Quality of life assessment in two consecutive years of patients in a waiting list for lung transplantation.

BACKGROUND: Patients on a waiting list for lung transplantation (LT) have physical and emotional setbacks due to limiting symptoms such as dyspnea and cough. Time on a waiting list may worsen the conditions of these patients and affect their quality of life (QoL). OBJECTIVE: Our objective was to evaluate QoL components in patients in 2 consecutive years who were waiting for transplantation. MATERIAL AND METHODS: We studied patients who remained on a waiting list for transplantation in the first 2 years after inclusion on the list. Evaluation was performed using the Short-Form-36 (SF-36) Questionnaire and the Saint George's Respiratory Questionnaire (SGRQ). RESULTS: Fifty-six patients were included (38.5 ± 15 years), 33 women (59%) and 23 men (41%). Of these, 18 had bronchiectasis, 14 had cystic fibrosis, 9 had lung fibrosis, 8 had lung emphysema, and 7 had other diseases. The domains with greater involvement in the first and second year were Functional Capacity and Physical Aspects. In the second year there was a significant worsening in Physical Aspects (2.5-0 points; P = .032). The domains related to the emotional component did not have significant changes. CONCLUSION: The progression of the disease and progressive worsening of symptoms of patients on a transplantation waiting list led to less physical exercise, worsening the effects of inactivity. After 1 year on a waiting list for LT, patients had a significant loss of functionality, which had an impact on QoL.

The quality of life of patients on the lung transplantation waiting list.

INTRODUCTION: Lung transplantation (LTx) candidates present incapacitating symptoms related to their mobility and activities of daily living, thereby affecting their work, social and emotional relations, and quality of life (QoL). OBJECTIVE: To study the QoL of LTx candidates, seeking to identify domains that suffer the greatest impact and verify if there are differences among these impairments according to the original lung disease. METHODS: We applied the Short Form-36 questionnaires and St George's Respiratory Questionnaire (SGRQ). All data were analyzed by one-way analysis of variance and the Kruskal Wallis test for the probability with significance at P < 0.05. RESULTS: Fifty patients were divided into groups of emphysema (n = 16), bronchiectasis (n = 12), idiopathic pulmonary fibrosis (n = 7), and cystic fibrosis (n = 15). The functional capacity, physical aspects, general status, and vitality domains showed average values below 50 points. The cystic fibrosis group showed higher functional capacity scores (46 +/- 23) than the emphysema (12 +/- 13) or idiopathic pulmonary fibrosis cohort (7 +/- 5). The limitation caused by pain affected the bronchiectasis more than the cystic fibrosis group (52 +/- 28 vs 81 +/- 25, respectively). The SGRQ scores showed impairment among all groups in all domains with average values over 50. The activities domain shows the highest score value; the emphysema (92 +/- 10) and idiopathic pulmonary fibrosis cohorts (91 +/- 9) were extremely affected compared with the cystic fibrosis (69 +/- 21) and bronchiectasis subjects (79 +/- 16). The impact domain show that subjects with cystic fibrosis were less emotionally affected by the disease. CONCLUSION: LTx candidates showed great impairment of their QoL due to their health problems, above all in the physical-functional aspects; the cystic fibrosis patients were the least affected by their health status.

Respiratory pattern, thoracoabdominal motion and ventilation in chronic airway obstruction.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) present abnormal respiratory mechanics, but its relation to ventilation variables at rest is not fully understood. METHODS: We evaluated breathing pattern, thoracoabdominal motion, and ventilation in moderate and severe COPD patients by means of respiratory inductive plethysmograph and analysis of respiratory metabolism in semirecumbent position at rest. Diaphragmatic movement was measured using radiographs. RESULTS: COPD patients showed an increase in mean inspiratory flow, minute ventilation, dead space ventilation, oxygen and carbon dioxide ventilatory equivalents and reduction of respiratory times and pulse oxymetry. These findings were more pronounced in severe COPD. Changes in ventilatory efficiency were correlated with decreased respiratory times, reduced diaphragmatic movement, and lower oxygen uptake. CONCLUSIONS: Rapid shallow breathing and reduced diaphragmatic movement have led to ventilatory inefficiency without changes in thoracoabdominal motion.

Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema.

OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2), continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69+/-7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at beginning, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05). Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05). CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

Perpectivas da capacitaçäo do profissional fisioterapeuta da área hospitalar no âmbito da formaçäo e da educaçäo continuada / Perspectives of capacitating the professional physiotherapist in the hospital dimensions in the compass of proficiency and continued education

O Serviço de Fisioterapia tem, ao longo desse período aprimorado sua organizaçäo para formar fisioterapeutas especialistas em Fisioterapia Respiratória. Esse processo é descrito através da formaçäo e atuaçäo do profissional inserido em uma instituiçäo voltada para a Assistência, Ensino e Pesquisa