Functional outcomes in patients with chronic obstructive pulmonary disease: a multivariate analysis

Background: Multiple factors can influence the severity of chronic obstructive pulmonary disease (COPD) and the functioning of patients with COPD, such as personal characteristics and systemic manifestations. Objective: To evaluate the different factors that can influence the activity and psychosocial impact domains of the Saint George's Respiratory Questionnaire (SGRQ) in COPD patients. Method: Participants, recruited in a university-based hospital, responded to the SGRQ, and in addition, personal, anthropometric, and clinical data were collected. The study was approved by the Institutional Ethics Committee. Data were analyzed using multiple linear regression models, with the SGRQ activity and psychosocial impact scores as outcome variables, and 10 explanatory variables (age, gender, forced expiratory volume in the first second - FEV1, smoking load, body mass index, oxygen therapy, associated diseases, regular physical activity, participation in a formal rehabilitation program, and SGRQ symptoms score) were considered. Results: The best regression model for predicting the SGRQ activity score (r2=0.477) included gender, FEV1, and SGRQ symptoms. In contrast, the predictive model with the highest proportion of explained variance in psychosocial impact score (r2=0.426) included the variables gender, oxygen therapy, and SGRQ symptoms. Conclusions: The results indicate that the outcomes, while based on functioning parameters in COPD patients, could be partly explained by the personal and clinical factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it appears that the health conditions of these patients cannot be described by isolated variables, including pulmonary function parameters. .

Evolution of respiratory muscle strength in post-operative gastroplasty / Evolução da força muscular respiratória no período pós-operatório de gastroplastia redutora

BACKGROUND: Obesity is a worldwide health problem that may also induce respiratory dysfunction. Literature linking weight loss and maximum respiratory pressures is inconclusive. OBJECTIVE: To evaluate longitudinally the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) of morbidly obese individuals before and after gastric bypass surgery, and to compare them to a control group matched by sex and age. METHODS: A vacuum manometer (GeRar®, SP, Brazil) was used to assess the MIP and MEP of 30 morbidly obese participants (24 women), aged 32±8 years and with body mass index (BMI) of 43±4 kg/m², both before and then one and six months after gastric bypass surgery. After an average of 36 months, 17 patients were reevaluated. A control group of 30 individuals with normal lung function (aged 30±8 with a BMI of 22±2 kg/m²) was also studied. An unpaired t-test and ANOVA for repeated measures were used for statistical analysis, with p<0.05 considered as significant. RESULTS: No significant differences were observed in the baseline evaluation between the two groups. A significant increase was found in MIP after approximately 36 months of surgery in the obese group. A significant decrease in MEP was observed after one month, as well as a significant increase after 36 months compared with one and six months post-surgery. CONCLUSION: The data showed a significant long-term increase in MIP, as well as a significant decrease in MEP after one month followed by a return to pre-operative values, which indicates that gastric bypass surgery has a positive influence on the strength of inspiratory muscles.

CONTEXTUALIZAÇÃO: A obesidade é um problema de saúde em todo o mundo e pode causar disfunção respiratória. A literatura que associa a perda de peso corporal às pressões respiratórias máximas (PRM) é inconclusiva. OBJETIVO: Avaliar, longitudinalmente, a pressão inspiratória máxima (PImáx) e a pressão expiratória máxima (PEmáx) de pacientes com obesidade mórbida antes e após gastroplastia redutora e compará-los a um grupo controle pareado por sexo e idade. MÉTODO: Um manovacuômetro (GeRar®, SP, Brasil) foi utilizado para avaliar PImáx e PEmáx de 30 participantes obesos (24 mulheres e seis homens, 32±8 anos), com índice de massa corporal (IMC) de 43±4 kg/m², antes da gastroplastia redutora e após um e seis meses. Após 36 meses, em média, foram reavaliados 17 obesos. Como grupo controle, foram avaliados 30 indivíduos com função pulmonar normal, 30±8 anos, e IMC de 22±2 kg/m². Para análise estatística, utilizou-se teste t de Student para grupos independentes e ANOVA para medidas repetidas. Um p<0,05 foi considerado significativo. Resultados: Não foram observadas diferenças significativas na avaliação inicial entre os dois grupos. Houve aumento significativo após 36 meses de cirurgia no grupo com obesidade em relação à PImáx. Em relação à PEmáx, houve diminuição significativa após um mês e aumento significativo após 36 meses, quando comparada com um e seis meses de cirurgia. CONCLUSÕES: Os dados demonstraram aumento significativo da PImáx em longo prazo, bem como redução significativa da PEmáx após um mês, seguido de um retorno aos valores de pré-operatório, indicando influência positiva da gastroplastia redutora sobre a força dos músculos inspiratórios.