Relationship between sniff nasal inspiratory pressure and BODE index in patients with COPD.

PURPOSE: The aims of this study were to investigate the relationship between sniff nasal inspiratory pressure (SNIP) and severity of chronic obstructive pulmonary disease (COPD) as defined by the BODE index, and to investigate the capacity of different SNIP cutoffs to predict a BODE index score ≥5 (i.e., worse disease severity). METHODS: Thirty-eight subjects with COPD (21 men, 66 ± 8 years, forced expiratory volume in the first second (FEV(1)) 42 ± 16 % predicted) underwent assessments of SNIP, airflow limitation, body mass index (BMI), dyspnea (Medical Research Council scale), and exercise capacity (6-min walking test, 6MWT). The BODE index was calculated, and patients were separated into two groups according to the BODE quartiles (1 and 2, or 3 and 4). RESULTS: Patients from quartiles 3 and 4 presented lower values of SNIP than patients from quartiles 1 and 2 (73 ± 18 vs 56 ± 21 cmH(2)O, respectively; p = 0.01). There was significant and inverse correlation between SNIP and the BODE index (r = -0.62; p<0.001). A logistic regression model revealed that a SNIP value below 63 cmH(2)O presented higher sensitivity and specificity (70 and 67 %, respectively) for predicting a BODE score equivalent to quartiles 3 or 4. CONCLUSION: SNIP is moderately and significantly related to COPD severity as assessed by the BODE index. Moreover, the cutoff point of 63 cmH2O showed the best combination of sensitivity and specificity for predicting worse scores in the BODE index.

Spirometry in healthy subjects: do technical details of the test procedure affect the results?

INTRODUCTION: Spirometry should follow strict quality criteria. The American Thoracic Society (ATS) recommends the use of a noseclip; however there are controversies about its need. ATS also indicates that tests should be done in the sitting position, but there are no recommendations neither about position of the upper limbs and lower limbs nor about who should hold the mouthpiece while performing the maneuvers: evaluated subject or evaluator. OBJECTIVES: To compare noseclip use or not, different upper and lower limbs positions and who holds the mouthpiece, verifying if these technical details affect spirometric results in healthy adults. METHODS: One hundred and three healthy individuals (41 men; age: 47 [33-58] years; normal lung function: FEV1/FVC = 83±5, FEV1 = 94 [88-104]%predicted, FVC = 92 [84-102]%predicted) underwent a protocol consisting of four spirometric comparative analysis in the sitting position: 1) maximum voluntary ventilation (MVV) with vs without noseclip; 2) FVC performed with vs without upper limbs support; 3) FVC performed with lower limbs crossed vs lower limbs in neutral position; 4) FVC, slow vital capacity and MVV comparing the evaluated subject holding the mouthpiece vs evaluator holding it. RESULTS: Different spirometric variables presented statistically significant difference (p<0.05) when analysing the four comparisons; however, none of them showed any variation larger than those considered as acceptable according to the ATS reproducibility criteria. CONCLUSIONS: There was no relevant variation in spirometric results when analyzing technical details such as noseclip use during MVV, upper and lower limb positions and who holds the mouthpiece when performing the tests in healthy adults.

Comparação do uso da pressão positiva com a fisioterapia convencional e incentivadores respiratórios após cirurgia cardíaca: revisão de literatura / Comparison among positive pressure, standard physioterapy and incentive spirometry after cardiac surgery: literature review

Introdução: No pós-operatório de cirurgia cardíaca frequentemente ocorrem complicações pulmonares, as quais podem ser prevenidas e tratadas com técnicas específicas de fisioterapia respiratória. Porém não se sabe qual a técnica mais efetiva. Objetivo: Revisão de literatura com o objetivo de verificara efetividade da pressão positiva (CPAP, VNI-2P, RPPI) comparada às técnicas de fisioterapia convencional e incentivador respiratório (IR) na recuperação da função pulmonar em pacientes no pós-operatório de cirurgia cardíaca. Métodos: Seleção de referências em inglês e português com descritores específicos ao tema nas seguintes fontes de dados: BIREME, SciELO Brazil, LILACS, PUBMED, de 1985 até 2010. Foram incluídos apenas ensaios clínicos randomizados. Resultados: Dez ensaios clínicos randomizadosforam incluídos para revisão. Em relação à superioridade de uma técnica sobre a outra, doisestudos verificaram que a modalidade CPAP e VNI-2P mostrou-se mais efetiva do que a fisioterapia convencional e o IR, enquanto que em dois outros estudos, demonstrou-se a superioridade da VNI-2P, em relação ao uso de cateter de oxigênio e à fisioterapia convencional. Apenas um estudo demonstrou diferença significativa ao comparar duas modalidades de pressão positiva, sendo a RPPI mais efetiva que a CPAP...

Introduction: Postoperative pulmonary complications in patients undergoing cardiac surgeries are usually a clinical challenge, which can be prevented and treated with specific physical therapy techniques. However, it is not known which technique is the most effective. Objective: Literature review with the objective of assessing the effectiveness of positive pressure (CPAP, IPPB, NIV-2P) compared to standard physioterapy therapy and incentive spirometry on improving pulmonary function in postoperative cardiac surgery patients. Methods: English and Portuguese studies were used as references, searching for specific descriptors on the following data sources: BIREME, SciELO Brazil, LILACS, PUBMED, from 1985 to 2010. Only randomized clinical trials were included. Results: Ten randomized control trials were included in this review. About the most effective technique, two studies showed that CPAP and NIV-2P were more effective than standard physioterapy and incentive spirometry. In other two studies, NIV-2P were more effective than nasal oxygen catheter and standard physioterapy...