Respiratory muscles stretching acutely increases expansion in hemiparetic chest wall.

Individuals post-stroke may present restrictive ventilatory pattern generated from changes in the functionality of respiratory system due to muscle spasticity and contractures. Objective was to assess the acute effects after respiratory muscle stretching on the ventilatory pattern and volume distribution of the chest wall in stroke subjects. Ten volunteers with right hemiparesis after stroke and a mean age of 60 ±â€¯5.7 years were randomised into the following interventions: respiratory muscle stretching and at rest (control). The ventilatory pattern and chest wall volume distribution were evaluated through optoelectronic plethysmography before and immediately after each intervention. Respiratory muscle stretching promoted a significant acute increase of 120 mL in tidal volume, with an increase in minute ventilation, mean inspiratory flow and mean expiratory flow compared with the control group. Pulmonary ribcage increased 50 mL after stretching, with 30 mL of contribution to the right pulmonary rib cage (hemiparetic side) in comparison to the control group. Respiratory muscle stretching in patients with right hemiparesis post-stroke demonstrated that acute effects improve the expansion of the respiratory system during tidal breathing. CLINICAL TRIAL REGISTRATION: NCT02416349 (URL: https://clinicaltrials.gov/ct2/show/ NCT02416349).

Exhaled nitric oxide as a diagnostic tool for wheezing in preschool children: A diagnostic accuracy study.

BACKGROUND: Airways inflammation may precede pulmonary dysfunction in wheezing individuals. The fraction of exhaled nitric oxide (FENO) has been described as a useful method for wheezing diagnosis in children, however, its application requires evidence. This study aimed to determine the accuracy of FENO in identifying wheezing in preschoolers. METHODS: A cross-sectional study was carried out with children from 3 to 5 years old, from Brazilian day care centers and public schools. They were evaluated by FENO measurement through the single breath method, and by ATS-DLD-78-C questionnaire that is used as a gold standard to phenotype wheezing patterns. RESULTS: The sample consisted of 243 non-wheezing children, 118 non-recurrent wheezing and 62 recurrent wheezing. The means of FENO and confidence intervals of 95%, were 5.4 (CI 95%, 5.2-5.6); 7.5 (CI 95%, 6.9-8.2) and 11.2 (CI 95%, 9.6-12.7), respectively. The sensitivity, specificity, positive and negative predictive FENO values in the 6 parts per billion (ppb) cut-off point that best diagnosed wheezing of non-wheezing children, were: 65.5%, 84.3%, 75.6% and 76.7%, respectively, with an area under the curve (AUC) = 0.77. At 10 ppb, the best cut-off points for differentiating recurrent wheezing of non-recurrent wheezing were: 56.4%, 81.3%, 61.4%, 78.0%, respectively, with an AUC = 0.69. The post-test probability for each FENO cut-off points was increased by 33% for wheezing and 20% for recurrent wheezing diagnosis when associated with clinical examination. CONCLUSION: FENO can provide a reliable and accurate method to discriminate the presence and type of wheezing in preschoolers with 92% of acceptable in this study population.

Bronchodilator response cut-off points and FEV 0.75 reference values for spirometry in preschoolers.

OBJECTIVE:: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. METHODS:: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. RESULTS:: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. CONCLUSIONS:: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children. OBJETIVO:: Determinar os pontos de corte de resposta ao broncodilatador do VEF1, VEF0,75, VEF0,5 e FEF25-75% em crianças pré-escolares saudáveis e gerar valores de referência para o VEF0,75. MÉTODOS:: Foi realizado um estudo transversal de base comunitária em crianças de 3-5 anos de idade. Pré-escolares saudáveis foram selecionados por um questionário padronizado. Foi realizada espirometria antes e depois do uso de broncodilatador. Foram definidos os pontos de corte dessa resposta como o percentil 95 de variação em cada parâmetro. RESULTADOS:: Foram recrutadas 266 crianças, e 160 (60,0%) foram capazes de gerar manobras expiratórias aceitáveis e reprodutíveis antes e depois do uso de broncodilatador. As médias de idade e estatura dos participantes foram 57,78 ± 7,86 meses e 106,56 ± 6,43 cm, respectivamente. A taxa de sucesso para o VEF0,5 foi de 35%, 68% e 70%, respectivamente, nos participantes com 3, 4 e 5 anos de idade. O percentil 95 de variação percentual do valor previsto na resposta ao broncodilatador foram, respectivamente, de 11,6%, 16,0%, 8,5% e 35,5%, para VEF1, VEF0,75, VEF0,5 e FEF25-75%. CONCLUSÕES:: Nossos resultados definiram pontos de corte de resposta ao broncodilatador para o VEF1, VEF0,75, VEF0,5 e FEF25-75 em crianças pré-escolares saudáveis. Adicionalmente, foram propostas equações de referência para o VEF0,75, separadas por sexo. Os achados deste estudo podem melhorar a avaliação fisiológica da função respiratória em pré-escolares.

The influence of supine posture on chest wall volume changes is higher in obese than in normal weight children.

The objective of this study was to analyze thoraco-abdominal kinematics in obese children in seated and supine positions during spontaneous quiet breathing. An observational study of pulmonary function and chest wall volume assessed by optoelectronic plethysmography was conducted on 35 children aged 8-12 years that were divided into 2 groups according to weight/height ratio percentiles: there were 18 obese children with percentiles greater than 95 and 17 normal weight children with percentiles of 5-85. Pulmonary function (forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC); and FEV1/FVC ratio), ventilatory pattern, total and compartment chest wall volume variations, and thoraco-abdominal asynchronies were evaluated. Tidal volume was greater in seated position. Pulmonary and abdominal rib cage tidal volume and their percentage contribution to tidal volume were smaller in supine position in both obese and control children, while abdominal tidal volume and its percentage contribution was greater in the supine position only in obese children and not in controls. No statistically significant differences were found between obese and control children and between supine and seated positions regarding thoraco-abdominal asynchronies. We conclude that in obese children thoraco-abdominal kinematics is influenced by supine posture, with an increase of the abdominal and a decreased rib cage contribution to ventilation, suggesting that in this posture areas of hypoventilation can occur in the lung.

Pulmonary rehabilitation and whole-body vibration in chronic obstructive pulmonary disease

The Whole-Body Vibration (WBV) has been described as an alternative therapeutic resource for patients with Chronic Obstructive Pulmonary Disease (COPD) with similarity to the Pulmonary Rehabilitation Program (PRP). The aim of the study was to compare PRP to WBV on functional capacity and quality of life in patients with COPD. Twenty individuals with COPD were assigned to PRP and WBV, who were evaluated regarding their lung function, functional capacity and quality of life through spirometry, 6-minute walk test (6MWT) and St. George Respiratory Questionnaire (SGRQ), respectively. The main results for the WBV group were, there were improvements in the walked distance on the 6MWT and in the symptoms and total domains of the SGRQ. For the PRP group, we observed improvement in the activity, impact and total domains of SGRQ. We could conclude that the WBV group increased the walked distance in regard to the PRP group and both programs improved the quality of life

Bronchodilator response cut-off points and FEV 0. 75 reference values for spirometry in preschoolers / Pontos de corte da resposta ao broncodilatador e valores de referência para VEF 0. 75 em espirometria de pré-escolares

ABSTRACT Objective: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. Methods: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. Results: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Conclusions: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children.

RESUMO Objetivo: Determinar os pontos de corte de resposta ao broncodilatador do VEF1, VEF0,75, VEF0,5 e FEF25-75% em crianças pré-escolares saudáveis e gerar valores de referência para o VEF0,75. Métodos: Foi realizado um estudo transversal de base comunitária em crianças de 3-5 anos de idade. Pré-escolares saudáveis foram selecionados por um questionário padronizado. Foi realizada espirometria antes e depois do uso de broncodilatador. Foram definidos os pontos de corte dessa resposta como o percentil 95 de variação em cada parâmetro. Resultados: Foram recrutadas 266 crianças, e 160 (60,0%) foram capazes de gerar manobras expiratórias aceitáveis e reprodutíveis antes e depois do uso de broncodilatador. As médias de idade e estatura dos participantes foram 57,78 ± 7,86 meses e 106,56 ± 6,43 cm, respectivamente. A taxa de sucesso para o VEF0,5 foi de 35%, 68% e 70%, respectivamente, nos participantes com 3, 4 e 5 anos de idade. O percentil 95 de variação percentual do valor previsto na resposta ao broncodilatador foram, respectivamente, de 11,6%, 16,0%, 8,5% e 35,5%, para VEF1, VEF0,75, VEF0,5 e FEF25-75%. Conclusões: Nossos resultados definiram pontos de corte de resposta ao broncodilatador para o VEF1, VEF0,75, VEF0,5 e FEF25-75 em crianças pré-escolares saudáveis. Adicionalmente, foram propostas equações de referência para o VEF0,75, separadas por sexo. Os achados deste estudo podem melhorar a avaliação fisiológica da função respiratória em pré-escolares.

Efeitos de exercícios resistidos, de equilíbrio e alongamentos sobre a mobilidade funcional de idosas com baixa massa óssea / Effects of resistance, balance and stretching on functional mobility in elderly with low bone mass

O envelhecimento é caracterizado por degeneração da função neuromuscular traduzida por diminuição da força muscular, do equilíbrio e da coordenação. Este estudo visou avaliar os efeitos de programas de exercícios resistidos, de equilíbrio e de alongamentos sobre a mobilidade funcional em idosas com baixa massa óssea. 36 voluntárias foram aleatorizadas em dois grupos: G1 [n=18; 69,4 ± 6,8 anos] e G2 [n=18; 69,4 ± 5,7 anos] e avaliadas através do Teste Sentar-levantar com 5 repetições (STS-5), Teste de Caminhada de seis metros (SMW) e Teste de Alcance funcional (FRT). O programa de exercício foi aplicado durante 4 meses, 2 vezes por semana, com treinamento de força muscular e mobilidade funcional para G1, e alongamentos e palestras informativas para G2. Após a intervenção os indivíduos de ambos os grupos diminuíram o tempo de realização do STS-5 (G1= 12,6±3,5 vs. 8,4±1,3 s, p=0,01; G2= 12,2±2,6 vs. 8,1±1,3 s, p= 0,00), bem como do SMW (G1= 4,4±1,2 vs. 3,9±0,8 s, p=0,014; G2= 4,2±0,5 vs. 3,6±0,4s, p= 0,000), enquanto se evidenciou aumento do alcance no FRT (G1=26,4±4,9 vs. 31,6±5,0 cm, p= 0,001; G2= 24,6±4,8 vs. 30,3±4,3 cm, p=0,001). Os nossos resultados permitem concluir que foram encontradas melhoras em ambos os grupos estudados e que os exercícios físicos propostos são capazes de trazer benefícios para idosas com baixa massa óssea, através de melhora na sua mobilidade funcional.

Aging is characterized by neuromuscular function degeneration reflected on a decrease of muscle strength, balance and coordination. This study aimed to evaluate the effects of resistance, balance and stretching exercise programs on functional mobility in community-dwelling elderly with low bone mass. 36 volunteers were randomized into two groups: G1 [n=18; 69.4 ± 6.8 years] e G2 [n=18; 69.4 ± 5.7 years] which were evaluated using the Sit-to-stand-5 Test (STS-5), Six metre walk test (SMW) and Functional Reach Test (FRT). The exercise program was applied for 4 months, two times per week, with muscle strength and functional mobility training for G1, and stretching and informative lectures for G2. After the intervention, individuals from both groups decreased their time of performance in STS-5 (G1= 12.6±3.5 vs. 8.4±1.3 s, p=0.01; G2= 12.2±2.6 vs. 8.1±1.3 s, p= 0.00), as well as in SMW (G1= 4.4±1.2 vs. 3.9±0.8 s, p=0.014; G2= 4.2±0.5 vs. 3.6±0.4 s, p= 0,000), while an increase in the reach of FRT was evident (G1 = 26.4±4.9 vs. 31.6±5.0 cm, p= 0.001; G2 = 24.6±4.8 vs. 30.3±4.3 cm, p=0.001). The results indicate that improvements were found in both studied groups and that the proposed exercise programs are able to provide benefits for elderly with low bone mass, throughout the improvement in their functional mobility.