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1.
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
3.
BMC Public Health ; 19(1): 690, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164109

RESUMO

BACKGROUND: Lung function is lower in people with disadvantaged socio-economic position (SEP) and is associated with hazardous health behaviours and exposures. The associations are likely to be interactive, for example, exposure to socially patterned environmental tobacco smoke (ETS) in childhood is associated with an increased effect of smoking in adulthood. We hypothesise that disadvantaged childhood SEP increases susceptibility to the effects of hazards in adulthood for lung function. We test whether disadvantaged childhood SEP moderates smoking, physical activity, obesity, occupational exposures, ETS and air pollution's associations with lung function. METHODS: Data are from the Nurse Health Assessment (NHA) in waves two and three of the United Kingdom Household Longitudinal Study (UKHLS). Analysis is restricted to English residents aged at least 20 for women and 25 for men, producing a study population of 16,339. Lung function is measured with forced expiratory volume in the first second (FEV1) and standardised to the percentage of expected FEV1 for a healthy non-smoker of equivalent age, gender, height and ethnicity (FEV1%). Using STATA 14, a mixed linear model was fitted with interaction terms between childhood SEP and health behaviours and occupational exposures. Cross level interactions tested whether childhood SEP moderated household ETS and neighbourhood air pollution's associations with FEV1%. RESULTS: SEP, smoking, physical activity, obesity, occupational exposures and air pollution were associated with lung function. Interaction terms indicated a significantly stronger negative association between disadvantaged childhood SEP and currently smoking (coefficient -6.47 %, 95% confidence intervals (CI): 9.51 %, 3.42 %) as well as with formerly smoking and occupational exposures. Significant interactions were not found with physical activity, obesity, ETS and air pollution. CONCLUSION: The findings suggest that disadvantaged SEP in childhood may make people's lung function more susceptible to the negative effects of smoking and occupational exposures in adulthood. This is important as those most likely to encounter these exposures are at greater risk to their effects. Policy to alleviate this inequality requires intervention in health behaviours through public health campaigns and in occupational health via health and safety legislation.


Assuntos
Envelhecimento/fisiologia , Pulmão/fisiopatologia , Exposição Ocupacional/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/fisiopatologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
4.
Medicine (Baltimore) ; 98(18): e15321, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045770

RESUMO

Patients with myotonic muscular dystrophy type 1 (DM1) tend to exhibit earlier respiratory insufficiency than patients with other neuromuscular diseases at similar or higher forced vital capacity (FVC). This study aimed to analyze several pulmonary function parameters to determine which factor contributes the most to early hypercapnia in patients with DM1.We analyzed ventilation status monitoring, pulmonary function tests (including FVC, maximal voluntary ventilation [MVV], and maximal inspiratory and expiratory pressure), and polysomnography in subjects with DM1 who were admitted to a single university hospital. The correlation of each parameter with hypercapnia was determined. Subgroup analysis was also performed by dividing the subjects into 2 subgroups according to usage of mechanical ventilation.Final analysis included 50 patients with a mean age of 42.9 years (standard deviation = 11.1), 46.0% of whom were male. The hypercapnia was negatively correlated with MVV, FVC, forced expiratory volume in 1 second (FEV1), and their ratios to predicted values in subjects with myotonic muscular dystrophy type 1. At the same partial pressure of carbon dioxide, the ratio to the predicted value was lowest for MVV, then FEV1, followed by FVC. Moreover, the P values for differences in MVV and its ratio to the predicted value between ventilator users and nonusers were the lowest.When screening ventilation failure in patients with DM1, MVV should be considered alongside other routinely measured parameters.


Assuntos
Hipercapnia/fisiopatologia , Pulmão/fisiopatologia , Ventilação Voluntária Máxima/fisiologia , Distrofia Miotônica/complicações , Adulto , Dióxido de Carbono/análise , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pressões Respiratórias Máximas/métodos , Pessoa de Meia-Idade , Distrofia Miotônica/classificação , Distrofia Miotônica/fisiopatologia , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/fisiopatologia , Polissonografia/métodos , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Capacidade Vital/fisiologia
5.
Ter Arkh ; 91(1): 60-63, 2019 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31090373

RESUMO

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


Assuntos
Asma/fisiopatologia , Obesidade/complicações , Capacidade Pulmonar Total/fisiologia , Asma/complicações , Estudos de Casos e Controles , Volume Expiratório Forçado/fisiologia , Humanos , Pletismografia/métodos , Capacidade Vital/fisiologia
7.
BMC Public Health ; 19(1): 501, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053065

RESUMO

BACKGROUND: Our study aimed to determine the association between forced expiratory volume in one second (FEV1) and subsequent fatal and non-fatal events in a general population. METHODS: The Norfolk (UK) based European Prospective Investigation into Cancer (EPIC-Norfolk) recruited 25,639 participants between 1993 and 1997. FEV1 measured by portable spirometry, was categorized into sex-specific quintiles. Mortality and morbidity from all causes, cardiovascular disease (CVD) and respiratory disease were collected from 1997 up to 2015. Cox proportional hazard regression analysis was used with adjustment for socio-economic factors, physical activity and co-morbidities. RESULTS: Mean age of the population was 58.7 ± 9.3 years, mean FEV1 for men was 294± 74 cL/s and 214± 52 cL/s for women. The adjusted hazard ratios for all-cause mortality for participants in the highest fifth of the FEV1 category was 0.63 (0.52, 0.76) for men and 0.62 (0.51, 0.76) for women compared to the lowest quintile. Adjusted HRs for every 70 cL/s increase in FEV1 among men and women were 0.77 (p < 0.001) and 0.68 (p < 0.001) for total mortality, 0.85 (p<0.001) and 0.77 (p<0.001) for CVD and 0.52 (p <0.001) and 0.42 (p <0.001) for respiratory disease. CONCLUSIONS: Participants with higher FEV1 levels had a lower risk of CVD and all-cause mortality. Measuring the FEV1 with a portable handheld spirometry measurement may be used as a surrogate marker for cardiovascular risk. Every effort should be made to identify those with poorer lung function even in the absence of cardiovascular disease as they are at greater risk of total and CV mortality.


Assuntos
Doenças Cardiovasculares/mortalidade , Doença da Artéria Coronariana/mortalidade , Volume Expiratório Forçado/fisiologia , Doenças Respiratórias/mortalidade , Adulto , Idoso , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Neoplasias/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Projetos de Pesquisa , Testes de Função Respiratória , Fatores de Risco , Espirometria/métodos , Capacidade Vital/fisiologia
8.
Arch. bronconeumol. (Ed. impr.) ; 55(4): 208-213, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181512

RESUMO

Introducción: El asma se caracteriza por una inflamación crónica de las vías respiratorias centrales y distales. El objetivo de este estudio ha sido evaluar la vía aérea pequeña (VAP) en niños con asma moderada y/o grave con FEV1 normal. Métodos: Estudio abierto, prospectivo, observacional y transversal con inclusión consecutiva de casos con asma moderada o grave, bajo tratamiento clínico habitual con FEV1 basal normal. Se ha determinado la FEno a flujos múltiples (CAno), resistencias y reactancia oscilatorias (R5-R20, X5), espirometría forzada (FEV1, FEF25-75), pletismografía corporal total (RV/TLC) y prueba de broncodilatación. La afectación de la VAP se definió por: Cano > 4,5 ppb, R5-R20 > 0,147kPa/L/s, X5 <-0,18kPa/L, FEF25-75 < -1,65 z-score, RV/TL > 33%. El mal control de asma se definió por ≤ 19 puntos en el cuestionario ACT o ≤ 20 en c-ACT. Resultados: Cohorte de 100 casos, 76 con asma moderada y 24 con asma grave, 71 niños clasificados como mal controlados y 29 bien controlados. El 77,78% del grupo con todas las determinaciones correctas (n =7 2) mostró ≥ 1 parámetro alterado de VAP y el 48,61% ≥ 2 parámetros. No hubo diferencias entre los casos bien y mal controlados. Conclusiones: Los niños con asma moderada y grave, con el FEV1 preservado, muestran un fenotipo de VAP disfuncionante. En nuestra muestra, la evaluación de la VAP mediante las técnicas descritas, no aporta información sobre el control habitual de la enfermedad


Introduction: Asthma is characterized by chronic inflammation of the central and distal airways. The aim of this study was to assess the small airway (SA) of children with moderate-severe asthma with normal FEV1. Methods: This was an open-label, prospective, observational, cross-sectional study with consecutive inclusion of patients with moderate-severe asthma, receiving standard clinical treatment, with normal baseline FEV1. We determined multiflow FEno (CAno), oscillatory resistance and reactance (R5-R20, X5), forced spirometry (FEV1, FEF25-75), total body plethysmography (RV/TLC) and bronchodilation test. SA involvement was defined as: Cano > 4.5 ppb, R5-R20 > 0.147kPa/L/s, X5< -0.18kPa/L, FEF25-75 < -1.65 z-score, RV/TLC > 33%. Poor asthma control was defined as ≤ 19 points on the ACT questionnaire or ≤ 20 on the c-ACT. Results: In a cohort of 100 cases, 76 had moderate asthma and 24 had severe asthma; 71 children were classified as poorly controlled and 29 were well-controlled. In total, 77.78% of the group with all the correct determinations (n=72) showed ≥ 1 altered SA parameter and 48.61% ≥ 2 parameters. There were no differences between well-controlled or poorly controlled cases. Conclusions: Children with moderate-severe asthma, with normal FEV1, show a phenotype of dysfunctional SA. In our series, the evaluation of SA using the techniques described above did not provide information on disease control


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Asma/fisiopatologia , Obstrução das Vias Respiratórias/fisiopatologia , Anormalidades do Sistema Respiratório , Volume Expiratório Forçado/fisiologia , Estudos Transversais , Estudos Prospectivos , Estudos de Coortes , Testes Respiratórios/métodos
9.
Respir Res ; 20(1): 74, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992021

RESUMO

BACKGROUND: Pulmonary vascular abnormalities are a characteristic feature of chronic obstructive pulmonary disease (COPD). Cigarette smoking is the most important risk factor for COPD. It is believed that its constant exposure triggers endothelial cell damage and vascular remodelling. Under pathological conditions, progenitor cells (PCs) are mobilized from the bone marrow and recruited to sites of vascular injury. The aim of the study was to investigate whether in COPD the number of circulating PCs is related to the presence of bone marrow-derived cells in pulmonary arteries and the association of these phenomena to both systemic and pulmonary endothelial dysfunction. METHODS: Thirty-nine subjects, 25 with COPD, undergoing pulmonary resection because of a localized carcinoma, were included. The number of circulating PCs was assessed by flow cytometry using a triple combination of antibodies against CD45, CD133 and CD34. Infiltrating CD45+ cells were identified by immunohistochemistry in pulmonary arteries. Endothelial function in systemic and pulmonary arteries was measured by flow-mediated dilation and adenosine diphosphate-induced vasodilation, respectively. RESULTS: COPD patients had reduced numbers of circulating PCs (p < 0.05) and increased numbers of CD45+ cells (< 0.05) in the pulmonary arterial wall than non-COPD subjects, being both findings inversely correlated (r = - 0.35, p < 0.05). In pulmonary arteries, the number of CD45+ cells correlated with the severity of vascular remodelling (r = 0.4, p = 0.01) and the endothelium-dependent vasodilation (r = - 0.3, p = 0.05). Systemic endothelial function was unrelated to the number of circulating PCs and changes in pulmonary vessels. CONCLUSION: In COPD, the decrease of circulating PCs is associated with their recruitment in pulmonary arteries, which in turn is associated with endothelial dysfunction and vessel remodelling, suggesting a mechanistic link between these phenomena. Our findings are consistent with the notion of an imbalance between endothelial damage and repair capacity in the pathogenesis of pulmonary vascular abnormalities in COPD.


Assuntos
Movimento Celular/fisiologia , Endotélio Vascular/metabolismo , Artéria Pulmonar/metabolismo , Doença Pulmonar Obstrutiva Crônica/sangue , Células-Tronco/metabolismo , Idoso , Endotélio Vascular/patologia , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/patologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Células-Tronco/patologia
10.
Lancet ; 393(10182): 1721-1732, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-30935737

RESUMO

BACKGROUND: Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities. METHODS: We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15-80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976. FINDINGS: From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45-6·37) for all patients, 5·37 years (4·36-6·32) in the continuous positive airway pressure group, and 5·55 years (4·53-6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34-1·77; p=0·561). Adverse events were similar between both groups. INTERPRETATION: In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available. FUNDING: Instituto de Salud Carlos III, Spanish Respiratory Foundation, and Air Liquide Spain.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Ventilação não Invasiva/métodos , Síndrome de Hipoventilação por Obesidade/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Positiva Contínua nas Vias Aéreas/mortalidade , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/mortalidade , Síndrome de Hipoventilação por Obesidade/mortalidade , Síndrome de Hipoventilação por Obesidade/fisiopatologia , Espanha/epidemiologia , Análise de Sobrevida , Resultado do Tratamento , Capacidade Vital/fisiologia , Adulto Jovem
11.
Int Marit Health ; 70(1): 61-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931519

RESUMO

BACKGROUND: The objective was to investigate the respiratory function of professional divers by conducting spirometry and to compare the data obtained with those of non-divers. MATERIALS AND METHODS: This study involved 52 military divers who carried out dives at small and medium depths using a self-contained underwater breathing apparatus (SCUBA) with open-circuit regulators attached to a mouthpiece. The control group consisted of 48 persons from deck commands with similar physiological characteristics and lifestyle that were not divers and had never been under increased pressure. RESULTS: It was found that, compared with non-divers, the spirometry parameters of the divers are charac- terised by higher values of forced vital capacity (FVC) of the lungs (p = 0.02), but significantly lower values of the mid-expiratory flow (MEF) parameters: MEF25 (p = 0.06), MEF50 (p = 0.04), and MEF75 (p = 0.01), as well as for the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FEV1/FVC; p = 0.001) and MEF25-75/FVC ratio (p < 0.001). CONCLUSIONS: Hyperoxia, gas decompression bubbles, hypothermia, mouth-breathing dry, cold, compressed air, and other factors accompanying the diving activity are capable of initiating damage to the airways, which is reflected in characteristic changes in spirometry. The pattern of these changes is consistent with small airway obstruction and they could be related mostly to diving activities.


Assuntos
Mergulho/efeitos adversos , Mergulho/fisiologia , Volume Expiratório Forçado/fisiologia , Capacidade Vital/fisiologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Testes de Função Respiratória , Fumar
12.
Neumol. pediátr. (En línea) ; 14(1): 41-51, abr. 2019. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: biblio-995742

RESUMO

Spirometry is the most commonly used test to evaluate lung function in children and adults. To obtain good quality results, several requirements must be fulfilled: professional capacity of the technician, the quality of the equipment, the patient's collaboration, the use of appropriate reference standards. The purpose of spirometry is to define types of ventilatory alterations of the central and peripheral airways, to evaluate the response to bronchodilators and to guide the presence of restrictive diseases. The new consensus of national and international experts are described, which have been perfecting several aspects of this test.


La espirometría es el examen más comúnmente utilizado para evaluar la función pulmonar en niños y adultos. Para obtener resultados de buena calidad deben cumplirse varios requisitos, desde la capacidad profesional del técnico, calidad de los equipos, colaboración del paciente y utilización de patrones de referencia adecuados. La espirometría tiene como utilidad definir alteraciones ventilatorias obstructivas de vía aérea central y periférica, evaluar respuesta a broncodilatador y orientar al diagnóstico de enfermedades restrictivas. Se describen los nuevos consensos de expertos nacionales e internacionales, los cuales han ido perfeccionando varios aspectos de este examen.


Assuntos
Humanos , Criança , Adolescente , Fenômenos Fisiológicos Respiratórios , Espirometria/normas , Medidas de Volume Pulmonar/instrumentação , Controle de Qualidade , Valores de Referência , Espirometria/instrumentação , Calibragem , Capacidade Vital/fisiologia , Volume Expiratório Forçado/fisiologia , Curvas de Fluxo-Volume Expiratório Máximo , Pulmão/fisiologia
13.
Respir Res ; 20(1): 61, 2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917825

RESUMO

BACKGROUND: COPD influences cardiac function and morphology. Changes of the electrical heart axes have been largely attributed to a supposed increased right heart load in the past, whereas a potential involvement of the left heart has not been sufficiently addressed. It is not known to which extent these alterations are due to changes in lung function parameters. We therefore quantified the relationship between airway obstruction, lung hyperinflation, several echo- and electrocardiographic parameters on the orientation of the electrocardiographic (ECG) P, QRS and T wave axis in COPD. METHODS: Data from the COPD cohort COSYCONET were analyzed, using forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), left ventricular (LV) mass, and ECG data. RESULTS: One thousand, one hundred and ninety-five patients fulfilled the inclusion criteria (mean ± SD age: 63.9 ± 8.4 years; GOLD 0-4: 175/107/468/363/82). Left ventricular (LV) mass decreased from GOLD grades 1-4 (p = 0.002), whereas no differences in right ventricular wall thickness were observed. All three ECG axes were significantly associated with FEV1 and FRC. The QRS axes according to GOLD grades 0-4 were (mean ± SD): 26.2° ± 37.5°, 27.0° ± 37.7°, 31.7° ± 42.5°, 46.6° ± 42.2°, 47.4° ± 49.4°. Effects of lung function resulted in a clockwise rotation of the axes by 25°-30° in COPD with severe airway disease. There were additional associations with BMI, diastolic blood pressure, RR interval, QT duration and LV mass. CONCLUSION: Significant clockwise rotations of the electrical axes as a function of airway obstruction and lung hyperinflation were shown. The changes are likely to result from both a change of the anatomical orientation of the heart within the thoracic cavity and a reduced LV mass in COPD. The influences on the electrical axes reach an extent that could bias the ECG interpretation. The magnitude of lung function impairment should be taken into account to uncover other cardiac disease and to prevent misdiagnosis.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/fisiopatologia , Eletrocardiografia/métodos , Volume Expiratório Forçado/fisiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Estudos de Coortes , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Qual Life Res ; 28(7): 1885-1892, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30707368

RESUMO

PURPOSE: Lung volume reduction surgery (LVRS) has been shown to improve lung function, but also improve the overall quality of life (QOL). The aim of this study is to compare two QOL questionnaires-EuroQol Questionnaire (EQ-5D-3L) and 36-item Short Form Health Survey (SF-36) in patients post-LVRS. METHODS: All patients undergoing LVRS for severe chronic obstructive pulmonary disease (COPD) at a single center of excellence were analyzed (n = 94). Baseline demographic and clinical outcomes were characterized. Both EQ-5D-3L and SF-36 questionnaires were administered to all patients at baseline (n = 94) and at the end of 1 year (n = 89) post-surgery. SF-36 was converted to Short Form six-dimensions (SF-6D) using standard algorithm. Correlation, discrimination, responsiveness and differences across the two questionnaires were examined. RESULTS: The mean age of patients enrolled in the cohort was 66 years. There was significant increase in forced expiratory volume (FEV1, 43%), forced vital capacity (FVC 46%), diffusion capacity (DLCO 15%), 6 min walk distance test (6MWD 21%) and a significant decrease in residual volume (RV 23%) at the end of 1-year follow-up. The overall mean utility index significantly improved for both SF-6D and EQ-5D-3L questionnaires at the end of follow-up (p = 0.0001). However, the magnitude of percentage increase was higher with EQ-5D-3L compared to SF-6D (32% vs. 13%). Stronger correlations confirmed convergent validity at the end of 1-year follow-up between similar domains. Both questionnaires failed to discriminate between different levels of disease severity post-LVRS in patients with severe COPD. CONCLUSIONS: Both questionnaires responded similarly in patients with COPD post-LVRS. Combining results from QOL questionnaire(s) along with symptoms of disease and history of exacerbation may be a possible solution for identifying disease severity in old and sick patients unwilling/unable to come to hospital for a pulmonary function test post-LVRS.


Assuntos
Pneumonectomia/psicologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida/psicologia , Inquéritos e Questionários , Idoso , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Doença Pulmonar Obstrutiva Crônica/cirurgia , Capacidade Vital/fisiologia , Caminhada
15.
Intern Med ; 58(11): 1613-1616, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30713306

RESUMO

Bronchial thermoplasty (BT), which delivers thermal radiofrequency to the bronchial wall, is an effective therapy for patients with severe persistent uncontrolled asthma. We herein report the case of a 47-year-old man who underwent BT for uncontrolled severe asthma. After BT, his asthma control, asthma-related quality of life, and pulmonary function improved. Furthermore, a histologic examination of transbronchial biopsy specimens revealed a decrease in goblet cell hyperplasia and the smooth muscle mass as well as in the subepithelial basement membrane thickness. BT can be effective for patients with severe uncontrolled asthma and mucus hypersecretion.


Assuntos
Asma/cirurgia , Termoplastia Brônquica/métodos , Asma/patologia , Asma/fisiopatologia , Biópsia , Brônquios/patologia , Broncoscopia/métodos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Muco/metabolismo , Qualidade de Vida , Capacidade Vital/fisiologia
16.
Clin Respir J ; 13(4): 239-246, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30735004

RESUMO

BACKGROUND: Pulmonary function is not routinely assessed in patients without respiratory disease and symptoms before surgery, even if they are smokers. We aimed to check whether the new spirometric reference values of the worldwide Global Lung Initiative (GLI) affected the preoperative assessment of lung function in allegedly lung-healthy patients compared with the still commonly used old predicted values. METHODS: Two hundred nineteen allegedly lung-healthy non-smokers, past and current smokers were examined by spirometry before elective surgery. The obtained values of forced expiratory volume in 1 second (FEV1 ), forced vital capacity (FVC) and FEV1 /FVC were transformed into z-scores according to the GLI guidelines. A comparison between the new and old reference values was performed. FEV1 was used for the grading of airway obstruction. RESULTS: One hundred eighty-three subjects performed the ventilation manoeuvre according to the GLI recommendations and were analysed. Most non-smokers and past smokers met the new references ranges for spirometric values. Only z-scores of FEV1 /FVC distinguished among all three patient groups, FEV1 between smokers and the other two groups and FVC did not discriminate the groups, irrespective of the reference values used. Airway obstruction was identified in 24% of asymptomatic smokers by z-scores of FEV1 /FVC but in only 14% by the old predicted values. In elderly smokers (>60 years), the corresponding values rose to 50% and 30%. Old predicted values of FEV1 underestimated the degree of airway obstruction mainly in middle-aged smokers. CONCLUSION: Allegedly lung-healthy current smokers showed a higher proportion of preoperatively reduced lung function when z-scores were used, especially in elderly subjects.


Assuntos
Obstrução das Vias Respiratórias/classificação , Pulmão/fisiopatologia , Testes de Função Respiratória/métodos , Espirometria/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/diagnóstico , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Volume Expiratório Forçado/fisiologia , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/normas , Ventilação Pulmonar , Valores de Referência , Fumantes/estatística & dados numéricos , Capacidade Vital/fisiologia
17.
Rev Invest Clin ; 71(1): 28-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810541

RESUMO

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. While the cut-off point to define airflow obstruction has been controversial, it is widely accepted that the spirometry test is vital, as well as performing it after using a bronchodilator. The 6-second spirometry and the forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) have demonstrated validity for defining obstruction, and it would be advisable to incorporate them in the definitions of obstruction. Another relevant issue is that spirometry with borderline obstruction can vary over time, changing to above or below the cut-off point. Thus, surveillance should be considered over time, repeating the spirometry to have a greater certainty in the diagnosis. The objective of this article was to conduct an in-depth review of the controversies in the diagnosis of COPD. During the past years, COPD definition has been updated in different times; however, it is now considered more as a complex syndrome with systemic participation, requiring a multidimensional assessment, and not only a spirometry.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/métodos , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/fisiopatologia , Broncodilatadores/administração & dosagem , Volume Expiratório Forçado/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Tempo
18.
ESC Heart Fail ; 6(2): 379-387, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30784223

RESUMO

AIMS: Patients with heart failure (HF) are known to have a reduced pulmonary diffusion capacity for carbon monoxide (DLCO ), but little is known about how lung function relates to central haemodynamics. The aim of this study was to investigate the association between haemodynamic variables and pulmonary diffusion capacity adjusted for alveolar volume in congestive HF patients and to analyse how predicted DLCO /VA affects mortality in relation to the haemodynamic status. METHODS AND RESULTS: We retrospectively studied right heart catheterization (RHC) and lung function data on 262 HF patients (mean age 51 ± 13 years) with a left ventricular ejection fraction < 45% referred non-urgently for evaluation for heart transplantation (HTX) or left ventricular assist device (LVAD). Univariate and multivariate linear regression models were constructed to examine the associations between predicted values of DLCO /VA , forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1 ), and haemodynamic parameters [pulmonary capillary wedge pressure (PCWP), central venous pressure, cardiac index, mean pulmonary artery pressure, and mean arterial pressure] as well as other factors known to affect lung function in HF. FEV1 was reduced to <80% of predicted value in 55% of the population, and DLCO/ VA was reduced in 63% of the population. DLCO /VA correlated positively with pulmonary capillary wedge pressure in both univariate and multivariate analyses for all included patients (P < 0.001 and P = 0.045, respectively) and a restricted population of patients with the shortest time between RHC and lung function testing (P = 0.005, P = 0.015). DLCO /VA predicted mortality in multivariate models [hazard ratio 1.5 (1.1-2.1)] but not the combined endpoint of death, LVAD implantation, or HTX. There was no significant correlation between haemodynamics and predicted FVC or FEV1 . CONCLUSIONS: Pulmonary diffusion capacity correlates positively with left ventricular fillings pressures, and reduced values predict increased mortality in patients with HF. This might be driven by increased lung capillary volume in patients with pulmonary congestion.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Circulação Pulmonar/fisiologia , Capacidade de Difusão Pulmonar , Pressão Propulsora Pulmonar/fisiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Função Ventricular Esquerda
19.
Eur J Radiol ; 112: 28-36, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30777216

RESUMO

OBJECTIVE: To assess the diaphragmatic motion in chronic obstructive pulmonary disease (COPD) patients during forced breathing by time-resolved quantitative analysis using dynamic chest radiography and to demonstrate the characteristics and the difference from that in normal subjects. MATERIALS AND METHODS: Thirty-one COPD patients and a matched control of 31 normal subjects on age, sex, height, and weight, who underwent chest radiographs during forced breathing using dynamic chest radiography, were included in this study. COPD patients were classified based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (GOLD 1, n = 3; GOLD 2, n = 12; GOLD 3, n = 13; GOLD 4, n = 3). We measured excursions and peak motion speeds of the diaphragms for each participant. We compared the results among GOLD 1/2, GOLD 3/4 groups and normal subjects and investigated associations between the data, and participants' demographics, or pulmonary function. RESULTS: The excursions of bilateral diaphragms were significantly decreased in the GOLD 3/4 group relative to normal subjects (right, 39.8 ± 15.3 mm vs. 52.7 ± 15.1 mm, P = 0.030; left, 43.7 ± 14.0 mm vs. 56.9 ± 15.5 mm, P = 0.017; mean ± standard deviation) and the GOLD 1/2 group (right, 39.8 ± 15.3 mm vs. 54.4 ± 16.7 mm, P = 0.036; left, 43.7 ± 14.0 mm vs. 60.5 ± 13.9 mm, P = 0.008). The peak motion speeds of the left diaphragm in the inspiratory phase were slower in the GOLD 1/2 group than in normal subjects (24.5 ± 8.0 mm/s vs. 33.6 ± 14.0 mm/s, P = 0.038), and in the GOLD 3/4 group than in normal subjects (25.6 ± 6.8 mm/s vs. 33.6 ± 14.0 mm/s, P = 0.067). The excursions of the diaphragms showed correlation with VC, %VC, and FEV1, while the peak motion speeds showed no significant correlation with pulmonary function tests. CONCLUSIONS: Time-resolved quantitative analysis of diaphragms with dynamic chest radiography indicated differences in diaphragmatic motion between COPD groups and normal subjects during forced breathing. The excursions of the diaphragms during forced breathing were significantly lower in the GOLD 3/4 group than those in the GOLD 1/2 group and normal subjects.


Assuntos
Diafragma/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Respiração , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diafragma/diagnóstico por imagem , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Pulmão/fisiologia , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Radiografia , Testes de Função Respiratória
20.
Respir Res ; 20(1): 37, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777086

RESUMO

BACKGROUND: Inhaled corticosteroids reduce inflammation in asthma but chronic use may cause adverse effects. AZD7594, an inhaled non-steroidal selective glucocorticoid receptor modulator, has the potential of an improved risk-benefit profile. We investigated the safety and efficacy of AZD7594 in asthma. METHODS: This phase 2a multi-center, randomized, double-blind, placebo-controlled crossover study enrolled adults with asthma aged 18 to 75 years. Patients were treated with budesonide 200 µg twice daily for 2-3 3 weeks (run in part one). If controlled, as demonstrated by an asthma control questionnaire-5 score of < 1.5, patients entered a three-week run-in (part two) where they received a short acting bronchodilator alone. Thereafter, patients with a fractional exhaled nitric oxide (FENO) ≥25 ppb and pre-dose FEV1 40 to 90% predicted were randomized to one of nine treatment sequences. Each patient received placebo and two of three dose levels of AZD7594 (58, 250, 800 µg) once daily via inhalation, in 14-day treatment periods, separated by three-week washout periods. The primary endpoint was the change from baseline in morning trough FEV1 versus placebo on day 15. Secondary endpoints included measures of airway inflammation and asthma control. RESULTS: Fifty-four patients were randomized and received at least 1 dose of treatment, 48 patients completed the study. Overall 52 patients received placebo, 34 received AZD7594 58 µg, 34 received AZD7594 250 µg, and 34 received AZD7594 800 µg. AZD7594 800 µg demonstrated a significant improvement in Day 15 morning trough FEV1versus placebo (LS means difference 0.148 L 95% CI 0.035-0.261, p = 0.011), with a dose-dependent response seen in the 250 µg (0.076 L -0·036-0·188, p = 0.183) and 58 µg (0·027 L -0·086-0·140, p = 0.683). All secondary endpoints showed statistically significant improvement at the 800 µg dose. All doses demonstrated a significant reduction in FENO at day 15 p < 0.01. No statistically significant difference in plasma cortisol level was observed between AZD7594 and placebo at any dose. AZD7594 was considered safe and well tolerated. CONCLUSIONS: Two-week treatment with AZD7594 demonstrated a favorable risk-benefit profile in patients with mild to moderate asthma. Further clinical studies are needed to fully characterize AZD7594. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02479412 .


Assuntos
Asma/diagnóstico , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Receptores de Glucocorticoides/fisiologia , Administração por Inalação , Adulto , Asma/fisiopatologia , Estudos Cross-Over , Método Duplo-Cego , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Glucocorticoides/agonistas , Resultado do Tratamento
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