RESUMEN
INTRODUCTION: Chronic obstructive pulmonary disease (CPOD) is a severe, incapacitating pathology. Inspiratory and/or expiratory muscle training may favorably impact the indicators of both specific and general improvement with regard to this disease. We are hypothesizing that when combined with bronchial decluttering, this training will have a beneficial effect on lung function and quality of life in these patients. METHOD: Fourty COPD subjects classified Gold I and Gold II and aged 60.38±8.02years were divided into four groups of 10. Three of the groups were trained with the help of Threshold(®) tools used for (1) inspiratory, (2) expiratory and (3) inspiratory and expiratory purposes; their training supplemented the decluttering and lower limb muscle exercise that the 4th group concurrently received. The patients underwent 16 rehabilitation sessions over an 8-week period. The variables consisted in: (1) forced expiratory volume in 1s (FEV1) and spirometrically measured peak expiratory and inspiratory flow rates (PEFR and PIFR); (2) fatigability, dyspnea, heart rate and walking distance evaluated during the 6-minute walk test; (3) maximum inspiratory pressure and (4) maximum expiratory pressure as assessed by the Threshold(®) tools and (5) the signs of quality of life in terms of the Saint-George's respiratory questionnaire (SGRQ) score. RESULTS: Only in group 1, there was significant improvement with regard to FEV1 and PEFR. There was no PIFR modification in any of the groups. On the other hand, signs of quality of life scores along with dyspnea, fatigability and heart rate showed significant improvement in the three experimental groups, and significant improvement in maximum inspiratory pressure was observed in groups 1 and 3. DISCUSSION: When associated with decluttering techniques, diaphragmatic rehabilitation and lower limb muscle exercise along with psychological support and educational efforts, respiratory muscle training is beneficial when compared with the usual protocols in rehabilitation of COPD patients.
Asunto(s)
Ejercicios Respiratorios , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Mecánica Respiratoria/fisiología , Músculos Respiratorios/fisiopatología , Anciano , Disnea/rehabilitación , Femenino , Volumen Espiratorio Forzado , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio , Resistencia Física , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de VidaRESUMEN
Apoptosis has been postulated as a contributing factor in ischemia-reperfusion graft dysfunction following lung transplantation. The purpose of this study was to determine whether treatment with an endothelin-A/endothelin-B- (ET(A)/ET(B)) receptor antagonist could reduce the level of apoptosis observed in the lung following ischemia-reperfusion injury. Eleven dogs were subjected to left lung allotransplantation. Heart-lung blocks were harvested from donor dogs and preserved with modified Eurocollins solution and stored at 4 degrees C for 18 to 20 h. We investigated the level of apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL), in the lungs of animals receiving an intravenous infusion of saline (control, n = 5) or the ET receptor antagonist SB209670 (n = 6) (15 microg/kg/min). The infusion began 30 min prior to transplantation and continued for up to 6 h thereafter. The TUNEL staining was significantly higher in the airway epithelium and the parenchyma of the saline (control) group (40.67 +/- 6.16), compared with native right lungs (5.00 +/- 0.56) and the treatment group (14.13 +/- 2.84). We conclude that treatment of lung allografts with the mixed ET(A)/ET(B)-receptor antagonist SB209670 can ameliorate lung injury by reducing the level of apoptosis seen in the allograft following ischemia-reperfusion injury.
Asunto(s)
Apoptosis/efectos de los fármacos , Antagonistas de los Receptores de Endotelina , Indanos/farmacología , Isquemia/fisiopatología , Trasplante de Pulmón/efectos adversos , Pulmón/irrigación sanguínea , Animales , Perros , Etiquetado Corte-Fin in Situ , Pulmón/patología , Pulmón/fisiopatología , Trasplante HomólogoRESUMEN
Endothelins are 21 amino acid peptides that are produced ubiquitously by vascular endothelial cells, smooth muscle cells, and other cells in different organs. Endothelins are secreted as big-endothelins that are converted to active proteins by the endothelin-converting enzyme. These peptides possess many biological activities, such as vasoconstriction and mitogenesis, and are involved in numerous physiological and pathophysiological processes in humans. Elevated plasma levels of endothelin have been associated with heart failure, and increased immunoreactivity for endothelin is observed in transplant coronary artery disease. In this brief review, we will discuss the regulation of endothelin in cardiac transplantation and the pathological role this peptide plays in renal impairment, systemic hypertension, graft rejection and arteriosclerosis after heart transplantation.