Kinesiología respiratoria en niños con disquinesia ciliar primaria / Respiratory phisioterapy in children with primary ciliary dyskinesia

Primary ciliary dyskinesia is a rare autosomal recessive disease with compromised mucociliary drainage. Among the most commonly recommended non-pharmacological therapeutic strategies are secretion drainage techniques. However, the evidence for the use and effectiveness of these techniques is low, and they are generally based on extrapolated evidence of cystic fibrosis. This article reviews the recommendations and available evidence of chest physiotherapy, mainly manual and instrumental techniques of bronchial drainage and physical exercise in children with primary ciliary dyskinesia.

La disquinesia ciliar primaria es una enfermedad autosómica recesiva rara con compromiso del drenaje mucociliar. Entre las estrategias terapéuticas no farmacológicas más comúnmente recomendadas se encuentra las técnicas de drenaje de secreciones. Sin embargo, la evidencia del uso y efectividad de estas técnicas es reducida y generalmente se basan en evidencia extrapolada de la fibrosis quística. Este artículo revisa las recomendaciones y la evidencia disponible de la kinesiología respiratoria, principalmente las técnicas manuales e instrumentales de drenaje bronquial y el ejercicio físico en niños con disquinesia ciliar primaria.

Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica / Tools for physical activity assessment in chronic obstructive pulmonary disease

The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice.

Acute Effects of Air Stacking Versus Glossopharyngeal Breathing in Patients with Neuromuscular Disease.

Objective: To compare the effects of Air Stacking (AS) and Glossopharyngeal Breathing (GPB) on the Maximum Insufflation Capacity (MIC) in patients with Neuromuscular Disease (NMD). Methods: We design a randomized cross-over study. Children and adolescents with NMD who were users of non-invasive mechanical ventilation were recruited. Vital capacity (VC) and MIC were measured before and after the intervention with AS and GPB. Values were compared pre- and post-intervention and were considered statistically significant if p <0.05. Results: We selected 14 patients with a median age of 12.5 years (range 9-18) with the following diagnoses: Duchenne Muscular Dystrophy (7), Spinal Muscular Atrophy Type II (3), Spinal Cord Injury (1) and Congenital Myopathies (3). The median baseline VC was 1325 ml (CI 1084-1594 ml). AS improved the VC to 1930 mL (CI 1630-2434 mL, p<0.001), and GPB increased the VC to 1600 mL (CI 1370-1960 mL, p=0.001). There was a significant difference of 290 mL (CI 168-567 mL, p<0.002) between both techniques. Conclusion: The air stacking and glossopharyngeal breathing were both effective in increasing the maximum insufflation capacity, but air stacking resulted in a greater increase in MIC.

La rehabilitación respiratoria no hospitalaria: un futuro prometedor / Respiratory rehabilitation does not hospital: a promising future

Recientemente, en el número 4, 2014 de la RAMR, Martín Sivori ha publicado una interesante revisión sobre la rehabilitación respiratoria en el domicilio de pacientes con enfermedad pulmonar obstructiva crónica (EPOC). En primer lugar, quiero destacar la importancia de este tipo de revisiones que, a partir de un análisis sistemático de la literatura, permiten tener una visión global de un tema aportando conocimientos prácticos fácilmente implementables en la clínica. Sivori, además, va un paso más allá y hace una inestimable aportación mediante las tablas 2 a 5, donde sintetiza de forma clara y acertada los modelos de entrenamiento utilizados, las pautas de ejercicio, los equipos y pacientes candidatos a seguir programas de entrenamiento en el domicilio

Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedades neuromusculares / Therapeutic strategies to increase the effectiveness of cough

Cough is a natural reflex that protects respiratory airways against infections or mucus retention. Cough maintains an adequate cleaning of the airways and is a mainstay of respiratory therapy. It can be triggered voluntarily by the patient or by a specific cough device. Peak cough flow (PCF) is used to assess the effectiveness of the cough. When this value is below 160 L/min, cough is considered inefficient and becomes a risk factor for respiratory problems. Patients with weak cough, especially those with neuromuscular disease, have in common a low tidal volume and a decreased maximum insufflation capacity. Both factors directly affect the inspiratory phase previous to cough, which is considered vital to obtain the optimum flow for a productive cough. Different therapeutic measures may help to increase cough efficiency among patients with cough weakness. These interventions may be performed using manual techniques or by mechanical devices. The aim of this review is to analyze the different techniques available for cough assistance, set a hierarchy of use and establish a scientific basis for their application in clinical practice.