ABSTRACT
El asma bronquial es una enfermedad respiratoria crónica que genera elevados índices de discapacidad, sobre todo en la población infantil. La aplicación de fisioterapia respiratoria constituye un coadyuvante en los esquemas terapéuticos de la enfermedad; en este sentido el entrenamiento muscular inspiratorio y el método Buteyko constituyen técnicas respiratorias que han sido reportadas como útiles en el tratamiento del asma bronquial. La presente investigación tuvo como objetivo describir las ventajas que ofrecen ambos métodos como esquemas terapéuticos de niños con asma bronquial. Como principales resultados se describen una serie de estudios que muestran las ventajas de la implementación de estos métodos para mejorar distintos componentes de la patogenia y manifestaciones clínicas del asma bronquial. Estos estudios muestran que la aplicación indistinta de uno o ambos métodos mejora diversos aspectos entre los que sobresalen mejorar volúmenes y capacidades pulmonares, función pulmonar, fuerza muscular ventilatoria y la mecánica respiratoria. Adicionalmente, mejoran algunos elementos relacionados con la mecánica respiratoria como es el uso de la respiración bucal. Se concluye que la realización de la fisioterapia respiratoria en niños con asma bronquial constituye una alternativa viable y eficaz en el mejoramiento de varios parámetros relacionados con esta enfermedad. Diversos estudios demuestran que la aplicación de estas técnicas respiratorias mejora la capacidad respiratoria, el tono y trofismo de músculos respiratorios y la mecánica respiratoria. Los resultados positivos evidencian la necesidad de aumentar la implementación del entrenamiento muscular inspiratorio y el método Buteyko como esquema terapéutico en niños con asma bronquial en unidades de atención pública y privada(AU)
Bronchial asthma is a chronic respiratory disease that generates high rates of disability, especially in children. The application of respiratory physiotherapy constitutes an adjunct in the therapeutic schemes of the disease; in this sense, inspiratory muscle training and the Buteyko method constitute respiratory techniques that have been reported as useful in the treatment of bronchial asthma. The present investigation aimed to describe the advantages offered by both methods as therapeutic regimens for children with bronchial asthma. The main results are a series of studies that show the advantages of the implementation of these methods to improve different components of the etiopathogenesis and clinical manifestations of bronchial asthma. These studies show that the indistinct application of one or both methods improves different aspects, among which the improvement of lung volumes and capacities, lung function, ventilatory muscle strength and respiratory mechanics stand out. Additionally, they improve some elements related to respiratory mechanics such as the use of mouth breathing. It is concluded that the performance of respiratory physiotherapy in children with bronchial asthma constitutes a viable and effective alternative in the improvement of various parameters related to this disease. Several studies show that the use of these respiratory techniques improves respiratory capacity, tone and trophism of respiratory muscles, and respiratory mechanics. The positive results demonstrate the need to increase the implementation of inspiratory muscle training and the Buteyko method as a therapeutic scheme in children with bronchial asthma in public and private care units(AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Asthma/therapy , Physical Therapy Modalities/education , Respiratory Mechanics/ethicsABSTRACT
BACKGROUND: Gastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. OBJECTIVE: The aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). METHODS: Twenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. RESULTS: Nineteen patients completed m-IMT. GERDQ (from 8.36±3.94 to 1.7±3.41; p<.05), RSI (from to 21.68±10.26 to 6.93±8.37; p<.05) and GERDHRQL (from 25.68±16.03 to 8.4±11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24±4.15 to 7.4±1.77; p<.05). CONCLUSIONS: m-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment schedule.
Subject(s)
Breathing Exercises/methods , Gastroesophageal Reflux/therapy , Myofunctional Therapy/methods , Adult , Combined Modality Therapy/methods , Esophageal Sphincter, Lower/physiology , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnostic imaging , Humans , Laryngoscopy , Male , Middle Aged , Patient Positioning/methods , Quality of Life , Supine Position/physiology , Surveys and Questionnaires , Symptom Assessment/methods , Treatment OutcomeABSTRACT
Respiratory muscle weakness is observed in chronic obstructive pulmonary disease (COPD) patients and contributes to hypoxemia, hypercapnia, dyspnoea, nocturnal oxygen desaturation and reduced exercise performance. During exercise it has been shown that diaphragm work is increased in COPD and COPD patients use a larger proportion of the maximal inspiratory pressure (PImax) than healthy subjects. This pattern of breathing is closely related to the dyspnoea sensation during exercise and might potentially induce respiratory muscle fatigue. However, diaphragmatic fatigue was not demonstrated after exhaustive exercise. Studies in patients with COPD have shown natural adaptations of the diaphragm to greater oxidative capacity and resistance to fatigue. The above mentioned considerations gave conflicting arguments to the rationale of inspiratory muscle training (IMT) in COPD. Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improvedfunctional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMTplus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness. From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness. The effect on exercise performance is still to be determined. In summary, IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspirat...
Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) tienen debilidad de los músculos respiratorios, lo cual contribuye a la disnea, hipoxemia, hipercapnia, desaturación nocturna y limitación de la actividad física. Durante el ejercicio se ha demostrado que aumenta el trabajo del diafragma en pacientes con EPOC y utilizan una mayor proporción de la presión inspiratoria máxima (PImax) comparado con los sujetos sanos. Elpatrón respiratorio anormal de los pacientes con EPOC está relacionado con la sensación de disnea durante el ejercicio y, potencialmente, podría inducir a la fatiga muscular respiratoria. Sin embargo, la fatiga del diafragma no se ha demostrado después de un ejercicio intenso. Los estudios en pacientes con EPOC han demostrado cambios adaptativos en las fibras musculares del diafragma que tienen mayor capacidad oxidativa y resistencia a la fatiga. De este modo, existen argumentos contradictorios en relación al beneficio clínico obtenido con el entrenamiento de los músculos inspiratorios (EMI) en pacientes con EPOC. El EMI aislado o como complemento de ejercicios de reacondicionamiento general aumenta significativamente la fuerza muscular inspiratoria y la resistencia a la fatiga, disminuyendo significativamente la disnea en reposo y durante el ejercicio. Además, los estudios sugieren que el EMI tiende a mejorar la capacidad funcional para realizar ejercicio, efecto favorable que no alcanzó significación estadística. El análisis de subgrupos ha demostrado mayor beneficio clínico del EMI en los pacientes con debilidad muscular inspiratoria. De esta revisión se concluye que el entrenamiento muscular inspiratorio puede ser útil en pacientes seleccionados con enfermedad pulmonar obstructiva crónica, que tienen disfunción muscular inspiratoria comprobada, insertado en un programa de rehabilitación integral. El efecto sobre la capacidad de realizar ejercicio aún no ha sido determinado. En resumen, el EMI aumenta la fuerza muscular inspirator...
