ABSTRACT
OBJECTIVE: To measure peak inspiratory flow (PIF) and assess dynamic lung function in children and adolescents with asthma, as well as to determine the association of PIF with dynamic lung function and clinical variables. METHODS: This was a cross-sectional study of children and adolescents with asthma using dry powder inhalers (DPIs) regularly. The control group included sex-, age-, weight-, and height-matched individuals without lung disease. Socioeconomic and clinical variables were collected. PIF and dynamic lung function variables were obtained with a specific device. Between-group comparisons were made with the Student's t-test and ANOVA. Multiple linear regression analysis was performed, and Pearson's correlation coefficients were calculated to assess associations between PIF and the other variables. RESULTS: A total of 88 individuals (44 asthma patients and 44 controls) participated in the study. PIF and respiratory muscle strength (S-index) values were lower in the asthma patients than in the controls. PIF correlated positively with age, weight, height, and S-index in the asthma group. After controlling for height, we found an increase of 0.05 units in PIF associated with an increase of 1 unit in the S-index in the asthma group. CONCLUSIONS: PIF appears to be lower in children and adolescents with asthma than in those without asthma, correlating positively with age, height, weight, and respiratory muscle strength.
Subject(s)
Asthma , Dry Powder Inhalers , Administration, Inhalation , Adolescent , Asthma/drug therapy , Child , Cross-Sectional Studies , Humans , Nebulizers and Vaporizers , Respiratory MusclesABSTRACT
OBJECTIVE: To evaluate the impact of age in health-related quality of life (HRQoL) in older adults with cancer. METHODS: This was a cross-sectional study of 608 older adults diagnosed with cancer. Age groups were considered an independent variable. For the analysis of HRQoL, the mean scores of age groups were compared by analysis of variance and the Scheffé comparison test. For measuring the association between age and HRQoL, we used simple and multiple linear regression analyses. RESULTS: Cognitive function showed the highest scores (average 87.94 ± 26.87), while physical function showed the lowest ones (68.04 ± 28.63). The highest symptom score was observed for financial difficulties (34.21 ± 39.06), followed by pain (29.47 ± 33.92) and insomnia (28.51 ± 37.03). After adjustment, we observed a decrease in physical function (p = 0.028) and an improvement in emotional function (p = 0.003) with increasing age. CONCLUSIONS: In older patients with cancer, age negatively impacted physical function and positively impacted emotional function.
OBJETIVO: Avaliar o impacto da idade na qualidade de vida relacionada à saúde (QVRS) em idosos com câncer. MÉTODOS: Estudo transversal envolvendo 608 idosos diagnosticados com câncer. Os grupos etários foram considerados uma variável independente. Para a análise da QVRS, os escores médios dos grupos etários foram comparados utilizando a análise de variância e o teste de Scheffé. Para medir a associação entre idade e QVRS, foram utilizadas análises de regressão linear simples e múltipla. RESULTADOS: A função cognitiva apresentou os maiores escores (média 87,94 ± 26,87), enquanto a função física apresentou os menores (68,04 ± 28,63). O maior escore de sintomas foi observado em dificuldades financeiras (34,21 ± 39,06), seguido por dor (29,47 ± 33,92) e insônia (28,51 ± 37,03). Após o ajuste, observamos diminuição da função física (p = 0,028) e melhora da função emocional (p = 0,003) com o aumento da idade. CONCLUSÕES: Em pacientes idosos com câncer, a idade impactou negativamente a função física e positivamente a função emocional.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Quality of Life , Neoplasms/psychology , Cross-Sectional Studies , Age Factors , Sociodemographic FactorsABSTRACT
ABSTRACT Objective: To measure peak inspiratory flow (PIF) and assess dynamic lung function in children and adolescents with asthma, as well as to determine the association of PIF with dynamic lung function and clinical variables. Methods: This was a cross-sectional study of children and adolescents with asthma using dry powder inhalers (DPIs) regularly. The control group included sex-, age-, weight-, and height-matched individuals without lung disease. Socioeconomic and clinical variables were collected. PIF and dynamic lung function variables were obtained with a specific device. Between-group comparisons were made with the Student's t-test and ANOVA. Multiple linear regression analysis was performed, and Pearson's correlation coefficients were calculated to assess associations between PIF and the other variables. Results: A total of 88 individuals (44 asthma patients and 44 controls) participated in the study. PIF and respiratory muscle strength (S-index) values were lower in the asthma patients than in the controls. PIF correlated positively with age, weight, height, and S-index in the asthma group. After controlling for height, we found an increase of 0.05 units in PIF associated with an increase of 1 unit in the S-index in the asthma group. Conclusions: PIF appears to be lower in children and adolescents with asthma than in those without asthma, correlating positively with age, height, weight, and respiratory muscle strength.
RESUMO Objetivo: Analisar o pico de fluxo inspiratório (PFI) e a função pulmonar dinâmica de crianças e adolescentes asmáticos e verificar sua associação com variáveis clínicas. Métodos: Estudo transversal com crianças e adolescentes asmáticos que faziam uso regular de inaladores de pó. O grupo controle foi composto por participantes sem doença pulmonar, pareados por sexo, idade, peso e altura. Foram coletadas variáveis socioeconômicas e clínicas. O PFI e variáveis de função pulmonar dinâmica foram obtidos através de um dispositivo específico. As associações entre os dois grupos foram estudadas utilizando-se o teste t de Student e ANOVA. Realizou-se um modelo de regressão linear múltipla e foram calculados os coeficientes de correlação de Pearson para estimar associações entre o PFI e as demais variáveis. Resultados: Foram incluídos no estudo 88 participantes (44 em cada grupo). Nos asmáticos, os valores do PFI e de força muscular respiratória (S-índex) foram menores que os dos controles. O PFI nos asmáticos apresentou correlações positivas com as variáveis idade, peso, altura e S-índex. Controlando-se a altura, houve um aumento de 0,05 unidades no PFI associado ao aumento de 1 unidade de S-índex nos asmáticos. Conclusões: O PFI é menor em crianças e adolescentes com asma em comparação àqueles sem asma com características antropométricas semelhantes e apresenta correlações positivas com idade, altura, peso e força dos músculos respiratórios.
Subject(s)
Humans , Child , Adolescent , Asthma/drug therapy , Dry Powder Inhalers , Administration, Inhalation , Nebulizers and Vaporizers , Respiratory Muscles , Cross-Sectional StudiesABSTRACT
OBJECTIVE: The aim of the present study was to evaluate health-related quality of life (HRQoL) changes at 6 to 12 months after cancer diagnosis and to assess the impact of age in older adults with cancer. METHODS: A cohort study using patients ≥60 years old diagnosed with cancer. Health-related quality of life scores were calculated according to the European Organisation for Research and Treatment of Cancer questionnaire. Student's t tests for paired samples and a binomial logistic regression were performed. RESULTS: The study included 241 patients. At diagnosis, the affected HRQoL functions were physical and emotional functions, financial difficulties, pain, and insomnia. At follow-up, cognitive function (P < .001) and dyspnea (P = .004) worsened, while emotional function improved (P = .003). DISCUSSION: At the 6 to 12 months of follow-up, older adult cancer patients showed worsening cognitive function and dyspnea and improved emotional function. These HRQoL changes were not associated with age.
ABSTRACT
OBJECTIVE: To assess the variations of end-expiratory volume of chest wall (EEVcw) measured by optoelectronic plethysmography (OEP) as a diagnostic tool in exercise-induced asthma (EIA) among asthmatic preschool children. METHODS: Forty children diagnosed with asthma were included in the study. Spirometry was used as a gold standard test for comparison with OEP. A 10% decline in forced expiratory volume in 1 second was considered positive for EIA. OEP was performed with 8 cameras at a frequency of 60 Hz and 89 markers were placed on the thoraco-abdominal surface of participants. Following bronchoprovocation testing on a treadmill, series of OEP and spirometry were conducted between 5 and 30 minutes after exercise. To obtain the ideal cut-off point, a receiver operating characteristic (ROC) curve was constructed for the largest EEVcw. The highest Youden index was used as criteria to obtain the cut-off point with the best sensitivity and specificity. RESULTS: Of the 40 children studied, 16 had EIA. According to the ROC curve, the cut-off point of 0.185% for EEWcw provided mean sensitivity (95% confidence interval) of 93.75% (0.69-0.99), for a specificity of 83.33% (0.63-0.95), when using the largest increase in the period of 5-30 minutes post-exercise. The low area of the ROC was 0.93 (0.85-1.00) for p < 0.001. CONCLUSION: OEP can be accurately used to replace spirometry in asthmatic children unable to adequately execute the required manoeuvres.
Subject(s)
Asthma, Exercise-Induced/diagnosis , Image Processing, Computer-Assisted/methods , Plethysmography/methods , Child , Female , Humans , Male , ROC Curve , Sensitivity and Specificity , SpirometryABSTRACT
A asma é uma das doenças crônicas de maior frequência na infância. Parcela significativa de crianças com asma desenvolve sintomas nos primeiros anos de vida, mas nem sempre a sua confirmação diagnóstica é fácil. Outras causas de sibilância que podem gerar confusão diagnóstica, além da complexidade para a obtenção de medidas objetivas, tais como a realização de provas de função pulmonar nessa faixa etária, são justificativas para esse fato. Especialistas na abordagem desses pacientes, da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria, após revisão extensa da literatura pertinente elaboraram esse documento, onde são comentados os possíveis agentes etiológicos, prevalência, diagnóstico diferencial, assim como tratamento e prevenção da sibilância e asma em pré-escolares.
Asthma is one of the most frequent chronic diseases in childhood. A significant portion of children with asthma develop symptoms in the first years of life, but diagnostic confirmation is not always easy. The difficulty is justified by other causes of wheezing that can generate diagnostic confusion, and by the complexity involved in obtaining objective measures such as pulmonary function tests in this age group. Specialists with expertise in the approach of these patients, from both the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics, after extensive review of the pertinent literature, developed this document to discuss possible etiological agents, prevalence, differential diagnosis, as well as treatment and prevention of wheezing and asthma in preschool children.
Subject(s)
Humans , Child, Preschool , Patients , Asthma , Societies, Medical , Respiratory Sounds , Guidelines as Topic , Pediatrics , Association , Respiratory Function Tests , Respiratory Syncytial Viruses , Retroviridae , Signs and Symptoms , Therapeutics , Bacteria , Chronic Disease , Prevalence , Enterovirus D, Human , Diagnosis, Differential , Allergy and Immunology , Age GroupsABSTRACT
Cystic Fibrosis (CF) is a multisystem disorder. The involvement of the respiratory system is frequent and culminates in dyspnea and exercise intolerance. Functional capacity is an important diagnostic tool, because it reflects the cardiorespiratory status, quality of life and prognosis. This systematic review aims to assess the reproducibility and validity of the six minute walk test (6MWT) to reflect the functional capacity of children and adolescents with cystic fibrosis, and also the correlation between 6MWT and lung function. Searches for articles were performed in eight databases using MeSH/DeCS keywords. A total of 695 articles were found and, after verifying all eligibility criteria, six articles were included for analysis and scoring regarding the methodological quality according to the QUADAS scale (Quality Assessment of Diagnostic Accuracy Studies). All articles had good methodology (QUADAS between 9 and 11 points). The 6MWT is not correlated with lung function. There is a strong indication that the 6MWT is a reproducible test to assess the functional capacity of children and adolescents with CF. The validity assessment could not be reached because the studies included in this systematic review did not use adequate statistical tools to carry out such an evaluation.
Subject(s)
Cystic Fibrosis/physiopathology , Exercise Tolerance/physiology , Respiratory Function Tests/methods , Walk Test/methods , Adolescent , Child , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Female , Forced Expiratory Volume/physiology , Humans , Male , Prognosis , Quality of Life , Randomized Controlled Trials as Topic , Reproducibility of Results , Young AdultABSTRACT
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.
Subject(s)
Bronchodilator Agents/therapeutic use , Spirometry/standards , Child, Preschool , Cross-Sectional Studies , Female , Forced Expiratory Flow Rates , Forced Expiratory Volume , Humans , Male , Reference Values , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
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.
Subject(s)
Humans , Male , Female , Child, Preschool , Bronchodilator Agents/therapeutic use , Spirometry/standards , Cross-Sectional Studies , Forced Expiratory Flow Rates , Forced Expiratory Volume , Reference Values , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
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.
Subject(s)
Nitric Oxide/metabolism , Respiratory Sounds/diagnosis , Respiratory Sounds/physiopathology , Breath Tests/methods , Child, Preschool , Cross-Sectional Studies , Data Accuracy , Exhalation , Female , Humans , Male , Nitric Oxide/analysis , Predictive Value of Tests , Reproducibility of ResultsABSTRACT
Tidal breathing measurements by Opto-Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP ) and a heated pneumotachograph (PNT) (VT,PNT ) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3-4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT ) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement -4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP , respectively. The OEP experimental protocol based on 52 markers and a three-compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850-857. © 2016 Wiley Periodicals, Inc.
Subject(s)
Plethysmography/methods , Respiratory Function Tests/instrumentation , Respiratory Function Tests/methods , Tidal Volume , Abdomen/physiology , Female , Gestational Age , Humans , Infant , Male , Retrospective Studies , Rib Cage/physiology , Sleep , Thoracic Wall/physiologyABSTRACT
Few studies have been conducted on the effects of aerobic exercise in children with asthma, particularly on the inflammatory component and functional outcomes. This study evaluated the effect of aerobic exercise on inflammation, functional capacity, respiratory muscle strength, quality of life and symptoms scores in asthmatic children. This was a 6-week randomized trial (NCT0192052) of 33 moderately asthmatic children (6-17 years). Patients were randomized aerobic training (exercise group; n = 14), while another group did not exercise (control; n = 19). Primary endpoint was evaluations serum cytokines (IL-17, IFN, TNF, IL-10, IL-6, IL-4 and IL-2) assessed by flow cytometry. The six-minute walk test, pulmonary function, quality of life and symptoms (asthma-free days) were secondary endpoint. The Mann-Whitney test was used to evaluate the independent variables and the Wilcoxon test for paired variables. The t-test was used for the remaining calculations. Significance was determined at 5%. Aerobic training failed to modify the inflammatory component. In the exercise group, an increase occurred in functional capacity (p < 0.01) and peak expiratory flow (p = 0.002), and maximal inspiratory (p = 0.005) and expiratory pressure (p < 0.01) improved. Furthermore, there was a significant increase in all the domains of the PAQLQ. The children who exercised had more asthma-free days than the controls (p = 0.012) and less sensation of dyspnea at the end of the study (p < 0.01). In conclusion, six weeks of aerobic exercise no changes in plasma cytokine patterns in asthmatic children and adolescents; however, an improvement was found in functional capacity, maximal respiratory pressure, quality of life and asthma-related symptoms. ClinicalTrials.gov Identifier: NCT0192052.
Subject(s)
Asthma , Exercise Therapy , Forced Expiratory Flow Rates/physiology , Respiratory Muscles/physiopathology , Vital Capacity/physiology , Adolescent , Asthma/physiopathology , Asthma/therapy , Child , Exercise Test , Female , Flow Cytometry , Humans , Interferons/blood , Interleukin-10/blood , Interleukin-17/blood , Interleukin-2/blood , Interleukin-4/blood , Interleukin-6/blood , Male , Peak Expiratory Flow Rate/physiology , Quality of Life , Treatment Outcome , Tumor Necrosis Factors/bloodABSTRACT
BACKGROUND: Dyspnea and exercise intolerance are the symptoms that most affect the quality of life of children and adolescents with respiratory disorders resulting from cystic fibrosis (CF). OBJECTIVE: To evaluate the effect of noninvasive ventilation (NIV) on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis patients. METHOD: Crossover clinical trial, randomized, controlled and open with 13 children and adolescents with CF, aged 7-16 years, with pulmonary impairment (NTC01987271). The patients performed a treadmill walking test (TWT) during 6 min, with and without NIV on a BiLEVEL mode, an interval of 24-48 h between tests. Before and after each test, patients were assessed by spirometry and optoelectronic plethysmography. RESULTS: Walking distance in TWT with NIV was significantly higher that without ventilatory support (mean ± sd: 0.41 ± 0.08 vs. 0.39 ± 0.85 km, p = 0.039). TWT with NIV increase forced expiratory volume on 1 s (FEV1; p = 0.036), tidal volume (Vt; p = 0.005), minute ventilation (MV; p = 0.013), pulmonary rib cage volume (Vrcp; p = 0.011), and decrease the abdominal volume (Vab; p = 0.013) after test. There was a significant reduction in oxygen saturation (p = 0.018) and permanent increase in respiratory rate after 5 min (p = 0.021) after the end test without NIV. CONCLUSION: During the walking test on the treadmill, the NIV change thoracoabdominal kinematics and lung function in order to optimized ventilation and tissue oxygenation, with improvement of walk distance. Consequently, NIV is an effective tool to increase functional capacity in children and adolescents with cystic fibrosis.
Subject(s)
Cystic Fibrosis/physiopathology , Dyspnea/physiopathology , Exercise/physiology , Noninvasive Ventilation , Adolescent , Child , Cross-Over Studies , Exercise Test , Female , Forced Expiratory Volume/physiology , Humans , Male , Plethysmography/methods , Spirometry , Tidal Volume/physiology , Vital Capacity/physiologyABSTRACT
OBJECTIVE: to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables. METHODS: this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%. RESULTS: 40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3 ± 2.1 years, mean height was 1.5 ± 0.1 m, and mean weight was 40.8 ± 12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9% ± 19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r = 0.373, p = 0.018) and negative correlation with cardiac rate at the end of the test (r = -0.518, p < 0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r = -0.311, p = 0.051). CONCLUSIONS: asthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style. .
OBJETIVO: comparar o desempenho físico e cardiorrespiratório do teste de caminhada de seis minutos (TC 6 min) em crianças asmáticas com valores de referência para saudáveis da mesma faixa etária e correlacioná-los com variáveis intervenientes. MÉTODOS: estudo transversal, prospectivo, em crianças com asma moderada/grave, entre seis e 16 anos, em acompanhamento ambulatorial. Coletaram-se dados demográficos e espirométricos. Os pacientes responderam questionário de qualidade de vida em asma (PAQLQ) e nível de atividade física basal. O TC 6 min foi realizado segundo recomendações da American Thoracic Society. Para comparações de médias usou-se teste t e correlação de Pearson para analisar o TC 6 min com variáveis estudadas. Nível de significância de 5%. RESULTADOS: incluídas 40 crianças, 52,5% meninos, 70% eutróficas e sedentárias. A média deidade 11,3 ± 2,1 anos, altura 1,5 ± 0,1 m e peso 40,8 ± 12,6 Kg. A média da distância percorrida no TC 6 min foi significativamente inferior correspondendo a 71,9% ± 19,7 dos valores previstos, onde as crianças sedentárias exibiram os piores valores. A diferença entre a distância percorrida no teste e os valores preditos mostrou correlação positiva com a idade (r = 0,373, p = 0,018) e negativa com a frequência cardíaca ao final do teste (r = -0,518, p < 0,001). Na avaliação da qualidade de vida, os valores do quesito limitações das atividades físicas, demonstraram pior pontuação com correlação negativa com a diferença das distâncias percorridas (r = -0,311,p = 0,051). CONCLUSÕES: o desempenho do TC6 min em crianças asmáticas avaliado através da distância percorrida é significativamente ...
Subject(s)
Adolescent , Child , Female , Humans , Male , Asthma/physiopathology , Exercise Test/methods , Walking/physiology , Cross-Sectional Studies , Heart Rate/physiology , Oximetry , Prospective Studies , Quality of Life , Reference Values , Sedentary Behavior , Spirometry , Surveys and QuestionnairesABSTRACT
OBJECTIVE: to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables. METHODS: this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%. RESULTS: 40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3±2.1 years, mean height was 1.5±0.1 m, and mean weight was 40.8±12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9%±19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r=0.373, p=0.018) and negative correlation with cardiac rate at the end of the test (r=-0.518, p<0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r=-0.311, p=0.051). CONCLUSIONS: asthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.
Subject(s)
Asthma/physiopathology , Exercise Test/methods , Walking/physiology , Adolescent , Child , Cross-Sectional Studies , Female , Heart Rate/physiology , Humans , Male , Oximetry , Prospective Studies , Quality of Life , Reference Values , Sedentary Behavior , Spirometry , Surveys and QuestionnairesABSTRACT
Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO-an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group.
Subject(s)
Cystic Fibrosis/microbiology , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa , Evidence-Based Medicine , Humans , PrognosisABSTRACT
Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO–an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group. .
As técnicas de medicina baseada em evidências são cada vez mais utilizadas para a construção de diretrizes clínicas e recomendações para a prática médica. O uso de níveis de evidências permite que o leitor identifique a qualidade da informação científica que sustenta as recomendações feitas pelos especialistas. Esta revisão teve por objetivo abordar conceitos atuais sobre o impacto clínico, diagnóstico e tratamento das infecções por Pseudomonas aeruginosa em pacientes com fibrose cística. Para a elaboração desta revisão, o grupo de autores definiu as perguntas que seriam respondidas, seguindo os preceitos de PICO, acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome (desfecho) de interesse. Para cada pergunta, uma revisão estruturada da literatura foi realizada nas bases de dados do Medline, buscando identificar os estudos com desenho metodológico mais adequado para responder à questão. As perguntas foram designadas para que cada um dos autores redigisse uma resposta, e um primeiro rascunho foi elaborado e discutido pelo grupo em uma reunião presencial. Após essa discussão, recomendações foram emitidas com base na força das evidências e na concordância entre os membros do grupo segundo o sistema de classificação do Oxford Centre for Evidence Based Medicine. .
Subject(s)
Humans , Cystic Fibrosis/microbiology , Pseudomonas aeruginosa , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Evidence-Based Medicine , PrognosisABSTRACT
We assessed the impact of the H1N1 influenza pandemic on acute respiratory infection in young children from low-income families in Brazil. Influenza (specifically H1N1) detection in acute respiratory infection quintupled during the pandemic and, during its peak, it was associated with 30% of all acute respiratory infection visits to the emergency department. H1N1 was also associated with increased risk of hospitalization and coinfection.
Subject(s)
Influenza, Human/epidemiology , Influenza, Human/pathology , Pandemics , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/pathology , Viruses/classification , Viruses/isolation & purification , Brazil/epidemiology , Child, Preschool , Coinfection/epidemiology , Coinfection/virology , Female , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Prospective StudiesABSTRACT
Avaliar a percepção da qualidade de vida, com relação à asma, pelas crianças, adolescentes e seus pais, verificando as concordâncias existentes em cada domínio do questionário Pediatric Asthma Quality of Life Questionnaire Adaptado (PAQLQ-A). MÉTODOS: Estudo transversal realizado em dois ambulatórios universitários de referência para seguimento de crianças e adolescentes asmáticos em Recife (PE). Após o cumprimento das exigências éticas, os dados sobre a qualidade de vida foram obtidos por aplicação do PAQLQ, em sua versão traduzida adaptada e validada para a língua portuguesa. O questionário foi respondido por 126 pacientes (70 crianças e 56 adolescentes) e seus respectivos pais. Um banco de dados criado no programa SPSS, versão 13.0, foi analisado com o teste de concordância Kappa. RESULTADOS: A concordância das respostas entre crianças e pais variou de ruim a sofrível, observando-se as piores concordâncias no domínio sintomas para o item "chiado no peito" e, no domínio emoções, para o item "sentiu-se irritado". As respostas dos adolescentes e seus pais tiveram a concordância avaliada entre ruim e regular; sendo a pior concordância observada no domínio atividades, no item "incomodado por não poder estar com os outros" e a melhor concordância notada no domínio emoções, no item "desconfortável". CONCLUSÕES: O PALQ-A não foi bem compreendido pela população estudada e não houve concordância na percepção sobre qualidade de vida das crianças e adolescentes asmáticos e seus pais. Recomenda-se a elaboração de instrumentos adequados às especificidades regionais ou ainda a revalidação de instrumentos internacionais, de forma que atendam à diversidade regional.
To evaluate the perception of the quality of life of asthmatic children and adolescents and their parents, investigating the agreement rates in each domain using the Pediatric Asthma Quality of Life Questionnaire - Adapted (PAQLQ-A). METHODS: Cross-sectional study conducted at two outpatient clinics of a university reference center for asthmatic children and adolescents in Recife, Brazil. After meeting the ethical requirements, health-related quality of life data were collected using the version of the PAQLQ adapted and translated into Portuguese. The questionnaire was answered by 126 patients (70 children and 56 adolescents) and their parents. Agreement was analyzed by the Kappa statistic test using the computer program SPSS, version 13.0, software. RESULTS: Agreement between children and parents' answers varied from "unsatisfactory" to "poor". The worst agreement rate was found in the domain symptoms, especially regarding the item "wheezing", and in the domain emotions, regarding the item "feel bothered". Agreement between adolescents and their parents' answers varied from "unsatisfactory" to "fair", with the worst agreement rate in the domain activities, especially in the item "feel bothered by not being able to be with other people", and the best agreement rate was found in the domain emotions, in the item "feel uncomfortable." CONCLUSIONS: The PAQLQ-A was not well understood by the studied population and agreement regarding the perception of the quality of life of asthmatic children and adolescents between patients and their parents was poor. Appropriate instruments adapted to regional characteristics or even revalidation of international instruments considering regional diversity should be developed.
Evaluar la percepción de la calidad de vida, respecto al asma, por los niños, adolescentes y sus padres, verificando las concordancias existentes en cada dominio cuando aplicado el cuestionario Pediatric Asthma Quality of Life Questionnaire Adaptado (PAQLQ-A). MÉTODOS: Estudio transversal realizado en dos ambulatorios universitarios de referencia para seguimiento de niños y adolescentes pediátricos asmáticos en Recife (PE, Brasil). Después del cumplimiento de las exigencias éticas, los datos sobre la calidad de vida fueron obtenidos mediante la aplicación del PAQLQ, en su versión traducida adaptada y validada para la lengua portuguesa. El cuestionario fue contestado por 126 pacientes (70 niños y 56 adolescentes) y sus respectivos padres. Una base de datos creada en el programa SPSS, versión 13.0, fue analizada estadísticamente con la prueba de concordancia de Kappa. RESULTADOS: La concordancia de las respuestas entre niños y padres varió de mala a aceptable, observándose las peores concordancias en el dominio síntomas para el ítem ®sibilancias en el pecho¼ y en el dominio emociones para el ítem ®se sintió irritado¼. Las respuestas de los adolescentes y sus padres tuvieron la concordancia evaluada entre mala y regular; siendo la peor concordancia observada en el dominio actividades, en el ítem ®incomodado por no poder estar con otros¼ y la menor concordancia notada en el dominio emociones, en el ítem ®incómodo¼. CONCLUSIONES: El PAQLQ-A no fue bien comprendido por la población estudiada y no hubo concordancia en la percepción sobre calidad de vida de los niños y adolescentes asmáticos y sus padres. Se recomienda la elaboración de instrumentos adecuados a las especificidades regionales o, además, mediante la revalidación de instrumentos internacionales, de modo a que atiendan a la diversidad regional.
