Efficacy of inspiratory muscle training on inspiratory muscle function, functional capacity, and quality of life in patients with asthma: A randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of an inspiratory muscle training protocol on inspiratory muscle function, functional capacity, and quality of life in patients with asthma. DESIGN: A single-blind, randomized controlled clinical trial. SETTING: Community-based. SUBJECTS: Patients with asthma, aged between 20 and 70 years old, non-smokers. INTERVENTIONS: Participants were randomized into two groups: inspiratory muscle training group performed inspiratory muscle training 5 days a week for 8 weeks, consisting of six sets of 30 breaths per day with a training load ⩾50% of maximal inspiratory pressure, plus an educational program; the control group only received the educational program. MAIN MEASUREMENTS: Maximal inspiratory pressure, inspiratory muscle endurance, and the distance performed on the incremental shuttle walking test were assessed pre-intervention, post-intervention and at follow-up (3 months after the end of the intervention). The asthma quality of life questionnaire was applied pre and post-intervention. RESULTS: Data from 39 participants were analyzed. Maximal inspiratory pressure in percentage of predicted and endurance test duration were significantly higher post-intervention in the inspiratory muscle training group (∆ post-pre: 50.8% vs 7.3% of predicted - P < 0.001 and ∆ post-pre: 207.9 seconds vs 2.7 seconds - P < 0.001, respectively). There was no significant difference in the incremental shuttle walking distance between groups (∆ post-pre: 30.9 m vs -8.1 m, P = 0.165). Quality of life was perceived as significantly better, without a difference between groups (P > 0.05). CONCLUSIONS: About 8 weeks of inspiratory muscle training in patients with controlled asthma significantly increased inspiratory muscle strength and endurance.

Validation of the International Classification of Functioning, Disability and Health Core Set for obstructive pulmonary diseases in the perspective of adults with asthma.

Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma.Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient's life were performed. The meaning condensation procedure was used for analysis.Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions (n = 168), Body Structures (n = 22), Activities and Participation (n = 33), Environmental Factors (n = 125). These concepts were linked to 61 categories: second level (n = 25), third level (n = 33), fourth level (n = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification.Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates.Implications for rehabilitationThe use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring.The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma.The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma.

Papel de mediadores endógenos na fisiopatologia da cirrose hepática / The role of endogenous mediators in the pathophysiology of hepatic cirrhosis

A cirrose hepática é o evento final das doenças hepáticas crônicas em pacientes adultos e pediátricos. Apesar de muitos estudos em relação ao desenvolvimento da fibrose hepática, o entendimento de sua etiopatogênese e fisiopatologia continua obscuro. Diversos mediadores, tais como componentes do sistema renina-angiotensina, o sistema nervoso simpático, a vasopressina, os peptideos natriuréticos, o sistema calicreína-cinina, a endotelina e o óxido nítrico podem estar envolvidos nesses mecanismos. Além disso, a abordagem terapêutica dos pacientes hepatopatas ainda é bastante limitada, contribuindo para o prognóstico reservado. Este artigo de revisão pretende discutir algumas evidências clínicas e experimentais relativas à participação destes mediadores endógenos na fisiopatologia da cirrose hepática.

The hepatic cirrhosis is the final event of many chronic hepatic diseases in adult and pediatric patients. In spite of many studies regarding the development of fibrosis, the understanding of its etio- and physiopathology remains obscure. Several mediators may be involved in these mechanisms: renin-angiotensin system, sympathetic nervous system, vasopressin, natriuretic peptides, kallicreinkynin system, endothelin, and nitric oxide. Furthermore, the therapeutic approach of the patients with chronic hepatic diseases is still limited, contributing to a bad outcome. Some clinical and experimental evidences regarding the participation of these endogeneous mediators in the physiopathology of hepatic cirrhosis are discussed.