• Tuberculosis and Respiratory Diseases
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• v.72 no.1
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• pp.24-29
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• 2012

Background: Measurement of peak expiratory flow rate (PEFR) in a follow-up examination for a chronic airway disease is useful because it has the advantages of being a simple measurement and can be repeated during examination. The aim of this study was to examine the annual decrease of PEFR in asthma and chronic obstructive pulmonary disease (COPD) patients and to confirm the factors which influence this decrease. Methods: From May, 2003 to September, 2010, the annual decrease of PEFR was obtained from asthma and COPD patients attending an outpatient pulmonary clinic. PEFR was measured using a Mini-Wright peak flow meter (Clement Clarke International Ltd. UK), and we conducted an analysis of factors that influence the change of PEFR and its average values. Results: The results showed an annual decrease of $1.70{\pm}12.86$ L/min the asthmatic patients and an annual decrease of $10.3{\pm}7.32$ L/min in the COPD patients. Age and $FEV_1$ were the predictive factors influencing change in asthma, and $FEV_1$ and smoking were the predictive factors influencing change in COPD. Conclusion: We confirmed the annual decreasing PEFR in patients with chronic airway disease and identified factors that work in conjunction with $FEV_1$ to influence the change.

• 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.11 no.2
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• pp.123-130
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• 2016

PURPOSE: This study was conducted to determine correlations between grip and lower limb muscle strength and pulmonary function and respiratory muscle in children with cerebral palsy. METHODS: Subjects were 17 children with cerebral palsy. Inclusion criteria for participation were having GMFCS from I to III grade and ability to independently blow into a spirometer. Pulmonary function and respiratory muscle were measured with a spirometer. All subjects performed maximal expiratory flow maneuvers using a spirometer in order to determine their forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and FEV1/FVC, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Muscle strength was measured in terms of grip strength and lower limb muscle strength in terms of knee extension strength with a dynamometer and manual digital muscle tester respectively. Data were analyzed using Person product correlation. RESULTS: Grip strength significantly positively correlated with FVC (r=0.95, p<0.01), FEV1 (r=0.95, p<0.01), PEF (r=0.84, p<0.01), MIP (r=0.65, p<0.01) MEP (r=0.71, p<0.01) and lower limb strength with FVC (r=0.72, p<0.01), FEV1 (r=0.69, p<0.01), PEF (r=0.54, p<0.05), and MEP (r=0.69, p<0.01). CONCLUSION: Grip and lower limb muscle strengths of children with cerebral palsy were positively correlated pulmonary function and respiratory muscle.

• Physical Therapy Korea
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• v.25 no.4
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• pp.37-45
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• 2018

Background: Posterior-anterior (PA) vertebral mobilization, a manual therapy technique has been used for relieving pain or stiffness treating in spinal segment for in clinical practice, however evidence to gauge efficacy is yet to be synthesised. Objects: This study aimed to investigate the effect of PA mobilization of the thoracic spine on the respiratory function in patients with low back pain (LBP). Methods: The study participants included 30 patients with chronic LBP. They were randomly allocated to the experimental and control groups. The experimental and control groups received PA mobilization of the T1-T8 level of the thoracic spine and placebo mobilization, respectively. All patients received interventions for 35 minutes a day, five times a week, over 2-week period, respectively. Forced vital capacity (FVC), forced expiratory volume in 1 second ($FEV_1$), peak expiratory flow (PEF), forced expiratory flow 25~75% ($FEF_{25{\sim}75%}$), and chest wall expansion were measured before and after the intervention. Statistical analysis was performed using independent t-test and two-way analysis of variance, and Pearson's correlation analysis was used to compare the correlation between respiratory function and chest measurement. Results: The experimental group showed significant improvements in FVC, $FEV_1$, PEF, $FEF_{25{\sim}75%}$ (p<.05), and chest wall expansion (p<.05) compared with the control group. Conclusion: PA mobilization of the upper thoracic spine may be beneficial for improving respiratory function parameters including FVC, $FEV_1$, PEF, $FEF_{25{\sim}75%}$, and chest wall expansion in patients with chronic LBP.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.4
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• pp.155-161
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• 2020

Purpose : This study was conducted to investigate the effect of positive active pressure technique and active breathing technique on lung function in healthy adults. Methods : In this study, the passive lung expansion technique and active respiration enhancement technique using an air mask bag unit were conducted in 30 normal adults to observe changes in pulmonary function with forced vital capacity (FVC), Forced expiratory volume at one second (FEV1). In order to observe the change in the level of respiratory function, we would like to investigate the peak expiratory flow (PEF) and the forced expiratory flow (FEF 25-75 %). Results : As a result of this study, there was no significant difference in comparison between the passive lung expansion technique and the active breathing enhancement technique (p>.05). The passive lung expansion technique effectively increased the effortful expiratory volume and the median expiratory flow rate of 1 second (p<.05). And the passive lung expansion technique effectively increased the effortless lung capacity and the maximum expiration flow rate (p<.05). Conclusion : The passive lung expansion technique effectively increases the range of motion of the lungs and chest cages, intrathoracic pressure, and elasticity of the lungs, and the active breathing technique increases the muscle functions such as the diaphragm and the biceps muscles. It is expected that it will be able to selectively improve the respiratory function of patients with respiratory diseases or functional limitations as it is found to be effective.

• Tuberculosis and Respiratory Diseases
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• v.51 no.3
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• pp.248-259
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• 2001

Background : In diagnosis or monitor of the airway obstruction in bronchial asthma, the measurement of $FEV_1$ in the standard method because of its reproducibility and accuracy. But the measurement of peak expiratory flow(PEF) by peak flow meter is much simpler and easier than that of $FEV_1$ especially in children. Yet there have been still no data of the predicted normal values of PEF measured by peak flow meter in Korean children. This study was conducted to provide equations to predict the normal value of PEF and correlation between PEF and $FEV_1$ in healthy children. Method : PEF was measured by MiniWright peak flow meter, and the forced expiratory volume and the maximum expiratory flow volume curves were measured by Microspiro HI 501(Chest Co.) in 346 healthy children(age:5-16 years, 194 boys and 152 girls) without any respiratory symptoms during 2 weeks before the study. The regression equations for various ventilatory parameters according to age and/or height, and the regression equations of $FEV_1$ by PEF were derived. Results : 1. The regression equation for PEF(L/min) was: $12.6{\times}$age(year)+$3.4{\times}$height(cm)-263($R^2=0.85$) in boys, and $6{\times}$age(year)+$3.9{\times}$height(cm)-293($R^2=0.82$) in girls. 2. The value of FEFmax(L/sec) derived from the maximum expiratory flow volume curves was multiplied by 60 to compare with PEF(L/min), and PEF was faster by 125 L/min in boys and 118 L/min in girls, respectively. 3. The regression equation for $FEV_1$(ml) by PEF(L/min) was:$7{\times}$PEF-550($R^2=0.82$) in boys, and $5.8{\times}$PEF-146 ($R^2=0.81$) in girls, respectively. Conclusion : This study provides regression equations predicting the normal values of PEF by age and/or height in children. And the equations for $FEV_1$, a gold standard of ventilatory function, was predicted by PEF. So, in taking care of children with airway obstruction, PEF measured by the peak flow meter can provide useful information.

• Proceedings of the Korean Environmental Health Society Conference
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• 2005.06a
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• pp.311-314
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• 2005

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 4th grades) living in Inner-Mongolia, China. 113 Chinese children were asked to record their daily levels of peak expiratory flow rate(PEPR) using portable peak flow meter(mini-Wright) for 40 days and 3 time everyday(12 April 2004 to 21 May 2004). The atmospheric concentration of fine particles in study area was also determined everyday during same period. The relationship between dailypeak expiratory flow rate(PEFR) and fine particle levels was analyzed using a mixed linear regression models including gender, age, height, the presence of respiratory symptoms, and daily average relative humidity as extraneous variables. The analysis showed that the increase of fine particle concentrations was negatively associated with the variability in PEPR. The IQR(inter-quartile range) increments of $PM_{10}$ or $PM_{2.5}(66.0{\mu}g/m^3$ and $118.9{\mu}g/m^3$, respectively) were also shown to be related with 1.422L/min(95% Confidence intervals: 0.270 ${\sim}$ 2.574) and 1.214L1min(95% Cl: 0.010 ${\sim}$ 2.418) decline in PEFR.

• Journal of International Academy of Physical Therapy Research
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• v.8 no.2
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• pp.1146-1151
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• 2017

The purpose of this study was to compare the effects of respiratory exercise on cardiopulmonary function and muscle activity of rectus abdominis in smokers and non-smokers with elderly people. All the participants were older than 65 years, and twenty non-smokers, and twenty smokers participated. Non-smokers and smokers were randomly divined into 10 feedback breathing exercises (FBE) and a balloon-blowing exercise (BBE) group. The FBE and the BBE were performed three times a week for four weeks. Forced vital capacity (FVC), forced expiratory volume at one second (FEV1), forced expiratory volume at one second/forced vital capacity (FEV1/FVC), peak expiratory flow (PEF), and vital capacity (VC) were measured as pulmonary function. EMG was used to measure the activity of the rectus abdominis. In the FBE and BBE groups, $FEV_1$ was significantly lower in non-smokers compared to smokers at two and four weeks (p<.05), $FEV_1/FVC$, PEF and VC were significantly lower in non-smokers compared to smokers to pre-test, two weeks, four weeks and six weeks (p<.05). Muscle activity of rectus abdominis was significantly difference in the BBE group at pre-test, two weeks, four weeks, and six weeks (p<.05). These results suggest that respiratory exercise was effective in improving pulmonary function and rectus muscle activity.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.654-661
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• 1999

Background : The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. Methods : PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test($FEV_1$, $FEV_1%$ pred, FVC, and FVC% pred) were measured at first visiting. Results : Values of PIFn, $FEV_1$, and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was $41.4{\pm}15.9$ years. Normal subjects were 32(22 males and 10 females) and the mean age was $39.8{\pm}18.6$ years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p<0.05). The PIFn values in patients with chronic cough was significantly lower than those of normal subjects($2.25{\pm}0.68\;L/sec$ vs. $2.75{\pm}1.00\;L/sec$ ; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects (mean$\pm$SD ; $2.18{\pm}0.66$ vs. $2.75{\pm}1.00\;L/sec$, p=0.006). Conclusion : There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.1
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• pp.75-83
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• 2022

PURPOSE: This study was conducted to investigate the effect of the resistance respiratory muscle exercise with transcutaneous electrical nerve stimulation (TENS) on the respiratory muscle tone and pulmonary function of stroke patients. METHODS: Twenty stroke patients were divided into the TENS group (n = 7), placebo TENS group (n = 7), and control group (n = 6), and each intervention was performed on the three groups 5 times a week for 4 weeks. The assessment was carried out by measuring changes in the muscle tone of the latissimus dorsi and abdominal external obliques, and pulmonary function. RESULTS: In this study, the TENS group and the placebo TENS group had significant increases in the paretic side latissimus dorsi muscle tone, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). There was no significant difference in changes in respiratory muscle tone between the three groups. The pulmonary function was significantly different between the three groups, and it was observed from the results of the post-hoc test that FVC showed a significant increase in the TENS group and the placebo TENS group compared to the control group. CONCLUSION: Through this study, it was found that the respiratory muscle resistance exercise was more effective as a method to increase respiratory muscle tone and pulmonary function in stroke patients than combined transcutaneous electrical nerve stimulation.