Analysis of the impact of different exercise methods on the physical health of obese adolescents / Análise do impacto entre diferentes métodos de exercício na saúde física de adolescentes obesos / Análisis del impacto entre diferentes métodos de ejercicio en la salud física de adolescentes obesos

ABSTRACT Introduction: The unregulated development in the current life pattern has strengthened obesity among adolescents, and this problem is becoming more serious. Objective: Compare the impact of two exercise methods on the physical health of obese adolescents. Methods: 24 obese adolescents (12 females; BMI>30% ± 3%; age concentrated between 10 and 16 years) were selected and divided into group I and group II for a 4-week experimental study, and changes in physical fitness and function were recorded. Results: After four weeks of aerobic exercise control (group I), waist circumference, hip circumference, skinfold thickness, and abdominal fold thickness were significantly reduced in boys (p<0.05), and girls' body shape indicators were significantly altered (p<0.05). After four weeks of aerobic exercise combined with resistance training (group II), the effects of weight, BMI, and body size were significant in boys and girls. Conclusion: Aerobic exercise can effectively improve the physical problems of obese adolescents. Under the same external conditions, the effect of aerobic exercise was shown to be more effective when combined with resistance training in the physical improvement of the analyzed group. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O desenvolvimento desregrado no padrão de vida atual fortaleceu a obesidade entre os adolescentes e esse problema está se tornando cada vez mais grave. Objetivo: Comparar o impacto entre dois métodos de exercício na saúde física de adolescentes obesos. Métodos: Foram selecionados 24 adolescentes obesos (12 mulheres; IMC>30% ± 3%; idade concentrada entre 10 e 16 anos) e divididos no grupo I e no grupo II para um estudo experimental de 4 semanas, sendo registradas as alterações no condicionamento e função física. Resultados: Após 4 semanas de controle de exercício aeróbico (grupo I), a circunferência da cintura, circunferência do quadril, espessura da dobra cutânea e espessura da dobra abdominal foram significativamente reduzidas em meninos (p<0,05), e os indicadores de forma corporal das meninas foram significativamente alterados (p<0,05). Após 4 semanas de exercício aeróbico combinado com treinamento de resistência (grupo II), os efeitos do peso, IMC e tamanho do corpo foram significativos em meninos e meninas. Conclusão: O exercício aeróbico pode melhorar efetivamente os problemas físicos dos adolescentes obesos. Sob as mesmas condições externas, o efeito do exercício aeróbico demonstrou-se mais eficaz quando aliado ao treinamento de resistência na melhoria física do grupo analisado. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El desarrollo desordenado en el patrón de vida actual ha potenciado la obesidad entre los adolescentes y este problema es cada vez más grave. Objetivo: Comparar el impacto de dos métodos de ejercicio en la salud física de adolescentes obesos. Métodos: Se seleccionaron 24 adolescentes obesos (12 mujeres; IMC>30% ± 3%; edad concentrada entre 10 y 16 años) y se dividieron en el grupo I y el grupo II para un estudio experimental de 4 semanas, y se registraron los cambios en la aptitud física y la función. Resultados: Después de 4 semanas de control de ejercicio aeróbico (grupo I), la circunferencia de la cintura, la circunferencia de la cadera, el grosor de los pliegues cutáneos y el grosor de los pliegues abdominales se redujeron significativamente en los niños (p<0,05), y los indicadores de la forma corporal de las niñas se alteraron significativamente (p<0,05). Tras 4 semanas de ejercicio aeróbico combinado con entrenamiento de resistencia (grupo II), los efectos del peso, el IMC y el tamaño corporal fueron significativos en chicos y chicas. Conclusión: El ejercicio aeróbico puede mejorar eficazmente los problemas físicos de los adolescentes obesos. En las mismas condiciones externas, el efecto del ejercicio aeróbico se mostró más eficaz cuando se combinó con el entrenamiento de resistencia en la mejora física del grupo analizado. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Método JaPer. Una nueva estrategia para mejorar la capacidad inspiratoria. Ensayo Clínico Aleatorizado / JaPer Method. A new strategy to improve inspiratory capacity. Randomized clinical trial

Introducción: las enfermedades pulmonares pueden generar hospitalizaciones, estancias prolongadas, complicaciones e inclusive la muerte. Estas enfermedades repercuten negativamente en la capacidad inspiratoria y en la calidad de vida. Por lo tanto, el presente artículo pretende analizar los efectos del Método JaPer sobre la capacidad inspiratoria de los pacientes hospitalizados. Material y métodos: ensayo clínico aleatorizado inicialmente con 653 pacientes hospitalizados que pasó a 587 distribuidos en 2 grupos (Grupo experimental-GE: Método JaPer vs Grupo control-GC: uso convencional de inspirómetro volumétrico). Se determinó la capacidad inspiratoria máxima, caminata de los 6 minutos, antropometría y un cuestionario creado por los autores. Se aplicó un programa de entrenamiento de 2 semanas de 3 sesiones por día. Al GE se le aplicó el Método Japer con protocolo estandarizado para hacer ejercicios entre el 50 y el 80 % de la capacidad inspiratoria máxima del paciente y a los pacientes del GC se les realizó incentivo inspiratorio a inspiración máxima. Resultados: 587 pacientes (F:300 vs M:287) con edad promedio de 53.61±14.24 años, entre los cuales el 9.88 % tenía bajo peso, 17.89 % peso normal y el 27.26 % y 44.97 % sobrepeso y obesidad, respectivamente. Todos los participantes realizaron una caminata de 6 minutos para determinar los metros recorridos (GE: 387.70±47.59 vs GC: 371.30±49.10), velocidad (GE: 64.62±7.93 vs GC: 61.88±8.18) y el Vo2 estimado (GE: 9.96±0.79 vs GC: 9.69±0.82). Todas las variables y la capacidad inspiratoria máxima (GE: 1708.54±707.84 vs GC: 1448.83±692.79) determinaron pre y post entrenamiento. Conclusiones: el Método JaPer obtuvó mejores resultados en todas las variables evaluadas con diferencia significativa (p= <0.05) frente al grupo control, resaltando que la capacidad inspiratoria máxima aumentó en ambos grupos (GE:44 % vs GC:28 %; p= <0.05).

Introduction: Pulmonary diseases can generate hospitalizations, prolonged stays, complications and even death. These diseases have a negative impact on inspiratory capacity and quality of life. Therefore, this paper tries to analyze the effects of the JaPer method on the inspiratory capacity of hospitalized patients. Materials and methods: Randomized clinical trial initially with 653 patients, which went on to 587 hospitalized patients distributed in 2 groups (Experimental group: JaPer Method vs. Control group: Conventional use of volumetric inspirometer). Maximum inspiratory capacity, 6-minute walk, anthropometry, and a questionnaire created by the authors were determined. A 2-week training program of 3 sessions per day was applied. The GE applied the Japer Method with a standardized protocol to exercise between 50 and 80% of the patient's maximum inspiratory capacity, and the CG underwent inspiratory incentive at maximum inspiration. Results: 587 patients (F:300 vs M:287) with a mean age of 53.61±14.24 years and 9.88% of the population were underweight, 17.89% normal weight and 27.26% and 44.97% overweight and obese, respectively. All participants performed a 6-minute walk to determine meters traveled (GE: 387.70±47.59 vs CG: 371.30±49.10), speed (GE: 64.62±7.93 vs CG: 61.88±8.18) and estimated VO2 (GE: 9.96 ±0.79 vs CG: 9.69±0.82). All variables and maximal inspiratory capacity (GE: 1708.54±707.84 vs CG: 1448.83±692.79) were determined before and after training. Conclusions: The JaPer method obtained better results in all the variables evaluated with a significant difference (p=<0.05) compared to the control group. Highlighting that the maximum inspiratory capacity increased in both groups (GE:44% vs CG:28%; p=<0.05).

Una propuesta para protocolizar el incentivo inspiratorio / A proposal to protocolize the inspiratory incentive

Los autores nos presentan en este artículo un ensayo clínico aleatorizado, cuyo objetivo es analizar los efectos del método JaPer sobre la capacidad inspiratoria de los pacientes hospitalizados. La primera inquietud a resolver es ¿En qué consiste el método JaPer y cuál es su finalidad? Pues bien, este método debe el nombre a su creador, quien es también uno de los autores del estudio. Se entiende como un protocolo de fisioterapia respiratoria que hace parte de la rehabilitación pulmonar y tiene como finalidad, realizar una prescripción del ejercicio a porcentajes de entrenamiento del 50 al 80 % de la capacidad inspiratoria máxima del participante, determinada a través del inspirómetro incentivo, que además funciona como instrumento de intervención, asociado a una serie de ejercicios respiratorios.

In this article, the authors present a randomized clinical trial, whose objective is to analyze the effects of the JaPer method on the inspiratory capacity of hospitalized patients. The first concern to resolve is what is the JaPer method and what is its purpose? Well, this method owes its name to its creator, who is also one of the authors of the study. It is understood as a respiratory physiotherapy protocol that is part of pulmonary rehabilitation and its purpose is to carry out an exercise prescription at training percentages of 50 to 80% of the maximum inspiratory capacity of the participant, determined through the incentive spirometer, which it also works as an intervention instrument, associated with a series of breathing exercises.

Effects of home-based inspiratory muscle training on sickle cell disease (SCD) patients

ABSTRACT Introduction: Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. Methods: This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. Results: Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSβ0 vs HbSC and HbSβ+), without differences between groups. Conclusion: Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. Trial registration:http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.

Efeito de frações inspiradas de oxigênio e modalidades ventilatórias diferentes sobre a idade de cães / [Effects of oxygeninspired fractions and different ventilatory modalities on the age of dogs]

Objetivou-se avaliar diferentes modalidades ventilatórias em cães de diferentes idades submetidos à fração inspirada de oxigênio (FiO2) de 40% e 100%. Foram utilizados 36 cães de três grupos etários (GJ: 0-5; GA: 5-10 e GG: 10-15 anos), sem padronização de peso, sexo, raça e procedimento cirúrgico. Foram pré-medicados com acepromazina e morfina (0,02 e 0,5mg/kg), induzidos à anestesia geral com propofol dose-efeito, manutenção do plano anestésico com isoflurano em 1,3 V% e fornecimento de oxigênio conforme a FiO2 estabelecida para o grupo. Os animais foram submetidos a quatro diferentes modalidades ventilatórias: ventilação espontânea (VE), ventilação ciclada a volume (VCV), ventilação ciclada a pressão (VCP) e ventilação ciclada a pressão com PEEP (VCPP), e permaneceram 30 minutos em cada modalidade. Os parâmetros cardiovasculares mantiveram-se estáveis para todas as FiO2, modalidades ventilatórias e idades. Com relação aos parâmetros ventilatórios, na FiO2 100%, foram observados PaCO2 de 45mmHge e 29% de shunt, enquanto a FiO2 40% apresentou PaCO2 de 43 mmHg e 13% de shunt. Em relação às diferentes idades, os animais adultos e geriátricos apresentaram maiores valores de shunt (26% e 22%) e PaCO2 (44mm/Hg e 46mm/Hg). Conclui-se que a fração inspirada de 40% e a modalidade ventilatória ciclada a volume mostraram-se mais eficientes.(AU)

The objective was to evaluate different ventilatory modalities in dogs of different ages submitted to the inspired fraction of oxygen (FiO2) of 40% and 100%. Thirty-six dogs from three age groups (GJ 0-5, GA 5-10 and GG 10-15 years) were used, without standardization of weight, gender, race and surgical procedure. They were premedicated with acepromazine and morphine (0.02 and 0.5mg/kg), induced to general anesthesia with propofol dose/effect, maintenance of the anesthetic plane with isoflurane in 1.3V% and oxygen supply according to FiO2 established for the group. The animals were submitted to 4 different ventilation modalities, spontaneous ventilation (VS), volume-cycled ventilation (VCV), pressure-cycled ventilation (VCP) and pressure-cycled ventilation with PEEP (VCPP) and remained 30 minutes in each modality. The cardiovascular parameters remained stable for all FiO2, ventilatory modalities and ages. Regarding ventilatory parameters, in FiO2 and PaCO2 of 45mmHg and 29% of shunt, in FiO2 100%, PaCO2 of 43mmHg and 13% of shunt were observed. Regarding the different ages, adult and geriatric animals presented higher values of Shunt (26 and 22%) and PaCO2 (44 and 46mmHg). It was concluded that the inspired fraction of 40% and the volume-cycled ventilatory modality were more efficient.(AU)

Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique / Pressões máximas inspiratórias e expiratórias no pré e pós-operatório de pacientes com hérnias incisionais abdominais corrigidas pela técnica de Lázaro da Silva

ABSTRACT Objective: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. Method: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. Results: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Conclusion: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

RESUMO Objetivo: verificar o efeito da herniorrafia incisional abdominal longitudinal na pressão dos músculos da respiração. Método: a técnica de herniorrafia incisional utilizada foi a proposta por Lázaro da Silva. Para aferir a pressão foi utilizado manômetro de água, em 20 pacientes, idade mediana 48,5 anos (mínimo 24, máximo 70). Foram analisadas a pressão máxima inspiratória no nível do volume residual (PIVR) e da capacidade residual funcional (PICRF) e a pressão máxima expiratória da capacidade residual funcional (PECRF) e da capacidade pulmonar total (PECPT), no pré-operatório e pós-operatório tardio (entre 40 e 90 dias), em 13 pacientes com hérnias incisionais grandes e em 7 pacientes com hérnias incisionais médias. Resultados: houve aumento significante da PICRF (p=0.027), da PIVR (p=0.011), da PECPT (p=0.003) nos pacientes com hérnias incisionais grandes. A PECRF aumentou, porém de forma não significante. Nos pacientes com hérnias incisionais médias as alterações não foram significantes. Conclusão: a correção cirúrgica da hérnia incisional grande melhora a função dos músculos da respiração, porém a cirurgia da hérnia incisional média não altera a referida função.

Comparison of the effects of voluntary and involuntary breath stacking techniques on respiratory mechanics and lung function patterns in tracheostomized patients: a randomized crossover clinical trial / Comparação dos efeitos das técnicas breath stacking e air stacking sobre a mecânica respiratória e o padrão ventilatório em pacientes traqueostomizados: ensaio clínico cruzado randomizado

ABSTRACT Objective: To compare the effects of voluntary breath stacking (VBS) and involuntary breath stacking (IBS) techniques on respiratory mechanics, lung function patterns, and inspiratory capacity in tracheostomized patients. Methods: This was a randomized crossover clinical trial involving 20 tracheostomized patients admitted to the ICU and submitted to the VBS and IBS techniques, in random order, with an interval of 5 h between each. Ten cycles of each technique were performed with an interval of 30 s between each cycle. In VBS, patients performed successive inspirations for up to 30 s through a one-way valve, whereas in IBS, successive slow insufflations were performed with a resuscitator bag until the pressure reached 40 cmH2O. Respiratory mechanics, inspiratory capacity, and the lung function pattern were evaluated before and after the interventions. Results: After IBS, there was an increase in static compliance (p = 0.007), which was also higher after IBS than after VBS (p = 0.03). There was no significant difference between the pre-VBS and post-VBS evaluations in terms of static compliance (p = 0.42). Inspiratory capacity was also greater after IBS than after VBS (2,420.7 ± 480.9 mL vs. 1,211.3 ± 562.8 mL; p < 0.001), as was airway pressure (38.3 ± 2.6 cmH2O vs. 25.8 ± 5.5 cmH2O; p < 0.001). There were no changes in resistance or lung function pattern after the application of either technique. Conclusions: In comparison with VBS, IBS promoted greater inspiratory capacity and higher airway pressure, resulting in an increase in static compliance.

RESUMO Objetivo: Comparar os efeitos das técnicas breath stacking (BS) e air stacking (AS) sobre a mecânica respiratória, o padrão ventilatório e a capacidade inspiratória em pacientes traqueostomizados. Métodos: Ensaio clínico cruzado randomizado envolvendo 20 pacientes traqueostomizados internados em UTI e submetidos a ambas as técnicas, com intervalo de 5 h entre si, de acordo com a randomização. Foram realizados dez ciclos de cada técnica com intervalos de 30 segundos entre si. No BS, os pacientes realizaram inspirações sucessivas por até 30 s por meio de uma válvula unidirecional, enquanto no AS foram realizadas insuflações lentas sucessivas através de um ressuscitador manual até que a pressão atingisse 40 cmH2O. Os pacientes foram avaliados quanto a mecânica respiratória, capacidade inspiratória e padrão ventilatório antes e depois da realização das intervenções. Resultados: Com relação à mecânica respiratória no AS, houve aumento da complacência estática na comparação pré- e pós-intervenção (p = 0,007), assim como entre os momentos pós-AS e pós-BS (p = 0,03). Não houve diferença significativa da complacência estática na realização do BS (p = 0,42). A capacidade inspiratória foi maior após o AS que após o BS (2.420,7 ± 480,9 mL vs. 1.211,3 ± 562,8 mL; p < 0,001), bem como em relação à pressão nas vias aéreas (38,3 ± 2,6 cmH2O vs. 25,8 ± 5,5 cmH2O; p < 0,001). Não foram observadas alterações na resistência ou no padrão ventilatório em ambas as técnicas. Conclusões: Na presente amostra, o AS promoveu maior capacidade inspiratória e maior pressão nas vias aéreas que as observadas após o BS, com consequente aumento da complacência estática.

Efeito da fisioterapia aquática na força muscular respiratória de crianças e adolescentes com Síndrome de Down / Effect of aquatic physioterapy on the respiratory muscle strength of children and teenagers with Down Syndrome

A força muscular respiratória em crianças e adolescentes com Síndrome de Down é comprometida pela hipotonia generalizada que os acometem. Analisar os efeitos da fisioterapia aquática na força muscular respiratória em crianças e adolescentes com síndrome de Down. Estudo de intervenção, quasi-experimental, com amostra constituída de oito crianças e adolescentes diagnosticados com SD e média de idade de 12 anos (± 3,8). Foram realizadas 10 sessões de fisioterapia aquática, com 50 minutos de duração cada, em piscina com água aquecida. A força muscular respiratória foi avaliada a partir da pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) com auxílio do manuvacuômetro, sendo obtido seus valores antes do primeiro atendimento e após o último. Analisou-se ainda a saturação periférica de oxigênio e frequência cardíaca. Para comparação das médias antes e depois da intervenção foi utilizado o Teste T pareado. Amostra de indivíduos predominantemente do sexo feminino (75,0%), pardos (75,0%) e residentes em zona urbana (87,5%). A comparação da PImáx e PEmáx antes e após as 10 sessões de fisioterapia aquática evidenciou melhora da força muscular inspiratória e expiratória, sendo tais diferenças estatisticamente significantes (valor de p<0,01). Também foram notadas melhorias na frequência cardíaca e saturação de oxigênio (valor de p<0,05) com a intervenção. Destaca-se neste estudo que a fisioterapia aquática parece ser um recurso terapêutico eficiente para o fortalecimento da musculatura respiratória e melhora dos sinais vitais de crianças e adolescentes de com diagnóstico de Síndrome de Down.

Respiratory muscle strength in children and adolescents with Down syndrome is compromised by the generalized hypotonia that affects them. This study aims to analyze the effects of aquatic physical therapy on respiratory muscle strength in children and adolescents with Down syndrome. Material and method: A quasi-experimental study with a sample consisting of eight children and adolescents diagnosed with DS and mean age of 12 years (± 3.8). Ten sessions of aquatic physiotherapy were performed, each with a duration of 50 minutes, in a pool with heated water. Respiratory muscle strength was assessed from maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a manuvacuometer, and its values were obtained before the first session and after the last one. Peripheral oxygen saturation and heart rate were also analyzed. The paired T-test was used to compare the means before and after the intervention. Sample of predominantly female (75.0%), brown (75.0%) and urban residents (87.5%). The comparison of MIP and MEP before and after the 10 sessions of aquatic physiotherapy showed an improvement in inspiratory and expiratory muscle strength, and these differences were statistically significant (p <0.01). Improvements in heart rate and oxygen saturation (p value <0.05) were also noted with the intervention. In this study, aquatic physiotherapy seems to be an efficient therapeutic resource for the strengthening of respiratory muscles and improvement of the vital signs of children and adolescents diagnosed with Down's Syndrome.

Nasal patency and otorhinolaryngologic-orofacial features in children / Patência nasal e características otorrinolaringológicas e orofaciais em crianças

Abstract Introduction: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. Objective: To compare nasal patency and otorhinolaryngologic-orofacial features in children. Methods: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. Results: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p = 0.006 and p = 0.002), nasal obstruction report (p = 0.027 and p = 0.023), runny nose (p = 0.004 and p = 0.012), unsystematic lip closure during mastication (p = 0.040 and p = 0.026), masticatory speed reduced (p = 0.006 and p = 0.008) and altered solid food swallowing (p = 0.006 and p = 0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p = 0.040), reduced hard palate width (p = 0.037) and altered speech (p = 0.004). Higher absolute values were found in children with increased tongue width (p = 0.027) and, higher absolute and predicted (%) in children with mild everted lip (p = 0.008 and p = 0.000). Conclusions: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Resumo Introdução: A obstrução nasal é um sintoma comum na infância relacionado a rinite e hipertrofia das tonsilas faríngeas. Na presença de obstrução nasal, a patência nasal pode estar reduzida e a respiração nasal ser substituída por respiração oral. Alterações orofaciais e otorrinolaringológicas estão relacionadas a esse modo de respiração. A avaliação objetiva das vias aéreas superiores pode ser obtida através da medida da patência nasal. Objetivo: Comparar a patência nasal e características otorrinolaringológicas e orofaciais em crianças. Método: Foram submetidas 123 crianças de seis a 12 anos, de ambos os sexos, a avaliação fonoaudiológica, de acordo com o protocolo de avaliação Miofuncional Orofacial, exame clínico e endoscópico otorrinolaringológico e medição da patência nasal, com o uso do pico de fluxo inspiratório nasal em valores absolutos e valores estimados (% pico de fluxo inspiratório nasal). Resultados: Valores mais baixos de pico de fluxo inspiratório nasal e % pico de fluxo inspiratório nasal foram encontrados em crianças com sono agitado (p = 0,006 e p = 0,002), relato de obstrução nasal (p = 0,027 e p = 0,023), rinorreia (p = 0,004 e p = 0,012), fechamento não sistemático dos lábios durante a mastigação (p = 0,040 e p = 0,026), velocidade mastigatória reduzida (p = 0,006 e p = 0,008) e alteração da ingestão de alimentos sólidos (p = 0,006 e p = 0,001). O pico de fluxo inspiratório nasal foi menor em crianças com conchas inferiores pálidas (p = 0,040), redução da largura do palato duro (p = 0,037) e alterações da fala (p = 0,004). Valores maiores foram encontrados em crianças com largura da língua aumentada (p = 0,027). Valores maiores de pico de fluxo inspiratório nasal e % de pico de fluxo inspiratório nasal foram observados em crianças com lábio levemente evertido (p = 0,008 e p = 0,000). Conclusões: A patência nasal foi menor em crianças com sono agitado, sinais e sintomas de rinite, redução da largura do palato duro e alterações nas funções de mastigação, deglutição e fala. Enfatiza-se também que a maioria das crianças apresentava sinais e sintomas de rinite alérgica.

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).

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.

Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome / Associação entre função pulmonar, força muscular respiratória e capacidade funcional de exercício em indivíduos obesos com síndrome da apneia obstrutiva do sono

ABSTRACT Objective: To evaluate lung function and inspiratory muscle strength, correlating them with exercise tolerance, in obese individuals with obstructive sleep apnea syndrome (OSAS). Methods: The sample comprised 31 adult subjects with moderate-to-severe OSAS diagnosed by polysomnography. We used spirometry to measure FVC, FEV1, and FVC/FEV1 ratio, using pressure manometry to measure MIP and MEP. The incremental shuttle walk test (ISWT) and the six-minute walk test (6MWT) were used in order to determine functional exercise capacity. Results: In this sample, the mean values for FVC (% of predicted), FEV1 (% of predicted): MIP, and MEP were 76.4 ± 12.3%, 80.1 ± 6.3%, 60.0 ± 21.9 cmH2O, and 81.3 ± 22.2 cmH2O, respectively. The mean distances covered on the ISWT and 6MWT were 221 ± 97 m and 480.8 ± 67.3 m, respectively. The ISWT distance showed moderate positive correlations with FVC (r = 0.658; p = 0.001) and FEV1 (r = 0.522; p = 0.003). Conclusions: In this sample of obese subjects with untreated OSAS, lung function, inspiratory muscle strength, and exercise tolerance were all below normal. In addition, we found that a decline in lung function, but not in respiratory muscle strength, was associated with exercise tolerance in these patients.

RESUMO Objetivo: Avaliar e correlacionar a função pulmonar e a força muscular inspiratória com a tolerância ao esforço em indivíduos obesos com síndrome de apneia obstrutiva do sono (SAOS). Métodos: Foram recrutados 31 adultos com diagnóstico de SAOS de moderada a grave através do exame de polissonografia. Os participantes foram submetidos à espirometria para a medida de CVF, VEF1 e relação CVF/VEF1, assim como à manovacuometria para a medida de PImáx e PEmáx. Para a determinação da capacidade funcional de exercício foram realizados o teste shuttle (TS) e o teste de caminhada de seis minutos (TC6). Resultados: Na amostra, as médias de CVF (% do previsto), VEF1 (% do previsto), PImáx e PEmáx foram de 76,4 ± 12,3%, 80,1 ± 6,3%, 60,0 ± 21,9 cmH2O e 81,3 ± 22,2 cmH2O, respectivamente. As médias das distâncias percorridas no TS e no TC6 foram de 221 ± 97 m e 480,8 ± 67,3 m, respectivamente. Houve correlações moderadas positivas entre a distância percorrida no TS e CVF (r = 0,658; p = 0,001) e entre a distância no TS e VEF1 (r = 0,522; p = 0,003). Conclusões: Nesta amostra de indivíduos obesos com SAOS não tratada, houve reduções na função pulmonar, força muscular inspiratória e capacidade física. Além disso, observou-se que o declínio da função pulmonar, mas não da força muscular respiratória, estava associado à tolerância ao esforço físico nestes pacientes.

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.

Propuesta de ecuaciones predictivas de capacidad inspiratoria y flujo espiratorio máximo considerando mediciones torácicas: un estudio piloto / Proposal of predictive equations of inspiratory capacity and maximum spiratory flow considering thoracic measurements: a pilot study

RESUMEN: El objetivo del siguiente estudio fue determinar si las mediciones de tórax provocan modificaciones en las ecuaciones predictivas de capacidad inspiratoria (CI) y flujo espiratorio máximo (FEM). Se evaluaron 24 sujetos de sexo masculino entre 18 y 26 años, todos estudiantes sedentarios de la Universidad Católica del Maule, Chile. Se les realizó antropometría corporal básica (peso y talla corporal) y específica de tórax, diámetro antero-posterior (DAT) y transverso (DTT) de tórax y perímetro mesoesternal (PME). Posterior a esto, se evaluó la función ventilatoria a través de pletismografía corporal. Para estimar las ecuaciones de regresión lineal se utilizó el método de mínimos cuadrados relacionando la CI y FEM. La comparación entre el valor predicho establecido y nuestra propuesta fue comparado utilizando la prueba t de student o U de Mann-Whitney según correspondiera, considerándose un nivel de significancia estadística de p<0,05. Los resultados indican que para la propuesta de la ecuación de FEM se consideró el DTT y PME, logrando diferencias significativas con los valores de Knudson et al. Por tanto, se concluye que las mediciones de DTT a VR y PME a CPT influyeron en la ecuación predictiva de FEM en estudiantes sedentarios.

SUMMARY: The aim of the following study was to determine if chest measurements cause changes in the predictive equations of inspiratory capacity (IC) and peak expiratory flow (PEF). Twenty- four male subjects between 18 and 26 years old, all sedentary students of the Universidad Catolica del Maule, Chile, were evaluated. They were subjected to basic body anthropometry (weight and body size) and chest specificity, anteroposterior diameter (APD) and transverse (TTD) of the thorax and mesosternal perimeter (MSP). After this, the ventilatory function was evaluated through body plethysmography. To estimate the linear regression equations, the least squares method were used, relating IC and PEF. The comparison between the established predicted value and our proposal was compared using the student t-test or Mann-Whitney U test as appropriate, considering a level of statistical significance of p <0.05. The results indicate that the TTD and MSP were considered for the proposal of the PEF equation, achieving significant differences with the values o f Knudson et al. Therefore, it is concluded that measurements of TTD to RV and MSP to TPC influenced the predictive equation of PEF in sedentary students.

Relationship between Fractional Exhaled Nitric Oxide Level and Efficacy of Inhaled Corticosteroid in Asthma-COPD Overlap Syndrome Patients with Different Disease Severity

This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCO₂, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaO₂, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.

Ventilatory demand and dynamic hyperinflation induced during ADL-based tests in Chronic Obstructive Pulmonary Disease patients

ABSTRACT Background Airflow limitation frequently leads to the interruption of activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Disease (COPD). These patients commonly show absence of ventilatory reserve, reduced inspiratory reserve volume, and dynamic hyperinflation (DH). Objective To investigate ventilatory response and DH induced by three ADL-based protocols in COPD patients and compare them to healthy subjects. Method Cross-sectional study. COPD group: 23 patients (65±6 years, FEV1 37.2±15.4%pred); control group: 14 healthy subjects (64±4 years) matched for age, sex, and body mass index. Both groups performed all three tests: Glittre-ADL test; an activity test that involved moving objects on a shelf (TSHELF); and a modified shelf protocol isolating activity with upper limbs (TSHELF-M). Ventilatory response and inspiratory capacity were evaluated. Results Baseline ventilatory variables were similar between groups (p>0.05). The ventilatory demand increased and the inspiratory capacity decreased significantly at the end of the tests in the COPD group. Ventilatory demand and DH were higher (p<0.05) in the TSHELF than in the TSHELF–M in the COPD group (p<0.05). There were no differences in DH between the three tests in the control group (p>0.05) and ventilatory demand increased at the end of the tests (p<0.05) but to a lower extent than the COPD group. Conclusion The TSHELF induces similar ventilatory responses to the Glittre-ADL test in COPD patients with higher ventilatory demand and DH. In contrast, the ventilatory response was attenuated in the TSHELF-M, suggesting that squatting and bending down during the Glittre-ADL test could trigger significant ventilatory overload.

A cycle ergometer exercise program improves exercise capacity and inspiratory muscle function in hospitalized patients awaiting heart transplantation: a pilot study

Abstract Objective: The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods: Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results: Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P =0.08 and P =0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P <0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P =0.22 and P <0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P <0.01). Conclusion: Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support.

Effects of diaphragmatic control on the assessment of sniff nasal inspiratory pressure and maximum relaxation rate

OBJECTIVE: To assess the influence of diaphragmatic activation control (diaphC) on Sniff Nasal-Inspiratory Pressure (SNIP) and Maximum Relaxation Rate of inspiratory muscles (MRR) in healthy subjects. METHOD: Twenty subjects (9 male; age: 23 (SD=2.9) years; BMI: 23.8 (SD=3) kg/m2; FEV1/FVC: 0.9 (SD=0.1)] performed 5 sniff maneuvers in two different moments: with or without instruction on diaphC. Before the first maneuver, a brief explanation was given to the subjects on how to perform the sniff test. For sniff test with diaphC, subjects were instructed to perform intense diaphragm activation. The best SNIP and MRR values were used for analysis. MRR was calculated as the ratio of first derivative of pressure over time (dP/dtmax) and were normalized by dividing it by peak pressure (SNIP) from the same maneuver. RESULTS: SNIP values were significantly different in maneuvers with and without diaphC [without diaphC: -100 (SD=27.1) cmH2O/ with diaphC: -72.8 (SD=22.3) cmH2O; p<0.0001], normalized MRR values were not statistically different [without diaphC: -9.7 (SD=2.6); with diaphC: -8.9 (SD=1.5); p=0.19]. Without diaphC, 40% of the sample did not reach the appropriate sniff criteria found in the literature. CONCLUSION: Diaphragmatic control performed during SNIP test influences obtained inspiratory pressure, being lower when diaphC is performed. However, there was no influence on normalized MRR.

Reflex cough PEF as a predictor of successful extubation in neurological patients / Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

AbstractObjective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

ResumoObjetivo:Avaliar o uso do pico de fluxo de tosse reflexa (PFTR) como preditor do sucesso da extubação de pacientes neurológicos candidatos a desmame da ventilação mecânica.Métodos:Estudo transversal com 135 pacientes ventilados mecanicamente por mais de 24 h na UTI do Hospital Cristo Redentor, em Porto Alegre (RS). Foram medidos o PFTR, o índice de respiração rápida e superficial, a PImáx e a PEmáx, bem como parâmetros ventilatórios, hemodinâmicos e clínicos.Resultados:A média de idade dos pacientes foi de 47,8 ± 17 anos. A taxa de insucesso na extubação foi de 33,3%. O PFTR < 80 l/min apresentou risco relativo de 3,6 (IC95%: 2,0-6,7), e a pontuação final na Escala de Coma de Glasgow apresentou risco relativo de 0,64 (IC95%: 0,51-0,83). A partir de 8 pontos, cada aumento de 1 ponto diminuiu em 36% o risco de insucesso na extubação.Conclusões:O PFTR e a pontuação na Escala de Coma de Glasgow são preditores independentes de falha na extubação em pacientes neurológicos internados na UTI.

Confiabilidad de la fuerza muscular respiratoria y flujos espiratorios forzados en adolescentes sanos / Reliability of pulmonary function tests in healthy adolescents

Inspiratory and expiratory muscle strength (MIP and MEP) assessment, and peak expiratory flow (PEF) and peak cough flow (PCF) measurements are often used to assess patients with respiratory diseases. Notwithstanding, there are few reports about reliability of these measurements. The aim of this study is to determine the intra-observer reliability of MIP, MEP, PCF and PEF in healthy adolescents. The study design was test retest. A sample of students from a public school of Talcahuano (Chile) were studied. MIP, MEP, PEF and PCF were recorded twice by the same appraiser, with an interval of 8 weeks. Intraclass correlation coefficient (ICC) was used as an index of reliability. Analysis of individual differences was performed by Bland and Altman’s method and the probability of discordance between test and retest was evaluated. A p value < 0.05 was considered significant. 23 students (9 males), ageing 16.3 ± 0.5 years-old entered to the study. ICC of MIP, MEP, PEF and PCF were 0.7; 0.78; 0.86 and 0.63 respectively. Bland-Altman analysis shows that the average discrepancy between the test and retest was -5 (95% CI: 35.6 to -52.6), -9.1 (95% CI: 20.2 to -38.4), -7.8 (95% CI: 107.7 to -123.2) and -28.5 (95% CI: 131.9 to -189.1) in MIP, MEP, PEF and PCF respectively. There was no significant difference in probability of discordance between parameters with the same unit of measure. Respiratory function variables show a moderate to high level of reliability, considering eight weeks of time interval between test and retest. PEF and MEP were the variables with the best performance.

La evaluación de fuerza muscular inspiratoria (PImax) y espiratoria (PEmax), la medición del flujo espiratorio máximo (FEM) y flujo máximo de tos (FMT) son, a menudo, utilizados para el seguimiento de pacientes con enfermedades respiratorias. No obstante, son escasos los reportes acerca de sus propiedades de evaluación. El objetivo de este estudio es determinar la confiabilidad intra-observador de la PImax, PEmax, FMT y FEM, en adolescentes sanos. Se empleó un diseño test retest en que se seleccionaron adolescentes voluntarios de un colegio público de Talcahuano. PImax, PImax, FEM y FMT fueron registradas por un mismo evaluador en dos oportunidades con un intervalo de 8 semanas. Se empleó el coeficiente de correlación intraclase (CCI) como índice de confiabilidad. Mediante el método de Bland-Altman se realizó el análisis de las diferencias individuales y se evaluó la probabilidad de discordancia entre test y retest. Se consideró significativo un valor de p < 0,05. Al estudio ingresaron 23 sujetos (9 varones), edad promedio 16,3 ± 0,5 años. El CCI de PImax, PEmax, FEM y FMT fueron 0,7; 0,78; 0,86 y 0,63 respectivamente. Por su parte, el análisis de Bland-Altman muestra que el promedio de discordancia entre los tests fue -8,5 (95% IC: 35,6 a -52,6), -9,1 (95% IC: 20,2 a -38,4), -7,8 (95% IC: 107,7 a -123,2) y -28,5 (95% IC: 131,9 a -189,1) en PImax, PEmax, FEM y FMT respectivamente. No existió diferencia significativa de probabilidad de discordancia entre parámetros con igual unidad de medida. Las variables de función respiratoria muestran un nivel de confiabilidad moderado a alto, considerando 8 semanas de intervalo de tiempo entre el test y retest. Las variables con mejor rendimiento fueron FEM y PEmax.