Efeito de um programa de condicionamento físico aeróbio nos aspectos psicossociais, na qualidade de vida, nos sintomas e no óxido nítrico exalado de portadores de asma persistente moderada ou grave / Effects of an aerobic physical training program on psychosocial characteristics, quality-of-life, symptoms and exhaled nitric oxide in individuals with moderate or severe persistent asthma

OBJETIVO: Avaliar o papel de um programa de condicionamento físico aeróbio nos aspectos psicossociais, qualidade de vida, sintomas e óxido nítrico exalado (NOe) de adultos com asma persistente moderada ou grave. MATERIAIS E MÉTODOS: Vinte pacientes foram divididos aleatoriamente em Grupo Controle (GC, n= 10; programa de educação e exercícios respiratórios) e Grupo Treinado (GT, n= 10; programa de educação e exercícios respiratórios mais condicionamento aeróbio, 70 por cento potência máxima obtida). A intervenção aconteceu duas vezes por semana durante três meses. Antes e após, foram avaliados a capacidade aeróbia máxima, a função pulmonar, a dispnéia ao esforço, os níveis de ansiedade e depressão e a qualidade de vida. Mensalmente, eram avaliados o NOe em repouso e o número de dias livres de sintomas. RESULTADOS: Apenas o GT apresentou redução dos sintomas (GT 24,8 [IC95 por cento= 23-27] versus GC 15,7 [IC95 por cento= 9-21] dias livres de sintomas, p< 0,05), dos níveis de NOe (GT 25,8 [IC95 por cento= 15,3-44] versus GC 44,3 [IC95 por cento= 24-60] ppb, p< 0,05), da ansiedade (GT 39,3 [IC95 por cento= 37-50] versus GC 40,9 [IC95 por cento= 37-50] escore, p< 0,001) e da depressão (GT 6,6 [IC95 por cento= 1-21] versus GC 9 [IC95 por cento= 1-20] escore, p< 0,001), melhora da qualidade de vida (GT 42,8 [IC95 por cento= 34,3-71,7] versus GC 69,7 [IC95 por cento= 45,1-87,9] por cento, p< 0,001), e incremento da aptidão aeróbia (GT 25,7 [IC95 por cento= 16,2-31,3] versus GC 20,5 [IC95 por cento= 17,3-24,1] mL/kg/min, p< 0,001). CONCLUSÕES: Os resultados sugerem que o treinamento físico reduz o NOe, os sintomas e melhora a qualidade de vida e os aspectos psicossociais de adultos com asma persistente moderada ou grave.

OBJECTIVE: To evaluate the role of an aerobic physical training program on psychosocial characteristics, quality of life, symptoms and exhaled nitric oxide of adults with moderate or severe persistent asthma. METHODS: Twenty patients were randomly assigned to a Control Group (CG, n= 10, education program and respiratory exercises) and a Trained Group (TG, n= 10, education program and respiratory exercises plus aerobic training at 70 percent of the maximum power obtained). The intervention took place twice a week for three months. Maximum aerobic capacity, pulmonary function, effort dyspnea, anxiety levels, depression levels and quality of life were assessed before and after the treatment. Exhaled nitric oxide at rest and the number of days without asthma symptoms were evaluated every month. RESULTS: The TG presented increased numbers of symptom-free days (TG 24.8 days [95 percentCI= 23-27] versus CG 15.7 days [95 percentCI= 9-21]; p< 0.05), decreased exhaled nitric oxide levels (TG 25.8 ppb [95 percentCI= 15.3-44.0] versus CG 44.3 ppb [95 percentCI= 24-60]; p< 0.05), decreased anxiety scores (TG 39.3 [95 percentCI= 37-50] versus CG 40.9 [95 percentCI= 37-50]; p< 0.001), decreased depression scores (TG 6.6 [95 percentCI= 1-21] versus CG 9 [95 percentCI= 1-20]; p< 0.001), improved quality of life (TG 42.8 percent [95 percentCI= 34.3-71.7] versus CG 69.6 percent [95 percentCI= 45.1-87.9]; p< 0.001) and improved aerobic aptitude (TG 25.7 mL/kg/min [95 percentCI= 6.2-31.3] versus CG 20.5 mL/kg/min [95 percentCI= 17.3-24.1]; p< 0.001). CONCLUSIONS: Our results suggest that physical training reduces exhaled nitric oxide and symptoms and improves the quality of life and psychosocial characteristics of adults with moderate or severe persistent asthma.

Interrelationship between serum and sputum inflammatory mediators in chronic obstructive pulmonary disease

Little is known about airway inflammatory markers in chronic obstructive pulmonary disease (COPD). The objective of the present study was to identify and try to correlate pulmonary and peripheral blood inflammatory markers in COPD. In a cross-sectional study on patients with stable COPD, induced sputum and blood samples were collected for the determination of C-reactive protein, eosinophilic cationic protein, serum amyloid A protein, a-1 antitrypsin (a-1AT), and neutrophil elastase. Twenty-two patients were divided into two groups according to post-bronchodilator forced expiratory volume in the first second ( percentFEV1): group 1 (N = 12, FEV1 <40 percent) and group 2 (N = 10, FEV1 ³40 percent). An increase in serum elastase, eosinophilic cationic protein and a-1AT was observed in serum markers in both groups. Cytology revealed the same total number of cells in groups 1 and 2. There was a significantly higher number of neutrophils in group 1 compared to group 2 (P < 0.05). No difference in eosinophils or macrophages was observed between groups. Serum elastase was positively correlated with serum a-1AT (group 1, r = 0.81, P < 0.002 and group 2, r = 0.83, P < 0.17) and negatively correlated with FEV1 (r = -0.85, P < 0.03 and -0.14, P < 0.85, respectively). The results indicate the presence of chronic and persistent pulmonary inflammation in stable patients with COPD. Induced sputum permitted the demonstration of the existence of a subpopulation of cells in which neutrophils predominated. The serum concentration of all inflammatory markers did not correlate with the pulmonary functional impairment.