Subjects With Stable Non-Cystic Fibrosis Bronchiectasis.

Respir Care 2017 May 21;62(5):524-531. Epub 2017 Feb 21.

Department of Pneumology.

Background: Lung clearance index (LCI), a measure of ventilation inhomogeneity derived from a multiple-breath washout test, is a promising tool for assessing airway function in patients with non-cystic fibrosis bronchiectasis. However, it is unknown whether ventilation inhomogeneity could improve after successful elimination of excessive secretions within bronchiectasis. The objective of this work was to assess the short-term effects of lung secretion clearance using the autogenic drainage technique on standard lung function tests and LCI in subjects with non-cystic fibrosis bronchiectasis.

Methods: Nitrogen-based multiple-breath washout, spirometry, and body plethysmography tests were performed 30 min before autogenic drainage in adults with stable non-cystic fibrosis bronchiectasis. The autogenic drainage session was followed by a 5-min break, after which the tests were repeated in the same order. Sputum expectorated during autogenic drainage was quantified as dry weight and correlated with change between post- and pre-measurements (Δ). Paired test or Wilcoxon signed-rank tests were used to compare pre- and post-autogenic drainage measurement outcomes. A value of ≤.05 was considered as statistically significant.

Results: Twenty-four subjects were studied (18 females, median age [range]: 65 [21-81] y). Mean ± SD LCI significantly improved after autogenic drainage (10.88 ± 2.62 vs 10.53 ± 2.35, = .042). However, only 20% of subjects with mucus hyperproduction during autogenic drainage had a ΔLCI that exceeded measurement variability. The percent of predicted slow vital capacity (SVC%) also slightly improved (88.7 ± 19.3% vs 90 ± 19.1%, = .02). ΔLCI was inversely related to dry sputum weight (r = -.48, = .02) and ΔSVC% (r = -.64, = .001). ΔSVC% also correlated with dry sputum weight (r = 0.46, = .02).

Conclusions: In adults with non-cystic fibrosis bronchiectasis and mucus hypersecretion, autogenic drainage improved ventilation inhomogeneity. LCI change may be the result of the maximum recruited lung volume and the amount of cleared mucus secretion. (ClinicalTrials.gov registration NCT02411981.).
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http://dx.doi.org/10.4187/respcare.05194DOI Listing
May 2017

Cephalometrics of Pharyngeal Airway Space in Lebanese Adults.

Int J Dent 2017 4;2017:3959456. Epub 2017 Jan 4.

Department of Periodontics, Lebanese University, School of Dentistry, Beirut, Lebanon.

. The upper airway space is significant in orthodontic diagnosis and treatment planning. The objectives of this study are to assess the dimensions of soft tissue elements of the upper pharyngeal space and evaluate potential correlations with modifying variables such as gender, skeletal class, and anthropometric parameters. . Lateral cephalograms were obtained from 117 healthy young adult Lebanese subjects. Nineteen cephalometric linear/angular measurements of the nasopharynx, oropharynx, and hypopharynx were recorded. Anthropometric parameters including body mass index and neck circumference were measured. . Significant differences were demonstrated for 12 out of the 19 parameters considered between genders. Uvula and tongue dimensions and the distances between epiglottis-posterior pharyngeal wall and epiglottis-posterior nasal spine were significantly larger in males. The anteroposterior inclination of the uvula and the distances between the uvula and posterior pharyngeal wall were significantly greater in females. No significant differences were found between skeletal classes relative to most of the variables. Body mass index and neck circumference were positively correlated with the dimensions of tongue and uvula. . Sexual dimorphism relative to some cephalometric variables and anthropometric parameters may account partly for larger oronasopharyngeal spaces in females. Anthropometric data need to be accounted for in population-related comparisons.
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http://dx.doi.org/10.1155/2017/3959456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241489PMC
January 2017

Influence of Different Kinds of Music on Walking in Children.

Rehabil Nurs 2017 Jan/Feb;42(1):33-38

1 Pôle de Pneumologie, ENT & Dermatologie, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium2 Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium3 Service de Médecine physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Purpose: The aim of this study was to evaluate the effect of different kinds of music on submaximal performance and exercise tolerance in healthy children by means of the 6-minute walking test (6MWT) and to explore the influence of gender.

Design: Cross-over study.

Method: Ninety-seven children performed 6MWT in four conditions (without music, with their preferred music, with slow and with fast music). Distance, cardio-respiratory parameters, perceived exertion rate, and amount of dyspnea were measured.

Findings: Walked distance depended on the kind of music (p = .022). To listen to fast music promoted a longer distance when compared with slow music. Walked distance was not influenced by gender (p = .721) and there was no interaction between music and gender for walked distances (p = .069). The other parameters were not modified by music and gender.

Conclusion: Music influences submaximal performances without modifying exercise tolerance in healthy children.

Clinical Relevance: Music does modify submaximal performance in children.
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http://dx.doi.org/10.1002/rnj.300DOI Listing
March 2018

Variability of gait speed during six minutes walking test in COPD and cystic fibrosis patients.

Gait Posture 2016 09 8;49:36-40. Epub 2016 Jun 8.

Service de Pneumologie, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, 1200 Brussels, Belgium; Centre de référence pour la mucoviscidose, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgium. Electronic address:

Background: Recently, gait speed reached an increasing importance in the management of respiratory patients. The aim of this retrospective study was to compare walking speed and physiological adaptations during the 6MWT in COPD and CF patients.

Methods: 6MWT performed by COPD and CF patients were retrospectively reviewed. Global and sequential walking speeds were measured on six minutes and every sequence of two minutes respectively. Heart rate, oxygen saturation and dyspnea were analyzed.

Results: 78 and 246 tests from CF and COPD patients were reviewed respectively. FEV1 (52.3 vs 56.2% pred) and FVC (72.5 vs 73.8% pred) were similar between both diseases. However, 6MWT in patients with CF were characterized by significantly higher heart rate, global walking speed and walking distance (+68%) while dyspnea evolutions and the proportions of patients presenting walking speed decline over the 6min were significantly lower.

Conclusion: Walking speed and cardio-respiratory parameters evolution during 6MWT differ between COPD and CF patients.
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http://dx.doi.org/10.1016/j.gaitpost.2016.06.007DOI Listing
September 2016

Reliability and Reproducibility of Chest Wall Expansion Measurement in Young Healthy Adults.

J Manipulative Physiol Ther 2016 Jul-Aug;39(6):443-449. Epub 2016 Jun 23.

Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Physiotherapist, cliniques universitaires Saint-Luc, Service de Pneumologie, Woluwe-Saint-Lambert, Belgium. Electronic address:

Objective: The purposes of this study were to (1) evaluate the reliability and reproducibility of chest expansion (CE) measurement on 2 different levels and (2) observe relationships between upper and lower CE measurements and lung function.

Methods: Fifty-three healthy subjects aged between 18 and 39 years were recruited. Chest expansion measurements were taken with a cloth tape measure at 2 levels of the rib cage (upper and lower). Reproducibility of the measurement was measured for 2 physiotherapists and on 2 different days. Lung function (ie, forced expiratory volume in 1 second [FEV1], forced vital capacity (FVC), vital capacity and, inspiratory capacity) was measured for all subjects by a spirometer (MEC Pocket-spiro USB100, Medical Electronic Construction, Brussels, Belgium).

Results: Upper CE was less than lower CE (5.4 cm and 6.4 cm, respectively; P < .001). Intrarater and interrater reliability were good for upper and lower CE. Reproducibility between physiotherapists was verified for both CE measurements. Reproducibility between days was only verified for upper CE. Sex influenced lower CE. Upper and lower CE values were correlated (r = 0.747; P < .01). Lower and upper CE were significantly and positively correlated with all lung function parameters and inspiratory muscle strength (moderately and weakly, respectively) except to inspiratory capacity for upper CE (P = .051) and for FEV1/FVC for both CE measurements.

Conclusion: Upper and lower CE measurements showed good intra- and interrater reliability and reproducibility in healthy subjects. Although both measurements were correlated with lung functions (ie, FEV1, FVC, and vital capacity), the findings of this study showed that upper CE measurements may be more useful in clinical practice to evaluate chest mobility and to give indirect information on lung volume function and inspiratory muscle strength.
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http://dx.doi.org/10.1016/j.jmpt.2016.05.004DOI Listing
March 2018

In Vitro Comparison of a Vibrating Mesh Nebulizer Operating in Inspiratory Synchronized and Continuous Nebulization Modes During Noninvasive Ventilation.

J Aerosol Med Pulm Drug Deliv 2016 08 16;29(4):328-36. Epub 2016 Jun 16.

6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium .

Unlabelled: Backround: Coupling nebulization with noninvasive ventilation (NIV) has been shown to be effective in patients with respiratory diseases. However, a breath-synchronized nebulization option that could potentially improve drug delivery by limiting drug loss during exhalation is currently not available on bilevel ventilators. The aim of this in vitro study was to compare aerosol delivery of amikacin with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes.

Methods: Using an adult lung bench model of NIV, we tested a vibrating mesh device coupled with a bilevel ventilator in both nebulization modes. Inspi-Neb delivered aerosol only during the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. The nebulizer was charged with amikacin solution (250 mg/3 mL) and placed at two different positions: between the lung and exhalation port and between the ventilator and exhalation port. Inhaled, expiratory wasted and circuit lost doses were assessed by residual gravimetric method. Particle size distribution of aerosol delivered at the outlet of the ventilator circuit during both nebulization modes was measured by laser diffraction method.

Results: Regardless of the nebulizer position, Inspi-Neb produced higher inhaled dose (p < 0.01; +6.3% to +16.8% of the nominal dose), lower expiratory wasted dose (p < 0.05; -2.7% to -42.6% of the nominal dose), and greater respirable dose (p < 0.01; +8.4% to +15.2% of the nominal dose) than Conti-Neb. The highest respirable dose was found with the nebulizer placed between the lung and exhalation port (48.7% ± 0.3% of the nominal dose).

Conclusions: During simulated NIV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization improves respirable dose and reduces drug loss of amikacin compared with continuous vibrating mesh nebulization.
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http://dx.doi.org/10.1089/jamp.2015.1243DOI Listing
August 2016

Randomized Controlled Trial of the Effect of Inspiratory Muscle Training and Incentive Spirometry on Respiratory Muscle Strength, Chest Wall Expansion, and Lung Function in Elderly Adults.

J Am Geriatr Soc 2016 05;64(5):1128-30

Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.

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http://dx.doi.org/10.1111/jgs.14097DOI Listing
May 2016