The Connection Between Breathing and Female Health

Title: The Effectiveness of Dry Carbon Dioxide Baths in Menopausal Syndrome: a Randomized Clinical Study

Authors: Anzhela N. Chekhoeva, Georgy E. Zangionov, Alina B. Bugulova, Alan S. Tsogoev, Olga O. Borisevich, Natalya V. Kotenko.

Journal: Вестник восстановительной медицины. 2024;23(4):55-61. doi:10.38025/2078-1962-2024-23-4-55-61

Link to full text: The Effectiveness of Dry Carbon Dioxide Baths in Menopausal Syndrome: a Randomized Clinical Study

Abstract:
INTRODUCTION: Climacteric syndrome is characterized by significant disorders in the nervous, musculoskeletal, urinary and cardiovascular systems in women of the perimenopausal and postmenopausal periods. The main reason is a sharp decrease in estrogen levels. Menopausal hormone therapy is often used for treatment, but due to contraindications and complications, it does not always completely solve the problem. This has sparked interest in alternative treatments such as dry carbon dioxide baths.

AIM: To study the effectiveness of using dry carbon dioxide baths in women with menopausal syndrome and evaluate their impact on the neurovegetative, metabolic and psycho-emotional state of these patients.

MATERIALS AND METHODS: A prospective randomized study was conducted involving 70 patients with moderate climacteric syndrome aged from 48 to 60 years. Using a simple randomization method, the women were divided into 2 groups: 35 patients of the main group received 10 procedures of dry carbon dioxide baths with a CO2 concentration of 15–20 %, temperature 28–32 °C, lasting 15–20 minutes, 35 patients of the control group did not receive any treatment. To assess the effectiveness of treatment, a modified Kupperman-Uvarova menopausal index, an assessment of the effect of “hot flashes” on daily life on the HFRDIS scale, as well as daily blood pressure monitoring (SMAD) were used.

RESULTS AND DISCUSSION: After treatment, patients in the main group observed a significantly significant (p < 0.05) improvement in the patients’ condition in the form of a decrease in integral indicators of the modified menopausal index and an assessment of the impact of hot flashes on daily activity on the HFRDIS scale by 28.2 and 43.1 %, respectively, as well as in the form of a decrease in average daily systolic blood pressure by 13.7 %.

CONCLUSION: The use of dry carbon dioxide baths is recommended for use in women with moderate climacteric syndrome, since this method significantly improves the quality of life of patients and is an effective non-drug that can reduce the drug load on the body of a woman suffering from neurovegetative disorders

Title: Asthma at 8 years of age in children born by caesarean section

Authors: Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, Brunekreef B, Hoekstra MO, Aalberse R, Smit HA.

Journal: Thorax. 2009 Feb;64(2):107-13. doi: 10.1136/thx.2008.100875. Epub 2008 Dec 3. PMID: 19052046.

Link to PubMed: Asthma at 8 years of age in children born by caesarean section

Abstract: Background: Caesarean section might be a risk factor for asthma because of delayed microbial colonisation, but the association remains controversial. A study was undertaken to investigate prospectively whether children born by caesarean section are more at risk of having asthma in childhood and sensitisation at the age of 8 years, taking into account the allergic status of the parents. Methods: 2917 children who participated in a birth cohort study were followed for 8 years. The definition of asthma included wheeze, dyspnoea and prescription of inhaled steroids. In a subgroup (n = 1454), serum IgE antibodies for inhalant and food allergens were measured at 8 years. Results: In the total study population, 12.4% (n = 362) of the children had asthma at the age of 8 years. Caesarean section, with a total prevalence of 8.5%, was associated with an increased risk of asthma (OR 1.79; 95% CI 1.27 to 2.51). This association was stronger among predisposed children (with two allergic parents: OR 2.91; 95% CI 1.20 to 7.05; with only one: OR 1.86; 95% CI 1.12 to 3.09) than in children with non-allergic parents (OR 1.36; 95% CI 0.77 to 2.42). The association between caesarean section and sensitisation at the age of 8 years was significant only in children of non-allergic parents (OR 2.14; 95% CI 1.16 to 3.98). Conclusions: Children born by caesarean section have a higher risk of asthma than those born by vaginal delivery, particularly children of allergic parents. Caesarean section increases the risk for sensitisation to common allergens in children with non-allergic parents only.

Title: Physiologic Changes in the Airway and the Respiratory System Affecting Management in Pregnancy

Authors: Izakson A, Cohen Y, Landau R.

Journal: Principles and practice of maternal critical care (2020): 271-283.

Link to Springer: Physiologic Changes in the Airway and the Respiratory System Affecting Management in Pregnancy

Abstract: Pregnancy is associated with significant anatomical and physiological changes in the airway and respiratory system. Reduction of functional residual capacity in parallel with increased oxygen consumption shortens the time available for airway manipulation before hypoxia becomes significant. Hormone-induced changes in respiratory drive cause a reduction of normal partial pressure of arterial carbon dioxide values during pregnancy, associated with compensatory metabolic acidosis. A thorough understanding of these changes is key for anesthesiologists and critical care providers managing obstetric patients with compromised oxygenation requiring airway manipulation and mechanical ventilation.

Title: Maternal carbon dioxide level during labor and its possible effect on fetal cerebral oxygenation: mini review

Authors: Tomimatsu T, Kakigano A, Mimura K, Kanayama T, Koyama S, Fujita S, Taniguchi Y, Kanagawa T, Kimura T.

Journal: J Obstet Gynaecol Res. 2013 Jan;39(1):1-6. doi: 10.1111/j.1447-0756.2012.01944.x. Epub 2012 Jul 6. PMID: 22765270.

Link to PubMed: Maternal carbon dioxide level during labor and its possible effect on fetal cerebral oxygenation: mini review

Abstract: During pregnancy, and especially during labor, the maternal carbon dioxide level declines considerably. Maternal carbon dioxide levels show a close relation with fetal carbon dioxide levels. The latter affects fetal cerebral oxygenation by regulating cerebral blood flow and shifting the oxyhemoglobin dissociation curve. In addition, maternal hypocapnia appears to impair placental oxygen transfer. Thus, maternal hyperventilation may interfere with optimal fetal cerebral oxygenation. Here, we provide a brief overview of the literature relevant to this issue.

Title: The effect of hyperventilation on maternal placental blood flow in pregnant rabbits

Authors: Leduc B.

Journal: J Physiol. 1972 Sep;225(2):339-48. doi: 10.1113/jphysiol.1972.sp009943. PMID: 4561482; PMCID: PMC1331109.

Link to full text: The effect of hyperventilation on maternal placental blood flow in pregnant rabbits

Abstract: 1. In anaesthetized pregnant rabbits near term, cardiac output and its distribution were measured by injection of isotope-labelled microspheres. Hypocapnia (mean arterial P(CO) (2) 18 mm Hg), induced by intermittent positive pressure hyperventilation, caused a 43% reduction in maternal placental blood flow, attributed mainly to vasoconstriction. Myometrial flow was not significantly changed.2. Moderate hypercapnia (mean arterial P(CO) (2) 46 mm Hg) caused no change in placental flow, compared with observations made while breathing air spontaneously (P(CO) (2) 31 mm Hg).3. Intravenous infusions of adrenaline or noradrenaline 1 mug/kg. min caused maternal placental vasoconstriction.4. During the especially warm summer of 1969, there was a mean 46% reduction in maternal placental blood flow in pregnant rabbits near term, breathing room air spontaneously with normal blood gas values and rectal temperatures. This was associated with an increase in the number of runts and dead foetuses.

Title: The effects of pregnancy on nasal physiology

Authors: Demir UL, Demir BC, Oztosun E, Uyaniklar OO, Ocakoglu G.

Journal: Int Forum Allergy Rhinol. 2015 Feb;5(2):162-6. doi: 10.1002/alr.21438. Epub 2014 Oct 27. PMID: 25348597.

Link to PubMed: The effects of pregnancy on nasal physiology

Abstract: Background: Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy. Methods: The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls. Results: The NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm(2), third trimester 0.31 cm(2). There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = -0.10, p = 0.318; r = -0.04, p = 0.654, respectively). Conclusion: Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters. Keywords: acoustic rhinometry; nasal symptoms; pregnancy; rhinitis; rhinomanometry.

Title: Effects of human pregnancy on the ventilatory chemoreflex response to carbon dioxide

Authors: Jensen D, Wolfe LA, Slatkovska L, Webb KA, Davies GA, O'Donnell DE.

Journal: Am J Physiol Regul Integr Comp Physiol. 2005 May;288(5):R1369-75. doi: 10.1152/ajpregu.00862.2004. Epub 2005 Jan 27. PMID: 15677521.

Link to full text: Effects of human pregnancy on the ventilatory chemoreflex response to carbon dioxide

Abstract: This study examined the effects of human pregnancy on the central chemoreflex control of breathing. Subjects were two groups (n=11) of pregnant subjects (PG, gestational age, 36.5+/-0.4 wk) and nonpregnant control subjects (CG), equated for mean age, body height, prepregnant body mass, parity, and aerobic fitness. All subjects performed a hyperoxic CO2 rebreathing procedure, which includes prior hyperventilation and maintenance of iso-oxia. Resting blood gases and plasma progesterone and estradiol concentrations were measured. During rebreathing trials, end-tidal Pco2 increased, whereas end-tidal Po2 was maintained at a constant hyperoxic level. The point at which ventilation (Ve) began to rise as end-tidal Pco2 increased was identified as the central chemoreflex ventilatory recruitment threshold for CO2 (VRTco2). Ve levels below (basal Ve) and above (central chemoreflex sensitivity) the VRTco2 were determined. The VRTco2 was significantly lower in the PG vs. CG (40.5+/-0.8 vs. 45.8+/-1.6 Torr), and both basal Ve (14.8+/-1.1 vs. 9.3+/-1.6 l/min) and central chemoreflex sensitivity (5.07+/-0.74 vs. 3.16+/-0.29 l.min-1.Torr-1) were significantly higher in the PG vs. CG. Pooled data from the two groups showed significant correlations for resting arterial Pco2 with basal Ve, central chemoreflex sensitivity, and the VRTco2. The VRTco2 was also correlated with progesterone and estradiol concentrations. These data support the hypothesis that pregnancy decreases the threshold and increases the sensitivity of the central chemoreflex response to CO2. These changes may be due to the effects of gestational hormones on chemoreflex and/or nonchemoreflex drives to breathe.

Title: Maternal hyperventilation and the fetus

Authors: Huch R.

Journal: J Perinat Med. 1986;14(1):3-17. doi: 10.1515/jpme.1986.14.1.3. PMID: 3517286.

Link to PubMed: Maternal hyperventilation and the fetus

Abstract: Pregnant women experience hyperventilation during pregnancy for several reasons: It occurs regularly and spontaneously during pregnancy, it occurs because of the type of ventilation practiced during the actual hours of labor and delivery, and sometimes it is induced by the anesthesiologic technique during obstetrical operations. This often results in excessive hyperventilation and has significant effects on blood gases, the cardiovascular and neuro-psychometrical systems of the female organism.

Title: Phasic menstrual cycle effects on the control of breathing in healthy women

Authors: Slatkovska L, Jensen D, Davies GA, Wolfe LA.

Journal: Respir Physiol Neurobiol. 2006 Dec;154(3):379-88. doi: 10.1016/j.resp.2006.01.011. Epub 2006 Mar 15. PMID: 16542884.

Link to PubMed: Phasic menstrual cycle effects on the control of breathing in healthy women

Abstract: This study examined the effects of menstrual cycle phase on ventilatory control. Fourteen eumenorrheic women were studied in the early follicular (FP; 1-6 days) and mid-luteal (LP; 20-24 days) phase of the menstrual cycle. Blood for the determination of arterial PCO(2) (PaCO(2)) , plasma strong ion difference ([SID]), progesterone ([P(4)]), and 17beta-estradiol ([E(2)]) concentrations were obtained at rest. Subjects performed a CO(2) rebreathing procedure that included prior hyperventilation and maintenance of iso-oxia to evaluate central and peripheral chemoreflex, and nonchemoreflex drives to breathe. Resting PaCO(2) and [SID] were lower; minute ventilation (V (E)), [P(4)] and [E(2)] were higher in the LP versus FP. Within the LP, significant correlations were observed for PaCO(2) with [P(4)], [E(2)] and [SID]. Menstrual cycle phase had no effect on the threshold or sensitivity of the central and/or peripheral ventilatory chemoreflex response to CO(2). Both (V (E)) and the ventilatory response to hypocapnia (representing nonchemoreflex drives to breathe) were approximately 1L/min greater in the LP versus FP accounting for the reduction in PaCO(2) . These data support the hypothesis that phasic menstrual cycle changes in PaCO(2) may be due, at least in part, to the stimulatory effects of [P(4)], [E(2)] and [SID] on ventilatory drive.

Title: Nasal congestion during pregnancy

Authors: Ellegård E, Karlsson G.

Journal: Clin Otolaryngol Allied Sci. 1999 Aug;24(4):307-11. doi: 10.1046/j.1365-2273.1999.00264.x. PMID: 10472465.

Link to PubMed: Nasal congestion during pregnancy

Abstract: We define pregnancy rhinitis as nasal congestion in the last 6 or more weeks of pregnancy without other signs of respiratory tract infection and with no known allergic cause, disappearing completely within 2 weeks after delivery. In order to describe physiological variations of nasal obstruction during pregnancy, subjective scores and nasal as well as oral peak expiratory flow values were recorded daily in 23 pregnancies until 1 month after delivery. Scores were higher during early and late pregnancy than in the month after delivery. Objectively registered blockage increased during pregnancy in eight women only. Unexpectedly nine women showed declining blockage. Five of 23 women had pregnancy rhinitis.

Title: Nasal Congestion and Its Management in Pregnancy Rhinitis

Authors: Poerbonegoro N.L.

Journal: Indonesian Journal of Obstetrics and Gynecology (2019): 320-328.

Link to full text: Nasal Congestion and Its Management in Pregnancy Rhinitis

Abstract: Background: Pregnancy rhinitis occurs approximately in one-fifth of pregnancies, at almost any gestational week. The incidence rate of pregnancy rhinitis reaches up to 40%, with prevalence as high as 17%. Pathomechanism is still unclear, but it is suspected that estrogen and placental growth hormone (PGH) play roles in the development of disease. Objective: To elaborate the pathomechanism of pregnancy rhinitis and the proper management of rhinitis symptoms, particularly nasal obstruction. Methods: Literature review. Conclusion: Pregnancy rhinitis, manifested as nasal congestion, is considered a phenomenon and may become a serious condition. Persistent nasal congestion acts as a potential risk factor in affecting fetal growth and development through gradual hypoxia process. This condition can lead to various complications such as maternal hypertension, preeclampsia, impaired fetal growth, and low APGAR scores. Indepth knowledge of pathomechanism is essential as guidance to accurate treatment including conservative and pharmaca therapies, which will lead to optimal outcome for both mother and baby.

Title: Nasal lavage in pregnant women with seasonal allergic rhinitis: a randomized study

Authors: Garavello W, Somigliana E, Acaia B, Gaini L, Pignataro L, Gaini RM.

Journal: Int Arch Allergy Immunol. 2010;151(2):137-41. doi: 10.1159/000236003. Epub 2009 Sep 15. PMID: 19752567.

Link to PubMed: Nasal lavage in pregnant women with seasonal allergic rhinitis: a randomized study

Abstract: Background: Nasal rinsing appears particularly suitable in the management of pregnant women with seasonal allergic rhinitis since no deleterious effects on the fetus are to be expected. However, to date, no studies have specifically investigated this option. Methods: Pregnant women with seasonal allergic rhinitis were randomized to intranasal lavage with hypertonic saline solution 3 times daily (n = 22) versus no local therapy (n = 23) during a 6-week period corresponding to the pollen season. Patients were invited to keep a daily record of rhinitis symptoms (rhinorrea, obstruction, nasal itching and sneezing), to record consumption of oral antihistamine and to undergo rhinomanometry. Results: The rhinitis score was similar at study entry but a statistically significant improvement in this score was observed in the study group during all subsequent weeks (p < 0.001 for weeks 2-6). The mean number of daily antihistamines use per patient per week was significantly reduced at weeks 2, 3 and 6 (p < 0.001, p < 0.001 and p = 0.001, respectively). Baseline rhinomanometry performed at week 1 showed similar nasal resistance in the study and control groups. In contrast, a statistically significant difference emerged in the 2 following evaluations. At week 3, nasal resistance in the study and control groups was 0.96 +/- 0.44 and 1.38 +/- 0.52 Pa/ml/s, respectively (p = 0.006). At week 6, it was 0.94 +/- 0.38 and 1.35 +/- 0.60 Pa/ml/s, respectively (p = 0.006). No adverse effect was reported in the active group. Conclusions: Nasal rinsing is a safe and effective treatment option in pregnant women with seasonal allergic rhinitis.

Title: Oxygen and oxidative stress in the perinatal period

Authors: Torres-Cuevas I, Parra-Llorca A, Sánchez-Illana A, Nuñez-Ramiro A, Kuligowski J, Cháfer-Pericás C, Cernada M, Escobar J, Vento M.

Journal: Redox Biol. 2017 Aug;12:674-681. doi: 10.1016/j.redox.2017.03.011. Epub 2017 Mar 12. PMID: 28395175; PMCID: PMC5388914.

Link to full text: Oxygen and oxidative stress in the perinatal period

Abstract: Fetal life evolves in a hypoxic environment. Changes in the oxygen content in utero caused by conditions such as pre-eclampsia or type I diabetes or by oxygen supplementation to the mother lead to increased free radical production and correlate with perinatal outcomes. In the fetal-to-neonatal transition asphyxia is characterized by intermittent periods of hypoxia ischemia that may evolve to hypoxic ischemic encephalopathy associated with neurocognitive, motor, and neurosensorial impairment. Free radicals generated upon reoxygenation may notably increase brain damage. Hence, clinical trials have shown that the use of 100% oxygen given with positive pressure in the airways of the newborn infant during resuscitation causes more oxidative stress than using air, and increases mortality. Preterm infants are endowed with an immature lung and antioxidant system. Clinical stabilization of preterm infants after birth frequently requires positive pressure ventilation with a gas admixture that contains oxygen to achieve a normal heart rate and arterial oxygen saturation. In randomized controlled trials the use high oxygen concentrations (90% to 100%) has caused more oxidative stress and clinical complications that the use of lower oxygen concentrations (30-60%). A correlation between the amount of oxygen received during resuscitation and the level of biomarkers of oxidative stress and clinical outcomes was established. Thus, based on clinical outcomes and analytical results of oxidative stress biomarkers relevant changes were introduced in the resuscitation policies. However, it should be underscored that analysis of oxidative stress biomarkers in biofluids has only been used in experimental and clinical research but not in clinical routine. The complexity of the technical procedures, lack of automation, and cost of these determinations have hindered the routine use of biomarkers in the clinical setting. Overcoming these technical and economical difficulties constitutes a challenge for the immediate future since accurate evaluation of oxidative stress would contribute to improve the quality of care of our neonatal patients. Keywords: Biomarkers; High-risk pregnancy; Ischemia-reperfusion; Newborn; Oxidative stress; Oxygen.

Title: Respiratory physiology of pregnancy: Physiology masterclass

Authors: LoMauro A, Aliverti A.

Journal: Breathe (Sheff). 2015 Dec;11(4):297-301. doi: 10.1183/20734735.008615. PMID: 27066123; PMCID: PMC4818213.

Link to full text: Respiratory physiology of pregnancy: Physiology masterclass

Abstract: During healthy pregnancy, pulmonary function, ventilatory pattern and gas exchange are affected through both biochemical and mechanical pathways, as summarised in figure 1. During pregnancy, the physiological alteration of hormonal patterns is the main cause of ventilatory changes in respiratory function.

Title: Respiratory and Acid-Base changes during pregnancy

Authors: Prowse C.M, Gaensler E.A.

Journal: Anesthesiology. 1965 Jul-Aug;26:381-92. doi: 10.1097/00000542-196507000-00003. PMID: 14313450.

Link to PubMed: Respiratory and Acid-Base changes during pregnancy

Abstract: Much of our knowledge of respiratory and acid-base changes in pregnancy stems from studies made more than ten years ago and even that material is limited and incomplete. This is surprising when one considers that pregnancy constitutes one of the most severe states of physiologic adaptations. Incongruously, the effect upon lung function of a number of exceedingly rare diseases has been studied exhaustively from every aspect, and by the most modern techniques, whereas the effect of pregnancy, where we are confronted with an ever-growing and inexhaustible supply of clinical material, has been explored so incompletely. Actually, more attention has been paid to states of pathologic stress upon pregnancy such as heart disease, tuberculosis and following chest surgery than to the physiologic norm.

Title: Respiratory physiologic changes in pregnancy

Authors: Wise RA, Polito AJ, Krishnan V.

Journal: Immunol Allergy Clin North Am. 2006 Feb;26(1):1-12. doi: 10.1016/j.iac.2005.10.004. PMID: 16443140.

Link to PubMed: Respiratory physiologic changes in pregnancy

Abstract: In summary, the major physiologic changes that occur in pregnancy are the increased minute ventilation, which is caused by increased respiratory center sensitivity and drive; a compensated respiratory alkalosis; and a low expiratory reserve volume. The vital capacity and measures of forced expiration are well preserved. Patients who have many lung diseases tolerate pregnancy well, with the exception of those who have pulmonary hypertension or chronic respiratory insufficiency from parenchymal or neuromuscular disease.

Title: Sleep-disordered breathing in pregnancy

Authors: Balserak BI.

Journal: Am J Respir Crit Care Med. 2014 Aug 15;190(4):P1-2. doi: 10.1164/rccm.1904P1. PMID: 25127314.

Link to PubMed: Sleep-disordered breathing in pregnancy

Abstract: Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancyrelated changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population

Title: The effect on the fetus of maternal hyperventilation during labour

Authors: Saling E, Ligdas P.

Journal: J Obstet Gynaecol Br Commonw. 1969 Oct;76(10):877-80. doi: 10.1111/j.1471-0528.1969.tb15724.x. PMID: 5386830.

Link to PubMed: The effect on the fetus of maternal hyperventilation during labour

Abstract: ONLY a few years ago it was difficult for midwives and obstetricians to imagine that an increase in the frequency and depth of respiration of women in labour might be too great and constitute a hazard for the fetus. It is still the practice in many places to encourage as much as possible deep breathing during labour so that "a good oxygen supply is ensured for the baby", although such a policy was proved wrong many years ago. It is also suggested that the majority of women in labour are tense and cannot relax because they are afraid of pain, and that, therefore, they do not breathe properly. Whilst tension is not rare during labour, the assumption that this is always associated with an inadequate breathing technique is erroneous. Hasselbach (1912) showed that pregnant women have a decreased blood carbon dioxide tension (Pco2) during pregnancy, and later studies (Sjosted, 1962) proved that this also applied to women in labour. An increase in blood progesterone levels is thought to account for hyperventilation.