Efectos del tratamiento con quimioterapia y radioterapia concomitante sobre los volúmenes pulmonares en mujeres con cáncer de mama en Talca, Chile / Effects of concurrent chemotherapy and radiotherapy on lung volumes in women with breast cancer living in Talca, Chile

Resumen Introducción. El cáncer de mama (CM) es la enfermedad crónica no transmisible más frecuente y letal en mujeres. La información disponible sobre el impacto de sus diversos tratamientos en el sistema respiratorio es controversial. Objetivo. Determinar el efecto del tratamiento con quimioterapia y radioterapia concomitante en los volúmenes pulmonares de un grupo de mujeres con CM en Talca, Chile. Materiales y métodos. Estudio de casos y controles. La muestra (n=22) se dividió en dos grupos: control (n = 11) y con CM (n = 11). Para medir la capacidad vital forzada, los volúmenes pulmonares y la resistencia de las vías aéreas, se usó la prueba de pletismografía corporal. Para determinar la normalidad de los datos, se usó la prueba Shapiro-Wilks y, según sus resultados, se utilizó la prueba de t-Student o la de U de Mann-Whitney; se consideró un nivel de significancia de p<0.05. Resultados. Los flujos ventilatorios no presentaron diferencias significativas entre los dos grupos, mientras que los volúmenes pulmonares en el grupo con CM experimentaron una disminución significativa en las variables capacidad inspiratoria (CI) y volumen residual (VR) (p<0.05). Conclusión. Las mujeres con CM y que fueron tratadas con quimioterapia y radioterapia concomitante experimentaron una disminución en su CI y su VR en comparación con el grupo control, lo que podría impactar su calidad de vida.

Abstract Introduction: Breast cancer (BC) is the most frequent and lethal chronic non-communicable disease in women, and available information on the impact that the different treatments for BC have on the respiratory system is controversial. Objective: To determine the effect of concurrent chemotherapy and radiotherapy on lung volumes in a group of women with BC living in Talca, Chile. Material and methods: Case-control study. The sample (n=22) was divided into two groups: control (n=11) and BC (n=11). A whole body plethysmography test was used to measure participants' forced vital capacity, lung volumes, and airway resistance. The Shapiro-Wilks test was used to determine the normality of data, and, according to the result of this test, the Student's t test or the Mann-Whitney U test were used. A significance level of p<0.05 was considered. Results: Ventilatory flows showed no significant differences between both groups, while lung volumes in the BC group experienced a significant decrease in the inspiratory capacity (IC) and residual volume (RV) variables (p<0.05). Conclusion: Compared to the CG, the women with BC who received concurrent chemotherapy and radiotherapy experienced a reduction of their IC and RV, which could affect their quality of life.

Incentive spirometry inspiratory capacity changes and predictors after open heart surgery: a 5-day prospective study

@#Introduction: Incentive spirometry (IS) is commonly used for increasing postoperative IS inspiratory capacity (ISIC) after open heart surgery (OHS). However, little is known about the serial changes in ISIC and their predictive factors. Objective: The aim of this study is to identify the postoperative ISIC changes relative to preoperative ISIC after OHS, and determine their predictors, including patient characteristics factors and IS performance parameters such as inspiration volumes (ISv) and frequencies (ISf). Methods: This is a prospective study with blinding procedures involving 95 OHS patients, aged 52.8±11.5 years, whose ISIC was measured preoperatively (PreopISIC) until fifth postoperative day (POD), while ISv and ISf monitored with an electronic device from POD1-POD4. Regression models were used to identify predictors of POD1 ISIC, POD2- POD5 ISIC increments, and the odds of attaining PreopISIC by POD5. Results: The ISIC reduced to 41% on POD1, increasing thereafter to 57%, 75%, 91%, and 106% from POD2-POD5 respectively. Higher PreopISIC (B=-0.01) significantly predicted lower POD1 ISIC, and, together with hyperlipedemia (B=11.52), which significantly predicted higher POD1 ISIC, explained 13% of variance. ISv at relative percentages of PreopISIC from POD1-POD4 (BPOD1=0.60, BPOD2=0.56, BPOD3=0.49, BPOD4=0.50) significantly predicted ISIC of subsequent PODs with variances at 23%, 24%, 17% and 25% respectively, but no association was elicited for ISf. IS performance findings facilitated proposal of a postoperative IS therapy target guideline. Higher ISv (B=0.05) also increased odds of patients recovering to preoperative ISIC on POD5 while higher PreopISIC (B=- 0.002), pain (B=-0.72) and being of Indian race (B=-1.73) decreased its odds. Conclusion: ISv appears integral to IS therapy efficacy after OHS and the proposed therapy targets need further verification through randomized controlled trials.

Capacidad inspiratoria y polimorfismo de la enzima convertidora de angiotensina en jóvenes chilenos / Inspiratory capacity and polymorphism of angiotensin converter enzyme in young Chileans

El objetivo de la presente investigación fue determinar la capacidad inspiratoria (CI) en un grupo de universitarios chilenos sedentarios agrupados por el genotipo (polimorfismo rs4646994) del gen de la enzima convertidora de angiotensina (ECA). Se seleccionaron a través de muestreo no probabilístico 83 individuos (de 18 a 35 años), 37 mujeres y 46 hombres. Se midió la CI a través de pletismografía corporal, se extrajo ADN a partir de sangre con EDTA y se realizó la reacción en cadena polimerasa (PCR) para el polimorfismo Ins/Del de la ECA. Se determinó normalidad de los datos, utilizándose t de Student o ANOVA para las variables paramétricas, y en las no paramétricas U de Mann-Whitney o Kruskal-Wallis, considerándose significativo un valor de p < 0,05. La distribución de los genotipos se encontró en equilibrio de Hardy Weinberg (X2= 1,872, p= 0,171 para los hombres y X2= 3,424, p= 0,064 para las mujeres), la CI, en ambos sexos, no mostró diferencias significativas al ser comparada por genotipo. Los hombres portadores del genotipo Ins/Ins presentaron mayores niveles de CI en relación al grupo del gentipo Del/Del-Ins/Del. Las mujeres con la dominancia alélica Ins presentaron una mayor CI que las pertenecientes al grupo Del/Del. Existió una mayor CI en participantes de sexo femenino con dominancia alélica Ins y masculino homocigotos Ins, del gen de la ECA.

The aim of the present research is to determine the inspiratory capacity (IC) in a group of sedentary Chilean university students grouped by the genotype (polymorphism rs4646994) of the angiotensin-converting enzyme (ACE) gene. Eighty three individuals (18 to 35 years old), 37 women and 46 men were selected through non-probabilistic sampling. The IC was measured through body plethysmograph, DNA was extracted from blood with EDTA and the polymerase chain reaction (PCR) was performed for the Ins / Del polymorphism of the ECA. Normality of the data was determined, using Student's t-test or ANOVA for the parametric variables, and in the non-parametric U-tests of Mann-Whitney or Kruskal-Wallis, a value of p <0.05 being considered significant. The distribution of genotypes was found in Hardy Weinberg equilibrium (X2 = 1.872, p = 0.171 for men and X2 = 3.424, p = 0.064 for women), the IC, in both sexes, showed no significant differences when compared by genotype. The men carrying the Ins / Ins genotype had higher IC levels in relation to the gentile group Del / Del - Ins / Del. Women with allelic dominance Ins had a higher IC than those belonging to the Del / Del group. There was a greater IC in female participants with allelic dominance Ins and masculine homozygous Ins, of the ACE gene.

Avaliação do tamanho do pulmão em cães: a capacidade inspiratória define o volume corrente / Sizing the lung in dogs: the inspiratory capacity defines the tidal volume

RESUMO Objetivo: Avaliar uma nova abordagem fisiológica para a determinação do volume corrente em ventilação mecânica, de acordo com a capacidade inspiratória, e determinar se isso resulta em medidas mecânicas e de troca gasosa adequadas em cães saudáveis e em estado crítico. Métodos: Incluíram-se, neste estudo, 24 animais para avaliar o volume corrente expresso como porcentagem da capacidade inspiratória. Para mensuração da capacidade inspiratória, o ventilador mecânico foi regulado como segue: modo controle de pressão, com 35cmH2O de pressão de inspiração e pressão expiratória final de zero, por 5 segundos. Subsequentemente, estudaram-se dez cães em condições clínicas críticas. Resultados: Cães saudáveis ventilados com volume corrente que correspondia a 17% da capacidade inspiratória demonstraram mecânica respiratória normal e apresentaram os valores previstos de PaCO2 mais frequentemente do que os animais nos demais grupos. A pressão no sistema respiratório e a pressão transpulmonar foram significantemente mais elevadas nos cães em condição crítica, porém em todos os casos, estiveram abaixo de 15cmH2O. Conclusões: O volume corrente calculado com base na capacidade inspiratória de cada animal comprovou ser uma ferramenta útil e simples para o estabelecimento dos parâmetros do ventilador. Convém também realizar abordagem semelhante em outras espécies, inclusive no ser humano, quando se consideram as potenciais limitações da titulação do volume corrente, com base no peso corpóreo ideal calculado.

ABSTRACT Objective: To evaluate a novel physiological approach for setting the tidal volume in mechanical ventilation according to inspiratory capacity, and to determine if it results in an appropriate mechanical and gas exchange measurements in healthy and critically ill dogs. Methods: Twenty healthy animals were included in the study to assess the tidal volume expressed as a percentage of inspiratory capacity. For inspiratory capacity measurement, the mechanical ventilator was set as follows: pressure control mode with 35cmH2O of inspired pressure and zero end-expiratory pressure for 5 seconds. Subsequently, the animals were randomized into four groups and ventilated with a tidal volume corresponding to the different percentages of inspiratory capacity. Subsequently, ten critically ill dogs were studied. Results: Healthy dogs ventilated with a tidal volume of 17% of the inspiratory capacity showed normal respiratory mechanics and presented expected PaCO2 values more frequently than the other groups. The respiratory system and transpulmonary driving pressure were significantly higher among the critically ill dogs but below 15 cmH2O in all cases. Conclusions: The tidal volume based on the inspiratory capacity of each animal has proven to be a useful and simple tool when setting ventilator parameters. A similar approach should also be evaluated in other species, including human beings, if we consider the potential limitations of tidal volume titration based on the calculated ideal body weight.

Is optoelectronic plethysmography a valid instrument to measure inspiratory capacity? / A pletismografia optoeletrônica é um instrumento válido para medir a capacidade inspiratória? / ¿Tiene validez para medir la capacidad inspiratoria la pletismografía optoelectrónica?

The aim of this study was to evaluate the concurrent validity of the optoelectronic plethysmography (OEP) to measure inspiratory capacity (IC) at rest and during submaximal exercise in healthy subjects. Twelve subjects (6 Male/6 Female; 23.8±1.34 yrs) with normal body mass index and lung function completed the study protocol. Participants were assessed at rest and during a 12-minute submaximal exercise protocol on a cycle ergometer. IC maneuvers were simultaneously recorded by OEP system and by a spirometer at rest and during exercise. The percentage of discrepancy between measurements, linear regression analysis and Bland-Altman method were used for data analysis. The study was approved by the institution ethics committee. It was considered 150 valid IC maneuvers for analysis (44 for resting and 106 for exercise). The percentage of discrepancy between the measurements were -9.6 (8.6%) at rest and -4.6 (5.5%) during exercise. Regression analysis showed good linear associations between methods at rest (r2=0.90; p=0.0002) and during exercise (r2=0.96; p=0.0008). Bland-Altman analysis using data obtained during exercise showed a bias between the two methods of 0.13L. The limits of agreement indicate that the difference between methods can vary from -0.04L to 0.57L. Additionally, data was equally distributed between the upper and lower limits, demonstrating no systematic overestimation or underestimation of the IC by any of the instruments. In conclusion, this study demonstrated that the OEP is a valid evaluation system to measure IC of healthy individuals at rest and during submaximal exercise.

O objetivo deste estudo foi avaliar a validade concorrente da pletismografia optoeletrônica (POE) para medir a capacidade inspiratória (CI) de indivíduos saudáveis no repouso e durante exercício submáximo. Doze voluntários (6 H/6 M; 23,8±1,34 anos) com índice de massa corporal e prova de função pulmonar normais completaram o protocolo do estudo. Eles foram avaliados no repouso (7 minutos) e durante 12 minutos de exercício submáximo em cicloergômetro. A CI foi mensurada simultaneamente pela POE e por um espirômetro. A porcentagem de discrepância entre as medidas, a análise de regressão linear e o método de Bland-Altman foram utilizados para análise. O estudo foi aprovado pelo comitê de ética em pesquisa da instituição. Foram consideradas 150 manobras de CI válidas para análise (44 para o repouso e 106 para o exercício). A porcentagem de discrepância entre as medidas foi de -9,6 (8,6%) no repouso e -4,6 (5,5%) durante o exercício. A análise de regressão linear mostrou associações entre os dois métodos no repouso (r2=0,90; p=0,0002) e durante o exercício (r2=0,96; p=0,0008). A análise de Bland-Altman realizada com os dados do exercício mostrou viés entre os métodos de 0,13L. Os limites de concordância mostraram que a diferença entre os métodos pode variar de -0,04 L to 0,57 L. Adicionalmente, os dados distribuíram-se igualmente entre os limites de concordância, sem superestimação ou subestimação sistemática da CI. Em conclusão, o estudo demonstrou que a POE é um sistema válido para mensuração da CI de indivíduos saudáveis no repouso e durante o exercício submáximo.

Este estudio tiene como propósito evaluar la validez de la pletismografía optoelectrónica (OEP) para medir la capacidad inspiratoria (CI) en sujetos saludables tanto en reposo como durante ejercicio submáximo. Participaron de este estudio 12 sujetos (6 hombres y 6 mujeres; 23,8 ± 1,34 años de edad) con índice de masa corporal y función pulmonar normales. Los participantes fueron evaluados en reposo por 7 minutos y durante 12 minutos de ejercicio submáximo en bicicleta estática. Se grabaron simultáneamente por la OEP y por un espirómetro las maniobras de la CI tanto en reposo como durante el ejercicio. Se utilizaron el porcentaje de discrepancia en las mediciones, el análisis de regresión lineal y el método Bland-Altman para análisis de datos del estudio, el que fue aprobado por el comité de ética de la institución. Se consideró 150 maniobras CI para el análisis, las cuales 44 fueron para reposo y 106 para ejercicio. El porcentaje de discrepancia entre las medidas fue del -9,6 (un 8,6%) en reposo y del -4,6 (un 5,5%) durante el ejercicio. El análisis de regresión lineal mostró asociaciones para los métodos en reposo (r2=0,90; p=0,0002) y durante el ejercicio (r2 = 0,96; p = 0,0008). Los datos obtenidos durante el ejercicio utilizándose el análisis Bland-Altman mostraron un sesgo de 0.13L entre los métodos. Los límites de concordancia indicaron que la diferencia entre los métodos puede tener variación desde -0.04L hasta 0.57L. Además, se distribuyeron por igual los datos entre los límites de concordancia, los cuales no mostraron sobreestimación o subestimación sistemática de la CI. En conclusión, este estudio mostró que el OEP es un sistema de evaluación valido para medir la CI de sujetos saludables tanto en reposo como durante ejercicio submáximo.

Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation? / Os broncodilatadores podem melhorar a tolerância ao exercício na ausência de hiperinsuflação dinâmica em pacientes com DPOC?

OBJECTIVE: To investigate the modulatory effects that dynamic hyperinflation (DH), defined as a reduction in inspiratory capacity (IC), has on exercise tolerance after bronchodilator in patients with COPD. METHODS: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometry and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed ΔIC(peak-rest) < 0 were considered to present with DH (DH+). RESULTS: In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without DH (DH-). Despite equivalent improvement in FEV1 after bronchodilator, the DH- group showed higher ΔIC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to ΔIC at peak exercise between DH+ and DH- groups (0.19 ± 0.17 L vs. 0.17 ± 0.15 L, p > 0.05). In addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60%] vs. 10% [3-53%]; p > 0.05). CONCLUSIONS: Improvement in TLim was associated with an increase in IC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise. .

OBJETIVO: Investigar os efeitos moduladores da hiperinsuflação dinâmica (HD), definida pela redução da capacidade inspiratória (CI), na tolerância ao exercício após broncodilatador em pacientes com DPOC. MÉTODOS: Estudo experimental e randomizado com 30 pacientes com DPOC sem hipoxemia grave. Na visita inicial, os pacientes realizaram avaliação clínica, espirometria e teste de exercício cardiopulmonar (TECP) incremental. Em duas visitas subsequentes, os pacientes foram randomizados para receber uma combinação de fenoterol/ipratrópio ou placebo e, em seguida, realizaram espirometria e TECP com velocidade constante até o limite da tolerância (Tlim). Os pacientes com ΔCI(pico-repouso) < 0 foram considerados com HD (HD+). RESULTADOS: Nesta amostra, 21 pacientes (70%) apresentaram HD. Os pacientes HD+ apresentaram maior obstrução ao fluxo aéreo e menor Tlim do que os pacientes sem HD (HD-). Apesar de ganhos equivalentes de VEF1 após broncodilatador, o grupo HD- apresentou maior ΔCI(broncodilatador-placebo) em repouso em relação ao grupo HD+ (p < 0,05). Entretanto, isso não ocorreu com a ΔCI no pico do exercício entre os grupos HD+ e HD- (0,19 ± 0,17 L vs. 0,17 ± 0,15 L; p > 0,05). Similarmente, ambos os grupos apresentaram melhoras equivalentes do Tlim após broncodilatador (mediana [intervalo interquartílico]: 22% [3-60%] e 10% [3-53%]; p > 0,05). CONCLUSÕES: A melhora da CI em repouso após broncodilatador associou-se com ganho de tolerância ao esforço mesmo nos pacientes com DPOC que não apresentem HD. Por outro lado, pacientes sem melhora da CI em repouso ainda podem obter beneficio funcional com o broncodilatador desde que apresentem HD no exercício. .

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave / Dynamic hyperinflation during treadmill exercise testing in patients with moderate to severe COPD

OBJETIVO: Caracterizar a presença, extensão e padrões de hiperinsuflação dinâmica (HD) durante teste em esteira rolante em pacientes com DPOC moderada a grave. Métodos: Estudo transversal com 30 pacientes não hipoxêmicos (VEF1= 43 ± 14 por cento do previsto) submetidos a teste cardiopulmonar de exercício em esteira rolante em velocidade constante (70-80 por cento da velocidade máxima) até o limite da tolerância (Tlim). Manobras seriadas de capacidade inspiratória (CI) foram utilizadas para avaliação da HD. RESULTADOS: Dos 30 pacientes estudados, 19 (63,3 por cento) apresentaram HD (grupo HD+), que apresentaram maior comprometimento funcional em repouso do que os pacientes sem HD (grupo HD-). Nenhuma das variáveis obtidas relacionou-se com a tolerância ao exercício no grupo HD-, enquanto Tlim, CI e percepção de dispneia ao esforço foram significativamente correlacionados no grupo HD+ (p < 0,05). No grupo HD+, 7 e 12 pacientes, respectivamente, apresentaram padrão progressivo e estável de HD (ΔCI Tlim,2min = -0,28 ± 0,11 L e 0,04 ± 0,10 L; p < 0,01). Pacientes com padrão progressivo de HD apresentaram maior relação percepção de dispneia/Tlim e menor tolerância ao exercício do que aqueles com padrão estável (354 ± 118 s e 465 ± 178 s, respectivamente; p < 0,05). CONCLUSÕES: A HD não é um fenômeno universal durante a caminhada em pacientes com DPOC, mesmo que apresentem obstrução ao fluxo aéreo de graus moderado a acentuado. Nos pacientes que apresentaram HD, um padrão progressivo de HD teve maior repercussão na tolerância ao exercício do que um padrão estável de HD.

OBJECTIVE: To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. METHODS: This was a cross-sectional study involving 30 non-hypoxemic patients (FEV1= 43 ± 14 percent of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80 percent of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (IC) maneuvers were used in order to assess DH. RESULTS: Of the 30 patients studied, 19 (63.3 percent) presented with DH (DH+ group), having greater pulmonary function impairment at rest than did those without DH (DH- group). None of the variables studied correlated with exercise tolerance in the DH- group, whereas Tlim, IC, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (ΔIC Tlim,2min = -0.28 ± 0.11 L vs. 0.04 ± 0.10 L; p < 0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 ± 118 s and 465 ± 178 s, respectively; p < 0.05). CONCLUSIONS: The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.

Relationship between waist to hip ratio and static lung volumes in adults / 中国病理生理杂志

AIM: The study is designed to probe for the relationship between waist to hip ratio(WHR)and static lung volumes of adults. METHODS: In July-October 2008, 1 307 healthy adults(372 males and 935 females)were selected in Heilongjiang province by means of questionnaire and physical examination. The height, weight, WHR, fat mass, percentage body fat and lung function were measured, and then grouped according to the standard of classification of WHR(central obesity male WHR ≥ 0.86, female ≥ 0.82)for analysis of the relationship between WHR and static lung volume. RESULTS: WHR was found, regardless of sex, to tend to go up with the increase in age and BMI(P<0.01), and both the fat mass and percentage body fat of the central obesity group were higher than those in the group with normal WHR(P<0.01). An independent negative correlation was found(P<0.05), also regardless of sex, between the WHR with expiratory reserve volume(ERV)in all these adults. ERV in central obesity group was lower than that in the group with normal WHR(P<0.05). Compared to the normal group, ERV in the central obesity group decreased by 11% for males and 8% for females(P<0.05). However, with regard to the relationship between WHR and VT, IC, MV, and VC, gender differences were found. For the males, a significant independent positive correlation was observed between WHR and IC(P<0.05), with IC of the central obesity group 6% higher than that in the group with normal WHR(P<0.05). For the females, significant independent positive correlation was found between WHR and MV(P<0.05), with the VT and MV of the central obesity group 7% and 6% higher(P<0.05), respectively, than that in the group with normal WHR. CONCLUSION: WHR is in an independent negative correlation with ERV. The elevation of WHR may play a role in the impairment of respiratory function. Its occurrence is accompanied by a rise of IC for the male and a rise of MV for the female. These changes in the two genders could be associated with the decrease in arterial oxygen tension caused by the decrease of ERV.

Variações da pressão inspiratória máxima e pressão expiratória máxima a partir da capacidade residual funcional ou da capacidade pulmonar total e volume residual em indivíduos normais / Variaciones de la presión inspiratoria máxima y de la presión espiratoria máxima desde la capacidad funcional residual o el volumen pulmonar total y el volumen residual en individuos normales / Variations of maximal inspiratory pressure and maximal expiratory pressure from residual functional capacity or total pulmonary capacity and residual volume in normal individuals

O objetivo deste trabalho foi verificar se existe variação nos dois métodos distintos que auxiliam a avaliação da pressão inspiratória máxima (Pimax) e pressão expiratória máxima (Pemax). Recrutamos 41 indivíduos voluntários, tendo como critério de inclusão faixa etária de 20-59 anos, ambos os sexos, índice de massa corpórea 18 a 29,9 kg/m2 e critérios de exclusão: tabagistas, doenças pulmonares crônicas, infecções de vias aéreas superiores e inferiores no último ano, doenças neuromusculares, deformidades torácicas e IMC > 30 kg/m2. A pesquisa foi aprovada pelo Comitê de Ética do CentroUniversitário São Camilo; os voluntários assinaram o termo de consentimento livre e esclarecido. Utilizou-se um manovacuômetro da marca Gerar, bocais, traquéias e clamp nasal de plástico. Observamos nos resultados de comparação entre as médias dos diferentes métodos p > 0,001 para a Pimax e Pemax. A média da Pimax a partir do VR e CRF foi, respectivamente, de 96,10 e 78,78 cm H2O, com um desvio-padrão de respectivamente 32,70 e 27,50 cm H2O. Entre Pemax, a partir da CPT e CRF, notou-se, respectivamente, uma média de 115,37 e 93,90 cm H2O, com um desvio-padrão de, respectivamente, 37,95 e 33,08 cm H2O. Houve diferença significativa dos valores obtidos da Pimax a partir da CRF e VR e da Pemax a partir da CRF e CPT, sendo que o método a partir da CRF subestima a Pimax em relação à medida feita a partir do VR, assim como subestima a Pemax em relação a CPT. Concluímos que um método não pode substituir o outro sem perda de informações.

The aim of this work was to verify if there exist variations in the two distinct methods that assist the evaluation of maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). We enlisted 41 voluntary individuals, both male and female, having as inclusion criteria age (20-59 years), body mass index (18-29,9 kg/m2) and exclusion criteria be a chronic smoker, having lung illnesses, thoracic infections of superior and inferior aerial ways in the last year, neuromuscular illnesses, deformities, and BMI > 30 kg/m2. The research was approved by the Committee of Ethics of the University Center São Camilo; the volunteers had signed the term of free and informed consent. We used a Gerar manuvacuometer, bocals, tracheas and plastic nasal clamps. We observe in results of the comparison of averages of the different methods p < 0.001 both for PImax and PEmax. PImax average from VR and CRF was, respectively, 96.10 and 78.78 cm H2O, with a standard deviation of respectively 32.70 and 27.50 cm H2O. Between Pemax, from CPT and CRF, it was noticed, respectively, a average of 115.37 and 93.90 cm H2O, with a standard deviation of, respectively, 37.95 and 33.08 cm H2O. There was a significant difference in PImax values from CRF and VR and those of PEmax from CRF and CPT, and the method based on CRF underestimates Imax in relation to the measure done with VR, as well as underestimates PEmax in relation to CPT. We conclude that a method cannot substitute the ther without loss of information.

Este trabajo intenciona verificar si existen variaciones en los dos métodos distintos que asisten a la evaluación de la presión inspiratoria máxima (PImax) y de la presión espiratoria máxima (PEmax). Alistamos a 41 individuos voluntarios, varones y hembras, teniendo como criterios de inclusión la edad (20-59 años), el índice de masa corporal (18-29.9 kilos/m2) y criterios de exclusión ser fumador crónico, tener enfermedades del pulmón, infeccionestorácicas de vías aéreas superiores e inferiores en el año anterior, enfermedades neuromusculares, deformidades, y IMC > 30 kilos/m2. La investigación fue aprobada por el Comité de Ética del Centro Universitario São Camilo; los voluntarios firmaran el Término de Consentimiento Previo, Libre e Informado. Utilizamos un manovacuómetro Gerar, bocales, traqueas y abrazaderas nasales plásticas. Observamos en los resultados de la comparación de las medias e los diferentes métodos p < 0.001 de PImax y de PEmax. La medio de PImax con VR y de CRF fue, respectivamente, 96.10 y 78.78 cm H2O, con una esviación estándar de respectivamente 32.70 y 27.50 cm H2O. Entre Pemax con CPT y CRF, fueran notadas, respectivamente, una media de 115.37 y 93.90 cm H2O, con una desviación estándar de, respectivamente, 37.95 y 33.08 cm H2O. Hubo una diferencia significativa en los valores de PImax con CRF y VR y de los de PEmax con CRF y CPT, y el método basado en CRF subestima la PImax en lo referente a la medida hecha con VR, así como subestima PEmax en lo referente a CPT. Concluimos que un método no puede substituir el otro sin la pérdida de información.

Capacidade inspiratória, limitação ao exercício, e preditores de gravidade e prognóstico, em doença pulmonar obstrutiva crônica / Inspiratory capacity, exercise limitation, markers of severity, and prognostic factors in chronic obstructive pulmonary disease

OBJETIVO: Correlacionar a capacidade inspiratória (CI), por cento do previsto, pós-broncodilatador (pós-BD), com outras variáveis indicativas de gravidade e prognóstico, na doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Oitenta pacientes estáveis com DPOC realizaram manobras de capacidade vital forçada, capacidade vital lenta, e teste de caminhada de 6 min, antes e após salbutamol spray (400 µg). Foram divididos em quatro grupos, segundo o volume expiratório forçado no primeiro segundo pós-BD. Diversas variáveis foram testadas, por análise univariada e multivariada, com a distância caminhada pós-BD, por cento do previsto. A CI pós-BD foi correlacionada com o estadiamento Global Initiative for Chronic Obstructive Lung Disease (GOLD) e o índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE). RESULTADOS: Por análise de regressão multivariada, a CI pós BD, por cento do previsto, (p = 0,001), o uso de oxigênio a longo prazo (p = 0,014), e o número de medicamentos usados (p = 0,044), mantiveram associação significativa com a distância caminhada, por cento do previsto. A CI < 70 por cento foi observada em 56 por cento dos pacientes em estágios GOLD 3 ou 4 comparado a 20 por cento em estágios GOLD 1 ou 2 ( p < 0,001). A CI < 70 por cento foi observada em 60 por cento dos pacientes com escore BODE 3 ou 4 vs. 33 por cento com BODE 1 ou 2 (p = 0,02). CONCLUSÃO: A CI, por cento do previsto, pós-BD é o melhor preditor funcional da distância caminhada, associando-se significativamente com o escore GOLD e o índice BODE. Por isso, propomos que a CI seja incluída na rotina de avaliação dos portadores de DPOC.

OBJECTIVE: To correlate the postbronchodilator (post-BD) inspiratory capacity (IC), percent of predicted, with other markers of severity and prognostic factors in chronic obstructive pulmonary disease (COPD). METHODS: Eighty stable patients with COPD performed forced vital capacity and slow vital capacity maneuvers, as well as the 6-min walk test, prior to and after receiving albuterol spray (400 µg). Patients were divided into four groups, based on post-BD forced expiratory volume in one second. Several variables were tested to establish correlations with the post-BD distance walked, using univariate and multivariate analysis. Post-BD IC was found to correlated with Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging and with the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. RESULTS: Multivariate regression analysis revealed that the distance walked, percent predicted, correlated significantly with the IC post-BD, percent predicted (p = 0.001), long-term oxygen use (p = 0.014), and number of medications used in the treatment (p = 0.044). IC < 70 percent was observed in 56 percent patients in GOLD stages 3 or 4 vs. 20 percent in GOLD 1 or 2 (p < 0.001). IC < 70 percent was observed in (60 percent) patients with BODE score 3 or 4 vs. (33 percent) BODE score 1 or 2 (p = 0.02). CONCLUSION: Post-BD IC percent predicted is the best functional predictor of distance walked and is significantly associated with GOLD staging and BODE index. Therefore, We propose that the inspiratory capacity should be added to the routine evaluation of the COPD patients.

The Change of Lung Volume after Uvulopalatopharyngoplasty in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this research was to study the change of lung volume after uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea (OSA) patients. MATERIALS AND METHOD: Eight OSA patients were participated in this study. These patients were treated with UPPP at Seoul adventist hospital. Vital capacity (VC), inspiratory capacity (IC), expiratory residual volume (ERV) and FEV1, FEV1/FVC, FEV25-75% were determined by standard spirometry at the preoperative, at 3 postoperative days and 1 postoperative month. RESULTS: Vital capacity (VC) was significantly larger at 3 post-operative days (3.58+/-0.87 L, mean+/-SD) than those at pre-operative (3.12+/-0.69 L, mean+/-SD) in the patient with OSA (p=0.047). FEV 1 (L) was larger at 3 post-operative days (2.91+/-0.76 L, mean+/-vSD) than those at pre-operative (2.68+/-0.85 L, mean+/-vSD), but was not significantly correlated statically (p=0.249). CONCLUSION: We found significant correlation between preopeative and postoperative VC, IC.

Variação da capacidade residual funcional e da capacidade inspiratória após o uso do broncodilatador / Variation of functional residual capacity and inspiratory capacity with bronchodilator

Introdução: a resposta aos broncodilatadores (BD) aferida do volume expiratório forçado no primeiro segundo (VEF1) já está universalmente estabelecida, porém as variações dos volumes pulmonares como critérios de responsividade aos BD precisam ser melhor avaliadas. Métodos: os pacientes foram divididos em dois grupos: Distúrbio Ventilatório Obstrutivo (DVO) e Normais (N), pela espirometria e classificados segundo o Consenso Brasileiro de Espirometria de 1996. Posteriormente foram subdivididos em responsivos ao BD (RBD) e não responsivos (NRBD). Todos realizaram medidas dos volumes pulmonares: Volume Residual (VR), Capacidade Residual Funcional (CRF), Capacidade Inspiratória (CI) através da pletismografia. Resultados: foram estudados 429 pacientes, 172 normais e 275 com distúrbio ventilatório obstrutivo. Os pacientes normais apresentaram uma variação média na CRF de 120ml, no VR de 115ml e na CI de 50ml com BD (p<0,05). Os pacientes com DVO apresentaram variação média na CRF de 263ml, no VR de 271ml e na CI de 185ml (p<0,05). Entre os pacientes DVO com RBD pela espirometria encontrou-se variação média na CRF de 387ml, no VR de 287ml e na CI de 295ml (p<0,001). Entre os pacientes DVO NRBD pela espirometria, a CRF variou 180ml, o VR 140ml e a CI 111ml (p<0,004). Conclusões: pacientes DVO RBD pelo VEF1, tiveram variações médias da CRF, do VR e da CI superiores ao limite superior do intervalo de confiança de 95% (IC 95%) da variação dos volumes dos pacientes normais. Entretanto, nos pacientes com DVO NRBD pelo VEF1 apenas a variação média da CI ultrapassou o limite superior do IC95% dos pacientes normais (100ml), indicando que apesar de não haver resposta ao BD pelo VEF1 (critério de fluxo), houve resposta ao BD pela CI (critério de volume).

Introduction: the response to brochodilators (BD) measured on the forced expiratory volume on the 1 second (FEV1) is already universally established, but the variations of pulmonary volumes as responsiveness criteria to BD need to be better assessed. Methods: patients were divided in two groups (obstructive ventilatory disturb OVD and normal) on the spirometry and were classified according to the 1996's Brazilian Guidelines. These groups were subdivided in responsive to the BD (RBD) and non responsive (NRBD). All patients were submitted to pulmonary volumes measurements (residual volume-RV, functional residual volume-FRC, and inspiratory capacity IC) on the plethysmography. Results: we studied 429 patients, 172 normal and 257 with obstructive disorder. The normal patients presented a medium variation of 120ml on the FRC, 115ml on the RV, and 50ml on the IC with the BD (p<0,05). The obstructive patients presented a medium variation of 263ml on the FRC, 271ml on the RV, and 185ml on the IC (p<0,05). Among the patients with OVD-RBD by the spirometry was found a medium variation of 180ml on the FRC, 140ml on the RV, and 111ml on th IC (p<0,004). Conclusion: patients with obstructive ventilatory disorder RBD on the FEV1 had superior variations of the FRC, RV and IC compared to the volumes of normal patients. However in patients with OVD NRBD on the FEV1 only the IC exceeded the superior limit of normal patients (100ml), indicating that even though there was no response to the BD on the FEV1 (flow criteria), there was response to the BD on the IC (volume criteria)

Influence and significance of tiotropium on inspiratory capacity in patients with stable chronic obstructive pulmonary disease / 中国实用内科杂志

0.05).FVC increased significantly in week 6 and 12(t=2.762,P =0.008;t=2.255,P =0.029,respectively).There was no statistical significance in FEV_1/FVC between two groups.IC increased significantly in week 6 and 12(t =3.204,P =0.002;t =3.109,P=0.003,respectively).Conclusion Inhaling tiotropium increases IC in patients with stable COPD.As lung function targets judging limit extent of airflow in patients with COPD,FEV_1/FVC and FEV_1(%)are not sensitive in evaluating therapeutic effect of bronchodilators.IC is more reliable than other targets in evaluating therapeutic effect of bronchodilators.

Effects of Intercostal Nerve Block Combined with IV-PCA on Pain and Inspiratory Capacity after Thoracotomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of intercostal nerve block added in intravenous patient-controlled analgesia (IV-PCA; PCA) on pain, pulmonary function and the movement of the ipsilateral arm after a thoracotomy. METHODS: Forty five patients undergoing elective thoracotomy were randomly allocated into one of three groups. The groups were divided as follows: PCA, ICB-PCA (PCA and intercostal nerve blocks by direct injection of 5 ml of 0.2% bupivacaine into the intercostal spaces of two upper and two lower segments around the surgical incision) and IM groups. For the PCA, the patients that received PCA, were administered IV bolus of 0.1 mg/kg of nalbuphine followed by PCA with 0.1% nalbuphine (basal rate 0.5 ml/hr, bolus dose 1 mg and lockout interval 8 minutes). In each group, VAS score, the inspiratory capacity and the movement of the ipsilateral arm were checked postoperatively at 6, 24, 48 and 72 hours. RESULTS: Inspiratory capacity was decreased less in ICB-PCA group (P<0.05) at 6 hour, but after 24 hour, there were no differences between the groups. The analgesic effect was significantly better in ICB-PCA group as compared to the PCA or IM groups (P<0.05). Furthermore, arm motion limitation after operation was the least in ICB-PCA group (P<0.01). CONCLUSION: Intraoperative intercostal nerve blocks added in PCA has a transient improvement of pulmonary function, and also provide better analgesia and improved ipsilateral arm motion after a thoracotomy than in PCA or IM analgesia. The authors recommend adding intercostal nerve block for patients undergoing thoracotomy who receive IV-PCA.

The determination and the clinical significance of maximal forced inspiratory flow volume curve / 第三军医大学学报

The procedure to delineate the maximal forced inspiratory flow volume curve(MIFVC)was described and the curve was determined in 56 normal subjects to serve as the control and 62 patients with various chronic obstructive pulmonary diseases(COPD).It was found that MIFVC was significantly lower in patients with various COPD than in the control(P