Función pulmonar: ¿Debemos cambiar la forma de calcular la respuesta broncodilatadora en la espirometría en niños? / Should we change the way we calculate the bronchodilator response in children's spirometry?

Tradicionalmente se ha definido la respuesta broncodilatadora (RB) positiva como una mejoría ≥ de 12 % del VEF1. En el año 2022 se publica una Guía sobre la interpretación de función la pulmonar de la Sociedad Americana de Tórax y la Sociedad Europea de Enfermedades Respiratorias, donde se propone que la RB debe expresarse como el cambio porcentual del VEF1 en relación con el VEF1 predicho y que un cambio ≥ 10 % indica una RB positiva. Las sociedades científicas en Chile están evaluando estas recomendaciones para decidir su adecuada implementación en pediatría.

Traditionally, a positive bronchodilator (BR) response has been defined as a ≥ 12% improvement in FEV1. In the year 2022, a Guide on the interpretation of pulmonary function of the American Thoracic Society and the European Society of Respiratory Diseases was published, where it was proposed that BR should be expressed as the percent change in FEV1 relative to predicted FEV1 and that a change ≥ 10% indicates a positive BR. Scientific societies in Chile are evaluating these recommendations to decide their proper implementation in pediatrics.

Función pulmonar oscilometría de impulso en pediatría: procedimiento y aplicación clínica / Pulmonary function impulse oscillometry in pediatrics: procedure and clinical application

La Oscilometría de Impulso (IOS) es una técnica no invasiva que evalúa las propiedades mecánicas de todo el sistema respiratorio durante la respiración tranquila. Mide la impedancia total del sistema respiratorio, evaluando la resistencia total de la vía aérea, la resistencia de la vía aérea alta y las propiedades elásticas del pulmón. Detecta el compromiso de la vía aérea periférica en forma muy precoz, antes que la espirometría, y es útil en niños pequeños porque no requiere maniobras de espiración forzada. Permite evaluar la respuesta broncodilatadora y broncoconstrictora a través de pruebas de provocación bronquial para el diagnóstico de hiperreactividad bronquial. La IOS tiene un rol en la evaluación temprana y seguimiento de la función pulmonar en niños con enfermedades respiratorias crónicas, principalmente asma bronquial, displasia broncopulmonar y fibrosis quística. Este artículo revisa los aspectos fisiológicos, técnicos y aplicación clínica de la IOS, considerando las últimas recomendaciones para la estandarización del examen y las limitaciones que dificultan su interpretación .

Impulse Oscillometry (IOS) is a non-invasive technique that assesses the mechanical properties of the entire respiratory system during quiet breathing. It measures the total impedance of the respiratory system by evaluating total airway resistance, upper airway resistance, and elastic properties of the lung. It detects peripheral airway compromise very early, before spirometry, and is useful in young children because it does not require forced expiration maneuvers. It allows evaluating the bronchodilator and bronchoconstrictor response through bronchial provocation tests for the diagnosis of bronchial hyperreactivity. The IOS has a role in the early evaluation and monitoring of lung function in children with chronic respiratory diseases, mainly bronchial asthma, bronchopulmonary dysplasia and cystic fibrosis. This article reviews the physiological, technical, and clinical application aspects, considering the latest recommendations for the standardization of the test and the limitations that hinder its interpretation.

Correlaciones entre el test de velocidad en 4 metros y el test de caminata en 6 min en enfermos respiratorios crónicos / Correlations between the 4 meter speed test and the 6-minute walking test in chronic respiratory patients

Resumen La prueba de velocidad de marcha en 4 metros (T4M) es considerada sustituto de la caminata en 6 min (TC6M) en EPOC. Sin embargo, no ha sido bien investigada en otras enfermedades respiratorias. Durante un año estudiamos pacientes que concurrieron a nuestra Unidad para realizar el TC6M midiendo la velocidad alcanzada en 4 metros, 2 h previo a realizar el TC6M. De 162 pacientes 99 eran mujeres. La edad media fue de 65 años, peso de 73 kg, talla de 158 cm, IMC 29,4 kg/m2. 36% tenían fibrosis pulmonar idiopática, 17% EPOC, GOLD IV,11% EPOC, GOLD III, 12% apnea de sueño y 12% otras enfermedades. No hubo diferencia para los distintos diagnósticos en ambos tests. La distancia media en TC6Mfue 368,5 m la velocidad: 1,01 m/s en T4M.Hubo una correlación positiva significativa entre ambos test: alto rendimiento en T4M es equivalente a un alto rendimiento en el TC6M. Hubo correlación negativa con la edad y positiva con la estatura. Al año de seguimiento 16 pacientes habían fallecido, siendo estos los que habían obtenido los más bajos rendimientos en ambos tests (T4M: 0,69 m/s y 248,1 m en TC6M) La posibilidad de sobrevida cayó a 20% en aquellos individuos que alcanzaron una velocidad inferior a 0,69 m/s. Es posible sustituir el TC6M por el T4M en pacientes con diferentes patologías respiratoria, podemos predecir la muerte por cualquier causa si un sujeto camina a una velocidad ≤ 0,69 m/s, T4M es barato y fácil de realizar en atención primaria, sirviendo como evaluación de riesgo para referir a un centro más complejo.

4-Meter Gait Speed Test (4MGST) a frailty test, is considered a surrogate for the 6-Minute Walk Test (6MWT) in COPD. However, it has not been investigated in other respiratory conditions. Over a year, we studied patients attending our Unit for evaluation with 6MWT, measuring the speed they achieved walking 4 m, 2 h before performing 6MWT. 162 patients (99 women) were studied; series' mean values were: age 65 years-old; body weight, 73 kg; height, 158 cm and BMI, 29.4 kg/m2. 36% of them had idiopathic pulmonary fibrosis, 17% GOLD IV COPD, 11% GOLD III COPD, 12% pulmonary arterial hypertension, 12% obstructive apnea-hypopnea syndrome, and 12% other conditions. ANOVA showed no difference between diagnostic categories for both test. Average score in 6MWT was 368.5 m and 1.01 m/s in 4MGST. Pearson correlation coefficient revealed significant positive correlation between results of both tests: high score in 4MGST is equivalent to high score in 6MWT. There was negative correlation with age and positive correlation with height. At one year follow-up, 16 patients had died. They obtained significantly lower scores in both tests (4MGST: 0.69 m/s and 6MWT: 248.1 m) Survival chance fell to 20% for patients walking slower than 0.69 m/s. It is possible to replace TC6M with T4M in patients with different respiratory pathologies, we can predict death for any cause if a subject walked at ≤ speed at 0.69 m/s. T4M is cheap and easy to perform in primary care, serving as a risk assessment to refer to a more complex center.

Infecciones Respiratorias Virales y la Placenta / Respiratory viral infections and the placenta

Las enfermedades infecciosas que comprometen el aparato respiratorio, generalmente son más graves en las gestantes y en las puérperas en comparación con las no embarazadas. Dentro de estas infecciones, se encuentran las producidas por agentes virales como la influenza estacional, pandémica y zoonótica, los coronavirus SARS, el MERS; y desde el año 2019 el SARS-CoV-2 causante de la actual pandemia COVID-19. Las noxas virales pueden ejercer un efecto deletéreo sobre el feto debido a respuesta inflamatoria vía cascada de citoquinas o daño directo a nivel de algunos tejidos. Los efectos del SARS-CoV-2 a nivel placentario, no están bien entendidos, los hallazgos histopatológicos incluyen alteraciones de la perfusión venosa materna y fetal y signos de inflamación placentaria en diferentes porcentajes. La placenta es un órgano altamente especializado que confiere una protección especial generando un ambiente protegido manteniendo un equilibrio de factores inmunes y bioquímicos que favorecen el desarrollo fetal. Su estructura funciona como una barrera protectora dificultando o impidiendo el paso de noxas al producto de la gestación. Diversos patógenos, incluyendo los virus pueden alterar los diferentes componentes celulares de la placenta. En la siguiente revisión describimos los más recientes hallazgos de la interacción con la placenta de diversos virus respiratorios y sus consecuencias en la salud materno fetal(AU)

Infectious diseases of the respiratory system generally present greater severity in women during pregnancy or puerperium, than in non-pregnant women. Among them, we find those produced by viral agents such as seasonal, pandemic and zoonotic influenza, SARS coronaviruses, MERS; and since 2019 the SARS-CoV-2, the cause of the current COVID-19 pandemic. Viral noxae can exert a deleterious effect on the fetus due to an inflammatory response via the cytokines cascade or direct damage at some tissues. The effects of SARS-CoV-2 on the placenta is not well understood, the histopathological findings include alterations of maternal and fetal perfusion and signs of placental inflammation in different degrees. The placenta is a highly specialized organ that confers a special protection by generating a protected environment maintaining a balance of immune and biochemical factors that favor the fetal development. Its structure works as a protective barrier, hindering or preventing the passage of noxae to the fetus. Several pathogens, including viruses, can alter different cellular components of the placenta. In the review, we describe the most recent findings of the interaction of various respiratory viruses with the placenta and their consequences on maternal and fetal health(AU)

Función pulmonar: escoliosis y evaluación de la función respiratoria / Scoliosis and assessment of respiratory function

La escoliosis es una enfermedad frecuente, de evolución variable según su etiología y edad de presentación. El diagnóstico y tratamiento oportuno permiten evitar el compromiso respiratorio, que es su principal complicación. La mayoría de los casos corresponden a escoliosis leves e idiopáticas, pero los casos severos, no idiopáticos o aquellos que presentan síntomas respiratorios, requieren de una evaluación oportuna por el equipo de enfermedades respiratorias. El objetivo de este trabajo es describir las alteraciones de la función pulmonar que se encuentran en niños con escoliosis y dar una orientación acerca de la evaluación y derivación de estos pacientes al neumólogo infantil. Con una evaluación oportuna se pueden iniciar planes de rehabilitación u otras intervenciones que permitan disminuir la morbimortalidad asociada a esta patología.

Scoliosis is a common disease with a variable evolution depending on its etiology and age of presentation. Timely diagnosis and treatment make it possible to avoid respiratory compromise, which is its main complication. Most cases correspond to mild and idiopathic scoliosis, but severe, non-idiopathic cases or those with respiratory symptoms require timely evaluation by the respiratory team. The objective of this work is to describe the pulmonary function alterations found in children with scoliosis and to provide guidance on the evaluation and referral of these patients to the pediatric pulmonologist. With a timely evaluation, rehabilitation plans or other interventions can be initiated to reduce the morbidity and mortality associated with this pathology.

Efeito das estações do ano no pico de fluxo expiratório de idosos institucionalizados e não institucionalizados / Efecto de las estaciones del año en el flujo espiratorio máximo de ancianos institucionalizados y no institucionalizados / Effect of the seasons on the peak expiratory flow in institutionalized and noninstitutionalized elderly

RESUMO As doenças respiratórias afetam milhões de pessoas, principalmente os idosos, e as mudanças climáticas estão entre os fatores predisponentes, interferindo na saúde dessa população. O objetivo deste estudo foi avaliar o pico de fluxo expiratório de idosos institucionalizados e não institucionalizados durante as quatro estações do ano. Estudo de coorte prospectivo com 67 idosos de ambos os sexos, residentes na cidade de Maringá (PR) e divididos em dois grupos: idosos institucionalizados (n=37) e idosos não institucionalizados (n=30). Os dados foram coletados durante um mês, uma vez por semana nas quatro estações do ano, totalizando 16 avaliações. O pico de fluxo expiratório foi avaliado com o equipamento peak flow meter. A comparação dos dois grupos de idosos foi feita por análise de variância de dois fatores utilizando o post-hoc de Bonferroni. A menor média de pico de fluxo expiratório para os idosos institucionalizados e não institucionalizados foi no verão (176,2±60,2 e 263,2±116,2), seguido pelo outono (193,4±59,5 e 287,5±118), inverno (215,3±82,5 e 291,5±08,4) e primavera (221,7±83,5 e 291,5±08,4). Conclui-se que o pico de fluxo expiratório de idosos varia de acordo com as estações do ano, porém os institucionalizados apresentam valores mais baixos. Os mais altos são encontrados na primavera, embora aquém do valor predito para os idosos de ambos os grupos.

RESUMEN Las enfermedades respiratorias afectan a millones de personas, especialmente a los ancianos, y el cambio climático es uno de los factores predisponentes que interfieren en la salud de esta población. El presente estudio tuvo como objetivo evaluar el flujo espiratorio máximo de ancianos institucionalizados y no institucionalizados durante las cuatro estaciones del año. Se realizó un estudio prospectivo de cohorte con 67 ancianos de ambos sexos que viven en la ciudad de Maringá (PR), los cuales se dividieron en dos grupos: ancianos institucionalizados (n=37) y ancianos no institucionalizados (n=30). Los datos se recolectaron durante un mes, una vez a la semana en las cuatro estaciones del año, y totalizó 16 evaluaciones. El flujo espiratorio máximo se evaluó con la herramienta peak flow meter. La comparación de los dos grupos de ancianos se realizó mediante el análisis de la varianza de dos factores utilizando el post hoc de Bonferroni. El promedio más bajo del flujo espiratorio máximo para los ancianos institucionalizados y no institucionalizados se registró en verano (176,2±60,2 y 263,2±116,2), seguido del otoño (193,4±59,5 y 287,5±118), invierno (215,3±82,5 y 291,5±08,4) y primavera (221,7±83,5 y 291,5±08,4). Se concluye que el flujo espiratorio máximo de los ancianos varía según las estaciones del año, sin embargo, los ancianos institucionalizados tienen los valores más bajos. Los más altos se encuentran en la primavera, aunque por debajo del valor previsto para los ancianos de ambos grupos.

ABSTRACT Respiratory diseases affect millions of people, especially the elderly, and climate change is among the predisposing factors interfering with the health of this population. This study aimed to evaluate the peak expiratory flow in institutionalized and noninstitutionalized elderly during the four seasons of the year. A prospective cohort study with 67 elderly men and women living in the city of Maringá, Paraná, Brazil, divided into two groups: institutionalized elderly (n=37) and noninstitutionalized elderly (n=30). The data were collected for one month, once a week in the four seasons of the year, totaling 16 evaluations. The peak expiratory flow was evaluated using the Peak-Flow Meter equipment. The two groups of elderly were compared by two-way analysis of variance using the Bonferroni post-hoc. The lowest mean peak expiratory flow for institutionalized and noninstitutionalized elderly was observed in the summer (176.2±60.2 and 263.2±116.2), followed by fall (193.4±59.5 and 287.5±118), winter (215.3±82.5 and 291.5±08.4), and spring (221.7±83.5 and 291.5±08.4). The conclusion was that the peak of expiratory flow of the elderly varies according to the seasons, but the institutionalized ones have lower values. The highest values are found in the spring, although below the value predicted for the elderly of both groups.

Asociación entre deterioro del flujo espiratorio máximo y prevalencia de enfermedades cardiovasculares y metabólicas en población adulta chilena: hallazgos preliminares de la Cohorte del Maule (MAUCO) / Peak expiratory flow and prevalence of cardiovascular and metabolic diseases in a Chilean adult population: preliminary findings from the Maule Cohort (MAUCO)

Introducción: La enfermedad respiratoria crónica determina alta morbimortalidad y frecuencia de comorbilidades cardiometabólicas. Evaluamos la asociación entre flujo espiratorio máximo (FEM) y algunas condiciones cardiometabólicas en adultos de una zona semirural, en la medición basal de la cohorte MAUCO (MAUle COhort). Material y Método: Estudio transversal (3.465 adultos, 40-74 años). Se midió el flujo espiratorio máximo (FEM) (mini-Wright, estándar ATS) utilizándose valores de Gregg y Nunn (FEM deteriorado ≤ 80% del teórico). Se obtuvo autorreporte/mediciones de hipertensión arterial (HTA), enfermedad cerebrovascular (ECV), infarto al miocardio (IAM), diabetes mellitus 2 (DM2), presión arterial, glicemia, colesterol, peso y talla. Actividad física y tabaquismo se evaluaron por encuesta, previa aprobación Ética. Se calcularon medidas de asociación, prevalencia y Odds Ratio (OR). Resultados: Muestra de 63,9% de mujeres edad media 55 (± 9) años, escolaridad media 9 (± 4) años. 84,7% tuvo exceso de peso, 81,5% inactividad física 29,4% fumadores actuales. Prevalencia de FEM bajo: 50,6% (IC 95% 48,9-52,3). El autorreporte fue: ACV 2,2% IAM 3,3, sospecha de hipertensión 24% y DM2 2,7%. Los OR crudos fueron significativos en mujeres que autorreportaron HTA, ECV, IAM y autorreporte/sospecha de DM2, y en hombres con autorreporte de ECV, sospecha de DM2 y autorreporte/sospecha de HTA. La asociación se mantuvo post-ajuste en mujeres para autorreporte de IAM y deterioro moderado (OR = 2,49) y severo del FEM (OR = 2,60) y en hombres para sospecha de DM2 y deterioro leve (OR = 5,24) y severo del FEM (OR = 6,19). Conclusiones: FEM resultó significativamente asociado con las enfermedades cardiometabólicas seleccionadas, con efecto sexo- específico para IAM (mujeres) y sospecha de DM2 (hombres). Se constata alta prevalencia de FEM alterado, y de enfermedades cardiometabólicas crónicas en la población estudiada.

Introduction: Chronic respiratory diseases determine high morbimortality and cardiometabolic comorbidities. We evaluated the association between peak expiratory flow (PEF) and cardiometabolic conditions in adults in a semi-rural area, in the baseline of MAUCO cohort (MAUle COhort). Material and Method: Cross-sectional study (3,465 adults, 40-74 years). Peak expiratory flow (PEF) (mini-Wright, ATS standard) was measured (Gregg & Nunn; impaired PEF ≤ 80% predicted). Self-reported/measured hypertension (HT), cerebrovascular disease (CVD), myocardial infarction (AMI), diabetes mellitus 2 (DM2), blood pressure, glycemia, cholesterol, weight and height were obtained. Physical activity and smoking were surveyed, after Ethical approval. Association's measures, prevalence and Odds Ratio (OR) were calculated. Results: Sample of 63.9% of women, mean age 55 (± 9) years, schooling 9 (± 4) years. 84.7% had overweight, 81.5%physical inactivity 29.4% smokers. Low PEF: 50.6% (48.9-52.3). Self-reported was: CVD 2.2% AMI 3.3%, suspicion of hypertension 24% and DM2 2.7%. Crude OR`s were significant for women by self-reported hypertension, stroke, AMI and self-reported/suspicion DM2; in men for self-reported CVD, suspected DM2 and self-reported/suspected hypertension. The association remained post-adjusted in women self-reported AMI -moderate deterioration (OR = 2.49) and severe PEF (OR = 2.60) and in men suspected DM2 and mild (OR = 5.24) and severe deteriorated PEF (OR = 6.19). Conclusions: PEF was significantly associated with cardiometabolic diseases; sex- specific findings for AMI (women) and suspicion of DM2 (men). High prevalence of altered PEF and chronic cardiometabolic diseases were detected among the studied population.

Fuzzy logic and hospital admission due to respiratory diseases using estimated values by mathematical model / Lógica fuzzy e internações por doenças respiratórias usando dados estimados por modelo matemático

Abstract Hospitalizations due to respiratory diseases generate financial costs for the Health System in addition to social costs. Objective of this study was to develop and validate a fuzzy linguistic model for prediction of hospitalization due to respiratory diseases. We constructed a fuzzy model for prediction of hospitalizations due to pneumonia, bronchitis, bronchiolitis and asthma second exposure to fine particulate matter (PM2.5) in residents of Volta Redonda, RJ, in 2012. The model contains two inputs, PM2.5 and temperature, with three membership functions for each input, and an output with three membership functions for admissions, which were obtained from DATASUS. There were 752 hospitalizations in the period, the average concentration of PM2.5 was 17.1 µg/m3 (SD = 4.4). The model showed a good accuracy with PM2.5, the result was between 90% and 76.5% for lags 1, 2 and 3, a sensitivity of up to 95%. This study provides support for creating executable software with a low investment, along with the use of a portable instrument could allow number of hospital admission due to respiratory diseases and provide support to local health managers. Furthermore, the fuzzy model is very simple and involves low computational costs, an implementation making possible.

Resumo Internações por doenças respiratórias geram custos financeiros para o Sistema de Saúde além de custos sociais. O objetivo deste estudo foi elaborar e validar um modelo linguístico "fuzzy" para previsão do número de internações por doenças respiratórias. Foi construído um modelo "fuzzy" para predição de internações por pneumonias, bronquite, bronquiolite e asma segundo exposição ao material particulado fino (PM2,5) em residentes de Volta Redonda, RJ, em 2012. O modelo contém duas entradas PM2,5 e temperatura, com três funções de pertinência para cada entrada, e uma saída com três funções de pertinência para internações, que foram obtidas do DATASUS. Foram 752 internações no período, a concentração média do PM2,5 foi 17,1 µg/m3 (dp = 4,4). O modelo mostrou uma boa acurácia com PM2,5, o resultado foi entre 90% e 76,5% para os lags 1, 2 e 3, com sensibilidade de até 95%. Este estudo fornece subsídios para a criação de programa executável, que não exige um grande investimento, juntamente com o uso de um instrumento portátil pode permitir uma estimativa do número de internações e prestar apoio aos gestores municipais de saúde. Além disso, o modelo "fuzzy" é muito simples e implica em baixas despesas computacionais, tornando possível uma implementação.

Respiratory impact of electronic cigarettes and low-risk tobacco

Abstract Electronic cigarettes, handheld devices that generate an aerosol that may contain nicotine by heating a solution or e-liquid, have been increasingly used especially in the young population. The aerosol's composition is determined by temperature, and by the substances contained in the heated liquid: glycerin, propylene glycol, nicotine in variable concentrations, flavoring agents, and other non-nicotine compounds. >80 compounds (including known toxics, e.g., formaldehyde, acetaldehyde, metallic nanoparticles, and acrolein) have been found in e-liquid and aerosols. Airway irritation, mucus hypersecretion, and inflammatory response, including systemic changes, have been observed after the exposure to e-cigarettes, leading to an increase in respiratory symptoms and changes in respiratory function and the host defense mechanisms. E-cigarette has been linked with an increase of symptoms in individuals with asthma, cystic fibrosis, and chronic obstructive pulmonary disease. One of the major concerns in public health is the rise in e-cigarette experimentation among never-smokers, especially children and adolescents, which leads to nicotine addiction and increases the chances of becoming with time a conventional smoker. There is an urgent need to regulate e-cigarettes and electronic nicotine delivery systems, at least with the same restrictions to those applied to tobacco products, and not to consider them as harmless products.

Symptomatic and asymptomatic smokers without airflow obstruction: a new clinical entity?

Abstract Non-obstructed ever-smokers, with or without symptoms, have generated a great deal of information recently, but few reviews. Even individuals with normal spirometry can present changes in sputum with inflammatory biomarkers (cellular and molecular) and airways and parenchyma with remodeling; when symptomatic (cough, sputum, wheezing, and dyspnea) exacerbations are frequent affecting the individuals’ quality of life, there is an increased use of health resources: more medication, emergency visits, and hospital admissions. Non-obstructed smokers may have exercise limitations, increased lung volumes, low diffusion capacity, air entrapment, peripheral airways obstruction, elevated airways resistance, and abnormal multiple breath nitrogen washout, as well as abnormalities in computed tomography studies, such as airway wall thickening, emphysema, or interstitial lung abnormalities. Quitting smoking comprises a first, inexpensive, and often abandoned intervention to arrest respiratory impairment. It is controversial whether or not this population should be treated with other medications. Further studies should be conducted to elucidate the consequences of follow-up and prognosis in this clinical entity.

Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry / Velhice extrema em um centro diagnóstico respiratório: frequência e qualidade técnica da espirometria

ABSTRACT Objective: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. Methods: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. Results: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). Conclusions: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.

RESUMO Objetivo: Determinar a frequência de idosos que realizaram espirometria num serviço de função pulmonar, e avaliar a qualidade da realização do exame na velhice extrema e se a idade cronológica influencia essa qualidade. Métodos: Estudo transversal retrospectivo utilizando informações (espirometria e questionário respiratório) de um banco de dados de um serviço de função pulmonar em Aracaju (SE) entre janeiro de 2012 e abril de 2017. Com base na amostra geral, determinou-se o número total de espirometrias realizadas em todas as idades, em idosos ≥ 60 anos, ≥ 65 anos, e por década de idade a partir da sexta década. Na velhice extrema, avaliou-se a qualidade da espirometria utilizando critérios de aceitabilidade e reprodutibilidade, e investigaram-se variáveis que influenciam essa qualidade, tal como déficit cognitivo. Resultados: A amostra geral foi composta por 4.126 espirometrias. Dessas, 961 (23,30%), 864 (20,94%), 102 (2,47%) e 26 (0,63%) foram realizadas em idosos com ≥ 60 anos de idade, ≥ 65 anos, ≥ 86 anos e ≥ 90 anos (velhice extrema), respectivamente. Na velhice extrema, os critérios de aceitabilidade e reprodutibilidade foram preenchidos em 88% (IC95%: 75,26-100,00) e 60% (IC95%: 40,80-79,20) das espirometrias, respectivamente. O déficit cognitivo influenciou negativamente a aceitabilidade e a reprodutibilidade (p ≤ 0,015; e p ≤ 0,007, respectivamente). Conclusões: Idosos na velhice extrema são uma realidade atual nos serviços de função pulmonar, e a maioria deles é capaz de realizar espirometrias adequadamente, apesar da idade avançada. O déficit cognitivo influencia negativamente a qualidade da espirometria.

State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea / Alterações nas vias aéreas superiores avaliadas por TC multidetectores durante a vigília e o sono em indivíduos saudáveis e em pacientes com apneia do sono durante eventos obstrutivos

ABSTRACT Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

Resumo Objetivo: Determinar se o estreitamento das vias aéreas durante eventos obstrutivos ocorre predominantemente na região retropalatal e resulta de alterações dinâmicas nas paredes laterais da faringe e na posição da língua. Métodos: Avaliamos 11 pacientes com apneia obstrutiva do sono (AOS) grave (grupo AOS) e 7 indivíduos saudáveis sem AOS (grupo controle) durante a vigília e o sono natural (documentado por meio de polissonografia completa). Por meio de TC multidetectores rápida, obtivemos imagens das vias aéreas superiores no estado de vigília e de sono. Resultados: O estreitamento das vias aéreas superiores durante o sono foi significativamente maior na região retropalatal do que na região retrolingual no grupo AOS (p < 0,001) e no grupo controle (p < 0,05). O volume da via aérea retropalatal foi menor no grupo AOS do que no grupo controle durante a vigília (p < 0,05) e diminuiu significativamente da vigília ao sono apenas no grupo AOS. O estreitamento retropalatal da faringe foi atribuído à redução do diâmetro anteroposterior (p = 0,001) e lateral (p = 0,006), que se correlacionou com o aumento do volume das paredes laterais da faringe (p = 0,001) e o deslocamento posterior da língua (p = 0,001). Não ocorreu estreitamento retrolingual da faringe durante o sono no grupo AOS. Conclusões: Em pacientes com AOS, o estreitamento das vias aéreas superiores durante o sono ocorre predominantemente na região retropalatal e afeta as dimensões anteroposterior e lateral, além de estar relacionado com aumento das paredes laterais da faringe e deslocamento posterior da língua.

Flujo espiratorio máximo: caracterización en un estudio en población adulta chilena; resultados basales de la cohorte del Maule (MAUCO) / Peak expiratory flow rate: characterization study in Chilean adult population; baseline results of the Maule cohort (MAUCO)

Resumen Introducción: Las enfermedades respiratorias crónicas tienen alta prevalencia en países en desarrollo, en poblaciones rurales y deprivadas. El flujo espiratorio máximo (FEM) obtenido mediante espiración forzada tiene uso clínico y de investigación. Describimos valores de medición del FEM en la medición basal de un estudio de cohorte en curso (Cohorte del Maule-MAUCO). Material y Método: Diseño transversal en 3.465 adultos (40-74 años) con registros de FEM (ATS). (Flujómetro Mini-Wright), usando valores de Gregg y Nunn. Valores < 80% del predicho se consideraron disminuidos. Se obtuvo sexo, edad, nivel educacional, actividad física y tabaquismo; se calculó índice de masa corporal (IMC) usando mediciones antropométricas. Resultados: La muestra tuvo 63,9% de mujeres; edad media de 55 (± 9) años, escolaridad de 9 (± 4) años; sobrepeso y obesidad fueron 43,1% y 41,5%: 81,5% fueron inactivos y 29,4% fumadores actuales. El valor medio de FEM fue 330 (± 80) L/min (mujeres) y 460 (± 119) L/min (hombres): el FEM disminuido alcanzó el 50,6% ([48,9-52,3]) con diferencias según edad, educación, IMC y actividad física. Conclusiones: Se observó alta prevalencia de FEM disminuido con variaciones según sexo, edad, escolaridad, IMC e inactividad física. Como otros estudios latinoamericanos, los valores bajos también fueron altamente prevalentes, sugiriendo sobreestimación de valores predichos al usar valores de Gregg & Nunn. Estos resultados sugieren la conveniencia de estudiar factores ambientales locales.

Introduction: Chronic respiratory (CRD) diseases show high prevalence in developing countries, rural and deprived populations. Peak expiratory flow rate (PEFR) is a functional measurement obtained through forced expiratory used for clinical and research purposes. We described PEFR in a rural setting in an ongoing cohort study (Maule Cohort-MAUCO). Material and Method: Cross-sectional design in 3,465 adults (40-74 years) with PEFR ATS standard records (Mini-Wright flowmeter) using Gregg and Nunn values. PEFR ≤ 80% predicted were considered decreased. Sex, age, educational level, physical activity and tobacco smoking were obtained. Body mass index (BMI) was calculated based on anthropometrical measurements. Main Results: Sample had 63.9% of women; mean age of 55 (± 9) years, schooling of 9 (± 4) years. Overweight and obesity were 43.1% and 41.5%. Physical inactivity was 81.5% and 29.4% were current smokers. PEFR mean value was 330 (± 80) L/min (women) and 460 (± 119) L/min (men): Decreased PEFR was 50.6% ([48.9-52.3]) with significant differences by age, schooling, BMI and physical activity. Conclusions: High prevalence of decreased PEFR was observed: PEFR showed variations according to sex, age, schooling, BMI and physical activity. As other Latin-American studies show, low values were also highly prevalent, suggesting that Gregg & Nunn overestimated PEFR values. These results suggests the convenience of studying local environmental factors.

Espirometría forzada versus oscilometría de impulso / Forced spirometry versus impulse oscillometry

Impulse oscillometry (IOS) is an emerging tool in the study of pulmonary function in respiratory diseases. In this review we compare its usefulness with that of forced spirometry in children. Although these techniques measure different mechanical properties of the respiratory system, -the first, resistance, and the second, flow- they are, undoubtedly, complementary tests.. This review includes a brief description of some comparative studies since 1973, year of the first publication about children; then, with the advent of technology, its application in the mid-80s and 90s made it possible to include reference values in order to establish functional diagnoses. IOS measures airway, pulmonary and thoracic resistance, which is a primary function of the mechanics of ventilation, whereas spirometry measures the flow, which is a secondary function. This principle allows us to understand why IOS indices are more sensitive than those of spirometry

La Oscilometría de Impulso (IOS) es una herramienta emergente en el estudio de la función pulmonar y en esta revisión se compara su utilidad con la espirometría forzada en niños. Aunque ambas técnicas miden diferentes propiedades mecánicas del sistema respiratorio, resistencias la primera y flujos la segunda, tienen un carácter complementario incuestionable. Esta revisión describe brevemente algunos trabajos comparativos a partir de 1973, fecha de la primera publicación en niños y luego con el advenimiento tecnológico, su aplicación a mediados de los 80 y 90 permite incluir valores de referencia para poder establecer diagnósticos funcionales. La IOS se caracteriza por medir resistencia de la vía aérea y toracopulmonar y que desde el punto de vista de la mecánica respiratoria ésta es una función primaria versus los flujos, medidos por espirometría, que son una función secundaria, este principio es el que permite entender porque sus índices son más sensibles que los de la espirometría

Fatores associados ao aleitamento materno em crianças menores de 5 anos com doença do aparelho respiratório / Factors associated with breastfeeding in children under 5 years of age with respiratory disease

Objetivo: Avaliar fatores associados ao aleitamento materno em casos de doenças do aparelho respiratório (DAR) em crianças menores de 5 anos. Método: Coleta de dados clínico-antropométricos e de aleitamento materno de 45 crianças internadas na enfermaria de um hospital universitário com enfermidades respiratórias. As variáveis contínuas avaliadas foram expressas em termos de mediana e as categóricas foram apresentadas a partir da frequência absoluta e relativa. O teste do Qui-Quadrado foi usado para testar as diferenças entre as proporções das variáveis nos grupos com e sem aleitamento materno. Para avaliação da associação das diferentes variáveis com o aleitamento materno, foi estimado o odds ratio e a razão de prevalência. Resultados: Trinta crianças (69%) foram amamentadas por pelo menos 1 mês. Foi verificado que 56% (n=25) tiveram episódios anteriores de DAR. A prematuridade (31%; n=14), o baixo peso ao nascer (33%; n=13), a ausência do pré-natal (9%; n=13) e a presença de intercorrências na mãe durante a gestação (20%; n=9) foram fatores que se associaram a ausência do aleitamento materno (OR e RP, respectivamente, de 3,99 e 9,36; 2,8 e 3,17; 6,75 e 8,67; 1,77 e 2,08). O QuiQuadrado revelou diferenças significantes entre a ausência da amamentação entre prematuros e não prematuros e entre as mães que realizaram e não realizaram o pré-natal (p<0,05). Houve maior razão de chances (OR:2,25) e razão de prevalência (RP:1,91) para o excesso de peso para a altura dentre as crianças não amamentadas. Conclusão: O incentivo ao aleitamento materno em lactentes nascidos prematuramente ou com baixo peso, bem como em neonatos de mães com problemas clínicos na gestação, é de extrema relevância, assim como o pré-natal na promoção da amamentação em crianças com afecções respiratórias. Aponta-se, ainda, o aleitamento materno como fundamental para a prevenção de excesso de peso nestas condições, bem como a conscientização de mães e profissionais na atenção materno-infantil.(AU)

Objective: To evaluate factors associated with breastfeeding in cases of respiratory diseases (ARD) in children under 5 years of age. Methods: Clinical-anthropometric and breastfeeding data collection of 45 children admitted to the ward of a university hospital with respiratory diseases. The continuous variables evaluated were expressed in median terms and the categorical variables were presented from the absolute and relative frequency.The Chi-Square test was used to test differences between the proportions of the variables in the groups with without breast-feeding. To evaluate the association of the different variables with breastfeeding, the odds ration and the prevalence ratio were estimated. Results:Thirty children (69%) were breastfed for at least 1 month. It was verified that 56% (n=25) had previous episodes of ARD. Preterm birth (31%;n=14),low birth weight (33%, n=13), absence of prenatal care (9%, n=13) and presence of intercurrences in the mother during pregnancy (20%; n=9) were factors that were associated with absence of breastfeeding (OR and PR, respectively, of 3.99 and 9.36; 2.8 and 3.17; 6.75 and 8.67; 1.77 and 2.08). The chi-square test reveled significant differences between the absence of breastfeeding among premature and non-premature infants and among those mothers who did and did not perform prenatal care (p<0.05). There was a higher odds ratio (OR=2.25) and prevalence ratio (PR=1.91) for overweight for height among non-breastfed children. Conclusion: Encouraging breastfeeding in infants born prematurely or with low birth weight, as well as in neonates of mothers with clinical problems during pregnancy is extremely relevant, as is prenatal breastfeeding promotion in children with respiratory diseases. It is also pointed out that breastfeeding is essential for the prevention of overweight in these conditions, as well as the awareness of mothers and professionals in the maternal and child care.(AU)

Evaluation of pulmonary function and respiratory symptoms in pyrochlore mine workers / Avaliação da função pulmonar e sintomas respiratórios em trabalhadores da mineração de pirocloro

ABSTRACT Objective: To identify respiratory symptoms and evaluate lung function in mine workers. Methods: This was a cross-sectional observational study involving production sector workers of a pyrochlore mining company. The subjects completed the British Medical Research Council questionnaire, which is designed to evaluate respiratory symptoms, occupational exposure factors, and smoking status. In addition, they underwent pulmonary function tests with a portable spirometer. Results: The study involved 147 workers (all male). The mean age was 41.37 ± 8.71 years, and the mean duration of occupational exposure was 12.26 ± 7.09 years. We found that 33 (22.44%) of the workers had respiratory symptoms and that 26 (17.69%) showed abnormalities in the spirometry results. However, we found that the spirometry results did not correlate significantly with the presence of respiratory symptoms or with the duration of occupational exposure. Conclusions: The frequencies of respiratory symptoms and spirometric changes were low when compared with those reported in other studies involving occupational exposure to dust. No significant associations were observed between respiratory symptoms and spirometry results.

RESUMO Objetivo: Determinar a presença de sintomas respiratórios e avaliar a função pulmonar de trabalhadores da mineração. Métodos: Estudo observacional de caráter transversal realizado com trabalhadores do setor de produção de uma mineradora de pirocloro. Para avaliar os sintomas respiratórios, fatores de exposição ocupacional e tabagismo, foi aplicado o questionário de sintomas respiratórios British Medical Research Council, e a função pulmonar foi avaliada utilizando-se um espirômetro portátil. Resultados: Participaram do estudo 147 trabalhadores, todos do sexo masculino, com média de idade de 41,37 ± 8,71 anos e com tempo de exposição ocupacional de 12,26 ± 7,09 anos. Foi observado que 33 (22,44%) dos trabalhadores apresentaram sintomas respiratórios e que 26 (17,69%) dos trabalhadores apresentaram alguma alteração nos resultados espirométricos. Entretanto, os resultados espirométricos não se correlacionaram significativamente com sintomas respiratórios e tempo de exposição. Conclusões: As frequências de sintomas respiratórios e de alterações espirométricas apresentaram-se baixas quando comparadas às de estudos que envolviam exposição à poeira ocupacional. Não foram observadas associações significativas dos sintomas respiratórios com os valores espirométricos.

Currents issues in cardiorespiratory care of patients with post-polio syndrome / Tópicos atuais no tratamento cardiorrespiratório de pacientes com síndrome pós-poliomielite

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

RESUMO Síndrome pós-polio (SPP) é uma condição que afeta sobreviventes da poliomielite aguda (PAA), anos após a recuperação de um ataque agudo inicial do vírus. Na maioria das vezes, os sobreviventes da polio começam a apresentar nova paresia gradual nos músculos que foram previamente afetados pela infecção. A incidência real de doenças cardiovasculares (DCV) em indivíduos que sofrem de SPP não é conhecida. Entretanto, há indícios para suspeitar de que sujeitos com SPP podem estar em maior risco. Método Realizou-se uma busca de artigos nas bases de dados: Bireme, Scielo e Pubmed, utilizando as seguintes palavras-chave: síndrome pós-poliomielite, função cardiorrespiratória e reabilitação, nos idiomas Inglês, Francês e Espanhol. Embora tenhamos selecionado um número expressivo de artigos, somente foram considerados os duplo-cegos, randomizados-controlados, além de consensos. Resultados e Discussão Certas características da SPP, tais como fadiga muscular, paresia, dor muscular e/ou articulares podem resultar em descondicionamento por inatividade física, além de obesidade e dislipidemia. Dificuldades respiratórias são comuns e podem resultar em hipoxemia. Conclusão Somente quando avaliados e tratados em tempo hábil, alguns pacientes são capazes de obter os benefícios do uso dos músculos respiratórios auxiliares em termos de qualidade de vida.

Enfermedades respiratorias ocupacionales / Occupational pulmonary diseases

Las enfermedades ocupacionales son aquellas producidas directamente por el ejercicio de la profesión. Estas se encuentran reguladas por la Ley 16.744 y son de cargo de prestadores de servicios denominados habitualmente mutuales. En este artículo se describen los principales aspectos epidemiológicos, fisiopatológicos, clínicos, de criterios diagnósticos y principios terapéuticos, de cuatro enfermedades respiratorias, las más relevantes en el medio nacional: Silicosis, asma, enfermedades por asbesto y enfermedades por hipobaria.

Occupational diseases are those produced directly by work activities. In Chile, occupational diseases are regulated by the law 16.744 and the service providers are called, mutualidades. In this paper is described epidemiology, physiopathology, clinical aspects, diagnostic criteria and therapeutic principles of the four most important occupational respiratory diseases in Chile: Silicosis, occupational asthma, asbestos diseases and altitude sickness.

Laboratorio de función pulmonar / Lung function laboratory

El laboratorio de función pulmonar es esencial en el manejo de los pacientes con enfermedades respiratorias. El laboratorio de Clínica Las Condes realiza pruebas diagnósticas de uso habitual. El propósito de este artículo es revisar las indicaciones, limitaciones y la interpretación de éstas analizando también los aspectos técnicos, Estos exámenes son: Espirometría, volúmenes pulmonares, capacidad de difusión, test de metacolina, medición de la fracción exhalada de óxido nítrico y presión máximas inspiratorias y espiratorias, También se analizan los test de ejercicio realizados: test de marcha de seis minutos y test cardiopulmonar. Finalmente nos referimos a la oximetría nocturna como una forma de aproximarnos al diagnóstico de apnea del sueño.

Lung function tests are essential in the management of Respiratory patients. In Clinica Las Condes lab, we perform the most usual and important functional tests. The aim of this article is to review the indications, limitations and interpretation of them and also the technical aspects. This includes: Spirometry, lung volumes, DLCO, methacholine test, exhaled nitric oxide and maximum inspiratory and expiratory pressure. We also perform exercises tests like six minute walking and cardiopulmonary exercise test which we also describe. Finally, it is mention the nocturnal oximetry as an approximation to sleep apnea study.

Obesity and lung function: a systematic review / Obesidade e função pulmonar: uma revisão sistemática

Obesity is a chronic disease characterized by the excessive accumulation of body fat that is harmful to the individuals. Respiratory disorders are among the comorbidities associated with obesity. This study had the objective of investigating the alterations in respiratory function that affect obese individuals. A systematic review was performed, by selecting publications in the science databases MEDLINE and LILACS, using PubMed and SciELO. The articles that assessed pulmonary function by plethysmography and/or spirometry in obese individuals aged under 18 years were included. The results demonstrated that the obese individuals presented with a reduction in lung volume and capacity as compared to healthy individuals. Reduction of total lung capacity and reduction of forced vital capacity, accompanied by reduction of the forced expiratory volume after one second were the most representative findings in the samples. The articles analyzed proved the presence of a restrictive respiratory pattern associated with obesity.

A obesidade é uma doença crônica, caracterizada pelo acúmulo excessivo de gordura corporal, que ocasiona prejuízos ao indivíduo. Dentre as comorbidades associadas à obesidade, estão as disfunções respiratórias. O presente estudo teve por objetivo investigar as alterações da função pulmonar que acometem indivíduos obesos. Foi realizada uma revisão sistemática, por meio da seleção de publicações nas bases científicas de dados MEDLINE e LILACS, por meio do PubMed e SciELO. Foram inclusos os trabalhos que avaliaram a função pulmonar, por meio de pletismografia e/ou espirometria, em indivíduos obesos maiores de 18 anos. Os resultados demonstraram que os indivíduos obesos apresentaram redução dos volumes e capacidades pulmonares quando comparados a indivíduos eutróficos. Redução da capacidade pulmonar total e redução da capacidade vital forçada, acompanhadas de redução do volume expiratório forçado após um segundo, foram os achados mais representativos dentre as amostras. Os trabalhos analisados comprovam a presença de padrão respiratório restritivo associado à obesidade.