Pipeline - future applications

PneumaCare is collaborating with leading clinicians and institutions to develop the below applications.

Dysfunctional Breathing (DB)

Dysfunctional Breathing (DB) is a debilitating condition. It is difficult to diagnose and it puts a financial burden on the health care provider. DB is a group of respiratory disorders that can be defined by a chronic or recurrent altered pattern of breathing in the absence of, or in excess of, organic disease.

Although Hyperventilation syndrome (HVS) is the most recognised form of DB in adults (rarer in children), it is just one of a proposed five point classification recently suggested1

1. R. Boulding, R. Stacey, R. Niven, and S. J. Fowler, “Dysfunctional breathing: a review of the literature and proposal for classification,” Eur. Respir. Rev., vol. 25, no. 141, p. 287 LP – 294, Sep. 2016.

This includes:

      1.  Hyperventilation syndrome (HVS)
      2. Periodic deep sighing: frequent sighing with an irregular breathing pattern
      3. Thoracic dominant breathing
      4. Forced abdominal expiration
      5. Thoraco-abdominal asynchrony (TAA)

It is also possible for some patients to have a number of the above patterns at the same time or switch between them.

Frequently asked questions

DB may occur as a response to, or in association with an underlying pathophysiology (Asthma, COPD) or may be of psychogenic origin (e.g. stress, anxiety)

Symptoms may be respiratory related such as breathlessness and wheeze or non-respiratory related such as chest pain and/or dizziness.

DB reduces quality of life for the patient and puts a considerable financial strain on the health care provider as the condition is challenging to identify. Misdiagnosis and multiple unnecessary and costly clinical investigations and interventions are common.

The general consensus seems to be that DB is common2, with estimates of HVS alone being as high as 6-10% of the general population rising to 34% in asthmatics1.

Yes, DB is treatable. The challenge is in getting an accurate diagnosis, which in itself may go some way to alleviate symptoms. Physiotherapy and breathing retraining can also have a positive and lasting effect on patients’ symptoms and quality of life.

1. R. Boulding, R. Stacey, R. Niven, and S. J. Fowler, “Dysfunctional breathing: a review of the literature and proposal for classification,” Eur. Respir. Rev., vol. 25, no. 141, p. 287 LP – 294, Sep. 2016.

2. N. Barker and M. L. Everard, “Getting to grips with ‘dysfunctional breathing,’” Paediatr. Respir. Rev., vol. 16, no. 1, pp. 53–61, 2015.

Where does SLP fit in all of this?

SLP captures movement of the thoraco-abdominal wall and provides both numerical outputs and a visual 3D reconstruction of the thoraco-abdominal wall motion. As such, it can potentially play a role in both diagnosis and treatment of DB.

SLP provides data and visual clues to help identify each of the 5 proposed classifications. For Hyperventilation Syndrome it can calculate and show respiratory rate; it provides a visualisation of sigh depth and rate and it provides visual and numerical outputs for thoracic dominant breathing, abdominal dominant breathing and thoraco-abdominal asynchrony (TAA).

SLP can also act as a powerful visual assistive tool to guide the clinicians in both diagnosis, and in treatment of the patient as a part of the physiotherapy/retraining program. It can also be used to provide biofeedback to the patient which can have a positive effect on their recovery from this debilitating condition.

Resources

PneumaCare has a growing number of clinical publications, abstracts and posters presented by our clinical collaborators and associates. See the list below for further information.

Pre and Post-Thoracic Surgery

An early clinical assessment of post-operative complications is vital for the successful outcome of Thoracic Surgery in the recovery phase.

Pre and Post-Thoracic Surgery and Thora-3Di®

A feasibility study observed that Thora-3Di® was able to detect changes in chest wall motion and asynchrony after the surgery for the side of the incision in patients undergoing lobectomy.1

With further clinical work, Thora-3Di® can provide valuable information to identify the impairment of respiratory muscle function, and spatial and temporal changes of Thoraco-abdominal wall movement with real-time regional respiratory function assessment after Thoracic Surgery. These would include lung resection, chest or airway reconstruction, chest wall resection, or diaphragm repair, among other procedures.

PneumaCare Limited are also currently working with clinicians to monitor adolescent patients suffering from chest wall deformities, and in particular Pectus Excavatum (Pre- and Post-Surgery using the Thora-3Di®), Pectus Carinatum and Pectus Arcuatum.

Further uses to be investigated include using the Thora-3Di® to optimise respiration treatment during patient ventilation (mechanical and non-invasive) and ensuring efficacy of further treatment options by tracking patient progress.

[1] Elshafie et al., “Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study”, Interactive CardioVascular ad Thoracic Surgery 23 (2016):544-547

COVID-19

Our technology provides assessment that is non-contact and non-aerosol generating and we believe that our device can potentially provide valuable information to diagnose lung diseases for patients who present with breathless symptoms.

New data suggests that many patients who recovered from COVID-19 experience persistent respiratory symptoms months after their initial illness[1]. A recent study followed up with patients admitted to hospitals with COVID-19, and approximately 53% people reported persistent breathlessness and 9% of them showed significant deterioration on chest radiographs[2]. This possible sequalae can attribute to developing lung fibrosis, which we have seen from the 2003 outbreak of severe acute respiratory syndrome (SARS)[3].

Thora-3Di® can help primary care to manage these complications further and to identify people at greater risk without involving any ionising radiation. This pragmatic approach may reduce the burden to secondary care to investigate lung pathology and treatment by providing easy, simple and contactless methods to assess and monitor lung function.

To find out how our device could support your assessment pathways in this current pandemic please contact us.

[1] National statistics, “The prevalence of long-COVID symptoms and COVID-19 implication”, 2020, https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications

[2]  Mandal et al., “’Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19”, Thorax 2020;0:1-3

[3] Ngai et al., “The long-term impact of severe acute respiratory syndrome on pulmonary function, excise capacity and health status” Respirology 2010;15:543-50

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