Deglutição orofaríngea, nutrição e qualidade de vida no indivíduo com doença pulmonar crônica / Oropharyngeal deglutition, nutrition, and quality of life in individuals with chronic pulmonary disease

RESUMO Objetivo descrever a eficácia e segurança da deglutição, o risco nutricional e a qualidade de vida em deglutição e relacionar o risco nutricional com a qualidade de vida dos indivíduos com doença pulmonar crônica. Método 17 indivíduos com diagnóstico de doença pulmonar crônica foram avaliados por meio do Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL), Mini Nutritional Assessment (MNA) e índice de massa corpórea. Resultados foi encontrada alteração de eficácia da deglutição em nove (52,94%) dos indivíduos e eficácia+segurança em dois (11,77%). Todos os indivíduos estavam eutróficos na avaliação nutricional. Houve relação entre o risco nutricional com os domínios 3 (r=-0,803; p=0,05) e 5 (r=0,636; p=0,026) do SWAL-QOL. Conclusão houve alteração de eficácia e segurança da deglutição, no entanto não foi encontrado risco nutricional evidente na amostra avaliada. Ainda, houve relação entre o risco nutricional com a qualidade de vida em deglutição.

ABSTRACT Purpose Describe efficacy and safety of deglutition, nutritional risk, and quality of life in deglutition, and associate nutritional risk with quality of life in individuals with chronic pulmonary disease. Methods The participants were 17 individuals with chronic pulmonary disease evaluated using the following instruments: Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire, Mini Nutritional Assessment (MNA), and body mass index (BMI). Results Changes in efficacy were observed in nine (52.94%) individuals and impairments in efficacy and safety were found in two (11.77%) individuals. All individuals were considered eutrophic by the nutritional assessment. Correlation was observed between nutritional risk and domains 3 (r=-0.803; p=0.05) and 5 (r=0.636; p=0.026) of the SWAL-QOL questionnaire. Conclusion Changes in efficacy and safety of deglutition were observed; however, no nutritional risk was evidenced in the sample evaluated. Correlation between nutritional risk and quality of life in deglutition was also observed.

Effects of Atorvastatin on Pulmonary Function,Pulmonary Arterial Pressure and Related Indexes in Sta-ble COPD Patients:A Meta-analysis / 中国药房

OBJECTIVE:To systematically evaluate the effects of atorvastatin on pulmonary function,pulmonary arterial pres-sure and related indexes in patients with stable chronic obstructive pulmonary disease(COPD),and to provide evidence-based refer-ence. METHODS:Retrieved from Cochrane Library,PubMed,EMBase,CJFD and VIP,randomized controlled trials(RCTs)about atorvastatin combined with conventional therapy(trial group)vs. conventional therapy alone(control group)in the treatment of sta-ble COPD were collected. Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation by Cochrane Handbook Manual 5.1.0. RESULTS:Totally 7 RCTs were included,involving 371 patients. Results of Me-ta-analysis showed,FEV1 [MD=0.07,95%CI(0.04,0.09),P<0.001],FEV1%pred [MD=6.18,95%CI(2.23,10.12),P=0.002] and 6MWD [MD=55.31,95%CI(36.44,74.18),P<0.001] of trial group were significantly higher/longer than those of con-trol group;pulmonary artery systolic pressure [MD=-6.78,95%CI(-11.62,-1.94),P=0.006],mean pulmonary artery pres-sure [MD=-6.61,95%CI(-7.26,-5.96),P<0.001],St. George respiratory questionnaire [MD=-13.21,95%CI(-23.90,-2.52), P=0.02] were significantly lower than control group,with statistical significance. There was no statistical difference in FEV1/FVC [MD=3.73,95%CI(-2.08,9.55),P=0.21] or hs-CRP [MD=0.29,95%CI(-1.37,1.95),P=0.73] between 2 groups. CONCLU-SIONS:Atorvastatin can significantly improve pulmonary function and pulmonary arterial pressure in patients with stable COPD, and can improve the quality of life.

Guí­as de rehabilitación respiratoria en niños con enfermedades respiratorias crónicas: actualización 2016 / Pulmonary rehabilitation guidelines in children with chronic respiratory diseases: 2016 update

Pulmonary rehabilitation (PR) is an essential tool in the management of chronic respiratory diseases in childhood. PR improve symptoms, physical performance, quality of life and social integration in children who have limitations in their daily activities. Health professionals have a key role in identifying those children who are candidates for pulmonary rehabilitation programs, in the initial evaluation and in the implementation of therapeutic strategies for training and education. This document is intended as a reference guide for all those professionals who are dedicated to the care of children with chronic respiratory diseases.

La rehabilitación respiratoria (RR) es un componente esencial en el manejo de las enfermedades respiratorias crónicas en la infancia. La RR ha demostrado mejorar los síntomas, el rendimiento físico, la calidad de vida y su participación social en aquellos niños que tienen limitaciones en el desarrollo de sus actividades de la vida diaria. Los profesionales de la salud tienen un rol fundamental en identificar aquellos niños que son candidatos para los programas de rehabilitación respiratoria, en la evaluación inicial y en la implementación de estrategias terapéuticas de entrenamiento y de educación. Este documento pretende ser una guía de consulta para todos aquellos profesionales que se dedican a la atención de niños con enfermedades respiratorias crónicas.

Association between skin reactions and efficacy of summer acupoint application treatment on chronic pulmonary disease: A prospective study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To examine the variations in the prevalence of skin reactions and the association between skin reactions and efficacy of summer acupoint application treatment (SAAT) on chronic pulmonary disease (CPD).</p><p><b>METHODS</b>A total of 2,038 patients with CPD were enrolled at 3 independent hospitals (defined as Groups A, B and C, respectively) in China. All patients were treated by SAAT, as applying a herbal paste onto the acupoints of Fengmen (BL 12) and Feishu (BL 13) on the dog days of summer, according to the lunar calendar, in 2008. Ten days after treatment, skin reaction data (no reaction, itching, stinging, blistering, and infection) were obtained via face-to-face interviews. Patients were retreated in the same hospital one year later, thereby allowing doctors to assess treatment efficacy based on the patients' symptoms, the severity of the spirometric abnormalities, and the concomitant medications used.</p><p><b>RESULTS</b>A large number of patients (85.3%) displayed reactive symptoms; however, the marked associations between reactive symptoms and age or gender were not observed. An increased number of patients from Group B (99.3%) and Group C (76.5%) displayed reactive symptoms due to the increased mass of crude Semen Sinapis Albae. The effective rate of SAAT was as high as 90.4% for patients of Group B, which was followed by Group A (70.9%) and Group C (42.2%). Using stratified analyses, a convincing association between reactive symptoms and therapeutic efficacy was observed for patients with asthma [itching: odds ratio (OR)=2.17, 95% confidence interval (CI): 1.49 to 3.14; blistering: OR=0.43, 95% CI: 0.25 to 0.73; and no reaction: OR=0.56, 95% CI: 0.35 to 0.90]. However, the same tendency was not observed for patients with chronic bronchitis and chronic obstructive pulmonary disease.</p><p><b>CONCLUSIONS</b>SAAT can induce very mild skin reactions for patients with CPD, among which patients with asthma displayed a strong association between skin reactions and therapeutic efficacy. The skin reactions may be induced by the crude Semen Sinapis Albae.</p>

Características clínicas e demográficas de pacientes pediátricos com fibrose cística acompanhados no Hospital de Clínicas de Porto Alegre no ano de 2009 / Clinical and demography characteristics of cystic fibrosis patients attending at the Hospital de Clínicas de Porto Alegre during 2009

INTRODUÇÃO: O diagnóstico precoce, o acompanhamento e o tratamento dos fibrocísticos têm levado o crescente aumento da sobrevida. O objetivo deste estudo é descrever os pacientes pediátricos com FC em acompanhamento no HCPA em 2009. MÉTODOS: As variáveis analisadas foram: idade, gênero, idade ao diagnóstico, número de consultas e internações, resultado de cultura de escarro, swab ou aspirado de orofaringe, estado nutricional, comprometimento hepático, provas de função pulmonar, tratamento realizado e óbitos constatados. RESULTADOS: A idade média foi de 10,8 anos (DP=4,28). Cinquenta e cinco pacientes eram do gênero masculino (49,1%). A mediana de idade no diagnóstico foi de 0,48 anos. Cento e sete (54,2%) compareceram entre três a quatro consultas ambulatoriais (média 3,4 consultas/ano). Setenta e um pacientes não internaram (64%), 33 pacientes internaram uma vez (29,7%), cinco pacientes (4,55%) duas vezes e os demais internaram mais de três vezes ao ano. A prevalência de Staphylococcus aureus meticilino-sensível na via aérea foi 74,6%, Staphylococcus aureus meticilino-reistente 8,41%, Pseudomonas aeruginosa 42,99% e a de Complexo Burkholderia cepacia 24,29%. Oitenta e três pacientes (74,1 %) eram eutróficos. A solução salina hipertônica foi administrada em 79,43% dos pacientes, dornase alfa em 57%, colomicina em 42,99%, tobramicina em 30,84%, enzimas pancreáticas em 90,65%, azitromicina 33.6%, ácido ursodesoxicólico em 42,11% dos pacientes. A função pulmonar foi estudada em 78 pacientes, não havendo diferença significativa dos resultados entre os grupos etários avaliados nos anos de 2005 (p=0,670) e 2009 (p=0,482). Constatados dois óbitos durante 2009 por insuficiência respiratória. CONCLUSÃO: Nossos resultados são semelhantes aos demais centros de fibrose cística

INTRODUCTION: Early diagnosis, monitoring and treatment of cystic fibrosis has led to increasing survival. Aim: To describe pediatric patients with CF followed at the HCPA in 2009. METHODS: The variables analyzed were age, gender, age at diagnosis, number of visits and hospitalizations, results of sputum culture, throat swab or aspirate, nutritional status, liver condition, pulmonary function tests, treatment given, and recorded deaths. RESULTS: The mean age was 10.8 years (SD=4.28). Fifty-five patients were males (49.1%). The median age at diagnosis was 0.48 years. One hundred and seven (54.2%) paid three or four medical visits (mean 3.4 visits/year). Seventy-one patients were not hospitalized (64%), 33 patients were hospitalized once (29.7%), five patients (4.55%) twice, and the others were hospitalized more than three times a year. The prevalence of methicillin-sensitive Staphylococcus aureus in the airways was 74.6%, methicillinresistant Staphylococcus aureus, 8.41%, Pseudomonas aeruginosa, 42.99%, and Burkholderia cepacia complex, 24.29%. Eighty-three patients (74.1%) were eutrophic. Hypertonic saline solution was administered to 79.43% of patients; dornase alfa to 57%, colomicine, 42.99%; tobramycin, 30.84%; pancreatic enzymes, 90.65%; azithromycin 33.6%; and ursodeoxycholic acid to 42.11% of patients. Pulmonary function was studied in 78 patients, and there was no significant difference in results between age groups tested in 2005 (p=0.670) and 2009 (p=0.482). Two deaths were recorded in 2009 due to respiratory failure. CONCLUSION: Our results are similar to those of other cystic fibrosis centers

The usefulness of dyspnea rating in evaluation for pulmonary impairment/disability in patients with chronic pulmonary disease / 결핵

BACKGROUND: Resting pulmonary function tests(PFTs) are routinely used in the evaluation of pulmonary impairment/disability. But the significance of the cardiopulmonary exercise test(CPX) in the evaluation of pulmonary impairment is controvertible. Many experts believe that dyspnea, though a necessary part of the assessment, is not a reliable predictor of impairment. Nevertheless, oxygen requirements of an organis m at rest are different from at activity or exercising, and a clear relationship between resting PFTs and exercise tolerance has not been established in patients with chronic pulmonary disease. As well, the relationship between resting PFTs and dyspnea is complex. To investigate the relationship of dyspnea, Resting PFTs, and CPX, we evaluated the patients of stabilized chronic pulmonary disease with clinical dyspnea rating(baseline dyspnea index, BDI), resting PFTs, and CPX. METHOD: The 50 patients were divided into two groups: non-severe and severe group on basis of results of resting PFTs(by criteria of ATS), CPX(by criteria of ATS or Ortega), and dyspnea rating(by focal score of BDI). Groups were compared with respect to pulmonary function, indices of CPX, and dyspnea rating. RESULTS: 1) According to the criteria of pulmonary impairment with resting PFTs, VO2 max, and focal score of BDI were significantly low in the severe group(p0.05). According to focal score(