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BackgroundHigh-flow nasal therapy (HFNT) is a widely used non-invasive respiratory support technique, but data on its clinical application remain limited. This study aimed to assess clinicians’ self-reported practices, perceptions and barriers regarding HFNT use in acute and chronic respiratory failure.MethodsA cross-sectional web-based survey was disseminated among members of the European Respiratory Society’s respiratory intensive care, rehabilitation and chronic care, and allied respiratory professionals assemblies from September to November 2023. Descriptive analysis was performed, with results presented as frequencies and percentages.ResultsA total of 1176 clinicians from 104 countries participated, primarily pulmonologists (78.3%) and respiratory therapists (9.7%). HFNT was most commonly used for de novo acute respiratory failure (56.2%) and interstitial lung disease exacerbations (56.3%), with lower utilisation for chronic obstructive pulmonary disease with hypercapnia (47.4%) and trauma/atelectasis (41.5%). Despite guideline recommendations, 67% of respondents initiated HFNT only after conventional oxygen therapy failure. HFNT was also frequently used for symptom relief in palliative care, despite limited supporting evidence. Respiratory distress was the primary clinical trigger for HFNT initiation, while the ROX (Respiratory Rate-Oxygenation) index was rarely used to guide escalation of care (32%). Barriers to HFNT adoption included equipment costs (23%), lack of funding (22%) and limited clinician knowledge (18%). HFNT use increased during the COVID-19 pandemic (84%), but long-term application for chronic respiratory failure remained rare (16%).ConclusionsThis survey highlights significant variability in HFNT practices and a disconnect between guidelines and real-world implementation. Addressing financial and educational barriers may improve adherence to evidence-based recommendations.

OBJECTIVES: The London Chest Activity of Daily Living Scale (LCADL) is a simple, useful, and comprehensive measure of dyspnea perception in activities of daily living. This study was conducted to determine the validity and reliability of the Turkish version of the LCADL. MATERIALS AND METHODS: A total of 64 patients with obstructive lung disease (24 chronic obstructive pulmonary disease, 20 asthma, and 20 bronchiectasis patients) were included. The Turkish LCADL was evaluated for interobserver reliability, test–retest reliability, and criterion validity. Two different observers applied the scale with an interval of 10 minutes to assess interobserver reliability. The second observer applied the scale twice at an interval of 10–15 days to assess test–retest reliability. Criterion validity was assessed using the 6-minute walk test (6MWT), Nottingham Health Profile (NHP), and Saint George Respiratory Questionnaire (SGRQ). RESULTS: The interobserver reliability of the scale was very high (rs=0.985, p<0.050). Cronbach's alpha coefficient for total score was 0.976 and intraclass correlation coefficient was 0.953. These results indicate that the Turkish LCADL has high reliability. The correlation between LCADL and 6MWT was moderate 0.503 (p=0.002). The LCADL total score was weakly correlated with NHP total score (rs=0.370, p=0.040) and SGRQ total score (rs=0.367, p=0.004). CONCLUSION: The Turkish version of the LCADL scale is reliable and valid in obstructive lung disease. The LCADL scale will be beneficial in existing pulmonary rehabilitation programs aiming to improve functional status. We believe that using the Turkish LCADL scale as an outcome measure in pulmonary rehabilitation programs will serve as an indicator of rehabilitation efficacy for individual patients.

OBJECTIVES: Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers toward applying physiotherapy in ICUs. MATERIALS AND METHODS: A 54-item survey for determining the characteristics of physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23–52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. RESULTS: The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapist (low level of employment and practice, lack of shift); patient (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. CONCLUSION: The most common interventions were positioning, active, passive, and breathing exercises and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, team, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Recovery from pneumonia takes around 3–6 months in individuals with severe COVID-19. In order to detect the isolated damage caused by COVID-19, the 6-month period must pass after the recoveries. However, to our knowledge, no published study analyzes a comprehensive evaluation of individuals with severe COVID-19 after 6 months. We aimed to evaluate long-term consequences of severe COVID patients by comparing respiratory function, functional capacity, quality of life, fatigue, and balance 6 months after the intensive care unit (ICU) discharge with healthy individuals. Method: 26 post-COVID adult patients and 26 healthy individuals (control group) were included in this study. Physical characteristics of both groups and patients’ ICU data, including APACHE II scores, were recorded. Lung function, respiratory, and peripheral muscle strength were measured. The lower limit of normal (LLN) cutoff points for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were calculated. A 6-minute walk test (6MWT) was used to assess functional capacity. Time Up and Go test (TUG) with a stadiometer was performed for balance evaluation. Quality of life was evaluated using Nottingham Health Profile (NHP) and St George Respiratory Questionnaire (SGRQ). Results: Percent predicted FVC and FEV1, 6MWT distance, change in oxygen saturation (SpO2) during 6MWT, were lower and NHP, SGRQ, FSS scores and TUG findings were higher in the COVID group than the control group (p < 0.05). The FVC of nine individuals and the FEV1 value of seven individuals in the COVID-19 group were below the LLN values. A moderate correlation was found between ICU length of stay and APACHE II scores with FVC, FEV1, 6MWT distance, and change in SpO2 values in the COVID-19 patients (p < 0.05). Conclusion: Respiratory function, functional capacity, quality of life, and fatigue levels of the individuals with severe COVID-19 infection are impaired at 6 months after ICU discharge. Impaired lung function might be associated with severe inflammation, which starts during the acute infection process and the fibrous tissue during the healing process, impairing lung compliance and diffusion capacity. Infiltration of coronavirus and inflammatory cytokines into the cerebrum and muscle might have increased fatigue and decreased functional capacity. Overall, our study suggests that severe COVID patients need post-discharge care even after 6 months of recovery.

Background There are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis. Methods Twenty patients with bronchiectasis (43.5 ± 14.1 years) and 20 healthy subjects (43.0 ± 10.9 years) participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP), and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC) were determined. A six-minute walk test (6MWT) was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively) using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS) and the Leicester Cough Questionnaire (LCQ), respectively. Results Number of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects ( p  < 0.05). In bronchiectasis patients, QMS was significantly associated with HGS, MIP and MEP ( p  < 0.05). The 6MWT distance was significantly correlated to LCQ psychological score ( p  < 0.05). The FSS score was significantly associated with LCQ physical and total and MMRC scores ( p  < 0.05). The LCQ psychological score was significantly associated with MEP and 6MWT distance ( p  < 0.05). Conclusions Peripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

Objectives: Work of walking is an important outcome measurement of functional capacity. The aim of this study was to compare work of walking in lung cancer patients with healthy subjects and and to investigate the relationship of respiratory muscle strength. Methods: Thirty patients with lung cancer (24 male, 6 female, mean age=62.66±7.32 years) and 30 healthy individuals (24 male, 6 female, mean age=59.86±5.99 years) were included in the study. Functional capacity was evaluated using 6 minute walking test (6MWT). The work of walking calculated as a result of multiplying by 6 MWT walking distance and the body weight. Respiratory muscle strength (maximal inspiratory pressure-MIP, maximal expiratory pressure-MEP) was assessed with a mouth pressure device. Results: Respiratory muscle strength, work of walking and 6MWT distance were significantly lower in lung cancer patients as compared to healthy subjects (p<0.05). The WOW in 6MWT was significantly related with MIP (r=0.515, p <0.001) and MEP (r=0.485, p <0.001). Conclusion: The work of walking and respiratory muscle strength was lower than in patients with lung cancer. Work of walking during submaximal exercise correlated with respiratory muscle strength. The work walking can be used as an appropriate outcome measure for effective pulmonary rehabilitation programs in lung cancer patients.

Objectives: The positive effects of weighted exercise training on balance and exercise capacity in different diseases with low bone mineral density have been demonstrated. The aim of our study was to investigate the effects of exercise training with weighted vest on lean body weight, balance and functional capacity in patients with cystic fibrosis (CF). Methods: Weighted exercise training was carried on treadmill that the patients wore a weighted vest (4–8% of body weight). Exercise training was performed in 70% of the maximal heart rate for 6 weeks, 3 days a week, 30-45 minutes a day. Body composition, body fat mass, and lean body mass were measured by bioelectrical impedance analysis. Balance was evaluated with Flamingo Balance Test (static balance) and Y Balance Test (dynamic balance). Functional exercise capacity was assessed using 6 Minute Walk Test (6MWT). Results: Six CF patients completed the weighted exercise training. Two of the four patients who did not complete the study stopped exercising due to acute lung infection and two others due to transportation problems. Demographic characteristics of the patients who completed and did not complete were similar (p>0.05). At the end of the training, there was a significant improvement in 6MWT distance and Flamingo Balance test score (p<0.05). No differences were found in the body composition and Y balance test after training (p>0.05). Conclusion: Exercise training with a weighted vest in CF improves the functional exercise capacity and the static balance. We need a greater number of patients and control group for evaluating the effects on the body composition.

Background General movements (GMs) in infants occur as fidgety movements (FMs) between postterm 9 and 20 weeks. We aimed to evaluate FMs and motor repertoire in infants with cystic fibrosis (CF) and their relation with clinical findings. Methods Demographic and clinical characteristics were recorded. FMs and motor repertoire were analyzed from a 5-min video recording of each infant. Videos were rated based on the Prechtl General Movement Assessment and motor optimality score (MOS) was calculated. Results The analysis included 18 infants with CF and 20 healthy infants at postterm age of 3−5 months. MOS was significantly lower in the infants with CF compared to controls ( p  < 0.05). Fifty percent of the infants with CF had abnormal or absent/sporadic FMs. MOS was negatively associated with hospitalization duration ( r  = −0.378, p  = 0.036); and positively associated with vitamin A level in CF infants ( r  = 0.665, p  = 0.026). Conclusions Infants with genetically anticipated severe CF phenotype tended to have lower MOS. MOS may be used in addition to genetic testing to predict disease severity in infants with CF. Infants with CF, absent/sporadic FMs, and lower MOS could be considered for planning specific age-adequate early intervention programs. Impact Motor repertoire was age-inadequate in infants with cystic fibrosis (CF). 50% of infants with CF had abnormal or absent/sporadic fidgety movements (FMs). Motor optimality score (MOS) was positively associated with vitamin A level and negatively correlated with hospitalization duration in infants with CF. MOS tended to decrease as genetically anticipated disease severity increased; thus, MOS might enable us to predict disease severity in CF. The relationship between motor repertoire and phenotype and genotype is unclear and warrants further study. CF infants with absent/sporadic FMs, and lower MOS could be considered for planning early intervention.

Background. Vascular changes are observed in children with cystic fibrosis (cwCF), and gender-specific differences may impact arterial stiffness. We aimed to compare arterial stiffness and clinical parameters based on gender in cwCF and to determine the factors affecting arterial stiffness in cwCF. Methods. Fifty-eight cwCF were included. Pulmonary function, lean body mass, handgrip strength, and peak oxygen uptake (VO2peak) were assessed using a cardiopulmonary exercise test. Arterial stiffness (pulse wave velocity [PWV] and augmentation index [AIx@75]) and hemodynamic parameters (resting heart rate [HR] and stroke volume [SV]) were measured using brachial pulse waves. Endothelial function (ICAM-1, sVCAM-1, sE-selectin, VEGF-A, ET-1) was evaluated using blood samples. Results. Female cwCF had significantly lower VO2peak, SV, and PWV, and higher resting HR, AIx@75, and AIx@75-z-score than male cwCF (p<0.05). AIx@75-z-score was associated with gender (r=0.516, p<0.001), age (r= -0.345, p=0.008), lean body mass (r= -0.451, p<0.001), forced expiratory volume in one second (FEV1)-z-score (r= -0.332, p=0.011), handgrip strength (r= -0.466, p<0.001), and VO2peak (r= -0.459, p<0.001) and peak workload (r= -0.527, p<0.001). AIx@75-z-score was not associated with ICAM-1, sVCAM-1, sE-selectin, VEGF-A, or ET-1 (p>0.05). The FEV1-z-score and gender explained 34.6% of the variance in AIx@75-z-score (p<0.05). Conclusions. Female cwCF have more impaired hemodynamics, less maximal exercise capacity, and increased arterial stiffness, indicating a higher cardiovascular risk compared to male cwCF. FEV1 and gender affect arterial stiffness in cwCF. Further studies are necessary to uncover the underlying factors for arterial stiffness and endothelial dysfunction and their clinical effects in cwCF.

Background. There is a need to identify the complex interplay between various physiological mechanisms in primary ciliary dyskinesia (PCD) and cystic fibrosis (CF). The study investigated the interaction between respiratory function, exercise capacity, muscle strength, and inflammatory and oxidant/antioxidant responses in patients with PCD and CF. Methods. The study included 30 PCD patients, 30 CF patients, and 29 age and sex-matched healthy subjects. Exercise capacity was assessed using the modified shuttle walk test (MSWT). Handgrip strength (HGS) was used to evaluate general muscle strength. Oxidative stress-inflammatory parameters were also assessed. Pulmonary function test was performed by spirometry. Regarding the forced expiratory volume in 1 second (FEV1) z-score, patients with PCD and CF were subdivided into normal, mild, and severe/moderate groups. Results. Forced vital capacity (FVC) z-scores were lower in PCD and CF patients than controls. FEV1, FEV1/FVC, peak expiratory flow (PEF), and forced mid expiratory flow (FEF25-75%) z-scores were lower in PCD than in the other groups. HGS was lower in both mild PCD and normal CF patients relative to the controls. MSWT distance was lower in severe/moderate PCD patients than controls. Catalase (CAT), glutathione S-transferase (GST), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels did not differ significantly among the study groups, but superoxide dismutase (SOD) level in severe/moderate PCD, and glutathione (GSH) level in normal CF were higher than in controls. Interleukin-6 (IL-6) level was higher in patients with normal PCD and CF compared to the controls. IL-1β level was higher in PCD compared to controls. Additionally, correlations among these parameters were also determined in some patient groups. Conclusion. Homeostasis related to respiratory function, aerobic performance, muscle strength, inflammatory response, and oxidant/antioxidant balance were affected in PCD and CF. Evaluating these mechanisms together may contribute to elucidating the pathophysiology of these rare diseases.