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Norlander, K., Johansson, H., Emtner, M., Jansson, C., Nordvall, L. & Nordang, L. (2020). Differences in laryngeal movements during exercise in healthy and dyspnoeic adolescents.. International Journal of Pediatric Otorhinolaryngology, 129, Article ID 109765.
Open this publication in new window or tab >>Differences in laryngeal movements during exercise in healthy and dyspnoeic adolescents.
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2020 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 129, article id 109765Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare glottic and supraglottic movements in healthy adolescents and adolescents experiencing dyspnoea during strenuous exercise.

METHODS: Using the continuous laryngoscopy exercise (CLE)-test laryngeal movements during exercise were analysed in healthy controls (n = 28) and compared to subjects with exercise induced bronchoconstriction (EIB) (n = 10), exercise induced laryngeal obstruction (EILO) (n = 10) and subjects experiencing exercise-induced dyspnoea without having any of these diagnoses (n = 31). Images from the video recordings were assessed regarding glottic angle, glottic area and supraglottic area using the software measuring tool EILOMEA.

RESULTS: No significant differences were detected between controls, the dyspnoea group without a diagnosis of EIB or EILO and the EIB group regarding glottis angle, glottis area or supraglottic area at maximum effort. All three parameters differed significantly in the EILO group compared to the other groups (p=<0.001). In the group with EILO all but one had supraglottic obstruction (corresponding to a CLE-test score ≥2). Movement of the laryngeal structures, corresponding to a CLE-test score of 1, at glottic and/or supraglottic level was seen in 26 of 35 (74%) of controls, 34 out of 41 (83%) of patients in the dyspnoea group, and in 25 of 38 (66%) of EIB-subjects.

CONCLUSION: Minor movements at both glottic and supraglottic level are equally common in healthy controls as among adolescents with exercise induced dyspnoea without EIB or EILO and adolescents with EIB. Adolescents with EILO had a statistically significant more pronounced supraglottic obstruction than the other groups.

Keywords
CLE-Score, EILOMEA, Exercise induced laryngeal obstruction, Exercise-induced bronchoconstriction, Exercise-induced dyspnoea, Vocal cord dysfunction
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-401361 (URN)10.1016/j.ijporl.2019.109765 (DOI)000509613300013 ()31706111 (PubMedID)
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-03-20Bibliographically approved
Troosters, T., Langer, D., Burtin, C., Chatwin, M., Clini, E. M., Emtner, M., . . . Pitta, F. (2019). A guide for respiratory physiotherapy postgraduate education: presentation of the harmonised curriculum. European Respiratory Journal, 53(6), Article ID 1900320.
Open this publication in new window or tab >>A guide for respiratory physiotherapy postgraduate education: presentation of the harmonised curriculum
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2019 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 53, no 6, article id 1900320Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-390337 (URN)10.1183/13993003.00320-2019 (DOI)000474194800024 ()31167882 (PubMedID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Westerdahl, E., Osadnik, C. & Emtner, M. (2019). Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden. Chronic Respiratory Disease, 16, Article ID UNSP 1479973119855868.
Open this publication in new window or tab >>Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden
2019 (English)In: Chronic Respiratory Disease, ISSN 1479-9723, E-ISSN 1479-9731, Vol. 16, article id UNSP 1479973119855868Article in journal (Refereed) Published
Abstract [en]

There is considerable global variability in clinical practice regarding the prescription of airway clearance techniques (ACTs) for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the physical therapy practice, and no international guidelines are available. The aim of this survey was to identify current physical therapy practice regarding ACT prescription for patients with AECOPD in Sweden. A cross-sectional, descriptive study was conducted via a Web-based questionnaire, sent to all (n = 70) hospitals that offer physical therapy service for patients with AECOPD in Sweden. Responses were received from 117 physical therapists (76%) across all sites. ACTs were prescribed for more than half of all patients with an AECOPD by 75% of physical therapists. The most frequently used ACTs were positive expiratory pressure (PEP) devices (90%), directed huffing (88%) and cough (71%). Most physical therapists (89%) perceived sputum clearance to be an important aspect of the overall management of patients with AECOPD. The main factors influencing choice of ACT were the 'degree of dyspnoea or work of breathing' and 'access to resources/equipment'. Physical therapists prescribe predominantly PEP-based ACTs for patients with AECOPD in Sweden. Several factors come into consideration that influences the choice of treatment technique.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2019
Keywords
Airway clearance techniques, acute exacerbation, chronic obstructive pulmonary disease, healthcare surveys, mucociliary clearance, physical therapy modalities
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-395559 (URN)10.1177/1479973119855868 (DOI)000487094900001 ()31220934 (PubMedID)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-21Bibliographically approved
Troosters, T., Tabin, N., Langer, D., Burtin, C., Chatwin, M., Clini, E. M., . . . Pitta, F. (2019). Introduction of the harmonised respiratory physiotherapy curriculum. Breathe, 15(2), 110-115
Open this publication in new window or tab >>Introduction of the harmonised respiratory physiotherapy curriculum
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2019 (English)In: Breathe, ISSN 1810-6838, E-ISSN 2073-4735, Vol. 15, no 2, p. 110-115Article, review/survey (Refereed) Published
Abstract [en]

Building on the core syllabus for postgraduate training in respiratory physiotherapy, published in 2014, the European Respiratory Society (ERS) respiratory physiotherapy task force has developed a harmonised and structured postgraduate curriculum for respiratory physiotherapy training. The curriculum outlines the knowledge, skills and attitudes which must be mastered by a respiratory physiotherapist working with adult or paediatric patients, together with guidance for minimal clinical exposures, and forms of learning and assessment. This article presents the rationale, methodology and content of the ERS respiratory physiotherapy curriculum. The full curriculum can be found in the supplementary material.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-387988 (URN)10.1183/20734735.0124-2019 (DOI)000469996300007 ()
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved
Carsin, A.-E., Fuertes, E., Schaffner, E., Jarvis, D., Anto, J. M., Heinrich, J., . . . Garcia-Aymerich, J. (2019). Restrictive spirometry pattern is associated with low physical activity levels. A population based international study. Respiratory Medicine, 146, 116-123
Open this publication in new window or tab >>Restrictive spirometry pattern is associated with low physical activity levels. A population based international study
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2019 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 146, p. 116-123Article in journal (Refereed) Published
Abstract [en]

Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry.

Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC >= Lower Limit of Normal and a FVC< 80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (< 1st study-specific tertile) was evaluated using adjusted logistic regression models.

Results: Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET.min/week in ECRHS, and 3519 vs 3945 MET.min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95% CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding.

Conclusion: Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Restrictive spirometry pattern, Body mass index, Epidemiology, Lung function, Physical activity
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376892 (URN)10.1016/j.rmed.2018.11.017 (DOI)000456074000018 ()30665509 (PubMedID)
Funder
EU, Horizon 2020, 633212EU, Horizon 2020, 704268
Available from: 2019-02-13 Created: 2019-02-13 Last updated: 2019-12-19Bibliographically approved
Johansson, H., Emtner, M., Janson, C., Malinovschi, A., Norlander, K. & Nordang, L. (2018). Exercise induced dyspnea among adolescents - prevalence and incidence, a five-year follow-up. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Exercise induced dyspnea among adolescents - prevalence and incidence, a five-year follow-up
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2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-376332 (URN)10.1183/13993003.congress-2018.PA4679 (DOI)000455567106321 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
Igelström, H., Åsenlöf, P., Emtner, M. & Lindberg, E. (2018). Improvement in obstructive sleep apnea after a tailored behavioural sleep medicine intervention targeting healthy eating and physical activity: a randomised controlled trial. Sleep and Breathing, 22(3), 653-661
Open this publication in new window or tab >>Improvement in obstructive sleep apnea after a tailored behavioural sleep medicine intervention targeting healthy eating and physical activity: a randomised controlled trial
2018 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 22, no 3, p. 653-661Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of the present single-centre randomised controlled trial was to assess the effect of a behavioural sleep medicine (BSM) intervention on obstructive sleep apnea (OSA) severity in patients who have been referred for new treatment with continuous positive airway pressure (CPAP).

METHODS: After baseline assessment including ventilatory and anthropometric parameters, and physical activity monitoring, 86 patients who were overweight (BMI ≥ 25) and had moderate-severe OSA with apnea-hypopnea index (AHI) ≥ 15 were randomised into a control group (CG; CPAP and advice about weight loss) or an experimental group (ExpG; CPAP and BSM intervention targeting physical activity and eating behaviour). The BSM intervention comprised 10 individual sessions with a dietician and a physiotherapist and included behaviour change techniques such as goal setting and self-monitoring. After 6 months, a new recording of ventilatory parameters was performed without CPAP.

RESULTS: In ExpG, 40% (n = 14) had improved from severe to moderate or mild OSA or from moderate to mild OSA compared to 16.7% in CG (n = 6, p = 0.02). Further, a lower AHI and amount body fat at baseline were correlated with improvement in severity class. Being in ExpG implied a mean improvement in AHI by 9.7 and an odds ratio of 4.5 for improving in severity classification.

CONCLUSIONS: The results highlight the clinical importance of lifestyle modifications in conjunction with CPAP treatment in patients with OSA.

Keywords
Behaviour modification, Diet, Obstructive sleep apnea, Physical activity
National Category
Respiratory Medicine and Allergy Physiotherapy
Identifiers
urn:nbn:se:uu:diva-339680 (URN)10.1007/s11325-017-1597-z (DOI)000443212100009 ()29222619 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2018-11-08Bibliographically approved
Fuertes, E., Markevych, I., Jarvis, D., Vienneau, D., de Hoogh, K., Maria Anto, J., . . . Garcia-Aymerich, J. (2018). Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study. Environment International, 120, 364-372
Open this publication in new window or tab >>Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study
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2018 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 120, p. 364-372Article in journal (Refereed) Published
Abstract [en]

Background: Very few studies have examined whether a long-term beneficial effect of physical activity on lung function can be influenced by living in polluted urban areas.

Objective: We assessed whether annual average residential concentrations of nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters < 2.5 mu m (PM2.5) and < 10 mu m (PM10) modify the effect of physical activity on lung function among never- (N = 2801) and current (N = 1719) smokers in the multi-center European Community Respiratory Health Survey. Methods: Associations between repeated assessments (at 27-57 and 39-67 years) of being physically active (physical activity: >= 2 times and >= 1 h per week) and forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated using adjusted mixed linear regression models. Models were conducted separately for never-and current smokers and stratified by residential long-term NO2, PM2.5 mass and PM10 mass concentrations (<= 75th percentile (low/medium) versus > 75th percentile (high)).

Results: Among current smokers, physical activity and lung function were positively associated regardless of air pollution levels. Among never-smokers, physical activity was associated with lung function in areas with low/medium NO2, PM2.5 mass and PM10 mass concentrations (e.g. mean difference in FVC between active and non-active subjects was 43.0 mL (13.6, 72.5), 49.5 mL (20.1, 78.8) and 49.7 mL (18.6, 80.7), respectively), but these associations were attenuated in high air pollution areas. Only the interaction term of physical activity and PM10 mass for FEV1 among never-smokers was significant (p-value = 0.03).

Conclusions: Physical activity has beneficial effects on adult lung function in current smokers, irrespective of residential air pollution levels in Western Europe. Trends among never-smokers living in high air pollution areas are less clear.

Keywords
Air pollution, Cohort, Lung function, Physical activity, Smoking
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-369602 (URN)10.1016/j.envint.2018.07.032 (DOI)000448688500037 ()30121517 (PubMedID)
Funder
EU, Horizon 2020, 704268EU, Horizon 2020, 633212
Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2018-12-18Bibliographically approved
Emtner, M. & Wadell, K. (2017). Personer med KOL behöver träna: Ökad fysisk aktivitet kan förbättra livskvalitet, dyspné, kondition och styrka och minska risken för förtida död. Läkartidningen, 114, Article ID D6PC.
Open this publication in new window or tab >>Personer med KOL behöver träna: Ökad fysisk aktivitet kan förbättra livskvalitet, dyspné, kondition och styrka och minska risken för förtida död
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id D6PCArticle in journal (Refereed) Published
Abstract [en]

Persons with COPD should be recommended training Persons with chronic obstructive pulmonary disease (COPD) should be recommended aerobic and resistance training to be able to improve quality of life and physical capacity, and to decrease dyspnoea, anxiety and depression (moderately strong scientific evidence - quality of evidence grade 3). Subjects with an exacerbation should be recommended training at a low intensity in direct connection with the exacerbation to improve quality of life and physical capacity (moderately strong scientific evidence - quality of evidence grade 3), and to lower the risk of mortality and hospitalization (limited scientific evidence - quality of evidence grade 2). Prescription of exercise should be based on assessment of physical capacity. Aerobic exercise can be performed as interval or continuous training. Special attention is needed regarding oxygen saturation, heart rate, blood pressure and subjective rating of dyspnea and leg fatigue.

Abstract [sv]

Personer med kroniskt obstruktiv lungsjukdom (KOL) har dyspné, nedsatt fysisk kapacitet och sänkt livskvalitet.

Livskvalitet, dyspné, kondition och styrka kan förbättras som en effekt av ökad fysisk aktivitet och träning.

Risken för förtida död minskar vid ökad fysisk aktivitetsnivå och ökad fysisk kapacitet.

Både patienter i stabilt skede av sjukdomen och de som haft en exacerbation ska erbjudas fysisk träning.

National Category
Respiratory Medicine and Allergy Physiotherapy
Identifiers
urn:nbn:se:uu:diva-342411 (URN)28140421 (PubMedID)
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-04-05Bibliographically approved
Westerberg, E., Molin, C. J., Lindblad, I., Emtner, M. & Rostedt Punga, A. (2017). Physical exercise in Myasthenia Gravis is safe and improves neuromuscular parameters and physical performance-based measures: A pilot study. Muscle and Nerve, 56(2), 207-214
Open this publication in new window or tab >>Physical exercise in Myasthenia Gravis is safe and improves neuromuscular parameters and physical performance-based measures: A pilot study
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2017 (English)In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 56, no 2, p. 207-214Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Due to the shortage of exercise-related research in Myasthenia Gravis (MG), there are no consensus guidelines on physical exercise for MG patients.

METHODS: In this prospective pilot study, 10 MG patients with mild disease performed supervised aerobic and resistance training twice weekly for 12 weeks. The Myasthenia Gravis Composite (MGC) score, compound motor action potential (CMAP), repetitive nerve stimulation, muscle force, physical performance-based measures, serum levels of interleukin-6, muscle enzymes as well as immuno-microRNAs miR-150-5p and miR-21-5p were assessed before and after the training period.

RESULTS: Physical exercise was well tolerated, and the MGC score was unchanged. Muscle resistance weights and CMAP amplitudes increased for biceps brachii and rectus femoris muscles, and physical performance-based measures improved. Muscle enzymes remained normal, whereas disease-specific microRNAs miR-150-5p and miR-21-5p were reduced after the training period.

CONCLUSIONS: We propose that general recommendations regarding physical exercise safely can be applied to well-regulated MG patients.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-314678 (URN)10.1002/mus.25493 (DOI)000406875000009 ()27935072 (PubMedID)
Funder
Swedish Research Council, 2014-02048Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 520281, 520411Swedish Society of Medicine, SLS-499271
Available from: 2017-02-04 Created: 2017-02-04 Last updated: 2018-03-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1308-105x

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