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1.
BMC Public Health ; 20(1): 6, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906909

RESUMO

BACKGROUND: Although previous studies have reported the benefits of physical activity (PA) to lung function in middle-aged and older adults, the biological mechanisms are still unclear. This study aimed to assess the extent to which C-reactive protein (CRP) mediates the association between leisure-time PA and lung function. METHODS: A population-based sample was recruited from English Longitudinal Study of Ageing (ELSA), Wave 6 (2012-2013). PA was self-reported by questionnaires. CRP was analyzed from peripheral blood. Lung function parameters including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by using a spirometer. Baron and Kenny's causal steps method and multiple linear regression models based on the Karlson/Holm/Bree (KHB) method were used to assess the mediating effect. RESULTS: Among 6875 participants, 28.4% were classified into low PA, 49.8% into moderate PA, and 21.8% into high PA. Multiple linear regression models suggested that higher PA was associated with lower levels of CRP (ß = - 0.048, P = 0.002 for moderate PA; ß = - 0.108, P < 0.001 for high PA). CRP negatively correlated with FEV1 (ß = - 0.180, P < 0.001) and FVC (ß = - 0.181, P < 0.001). Higher levels of PA were associated with better FEV1 (ß = 0.085, P < 0.001 for moderate PA; ß = 0.150, P < 0.001 for high PA) and FVC (ß = 0.131, P < 0.001 for moderate PA; ß = 0.211, P < 0.001 for high PA). After introducing the CRP into the models, regression coefficients of PA with FEV1 (ß = 0.077, P < 0.001 for moderated PA; ß = 0.130, P < 0.001 for high PA) and FVC (ß = 0.123, P < 0.001 for moderated PA; ß = 0.188, P < 0.001 for high PA) decreased. The indirect effect of high PA on lung function via CRP was significant, with 9.42-12.99% of the total effect being mediated. CONCLUSIONS: The association between PA and lung function is mediated by CRP, suggesting that this association may be partially explained by an inflammation-related biological mechanism. This finding highlights the possible importance of PA in systemic inflammation and lung function, thus, middle-aged and older adults should be encouraged to enhance PA levels.


Assuntos
Proteína C-Reativa/análise , Exercício/fisiologia , Volume Expiratório Forçado/fisiologia , Atividades de Lazer , Capacidade Vital/fisiologia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Autorrelato
2.
J Surg Res ; 245: 168-178, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421359

RESUMO

BACKGROUND: Esophagectomy for esophageal cancer is known to lead to deterioration in respiratory function (RF). The aim of this study was to assess long-term trends in RF after esophagectomy and the impact of different operative procedures. METHODS: A total of 52 patients with thoracic esophageal cancer who were scheduled for esophagectomy from 2003 to 2012 were enrolled. We prospectively evaluated patients for vital capacity (VC), forced expiratory volume in 1 s (FEV1.0), and 6-min walk distance (6MWD) before and after esophagectomy at 3, 6, 12, 24, and 60 mo. RESULTS: Patients had mostly recovered their VC and FEV1.0 after 12 mo. After that point, VC and FEV1.0 declined again, reaching levels lower than baseline at 60 mo, with a median change ratio of 0.85 and 0.86, respectively. Although the 6MWD after open esophagectomy declined, patients treated with transhiatal esophagectomy and minimally invasive esophagectomy maintained above baseline levels throughout the follow-up period. Furthermore, we identified transhiatal esophagectomy (odds ratio [OR] = 0.03, 95% confidence interval [CI] 0.002-0.43, P = 0.01) and minimally invasive esophagectomy (OR = 0.14, 95% CI 0.02-0.94, P = 0.04) as favorable factors and postoperative pulmonary complication (OR = 9.14, 95% CI 1.22-68.6, P = 0.03) as an unfavorable factor for RF after 12 mo. Operative procedures had no significant impact on RF after 60 mo. CONCLUSIONS: Our results support the notion that RF does not recover to the baseline level, and operative procedures have no significant impact on RF at late phase after esophagectomy.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Volume Expiratório Forçado/fisiologia , Complicações Pós-Operatórias/diagnóstico , Capacidade Vital/fisiologia , Idoso , Esofagectomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
3.
J Bras Pneumol ; 45(6): e20180355, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851214

RESUMO

OBJECTIVE: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. METHODS: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. RESULTS: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting ß2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. CONCLUSIONS: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.


Assuntos
Broncodilatadores/economia , Broncodilatadores/provisão & distribução , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brometo de Tiotrópio/provisão & distribução , Idoso , Brasil , Custos de Medicamentos/estatística & dados numéricos , Feminino , Volume Expiratório Forçado , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Tempo , Capacidade Vital/fisiologia
4.
J Bras Pneumol ; 45(6): e20180252, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31644702

RESUMO

OBJECTIVE: To establish a cut-off point for clinical and functional variables to determinate sarcopenia and dynapenia in COPD patients, and to analyze the impact of skeletal muscle dysfunction (SMD) on these variables. METHODS: Cross-sectional study, screened COPD patients for sarcopenia or dynapenia through low muscle mass and hand grip strength (HGS). Clinical variables: pulmonary function, respiratory muscle strength and functional capacity (FC). The precision of the variables in determining points of predictive cut-off for sarcopenia or dynapenia were performed using the Receiver Operating Characteristic curve and two-way analysis of variance. RESULTS: 20 COPD patients stratified for sarcopenia (n = 11) and dynapenia (n = 07). Sarcopenia group presented lower lean mass and lower maximal inspiratory pressure (MIP), decreased HGS, reduced FC (p<0.050). Dynapenia group presented reduced MIP, lower HGS and walked a shorter distance at Incremental shuttle walk test (ISWT) (p<0.050). We found cut-off points of forced expiratory volume in one second (FEV1), MIP and maximal expiratory pressure (MEP) and ISWT. It is possible to identify sarcopenia or dynapenia in these patients. We found the coexistence of the conditions (SMD effect) in COPD - reduction in the distance in the ISWT (p = 0.002) and %ISWT (p = 0.017). CONCLUSION: In moderate to very severe COPD patients the sarcopenia could be predicted by FEV1 (%predicted) < 52, MIP < 73 cmH2O, MEP < 126 cmH2O and distance traveled of < 295 m in ISWT. Whereas dynapenia could be predicted by FEV1 < 40%, MIP < 71 cmH2O, MEP < 110 cmH2O and distance of < 230 m traveled in ISWT.


Assuntos
Pulmão/fisiopatologia , Debilidade Muscular/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Sarcopenia/fisiopatologia , Idoso , Análise de Variância , Estudos Transversais , Feminino , Volume Expiratório Forçado/fisiologia , Força da Mão/fisiologia , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Força Muscular/fisiologia , Curva ROC , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Capacidade Vital/fisiologia , Teste de Caminhada
5.
J Bras Pneumol ; 45(6): e20180132, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618297

RESUMO

OBJECTIVE: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. METHODS: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. RESULTS: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). CONCLUSIONS: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/reabilitação , Terapia por Exercício/métodos , Neoplasias Pulmonares/reabilitação , Doença Pulmonar Obstrutiva Crônica/reabilitação , Idoso , Dióxido de Carbono/metabolismo , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Teste de Esforço , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Valores de Referência , Estudos Retrospectivos , Espirometria , Fatores de Tempo , Resultado do Tratamento , Capacidade Vital/fisiologia
6.
J Orthop Surg Res ; 14(1): 250, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387629

RESUMO

PURPOSES: Hip fracture leads to decreased activity and an increased risk of pulmonary complications. The main purpose of this study was to observe the lung capacity, cough capacity of the elderly patient with acute hip fracture, and assess the effects and the feasibility of using a special-designed "upper-body yoga" training to treat elderly patients with hip fracture. METHODS: This was a prospective, randomized, and single-blind study. Eighty-four subjects aged over 65 years were randomly divided into either a control group or a yoga group to undergo an abdominal breathing program or an "upper-body yoga" program until 4 weeks after surgery. The primary outcomes were forced vital capacity/predicted value (FVC%), peak cough flow (PCF), Barthel Index (BI), and the incidence of pneumonia. The secondary outcomes were the rates of right skills and inclination. RESULTS: Thirty-nine subjects in the yoga group and 40 subjects in the control group completed this study. At the end of the first training week, FVC% (74.14% ± 13.11% vs. 70.87% ± 10.46%, P = 0.231) showed no significant difference between the two groups, while the value of PCF (204.80 ± 33.45 L/min vs. 189.06 ± 34.80 L/min, P = 0.048) and BI (38.59 ± 8.66 vs. 33.00 ± 9.32, P = 0.009) in the yoga group was higher. After 4 weeks of treatment, FVC%, PCF, and BI were higher in the yoga group (78.83% ± 13.31 % vs. 72.20% ± 10.53%, P = 0.016; 216.16 ± 39.29 L/min vs. 194.95 ± 31.14 L/min, P = 0.008; 70.77 ± 10.23 vs. 65.75 ± 11.30, P = 0.019). One in the control group and nobody in the yoga group was diagnosed with pneumonia. There was no significant difference between the two groups in terms of the rates of right skills, whereas more elderly people preferred the training program of the "upper-body yoga." CONCLUSION: Elderly patients with acute hip fractures are at risk of impaired lung capacity and inadequate cough. "Upper-body yoga" training may improve the quality of daily life, vital capacity, and cough flow in elderly patients, making it a better choice for bedridden patients with hip fracture.


Assuntos
Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/terapia , Capacidade Vital/fisiologia , Ioga , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Método Simples-Cego , Extremidade Superior/fisiologia
7.
J Bras Pneumol ; 45(4): e20180232, 2019 Jul 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31365683

RESUMO

OBJECTIVE: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. METHODS: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. RESULTS: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). CONCLUSIONS: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.


Assuntos
Pulmão/fisiopatologia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/fisiopatologia , Espirometria/normas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Disfunção Cognitiva , Comorbidade , Estudos Transversais , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Reprodutibilidade dos Testes , Doenças Respiratórias/psicologia , Estudos Retrospectivos , Fatores Sexuais , Espirometria/métodos , Espirometria/psicologia , Capacidade Vital/fisiologia
8.
Braz J Med Biol Res ; 52(8): e8513, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365695

RESUMO

Phenotypic differences have been described between patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD) and SSc-associated pulmonary hypertension, including performance differences in the 6-min walk test (6MWT). Moreover, the correlations between the 6MWT and traditional pulmonary function tests (PFTs) are weak, indicating the need to search for new parameters that explain exercise performance. Thus, our objective was to evaluate the impact of ventilation distribution heterogeneity assessed by the nitrogen single-breath washout (N2SBW) test and peripheral muscle dysfunction on the exercise capacity in patients with SSc-ILD and limited involvement of the pulmonary parenchyma. In this cross-sectional study, 20 women with SSc-ILD and 20 matched controls underwent PFTs (including spirometry, diffusing capacity for carbon monoxide (DLco), and the N2SBW test) and performed the 6MWT and knee isometric dynamometry. The 6-min walking distance (6MWD, % predicted) was strongly correlated with the phase III slope of the single-breath nitrogen washout (phase III slopeN2SBW) (r=-0.753, P<0.0001) and reasonably correlated with the forced vital capacity (FVC) (r=0.466, P=0.008) and DLco (r=0.398, P=0.011). The peripheral oxygen saturation (SpO2) during exercise was not significantly correlated with any of the pulmonary or muscle function parameters. The phase III slopeN2SBW was the only predictive variable for the 6MWD, whereas quadriceps strength and FVC/DLco were predictive variables for SpO2. Ventilation distribution heterogeneity is one factor that contributes to a lower 6MWD in SSc-ILD patients. In addition, muscle dysfunction and abnormal lung diffusion at least partly explain the decreased SpO2 of these patients.


Assuntos
Tolerância ao Exercício/fisiologia , Hipertensão Pulmonar/fisiopatologia , Doenças Pulmonares Intersticiais/fisiopatologia , Pulmão/fisiologia , Testes de Função Respiratória/métodos , Escleroderma Sistêmico/complicações , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/etiologia , Medidas de Volume Pulmonar/métodos , Pessoa de Meia-Idade , Ventilação Pulmonar , Doença de Raynaud/complicações , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia , Teste de Caminhada/métodos
9.
Braz J Med Biol Res ; 52(8): e8671, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389492

RESUMO

Myelomeningocele (MMC) is a neural tube defect that often causes spinal cord injury at the thoracolumbar region, as well as sensory and motor paralysis in the lower limbs. This leads to continuous use of a wheelchair and, consequently, a sedentary lifestyle, predisposition to muscle weakness, cardiovascular and respiratory disorders, obesity, and structural alterations in the spine. We assessed the respiratory function and shoulder strength of MMC participants who were wheelchair-users and had no respiratory complaints and compared them to healthy children and adolescents. MMC (n=10) and healthy (n=25) participants of both genders with a mean age of 12.45 years (SD=2.1) were assessed for weight, height, respiratory performance, and isometric peak for shoulder flexors, extensors, abductors, and adductors, using an isokinetic dynamometer. Medullary lesion, functional levels, and abnormal curvatures of the spine were assessed for MMC participants. The level of spinal cord injury for the majority of the MMC participants was high lumbar and they had scoliosis. MMC showed lower values for forced vital capacity, forced expiratory volume at the first second, forced expiratory flow (25-75%), maximal voluntary ventilation, and isometric peak for shoulder flexors and adductors compared to healthy participants. This indicated a decreased vital capacity, respiratory muscle endurance, and shoulder muscle strength.


Assuntos
Volume Expiratório Forçado/fisiologia , Meningomielocele/fisiopatologia , Músculos Respiratórios/fisiopatologia , Capacidade Vital/fisiologia , Cadeiras de Rodas , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Dados Preliminares , Testes de Função Respiratória
10.
J Bras Pneumol ; 45(6): e20170157, 2019 Jul 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31365731

RESUMO

OBJECTIVE: To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). METHODS: This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. RESULTS: Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = -1.7 ± 8.1 and ΔBMI = -0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = -0.5 ± 5.4 and ΔBMI = -0.8 ± 3.3). CONCLUSIONS: Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.


Assuntos
Antropometria , Peso Corporal/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Adulto , Idoso , Análise de Variância , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Valores de Referência , Fatores de Risco , Índice de Gravidade de Doença , Espirometria , Fatores de Tempo , Capacidade Vital/fisiologia
11.
Respir Res ; 20(1): 135, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266489

RESUMO

BACKGROUND: Smoking is a major risk factor for COPD and may impact the efficacy of COPD treatments; however, a large proportion of COPD patients continue to smoke following diagnosis. METHODS: This post-hoc analysis of pooled data from the replicate 12-week, placebo-controlled GEM1 and GEM2 studies assessed the impact of smoking status on the efficacy and safety of glycopyrrolate 15.6 µg twice daily vs placebo in patients with moderate-to-severe COPD. Data from 867 patients enrolled in GEM1 and GEM2 were pooled for analysis and grouped by smoking status (57% current smokers, 43% ex-smokers). Forced expiratory volume in 1 s (FEV1) area under the curve from 0 to 12 h, trough FEV1, forced vital capacity, St George's Respiratory Questionnaire (SGRQ) total score, COPD assessment test (CAT) score, transition dyspnea index (TDI) focal score, daily symptom scores, and rescue medication use were assessed in current smokers and ex-smokers. Incidences of adverse events (AEs) and serious AEs (SAEs) were also assessed. RESULTS: Treatment with glycopyrrolate resulted in significant improvements in all lung function measures, independent of smoking status. In both current and ex-smokers, changes from baseline in trough FEV1 were less marked in patients taking inhaled corticosteroids (ICS) than those not receiving ICS. Changes from baseline in SGRQ total score and rescue medication use were significantly greater with glycopyrrolate compared with placebo, regardless of smoking status. Changes in the CAT score, TDI focal score, and daily symptom scores significantly improved versus placebo, but only in current smokers. Improvements in patient-reported outcomes (PROs) with glycopyrrolate relative to placebo were numerically greater in current smokers than ex-smokers. The incidences of AEs and SAEs were similar regardless of smoking status. CONCLUSIONS: In this post-hoc analysis of GEM1 and GEM2, glycopyrrolate use led to significant improvements in lung function, independent of baseline smoking status; improvements were less marked among patients receiving background ICS, regardless of baseline smoking status. Improvements in PROs were greater with glycopyrrolate than placebo, and the magnitude of changes was numerically greater among current smokers. The safety profile of glycopyrrolate was comparable between current smokers and ex-smokers.


Assuntos
Broncodilatadores/administração & dosagem , Glicopirrolato/administração & dosagem , Pulmão/efeitos dos fármacos , Medidas de Resultados Relatados pelo Paciente , Fumar Tabaco/tratamento farmacológico , Capacidade Vital/efeitos dos fármacos , Administração por Inalação , Idoso , Método Duplo-Cego , Feminino , Humanos , Pulmão/fisiologia , Masculino , Pessoa de Meia-Idade , Fumar Tabaco/fisiopatologia , Resultado do Tratamento , Capacidade Vital/fisiologia
12.
Br J Surg ; 106(10): 1341-1351, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31282584

RESUMO

BACKGROUND: It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer. METHODS: Consecutive patients treated between 2010 and 2016 were included. Three-dimensional conformal radiation was standard, with a lung dose-volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41·4 Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were assessed at baseline and 1 month after nCRT. Radiation-induced lung injury (grade 2 or greater), comprehensive complications index (CCI) and pulmonary complications were monitored prospectively. Health-related quality of life was assessed among disease-free patients in survivorship. RESULTS: Some 228 patients were studied. Comparing pulmonary physiology values before with those after nCRT, FEV1 decreased from mean(s.d.) 96·8(17·7) to 91·5(20·4) per cent (-3·6(10·6) per cent; P < 0·001), FVC from 104·9(15·6) to 98·1(19·8) per cent (-3·2(11·9) per cent; P = 0·005) and DLCO from 97·6(20·7) to 82·2(20·4) per cent (-14·8(14·0) per cent; P < 0·001). Five patients (2·2 per cent) developed radiation-induced lung injury precluding surgical resection. Smoking (P = 0·005) and increased age (P < 0·001) independently predicted percentage change in DLCO. Carboplatin and paclitaxel with 41·4 Gy resulted in a greater DLCO decline than cisplatin and 5-fluorouracil with 40 Gy (P = 0·001). On multivariable analysis, post-treatment DLCO predicted CCI (P = 0·006), respiratory failure (P = 0·020) and reduced physical function in survivorship (P = 0·047). CONCLUSION: These data indicate that modern nCRT alters pulmonary physiology, in particular diffusion capacity, which is linked to short- and longer-term clinical consequences, highlighting a potentially modifiable index of risk.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia Adjuvante/métodos , Neoplasias Esofágicas/terapia , Qualidade de Vida , Transtornos Respiratórios/etiologia , Monóxido de Carbono/análise , Carboplatina/administração & dosagem , Esofagectomia/métodos , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Paclitaxel/administração & dosagem , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Capacidade Vital/fisiologia
13.
Turk J Med Sci ; 49(4): 1008-1013, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31269786

RESUMO

Background/aim: The aim of this study was to compare the effect of salbutamol delivered to children by jet nebulizer (JN) and mesh nebulizer (MN). Materials and methods: Children admitted with acute asthma were treated with 3 doses of nebulized salbutamol, 1 given by MN. The patients' vital signs, lung function measurements, modified pulmonary index score (MPIS), and whole body plethysmography (WBP) measurements were evaluated before and 20 min after each dose of salbutamol. Results: Thirty-onechildren [9.5 (6.4­17.2) years, 67.7% male, 32.3% female] with mild (67.7%) and moderate (32.3%) asthma attacks were included in the study. The improvements with MN were comparable with JN in terms of changes in pretreatment and posttreatment forced expiratory volume in the first second (FEV1) (2.57 ± 4.57, 3.65 ± 5.44; P = 0.44), forced vital capacity (FVC) (2.52 ± 5.29, 4.17 ± 7.54; P = 0.28), heart rate (7.33 ± 10.21, 4.14 ± 9.32; P = 0.24), peripheral capillary oxygen saturation (SpO2) (0.38 ± 0.23, 0.43 ± 0.15; P = 0.83), and modified pulmonary index score (MPIS) (−6.30 ± 22.70, −8.77 ± 25.46; P = 0.70). The pre- and posttreatment values of total lung capacity (TLC), residual volume (RV), specific conductance (sGaw), and RV/TLC were similar for the JN and MN groups. Adverse effects were not different: however, complaints of palpitation were significantly higher in the posttreatment MN group than the pretreatment MN group (32.3% vs 9.7%, respectively, P = 0.016). Conclusion: These findings support the previous evidence found in studies of adults that MN is as effective as and as safe as JN in the treatment of acute asthma in children


Assuntos
Asma/terapia , Broncodilatadores/administração & dosagem , Nebulizadores e Vaporizadores , Administração por Inalação , Adolescente , Albuterol/administração & dosagem , Albuterol/uso terapêutico , Asma/diagnóstico , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Criança , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pletismografia Total , Espirometria , Capacidade Vital/fisiologia
14.
J Bone Joint Surg Am ; 101(12): 1109-1118, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31220028

RESUMO

BACKGROUND: Patients with congenital scoliosis often have restrictive pulmonary dysfunction on static pulmonary function testing (PFT). Although frequently asymptomatic during daily activities, these patients are generally assumed to have reduced exercise capacity. The aim of this study was to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity and its association with spinal deformity in patients with congenital scoliosis. METHODS: Sixty patients with congenital scoliosis who underwent preoperative spinal radiography, PFT, and CPET were included from January 2014 to November 2017. The impact of thoracic spinal deformity and rib anomalies on pulmonary function and physical capacity was investigated. RESULTS: A significant deterioration in pulmonary function with increases in the severity of the major thoracic curve was demonstrated by the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (all p < 0.001). The ratio of FEV1 to FVC was similar regardless of thoracic curve severity. A smaller tidal volume during exercise testing reflected restrictive dysfunction in the patients with the most severe curves. CPET also revealed a significant trend of faster breathing by patients with a severe thoracic curve (p < 0.001). Exercise capacity indicators such as work rate (p = 0.019), heart rate (p = 0.015), and oxygen saturation (p = 0.006) were significantly reduced only in patients with a thoracic curve of >100°. Pulmonary dysfunction was the major contributor to exercise intolerance. Compared with mild pulmonary dysfunction, moderate and severe dysfunction was associated with an abnormal breathing pattern and lower work rate (p = 0.032) and peak oxygen intake (p = 0.042), indicating worse exercise tolerance. CONCLUSIONS: Congenital scoliosis leads to restrictive pulmonary dysfunction, which reduces the tidal volume and forces patients to accelerate respiratory rates during exercise. Patients with a thoracic curve of >100° are unable to compensate and have significantly reduced exercise capacity. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Tolerância ao Exercício/fisiologia , Pulmão/fisiologia , Escoliose/fisiopatologia , Adolescente , Adulto , Criança , Teste de Esforço , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Capacidade Vital/fisiologia , Adulto Jovem
15.
J Physiol Anthropol ; 38(1): 7, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234934

RESUMO

AIMS: To study the associations between fat distribution and lung functions in healthy subjects of young adults and to explore potential gender difference in these correlations. METHODS: A total of 2101 adult participants were recruited. Height, weight, and vital capacity index (VCI) were measured and recorded according to the national physical fitness test standard. Body compositions, including body mass index (BMI), body fat percentage (BFP), waist-to-hip ratio (WHR), fat-free mass (FFM), trunk muscle mass (TMM), fat mass (FM), visceral fat area (VFA), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT), were conducted using body composition analyzer. Data were analyzed by SPSS 20.0 software. RESULTS: We found that male participants showed significantly higher BMI, WHR, FFM, TMM, VFA, and VCI, but lower FM, BFP, and SAT in comparison with women. However, there was no significant difference in VAT between the male and female. Lung functions represented by VCI were negatively correlated with FM, VAT, SAT, and VFA for both men and women (r < 0; P < 0.05). Among these negative correlations, VCI was more inversely correlated with VFA for men but with SAT for women, respectively. After dividing the whole populations by BMI, BFP, and WHR, further correlation analysis showed VCI was still more negatively correlated with VFA for all male subgroups (r < 0; P < 0.05). On the contrary, VCI was more negatively correlated with SAT in BMI-underweight, BMI-normal, BFP-low fat, BFP-normal fat, WHR-normal, and WHR-obese subgroups (r < 0; P < 0.05), while VFA and VAT was more inversely correlated with VCI in BMI- and BFP-overweight+obese subgroups (r < 0; P < 0.05). CONCLUSIONS: Fat accumulation is highly associated with the vital capacity index in young adults. In general, VCI was more negatively correlated with VFA for men but with SAT for women, respectively, in comparison with other tested indices.


Assuntos
Gordura Abdominal/fisiologia , Composição Corporal/fisiologia , Capacidade Vital/fisiologia , Adolescente , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
16.
PLoS One ; 14(6): e0219077, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31247010

RESUMO

The objective was to verify the association between body composition from 18 to 22 years and pulmonary function at 22 years of age. This longitudinal analysis was conducted with a Brazilian birth cohort data. The outcomes were the forced expiratory volume in the first second and forced vital capacity (FVC), measured at 22 years follow-up. Main exposures: obesity (body mass index ≥ 30kg/m2), and highest tertiles of fat mass (FM) and fat mass index (air displacement plethysmography) measured at 18 and 22 years-old follow-ups. The reference category (not exposed) was defined by those individuals who were not classified in the highest adiposity categories mentioned, in both ages. Multivariable linear regressions stratified by sex were used. The sample comprised 3,511 participants. Those who belonged to the highest adiposity categories in 18 and 22 years follow-ups showed lower pulmonary function at 22 years when compared to those who were not classified in the higher adiposity categories in both ages (reference category); those in the highest tertile of FM showed a mean FVC -313mL (95%CI -421; -206) and -259mL (95%CI -336; -182) in men and women, compared to the reference category, respectively. Those who changed from the higher to the lower adiposity categories (from 18 to 22 years) showed pulmonary function similar to the reference, and those who presented the opposite body composition trajectory, showed decreased pulmonary function results at 22 years, mainly among women. We concluded that high body adiposity in two follow-ups and especially contemporary adiposity was associated with lower pulmonary function at 22 years.


Assuntos
Composição Corporal/fisiologia , Volume Expiratório Forçado/fisiologia , Capacidade Vital/fisiologia , Adiposidade/fisiologia , Adolescente , Índice de Massa Corporal , Brasil , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Estudos Longitudinais , Pulmão/fisiopatologia , Masculino , Análise Multivariada , Obesidade/complicações , Obesidade/patologia , Obesidade/fisiopatologia , Pletismografia , Fatores de Risco , Espirometria , Adulto Jovem
17.
Muscle Nerve ; 60(3): 286-291, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31250930

RESUMO

INTRODUCTION: Duchenne muscular dystrophy (DMD) is characterized by absence of the subsarcolemmal protein dystrophin, present in skeletal muscles and cardiomyocytes. We hypothesized that progressive respiratory and left ventricular (LV) insufficiencies in DMD could be parallel and interrelated phenomena. METHODS: We conducted a retrospective chart review of 27 patients with DMD. Our primary objective was to compare the rates of decline between pulmonary function test (PFT) measures (forced expiratory volume in the first second, forced vital capacity, peak expiratory flow rate, maximal inspiratory/expiratory pressure) and echocardiographic estimates of LV end-diastolic volume and LV ejection fraction. RESULTS: The rates of decline/year of PFTs and LV estimates were not significantly different. Pulmonary function test measures of ventilatory efficiency and strength had strong intercorrelations. Pulmonary function tests and LV estimates had weak but statistically significant correlations. DISCUSSION: A comparable rate of decline in PFTs and LV indices in DMD provides evidence for concurrently progressive deterioration in respiratory and LV functions. Muscle Nerve, 2019.


Assuntos
Volume Expiratório Forçado/fisiologia , Distrofia Muscular de Duchenne/fisiopatologia , Função Ventricular Esquerda/fisiologia , Capacidade Vital/fisiologia , Adolescente , Adulto , Criança , Ecocardiografia/métodos , Humanos , Masculino , Testes de Função Respiratória , Adulto Jovem
18.
J Neurol ; 266(9): 2312-2321, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187190

RESUMO

BACKGROUND: Late-onset Pompe disease (LOPD) is a rare, metabolic disease primarily affecting the musculoskeletal and respiratory systems. Forced vital capacity (FVC) is commonly used to measure pulmonary function; however, associations between FVC and other LOPD outcomes remain unclear. METHODS: A systematic literature review was conducted on November 2015, updated September 2016 and supplemented with clinical trial data from the sponsor. Outcomes included: 6-min walk test distance (6MWT), FVC, maximal inspiratory/expiratory pressure (MIP/MEP), Medical Research Council-skeletal muscle strength score (MRC), 36-item short-form survey-physical component score (SF-36), Rotterdam Handicap Scale (RHS), Fatigue Severity Scale (FSS) and survival. Individual patient data meta-analysis was used for cross-sectional analyses and longitudinal analyses to determine associations between percent of predicted FVC and LOPD measures and outcomes. RESULTS: Fifteen studies were selected. From cross-sectional analyses, FVC and MRC were most strongly associated. Specifically, patients with 10% higher FVC (a round number for illustrative purposes only) were associated with a 4.72% (95% confidence interval [CI]: 3.37, 6.07) higher MRC score, indicating a positive association. Similarly, slopes for the 6MWT and SF-36 relative to a 10% higher FVC were estimated at 33.2 meters (95% CI 24.0, 42.4) and 1.2% (95% CI 0.24, 2.16%), respectively. From longitudinal analyses, a 10% incremental increase in predicted FVC was associated with an average increase of 4.12% in MRC score (95% CI 1.29, 6.95), 35.6 m in the 6MWT (95% CI 19.9, 51.6), and 1.34% in SF-36 (95% CI 0.08, 2.60). There was insufficient data to conduct analyses for RHS, FSS and survival. CONCLUSIONS: FVC is positively associated with LOPD measures and outcomes across multiple domains. Additionally, longitudinal changes in FVC are positively associated with changes in the 6MWT, MRC and SF-36.


Assuntos
Doença de Depósito de Glicogênio Tipo II/diagnóstico , Doença de Depósito de Glicogênio Tipo II/fisiopatologia , Capacidade Vital/fisiologia , Idade de Início , Estudos Transversais , Doença de Depósito de Glicogênio Tipo II/epidemiologia , Humanos , Resultado do Tratamento
19.
Environ Int ; 130: 104795, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31200155

RESUMO

Previous studies have suggested increased risk of respiratory diseases and mortality following short-term exposures to ionizing radiation. However, the short-term respiratory effects of low-level environmental radiation associated with air pollution particles have not been considered. Although ambient particulate matter (PM) has been reproducibly linked to decreased lung function and to increased respiratory related morbidity, the properties of PM promoting its toxicity are uncertain. As such, we evaluated whether lung function was associated with exposures to radioactive components of ambient PM, referred to as particle radioactivity (PR). For this, we performed a repeated-measures analysis of 839 men to examine associations between PR exposure and lung function using mixed-effects regression models, adjusting for potential confounders. We examined whether PR-lung function associations changed after adjusting for PM2.5 (particulate matter≤2.5 µm) or black carbon, and vice versa. PR was measured by the USEPA's radiation monitoring network. We found that higher PR exposure was associated with a lower forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). An IQR increase in 28-day PR exposure was associated with a 2.4% lower FVC [95% confidence interval (CI): 1.4, 3.4% p < 0.001] and a 2.4% lower FEV1 (95% CI: 1.3, 3.5%, p < 0.001). The PR-lung function associations were partially attenuated with adjustment for PM2.5 and black carbon. This is the first study to demonstrate associations between PR and lung function, which were independent of and similar in magnitude to those of PM2.5 and black carbon. If confirmed, future research should account for PR exposure in estimating respiratory health effects of ambient particles. Because of widespread exposure to low levels of ionizing radiation, our findings may have important implications for research, and environmental health policies worldwide.


Assuntos
Poluentes Radioativos do Ar/análise , Volume Expiratório Forçado/fisiologia , Exposição por Inalação , Material Particulado/análise , Capacidade Vital/fisiologia , Humanos , Exposição por Inalação/análise , Exposição por Inalação/estatística & dados numéricos , Masculino
20.
Osteoporos Int ; 30(8): 1561-1571, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161317

RESUMO

CT scans performed to evaluate chronic obstructive pulmonary disease (COPD) also enable evaluation of bone attenuation (BA; a measure of bone density) and vertebral fractures (VFs). In 1239 current/former smokers with (n = 999) and without (n = 240) COPD, the combination of BA and prevalent VFs was associated with the incident VF risk. INTRODUCTION: Chest CT scans are increasingly used to evaluate pulmonary diseases, including COPD. COPD patients have increased risk of osteoporosis and VFs. BA on CT scans is correlated with bone mineral density and prevalent VFs. The aim of this study was to evaluate the association between BA and prevalent VFs on chest CT scans, and the risk of incident VFs in current and former smokers with and without COPD. METHODS: In participants of the ECLIPSE study with baseline and 1-year and 3-year follow-up CT scans, we evaluated BA in vertebrae T4-T12 and prevalent and incident VFs. RESULTS: A total of 1239 subjects were included (mean age 61.3 ± 8.0, 61.1% men, 999 (80.6%) COPD patients). The mean BA was 155.6 ± 47.5 Hounsfield Units (HU); 253 (20.5%) had a prevalent VF and 296 (23.9%) sustained an incident VF within 3 years. BA and prevalent VFs were associated with incident VFs within 1 (per - 1SD HR = 1.38 [1.08-1.76] and HR = 3.97 [2.65-5.93] resp.) and 3 years (per - 1SD HR = 1.25 [1.08-1.45] and HR = 3.10 [2.41-3.99] resp.), while age, sex, body mass index (BMI), smoking status and history, or presence of COPD was not. In subjects without prevalent VFs and BA, and for 1-year incidence, BMI values were associated with incident fractures (1 year, BA per - 1SD HR = 1.52 [1.05-2.19], BMI per SD HR = 1.54 [1.13-2.11]; 3 years, per - 1SD HR = 1.37 [1.12-1.68]). CONCLUSIONS: On CT scans performed for pulmonary evaluation in (former) smokers with and without COPD, the combination of BA and prevalent VFs was strongly associated with the short-term risk of incident VFs.


Assuntos
Densidade Óssea/fisiologia , Fraturas por Osteoporose/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Fraturas da Coluna Vertebral/etiologia , Adulto , Idoso , Ex-Fumantes , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Medição de Risco/métodos , Fumar/efeitos adversos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
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