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      A Low-Cost Breath Analyzer Module in Domiciliary Non-Invasive Mechanical Ventilation for Remote COPD Patient Monitoring †

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          Abstract

          Smart Breath Analyzers were developed as sensing terminals of a telemedicine architecture devoted to remote monitoring of patients suffering from Chronic Obstructive Pulmonary Disease (COPD) and home-assisted by non-invasive mechanical ventilation via respiratory face mask. The devices based on different sensors (CO 2/O 2 and Volatile Organic Compounds (VOCs), relative humidity and temperature (R.H. & T) sensors) monitor the breath air exhaled into the expiratory line of the bi-tube patient breathing circuit during a noninvasive ventilo-therapy session; the sensor raw signals are transmitted pseudonymized to National Health Service units by TCP/IP communication through a cloud remote platform. The work is a proof-of-concept of a sensors-based IoT system with the perspective to check continuously the effectiveness of therapy and/or any state of exacerbation of the disease requiring healthcare. Lab tests in controlled experimental conditions by a gas-mixing bench towards CO 2/O 2 concentrations and exhaled breath collected in a sampling bag were carried out to test the realized prototypes. The Smart Breath Analyzers were also tested in real conditions both on a healthy volunteer subject and a COPD suffering patient.

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          Most cited references62

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          Hypoxemia in patients with COPD: cause, effects, and disease progression

          Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.
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            Exacerbations of COPD

            Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure. This article highlights the importance of preventing exacerbations of COPD http://ow.ly/ODQp30i5Cel
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              Respiratory failure

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                Author and article information

                Journal
                Sensors (Basel)
                Sensors (Basel)
                sensors
                Sensors (Basel, Switzerland)
                MDPI
                1424-8220
                24 January 2020
                February 2020
                : 20
                : 3
                : 653
                Affiliations
                [1 ]Institute for Microelectronics and Microsystems, National Research Council (CNR-IMM), Campus Ecotekne, Str. Prov. Lecce-Monteroni km 1.2, 73100 Lecce, Italy; pietro.siciliano@ 123456le.imm.cnr.it
                [2 ]Institute of Clinical Physiology, National Research Council (CNR-IFC), Campus Ecotekne, Str. Prov. Lecce-Monteroni km 1.2, 73100 Lecce, Italy; sabina@ 123456ifc.cnr.it
                [3 ]“A. Perrino” Hospital, Pulmonology Ward, 72100 Brindisi, Italy; sabatoeugenio@ 123456gmail.com
                [4 ]Institute for Research on Population and Social Policies, (CNR-IRPPS), 72100 Brindisi, Italy
                Author notes
                [†]

                This paper is an expanded version of “Radogna, A.V.; Capone, S.; Di Lauro, G.A.; Fiore, N.; Francioso, L.; Casino, F.; Siciliano, P.; Sabina, S.; Sabato, E. A smart device for supporting mechanical ventilo-therapy” in Proceedings of the IEEE International Conference on IC Design and Technology (ICICDT 2018), Otranto, Italy, 4–6 June 2018.

                Author information
                https://orcid.org/0000-0002-7305-5614
                https://orcid.org/0000-0002-5337-2356
                Article
                sensors-20-00653
                10.3390/s20030653
                7038329
                31991608
                a23a6195-4cd1-47e1-aa9c-214c1f9c5972
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 15 November 2019
                : 17 January 2020
                Categories
                Article

                Biomedical engineering
                copd,exhaled breath,noninvasive ventilation,sensors,patient monitoring
                Biomedical engineering
                copd, exhaled breath, noninvasive ventilation, sensors, patient monitoring

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