Lung diffusing capacity relates better to short-term progression on HRCT abnormalities than spirometry in mild asbestosis.

BACKGROUND: Pulmonary function tests (PFT), particularly spirometry and lung diffusing capacity for carbon monoxide (DL(CO) ), have been considered useful methods for the detection of the progression of interstitial asbestos abnormalities as indicated by high-resolution computed tomography (HRCT). However, it is currently unknown which of these two tests correlates best with anatomical changes over time. METHODS: In this study, we contrasted longitudinal changes (3-9 years follow-up) in PFTs at rest and during exercise with interstitial abnormalities evaluated by HRCT in 63 ex-workers with mild-to-moderate asbestosis. RESULTS: At baseline, patients presented with low-grade asbestosis (Huuskonen classes I-II), and most PFT results were within the limits of normality. In the follow-up, most subjects had normal spirometry, static lung volumes and arterial blood gases. In contrast, frequency of DL(CO) abnormalities almost doubled (P < 0.05). Twenty-three (36.5%) subjects increased the interstitial marks on HRCT. These had significantly larger declines in DL(CO) compared to patients who remained stable (0.88 vs. 0.31 ml/min/mm Hg/year and 3.5 vs. 1.2%/year, respectively; P < 0.05). In contrast, no between-group differences were found for the other functional tests, including spirometry (P > 0.05). CONCLUSIONS: These data demonstrate that the functional consequences of progression of HRCT abnormalities in mild-to-moderate asbestosis are better reflected by decrements in DL(CO) than by spirometric changes. These results might have important practical implications for medico-legal evaluation of this patient population.

Skeletal muscle structure and function in response to electrical stimulation in moderately impaired COPD patients.

STUDY OBJECTIVE: To determine the structural and functional consequences of high-frequency neuromuscular electrical stimulation (hf-NMES) in a group of moderately impaired outpatients with chronic obstructive pulmonary disease (COPD). DESIGN: A prospective, cross-over randomized trial. SETTING: An university-based, tertiary center. PATIENTS AND MATERIALS: Seventeen patients (FEV(1)=49.6+/-13.4% predicted, Medical Research Council dyspnoea grades II-III) underwent 6-weeks hf-NMES (50Hz) and sham stimulation of the quadriceps femoris in a randomized, cross-over design. Knee strength was measured by isokinetic dynamometry (peak torque) and leg muscle mass (LMM) by DEXA; in addition, median cross-sectional area (CSA) of type I and II fibres and capillary-fibre ratio were evaluated in the vastus lateralis. The 6-min walking distance (6MWD) was also determined. RESULTS: At baseline, patients presented with well-preserved functional capacity, muscle strength and mass: there was a significant relationship between strength and type II CSA (P<0.05). NMES was not associated with significant changes in peak torque, LMM or 6MWD as compared to sham (P>0.05). At micro-structural level, however, electrical stimulation increased type II, but decreased type I, CSA; no change, however, was found in the relative fibre distribution or capillary:fibre ratio (P<0.05). There was no significant association between individual changes in structure and function with training (P>0.05). Post-NMES increase in type II CSA was inversely related to baseline mass and strength (P<0.05). CONCLUSION: NMES may promote a modest degree of type II muscle fibre hypertrophy in COPD patients with well-preserved functional status. These micro-structural changes, however, were not translated into increased volitional strength in this sub-population.

Asbestos-related disease: progression of parenchymal abnormalities on high-resolution CT.

PURPOSE: To evaluate the changes over time in the pattern and extent of parenchymal abnormalities in asbestos-exposed workers after cessation of exposure and to compare 3 proposed semiquantitative methods with a careful side-by-side comparison of the initial and the follow-up computed tomography (CT) images. MATERIALS AND METHODS: The study included 52 male asbestos workers (mean age+/-SD, 62.2 y+/-8.2) who had baseline high-resolution CT after cessation of exposure and follow-up CT 3 to 5 years later. Two independent thoracic radiologists quantified the findings according to the scoring systems proposed by Huuskonen, Gamsu, and Sette and then did a side-by-side comparison of the 2 sets of scans without awareness of the dates of the CT scans. RESULTS: There was no difference in the prevalence of the 2 most common parenchymal abnormalities (centrilobular small dotlike or branching opacities and interstitial lines) between the initial and follow-up CT scans. Honeycombing (20%) and traction bronchiectasis and bronchiolectasis (50%) were seen more commonly on the follow-up CT than on the initial examination (10% and 33%, respectively) (P=0.01). Increased extent of parenchymal abnormalities was evident on side-by-side comparison in 42 (81%) patients but resulted in an increase in score in at least 1 semiquantitative system in only 16 (31%) patients (all P>0.01, signed test). CONCLUSIONS: The majority of patients with previous asbestos exposure show evidence of progression of disease on CT at 3 to 5 years follow-up but this progression is usually not detected by the 3 proposed semiquantitative scoring schemes.

Relação do pico de fluxo expiratório com o tempo de fonação em pacientes asmáticos / Relation of peak-flow with fonation time in asmatic patients

Objetivo: investigar a possível relação do Pico de Fluxo Expiratório (PFE) com o Tempo Máximo deFonação (TMF) em pacientes asmáticos. Métodos: a pesquisa enfocou 16 indivíduos com o diagnósticode asma pura, sendo 9 do gênero feminino e 7 do gênero masculino, atendidos no serviçoambulatorial de pneumologia do Hospital Júlia Kubitschek em BH. A equipe de pneumologia diagnosticou,classificou a asma e realizou o teste PFE. Posteriormente os pacientes foram submetidos àextração de tempo Máximo de Fonação (TMF) para os sons /a/, /i/, /u/, /e áfono/, /e sonoro/, /s/ e /z/.Resultados: dos pacientes atendidos havia 12,50% (2) com asma tratada, 18,75% (3) com asma persistenteleve, 43,75% (7) com asma persistente moderada, 6,25% (1) com asma moderada grave e18,75% (3) com asma persistente grave. Foi observado que quando o TMF encontrava-se reduzidoocorria também uma redução do PFE e quando havia um aumento do TMF era encontrado no PFEvalor também maior. Conclusão: foi possível observar uma associação e uma correlação entre asmedidas TMF e PFE que sugerem uma relação direta dessas medidas.

Purpose: to investigate the possible relationship between Expiratory Flow Peak (EFP) and MaximumPhonation Duration (PMD) for asthmatic patients Methods: the research focused on 16 individualsdiagnosed with pure asthma, where 9 were female and 7 were males, treated at the pneumologyclinical services of Júlia Kubitschek Hospital. The pneumology team diagnosed, classified the asthmaand performed the EFP test. The patients were submitted afterwards to PMD speech therapy evaluation.Results: within the treated patients there were 12.50% (2) with treated asthma, 18.75% (3) with lightpersistent asthma, 43.75 % (7) with moderate persistent asthma, 6.25% (1) with severe moderateasthma and 18.75% (3) with severe persistent asthma. It was found that when PMD had decreasedthere was a decrease in EFP as well, and that when there was an increase of PMD the EFP valuewould also increase. Conclusion: it was possible to note a relation and a correlation between PMDand EFP measures, suggesting a direct relation between these measurements.