ABSTRACT Objective To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation. Methods During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected. Results Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6) Conclusion A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure. ClinicalTrials.gov Identifier: NCT04033666. highflow high flow trial randomization function signs pulmonary index collected (2 2 group. . group) 4 therapy observed O (O2 use number puffs, puffs , puffs) 6.1±1.9 6119 6 9 (6.1±1. 4313 3 4.3±1. 95 interval 5.0 50 5 0 -5. 0.6 06 -0.6 Additionally ClinicalTrialsgov ClinicalTrials gov Identifier NCT04033666 NCT ( (O 6.1±1. 611 (6.1±1 431 4.3±1 5. -5 0. -0. NCT0403366 6.1±1 61 (6.1± 43 4.3± - -0 NCT040336 6.1± (6.1 4.3 NCT04033 6.1 (6. 4. NCT0403 6. (6 NCT040 NCT04 NCT0

Abstract Introduction Chronic obstructive pulmonary disease (COPD) is characterized by limited airflow associated with inflammatory response and systemic manifestations, such as dyspnea, as well as physical inactivity and intolerance to exercise. The sum of these changes can lead to peripheral muscle fatigue and exert an impact on the performance of activities of daily living (ADL). Objective To investigate the possible association between peripheral muscle fatigue and performance on ADL in individuals with COPD, and to compare the results to those of healthy age-matched individuals. Methods Individuals with a diagnosis of COPD and healthy volunteers aged 60 years or older were submitted to evaluations of peripheral muscle fatigue (using surface electromyography) and performance on the Glittre-ADL test. Results Nine individuals with COPD and ten controls were evaluated. Median isometric quadriceps contraction time was 72 [38] and 56 [51] seconds, respectively. Execution time on the ADL test was 6.1 [4] and 3.6 [1.3] minutes for COPD and control group respectively, with a significant difference between groups (p < 0.05). However, no significant correlation was found between the evaluations. Conclusion No association was found between quadriceps muscle fatigue and performance on ADL in the sample studied. In the intergroup comparison, the individuals with COPD exhibited worse ADL time execution, but no significant difference was found regarding quadriceps muscle fatigue. (COPD manifestations dyspnea exercise ADL. . (ADL) agematched age matched 6 using electromyography GlittreADL Glittre evaluated 7 38 [38 5 51 [51 seconds respectively 61 1 6. 4 [4 36 3 3. 1.3 13 [1.3 p 0.05. 005 0.05 0 05 0.05) However studied comparison execution (ADL [3 [5 [ 1. [1. 00 0.0 [1 0.

Resumo Introdução A doença pulmonar obstrutiva crônica (DPOC) é caracterizada por fluxo aéreo limitado associado à resposta inflamatória e manifestações sistêmicas, como dispneia, além de inatividade física e intolerância ao exercício. A soma dessas alterações pode levar à fadiga muscular periférica e exercer impacto no desempenho das atividades de vida diária (AVD). Objetivo Investigar a possível associação entre fadiga muscular periférica e desempenho em AVD em indivíduos com DPOC e comparar os resultados com indivíduos saudáveis da mesma faixa etária. Métodos Indivíduos com diagnóstico de DPOC e voluntários saudáveis com idade igual ou superior a 60 anos foram submetidos a avaliações de fadiga muscular periférica (por meio de eletromiografia de superfície) e desempenho no teste Glittre-ADL. Resultados Foram avaliados nove indivíduos com DPOC e dez controles. O tempo médio de contração isométrica do quadríceps foi de 72 [38] e 56 [51] segundos, respectivamente. O tempo de execução do teste de AVD foi de 6,18 [4,09] e 3,67 [1,3] minutos para DPOC e grupo controle, respectivamente, com diferença significativa entre os grupos (p < 0,05). No entanto não encontrou-se correlação significativa entre as avaliações. Conclusão Não encontrou-se associação entre a fadiga muscular do quadríceps e o desempenho nas AVD na amostra estudada. Na comparação intergrupos, os indivíduos com DPOC apresentaram pior tempo de execução das AVD, mas não encontrou-se diferença significativa em relação à fadiga muscular do quadríceps. (DPOC sistêmicas dispneia exercício AVD. . (AVD) etária 6 superfície GlittreADL. GlittreADL Glittre ADL. ADL Glittre-ADL controles 7 38 [38 5 51 [51 segundos respectivamente 618 18 6,1 4,09 409 4 09 [4,09 367 3 67 3,6 1,3 13 1 [1,3 controle p 0,05. 005 0,05 0 05 0,05) encontrouse encontrou se estudada intergrupos (AVD [3 [5 61 6, 4,0 40 [4,0 36 3, 1, [1, 00 0,0 [ 4, [4, [1 0, [4

Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and psychological impairments. Physical exercise is a therapy that can restore physical and functional capacities; however, it is necessary to understand the effects of its practice in post-HSCT individuals. The purpose of this systematic review (SR) was to assess the impact of physical exercise in children and adolescents undergoing HSCT. The SR was conducted following the PRISMA guidelines through search in the electronic databases Embase, Lilacs, PEDro, PubMed and SCOPUS, without limitation of dates and languages. Randomized or non-randomized clinical trials with children and adolescents who underwent HSCT, aged between 3 to 19 years old, who participated in a regular physical activity program, were assessed. After removing duplicates and selecting studies according to the eligibility criteria, seven parallel studies incorporating hospitalized and discharged participants undertaking aerobic and strengthening exercises were included in this study. The main outcomes analyzed were exercise capacity, quality-of-life, body composition and freedom. Five studies comprised the meta-analysis regarding the effects of the distance walked in the 6-min walk test and quality-of-life. Physical exercise is considered to be safe, feasible and efficacious to prevent the decline of the quality-of-life in children and adolescents undergoing HCST, as well as a considerable improvement in physical capacity.

RESUMO Objetivo: Avaliar as respostas fisiológicas e do sistema nervoso autônomo de recém-nascidos prematuros ao posicionamento do corpo e ruídos ambientais na unidade de terapia intensiva neonatal. Métodos: Este foi um estudo quasi-experimental. O sistema nervoso autônomo de recém-nascidos foi avaliado com base na variabilidade da frequência cardíaca quando os recém-nascidos foram expostos ao ruído ambiental e colocados em diferentes posições: supina sem suporte, supina com restrição manual e prona. Resultados: Cinquenta recém-nascidos prematuros foram avaliados (idade gestacional de 32,6 ± 2,3 semanas, peso de 1.816 ± 493g e nível Brazelton de sono/vigília de 3 a 4). Identificou-se correlação positiva entre o ruído ambiental e a atividade simpática (R = 0,27; p = 0,04). O ruído ambiental médio foi de 53 ± 14dB. A frequência cardíaca foi mais elevada na posição supina do que nas posições com restrição manual e prona (148,7 ± 21,6; 141,9 ± 16 e 144 ± 13, respectivamente; p = 0,001). A atividade simpática, representada por um índice de baixa frequência, foi mais elevada na posição supina (p < 0,05) do que nas demais posições, e a atividade parassimpática (alta frequência, raiz quadrada da média dos quadrados das diferenças entre os intervalos RR normais adjacentes e porcentagem dos intervalos R-R adjacentes com diferença de duração maior que 50ms) foi mais elevada na posição prona (p < 0,05) do que nas demais posições. A complexidade dos ajustes autonômicos (entropia aproximada e entropia da amostra) foi mais baixa na posição supina do que nas demais posições. Conclusão: A posição prona e a posição com restrição manual aumentaram tanto a atividade parassimpática quanto a complexidade dos ajustes autonômicos em comparação com a posição supina, mesmo na presença de ruído ambiental maior do que o nível recomendado, o que tende a aumentar a atividade simpática.

ABSTRACT Objective: Evaluate the physiological and autonomic nervous system responses of premature newborns to body position and noise in the neonatal intensive care unit. Methods: A quasi-experimental study. The autonomic nervous system of newborns was evaluated based on heart rate variability when the newborns were exposed to environmental noise and placed in different positions: supine without support, supine with manual restraint and prone. Results: Fifty premature newborns were evaluated (gestational age: 32.6 ± 2.3 weeks; weight: 1816 ± 493g; and Brazelton sleep/awake level: 3 to 4). A positive correlation was found between environmental noise and sympathetic activity (R = 0.27, p = 0.04). The mean environmental noise was 53 ± 14dB. The heart rate was higher in the supine position than in the manual restraint and prone positions (148.7 ± 21.6, 141.9 ± 16 and 144 ± 13, respectively) (p = 0.001). Sympathetic activity, represented by a low frequency index, was higher in the supine position (p < 0.05) than in the other positions, and parasympathetic activity (high frequency, root mean square of the sum of differences between normal adjacent mean R-R interval and percentage of adjacent iRR that differed by more than 50ms) was higher in the prone position (p < 0.05) than in the other positions. The complexity of the autonomic adjustments (approximate entropy and sample entropy) was lower in the supine position than in the other positions. Conclusion: The prone position and manual restraint position increased both parasympathetic activity and the complexity of autonomic adjustments in comparison to the supine position, even in the presence of higher environmental noise than the recommended level, which tends to increase sympathetic activity.

OBJECTIVE: To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics. METHODS: Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery. RESULTS: Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes. CONCLUSION: The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.

RESUMO No processo de envelhecimento, entre outras perdas funcionais, ocorrem reduções no desempenho físico e capacidade funcional respiratória. Sabe-se que o treinamento resistido (TR) é eficaz no desenvolvimento do trofismo e força muscular, contudo, pouco se sabe sobre a influência do TR em variáveis respiratórias. Este estudo comparou as pressões inspiratórias e expiratórias máximas (PImáx; PEmáx), as amplitudes Axilar (AAx), Xifoideana (AXi) e Abdominal (AAb), o Peak-Flow e o desempenho no Incremental ShuttleWalk Test (ISWT) de idosas praticantes de um programa de TR, com os de idosas não treinadas. Foram avaliadas 53 mulheres idosas, idade de 66±5,2 anos, sendo 28 participantes de um projeto de extensão da Universidade do Estado do Pará, com mínimo de seis meses de matrículaem um programa de TR, que compuseram o grupo de treinadas (GT) e, 25 voluntárias que compuseram o grupo de nãotreinadas (GNT). As avaliações constaram de medidas de PImáx, PEmáx, AAx, AXi, AAb, Peak-Flow e de desempenho no ISWT. Constataram-se diferenças significativas, com valores favoráveis ao GT em todas as variáveis avaliadas, exceto AAb. Conclui-se que mulheres idosas do GT obtiveram diferenças favoráveis e significativas na PImáx, PEmáx, AAx, AXi, Peak-Flow e ISWT, quando comparadas com mulheres idosas do GNT.

ABSTRACT In the aging process, additionally to other functional losses, there are reductions in physical and functional respiratory performance.It is known that resistance training (RT) is effective at developing trophism and muscle strength; however, little is known about the influence of RT on respiratory variables. To compare maximal inspiratory and expiratory pressures (MIP; MEP), Axillary, Xiphoid and Abdominal ranges - AxR, XiR and AbR -, Peakflow and performance in theIncremental Shuttle Walk Test (ISWT) of elderly women participating in an RT program with those of untrained ones. Methods: 53 women, aged 66 ± 5.2 years -28 participants of an extension project at Pará State University, with a minimum of 6 months of practice in a RT program, composing the trained group (TG), and 25 volunteers who composed the untrained group (UG). Assessments consisted of measurements of MIP, MEP, AxR, XiR, AbR, Peak Flow and performance in the ISWT. As results, significant differences were found, with better values in the TG as to all variables assessed, except for AbR. In conclusion, elderly women subjected to anRT program showed favorable and significant differences in MIP, MEP, XiR, Peakflow and ISWT compared tountrained ones.

Resumo Justificativa e objetivo: Observar a prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica e a influência do índice de massa corporal (IMC), do sexo e da idade sobre a prevalência de atelectasia. Método: Estudo retrospectivo de 407 pacientes e laudos de radiografias de tórax feitas antes e após a cirurgia bariátrica durante 14 meses. Apenas os pacientes submetidos à cirurgia bariátrica por laparotomia foram incluídos. Resultados: Houve uma prevalência geral de atelectasia de 37,84%, com maior prevalência nas bases pulmonares e em mulheres (RR = 1,48). Houve uma proporção de 30% para a influência da idade nos indivíduos com menos de 36 anos e de 45% naqueles com mais de 36 anos (RR = 0,68). Não houve influência significativa do IMC sobre a prevalência de atelectasia. Conclusão: A prevalência de atelectasia em cirurgia bariátrica é de 37% e os principais fatores de risco são sexo feminino e idade superior a 36 anos.

Abstract Background and objective: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. Method: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. Results: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR = 1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR = 0.68). There was no significant influence of BMI on the prevalence of atelectasis. Conclusion: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

RESUMO: O presente trabalho foi executado por uma equipe multidisciplinar e interinstitucional, objetivando determinar o perfil hematológico, a concentração de proteínas totais e o fibrinogênio plasmático de equinos adultos e clinicamente sadios da raça Campeiro. Foram utilizados 138 animais (14 machos inteiros, 74 fêmeas vazias e 50 prenhes), com idades acima de três anos, provenientes de criatórios localizados em Santa Catarina e Rio Grande do Sul, divididos em grupos de acordo com a idade, sexo e estado gestacional. A análise estatística dos dados foi realizada por meio do teste ANOVA, teste t de Student e análise descritiva (P<0,05). Houve diferença significativa (P<0,05) para os valores do HCM, VCM e número total de eosinófilos, quando comparadas as diferentes faixas etárias. Também houve diferença (P<0,05) para as variáveis PTP e número total de eosinófilos, quando comparadas fêmeas prenhas e vazias. A partir desses resultados, pode-se concluir que os equinos Campeiros apresentam particularidades com relação às variáveis do hemograma, proteínas totais e fibrinogênio plasmático, quando comparados aos descritos por outros autores em outras raças. Sendo assim, sugere-se que os valores estabelecidos no presente estudo sejam tomados como valores de referência na interpretação do eritrograma e leucograma para a avaliação dessas variáveis em equinos da raça Campeiro.

ABSTRACT: This research was performed by a multidisciplinary and interagency team and sought to determine the blood profile, total plasma protein and fibrinogen concentrations of clinically healthy adult Campeiro horses. A total of 138 horses (14 stallions, 74 non-pregnant and 50 pregnant mares) over three years of age from breeders located in the states of Santa Catarina and Rio Grande do Sul were divided into groups according to age, sex and pregnancy status. Statistical analysis of the data was performed using the ANOVA test, Student's T test, and descriptive analyses (P<0.05). There was a significant difference (P<0.05) in the values for MCV, MCH, and total number of eosinophiles when comparing different age groups. There was also a notable difference (P<0.05) in the total plasma protein and total number of eosinophile variables when comparing pregnant females to non-pregnant females. These results show that the Campeiro breed presents certain peculiarities regarding variables in the complete blood count, total plasma protein and fibrinogen compared to the values described by other authors for other breeds. Thus, it is suggested that the values established in this study should be used as benchmarks for interpreting erythrocyte and leukocyte counts when evaluating these variables in Campeiro horses.

Objetivo Correlacionar as respostas de testes de capacidade funcional em indivíduos portadores de doença pulmonar obstrutiva crônica (DPOC) com o estado funcional avaliado de maneira subjetiva pelos questionários de qualidade de vida, sendo um específico para doença respiratória (SGRQ) e outro genérico (SF-36). Materiais e métodos Foi realizado um estudo de uma série de casos com oito pacientes portadores de DPOC que realizaram os seguintes testes: 1) Teste de caminhada de seis minutos (TC6’); 2) Shuttle walking test (SWT); 3) Teste do degrau de seis minutos (TD6’); 4) Teste de sentar e levantar-se da cadeira em dois minutos (TCad-2min); e 5) Pegboard and ring test (PBRT). Além dos testes, foram aplicados dois questionários de qualidade de vida: Hospital Saint George na doença respiratória (SGRQ) e o Short Form 36 (SF-36). A análise estatística foi realizada pelo teste de normalidade Shapiro-Wilk seguido dos testes de correlação de Pearson (dados paramétricos) ou de Spearman (dados não-paramétricos) com p < 0,05. Resultados Somente o TC6’ mostrou forte correlação com o SF-36 nos aspectos físicos, estado geral de saúde, vitalidade, aspectos sociais e saúde mental, diferentemente dos outros testes de capacidade funcional que não mostraram correlação com este questionário. Com relação ao SGRQ, não houve correlação com nenhum dos testes. Conclusões O TC6’ pode ser um bom teste para refletir a qualidade de vida dos indivíduos portadores de DPOC.

Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson's (parametric data) or Spearman's (non-parametric data) rank tests, with p < 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

BACKGROUND: Diaphragmatic breathing (DB) is widely used in pulmonary rehabilitation (PR) of patients with chronic obstructive pulmonary disease (COPD), however it has been little studied in the scientific literature. The Pilates breathing (PB) method has also been used in the rehabilitation area and has been little studied in the scientific literature and in COPD. OBJECTIVES: To compare ventilatory parameters during DB and PB in COPD patients and healthy adults. METHOD: Fifteen COPD patients (COPD group) and fifteen healthy patients (healthy group) performed three types of respiration: natural breathing (NB), DB, and PB, with the respiratory pattern being analyzed by respiratory inductive plethysmography. The parameters of time, volume, and thoracoabdominal coordination were evaluated. After the Shapiro-Wilk normality test, ANOVA was applied followed by Tukey's test (intragroup analysis) and Student's t-test (intergroup analysis; p<0.05). RESULTS: DB promoted increase in respiratory volumes, times, and SpO2 as well as decrease in respiratory rate in both groups. PB increased respiratory volumes in healthy group, with no additional benefits of respiratory pattern in the COPD group. With respect to thoracoabdominal coordination, both groups presented higher asynchrony during DB, with a greater increase in the healthy group. CONCLUSIONS: DB showed positive effects such as increase in lung volumes, respiratory motion, and SpO2 and reduction in respiratory rate. Although there were no changes in volume and time measurements during PB in COPD, this breathing pattern increased volumes in the healthy subjects and increased oxygenation in both groups. In this context, the acute benefits of DB are emphasized as a supporting treatment in respiratory rehabilitation programs.

A doença pulmonar obstrutiva crônica (DPOC) está relacionada a um baixo índice de massa corporal (IMC), à redução da capacidade funcional e à redução da densidade óssea, justificando assim a importância de se avaliar todos esses parâmetros nos pacientes portadores da doença. Trata-se de um estudo transversal, com amostra composta por 20 pacientes, que realizaram medida de composição corporal por bioimpedância, avaliação da capacidade funcional pela distância percorrida no Incremental Shuttle Walk Test (ISWT) e avaliação da gravidade da obstrução pela espirometria. Foram encontradas diferenças significantes entre a distância percorrida e prevista do ISWT (p<0,01), correlações positivas entre massa muscular e distância percorrida no ISWT (r=0,54 com p=0,01), com VEF1 (r=0,488 com p=0,02), VEF1 e massa óssea (r=0,497 com p=0,02) e distância percorrida com VEF1 (r=0,541 com p=0,01). As correlações encontradas neste estudo, além de confirmarem a hipótese de que a gravidade da obstrução apresentada pela alteração no parênquima pulmonar nos pacientes com DPOC está relacionada com as alterações na composição corporal e com a redução da capacidade funcional, evidenciam também a correlação com a massa óssea.

Chronic obstructive pulmonary disease (COPD) is related to a low body mass index (BMI), reduced functional capacity and reduced bone density, thus justifying the importance of evaluating all of these parameters in the patients with the disease. This is a cross-sectional study, with sample consisting of 20 patients who performed measurement of body composition by bioelectrical impedance, evaluation of functional capacity by the distance traveled in the Incremental Shuttle Walk Test (ISWT) and assessment of severity of obstruction by spirometry. Significant differences were found between the travelled and scheduled distance in the ISWT (p<0.01), positive correlations between muscle mass and distance walked in ISWT (r=0.54 with p=0.01), with FEV1 (r=0.488 with p=0.02), FEV1 and bone mass (r=0.497 with p=0.02) and distance traveled with FEV1 (r=0,541 with p=0.01). The correlations found in this study, besides confirming the hypothesis that the severity of the obstruction presented by the change in the lung parenchyma in patients with COPD is related to changes in body composition and functional capacity reduction, also highlight the correlation with bone mass.

La enfermedad pulmonar obstructiva crónica (EPOC) está relacionada con un bajo índice de masa corporal (IMC), reducción de la capacidad funcional y reducción de la densidad ósea, justificando así la importancia de evaluar todos estos parámetros en pacientes con la enfermedad. Este es un estudio transversal, con una muestra de 20 pacientes, que se sometieron a la medición de la composición corporal por bioimpedancia, la evaluación de la capacidad funcional por la distancia recorrida en el Incremental Shuttle Walk Test (ISWT) y la evaluación de la gravedad de la obstrucción por la espirometría. Se encontraron diferencias significativas entre la distancia recorrida y prevista del ISWT (p<0,01), correlaciones positivas entre la masa muscular y la distancia en el ISWT (r=0,54 con p=0,01), con FEV1 (r=0,488 con p=0,02 ), FEV1 y la masa ósea (r=0,497 con p=0,02) y la distancia recorrida con el FEV1 (r=0,541 con p=0,01) . Las correlaciones encontradas en este estudio, además de confirmar la hipótesis de que la gravedad de la obstrucción presentada por los cambios en el parénquima pulmonar en pacientes con EPOC se asocia con cambios en la composición corporal y la reducción de la capacidad funcional, evidencian también la correlación con la masa ósea.

BACKGROUND: Transcutaneous electrical diaphragmatic stimulation (TEDS) has been used to improve respiratory muscle strength in patients with respiratory muscle weakness. However, this physical therapy resource has not been studied in chronic obstructive pulmonary disease (COPD). OBJECTIVE: To evaluate the respiratory pattern during one session of TEDS in COPD patients. METHOD: Fifteen COPD patients participated in one TEDS session for plethysmographic analysis and assessment of peripheral oxygen saturation (SpO2) and heart rate (HR). After the session, patients were divided into two groups: Responder (R; n=9) and Non-Responder (NR; n=6) to TEDS. Statistic analysis was performed using the Shapiro-Wilk normality test and two-way ANOVA. For the parameters that showed interaction, the Student t test was used (P<0.05). RESULTS: R group consisted mainly of men, with lower SpO2 and higher HR than NR group. When time (before and during) and groups (R and NR) were compared (interaction), there were differences in the parameters minute ventilation (Vent), inspiratory tidal volume (ViVol), expiratory tidal volume (VeVol), and respiratory rate (Br/M). In the intergroup comparison, differences were observed in the parameters Vent, ViVol, and VeVol. A significant effect was also observed for time in change in end-expiratory lung volume level (qDEEL), phase relation during inspiration (PhRIB); phase relation during expiration (PhREB); phase relation of entire breath (PhRTB), and phase angle (PhAng). During TEDS, there was an increase in SpO2 and a reduction in HR in both groups. CONCLUSIONS: The most hypoxemic group with greater HR responded to TEDS and there was interaction between group and time of analysis for the pulmonary volumes. The time factor had an influence on the two groups with an increase in thoracoabdominal asynchrony.

O objetivo do estudo foi avaliar o efeito da estimulação diafragmática elétrica transcutânea (EDET) sobre a força e endurance muscular respiratória, expansibilidade toracoabdominal e variáveis espirométricas de indivíduos com doença pulmonar obstrutiva crônica (DPOC). Oito pacientes com DPOC submetidos à fisioterapia respiratória receberam tratamento com EDET duas vezes por semana durante 06 semanas, totalizando 12 sessões. Antes e depois do tratamento eles foram avaliados pelos seguintes parâmetros: pressão inspiratória máxima (PImáx); pressão expiratória máxima (PEmáx); cirtometria axilar, xifoideana e abdominal; e espirometria. Após o teste Shapiro-Wilk, o teste t de Student pareado e o teste Mann-Whitney foram aplicados para a comparação dos dois estágios (antes e após a EDET). Para a comparação dos estágios antes, após (pós-1a sessão), 1ª, 2ª, 3ª e 4ª semana, a ANOVA seguida do teste de Tukey foram aplicados (p<0,05). De acordo com os resultados obtidos, foi observado que a EDET promoveu aumento significativo em: PImáx (47,3%); PEmáx (21,7%); cirtometria axilar (55,5%); xifoideana (59,2%) e abdominal (74,2%), mas não nas variáveis espirométricas. Na análise longitudinal (nas 4 semanas seguintes) o aumento encontrado na PImáx e na expansibilidade toracoabdominal foi mantido. Assim conclui-se que a EDET promoveu melhora na força muscular respiratória e na expansibilidade toracoabdominal em pacientes com DPOC sem alteração nas variáveis espirométricas; e alguns parâmetros foram mantidos nas quatro semanas seguintes.

The objective of this study was to evaluate the effect of transcutaneous electrical diaphragmatic stimulation (TEDS) on respiratory muscle strength and endurance, thoracic-abdominal expansibility and spirometric variables of subjects with chronic as obstructive pulmonary disease (COPD). Eight COPD patients submitted to respiratory physiotherapy received treatment with TEDS twice a week for 06 weeks, totaling 12 sessions. Before and after TEDS they were evaluated by the following parameters: maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP); axillary, xiphoid and abdominal cyrtometry; and spirometry. After the Shapiro-Wilk test, the paired Student's-t test and the Mann-Whitney test were applied for comparison of the two stages (before and after TEDS). For comparison of the before, after (post-1st session), 1st, 2nd, 3rd, 4th week stages, the ANOVA followed by Tukey test were applied (p<0.05). In accordance with the results obtained it was observed that TEDS promoted significant increase in: MIP (47.3%); MEP (21.7%); axillary (55.5%); xiphoid (59.2%) and abdominal (74.2%) cyrtometry, but not in the spirometric variables. In longitudinal analysis (in the 4 following weeks) the increase found in MIP and in thoracic-abdominal expansibility was maintained. Thus, we conclude that TEDS promoted improvement in respiratory muscle strength and thoracic-abdominal expansibility in COPD patients without alterations in spirometric variables, and some parameters were maintained in the following 4 weeks..

El objetivo del estudio fue evaluar el efecto de la estimulación diafragmática eléctrica transcutánea (EDET) sobre la fuerza y endurance muscular respiratoria, expansibilidad toracoabdominal y variables espirométricas de individuos con enfermedad pulmonar obstructiva crónica (EPOC). Ocho pacientes con EPOC sometidos a fisioterapia respiratoria recibieron tratamiento con EDET dos veces por semana durante 6 semanas, totalizando 12 sesiones. Antes y después del tratamiento fueron evaluados por los siguientes parámetros: presión inspiratoria máxima (PImáx); presión expiratoria máxima (PEmáx); cirtometría axilar, xifoidea y abdominal; y espirometría. Después del test Shapiro-Wilk, el test t de Student pareado y el test Mann-Whitney fueron aplicados para la comparación de los dos niveles (antes y después de la EDET). Para la comparación de los niveles antes, después (post-1a sesión), 1ª, 2ª, 3ª y 4ª semana, la ANOVA seguida del test de Tukey fueron aplicados (p<0,05). De acuerdo con los resultados obtenidos, fue observado que la EDET promovió aumento significativo en: PImáx (47,3%); PEmáx (21,7%); cirtometría axilar (55,5%); xifoidea (59,2%) y abdominal (74,2%), pero no en las variables espirométricas. En el análisis longitudinal (en las 4 semanas siguientes) el aumento encontrado en la PImáx y en la expansibilidad toracoabdominal fue mantenido. Así se concluye que la EDET promovió mejora en la fuerza muscular respiratoria y en la expansibilidad toracoabdominal en pacientes con EPOC sin alteración en las variables espirométricas; y algunos parámetros fueron mantenidos en las cuatro semanas siguientes.

OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC) e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obesas mórbidas apresentaram uma idade pulmonar significativamente superior (50,1 ± 6,8 anos) às eutróficas (38,8 ± 11,4 anos). Não houve diferença entre a idade cronológica entre os grupos. Houve uma correlação significativa e positiva entre idade cronológica, massa corporal e IMC com a idade pulmonar (r = 0,3647, 0,4182, 0,3743, respectivamente). Houve uma correlação negativa entre a capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1), razão (VEF1/CVF) e volume de reserva expiratório (VRE) com a idade pulmonar (r = -0.7565, -0.8769, -0.2723, -0.2417, respectivamente). CONCLUSÃO: A idade pulmonar das obesas mórbidas encontra-se aumentada e está associada com o aumento da massa corporal e IMC.

OBJECTIVE: To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables. METHODS: This was a cross-sectional study with 72 morbidly obese women and a control group consisting of 37 normal weight women. The subjects performed a pulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes. RESULTS: The morbidly obese group had significantly higher lung age (50.1 ± 6.8 years) than the control group (38.8 ± 11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r = 0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lung age (r = -0.7565, -0.8769, -0.2723, and -0.2417, respectively). CONCLUSION: Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.