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1.
Adv Exp Med Biol ; 1222: 17-25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31541364

RESUMO

Osteopathic manual therapy (OMT) may reduce hyperinflation in patients with chronic obstructive pulmonary disease (COPD) by improving breathing mechanics. The aim of the study was to evaluate the immediate effects of OMT on hyperinflation in stable COPD patients with forced expired volume in 1 s (FEV1) <50% predicted. Nineteen COPD patients of the median age 68 (IQR 63-72) years and the median FEV1 39.8 (IQR 33.4-46.6) % predicted were enrolled into the study. For the first session, patients were randomly assigned to either OMT or sham therapy. During the second session, the two groups of patients were crossed over. Pulmonary function and dyspnea were compared before and after both procedures. Neither pulmonary function nor dyspnea differed significantly before and after OMT or sham procedures. However, 36.7% and 47.4% patients achieved the minimally important difference for residual volume (RV) reduction after both OMT and sham therapy, respectively. Responders to OMT had a greater median (IQR) baseline sense of dyspnea compared to non-responders, assessed on a visual analog scale, of 7.0 (4.5-7.0) vs. 3.0 (0.0-5.0), p = 0.040, respectively. Although OMT did not have an immediate effect on hyperinflation or dyspnea, a subgroup experienced a reduction in RV following OMT and sham therapy. Future studies are needed to identify the characteristics of responders.


Assuntos
Pulmão/fisiopatologia , Manipulação Osteopática , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Estudos Cross-Over , Dispneia , Feminino , Volume Expiratório Forçado , Humanos , Capacidade Inspiratória , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Volume Residual , Testes de Função Respiratória , Capacidade Pulmonar Total , Resultado do Tratamento
2.
J Bras Pneumol ; 45(3): e20180065, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166555

RESUMO

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.


Assuntos
Medidas de Volume Pulmonar/métodos , Pulmão/fisiologia , Pletismografia/métodos , Capacidade Pulmonar Total/fisiologia , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Testes de Função Respiratória , Fatores Sexuais , Adulto Jovem
3.
Ter Arkh ; 91(1): 60-63, 2019 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31090373

RESUMO

AIM: To assess the functional status of the small Airways in patients with bronchial asthma associated with obesity, by body plethysmography. MATERIALS AND METHODS: 65 patients with bronchial asthma of mild severity, partially controlled course, including 30 patients with normal body weight and 35 patients with obesity of I degree were examined. Control group-30 healthy volunteers. Examined forced vital capacity (FVC), forced expiratory volume in first second (FEV1) ratio of FEV1 to FVC (FEV1/FVC), maximum volumetric exhalation rate after 25.50 and 75% FVC (MEF75, MEF50, MEF25), average flow velocity in the exhalation interval 25-75% of FVC (MMEF25-75). Method bodyplethysmography was evaluated in bronchial resistance, functional residual capacity (FRC), residual volume of the lungs (RV), total lung capacity (TLC), the percentage of RV/TLC. RESULTS: Patients with bronchial asthma with obesity showed a reduction of indicators of bronchial obstruction: FEV1 of 14% (p=0.02), FEV1/FVC by 14% (p=0.001), MEF75 30% (p=0.001), MEF50 by 35% (p=0.001), MEF25 by 44% (p=0.003), MMEF25-75 by 38% (p=0.001). The increase of bronchial resistance on inhalation in 2 times (p=0.001), on exhalation in 3.3 times (p=0.003) was found, which is typical for generalized bronchial obstruction at the proximal level. An increase in RV by 24% (p=0.03), TLC - by 9% (p=0.03), RV/TLC - by 18% (p=0.03), indicating the presence of "air traps" and dysfunction of the small respiratory tract. CONCLUSION: In patients with asthma of mild severity associated with obesity, both the central bronchis and the distal lung are affected, which are manifested by generalized bronchial obstruction, the formation of "air traps" and dysfunction of the small respiratory tract.


Assuntos
Asma/fisiopatologia , Obesidade/complicações , Capacidade Pulmonar Total/fisiologia , Asma/complicações , Estudos de Casos e Controles , Volume Expiratório Forçado/fisiologia , Humanos , Pletismografia/métodos , Capacidade Vital/fisiologia
4.
Chin Med J (Engl) ; 132(11): 1283-1292, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31021982

RESUMO

BACKGROUNDS: Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) that develops in response to the inhalation of various antigens. The clinical pathologies are very complex and undetermined. The clinical features and outcomes of HP have not been fully elucidated. The aim of this study was to analyze the incidence, clinical features, and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP (CHP). METHODS: The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017. The patients were categorized into acute HP (AHP, n = 72) and CHP (n = 29) groups according to the updated international criteria. The clinical, imaging, treatment, and follow-up data were retrospectively reviewed. All patients were followed up until December 31, 2017. Statistical analysis was performed, and a clinical scoring system for CHP was constructed by SPSS 20.0 software. RESULTS: The incidence of HP was 2.4% in ILD inpatients in our center. Patients in the CHP group were older (t = -2.212, P = 0.029), had more smokers (χ = 8.428, P = 0.004), and longer duration of symptoms (t = -4.852, P < 0.001) than those in the AHP group. Weight loss, crackles, digital clubbing, and cyanosis were more common in the CHP group than those in the AHP group (χ = 5.862, P < 0.001; χ = 8.997, P = 0.003; χ = 11.939, P = 0.001; and χ = 4.025, P = 0.045, respectively). On chest high-resolution computed tomography (HRCT), reticular patterns, traction bronchiectasis, and accompanying honeycombing were more common in CHP cases than those in AHP cases (χ = 101.000, P < 0.001; χ = 32.048, P < 0.001; and χ = 36.568, P < 0.001, respectively). The clinical scoring system for CHP was established based on the clinical variables (age [A], duration of symptoms [D], smoking history [S], unidentified exposure [U], and chest HRCT [C]; ADSUC) (area under the curve 0.935, 95% confidence interval: 0.883-0.987, P < 0.001). Eleven patients (15.3%) in the AHP group developed CHP, and unidentified exposure was an independent risk factor for the progression of disease (P = 0.038). The survival of patients with CHP, smoking history, unidentified antigens and fibrosis on Chest HRCT were significantly worse (P = 0.011, P = 0.001, P = 0.005, and P = 0.011, respectively) by Kaplan-Meier analysis. Cox multivariate regression analysis revealed that unidentified exposure and total lung volume (TLC pred%) were independent prognostic predictors for HP patients (P = 0.017 and P = 0.017, respectively). CONCLUSIONS: The clinical features and outcomes of the CHP patients differ from those of the AHP patients. ADSUC is a simple and feasible clinical model for CHP. Unidentified exposure is an independent risk factor for the progression of AHP to CHP. Unidentified exposure and a low baseline TLC pred% are independent predictors for survival in HP patients.


Assuntos
Alveolite Alérgica Extrínseca/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico , Adulto , Idoso , Alveolite Alérgica Extrínseca/mortalidade , Alveolite Alérgica Extrínseca/fisiopatologia , China , Doença Crônica , Estudos de Coortes , Feminino , Fibrose , Humanos , Estimativa de Kaplan-Meier , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Capacidade Pulmonar Total/fisiologia
5.
Respir Investig ; 57(4): 312-320, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981683

RESUMO

BACKGROUND: Physicians have few opportunities to perform surgical lung biopsy (SLB) to diagnose idiopathic pleuroparenchymal fibroelastosis (IPPFE). Therefore, diagnostic criteria for IPPFE that do not require SLB must be established. Herein, we propose diagnostic criteria for IPPFE with and without SLB. METHODS AND RESULTS: The diagnostic criteria for IPPFE with SLB are histological, based on computed tomography (CT) lesions compatible with PPFE, predominantly in the upper lobes. The three diagnostic criteria for IPPFE without SLB are as follows: (1) radiologically possible IPPFE (a radiological criterion confirming CT lesions in both lung apexes, regardless of the lower lobe lesions); (2) radiologically probable IPPFE (also a radiological criterion, but mandatory to confirm chest radiograph findings of bilateral upward shift of the hilar structures and/or CT findings of volume loss of the upper lobes); (3) radiologically and physiologically probable IPPFE. Our data from 41 patients with IPPFE and 97 with idiopathic pulmonary fibrosis (IPF) showed that the percentage of the predicted values of the ratio of residual volume to total lung capacity (RV/TLC %pred.) ≥115% and body mass index (BMI) ≤20 kg/m2 plus RV/TLC %pred. ≥80% performed well for discriminating IPPFE from IPF. These parameters were thus added to criterion (3). CONCLUSIONS: We have proposed diagnostic criteria for IPPFE in patients with and without SLB. Both imaging criteria and physiological criteria using RV/TLC and BMI successfully discriminate IPPFE from chronic IIPs when SLB cannot be performed.


Assuntos
Tecido Elástico , Doenças Pulmonares Intersticiais/diagnóstico , Tecido Parenquimatoso , Doenças Pleurais/diagnóstico , Índice de Massa Corporal , Diagnóstico Diferencial , Tecido Elástico/patologia , Fibrose , Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Doenças Pulmonares Intersticiais/patologia , Doenças Pleurais/patologia , Radiografia Torácica , Volume Residual , Tomografia Computadorizada por Raios X , Capacidade Pulmonar Total
6.
Respir Physiol Neurobiol ; 264: 28-32, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30953791

RESUMO

The aim of the present study is to investigate the effects of inspiratory muscle training (IMT) on pulmonary function and respiratory muscle strength of both healthy smokers and nonsmokers. Forty-two healthy males (16 in the IMT smokers group [IMTS], 16 in the IMT nonsmokers group [IMTN], and 10 in the placebo group) participated in the present study. Using a randomized, double-blind, placebo-controlled design, IMTS and IMTN underwent 4 weeks of 30 breaths twice daily at 50% (+5% increase each week) of maximum inspiratory pressure (MIP), while the placebo group maintained 30 breaths twice daily at 15% MIP using an IMT device. The data were analyzed with repeated measures for one-way analysis of variance, 3 × 2 mixed factor analysis of variance, and least significant difference tests. Respiratory muscle strength (MIP and maximal expiratory pressure [MEP]) and pulmonary functions significantly improved after a 4-week period (between the pre and posttests) in the IMTN and IMTS groups (p < 0.05). The mean difference and percentage differences showed significant alterations in the respiratory muscle strength, forced and slow pulmonary capacities, and pulmonary volume between the IMTN and IMTS groups (p < 0.05). There were significant changes in the expiratory muscle strength (MEP), slow vital capacity (SVC), and forced pulmonary measurements (forced expiratory volume after 1 s and maximal voluntary ventilation) between IMTN and IMTS groups in favor of smokers (p < 0.05). These results show that greater improvements occurred in smokers after IMT. Increased respiratory muscle strength may be the underlying mechanism responsible for this improvement. Additionally, the benefits of IMT were greater in smokers than nonsmokers. This difference between smokers and nonsmokers may potentially be explained by higher influence of exercise on smokers' lung microbiome, resulting in greater reversal of negative effects.


Assuntos
Exercícios Respiratórios/métodos , Força Muscular/fisiologia , Mecânica Respiratória/fisiologia , Músculos Respiratórios/fisiologia , Fumantes , Capacidade Pulmonar Total/fisiologia , Adulto , Método Duplo-Cego , Humanos , Masculino , Espirometria , Resultado do Tratamento , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-30863041

RESUMO

Background: Severe hyperinflation causes detrimental effects such as dyspnea and reduced exercise capacity and is an independent predictor of mortality in COPD patients. Static lung volumes are required to diagnose severe hyperinflation, which are not always accessible in primary care. Several studies have shown that the area under the forced expiratory flow-volume loop (AreaFE) is highly sensitive to bronchodilator response and is correlated with residual volume/total lung capacity (RV/TLC), a common index of air trapping. In this study, we investigate the role of AreaFE% (AreaFE expressed as a percentage of reference value) and conventional spirometry parameters in indicating severe hyperinflation. Materials and methods: We used a cohort of 215 individuals with COPD. The presence of severe hyperinflation was defined as elevated air trapping (RV/TLC >60%) or reduced inspiratory fraction (inspiratory capacity [IC]/TLC <25%) measured using body plethysmography. AreaFE% was calculated by integrating the maximal expiratory flow-volume loop with the trapezoidal rule and expressing it as a percentage of the reference value estimated using predicted values of FVC, peak expiratory flow and forced expiratory flow at 25%, 50% and 75% of FVC. Receiver operating characteristics (ROC) curve analysis was used to identify cut-offs that were used to indicate severe hyperinflation, which were then validated in a separate group of 104 COPD subjects. Results: ROC analysis identified cut-offs of 15% and 20% for AreaFE% in indicating RV/TLC >60% and IC/TLC <25%, respectively (N=215). On validation (N=104), these cut-offs consistently registered the highest accuracy (80% each), sensitivity (68% and 75%) and specificity (83% and 80%) among conventional parameters in both criteria of severe hyperinflation. Conclusion: AreaFE% consistently provides a superior estimation of severe hyperinflation using different indices, and may provide a convenient way to refer COPD patients for body plethysmography to address static lung volumes.


Assuntos
Pulmão/fisiopatologia , Fluxo Máximo Médio Expiratório , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria , Idoso , Área Sob a Curva , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia Total , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Curva ROC , Volume Residual , Índice de Gravidade de Doença , Capacidade Pulmonar Total , Capacidade Vital
9.
Zhonghua Wai Ke Za Zhi ; 57(2): 119-123, 2019 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-30704215

RESUMO

Objective: To evaluate the efficiency of preoperative Halo-gravity traction (HGT) in the treatment of severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ (NF1). Methods: A retrospective review was conducted on patients with severe kyphoscoliosis secondary to NF1 at Department of Spinal Surgery, Drum Tower Hospital, Medical School of Nanjing University between July 2007 and May 2016. A total of 29 patients including 17 males and 12 females were finally enrolled and the age was (13.7±2.9) years. The Cobb angle of major coronal curve and global kyphosis were measured before and after HGT. The forced vital capacity (FVC)and forced expiratory volume in 1 second (FEV(1)) before and after traction were also recorded. The paired t test was used for comparison analysis. Results: The average maximum traction weight of HGT was (12.2±2.8) kg and the traction duration was (10.2±6.6) weeks. The coronal Cobb angle before HGT was (87.5±36.5)°, which improved to (68.4±25.9)° after HGT with a correction rate of (21.9±12.1)% (t=9.14, P<0.001); the average global kyphosis before HGT was (79.1±27.1)°, which improved to (59.9±19.4)° after HGT and the correction rate was (20.2±14.1)% (t=8.55, P<0.001). One patient had transient brachial plexus palsy which resolved completely after reducing the traction weight. After HGT treatment, FVC increased from (0.83±0.16) L to (0.89±0.19) L (t=1.48, P=0.12) and FEV(1) increased from (0.72±0.16) L to (0.78±0.20) L (t=0.49,P=0.63). FVC predicted and FEV(1) predicted improved from (42.9±20.1)% and (40.6±19.6)% to (46.9±20.5)% (t=0.98,P=0.33) and (43.6±25.8)% (t=1.24,P=0.22), respectively. Conclusion: Preoperative HGT in the treatment of severe kyphoscoliosis secondary to NF1 can improve spinal deformity and pulmonary function to some extent, which can further benefit the patients by improving their surgical tolerance.


Assuntos
Cifose/cirurgia , Neurofibromatose 1/complicações , Escoliose/cirurgia , Tração/instrumentação , Adolescente , Criança , Feminino , Humanos , Cifose/etiologia , Cifose/fisiopatologia , Masculino , Cuidados Pré-Operatórios , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/fisiopatologia , Transtornos Respiratórios/cirurgia , Estudos Retrospectivos , Escoliose/etiologia , Escoliose/fisiopatologia , Fusão Vertebral , Capacidade Pulmonar Total , Resultado do Tratamento
10.
Artigo em Inglês | MEDLINE | ID: mdl-30787605

RESUMO

Background and objective: FEV1 is the gold standard for assessment of COPD. We compared efficacy of FEV1, inspiratory capacity (IC), and IC to total lung capacity (TLC) ratio in the evaluation of COPD and their association with exacerbation. Methods: We analyzed the association of dyspnea severity, quality of life status, and lung function with lung function measurements and exacerbation risk in 982 patients enrolled in the Korea COPD Subgroup Registry and Subtype Research study. Exacerbation and longitudinal lung function change were evaluated in 3 years' follow-up. Results: The FEV1, IC, and IC to TLC ratio showed comparable negative correlations with dyspnea severity and quality of life status, and positive correlation with exercise capacity. In patients with >2 events/year, annual rate of change in FEV1 and IC tended to decline more rapidly in those with FEV1 <50% than in those with FEV1 >50% (-14.46±19.40 mL/year vs 12.29±9.24 mL/year, P=0.213; -4.75±17.28 mL/year vs -78.05±34.16 mL/year, P=0.056 for FEV1 and IC, respectively), without significance. Conclusion: Longitudinal changes in IC and FEV1 were not significantly associated with exacerbation risk.


Assuntos
Volume Expiratório Forçado , Capacidade Inspiratória , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Sistema de Registros , República da Coreia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Capacidade Pulmonar Total
11.
Clin Rehabil ; 33(5): 913-922, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30722696

RESUMO

OBJECTIVE: To determine the prophylactic efficacy of short-term intensive preoperative inspiratory muscle training on the incidence of postoperative pulmonary complications in patients scheduled for cardiac surgery. DESIGN: Single-blind, randomized controlled pilot study. SETTING: TEDA International Cardiovascular Hospital, China. SUBJECTS: In total, 197 subjects aged ⩾50 years scheduled for cardiac surgery were selected. INTERVENTION: The intervention group ( n = 98) received five days of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group ( n = 99). MAIN MEASURES: The primary outcome variable was the occurrence of postoperative pulmonary complications. The secondary outcome variables were inspiratory muscle strength, lung function and length of hospitalization. RESULTS: After cardiac surgery, a total of 10 (10.2%) of the 98 patients in the intervention group and 27 (27.3%) of 99 patients in the control group had postoperative pulmonary complications (risk ratio, 0.23; 95% confidence interval (CI), 0.09-0.58, P = 0.002). The study revealed that, compared with the control group, the intervention group had a significant increase in inspiratory muscle strength (by 10.48 cm H2O, P < 0.001), forced expiratory volume in the first second of expiration (FEV1) %predicted (by 3.75%, P = 0.030), forced vital capacity (FVC) %predicted (by 4.15%, P = 0.008) and maximal voluntary ventilation (MVV) %predicted (by 6.44%, P = 0.034). Length of hospital stay was 7.51 (2.83) days in the intervention group and 9.38 (3.10) days in the control group ( P = 0.039). CONCLUSION: A five-day intensive pattern of preoperative inspiratory muscle training reduced the incidence of postoperative pulmonary complications and duration of postoperative hospitalization in patients undergoing cardiac surgery.


Assuntos
Exercícios Respiratórios , Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Projetos Piloto , Ventilação Pulmonar/fisiologia , Método Simples-Cego , Capacidade Pulmonar Total/fisiologia
12.
Ann Thorac Surg ; 107(4): e275-e277, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30326236

RESUMO

Severe chest wall deformities are considered a contraindication for lung transplantation. A 38-year-old man with idiopathic pulmonary fibrosis and severe pectus excavatum with a Haller index of 4.3 was considered eligible and listed for lung transplantation. Bilateral sequential transplantation and simultaneous correction of the pectus excavatum were performed via anterolateral thoracotomies and Nuss bar insertion with peripheral femorofemoral venoarterial extracorporeal membrane oxygenation support. Total lung capacity increased from 4.1 L preoperative to 5.8 L postoperative. This case demonstrates that a combined approach is feasible with good functional outcome.


Assuntos
Tórax em Funil/cirurgia , Fibrose Pulmonar Idiopática/cirurgia , Transplante de Pulmão/métodos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Terapia Combinada , Oxigenação por Membrana Extracorpórea , Seguimentos , Tórax em Funil/complicações , Tórax em Funil/diagnóstico por imagem , Humanos , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Fixadores Internos , Masculino , Medição de Risco , Toracotomia/métodos , Capacidade Pulmonar Total/fisiologia , Resultado do Tratamento
13.
Surg Today ; 49(3): 268-274, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30229311

RESUMO

PURPOSE: Glucocorticoids are used to prevent chronic lung allograft dysfunction (CLAD) after lung transplantation (LT). Our study was aimed at assessing the association between the glucocorticoid-induced transcript 1 gene (GLCCI1) variant, which modulates glucocorticoid sensitivity, and the postoperative lung function and development of CLAD after LT. METHODS: A total of 71 recipients of LT were genotyped for the GLCCI1 variant (rs37972) and divided into three groups: the homozygous mutant allele (TT) group, the heterozygous mutant allele (CT) group, and the wild-type allele (CC) group. The results of pulmonary function tests were compared with the postoperative baseline values. RESULTS: The total lung capacity (TLC) in the TT group was significantly lower than that in the CC group at 3 years after LT (P = 0.029). In the recipients of cadaveric LT, the TLC and forced expiratory volume in 1 s in the TT group were significantly lower than those in the CC groups, resulting in a significant worse CLAD-free survival at 3 years after LT (P = 0.016). CONCLUSION: The GLCCI1 variant was associated with a significant decrease of the TLC at 3 years after LT and the development of CLAD at 3 years, especially in patients undergoing cadaveric LT.


Assuntos
Glucocorticoides/metabolismo , Transplante de Pulmão , Polimorfismo de Nucleotídeo Único/genética , Disfunção Primária do Enxerto/genética , Receptores de Glucocorticoides/genética , Capacidade Pulmonar Total/genética , Adolescente , Adulto , Criança , Doença Crônica , Feminino , Glucocorticoides/uso terapêutico , Humanos , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/prevenção & controle , Taxa de Sobrevida , Fatores de Tempo , Adulto Jovem
14.
Injury ; 50(1): 101-108, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30482587

RESUMO

AIM: To estimate and compare lung volumes from pre- and post-operative computed tomography (CT) images and correlate findings with post-operative lung function tests in trauma patients with flail chest undergoing stabilizing surgery. PATIENTS AND METHODS: Pre- and post-operative CT images of the thorax were used to estimate lung volumes in 37 patients who had undergone rib plate fixation at least 6 months before inclusion for flail chest due to blunt thoracic trauma. Computed tomography lung volumes were estimated from airway distal to each lung hilum by outlining air-filled lung tissue either manually in images of 5 mm slice thickness or automatically in images of 0.6 mm slice thickness. Demographics, pain, range of motion in the thorax, breathing movements and Forced Vital Capacity (FVC) were assessed. Total Lung Capacity (TLC) measurements were also made in a subgroup of patients (n = 17) who had not been intubated at time of the initial CT. Post-operative CT lung volumes were correlated to FVC and TLC. RESULTS: Patients with a median age of 62 (19-90) years, a median Injury Severity Score (ISS) of 20 (9-54), and a median New Injury Severity Score (NISS) of 27 (17-66) were enrolled in the study. Median follow-up time was 3.9 (0.5-5.6) years. Two patients complained of pain at rest and when breathing. Pre-operative CT lung volumes were significantly different (p < 0.0001) from post-operative CT lung volumes, 3.51 l (1.50-6.05) vs. 5.59 l (2.18-7.78), respectively. At follow-up, median FVC was 3.76 l (1.48-5.84) and median TLC was 6.93 l (4.21-8.42). Post-operative CT lung volumes correlated highly with both FVC [rs = 0.75 (95% CI 0.57‒0.87, p < 0.0001)] and TLC [rs = 0.90 (95% CI 0.73‒0.96, p < 0.0001)]. The operated thoracic side showed decreased breathing movements. Range of motion in the lower thorax showed a low correlation with FVC [rs = 0.48 (95% CI 0.19‒0.70, p = 0.002)] and a high correlation with TLC [rs = 0.80 (95% CI 0.51‒0.92, p < 0.0001)]. CONCLUSIONS: Post-operative CT-lung volume estimates improve compared to pre-operative values in trauma patients undergoing stabilizing surgery for flail chest, and can be used as a marker for lung function when deciding which patient with chest wall injuries can benefit from surgery.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Tórax Fundido/fisiopatologia , Volume Expiratório Forçado/fisiologia , Fraturas das Costelas/cirurgia , Traumatismos Torácicos/fisiopatologia , Capacidade Pulmonar Total/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Tórax Fundido/cirurgia , Seguimentos , Fixação Interna de Fraturas , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Mecânica Respiratória , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia , Resultado do Tratamento , Adulto Jovem
15.
Spine J ; 19(2): 330-338, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30025996

RESUMO

BACKGROUND CONTEXT: The evaluation of ventilatory functional restrictions during a maximal exercise tolerance test in patients with Scheuermann disease has never been described. PURPOSE: This study evaluated the respiratory functional capacity of patients with Scheuermann disease compared to healthy adolescents matched in age. STUDY DESIGN/SETTING: Prospective comparative study. PATIENTS SAMPLE: Forty-one consecutive adolescents with Scheuermann hyperkyphosis (SK) and 20 healthy controls matched in age were included in the study. OUTCOME MEASURES: Basal spirometry and dynamic ventilatory parameters were measured during a maximal cardiopulmonary exercise tolerance test. Heart rate, oxygen saturation (SatO2), maximum oxygen uptake (VO2 max), quotient between ventilation and volume of exhaled carbon dioxide (VE/CO2), respiratory exchange rate (RER), ventilatory capacity at maximal exercise (VEmax), and test duration were recorded at initium and at maximal exercise. METHODS: The exercise tolerance test (ETT) was completed to exhaustion using a standard Bruce protocol on a ramp treadmill. Comparisons of quantitative variables between SK and control group were analyzed by statistical nonparametric test. The correlations between the magnitude of the thoracic kyphosis and both the VO2 max/kg and VEmax of the SK group were also analyzed. No funds were required. The authors have no conflicts of interests. RESULTS: Patients with SK started the test with a higher heart rate (p<.01) and reached exhaustion with a lower heart rate (p<.05) than healthy controls. At maximal exercise, the SatO2 was declined in Scheuermann patients compared to healthy subjects (p<.05). The maximal aerobic power (VO2max) was greater in healthy controls than in hyperkyphotic patients (50.0±6.7 vs. 43.4±11.3 mL/kg/min; p<.05). There was an inverse correlation between the increase in the magnitude of thoracic kyphosis and the deterioration of the maximal aerobic power. VO2max and VEmax were severely deteriorated in patients with more than 75° kyphosis. Patients with >75° thoracic kyphosis also showed an impairment in their cardiovascular efficiency as measured by the heart rate/VO2 quotient. The limited tolerance to the exercise in SK patients was reflected by a shorter duration of the exercise test and a lower energy cost measured in METS (metabolic equivalents) as compared to healthy controls. CONCLUSIONS: Patients with severe hyperkyphosis (>75°) show significant respiratory inefficiency together with a lower ventilation capacity and lower VO2max. There is an inverse correlation between the increase in the magnitude of thoracic kyphosis and the deterioration of the maximal aerobic power.


Assuntos
Tolerância ao Exercício , Consumo de Oxigênio , Doença de Scheuermann/fisiopatologia , Adolescente , Feminino , Frequência Cardíaca , Humanos , Masculino , Capacidade Pulmonar Total
16.
Eur J Phys Rehabil Med ; 55(1): 103-112, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29904044

RESUMO

BACKGROUND: Pulmonary rehabilitation (PR) improves performance in the 6-min walk test (6MWT) in a subset of patients with fibrotic idiopathic interstitial pneumonia (f-IIP); however, a large proportion of patients does not respond to PR. AIM: To investigate the effects of a PR program on cardiorespiratory responses during a 6MWT and to identify the characteristics of patients who do not show improved performance after PR. DESIGN: An observational study. SETTING: Patients were recruited from the Competence Centre for Rare Pulmonary Diseases at Lille University Hospital, France and completed an 8-week home-based PR program. POPULATION: A total of 19 patients with f-IIP; 12 with idiopathic pulmonary fibrosis (IPF) and 7 with fibrotic non-specific interstitial pneumonia. METHODS: Patients underwent spirometry and completed a 6MWT before and after an 8-week PR program. Gas exchange, heart rate, and pulse O2 saturation were measured continuously during the 6MWT. Quality of life, dyspnea, and anxiety/depression were assessed using the Short-Form 36 (SF-36), the baseline/transition dyspnea index (BDI/TDI), and the Hospital Anxiety and Depression Scale (HADS) questionnaires. RESULTS: Patients who did and did not improve the distance walked in the 6MWT by at least 30 m after PR were classified as responders (N.=9) and non-responders (N.=10), respectively. O2 uptake, ventilation rate, and distance covered during the 6MWT were significantly improved only in the responder group (P<0.05). Changes in SF-36, BDI/TDI, and HADS scores did not differ significantly between responders and non-responders. The non-responder group contained significantly more patients with IPF (P<0.05) and experienced greater arterial oxygen desaturation during the 6MWT compared with the responder group. CONCLUSIONS: Failure to improve performance in the 6MWT after PR was associated with a diagnosis of IPF, non-improvement in gas exchange, and greater arterial oxygen desaturation. CLINICAL REHABILITATION IMPACT: Most f-IIP patients who did not respond to PR were diagnosed with IPF and displayed greater hypoxemia during exercise. Clinical practitioners should seek to determine why patients fail to improve exercise performance after PR and propose an alternative exercise regimen to these patients.


Assuntos
Frequência Cardíaca/fisiologia , Fibrose Pulmonar Idiopática/fisiopatologia , Fibrose Pulmonar Idiopática/reabilitação , Troca Gasosa Pulmonar/fisiologia , Teste de Caminhada , Idoso , Feminino , Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Masculino , Pessoa de Meia-Idade , Oximetria , Qualidade de Vida , Espirometria , Capacidade Pulmonar Total , Falha de Tratamento
17.
Eur Radiol ; 29(3): 1595-1606, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30151641

RESUMO

OBJECTIVES: Whole-body MR imaging is increasingly utilised; although for lung dedicated sequences are often not included, the chest is typically imaged. Our objective was to determine the clinical utility of lung volumes derived from non-dedicated MRI sequences in the population-based KORA-FF4 cohort study. METHODS: 400 subjects (56.4 ± 9.2 years, 57.6% males) underwent whole-body MRI including a coronal T1-DIXON-VIBE sequence in inspiration breath-hold, originally acquired for fat quantification. Based on MRI, lung volumes were derived using an automated framework and related to common predictors, pulmonary function tests (PFT; spirometry and pulmonary gas exchange, n = 214) and obstructive lung disease. RESULTS: MRI-based lung volume was 4.0 ± 1.1 L, which was 64.8 ± 14.9% of predicted total lung capacity (TLC) and 124.4 ± 27.9% of functional residual capacity. In multivariate analysis, it was positively associated with age, male, current smoking and height. Among PFT indices, MRI-based lung volume correlated best with TLC, alveolar volume and residual volume (RV; r = 0.57 each), while it was negatively correlated to FEV1/FVC (r = 0.36) and transfer factor for carbon monoxide (r = 0.16). Combining the strongest PFT parameters, RV and FEV1/FVC remained independently and incrementally associated with MRI-based lung volume (ß = 0.50, p = 0.04 and ß = - 0.02, p = 0.02, respectively) explaining 32% of the variability. For the identification of subjects with obstructive lung disease, height-indexed MRI-based lung volume yielded an AUC of 0.673-0.654. CONCLUSION: Lung volume derived from non-dedicated whole-body MRI is independently associated with RV and FEV1/FVC. Furthermore, its moderate accuracy for obstructive lung disease indicates that it may be a promising tool to assess pulmonary health in whole-body imaging when PFT is not available. KEY POINTS: • Although whole-body MRI often does not include dedicated lung sequences, lung volume can be automatically derived using dedicated segmentation algorithms • Lung volume derived from whole-body MRI correlates with typical predictors and risk factors of respiratory function including smoking and represents about 65% of total lung capacity and 125% of the functional residual capacity • Lung volume derived from whole-body MRI is independently associated with residual volume and the ratio of forced expiratory volume in 1 s to forced vital capacity and may allow detection of obstructive lung disease.


Assuntos
Medidas de Volume Pulmonar , Imagem por Ressonância Magnética , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Idoso , Algoritmos , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado , Humanos , Processamento de Imagem Assistida por Computador , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Volume Residual , Fumar/efeitos adversos , Fumar/fisiopatologia , Espirometria , Capacidade Pulmonar Total , Capacidade Vital
18.
Am J Physiol Heart Circ Physiol ; 316(2): H335-H344, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30388023

RESUMO

Many adults with single-ventricle congenital heart disease who have undergone a Fontan procedure have abnormal pulmonary function resembling restrictive lung disease. Whether this contributes to ventilatory limitations and increased dyspnea has not been comprehensively studied. We recruited 17 Fontan participants and 17 healthy age- and sex-matched sedentary controls. All participants underwent complete pulmonary function testing followed by a symptom-limited incremental cardiopulmonary cycle exercise test with detailed assessments of dyspnea and operating lung volumes. Fontan participants and controls were well matched for age, sex, body mass index, height, and self-reported physical activity levels (all P > 0.05), although Fontan participants had markedly reduced cardiorespiratory fitness and peak work rates ( P < 0.001). Fontan participants had lower values for most pulmonary function measurements relative to controls with 65% of Fontan participants showing evidence of a restrictive ventilatory defect. Relative to controls, Fontan participants had significantly higher breathing frequency, end-inspiratory lung volume (% total lung capacity), ventilatory inefficiency (high ventilatory equivalent for CO2), and dyspnea intensity ratings at standardized absolute submaximal work rates. There were no between-group differences in qualitative descriptors of dyspnea. The restrictive ventilatory defect in Fontan participants likely contributes to their increased breathing frequency and end-inspiratory lung volume during exercise. This abnormal ventilatory response coupled with greater ventilatory inefficiency may explain the increased dyspnea intensity ratings in those with a Fontan circulation. Interventions that enhance the ventilatory response to exercise in Fontan patients may help optimize exercise rehabilitation interventions, resulting in improved exercise tolerance and exertional symptoms. NEW & NOTEWORTHY This is the first study to comprehensively characterize both ventilatory and sensory responses to exercise in adults that have undergone the Fontan procedure. The majority of Fontan participants had a restrictive ventilatory defect. Compared with well-matched controls, Fontan participants had increased breathing frequency, end-inspiratory lung volume, and ventilatory inefficiency. These abnormal ventilatory responses likely form the mechanistic basis for the increased dyspnea intensity ratings observed in our Fontan participants during exercise.


Assuntos
Exercício , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Ventilação Pulmonar , Respiração , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Troca Gasosa Pulmonar , Capacidade Pulmonar Total
19.
Int J Chron Obstruct Pulmon Dis ; 13: 3689-3698, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30510411

RESUMO

Background: Alpha-1-antitrypsin (AAT) deficiency is a hereditary disorder that predisposes to emphysema. A cohort of severe (PiZZ) and moderate (PiSZ) AAT-deficient newborn infants was identified by the Swedish national neonatal AAT screening program in 1972-1974 and has been followed-up since birth. Our aim was to study whether the cohort has signs of emphysema in pulmonary function tests (PFTs) and computed tomography (CT) densitometry at 38 years of age in comparison with an age-matched control group, randomly selected from the population registry. Methods: Forty-one PiZZ, 18 PiSZ, and 61 control subjects (PiMM) underwent complete PFTs, measurement of resistance and reactance in the respiratory system by impulse oscillometry (IOS)/forced oscillation technique (FOT), and CT densitometry. The results were related to self-reported smoking habits. Results: The total lung capacity (TLC) % of the predicted value was significantly higher in the PiZZ ever-smokers than in the PiZZ never-smokers (P<0.05), PiSZ never-smokers (P=0.01) and the PiMM never-smokers (P=0.01). The residual volume (RV) % of the predicted value was significantly higher in the PiZZ ever-smokers compared to the PiMM never-smokers (P<0.01). The PiZZ ever-smokers had a significantly lower carbon monoxide transfer coefficient (Kco) than the PiSZ never-smokers (P<0.01) and PiMM never-smokers (P<0.01). Respiratory system resistance at 5 Hz (P<0.01), at 20 Hz (P<0.01), and the area of low reactance (Alx; P<0.05) were significantly lower and respiratory system reactance at 5 Hz (P<0.05) was significantly higher in PiZZ subjects compared to the PiMM subjects. No statistically significant differences in the CT densitometry parameters were found between the Pi subgroups. Conclusion: The physiological parameters in the PiZZ ever-smokers showed evidence of hyperinflation and emphysema before the age of 40 years.


Assuntos
Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Testes de Função Respiratória , Tomografia Computadorizada por Raios X , Deficiência de alfa 1-Antitripsina/diagnóstico por imagem , Deficiência de alfa 1-Antitripsina/fisiopatologia , Adulto , Fatores Etários , Estudos de Casos e Controles , Densitometria , Progressão da Doença , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Enfisema Pulmonar/genética , Sistema de Registros , Volume Residual , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/fisiopatologia , Suécia , Capacidade Pulmonar Total , Deficiência de alfa 1-Antitripsina/genética
20.
Arch. bronconeumol. (Ed. impr.) ; 54(12): 607-613, dic. 2018. graf, tab
Artigo em Inglês | IBECS | ID: ibc-174926

RESUMO

Introduction: Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm delivery, and is associated with reduced exercise tolerance and exercise capacity. The aim of this study was to assess the effects of a physical activity programme on exercise tolerance, exercise capacity, flexibility, and lung function in prematurely born children with BPD. Methods: This was a randomized controlled trial. Preterm children with BPD (4-6 years) were randomized to intervention (IG) and control (CG) groups. The CG did not participate in any physical activity during the study period. The IG performed a 4-week exercise programme based on aerobic interval and resistance training. Outcomes were based on the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT), modified sit and reach test (MSRT) and spirometry results. Results: Twenty individuals were recruited. In the IG (n = 10), statistical and clinical improvement was observed in the 6MWT (316.3 ± 31.4 m vs 376.2 ± 39.5m; P = .002). Significant improvements were also seen in the IG in the ISWT (248.0 ± 45. 2m vs 465.3 ± 58.2 m; P=.013), MSRT (14.5 ± 7.7 cm vs 22.8 ± 6.9 cm; P = .003), and FEV1 (102% ± 16% pred vs 104% ± 17% pred; P = .004). No significant differences between pre- and post-intervention were observed in the CG for all outcomes (n = 10). Conclusion: This 4-week programme resulted in statistical and clinical improvements in exercise tolerance, exercise capacity and flexibility in preterm children with BPD


Introducción: La displasia broncopulmonar (DBP) es una secuela frecuente entre los prematuros extremos, asociándose a una reducción en la tolerancia y en la capacidad al ejercicio. El objetivo de este estudio es evaluar los efectos de un programa de entrenamiento basado en la tolerancia y en la capacidad al ejercicio, la flexibilidad y la función pulmonar en niños prematuros con DBP. Métodos: El ensayo clínico se hizo con niños prematuros con DBP (de 4 a 6 años), aleatorizados en 2 grupos, control (GC) e intervención (GI). El GC no participó en ninguna actividad física durante el estudio. El GI realizó un programa interválico y de resistencia de 4 semanas. Se evaluó el Six Minute Walking test (6MWT), el Incremental Shuttle Walk test (ISWT), el Modified Sit and Reach test (MSRT) y la espirometría. Resultados: Se reclutaron 20 niños. No se observaron diferencias significativas entre la pre- y la postintervención en el GC (n = 10). En el 6MWT se observó una mejoría significativa y clínica (316,3 ± 31,4 m vs. 376,2 ± 39,5 m; p=0,002) al final de la intervención en el GI (n = 10). El ISWT (248,0 ± 45,2 m vs. 465,3 ± 58,2 m; p = 0,013), el MSRT (14,5 ± 7,7 cm vs. 22,8 ± 6,9 cm; p=0,003) y la FEV1 (102 ± 16% pred vs. 104 ± 17% pred; p = 0,004) también mejoraron significativamente en el GI. Conclusiones: Este programa de 4 semanas, mejora estadísticamente y clínicamente la tolerancia y la capacidad al ejercicio, y la flexibilidad en niños prematuros con DBP


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Terapia por Exercício , Displasia Broncopulmonar/reabilitação , Capacidade Pulmonar Total , Tolerância ao Exercício/fisiologia , Estudos de Casos e Controles , Resultado do Tratamento , Testes de Função Respiratória , Espirometria
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