This article was originally published here

Am J Emerg Med. 2022 May 4;58:5-8. doi: 10.1016/j.ajem.2022.04.052. Online ahead of print.


BACKGROUND: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator and mild bronchodilator that has been shown to improve systemic oxygenation, but has rarely been administered in the Emergency Department (ED). In addition to its favorable pulmonary vascular effects, in-vitro studies report that NO donors can inhibit replication of viruses, including SARS Coronavirus 2 (SARS-CoV-2). This study evaluated the administration of high-dose iNO by mask in spontaneously breathing emergency department (ED) patients with respiratory symptoms attributed to Coronavirus disease 2019 (COVID-19).

METHODS: We designed a randomized clinical trial to determine whether 30 min of high dose iNO (250 ppm) could be safely and practically administered by emergency physicians in the ED to spontaneously-breathing patients with respiratory symptoms attributed to COVID-19. Our secondary goal was to learn if iNO could prevent the progression of mild COVID-19 to a more severe state.

FINDINGS: We enrolled 47 ED patients with acute respiratory symptoms most likely due to COVID-19: 25 of 47 (53%) were randomized to the iNO treatment group; 22 of 47 (46%) to the control group (supportive care only). All patients tolerated the administration of high-dose iNO in the ED without significant complications or symptoms. Five patients receiving iNO (16%) experienced asymptomatic methemoglobinemia (MetHb) > 5%. Thirty-four of 47 (72%) subjects tested positive for SARS-CoV-2: 19 of 34 were randomized to the iNO treatment group and 15 of 34 subjects to the control group. Seven of 19 (38%) iNO patients returned to the ED, while 4 of 15 (27%) control patients did. One patient in each study arm was hospitalized: 5% in iNO treatment and 7% in controls. One patient was intubated in the iNO group. No patients in either group died. The differences between these groups were not significant.

CONCLUSION: A single dose of iNO at 250 ppm was practical and not associated with any significant adverse effects when administered in the ED by emergency physicians. Local disease control led to early study closure and prevented complete testing of COVID-19 safety and treatment outcomes measures.

PMID:35623183 | DOI:10.1016/j.ajem.2022.04.052

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The Centers for Disease Control and Prevention (CDC) has vowed to exert more effort in better understanding long COVID while still monitoring the ongoing pandemic. 

More than two years into the global health crisis, the medical community has become more perplexed by the syndrome of conditions that continues to persist in millions of people who previously battled COVID-19. 

“A growing number of persons previously infected with SARS-CoV-2, the virus that causes COVID-19, have reported persistent symptoms, or the onset of long-term symptoms, ≥4 weeks after acute COVID-19; these symptoms are commonly referred to as post-COVID conditions, or long COVID,” the public health agency said this week. 

In its latest Morbidity and Mortality Weekly Report, the CDC pointed out how post-COVID syndrome appeared more common among adults, specifically the 18-64 and over 65 age groups in the United States. 

The incidence of long COVID in the 18-64 group was one in five, while the incidence in the over 65 age group was one in four. The CDC also noted that these COVID-19 survivors have a higher risk of developing pulmonary embolism or respiratory conditions. 

As such, the agency has called for the implementation of prevention strategies and routine assessment for post-COVID syndrome in patients who survive COVID-19. This is to reduce the incidence of long COVID and lower the impact of the lingering symptoms on the two age groups, as per Fox News.  

The CDC organized the long COVID symptoms into several categories, including neurologic and mental health conditions, cardiovascular conditions, respiratory conditions, musculoskeletal conditions, blood and vascular tissue problems, and kidney failure. COVID survivors who have any of the symptoms are urged to speak with their health care provider. 

Finally, the agency reiterated the need for vaccinations during the pandemic to prevent infection and the complications that come with the virus. The CDC maintained that vaccination is still the best way to control the long COVID situation. 

“The best way to prevent post-COVID conditions is to protect yourself and others from becoming infected. For people who are eligible, getting vaccinated and staying up to date with vaccines against COVID-19 can help prevent COVID-19 infection and protect against severe illness,” the CDC said. 

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The airway connects the nose and mouth to the alveoli in the lungs, where oxygen (O2) and carbon dioxide (CO2) are exchanged naturally. Airway management is a technique, maneuver, or equipment used to maintain the patency of the airway so that normal physiological activities, such as gas exchange, can be accomplished.1 Manual ventilation may be required if a person’s O2 and CO2 exchange is inadequate. However, basic airway maneuvers to open the airway are typically enough to regulate or improve spontaneous air movements.2

As airway issues or respiratory failures are the leading causes of death in the first hours after an injury, the basic procedures remain the “cornerstones” of appropriate emergency care.3,4 Airway and breathing management require immediate attention, as patients may die if these actions are not taken. One of the most important emergency airway management procedures for keeping patients alive is airway maintenance without “endotracheal intubation”.5

Opening the airway with manual maneuvers such as head tilt - chin lift, jaw thrust, recovery positioning, keeping the airway open with devices such as oropharyngeal and nasopharyngeal airways, oxygen therapy, suctioning/removing secretion, and ventilation are all basic airway and breathing management. In the event of a foreign body obstruction, numerous treatments such as abdominal thrusts (Heimlich maneuver), chest thrusts, and back blows (slaps) can be used to manage the fundamental airway. The presence of arterial hypoxemia and tissue hypoxia is the most common reasons for supplementary oxygen. High-flow delivery systems (venture masks), low-flow delivery systems (nasal prong/cannula), basic masks, partial rebreathing masks, and Bag-Mask Ventilation are all options for delivering oxygen.2,5–9

In patients who are at risk of secretion, suctioning using large-bore suction catheters can help with emergency airway control. The bag valve mask, which was pioneered by anesthesiologists in the 1950s and 1960s and has saved many lives, takes first place in the revolution of airway management for substantial improvements in anesthesiology and resuscitation.7,8,10–13

In developed countries, well-organized Emergency Medical Service (EMS) systems have been shown to save lives that were previously at high risk of dying at the scene or while being transported to the hospital. However, in developing metropolitan cities such as Addis Ababa, Ethiopia, there is still a high rate of preventable morbidity and mortality. The main causes are a lack of a coordinated EMS system, a designated well-developed emergency center (EC), insufficient human and material resources to care for injured or acutely ill patients, insufficient medical training on triage and emergency management principles, and a lack of long-term funding for emergency care services.14,15

Previous studies have demonstrated inadequate fundamental airway and breathing management with wide variance between emergency departments, despite its clinical and research importance in the management of critically ill and injured patients.16–18 According to a Nepalese study, just 33% of health practitioners knew how to properly open the airway of an unresponsive injured victim. Similarly, an Egyptian study found that more than 85% of respondents could not name the first step in confirming a suspected airway obstruction.9,19

According to the authors’ knowledge, no study has been conducted specifically on nurses’ knowledge and practice of emergency airway and breathing management in our study areas, which is the most important in planning training for its use, differentiating, and preventing the factors linked to poor patient outcomes. As a result, the purpose of this study was to evaluate the knowledge, practice, and associated factors of airway and breathing management among nurses working in the emergency departments of selected public hospitals governed by the Addis Ababa Health Bureau (AAHB) in Addis Ababa, Ethiopia.


General Objective

To analyze nurses’ emergency airway and breathing management knowledge, practices, and associated factors in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia.

Specific Objective

To assess knowledge of emergency airway and breathing management among nurses working in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia.

To assess practice of emergency airway and breathing management among nurses working in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia.

To find out what factors were linked to emergency airway and breathing management expertise among nurses working in the emergency departments of a few public hospitals in Addis Ababa, Ethiopia.

Materials and Methods

Study Area and Study Period

The research was conducted in Addis Ababa, Ethiopia’s capital city, at AAHB-managed public hospitals. AAHB was in charge of six public hospitals in Addis Ababa. Three of these hospitals were chosen at random for this investigation. Yekatit 12 Hospital, Zewditu Memorial Hospital, and Tirunesh Beijing Hospital are the hospitals in question. There are 44 nurses at Yekatit 12 Hospital; 45 nurses at Zewditu Memorial Hospital; and 17 nurses at Tirunesh Beijing Hospital. A total of 106 nurses were working in the emergency rooms of the three hospitals. The current research took place from April 12 to April 30, 2021.

Study Design

A cross-sectional survey study design was conducted to assess nurses´ knowledge, practice, and associated factors of airway and breathing management in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia.


Source Population

All nurses who were working at the emergency departments of government hospitals under the AAHB.

Study Population

All nurses who were working at the emergency departments of the three randomly selected governmental hospitals under AAHB.

Eligibility Criteria

Inclusion and Exclusion Criteria

Nurses working in the emergency departments of the participating hospitals who were available during the study period and had at least six months of experience had been included, while nurses who did not volunteer to participate in the study were omitted.

Sample Size Determination

There was no need to calculate the sample size because the total number of nurses working in the emergency departments of the three randomly selected hospitals was modest; therefore, all nurses who met the inclusion criteria were included in the study. A total of 102 people were included in the study.

Study Variables

Dependent Variables

Knowledge and practice of nurses toward emergency airway and breathing management were dependent variables of the study.

Independent Variables

Sociodemographic characteristics: age, sex, educational level, work experience, and previous emergency training were independent variables of the study.

Operational Definition

Airway and breathing management: Basic airway management knowledge and skills that include opening the airway, clearing secretion, O2 therapy, bag-mask ventilation, using devices to keep the airway open, and so on.6

Knowledge: The level of understanding of the different subjects regarding airway and breathing management. Good knowledge was defined as a score of greater or equal to the mean value of the knowledge questions, whereas poor knowledge was less than the mean value.

Practice: The necessary actions to be taken to help patients with emergency airway and breathing problems, like opening the airway for patients with trauma or non-trauma, applying maneuvers for choking patients, oxygen administration by bag valve masks for gasping patients, and so on.

Data Collection Tools and Procedures

After evaluating several studies, data was obtained from the study population using a standardized self-administered questionnaire15,20,21 based on the objectives intended for the study. The questionnaire is divided into three sections. Nurses’ sociodemographic features, knowledge of emergency airway and breathing management, and practice of emergency airway and breathing management were all examined. Age, sex, degree of schooling, work experience, and previous emergency-related training are among the sociodemographic questions. There are sixteen (16) multiple-choice questions in the knowledge section, each with one right answer. The correct answer received one point, while all other erroneous responses received zero points. The mean value for the knowledge questions was then determined, and respondents who scored greater or equal to the mean value were regarded to have strong knowledge of emergency airway and breathing management, while those who scored less than the mean value were judged to have poor knowledge. There are ten (10) multiple-choice questions in the practice questions about nurses’ emergency airway and breathing management skills. Descriptive statistics were used to summarize the data on nurse practice in the emergency airway and breathing management. Previous researchers examined the validity and reliability of the questionnaires, which were written in English. For this study, the questionnaire was pre-tested on 5% of nurses working in the emergency department of Menelik II hospital. Based on the results of the pretest, corrections were made to some of the questions by senior emergency physicians of Addis Ababa University. Three bachelors of science degree (BSC) nurses with prior expertise in data gathering were chosen and received a one-day training on the data collection process. For each hospital, a data collector was assigned, and all processes were done under the supervision of the lead investigator.

Data Quality Control

In addition to the training provided to data collectors, the primary investigator was reviewing how the data collectors were doing their jobs and supervising the activity on a daily basis during data collection. The lead investigator checked the completeness of questionnaires at the end of each data collection day.

Data Analysis

The information was double-checked for accuracy, coded, and entered into Epi Data version 3.1 before being transferred to the Statistical Package for Social Science (SPSS) version 25 for further analysis. For continuous variables, descriptive statistics such as mean and standard deviation were utilized, whereas, for categorical variables, frequency, and percentage distribution were used. The study’s findings were then arranged and presented, utilizing narratives, texts, tables, and graphs. The link between dependent and independent factors was demonstrated using bivariable and multivariable logistic regression models. To find variables associated with nurse knowledge and practice, all independent variables with p-values less than 0.25 in the bivariable logistic regression analysis were fitted into the multivariable logistic regression analysis. The strength of the connection was measured using the crude odds ratio (COR) and adjusted odds ratio (AOR) with corresponding 95% confidence intervals (CI). Finally, factors in the multivariable logistic regression were considered statistically significant if their P-values were less than 0.05.


Socio-Demographic Characteristics of Respondents

A total of 102 nurses took part in the survey, with a 96.2% response rate, while four nurses were unavailable throughout data collection. More than half of the study participants (52.9%) were females, ranging in age from 24 to 48 years old, with a mean age of 29.50 (SD 4.96). The majority of the study participants, 92 (90.2%), had a BSc degree, and the majority of them, 74 (72.5%), had emergency job experience ranging from one to five years (Table 1). In terms of past emergency-related training, 53 (52%) of the respondents had had different training, while 49 (48%) had not received any emergency-related training, and 11.32% took other type of training lke infection prevention, and general training on covid (Figure 1).

Table 1 Socio-Demographic Characteristics of Respondents, 2021 (N=102)

Figure 1 Status of the respondents on the emergency related training, 2021 (N=102).

Abbreviations: BLS, basic life support; ATLS, advanced trauma life support; ACLS, advanced cardiac life support; Other*, training like infection prevention, general training on COVID-19, and soft ware training on patient data.

Knowledge of Nurses on the Airway and Breathing Managements

To begin with, the mean value of knowledge questions was determined to be 9.44 (59%). Respondents who scored greater or equal to the mean value were considered knowledgeable about airway and breathing management. As a result, the participants’ overall knowledge of airway and breathing management was 46 (45.1%) (Figure 2). Respondent’s knowledge of the specific cases was variable. Seventy-five (73.5%) and 61 (59.8%) of respondents correctly identified the maneuvers used to open the airway with and without trauma suspicion (jaw thrust maneuver and head tilt-chin lift maneuver), respectively. Eighty-seven (85.3%) of the participants correctly identified difficulty speaking, breathing, or coughing as signs and symptoms of complete airway obstruction, and nearly all 98 (96.1%) of the participants correctly identified positioning a patient as a basic maneuver for airway and breathing management. Only 37 (36.3%) of the total respondents correctly identified endotracheal intubation as a non-basic airway device, and 37 (36.3%) correctly identified bag valve mask as a manual ventilation device that provides high oxygen concentration and artificial ventilation for someone with airway and breathing problems. The knowledge question with the fewest responses was “Not supraglottic airway,” which revealed that only 30.4% of the participants correctly answered that a bag valve mask is not a supraglottic airway (Table 2).

Table 2 Distribution of Responses on Knowledge Assessment of Airway and Breathing Management 2021 (N=102)

Figure 2 Overall level of knowledge of respondents, 2021 (N=102).

Practice of Nurses on the Airway and Breathing Managements

As shown in Table 3, the proper action (jaw thrust) was chosen by 88 (86.3%) of the responders when opening the airway for a patient with a suspected neck injury. The activities to be done for a responsive patient displaying choking symptoms, before suctioning, and a comatose injured patient as a first action was properly answered by about 25 (24.5%), 49 (48.0%), and 74 (72.5%) of the respondents, respectively. When it came to appropriate nursing care during oxygen therapy, only 33 (32.4%) of the study participants were able to provide an accurate response. Only 30 (29.4%) of respondents correctly answered the question about using a face mask for a patient with airway and breathing problems, while the majority of 73 (71.6%) correctly answered the question about using an ambu bag for a patient with airway and breathing problems.

Table 3 Distribution of Responses on the Practice Assessment of Airway and Breathing Management, 2021 (N=102)

Factors Affecting Knowledge of the Respondents

Bivariable logistic regression was used to establish the crude odds ratio of nurses’ strong understanding of airway and breathing management based on socio-demographic parameters such as age, sex, having received related training, emergency work experience, and educational level (Table 4). In bivariable logistic regression, only being trained in related training and job experience were significantly correlated with knowledge of airway and breathing management, with P = 0.029 and P = 0.075, respectively. Nurses who had been trained were 2.72 times more likely to be knowledgeable [COR = 2.72, 95% CI (1.11–6.67)] than those who had not been trained, and nurses with one to five years of emergency work experience were 2.54 times more likely to be knowledgeable [COR = 2.54, 95% CI (0.91–7.12)] than those with less than one year of work experience. Then, with a p-value, less than 0.25, the two variables of being trained in related training and having emergency job experience were included in multivariable logistic regression. In multivariate logistic regression, only individuals who had received related training were significantly correlated with knowledge of airway and breathing management with a p-value less than 0.05. As a result, nurses who had received relevant training were 2.78 times more likely to be informed than nurses who had not [AOR = 2.78, 95% CI (1.01–7.64)].

Table 4 Bivariable and Multivariable Analysis of Factors Affecting the Knowledge Towards Airway and Breathing Management 2021 (N=102)


Nurses are the frontline workers in emergency rooms, dealing with a variety of patients with a variety of issues, particularly those with airway and breathing problems that require immediate attention. Nurses’ knowledge and experience are critical in dealing with such issues. As a result, the goal of this study was to analyze nurses’ knowledge, practice, and associated factors related to emergency airway and breathing treatment in public hospitals in Addis Ababa, Ethiopia.

With a score of ≥ mean value of 59% on the knowledge questions, only 45.1% of the respondents had an overall good understanding of airway and breathing management. The findings were consistent with a study conducted across several departments at Jazan University in Saudi Arabia, which found that the majority of students lacked fundamental knowledge of airway and breathing management. However, the current study’s findings were lower than those of a study conducted in India, which revealed a 63% success rate. The writers, on the other hand, described this as an insufficient level of expertise. The disparity could be owing to the study participants, who in the Indian study were undergraduate dental students learning about airway-related diseases and their managements in their courses, whereas in our study, the participants were nurses working in hospitals.22,23

More than half of the study’s participants (52.0%) had received airway and breathing management training. This was in contrast to research conducted at Jazan University in Saudi Arabia, which revealed that 52.3% of the participants had received no training on airway and breathing management. The difference could be due to the fact that the participants in the Jazan University study came from a variety of departments, including health sciences and non-health departments such as engineering, computer science, and business administration, so they were not trained in specific emergency training.22,24

According to the findings of the current study, the vast majority of participants (85.3%) were aware of the symptoms of complete airway obstruction. Our findings compare favorably to those of research conducted in Ethiopia by Legese Mebrahtu (58.9%) and Tiruneh Tafere (22.65%).25,26 Furthermore, a study conducted in Gondar, Ethiopia, differed from this one in that 79.6% of study participants were aware of the signs of airway blockage.27 The discrepancy could be related to the study’s utilization of a variety of health providers, as well as the study’s setting and study period. However, the current study’s findings are remarkably identical to those of Gangadevi Nandasena’s study, which found that 84.3% of the study subjects had knowledge of blocked airway care.28,29

A small but vocal majority in this study, 73.5% of participants correctly identified the procedure performed to open the airway for a patient who has no worry of neck damage. Our findings are similar to those reported in studies by Gondar Comprehensive Hospital in Ethiopia and Ali M. Alabdali, who found that 71.7% and 69.4% of respondents, respectively, were aware of airway opening maneuvers.27,30

When a patient’s airway cannot be protected, airway and breathing management equipment must be employed.25 According to the current study, just 36.3% of respondents recognized the use of an Ambu bag. This was refuted by research conducted in Rwanda, which found that 92.2% of study participants correctly answered questions on how to use the device.15 The discrepancy might be due to the fact that every health professional in our country Ethiopia are un familiar with airway and breathing management because the emergency department was newly emerged in our country. So, many of our study participants were unable to recognize the use of Ambu bag during airway and breathing management. Another prospective study conducted at Nikoukari hospital, a teaching hospital located in Tabriz, Iran showed that most residents who took traditional instructions regarding airway management faced difficult ventilation and intubation; but they improved this gap after rotating of anesthesiology rotation.31 This could also be supported by another study conducted at Nikoukari hospital.32

Only 38.2% of the participants in this study were able to correctly answer the question about why they needed to use an oral airway device. This contrasted with a study conducted in Rwanda, which found that 86.3% of study participants were aware of the objective of using an oral airway device.15 According to a Turkish study, only 7.7% of respondents were able to correctly attach nasal airway devices while regulating their airways and breathing.33 The explanation, in our opinion, could be due to the low value placed on such critical emergency medical equipment.

In multivariable logistic regression, the socio-demographic information being trained on related training on airway and breathing management was statistically connected with the respondents’ knowledge at a p-value less than 0.05, with p = 0.047 and [AOR = 2.783, 95% CI (1.013–7.645)]. The findings of this study are consistent with those of a study conducted in Gondar, Ethiopia, and Rwanda, which found that training improved respondents’ understanding of emergency treatment [AOR: 2.76, 95% CI (1.40–5.42)] and (Chi2 = 12.632, P = 0.006), respectively.15,24,27

The current study’s 86.3% finding is nearly identical to findings from studies conducted in Ethiopia and Rwanda, which revealed that a large majority of respondents, 88.3% and 96.1%, respectively, gave the correct response to the question, “What action should be taken while opening the airway for a patient with a suspected neck injury?” immobilizing the cervical spine by using the jaw thrust maneuver during airway and breathing management.15,26 In contrast to this study, another one conducted in Nepal found that just 33% of volunteers were able to open the injured patient’s airway.33 The explanation for the disparity could be attributed to the fact that the Nepalese study used volunteers who did not all work in the same field.

Only 24.5% of survey participants were aware of the first action that should be taken for a victim who suddenly displayed a sign of choking while eating. The majority of trial participants (71.6%) were able to provide ventilation using an Ambu bag. This is a significant difference from a study conducted in Botswana, which found that 48.2% of respondents were unable to deliver ventilation using an Ambu bag.34 The reason for this could be due to the fact that the study subjects in Botswana were district hospital nurses, and during the management of any emergency situations, the focus should be given to breathing before taking time for any system adjustments. Because oxygen treatment is one of the most important and fundamental abilities in the management of breathing, nurses should be familiar with indications, safe delivery techniques, and the amount of oxygen to be provided during the procedure. If oxygen therapy is chosen, the appropriate delivery device should be employed.20,28,34

This study has its own strength and limitations. As strength, the study tried to find the gaps in knowledge and practice towards airway and breathing management among nurses working in the emergency department which will serve as a source of information for further study. The limitations of this study were: the study used a cross-sectional study design which does not show the cause and effect association; the attitude aspect of respondents towards airway and breathing management was not included in this study even though it is very important for exercise, and the study did not use observation for practical assessment questions rather it used only theoretical information.


Finally, the goal of this research was to assess the nurses’ knowledge and practice in the three hospitals’ emergency departments, as well as the factors that influence airway and breathing care. According to the findings of this study, nurses working in emergency rooms lacked a basic understanding of airway and breathing treatment. Participation in related training was found to be strongly linked to nurses’ expertise. As a result, all nurses working in emergency departments of hospitals in Addis Ababa, Ethiopia, should get in-service training on basic life support.


AAHB, Addis Ababa Health Bureau; ACLS, advanced cardiac life support; AOR, adjusted odds ratio; ATLS, advanced trauma life support; BLS, basic life support; BSC, bachelor of science degree; CI, confidence interval; CO2, carbondioxide; COR, crude odds ratio; EC, emergency center; EMS, emergency medical service; IRB, institutional review board; O2, oxygen, SD, standard deviation; SPSS, statistical package for social science.

Data Sharing Statement

All the data used to support the findings of this study are found in the hands of the corresponding author.

Ethical Considerations

Ethical clearance was obtained from both Addis Ababa University, College of Health Sciences, Department of Emergency Medicine, and the AAHB Institutional Review Board (IRB). The cooperative letter was written to each hospital’s administration for the activity. The purpose and data collection procedure of the study were communicated with the concerned body of the institutions. Permission was obtained from the relevant personnel in charge of the hospitals. Formal permission was secured from each hospital before distribution of the questionnaires and respondents were informed verbally to identify their willingness to respond to the questionnaires. Finally, written consent was obtained from the respondents who had participated in the study, and the confidentiality of the participants was kept throughout the study by not writing their names on the questionnaire.


First and foremost, we would like to express our gratitude to Addis Ababa University, College of Health Sciences, Department of Emergency Medicine, and Addis Ababa Health Bureau for their assistance in obtaining approval. Second, we praised the leadership of each institution, as well as the data collectors and participants.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.


The study was funded by Addis Ababa University, College of Health Sciences.


The authors report no conflicts of interest in relation to this work.


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29. Alsayil SN, Alzahran S, Alhawiti W. Awareness of basic life support among medical and nursing students at Tabuk University. Basic Res J Med Clin Sci. 2016;5(3):53–57.

30. Alqurashi AI. Attitude and awareness toward heart attack symptoms and lifesaving actions among population of western region, KSA. Middle East J Fam Med. 2020;7(10):42.

31. Soleimanpour H, Gholipouri C, Panahi JR, Afhami MR, Ghafouri RR, Golzari SE. Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study. BMC Emerg Med. 2011;11:8. doi:10.1186/1471-227X-11-8

32. Soleimanpour H, Panahi JR, Mahmoodpoor A. Digital intubation training in residency program, as an alternative method in airway management. Pak J Med Sci. 2011;27:401–404.

33. Gok F, Kılıcaslan A, Topal A, Yavsan D, Yosunkaya A. An assessment of the current knowledge of nurses, staffed in intensive care units, about airway management and basic life support. J Chest Dis Crit Care Med. 2014;1:56–60. doi:10.15197/sabad.4.1.09

34. Uwineza Didi V. Knowledge, attitudes and practice among nurses toward oxygen administration to the critically ill patients at UTHK. University of Rwanda; 2017.

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In fixed-dose inhaled corticosteroids (ICS) combined with long-acting beta-agonist (LABA) bronchodilators, the airway deposition patterns of the component drugs in various sections of the airway can vary widely. This was among results of a study recently published in the European Journal of Pharmaceutical Sciences.

Combination ICS-LABA drugs form the basis of current treatment for asthma and COPD. But the airway distribution of the receptors for each drug is unique, making delivery to the right receptor hit and miss. To better fine tune drug-receptor delivery, researchers based in Budapest, Hungary, attempted to compare the co-deposition patterns of 2 ICS-LABA medications with the distribution patterns of their corresponding airway receptors using numerical modelling.

The researchers chose 2 widely used combination drugs for their analysis. The first,  Symbicort Turbuhaler, contained budesonide as the ICS and formoterol fumarate dehydrate as the LABA; the second, Relvar Ellipta, contained the fluticasone furoate as the ICS combined with vilanterol (trifenatate) as the LABA. Both combination drugs offered a ready availability of data on their aerodynamic properties.

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A total of 49 patients with chronic obstructive pulmonary disease (COPD) underwent Turbuhaler testing, and 59 patients with COPD were selected for Ellipta. “The amount and size distribution of the particles emitted by [dry powder inhalers] depend on the inhalation profile of the patient,” the authors wrote. They elicited 50% inhalation profiles from airflow measurements taken as each patient inhaled the assigned medication. 

Using a stochastic lung model, the investigators calculated the deposition amount of each component drug in patient airways. They found that the ICS and LABA portions of Symbicort Turbuhaler reached their target receptors uniformly throughout the entire respiratory tract. However, the corticosteroid in Relvar Ellipta delivered its contents up to 25% better than its partner component in the large bronchi but nearly 40% worse in the deeper airways

“Better co-deposition would enhance the synergistic effects between the components, while selective deposition based on receptor distribution would lower it,” wrote the authors. But a perfect match is not an option, and only large clinical trials can uncover the most optimal resolution to the problem, the researchers said.

A key limitation of the study was variability in predicting where in the airway the drugs would be deposited, depending on the model used. To ensure that their conclusions were generalizable, the investigators repeated the simulations using another reliable model, the Multiple-Path Particle Dosimetry Model, which confirmed the trends seen in the original modelling.

“Present results highlight the need for extensive research to elucidate whether each drug component should deposit according to its receptor distribution or similar deposition distribution patterns of the components should be attained to benefit from the synergistic effects documented in the open literature,” the authors explained. “Once this aspect [is] clarified, the next step will be to tailor the aerodynamic properties of each component of combination drugs to yield the desired deposition distribution in the lungs,” they added.


Farkas Á, Horváth A, Tomisa G, et al. Do we really target the receptors? Deposition and co-deposition of ICS-LABA fixed combination drugs. Eur J Pharm Sci. Published online April 12, 2022. doi:10.1016/j.ejps.2022.106186

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Traditional Dance In Kyrgyzstan Used To Treat This Lung Disease

Kara Jorgo is Kyrgyzstan's national dance

In the country of Kyrgyzstan there is a traditional dance called Kara Jorgo which is also the country's national dance. The interesting thing about this dance is that it is used to treat people with Chronic Obstructive Pulmonary Disease, better known as COPD. COPD is a common, preventable and treatable lung disease.

The dance involve a range of body movements that help the patients with their COPD. According to The Guardian, in the beginning most patients complain of shortness of breath. Speaking to the news outlet Aidai Temiraly Kyzy, a 24 year old nurse says “Almost all patients, before doing this, complain of shortness of breath, a cough and say they have no physical aptitude…But, even on the second or third day, the improvement is noticeable. Physically, they can do more.”

She goes on to add “I've seen patients with really low mood transform and, by the end, they smile and are so grateful.”

Kyrgyzstan's health ministry has officially adopted this treatment and it is already being done in 3 hospitals. The sessions run for six weeks, with a couple of two hour sessions every week.

Prof Talant Sooronbaev who is the director of the National Centre of Cardiology and Internal Medicine, speaking to The Guardian said “When we give patients with COPD medicine and drugs, this is not a real medical service,” he says. “Pulmonary rehabilitation is an important part of treatment. This is why we have plans to extend, and why we will share our experience with neighbouring countries – Tajikistan, Uzbekistan, Kazakhstan and Turkmenistan.”

COPD often develops in one's midlife, with symptoms such as breathlessness, cough and fatigue. It can be caused by smoking, or being exposed to polluted air. If detected early it can be treated and managed.

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Adherence to guidelines for COPD in an ED setting can help patients avoid compromising their health-related quality of life.

Evidence suggests that adherence to COPD guidelines in the ED can help avoid compromising a patient’s HRQOL.

However, “challenges in the acute clinical setting include a lack of a single integrated platform, supporting infrastructure, interdisciplinary staff capacity, lack of clinician training and support for underconfident clinicians to use digital devices, and a lack of critical information at point of care,” write Hancy Issac, PhD-candidate and colleagues in the International Journal of Chronic Obstructive Pulmonary Disease.

Cultivating Consensus on COPD Management

Given these obstacles to adherence, the study team sought to cultivate a consensus of information necessary to develop an electronic integrated COPD proforma (E-ICP) that improves COPD management in the ED. This digital resource would provide staff with consistent information based on up-to-date guidelines, the ability to make referrals with ease, patient resources, and staff training opportunities.

Issac and colleagues used a modified Delphi study method that allowed targeted experts (eg, ED and respiratory clinicians) to share their opinions and experiences in order to develop an actionable consensus that could be used in the E-ICP. The process began with an extensive literature review, and then the investigators applied a mixed-method design using electronic surveys that kept participants semi-anonymous. This first convened a panel to identify interventions that should be included in the proforma. The next portion of the study aimed to find consensus among the experts regarding the interventions they identified, which required three rounds of a quantitative survey that was scored to narrow in on agreement among the experts.

The results were analyzed and consensus on a topic was “considered reached if at least 70% of the panel strongly agreed that an item should be included or excluded from the proforma,” explain Issac and team.

Agreement among the expert participants was highest (more than 80%) when it came to addressing barriers to care. General concern existed over lack of resources, lack of sufficient time to provide care, and lack of clear direction regarding the referral process. There was also a positive response to the development of the electronic proforma. Participants believed that this type of standardized digital tool could help with efficiencies and the distribution of information.

Providing Consistent COPD Guideline Adherence

The iteration of surveys also revealed that although ED and respiratory staff did not initially agree on the application of referrals when a patient presented with COPD symptoms in the ED, they did eventually agree that a respiratory nurse serving as a single point of contact would be the ideal advocate to provide consistent guideline adherence potentially avoiding readmission or compromised care.

Issac and colleagues explained that an E-ICP based on the information gleaned from their modified Delphi study has the potential to ease the referral process, reduce hospital admissions rates and lengths of stay, provide a more complete approach to care, and increase utilization of, and adherence to, up-to-date COPD guidelines (Table). “This proforma will aid to resolve major barriers of knowledge, environmental resources, and professional role clarity in the management of COPD patients in the ED,” they wrote.

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New York, May 27, 2022 (GLOBE NEWSWIRE) -- announces the release of the report "Respiratory Devices And Equipment (Diagnostic) Global Market Report 2022" -

The global respiratory devices and equipment (diagnostic) market is expected to grow from $6.36 billion in 2021 to $6.93 billion in 2022 at a compound annual growth rate (CAGR) of 9.0%. The market is expected to grow to $9.35 billion in 2026 at a compound annual growth rate (CAGR) of 7.8%.

The respiratory devices and equipment (diagnostic) market consists of sales of diagnostic respiratory devices and equipment and related services by entities (organizations, sole traders, and partnerships) that manufacture respiratory devices and equipment.Respiratory devices and equipment are used in the diagnosis of respiratory disorders such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease.

Only goods and services traded between entities or sold to end consumers are included.

The main products of the respiratory devices and equipment (diagnostic) market are instruments and devices, assays, and reagents.The respiratory instruments and devices are used to diagnose respiratory disorders.

The test type included is traditional diagnostic tests, mechanical tests, imaging tests, and molecular diagnostic tests that are used to diagnose chronic obstructive pulmonary disease, lung cancer, asthma, tuberculosis, and other diseases. These are used in hospital/clinical laboratories, physician offices, reference laboratories, and other end users.

Asia Pacific was the largest region in the respiratory devices and equipment (diagnostic) market in 2021.North America was the second largest region in the respiratory devices and equipment (diagnostic) market.

Eastern Europe was the smallest region in the respiratory devices and equipment (diagnostic) market. The regions covered in this report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, and Africa.

The increasing prevalence of various respiratory diseases contributed to the global respiratory devices and equipment market growth by increasing the use of diagnostic devices and equipment for diagnosis and treatment.Diseases such as chronic obstructive pulmonary disease (COPD) are more prevalent in the geriatric population.

COPD is a type of obstructive lung disease that results in long-term breathing problems.For instance, in June 2021, according to the world health organization data, chronic obstructive pulmonary disease (COPD) is the third disease on the list of causing death in the world.

There are about 3.23 million deaths that are caused by chronic obstructive pulmonary disease (COPD) in 2019. . Thus, the increased number of such cases has surged the demand for diagnostic devices and equipment, therefore driving the market’s growth.

Stringent regulatory practices are expected to negatively impact the growth of diagnostic respiratory devices in the forecast period.In the USA, respiratory devices undergo a strict approval process as they come under Class III devices (that pose a significant risk to patients) as per the Food and Drug Administration (FDA) classification of medical devices.

These devices require clinical evidence that supports their intended use unlike, Class I and II devices, to receive marketing approval.In countries such as China, the approval process for medical devices, especially for devices used for support or sustenance, is strict and time-consuming.

Such a process has slowed the entry of medical devices into the market, thus restraining the growth.

Companies in the market are increasingly investing in portable and wireless diagnostic respiratory devices.The trend is being driven by the ease of handling, cost-effectiveness, advanced features of these devices, and their suitability for use at home care organizations.

Innovative technology-enabled portable respiratory devices are being launched into the market, which, unlike traditional devices, can be used for immediate diagnosis of vital signs, for example, the patients’ respiratory rate and the pulse rate. For instance, in 2019, the US Food and Drug Administration approved MediPines Corporation’s non-invasive portable medical device, which provides clinicians with real-time pulmonary parameters and insights to support rapid triage and treatment decisions for respiratory conditions.

In June 2020, AireHealth acquired BreathResearch for an undisclosed amount.The deal comprises the acquisition of IP, research, and patents, which include work on machine learning analytics for respiratory condition tracking.

BreathResearch is a US-based company engaged in converting the airwaves of breathing into sound waves producing new respiratory analytics which improve health, fitness, and performance.

The countries covered in the respiratory devices and equipment (diagnostic) market are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, and USA.

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Pinch-lip or pursed-lip breathing exercises, mouth breathing can help you improve breathing difficulties . Pursed-lip breathing helps you get more air in without over-breathing. Some of the effects of pursed-lip breathing are:
Releases large amounts of air trapped in your lungs; Clearing the airways makes it easier for you to breathe; Improve respiratory function; Evens out breathing due to deeper, longer breathing; Help you relax; Helps circulate air in the lungs; Reduce shortness of breath.

Pursed-lip breathing has many benefits for patients with chronic obstructive pulmonary disease (COPD). COPD causes a patient's airway to collapse. By prolonging expiration, pursed-lip breathing creates a small amount of backpressure, known as positive end-expiratory pressure (PEEP). Elastic pressure is generated by elastic contraction of the lung, chest wall (elastance) and volume of air delivered. For a given volume, elastic pressure is increased either by increased pulmonary stiffness (eg, pulmonary fibrosis) or restricted by the chest wall or diaphragm (eg, due to severe ascites or obesity).
Some studies show that pursed-lip breathing improves exercise tolerance in people with COPD. It also improves their ventilation system and increases the amount of oxygen in the blood.
Pursed-lip breathing also gives you a sense of control over your breathing. This can help prevent shortness of breath or anxiety and restlessness caused by shortness of breath.


#pursedlipbreathing #breathingexercise

Coronavirus survivors have twice the risk of developing dangerous blood clots that travel to their lungs compared to people who weren't infected, as well double the chance of respiratory symptoms, says a large new study. — AFP pic

Coronavirus survivors have twice the risk of developing dangerous blood clots that travel to their lungs compared to people who weren't infected, as well double the chance of respiratory symptoms, says a large new study. — AFP pic

Thursday, 26 May 2022 7:41 AM MYT

WASHINGTON, May 26 — Coronavirus survivors have twice the risk of developing dangerous blood clots that travel to their lungs compared to people who weren’t infected, as well double the chance of respiratory symptoms, a large new study said Tuesday.

The research by the Centers for Disease Control and Prevention found that as many as one in five adults aged 18-64 years and one in four of those over 65 went on to experience health conditions that could be related to their bout of Covid — a finding consistent with other research.

Among all conditions, the risk of developing acute pulmonary embolism — a clot in an artery of the lung — increased the most, by a factor of two in both adults younger and older than 65, as did respiratory symptoms like a chronic cough or shortness of breath.

Pulmonary embolisms usually travel to the lungs from a deep vein in the legs, and can cause serious problems, including lung damage, low oxygen levels and death.

The study was based on more than 350,000 patient records of people who had Covid-19 from March 2020 - November 2021, paired with 1.6 million people in a "control" group who had sought medical attention in the same month as a corresponding "case" patient, but weren’t diagnosed with Covid.

The team assessed the records for the occurrence of 26 clinical conditions previously associated with long Covid.

Patients were followed one month out from the time they were first seen until they developed a subsequent condition, or until a year had passed, whichever came first.

The most common conditions in both age groups were respiratory symptoms and musculoskeletal pain.

In patients under 65, risks after Covid elevated for most types of condition, but no significant differences were observed for cerebrovascular disease, mental health conditions, or substance-related disorders.

“Covid-19 severity and illness duration can affect patients’ health care needs and economic well-being," the authors wrote.

"The occurrence of incident conditions following infection might also affect a patient’s ability to contribute to the workforce and might have economic consequences for survivors and their dependents," as well as placing added strain on health systems.

Limitations of the study included the fact that data on sex, race, and geographic region were not considered, nor was vaccination status. Because of the time period, the study also didn’t factor in newer variants. — AFP

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Oxygen Conserving Devices Market: Overview

According to the report, the global oxygen conserving devices market was valued at ~US$ 164 Mn in 2018. It is projected to expand at a moderate CAGR during the forecast period. Oxygen therapy is considered to be a highly important tool to help save lives of patients suffering from hypoxemia and other health conditions. Oxygen conservers are used to regulate the supply of oxygen, thus saving the overuse of oxygen by offering precise amount of oxygen. Oxygen conservers are prescribed with ambulatory cylinders, which optimizes the supply for a long duration of up to three days. Pneumatic, electronic, liquid oxygen, and disposable are the various oxygen conserver devices available in the market.

Significant expansion of the oxygen conserving devices market can be attributed to investments in technology, strong product portfolio, and rise in patient pool suffering from pulmonary or non-pulmonary condition. Moreover, increase in geriatric population is another factor fueling the oxygen conserving devices market.

North America dominated the oxygen conserving devices market in 2018, and the trend is anticipated to continue during the forecast period. This can be ascribed to the rise in awareness about hypoxemia that is caused by COPD and other respiratory diseases, presence of key players, increase in patient pool, favorable reimbursement policies, and availability of new oxygen conservers for pediatric patients in the region. However, misdiagnosis or underdiagnoses and high product pricing of certain oxygen conservers are likely to hamper the oxygen conserving devices market in North America during the forecast period.

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Rise in Incidences of COPD and Other Chronic Respiratory Diseases to Drive Market

Rising incidences of chronic obstructive pulmonary disease (COPD) and other respiratory diseases globally is likely to prompt key players to develop oxygen conservers as a supplemental oxygen therapy and subsequently, save wastage of oxygen. COPD is considered to be the third-leading cause of death in the U.S., and fourth-leading cause of death across the world. According to an article published on Verywell Health, COPD affects around 11 million people in the U.S. and commonly occurs in people over the age of 40. This indication drives the need for supplemental oxygen, which is managed by the use of oxygen conserving devices.

According to the Global Burden of Disease Study, in 2016251 million cases of COPD were identified, and 3.17 million deaths were recorded due to this disease, globally. Mostly 90% of deaths by COPD occur in middle or low income countries. A major cause for COPD disease is the increase in incidence of smoking among adults across the globe. Moreover, long-term asthma is also responsible for causing the COPD disease. According to research published in Science Daily, in April 2018, China was home to a significantly large population of adult COPD patients, which is estimated to be 100 million. This number represents around 8.6% of the population of China, which indicates that the prevalence of COPD is considerably high in China.

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Increasing Geriatric Population Fuels Demand for Continuous Innovation in Oxygen Therapy

Rising geriatric population, globally, is fueling the demand for oxygen conserving devices to carry out their daily activities. The geriatric population often suffers from certain chronic respiratory diseases that hamper their mobility; hence, their dependence on oxygen therapy helps improve the quality of their life. For instance, pneumatic, electronic, and disposable oxygen conservers are available for geriatric patients and thus, fulfill the need for devices offering supplemental oxygen. Rise in the geriatric population demands better treatment options, which in turn is likely to provide opportunities to companies that operate in the oxygen conserving devices market. According to the United Nations, the geriatric population, or people above the age of 60, is expected to double by 2050, and triple by 2100. It is projected to rise from 962 million in 2017 to 2.1 billion by 2050 and reach 3.1 billion by 2100. Globally, the geriatric population is the rising at a rapid pace, as compared to the population growth rate of the younger age group.

Rising Prevalence of Chronic Bronchitis Drives Demand for Oxygen Conserving Devices

In terms of indication, the oxygen conserving devices market has been segmented into chronic bronchitis, emphysema, sleep apnea, and others. Chronic bronchitis and emphysema are two major COPD diseases that accounted for considerable deaths and these conditions drive the need for oxygen therapy across globe. Patients suffering from severe COPD require continuous supply of oxygen. According to WHO, COPD is the fourth-leading cause of death in the world, with approximately 2.75 million deaths per annum. The WHO predicts that COPD would be the third-leading cause of death by 2030. According to the CDC, over 16 million people in the U.S. are living with respiratory disorders such as lung cancer, COPD, and heart diseases, caused due to smoking.

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Oxygen Conserving Devices Market: Prominent Regions

In terms of region, the oxygen conserving devices market has been segmented into five major regions: North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America dominated the oxygen conserving devices market in 2018, followed by Europe. North America accounted for a major share of the oxygen conserving devices market in 2018, owing to a rise in incidence of COPD and supportive government policies. Moreover, aging baby boomers are estimated to fuel the demand for oxygen therapy, including oxygen conservers, to help them lead a comfortable life.

According to the U.S. Census Bureau, all baby boomers are expected to be older than the age of 65 by the year 2030. Technological advancements and reliable reimbursement policies in the U.S. for oxygen therapy devices helps patients to access these devices. Moreover, presence of key players in the region and a strong product portfolio of supplemental oxygen therapy are projected to drive the market in the region.

The oxygen conserving devices market in Asia Pacific is projected to expand at a notable CAGR from 2019 to 2027. This can be attributed to an increase in healthcare expenditure, rapid increase in rate of adoption of devices used for oxygen therapy, and growing prevalence of chronic respiratory diseases among patient population in developing countries. Moreover, rising geriatric population in countries such as Japan, India, and China is estimated to positively impact the development of innovative oxygen conserver devices in these countries. Furthermore, strong medical devices supply chain in countries such as India, Japan, and China is driving the oxygen conserving devices market in the region.

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Development of Innovative Disposable Oxygen Conservers Offers Significant Growth Opportunities

The oxygen conserving devices market is fragmented, in terms of number of players. Key as well as local players have been offering various oxygen conserving devices, including pneumatic, liquid oxygen, and disposable types in the market for the past few years. Key players operating in the oxygen conserving devices market include Inogen Inc., GCE Group, Precision Medical Inc., Drive DeVilbiss International, Medline Industries, Inc., GF health Products, Inc., Inovo, Inc., Essex Industries, and Krober Medizintechnik. These players have adopted various strategies, such as investments toward the development of oxygen conserving devices, which include disposable oxygen conservers, electronic oxygen conservers, and strengthening their distribution network and product portfolio.

Companies such as Drive Devilbliss Healthcare have introduced disposable oxygen conservers, such as Oxymizer disposable oxygen conserver, which provides and saves oxygen in 4:1 ratio, as compared to that offered by other continuous flow oxygen therapy devices.

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This article was originally published here

Chron Respir Dis. 2022 Jan-Dec;19:14799731221104102. doi: 10.1177/14799731221104102.


INTRODUCTION: The Coronavirus disease (COVID-19) pandemic has significantly altered the provision of rehabilitation services, especially pulmonary rehabilitation (PR). Our objective was to assess the provision of PR services in Latin America 18 months after the COVID-19 pandemic was declared.

METHODS: A cross-sectional study that included professionals dedicated to PR in centres in Latin America was applied. Responses to an online questionnaire were collected from May to September 2021. The following data were included for the analysis: demographic data, evaluation strategies, program structure, PR intervention in post-COVID-19 patients, and perception of strategies therapies for the care of post-COVID-19 patients. The questionnaire was distributed in Spanish and Portuguese languages.

RESULTS: Responses were received from 196 PR centres. Exercise tolerance was predominantly measured with the six-minute walk test. Less than 50% of the institutions evaluate quality of life, physical qualities, symptoms, and lung function. Most of the programmes have physiotherapists (90.8%), as well as pulmonologists (60%), and psychologists (35%), among other professionals.

CONCLUSION: PR services in Latin America have adapted in their way to the requirements of the pandemic, and most continued to provide face-to-face services. It was identified that the application of the programs is heterogeneous both in evaluations and interventions.

PMID:35616253 | DOI:10.1177/14799731221104102

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In patients with heart failure who have a pacemaker, inspiratory muscle strength training (IST) and endurance training of the inspiratory muscle (IET) show equal benefit with respect to respiratory muscle endurance, lung function, quality of life, dyspnea, fatigue, and physical activity. These findings from a randomized, controlled, double-blind study were published recently in Heart and Lung.

Earlier studies have shown that IST improves the strength of the inspiratory muscles as well as physical endurance in general, but no studies have compared IST with IET in heart failure patients with a pacemaker, noted authors of the current study, who added that implantation of a pacemaker in heart failure patients has been rising dramatically in recent years.

In the current study, Turkish investigators conducted a prospective , randomized, controlled trial (RCT; Identifier: NCT03501355) of clinically stable heart failure patients with pacemakers between the ages of 18 and 70 years. Of 110 patients screened, those with conditions such as unstable angina, acute myocardial infarction, or uncontrolled hypertension (74) were excluded. The 36 remaining patients were placed randomly into the IST or the IET cohort and assigned to 8 weeks of inspiratory muscle training, involving high-intensity (50% or more of maximal inspiratory pressure [MIP]), low-repetition training for the strength training group and low-intensity (30% or more of MIP), high-repetition for the endurance training group. 

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Participants trained using a breathing device (POWERbreathe, Classic Low Resistance) designed to create resistance during inhalation. Training proceeded 30 minutes per day, 7 days per week, for 8 weeks. Before and after training, all participants underwent 6-minute walk tests (6MWT); pulmonary function, peripheral muscle strength, dyspnea, and fatigue perception measurements; incremental shuttle walk tests (ISWT); and measurements of respiratory muscle strength and endurance, quality of life, and physical activity level measurements. 

Both groups achieved significant improvements in MIP, maximal expiratory pressure, respiratory muscle endurance, peripheral muscle strength, 6MWT and ISWT walking distances, dyspnea, quality of life, physical activity level, and fatigue scores (P ≤.05), but no significant differences were noted between the groups (P >.05). The training did not produce any significant improvements in percentages of forced expiratory volume in the first second of expiration (FEV1), forced vital capacity (FVC), FEV1/FVC, or forced midexpiratory flow (FEF25%-75%) in or between the cohorts (P >.05). No adverse events occurred during the training.

Limitations of the study included its small sample size and the inclusion of smokers, which could have affected the results.

None of the participants received cardiac rehabilitation before or during the trial, and the adherence of pacemaker patients, especially those with implanted cardiac defibrillators (ICDs), to such programs remains poor because of fear of ICD shocks, according to the authors. But the safety of the training shown in this study should alleviate some of that trepidation. “Considering the current results, inspiratory muscle strength or endurance training should be added as a safe and effective intervention to cardiopulmonary rehabilitation programs for pacemaker patients with HF (heart failure),“ the authors recommended. 


Katayıfçı N, Boşnak Güçlü M, Şen F. A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: a randomized study. Heart Lung. Published online April 23, 2022. doi:10.1016/j.hrtlng.2022.04.006

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We identified 11 RCTs (10 double-blind and 1 single-blind) with a total 762 participants. The mean age of participants ranged from 62 to 76 years. Trials were single- or two-centre trials conducted in Iran, New Zealand, Nepal, Turkey, the UK, Tunisia and the USA between 2004 and 2018. We judged studies to be at low or unclear risk of bias for most of the domains. Three studies were at high risk for blinding and other biases. 

Intravenous magnesium sulfate versus placebo

Seven studies (24 to 77 participants) were included. Fewer people may require hospital admission with magnesium infusion compared to placebo (odds ratio (OR) 0.45, 95% CI 0.23 to 0.88; number needed to treat for an additional beneficial outcome (NNTB) = 7; 3 studies, 170 participants; low-certainty evidence). Intravenous magnesium may result in little to no difference in the requirement for non-invasive ventilation (OR 0.74, 95% CI 0.31 to 1.75; very low-certainty evidence). There were no reported cases of endotracheal intubation (2 studies, 107 participants) or serious adverse events (1 study, 77 participants) in either group. Included studies did not report intensive care unit (ICU) admission or deaths. Magnesium infusion may reduce the length of hospital stay by a mean difference (MD) of 2.7 days (95% CI 4.73 days to 0.66 days; 2 studies, 54 participants; low-certainty evidence) and improve dyspnoea score by a standardised mean difference of -1.40 (95% CI -1.83 to -0.96; 2 studies, 101 participants; low-certainty evidence). We were uncertain about the effect of magnesium infusion on improving lung function or oxygen saturation. For all adverse events, the Peto OR was 0.14 (95% CI 0.02 to 1.00; 102 participants); however, the event rate was too low to reach a robust conclusion. 

Nebulised magnesium sulfate versus placebo

Three studies (20 to 172 participants) were included. Magnesium inhalation may have little to no impact on hospital admission (OR 0.77, 95% CI 0.21 to 2.82; very low-certainty evidence) or need for ventilatory support (NIV or mechanical ventilation) (OR 0.33, 95% CI 0.01 to 8.20; very low-certainty evidence). It may result in fewer ICU admissions compared to placebo (OR 0.39, 95% CI 0.15 to 1.00; very low-certainty evidence) and improvement in dyspnoea (MD -14.37, 95% CI -26.00 to -2.74; 1 study, 20 participants; very low-certainty evidence). There were no serious adverse events reported in either group. There was one reported death in the placebo arm in one trial, but the number of participants was too small for a conclusion. There was limited evidence about the effect of magnesium inhalation on length of hospital stay, lung function outcomes or oxygen saturation. Included studies did not report adverse events. 

Magnesium sulfate versus ipratropium bromide 

A single study with 124 participants assessed nebulised magnesium sulfate plus intravenous magnesium infusion versus nebulised ipratropium plus intravenous normal saline. There was little to no difference between these groups in terms of hospital admission (OR 1.62, 95% CI 0.78 to 3.37), endotracheal intubation (OR 1.69, 95% CI 0.61 to 4.71) and length of hospital stay (MD 1.10 days, 95% CI -0.22 to 2.42), all with very low-certainty evidence. There were no data available for non-invasive ventilation, ICU admission and serious adverse events. Adverse events were not reported. 

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Liquid Clenbuterol is a powerful and effective weight loss supplement that has been used by bodybuilders and athletes to help them lose weight. It is also used to treat breathing disorders such as asthma and chronic obstructive pulmonary disease. Clenbuterol has been used by many bodybuilders and athletes to help them lose weight. You can clenbuterol buy in online stores. It is also used to treat breathing disorders such as asthma and chronic obstructive pulmonary disease.

Clenbuterol is manufactured in the form of a tablet that is taken orally, often before exercise. The main ingredient found in Clenbuterol is called clenbuterol hydrochloride. This substance activates the cells in your body that are responsible for burning fat, which leads to weight loss. In addition, it can help with breathing problems by relaxing the muscles in your airways and opening up airways passages. Liquid Clenbuterol is not a steroid or anabolic agent. Instead, it is a thermogenic blend that burns body fat in order to generate heat and energy.

What is Liquid Clenbuterol and How is it Used?

Liquid Clenbuterol is a dietary supplement that has been designed to help people lose weight and get in shape. It is also called liquid clean, liquid clenbuterol, or clean. Liquid clenbuterol comes in the form of a liquid that is taken orally. It is an alternative to the pill form of this supplement that can be hard to swallow for some people.

Liquid Clenbuterol has been used by athletes and bodybuilders for many years to improve their performance and appearance, but it has also become popular among those who are looking for a way to lose weight quickly. You can buy the best clenbuterol from an online store. You can also consult a trainer or a doctor to decide on what can be your regular dose.

What are the Benefits of Liquid Clen?

Liquid Clen is a natural supplement that aids in weight loss by boosting the metabolism and suppressing appetite. Liquid Clen is a natural supplement that aids in weight loss by boosting the metabolism and suppressing appetite. It helps to reduce body fat, maintain muscle mass, and improve general health. Liquid Clen helps to reduce body fat, maintain muscle mass, and improve general health. It also contains ingredients that are proven to help with weight loss such as green tea extract and CLA (conjugated linoleic acid).  Liquid Clen is a natural supplement that aids in weight loss by boosting the metabolism and suppressing appetite. It helps to reduce body fat, maintain muscle mass, and improve general health.

 It helps to reduce body fat, maintain muscle mass, and improve general health. It also contains ingredients that are proven to help with weight loss such as green tea extract and CLA (conjugated linoleic acid).

Some of the effects of liquid clenbuterol include:

  • Increased calorie burning rates to help people lose weight 
  • Improved energy levels due to increased metabolism and improved fat oxidation. rates 
  • Increase in oxygen transport and use within the body
  • Enhanced muscle building, Clenbuterol can be administered via inhalation or intravenously. Inhalation is thought to be more effective, due to the drug being able to be absorbed into the bloodstream faster. 
  • Increased endurance and reduced muscle fatigue
  • Improved recovery time 
  • Reduced performance anxiety
  • Enhanced focus, concentration, and alertness

Conclusion: Final Thoughts on the Best Way to Use Liquid Clen Buterol In The Future

Some people have been using liquid clenbuterol for weight loss purposes. It can be hard to lose weight because of the lack of time and motivation, but this supplement can help you with both of these things. Liquid clenbuterol can also help you build muscle mass and reduce fat deposits in your body. The best way to use liquid clenbuterol is by taking one or two doses per day with breakfast or lunch, and then before you work out at night.

There are many ways that you can use Liquid Clenbuterol in the future. It’s important to take care of what you put into your body and make sure that you are using it responsibly. 

The best way to use liquid clenbuterol in the future is to use it as a supplement for weight loss. It will help you get rid of the excess fat and tone your body. The only downside is that it can’t be used for long periods of time because it can cause side effects. 

Liquid clenbuterol will give you some of the same benefits as the injectable and pills. It might be best to use it when you don’t have time to do a lot of exercise. It sounds like liquid clenbuterol is a good option for you! Based on your symptoms, you should use liquid clenbuterol to help your breathing. It will also help you burn more fat and have a happier overall life.

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This post was written by Courtney Leach, social media manager, Parkview Health.

I can admit it now, I wasn’t thrilled when I learned we would be meeting at Parkview LaGrange at 6:45 in the morning. But cruising up State Road 3, “Kodachrome” by Paul Simon coming through the speakers, it was a bit of a treat to greet the day. As the miles elapsed from the app on my dashboard, I saw ominous dark clouds to the west and a blazing coral wave bleeding up over the tree line to the east. I was somewhere in between, where the two skies met and mingled.

I caught the first light stretching out over Sylvan Lake. I passed turkey buzzards picking at breakfast and shaky spring foals skipping in their dewy pastures. I snaked along, by mammoth overhead sprinklers spanning across primed fields, tractors dozing here and there, waiting to see which side of the sky would win and dictate their workday.

The phased approach

I met Shea Pyle, BS, ACSM EP-C, an exercise physiologist, on the farthest end of the parking lot, near the entrance for Outpatient Therapy. We walked down the steps to a door on the lower level. A left at the cafeteria and we arrived at the Cardiac and Pulmonary Rehab room. This is Shea’s space, where he helps patients recoup and reclaim their physical stamina and self-esteem.

After we exchanged a few pleasantries, just before 7 a.m., the first gentleman of the day walked in. He was in Phase 2 of Cardiac Rehab. Shea explained that there are three phases to the cardiac rehabilitation process.

Cardiac Rehab

Since assuming the role of manager for Cardiac Rehab in Allen County, Emily Keltner has worked diligently to improve the referral process for Parkview Heart Institute (PHI) patients. During Phase 1, Cardiac Rehab staff (primarily exercise physiologists, like Shea) visit patients in the hospital who qualify for Cardiac Rehab. They educate them on what is involved in the Phase 2 program, the benefits of going, provide educational material that will be covered during their Phase 2 onboarding and answer any questions they have. They ask which location the patient prefers and put that information into the medical record system so that location can call them to schedule the orientation appointment for Phase 2.

“We used to wait until they’d had their follow-up appointment with their cardiologist,” Shea explained. “But now the care team can clear them for exercise when they get discharged from the hospital if they think it’s safe. This has helped us get people in much quicker and eliminate lost time.”

Phase 2 involves 36 sessions of exercise while attached to a heart rate monitor and supervised by a Cardiac Rehab team member. Sessions for Phase 2 patients involve arm and leg exercises, increased gradually over time, for 30-60 minutes. “You see a big demeanor shift over the course of their 36 sessions,” Shea said. “That first appointment, they’re so scared. They’ve just had a life-changing event and they’re terrified it will happen again if they push their bodies. So much of the first few appointments are about gaining the confidence to move again.”

Cardiac Rehab

Shea watches the heart rates for all Phase 2 patients on his computer monitor, and routinely checks in with them both verbally and by taking their blood pressure during activity. “In order to take this job, I had to be very comfortable reading the heart rhythms.” He is looking for any concerning changes or patterns, at which point he would intervene. Parkview LaGrange has PPG cardiologists on staff Mondays and Wednesdays. Shea defers to the ER physician in charge on other days. “We have a standard protocol for addressing medical emergencies and I have a lot of support here, if I need help. Mostly, when we do have complications, it’s a patient’s blood pressure dropping or they become light-headed, so I have them sit and rest for a bit.”

Phase 3 is for those who wish to pay a small monthly fee for continued use of the equipment in the facility. This is a safe, but more independent option for Cardiac Rehab grads. For residents in LaGrange, entering Phase 3 is a great option, as there are limited choices for gyms in the area.

“Friday’s the big day!” Shea said to his 7 a.m. appointment, as the gentleman peeled the stickers off of the backs of the electrodes he’d attach to his chest. “Session 36. You made it.” Shea then began the series of check-in questions he offered each of the patients as they arrived, “Did you get in any exercise yesterday? How’s your sugar?” After reporting their recent activity, the patients would weigh in and Shea would check their blood pressure. Then it was time to get moving.  

Shea tailors each patient’s exercise routine to their abilities and condition. If they are experiencing knee or shoulder discomfort, he’ll work around those sore spots to keep them comfortable. Before they ever touch a machine, he has a one-on-one orientation to cover education (Mary Buuck, RN, assists with Pulmonary patients), goals and the equipment. Patients also do a 6-minute walking test. “I want to understand where they are, physically and mentally.”

A twenty-something takes on a challenge

Men have gathered for centuries, around fires, bar stools and locker room benches. While the motive is to mend their stamina and moxie, make no mistake, when local guys convene in the rehab room in LaGrange, it’s akin to a modern golf course clubhouse. Shouting output numbers over their shoulders as both a cheer and a challenge, comparisons, friendly jabs … at various points in the day it was the hospital equivalent of a pickup basketball game at the neighborhood park, egos and tenacity rebounding before our eyes.

The healthy competition doesn’t bother Shea a bit. “It can certainly push them,” he said. “Which can be a good thing. A lot of times, patients think they’re getting in plenty of movement, but then they come in here and see the monitors and realize they haven’t really been elevating their heart rate as much as they thought outside of the gym. There’s a difference between yard work and what we’re doing with these machines.”

The ease with which these patients engaged in playful one-upping is evidence of the inevitable intimacy fostered in smaller towns. “It’s fun to hear them sharing these stats and giving each other a hard time. Most of these guys have known each other for years. It’s part of what’s so special about LaGrange. You wouldn’t get this at the bigger locations.”

It’s a particular charisma that the exercise specialist is very familiar with. LaGrange bears many similarities to Berne, Indiana, where Shea grew up. “As a teen, I always loved working out. I played four sports and, eventually realized it was the exercise I enjoyed more than the actual games.” In 2017, during his final semester at Ball State University he began an internship in Cardiac Rehab at the Parkview Heart Institute. He spent time shadowing in the Heart Station and took an EKG class. Shea graduated with a degree in Exercise Science in the spring of 2017, but there were no openings in Cardiac Rehab, so he took a job with Parkview’s Wellness team, doing community health screenings.

After a team member took another position, a job became available in the brand-new Cardiac Rehab gym at Parkview LaGrange. So, in July 2018, at just 23 years old, Shea welcomed the first patient to the community hospital facility and became the primary team member overseeing the program. 

A slow start, unexpected stop, and restart

“Initially, I was basically cold calling patients trying to get them in here,” Shea recalled. Eventually, he got up to 12-14 patients three times a week. Then COVID hit.

In late March 2020, Cardiac Rehab followed on the heels of Physical Therapy (and many other departments) and closed down sessions as the health system fought to address the new and unsettling pandemic. “Things were changing every day. After we closed, I became a greeter in the Emergency Room. I would write down the names of everyone who came into the hospital and their temperature. I was never scared, but I knew it would impact our patients. We reopened, with new safety and cleaning protocols, in May 2020, and we’re just now getting back to the same patient volume we had before the pandemic.”

If you forget about COVID even for a second, you need only watch Shea dutifully distributing sanitizing wipes for the equipment. In addition to an increased demand for cleaning supplies, the pandemic also introduced a new patient population – those impacted by the lasting effects of coronavirus. A patient can be referred by their physician if they are having a hard time breathing or maintaining their oxygen level post-COVID. “I’m seeing pretty good success with these patients,” Shea said. “Every COVID story is a little different, but we find that once we get them in here and start building up their endurance, they get some of that confidence back and make strong progress fairly quickly.” Shea has his own COVID story. He contracted the virus in December 2020, losing 30 pounds and his sense of taste and smell.

“It’s OK to get winded”

While some of Shea’s post-COVID patients are a bit younger, the majority of his day is spent with older adults and, I couldn’t help but notice, predominantly men. During a brief break in activity, I asked Shea about the demographics on his docket for the day. “It ebbs and flows, but I would say I do see more male patients overall. The gap is closing, but it’s still more common for men to have heart events. It seems like women are busier, or maybe more concerned with taking care of others, so they are less likely to participate.” Adherence is a real problem for Cardiac and Pulmonary Rehab patients, which is surprising, considering finishing the program can decrease your risk of recurrence by up to 35%.

Cardiac Rehab

Around 9 o’clock, things really started to pick up. A mix of Phase 3 gym goers and Phase 2 patients kept Shea busy. Between check-ins, helping with machines, watching rhythms and oxygen levels, and “running the floor” (checking blood pressures during activity), he was in a state of perpetual motion; a one-man band, entirely present, keeping all of the necessary plates spinning.

I held a position by the water cooler and listened in as the friends and fellow patients joked about their golf games and meeting for coffee at the local McDonald’s. I asked one gentleman how long he’d been coming. He’d been in Phase 3 for more than a year. “I like the atmosphere,” he said, “And Shea does a good job.” Another chimed in, “It’s like babysitting!” he joked. “Yes, he’s a great babysitter,” the first gentleman agreed, subtly tipping his cup up toward Shea.  

From my spot near Shea’s desk, it was hard to ignore the, at-times, heavy huffing and puffing. “It’s OK if they’re winded, as long as they can carry on a conversation,” Shea assured me. “Plus, I get to know their normal and I can tell if something is different or concerning. Sometimes, pulmonary patients in particular, start talking and forget to breathe.” He asked a few patients to stop and rest when their numbers climbed to a range he didn’t like.

The goal for Cardiac Rehab patients – many of whom are post-surgery or recovering from a major heart event or diagnosis – is to get their heart rate into the target range and maintain it. Then for it to come back down. For Pulmonary Rehab patients, most of whom have COPD or are post-COVID, the goal is to maintain their oxygen level above 88%. “The challenging thing with Pulmonary patients is that they are often dealing with a chronic diagnosis. This isn’t going to be cured, we’re just trying to manage it. That can be tough mentally.”

When someone is feeling down or hesitant, Shea defaults to subtle but sincere encouragement.

“Nice!” “Great work!” “Dang! You’re feeling good today!”

“My grandfather died of a heart attack my senior year of high school and that certainly makes it more personal for me. These are people who are used to doing whatever they want. Suddenly, they’re feeling limited and like they’ve lost their independence. They’re facing unknowns. I don’t treat them like they’re fragile. I’m not going to push them to a point where they aren’t safe, but I want to help them get their confidence back and see that this isn’t what life has to be like. They can return to where they were and improve beyond that.”

Cardiac Rehab 1

Over the course of a few hours, the door swung open and closed a handful of times and, as more patients attached their monitors, checked in and got to work, the volume rose in a roaring ensemble of energy. The beeping of monitors, the clicking of seats sliding into place, the pumping of recumbent pedals, the whishing of the airbike, the uneven thud of sneaker soles alternating on the rubber pad of the treadmill and the constant cranking of the hand levers. It was easy to get lost in the sonic sum of the room’s moving parts.

A person about the people

If the machines weren’t humming, it was fairly common for some healthy water cooler conversation to break out. Patients exchanged war stories of stents and surgeries. Pacemakers, clots and blockages. But it wasn’t all about their medical misfortunes. They talked about travel, relationships (an upcoming 50th anniversary!), crop conditions and challenges, the weather, glory days on the football and softball fields, and, yes, politics. In the span of an hour, they could solve all the world’s problems.

“There’s typically at least one patient who hangs out and talks,” Shea said. “I love hearing all their stories, and it keeps the mood light.” The socialization is as much a form of medicine as the movement is. After all, the group has a shared experience: A second lease on life.

Of course, it’s inevitable that some patients just stand out. “I had a 93-year-old woman who came in and said, ‘I guess I’ll try it.’ And she made it all 36 sessions and did Phase 3 for over a year. She quit coming during COVID, but she still sends me cards at Christmas and Valentine’s Day.“

When I asked him about the responsibility of overseeing the program at LaGrange, Shea was quick to drop names. “There are so many people who helped me and continue to help me in this job. Cale Tabler, Jim Uecker, Nickole Kosan, Nicole Schaekel, and Megan Zink have been so incredible. I spent a lot of time observing Kim Clouse, who oversees the program at Noble, because it’s a similar size. I watched how she ran things and I still reach out to her when I have questions about pulmonary patients, since she’s a respiratory therapist. And Trevor Fry, RN, the ER manager here is an amazing resource. He’s just awesome to work with.”

All of the Cardiac and Pulmonary Rehab programs at our community hospitals are run by either an exercise physiologist, registered nurse or respiratory therapist. Parkview Regional Medical Center has all on staff.

SET therapy

One of Shea’s final patients of the day was there for Supervised Exercise Therapy (SET), a treatment he has offered since February 2021. SET is designed to help those experiencing leg pain as a result of restricted blood flow. This being only his second SET patient, Shea admits, “I’m learning right along with him.” The treatment is predominantly treadmill-based. Patients walk at a prescribed pace and incline, checking in when they reach different degrees of discomfort, until they reach a “5”, the highest on the pain rating scale, and stop until they can go again. The benefits are both mental, because it helps patients get used to feeling the pain and pushing past it, and physical, as the practice increases blood flow. Participants also begin taking a vasodilator (medication that opens blood vessels) at the start of treatment. Just seven visits in, the patient was already feeling improvements. Notably, it was easier for him to get up off the ground when working in his garden.  

“When I hear them talk about how well they’re doing at home, it makes me feel like my work matters. I’m helping people. It’s the type of environment I always imagined myself in. Maybe not this demographic necessarily, but I love it so much. I know how lucky I am to have this opportunity at my age. These are the jobs that you take and never leave. I’m proud of what I’m doing here.”

I thanked Shea for letting me look over his shoulder and walked out into the gentle rain shower patients had been commenting on all day. There was the unmistakable clip-clop of hooves in the distance. One buggy coming and one going.  

LaGrange, like many of the smaller communities we serve, has a distinct personality, punctuated by particular characteristics. After spending time with Shea, in his gym with its chorus of whishing and walking and conversation, the attributes that stood out to me above the rest were the connections and encouragement. The space I stepped into was one where neighbors quipped about unmanaged weeds and fellow survivors spurred each other on, toward goals and a capacity once, in the not-so-distant past, feared lost.

And then there’s Shea. The captain of a concerted climate, designed to introduce the beautiful possibility that this isn’t over. That setbacks are different than swan songs. That progress is always possible with hard work and a few drops of grit.

Shea keeps showing up for his patients and urging them to keep showing up for themselves. All things heal, but not without time and humility. As I witnessed firsthand in LaGrange, you just have to have the right attitude. You have to have someone gifted in the art of the subtle nudge. And above all else, you have to have heart.    



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What Is Trelegy Ellipta?

Trelegy Ellipta (fluticasone, umeclidinium, and vilanterol) is an inhaled prescription drug used for the maintenance treatment of adults with asthma or chronic obstructive pulmonary disease (COPD). Maintenance treatment helps to prevent and control symptoms. COPD is a chronic lung disease that includes chronic bronchitis, emphysema, or both.

Trelegy Ellipta contains three drugs. Fluticasone is an inhaled corticosteroid. Umeclidinium is in a drug class called anticholinergics. Vilanterol is in a drug class called long-acting beta-agonists (LABAs). These three ingredients in Trelegy Ellipta work together to relax and open air passages in the lungs, making it easier to breathe.

Trelegy Ellipta is available as an inhaler. 

Drug Facts

Generic Name: Fluticasone, umeclidinium, and vilanterol

Brand Name: Trelegy Ellipta

Drug Availability: Prescription

Therapeutic Classification: Corticosteroid; anticholinergic; LABA

Available Generically: No

Controlled Substance: N/A

Administration Route: Inhalation

Active Ingredient: Fluticasone, umeclidinium, and vilanterol

Dosage Form: Powder for inhalation

What Is Trelegy Ellipta Used For?

The Food and Drug Administration (FDA) approved Trelegy Ellipta for adults (18 years and older) for the maintenance treatment of:

Trelegy Ellipta is not approved for children and does not treat acute bronchospasm (narrowing of the airways, which can cause wheezing and difficulty breathing).

How to Take Trelegy Ellipta

While using this medication, read the prescription label and information leaflet that comes with it. Trelegy Ellipta is administered with an inhaler. Consult your healthcare provider if you have any questions about using the inhaler.

If you are prescribed Trelegy Ellipta, remember the following:

  • Take your medication once a day, at the same time every day. 
  • Rinse with water and spit (do not swallow the water) after using Trelegy Ellipta to help prevent yeast infection in the mouth.
  • Do not take Trelegy Ellipta more than once in 24 hours. 
  • Discard Trelegy Ellipta six weeks after removing it from the foil pouch or if the dose indicator reaches zero (whichever comes first). Write the day you opened the pouch on the label on the inhaler.

It is important to take this medication exactly as prescribed. Trelegy Ellipta is not a rescue inhaler. Use your rescue inhaler for asthma or bronchospasm attacks. 

Call your healthcare provider if you are sick, feeling stressed, or are planning to have surgery. Get medical help if your breathing problems worsen or if it seems like your medicines are not working as well as before. Your healthcare provider will tell you what tests you need, such as vision and bone mineral density. 

Ask your healthcare provider if you have any questions or concerns.


Store Trelegy Ellipta at room temperature (between 68 and 77 degrees Fahrenheit) and away from heat, direct light, and moisture. Keep this medication in its sealed foil package until ready to use. Throw away the inhaler device six weeks after taking it out of the foil pouch or when the dose indicator is zero, whichever comes first.

Keep this medication out of reach and out of sight of children and pets.

How Long Does Trelegy Ellipta Take to Work?

Trelegy Ellipta may start working after the first dose, but it is essential to take it daily to prevent and control symptoms. It may take a few weeks to feel the full effect of Trelegy Ellipta.

What Are the Side Effects of Trelegy Ellipta?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at or 800-FDA-1088.

Common Side Effects

The most common side effects of Trelegy Ellipta are:

  • Yeast (fungal) infection of the mouth, throat, and/or esophagus
  • Upper respiratory infection (URI) symptoms (e.g., runny or stuffy nose, sore throat, cough)
  • Headache
  • Back or joint pain
  • Altered taste 
  • Mouth sores 
  • Hoarse voice
  • Stomach problems (e.g., nausea, vomiting, constipation, diarrhea)
  • Urinary tract infection (UTI)

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Pneumonia (when Trelegy Ellipta is used for COPD): Call your provider if you have a fever, chills, cough with mucus, or shortness of breath
  • Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, and difficulty breathing, and require emergency medical attention. 
  • Weakened immune system and increased chance of getting infections
  • Osteoporosis (bone thinning or weakness, which can lead to fractures)
  • Nervous system reactions, including tremors and nervousness
  • Changes in blood test values
  • Urinary retention
  • Effects on the heart, including chest pain, increased blood pressure, arrhythmia (irregular heartbeat), cardiac arrest (sudden loss of heart function, breathing, and consciousness)
  • Paradoxical bronchospasm (unexpected airway tightening after using the inhaler)
  • Worsening of asthma
  • Low levels of potassium in the blood (call your provider if you have leg cramps, constipation, chest fluttering, muscle weakness, irregular heartbeat, or numbness and tingling)
  • High levels of blood sugar (call your provider if you have increased thirst and urination)
  • Eosinophilia (high levels of eosinophils, a type of white blood cell)
  • Churg-Strauss syndrome (blood vessel inflammation)
  • Eye problems (including glaucoma and cataracts in COPD patients)

Long-Term Side Effects

While many people tolerate Trelegy Ellipta well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:

  • Back pain 
  • Taste disorder
  • Reflux
  • Muscle cramps
  • Anxiety 
  • Mouth pain

Moderate long-term side effects can include:

Severe long-term side effects may include: 

  • Bone fractures
  • Heart attack
  • Asthma-related death
  • Churg-Strauss syndrome
  • Vasculitis (blood vessel inflammation)
  • Increased pressure in the eye

Report Side Effects

Trelegy Ellipta may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Trelegy Ellipta Should I Take?

Drug Content Provided and Reviewed by

IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For inhalation dosage form (powder):

    • For treatment of asthma:

      • Adults—One inhalation once a day. Each inhalation contains 100 or 200 micrograms (mcg) of fluticasone, 62.5 mcg of umeclidinium, and 25 mcg of vilanterol.
      • Children—Use is not recommended.
    • For treatment and prevention of worsening attacks of COPD:

      • Adults—One inhalation once a day. Each inhalation contains 100 micrograms (mcg) of fluticasone, 62.5 mcg of umeclidinium, and 25 mcg of vilanterol.
      • Children—Use is not recommended.


You may need to use caution when taking Trelegy Ellipta if you are 65 years or older or have moderate to severe liver problems. Consult your healthcare provider.

If you are pregnant, planning to become pregnant, or are breastfeeding, consult your healthcare provider.

Missed Dose

Use Trelegy Ellipta as your provider directs, and do not skip doses. Misusing Trelegy Ellipta may cause serious heart problems or death.

If you do miss a dose, take it as soon as possible. Skip the missed dose if it is almost time for the next dose. Do not take two doses together. Do not take more than one inhalation of Trelegy Ellipta in 24 hours.

Overdose: What Happens If I Take Too Much Trelegy Ellipta?

Taking too much Trelegy Ellipta can cause shakiness, chest pain, a fast heart rate, and shortness of breath.

What Happens If I Overdose on Trelegy Ellipta?

If you think you or someone else may have overdosed on Trelegy Ellipta, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Trelegy Ellipta, call 911 immediately.


Drug Content Provided and Reviewed by

IBM Micromedex®

If you will be using this medicine for a long time, it is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.

Tell your doctor about other medicines you are using for your asthma or COPD. Follow your doctor's instructions on how you should take your medicine.

This medicine should not be used if you are having an asthma or COPD attack, or if symptoms of an asthma or COPD attack has already started. Your doctor will prescribe another medicine for you to use in case of an acute attack. If the other medicine does not work as well, tell your doctor right away.

This medicine may increase the chance of asthma-related problems. Be sure to read about these risks in the Medication Guide and talk to your doctor or pharmacist about any questions or concerns that you have.

This medicine may increase the risk of worsening asthma, which may lead to hospitalization, intubation, and death in patients with asthma. Talk to your doctor if you have concerns about this.

This medicine should not be used together with similar inhaled medicines such as arformoterol (Brovana®), formoterol (Foradil®, Perforomist®), indacaterol (Onbrez®), or salmeterol (Serevent®).

Your doctor may want you to carry a medical identification (ID) card stating that you are using this medicine. The card will say that you may need additional medicine during an emergency, a severe asthma or COPD attack or other illness, or unusual stress.

This medicine may weaken your immune system and increase your risk for infections. Tell your doctor about any immune system problems or infections, including tuberculosis or herpes infection in your eye. Tell your doctor right away if you have been exposed to chickenpox or measles.

This medicine may cause a fungus infection of the mouth or throat (thrush). Tell your doctor right away if you have white patches in the mouth or throat, or pain when eating or swallowing.

This medicine may increase your risk of having pneumonia. Call your doctor if you start having increased sputum (spit) production, change in sputum color, fever, chills, increased cough, or an increase in breathing problems.

Using too much of this medicine or using it for a long time may cause may increase your risk of having adrenal gland problems. Talk to your doctor if you have darkening of the skin, diarrhea, lightheadedness, dizziness, or fainting, loss of appetite, mental depression, muscle pain or weakness, nausea, skin rash, unusual tiredness or weakness, or vomiting.

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. This may be life-threatening. Check with your doctor right away if you have coughing, or difficulty breathing after using this medicine.

This medicine may cause serious allergic reactions, including anaphylaxis and angioedema, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine.

This medicine may increase your risk for heart and blood vessel problems, including changes in heart rhythm. Check with your doctor right away if you have dizziness, fainting spells, severe tiredness, chest pain, trouble with breathing, sudden or severe headache, or fast or irregular heartbeat.

This medicine may decrease bone mineral density when used for a long time. A low bone mineral density can cause weak bones or osteoporosis. If you have any questions about this, ask your doctor.

Check with your doctor right away if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want your eyes be checked by an ophthalmologist (eye doctor).

This medicine may affect blood sugar and potassium levels. If you have heart disease or diabetes and notice a change in the results of your blood or urine sugar or potassium tests, check with your doctor.

This medicine may cause a slowed growth in children. Talk with your doctor if you have any concerns about this.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Trelegy Ellipta?

Trelegy Ellipta is not appropriate for everyone.

There are certain reasons that you should not take this medication, such as:

  • If you are allergic to fluticasone, umeclidinium, vilanterol, or any of the inactive ingredients in Trelegy Ellipta
  • If you are allergic to milk protein
  • To attempt to treat an acute attack or a worsening of asthma or COPD
  • If you are taking any other drug that contains an anticholinergic or a LABA

Trelegy Ellipta may be prescribed with caution in some people only if the healthcare provider determines it is safe, including in people who have taken a drug called a monoamine oxidase inhibitor (MAOI) or tricyclic antidepressant within 14 days. This also includes people with:

What Other Medications May Interact With Trelegy Ellipta?

Tell your healthcare provider about the medications you take, including prescription and over-the-counter (OTC) drugs and vitamins or supplements.

Drug interaction studies have not been explicitly done with Trelegy Ellipta, so the available information is for each component—fluticasone, umeclidinium, and vilanterol.

Monoamine oxidase inhibitors should never be taken with Trelegy Ellipta. An MAOI combined with Trelegy Ellipta can cause high blood pressure and heart problems. Examples of MAOIs are:

  • Marplan (isocarboxazid)
  • Nardil (phenelzine)
  • Parnate (tranylcypromine)

Tricyclic antidepressants combined with Trelegy Ellipta can also increase blood pressure and cause heart problems. Examples of TCAs include:

  • Elavil (amitriptyline)
  • Pamelor (nortriptyline)

Beta-blockers should generally not be taken with Trelegy Ellipta (or may be used with caution in some instances) because the combination can lower the efficacy of both drugs. Examples of beta-blockers include:

  • Coreg (carvedilol)
  • Inderal (propranolol)
  • Lopressor, Toprol XL (metoprolol)
  • Tenormin (atenolol)

Other drug interactions may occur with Trelegy Ellipta. Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar?

Trelegy Ellipta contains three drugs: a steroid, an anticholinergic drug, and a LABA. It can be used for the maintenance treatment of COPD or asthma.

Breztri Aerosphere is an inhaler that also contains a drug from each of these categories. It contains budesonide (a steroid), glycopyrrolate (an anticholinergic), and formoterol fumarate (a LABA). Breztri Aerosphere is approved for the maintenance treatment of COPD, but it is not approved for asthma.

There are other combination inhaled drugs that contain a steroid and a LABA. Some examples include:

  • Advair Diskus (fluticasone and salmeterol)
  • Breo (fluticasone and vilanterol)
  • Dulera (mometasone and formoterol)
  • Symbicort (budesonide and formoterol)

Inhaled corticosteroid inhalers are available as single-ingredient products as well. Some examples include:

  • Alvesco (ciclesonide)
  • Asmanex (mometasone)
  • Flovent HFA (fluticasone)
  • Pulmicort Flexhaler (budesonide)
  • Qvar RediHaler (beclomethasone-diproprionate HFA)

LABAs are also available as single-ingredient products but should never be taken alone. LABAs should always be taken with an inhaled steroid, as taking them without a steroid can increase the risk of death. This can be done as two individual products or as a combination product. Serevent (salmeterol) is an example of a LABA. 

There are also a variety of other drugs that may be prescribed for asthma or COPD maintenance, such as oral medications like Singulair (montelukast). Biologics, which are injected, are sometimes used in patients with difficult-to-control asthma.

This is a list of drugs also prescribed for asthma and COPD. It is not a list of drugs recommended to take with Trelegy Ellipta. Ask your pharmacist or a healthcare practitioner if you have questions.

Frequently Asked Questions

  • What is Trelegy Ellipta used for?

    Trelegy Ellipta is used in adults 18 years and older for maintenance treatment of COPD or asthma. Trelegy Ellipta does not treat an acute attack.

  • How does Trelegy Ellipta work?

    Trelegy Ellipta contains three drugs: fluticasone (a steroid), umeclidinium (an anticholinergic), and vilanterol (a long-acting beta-agonist). These ingredients help to relax and open the lungs, making it easier to breathe. 

  • What drugs should not be taken with Trelegy Ellipta?

    Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants are some examples of drug classes that should not be mixed with Trelegy Ellipta. Beta-blockers generally should not be prescribed with Trelegy Ellipta, but in some cases, a beta-blocker may be used with caution if needed. There are other potential drug interactions as well. Tell your healthcare provider about all of the medications you take before taking Trelegy Ellipta. This includes prescription and OTC drugs as well as vitamins and supplements.

  • How long does it take for Trelegy Ellipta to work?

    Trelegy Ellipta may start to work after the first dose. However, it is important to take Trelegy Ellipta every day to prevent and control symptoms. The full effect may take a few weeks of treatment to be seen.

  • What are the side effects of Trelegy Ellipta?

    The most common side effects of Trelegy Ellipta are cold and flu symptoms, headache, back pain, joint pain, altered taste, mouth sores, hoarseness, urinary tract infection, nausea, vomiting, constipation, diarrhea, and yeast infection of the mouth, throat, and/or esophagus. Other side effects can occur.

  • How do I stop taking Trelegy Ellipta?

    Your healthcare provider will advise you on how long to take Trelegy Ellipta. Do not stop taking the medication without guidance from your provider. Trelegy Ellipta should not be stopped abruptly.

How Can I Stay Healthy While Taking Trelegy Ellipta?

Before taking Trelegy Ellipta, discuss your medical history and all medication you take with your healthcare provider. When taking Trelegy, follow your healthcare provider’s instructions for use. Read the patient information leaflet that comes with your prescription and ask your provider if you have any questions about the drug or how to use the inhaler.

Trelegy Ellipta must be taken once daily, every day, to help prevent and control symptoms. Each time you use Trelegy Ellipta, rinse your mouth with water and spit it out. This will help prevent a fungal infection of the mouth. 

Trelegy Ellipta cannot be used to treat an acute attack. Your rescue inhaler is fast-acting and should be used to treat symptoms of an acute asthma attack or bronchospasm. Common rescue inhalers include ProAir HFA (albuterol), Proventil HFA (albuterol), Ventolin HFA (albuterol), and Xopenex HFA (levalbuterol). If you notice you are using your rescue inhaler more frequently than usual, or feel like it is not working as well as it used to, contact your healthcare provider. 

Always carry your rescue inhaler with you. It can be helpful to have an extra rescue inhaler for work or school. Check the dose counter frequently to make sure your inhaler has enough remaining doses, and always call in your refills a few days early. This will allow extra time in case the pharmacy staff needs to contact your provider for refills, or if the inhaler has to be ordered. Check expiration dates periodically, to make sure your rescue inhaler is not expired.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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This article was originally published here

ERJ Open Res. 2022 May 23;8(2):00674-2021. doi: 10.1183/23120541.00674-2021. eCollection 2022 Apr.


This paper provides an overview of some of the most memorable sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2021 European Respiratory Society International Congress, which was held online for the second consecutive year due to the COVID-19 pandemic. Early Career Members from Assembly 9 summarised the content of the sessions (three oral communication sessions, two symposia and one Expert View) with the support of the chairs from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: impact of COVID-19 on lung function and healthcare services, and the importance of quality assurance and technology in lung function assessment; diagnosis and management of sarcopenia in patients with chronic respiratory disease; maintenance of the effects of pulmonary rehabilitation; solutions outside the hospital for the management of patients with COVID-19 in need of health care; the nursing perspective during the COVID-19 pandemic; and psychological and behavioural issues in respiratory care. This highlights article provides valuable insight into the latest scientific data and emerging areas affecting clinical practice of allied respiratory professionals.

PMID:35615415 | PMC:PMC9125039 | DOI:10.1183/23120541.00674-2021

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COVID-19 is a respiratory infection. It can cause difficulty breathing and can lead to low levels of oxygen in your bloodstream. Low levels of oxygen make it impossible for your body to function normally and can be life threatening.

Monitoring blood oxygen levels at home is one way to keep an eye on your COVID-19 infection and recovery. You can measure your blood oxygen levels with an inexpensive and easy-to-use device called a pulse oximeter.

A pulse oximeter gives you your blood oxygen level as a simple percentage. Any pulse oximeter reading of lower than 90 percent is a sign you need to seek urgent medical care.

Your blood oxygen level is a measure of the amount of oxygen in your blood.

Your body gets oxygen when you breathe in. As air passes through your lungs, oxygen moves into your bloodstream. When your lungs are inflamed due to a severe infection like COVID-19, you may take in less oxygen with each breath.

You need the right level of oxygen in your bloodstream for your body to perform essential functions, like keeping your heart beating. The oxygen in your blood also helps your cells create energy. That energy enables you to think, move, and carry out other daily tasks.

Blood oxygen levels are measured as a percentage. Levels that are closer to 100 percent are best and mean that your body has enough oxygen.

For most people, an oxygen level of 95 percent or higher is ‌standard and healthy.

Some people with chronic lung conditions like chronic obstructive pulmonary disease (COPD) live with lower-than-average blood oxygen levels.

If you have a lung condition, you should call your doctor as soon as you test positive for COVID-19. Your doctor can advise you on how to monitor and treat your condition during the infection.

If you’re monitoring your blood oxygen at home with a pulse oximeter, follow these general guidelines:

  • Contact a doctor if your blood oxygen level falls below 95 percent
  • Seek emergency medical care if your blood oxygen level falls below 90 percent.

A pulse oximeter (pulse ox) is a device that can measure your blood oxygen level quickly and noninvasively. They’re regularly used in doctor’s offices and hospitals, so you’ve most likely had one clipped on your finger before.

During a respiratory illness like COVID-19, your doctor might recommend that you use a pulse oximeter at home to keep track of your blood oxygen levels.

Blood oxygen levels can sometimes drop dangerously low without causing symptoms like shortness of breath. In these instances, a pulse oximeter can help detect low oxygen levels early on, when they can be treated with supplemental oxygen.

Overall, pulse oximeters can be a helpful tool for people with COVID-19. You can buy a pulse oximeter at most drug and grocery stores without a prescription.

Pulse ox readings in people with darker skin

Pulse oximeter readings aren’t perfect. Readings can sometimes be inaccurate, especially in people with darker skin. Because they work by passing a beam of light through your finger, skin tone can affect the results.

Studies have found that in people who self-identify as Black, pulse ox readings are often several points higher than their true values, which can be measured with a blood test called an arterial blood gas.

One study found that Black people were more than three times more likely than white people to have a pulse oximetry reading higher than the true value.

To get more reliable data on blood oxygen levels in people with darker skin, it’s best to take regular readings throughout the day and to keep a record. That way, you’ll notice any downward trends.

Low blood oxygen can affect how your body functions. It can cause severe symptoms, but sometimes it causes no symptoms at all. Either way, it can be life threatening.

Symptoms of a low blood oxygen level include:

The primary treatment for low oxygen levels is oxygen therapy. Oxygen therapy gets oxygen into your bloodstream and helps take the pressure off your lungs so that you recover from COVID-19.

There are a few ways to receive oxygen therapy. In most cases, you’ll receive extra oxygen through a nasal cannula.

A nasal cannula is plastic tubing that sits in your nose. Oxygen from a tank goes into the tubing and then into your body. Doctors and respiratory therapists can adjust the amount of oxygen you receive until your blood oxygen levels return to normal.

As you start to recover, they can slowly reduce the amount of oxygen you receive through the tubing.

If you need more support, you might receive oxygen therapy through a process called intubation. This involves putting plastic tubing directly into your trachea, or windpipe.

Intubation helps keep your airways open so that oxygen can get to your body. The tubing can then be connected to an oxygen supply. As you recover, you’ll transition from intubation to a nasal cannula and tank oxygen.

In some cases, you might be discharged from the hospital with portable oxygen, home oxygen tanks, and a nasal cannula.

In other cases, your treatment team might want you to be breathing entirely on your own and achieving healthy blood oxygen levels before discharge. Your goals will depend on factors such as:

  • your overall health
  • your age
  • any existing lung conditions
  • whether COVID-19 has damaged your lungs

You can take steps at home to help keep your oxygen levels up.

Your treatment team might have given you specific instructions, especially if you were sent home with oxygen. It’s important to follow any instructions you were given by your doctor or respiratory therapist.

Steps you can take on your own include:

  • Stop smoking, if you smoke. Smoking reduces the amount of oxygen circulating in your body.
  • Adjust your sleeping position. It’s best to avoid sleeping flat on your back. Instead, try sleeping on your side. You can also sleep on your stomach with pillows propped under your neck, chest, thighs, and chin.
  • Try pursed-lip breathing. Pursing your lips like you’re about to whistle and breathing deeply is a great way to reduce shortness of breath and increase blood oxygen levels.
  • Adjust how you sit. Try sitting up straight with a pillow behind your back when you’re on a couch or chair to help your lungs get more oxygen.
  • Get plenty of fresh air. Spend time outdoors or keep your windows open to ensure you’re getting fresh air.
  • Go for a walk. Short walks can increase your circulation and blood oxygen level.

COVID-19 is a respiratory infection that can lead to dangerously low blood oxygen levels. This is a medical emergency that requires immediate care. A pulse oximeter can help you monitor your blood oxygen levels at home.

The best use of a pulse oximeter as an indicator of when to call a doctor or seek emergency care. For most people, any reading of lower than 95 percent is a sign to call a doctor.

However, it’s important for everyone to seek urgent care if their blood oxygen level drops below 90 percent.

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ATLANTA--()--Altesa BioSciences, Inc. (Altesa), a clinical-stage biopharmaceutical company developing and commercializing novel antiviral drugs against common respiratory viruses and global viral threats, has U.S. Food & Drug Administration approval to proceed with a clinical study of a promising antiviral treatment, vapendavir. Accordingly, Altesa will initiate this trial and a series of others later this year and early next year, respectively.

Brett P. Giroir, MD, Altesa Chief Executive Officer and former United States Assistant Secretary for Health, announced the news today at the 2022 AdvanSE Life Science Conference in Atlanta.

“The green light from the FDA in response to our investigational new drug application (IND) is a significant step forward as we continue the clinical development of vapendavir, a Phase 2 oral antiviral drug,” Dr. Giroir said. “We believe vapendavir is well poised to mitigate the serious consequences resulting from viral respiratory infections in vulnerable populations. We are committed to evaluating its safety and effectiveness for patients in need.”

The broad spectrum viral capsid inhibitor, vapendavir, is Altesa’s lead clinical stage antiviral drug, which was in-licensed in 2021. Based on prior evaluations in nearly 700 trial participants and patients, vapendavir was well tolerated and showed clear evidence of an antiviral response.

Andrea True Kelly, PhD, Altesa’s Vice President of Clinical Development and Medical Affairs (formerly with Trimeris and Istari), said Altesa will initiate a clinical study this year to evaluate a new formulation of vapendavir. The study will be rapidly followed by Phase 2b clinical trials in 2023 to treat viral infections in vulnerable patients living with chronic obstructive pulmonary disease (COPD).

“Our goal at Altesa is to provide simple, safe, and effective treatments, especially for those at greatest risk from the most common viral respiratory infections,” Dr. Kelly said. “We look forward to finalizing our development partners and initiating trials for this promising therapy in the coming months.”

Over 16 million Americans suffer from COPD, the 4th leading cause of mortality in the U.S., which is anticipated to account for over $800 billion in direct medical expenditures from 2019 through 2038. Rhinoviruses, typically responsible for the common cold, are one of the viruses most commonly associated with serious disease exacerbation in patients suffering from COPD. In healthy individuals, rhinoviruses generally cause self-limiting upper respiratory tract infections, but in people with COPD, infection is readily associated with persistent lung inflammation, airflow obstruction and frequently with secondary bacterial infections, all of which can be life-threatening. By targeting rhinovirus, vapendavir holds great promise to reduce the severity of – or possibly prevent – exacerbations in infected patients with COPD.

About Altesa

Altesa BioSciences, Inc., is a biopharmaceutical company based in Atlanta, GA focused on developing antivirals to addresses diseases of global importance. Altesa has a preferred partnership with Emory DRIVE, a wholly-owned, not-for-profit drug discovery entity within Emory University. That collaboration includes a license to ALT-2023, a broadly active nucleoside analogue that is IND-enabled, as well as options to additional compounds targeting RNA viruses. In 2021, Altesa in-licensed vapendavir, a Phase 2 antiviral, broadly active against enteroviruses, including rhinovirus, from Vaxart. Altesa intends to progress vapendavir into a Phase 2b trial in the coming months for treatment of rhinoviral infection in vulnerable people suffering from chronic obstructive pulmonary disease (COPD).

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Blood Clots In Lungs: Unusual Post-COVID Complication That Can Damage Your Health Completely

The CDC has stated that COVID-19 survivors are at double the risk of developing blood clots in the lungs or respiratory conditions than others.

In late 2019, the first case of deadly COVID-19 (the infectious disease which is caused by the SARS-CoV-2 virus) emerged from China's Wuhan city. The virus was found to mainly attack the lungs, leading to severe respiratory problems such as trouble breathing, pneumonia, etc. however, there is much more than just an attack that COVID virus does on the lungs. In a recent study, researchers have revealed that the virus may remain inside the lungs even after recovery and can keep causing major health issues.

Are You A COVID Survivor?

In a recent study, the US Centers for Disease Control and Prevention (CDC) has stated that COVID-19 survivors are at double the risk of developing blood clots in the lungs or respiratory conditions than others. According to the researchers, with the rise in the numbers of daily COVID infections, there is a steady spike in the reports of patients who experience persistent symptoms or organ dysfunction after acute Covid and develop post-Covid conditions.

The study says that one in five Covid survivors aged between 18 and 64 years face a double risk of pulmonary embolism - a clot in an artery of the lung - or chronic cough or shortness of breath. Implementation of Covid-19 prevention strategies, as well as routine assessment for post-Covid conditions among persons who survive Covid-19, is critical to reducing the incidence and impact of post-Covid conditions, particularly among adults aged over 65 years," said Lara Bull-Otterson, from CDC's Covid-19 Emergency Response Team, along with co-authors, in a statement.

What Are Blood Clots?

Did you ever notice blood clot formations when you get a cut? they quickly stop the bleeding, and when it's done its job, it usually breaks up. But what is worrisome is what happens when they don't fall apart? When blood clots don't fall apart, they can be dangerous and lead to serious medical conditions.

Signs of Blood Clots In The Lungs

While the formation of blood clots inside the lungs can be very dangerous and pose serious health threats, there are ways one can manage the condition and stop it from getting worse. And to do that, one needs to know the symptoms of blood clots in the lungs. These signs include -

  1. Difficulty in breathing
  2. Strong pain in the chest
  3. Persistent cough
  4. Excessive sweating
  5. Dizziness and extreme fatigue

(With inputs from agencies)

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