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1.
Respir Res ; 21(1): 163, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600344

RESUMO

OBJECTIVE: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. METHODS: A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. RESULTS: Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. CONCLUSION: Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Músculos Respiratórios/fisiopatologia , Síndrome Respiratória Aguda Grave/diagnóstico , Adulto , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos de Coortes , Convalescença , Teste de Esforço , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Força Muscular , Pandemias , Alta do Paciente , Radiografia Torácica/métodos , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Espirometria/métodos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
2.
Ann Rheum Dis ; 79(9): 1210-1217, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32606043

RESUMO

OBJECTIVE: To prospectively investigate whether differences in pulmonary vasculature exist in systemic sclerosis (SSc) and how they are distributed in patients with different pulmonary function. METHODS: Seventy-four patients with SSc undergoing chest CT scan for interstitial lung disease (ILD) screening or follow-up were prospectively enrolled. A thorough clinical, laboratory and functional evaluation was performed the same day. Chest CT was spirometry gated at total lung capacity and images were analysed by two automated software programs to quantify emphysema, ILD patterns (ground-glass, reticular, honeycombing), and pulmonary vascular volume (PVV). Patients were divided in restricted (FVC% <80, DLco%<80), isolated DLco% reduction (iDLco- FVC%≥80, DLco%<80) and normals (FVC%≥80, DLco%≥80). Spearman ρ, Mann-Whitney tests and logistic regressions were used to assess for correlations, differences among groups and relationships between continuous variables. RESULTS: Absolute and lung volume normalised PVV (PVV/LV) correlated inversely with functional parameters and positively with all ILD patterns (ρ=0.75 with ground glass, ρ=0.68 with reticular). PVV/LV was the only predictor of DLco at multivariate analysis (p=0.007). Meanwhile, the reticular pattern prevailed in peripheral regions and lower lung thirds, PVV/LV prevailed in central regions and middle lung thirds. iDLco group had a significantly higher PVV/LV (2.2%) than normal (1.6%), but lower than restricted ones (3.8%). CONCLUSIONS: Chest CT in SSc detects a progressive increase in PVV/LV as DLco decreases. Redistribution of perfusion to less affected lung regions rather than angiogenesis nearby fibrotic lung may explain the results. Further studies to ascertain whether the increase in PVV/LV reflects a real increase in blood volume are needed.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pulmão/irrigação sanguínea , Escleroderma Sistêmico/diagnóstico por imagem , Espirometria/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Feminino , Humanos , Modelos Logísticos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função Respiratória , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/fisiopatologia , Espirometria/métodos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital
3.
J Bras Pneumol ; 46(3): e20190138, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32236343

RESUMO

OBJECTIVE: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. METHODS: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. RESULTS: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. CONCLUSIONS: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.


Assuntos
Espirometria/normas , Capacidade Vital/fisiologia , Brasil , Criança , Pré-Escolar , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Valor Preditivo dos Testes , Valores de Referência , Espirometria/métodos
4.
Rev. chil. enferm. respir ; 36(1): 13-17, mar. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115457

RESUMO

Las guías ATS/ERS recomiendan utilizar valores de referencia nacionales para la interpretación de la espirometría. En 2014 se publicaron valores de referencia en población general chilena adulta, que difieren de los de Knudson actualmente en uso. Sin embargo, la mayoría de los laboratorios de función pulmonar siguen utilizando estas últimas ecuaciones. En 2012 se publicaron las ecuaciones multi-étnicas de la Global Lung Function Initiative (GLI) a fin de estandarizar mundialmente la interpretación de los exámenes de función pulmonar Nuestro objetivo fue comparar la concordancia de los informes espirométricos utilizando las ecuaciones más usadas en Chile versus las GLI. Métodos: Se comparó la concordancia en interpretación del patrón espirométrico (normal, obstructivo y restrictivo) y el grado de alteración, entre GLI con Gutiérrez 2014, con Knudson, y con NHANES III según las recomendaciones de la Sociedad Chilena de Enfermedades Respiratorias, a través del coeficiente de concordancia Kappa (K). Se estudiaron 315 sujetos mayores de 40 años (55% mujeres, edad: 59,3 ± 9,2 años), fumadores o ex fumadores, sanos o con EPOC, sometidos a una espirometría con broncodilatador como parte de un reconocimiento respiratorio. Se graficaron las diferencias utilizando el método de Bland-Altman. Resultados: La concordancia para patrón entre GLI con Gutiérrez 2014, con Knudson y con NHANES III fue buena (K = 0,73; 0,71 y 0,77 respectivamente), al igual que para patrón y grado de alteración (K = 0,68; 0,67 y 0,76 respectivamente). Conclusiones: Encontramos una buena concordancia entre las ecuaciones más usadas en Chile y las de GLI, en una muestra que incluyó adultos, fumadores, ex fumadores sanos y enfermos.


ATS/ERS recommend the use of national reference values for the interpretation of spirometry. Reference values were published (2014) in general adult Chilean population, which are different from those of Knudson currently in use. However, most pulmonary function laboratories continue to use these latter equations. Multi-ethnic Global Lung Function Initiative (GLI) equations were published (2012) in order to standardize the interpretation of pulmonary function tests worldwide. Our objective was to evaluate the agreement in the spirometric reports between the most used equations in Chile with those from GLI. Methods: We compared the agreement in the interpretation of the spirometric pattern (normal, obstructive and restrictive) and the degree of alteration between GLI with Gutiérrez 2014, with Knudson and with NHANES III according to recommendations of the Chilean Society of Respiratory Diseases, through the Kappa concordance coefficient (K). The sample correspond to 315 adults over 40 years of age (55% women, 59.3 ± 9.2 years-old), smokers or ex-smokers, healthy or with COPD, who underwent spirometry with a bronchodilator as part of a respiratory check-up. Differences were plotted using the Bland-Altman method. Results: agreement for pattern between GLI with Gutiérrez 2014, with Knudson and with NHANES III was good (K = 0.73, 0.71 and 0.77 respectively) and also was good for the pattern and degree of alteration (K = 0.68, 0.67 and 0.76 respectively). Conclusions: We found a good agreement between the equations most used in Chile and those from the GLI, for a sample that includes subjects with and without lung disease, smokers and ex-smokers.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Espirometria/métodos , Espirometria/normas , Pulmão/fisiologia , Modelos Teóricos , Valores de Referência , Testes de Função Respiratória/métodos , Testes de Função Respiratória/normas , Sociedades Médicas , Capacidade Vital/fisiologia , Volume Expiratório Forçado/fisiologia
5.
Am Fam Physician ; 101(6): 362-368, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-32163256

RESUMO

High-quality, office-based spirometry provides diagnostic information as useful and reliable as testing performed in a pulmonary function laboratory. Spirometry may be used to monitor progression of lung disease and response to therapy. A stepwise approach to spirometry allows for ease and reliability of interpretation. Airway obstruction is suspected when there is a decreased forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, but there is no strong evidence to clearly define what constitutes a significant decrease in this ratio. A low FVC is defined as a value below the 5th percentile in adults or less than 80% of predicted in children and adolescents five to 18 years of age. The FEV1/FVC ratio and FVC are used together to identify obstructive defects and restrictive or mixed patterns. Obstructive defects should be assessed for reversibility, as indicated by an improvement of the FEV1 or FVC by at least 12% and 0.2 L in adults, or by more than 12% in children and adolescents five to 18 years of age after the administration of a short-acting bronchodilator. FEV1 is used to determine the severity of obstructive and restrictive disease, although the values were arbitrarily determined and are not based on evidence from patient outcomes. Bronchoprovocation testing may be used if spirometry results are normal and allergen- or exercise-induced asthma is suspected. For patients with an FEV1 less than 70% of predicted, a therapeutic trial of a short-acting bronchodilator may be tried instead of bronchoprovocation testing.


Assuntos
Volume Expiratório Forçado/fisiologia , Pneumopatias/diagnóstico , Pulmão/fisiopatologia , Espirometria/métodos , Humanos , Pneumopatias/fisiopatologia , Reprodutibilidade dos Testes
6.
Fisioterapia (Madr., Ed. impr.) ; 42(1): 24-32, ene.-feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187812

RESUMO

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), se caracteriza por la limitación al flujo aéreo crónica que genera síntomas como disnea, tos y sibilancias. La GOLD 2018 plantea estrategias de tratamiento farmacológico. Sin embargo, la adherencia es baja. Las diferencias entre pacientes adherentes y no adherentes no están claramente establecidas, debido a que podría existir una relación inversa entre la adherencia y las exacerbaciones. Objetivo: Determinar las diferencias entre pacientes adherentes y no adherentes al tratamiento farmacológico propuesto por la GOLD 2018 en variables clínicas, índices CODEX, COTE y BODE. Métodos: Estudio de tipo transversal, se incluyeron 126 pacientes con diagnóstico de EPOC entre enero y septiembre de 2018. Divididos en dos grupos: adherentes (EPOC-A) y no adherentes (EPOC-NA) teniendo en cuenta el tratamiento farmacológico de la GOLD 2018. Resultados: Setenta y nueve pacientes (EPOC-NA) y 50 (EPOC-A), el 61% pertenecían al género masculino y el 39% restante al género femenino. La edad promedio fue de 70,62 ± (8,290), la evaluación de aspectos de la GOLD, la mayoría de los pacientes adherentes pertenecen al grupo D y los no adherentes al grupo B; obteniéndose un valor p=0,004. En cuanto a los días hospitalizados, los pacientes adherentes permanecieron más días hospitalizados con una media de 11,32 ± (13,39) respecto a los no adherentes que tenían menos días 7,68 ± (13,13); valor p=0,031. Conclusión: Los pacientes adherentes al tratamiento farmacológico de la GOLD 2018 visitan más urgencias y presentan mayor número de exacerbaciones, lo cual se refleja en un aumento en la probabilidad de muerte


Background: Chronic obstructive pulmonary disease (COPD) is characterized by the chronic limitation of airflow that generates symptoms such as dyspnoea, coughing, and wheezing. The GOLD 2018 proposes pharmacological treatment strategies. However, adherence is low. The differences between adherent and non-adherent patients are not clearly established, although there could be an inverse relationship between adherence and exacerbations. Objective: To determine the differences between adherent and non-adherent patients to the pharmacological treatment proposed by GOLD 2018 in clinical variables, as well as the CODEX, COTE, and BODE indices. Methods: Cross-sectional study was conducted on 126 patients diagnosed with COPD between January and September 2018. They were divided into two groups: adherent (COPD-A) and non-adherent (COPD-NA), taking into account the pharmacological treatment of GOLD 2018. Results: The groups included 79 patients inCOPD-NA, and 50 in COPD-A), of which 61% were males and 39% females. The mean age was 70.62 ± (8.29. The majority of adherent patients belonged to GOLD group D, and the non-adherent to GOLD group B (P=.004). As regards days hospitalised, the adherent patients spent more days in hospital, with a mean of 11.32 ± (13.39) days, compared to non-adherent patients with fewer days 7.68 ± (13.13); P =.031. Conclusion: Patients adhering to the pharmacological treatment of GOLD 2018 make more emergency department visits and present with a greater number of exacerbations, and is reflected in an increase in the probability of mortality


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Cooperação e Adesão ao Tratamento , Atividade Motora , Comorbidade , Teste de Caminhada/métodos , Estudos Transversais , Doença Pulmonar Obstrutiva Crônica/reabilitação , Espirometria/métodos
7.
PLoS One ; 15(2): e0229250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092097

RESUMO

Variability during spirometry can persist despite control of technical and personal factors. We postulate spirometry induces gastro-oesophageal reflux (GOR), which may cause variability and affect results of spirometry. Fifty-eight (58) subjects undergoing GOR investigation with oesophageal manometry and 24hr pH monitoring were recruited. Oesophageal dysmotility and GOR were assessed as part of clinical care. Subjects performed 2 sets of spirometry separated by a 10-minute rest period. The assessment of GOR during spirometry procedure (defined by a lower oesophageal pH<4) started from the first set of spirometry and concluded when the second set of spirometry was completed. We calculated variability (%) of FEV1, FVC and PEFR within each set as well as changes over 10-minutes. Twenty-six subjects (45%) recorded GOR during assessment. Of these, 23 subjects recorded GOR during the 10-minute rest period. Four subjects had GOR recorded only during spirometry tests. We did not find variability of spirometry parameters between the groups with and without GOR during spirometry procedure. However, in subjects with GOR, we found small but significant reductions of PEFR (0.5L/s, 8%, p<0.001) and FEV1 (84 mL, 3%, p = 0.048) in the second set of spirometry compared to the first spirometry set. This pilot study demonstrates that GOR can occur during and following spirometry. Presence of GOR during spirometry in this patient population caused small decreases in PEFR and FEV1 when it is repeated 10-minutes later however not increase variability in a single series of measurements.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Espirometria/métodos , Adulto , Idoso , Esôfago/fisiopatologia , Feminino , Refluxo Gastroesofágico/etiologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Projetos Piloto , Prevalência , Testes de Função Respiratória , Espirometria/efeitos adversos
8.
PLoS One ; 15(1): e0227980, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978133

RESUMO

INTRODUCTION: Particles in exhaled air (PEx) provide samples of respiratory tract lining fluid from small airways containing, for example, Surfactant protein A (SP-A) and albumin, potential biomarkers of small airway disease. We hypothesized that there are differences between morning, noon, and afternoon measurements and that the variability of repeated measurements is larger between days than within days. METHODS: PEx was obtained in sixteen healthy non-smoking adults on 11 occasions, within one day and between days. SP-A and albumin were quantified by ELISA. The coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and coefficient of variation (CV) were used to assess the variation of repeated measurements. RESULTS: SP-A and albumin increased significantly from morning towards the noon and afternoon by 13% and 25% on average, respectively, whereas PEx number concentration and particle mean mass did not differ significantly between the morning, noon and afternoon. Between-day CRs were not larger than within-day CRs. CONCLUSIONS: Time of the day influences the contents of SP-A and albumin in exhaled particles. The variation of repeated measurements was rather high but was not influenced by the time intervals between measurements.


Assuntos
Albuminas/isolamento & purificação , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Proteína A Associada a Surfactante Pulmonar/isolamento & purificação , Sistema Respiratório/química , Adulto , Idoso , Ar/análise , Albuminas/metabolismo , Biomarcadores/química , Testes Respiratórios , Expiração/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/patologia , Proteína A Associada a Surfactante Pulmonar/metabolismo , Sistema Respiratório/metabolismo , Espirometria/métodos
9.
J Clin Neurosci ; 72: 50-56, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31982274

RESUMO

In this study, we correlate single breath count (SBC) with arterial blood gas (ABG) parameters to derive a cutoff point for intubation and mechanical ventilation (MV) in Guillain-Barré Syndrome (GBS). Ninety-four GBS patients underwent serial SBC at 2 Hz using an audio program. ABG was done at admission, and repeated if SBC declined. The patients were intubated based on "the modified intubation criteria" as follows (a + b or c): (a) hypoxia (PaO2 < 60 mm of Hg on ventimask); (b) hypercarbia (PaCO2 > 50 mm of Hg); (c) acidosis (pH < 7.3). The primary outcome was the absolute SBC at which patients had ABG alteration needing intubation. All the patients maintained a desired ABG without respiratory distress till SBC 7. At SBC 5, need for MV could be predicted with a sensitivity of 90.6% and specificity of 95.2%. Admission SBC cut-off of 13 and relative delta SBC at 24 h cut-off of > 20% had a negative predictive value of 88.5% (95% CI 77.0%-96.0%) and 80.8% (95% CI 60.7%-93.4%) respectively for ruling out need of MV. SBC is a useful non-invasive measure for monitoring respiratory function and guiding ABG analysis. Till SBC 7, repeated ABG may be avoided in GBS.


Assuntos
Gasometria/métodos , Síndrome de Guillain-Barré/diagnóstico , Hipóxia/diagnóstico , Espirometria/métodos , Gasometria/instrumentação , Gasometria/normas , Feminino , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/terapia , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Espirometria/instrumentação , Espirometria/normas
11.
Nord J Psychiatry ; 74(3): 181-186, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31928298

RESUMO

Objective: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality worldwide and it remains under-diagnosed. Unrecognized somatic disease contributes significantly to the observed increased mortality rate in patients with psychiatric diseases.Aims: To investigate whether screening with spirometry and simple questions on respiratory symptoms were efficacious in identifying previously unknown cases of COPD and/or asthma in patients admitted to psychiatric wards.Methods: In this observational cohort study, we included hospitalized psychiatric patients in2013. All were assessed with handheld spirometry, medical history and completion of a simple, short questionnaire on respiratory symptoms, the COPD assessment test (CAT questionnaire).Results: In total, 106 patients were screened and 45 patients (age: median 45, range 19-75, 43% female gender) were included whereas 61 patients (age: median 42, range 19-73) 34% female gender) were excluded. Prior to screening three patients (6.5%) reported having a diagnosis of COPD whereas eight patients (17%) reported having a diagnosis of asthma. Six new cases were diagnosed with COPD and four new cases with asthma. The number needed to screen to find one new case was 3.4 (total cohort 4.5).Conclusion: We present a simple study where the patients are screened for obstructive lung disease with a handheld spirometry and a questionnaire on respiratory symptoms. Number needed to screen is low at 3.4-4.5. In all, 10 new cases of obstructive lung disease were diagnosed. This study illustrates that screening for COPD and asthma is feasible even in a psychiatric population.


Assuntos
Hospitalização , Programas de Rastreamento/métodos , Transtornos Mentais/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Hospitalização/tendências , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Inquéritos e Questionários
12.
Fisioter. Pesqui. (Online) ; 27(1): 64-70, jan.-mar. 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1090404

RESUMO

RESUMO O objetivo do estudo foi correlacionar a diferença entre capacidade vital lenta (CVL) e capacidade vital forçada (CVF) (CVL-CVF) com a atividade física na vida diária (AFVD) em pacientes com doença pulmonar obstrutiva crônica (DPOC); e verificar as diferenças na AFVD entre indivíduos com CVL maior ou menor do que a CVF. Vinte e oito indivíduos com DPOC (18 homens; 67±8 anos; VEF1: 40±13% previsto) tiveram a função pulmonar avaliada pela espirometria e foram divididos em dois grupos: CVL>CVF (n=17) e CVL≤CVF (n=11). Ademais, tiveram a AFVD avaliada objetivamente pelo monitor de atividade física DynaPort®, que quantifica na vida diária, dentre outros, o tempo gasto por dia andando, em pé, sentado e deitado. Não foram encontradas correlações significativas entre CVL-CVF e as variáveis da AFVD no grupo geral. No grupo CVL>CVF foi encontrada significância estatística na correlação entre a CVL-CVF e o tempo gasto por dia em pé (r=−0,56) e sentado (r=0,75). Já no grupo CVL≤CVF, houve correlação significativa somente com o tempo gasto por dia em pé (r=0,57) e deitado (r=−0,62). Ao comparar ambos os grupos, não houve diferença estatisticamente significante para nenhuma das variáveis da AFVD (p>0,05 para todas). No grupo com CVL maior que a CVF houve correlação alta com o tempo gasto sentado, mas não com o tempo andando. Portanto, indivíduos com maior obstrução ao fluxo aéreo segundo a diferença CVL-CVF tendem a gastar mais tempo em atividades de menor gasto energético, que não envolvam caminhar.


RESUMEN El presente estudio tuvo el objetivo de correlacionar la diferencia entre la capacidad vital lenta (CVL) y la capacidad vital forzada (CVF) (CVL-CVF) con la actividad física en la vida diaria (AFVD) de pacientes con enfermedad pulmonar obstructiva crónica (EPOC); y verificar las diferencias de la AFVD entre individuos con CVL mayor o menor que la CVF. Se evaluaron la función pulmonar de veintiocho personas con EPOC (18 hombres; 67±8 años; VEF1: 40±13% esperado) mediante espirometría, y los dividieron en dos grupos: CVL>CVF (n=17) y CVL≤CVF (n=11). La AFVD también se evaluó objetivamente por el monitor de actividad física DynaPort®, el cual cuantifica el tiempo que se gasta en la vida diaria caminando, de pie, sentado y acostado. No se encontraron correlaciones significativas entre CVL-CVF y las variables de la AFVD en el grupo general. En el grupo CVL>CVF, se encontró una significación estadística en la correlación entre CVL-CVF y el tiempo que se gasta diariamente en pie (r=−0,56) y sentado (r=0,75). El grupo CVL≤CVF presentó una correlación significativa solo con el tiempo que se gasta diariamente en pie (r=0,57) y acostado (r=−0,62). La comparación entre ambos grupos no resultó en diferencias estadísticamente significativas en ninguna de las variables de AFVD (p>0,05 para todas). En el grupo con CVL mayor que la CVF, hubo una alta correlación con el tiempo que se gasta sentado, pero con el tiempo que se gasta caminando no se encontró este resultado. Se concluye que las personas con una mayor obstrucción del flujo de aire de acuerdo con la diferencia CVL-CVF tienden a gastar más tiempo en actividades con menos gasto de energía, las que no implican caminar.


ABSTRACT The aim of this study was to correlate the difference of vital capacity (VC) and forced vital capacity (FVC) (VC-FVC) with physical activity in daily life (PADL) in patients with chronic obstructive pulmonary disease (COPD); and investigate the differences in PADL in individuals with VC smaller or greater than FVC. Twenty-eight patients with COPD (18 men, 67±8 years; FEV1: 40±13% predicted) had their lung function assessed by spirometry and were divided into two groups: VC>FVC (n=17) and VC≤CVF (n=11). Furthermore, they had their PADL evaluated by a validated activity monitor which measures, among other variables, time spent/day walking, standing, sitting and lying. There were no correlations between VC-FVC and the variables of PADL in the general group. In the group VC>FVC there was statistically significant correlation between VC-FVC and the time spent/day standing (r=−0.56) and sitting (r=0.75). In the group VC≤CVF , VC-FVC was significantly correlated with time spent/day standing (r=0.57) and lying (r=−0.62). When comparing the groups, there was no statistically significant difference for any variable of PADL (p>0.05 for all). In conclusion, in patients with VC greater than FVC there was high correlation with time spent/day sitting, but not with time spent/day walking. Therefore, individuals with greater airflow obstruction according to the VC-FVC difference tend to spend more time in activities of lower energy expenditure, which do not involve walking.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Exercício Físico/fisiologia , Capacidade Vital/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Espirometria/métodos , Estudos Transversais , Monitoramento , Dispneia/fisiopatologia , Teste de Esforço/métodos , Comportamento Sedentário
13.
Postgrad Med J ; 96(1131): 28-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31375557

RESUMO

OBJECTIVE: The present study was designed to investigate the biomarkers levels of fractalkine (FKN), neutrophil elastase (NE) and matrix metalloproteinase-12 (MMP-12) in chronic obstructive pulmonary disease (COPD) with 'exacerbator with emphysema phenotype' and to evaluate the associations between the biomarkers levels and the severity of disease by spirometric measurements. METHODS: A total of 84 COPD patients and 49 healthy controls were enrolled in our study. ELISA were utilised to detect the FKN, MMP-12 and NE in serum from all subjects. RESULTS: FKN (p<0.001), NE (p=0.039) and MMP-12 (p<0.001) in serum of COPD patients showed higher levels than that of healthy control subjects. Serum FKN (p<0.001), MMP-12 (p<0.001) and NE (p=0.043) levels were significantly higher in severe and very severe COPD patients than that in mild and moderate COPD patients. Circulating FKN, MMP-12 and NE expression levels were significantly elevated (p<0.001) in COPD smokers compared with COPD non-smokers. The smoke pack years were negatively correlated with FEV1%pred (r=-0.5036), FEV1/FVC ratio (r=-0.2847) (FEV, forced expiratory volume; FVC, forced vital capacity). Similarly, we observed a strong positive correlation between the smoke pack years and serum levels of FKN (r=0.4971), MMP-12 (r=0.4315) and NE (r=0.2754). FEV1%pred was strongly negatively correlated with cytokine levels of FKN (r=-0.4367), MMP-12 (r=-0.3295) and NE (r=-0.2684). Likewise, FEV1/FVC ratio was negatively correlated with mediators of inflammation levels of FKN (r=-0.3867), MMP-12 (r=-0.2941) and NE (r=-0.2153). CONCLUSION: Serum FKN, MMP-12 and NE concentrations in COPD patients are directly associated with the severity of COPD with 'exacerbator with emphysema phenotype'. This finding suggests that FKN, MMP-12 and NE might play an important role in the pathophysiology of COPD.


Assuntos
Quimiocina CX3CL1/sangue , Metaloproteinase 12 da Matriz/sangue , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Espirometria/métodos , Biomarcadores/sangue , Correlação de Dados , Progressão da Doença , Feminino , Humanos , Elastase de Leucócito/sangue , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/sangue , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Índice de Gravidade de Doença
14.
Respir Physiol Neurobiol ; 271: 103287, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31494306

RESUMO

PURPOSE: Remote ischemic preconditioning (RIP) may protect remote organs from ischemia-reperfusion-injury (IRI) in surgical and non-surgical patients. There are few data available on RIP and lung function, especially not in healthy volunteers. The null-hypothesis was tested that RIP does not have an effect on pulmonary function when applied on healthy volunteers that were breathing spontaneously and did not experience any intervention. After approval of the Ethics Committee and informed consent of the study subjects, 28 healthy non-smoking volunteers were included and randomized in either the RIP group (n = 13) or the control group (n = 15). In the RIP group, lower limb ischemia was induced by inflation of a blood pressure cuff to a pressure 20 mmHg above the systolic blood pressure. After five minutes the blood pressure cuff was released for five minutes rest. The procedure was repeated three times resulting in 40 min ischemia and reperfusion. Capillary blood samples were taken, and lung function tests were performed at baseline (T1) and 60 min (T2) and 24 h (T3) after RIP. The control group was treated in the same fashion, but the RIP procedure was replaced by a sham protocol. RESULTS: 60 min after RIP capillary pO2 decreased significantly and returned to baseline level after 24 h in the RIP group. This did not occur in the control group. Capillary pCO2, variables of lung function tests and pulmonary capillary blood volume remained unchanged throughout the experiment in both groups. CONCLUSION: Oxygenation is impaired early after RIP which is possibly induced by transient ventilation-perfusion inequality. No late effects of RIP were observed. The null hypothesis has to be rejected that RIP has no effect on respiratory variables in healthy volunteers.


Assuntos
Precondicionamento Isquêmico/métodos , Pulmão/fisiologia , Troca Gasosa Pulmonar/fisiologia , Traumatismo por Reperfusão/fisiopatologia , Traumatismo por Reperfusão/terapia , Espirometria/métodos , Adolescente , Adulto , Feminino , Voluntários Saudáveis , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiologia , Medidas de Volume Pulmonar , Masculino , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
15.
Respir Physiol Neurobiol ; 271: 103315, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586648

RESUMO

STUDY OBJECTIVES: Overlap syndrome occurs when obstructive sleep apnea (OSA) and chronic obstructive pulmonary disorder (COPD) coexist in the same patient. Although several studies highlighted the importance of clinical phenotyping in OSA, the trait contribution to OSA pathogenesis in overlap syndrome has not been investigated. With this pilot study, we aimed to measure OSA determinants and their relationship with functional respiratory parameters in a sample of patients with overlap syndrome. In particular, we hypothesize that patients with COPD have in the low arousal threshold a major contributor for the development of OSA. METHODS: Ten consecutive non-hypercapnic COPD patients (body mass index<35 kg/m2) suffering from overlap syndrome with no other relevant comorbidities underwent a phenotyping polysomnography. Traits were measured with CPAP dial-downs. RESULTS: Arousal threshold was found to be inversely associated to functional measures of lung air trapping and static hyperinflation. Particularly, correlations with residual volume (r2 = 0.49, p =  0.024) and residual volume to total lung capacity ratio (r2 = 0.48, p =  0.026) were evident. Only 20% of patients showed a high upper airway passive collapsibility as single pathological trait. In contrast, among those patients with multiple altered traits (6 out of 10), all had an elevated loop gain and 4 (∼65%) a low arousal threshold. CONCLUSIONS: High loop gain and particularly low arousal threshold seem important contributors to OSA pathogenesis and severity in patients with COPD. Recognizing in COPD patients these features as key traits may open avenues for personalized medicine in the field of overlap syndrome.


Assuntos
Nível de Alerta/fisiologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Mecânica Respiratória/fisiologia , Apneia Obstrutiva do Sono/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/diagnóstico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/fisiopatologia , Feminino , Humanos , Medidas de Volume Pulmonar/métodos , Masculino , Projetos Piloto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Espirometria/métodos
16.
Rev Assoc Med Bras (1992) ; 65(11): 1343-1348, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31800894

RESUMO

OBJECTIVE: To evaluate chronological age as a limiting factor to perform the bronchodilator test, determine significant adverse effects of short-acting beta 2 agonists with clinical repercussions, and assess bronchodilator response in extreme-old-age patients who undergo the spirometry test. METHODS: This is a cross-sectional and retrospective study. The sample was extracted from the database (spirometer and respiratory questionnaire) of a pulmonary function service. Patients over 90 years old were included in the research, and we evaluated their bronchodilator response and its significant adverse effects that may have clinical repercussions related to the bronchodilator. RESULTS: A sample of 25 patients aged 92.12 ± 2.22 years (95% CI, 91.20 - 93.04), with a minimum age of 90 years and a maximum of 97 years and a predominance of females with 72% (18/25). The bronchodilator test was performed in 84% (21/25) of the patients. The bronchodilator response was evaluated in 19 of the 21 patients (90.47%) who underwent the bronchodilator test. Two tests did not meet the criteria of acceptability and reproducibility. No clinical adverse effects were observed with the bronchodilator medication (salbutamol) during or after the exam. CONCLUSIONS: Chronological age is not a limiting factor for the bronchodilator test, short-acting beta-2 agonists did not present adverse effects with significant clinical repercussion and were useful in the diagnosis and therapeutic guidance of extreme-old-age patients.


Assuntos
Agonistas Adrenérgicos beta/administração & dosagem , Envelhecimento , Testes de Provocação Brônquica/métodos , Broncodilatadores/administração & dosagem , Espirometria/métodos , Agonistas Adrenérgicos beta/efeitos adversos , Idoso de 80 Anos ou mais , Testes de Provocação Brônquica/efeitos adversos , Broncodilatadores/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Espirometria/efeitos adversos
17.
Fisioterapia (Madr., Ed. impr.) ; 41(6): 337-341, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187807

RESUMO

Antecedentes y objetivos: La toxicidad pulmonar inducida por radiación es un proceso común, pero poco atendido, ocasionado tras la aplicación de radioterapia en el cáncer de mama. A largo plazo tras la aplicación de radioterapia se ha encontrado una disminución de los test pulmonares y de la difusión de oxígeno, pudiendo provocar fatiga e intolerancia al ejercicio en las mujeres supervivientes al carcinoma mamario. El objetivo de este trabajo fue mejorar la función pulmonar a través de un programa de trabajo con espirometría incentiva y máscara de presión espiratoria positiva en las mujeres tratadas de cáncer de mama con radioterapia, y describir su efecto sobre la tolerancia al esfuerzo y la percepción de fatiga. Descripción de los casos: Cinco mujeres que percibieron fatiga tras la aplicación de radioterapia. Intervención: Se llevó a cabo un tratamiento domiciliario basado en la utilización de la espirometría incentiva y de la máscara de presión espiratoria positiva, trabajando diariamente 30min, a lo largo de 3 semanas. Resultados y discusión: El tratamiento con espirometría incentiva y máscara presión espiratoria positiva parece mejorar las secuelas pulmonares inducidas por radioterapia y aumentar la tolerancia al esfuerzo en mujeres tratadas de cáncer de mama. Sin embargo, la variabilidad en los resultados obtenidos hace que no puedan ser concluyentes


Background and objective: Radiation-induced pulmonary toxicity is a common process following radiation therapy in breast cancer which is not usually considered. In the long term after the application of radiotherapy, a decrease in pulmonary tests and in carbon monoxide diffusing capacity has been found. It may lead to fatigue and intolerance to exercise in women surviving mammary carcinoma. The objective of this paper was to improve pulmonary function through a work programme with EI and mask of PEP in women treated for breast cancer with radiotherapy and describe if it has a beneficial effect on the tolerance to effort and the perception of fatigue. Cases description: Five women who perceived fatigue after the application of radiotherapy. Intervention: A domiciliary treatment was carried out based on the use of the EI and the PEP mask, working daily for 30minutes over 3 weeks. Result and discussion: Treatment with IE and the PEP mask seems to improve the pulmonary effects induced by radiotherapy and increases exercise tolerance in women treated for breast cancer. However, the variability in the results obtained means that they cannot be conclusive


Assuntos
Humanos , Feminino , Espirometria/métodos , Neoplasias da Mama/terapia , Radioterapia/efeitos adversos , Fadiga/etiologia , Neoplasias da Mama/radioterapia , Espirometria , Fadiga/radioterapia , Respiração com Pressão Positiva/métodos , Exercícios Respiratórios/métodos , Estudos Longitudinais
18.
Sensors (Basel) ; 19(23)2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31766452

RESUMO

This work proposes adapting an existing sensor and embedding it on mannequins used in cardiopulmonary resuscitation (CPR) training to accurately measure the amount of air supplied to the lungs during ventilation. Mathematical modeling, calibration, and validation of the sensor along with metrology, statistical inference, and spirometry techniques were used as a base for aquiring scientific knowledge of the system. The system directly measures the variable of interest (air volume) and refers to spirometric techniques in the elaboration of its model. This improves the realism of the dummies during the CPR training, because it estimates, in real-time, not only the volume of air entering in the lungs but also the Forced Vital Capacity (FVC), Forced Expiratory Volume (FEVt) and Medium Forced Expiratory Flow (FEF20-75%). The validation of the sensor achieved results that address the requirements for this application, that is, the error below 3.4% of full scale. During the spirometric tests, the system presented the measurement results of (305 ± 22, 450 ± 23, 603 ± 24, 751 ± 26, 922 ± 27, 1021 ± 30, 1182 ± 33, 1326 ± 36, 1476 ± 37, 1618 ± 45 and 1786 ± 56) × 10-6 m3 for reference values of (300, 450, 600, 750, 900, 1050, 1200, 1350, 1500, 1650 and 1800) × 10-6 m3, respectively. Therefore, considering the spirometry and pressure boundary conditions of the manikin lungs, the system achieves the objective of simulating valid spirometric data for debriefings, that is, there is an agreement between the measurement results when compared to the signal generated by a commercial spirometer (Koko brand). The main advantages that this work presents in relation to the sensors commonly used for this purpose are: (i) the reduced cost, which makes it possible, for the first time, to use a respiratory volume sensor in medical simulators or training dummies; (ii) the direct measurement of air entering the lung using a noninvasive method, which makes it possible to use spirometry parameters to characterize simulated human respiration during the CPR training; and (iii) the measurement of spirometric parameters (FVC, FEVt, and FEF20-75%), in real-time, during the CPR training, to achieve optimal ventilation performance. Therefore, the system developed in this work addresses the minimum requirements for the practice of ventilation in the CPR maneuvers and has great potential in several future applications.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Pulmão/fisiologia , Espirometria/instrumentação , Espirometria/métodos , Idoso , Retroalimentação , Humanos , Masculino , Manequins , Testes de Função Respiratória/métodos , Volume de Ventilação Pulmonar/fisiologia , Ventilação/instrumentação , Capacidade Vital/fisiologia
19.
Respir Res ; 20(1): 254, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718676

RESUMO

BACKGROUND: Pulmonary and systemic inflammation are central features of chronic obstructive pulmonary disease (COPD). Previous studies have demonstrated relationships between biologically active extracellular matrix components, or matrikines, and COPD pathogenesis. We studied the relationships between the matrikine acetyl-proline-glycine-proline (AcPGP) in sputum and plasma and clinical features of COPD. METHODS: Sputum and plasma samples were obtained from COPD participants in the SPIROMICS cohort at enrollment. AcPGP was isolated using solid phase extraction and measured by mass spectrometry. Demographics, spirometry, quality of life questionnaires, and quantitative computed tomography (CT) imaging with parametric response mapping (PRM) were obtained at baseline. Severe COPD exacerbations were recorded at 1-year of prospective follow-up. We used linear and logistic regression models to measure associations between AcPGP and features of COPD, and Kaplan-Meier analyses to measure time-to-first severe exacerbation. RESULTS: The 182 COPD participants in the analysis were 66 ± 8 years old, 62% male, 84% White race, and 39% were current smokers. AcPGP concentrations were 0.61 ± 1.89 ng/mL (mean ± SD) in sputum and 0.60 ± 1.13 ng/mL in plasma. In adjusted linear regression models, sputum AcPGP was associated with FEV1/FVC, spirometric GOLD stage, PRM-small airways disease, and PRM-emphysema. Sputum AcPGP also correlated with severe AECOPD, and elevated sputum AcPGP was associated with shorter time-to-first severe COPD exacerbation. In contrast, plasma AcPGP was not associated with symptoms, pulmonary function, or severe exacerbation risk. CONCLUSIONS: In COPD, sputum but not plasma AcPGP concentrations are associated with the severity of airflow limitation, small airways disease, emphysema, and risk for severe AECOPD at 1-year of follow-up. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01969344 (SPIROMICS).


Assuntos
Glicina/sangue , Prolina/sangue , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Espirometria/métodos , Escarro/metabolismo , Idoso , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escarro/química
20.
Adv Respir Med ; 87(5): 269-275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680226

RESUMO

INTRODUCTION: Several studies have investigated different tools for asthma diagnosis in order to reduce the cost and improve its early recognition. The goal of this study is to establish ashort questionnaire to be used in practice for asthma screening and compare diagnostic values between this method and spirometric response to bronchodilators. MATERIAL AND METHOD: 208 patients presenting with chronic stable dyspnea (> 6 months) and definite clinical diagnosis of chronic obstructive pulmonary disease, bronchiectasis, pulmonary fibrosis or asthma, were enrolled. 9 questions out of 43 based on the literature search were selected by regression analysis. Patients were asked to complete the questionnaire and then their spirometric responses to bronchodilators were evaluated. RESULTS: Of all, 53.8% of cases were diagnosed clinically to have asthma. For establishing diagnosis of asthma, the bronchodilator test had 48.2% sensitivity, 78.1% specificity, 72% positive, 56.4% negative predictive values, 2.2 positive, 0.66 negative likeli-hood ratios, and false positive, false negative and accuracy of 21.9%, 51.8% and 62.01%, respectively. The revised 9 questions from the questionnaire had 97.3% sensitivity, 77.1% specificity, 83.2% positive, 96.1% negative predictive values, 4.24 positive, 0.03 negative likelihood ratios, 22.9% false positive, 2.7% false negative and 87.98% accuracy. CONCLUSIONS: The 9-question questionnaire had better diagnostic values in defining asthma in patients with chronic dyspnea than reversibility of airway obstruction to salbutamol and can be used as auseful screening test for diagnosis of asthma in clinical practice and for investigational purposes.


Assuntos
Broncodilatadores/uso terapêutico , Pneumopatias Obstrutivas/tratamento farmacológico , Avaliação de Processos e Resultados em Cuidados de Saúde , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , Pneumopatias Obstrutivas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Espirometria/métodos
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