Relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults / Relação entre força muscular respiratória e de preensão palmar em idosos institucionalizados e da comunidade

OBJECTIVE: To evaluate the relationship between respiratory muscle strength and grip strength in institutionalized and communitydwelling older adults. METHODS: This convenience sampled cross-sectional study had 64 voluntary participants with a good general health status and without limiting chronic diseases: 33 were institutionalized and 31 lived in the community. Maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, grip strength, anthropometric data, and physical activity level were assessed. The data were subjected to descriptive analysis, Pearson's correlation test, and linear regression analysis. RESULTS: In the institutionalized group, there was no between respiratory variables and grip strength, but maximal expiratory pressure was the respiratory predictor most strongly associated with grip strength (p = 0.04). In the community-dwelling group, there was a correlation between maximal inspiratory pressure and grip strength (r = 0.54), maximal expiratory pressure and grip strength (r = 0.62), and peak expiratory flow and grip strength (r = 0.64); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). In a joint group analysis, there was an association between maximal inspiratory pressure and grip strength (r = 0.40), maximal expiratory pressure and grip strength (r = 0.57), and peak expiratory flow and grip strength (r = 0.57); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). CONCLUSIONS: Peak expiratory flow and maximal expiratory pressure seem to be good predictors of grip strength in community-dwelling older adults, but this relationship does not seem to be maintained in institutionalized patients, possibly because of a greater loss of respiratory function.

OBJETIVO: Avaliar a relação entre força muscular respiratória e força de preensão palmar em idosos institucionalizados e da comunidade. METODOLOGIA: Caracteriza-se por um estudo transversal com 64 voluntários, sendo 33 institucionalizados e 31 da comunidade. Avaliou-se a pressão inspiratória máxima, pressão expiratória máxima, pico de fluxo expiratório, força de preensão palmar, dados antropométricos e nível de atividade física.Os dados foram submetidos a uma análise descritiva, teste de correlação de Pearson e análise de regressão linear. RESULTADOS: No grupo de institucionalizados, não houve correlação entre as variáveis respiratórias e as de força de preensão palmar, porém o preditor respiratório mais fortemente associado à força de preensão palmar foi a pressão expiratória máxima (p = 0,04). No grupo da comunidade, verificou-se correlação entre pressão inspiratória máxima e força de preensão palmar (r = 0,54), pressão expiratória máxima e força de preensão palmar (r = 0,62), pico de fluxo expiratório e força de preensão palmar (r = 0,64), e o preditor respiratório mais fortemente associado à força de preensão palmar foi pico de fluxo expiratório e pressão expiratória máxima (p < 0,05). Na análise conjunta dos grupos, verificou-se associação entre pressão inspiratória máxima e força de preensão palmar (r = 0,40), pressão expiratória máxima e força de preensão palmar (r = 0,57), pico de fluxo expiratório e força de preensão palmar (r = 0,57), e o preditor respiratório mais fortemente associado à força de preensão palmar foi pico de fluxo expiratório e pressão expiratória máxima (p < 0,05). CONCLUSÕES: Em idosos da comunidade, o pico de fluxo expiratório e a pressão expiratória máxima parecem ser bons preditores da força de preensão palmar, enquanto, em institucionalizados, essa relação parece não se manter possivelmente por conta de maior acentuação de perda da função respiratória.

Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water / Impacto da pressão positiva contínua nas vias aéreas sobre as alterações pulmonares promovidas pela imersão em água

ABSTRACT Objective: To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. Methods: This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. Results: We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. Conclusions: When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.

RESUMO Objetivo: Verificar se continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas) em diferentes pressões melhora os volumes e capacidades pulmonares de sujeitos saudáveis em imersão em água. Métodos: Estudo clínico randomizado realizado entre abril e junho de 2016 com voluntárias saudáveis em uso de anticoncepcional oral. Foram aplicados três protocolos em imersão em água, todos com duração de 20 min: controle (sem aplicação de CPAP); CPAP5 (CPAP de 5 cmH2O); e CPAP10 (CPAP de 10 cmH2O). Avaliaram-se FC, SpO2, CVF, VEF1, relação VEF1/CVF em % do previsto, taxa de pico de fluxo expiratório e FEF25-75% em três momentos distintos: pré-imersão, 10 min após a imersão e 10 min após o final dos protocolos. Resultados: Foram avaliadas 13 voluntárias saudáveis. O protocolo CPAP10 foi capaz de reverter o padrão restritivo pulmonar induzido pela imersão em água em indivíduos saudáveis, mantendo normais os volumes e as capacidades pulmonares por um período mais prolongado quando comparado ao protocolo CPAP5. Conclusões: Nossos resultados indicam que, em condições cuja alteração hemodinâmica causadora do distúrbio pulmonar seja persistente, apenas a aplicação de pressões positivas mais elevadas é efetiva para manter as melhoras no quadro pulmonar por um maior tempo após a sua aplicação.

Effects of vitamin D supplementation on pulmonary function in postmenopausal women following an aquatic exercise program

ABSTRACT Objective This study sought to investigate the effects of vitamin D supplementation and aquatic exercise on pulmonary function in postmenopausal women. Materials and methods This prospective and controlled study included 104 women (62 ± 6.5 years) divided into three groups: a control group lacking vitamin D and calcium supplementation which remained sedentary (CG; n = 17); a control group receiving vitamin D and calcium supplementation which remained sedentary (CDG, n = 33); and a group that completed aquatic exercises three times a week and received vitamin D and calcium supplementation (DTG, n = 54). Data before and after 6 months of the study were analyzed, including serum 25-hydroxyvitamin D (25(OH)D) and calcium concentrations, peak expiratory flow (PEF), forced vital capacity (FVC), and cirtometry. Results We observed significant increases in 25(OH)D concentrations in CDG (52.9 ± 2.4 to 69.1 ± 2.2; nmol/L; p < 0.0001) and DTG groups (55.5 ± 3 to 71.5 ± 3 nmol/L; p < 0.0001). PEF increased by 7 ± 2% (p = 0.0080) in CDG group and 11 ± 2% (p < 0.0001) in DTG group, whereas FVC increased by 7 ± 2% (p = 0.0016) in the CDG group and 10 ± 2% (p < 0.0001) in the DTG group, whereas CG had no changes in any of these parameters. The increment value of cirtometry in DTG group (+43 ± 3%) were significantly (p < 0.0001) higher than those in CG (−4 ± 8%) and CDG (+4 ± 9%) groups. Conclusion Our data suggest that vitamin D supplementation improves pulmonary function parameters in postmenopausal women.

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

Prediction equations for spirometry in four- to six-year-old children / Equações de predição da espirometria em crianças de quatro a seis anos

Abstract Objective To generate prediction equations for spirometry in 4- to 6-year-old children. Methods Forced vital capacity, forced expiratory volume in 0.5 s, forced expiratory volume in one second, peak expiratory flow, and forced expiratory flow at 25–75% of the forced vital capacity were assessed in 195 healthy children residing in the town of Sete Lagoas, state of Minas Gerais, Southeastern Brazil. The least mean squares method was used to derive the prediction equations. The level of significance was established as p < 0.05. Results Overall, 85% of the children succeeded in performing the spirometric maneuvers. In the prediction equation, height was the single predictor of the spirometric variables as follows: forced vital capacity = exponential [(−2.255) + (0.022 × height)], forced expiratory volume in 0.5 s = exponential [(−2.288) + (0.019 × height)], forced expiratory volume in one second = exponential [(−2.767) + (0.026 × height)], peak expiratory flow = exponential [(−2.908) + (0.019 × height)], and forced expiratory flow at 25–75% of the forced vital capacity = exponential [(−1.404) + (0.016 × height)]. Neither age nor weight influenced the regression equations. No significant differences in the predicted values for boys and girls were observed. Conclusion The predicted values obtained in the present study are comparable to those reported for preschoolers from both Brazil and other countries.

Resumo Objetivo Gerar equações de predição da espirometria em crianças de quatro a seis anos. Métodos Capacidade vital forçada, volume expiratório forçado em 0,5 segundo, volume expiratório forçado em um segundo, pico de fluxo expiratório e fluxo expiratório forçado com 25-75% da capacidade vital forçada foram avaliados em 195 crianças saudáveis que residem em Sete Lagoas, Estado de Minas Gerais, Sudeste do Brasil. O método dos mínimos quadrados foi usado para derivar as equações de predição. O nível de significância foi estabelecido como p < 0,05. Resultados No geral, 85% das crianças foram bem-sucedidas ao fazer as manobras espirométricas. Na equação de predição, a estatura foi a única variável preditora das variáveis espirométricas, da seguinte forma: capacidade vital forçada = exponencial [(-2,255) + (0,022 x estatura)], volume expiratório forçado em 0,5 segundo = exponencial [(-2,288) + (0,019 x estatura)], volume expiratório forçado em um segundo = exponencial [(-2,767) + (0,026 x estatura)], pico do fluxo expiratório = exponencial [(-2,908) + (0,019 x estatura)] e fluxo expiratório forçado com 25-75% da capacidade vital forçada = exponencial [(-1,404) + (0,016 x estatura)]. Nem a idade nem o peso influenciaram as equações de regressão. Não foi observada diferença significativa nos valores previstos em meninos e meninas. Conclusão Os valores previstos obtidos neste estudo são comparáveis àqueles relatados em crianças em idade pré-escolar tanto do Brasil quanto de outros países.

Variations in peak nasal inspiratory flow among healthy students after using saline solutions / Variações do pico de fluxo inspiratório nasal entre escolares sadios após o uso de soluções salinas

ABSTRACT INTRODUCTION: Nasal hygiene with saline solutions has been shown to relieve congestion, reduce the thickening of the mucus and keep nasal cavity clean and moist. OBJECTIVE: Evaluating whether saline solutions improve nasal inspiratory flow among healthy children. METHODS: Students between 8 and 11 years of age underwent 6 procedures with saline solutions at different concentrations. The peak nasal inspiratory flow was measured before and 30 min after each procedure. Statistical analysis was performed by means of t test, analysis of variance, and Tukey's test, considering p < 0.05. RESULTS: We evaluated 124 children at all stages. There were differences on the way a same concentration was used. There was no difference between 0.9% saline solution and 3% saline solution by using a syringe. CONCLUSION: The 3% saline solution had higher averages of peak nasal inspiratory flow, but it was not significantly higher than the 0.9% saline solution. It is important to offer various options to patients.

RESUMO INTRODUÇÃO: A higiene nasal com soluções salinas tem sido indicada para aliviar a congestão, reduzir o espessamento do muco e manter a cavidade nasal limpa e úmida. OBJETIVO: Avaliar se as soluções salinas melhoram o fluxo inspiratório nasal entre crianças sadias. MÉTODO: Escolares com idades entre 8 e 11 anos foram submetidos a 6 procedimentos com soluções salinas em diferentes concentrações. O pico de fluxo inspiratório nasal foi medido antes e 30 minutos após cada procedimento. A análise estatística foi realizada por meio do teste t, análise de variância e teste de Tukey, considerando p < 0,05. RESULTADOS: Foram avaliadas 124 crianças em todas as etapas. Houve diferenças quanto à forma de uso de uma mesma concentração. Não houve diferença entre solução salina a 0,9% e solução salina a 3% por meio de seringa. CONCLUSÕES: A solução salina a 3% obteve maiores médias do pico de fluxo inspiratório nasal, porém não foi significativamente superior à solução salina a 0,9%. É importante oferecer diferentes opções aos pacientes.

Effects of chest wall compression on expiratory flow rates in patients with chronic obstructive pulmonary disease

Background: Manual chest wall compression (CWC) during expiration is a technique for removing airway secretions in patients with respiratory disorders. However, there have been no reports about the physiological effects of CWC in patients with chronic obstructive pulmonary disease (COPD). Objective: To compare the effects of CWC on expiratory flow rates in patients with COPD and asymptomatic controls. Method: Fourteen subjects were recruited from among patients with COPD who were receiving pulmonary rehabilitation at the University Hospital (COPD group). Fourteen age-matched healthy subjects were also consecutively recruited from the local community (Healthy control group). Airflow and lung volume changes were measured continuously with the subjects lying in supine position during 1 minute of quiet breathing (QB) and during 1 minute of CWC by a physical therapist. Results: During CWC, both the COPD group and the healthy control group showed significantly higher peak expiratory flow rates (PEFRs) than during QB (mean difference for COPD group 0.14 L/sec, 95% confidence interval (CI) 0.04 to 0.24, p<0.01, mean difference for healthy control group 0.39 L/sec, 95% CI 0.25 to 0.57, p<0.01). In the between-group comparisons, PEFR was significantly higher in the healthy control group than in the COPD group (-0.25 L/sec, 95% CI -0.43 to -0.07, p<0.01). However, the expiratory flow rates at the lung volume at the PEFR during QB and at 50% and 25% of tidal volume during QB increased in the healthy control group (mean difference for healthy control group 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.27 L/sec, 95% CI 0.13 to 0.41, p<0.01, respectively) but not in the COPD group (0.05 L/sec, 95% CI -0.01 to 0.12: -0.01 L/sec, 95% CI -0.11 to 0.08: 0.02 L/sec, 95% CI -0.05 to 0.90) with the application of CWC. Conclusion: The effects of chest wall compression on expiratory flow rates was different between COPD patients and asymptomatic controls.

Reflex cough PEF as a predictor of successful extubation in neurological patients / Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

AbstractObjective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

ResumoObjetivo:Avaliar o uso do pico de fluxo de tosse reflexa (PFTR) como preditor do sucesso da extubação de pacientes neurológicos candidatos a desmame da ventilação mecânica.Métodos:Estudo transversal com 135 pacientes ventilados mecanicamente por mais de 24 h na UTI do Hospital Cristo Redentor, em Porto Alegre (RS). Foram medidos o PFTR, o índice de respiração rápida e superficial, a PImáx e a PEmáx, bem como parâmetros ventilatórios, hemodinâmicos e clínicos.Resultados:A média de idade dos pacientes foi de 47,8 ± 17 anos. A taxa de insucesso na extubação foi de 33,3%. O PFTR < 80 l/min apresentou risco relativo de 3,6 (IC95%: 2,0-6,7), e a pontuação final na Escala de Coma de Glasgow apresentou risco relativo de 0,64 (IC95%: 0,51-0,83). A partir de 8 pontos, cada aumento de 1 ponto diminuiu em 36% o risco de insucesso na extubação.Conclusões:O PFTR e a pontuação na Escala de Coma de Glasgow são preditores independentes de falha na extubação em pacientes neurológicos internados na UTI.

Análise das variáveis hemodinâmicas em idosos revascularizados após mobilização precoce no leito / Analysis of Hemodynamic Variables among Elderly Revascularized Patients after Early In-Bed Mobilization

Fundamentos: Durante o pós-operatório da cirurgia de revascularização do miocárdio (CRM), o repouso prolongado no leito aumenta a possibilidade de ocorrer complicações sistêmicas decorrentes do imobilismo. Objetivo: Verificar o comportamento das variáveis hemodinâmicas e no pico de fluxo expiratório (peack flow) em pacientes idosos, em pós-operatório de CRM submetidos a três tipos diferentes de intervenção fisioterapêutica. Métodos: Estudados 30 idosos estratificados em três grupos: Grupo A - mobilização com cicloergômetro; Grupo B - mobilização sem uso do cicloergômetro, mas com fisioterapia e Grupo C - sem qualquer mobilização, mas com ventilação não invasiva (VNI), sendo analisados o comportamento da frequência cardíaca (FC), frequência respiratória (FR), pressão arterial (PA), saturação periférica de oxigênio (SpO2) e pico de fluxo expiratório (peack flow). Para a variação dos resultados intragrupos, nas fases pré e pós-teste utilizou-se o teste de Wilcoxon; para a comparação intergrupos nas fases pré e pós-teste utilizou-se o teste de Kruskal-Wallis. Considerou-se significância estatística p<0,05.Resultados: Observou-se aumento significativo para os valores peack flow em todos os grupos (pré e pós-teste); redução significativa da PAS no grupo A, aumento da FC e da FR no grupo B (pré e pós-teste). Na análise intergrupos, observou-se redução da PAD no grupo C, com significado estatístico.

Background: During the post-operative phase after coronary artery bypass (CAB) surgery, prolonged bed rest increases the possibility of systemic complications resulting from immobilization. Objective: To ascertain the behavior of peak expiratory flow and hemodynamic variables among elderly patients during the CAB postoperative period undergoing three types of physiotherapy interventions. Methods: Thirty elderly patients were studied, divided into three groups: Group A - mobilization with an ergometric bicycle; Group B - mobilization without an ergometric bicycle but with physiotherapy; and Group C - no mobilization but with non-invasive ventilation, analyzing the heart rate (HR), respiration rate (RR), blood pressure (BP), peripheral oxygen saturation (SpO2)and expiratory peak flow. The Wilcoxon test was used for variations in the intra-group results for the pre- and post-test phases, using the Kruskal-Wallis test for the inter-group comparison of the pre and post-test phases, with a statistical significance of p<0.05.Results: A significant increase was observed in the peak flow values for the three groups (pre- and post-test);with a significant reduction in the systolic blood pressure for group A and higher heart rates and respiration rates in group B. The inter-group analysis presented a statistically significant reduction in the diastolic blood pressure for group C.

Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects / Efeitos do posicionamento em decubito dorsal e lateral no pico de fluxo expiratorio em adultos saudaveis

BACKGROUND: One of the measures of the pulmonary function is the peak expiratory flow (PEF) that can be defined as the major flow obtained in an expiratory pressure after a complete inspiration to the level of the total lung capacity. This measure depends on the effort and strength of expiratory muscles, the airway diameter and the lung volume. OBJECTIVE: To compare the results of the peak expiratory flow in healthy male and female obtained in a seated position and dorsal decubitus (DD), right lateral decubitus (RLD) and left lateral decubitus (LLD). METHOD: Thirty young subjects with mean age 22.7 years, healthy and non-smokers were included at the study, 15 of male sex. They did spirometry and IPAQ questionnaire to check the normal pulmonary function and physical activity level. The measures of PEF were performed in four positions, being performed 3 measures in which position, in a random order. Statistical analysis was performed according to Student's t test, with significance level set at 5%. RESULTS: There was a difference between the values obtained in sitting position(481±117.1 L/min) with DD(453.2±116.3 L/min) and RLD (454±112.9 L/min) (p<0.05), however, did not find a significant difference between the sitting position and LLD (469±83 L/min). CONCLUSIONS: Body position affects the values of PEF, with decreasing values in DD and RLD. The LLD can be an alternative to optimize the expiratory flow in situations of constraint to the sitting position. .

CONTEXTUALIZAÇÃO: Pico de fluxo expiratório (PFE) é uma das medidas de função pulmonar definida como o maior fluxo obtido em uma expiração forçada a partir de uma inspiração completa ao nível da capacidade pulmonar total (CPT). Essa medida é dependente do esforço, da força dos músculos expiratórios, do calibre das vias aéreas e do volume pulmonar. OBJETIVO: Comparar os resultados de PFE em homens e mulheres saudáveis, obtidos na posição sentada, com decúbito dorsal (DD), decúbito lateral direito (DLD) e esquerdo (DLE). MÉTODO: Participaram 30 indivíduos, com média de idade de 22,7 anos, saudáveis e não fumantes, sendo 15 do sexo masculino. Todos realizaram espirometria e responderam ao questionário IPAQ para caracterizar a normalidade da função pulmonar e o nível de atividade física. As medidas de PFE foram realizadas nas quatro posições, sendo realizadas três medidas em cada posição, em ordem aleatória. Para análise estatística, foi utilizado o teste t de Student, com nível de significância estabelecido em 5%. RESULTADOS: Houve diferença entre os valores obtidos na posição sentada (481±117, 1 L/min) com o DD (453,2±116,3 L/min) e DLD (454±112,9 L/min) (p<0,05), porém, não encontramos diferença significativa entre as posições sentada e DLE (469±83 L/min). CONCLUSÕES: A posição corporal afeta os valores de PFE, com diminuição dos valores em DD e DLD. O DLE pode ser uma alternativa para otimizar o fluxo expiratório em situações de restrição à posição sentada. .

Correlação entre a pressão expiratória máxima (pemáx) e pico de fluxo expiratório máximo (pfe) em indivíduos saudáveis / Correlation between maximal expiratory pressure (mpe) and maximal expiratory flow peak (mefp) in healthy individuals

Introdução: A prova de função pulmonar é um recurso que tem colaborado com a validação científica da fisioterapia respiratória. Ela é capaz de estimar, entre outras variáveis, as alterações dos volumes e capacidades pulmonares, e/ ou as alterações da força dos músculos respiratórios. A mensuração da força é realizada através do manovacuômetro, no qual se obtém a pressão expiratória máxima (PEmáx.). Outra forma de avaliar a função pulmonar é a medida do pico de fluxo expiratório (PFE). Objetivos: Investigar a correlação entre a PEmáx. e PFE, em indivíduos saudáveis. Métodos: O estudo foi realizado na Universidade Severino Sombra. Oitenta e um voluntários de ambos os sexos, 55 do sexo feminino (22,69 ± 0,41 anos), e 26 do sexo masculino (23,11 ± 3,51 anos) participaram deste estudo. Um questionário respiratório foi aplicado para investigar parâmetros clínicos. Todos os indivíduos realizaram exame de manovacuometria e medidor de PFE, em posição ortostática. Os dados foram expressos como média ± erro padrão da média. Resultados: Uma correlação positiva foi encontrada entre a PEmáx. e PFE (r = 0,43; r2 = 0,18, p <0,001). Foi estimada a equação de regressão linear (PFE = 2,93 + 148,07 x PEmáx.), e os valores normais estimados foram apresentados em uma tabela. Conclusões: Este estudo mostra a influência da força dos músculos expiratórios no PFE em vias aéreas, e sugeriu uma equação para estimar a função ventilatória normal, na prática clínica.

Introduction: The pulmonary function is a feature that has collaborated with the scientific validation of respiratory therapy. It is able to estimate, among other variables, changes in lung volumes and capacities, and/or changes in respiratory muscle strength. The measurement of force is obtained by the manometer, through which one can obtain the maximum expiratory pressure (MEP). Another way to assess lung function is by the measurement of expiratory flow peak (EFP). Objectives: To investigate the correlation between MEP and EFP in healthy individuals (patients). Methods: This study was developed at the Severino Sombra University. Eighty-one volunteers of both sexes, 55 females (22.69 ± 0.41 years) and 26 males (23.11 ± 3.51 years) participated in this study. A respiratory questionnaire was applied to investigate clinical parameters. All individuals underwent manometer examination and flow peak measurement, in the standing position. Data were expressed as mean ± standard error of mean. Results: A positive correlation was found between MEP and EFP (r = 0.43, r2 = 0.18, p <0.001). The linear regression equation was estimated (PEF = 148.07 + 2.93 x MEP) and normal values were presented in a table. Conclusions: This study shows the influence of expiratory muscle strength in EFP in the airways, and suggested an equation to estimate the normal ventilating function in clinical practice.

Treinamento muscular melhora o volume corrente e a capacidade vital no pós-operatório de revascularização do miocárdio / Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery

OBJETIVO: Avaliar a função pulmonar e força da musculatura respiratória no período pós-operatório e verificar o efeito do treinamento muscular inspiratório sobre as medidas de desempenho da musculatura respiratória em pacientes submetidos à revascularização do miocárdio. MÉTODOS: Estudo randomizado, incluindo 47 pacientes submetidos à revascularização do miocárdio com circulação extracorpórea. Os pacientes foram divididos em grupo controle (GC), 24 pacientes, e grupo estudo (GE) 23 pacientes, com idade média de 66,33 ± 10,20 anos e 61,83 ± 8,61 anos, respectivamente. O GE foi submetido à fisioterapia convencional e ao treinamento muscular inspiratório com threshold® IMT e o GC à fisioterapia convencional. Foram comparadas as pressões respiratórias máximas (Pimáx e Pemáx), volume corrente (VC), capacidade vital (CV) e pico de fluxo expiratório (Peak Flow) no pré-operatório (Pré-OP), 1º e 3º dias de pós-operatório (PO1) e (PO3). RESULTADOS: Observou-se redução significativa em todas as variáveis mensuradas no PO1, quando comparadas ao pré-operatório, nos dois grupos estudados, Pimáx (P<0,0001), Pemáx (P<0,0001), VC: GE (P<0,0004) e GC: (P< 0,0001) e CV GE: (P<0,0001) e GC: (P<0,0001) e peak flow (P<0,0001). No PO3, o GE apresentou em comparação ao GC, maior valor de CV, GE 1230,4 ± 477,86 ml vs. GC 919,17 ± 394,47 ml (P= 0,0222) e VC GE 608,09 ± 178,24 ml vs. GC 506,96 ± 168,31 ml (P=0,0490). CONCLUSÃO: Pacientes submetidos à cirurgia cardíaca sofrem redução da CV e da força muscular respiratória após a cirurgia. O treinamento muscular realizado foi eficaz em recuperar o VC e a CV no PO3, no grupo treinado.

OBJECTIVE: To evaluate lung function and respiratory muscle strength in the postoperative period and investigate the effect of inspiratory muscle training on measures of respiratory muscle performance in patients undergoing coronary artery bypass grafting. METHODS: A randomized study with 47 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. They were divided into study group (SG) 23 patients and control group (CG) 24 patients, mean age 61.83 ± 8.61 and 66.33 ± 10.20 years, EuroSCORE SG 0.71 ± 0.0018 and CG 0.76 ± 0.0029, respectively. The study group underwent physical therapy and inspiratory muscle training with threshold IMT® and CG underwent conventional physiotherapy. We compared the maximal respiratory pressures (MIP and MEP), tidal volume (TV), vital capacity (VC) and peak expiratory flow (peak flow) preoperatively (Pre-OP), 1st (PO1) and 3rd (PO3) postoperative day. RESULTS: There was a significant reduction in all variables measured on PO1 compared to preoperative values in both groups, MIP (P <0.0001), MEP (P <0.0001), TV SG (P <0.0004) and CG (P <0.0001) and VC SG (P <0.0001) and CG (P <0.0001) and peak flow (P <0.0001). At PO3, SG presented higher value of VC, GE 1230.4 ± 477.86 ml vs. GC 919.17 ± 394.47 ml (P=0.0222) and TV SG 608.09 ± 178.24 ml vs. CG 506.96 ± 168.31 ml (P= 0.0490). CONCLUSION: Patients undergoing cardiac surgery experience reduced ventilatory capacity and respiratory muscle strength after surgery. Muscle training was performed to retrieve TV and VC in the PO3, in the trained group.

Percepção da dispneia na crise asmática pediátrica pelos pacientes e responsáveis / Perception of dyspnea in childhood asthma crisis by the patients and those in charge of them

OBJETIVO: Avaliar a correlação entre a percepção da dispneia durante uma crise de asma leve a moderada, por meio da escala modificada de Borg, com a medida do pico de fluxo expiratório (PFE). MÉTODOS: Estudo transversal de crianças e adolescentes que procuraram a emergência pediátrica devido a crise asmática, com dados coletados de julho de 2005 a junho de 2006. Foram registrados dados demográficos. Pacientes e seus responsáveis foram solicitados a graduar, individualmente, a dispneia do paciente por meio da escala modificada de Borg e, posteriormente, foi avaliada a medida do PFE. RESULTADOS: Foram avaliados 181 pacientes asmáticos, com idade média de 7,2 (±2,4) anos (4-12). A mãe procurou atendimento médico em 83,4% (151/181). Os sintomas incluíram tosse, em 68,5% (124/181), dispneia, em 47,0% (85/181), e sibilância, em 12,7% (23/181). Trinta e seis por cento (65/181) apresentavam crise leve, e 64,1% (116/181), moderada. Correlação negativa significativa foi evidenciada entre a percepção dos responsáveis e dos pacientes com dispneia e a medida do PFE dos pacientes (percentual previsto; r s = -0,240 e r s = -0,385, respectivamente). CONCLUSÃO: Pacientes e responsáveis demonstraram percepção limitada da gravidade da dispneia do paciente, evidenciando a necessidade de monitorar medidas objetivas, como a medida do PFE e o desenvolvimento de melhores meios de avaliação da dispneia.

OBJECTIVE: To evaluate the correlation between perception of dyspnea during a mild to moderate asthma attack using the Modified Borg Scale (MBS) and peak expiratory flow rate (PEFR). METHODS: This was a cross-sectional study conducted with children and adolescents who sought a pediatric emergency service due to an asthma attack. Data were collected from July 2005 to June 2006. Demographic data were recorded. Patients and those in charge of them were requested to grade, individually, the patient's dyspnea using the MBS; afterwards, the peak expiratory flow rate was measured. RESULTS: 181 asthmatic patients were evaluated, with a mean age of 7.2 (± 2.4) years (range, 4-12). The mother sought medical aid in 83.4% of the cases (151/181). Patient symptoms included coughing in 68.5% (124/181), dyspnea in 47.0% (85/181), and wheezing in 12.7% (23/181). Thirty-six percent (65/181) had a mild attack, and 64.1% (116/181) a moderate one. A significant negative correlation was found between the patients' and accompanying adults' perceptions of patient's dyspnea and the PEFR (% predicted; r s = -0.240 and r s = -0.385, respectively). CONCLUSION: Both the patients and those looking after them had a poor perception of the severity of the patient's dyspnea. This emphasizes the need to monitor objective measures such as the PEFR and to develop better ways of evaluating dyspnea.

Adiposity: Determinant of peak expiratory flow rate in young Indian adults male.

Background. Although several factors such as respiratory muscle strength, lung compliance, resistance to airflow, and even obesity affect the lung functions, the nature of relationship with markers of adiposity is not clear. We hypothesised that central pattern of fat distribution is a significant predictor of decreased peak expiratory flow rate (PEFR). The present study was designed with the aim to examine the effects of adiposity on PEFR in males. Methods. One hundred young healthy male volunteers were analysed in the study. They were classified into non-obese, and obese groups based on body mass index (BMI) (obese ≥30Kg/m2 and non-obese <30Kg/m2). The PEFR was measured by using Wright’s peak flow meter. Data was analysed using unpaired ‘t’ test for statistical significance of differences between the non-obese and the obese, stratified into age groups of 20 to 30 years and 30 to 40 years. A partial correlation adjusted to age, height and BMI followed by regression analysis was conducted using adiposity markers as a predictor of PEFR. Results. The model adjusted to age, height, weight and BMI revealed waist hip ratio (WHR) as the only parameter which shows significant variance in PEFR with a Pearson’s r=-0.59, F (1, 100)=12.23, p=0.04. The resulting linear regression equation is y=-388.72xWHR+850.68. Conclusions. Our findings suggest that obesity itself and especially the pattern of body fat distribution have independent effects on PEFR. These results suggest that abdominal adiposity, measured as WHR, is a better predictor of expiratory flow than weight or BMI.

Comparison of five portable peak flow meters

OBJECTIVE: To compare the measurements of spirometric peak expiratory flow (PEF) from five different PEF meters and to determine if their values are in agreement. Inaccurate equipment may result in incorrect diagnoses of asthma and inappropriate treatments. METHODS: Sixty-eight healthy, sedentary and insufficiently active subjects, aged from 19 to 40 years, performed PEF measurements using Air Zone®, Assess®, Galemed®, Personal Best® and Vitalograph® peak flow meters. The highest value recorded for each subject for each device was compared to the corresponding spirometric values using Friedman's test with Dunn's post-hoc (p<0.05), Spearman's correlation test and Bland-Altman's agreement test. RESULTS: The median and interquartile ranges for the spirometric values and the Air Zone®, Assess®, Galemed®, Personal Best® and Vitalograph® meters were 428 (263-688 L/min), 450 (350-800 L/min), 420 (310-720 L/min), 380 (300-735 L/min), 400 (310-685 L/min) and 415 (335-610 L/min), respectively. Significant differences were found when the spirometric values were compared to those recorded by the Air Zone® (p<0.001) and Galemed ® (p<0.01) meters. There was no agreement between the spirometric values and the five PEF meters. CONCLUSIONS: The results suggest that the values recorded from Galemed® meters may underestimate the actual value, which could lead to unnecessary interventions, and that Air Zone® meters overestimate spirometric values, which could obfuscate the need for intervention. These findings must be taken into account when interpreting both devices' results in younger people. These differences should also be considered when directly comparing values from different types of PEF meters.

Empilhamento de ar e compressão torácica aumentam o pico de fluxo da tosse em pacientes com distrofia muscular de Duchenne / Air stacking and chest compression increase peak cough flow in patients with Duchenne muscular dystrophy

OBJETIVO: Avaliar a eficiência da tosse através do uso de duas manobras manuais de auxílio à tosse. MÉTODOS: Foram selecionados 28 pacientes portadores de distrofia muscular de Duchenne em uso de ventilação mecânica não-invasiva noturna e CVF < 60 por cento do previsto. O pico de fluxo da tosse (PFT) foi medido, com o paciente sentado, em quatro momentos: com esforço expiratório máximo (EEM) de forma espontânea (basal), EEM associado à compressão torácica, EEM após empilhamento de ar com bolsa de ventilação e EEM com o uso dessas duas técnicas (técnica combinada). As três últimas medições foram realizadas em ordem aleatória. Os resultados foram comparados usando o teste de correlação de Pearson e ANOVA para medidas repetidas, seguido do teste post hoc de Tukey (p < 0,05). RESULTADOS: A idade média dos pacientes foi de 20 ± 4 anos, e a CVF média foi de 29 ± 12 por cento. A média de PFT basal, com compressão torácica, com empilhamento de ar e com o uso da técnica combinada foi 171 ± 67, 231 ± 81, 225 ± 80, e 292 ±86 L/min, respectivamente. Os resultados com o uso da técnica combinada foram maiores que aqueles com o uso das duas técnicas separadamente [F(3,69) = 67,07; p < 0,001]. CONCLUSÕES: As técnicas de compressão torácica e de empilhamento de ar foram eficientes para aumentar o PFT. No entanto, a combinação dessas manobras teve um efeito aditivo significativo (p < 0,0001).

OBJECTIVE: To evaluate cough efficiency using two manually-assisted cough techniques. METHODS: We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60 percent of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05). RESULTS: The mean age of the patients was 20 ± 4 years, and the mean FVC was 29 ± 12 percent. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 ± 67, 231 ± 81, 225 ± 80, and 292 ± 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001). CONCLUSIONS: Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).

Noninvasive determination of inspiratory pressure in patients with spinal cord injury: what is the best method? / Determinação não-invasiva da pressão inspiratória em pacientes com lesão medular traumática: qual é o melhor método?

The aim of the study was to evaluate the performance of sniff nasal inspiratory pressure (SNIP) and MIP in individuals with spinal cord injury. We evaluated 26 patients with spinal cord injury. Mean FVC in those with tetraplegia was 52 ± 19 percent of predicted, compared with 78 ± 23 percent of predicted in those with paraplegia (p < 0.05). In contrast, the percentage of predicted SNIP was lower in those with tetraplegia than in those with paraplegia (p < 0.05). In all participants, SNIP correlated significantly with the level of the injury (r = 0.489; 95 percent CI: 0.125-0.737). The impact that the greater discriminatory power of SNIP has on the diagnosis of impaired pulmonary function in spinal cord-injured patients should be investigated further.

O objetivo deste estudo foi verificar o desempenho da pressão inspiratória nasal durante o fungar (PInas) e da PImáx em indivíduos com lesão medular traumática. Foram avaliados 26 pacientes com lesão medular traumática. Os pacientes tetraplégicos e paraplégicos exibiram diferentes médias do percentual do previsto da CVF, respectivamente, 52 ± 19 por cento e 78 ± 23 por cento (p < 0,05). Ao contrário da PImáx, o percentual do previsto médio da PInas foi inferior nos tetraplégicos (p < 0,05) e, em todos os participantes, a correlação com o nível da lesão foi significativa (r = 0,489; IC95 por cento: 0,125-0,737). O impacto do melhor discernimento da PInas no diagnóstico das alterações da função inspiratória de pacientes com lesão medular traumática merece ser aprofundado.

Efeitos da poluição do ar na função respiratória de escolares, Rio de Janeiro, RJ / Efectos de la polución del aire en la función respiratoria de escolares, Rio de Janeiro, Sureste de Brasil / Effect of air pollution on lung function in schoolchildren in Rio de Janeiro, Brazil

OBJETIVO: Analisar a associação entre exposição diária à poluição do ar e função respiratória de escolares. MÉTODOS: Estudo de painel com uma amostra aleatória de 118 escolares (seis a 15 anos de idade) da rede pública do Rio de Janeiro (RJ), residentes até 2 km do local do estudo. Dados sobre características das crianças foram obtidos por questionário, incluindo o International Study of Asthma and Allergies in Childhood. Exames diários de pico de fluxo foram realizados para medir a função respiratória. Dados diários dos níveis de PM10, SO2, O3, NO2 e CO, temperatura e umidade foram fornecidos por um monitor móvel. As medidas repetidas de função respiratória foram associadas aos níveis dos poluentes por meio de modelo multinível ajustado por tendência temporal, temperatura, umidade do ar, exposição domiciliar ao fumo, ser asmático, altura, sexo, peso e idade das crianças. RESULTADOS: O pico de fluxo expiratório médio foi 243,5 l/m (dp=58,9). A menor média do pico de fluxo expiratório foi 124 l/m e a maior 450 l/m. Para o aumento de 10 µg/m³ de PM10 houve uma diminuição de 0,34 l/min na média do pico de fluxo no terceiro dia...

OBJECTIVE: To assess the association between daily exposure to air pollution and lung function in school children. METHODS: Panel study with a random sample of 118 students (between 6 and 15 years of age), enrolled in a public school of the city of Rio de Janeiro, state of Rio de Janeiro, and living within 2 km of the study site. Data on students' characteristics were obtained with a questionnaire, including the International Study of Asthma and Allergies in Childhood - ISAAC. Daily peak expiratory flow measurements were taken to measure lung function. Daily data on PM10, SO2, O3, NO2 and CO levels, temperature and humidity were provided by a portable monitor. Repeated measurements of lung function were associated with pollutant levels with a multilevel model adjusted for time trend, temperature, air humidity, exposure to smoking at home, presence of asthma, height, sex, weight and age of children. RESULTS: Mean peak expiratory flow was 243.5 l/m (sd=58.9). The lowest mean peak expiratory flow was 124 l/m, and the highest, 450 l/m. For the 10 µg/m³ increase in PM10, there was a 0.34 l/min decrease in mean peak flow on the third day...

OBJETIVO: Analizar la asociación entre exposición diaria a la polución del aire y función respiratoria de escolares. MÉTODOS: Estudio de painel con una muestra aleatoria de 118 escolares (seis a 15 años de edad) de la red pública de Río de Janeiro (Sureste de Brasil), residentes hasta 2 km de la localidad de estudio. Datos sobre características de los niños fueron obtenidos por cuestionario, incluyendo el International Study of Asthma and Allergies in Childhood. Exámenes diarios de pico de flujo fueron realizados para medir la función respiratoria. Datos diarios de los niveles de PM10, SO2, O3, NO2 y CO, temperatura y humedad fueron providenciados por un monitor móvil. Las medidas repetidas de función respiratoria fueron asociadas a los niveles de los contaminantes por medio de modelo multinivel ajustado por tendencia temporal, temperatura, humedad del aire, exposición domiciliar al humo de cigarro, ser asmático, altura, sexo, peso y edad de los niños. RESULTADOS: El pico de flujo de expiración promedio fue de 243,5 l/m (dp=58,9). El menor pico promedio del flujo de expiración fue 124 l/m y el mayor 450 l/m. Para el aumento de 10 ?g/m³ de PM10 hubo una disminución de 0,34 l/min en el promedio de pico de flujo en el tercer día...

Circadian rhythm of peak expiratory flow rate in healthy north Indian men.

Peak expiratory flow rate (PEFR) variability follows a specific pattern in asthmatics as well as in healthy individuals. There is scarcity of data for Indian healthy subjects. The PEFR (L/min.) was measured with Wright's portable peak flow meter at 05:00, 8:00, 11:00, 14:00, 17:00, 20:00 and 23:00 hours in 42 healthy, non-smoking adults of age group between 18-26 years. The variability of PEFR revealed a circadian pattern. PEFR levels tend to increase from morning at 5:00 hours till evening at 17:00 hours, with peak PEFR in evening at 17:00 hours, after which there was a progressive fall in PEFR levels, till morning 5:00 hours. This study provides the preliminary reference data of circadian pattern of PEFR in healthy individuals.

Decline in respiratory performance of Varanasi population in 22 years: a cross-sectional study.

Lung function tests were performed on apparently healthy, non-smoking male volunteers aged 16-50 years normally staying in Varanasi city area. The volunteers were divided into five groups according to their age (16-19 yr, 20-25 yr, 26-30 yr, 31-35 yr, 40-50 yr). Anthropometric determinants (height and weight) and respiratory performance (vital capacity and peak expiratory flow rate) were recorded in the year 1982 and 2004. No significant (P>0.05) difference in height, weight and body mass index was detected between the age matched groups in the year 1982 and 2004. The Vital capacity (VC) was measured in 483 and 387 volunteers in the year 1982 and 2004 respectively; peak expiratory flow rate (PEFR) was measured in 200 and 388 subjects in the year 1982 and 2004 respectively. Both VC and PEFR were found to be reduced in the year 2004 as compared to those measured in 1982 from the similar population matched for age groups. They were significantly (P<0.001) lower (20-23% less for VC and 4-14% less for PEFR) in the 20-30 years age group. There was also significant (P<0.05) decrease in PEFR for the population of 16-19 years age group studied in 2004 compared to that of 1982. Significant (P<0.001) deterioration in VC per meter of height was observed in the population above 20 years of age. The mean values of VC (ml/m height) ranging from 2119.27 +/- 316.64 (20-25 years age group) to 1923.29 +/- 225.43 (40-50 years age group) in 1982 have dropped to 1896.54 +/- 289.50 and 1593.64 +/- 419.36 for the respective age groups in 2004. Similarly, mean value of PEFR (L/ min) was found to be reduced from 523.67 +/- 64.69 in 1982 to 471.44 +/- 85.25 in 2004 for the same age groups of 20-25 years. Similar reduction was also recorded for 16-19 yr group and 26-30 yr group of population. Air-pollution and sedentary lifestyles in the population of this city may be probable reasons for the decline in respiratory performance.