Análise da função respiratória em músicos instrumentistas de sopro / Analysis of the breathing function in wind instrumental musicians

Objetivo: realizar uma revisão integrativa a respeito da função pulmonar e da força muscular respiratória nos músicos de instrumentos de sopro. A relação da função respiratória com a utilização de instrumentos musicais de sopro é uma área do conhecimento ainda pouco explorada. Métodos: Realizada a revisão bibliográfica nas bases de dados MEDLINE, Embase, Cochrane, PeDro, BVS, Scopus, Web of Science e SciELO, através da combinação das palavras-chave "respiratory function test", "wind instrument", musician, "pulmonary ventilation" e "Lung Function Test". Resultados: Inicialmente foram encontrados 108 artigos, sendo que destes foram selecionados 11, totalizando 596 músicos instrumentistas de sopro, que fizeram parte dos grupos de estudo. Na maioria dos estudos os músicos apresentaram valores menores do volume expirado no primeiro segundo (VEF1) e da capacidade vital forçada (CVF) na espirometria que o grupo controle. No entanto, sem diferença quanto a relação VEF1/CVF. Assim como não há diferença na força muscular respiratória ou relação com doenças respiratórias. Conclusão: Os estudos atuais a respeito da consequência do instrumento de sopro em indivíduos não são capazes de evidenciar impactos positivos ou negativos na saúde respiratória desta população.

Objective: To conduct an integrative review of lung function and respiratory muscle strength in wind instrument musicians. The relationship between respiratory function and the use of wind musical instruments is an area of knowledge that has not been extensively explored. Methods: A bibliographic review was carried out in the MEDLINE, Embase, Cochrane, PeDro, BVS, Scopus, Web of Science, and SciELO databases by combining the keywords "respiratory function test", "wind instrument", musician, "pulmonary ventilation" and "Lung Function Test". Results: Initially, 108 articles were found, of which 11 were selected, totaling 596 wind instrumentalists who were part of the study groups. In most studies, musicians showed lower values of expired volume in one second (FEV1) and forced vital capacity (FVC) in spirometry than in the control group. However, there was no difference regarding the FEV1/FVC ratio, just as there was no difference in respiratory muscle strength or relationship with respiratory diseases. Conclusion: Current studies regarding the effect of wind instruments on individuals are unable to show positive or negative impacts on the respiratory health of this population.

Fitness checklist model for spontaneous breathing tests in pediatrics / Modelo de checklist de, aptidão para teste de respiração espontânea em pediatria

ABSTRACT Objective: To evaluate whether a model of a daily fitness checklist for spontaneous breathing tests is able to identify predictive variables of extubation failure in pediatric patients admitted to a Brazilian intensive care unit. Methods: This was a single-center, cross-sectional study with prospective data collection. The checklist model comprised 20 items and was applied to assess the ability to perform spontaneous breathing tests. Results: The sample consisted of 126 pediatric patients (85 males (67.5%)) on invasive mechanical ventilation, for whom 1,217 daily assessments were applied at the bedside. The weighted total score of the prediction model showed the highest discriminatory power for the spontaneous breathing test, with sensitivity and specificity indices for fitness failure of 89.7% or success of 84.6%. The cutoff point suggested by the checklist was 8, with a probability of extubation failure less than 5%. Failure increased progressively with increasing score, with a maximum probability of predicting extubation failure of 85%. Conclusion: The extubation failure rate with the use of this model was within what is acceptable in the literature. The daily checklist model for the spontaneous breathing test was able to identify predictive variables of failure in the extubation process in pediatric patients.

RESUMO Objetivo: Avaliar se um modelo de checklist diário de aptidão para o teste de respiração espontânea é capaz de identificar variáveis preditivas de falha no processo de extubação em pacientes pediátricos internados em uma unidade de terapia intensiva brasileira. Métodos: Estudo unicêntricotransversal, com coleta prospectiva de dados. O modelo de checklist foi elaborado com 20 itens e aplicado para avaliação de aptidão para o teste de respiração espontânea. Resultados: A amostra foi composta de 126 pacientes pediátricos em ventilação mecânica invasiva, 85 do sexo masculino (67,5%), para os quais foram aplicadas 1.217 avaliações diárias à beira do leito. A pontuação total ponderada do modelo de predição apresentou o maior poder de discriminação para a realização do teste de respiração espontânea, com índices de sensibilidade e especificidade para a falha de aptidão de 89,7% ou sucesso de 84,6%. O ponto de corte sugerido pelo checklist foi 8, com probabilidade de falha de extubação inferior a 5%. Observou-se que a falha aumentou progressivamente com o aumento da pontuação obtida, com probabilidade máxima de predição de falha de extubação de 85%. Conclusão: A taxa de falha de extubação com a utilização desse modelo ficou dentro do que é aceitável na literatura. O modelo de checklist diário para aptidão do teste de respiração espontânea foi capaz de identificar variáveis preditivas de falha no processo de extubação em pacientes pediátricos.

Programa Condicionamento Vocal e Respiratório (CVR): proposta de intervenção para profissionais da voz / Vocal and Respiratory Conditioning (VRC) Program: intervention proposal for voice professional / Programa de Condicionamiento Vocal y Respiratorio (CVR): propuesta de intervención para profesionales de la voz

Programas de intervenção para profissionais da voz podem englobar estratégias de treinamento muscular vocal e respiratório. Neste tipo de abordagem, a integração de ações fonoaudiológicas e fisioterapêuticas tem produzido resultados positivos. A presente comunicação tem como objetivo apresentar uma proposta de intervenção fonoaudiológica e fisioterapêutica denominada Condicionamento Vocal e Respiratório (CVR), desenvolvida com profissionais da voz. Composta por oito encontros semanais, ela teve como objetivo aumentar a resistência vocal e respiratória dos participantes, promovendo melhor desempenho profissional. Para a fonação, foram indicados exercícios de trato vocal semiocluído com a utilização de canudos comerciais e de silicone; para a respiração, foram realizados exercícios com um incentivador a fluxo (Respiron Classic®).

Intervention program for voice professionals may cover strategies for vocal and respiratory muscle training. The integration of speech-language pathology and physiotherapeutic interventions in these approaches has resulted in positive outcomes. This communication aims to introduce a proposal for speech-language pathology and physiotherapy intervention called Vocal and Respiratory Conditioning (VRC). Developed with voice professionals and consisting of eight weekly meetings, this proposal aimed to increase the vocal and respiratory endurance of the participants, promoting better professional performance. On the one hand, semi-occluded vocal tract exercises using commercial and silicone straws were indicated for phonation; on the other hand, exercises with a flow stimulator (Respiron®) were performed for breathing.

Los programas de intervención para profesionales de la voz pueden incluir estrategias de entrenamiento de los músculos vocales y respiratorios. En este tipo de abordaje, la integración de las acciones de fonoaudiología y fisioterapia ha producido resultados positivos. Esta comunicación tiene como objetivo presentar una propuesta de intervención fonoaudiológica y fisioterapeutica denominada Condicionamiento Vocal y Respiratorio (CVR), desarrollada con profesionales de la voz. Compuesto por ocho reuniones semanales, tuvo como objetivo aumentar la resistencia vocal y respiratoria de los participantes, promoviendo un mejor desempeño profesional. Para la fonación, se indicaron ejercicios de vías vocales semicerrados utilizando canutos comerciales y de silicona; para la respiración, los ejercicios se realizaron con un estimulador de flujo (Respiron Classic®).

Lung function and stress echocardiography in pulmonary arterial hypertension: a cross-sectional study

ABSTRACT BACKGROUND: The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals. OBJECTIVE: To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients. DESIGN AND SETTING: Single-center prospective study conducted in a Brazilian university hospital. METHODS: We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables. RESULTS: The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia. CONCLUSIONS: The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.

Pranayama improves cardio-respiratory efficiency and physical endurance in young healthy volunteers

Background: Pranayama involves manipulation of the breath, which is a dynamic bridge between body and mind. The aim of the study was to compare cardio respiratory parameters before and after pranayama practice and to correlate the changes in physical endurance with the changes in cardio-respiratory parameters.Methods: A quasi experimental study was conducted among 120 healthy students in the age group 18-25 years. These students were given pranayama practice for 30 minutes a day for 3 days in a week for 12 weeks. The subjects were assessed for various cardio-respiratory parameters like respiratory rate (RR), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR) , breath holding time (BHT), Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), hand grip and rate of oxygen uptake per minute (VO2max) before and after pranayama practice. Statistical analysis included descriptive statistics, paired t test and Pearson correlation.Results: There was a significant decrease in RR, HR, SBP and DBP after pranayama practice. BHT, FVC, FEV1, PEFR, hand grip and vo2 max were significantly increased after pranayama practice. Physical endurance is positively correlated with hand grip and heart rate.Conclusions: The results emphasis the health benefits of pranayama. Regular pranayama improves the cardiovascular efficiency and physical endurance. In spite of yogic training being not very vigorous, cardio-respiratory efficiency was found to increase. Pranayama practice can be advocated to improve cardio-respiratory efficiency for patients as well as healthy individuals.

Verticalization of frontal P axis on electrocardiography in patients with acute exacerbation of chronic obstructive pulmonary disease and asthma / 中华全科医师杂志

Objective@#To investigate the clinical significance of verticalization of frontal P axis on electrocardiagraphy (ECG) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma.@*Methods@#Thirty five COPD patients and 20 asthma patients with acute exacerbation admitted in Jing′an District Central Hospital were enrolled and 20 health subjects served as a control group. The 12 lead ECG examination, pulmonary function test and high resolution CT (HRCT) scan of lung were performed. The P axis in ECG, pulmonary function and CT emphysema score were compared among three groups. The correlation of P axis verticalization with pulmonary function and CT emphysema score was analyzed.@*Results@#There were significant differences in P axis(F=24.36), FEV1/FVC(F=39.36), FEV1(F=28.82), FEV1%(F=30.64), FVC%(F=3.45), PEF%(F=13.22), RV/TLC(F=10.46) and total emphysema score (F=50.60) among the three groups (all P<0.01). P axis was positively correlated with age(r=0.229), total emphysema score(r=0.567), upper lung emphysema score(r=0.542), middle lung emphysema score(r=0.507), lower lung emphysema score(r=0.572)(all P<0.01), and negative correlation with body mass index(r=-0.491), cardiothoracic ratio (r=-0.396), FEV1/FVC(r=-0.609), FEV1(r=-0.389), FEV1%(r=-0.460), and PEF% (r=-0.419)(all P<0.01). Taking P axis>60 ° as cut-off value for screening COPD, the sensitivity was 0.933, specificity was 0.667, positive predictive value was 0.833 and negative predictive value was 0.857.@*Conclusion@#The verticalization of frontal P axis on ECG is significantly associated with obstructive ventilation disorder and CT emphysema score, which can be used as a preliminary screening index for COPD.

Effect of Smoking Duration, Smoked Cigarettes per Day and Cessation Period on Pulmonary Function in Ex-smokers: Based on the 6th Korea National Health and Nutrition Examination Survey Data (KNHANES, 2016)

PURPOSE: This study aimed to investigate the effect of smoking duration, smoked cigarettes per day and smoking cessation period on pulmonary function among ex-smokers: based on the 6th Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: This study was analyzed using the 6th KNHANES data. Pulmonary function tests were performed on a total of 4,214 adults (>40 years old). A total of 770 adults ex-smokers were eligible for inclusion in the final analysis. Forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and FEV₁/FEV were measured to evaluate pulmonary function. RESULTS: This study showed that there were significant differences in both FEV₁ and FVC values based on gender, age and height, among ex-smokers. FEV₁/FVC significantly differed by age, height and the smoking duration prior to smoking cessation. Multiple regression analysis revealed that, FEV₁/FVC accounted for 26.0% of the variance by age, height and smoking duration. There was a difference in the mean value of FEV₁/FVC with or without smoking for more than 10 years. CONCLUSION: This study's findings show that smoking for over 10 years in an ex-smoker can lead to problems with the respiratory system. The long-term cigarette has progressive ill effects on the respiratory system.

Nursing intervention for respiratory function exercise in patients with silicosis complicated by stable chronic obstructive pulmonary disease / 中华劳动卫生职业病杂志

Objective@#To investigate the clinical effect of nursing intervention for respiratory function exercise in patients with silicosis complicated by stable chronic obstructive pulmonary disease (COPD) .@*Methods@#A total of 60 patients with silicosis complicated by stable COPD who were hospitalized in Department of Occupational Diseases, Laigang Hospital Affiliated to Taishan Medical College, from August 2017 to April 2018 were enrolled and randomly divided into control group and observation group, with 30 patients in each group. The patients in the control group were given routine treatment and respiratory function exercise, and those in the observation group were given nursing intervention in addition to the treatment in the control group. The two groups were compared in terms of pulmonary function, blood gas parameters, and six-minute walk distance before intervention and after 2 months of intervention.@*Results@#After intervention, the observation group had significantly higher forced expiratory volume in 1 second (FEV1) , forced vital capacity (FVC) , arterial partial pressure of oxygen (PaO2) , and six-minute walk distance than the control group (P<0.05) , while there were no significant differences between the two groups in FEV1/FVC and partial pressure of carbon dioxide (P>0.05) .@*Conclusion@#Nursing intervention can effectively improve FEV1, FVC, PaO2, and 6-minute walking distance in patients with silicosis complicated by stable COPD.

Prevalencia de síntomas respiratorios y riesgo de obstrucción al flujo aéreo en ginebra - valle del cauca / Prevalence of respiratory symptoms and risk of obstruction to air flow in ginebra - valle del cauca / Prevalência de sintomas respiratórios e riscos de obstrução ao fluxo de aire em ginebra - valle del cauca

RESUMEN Antecedentes y Objetivo: La prevalência de los principales síntomas respiratorios en Ginebra (Valle del Cauca) es desconocida. Este estudio busca investigar la prevalencia de disnea, tos, sibilancias y expectoración en Ginebra, un municipio rural de Colombia. Métodos: Se realizó un estudio de corte transversal, con una estrategia de muestreo por conglomerados para tener una muestra representativa de adultos mayores de 40 años. Cada paciente fue entrevistado con dos cuestionarios, el cuestionario de síntomas respiratorios Ferris validado para el español y el cuestionario de función pulmonar (LFQ), de este último, un puntaje menor o igual a 18 puntos fue considerado como riesgo de obstrucción al flujo aéreo. El análisis de datos fue realizado con software estadístico, el tamaño de muestra fue de 115 sujetos (prevalencia 50%, precisión 10% y porcentaje de pérdida del 20%), las variables cuantitativas se resumieron en frecuencias y porcentajes y las variables cuantitativas en medianas y rangos intercuartílicos, la prevalencia de síntomas respiratorios se calculó con un intervalo de confianza del 95% y se realizaron cruces exploratorios entre las variables de síntomas respiratorios y antecedentes exposicionales. Resultados: 146 sujetos, 2 pérdidas, mediana de edad 60,5 años (RIQ:22), 52,1% hombres, prevalencia de tos 18,1% (IC95%:11,8-24,3), expectoración 20,1% (IC95%:13,9-27,1), sibilancias 28,2% (IC95%:21,1-35,9), disnea 33,3% (IC95%:25-41), personas a riesgo de limitación flujo aéreo 19,4% (IC95%:14,2-28,4). En la realización de cruces exploratorios se obtuvo una relación entre el número de paquetes año y la presencia de tos (p=0,008), antecedente de exposición a leña y tos (p=0,008), número de paquetes año y expectoración (p=0,018), sibilancias y consumo de cigarrillo (p=0,047), disnea y antecedente de enfermedad coronaria (p=0,028), disnea y antecede de hipertensión arterial (p=0,037). Conclusión: La disnea es el síntoma respiratorio más frecuente en pacientes mayores de 40 años en Ginebra (Valle del Cauca), el antecedente de tabaquismo se relacionó con tos y sibilancias. La utilización de un cuestionario de síntomas respiratorios puede ser útil para identificar pacientes con riesgo de obstrucción al flujo aéreo cuando se compara con el auto-reporte de enfermedad respiratoria.

ABSTRACT Background and objective: The prevalence of main respiratory symptoms in Ginebra (Valle del Cauca) is unknown. This study aimed to investigate dyspnea, cough, wheezes and expectoration in Ginebra a Town of Colombia. Methods: A cross-sectional design and a random, conglomerates-sampling strategy were used to provide representative samples of adults aged > 40 years. Each participant was interviewed with two questionnaires, validated Spanish version of the Ferris Respiratory Questionnaire and Lung Function Questionnaire (LFQ), of the latter, and a score less or equal 18 points was considered with risk of obstructive airflow. Analysis was performed using statistical software, sample size of 115 subjects (prevalence 50%, precision 10% and lost percentage 20%), the variables quantitative were summarized with frequencies and percentages, and the variables qualitative in Median and range interquartile, the prevalence of respiratory symptoms was calculated with CI95%, exploratory analysis were made with respiratory symptoms variables and exposure antecedents. Results: 146 participants, with 2 missing, Median of age 60,5 years (IQR: 22), 52,1% men, prevalence of cough 18,1% (CI95%: 11,8-24,3), expectoration 20,1% (IC95%:13,9-27,1), wheezes 28,2% (IC95%:21,1-35,9), dyspnea 33,3% (CI95%:25-41), subjects with risk of airflow obstruction 19,4% (CI95%:14,2-28,4). Exploratory analysis showed relationship between package-year index and cough (p=0,008), wood smoke exposure and cough (p=0,008), package-year index and expectoration (p=0,018), wheezes and smoking exposure (p=0,047), dyspnea and coronary disease (p=0,028), and dyspnea and arterial hypertension (p=0,037). Conclusion: Dyspnea is the respiratory symptom more frequent in Ginebra (Valle del Cauca), the antecedent of smoking was relationship with cough and wheezes. Using a questionnaire of respiratory symptoms can be useful to identify patients with risk of airflow obstruction, when is compared with the auto-report of respiratory disease.

RESUMO Antecedentes e objetivo: A prevalência de sintomas respiratórios principais em Ginebra (Valle del Cauca) é desconhecida. Este estudo teve como objetivo investigar a dispneia, tosse, sibilos e expectoração em Ginebra, uma cidade da Colômbia. Métodos: Um desenho transversal e uma estratégia aleatória de amostragem de conglomerados foram utilizados para fornecer amostras representativas de adultos com idade> 40 anos. Cada participante foi entrevistado com dois questionários, versão validada em espanhol do Questionário Respiratório Ferris e Questionário de Função Pulmonar (LFQ), sendo este último considerado menor ou igual a 18 pontos com risco de fluxo obstrutivo de ar. A análise foi realizada utilizando software estatístico, tamanho de amostra de 115 indivíduos (prevalência 50%, precisão 10% e porcentagem perdida de 20%), as variáveis quantitativas foram resumidas com freqüências e porcentagens, e as variáveis qualitativas na mediana e intervalo interquartil, a prevalência de Os sintomas respiratórios foram calculados com IC95%, foram realizadas análises exploratórias com variáveis de sintomas respiratórios e antecedentes de exposição. Resultados: 146 participantes, com 2 perdidos, médios de idade 60,5 anos (IQR: 22), 52,1% homens, prevalência de tosse 18,1% (CI95%: 11,8-24,3), expectoração 20, 1% (IC95%: 13,9-27,1), sibilos 28,2% (IC95%: 21,1-35,9), dispnéia 33,3% (CI95%: 25-41), indivíduos com risco de obstrução do fluxo aéreo 19,4% (CI95%: 14,2-28,4). A análise exploratória mostrou relação entre índice do ano da embalagem e tosse (p = 0,008), exposição à fumaça da madeira e tosse (p = 0,008), índice do ano da embalagem e expectoração (p = 0,018), sibilos e exposição ao tabagismo (p = 0,047) dispnéia e doença coronária (p = 0,028) e dispnéia e hipertensão arterial (p = 0,037). Conclusão: A disnea é o sintoma respiratório mais freqüente em Ginebra (Valle del Cauca), o antecedente do tabagismo foi relação com tosse e sibilância. O uso de um questionário de sintomas respiratórios pode ser útil para identificar pacientes com risco de obstrução do fluxo aéreo, quando comparados com o auto-relato de doenças respiratórias.

Effects of Exercise on Cervical Angle and Respiratory Function in Smartphone Users

OBJECTIVES: The aim of this study was to determine whether exercises can change the cervical angle and respiratory function in smartphone users. METHODS: Thirty healthy volunteers were recruited. The subjects were randomly divided into an exercise group and a control group. All participants used a smartphone for 1 hour while maintaining a sitting posture. Then, each group performed their assigned activity. The exercise group performed two types of exercises and the control group maintained routine activities for 20 minutes. To investigate the changes in cervical angle and respiratory function, we measured the craniovertebral angle by using a spirometer. RESULTS: Statistically significant differences were noted in the craniovertebral angle, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure of the two groups (p < 0.05). CONCLUSION: Our findings showed that proper exercise could be a good method of improving the cervical angle and respiratory function in smartphone users.

Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

PURPOSE: It is recommended to use 200 (2 puffs) or 400 (4 puffs) µg of salbutamol in the bronchodilator response (BDR) test. We aimed to compare the difference between these 2 doses with regard to small airway dysfunction. METHODS: One hundred sixteen subjects who visited the hospital for diagnosis or follow-up of asthma were consecutively enrolled between June 1 and November 31, 2013. The subjects were randomly assigned to the BDR test at the 2 doses (200 or 400 µg of salbutamol), with physicians blinded to the group each subject was assigned to and undertook the BDR test using the spirometry and impulse oscillometry system (IOS). RESULTS: A total of 116 subjects participated in this study; the mean age was 7.8±3.6 years. The number of participants who were assigned to 2 and 4 puffs groups was 59 and 57, respectively. The mean age was older in the 4 puffs group than in the 2 puffs group (P=0.008). There were no significant difference in spirometric and oscillometric parameters between the 2 and 4 puffs groups. However, in subgroup analysis of asthmatic patients on maintenance therapy (n=21), there was a significant difference in relative changes in Rrs5 between the 2 and 4 puffs groups (16.4%±9.6% vs. 28.7%±8.8%, P=0.035). The forced expiratory volume of 1 second showed a significant correlation with resistance in the 2 puffs group and with reactance in the 4 puffs group. CONCLUSION: There was a significant relationship between the amounts of bronchodilators administered and the small airway dysfunction in children with asthma on maintenance therapy. Further research is warranted to delineate changes in spirometric and IOS measures in accordance with the different amounts of bronchodilators administered.

Analysis of Pulmonary Function Test in Korean Patients With Duchenne Muscular Dystrophy: Comparison of Foreign and Korean Reference Data

OBJECTIVE: To determine the abnormal pulmonary function value in Korean Duchenne muscular dystrophy (DMD) patients, we performed a comparative analysis of the patients' pulmonary function value expressed as % of the overseas reference data and Korean healthy children and adolescent reference data. METHODS: We performed pulmonary function test (PFT) in a total of 27 DMD patients. We compared the patients' FVC% and FEV1% of the overseas reference data with those of the Korean children and adolescent reference data. Also, we compared the patients' MIP% and MEP% of the prediction equation data with those of the Korean children and adolescent reference data. RESULTS: Age of the subjects ranged from 8 to 16 years (12.03±2.27 years). The mean maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak cough flow (PCF) were 36.93±9.5 cmH₂O, 45.79±17.46 cmH₂O, 1.4±0.43 L, 1.45±0.45 L, 1.40±0.41 L, and 206.25±61.21 L/min, respectively. The MIP%, MEP%, and FVC% of the Korean children and adolescent reference data showed statistically significant higher values than those of the prediction equation data. CONCLUSION: We observed a clear numeric difference between Korean DMD patients' pulmonary function value expressed as % of the overseas data and inland data. To perform a precise assessment of respiratory function and to determine appropriate respiratory therapy, pulmonary function values of Korean DMD patients should be interpreted taking into account the inland normal pulmonary function test data.

Influenza Vaccination Coverage Rate according to the Pulmonary Function of Korean Adults Aged 40 Years and Over: Analysis of the Fifth Korean National Health and Nutrition Examination Survey

Influenza vaccination is an effective strategy to reduce morbidity and mortality, particularly for those who have decreased lung functions. This study was to identify the factors that affect vaccination coverage according to the results of pulmonary function tests depending on the age. In this cross-sectional study, data were obtained from 3,224 adults over the age of 40 who participated in the fifth National Health and Nutrition Examination Survey and underwent pulmonary function testing in 2012. To identify the factors that affect vaccination rate, logistic regression analysis was conducted after dividing the subjects into two groups based on the age of 65. Influenza vaccination coverage of the entire subjects was 45.2%, and 76.8% for those aged 65 and over. The group with abnormal pulmonary function had a higher vaccination rate than the normal group, but any pulmonary dysfunction or history of COPD did not affect the vaccination coverage in the multivariate analysis. The subjects who were 40-64 years-old had higher vaccination coverage when they were less educated or with restricted activity level, received health screenings, and had chronic diseases. Those aged 65 and over had significantly higher vaccination coverage only when they received regular health screenings. Any pulmonary dysfunction or having COPD showed no significant correlation with the vaccination coverage in the Korean adult population.

Impacto de la frecuencia y la gravedad de la rinitis sobre la función pulmonar en niños y adolescentes sin asma / Impact of frequency and severity of rhinitis on lung function in children and adolescents without asthma

Introducción. Se han observado alteraciones espirométricas en pacientes con rinitis, sin asma, proporcionales al grado clínico de la rinitis establecido por la guía Allergic Rhinitis and its Impact on Asthma (ARIA). Recientemente se ha validado una nueva clasificación de la rinitis como ARIA modificada (ARIAm), que disocia la forma moderada de la grave. Se desconoce el impacto de la rinitis sobre la función pulmonar considerando su frecuencia y gravedad por separado. Objetivos. Determinar las posibles alteraciones de la función pulmonar y su potencial reversibilidad al broncodilatador en niños y adolescentes con rinitis alérgica y no alérgica sin asma, de acuerdo a su frecuencia (intermitente y persistente) y gravedad (leve, moderada y grave) establecida según ARIAm. Población y métodos. Estudio observacional, analítico de corte transversal, que incluyó pacientes de ambos sexos, entre 5 y 18 años, con rinitis alérgica y no alérgica, sin asma. Se realizó espirometría por curva flujo-volumen y se analizó la existencia de anormalidades en la función pulmonar y la respuesta broncodilatadora en relación con el grado de rinitis por ARIAm ajustando un modelo logístico. Se consideró un valor de p<0,05 para establecer significación estadística. Resultados. Se incluyeron 189 pacientes. En 42 (22,2%) se observó al menos un parámetro alterado en la función pulmonar. Los pacientes con rinitis persistente exhibieron mayor afectación de la función pulmonar que los de grado intermitente (p=0,0257). El defecto funcional fue más frecuente en las formas grave y moderada que en el grado leve (p=0,0052) y fue independiente de la condición de atopia (p=0,1574 para frecuencia y p =0,5378 para gravedad). No se encontró diferencia en la reversibilidad al broncodilatador entre los grupos (p=0,1859 y p=0,0575, respectivamente). Conclusiones. La alteración de la función pulmonar se asoció con rinitis persistente. Fue más prevalente en las formas moderada y grave pero no existieron diferencias significativas entre ambas. El defecto funcional se demostró tanto en rinitis alérgica como no alérgica. (AU)

Background: Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, proportional to the clinical grade established by Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline. Recently has been validated a new criteria of rhinitis classification designed as ARIA modified (ARIAm), which allow to discrimination moderate to severe grades. Rhinitis impact on lung function according to frequency and severity considering separately is unknown. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic and nonallergic rhinitis without asthma, according to the frequency and severity criteria of rhinitis classified by ARIAm. Methods: In an observational cross sectional study we included children and adolescents aged 5 to 18 years with symptoms of allergic and nonallergic rhinitis without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIAm using an adjusted logistic model. A p value <0.05 was considered statistically significant. Results: We studied 189 patients; 42 (22.2%) had some spirometric abnormalities. Patients with persistent rhinitis had greater impairment of lung function compared to intermittently grade (p = 0.0257). The functional defect was more frequent in rhinitis severe and moderate than mild grade (p = 0.0052) and was independent of atopy status both frequency (p = 0.1574) and severity (p=0.5378). There was no difference in bronchodilator reversibility between groups (p = 0.1859 and p = 0.0575 respectively). Conclusion: Impaired lung function was associated with persistent rhinitis. It was more prevalent in moderate and severe rhinitis, but there wasn't a significant difference between them. The functional defect was demonstrated in both allergic and nonallergic rhinitis.(AU)

Pattern of Respiratory Deterioration in Sporadic Amyotrophic Lateral Sclerosis According to Onset Lesion by Using Respiratory Function Tests

Most amyotrophic lateral sclerosis (ALS) patients show focal onset of upper and lower motor neuron signs and spread of symptoms to other regions or the other side clinically. Progression patterns of sporadic ALS are unclear. The aim of this study was to evaluate the pattern of respiratory deterioration in sporadic ALS according to the onset site by using respiratory function tests. Study participants included 63 (42 cervical-onset [C-ALS] and 21 lumbosacral-onset [L-ALS]) ALS patients and 31 healthy controls. We compared respiratory function test parameters among the 3 groups. Age was 57.4+/-9.6 (mean+/-SD), 60.8+/-9, and 60.5+/-7 years, and there were 28, 15, and 20 male participants, in the C-ALS, L-ALS, and control groups, respectively. Disease duration did not differ between C-ALS and L-ALS patients. Sniff nasal inspiratory pressure (SNIP) was significantly low in C-ALS patients compared with controls. Maximal expiratory pressure (MEP) and forced vital capacity percent predicted (FVC% predicted) were significantly low in C-ALS and L-ALS patients compared with controls. Maximal inspiratory pressure to maximal expiratory pressure (MIP:MEP) ratio did not differ among the 3 groups. Eighteen C-ALS and 5 L-ALS patients were followed up. DeltaMIP, DeltaMEP, DeltaSNIP, DeltaPEF, and DeltaFVC% predicted were higher in C-ALS than L-ALS patients without statistical significance. Fourteen C-ALS (77.8%) and 3 L-ALS (60%) patients showed a constant MIP:MEP ratio above or below 1 from the first to the last evaluation. Our results suggest that vulnerability of motor neurons in sporadic ALS might follow a topographic gradient.

Avaliação do comprometimento respiratório em pacientes com lúpus eritematoso sistêmico com o teste de caminhada de seis minutos / Evaluation of respiratory impairment in patients with systemic lupus erythematosus with the six-minute walk test

Objetivo: Avaliar pacientes com LES estável, sem comprometimento respiratório evidente, por meio do TC6M. Casuística e métodos: Foram recrutados 45 pacientes com LES estável. Foi utilizado o protocolo ATS/ERS para TC6M, tendo sido escolhidos dois parâmetros com pontos de corte. Resultados: Quarenta e dois dos pacientes eram mulheres.A média de idade foi 39 ± 11,4 anos; a duração média da doença, 121 ± 93,1 meses; valor médio de MRC 2 ± 0; CVF média 85,9 ± 34,2%; VEF1 médio 67,5 ± 21,6%; PIM média 82 ± 58,4%; PEM média 78 ± 37,3%; frequência cardíaca média em repouso 75 ± 12,8 bpm; frequência respiratória média em repouso 19 ± 5,3 bpm; distância média no TC6M 478 ± 82 m; SpO2 média em repouso 98 ± 0,8%; queda média em SpO2 4 ± 6 pontos. Quando a população em estudo foi dividida de acordo com o valor de corte de 400 m de distância caminhada, a frequência cardíaca imediatamente antes do teste foi significativamente menor naqueles participantes que caminharam menos de 400 m (p = 0,0043), da mesma forma que o valor da escala de Borg (p = 0,0036). De acordo com a presença de saturação ≥ 4, a frequência cardíaca ao final do teste estava significativamente mais elevada naqueles participantes exibindo dessaturação (p = 0,0170); PEM (p = 0,0282) e TC6M (p = 0,0291) estavam significativamente menores e PIM revelou uma tendência para diminuir (p = 0,0504). CVF < limite inferior do normal foi achado significativamente associado com o grupo com dessaturação (p = 0,0274). Conclusão: Comparado com TC6M, a dessaturação foi o indicador mais apropriado para localizar os pacientes com os índices mais comprometidos nos testes de função respiratória. .

Objective: Evaluate SLE stable patients, without overt respiratory compromise, by means of 6MWT. Casuistic and methods: Forty-five stable SLE patients were enrolled. The ATS/ERS protocol for 6MWT, was used and two parameters with cut-off points were chosen. Results: Forty-two patients were women. The mean age was 39 ± 11.4 years; mean duration of disease, 121 ± 93.1 months; mean value of MRC, 2 ± 0; mean FVC, 85.9 ± 34.2%; mean FEV1, 67.5 ± 21.6%; mean MIP, 82 ± 58.4%; mean MEP, 78 ± 37.3%; mean heart rate at rest, 75 ± 12.8 bpm; mean respiratory rate at rest, 19 ± 5.3 bpm; mean 6MWD, 478 ± 82 m; mean SpO2 at rest was 98 ± 0.8%; mean fall in SpO2, 4 ± 6 points. When the study population was divided according to the 400-m walk distance cut-off value, the heart rate immediately before the test was significant lower in those participants who walked less than 400 m (p = 0.0043), just like the value of Borg scale (p = 0.0036); according to the presence of saturation ≥ 4, heart rate at the end of the test was significantly higher in those participants who were showing desaturation (p = 0.0170); MEP (p = 0.0282) and 6MWD (p = 0.0291) were significantly lower, and MIP showed a tendency towards being smaller (p = 0.0504). FVC < normal inferior limit was significantly associated with the group with desaturation (p = 0.0274). Conclusion: Compared to 6MWD, desaturation was better suited to find the patients with the most compromised indexes in respiratory function tests. .

Comparación de las pruebas de función pulmonar en población adulta sana de la Provincia de Mendoza, Argentina, con valores de referencia internacionales / Comparison of Pulmonary Function Tests in Healthy Adult Population in Mendoza Province, Argentina, with International Reference Values

Las pruebas de función pulmonar (PFP) son herramientas de gran utilidad clínica, que presentan diferencias regionales, étnicas y antropométricas. El objetivo es realizar PFP a adultos sanos de la Provincia de Mendoza, Argentina, para comparar los valores obtenidos en dicha población con los valores de referencia internacionales y determinar si existe adecuada correlación. Se realizó un estudio prospectivo, transversal, observacional y descriptivo, desde noviembre 2011 a junio 2013 que incluyó a 103 personas. Se realizaron las siguientes PFP: espirometría, test de marcha de 6 minutos (T6m), presiones bucales máximas y flujo pico espiratorio (FPE). Se compararon con valores de referencia, para espirometría con NHANES III y para T6m con Enright, utilizando el modelo de regresión lineal; en el caso de FPE por comparar dos instrumentos de medición se utilizó además el método de Bland-Altman. Se observó una adecuada correlación entre los valores obtenidos en la población de Mendoza y los valores de referencia propuestos por NHANES III especialmente en el VEF1. En el caso de VEF1/CVF el uso de límite inferior de la normalidad resultó más adecuado para definir normalidad. El T6m mostró una menor distancia recorrida en la muestra estudiada. Se observó una inadecuada correlación de presiones bucales máximas entre la muestra y los valores de referencia. Se observó buena correlación entre la medición de FPE automatizado y portátil. Este es el primer estudio epidemiológico de valores normales en pruebas de función respiratoria en la población de Mendoza por lo que presenta una contribución en el conocimiento de nuestra región.

Pulmonary Function Tests (PFTs) are useful clinical tools, presenting regional, ethnic, and anthropometric differences. The aim was to perform PFTs among healthy adults in the Mendoza province, Argentina, so as to compare the values obtained in the aforesaid population with the international reference values, and determine if there is an adequate correlation. From November 2011 to June 2013, a prospective, transversal, observational and descriptive study was performed, with the participation of 103 healthy adults. The following PFTs were performed: spirometry, 6-minute walk test (6MWT), maximum static mouth pressures, and Peak Expiratory Flow. They were compared with the reference values, for spirometry with NHANES III and for T6m with Enright, using the lineal regression model; for Peak Expiratory Flow, since two measurement instruments were compared, the Bland-Altman method was also used. An adequate correlation was observed to exist between the values in Mendoza and the reference values proposed by NHANES III, particularly in the FEV1. As for FEV1/FVC, the use of the lower limit of normality was more appropriate in defining normality. The 6MWT showed that a shorter distance was covered by the tested population sample. The correlation observed for the maximum static mouth pressures between the population sample and the reference values was inadequate. An adequate correlation was observed between the automated and the portable Peak Expiratory Flow measurements. This is the first epidemiological study of normal PFT values in the Mendoza population, which contributes to the knowledge about our region.

The clinical characteristics of systemic sclerosis-related pulmonary arterial hypertension / 中华内科杂志

Objective To study the clinical,cardiopulmonary functional and hemodynamic profiles of systemic sclerosis patients with pulmonary hypertension (SSc-PAH) compared with those of idiopathic pulmonary hypertension (IPAH).Methods Patients diagnosed with SSc-PAH or IPAH by right heart catheterization were consecutively enrolled into the study between 2011 and 2013 in Peking Union Medical College Hospital (PUMCH).Cases with pulmonary hypertension related to other diseases were excluded.Demographic data,laboratory parameters,6 minutes walk distance (6MWD),pulmonary function and hemodynamic variables at the time of diagnosis were collected and compared between the two groups.Results A total of 20 SSc-PAH patients including 19 females and one male with age of (43.1 ± 12.2) years,and 18IPAH patients including 16 females and 2 males with age of (38.4 ± 12.4) years were enrolled in this study.Subjects in both groups had similar mean pulmonary arterial pressure,cardiac index and pulmonary vascular resistance (PVR) when recruited.Compared with IPAH patients,SSc-PAH patients showed significantly decreased all parameters including forced vital capacity (FVC)％ [(77.1 ± 13.2)％ vs (88.6 ± 14.9)％,P =0.026],diffusing capacity of the lung for carbon monoxide (DLCO) ％ [(46.2 ±13.1) ％ vs (66.6± 13.3)％,P ＜0.001],DLCO/alveolar ventilation(VA) [(55.1 ± 14.3)％ vs (75.1 ± 11.5)％,P ＜0.001],and 6MWD [(365.6 ±85.1) m vs (454.3 ± 136.8) m,P =0.034].In subgroup analysis of SSc-PAH patients,elevated PVR (OR 2.122,95％ CI 1.093-4.119,P =0.026) and decreased DLCO％ (OR 0.916,95％ CI 0.842-0.996,P =0.040) were independently associated with reduced 6MWD.Conclusions Under the similar hemodynamic condition,SSc-PAH patients had more severe restrictive ventilation dysfunction and diffusion capacity dysfunction.Decreased 6MWD in SSc-PAHpatients was probably related to the impairment of pulmonary function.

A 4-Year Follow-up Cohort Study of the Respiratory Functions in Toner-handling Workers

BACKGROUND: Focusing on the respiratory function for health effect indices, we conducted a cross-sectional study on workers who did and did not handle toner to compare the longitudinal changes. METHODS: Among 116 individuals who worked for a Japanese business equipment manufacturer and participated in the study, the analysis included 69 male workers who we were able to follow up for 4 years. We categorized the 40 workers engaged in toner-handling work as the exposed group and the 29 workers not engaged in these tasks as the referent group, and compared their respiratory function test results: peak expiratory flow rate (PEFR), vital capacity (VC), predicted vital capacity (%VC), forced expiratory volume in 1 second (FEV1), and forced expiratory volume in 1 second as a percent of forced vital capacity (FEV1%). RESULTS: The cross-sectional study of the respiratory function test results at the baseline and at the 5th year showed no statistically significant differences in PEFR, VC, %VC, FEV1, and FEV1% between the exposed and referent workers. Also, respiratory function time-course for 4 years was calculated and compared between the groups. No statistically significant differences were shown. CONCLUSION: Our study does not suggest any toner exposure effects on respiratory function. However, the number of subjects was small in our study; studies of larger populations will be desired in the future.

Clinical significance in non-cystic fibrosis bronchiectasis followed in a real practice / Relevância clínica em não fi brose cística bronquiectasia seguida em uma prática real

INTRODUCTION: Bronchiectasis is a chronic disorder characterized by permanent dilation of the bronchi and bronchioles accompanied by inflammatory changes in the walls of these structures and adjacent lung parenchyma. OBJECTIVE: The aim of the present study was to perform a clinical and functional characterization of adult patients with non-cystic fibrosis bronchiectasis. METHODS: A clinical, descriptive, retrospective, case-series study was carried out involving 232 patients with non-cystic fibrosis bronchiectasis treated at a lung ambulatory between 2004 and 2012. RESULTS: The sample consisted of 232 patients (134 females; mean age: 52.9 years ± 17.7; body mass index: 23.5 kg/m² ± 4.4). The predominant symptoms were cough (91.4%), expectoration (85.8%) and dyspnea (76.3%). The majority of cases were of a non-tuberculosis etiology (64.7%). Regarding lung function, the obstructive breathing pattern was predominant (43.5%). The most common comorbidities were of a cardiovascular origin (51.0%). CONCLUSIONS: Adult patients with non-cystic fibrosis bronchiectasis (mainly post-infection or post-tuberculosis in origin) are characterized by a low educational level, excessive cough, sputum, dyspnea, muscle fatigue, an obstructive breathing pattern with frequent hypoxemia and multiple comorbidities, mainly of a cardiovascular origin. However, our patients have a low index of exacerbations and hospitalizations that can be assigned to a clinical protocol for monitoring.

INTRODUÇÃO: Bronquiectasia é uma doença crônica caracterizada pela dilatação permanente dos brônquios e bronquíolos acompanhada por alterações inflamatórias nas paredes dessas estruturas e parênquima pulmonar adjacente. OBJETIVO: O objetivo do presente estudo é realizar uma caracterização clínica e funcional de pacientes adultos com bronquiectasias e fibrose não cística. Métodos: Um estudo clínico descritivo e retrospectivo foi realizado com pacientes com bronquiectasias e fibrose não cística atendidos em um ambulatório de pulmão entre 2004 e 2012. RESULTADOS: A amostra foi composta por 232 pacientes (134 mulheres, idade média: 52,9 anos ± 17,7, índice de massa corporal: 23,5 ± 4,4 kg/m2). Os sintomas predominantes foram tosse (91,4%), expectoração (85,8%) e dispneia (76,3%). A maioria dos casos foi de etiologia não tuberculosa (64,7%). Em relação à função pulmonar, o padrão de respiração obstrutiva foi predominante (43,5%). As comorbidades mais comuns foram de origem cardiovascular (51,0%). CONCLUSÕES: pacientes adultos com bronquiectasias de fibrose não cística (principalmente pós-infecção ou pós-tuberculose de origem) são caracterizados por um baixo nível de escolaridade, tosse excessiva, expectoração, dispneia, fadiga muscular, um padrão de respiração obstrutiva com hipoxemia frequente e múltiplas comorbidades, essencialmente de origem cardiovascular. No entanto, nossos pacientes têm um baixo índice de exacerbações e hospitalizações que podem ser atribuídos a um protocolo clínico para o acompanhamento.