Pruebas de función pulmonar en el asma, más allá del protocolo diagnóstico / Pulmonary function tests in asthma, beyond the diagnostic protocol

Las pruebas funcionales respiratorias son imprescindibles para el diagnóstico y el seguimiento de los pacientes asmáticos,principalmente la espirometría forzada junto a la prueba broncodilatadora. Sin embargo, en determinados grupos de pacien-tes pueden ser necesarias o complementarias otras pruebas funcionales que no están incluidas en los protocolos diagnós-ticos de las guías de práctica clínica. Si bien estas pruebas suelen ser más complejas y no están disponibles en todos losniveles asistenciales, hay pacientes en los que hay que descartar otras posibles enfermedades respiratorias o incluso ca-racterizar mejor el asma mediante un estudio más completo de la afectación de la vía aérea. También hay que contemplarla posibilidad de la medición de la función pulmonar en el domicilio en algunos pacientes, lo que puede optimizar sucontrol y disminuir la sobrecarga de recursos sanitarios. En esta revisión describimos la evidencia actual que apoyaría enpacientes con asma el uso de la telemedicina, así como las posibles indicaciones de otras pruebas funcionales como laoscilometría, la pletismografía, la prueba de difusión y las pruebas de esfuerzo.(AU)

Respiratory function tests are essential for the diagnosis and follow-up of asthmatic patients, mainly forced spirometry toge-ther with bronchodilator testing. However, in certain groups of patients, other functional tests that are not included in thediagnostic protocols of clinical practice guidelines may be necessary or complementary. Although these tests are usuallymore complex and are not available at all levels of care, there are patients in whom other possible respiratory diseases mustbe ruled out or even to better characterize asthma through a more complete study of airway involvement. It is also necessaryto consider the possibility of measuring lung function at home in some patients, which can optimize its control and reducethe overload of health resources. In this review we describe the current evidence that would support the use of telemedici-ne in people with asthma, as well as possible indications of other functional tests such as oscillometry, plethysmography,diffusion test, and stress tests.(AU)

Gestational age, intrauterine growth and body composition at 11 years of age / Idade gestacional, crescimento intrauterino e composição corporal aos 11 anos de idade

ABSTRACT OBJETIVE To assess the association of gestational age (GA) and intrauterine growth with body composition at 11 years of age. METHOD Analysis of data from the 2004 Pelotas birth cohort, whose outcomes were fat mass (FM, kg), fat mass index (FMI, kg/m2), fat-free mass (FFM, kg), fat-free mass index (FFMI, kg/m2) - measured by air displacement plethysmography - and body mass index for age (BMI/age, Z-score). The exposures of interest were the gestational index (GA) of infants born at less than 33 weeks, from 34 to 36 and from 37 to 41, and intrauterine growth categorized as small (SGA), adequate (AGA) and large (LGA) for gestational age. Analysis of variance was used to compare means and linear regression was used to assess the strength of association. The analyses were adjusted according to variables collected at birth, such as monthly family income, maternal characteristics - education, age, pre-gestational body mass index (BMI), weight gain during pregnancy, smoking during pregnancy, type of delivery, and parity - and adolescent characteristics - skin color and birth weight. For analysis, FM and FMI underwent logarithmic transformation due to data asymmetry. RESULTS A total of 3,401 adolescents were analyzed, including boys and girls born at less than 33 weeks, with lower FM and FFM means than those born at term. However, in the adjusted analyses, there was no association between GA and any of the outcomes in either sex. LGA boys had a 10.5% higher FMI (p = 0.026) and +0.3 BMI/age Z-score (p = 0.019) as compared to AGA boys, and LGA girls had +0.3 kg/m 2 of FFMI (p = 0.039) than AGA girls. CONCLUSION GA was not associated with body composition at 11 years of age. However, LGA boys had higher BMI and BMI/age Z-score, and LGA girls had higher FFMI than AGA girls.

RESUMO OBJETIVO Avaliar a associação da idade gestacional (IG) e crescimento intrauterino com a composição corporal aos 11 anos de idade. MÉTODO Análise de dados da coorte de nascimentos de Pelotas de 2004, cujos desfechos foram massa gorda (MG, kg), índice de massa gorda (IMG, kg/m2), massa livre de gordura (MLG, kg), índice de massa livre de gordura (IMLG, kg/m2) - medidos por pletismografia por deslocamento de ar -, e índice de massa corporal para idade (IMC/Idade, escore-Z). Sendo as exposições de interesse o índice gestacional (IG) de nascidos com menos de 33 semanas, de 34 a 36 e de 37 a 41, e crescimento intrauterino categorizado em pequeno para a idade gestacional (PIG), adequado (AIG) e grande (GIG). Para comparar médias, utilizou-se análise de variância e, para avaliar a força de associação, regressão linear. As análises foram ajustadas de acordo com variáveis coletadas ao nascer, como renda familiar mensal, características maternas - escolaridade, idade, índice de massa corporal (IMC) pré-gestacional, ganho de peso na gestação, tabagismo na gestação, tipo de parto e paridade - e características dos adolescentes - cor da pele e peso ao nascer. Para análise, o MG e o IMG sofreram transformação logarítmica devido a assimetria dos dados. RESULTADOS Foram analisados 3.401 adolescentes, entre meninos e meninas nascidos com menos de 33 semanas, com médias de MG e MLG menores que as dos nascidos(as) a termo. Porém, nas análises ajustadas, não houve associação entre IG e qualquer um dos desfechos em ambos os sexos. Meninos GIG apresentaram IMG 10,5% maior (p = 0,026) e +0,3 escore-Z de IMC/Idade (p = 0,019) em relação aos AIG, e meninas GIG apresentaram +0,3 kg/m2 de IMLG (p = 0,039) do que as AIG. CONCLUSÃO A IG não se associou à composição corporal aos 11 anos. Entretanto, meninos GIG apresentaram maiores IMG e escore-Z de IMC/Idade e meninas GIG, maior IMLG, quando comparados aos AIG.

Comportamiento de volúmenes pulmonares estáticos por pletismografía en enfermedad pulmonar obstructiva crónica con disociación clínico-espirométrica / Behavior of static lung volumes due to plethysmography in chronic obstructive pulmonary disease with clinical-spirometric dissociation

Introducción: La enfermedad pulmonar obstructiva crónica es un problema sanitario mundial por su elevada prevalencia, morbilidad y cuantioso costo económico. Objetivo: Caracterizar mediante la pletismografía a los pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica que presentaron una discrepancia clínica espirométrica. Métodos: Se realizó un estudio descriptivo y transversal en 33 pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica que acudieron a consulta externa del Hospital Neumológico Benéfico Jurídico y el Centro de Investigaciones Clínicas. Se les realizaron volúmenes pulmonares por pletismografía corporal y espirometría en el período comprendido de noviembre 2016 a marzo 2018. Resultados: El sexo masculino (69,7 por ciento) resultó el más frecuente y el grupo de edad predominante fue mayor de 65 años (60,6 por ciento). El 41,2 por ciento de los pacientes presentaron grado de obstrucción moderadamente severo. La capacidad pulmonar total y el volumen residual fueron normales (72,7 por ciento y 42,5 por ciento) respectivamente. El 43,8 por ciento de los pacientes presentaron hiperinsuflación leve. El grado 3 de disnea fue el que predominó en los pacientes. El 12,1 por ciento de los pacientes presentaron aumento del volumen residual dado por atrapamiento aéreo grave con la disminución del volumen espiratorio forzado en el primer segundo. Conclusiones: El comportamiento de los volúmenes pulmonares por pletismografía corporal en la enfermedad pulmonar obstructiva crónica con disociación clínico-espirométrica, evidenció la disminución del volumen espiratorio forzado en el primer segundo y el aumento del volumen residual relacionándose con el grado de disnea(AU)

Introduction: Chronic obstructive pulmonary disease is a global health problem due to its high prevalence, morbidity and high economic cost. Objective: By using plethysmography, to describe patients with diagnosis of chronic obstructive pulmonary disease that had spirometric clinical discrepancy. Methods: A descriptive and cross-sectional study was carried out in 33 patients with diagnosis of chronic obstructive pulmonary disease who attended the outpatient clinic at Benéfico Jurídico Pneumologic Hospital and the Clinical Research Centre. Lung volumes were performed by body plethysmography and spirometry from November 2016 to March 2018. Results: The male sex (69.7 percent) was the most frequent and the predominant age group was older than 65 years (60.6 percent). 41.2 percent of the patients had moderately severe degree of obstruction. Total lung capacity and residual volume were normal, 72.7 percent and 42.5 percent, respectively. 43.8 percent of the patients had mild hyperinflation. Grade 3 dyspnea was the one that predominated in the patients. 12.1 percent of the patients showed increased residual volume due to severe air trapping with decreased forced expiratory volume in the first second. Conclusions: The behavior of lung volumes by body plethysmography in chronic obstructive pulmonary disease with clinical-spirometric dissociation, evidenced decrease in forced expiratory volume in the first second and increased in residual volume related to the degree of dyspnea(AU)

Pulmonary capacity of patients with total traumatic injury of the brachial plexus submitted to neurotization with the phrenic nerve: a case series / Capacidade pulmonar de pacientes com lesão traumática total do plexo braquial submetidos à neurotização com o nervo frênico: uma série de casos

Total traumatic injury often requires surgical intervention such as neurotization using the phrenic nerve with the aim to recover the elbow function. However, its repercussions on the respiratory kinematics are unknown. Objective: To evaluate the ribcage volume in tricompartments division, kinematics of Duty Cycle, and shortening velocity of the respiratory muscles after nerve phrenic transfer. Methods: Five participants (4 male), aged 18 to 40 years old (32±2), diagnosed with total brachial plexus injury and with nerve phrenic transfer. The optoelectronic plethysmography (OEP) was the instrument to evaluate volume in quiet breathing (QB), inspiratory capacity (IC) and vital capacity (VC) of the rib cage in its tricompartments division (pulmonary rib cage, abdominal rib cage and abdomen rib cage) and in each hemithorax, as well as the shortening velocity of the respiratory muscles, and respiratory rate. Assessments occurred 30 days prior and 30 days after surgery. Results: There was a decrease in the total compartmental distribution in QB with statistical difference only in the abdominal compartment (p <0.05). Four patients showed a reduction in the shortening speed of the left diaphragm muscle. It was not possible to perform a group analysis of respiratory kinematics and volumes in CV, IC due to the variation found in each patient analyzed. Conclusion: There was a reduction in volume in the rib cage as well as a change in the speed of shortening of the respiratory muscles after the transfer of the phrenic nerve one month after surgery.

A lesão traumática total freqüentemente requer intervenção cirúrgica, como neurotização usando o nervo frênico, com o objetivo de recuperar a função do cotovelo. No entanto, suas repercussões na cinemática respiratória são desconhecidas. Objetivo: Avaliar o volume da caixa torácica na divisão dos tricompartimentos, a cinemática do Duty Cycle e a velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico. Métodos: Cinco participantes (4 do sexo masculino), com idade entre 18 e 40 anos (32 ± 2), com diagnóstico de lesão total do plexo braquial e transferência do nervo frênico. A pletismografia optoeletrônica (OEP) foi o instrumento para avaliar o volume na respiração silenciosa (QB), a capacidade inspiratória (IC) e a capacidade vital (VC) da caixa torácica em sua divisão tricompartimental (caixa torácica pulmonar, caixa torácica abdominal e caixa torácica do abdômen ) e em cada hemitórax, bem como a velocidade de encurtamento dos músculos respiratórios e a frequência respiratória. As avaliações ocorreram 30 dias antes e 30 dias após a cirurgia. Resultados: Houve diminuição da distribuição compartimental total no QB com diferença estatística apenas no compartimento abdominal (p <0,05). Quatro pacientes apresentaram redução da velocidade de encurtamento do músculo diafragma esquerdo. Não foi possível realizar uma análise de grupo da cinemática respiratória e dos volumes em CV, IC devido à variação encontrada em cada paciente analisado. Conclusão: Houve redução do volume da caixa torácica e também alteração da velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico um mês após a cirurgia.

Evaluation of anthropometric equations developed to estimate neonates body composition: a systematic review / Avaliação de equações antropométricas desenvolvidas para estimar a composição corporal de neonatos: uma revisão sistemática

Abstract This article aims to evaluate the anthropometric equations developed by selected studies in order to estimate the body composition of neonates. The systematic review consisted in the research of published articles in the following databases: PubMed, Brazilian Virtual Health Library, Embase and ScienceDirect by utilizing the following descriptors: "fat mass, fat free mass, anthropometry, air displacement plethysmography, validation, neonate". For doing so, the PRISMA protocol has been utilized. The bibliographical research resulted in 181 articles. However, only eight were selected for the present review because repetition in different databases and having been performed in adults, during pregnancy, in athletes, in preterm and children. There was discrepancy in terms of study method, mainly over the variables of the anthropometric equations, age and ethnicity of the neonates. All studies used the plethysmography method as a reference apart from one study. Only four studies had their equations validated. The studies that developed anthropometric models for estimating the body composition of neonates are scarce, and the use of these equations needs to be conducted carefully in order to avoid errors in nutritional diagnosis.

Resumo Este artigo tem por objetivo avaliar as equações antropométricas desenvolvidas pelos estudos selecionados para estimar a composição corporal de neonatos. A revisão sistemática consistiu na busca de artigos publicados nas bases de dados PubMed, Biblioteca Virtual de Saúde, Embase e ScienceDirect utilizando os seguintes descritores: "fat mass, fat free mass, anthropometry, air displacement plethysmography, validation, neonate". Para isso foi utilizado o protocolo PRISMA. A busca bibliográfica resultou em 181 artigos. Entretanto, apenas oito foram selecionados para compor a presente revisão por estarem presentes em outras bases de dados, por terem sido realizados com adultos, atletas, prematuros e crianças. Houve discrepância em relação aos métodos dos estudos, sobretudo no que diz respeito as variáveis que compuseram as equações antropométricas. Com exceção de um artigo, todos utilizaram a pletismografia como método de referência. Apenas quatro estudos tiveram suas equações validadas. Além de serem escassos os estudos que desenvolveram equações antropométricos para estimar a composição corporal de neonatos, o uso desses modelos deve ser realizado com cautela para evitar erros no diagnóstico nutricional dos neonatos.

Body composition among long distance runners

SUMMARY OBJECTIVE The current study aimed to examine the body composition of adult male ultra-trail runners (UTR) according to their level of participation (regional UTR-R, vs. national UTR-N). METHODS The sample was composed of 44 adult male UTR (aged 36.5±7.2 years; UTR-R: n=25; UTR-N: n=19). Body composition was assessed by air displacement plethysmography, bioelectrical impedance, and dual-energy X-ray absorptiometry. In addition, the Food Frequency Questionnaire (FFQ) was applied. A comparison between the groups was performed using independent samples t-test. RESULTS Significant differences between groups contrasting in the competitive level were found for chronological age (in years; UTR-R: 38.8±8.2 vs. UTR-N: 33.5±4.1); body density (in L.kg-1; UTR-R: 1.062±0.015 vs. UTR-N: 1.074±0.009); and fat mass (in kg; UTR-R: 12.7±6.8 vs. UTR-N: 7.6±2.7). CONCLUSION UTR-N were younger, presented higher values for body density, and had less fat mass, although no significant differences were found for fat-free mass. The current study evidenced the profile of long-distance runners and the need for weight management programs to regulate body composition.

RESUMO OBJETIVO O presente estudo objetivou examinar a composição corporal dos corredores de ultra-trail (UTR) e, adicionalmente, comparar dois grupos de acordo com o nível de participação (Regional vs. Nacional, respectivamente UTR-R e UTR-N). MÉTODOS A amostra foi composta por 44 corredores adultos masculinos (36,5±7,2 anos de idade; UTR-R: n=25; UTR-N: n=19). A composição corporal foi avaliada recorrendo à pletismografia de ar deslocado, bioimpedância elétrica e absorciometria de raios X de dupla energia. Adicionalmente, foi utilizado o Questionário de Frequência Alimentar. A comparação entre grupos foi realizada com base na prova t-student para amostras independentes. RESULTADOS Foram encontradas diferenças significativas por nível de competição para as seguintes variáveis dependentes: idade cronológica (em anos; UTR-R: 38,8±8,2 vs. UTR-N: 33,5±4,1); densidade corporal (em kg/L; UTR-R: 1,062±0,015 L/kg vs. UTR-N: 1,074±0,009); massa gorda (em kg; UTR-R: 12,7±6,8 kg vs. UTR-N: 7,6±2,7). CONCLUSÃO Os UTR-N tendem a ser mais jovens e apresentam valores superiores de densidade corporal e, consequentemente, valores menores de massa gorda, sendo a massa isenta de gordura semelhante entre os grupos. O presente estudo determinou o perfil dos corredores adultos masculinos de longa distância (ultra-trail), realçando a importância de uma cuidadosa regulação da massa corporal.

Characterization of the severity of dyspnea in patients with bronchiectasis: correlation with clinical, functional, and tomographic aspects / Caracterização da gravidade de dispneia em pacientes com bronquiectasias: correlação com aspectos clínicos, funcionais e tomográficos

ABSTRACT Objective: To characterize a population of patients with bronchiectasis, correlating clinical, radiological, and functional aspects with the severity of dyspnea. Methods: This was a cross-sectional study involving adult patients with HRCT-confirmed bronchiectasis, categorized according to the severity of dyspnea (as being mildly or severely symptomatic, on the basis of the modified Medical Research Council scale). We correlated the severity of dyspnea with clinical parameters, functional parameters (spirometry values, lung volumes, and DLCO), and CT parameters. Results: We evaluated 114 patients, 47 (41%) of whom were men. The median age (interquartile range) was 42 years (30-55 years). The most common form was idiopathic bronchiectasis. Of the 114 patients, 20 (17.5%) were colonized with Pseudomonas aeruginosa and 59 (51.8%) were under continuous treatment with macrolides. When we applied the Exacerbation in the previous year, FEV1, Age, Colonization, Extension, and Dyspnea score, the severity of dyspnea was categorized as moderate in 54 patients (47.4%), whereas it was categorized as mild in 50 (43.9%) when we applied the Bronchiectasis Severity Index. The most common lung function pattern was one of obstruction, seen in 95 patients (83.3%), and air trapping was seen in 77 patients (68.7%). The prevalence of an obstructive pattern on spirometry was higher among the patients with dyspnea that was more severe, and most functional parameters showed reasonable accuracy in discriminating between levels of dyspnea severity. Conclusions: Patients with bronchiectasis and dyspnea that was more severe had greater functional impairment. The measurement of lung volumes complemented the spirometry data. Because bronchiectasis is a complex, heterogeneous condition, a single variable does not seem to be sufficient to provide an overall characterization of the clinical condition.

RESUMO Objetivo: Caracterizar uma população de portadores de bronquiectasias e correlacionar aspectos clínicos, radiológicos e funcionais com a gravidade da dispneia. Métodos: Estudo transversal realizado em adultos, portadores de bronquiectasias confirmadas por TCAR, categorizados de acordo com a gravidade da dispneia (pacientes pouco e muito sintomáticos), correlacionando-os com seus parâmetros clínicos, funcionais (espirometria, volumes pulmonares e DLCO) e tomográficos. Resultados: Foram avaliados 114 pacientes (47 homens, 41%). A mediana (intervalo interquartil) de idade foi de 42 (30-55) anos. A etiologia mais frequente foi idiopática. Em relação à colonização, 20 pacientes (17,5%) eram colonizados por Pseudomonas aeruginosa e grande parte fazia uso de macrolídeo continuamente (51,8%). Quanto à gravidade da dispneia, ela foi considerada moderada em 54 pacientes (47,4%) pelo escore Exacerbation in previous year, FEV1, Age, Colonization, Extension, and Dyspnea e leve em 50 (43,9%) pelo Bronchiectasis Severity Index. O padrão funcional mais encontrado foi distúrbio ventilatório obstrutivo (em 83%), e 68% apresentavam aprisionamento aéreo. Pacientes com maior grau de dispneia apresentaram maior prevalência de distúrbio obstrutivo na espirometria, e a maioria dos parâmetros funcionais apresentaram acurácia razoável em discriminar a gravidade da dispneia. Conclusões: Pacientes com bronquiectasias e maior gravidade da dispneia apresentaram um comprometimento funcional mais expressivo. A medida de volumes pulmonares complementou os dados da espirometria. Por se tratar de uma condição complexa e heterogênea, uma única variável parece não ser suficiente para caracterizar a condição clínica de forma global.

Clinical and functional correlations of the difference between slow vital capacity and FVC / Correlação clínica e funcional da diferença entre capacidade vital lenta e CVF

ABSTRACT Objective: To evaluate the relationship that the difference between slow vital capacity (SVC) and FVC (ΔSVC-FVC) has with demographic, clinical, and pulmonary function data. Methods: This was an analytical cross-sectional study in which participants completed a respiratory health questionnaire, as well as undergoing spirometry and plethysmography. The sample was divided into two groups: ΔSVC-FVC ≥ 200 mL and ΔSVC-FVC < 200 mL. The intergroup correlations were analyzed, and binomial logistic regression analysis was performed. Results: The sample comprised 187 individuals. In the sample as a whole, the mean ΔSVC-FVC was 0.17 ± 0.14 L, and 61 individuals (32.62%) had a ΔSVC-FVC ≥ 200 mL. The use of an SVC maneuver reduced the prevalence of nonspecific lung disease and of normal spirometry results by revealing obstructive lung disease (OLD). In the final logistic regression model (adjusted for weight and body mass index > 30 kg/m2), OLD and findings of air trapping (high functional residual capacity and a low inspiratory capacity/TLC ratio) were predictors of a ΔSVC-FVC ≥ 200 mL. The chance of a bronchodilator response was found to be greater in the ΔSVC-FVC ≥ 200 mL group: for FEV1 (OR = 4.38; 95% CI: 1.45-13.26); and for FVC (OR = 3.83; 95% CI: 1.26-11.71). Conclusions: The use of an SVC maneuver appears to decrease the prevalence of nonspecific lung disease and of normal spirometry results. Individuals with a ΔSVC-FVC ≥ 200 mL, which is probably the result of OLD and air trapping, are apparently more likely to respond to bronchodilator administration.

RESUMO Objetivo: Avaliar a relação da diferença entre a capacidade vital lenta (CVL) e CVF (ΔCVL-CVF) com dados demográficos, clínicos e de função pulmonar. Métodos: Estudo analítico, transversal, no qual os participantes responderam a um questionário de saúde respiratória e foram submetidos a espirometria e pletismografia. A amostra foi dividida em dois grupos: ΔCVL-CVF ≥ 200 mL e ΔCVL-CVF < 200 mL. Foram realizadas análises de correlações entre os grupos e de regressão logística binominal. Resultados: Foram selecionados 187 indivíduos. Na amostra total, a média da ΔCVL-CVF foi de 0,17 ± 0,14 L. Na amostra, 61 indivíduos (32,62%) apresentaram ΔCVL-CVF ≥ 200 mL. O uso da manobra expiratória lenta reduziu a prevalência de distúrbio ventilatório inespecífico e resultados espirométricos normais, ao revelar distúrbio ventilatório obstrutivo (DVO). DVO e achados de aprisionamento aéreo (capacidade residual funcional elevada e capacidade inspiratória/CPT reduzida) foram preditores de ΔCVL-CVF ≥ 200 mL no modelo final da regressão logística (ajustada para peso e índice de massa corpórea > 30 kg/m2). Foi observada maior chance de resposta ao broncodilatador no grupo ΔCVL-CVF ≥ 200 mL: VEF1 (OR = 4,38; IC95%: 1,45-13,26) e CVF (OR = 3,83; IC95%: 1,26-11,71). Conclusões: O uso da manobra expiratória lenta diminuiu a prevalência de distúrbio ventilatório inespecífico e de resultados espirométricos normais, podendo a ΔCVL-CVF ≥ 200 mL ser resultado de DVO e aprisionamento aéreo, tendo maior chance de resposta ao broncodilatador.

Evaluation of lung function in patients submitted to total laryngectomy / Avaliação da função pulmonar em pacientes submetidos à laringectomia total

Abstract Introduction: The post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment. Objective: Characterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device. Methods: This transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer. Results: 56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals. Conclusion: Most patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.

Resumo Introdução: A condição pós-laringectomia é caracterizada por várias alterações na função pulmonar. Uma estimativa confiável da função pulmonar pode ser muito útil em pacientes laringectomizados para prevenir complicações após as intervenções cirúrgicas e avaliar os resultados do tratamento. Objetivo: Caracterizar a presença de distúrbios funcionais respiratórios e o padrão funcional de pacientes laringectomizados através do uso de um dispositivo extratraqueal. Método: Estudo transversal que incluiu 50 pacientes submetidos à laringectomia total pelo menos seis meses antes desta investigação, como tratamento de escolha para o câncer de laringe. Resultados: Dos participantes, 56% apresentavam padrão respiratório alterado, assim distribuídos: 14 com padrão obstrutivo sem aprisionamento aéreo, 11 com padrão obstrutivo e aprisionamento aéreo e apenas três com padrão restritivo. Em média, verificou-se que a difusão encontrava-se diminuída (74,3%) e a resistência das vias aéreas aumentada (121,7%) em relação aos resultados esperados em brasileiros. Conclusão: A maioria dos pacientes submetidos à laringectomia total apresenta função pulmonar alterada, do tipo obstrutiva, quase sempre associada a história de tabagismo.

Comparison of bioelectrical impedance analysis and air displacement plethysmography / Comparación de análisis de impedancia bioeléctrica y pletismografía de desplazamiento de aire

The measurement of body composition has become an important component in the diagnosis of health, physical conditioning and nutritional status. The aim of this study was to compare two methods of detecting body composition, bioelectrical impedance and air displacement plethysmography for athletes and non-athletes. Specifically, we compared the parameters as fat mass, fat free mass and the value of basal metabolic rate. A sample size of 52 men (age 26.2 ± 5.4 years) that included a group of mixed martial arts (MMA) fighters (n = 31, age 27.2 ± 5.5 years) and a group of the non-athletes (n =21, age 24.6 ± 5.1 years). Both groups were measured by bioelectrical impedance and air displacement plethysmography. Significant differences in % body fat (p<0.05) and fat-free mass (p<0.05) were noted between bioelectrical impedance and air displacement plethysmography of non-athletes, but there were no significant differences for athletes. Furthermore, there was a significant difference (p<0.001) of basal metabolic rate between bioelectrical impedance and air displacement plethysmography, but the correlation with fat free mass was very strong for both methods. Therefore, the use of bioelectrical impedance and air displacement plethysmography may be useful for detecting changes in body composition, but their accuracy is controversial and for this reason we recommend using only one method and not combining them.

La medición de la composición corporal se ha convertido en un componente importante en el diagnóstico de la salud, el acondicionamiento físico y el estado nutricional. El objetivo de este estudio fue comparar dos métodos para detectar la composición corporal, la impedancia bioeléctrica y la pletismografía de desplazamiento de aire para atletas y no atletas. Específicamente, comparamos los parámetros como masa grasa, masa libre de grasa y el valor de la tasa metabólica basal. Un tamaño de muestra de 52 hombres (edad 26,2 ± 5,4 años) de un grupo de luchadores de artes marciales mixtas (MMA) (n = 31, edad 27,2 ± 5,5 años) y un grupo de no deportistas (n = 21, edad 24,6 ± 5,1 años). Ambos grupos se midieron por impedancia bioeléctrica y pletismografía de desplazamiento de aire. Se observaron diferencias significativas en el porcentaje de grasa corporal (p<0,05) y la masa libre de grasa (p<0,05) entre la impedancia bioeléctrica y la pletismografía de desplazamiento de aire de los no deportistas, sin embargo no hubo diferencias significativas en los atletas. Además, se observó una diferencia significativa (p<0,001) de la tasa metabólica basal entre la impedancia bioeléctrica y la pletismografía de desplazamiento de aire, pero la correlación con la masa libre de grasa fue importante para ambos métodos. Por lo tanto, el uso de la pletismografía de impedancia bioeléctrica y desplazamiento de aire puede ser útil para detectar cambios en la composición corporal, pero su precisión es controvertida por lo que recomendamos usar solo un método y no una combinación de ambos.

Evaluation of lung function in patients submitted to total laryngectomy.

INTRODUCTION: The post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment. OBJECTIVE: Characterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device. METHODS: This transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer. RESULTS: 56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals. CONCLUSION: Most patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.

Reference values for pulmonary volumes by plethysmography in a Brazilian sample of white adults / Valores de referência para volumes pulmonares por pletismografia em uma amostra brasileira de adultos da raça branca

ABSTRACT Objective: To derive reference values for healthy white Brazilian adults who have never smoked and to compare the obtained values with reference values derived by Crapo and by Neder. Methods: Reference equations by quantile regressions were derived in 122 men and 122 women, non-obese, living in seven cities in Brazil. Age ranged from 21 to 92 years in women and from 25 to 88 years in men. Lung function tests were performed using SensorMedics automated body plethysmographies according ATS/ERS recommendations. Lower and upper limits were derived by specific equations for 5 and 95 percentiles. The results were compared to those suggested by Crapo in 1982, and Neder in 1999. Results: Median values for total lung capacity (TLC) were influenced only by stature in men, and by stature and age in women. Residual volume was influenced by age and stature in both genders. Weight was directly related to inspiratory capacity and inversely with functional residual capacity and expiratory reserve volume in both genders. A comparison of observed TLC data with values predicted by Neder equations showed significant lower values by the present data. Mean values were similar between data from present study and those derived by Crapo. Conclusion: New predicted values for lung volumes were obtained in a sample of white Brazilians. The values differ from those derived by Neder, but are similar to those derived by Crapo.

RESUMO Objetivo: Derivar valores de referência para brasileiros adultos brancos saudáveis que nunca fumaram e comparar os valores obtidos com os valores de referência derivados por Crapo e por Neder. Métodos: Equações de referência por regressões quantílicas foram derivadas em 122 homens e 122 mulheres, não obesos, em sete cidades do Brasil. A idade variou entre 21 e 92 anos nas mulheres e de 25 a 88 anos nos homens. Os volumes pulmonares foram medidos por pletismógrafo de corpo automatizados SensorMedics, de acordo com as recomendações da SBPT e ATS/ERS. Os limites inferior e superior, expressos pelo percentil 5 e 95, foram derivados por equações específicas. Os resultados foram comparados aos sugeridos por Crapo em 1982 e Neder em 1999. Resultados: Os valores medianos para a capacidade pulmonar total (CPT) foram influenciados apenas pela estatura nos homens, e pela estatura e idade nas mulheres. O volume residual foi influenciado pela idade e estatura em ambos os sexos. O peso se correlacionou diretamente com a capacidade inspiratória e inversamente com a capacidade residual funcional e com o volume de reserva expiratório em ambos os sexos. A CPT observada, comparada com os valores previstos pela equação de Neder, foi significativamente menor. Os valores médios foram semelhantes entre os dados do presente estudo e os de Crapo. Conclusões: Novos valores previstos para os volumes pulmonares foram obtidos em uma amostra de brasileiros de raça branca. Os valores diferem daqueles derivados por Neder, mas são semelhantes aos derivados por Crapo.

Monitoring of nociception, reality or fiction? / Monitorización de la nocicepción, ¿realidad o ficción?

There are currently various projects underway that attempt to monitor the nociceptive responses caused by surgical stress and ensure patients the best analgesic conditions. The systemic response to surgical stress has repercussions in the postoperative period, such as worse pain control, delayed recovery, greater complications, longer stay in resuscitation and hospital units, and increased healthcare costs. However, treatment with higher doses of opioids than necessary may lead to slower awakening, increased drowsiness and adverse effects, as well as situations of postoperative opioid-induced hyperalgesia. There are 2 large groups of nociceptive monitoring according to the origin of the theoretical objective of monitoring response to the stimulus, that may derive from changes in the electroencephalogram or the response of the autonomic nervous system.

Effects of obesity on lung volume and capacity in children and adolescents: a systematic review / Efeitos da obesidade sobre os volumes e as capacidades pulmonares em crianças e adolescentes: uma revisão sistemática

Abstract Objective: To assess the effects of obesity on lung volume and capacity in children and adolescents. Data source: This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. Data synthesis: Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. Conclusions: Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.

Resumo Objetivo: Avaliar os efeitos da obesidade sobre os volumes e as capacidades pulmonares em crianças e adolescentes. Fontes de dados: Trata-se de uma revisão sistemática, através das bases de dados Pubmed, Lilacs, SciELO e PEDro, por meio das seguintes palavras-chave: Plethysmography, Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Foram selecionados estudos observacionais ou ensaios clínicos que avaliaram os efeitos da obesidade sobre os volumes e as capacidades pulmonares em crianças e adolescentes (0 a 18 anos), sem qualquer outra doença associada, nos idiomas inglês, português e espanhol. A qualidade metodológica foi avaliada através da Agency for Healthcare Research and Quality. Síntese dos dados: Dos 1.030 artigos, apenas quatro foram incluídos nesta revisão. Os estudos totalizaram 548 participantes, com predomínio do sexo masculino e tamanho amostral entre 45 e 327 indivíduos; 100% dos estudos avaliaram o estado nutricional através do IMC (escore-z) e 50% informaram os dados da circunferência abdominal. Todos demonstraram que a obesidade causa efeitos negativos sobre os volumes e as capacidades pulmonares, causa redução, principalmente, da capacidade residual funcional em 75% dos estudos, do volume de reserva expiratório em 50% e do volume residual em 25%. A qualidade metodológica variou entre moderada e alta, com 75% dos estudos classificados com alta qualidade metodológica. Conclusões: A obesidade causa efeitos deletérios sobre os volumes e as capacidades pulmonares em crianças e adolescentes, com redução principalmente da capacidade residual funcional, volume de reserva expiratório e volume residual.

The clinical importance of air plethysmography in the assessment of chronic venous disease / Importância clínica da pletismografia a ar na avaliação da doença venosa crônica

Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

Resumo A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.

Effects of obesity on lung volume and capacity in children and adolescents: a systematic review. / Efeitos da obesidade sobre os volumes e as capacidades pulmonares em crianças e adolescentes: uma revisão sistemática.

OBJECTIVE: To assess the effects of obesity on lung volume and capacity in children and adolescents. DATA SOURCE: This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. DATA SYNTHESIS: Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. CONCLUSIONS: Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.

Is optoelectronic plethysmography a valid instrument to measure inspiratory capacity? / A pletismografia optoeletrônica é um instrumento válido para medir a capacidade inspiratória? / ¿Tiene validez para medir la capacidad inspiratoria la pletismografía optoelectrónica?

The aim of this study was to evaluate the concurrent validity of the optoelectronic plethysmography (OEP) to measure inspiratory capacity (IC) at rest and during submaximal exercise in healthy subjects. Twelve subjects (6 Male/6 Female; 23.8±1.34 yrs) with normal body mass index and lung function completed the study protocol. Participants were assessed at rest and during a 12-minute submaximal exercise protocol on a cycle ergometer. IC maneuvers were simultaneously recorded by OEP system and by a spirometer at rest and during exercise. The percentage of discrepancy between measurements, linear regression analysis and Bland-Altman method were used for data analysis. The study was approved by the institution ethics committee. It was considered 150 valid IC maneuvers for analysis (44 for resting and 106 for exercise). The percentage of discrepancy between the measurements were -9.6 (8.6%) at rest and -4.6 (5.5%) during exercise. Regression analysis showed good linear associations between methods at rest (r2=0.90; p=0.0002) and during exercise (r2=0.96; p=0.0008). Bland-Altman analysis using data obtained during exercise showed a bias between the two methods of 0.13L. The limits of agreement indicate that the difference between methods can vary from -0.04L to 0.57L. Additionally, data was equally distributed between the upper and lower limits, demonstrating no systematic overestimation or underestimation of the IC by any of the instruments. In conclusion, this study demonstrated that the OEP is a valid evaluation system to measure IC of healthy individuals at rest and during submaximal exercise.

O objetivo deste estudo foi avaliar a validade concorrente da pletismografia optoeletrônica (POE) para medir a capacidade inspiratória (CI) de indivíduos saudáveis no repouso e durante exercício submáximo. Doze voluntários (6 H/6 M; 23,8±1,34 anos) com índice de massa corporal e prova de função pulmonar normais completaram o protocolo do estudo. Eles foram avaliados no repouso (7 minutos) e durante 12 minutos de exercício submáximo em cicloergômetro. A CI foi mensurada simultaneamente pela POE e por um espirômetro. A porcentagem de discrepância entre as medidas, a análise de regressão linear e o método de Bland-Altman foram utilizados para análise. O estudo foi aprovado pelo comitê de ética em pesquisa da instituição. Foram consideradas 150 manobras de CI válidas para análise (44 para o repouso e 106 para o exercício). A porcentagem de discrepância entre as medidas foi de -9,6 (8,6%) no repouso e -4,6 (5,5%) durante o exercício. A análise de regressão linear mostrou associações entre os dois métodos no repouso (r2=0,90; p=0,0002) e durante o exercício (r2=0,96; p=0,0008). A análise de Bland-Altman realizada com os dados do exercício mostrou viés entre os métodos de 0,13L. Os limites de concordância mostraram que a diferença entre os métodos pode variar de -0,04 L to 0,57 L. Adicionalmente, os dados distribuíram-se igualmente entre os limites de concordância, sem superestimação ou subestimação sistemática da CI. Em conclusão, o estudo demonstrou que a POE é um sistema válido para mensuração da CI de indivíduos saudáveis no repouso e durante o exercício submáximo.

Este estudio tiene como propósito evaluar la validez de la pletismografía optoelectrónica (OEP) para medir la capacidad inspiratoria (CI) en sujetos saludables tanto en reposo como durante ejercicio submáximo. Participaron de este estudio 12 sujetos (6 hombres y 6 mujeres; 23,8 ± 1,34 años de edad) con índice de masa corporal y función pulmonar normales. Los participantes fueron evaluados en reposo por 7 minutos y durante 12 minutos de ejercicio submáximo en bicicleta estática. Se grabaron simultáneamente por la OEP y por un espirómetro las maniobras de la CI tanto en reposo como durante el ejercicio. Se utilizaron el porcentaje de discrepancia en las mediciones, el análisis de regresión lineal y el método Bland-Altman para análisis de datos del estudio, el que fue aprobado por el comité de ética de la institución. Se consideró 150 maniobras CI para el análisis, las cuales 44 fueron para reposo y 106 para ejercicio. El porcentaje de discrepancia entre las medidas fue del -9,6 (un 8,6%) en reposo y del -4,6 (un 5,5%) durante el ejercicio. El análisis de regresión lineal mostró asociaciones para los métodos en reposo (r2=0,90; p=0,0002) y durante el ejercicio (r2 = 0,96; p = 0,0008). Los datos obtenidos durante el ejercicio utilizándose el análisis Bland-Altman mostraron un sesgo de 0.13L entre los métodos. Los límites de concordancia indicaron que la diferencia entre los métodos puede tener variación desde -0.04L hasta 0.57L. Además, se distribuyeron por igual los datos entre los límites de concordancia, los cuales no mostraron sobreestimación o subestimación sistemática de la CI. En conclusión, este estudio mostró que el OEP es un sistema de evaluación valido para medir la CI de sujetos saludables tanto en reposo como durante ejercicio submáximo.

O efeito do índice de massa corpórea na função pulmonar / The effect of body mass index on pulmonary function

Objetivo: caracterizar os volumes pulmonares, a resistência das vias aéreas (Rva) e a capacidade de difusão do monóxido do carbono (DCO) em indivíduos com índice de massa corpórea (IMC) normal, pré-obesos, obesidade classe I, obesidade classe II e obesidade classe III. Metodologia: estudo retrospectivo, quantitativo e transversal. A amostra foi constituída por 304 indivíduos de ambos os gêneros com suspeita ou diagnóstico clínico de asma, com IMC?25 kg/m2 e sem alterações nas provas funcionais respiratórias e por 95 indivíduos de ambos os gêneros, saudáveis e com IMC.

Objective: to characterize lung volumes, airway resistance (AWR), and carbon monoxide diffusion capacity (CMD) in individuals with normal, pre obese, class I obesity, class II obesity, and class III obesity body mass index (BMI). Methodology: this was a retrospective, quantitative, and cross-sectional study. The sample consisted of 304 individuals of both genders with suspicion or clinical diagnosis of asthma, with BMI ? 25 kg/m2, and without alterations in respiratory functional tests and 95 healthy and with normal BMI individuals of both genders.

[Body plethysmography (I): Standardisation and quality criteria]. / Pletismografía corporal (I): estandarización y criterios de calidad.

Whole body plethysmography is used to measure lung volumes, capacities and resistances. It is a well standardised technique, and although it is widely used in paediatric chest diseases units, it requires specific equipment, specialist staff, and some cooperation by the patient. Plethysmography uses Boyle's law in order to measure the intrathoracic gas volume or functional residual capacity, and once this is determined, the residual volume and total lung capacity is extrapolated. The measurement of total lung capacity is necessary for the diagnosis of restrictive diseases. Airway resistance is a measurement of obstruction, with the total resistance being able to be measured, which includes chest wall, lung tissue and airway resistance, as well as the specific airway resistance, which is a more stable parameter that is determined by multiplying the measured values of airway resistance and functional residual capacity. The complexity of this technique, the reference equations, the differences in the equipment and their variability, and the conditions in which it is performed, has led to the need for its standardisation. Throughout this article, the practical aspects of plethysmography are analysed, specifying recommendations for performing it, its systematic calibration and the calculations that must be made, as well as the interpretation of the results obtained. The aim of this article is to provide a better understanding of the principles of whole body plethysmography with the aim of optimising the interpretation of the results, leading to improved management of the patient, as well as a consensus among the speciality.

Clinical performance of 3-body fat measurements in obese adolescents 15 to 18 years-old / Medidas da gordura corporal em adolescentes obesos de 15 a 18 anos

There is a lack of information about the performance and clinical use of body fat measurements in children and adolescents, particularly in obese people. Objective: the purpose of this study was to compare percentage body fat (%BF) among 3 different methodologies, including hydrostatic weighing (HW), dual energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP), in obese adolescents. Subjects: A total of 36 obese adolescents were evaluated, which 15 males (16.00 + 0.9 yrs, 105.0 + 10.9 kg, 179.9 + 7.2 cm, 34.9 + 4.4 kg/m2) and 21 females (16.5 + 1.5 yrs, 91.1 + 10.5 kg, 163.6 + 4.2 cm, 34.1 + 3.7 kg/m2). All of them performed HW, total body DXA and ADP. Results: For males, the means of %BF regarding HW, DXA and ADP were 45.7 + 9.0, 42.3 + 5.2 and 35.6 + 7.9, respectively. For females, the means of %BF were 47.7 + 6.8, 50.7 + 4 and 42.4 + 5.3, respectively. No significant difference was found between HW and DXA. In general, the %BF values provided by ADP measurements were lower than other two methods. Conclusion: There was a good agreement between DXA and HW methods, but ADP measurements can underestimate the %BF in obese adolescents.