Pulmonary function, functional capacity and quality of life in adults with cystic fibrosis.

BACKGROUND: As there are few studies on the impact of respiratory and functional status on the quality of life domains in adults with cystic fibrosis, this study aimed to evaluate the association between respiratory function, functional capacity and quality of life in these subjects. METHODS: This is a cross-sectional study, where adults with clinical and laboratorial diagnoses of CF fibrosis underwent pulmonary function tests, the six-minute walk distance test (6MWT) and responded to the Cystic Fibrosis Questionnaire-Revised (CFQ-R). Descriptive statistics was used to summarize the findings. The associations were tested by means of Pearson's or Spearman tests, and the significance level was set at 5%. RESULTS: The 21 patients who completed the study presented with reduced quality of life in all CFQ-R domains, obstructive pulmonary disease and reduced 6MWT distance. The following associations were found between pulmonary function and CFQ-R domains: forced vital capacity - FVC (%) and treatment burden and digestive symptoms (r=-0.433, p<0.05; r=-0.443, p<0.05, respectively), forced expiratory volume in one second - FVC ratio - FEV1/FVC (%) and physical functioning, social and respiratory symptoms (r=0.5, p<0.05; r=0.58, p<0.01; r=0.45, p<0.05, respectively), residual volume (%) and physical functioning (r=0.49, p<0.05), airways' resistance - Raw and physical functioning and emotional functioning (r=-0.44, p<0.05; r=-0,46, p<0.05, respectively), carbon monoxide diffusing capacity (%pred) and physical functioning (r=-0,51; p<0.05). CONCLUSION: Adults with CF have reduced quality of life, which in part is associated with the severity of their lung function.

[Correlation between pulmonary function, posture, and body composition in patients with asthma]. / Correlação entre função pulmonar, postura e composição corporal em pacientes com asma.

AIM: Asthma may result in postural disorders due to increased activity of accessory respiratory muscles and hyperinflation. Our primary objective was to assess the correlation between pulmonary function and posture in adult patients with asthma. Secondarily, we aimed to study the correlation between body composition and body posture in this group of patients. METHOD: This was a cross-sectional study including 34 patients with asthma who were subjected to postural assessment (photogrammetry), pulmonary function testing (spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide, and respiratory muscle strength), and body composition estimation by means of bioelectrical impedance. RESULTS: Most patients were female (70.6%) with a median age of 32.5 years (range: 23-42 years old). We found a significant correlation between horizontal alignment of head (anterior view) and the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC; ρ=-0,37; P=.03), total lung capacity (TLC; ρ=0,42; P=.01), and residual volume (RV; ρ=0,45; P<.001). Bronchial obstruction and respiratory muscle strength variables also correlated with postural assessment measures on the right and left lateral views. Both body mass index and the percentage of fat mass correlated with horizontal alignment of head, horizontal alignment of the pelvis, and the frontal angle of the lower limbs. CONCLUSION: Adult patients with asthma exhibit specific postural disorders that correlate with pulmonary function and body composition. The assessment of postural variables may provide a better pulmonary rehabilitation approach for these patients.

A long-term pulmonary rehabilitation program progressively improves exercise tolerance, quality of life and cardiovascular risk factors in patients with COPD.

BACKGROUND: Support and treatment options have been widely discussed in recent decades with the aim of improving morbidity, mortality and quality of life of chronic respiratory disease (COPD) patients. Although it is believed that longer pulmonary rehabilitation programs can provide better results, most of the evidence comes from short-term programs. AIM: To determine the effects of an outpatient pulmonary rehabilitation program on exercise tolerance, dyspnoea, hemodynamic variables and quality of life. DESIGN: Case series study. SETTING: Rehabilitation Centre. POPULATION AND METHODS: A convenience sample of COPD patients was enrolled in this study. The intervention consisted of a 96-wk exercise training program, including aerobic training, upper-limb exercises and inspiratory muscle training. Pulmonary function tests, blood biochemistry, six-minute walking distance test and health-related quality of life were recorded at baseline and after completion of the 6th, 12th, 18th, 24th months. RESULTS: Forty one consecutive COPD patients were recruited and thirty six completed the study. There was a significant improvement in hemodynamics, demonstrated by the gradual reduction in heart rate, blood pressure and MvO2 (double product) starting from the 12th month. Lipid profile showed a reduction of low density lipids and an increase of the high density lipids levels starting from the 6th month. Exercise tolerance, dyspnoea, respiratory muscle strength and quality of life also improved starting from the 6th month. CONCLUSION: A 24-month pulmonary rehabilitation program leads to a progressive improvement in quality of life, dyspnoea and exercise tolerance, and reduces cardiovascular risk factors in patients with chronic obstructive pulmonary disease. IMPACT: Our study suggests that long-term pulmonary rehabilitation programs can result in further improvements in the aforementioned cardiorespiratory variables.

Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis

Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (D LCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and D LCOsb measurement. After 5 years, forced vital capacity (FVC) percent and D LCOsb percent had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC percent and D LCOsb percent (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40 percent were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC percent and D LCOsb percent after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function.

Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis.

Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (D LCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and D LCOsb measurement. After 5 years, forced vital capacity (FVC)% and D LCOsb% had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC% and D LCOsb% (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40% were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC% and D LCOsb% after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function.

Inspirometria de incentivo e breath stacking: repercussões sobre a capacidade inspiratória em indivíduos submetidos à cirurgia abdominal / Incentive spirometry and breath stacking: effects on the inspiratory capacity of individuals submitted to abdominal surgery

CONTEXTUALIZAÇÃO: As complicações respiratórias são as principais causas de aumento da morbidade e da mortalidade em indivíduos submetidos à cirurgia de andar superior do abdômen. A eficácia dos procedimentos fisioterapêuticos precisa ser melhor definida, assim como é necessário o conhecimento da melhor estratégia terapêutica a ser implementada. OBJETIVO: Comparar o volume inspiratório mobilizado durante a técnica de breath stacking, com o volume na inspirometria de incentivo em pacientes submetidos à cirurgia abdominal. MATERIAIS E MÉTODOS: Doze pacientes, no primeiro dia de pós-operatório, foram orientados a inspirar profundamente por meio do inspirômetro de incentivo Voldyne® e a realizar esforços inspiratórios sucessivos pela máscara facial adaptada para realização da manobra de breath stacking. Cada técnica foi realizada cinco vezes de acordo com a randomização. No período pré-operatório, os pacientes realizaram prova espirométrica, foram avaliados e instruídos quanto à realização das técnicas. Um ventilômetro de Wright® permitiu o registro da capacidade inspiratória. RESULTADOS: A capacidade inspiratória foi significativamente maior durante o breath stacking do que durante a inspirometria de incentivo, tanto no pré quanto no pós-operatório. Houve redução significativa dos volumes após o procedimento cirúrgico, independentemente da técnica realizada. CONCLUSÕES: A técnica de breath stacking mostrou-se eficaz e superior à inspirometria de incentivo para a geração e sustentação de volumes inspiratórios. Por não haver descrição de efeitos adversos, essa técnica pode, provavelmente, ser utilizada de forma segura e eficaz, principalmente em pacientes pouco cooperativos.

BACKGROUND: Respiratory complications are the main causes of increased morbidity and mortality in individuals who undergo upper abdominal surgery. The efficacy of physical therapy procedures needs clarification, and it is necessary to know which therapeutic approaches are the best ones to implement. OBJECTIVE: To compare the inspiratory volume during the breath stacking maneuver with the volume during incentive spirometry, in abdominal surgery patients. METHODS: Twelve patients, on their first postoperative day, were instructed to take a deep breath through the VoldyneTM incentive spirometer and to make successive inspiratory efforts using a facemask that had been adapted for performing the breath stacking maneuver. Each technique was performed five times according to the randomization. Before the operation, the patients performed a spirometric test. They were also assessed and instructed about the procedures. A WrightTM ventilometer allowed inspiratory capacity to be recorded. RESULTS: The inspiratory capacity during breath stacking was significantly higher than during incentive spirometry, both before and after the operation. There was a significant reduction in volumes after the surgical procedure, independent of the technique performed. CONCLUSIONS: The breath stacking technique was shown to be effective. This technique was better than incentive spirometry for generating and sustaining inspiratory volumes. Since no adverse effects have been described, this technique can probably be used safely and effectively, particularly in uncooperative patients.

Avaliação da pressão inspiratória máxima em pacientes críticos não-cooperativos: comparação entre dois métodos / Maximal inspiratory pressure evaluation among non-cooperative critical patients: comparison between two methods

CONTEXTUALIZAÇÃO: A ventilação mecânica, embora necessária para o tratamento da insuficiência respiratória aguda, pode estar associada ao descondicionamento e à disfunção muscular respiratória. A avaliação da pressão inspiratória máxima (PiMáx) é utilizada para estimar a força muscular inspiratória de pacientes ventilados artificialmente, porém não há uma definição quanto à melhor forma de realizar esta medida. OBJETIVO: Comparar 2 métodos de avaliação da PiMáx, por meio de 4 protocolos diferentes, em pacientes não cooperativos ventilados artificialmente. MÉTODO: Foram avaliados 30 pacientes não cooperativos e em processo de desmame da ventilação mecânica. De acordo com a randomização em blocos, o Método de Oclusão Simples (MO) e o Método da Válvula Unidirecional (VU) foram aplicados com tempo de duração de 20 e 40 segundos para cada paciente. Adicionalmente, durante as medições em 40s, foi anotado o valor da PiMáx em 30s. RESULTADOS: Os valores de PiMáx foram maiores em 40s do que em 20s para MO (48,2 ± 21,7 vs 36 ± 18,7 cmH2O; p< 0,001) e VU (56,6 ± 23,3 vs 43,4 ± 24 cmH2O; p< 0,001). Os valores de PiMáx foram maiores no método VU em 40s (VU40) do que MO em 40s (MO40) (56,6 ± 23,3 vs 48,2 ± 21,7 cmH2O; p< 0,001). Houve diferença entre VU em 30 e 40s (51,5 ± 20,8 vs 56,6 ± 23,3 cmH2O; p< 0,001). CONCLUSÃO: Em pacientes não-cooperativos, valores maiores de PiMax são obtidos com o método da válvula unidirecional com oclusão durante 40 segundos em comparação com os outros protocolos avaliados.

BACKGROUND: Although mechanical ventilation is necessary for treating acute respiratory insufficiency, it may be associated with deconditioning and respiratory muscle dysfunction. Maximal inspiratory pressure (MIP) evaluation is used to estimate inspiratory muscle strength in artificially ventilated patients, but there is no definition as to the best way to make this measurement. OBJECTIVE: To compare two methods for MIP evaluation, using four different protocols, among non-cooperative artificially ventilated patients. METHOD: Thirty non-cooperative patients undergoing the process of weaning off mechanical ventilation were evaluated. In accordance with block randomization, the simple occlusion method (OM) or the unidirectional valve method (UV) was applied to each patient for time periods of 20 and 40 seconds. Additionally, during the 40s measurements, the MIP value at 30s was recorded. RESULTS: The MIP values were higher at 40s than at 20s, both from OM (48.2 ± 21.7 vs. 36 ± 18.7 cmH2O; p< 0.001) and from UV (56.6 ± 23.3 vs. 43.4 ± 24 cmH2O; p< 0.001). The MIP values were higher from UV at 40s (UV40) than from OM at 40s (OM40) (56.6 ± 23.3 vs. 48.2 ± 21.7 cmH2O; p< 0.001). There was a difference between UV at 30 and 40s (51.5 ± 20.8 vs. 56.6 ± 23.3 cmH2O; p< 0.001). CONCLUSION: Among non-cooperative patients, higher MIP values were obtained from the unidirectional valve method with 40s of occlusion than from the other protocols evaluated.

Respiratory mechanics and pleural remodelling in pleurodesis induced by barium sulphate.

The aim of this study was to determine whether an intrapleural injection of barium sulphate would produce pleurodesis in rats. Additionally, respiratory mechanics and pleural remodelling were analysed. Single intrapleural injection of barium sulphate (100%) or saline was given to Wistar rats. Respiratory system, lung, and chest wall elastic, resistive and viscoelastic/inhomogeneous pressures were measured by the end-inflation occlusion method at 2 and 30 days after injection. The pleura were examined for gross and histopathological evidence of pleural inflammation and fibrosis, and the underlying lungs were also studied by morphometry. All pulmonary mechanical parameters increased at day 2, but were not different from control at 30 days after injection. Chest wall mechanical parameters did not change. Macroscopic evaluation demonstrated pleural adherence without haemothorax. Histopathologic analysis showed pleural inflammation and fibrosis. There was no alveolar inflammation or fibrosis in both groups. In conclusion, barium sulphate induced pleurodesis with either no changes in respiratory mechanics or lung lesion at day 30.