Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial.

AIM: To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. METHODS: Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. RESULTS: After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4-143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. CONCLUSION: HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.

Quality of Life Questionnaire-Bronchiectasis: a study of the psychometric properties of the Brazilian Portuguese version.

OBJECTIVE: To evaluate the psychometric properties of the Brazilian Portuguese version of the Quality of Life Questionnaire-Bronchiectasis. DESIGN: Cross-sectional study. SETTING: Outpatient clinic. SUBJECTS: Clinically stable individuals with a diagnosis of bronchiectasis. MEASURES: The evaluations performed were spirometry, incremental shuttle walk test, Saint George's Respiratory Questionnaire, and the modified Medical Research Council dyspnea scale. The Quality of Life Questionnaire-Bronchiectasis was administered twice (seven to 14 days apart). Psychometric analyses were performed as follows: reliability, construct validity, criterion validity, and interpretability. RESULTS: In total, 108 individuals (48 ± 14 years, 61 women) participated in the study. Internal consistency was considered adequate (Cronbach's alpha ⩾ 0.70) for the majority of scales (from 0.58 to 0.93). Test-retest coefficients were moderate to excellent (intraclass correlation coefficients from 0.70 to 0.93). In the construct validity, 35 of 37 items correlated more strongly with their assigned scale than a competing scale. The convergent validity showed significant correlations between scales of the Quality of Life Questionnaire-Bronchiectasis with modified Medical Research Council dyspnea scale, and incremental shuttle walk test (r from 0.20 to 0.59). A low to moderate correlations was revealed between all scales of the Quality of Life Questionnaire-Bronchiectasis and the Saint George's Respiratory Questionnaire domains (r from 0.26 to 0.70). The standard error of measurement was acceptable. Ceiling effects were found for the Social Functioning and Treatment Burden scales. CONCLUSIONS: The Quality of Life Questionnaire-Bronchiectasis is a reliable, valid instrument with adequate internal consistency for the evaluation of the impact of bronchiectasis on the health-related quality of life of Brazilian adults.

Physiological Responses During Field Walking Tests in Adults with Bronchiectasis.

BACKGROUND: Field walking tests are commonly used in patients with chronic pulmonary diseases for assessment of functional capacity. However, the physiological demands and magnitude of desaturation on 6-min walk test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT) have not been investigated in patients with bronchiectasis. The objective of this study was to compare the physiological responses and the magnitude of desaturation of subjects with bronchiectasis when performing the 6MWT, ISWT, and ESWT. METHODS: Thirty-two subjects underwent the 6MWT, ISWT, and ESWT on 3 different days. Pulmonary gas exchange, heart rate, and [Formula: see text] were measured in all tests. RESULTS: There were no differences in the peak rate of oxygen uptake, ventilation, dyspnea, and leg fatigue between the tests. Equivalent cardiac demand (ie, heart rate at peak) was observed with the 6MWT (137 ± 21 beats/min) and the ESWT (142 ± 21 beats/min), but this was lower in the ISWT (135 ± 19 beats/min) compared to ESWT (P < .05). Most subjects achieved a vigorous exercise intensity (heart rate of 70-90% of predicted) in all tests. There was no difference in desaturation among the tests (6MWT: -6.8 ± 6.6%, ISWT: -6.1 ± 6.0%, and ESWT: -7.0 ± 5.4%). CONCLUSIONS: The 6MWT, ISWT, and ESWT induced similar physiological responses at the peak of exercise, eliciting a vigorous exercise intensity. The magnitude of desaturation was similar across tests. This means these tests can be used interchangeably for evaluation of exercise-induced desaturation.

Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care?

BACKGROUND: Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis. OBJECTIVES: To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis. METHODS: An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. INTERVENTIONS: The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20min (intensity: 60-80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). CONTROL: The patients will receive an educational manual and a recommendation to walk three times a week for 30min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. MAIN OUTCOME MEASURES: incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization. DISCUSSION: The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis. TRIAL REGISTRATION: www.ClinicalTrials.gov (NCT02731482). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00060X6&selectaction=Edit&uid=U00028HR&ts=2&cx=1jbszg.

Incremental shuttle walking test: a reproducible and valid test to evaluate exercise tolerance in adults with noncystic fibrosis bronchiectasis.

OBJECTIVE: To analyze the reliability, validity, and determinants of the incremental shuttle walk test (ISWT) in adults with noncystic fibrosis bronchiectasis. DESIGN: Cross-sectional study. SETTING: Outpatient clinic. PARTICIPANTS: Subjects (N=75; 26 men) underwent, on different days, cardiopulmonary exercise testing (CPET) and 2 ISWTs, 30 minutes apart. The number of steps in daily life was recorded. Concurrent validity was tested by the relation between distance walked with peak load and oxygen consumption (V˙o2). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Distance walked (m) was compared between the first and second ISWTs; greatest distance walked was correlated with peak load and Vo2peak obtained from CPET, steps per day, and dyspnea evaluated by the Medical Research Council (MRC) scale; and desaturation was compared between CPET and the ISWT. RESULTS: Distance walked was equivalent between the first ISWT (441±152m) and the second ISWT (445±153m) with an excellent intraclass correlation coefficient (.995; 95% confidence interval, .99-.997). There were significant correlations between distance walked and peak load (r=.82), V˙o2 (r=.72), steps per day (r=.61), and the MRC scale (r=-.69). Age, body mass index, sex, forced vital capacity (% predicted), dyspnea, and steps per day explained 70% of the variation in distance walked (m) and 60% of the variance when expressed as percent predicted. Higher desaturation was observed during the ISWT (-4%±4%) than cycling (-2±3%) (P<.001). CONCLUSIONS: The ISWT is reliable, represents functional capacity, and induces greater desaturation than cycling. Age, body composition, pulmonary function, dyspnea, and physical activity in daily life are determinants of the distance walked on the ISWT.

[Clinical presentation of obese patients with polysomnographic diagnosis of obstructive sleep apnea]. / Apresentação clínica de pacientes obesos com diagnóstico polissonográfico de apnéia obstrutiva do sono.

AIM: To evaluate the symptoms of obese patients with polysomnographic diagnosis of obstructive sleep apnea (OSA). METHODS: All obese patients (BMI > or =30 kg/m(2)) that accomplished overnight polysomnography in two sleep laboratories in the city of Salvador, BA, Brazil, in the period of July to December of 2004, and had an apnea hypopnea index (AHI) > or =5. The considered symptoms were excessive daytime sleepiness, awakenings during the night and nocturnal choking or gasping. RESULTS: 73 patients were included, being 57.5% male, with mean age and BMI of 45.2 years old and 38.0 kg/m(2), respectively. The majority (49.3%) was classified as having severe OSA (AHI > or =30). Data revealed that 19.2% of the patients did not have any symptoms, while 28.8% had one symptom, 30.1% had two and 21.9% had three. There was no statistically significant difference in the severity of OSA between the subjects with and without symptoms. There was a higher prevalence of asymptomatic patients in the subgroup with severe obesity--BMI > or =35 kg/m(2) (30.8% vs. 5.9%; p = 0.007). CONCLUSIONS: The polysomnography seems to be a fundamental exam in the evaluation of obese patients due to the elevated prevalence of asymptomatic individuals with OSA in this group, especially the severely obese.

Apresentação clínica de pacientes obesos com diagnóstico polissonográfico de apnéia obstrutiva do sono / Clinical presentation of obese patients with polysomnographic diagnosis of obstructive sleep apnea

OBJETIVO: Avaliar a sintomatologia de pacientes obesos com diagnóstico polissonográfico de Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS). MÉTODOS: Foram avaliados todos os pacientes obesos (IMC > 30 kg/m²) que realizaram polissonografia em dois laboratórios de sono da cidade de Salvador, BA, no período de julho a dezembro de 2004 e apresentaram Índice de Apnéia/Hipopnéia (IAH) > 5 ev/h/sono. Os sintomas considerados foram sonolência excessiva diurna, despertares noturnos, sensação de engasgos e/ou sufocamentos durante o sono. RESULTADOS: Foram incluídos 73 pacientes, sendo 57,5 por cento do sexo masculino com média de idade e IMC de, respectivamente, 45,2 anos e 38,0 kg/m². A maioria (49,3 por cento) foi classificada como SAHOS grave (IAH > 30). Os dados revelaram que 19,2 por cento destes pacientes não apresentavam nenhum dos sintomas pesquisados, 28,8 por cento, apenas um sintoma, 30,1 por cento, dois e 21,9 por cento, três. Não houve diferença estatisticamente significante em relação à gravidade da doença entre os indivíduos com e sem sintomas. Houve uma maior freqüência de pacientes assintomáticos entre os pacientes com obesidade severa (30,8 por cento versus 5,9 por cento; p = 0,007). CONCLUSÕES: A polissonografia parece ser um exame fundamental na avaliação de pacientes obesos devido à alta taxa de indivíduos assintomáticos com índices polissonográficos alterados neste grupo, em especial nos obesos graves.

AIM: To evaluate the symptoms of obese patients with polysomnographic diagnosis of obstructive sleep apnea (OSA). METHODS: All obese patients (BMI > 30 kg/m²) that accomplished overnight polysomnography in two sleep laboratories in the city of Salvador, BA, Brazil, in the period of July to December of 2004, and had an apnea hypopnea index (AHI) > 5. The considered symptoms were excessive daytime sleepiness, awakenings during the night and nocturnal choking or gasping. RESULTS: 73 patients were included, being 57.5 percent male, with mean age and BMI of 45.2 years old and 38.0 kg/m², respectively. The majority (49.3 percent) was classified as having severe OSA (AHI > 30). Data revealed that 19.2 percent of the patients did not have any symptoms, while 28.8 percent had one symptom, 30.1 percent had two and 21.9 percent had three. There was no statistically significant difference in the severity of OSA between the subjects with and without symptoms. There was a higher prevalence of asymptomatic patients in the subgroup with severe obesity - BMI > 35kg/m² (30.8 percent vs. 5.9 percent; p = 0.007). CONCLUSIONS: The polysomnography seems to be a fundamental exam in the evaluation of obese patients due to the elevated prevalence of asymptomatic individuals with OSA in this group, especially the severe obese.