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.

Wall shear stress: tensión de corte de la pared / Wall shear stress / Wall shear stress: esforço de cisalhamento da parede

Para analizar los resultados obtenidos mediante cirugías funcionales en las fosas nasales (septumplastia y turbinoplastia fundamentalmente), o para evaluar los trastornos funcionales generados por alteraciones anatómicas endonasales, recurrimos usualmente a respuestas de los pacientes a través de cuestionarios subjetivos (escala visual análoga), o en forma objetiva a las rinodebitomanometría y la rinomanometría acústica. En forma más reciente contamos con análisis de modelos dinámicos de flujo computarizados. Este último permite cuantificar los efectos del flujo de aire sobre las paredes nasales, fenómeno llamado wall shear stress, transpolando el término usado en el sistema cardiovascular respecto al efecto de la presión sanguínea sobre las paredes arteriales, que traducido al castellano sería tensión de corte en la pared (nasal). Este método es laborioso, costoso y de difícil acceso. Presentamos una alternativa para diagnosticar este fenómeno durante la consulta: la observación con el videoendoscopio del efecto producido por el paso del aire en forma crónica en la mucosa de las paredes nasales, realzando estos cambios mediante el uso de narrow band imaging.

When analyzing the results obtained by functional surgeries of the nostrils (mainly septumplasty and turbinoplasty), or when assessing functional disorders generated by endonasal anatomical alte rations, we usually resort to subjective questionnaires (analog visual scale), and, objetively, to rhinodebitomanometry and acoustic rhinomanometry. Nowadays, analysis of computerized Dynamic flow models allows to quantify the tension that nasal walls receive from airflow, phenomenon called wall shear stress. This concept was transposed from cardiovascular system, regarding the effect of blood pressure on the arterial walls. This method is laborious and expensive. We present an alternative method to diagnose this phenomenon in the consulting room: the observation with the videoendoscope of the effect produced by chronic air flow on nasal walls' mucosa. This changes are enhanced by the use of narrow banding imaging

Analisar os resultados obtidos através de cirurgias funcionais nas passagens nasais (septuplastia e turbinoplastia fundamentalmente), ou avaliar os distúrbios funcionais gerados por alterações anatômicas endonasais, Geralmente recorre-se a respostas do paciente através de questionários subjetivos (escala analógica visual), ou de forma objetiva à rinodebitomanometria e rinomanometria acústica. Mais recentemente, temos análises de modelos de fluxo dinâmicos computadorizados. Este último permite quantificar os efeitos do fluxo de ar nas paredes nasais, um fenômeno chamado wall shear stress, transpolar o termo usado no sistema cardiovascular em relação ao efeito da pressão arterial nas paredes arteriais, que traduzido para o português seria esforço de cisalhamento da parede (Nasal). Este método é trabalhoso, caro e de difícil acesso. Apresentamos uma alternativa para diagnosticar esse fenômeno durante a consulta: observação com o videoendoscópio do efeito produzido pela passagem de ar de forma crônica na mucosa das paredes nasais, aprimorando essas mudanças através do uso de narrow band imaging

Avaliação dos fatores de risco associados ao broncoespasmo induzido pelo exercício em crianças e adolescentes sem diagnóstico prévio de asma / Assessment of risk factors associated with exercise-induced bronchospasm in children and adolescents without prior diagnosis of asthma

Objetivo: Avaliar os fatores de risco associados ao broncoespasmo induzido pelo exercício (BIE) em crianças e adolescentes sem diagnóstico prévio de asma por meio dos parâmetros espirométricos. Métodos: 90 voluntários acima do percentil 85th do peso (EP) e 30 eutróficos (EU) participaram deste estudo. Foi realizado teste de broncoprovocação de acordo com o protocolo de Del Rio-Navarro et al. (2000), utilizando-se esteira ergométrica. O BIE foi considerado positivo quando o voluntário apresentou redução ≥ 10% do volume expiratório forçado no primeiro segundo (VEF1) basal, ou redução ≥ 26% do fluxo expiratório forçado entre 25 e 75% da capacidade vital forçada (FEF25-75%). Resultados: Houve associação do excesso de massa corpórea com o BIE demonstrado nas crianças e adolescentes, o que não foi observado com o nível de atividade física. Além disso, o diagnóstico positivo de BIE apresentou reduções significativas da função pulmonar até uma hora pós-exercício avaliado pelos métodos VEF1 e FEF25-75% da espirometria. Conclusão: O excesso de massa corporal pode influenciar no aumento da frequência de BIE em crianças e adolescentes sem o diagnóstico prévio de asma quando comparado a eutróficos por diferentes parâmetros na espirometria.

Objective: To assess risk factors associated with exercise-induced bronchospasm (EIB) in children and adolescents without prior diagnosis of asthma using spirometric parameters. Methods: 90 volunteers above the 85th percentile for weight (overweight) and 30 eutrophic participants were included in this study. EIB testing was performed according to the protocol proposed in 2000 by Del Rio-Navarro et al., using a treadmill. The EIB test was considered positive when there was a decrease of 10% or more in forced expiratory volume in one second (FEV1) or a reduction of 26% or more in forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75%). Results: There was an association between EIB and excess body mass in children and adolescents, but not between EIB and level of physical activity. Furthermore, the diagnosis of EIB was associated with prolonged significant reductions in pulmonary function parameters FEV1 and FEF 25­75%.Conclusion: Excess body weight may increase the frequency of BIE in children and adolescents without prior diagnosis of asthma when compared with eutrophic subjects, based on different spirometric parameters.

Spirometry reference values in the Brazilian population

The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF50%), 75% average vital capacity (FEF25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

Bronchodilator response cut-off points and FEV 0. 75 reference values for spirometry in preschoolers / Pontos de corte da resposta ao broncodilatador e valores de referência para VEF 0. 75 em espirometria de pré-escolares

ABSTRACT Objective: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. Methods: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. Results: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Conclusions: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children.

RESUMO Objetivo: Determinar os pontos de corte de resposta ao broncodilatador do VEF1, VEF0,75, VEF0,5 e FEF25-75% em crianças pré-escolares saudáveis e gerar valores de referência para o VEF0,75. Métodos: Foi realizado um estudo transversal de base comunitária em crianças de 3-5 anos de idade. Pré-escolares saudáveis foram selecionados por um questionário padronizado. Foi realizada espirometria antes e depois do uso de broncodilatador. Foram definidos os pontos de corte dessa resposta como o percentil 95 de variação em cada parâmetro. Resultados: Foram recrutadas 266 crianças, e 160 (60,0%) foram capazes de gerar manobras expiratórias aceitáveis e reprodutíveis antes e depois do uso de broncodilatador. As médias de idade e estatura dos participantes foram 57,78 ± 7,86 meses e 106,56 ± 6,43 cm, respectivamente. A taxa de sucesso para o VEF0,5 foi de 35%, 68% e 70%, respectivamente, nos participantes com 3, 4 e 5 anos de idade. O percentil 95 de variação percentual do valor previsto na resposta ao broncodilatador foram, respectivamente, de 11,6%, 16,0%, 8,5% e 35,5%, para VEF1, VEF0,75, VEF0,5 e FEF25-75%. Conclusões: Nossos resultados definiram pontos de corte de resposta ao broncodilatador para o VEF1, VEF0,75, VEF0,5 e FEF25-75 em crianças pré-escolares saudáveis. Adicionalmente, foram propostas equações de referência para o VEF0,75, separadas por sexo. Os achados deste estudo podem melhorar a avaliação fisiológica da função respiratória em pré-escolares.

Efecto del entrenamiento de músculos abdominales sobre la fuerza muscular respiratoria y flujos espiratorios forzados en adolescentes sanos sedentarios / Effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in sedentary, healthy adolescents

Introducción. El entrenamiento muscular respiratorio es el método más utilizado para revertir la debilidad muscular respiratoria; no obstante, el efecto de protocolos basados en maniobras no respiratorias no ha sido suficientemente estudiado en población pediátrica. El objetivo de este estudio fue determinar el efecto del entrenamiento de la musculatura abdominal sobre la fuerza de los músculos respiratorios y los flujos espiratorios forzados en adolescentes sanos. Métodos. Estudio cuasiexperimental. La muestra estuvo integrada por adolescentes sanos divididos en dos grupos: un grupo experimental, quienes realizaron 8 semanas de entrenamiento de la musculatura abdominal activo, y un grupo control equivalente. Se midió la fuerza de los músculos abdominales, la presión inspiratoria máxima, la presión espiratoria máxima (PeMax), el flujo espiratorio máximo y el flujo máximo de tos antes y después del protocolo. Se consideró significativo un valor de p < 0,05. Resultados. Todas las variables estudiadas aumentaron significativamente en el grupo experimental; sin embargo, solo la PeMax se incrementó en el grupo control. Adicionalmente, el grupo experimental presentó una mayor PeMax que el grupo control al final del protocolo, así como también una mayor ganancia en la PeMax y flujo espiratorio máximo. Finalmente, el incremento en la PeMax se asoció con el aumento en el flujo máximo de tos en el grupo experimental, lo que no fue observado en el grupo control. Conclusión. En 8 semanas de entrenamiento de la musculatura abdominal, se logró incrementar la PeMax y el flujo espiratorio máximo en adolescentes sanos (sedentarios). Estos efectos se asociaron a incrementos en el flujo máximo de tos inducidos por la intervención.

Introduction. Respiratory muscle training is the most commonly used method to revert respiratory muscle weakness; however, the effect of protocols based on non-respiratory maneuvers has not been adequately studied in the pediatric population. The objective of this study was to establish the effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in healthy adolescents. Methods. This was a quasi-experiment. The sample was made up of healthy adolescents divided into two groups: an experimental group who completed eight weeks of active abdominal muscle training, and an equivalent control group. The following indicators were measured: abdominal muscle strength, maximal inspiratory pressure, maximal expiratory pressure (MEP), peak expiratory flow, and peak cough flow, before and after protocol completion. A value of p < 0.05 was considered significant. Results. All studied outcome measures increased significantly in the experimental group but only MEP increased in the control group. In addition, a higher MEP was observed in the experimental group compared to the control group at the end of the protocol, together with a greater increase in MEP and peak expiratory flow. Finally, the increase in MEP was associated with an increase in cough peak flow in the experimental group but not in the control group. Conclusion. After eight weeks of abdominal muscle training, MEP and peak expiratory flow increased in healthy (sedentary) adolescents. Such effects were associated with intervention-induced increases in cough peak flow.

Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility / Avaliação da resposta ao broncodilatador em pacientes pediátricos com bronquiolite obliterante pós-infecciosa: uso de diferentes critérios de identificação de reversibilidade das vias aéreas

ABSTRACT Objective: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. Methods: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. Results: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25-75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Conclusions: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications.

RESUMO Objetivo: A bronquiolite obliterante pós-infecciosa (BOPI) é uma entidade clínica que tem sido classificada como obstrução fixa e constritiva do lúmen por tecido fibrótico. Entretanto, estudos recentes utilizando oscilometria de impulso relataram resposta ao broncodilatador em pacientes com BOPI. O objetivo deste estudo foi avaliar a resposta broncodilatadora em pacientes pediátricos com BOPI, comparando critérios diferentes para a definição da resposta. Métodos: Foram avaliados pacientes pediátricos com diagnóstico de BOPI tratados em um de dois ambulatórios de pneumologia pediátrica na cidade de Porto Alegre (RS). Parâmetros espirométricos foram medidos de acordo com recomendações internacionais. Resultados: Foram incluídos 72 pacientes pediátricos com BOPI no estudo. As médias dos valores pré- e pós-broncodilatador foram claramente inferiores aos valores de referência para todos os parâmetros, especialmente FEF25-75%. Houve uma melhora pós-broncodilatador. Quando medidos como aumentos percentuais médios, VEF1 e FEF25-75% melhoraram em 11% e 20%, respectivamente. Entretanto, quando os valores absolutos foram calculados, as médias de VEF1 e FEF25-75% aumentaram somente em 0,1 l. Verificamos que a idade da agressão viral, história familiar de asma e alergia não tiveram efeitos significativos na resposta ao broncodilatador. Conclusões: Pacientes pediátricos com BOPI têm uma obstrução das vias aéreas periféricas que responde ao tratamento, mas não uma reversão completa com o broncodilatador. O conceito de BOPI como obstrução fixa e irreversível parece não se aplicar a essa população. Nossos dados sugerem que a obstrução de vias aéreas em pacientes com BOPI é variável, e esse achado pode ter importantes implicações clínicas.

The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease

The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC > or = 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P < 0.001), higher St. George Respiratory Questionnaire (SGRQ) score (P = 0.019), and higher emphysema index (P = 0.010) were associated independently with resting hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P < 0.001) were independent predictors of all-cause mortality. Our data showed that older age, higher emphysema index, higher SGRQ score, and lower FEV1 were associated independently with resting pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.

Efecto del entrenamiento de músculos abdominales sobre la función respiratoria en adolescentes sanos: Estudio piloto / Effect of abdominal muscle training on respiratory function in healthy adolescents: A preliminar study

The respiratory muscle training has been used to improve muscle strength and optimize the mechanism of cough. The aim of this study is to evaluate the effect of abdominal muscle training on respiratory muscle strength (MIP, MEP), peak expiratory flow (PEF) and peak cough flow (PCF) in healthy adolescents. The study design was quasi-experimental, variables of respiratory function were assessed before and after the muscle training protocol in a sample of sedentary healthy adolescents without gender restriction. The sample size calculated was 15 subjects. The training protocol consisted in 8 weeks of training divided into two stages (basic and advanced training plan) twice a week. Descriptive statistics were performed, tests for normality (Shapiro Wilk), U Mann Whitney test, Pearson coefficient and t-student test were used. Results are expressed as mean and its standard deviation. It was considered significant a p value < 0,05. Seventeen subjects (8 males and 9 females) entered to the study, all subjects performed the protocol and completed it without incidents. After completing the training protocol the sit-up test performance increased 21.7% (p = 0.0001), the MIP increase 16,5 cm H2O (17.1%) (p = 0.006), MEP increased 34.9 cm H2O (50,2 %) (p = 0.0001). Moreover, PEF increased 35.3 L/min (8.3%) (p = 0.003) and PCF increased 36.6 L/min (9,1%). There was no correlation between sit-up test performance and lung function variables. PEF showed only a moderate correlation with PCF (r = 0.6; p = 0.007) and MEP (r = 0.59; p = 0.01). We conclude that, in this sample, increases in respiratory muscle strength, PEF and PCF were observed after abdominal muscle training. No association between abdominal muscle strength and respiratory function variables was found before initiating the training protocol.

El entrenamiento muscular respiratorio ha sido utilizado para mejorar la fuerza de los músculos y optimizar el mecanismo de la tos. El objetivo de este estudio es evaluar el efecto del entrenamiento de músculos abdominales sobre la fuerza de los músculos respiratorios (Pimax, Pemax), flujo espiratorio máximo (FEM) y flujo máximo de tos (FMT) en adolescentes sanos. Este estudio es cuasi experimental, donde se evaluaron las variables de función respiratoria antes y después del protocolo de entrenamiento. La muestra estuvo integrada por adolescentes sanos sedentarios sin restricción de sexo. La muestra mínima estimada fue de 15 sujetos. El protocolo de entrenamiento consistió en 8 semanas de entrenamiento dividido en 2 etapas (plan básico y avanzado de ejercicios) dos veces por semana. Se realizó estadística descriptiva, pruebas de normalidad (Shapiro Wilk); se utilizó test U de Mann Whitney, coeficiente de correlación de Pearson y test t-student para muestras pareadas. Los resultados se expresan en promedios y desviación estándar. Se consideró significativo un valor de p < 0,05. Ingresaron al estudio 17 sujetos (8 hombres y 9 mujeres), todos los sujetos realizaron el protocolo completo. Posterior al protocolo los sujetos incrementaron en 21,7% el rendimiento del sit-up test (p=0,0001); la Pimax aumentó 16,5 cm H2O (+17,1%) (p=0.006), la Pemax aumentó 34,9 cm H2O (+50,2%) (p=0,0001). Por otra parte, el FEM aumentó 35,3 L/min (+8,3%) (p=0,003) y el FMT aumentó 36,6 L/min (+9,1%). La fuerza de músculos abdominales no muestra correlación con las variables de función respiratoria. Sólo FEM muestra correlación moderada con el FMT (r = 0,6; p = 0,007) y Pemax (r = 0,59; p = 0,01). Se concluye que, en la muestra estudiada, se observan incrementos en la fuerza muscular respiratoria, FEM y FMT luego de un protocolo de entrenamiento de músculos abdominales. No se observó asociación entre la fuerza muscular abdominal y las variables de función respiratoria antes de iniciado el protocolo.

Proposición de nuevas ecuaciones para calcular valores espirométricos de referencia en población chilena adulta: Sociedad Chilena de Enfermedades Respiratorias (SER) / New spirometric reference equations for healthy Chilean adults

Background: To correctly interpret spirometric results, reference values should come from the same population. Current spirometric reference equations have been under scrutiny due to deficiencies to fit adequately for Chilean population, specially, for those aged over 65 years old. Aim: To develop new spirometric reference values for Chilean adults, based on national studies in which spirometries were performed in healthy non-smoker adults. Material and Methods: A standardized database of spirometric values was developed combining spirometric data collected from five population-based studies, in which healthy nonsmoker adults participated. Spirometries from 448 males aged 19 to 84 years and from 726 females aged 19 to 94 years, obtained according to guidelines from the American Thoracic and European Respiratory Societies, were analyzed. Using multiple regression models, which included height, gender, and age, the theoretical value and inferior limits of normality were calculated for 1st second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced mid-expiratory flow rate (FEF25-75). Results: Reference values and lower limits of normality (LLN) were constructed for Chilean adults of both genders. The new proposed set of equations had a better fit, when compared with the current reference values used in Chile. Conclusions: The new spirometric references values derived from this study, fit better than currently used ones. Therefore, they should be used as new references values for Chilean adults.

Obesidade e asma: associação ou epifenômeno? / Obesity and asthma: association or epiphenomenon? / Obesidad y asma: association or epiphenomenon?

OBJETIVO: Avaliar a associação entre obesidade e asma pela comparação entre idade, gênero, classificação inicial e controle da asma, valores de volume expiratório forçado no primeiro segundo (VEF1) e fluxo expiratório forçado entre 25 e 75% (FEF25-75%) basais com os índices de massa corpórea (IMC) em adolescentes asmáticos. MÉTODOS: Estudo transversal envolvendo 120 pacientes (1,9 masculino:1 feminino) asmáticos com mediana de idade de 14,1 anos (9 a 20,1 anos), classificados quanto ao controle e gravidade da asma e avaliados pela espirometria utilizando VEF1 e FEF25-75% basais. Esses dados foram descritos pela frequência, médias e desvio padrão ou medianas e variação, sendo analisados pelos testes de ANOVA, teste t não pareado, teste exato de Fisher, Kruskal-Wallis e pela correlação de Pearson, considerando-se significante p<0,05. RESULTADOS: Não houve diferença entre os gêneros em relação à classificação inicial da asma e ao nível de controle. Receberam classificação inicial persistente 91,7% (100 casos), sendo que 106 casos (88,3%) encontravam-se parcial ou totalmente controlados. Não houve diferença estatística entre os pacientes controlados e os demais em relação ao IMC. Não foram encontradas correlações significantes entre zIMC e VEF1 e entre zIMC e FEV25-75%, analisando-se todos os pacientes e apenas pacientes com sobrepeso ou obesos. CONCLUSÕES: Neste estudo, não foi encontrada correlação significante entre sobrepeso/obesidade e asma, utilizando-se parâmetros clínicos, antropométricos e espirométricos.

OBJECTIVE: To relate obesity and asthma by comparing gender, age, initial classification of asthma, clinical control, basal forced expiratory volume in one second (FEV1) and forced expiratory flow between 25 and 75% (FEF25-75%) with rates of body mass index (BMI) in asthmatic adolescents. METHODS: Cross-sectional study involving 120 asthmatics patients (1.9 male: 1 female) with a mean age of 14.1 years (9 to 20.1 years of age), classified according to asthma severity and control, and evaluated by spirometry using their basal FEV1 and FEF25-75%. The data were described by frequency, mean and standard deviation or median and range and analyzed by ANOVA, unpaired t test, Fischer's exact test, Kruskal-Wallis and Pearson's correlation, considering significant p​​​​<0.05. RESULTS: There was no difference between gender in relation to the initial classification and the level of asthma control; 91.7% (100 cases) received initial classification as persistent and 106 cases (88.3%) were partially or totally controlled. There was no statistical difference between controlled patients and the others in relation to BMI. No significant correlations were found between zBMI and FEV1 and between zBMI and FEF25-75%, analyzing all patients and only patients with overweight or obese. CONCLUSIONS: In this study, no significant correlation was found between overweight/obesity and asthma using clinical, anthropometric and spirometric parameters.

OBJETIVO: Evaluar la asociación entre obesidad y asma por la comparación entre edad, género, clasificación inicial y control del asma, valores de volumen espiratorio forzado en el primer segundo (VEF1) y flujo espiratorio forzado entre 25 y 75% basal (FEF25-75%) con los índices de masa corporal (IMC) en adolescentes asmáticos. MÉTODOS: Estudio transversal implicando a 120 pacientes (1,9M:1F) asmáticos con mediana de edad de edad de 14,1 años (9 a 20,1 años), clasificados respecto al control y gravedad del asma, y evaluados por la espirometría utilizando su VEF1 y FEF25-75% basales. Estos datos fueron descriptos por la frecuencia, promedios y desviaciones estándar o medianas y variación y analizados por las pruebas de ANOVA, prueba t no pareada, Prueba exacto de Fisher, Kruskal-Wallis y por la correlación de Pearson considerándose significantes valores de p<0,05. RESULTADOS: No hubo diferencia entre los géneros respecto a la clasificación inicial del asma y el nivel de control. Recibieron clasificación inicial persistente 91,7% (100 casos), siendo que 106 casos (88,3%) estaban parcial o totalmente controlados. No hubo diferencia estadística entre los pacientes controlados y los restantes respecto al IMC. No se encontraron correlaciones significantes entre zIMC y VEF y entre zIMC y FEF25-75% al analizar todos los pacientes y solamente los pacientes con sobrepeso u obesos. CONCLUSIONES: En este estudio, no fue encontrada correlación significante entre sobrepeso/obesidad y asma, utilizándose parámetros clínicos, antropométricos y espirométricos.

Oscillation mechanics of the respiratory system in never-smoking patients with silicosis: pathophysiological study and evaluation of diagnostic accuracy

OBJECTIVES: Silicosis is a chronic and incurable occupational disease that can progress even after the cessation of exposure. Recent studies suggest that the forced oscillation technique may help to clarify the changes in lung mechanics resulting from silicosis as well as the detection of these changes. We investigated the effects of airway obstruction in silicosis on respiratory impedance and evaluated the diagnostic efficacy of the forced oscillation technique in these patients. METHODS: Spirometry was used to classify the airway obstruction, which resulted in four subject categories: controls (n=21), patients with a normal exam (n=12), patients with mild obstruction (n=22), and patients with moderate-to-severe obstruction (n=12). Resistive data were interpreted using the zero-intercept resistance (R0), the resistance at 4 Hz (Rrs4), and the mean resistance. We also analyzed the mean reactance (Xm) and the dynamic compliance. The total mechanical load was evaluated using the absolute value of the respiratory impedance (Z4Hz). The diagnostic potential was evaluated by investigating the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01725971. RESULTS: We observed significant (p<0.0002) increases in R0, Rrs4, Rm, and Z4Hz and significant reductions in Crs,dyn (p<0.0002) and Xm (p<0.0001). R0, Rrs4, Rm, and Z4Hz performed adequately in the diagnosis of mild obstruction (area under the curve>0.80) and highly accurately in the detection of moderate-to-severe obstruction (area under the curve>0.90). CONCLUSIONS: The forced oscillation technique may contribute to the study of the pathophysiology of silicosis and may improve the treatment offered to these patients, thus representing an alternative and/or complementary tool for evaluating respiratory mechanics. .

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos / Bronchodilator effect on maximal breath-hold time in patients with obstructive lung disease

OBJETIVO: Identificar o papel do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVOs). MÉTODOS: Estudo caso-controle incluindo pacientes com DVOs e grupo controle. Foram realizadas espirometrias antes e após o uso de broncodilatador, assim como testes de apneia respiratória, utilizando-se um microprocessador eletrônico e um pneumotacógrafo como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil, e os tempos de apneia voluntária inspiratória e expiratória máximos (TAVIM e TAVEM, respectivamente) foram determinados a partir do sinal adquirido. RESULTADOS: Um total de 35 pacientes com DVOs e 16 controles foram incluídos no estudo. O TAVIM sem o uso de broncodilatador foi significativamente menor no grupo DVO que no grupo controle (22,27 ± 11,81 s vs. 31,45 ± 15,73; p = 0,025), mas essa diferença não foi significativa após o uso de broncodilatador (24,94 ± 12,89 s vs. 31,67 ± 17,53 s). Os valores de TAVEM foram significativamente menores no grupo DVO que no grupo controle antes (16,88 ± 6,58 s vs. 22,09 ± 7,95 s; p = 0,017) e após o uso de broncodilatador (21,22 ± 9,37 s vs. 28,53 ± 12,46 s; p = 0,024). CONCLUSÕES: Estes resultados fornecem uma evidência adicional da utilidade clínica do teste de apneia na avaliação da função pulmonar e do papel do broncodilatador nesse teste.

OBJECTIVE: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD). METHODS: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end-inspiratory volume and at end-expiratory volume (BHTmaxV EI and BHTmaxV EE, respectively) were determined from the acquired signal. RESULTS: A total of 35 patients with OLD and 16 controls were included. Prior to the use of a bronchodilator, the BHTmaxV EI was significantly lower in the OLD group than in the control group (22.27 ± 11.81 s vs. 31.45 ± 15.73 s; p = 0.025), although there was no significant difference between the two groups in terms of the post-bronchodilator values (24.94 ± 12.89 s vs. 31.67 ± 17.53 s). In contrast, BHTmaxV EE values were significantly lower in the OLD group than in the control group, in the pre- and post-bronchodilator tests (16.88 ± 6.58 s vs. 22.09 ± 7.95 s; p = 0.017; and 21.22 ± 9.37 s vs. 28.53 ± 12.46 s; p = 0.024, respectively). CONCLUSIONS: Our results provide additional evidence of the clinical usefulness of the breath-hold test in the assessment of pulmonary function and add to the existing knowledge regarding the role of the bronchodilator in this test.

Teste de pressão negativa expiratória: um novo método simples para identificar pacientes com risco para apneia obstrutiva do sono / Negative expiratory pressure test: a new, simple method to identify patients at risk for obstructive sleep apnea

O objetivo deste artigo foi descrever um novo método para avaliar a limitação ao fluxo expiratório durante a respiração espontânea, possibilitando a identificação do risco para apneia obstrutiva do sono através do teste de pressão negativa expiratória. A colapsabilidade da via aérea superior é avaliada pela medida da queda de fluxo e de volume expirado a 0,2 segundos imediatamente após a aplicação de pressão negativa expiratória de 10 cmH2O. O teste de pressão negativa expiratória é de fácil aplicação e poderia ser utilizado na avaliação da limitação ao fluxo expiratório causada por obstrução da via aérea superior em sujeitos portadores de apneia obstrutiva do sono.

The objective of this article was to describe a new method for assessing expiratory flow limitation during spontaneous breathing, using the negative expiratory pressure test to identify patients at risk for obstructive sleep apnea. Upper airway collapsibility is evaluated by measuring decreases in flow and in expired volume in the first 0.2 seconds after negative expiratory pressure application at 10 cmH2O. The negative expiratory pressure test is easily applied and could be adopted for the evaluation of expiratory flow limitation caused by upper airway obstruction in patients with obstructive sleep apnea.

Función pulmonar y calidad de vida en niños y adolescentes con bronquiolitis obliterante por adenovirus / Pulmonary function and quality of life in children and adolescents with bronchiolitis obliterans post-adenoviral infection

Introduction: Adenovirus infection is an important cause of pneumonia in Chilean children. Postinfectious Bronchiolitis Obliterans (PIBO) is the most important complication. There are few studies assessing pulmonary function and quality of life in PIBO patients. Objective: The aim of this study is to assess the pulmonary function and the quality of life of patients with PIBO and the correlation between both variables. Methods: 14 children with PIBO in follow up at the pediatric pulmonology outpatient clinic of a public children hospital were included in this study. Study period: April 2009 - April 2010. Pulmonary function was assessed in a medical visit by spirometry, flow/volume curve and intrathoracic gas volume measurement. The following indices were analyzed FVC, FEV1, FEV25-75, FEV1/FVC, RV, TLC, RV and RV/TLC. A survey of a self-administered Quality of Life (PedsQL, version 4.0, Spanish for Chile) was applied at the visit to investigate their global, physical and psychosocial quality of life. The Pearson linear correlation between quality of life and the pulmonary function test parameters was assessed, in the statistical analysis ap value < 0.05 was considered significant. Results: The mean age of our patients was 12.4 (range: 9-19 years-old). The functional alterations were characteristics of an obstructive respiratory disorder in 64.3 percent of the patients. Average pulmonary function test indices showed decreases in FEV1 (75 percent), FEV25-75 (48.8 percent), FEV1/FVC (67.6 percent) with normal value of FVC (93,7 percent) as well as pronounced increases in RV (333.5 percent), TLC (156 percent) and RV/TLC (51.8 percent). Mean change of FEV1 and FEV25-75post-bronchodilator was 11.3 percent and 26.4 percent respectively. Only 14.3 percent of our patients showed normal pulmonary function. The quality of life parameters were in average 58.2 percent of overall quality of life, 58.6 percent of physical quality of life and 57.9 percent of psychosocial ...

Introducción: La infección por adenovirus es una causa importante de neumonía en niños chilenos. La bronquiolitis obliterante (BOPI) es la complicación más importante. Existen pocos estudios donde evalúen la función pulmonar y la calidad de vida de los pacientes con BOPI. Objetivo: Evaluar la función pulmonar y la calidad de vida de los pacientes con BOPI y la correlación entre ambas variables. Métodos: Se incluyeron 14 niños con BOPI en el policlínico de la unidad de broncopulmonar de un hospital público de niños. Período de estudio: abril de 2009-abril de 2010. La función pulmonar se evaluó en una visita médica por espirometría, curva flujo / volumen y la determinación de volumen de gas intratorácico. Los índices analizados fueron los siguientes CVF, VEF1, FEV25-75, VEF1/CVF, VR,CPT, VR y VR / CPT. En la misma visita se realizó una encuesta auto-administrada de Calidad de Vida (PedsQL, versión 4.0, español de Chile) para investigar la calidad de vida global, física y psi-cosocial. Se aplicó la correlación lineal de Pearson entre calidad de vida y los parámetros de función pulmonar. Se consideró estadísticamente significativo unp <0,05. Resultados: La edad media de nuestros pacientes fue de 12,4 (rango: 9-19 años). La alteración funcional característica fue la obstructiva en el 64,3 por ciento de los pacientes. El promedio de los índices de pruebas de función pulmonar mostraron una disminución en VEF1 (75 por ciento), FEV25-75 (48,8 por ciento), VEF1/CVF (67,6 por ciento) con un valor normal de la CVF (93,7 por ciento), así como aumentos pronunciados en VR (333,5 por ciento), CPT (156 por ciento) y VR/CPT (51,8 por ciento). La media del cambio del VEF1 y FEV25-75post-broncodilatador fue 11,3 por ciento y 26,4 por ciento respectivamente. Sólo el 14,3 por ciento mostró una función pulmonar normal. Los parámetros de calidad de vida fueron en promedio 58,2 por ciento de calidad de vida general, 58,6 por ciento de calidad de vida física y el 57,9 por ciento...

Ultrasonido: una alternativa en la evaluación del diafragma en niños con distrofia muscular de Duchenne / Ultrasound, an alternative in the evaluation of the diaphragm in children with Duchenne muscular dystrophy

The outcome of children with Duchenne muscular dystrophy (DMD) depends on respiratory involvement, so a timely assessment of the diaphragm is required. We propose ultrasound (US) imaging as an alternative in the evaluation of the diaphragm in children with DMD, correlating diaphragmatic thickness and excursion values yielded by the US study with pulmonary function tests. We conducted a case-control study including 27 children, 15 controls and 12 patients. Excursion and thickness of both hemidiaphragms were measured by U.S., and spirometry was performed. The DMD group showed less excursion and a significantly higher thickness of the right hemidiaphragm; 60 percent of patients showed spirometric restrictive pattern and FEV1, FVC, PEF and PIM values were significantly lower. We found a negative trend when correlating diaphragmatic excursion with pulmonary function tests. We conclude that the US technique is suitable for screening alterations in diaphragmatic excursion and thickness in children with DMD, since it provides supporting data to pulmonary function tests.

El pronóstico de los niños con distrofia muscular de Duchenne (DMD) depende del compromiso respiratorio, siendo necesaria la evaluación oportuna del diafragma. Proponemos el ultrasonido (US) como alternativa en la evaluación del diafragma en niños con DMD, correlacionando los valores de excursión y grosor del diafragma obtenido con US, con las pruebas de función pulmonar. Realizamos un estudio de casos y controles, incluyendo 27 niños, 15 controles y 12 pacientes. Se midió excursión y grosor de ambos hemidiafragmas con US; se realizó espirometría y pimometría. El grupo DMD presentó menor excursión y grosor significativamente mayor del hemidiafragma derecho; el 60 por ciento mostró patrón restrictivo en la espirometría y los valores de VEF1, CVF, FEP y PIM fueron significativamente menores. Encontramos una tendencia negativa al correlacionar la excursión diafragmática con las pruebas de función pulmonar. Concluimos que el US es apto para pesquisar alteraciones en la excursión y grosor del diafragma en niños con DMD, apoyando las pruebas de función pulmonar.

Fisioterapia respiratória na fibrose cística / Respiratory physiotherapy in cystic fibrosis

A fisioterapia torácica convencional (FTC) foi introduzida na década de 1950 como padrão-ouro nos cuidados dos pacientes com fibrose cística (FC), no entanto há poucas evidências para que seu uso seja mantido na rotina diária. Neste trabalho, revisamos a evolução das condutas fisioterapêuticas em pacientes portadores de FC, bem como as novas opções de tratamento, com base nas evidências descritas na literatura nos últimos anos. Na últimas décadas, a fisioterapia respiratória modificou-se consideravelmente introduziu-se novas abordagens, tais como técnicas ativas, os pacientes são mantidos em posições mais confortáveis, que se mostram mais eficazes do que as convencionais. Entre elas, destacamos a pressão expiratória positiva (PEP), PEP oscilatória, ciclo ativo da respiração, aumento do fluxo expiratório, drenagem autógena e drenagem autógena modificada. O paciente deve conhecer e eventualmente participar, juntamente ao profissional, da definição da técnica mais apropriada a seu caso. Para tal, uma boa relação fisioterapeuta-paciente é de fundamental importância.

Conventional chest physiotherapy (CCP) started to be used in the 1950s as the gold standard in the care of patients with cystic fibrosis (CF). However, there is little evidence that its use is maintained in the daily routine. The present review of the literature presents the evolution of the practice of physical therapy in patients with CF, as well as new treatment options based on the evidence described in recent years. In the last decades respiratory physiotherapy has changed considerably. By means of new approaches, such as active techniques, patients are offered more comfortable positions, which are more effective than the conventional ones. Among these techniques, the following are highlighted: positive expiratory pressure (PEP), oscillatory PEP, active cycle of breathing, expiratory flow increase, autogenic drainage, and modified autogenic drainage. Patients must understand the therapy and help the physical therapist to define the most appropriate technique for their cases. A good physical therapistpatient relationship is crucial so that such objective can be achieved.

Artificial External Glottic Device for Passive Lung Insufflation

PURPOSE: For patients with neuromuscular disease, air stacking, which inflates the lungs to deep volumes, is important for many reasons. However, neuromuscular patients with severe glottic dysfunction or indwelling tracheostomy tubes cannot air stack effectively. For these patients, we developed a device that permits deep lung insufflations substituting for glottic function. MATERIALS AND METHODS: Thirty-seven patients with bulbar-innervated muscle weakness and/or tracheostomies were recruited. Twenty-three had amyotrophic lateral sclerosis, and 14 were tetraplegic patients due to cervical spinal cord injury. An artificial external glottic device (AEGD) was used to permit passive deep lung insufflation. In order to confirm the utility of AEGD, vital capacity, maximum insufflation capacity (MIC), and lung insufflation capacity (LIC) with AEGD (LICA) were measured. RESULTS: For 30 patients, MICs were initially zero. However, with the use of the AEGD, LICA was measurable for all patients. The mean LICA was 1,622.7+/-526.8 mL. Although MIC was measurable for the remaining 7 patients without utilizing the AEGD, it was significantly less than LICA, which was 1,084.3+/-259.9 mL and 1,862.9+/-248 mL, respectively (p<0.05). CONCLUSION: The AEGD permits lung insufflation by providing deeper lung volumes than possible by air stacking.

Pulmonary functions in children with segmental Mycoplasma pneumoniae pneumonia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the changes of pulmonary functions in children with segmental Mycoplasma pneumoniae pneumonia (SMPP).</p><p><b>METHODS</b>A total of 55 children with SMPP were recruited into this study. Pulmonary functions were measured at both acute and recovery phases, including FVC, FEV1, FEV1/FVC, PEF, FEF25%, FEF50%, FEF75% and FEF25%-75%.</p><p><b>RESULTS</b>FVC, FEV1, FEV1 /FVC, PEF, FEF25%, FEF50%, FEF75%, and FEF25%-75% were reduced in all of the 55 cases at the acute phase. FEF25%, FEF50%, FEF75% and FEF25%-75% decreased more significantly. The indexes above mentioned were improved significantly at the recovery phase compared with the acute phase (P<0.05). During the acute phase FVC and FEV1 decreased more significantly in the group with multiple area lesions than in the group with single area lesions (P<0.05).</p><p><b>CONCLUSIONS</b>Both large and small airway functions are damaged in different degrees in children with SMPP during the acute phase. More cases show restrictive ventilatory disorders and the injury of small airway function is more severe. The pulmonary function is markedly improved at the recovery phase, suggesting that the pulmonary function impairments are reversible. The pulmonary function impairments are more severe in children with multiple area lesions.</p>

Técnicas de fisioterapia respiratória não provocam efeitos adversos na função pulmonar de crianças asmáticas hospitalizadas: ensaio clínico randomizado / Chest physiotherapy does not cause adverse effects on lung function in children hospitalized with asthma: randomized clinical trial

A asma é doença de prevalência elevada na criança e responsável por número significativo de hospitalizações. O emprego de técnicas convencionais de fisioterapia respiratória em pacientes durante exacerbação é controverso pela possibilidade de induzir ou acentuar broncoespasmo pré-existente.Objetivos: Identificar alterações na função pulmonar de pacientes asmáticos com hipersecreção brônquica e hospitalizados avaliando-se o volume expiratório forçado no primeiro segundo (VEF 1) e o pico de fluxo expiratório (PFE) após a realização de técnicas convencionais de fisioterapia respiratória.Pacientes e métodos: Ensaio clínico randomizado com 21 crianças asmáticas hospitalizadas por exacerbação e submetidas à tapotagem ou vibrocompressão. A função pulmonar e as frequências respiratória (FR) e cardíaca (FC) foram mensuradas antes, imediatamente após e 30 minutos após as terapias.Resultados: Onze pacientes foram submetidos à vibrocompres¬são (Vib) e dez a tapotagem (Tap). A idade variou entre 7 e 14 anos sendo 13 (62%) do sexo masculino. Os valores do VEF1 no grupo Tap antes, imediatamente após e após trinta minutos foram: 1,47±0,20 L; 1,57±0,29 L; 1,46±0,37 L respectivamente (p=0,60) e 1,54 ± 0,31 L; 1,58±0,32 L; 1,65 ± 0,27 L (p=0,21) no grupo Vib. Não houve mudanças significantes nos valores de FR, FC e do PFE.Conclusão: a Vib e a Tap aplicadas à pacientes asmáticos hospita¬lizados por exacerbação não interferiram com a função pulmonar (VEF 1 e PFE) e não induziram desconforto respiratório nesses pacientes. As técnicas de tapotagem e vibrocompressão são seguras e podem ser realizadas nestes pacientes.

Asthma is a common disease in children, and it is one ofthe major causes of hospitalization due to exacerbations. The asthmatic patient can benefitfrom treatment with conventional chest physiotherapy techniques when there ís presence of bronchial secretions; however, it may improve bronchial constriction due to inflammation.Objective: To identify adverse effects on lung function in asthmatics with hyper secretion in the hospital for evaluation of forced expiratory volume in the first second (FEV1) and expiratory peak flow (PEF) after conventional chest physiotherapy techniques. Method: Randomized clinicai trlal with 21 children hospitalized for asthma exacerbation in a pediatric hospital, submitted to percussion and vibrocompression techniques. Lung function, respiratory rate (RR) and heart rate (HR) were measured before, immediately after and 30 minutes after each therapyResults: Eleven patients were included in the vibrocompression (Vib) group and ten in the percussion (Perc) group. The age ranged between 7 and 14 years, and 13 (62%) were male. Values of VEF1 in Perc before, immediately after, and thirty minutes after were: 1.47±0.20 L, 1.57±0.29 L, 1.46±0.37 L respectively (p = 0.60) and 1.54 ± 0.31 L, 1.58±0.32 L, 1.65±0.27 L (p = 0.21) in Vib group. RR, HR and PEF did not change significantlyConclusion: Perc and Vib techniques did not alter lung function (FEV1 and PEF) and did not cause respiratory distress in hyperesecretory asthmatic patients during hospital admission, becoming safe techniques to be performed in this group.