Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique / Pressões máximas inspiratórias e expiratórias no pré e pós-operatório de pacientes com hérnias incisionais abdominais corrigidas pela técnica de Lázaro da Silva

ABSTRACT Objective: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. Method: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. Results: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Conclusion: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

RESUMO Objetivo: verificar o efeito da herniorrafia incisional abdominal longitudinal na pressão dos músculos da respiração. Método: a técnica de herniorrafia incisional utilizada foi a proposta por Lázaro da Silva. Para aferir a pressão foi utilizado manômetro de água, em 20 pacientes, idade mediana 48,5 anos (mínimo 24, máximo 70). Foram analisadas a pressão máxima inspiratória no nível do volume residual (PIVR) e da capacidade residual funcional (PICRF) e a pressão máxima expiratória da capacidade residual funcional (PECRF) e da capacidade pulmonar total (PECPT), no pré-operatório e pós-operatório tardio (entre 40 e 90 dias), em 13 pacientes com hérnias incisionais grandes e em 7 pacientes com hérnias incisionais médias. Resultados: houve aumento significante da PICRF (p=0.027), da PIVR (p=0.011), da PECPT (p=0.003) nos pacientes com hérnias incisionais grandes. A PECRF aumentou, porém de forma não significante. Nos pacientes com hérnias incisionais médias as alterações não foram significantes. Conclusão: a correção cirúrgica da hérnia incisional grande melhora a função dos músculos da respiração, porém a cirurgia da hérnia incisional média não altera a referida função.

Asociación entre deterioro del flujo espiratorio máximo y prevalencia de enfermedades cardiovasculares y metabólicas en población adulta chilena: hallazgos preliminares de la Cohorte del Maule (MAUCO) / Peak expiratory flow and prevalence of cardiovascular and metabolic diseases in a Chilean adult population: preliminary findings from the Maule Cohort (MAUCO)

Introducción: La enfermedad respiratoria crónica determina alta morbimortalidad y frecuencia de comorbilidades cardiometabólicas. Evaluamos la asociación entre flujo espiratorio máximo (FEM) y algunas condiciones cardiometabólicas en adultos de una zona semirural, en la medición basal de la cohorte MAUCO (MAUle COhort). Material y Método: Estudio transversal (3.465 adultos, 40-74 años). Se midió el flujo espiratorio máximo (FEM) (mini-Wright, estándar ATS) utilizándose valores de Gregg y Nunn (FEM deteriorado ≤ 80% del teórico). Se obtuvo autorreporte/mediciones de hipertensión arterial (HTA), enfermedad cerebrovascular (ECV), infarto al miocardio (IAM), diabetes mellitus 2 (DM2), presión arterial, glicemia, colesterol, peso y talla. Actividad física y tabaquismo se evaluaron por encuesta, previa aprobación Ética. Se calcularon medidas de asociación, prevalencia y Odds Ratio (OR). Resultados: Muestra de 63,9% de mujeres edad media 55 (± 9) años, escolaridad media 9 (± 4) años. 84,7% tuvo exceso de peso, 81,5% inactividad física 29,4% fumadores actuales. Prevalencia de FEM bajo: 50,6% (IC 95% 48,9-52,3). El autorreporte fue: ACV 2,2% IAM 3,3, sospecha de hipertensión 24% y DM2 2,7%. Los OR crudos fueron significativos en mujeres que autorreportaron HTA, ECV, IAM y autorreporte/sospecha de DM2, y en hombres con autorreporte de ECV, sospecha de DM2 y autorreporte/sospecha de HTA. La asociación se mantuvo post-ajuste en mujeres para autorreporte de IAM y deterioro moderado (OR = 2,49) y severo del FEM (OR = 2,60) y en hombres para sospecha de DM2 y deterioro leve (OR = 5,24) y severo del FEM (OR = 6,19). Conclusiones: FEM resultó significativamente asociado con las enfermedades cardiometabólicas seleccionadas, con efecto sexo- específico para IAM (mujeres) y sospecha de DM2 (hombres). Se constata alta prevalencia de FEM alterado, y de enfermedades cardiometabólicas crónicas en la población estudiada.

Introduction: Chronic respiratory diseases determine high morbimortality and cardiometabolic comorbidities. We evaluated the association between peak expiratory flow (PEF) and cardiometabolic conditions in adults in a semi-rural area, in the baseline of MAUCO cohort (MAUle COhort). Material and Method: Cross-sectional study (3,465 adults, 40-74 years). Peak expiratory flow (PEF) (mini-Wright, ATS standard) was measured (Gregg & Nunn; impaired PEF ≤ 80% predicted). Self-reported/measured hypertension (HT), cerebrovascular disease (CVD), myocardial infarction (AMI), diabetes mellitus 2 (DM2), blood pressure, glycemia, cholesterol, weight and height were obtained. Physical activity and smoking were surveyed, after Ethical approval. Association's measures, prevalence and Odds Ratio (OR) were calculated. Results: Sample of 63.9% of women, mean age 55 (± 9) years, schooling 9 (± 4) years. 84.7% had overweight, 81.5%physical inactivity 29.4% smokers. Low PEF: 50.6% (48.9-52.3). Self-reported was: CVD 2.2% AMI 3.3%, suspicion of hypertension 24% and DM2 2.7%. Crude OR`s were significant for women by self-reported hypertension, stroke, AMI and self-reported/suspicion DM2; in men for self-reported CVD, suspected DM2 and self-reported/suspected hypertension. The association remained post-adjusted in women self-reported AMI -moderate deterioration (OR = 2.49) and severe PEF (OR = 2.60) and in men suspected DM2 and mild (OR = 5.24) and severe deteriorated PEF (OR = 6.19). Conclusions: PEF was significantly associated with cardiometabolic diseases; sex- specific findings for AMI (women) and suspicion of DM2 (men). High prevalence of altered PEF and chronic cardiometabolic diseases were detected among the studied population.

Propuesta de ecuaciones predictivas de capacidad inspiratoria y flujo espiratorio máximo considerando mediciones torácicas: un estudio piloto / Proposal of predictive equations of inspiratory capacity and maximum spiratory flow considering thoracic measurements: a pilot study

RESUMEN: El objetivo del siguiente estudio fue determinar si las mediciones de tórax provocan modificaciones en las ecuaciones predictivas de capacidad inspiratoria (CI) y flujo espiratorio máximo (FEM). Se evaluaron 24 sujetos de sexo masculino entre 18 y 26 años, todos estudiantes sedentarios de la Universidad Católica del Maule, Chile. Se les realizó antropometría corporal básica (peso y talla corporal) y específica de tórax, diámetro antero-posterior (DAT) y transverso (DTT) de tórax y perímetro mesoesternal (PME). Posterior a esto, se evaluó la función ventilatoria a través de pletismografía corporal. Para estimar las ecuaciones de regresión lineal se utilizó el método de mínimos cuadrados relacionando la CI y FEM. La comparación entre el valor predicho establecido y nuestra propuesta fue comparado utilizando la prueba t de student o U de Mann-Whitney según correspondiera, considerándose un nivel de significancia estadística de p<0,05. Los resultados indican que para la propuesta de la ecuación de FEM se consideró el DTT y PME, logrando diferencias significativas con los valores de Knudson et al. Por tanto, se concluye que las mediciones de DTT a VR y PME a CPT influyeron en la ecuación predictiva de FEM en estudiantes sedentarios.

SUMMARY: The aim of the following study was to determine if chest measurements cause changes in the predictive equations of inspiratory capacity (IC) and peak expiratory flow (PEF). Twenty- four male subjects between 18 and 26 years old, all sedentary students of the Universidad Catolica del Maule, Chile, were evaluated. They were subjected to basic body anthropometry (weight and body size) and chest specificity, anteroposterior diameter (APD) and transverse (TTD) of the thorax and mesosternal perimeter (MSP). After this, the ventilatory function was evaluated through body plethysmography. To estimate the linear regression equations, the least squares method were used, relating IC and PEF. The comparison between the established predicted value and our proposal was compared using the student t-test or Mann-Whitney U test as appropriate, considering a level of statistical significance of p <0.05. The results indicate that the TTD and MSP were considered for the proposal of the PEF equation, achieving significant differences with the values o f Knudson et al. Therefore, it is concluded that measurements of TTD to RV and MSP to TPC influenced the predictive equation of PEF in sedentary students.

Flujo espiratorio máximo: caracterización en un estudio en población adulta chilena; resultados basales de la cohorte del Maule (MAUCO) / Peak expiratory flow rate: characterization study in Chilean adult population; baseline results of the Maule cohort (MAUCO)

Resumen Introducción: Las enfermedades respiratorias crónicas tienen alta prevalencia en países en desarrollo, en poblaciones rurales y deprivadas. El flujo espiratorio máximo (FEM) obtenido mediante espiración forzada tiene uso clínico y de investigación. Describimos valores de medición del FEM en la medición basal de un estudio de cohorte en curso (Cohorte del Maule-MAUCO). Material y Método: Diseño transversal en 3.465 adultos (40-74 años) con registros de FEM (ATS). (Flujómetro Mini-Wright), usando valores de Gregg y Nunn. Valores < 80% del predicho se consideraron disminuidos. Se obtuvo sexo, edad, nivel educacional, actividad física y tabaquismo; se calculó índice de masa corporal (IMC) usando mediciones antropométricas. Resultados: La muestra tuvo 63,9% de mujeres; edad media de 55 (± 9) años, escolaridad de 9 (± 4) años; sobrepeso y obesidad fueron 43,1% y 41,5%: 81,5% fueron inactivos y 29,4% fumadores actuales. El valor medio de FEM fue 330 (± 80) L/min (mujeres) y 460 (± 119) L/min (hombres): el FEM disminuido alcanzó el 50,6% ([48,9-52,3]) con diferencias según edad, educación, IMC y actividad física. Conclusiones: Se observó alta prevalencia de FEM disminuido con variaciones según sexo, edad, escolaridad, IMC e inactividad física. Como otros estudios latinoamericanos, los valores bajos también fueron altamente prevalentes, sugiriendo sobreestimación de valores predichos al usar valores de Gregg & Nunn. Estos resultados sugieren la conveniencia de estudiar factores ambientales locales.

Introduction: Chronic respiratory (CRD) diseases show high prevalence in developing countries, rural and deprived populations. Peak expiratory flow rate (PEFR) is a functional measurement obtained through forced expiratory used for clinical and research purposes. We described PEFR in a rural setting in an ongoing cohort study (Maule Cohort-MAUCO). Material and Method: Cross-sectional design in 3,465 adults (40-74 years) with PEFR ATS standard records (Mini-Wright flowmeter) using Gregg and Nunn values. PEFR ≤ 80% predicted were considered decreased. Sex, age, educational level, physical activity and tobacco smoking were obtained. Body mass index (BMI) was calculated based on anthropometrical measurements. Main Results: Sample had 63.9% of women; mean age of 55 (± 9) years, schooling of 9 (± 4) years. Overweight and obesity were 43.1% and 41.5%. Physical inactivity was 81.5% and 29.4% were current smokers. PEFR mean value was 330 (± 80) L/min (women) and 460 (± 119) L/min (men): Decreased PEFR was 50.6% ([48.9-52.3]) with significant differences by age, schooling, BMI and physical activity. Conclusions: High prevalence of decreased PEFR was observed: PEFR showed variations according to sex, age, schooling, BMI and physical activity. As other Latin-American studies show, low values were also highly prevalent, suggesting that Gregg & Nunn overestimated PEFR values. These results suggests the convenience of studying local environmental factors.

Evaluación de flujos y volúmenes dinámicos en pacientes con compromiso muscular respiratorio / Dynamic flows and volumes evaluation in patients with respiratory muscle impairment

Spirometry measures the forced expiratory volumes and flows. In patients with neuromuscular disease, these are altered since there is some respiratory muscle involvement. The usefulness of this test is based on the interpretation of the shape of the flow / volume loop and values of spirometric variables. In patients with neuromuscular disease, Forced Vital Capacity is the most used especially for its prognosis value.

La espirometría mide volúmenes y flujos espiratorios forzados. En los pacientes con enfermedad neuromuscular (ENM) estos se ven alterados debido al compromiso muscular respiratorio. La utilidad de este examen se basa en la interpretación de la forma de la curva flujo/volumen y los valores de las variables espirométricas. En los pacientes con ENM la Capacidad Vital Forzada es la más utilizada ya que otorga valor pronóstico.

Confiabilidad de la fuerza muscular respiratoria y flujos espiratorios forzados en adolescentes sanos / Reliability of pulmonary function tests in healthy adolescents

Inspiratory and expiratory muscle strength (MIP and MEP) assessment, and peak expiratory flow (PEF) and peak cough flow (PCF) measurements are often used to assess patients with respiratory diseases. Notwithstanding, there are few reports about reliability of these measurements. The aim of this study is to determine the intra-observer reliability of MIP, MEP, PCF and PEF in healthy adolescents. The study design was test retest. A sample of students from a public school of Talcahuano (Chile) were studied. MIP, MEP, PEF and PCF were recorded twice by the same appraiser, with an interval of 8 weeks. Intraclass correlation coefficient (ICC) was used as an index of reliability. Analysis of individual differences was performed by Bland and Altman’s method and the probability of discordance between test and retest was evaluated. A p value < 0.05 was considered significant. 23 students (9 males), ageing 16.3 ± 0.5 years-old entered to the study. ICC of MIP, MEP, PEF and PCF were 0.7; 0.78; 0.86 and 0.63 respectively. Bland-Altman analysis shows that the average discrepancy between the test and retest was -5 (95% CI: 35.6 to -52.6), -9.1 (95% CI: 20.2 to -38.4), -7.8 (95% CI: 107.7 to -123.2) and -28.5 (95% CI: 131.9 to -189.1) in MIP, MEP, PEF and PCF respectively. There was no significant difference in probability of discordance between parameters with the same unit of measure. Respiratory function variables show a moderate to high level of reliability, considering eight weeks of time interval between test and retest. PEF and MEP were the variables with the best performance.

La evaluación de fuerza muscular inspiratoria (PImax) y espiratoria (PEmax), la medición del flujo espiratorio máximo (FEM) y flujo máximo de tos (FMT) son, a menudo, utilizados para el seguimiento de pacientes con enfermedades respiratorias. No obstante, son escasos los reportes acerca de sus propiedades de evaluación. El objetivo de este estudio es determinar la confiabilidad intra-observador de la PImax, PEmax, FMT y FEM, en adolescentes sanos. Se empleó un diseño test retest en que se seleccionaron adolescentes voluntarios de un colegio público de Talcahuano. PImax, PImax, FEM y FMT fueron registradas por un mismo evaluador en dos oportunidades con un intervalo de 8 semanas. Se empleó el coeficiente de correlación intraclase (CCI) como índice de confiabilidad. Mediante el método de Bland-Altman se realizó el análisis de las diferencias individuales y se evaluó la probabilidad de discordancia entre test y retest. Se consideró significativo un valor de p < 0,05. Al estudio ingresaron 23 sujetos (9 varones), edad promedio 16,3 ± 0,5 años. El CCI de PImax, PEmax, FEM y FMT fueron 0,7; 0,78; 0,86 y 0,63 respectivamente. Por su parte, el análisis de Bland-Altman muestra que el promedio de discordancia entre los tests fue -8,5 (95% IC: 35,6 a -52,6), -9,1 (95% IC: 20,2 a -38,4), -7,8 (95% IC: 107,7 a -123,2) y -28,5 (95% IC: 131,9 a -189,1) en PImax, PEmax, FEM y FMT respectivamente. No existió diferencia significativa de probabilidad de discordancia entre parámetros con igual unidad de medida. Las variables de función respiratoria muestran un nivel de confiabilidad moderado a alto, considerando 8 semanas de intervalo de tiempo entre el test y retest. Las variables con mejor rendimiento fueron FEM y PEmax.

Traqueobroncomalacia / Tracheobronchomalacia

A 10-years-old girl with recurrent wheezing was diagnosed as asthmatic. Her spirometry showed variable central airway intrathoracic obstruction. The bronchoscopy confirmed the presence of bronchomalacia.

Se presenta el caso de una paciente de edad escolar, quien por sibilancias recurrentes se trataba como asmática. Al realizar espirometría forzada se detectó un compromiso variable de vía central intratorácica. La fibrobroncoscopía confirmó la presencia de broncomalacia.

A importância da medida da força muscular respiratória na prática da pneumologia / The importance of measurement of respiratory muscle strenght in pulmonology practice

A medida da força dos músculos respiratórios é um exame não invasivo, simples, de baixo custo e útil naprática clínica. Dentre os métodos utilizados para mensuração da força muscular respiratória, destaca-se, a medida das pressões respiratórias máximas em nível da boca: PImáx e PEmáx. A Pressão inspiratória máxima (PImáx) reflete a força dos músculos inspiratórios e do diafragma; enquanto a pressão expiratória máxima (PEmáx) reflete a força dos músculos abdominais e expiratórios. As indicações comuns na prática clínica incluem: a confirmação da disfunção muscular respiratória em doenças neuromusculares; diagnóstico diferencial de dispneia, tosse ineficaz; espirometria com distúrbio ventilatório restritivo sem causa aparente; avaliação de resposta à fisioterapia e à reabilitação pulmonar; avaliação pré-operatória da função dos músculos ventilatórios e da possibilidade de desmame da ventilação mecânica; e, avaliação do risco de mortalidade e hospitalizações em pacientes com DPOC e insuficiência cardíaca.Esta revisão teve como objetivo apresentar a importância da aplicação do teste da força muscular respiratória na prática da pneumologia. Descreveremos a técnica e a interpretação dos resultados.

The measurement of respiratory muscle strength is a noninvasive test, simple, inexpensive and useful in clinical practice. Among the used methods to measure the respiratory muscle strength, the determination ofmaximal respiratory pressures in terms of mouth: MIP and MEP have been showed most important. The MaximumInspiratory Pressure (MIP) reflects the strength of the inspiratory muscles and the diaphragm; while the MaximumExpiratory Pressure (MEP) reflects the strength of the abdominal and expiratory muscles. The common indications in clinical practice include: confirmation of respiratory muscle dysfunction in neuromuscular diseases; differential diagnosis of dyspnea, ineffective cough or restrictive lung disease without apparent cause; response evaluation to physical therapy and pulmonary rehabilitation; preoperative evaluation of thefunction of respiratory muscles and the possibility of ventilation weaning ; and mortality and hospitalization riskassessment in patients with COPD and heart failure. This review aims to present the importance of the application of respiratory muscle strength test in the practice of pulmonology. Furthermore, this review also describes the technique and interpretation of results.

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.

Treinamento muscular inspiratório melhora a força muscular respiratória e o pico de fluxo expiratório em idosas hipertensas / Inspiratory muscle training improves respiratory muscle strength and the peak expiratory flow in hypertensive elderly women

Introdução: O processo de envelhecimento promove alterações no sistema cardiorrespiratório, aumentando a prevalência de hipertensão arterial e reduzindo a força da musculatura respiratória. Objetivos: Avaliar os efeitos de um programa de treinamento muscular inspiratório domiciliar (TMID) sobre a função pulmonar, força muscular respiratória e distância percorrida no teste de caminhada de 6 minutos (TC6min) em idosas hipertensas. Métodos: Dezesseis mulheres com diagnóstico de hipertensão arterial foram divididas em dois grupos. Oito participaram do grupo intervenção (GI) e foram submetidas ao TMID durante seis semanas, e as demais compuseram o grupo controle (GC). Resultados: Ao final do TMID, constatou-se aumento da PImáx, -47±13 cmH₂0 para -92±32 cmH₂0 (p<0,001), e PEmáx, 45±6 cmH₂0 para 84±24 cmH₂0 (p<0,001), do Pico de Fluxo Expiratório (PFE), 211,6±60 L/min para 248,8±58 L/min (p=0,004). Conclusões: O TMID realizado diariamente durante seis semanas proporciona melhora na força muscular respiratória e no pico de fluxo expiratório em idosas hipertensas.

Introduction: The aging process brings changes to the cardiovascular system, increasing the prevalence of hypertension and reducing the respiratory muscle strength. Objectives: To assess the effects of a home-based inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength and distance walked in 6-minute walk test (6MWT) in hypertensive elderly women. Methods: Sixteen women with clinical diagnosis of hypertension were divided into two groups. Eight participated in the intervention group (IG) and were subjected to the home-based IMT during six weeks, and the others composed the control group (CG). Results: At the end of the IMT, we found out the increase of maximal inspiratory pressure (MIP), -47±13 cmH₂0 to -92±32 cmH₂0 (p<0.001), the maximal expiratory pressure (MEP), 45±6 cmH₂0 to 84±24 cmH₂0 (p<0.001), and the peak expiratory flow (PEF), 211.6±60 l/min to 248.8±58 l/min (p=0.004). Conclusions: The home-based IMT daily performed for six weeks improves the respiratory muscle strength and in the PEF in hypertensive elderly women.

Proposal Intensity Adequacy of Expiratory Effort and Heart Rate Behavior During the Valsalva Maneuver in Preadolescents / Proposta de Adequação da Intensidade do Esforço Expiratório e Comportamento da Frequência Cardíaca Durante a Manobra de Valsalva em Pré-Adolescentes

Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice. .

Fundamento: Durante a manobra de Valsalva (MV), os valores de resistência expiratória utilizados por adultos são os mesmos aplicados em pré-adolescentes. Objetivo: Analisar as respostas da frequência cardíaca (FC) de pré-adolescentes durante a MV e propor nova metodologia para eleição da resistência expiratória. Métodos: Submeteram-se 45 pré-adolescentes com idades entre 9 e 12 anos à avaliação das pressões expiratórias máximas (PEmáx). Valores de 60%, 70% e 80% dessas PEmáx foram selecionados para ser aplicados nas MV, mantidas por 20 s. Batimentos cardíacos foram registrados antes, durante e após a manobra. Trinta dias após, todos os procedimentos foram repetidos, e os dados da primeira (A1) e da segunda (A2) avaliações foram comparados. As análises foram feitas com testes não paramétricos, destacando-se os momentos antes, durante (0-10 s e 10-20 s) e após as manobras. Resultados: Os 45 pré-adolescentes conseguiram realizar adequadamente a manobra à resistência de 60% da PEmáx, enquanto apenas 38 (84,4%) e 25 (55,5%) a realizaram com resistências de 70% e 80% da PEmáx, respectivamente. Os deltas de FC 0-10 s e 10-20 s, calculados durante o esforço, foram significativamente maiores quanto maior foi o esforço expiratório, revelando efetiva resposta autonômica cardíaca durante a manobra. Entretanto, o estudo sugere que essas intensidades não devam ser empregadas. Conclusão: A FC se elevou em todas as intensidades de esforço testadas durante a MV, porém somente quando foi realizada com resistência expiratória de 60% da PEmáx é que todos os participantes conseguiram realizá-la, sugerindo ser a intensidade ideal para ser empregada na prática clínica. .

[Effect of a course of aerobic exercise and consumption of vitamin d supplementation on respiratory indicators in patients with asthma]

Despite the use of exercise therapy in patients with respiratory disease such as asthma, some researchers have emphasized on taking supplementation as a therapeutic approach. The aim of this research was to investigate the effect of a course of aerobic exercise and consumption of vitamin D supplementation [1000 IU] on respiratory indicators of patients with asthma. This study was designed as a quasi-experimental investigation on a total of 32 female asthmatic patients with a mean age of 20-30 years. Subjects were classified into four eight-person groups: 1- [AT+S] group which had both aerobic training and supplementation consumption; 2- Aerobic training [AT] group that only participated in exercise training; 3- Group [S] that only consumed vitamin D supplementation; 4- Control [C] Group that had neither aerobic training nor supplementation consumption. Statistical analysis was performed by ANOVA and Bonferroni post-hoc test. Significant difference considered as p<0.05. In this study, there was a significant difference in post test [p<0.001] between groups in case of maximum voluntary ventilation [MVV], peak expiratory flow rate [PEF] and maximum expiratory flow at 75% vital capacity [FEF75%] and Maximum expiratory flow between 25% to 75% vital capacity [FEF25%-75%]. These indices increased in group AT and AT+S, whereas, they showed decrease in group S and C. Our results indicated that aerobic exercise together with consumption of vitamin D supplementation for 8 weeks could improve the pulmonary function and level of aerobic performance of asthmatic patients and could be considered as a part of pulmonary rehabilitation programs for asthmatic patients

Association of FEV1 and PEF with small airway function in asthmatic children: cross-sectional analysis of 619 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the association of forced expiratory volume in 1 second (FEV1) and the maximum peak expiratory flow (PEF) with small airway function in asthmatic children of different ages and genders.</p><p><b>METHODS</b>This cross-sectional study was conducted among 619 asthmatic children with disease remission aged 3 to 13 years. The children were divided into 3 age groups, namely 3 to 5 years group (314 cases), 6 to 9 years group (207 cases) and 10 to 13 years group (98 cases), and their respiratory physiological parameters such as FEV1 and PEF were measured.</p><p><b>RESULTS</b>Of the airway function parameters, PEF showed the highest abnormality rate (>85%) in these asthmatic children. In male and female asthmatic children aged 6 to 9 years, abnormalities in forced expiratory flow rate 25% (MEF25) showed the highest frequency (56% and 63%, respectively). In 3-5 years and 10-13 years groups, MEF25 abnormalities were the most frequent in male children (43% and 71%, respectively), whereas abnormalities in MEF50 were the most common in female children (33% and 69%, respectively). FEV1 and PEF were positively correlated to all the parameters of small airway functions in these asthmatic children (r>0.5, P<0.01) except for MEF25 in female asthmatic children aged 3 to 5 years (r=0.19, P=0.168; r=0.086, P=0.535).</p><p><b>CONCLUSION</b>In asthmatic children, FEV1 and PEF are positively correlated to the parameters of small airway function with only the exception of MEF25 in female children aged 3 to 5 years, suggesting the value of FEV1 in the diagnosis of asthma in children.</p>

Spirometric Standards for Healthy Children and Adolescents of Korean Chinese in Northeast China

In China there are 1,923,842 Korean Chinese, who live mostly (92.27%) in the country's three northeast provinces. In spite of this sizeable number, no spirometric data are available at present on them. The present study investigated normal spirometric reference values for the Korean Chinese children and adolescents. Spirometry was performed in 443 healthy Korean Chinese children and adolescents aged 8-18 yr with measurements of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF) and maximum mid-expiratory flow (MMEF). Reference equations for FEV1, FVC, PEF and MMEF were derived by using multiple regression analysis. All of the measured spirometric parameters correlated positively with height and age significantly (P < 0.001). The predicted values of FVC and FEV1 were higher than values obtained by using Caucasian and other Asian equations (P < 0.001). A set of spirometric reference equations has been derived using a relatively large, healthy, non-smoking young Korean Chinese population with a wide range of ages and heights, the results of which differ from those gained from several other reference equations. These reference equations should be used for evaluation of lung function in this population.

Flujometría en la práctica de atención primaria / Peak expiratory fow measurement in primary clinical practice

Measurement of peak expiratory fow (PEF) by using the mini Wright meter is widely used for assessing patients with airway obstruction in the clinical practice. This document -written by the Pulmonary Function Commission of Chilean Respiratory Disease Society- provides a basic guideline for using this measurement in adult patients. Indications, technique and evaluation of the airway obstruction by measuring PEF through a mini Wrigth meter are briefy described.

La medición del fujo espiratorio máximo (FEM) con el mini-fujómetro de Wright se usa ampliamente en la práctica clínica para evaluar pacientes con obstrucción de las vías aéreas. Este documento redactado por la Comisión de Función Pulmonar de la Sociedad Chilena de Enfermedades Respiratorias, proporciona una guía práctica para efectuar esta medición en pacientes adultos. En este artículo se describen resumidamente las indicaciones, la técnica y la evaluación de la obstrucción de las vías aéreas a través de la medición del FEM con el mini-fujómetro de Wright.

Padrões ventilatórios na espirometria em pacientes adolescentes e adultos com fibrose cística / Respiratory patterns in spirometric tests of adolescents and adults with cystic fibrosis

OBJETIVO: Avaliar os padrões dos distúrbios ventilatórios observados na espirometria em pacientes com fibrose cística (FC) e suas relações com a gravidade funcional e com o comportamento dos fluxos máximos expiratórios a baixos volumes. MÉTODOS: Estudo transversal e retrospectivo, incluindo pacientes adolescentes e adultos com FC. Todos os pacientes foram submetidos à espirometria. Os pacientes foram classificados como tendo função ventilatória preservada, distúrbio ventilatório obstrutivo (DVO), DVO com CVF reduzida, sugestivo de distúrbio ventilatório restritivo (DVR) ou distúrbio ventilatório combinado (DVC). Os fluxos máximos expiratórios a baixos volumes foram avaliados utilizando-se FEF25-75 por cento, FEF75 por centoe FEF75 por cento/CVF. O grupo controle incluiu 65 indivíduos normais, também submetidos à espirometria. RESULTADOS: Foram incluídos 65 pacientes no grupo de estudo: 8 (12,3 por cento) com função pulmonar preservada, 18 (27,7 por cento) com DVO, 24 (36,9 por cento) com DVO com CVF reduzida, 5 (7,7 por cento) com padrão sugestivo de DVR e 10 (15,4 por cento) com DVC. O VEF1 foi significativamente menor nos grupos DVO com CVF reduzida e DVC, comparados com os outros grupos (p < 0,001). Nos pacientes com função ventilatória preservada, FEF25-75 por cento e FEF75 por cento foram significativamente reduzidos em 1 paciente, assim como FEF75 por cento/CVF em 2 pacientes. CONCLUSÕES: O padrão ventilatório estava alterado em 88 por cento dos pacientes com FC. O distúrbio mais frequente foi DVO com CVF reduzida. Houve maior prejuízo funcional nos pacientes com DVO e CVF reduzida e com DVC. Os fluxos expiratórios máximos a baixos volumes foram alterados em uma pequena percentagem de pacientes com função pulmonar preservada.

OBJECTIVE: To evaluate spirometric patterns of respiratory disorders and their relationship with functional severity and maximal expiratory flows at low lung volumes in patients with cystic fibrosis (CF). METHODS: A retrospective cross-sectional study including adolescents and adults with CF. All of the patients were submitted to spirometry. Patients were classified as having preserved respiratory function, obstructive lung disease (OLD), OLD with reduced FVC, presumptive restrictive lung disease (RLD) or mixed obstructive and restrictive lung disease (MORLD). Maximal expiratory flows at low lung volumes were assessed using FEF25-75 percent, FEF75 percent and FEF75 percent/FVC. We included 65 normal subjects, also submitted to spirometry, as a control group. RESULTS: The study group included 65 patients: 8 (12.3 percent) with preserved lung function; 18 (27.7 percent) with OLD; 24 (36.9 percent) with OLD and reduced FVC; 5 (7.7 percent) with presumptive RLD; and 10 (15.4 percent) with MORLD. The FEV1 was significantly lower in the OLD with reduced FVC group and the MORLD group than in the other groups (p < 0.001). In the patients with preserved respiratory function, FEF25-75 percent and FEF75 percent were significantly reduced in 1 patient, as was FEF75 percent/FVC in 2 patients. CONCLUSIONS: The respiratory pattern was impaired in 88 percent of the patients with CF. The most common pattern was OLD with reduced FVC. The degree of functional impairment was greater in the OLD with reduced FVC group and in the MORLD group than in the other groups. Maximal expiratory flows at low lung volumes were impaired in a low percentage of patients with preserved respiratory function.

Prevalence of reduced respiratory muscle strength in institutionalized elderly people / Prevalência de redução da força muscular respiratória em idosas institucionalizadas

CONTEXT AND OBJECTIVES: Respiratory muscle strength is relevant to the clinical situation of elderly patients, particularly those presenting with respiratory or cardiac diseases. The objectives of this study were to evaluate the respiratory muscle strength of institutionalized elderly women, compare this with predicted values for the Brazilian population and calculate the correlation with age and anthropometric characteristics. DESIGN AND SETTING: Cross-sectional study at the Department of Physiotherapy of Universidade Camilo Castelo Branco. METHODS: The participants were 56 institutionalized elderly women (74.87 ± 10.55 years of age), evaluated in eight institutions in three cities in the central region of the State of São Paulo, between January 2005 and March 2006. They were separated into three subgroups according to age: 60-69 years (n = 20), 70-79 (n = 18) and 80-89 years (n = 18). Maximal respiratory pressures were obtained using a manovacuometer. The values obtained were compared between subgroups and with predicted values. Correlation analysis was used to evaluate age, weight, height and body mass index in relation to maximal respiratory pressures. The significance level was P < 0.05. RESULTS: No significant differences in maximal respiratory pressures were seen between the three subgroups. The maximal respiratory pressures were significantly lower in the three subgroups, compared with predicted values. Negative correlations between maximal respiratory pressures and age and positive correlations in relation to weight, height and body mass index were found. CONCLUSIONS: Respiratory muscle strength was markedly reduced in institutionalized 60 to 89-year-old women and the values demonstrated correlations with age and anthropometric characteristics.

CONTEXTO E OBJETIVOS: A força muscular respiratória é relevante para a situação clínica de pacientes idosos, particularmente os que apresentam doença cardíaca ou respiratória. Os objetivos deste estudo foram avaliar a força muscular respiratória de mulheres idosas asiladas, comparar com os valores preditos para a população brasileira e correlacioná-los com a idade e características antropométricas. TIPO DE ESTUDO E LOCAL: Estudo transversal desenvolvido pelo Departamento de Fisioterapia da Universidade Camilo Castelo Branco. MÉTODOS: Foram estudadas 56 mulheres idosas asiladas (74,87 ± 10,55 anos) sendo avaliadas em oito instituições em três cidades do interior do estado de São Paulo, entre janeiro de 2005 e março de 2006. Elas foram separadas em três subgrupos: de 60-69 anos (n = 20), de 70-79 anos (n = 18) e de 80-89 anos (n = 18). As pressões respiratórias máximas foram obtidas através de um manovacuômetro. Os valores obtidos foram comparados entre os subgrupos e também com os preditos para a população brasileira. Análise de correlação foi aplicada para a idade, peso, altura e índice de massa corpórea com os valores das pressões respiratórias máximas. O nível de significância adotado foi P < 0,05. RESULTADOS: Não houve diferenças significativas das pressões respiratórias máximas entre os três subgrupos. Em relação aos valores preditos, as pressões respiratórias máximas obtidas foram significativamente menores nos três subgrupos. Correlações negativas entre as pressões respiratórias máximas e a idade e positivas em relação ao peso, altura e índice de massa corpórea foram encontradas. CONCLUSÕES: A força muscular respiratória é marcantemente reduzida em idosas asiladas de 60 a 89 anos, havendo correlação das pressões respiratórias máximas com a idade e com as características antropométricas.

A análise da eficácia da manipulação de costelas no aumento do fluxo expiratório medido pelo peak flow meter / The analysis of the efficiency of ribs handling in the increase of the expiratory flow measured by the peak flow meter

A presente pesquisa tem como objetivo demonstrar que a manipulação de costelas do tipo "dog técnica" é eficaz, causando um aumento no valor do fluxo expiratório máximo de sujeitos saudáveis. Este foi um estudo de campo do tipo experimental. O estudo foi realizado com uma amostra (n) de 50 sujeitos, voluntários, com idades diferenciadas entre 30 e 60 anos. O fluxo expiratório máximo foi avaliado antes e depois da manobra, verificando se havia diferença entre ambos. Através da análise dos dados foram verificados resultados favoráveis. Onde 43 voluntários obtiveram aumento entre 1 e 30% do fluxo expiratório máximo. Com este resultado, chegamos a conclusão que a manipulação de costelas é realmente eficaz no tratamento fisioterapêutico, aumentando o fluxo expiratório máximo e consequentemente melhorando a respiração do paciente, pois com um diagnóstico mais preciso e o tratamento eficiente podemos gerar maior qualidade de vida; pois uma boa ou má respiração depende basicamente da mobilidade das costelas.

The present research aims to demonstrate that the ribs handling type "dog technique" is efficient, causing na increase in the value of the maximum expiratory flow of healthy individuals. This was a field research type experimental and quantitative. The research was conducted by a sample (n) of 50 individuals, volunteers with different age, between 30 and 60 years old. The maximum expiratory flow was valued before and after the operation, checking if it had a difference between both. Through analysis of data, favorable results were checked, were 43 volunteers had increased between 1 and 30% of the maximum expiratory flow. With this result, we reached the conclusion that the ribs handling is really efficient in the physiotherapeutic treatment, increasing the maximum expiratory flow and consequently improving the patient's breathing, because through a accurate diagnosis and na efficient treatment we can give higher quality of life, because a good or a bad breath depends essentially of the ribs mobility.(

Efeitos cardiorrespiratórios imediatos do tabagismo / Immediate cardiopulmonary effects of smoking

Objetivo: O tabagismo é caracterizado pela Organização Mundial de Saúde como uma doença e um problema de saúde pública, uma vez que causou a morte de mais de 100 milhões de pessoas no século XX. As repercussões em médio e longo prazo são estudadas, porém as alterações em curto prazo são pouco elucidadas. O objetivo foi verificar as alterações imediatas do tabagismo nas frequências cardíaca (FC) e respiratória (FR), pico de fluxo expiratório (PFE) e saturação de pulso de oxigênio (SpO2). Metodologia: Estudo observacional com 50 indivíduos tabagistas entre 20 e 50 anos de ambos os sexos. Foram avaliados os parâmetros de FC, FR, PFE e SpO2 antes do ato tabágico (PRÉ), imediatamente após (DUR) e 15 minutos após o término do cigarro (PÓS). Para análise, foi calculado delta percentual dos parâmetros PRÉ e DUR e teste ANOVA para medidas repetidas. Resultados: Houve aumento de 15,1% na FC (p<0,001), de 23,7% na FR (p<0,001) e de 10,2% no PFE (p<0,001) e queda de 1,5% na SpO2 (p<0,05), com retorno próximo ao valores basais após 15 minutos. Conclusão: O tabagismo pode alterar os valores de FC, FR, PFE e SpO2 em curto prazo.

Introduction: Smoking is considered a disease and a public heath problem. Over than a million person died last century. The long-term repercussions are well stabilished, however, few studies listed short-term consequences. Thus, the objective was to verify short-term alterations of peak expiratory flow (PEF), respiratory (RR) and heart (HR) and oxymetry during smoke. Methodology: Observational study including 50 persons between 30 and 50 years old. Parameters of PEF, RR, HR and oxymmetry were evaluated; before smoke (BS), immediately after smoke (DS) and 15-minute after smoke (AS). Statistical analisys were calculated with delta percentile of BS and DS parameters and ANOVA were used for repeated measurements. Results:There were an increase of 15.1% in HR (p < 0,001), 23.7% in RR (p < 0,001), and 10.2% in PEF (p< 0,001) and there was a decrease of 1.5% in oxymmetry (p< 0,05), during smoking with returning of basal levels after 15 minutes. Conclusion: Smoking action could alter RR, HR, PEF and oxymmetry in a short-term.