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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Late onset Pompe disease &#40;LOPD&#41; is a glycogen storage disorder characterised by progressive skeletal and respiratory &#40;i&#46;e&#46; diaphragmatic&#41; muscle weakness and ventilatory pump failure &#40;VPF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Enzyme replacement therapy &#40;ERT&#41; can prolong survival&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Noninvasive ventilation &#40;NIV&#41; is often used with low bi-level positive airway pressure &#40;PAP&#41; which may be inadequate for optimal respiratory muscle rest and ventilator support&#46; Higher pressure support &#40;PS&#41; of 14&#8239;cm H2O or more often called Noninvasive ventilatory support &#40;NVS&#41; needs to be used&#46; While NIV can improve gas exchange&#44; sleep&#44; and quality of life &#40;QOL&#41; for mild cases&#44; only increased pressures can be used for continuous support to prolong survival&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Both NIV and NVS can be provided during sleep via different interfaces&#46; The nasal mask or mouth-piece is better during daytime&#46; Intermittent abdominal pressure ventilator &#40;IAPV&#41; can also provide daytime support&#46; It consists of an air-sack inside a corset inflated by a ventilator&#46; The sack compresses the abdomen to raise the diaphragm and to increase tidal volumes&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> IAPV use by LOPD patients has not yet been described&#44; and we aimed to report its feasibility in this study&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case Study&#58; A 22-year-old male university student&#44; diagnosed with LOPD at age two&#44; began bi-weekly ERT at age 11&#46; The ERT was adjusted over the years based on his body weight&#46; At age 13 he began nocturnal CPAP for obstructive sleep apnoea &#40;OSA&#41;&#46; Within two years&#44; due to hypercapnia&#44; he was transitioned to NIV&#44; and since then continued with limited follow-up&#46; Settings&#58; inspiratory &#40;I&#41;PAP 12&#44; expiratory &#40;E&#41;PAP 4&#8239;cm H2O&#44; respiratory rate 14&#47;min which he presented to us using in 2019&#46; During our first visit&#44; he had severe scoliosis&#44; emaciation &#40;BMI 12&#46;8&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; and recent onset of hyper-somnolence and morning headaches&#46; Pulmonary function testing &#40;PFT&#41;&#44; arterial blood gases &#40;ABG&#41;&#44; and polysomnography &#40;PSG&#41; using NIV data are in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; His QoL was assessed by the McGill Questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Over the previous 30 days mean nocturnal use was 9&#8239;h with average Vt 350&#8239;mL with 85&#37; of the breaths triggered&#46; Then&#44; IPAP was gradually increased to 16 &#40;i&#46;e&#46; PS of 12&#8239;cm H2O&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This resulted in 600&#8239;mL tidal volumes which he was happy to continue&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">One month later&#44; he continued 12&#8239;cm PS NIV for a mean 10&#8239;h per night&#44; had an apnea-hypopnea index of 0&#46;7&#44; and average Vt 500&#8239;mL with 96&#37; of breaths triggered&#46; However&#44; daytime dyspnea and fatigue continued&#44; and despite a trial with the same ventilator he was not inclined to use mouthpiece&#44; or NIV via nasal mask at university or socially&#46; Diurnal hypercapnia persisted so the IAPV was introduced with a belt pressure &#40;PBelt&#41; of 50&#8239;cm H2O &#40;LUNA DS&#44; Dima Italia Inc&#46;&#44; Bologna&#44; Italy&#41;&#46; His symptoms cleared&#44; ABG&#44; and tidal volumes improved &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Transcutaneous CO2 &#40;TCO2&#41; averaged 45&#8239;mmHg during IAPV use and 51&#8239;mmHg during nocturnal NIV&#46; He was instructed to increase PS to NVS settings of IPAP 18&#44; EPAP 4&#8239;cm H2O&#46; Delivered volumes increased up to 750&#8239;mL&#46; He also combined used the IAPV about 4&#8239;h during daytime&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">At 3 month follow-up he reported reduction of morning headaches and sleepiness&#46; The ABG and QoL improved&#44; while PFT and PSG remained stable&#46; Given the residual hypercapnia we further increased IPAP to 20&#8239;cm H2O&#46; Six 6 months later &#40;T3&#41;&#44; 24-h mean TCO2 was 38&#46;9 during IAPV&#44; and 44&#8239;mmHg during NVS&#44; and ABG and QOL further improved &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This case demonstrates both diurnal and nocturnal blood gas improvements by increasing typical NIV settings to NVS settings&#46; However&#44; with advancing weakness&#44; diurnal hypercapnia can persist or return&#46; For this&#44; IAPV use was practical and effective for this LOPD patient who was not compliant with diurnal NVS&#46; Indeed&#44; NVS has become the cornerstone of daytime support for VPF&#46; It normalizes ABG&#44; and continuous dependence on it has prolonged the lives of some post-polio patients by over 66 years&#44; Duchenne muscular dystrophy patients by 30 years&#44; and spinal muscular atrophy type 1 by 25 years so far&#44; without resort to tracheotomy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Varying interfaces helps avoid excessive skin pressure&#44; mouth and upper airway dryness&#44; mucus impaction&#44; social interaction and eating difficulties&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;7</span></a> Daytime IAPV facilitates activities of daily living to improve QoL&#44; especially for patients unwilling to use daytime NVS&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There are several advantages to the IAPV&#58; no facial interfaces&#44; increased cough flows and tidal volumes&#44; improved speech duration&#44; and it is simple to don and wear&#46; Disadvantages include&#58; regurgitation after meals&#44; need to be seated&#44; and cannot be used in a bath or shower&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion&#44; in this young LOPD patient IAPV normalized alveolar ventilation&#44; tidal volumes&#44; gas exchange&#44; and relieved daytime symptoms to improve QoL in both his &#34;physical and existential well-being&#34;&#46; It also avoided NVS side effects for the combined IAPV use&#46; Further studies are warranted to broaden its application&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">6&#46;6</td><td class="td" title="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IAPV settings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frequency &#40;cpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inspiratory Volume &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">670&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">674&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">380&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">507&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">830&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Expiratory Volume &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">510&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">655&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">323&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">470&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">512&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">679&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">388&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">512&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">564&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PIF &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEF &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Letter to the Editor
Daytime non-invasive ventilatory support via intermittent abdominal pressure for a patient with Pompe disease
P. Pieruccia,
Corresponding author
, J.R. Bachb, V. Di Lecce Valentinaa, P. Banfic, G.E. Carpagnanoa, O. Restaa
a Azienda Ospedaliero Universitaria di Bari, "Aldo Moro" University, Italy
b Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
c Pulmonary Rehabilitation Unit, Don Carlo Gnocchi Foundation, Milan, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Late onset Pompe disease &#40;LOPD&#41; is a glycogen storage disorder characterised by progressive skeletal and respiratory &#40;i&#46;e&#46; diaphragmatic&#41; muscle weakness and ventilatory pump failure &#40;VPF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Enzyme replacement therapy &#40;ERT&#41; can prolong survival&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Noninvasive ventilation &#40;NIV&#41; is often used with low bi-level positive airway pressure &#40;PAP&#41; which may be inadequate for optimal respiratory muscle rest and ventilator support&#46; Higher pressure support &#40;PS&#41; of 14&#8239;cm H2O or more often called Noninvasive ventilatory support &#40;NVS&#41; needs to be used&#46; While NIV can improve gas exchange&#44; sleep&#44; and quality of life &#40;QOL&#41; for mild cases&#44; only increased pressures can be used for continuous support to prolong survival&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Both NIV and NVS can be provided during sleep via different interfaces&#46; The nasal mask or mouth-piece is better during daytime&#46; Intermittent abdominal pressure ventilator &#40;IAPV&#41; can also provide daytime support&#46; It consists of an air-sack inside a corset inflated by a ventilator&#46; The sack compresses the abdomen to raise the diaphragm and to increase tidal volumes&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> IAPV use by LOPD patients has not yet been described&#44; and we aimed to report its feasibility in this study&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case Study&#58; A 22-year-old male university student&#44; diagnosed with LOPD at age two&#44; began bi-weekly ERT at age 11&#46; The ERT was adjusted over the years based on his body weight&#46; At age 13 he began nocturnal CPAP for obstructive sleep apnoea &#40;OSA&#41;&#46; Within two years&#44; due to hypercapnia&#44; he was transitioned to NIV&#44; and since then continued with limited follow-up&#46; Settings&#58; inspiratory &#40;I&#41;PAP 12&#44; expiratory &#40;E&#41;PAP 4&#8239;cm H2O&#44; respiratory rate 14&#47;min which he presented to us using in 2019&#46; During our first visit&#44; he had severe scoliosis&#44; emaciation &#40;BMI 12&#46;8&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; and recent onset of hyper-somnolence and morning headaches&#46; Pulmonary function testing &#40;PFT&#41;&#44; arterial blood gases &#40;ABG&#41;&#44; and polysomnography &#40;PSG&#41; using NIV data are in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; His QoL was assessed by the McGill Questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Over the previous 30 days mean nocturnal use was 9&#8239;h with average Vt 350&#8239;mL with 85&#37; of the breaths triggered&#46; Then&#44; IPAP was gradually increased to 16 &#40;i&#46;e&#46; PS of 12&#8239;cm H2O&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This resulted in 600&#8239;mL tidal volumes which he was happy to continue&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">One month later&#44; he continued 12&#8239;cm PS NIV for a mean 10&#8239;h per night&#44; had an apnea-hypopnea index of 0&#46;7&#44; and average Vt 500&#8239;mL with 96&#37; of breaths triggered&#46; However&#44; daytime dyspnea and fatigue continued&#44; and despite a trial with the same ventilator he was not inclined to use mouthpiece&#44; or NIV via nasal mask at university or socially&#46; Diurnal hypercapnia persisted so the IAPV was introduced with a belt pressure &#40;PBelt&#41; of 50&#8239;cm H2O &#40;LUNA DS&#44; Dima Italia Inc&#46;&#44; Bologna&#44; Italy&#41;&#46; His symptoms cleared&#44; ABG&#44; and tidal volumes improved &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Transcutaneous CO2 &#40;TCO2&#41; averaged 45&#8239;mmHg during IAPV use and 51&#8239;mmHg during nocturnal NIV&#46; He was instructed to increase PS to NVS settings of IPAP 18&#44; EPAP 4&#8239;cm H2O&#46; Delivered volumes increased up to 750&#8239;mL&#46; He also combined used the IAPV about 4&#8239;h during daytime&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">At 3 month follow-up he reported reduction of morning headaches and sleepiness&#46; The ABG and QoL improved&#44; while PFT and PSG remained stable&#46; Given the residual hypercapnia we further increased IPAP to 20&#8239;cm H2O&#46; Six 6 months later &#40;T3&#41;&#44; 24-h mean TCO2 was 38&#46;9 during IAPV&#44; and 44&#8239;mmHg during NVS&#44; and ABG and QOL further improved &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This case demonstrates both diurnal and nocturnal blood gas improvements by increasing typical NIV settings to NVS settings&#46; However&#44; with advancing weakness&#44; diurnal hypercapnia can persist or return&#46; For this&#44; IAPV use was practical and effective for this LOPD patient who was not compliant with diurnal NVS&#46; Indeed&#44; NVS has become the cornerstone of daytime support for VPF&#46; It normalizes ABG&#44; and continuous dependence on it has prolonged the lives of some post-polio patients by over 66 years&#44; Duchenne muscular dystrophy patients by 30 years&#44; and spinal muscular atrophy type 1 by 25 years so far&#44; without resort to tracheotomy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Varying interfaces helps avoid excessive skin pressure&#44; mouth and upper airway dryness&#44; mucus impaction&#44; social interaction and eating difficulties&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;7</span></a> Daytime IAPV facilitates activities of daily living to improve QoL&#44; especially for patients unwilling to use daytime NVS&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There are several advantages to the IAPV&#58; no facial interfaces&#44; increased cough flows and tidal volumes&#44; improved speech duration&#44; and it is simple to don and wear&#46; Disadvantages include&#58; regurgitation after meals&#44; need to be seated&#44; and cannot be used in a bath or shower&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion&#44; in this young LOPD patient IAPV normalized alveolar ventilation&#44; tidal volumes&#44; gas exchange&#44; and relieved daytime symptoms to improve QoL in both his &#34;physical and existential well-being&#34;&#46; It also avoided NVS side effects for the combined IAPV use&#46; Further studies are warranted to broaden its application&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IAPV settings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frequency &#40;cpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inspiratory Volume &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">580&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">670&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">496&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">674&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">380&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">507&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">830&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Expiratory Volume &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">340&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">400&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">510&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">655&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">323&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">470&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">512&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">679&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">388&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">512&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PIF &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PEF &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">McGill QoL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>- Physical well-being</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>- Physical symptoms</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>- Psychological symptoms</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;75</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;75</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;75</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>- Existential well-being</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;5</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>- Support</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5</td></tr></tbody></table>
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Pulmonology

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