AimCurrent pricing of commercial mechanical ventilators in low-/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to-build noninvasive bilevel pressure ventilator to allow a reduction in the serious shortage of ventilators in LMICs.MethodsThe ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost <75 USD), with construction details provided open source for free replication. The ventilator was evaluated, and compared with a commercially available device (Lumis 150 ventilator; Resmed, San Diego, CA, USA): 1) in the bench setting using an actively breathing patient simulator mimicking a range of obstructive/restrictive diseases; and b) in 12 healthy volunteers wearing high airway resistance and thoracic/abdominal bands to mimic obstructive/restrictive patients.ResultsThe designed ventilator provided inspiratory/expiratory pressures up to 20/10 cmH2O, respectively, with no faulty triggering or cycling; both in the bench test and in volunteers. The breathing difficulty score rated (1–10 scale) by the loaded breathing subjects was significantly (p<0.005) decreased from 5.45±1.68 without support to 2.83±1.66 when using the prototype ventilator, which showed no difference with the commercial device (2.80±1.48; p=1.000).ConclusionThe low-cost, easy-to-build noninvasive ventilator performs similarly to a high-quality commercial device, with its open-source hardware description, which will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated.

Sub-optimal chronic obstructive pulmonary disease (COPD) management has been found largely due to patients’ medication non-adherence and incorrect inhaler technique. This study aimed to examine inhaler use technique and medication adherence among Vietnamese COPD patients as well as potential associated factors. A cross-sectional study involving 70 COPD exacerbators was conducted. Inhaler technique and adherence were evaluated by the 10-item and 12-item Test of Adherence to Inhaler (TAI). Data on the history of COPD, home prescription of inhalers and duration of hospitalization were also collected. Generalized linear regression models were used to determine the associated factors with inhaler use and medication adherence. The results showed that the proportion of patients with good inhaler technique was 22.7% for metered-dose inhalers (MDI), 30.4% for dry powder inhalers (DPI) and 31.8% for soft-mist inhalers (SMI). Full exhalation was the most common mistake. The rates of non-compliance patterns were: “ignorant” (77.1%), “sporadic” (58.6%), and “deliberate” (55.7%). Worse dyspnea, greater health condition impairment, and an increased frequency of exacerbations and hospitalizations were found to be associated negatively with correct inhaler use and treatment adherence. Instructions to COPD patients about using inhalers should focus on correct inhaler technique and adherence even when feeling healthy.

Comorbidities are common in respiratory disease patients and have been well-known to impact their quality of life. The objective of this study is to estimate the minimal clinically important difference (MCID) of the health-related quality of life (HRQOL) among respiratory disease patients with different comorbidities in a Vietnamese tertiary hospital. We performed a cross-sectional study from October to November 2016 at the Respiratory Center of Bach Mai Hospital, Hanoi, with a total of 508 participants. Information about socio-economic characteristics, HRQOL and comorbidities of participants was collected. ANOVA was used to identify MCID between patients with and without specific comorbid conditions. Tobit regression was used to explore the associations between comorbidities and the HRQOL. Results showed that the prevalence of cardiovascular comorbidities was 23.8%, followed by musculoskeletal diseases (12.0%), digestive diseases (11.8%), endocrine diseases (10.0%), kidney diseases (5.1%) and ear, nose, and throat diseases (4.5%). Regarding HRQOL, having a problem in pain/discomfort was observed in 61.0% of participants, followed by anxiety/depression (48.2%). Mean EQ-5D index was 0.66 (SD (Standard Deviation) = 0.31). The significant MCID (p < 0.05) was found between patients with and without cardiovascular diseases, musculoskeletal diseases, kidney diseases, and endocrine diseases. The multivariate regression model showed that only musculoskeletal diseases were found to be related with the marked decrement of EQ-5D index score (Coef. = −0.13; 95% CI (Confident Interval) = −0.23; −0.02). Suffering at least one chronic illness was correlated to the marked decrease of EQ-5D index score (Coef. = −0.09; 95%CI = −0.17; −0.01). These results underline the importance of appropriate pain management as well as the provision of an interprofessional care approach to patients in order to alleviate the burden of comorbidities to their treatment outcomes and HRQOL.

Exposure to second-hand smoke (SHS) among non-smoking pregnant women can lead to adverse maternal and fetal outcomes. A cross-sectional study was performed from July to August 2016 among 432 pregnant women at Bach Mai Hospital, Hanoi, Vietnam, to assess the prevalence and sources of SHS exposure among non-smoking pregnant women. Socio-economic characteristics and information regarding SHS exposure of participants were collected. Multivariable logistic regression was employed to identify associated factors. Overall, 92.6% and 64.5% of pregnant women were exposed to SHS in their lifetime and in the last 30 days, respectively. Cafeterias and restaurants had the highest proportion of pregnant women exposed to SHS. Those who reported that “smoking is allowed at home” (OR = 3.18; 95%CI = 1.97–5.13); going to working place (OR = 1.86; 95%CI = 1.08–3.19), going to state authority offices (OR = 1.98; 95%CI = 1.15–3.41), and cafeterias (OR = 1.96; 95%CI = 1.22–3.16) had the highest risk of SHS exposure in the last 30 days. We have found a high proportion of SHS exposure among non-smoking pregnant women in Vietnam. This comes from a multitude of sources, including homes, workplaces, cafeterias, and restaurants. The data emphasises the need for further intervention to address this health issue.