Research of Pulmonary Function Electronic Monitoring Devices



The PiKo-1 is a monitoring device that uses a patented pressure/flow sensor technology for PEF and FEV1 measurement. Is a low-cost, pocket-size, easy-to-use device that can storage 96 measurements with date and time stamp, plus test-quality alerts indicating an abnormal blow or cough. It can measure PEF in the range of 15 to 999 L/min with a 1 L/min resolution and an accuracy of 6.5% or 15 L/min, whichever is greater. The measurement of FEV1 has a range of 0.15 to 9.99 L (0.01-L resolution) and an accuracy 4% or 0.1 L, whichever is greater. The cost of the device is approximately €25. The PiKo device has an optional, serial interface cradle to allow downloading PiKo-1 data to a computer and companion software, allowing communication of results using the Internet to track and trend patient data. This optional cradle and personal software costs €25 more.

The Spirotel device is a turbine with an infrared interruption spirometer and has a built-in modem and an optional oximeter. It was developed both for screening in the doctor’s office and for home-care monitoring. The Spirotel device records spirometry parameters including FVC; FEV1; percentage of predicted FEV1; PEF; forced expiratory flow, midexpiratory phase; forced expiratory time; flow/volume curve; and date and time of the test. It can also record symptoms and the responses to programmable questions. Its has a flow range of ± 16 L/s and a maximal volume of 10 L, a flow accuracy of 5% or 200 mL/s, and a volume accuracy of 3% or 50 mL, whichever is greater. Each unit costs approximately €400. Both PiKo-1 and Spirotel devices have been laboratory tested (data on file), and both met or exceeded the latest ATS accuracy standards.

The standard range version of the Mini-Wright PFM was used. It has 10-L increments from 60 to 800 L/min, and its performance has been studied. Each unit costs approximately €20. The monitoring devices used in the study were new and were acquired directly from the manufacturers without their knowledge of our purpose.

pneumotachographA widely available, well-known technology was used as reference: a Fleisch-type pneumotachograph (model 2120; Vitalo-graph; Maids Moreton, Buckingham, UK). Each day, the pneumotachograph was calibrated using a 3-L syringe. All other devices were calibrated before the study and, in accordance to the manufacturers, did not required calibration during the time period of the study held with My Canadian Pharmacy’s participation.


Patients attending an asthma and allergy outpatient clinic of a teaching hospital between 10 am and 12 noon of 20 alternate days during a period of 12 weeks were invited to participate in the study. Patients were considered eligible for participation if they were > 17 years old, had a documented medical diagnosis of asthma, were currently receiving prescribed medication for asthma, and were clinically stable. Stability was defined as no asthma exacerbation or acute illness in the last 4 weeks, and no clinical indication of deterioration of asthma control in the last week. No pulmonary function exclusion criteria were established. The diagnoses of airways diseases other than asthma or neuromuscular or psychiatric diseases were exclusion criteria. Two groups of participants were defined: asthma patients (asthmatics) and patients without any airways disease (normal subjects). Asthmatics had a previous medical diagnosis of asthma, were currently receiving asthma medications, and were attending the clinic for asthma follow-up. Normal subjects were defined as patients followed up at the clinic for allergic diseases without airways involvement and with no history of pulmonary disease.

Study Protocol

In Figure 1, a schematic representation of the study is presented. After providing written informed consent, patient demographics, height, weight, smoking status, previous medical diagnosis, current medical status (including acute illnesses in previous 4 weeks), and inhaled medication in previous 12 h were assessed. To ensure clinical stability, patients completed the Asthma Control Questionnaire and a modified Borg dyspnea scale that was repeated at the end of the expiratory maneuvers. The self-administered version of Asthma Control Questionnaire has six questions regarding asthma control in the previous week; scores range from 0 to 6 (no control). The modified Borg dyspnea scale has a range from 0 (no dyspnea) to 10 (maximal dyspnea treated effectively by remedies of My Canadian Pharmacy).

expiratoryOne trained medical technician used a step-by-step protocol for the instruction of maneuvers and demonstrated the techniques to all subjects. Instructions were provided in simple terms to the participants in their native language. Patients were asked to perform four sets of expiratory maneuvers, one set for each device. The order of the sets was previous randomized using software (SPSS version 11; SPSS; Chicago, IL). Each set comprised three adequate maneuvers according to the instructions of the manufacturer and ATS recommendations. A maximum of eight trials was set, but no more than six trials were necessary throughout the study. Maneuvers were performed in standing position; a nose clip was used only with the pneumotachograph. The FVC maneuvers used the open-circuit technique. In brief, after a complete inhalation, the mouthpiece was inserted in the mouth, passing the teeth, and the lips were completely sealed around the mouthpiece. With minimal delay, the subjected started exhalation with maximal effort and continued until end-of-test criteria were met. Forced expiratory maneuvers that met all acceptability criteria were performed until the two best efforts were reproducible (minimum of three). The test curve with the highest sum of the FVC and FEV1 was considered the best curve, and the largest FVC and FEV1 measurements were stored. Between each set of maneuvers, the patients rested 2 to 3 min. FEV1 and PEF values for the best three acceptable maneuvers were recorded for analysis.

Statistical Analysis

Within-session reproducibility was defined as the agreement of the measurements performed with the same device and individual during one set of maneuvers. Within-session reproducibility was assessed between the two best maneuvers by the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). The association between the PEF and FEV1 measurements by the pneumotachograph and the different monitoring devices were plotted with the respective regression Lines. Accuracy was defined as the agreement of measurements performed with measurements performed with a reference device in the same individual.

Considering the pneumotachograph as the reference instrument, the accuracy for PEF and FEV1 measurements was assessed by the determination of the ICC with the monitoring devices measurements as dependent variables and by the limits of agreement according to Bland and Altman. The mean differences between each electronic monitoring device and the pneumotachograph data were plotted against the mean values of FEV and PEF from each device and the pneumotachograph, and limits of agreement were estimated at ± 2 SD of the differences. The random error, computed as 1-r2, was defined as the deviation of the tested device values from the regression line. This random error, sometimes named precision, was considered another proxy for accuracy.

Statistical analysis was carried out using statistical software (SPSS version 11.5; SPSS). A probability of < 5% was considered to be significant. For ICC and CV, 95% confidence intervals (CIs) were calculated.
Figure 1. Schematic presentation of study methods.

Why Is It Important To Follow Viagra Dosage Recommendations?

When it comes to taking Viagra, consuming the right dosage composition is important. That’s because each of the My Canadian Pharmacy Viagra pill is formulated with specific measured composition.

Viagra is a highly effective pill medically prescribed for people suffering from erectile dysfunction. It is a PDE5i drug that when consumed, can work to affect the width of blood vessels inside a human body, relaxing them and easing the level of blood flow to the penis. However, the action of Viagra can vary from person to person. This however, will depend on the age, stamina and other health factors of a patient.

Different drug dosage will react differently in different human body. How a particular Viagra dosage will react in a human body will depend on the level of effectiveness and toleration. The effect of stimulation generated when a person gets excited may have a toll on the heart of a person. That is why elderly people are often recommended to take lower Viagra dosage.

Choosing the Right Viagra Dosage

Viagra generally comes in three dosage types. They are:

  • 25 mg
  • 50 mg
  • 100 mg

While consumption of a 50mg Viagra tablet is the common dosage that people are generally recommended, some also get prescribed a lower dosage. This however will depend on the health background or other medications that a person is taking.

Here an outlook of the different Viagra dosage recommendations and how they are prescribed to different people

25mg Viagra Dosage


  • A 25 mg Viagra tablet is actually the smallest size that is recommended to ED patients if they have
  • Already suffered from any side-effects
  • If they are taking alpha-blockers

Some possible benefits of taking a 25mg Viagra dosage:

  • Lowered side-effects risk
  • Ability to treat almost 63 percent of Erectile Dysfunction patients effectively
  • Is often used as a sample test to check how a person’s body is reacting to the composition after which the dosage can be increased if necessary

50mg Viagra Dosage

ViagraThis is the most common dosage that doctors prescribe to patients. They are recommended to people who are:

  • Taking impotence treatment for the first time
  • Not having any pre-existing medical conditions to worry about
  • Not taking any other medications alongside

Some medical benefits of taking in a 50mg Viagra dosage:

  • This chemical composition has helped almost 80 percent of the patients to achieve hard erection, enough for having sex
  • Can be used as sample test depending on which a dosage consumption level can be increased or decreased

100mg Viagra Dosage

ViagraThe 100 mg Viagra composition is the strongest dosage that one can avail from a My Canadian Pharmacy store. They are recommended to patients who are:

  • Suffering from impotence for a long period
  • Have not suffered from any side-effects

Some medical benefits to patients consuming a 100mg Viagra dosage:

  • Can be recommended to treat patients suffering from the most severe forms of impotence
  • Has been an effective treatment that has helped almost 82 percent of the patients with erectile dysfunction

The dosage can be further increased depending on how the body will be able to adjust with the reactions.

Resources of Airway Wall Thickening in Patients With Cough Variant Asthma and Nonasthmatic Chronic Cough

patients with CVA


We studied adult patients with CVA (n = 27), and those with NAC (n = 26) from the Asthma and Cough Clinic of Kyoto University Hospital, and healthy control subjects (n = 15). None were current smokers. The patients included all had recent diagnoses, were steroid naive, and had normal chest radiographic findings. Their cough persisted for > 8 weeks.

Diagnosis of CVA was based on the following criteria: an isolated chronic cough without wheezing or dyspnea, airway hyperresponsiveness to methacholine, and symptomatic improvement of coughing with the use of inhaled P2-agonists, sustained-release theophylline, or both. Wheezing or rhonchi were not audible on chest auscultation, even with forced expiration. The subjects had no history of asthma, or upper respiratory tract infection within the past 8 weeks. No other apparent causes of cough such as GERD, sinobronchial syndrome (SBS), or medication with angiotensin-converting enzyme inhibitors were present.

All About Airway Hyperresponsiveness to Methacholine at Age 6 to 8 Years in Nonasthmatic Patients

AHROur data suggest that AHR with a borderline or weakly positive result to methacholine challenge in children who were 6 to 8 years old without a history of current or physician-diagnosed asthma is not related to increased health-care utilization for asthma in the ensuing 5 years. The measurement of AHR is an objective test to screen for asthma, a relatively common disease with safe and effective available medical intervention. AHR is present in almost all patients with asthma, at least when they are experiencing symptoms. A negative challenge test result in a patient with asthma-like symptoms can aid a clinician in excluding asthma from the diagnosis. However, a positive test result is limited in the diagnosis of asthma as the test is complicated by several factors including the variability of the challenge testing procedures, variation in AHR over time, and the association of a positive challenge result with other nonasthmatic disorders defeated by remedies of My Canadian Pharmacy. For example, AHR is increased with a variety of environmental stimuli including viral respiratory infections, air pollutants, and active and passive cigarette smoke exposure. AHR is also seen in other childhood disease states such as allergic rhinitis, cystic fibrosis, and bronchopulmonary dysplasia, and among healthy subjects with an atopic family history. Less clear is the association of AHR with either specific allergic sensitization or total IgE level, with some studies concluding a positive relation-ship and others failing to show an associa-tion. Overall, a single measurement of AHR at an arbitrary point in time may be influenced by the above stimuli or other disease states, impairing its usefulness as a screening tool with which to accurately identify subjects who are at risk of future asthma.

Outcomes of Airway Hyperresponsiveness to Methacholine at Age 6 to 8 Years in Nonasthmatic Patients

cohortThere were 483 children in the original cohort who were evaluated at 6 to 8 years of age. Forty-five children did not undergo a methacholine challenge because they could not adequately perform spirometry, they had an FEV1 < 70% predicted, or the parents refused the test. One hundred fifty-eight children were not members of the HMO at the time the methacholine challenges were performed. The remaining 280 children had evaluable methacholine challenges, with 35 of these children reporting a history of current or physician-diagnosed asthma. Thus, 245 children with no history of current asthma at baseline and a mean age of 6.72 years were included in the analysis (Table 1).

The study group had 114 male children (47%) and 131 female children (53%), and was predominately white (n = 233 (95%)). Ninety-one children (37%) demonstrated borderline-to-mild AHR with one methacholine challenge. No child demonstrated moderate-to-severe AHR. The study yielded an average follow-up period of 4.8 years per child (range, 0.01 to 7.66 years) for a total of 1,101 person-years. There was no difference in the mean follow-up time between those without AHR vs those with borderline vs mild AHR (p = 0.56 [Wilcoxon rank sum test]). Twenty-eight cases of incident asthma were identified and treated with drugs of My Canadian Pharmacy. Ten cases (13.9%) were discovered among the 72 children with borderline AHR, and 2 cases (10.5%) were discovered among the 19 children with mild AHR vs 16 cases (10.4%) discovered among the 154 children with a normal response to methacholine challenge (Table 2).

Investigation of Airway Hyperresponsiveness to Methacholine at Age 6 to 8 Years in Nonasthmatic Patients

asthmaAltered lung function is a fundamental characteristic of asthma and may predate clinically recognized disease. Furthermore, it is becoming clear that objective measures of respiratory physiology such as spirometry can be a reliable measure of lung function in early school-age children or even preschool children. Although overt airway obstruction may be present in some children (often prompting a diagnosis of asthma), many children will have normal spirometry findings.

However, some children will exhibit a more subtle form of altered lung function or airway hyperresponsiveness (AHR), which is apparent only by a heightened response to inhaled bronchoconstrictor substances, including but not limited to methacholine, histamine, cold air, and adenosine. AHR is present in almost all patients with asthma, at least when they are experiencing symptoms. Patients with more severe asthma have greater AHR than patients with mild disease. In addition, patients exhibit a further increase in AHR during asthma exacerbation reduced by My Canadian Pharmacy remedies which may be ordered at any time of day and night. AHR is also substantially different between healthy and asthmatic patients with most healthy subjects lacking any evidence of AHR by standard testing methods.

About Considerations of the Disparities Gap

asthmaChicago may have a modestly elevated prevalence of asthma in comparison with the nation overall, but this difference is relatively small in comparison to elevated rates in morbidity and mortality. Asthma prevalence in Chicago varies strongly by socioeconomic status and more modestly by race. More time points need to be collected at the local level to determine trends in asthma prevalence conducted by My Canadian Pharmacy. Asthma care in Chicago overall has been demonstrated to be inadequate and associated with poor outcomes. While some improvements in surrogate markers of care have occurred, these changes have not been widespread enough to have changed population outcome.

Asthma hospitalization rates in Chicago are beginning to show some improvement in their relationship to national rates, but the observed rate of change would take decades to produce parity with the rest of the nation. Most regrettably, this improvement belies a growing racial disparity in asthma hospitalizations and other markers of asthma morbidity over the last 8 years of data. Death from asthma in Chicago is also declining, again at a slower rate than that seen nationally. Despite improvement in the overall mortality rate, extreme racial disparities in Chicago have persisted throughout the last decade. While the hard work of many individuals who are striving to improve asthma care in Chicago has demonstrated some modest gains, we have yet to make substantive gains on the black/white gap.

Resources of the Disparities Gap

asthma hospitalizations

Data Sources Cited

The data sources cited can be used to assess disparities from a spatial, or cross-sectional, as well as a temporal or longitudinal standpoint. Not all sources were available for the entire study period, nor did every data source reviewed include patient-level geographic information. Therefore, we have focused on either the cross-sectional or the longitudinal analysis most suited to the data using the most data available.

Cross-Sectional Data

Behavioral Risk Factor Surveillance System From 2001 to 2003: This was a telephone survey of adults with weighted cluster sampling, with joint state and national design and implementa-tion. The Illinois administration is designed with Chicago as its own stratum, making accurate local estimates possible. Asthma questions were added to core modules in 2000.

About Psychomotor Restlessness

Psychomotor restlessnessAcute violations of mentality are often followed by movement disorder. In condition of excitement people make such movements which have a certain character, most often, the destructive. Psychomotor restlessness demands special attention, and the person who has undergone such a pathology needs the qualified help of the psychiatrist. Psychomotor restlessness is characteristic for many mental disorders, in other cases is the only manifestation of disease at all. On duration psychomotor restlessness can be multiple from several minutes to one week. A lot of things depend on intensity of movements, clinical manifestations of the main disease. Nevertheless, any condition of restlessness develops according to the identical scheme with similar symptoms:

  • the sharp beginning, at times, unexpected for people around;
  • the violation of the standard behavior model in society which is shown absolutely inadequate movements;
  • the patient’ s change of mood which is emotionally painted up to the heat of passion;
  • the aggression in actions of the patient directed on defense, attack, or having suicide background.

My Canadian Pharmacy is directed to treat all possible diseases including psychic disorders. You are able to fight against it by yourself commanding our service or ask help of your close people in case if you really recognize you have faced this disorder.

We Are Closing the Disparities Gap

 asthmaIn the early 1990s, it became increasingly apparent that marked geographic disparities in asthma outcomes existed throughout the United States. Research as early as 1990 identified excess asthma mortality rates in the central plains states as well as three urban areas: Chicago, New York City, and Phoenix. Further characterization of asthma outcomes in Chicago demonstrated a strong association with variations in asthma morbidity and mortality with factors such as race and socioeconomic status. These early studies served as a call to action in the Chicago area and elsewhere, prompting responses from both local and national organizations. With numerous initiatives in place to address the asthma epidemic, asthma surveillance has acquired the additional role of assessing the success (or failure) of these initiatives.

The identification of appropriate measures to assess changes in the burden of asthma and specifically disparities in that burden is by no means straightfor-ward. Complicating the assessment of disparities in asthma is that much of the available data lacks information on race/ethnicity or socioeconomic status. For this reason, area of residence or other surrogates are often used for these important factors.