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Background: The quality of the spirometry is estimated with criteria of acceptability and repeatability. The repeatability criteria accepted by consensus is < 0.150 L. Objective: To know the repeatability in quality A spirometry. Material and methods: Analytical cross-sectional design. The demographic variables and the 3 best spirometry curves with normal, suggestive of restriction and bronchial obstruction profiles were obtained from consecutive subjects of both genders from 18 to 80 years of age. The repeatability was analyzed with the mean difference (bias) and the intraclass correlation coefficient. Results: 630 curves from 210 subjects were accepted. Group age 60 ± 15 years. Female predominance 113 (53.8%), occupation: domestic services 61 (29%), and diagnosed with chronic obstructive pulmonary disease: 70 (33.4%). The differences in the curves were < 0.150 L. The mean difference (bias) and the intraclass correlation coefficient (95% confidence interval, 95% CI) of the forced expiratory volume in the first second were 1 vs. 2 maneuver: -0.01 (0.13, -0.14), 0.997 (95% CI 0.996, 0.998); 2 vs. 3 maneuver: 0.00 (0.13, -0.13), 0.997 (95% CI 0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.16, -0.17), 0.995 (95% CI 0.994, 0.996). Forced vital capacity: 1 vs. 2 maneuver: -0.01 (0.17, -0.18), 0.996 (95% CI 0.995, 0.997); 2 vs. 3 maneuver: 0.01 (0.17, -0.16), 0.997 (95% CI 0.0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.18, -0.19), 0.996 (95% CI 0.995, 0.997). Conclusion: The repeatability obtained in spirometry with quality A validates the use of the repeatability criterion of 0.150 L.
Introducción: la calidad de la espirometría se estima con criterios de aceptabilidad y repetitividad. La repetitividad aceptada por consenso es < 0.150 L. Objetivo: conocer la repetitividad en espirometrías de calidad A. Material y métodos: diseño transversal analítico. Se obtuvieron las variables demográficas y las 3 mejores curvas de espirometría con perfil normal, que sugiriera restricción y obstrucción bronquial de sujetos consecutivos de ambos géneros de 18 a 80 años. La repetitividad se analizó con la diferencia de medias (sesgo) y el coeficiente de correlación intraclase. Resultados: se aceptaron 630 curvas de 210 sujetos. Edad grupal 60 ± 15 años. Predominio femenino 113 (53.8%), ocupación: servicios domésticos 61 (29%) y con enfermedad pulmonar obstructiva crónica 70 (33.4%). Las diferencias en las curvas fueron < 0.150 L. Las diferencias medias (sesgo) y el coeficiente de correlación intraclase (intervalo de confianza al 95%, IC 95%) del volumen espiratorio forzado en el primer segundo fueron: maniobra 1 frente a 2: −0.01 (0.13, −0.14), 0.997 (IC 95% 0.996, 0.998); maniobra 2 frente a 3: 0.00 (0.13, −0.13), 0.997 (IC 95% 0.996, 0.998), y maniobra 1 frente a 3: −0.00 (0.16, −0.17), 0.995 (IC 95% 0.994, 0.996). La capacidad vital forzada: maniobra 1 frente a 2: −0.01 (0.17, −0.18), 0.996 (IC 95% 0.995, 0.997); maniobra 2 frente a 3: 0.01 (0.17, −0.16), 0.997 (IC 95% 0.0.996, 0.998), y maniobra 1 frente a 3: −0.00 (0.18, −0.19), 0.996 (IC 95% 0.995, 0.997). Conclusión: la repetitividad obtenida en espirometrías con calidad A valida el uso del criterio de repetitividad de 0.150 L.
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Espirometria , Humanos , Estudos Transversais , Espirometria/normas , Espirometria/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Reprodutibilidade dos Testes , Adolescente , Adulto Jovem , Idoso de 80 Anos ou mais , Volume Expiratório Forçado , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologiaRESUMO
Introducción. Los niños requieren especial dedicación para lograr espirometrías de calidad. Objetivo. Este trabajo evalúa la frecuencia de maniobras aceptables en escolares, la utilidad de gestos de incentivo para optimizar la obtención de pruebas de alta calidad y realiza un análisis de ajuste a varias ecuaciones de referencia. Materiales y Métodos. Se realizaron maniobras espiratorias forzadas en un grupo de escolares de Asunción- Paraguay, escogiendo variables recomendadas para la interpretación en un espirómetro portátil, para evaluar la frecuencia de pruebas de calidad. Aquellos que no consiguieron estudios aceptables, fueron sometidos a un entrenamiento con silbato en rollo (juguete) para evaluar el desempeño ulterior. Los resultados de alta calidad fueron pareados a valores esperados determinados por diversas ecuaciones buscando evaluar el grado de adecuación. Resultados. De 113 escolares, el 58,4% pudo conseguir maniobras de grado A o B. Después del estímulo con el silbato en rollo, la frecuencia de estudios aceptables ascendió a 79,6%. Los parámetros de referencia con mejor ajuste fueron aquellos determinados por la Global Lung Initiative (GLI). Conclusión. Los incentivos lúdicos son una alternativa para optimizar la obtención de pruebas de espirometría en escolares, que con el uso de parámetros de GLI adecuarían el manejo clínico de ciertas enfermedades respiratorias.
Introduction. Children require special dedication to achieve high quality spirometry. Objective. This work evaluates the frequency of acceptable maneuvers in schoolchildren, the usefulness of incentive gestures to optimize the obtaining of high-quality tests, and performs an analysis of adjustments to several reference equations. Material and Methods. Forced expiratory maneuvers were performed in a group of schoolchildren from Asunción, Paraguay, choosing variables recommended for interpretation in a portable spirometer, to evaluate the frequency of high quality tests. Those who did not achieve acceptable studies were subjected to training with a roll whistle (toy) to evaluate their subsequent performance. The high-quality results were matched to expected values determined by various equations to evaluate adequacy. Results. Of 113 schoolchildren, 58,4% were able to achieve grade A or B maneuvers. After the stimulus with the roll whistle, the frequency of acceptable studies rose to 79,6%. The reference parameters with the best fit were those determined by the Global Lung Initiative (GLI). Conclusion. Playful incentives are an alternative to obtaining acceptable spirometry tests in schoolchildren, which, with the use of GLI parameters, would adjust the clinical management of certain respiratory diseases.
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Humanos , Masculino , Feminino , Criança , Testes de Função Respiratória , Espirometria , Criança , Capacidade Vital , Volume Expiratório ForçadoRESUMO
Introduction: The National Health and Nutrition Assessment Survey (NHANES) is being adopted for interpreting spirometry in occupational examinations. Rubber workers have an elevated risk of respiratory health issues due to industrial exposure, and changes in the equations would affect spirometry monitoring programs. Objective: To determine the differences in the use of the Knudson and NHANES III equations in nonsmoking workers in the rubber industry. Method: A cross-sectional study was conducted with 75 nonsmoking workers with occupational exposure to rubber for at least two years. The factory had engineered protection controls and provided respiratory protection to the workers. Spirometry was conducted according to Spirometry Testing in Occupational Health Programs and Standardization of Spirometry: American Thoracic Society/European Respiratory Society. Result: Spirometric prediction differences were present in the restrictive pattern assessment based on forced vital capacity (FVC), in which three individuals (4%) classified as normal according to Knudson presented restrictive disease according to NHANES III; only in the record of one participant was there restrictive disease using both equations. There was an 8% discrepancy for small airway obstruction in which six workers classified as normal using NHANES III were classified as diseased (FEF 25-75 <50%) using the Knudson equation. Conclusion: In the respiratory examination of workers exposed to rubber, the NHANES III equation is better able to detect restrictive diseases than is the Knudson equation; however, the Knudson equation is more sensitive to obstructive patterns.
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Los objetivos del presente estudio fueron primero evaluar la asociación de dimensiones antropométricas de tórax y tronco con índices espirométricos, segundo, ajustar una ecuación de predicción con dimensiones antropométricas de tronco y tercero, comparar nuestro modelo predictivo con dos ecuaciones diagnósticas. Se evaluaron 59 estudiantes universitarios entre 20 y 40 años, de ambos sexos, sin hábito tabáquico. Las variables consideradas fueron: edad, sexo, peso, estatura, diámetro transverso de tórax, diámetro anteroposterior de tórax, perímetro de tórax, altura de tórax, altura de tronco, flujo espiratorio máximo (FEM), volumen espiratorio forzado en el primer segundo (VEF1) y capacidad vital forzada (CVF). Se utilizó el análisis de regresión múltiple para estimar los valores espirométricos en función de las variables demográficas y antropométricas. La CVF y el VEF1 tienen asociación lineal directa con el diámetro transverso de tórax, altura de tórax, perímetro de tórax y altura de tronco. Se ajustó una ecuación de regresión lineal múltiple que indicó que es posible estimar la CVF y el VEF11 en función de la altura de tronco y el perímetro de tórax para ambos sexos. Estas variables son capaces de explicar el 74 % de los valores de CVF y el 68 % de los valores de VEF1. Al comparar los valores obtenidos por nuestras ecuaciones predictivas con las ecuaciones de referencia nacional observamos que nuestros resultados son más cercanos a los de Quanjer et al. (2012) que a los de Knudson et al. (1983). La altura de tronco y el perímetro de tórax tienen asociación directa con el VEF1 y CVF y son buenos predictores del VEF1 y CVF en estudiantes universitarios. Nuestros valores estimados son más cercanos a las ecuaciones de Quanjer et al. (2012) en comparación a las estimaciones de Knudson (1983).
SUMMARY: The purposes of the present study were first to evaluate the association between anthropometric dimensions of the thorax and trunk with spirometric indices, second, to fit a prediction equation with anthropometric dimensions of the trunk, and third, to compare our predictive model with two diagnostic equations. Fifty-nine university students between 20 and 40 years old, of both sexes and non-smokers were recruited. Variables considered were age, sex, weight, height, chest transverse diameter, chest anteroposterior diameter, chest perimeter, chest height, trunk height, maximum expiratory flow (PEF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Multiple regression analysis was used to estimate spirometric values based on demographic and anthropometric variables. FVC and FEV1 have a direct linear association with chest transverse diameter, chest height, chest circumference, and trunk height. A multiple linear regression equation was fitted, indicating that it is possible to estimate FVC and FEV1 as a function of trunk height and chest girth for both sexes. These variables can explain 74% of the FVC values and 68% of the FEV1 values. Comparing the values obtained by our predictive equations with the national reference equations, we observe that our results are closer to those of Quanjer et al. (2012) than to those of Knudson et al. (1983). Trunk height and chest circumference have a direct association with FEV1 and FVC and are good predictors of FEV1 and FVC in university students. Our estimated values are closer to Quanjer et al. (2012) than Knudson et al. (1983) prediction equations.
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Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Espirometria , Antropometria , Tronco/anatomia & histologia , Tronco/fisiologia , Tórax/anatomia & histologia , Tórax/fisiologia , Capacidade Vital/fisiologia , Volume Expiratório Forçado/fisiologia , Análise de RegressãoRESUMO
BACKGROUND: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.
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Asma , Composição Corporal , Humanos , Índice de Massa Corporal , Qualidade de Vida , Asma/tratamento farmacológico , Impedância ElétricaRESUMO
Indoor environments contribute significantly to total human exposure to air pollutants, as people spend most of their time indoors. Household air pollution (HAP) resulting from cooking with polluting ("dirty") fuels, which include coal, kerosene, and biomass (wood, charcoal, crop residues, and animal manure) is a global environmental health problem. Indoor pollutants are gases, particulates, toxins, and microorganisms among others, that can have an impact especially on the health of children and adults through a combination of different mechanisms on oxidative stress and gene activation, epigenetic, cellular, and immunological systems. Air pollution is a major risk factor and contributor to morbidity and mortality from major chronic diseases. Children are significantly affected by the impact of the environment due to biological immaturity, prenatal and postnatal lung development. Poor air quality has been related to an increased prevalence of clinical manifestations of allergic asthma and rhinitis. Health professionals should increase their role in managing the exposure of children and adults to air pollution with better methods of care, prevention, and collective action. Interventions to reduce household pollutants may promote health and can be achieved with education, community, and health professional involvement.
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Introducción: La obesidad está asociada al uso frecuente de medicación de rescate y padecer asma de mayor gravedad. Los obesos asmáticos tienen menor reactividad bronquial, sin embargo, existe información limitada sobre la magnitud de la reversibilidad aguda al broncodilatador (RAB). Objetivo: Evaluar la magnitud de respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos. Métodos: Se realizó un estudio descriptivo transversal con 49 pacientes asmáticos sobrepesos y obesos atendidos en consulta externa del Hospital Neumológico Benéfico Jurídico (enero 2017˗ enero 2018) y se constató mediante espirometría la respuesta aguda al broncodilatador. Resultados: Predominó la edad (40-59 años), mayor asociación de padecer asma, poca mejoría con la aplicación del broncodilatador. El sexo femenino (20-59 años) presentó mayor número que el masculino y menor reversibilidad al broncodilatador. Los pacientes con antecedentes patológicos familiares de asma o atopia representaron 73,5 por ciento del total. El 76,5 por ciento de los obesos no presentó mejoría con la aplicación del broncodilatador. Predominó la categoría de gravedad persistente moderada. Conclusiones: El sexo femenino tiene más riesgo de padecer asma y no tener mejoría al aplicar el broncodilatador. Los obesos mayores de 40 años tienen mayor riesgo de no presentar reversibilidad aguda al broncodilatador. Los antecedentes patológicos familiares de asma o atopia y personales de otras enfermedades no predisponen a menor reversibilidad aguda al broncodilatador. La gravedad del asma no influye en la reversibilidad aguda al broncodilatador(AU)
Introduction: Obesity is associated with the frequent use of rescue medication and suffering from more severe asthma. Obese asthmatics have less bronchial reactivity, however, there is limited information on the magnitude of acute bronchodilator reversibility. Objective: To assess the magnitude of the acute response to the bronchodilator in overweight and obese asthmatic patients. Methods: A cross-sectional descriptive study was carried out in 49 overweight and obese asthmatic patients seen in the outpatient clinic at Benéfico Jurídico Pneumologic Hospital from January 2017 to January 2018, and the acute response to bronchodilator was verified by spirometry. Results: Age predominated (40-59 years), greater association of suffering from asthma, and little improvement with the use of bronchodilator. The female sex (20-59 years) showed greater number than the male and less reversibility to bronchodilator. Patients with family pathological history of asthma or atopy represented 73.5 percent of the total. 76.5 percent of the obese did not show improvement with the use of bronchodilator. The category of moderate persistent severity predominated. Conclusions: The female sex has greater risk of suffering from asthma and has no improvement when applying bronchodilator. Obese individuals over 40 years of age have higher risk of not having acute reversibility to the bronchodilator. Family pathological history of asthma or atopy and personal history of other diseases do not predispose to less acute reversibility of bronchodilator. The severity of asthma does not influence acute reversibility to bronchodilator(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Broncodilatadores/uso terapêutico , Relação Dose-Resposta a Droga , Obesidade/complicações , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Abstract Background: A 6 s spirometry with an inexpensive pocket spirometer efficiently selects individuals for a diagnostic-quality spirometry for airflow limitation, but could also be useful to identify individuals with a restrictive pattern. Objectives: We evaluated an inexpensive simplified spirometer (chronic obstructive pulmonary disease [COPD]-6) as a screening tool to identify spirometric abnormalities. Methods: A population-based survey in Mexico City, with 742 participants performing pre- and post-BD spirometry and a three-maneuver 6 s spirometry (pre-BD) with a COPD-6. We evaluated forced expiratory volume in 1 s (FEV1), FEV6, and FEV1/FEV6 from the COPD-6, crude and expressed as the percentage of predicted (%P), to discriminate post-bronchodilator airflow obstruction (FEV1/forced vital capacity [FVC] <5th percentile) or restriction (FVC or FEV1 <5th percentile with normal FEV1/FVC) through receiver operating characteristics and their area under the curve (AUC). Results: FEV1%P was the best predictor to identify pre- and post-BD ventilatory abnormalities (best cutoff point 87%P, AUC 92% for restrictive pattern, 89% for obstructive pattern, and 91% for any spirometric abnormality). Deriving to clinical spirometry only those with <87%P (26% of the sample) missed only 12% of spirometric abnormalities most of the latter mild. Conclusions: An FEV1 <87%P from a pre-BD 6 s spirometry correctly identified individuals with spirometric ventilatory defects, either obstructive or restrictive.
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Humanos , Adulto , Pessoa de Meia-Idade , Espirometria , Programas de Rastreamento/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Capacidade Vital , Volume Expiratório Forçado , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , MéxicoRESUMO
PURPOSE: To evaluate the concordance between the value of the actual maximum voluntary ventilation (MVV) and the estimated value by multiplying the forced expiratory volume in the first second (FEV1) and a different value established in the literature. METHODS: A retrospective study was conducted with healthy subjects and patients with stable chronic obstructive pulmonary disease (COPD). Five prediction formulas MVV were used for the comparison with the MVV values. Agreement between MVV measured and MVV obtained from five prediction equations were studied. FEV1 values were used to estimate MVV. Correlation and agreement analysis of the values was performed in two groups using the Pearson test and the Bland-Altman method; these groups were one group with 207 healthy subjects and the second group with 83 patients diagnosed with COPD, respectively. RESULTS: We recruited 207 healthy subjects (105 women, age 47 ± 17 years) and 83 COPD patients (age 66 ± 6 years; 29 GOLD II, 30 GOLD III, and 24 GOLD IV) for the study. All prediction equations presented a significant correlation with the MVV value (from 0.38 to 0.86, p < 0.05) except for the GOLD II subgroup, which had a poor agreement with measured MVV. In healthy subjects, the mean difference of the value of bias (and limits of agreement) varied between -3.9% (-32.8 to 24.9%), and 27% (-1.4 to 55.3%). In COPD patients, the mean difference of value of bias (and limits of agreement) varied between -4.4% (-49.4 to 40.6%), and 26.3% (-18.3 to 70.9%). The results were similar in the subgroup analysis. CONCLUSION: The equations to estimate the value of MVV present a good degree of correlation with the real value of MVV, but they also show a poor concordance. For this reason, we should not use the estimated results as a replacement for the real value of MVV.
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BACKGROUND: Improved understanding of the normal range of blood eosinophil counts (BEC) and conditions that influence them in non-asthmatic individuals should allow more accurate estimation of the threshold at which eosinophilic disease should be considered, diagnosed, and treated. This analysis investigated the impact of atopy, smoking, and parasitic infection on BEC. METHODS: This was a post hoc analysis of non-asthmatic subjects from a case-control study (CONEP 450/10) conducted at the Program for Control of Asthma in Bahia (ProAR). Participant BECs were measured at baseline; correlations between predefined risk factors and BEC were assessed via univariate and stratified analysis. RESULTS: Of the 454 participants included, 3% were helminth parasite-positive, 18% were non-helminth parasite-positive; and 450 had BEC data. The median (interquartile range [IQR]) BEC was 152 (96, 252) cells/µL. Any positive skin prick test, elevated total immunoglobulin E, allergic rhinitis, and being a current smoker were all individually associated with higher BEC (p < 0.05) compared with BEC in participants without these factors, but having a non-helminthic parasitic infection was not. Participants with all 4 risk factors that were associated with higher BEC had a median (IQR) BEC of 192 cells/µL (94, 416) versus 106 cells/µL (70, 164) for those with no risk factors. CONCLUSIONS: In non-asthmatic subjects, atopy, allergic rhinitis, and current smoking status were associated with higher BEC compared with subjects without these factors, but BEC values were well below the threshold commonly accepted as normal. Therefore, BEC should be interpreted in the context of an individual's medical conditions and other BEC-influencing factors.
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OBJECTIVES: To compare the obtained and expected values of pulmonary function variables between sarcopenic and non-sarcopenic elderly; verify the association between the pulmonary function and the indicators and diagnosis of sarcopenia; and establish cut-off points for pulmonary function variables to predict sarcopenia. DESIGN: Cross-sectional study. LOCATION: Macapá, Brazil. PARTICIPANTS: community-dwelling elderly ≥ 60 years old (n=383), both sexes. MEASURES: Were evaluated according to variables of pulmonary function (spirometry) and sarcopenia, according to the EWGSOP consensus. The association between pulmonary function and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve. RESULTS: The prevalence of sarcopenia was 12.53% (n = 48). Sarcopenic individuals had significantly lower mean values for FVC, FEV1, FEF25-75% and PEF than non-sarcopenic. After adjustment, spirometric variables were inversely associated with sarcopenia (the increase by one unit of liter in FVC, FEV1 and FEF25-75% decreased the probability of sarcopenia by 59%, 67% and 39%, respectively), and the majority of these variables with the muscular strength indicator. Cut-off points, for elderly men and women, were discriminant criteria for the presence of sarcopenia: FVC (≤2.52 L and ≤1.82 L), FEV1 (≤2.1 L and ≤1.39 L), PEF (≤3.45 L/s and ≤2.93 L/s) and FEF5-75% (≤1.97 L/s and ≤1.74 L/s). CONCLUSIONS: There was loss of pulmonary function in sarcopenic elderly patients and an inverse association with the diagnosis of sarcopenia and its indicators. Cut-off points of pulmonary function variables can be used as a useful tool to discriminate sarcopenia.
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Pulmão/patologia , Testes de Função Respiratória/métodos , Sarcopenia/diagnóstico , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Spirometry is a pulmonary function test that allows screening, diagnosis and monitoring of respiratory diseases. This is a simple, non-invasive test that is easy to perform. By quantifying the respiratory volumes and flows, such as forced vital capacity (FVC) or forced expiratory volume in six seconds (FEV6), forced expiratory volume in the first second (FEV1), and the relationship between these parameters (FEV1/FVC or FEV1/FEV6 ratio), obstruction can be detected with high sensitivity and specificity; likewise, it is possible to classify the severity and response to the bronchodilator. This article presents indications, contraindications, and basic concepts for the interpretation of spirometry.
La espirometría es una prueba de función pulmonar que permite el cribado, diagnóstico y monitorización de las enfermedades respiratorias. Esta prueba es sencilla, fácil de realizar y no invasiva. Mediante la cuantificación de los volúmenes y los flujos respiratorios como la capacidad vital forzada (CVF) o volumen espiratorio forzado en seis segundos (VEF6), el volumen espiratorio forzado en el primer segundo (VEF1) y la relación entre estos parámetros (índice VEF1/CVF o VEF1/VEF6) se detecta obstrucción, con alta sensibilidad y especificidad; asimismo, es posible clasificar la gravedad y la respuesta al broncodilatador. En este artículo se exponen indicaciones, contraindicaciones y conceptos básicos para la interpretación de la espirometría.
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Transtornos Respiratórios/diagnóstico , Espirometria , Desenho de Equipamento , Volume Expiratório Forçado , Humanos , Espirometria/instrumentação , Espirometria/métodos , Capacidade VitalRESUMO
INTRODUCCIÓN: La Enfermedad Pulmonar Obstructiva Crónica afecta a 260 millones de personas a nivel mundial y representará la tercera causa de muerte para el año 2020. MATERIALES Y MÉTODOS: Se realizó un estudio observacional descriptivo transversal con la finalidad de comparar la estadificación de un grupo de pacientes venezolanos con EPOC según la Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007, 2011 y 2019. RESULTADOS: La muestra estuvo constituida por ochenta y nueve (89) pacientes con una edad promedio de 66,7 ± 0,9 años, siendo el 60,7% de los pacientes del sexo masculino y 82% fumadores. El 14,6% de los pacientes presentaban EPOC leve, 36% EPOC moderado, 41,6% EPOC severo y 7,9% EPOC muy severo. El valor del test Kappa de Cohen entre las escalas mMRC y CAT (COPD Assessment Test) fue de 0,529 (GOLD 2011) y 0,555 (GOLD 2019). CONCLUSIONES: 1) la poca concordancia entre el VEF1, grado de disnea e historial de exacerbaciones impacta la clasificación de la severidad de la EPOC al utilizar GOLD 2011; 2) la concordancia moderada entre las escalas mMRC y CAT sugiere que el tipo de cuestionario utilizado afecta la categorización de la severidad de la enfermedad; 3) los pacientes del grupo B mostraron una importante afectación en el intercambio gaseoso dado por valores más bajos de DLCO y oximetría arterial y 4) una proporción significativa de pacientes fueron clasificados en los grupos de alto riesgo (B y D) en GOLD 2011 y 2019.
INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) affects 260 million people worldwide and it is thought to become the third leading cause of mortality by the year 2020. MATERIAL AND METHODS: A transversal descriptive observational study was conducted to compare the categorization of a group of Venezuelan COPD patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007, 2011 and 2019. RESULTS: Eighty-nine (89) patients with a mean age of 66.7 ± 0.9 years were included, 60.7% were male and 82% smokers. 14.6% of the patients had mild COPD, 36% moderate COPD, 41.6% severe COPD and 7.9% very severe COPD. Cohen's Kappa coefficient value between mMRC and COPD Assessment test (CAT) was 0,529 (GOLD 2011) and 0,555 (GOLD 2019). CONCLUSIONS: 1) the lack of concordance between FEV1 values, degree of dyspnea and history of exacerbations impacts COPD severity classification when using GOLD 2011; 2) moderate agreement between mMRC and CAT scales suggests that the type of questionnaire used to evaluate perception of dyspnea can affect disease severity categorization; 3) group B patients showed a significant gas exchange impairment due to lower values of DLCO and arterial oxymetry and 4) a significant proportion of patients were categorized in the high-risk groups (B and D) both in GOLD 2011 and 2019. Optimization of the evaluation of COPD severity is important to allow a better standardization of care and pharmacological management of patients with this disease.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Índice de Gravidade de Doença , Doença Pulmonar Obstrutiva Crônica/classificação , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Espirometria , Venezuela , Capacidade Vital , Volume Expiratório Forçado , Estudos Transversais , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Pressão Arterial , Frequência CardíacaRESUMO
Abstract Objective: To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function. Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05). Conclusion: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function. Trial Registration: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ponte de Artéria Coronária/métodos , Respiração com Pressão Positiva/métodos , Ventilação não Invasiva/métodos , Pneumopatias/prevenção & controle , Oxigênio/sangue , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/sangue , Fatores de Tempo , Capacidade Vital , Volume Expiratório Forçado , Ponte de Artéria Coronária/efeitos adversos , Fatores de Risco , Análise de Variância , Resultado do Tratamento , Estatísticas não Paramétricas , Ácido Láctico/sangue , Tempo de Internação , Pneumopatias/etiologia , Pneumopatias/sangueRESUMO
INTRODUCTION: We sought to describe: 1) The influence of orthotopic liver transplantation (OLT) on exercise capacity, pulmonary function and respiratory muscle strength after surgery, 2) The relationship between exercise capacity and symptoms of anxiety and depression. MATERIAL AND METHODS: This is a prospective follow up study conducted with patients submitted to OLT. All patients were assessed before and 1 month after surgery through measurements: six minute walk test (6MWT), 6 min step test (6MST) and HADS (Hospital Anxiety and Depression Scale). FEV1% (forced expiratory volume), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured in the pre-operative and on 1st, 3rd, 5th day and 1 month after surgery. RESULTS: In 77 patients , 6MWD improved 20.2 m (95%CI 8.1-32.3) and 6MST improved 7.8 steps after surgery (95%CI 3.9-11.6). Change in 6 MWD and 6 MST did not correlated with change HADS. The FEV1% at each time point were 88.8 ± 21.3 before surgery, 32.9 ± 9.9 on 1st day, 39.6 ± 11.5 on 3rd day, 46 ± 12.1 on 5th day and 86.6 ± 21.1 one month after surgery. MIP and MEP values at each time point were -67.4 ± 23.2 and 79.7 ± 26 before surgery, -30.8 ± 12.3 and 36.4 ± 15.4 on 1st day, -38.6 ± 14.1 and 43.8 ± 17 on 3rd day, -45.8 ± 15.9 and 49.7 ± 18.7 on 5th day and -67.1 ± 29.4 and 80.9 ± 23.9 one month after surgery. CONCLUSION: Exercise capacity was modestly increased after OLT without any correlation with symptoms of anxiety and depression. Pulmonary function and respiratory muscle strength decreased immediately after liver transplantation, and progressively recovered, returning to baseline values after 1 month.
Assuntos
Doença Hepática Terminal/cirurgia , Tolerância ao Exercício , Transplante de Fígado , Pulmão/fisiopatologia , Respiração , Músculos Respiratórios/fisiopatologia , Adulto , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/fisiopatologia , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Força Muscular , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Teste de CaminhadaRESUMO
BACKGROUND: Patients with cystic fibrosis (CF) have airway inflammation that contributes to symptoms and to pulmonary function derangement. Current drugs used to diminish airway inflammation improve the clinical and spirometric status of patients with CF, but their use is limited due to their undesired side effects, for example, glucose intolerance, growth retardation, and cataracts with corticosteroids, gastrointestinal toxicity with ibuprofen, and macrolide resistance with azythromycin. Glycine is known to decrease activation of inflammatory cells, including alveolar macrophages and neutrophils, and is relatively inexpensive, palatable, and virtually devoid of untoward effects. These features make glycine a good candidate for antiinflammatory treatment of CF. Thus, we aimed to explore whether glycine can exert a beneficial effect in a population of patients with CF. METHODS: This was a randomized, double blinded, cross-over pilot clinical trial. Subjects with CF received, in random order, oral glycine (0.5 g/kg/day, dissolved in any liquid) and placebo (glass sugar), each during 8 weeks with an intermediate 2-week wash-out period. RESULTS: Thirteen subjects aged 6-23 years, 8 females, completed the two arms of the study. As compared with placebo, after glycine intake patients had better symptom questionnaire scores (p = 0.02), mainly regarding sputum features and dyspnea. While spirometric variables tended to decline during placebo intake, they remained stable or even increased during glycine treatment (p = 0.04 to p = 0.003). In this context, FEV1 declined 8.6% after placebo and increased 9.7% at the end of the glycine period. Pulse oximetry improved after glycine intake (p = 0.04 vs. placebo). TNF-α in serum and IL-6 and G-CSF in sputum tended to decline at the end of the glycine period (p = 0.061, p = 0.068 and p = 0.04, respectively, vs placebo). Glycine was remarkably well tolerated. CONCLUSIONS: The clinical, spirometric and inflammatory status of subjects with CF improved after just 8 weeks of glycine intake, suggesting that this amino acid might constitute a novel therapeutic tool for these patients. Thus, further studies are warranted. TRIAL REGISTRATION: www.clinicaltrials.gov , registration number: NCT01417481 , date of registration: March 12, 2012.
Assuntos
Anti-Inflamatórios/farmacologia , Fibrose Cística/tratamento farmacológico , Fibrose Cística/fisiopatologia , Glicina/farmacologia , Pulmão/fisiopatologia , Administração Oral , Adolescente , Anti-Inflamatórios/administração & dosagem , Biomarcadores/sangue , Criança , Estudos Cross-Over , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Glicina/administração & dosagem , Humanos , Inflamação/tratamento farmacológico , Pulmão/efeitos dos fármacos , Masculino , Neutrófilos/efeitos dos fármacos , Projetos Piloto , Espirometria , Adulto JovemRESUMO
ABSTRACT Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls). Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL) group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL) group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%). The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01), and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05). However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5) were higher in patients than in controls (p < 0.001) but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile.
RESUMO Objetivo: Determinar se a gravidade da DPOC se correlaciona com a contagem de células no escarro, atopia e asma. Métodos: Estudo transversal com 37 pacientes com DPOC e 22 indivíduos saudáveis com função pulmonar normal (controles). As contagens de células no escarro foram determinadas por microscopia após a centrifugação das amostras. Foram realizados testes cutâneos de puntura, e as citocinas séricas foram determinadas por ELISA. Resultados: Os pacientes foram estratificados pela resposta ao broncodilatador: o grupo de limitação ao fluxo aéreo não reversível (LFAnr) envolveu 24 pacientes sem alteração significativa do VEF1 pós-broncodilatador, e o grupo de limitação ao fluxo aéreo parcialmente reversível (LFApr) envolveu 13 pacientes com reversibilidade do VEF1 (aumento do VEF1 pós-broncodilatador ≥ 12%). A proporção de eosinófilos no escarro foi maior no grupo LFApr do que no LFAnr (p < 0,01), e houve uma correlação inversa entre a proporção de eosinófilos e VEF1 (p < 0,05). Entretanto, nenhum dos pacientes apresentou histórico de asma e os resultados dos testes cutâneos não diferiram entre os dois grupos. Nas amostras de escarro dos pacientes, os neutrófilos predominaram. Os níveis séricos de TNF, IL-6, IL-8 e RANTES (CCL5) foram maiores nos pacientes que nos controles (p < 0,001), mas não diferiram entre os dois grupos de pacientes. Conclusões: Pacientes com DPOC e reversibilidade parcial do VEF1 parecem apresentar maiores contagens de eosinófilos no escarro e maior hiper-responsividade das vias aéreas que aqueles sem reversibilidade do VEF1. Entretanto, a gravidade da DPOC não se correlacionou com atopia ou perfil das citocinas.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Asma/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Escarro , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Estudos de Casos e Controles , Estudos Transversais , Citocinas/sangue , Ensaio de Imunoadsorção Enzimática , Volume Expiratório Forçado/fisiologia , Neutrófilos/imunologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
La enfermedad pulmonar obstructiva crónica (EPOC), caracterizada por una limitación progresiva al fujo aéreo, es una patología frecuente, conocida y tratable que para su diagnóstico requiere de historia personal de tabaquismo o antecedentes exposicionales y una espirometria con mediciones pre y post broncodilatadoras con patrón obstructivo. El grado de reversibilidad al flujo aéreo difiere entre pacientes, no predice la respuesta al tratamiento broncodilatador y puede verse en términos de capacidad vital forzada o de flujo espiratorio forzado, dependiendo del grado de severidad de la enfermedad. En el presente trabajo se detalla la diferencia en respuesta broncodilatadora en término tanto de respuesta en el flujo como en el volumen en pacientes con diagnóstico de EPOC y en diferentes estadios de GOLD, analizando la respuesta broncodilatadora y su relación con la severidad de la enfermedad.
The chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation. It is a frequent, known and treatable disease. The diagnosis requires tobacco smoking personal history or expositional history and evidence of an obstructive pattern at the spirometry measured before and after bronchodilators. The degree of reversibility of airfow differs between patients, and does not predict the response to bronchodilator therapy. It can be seen in terms of forced vital capacity or forced expiratory fow, depending on the severity of the disease. This paper presents the differences in bronchodilator response in terms of measurements of the flow and the volume in patients diagnosed with COPD at different stages of GOLD. The bronchodilator response and its relationship to the severity of the disease were analized.
Assuntos
Espirometria , Broncodilatadores , Doença Pulmonar Obstrutiva CrônicaRESUMO
BACKGROUND: (1) To compare nutrition and hydration status between a group of children/adolescents with cystic fibrosis (CFG; n = 46; median age, 8.5 years) and a control group without cystic fibrosis (CG). (2) To examine the association of nutrition and hydration status with lung function in the CFG. MATERIAL AND METHODS: A cross-sectional study. Nutrition screening, anthropometric parameters, and bioelectrical impedance analysis (BIA) were assessed. The z scores for body mass index for age, height for age, mid upper arm circumference, triceps and subscapular skinfold thickness, mid upper arm muscle area, resistance/height, and reactance/height were calculated. Bioelectrical impedance vector analysis was conducted. Forced expiratory volume in 1 second <80% was considered lung function impairment. An adjusted logistic regression was applied (P < .05). RESULTS: In the CFG, lung function impairment was observed in 51.1%. All anthropometric parameters were lower, and the mean z-resistance/height and z-reactance/height were higher in the CFG (P < .05) compared with the CG. In the CFG, 43% were severely/mildly dehydrated, while none were in the CG (P = .007). In the CFG, there was an association between high nutrition risk-via nutrition screening (odds ratio [OR], 22.28; P < .05), lower values of anthropometric parameters, higher z-resistance/height (OR, 2.23; P < .05) and z-reactance/height (OR, 1.81; P < .05), and dehydration (OR, 4.94; P < .05)-and lung function impairment. CONCLUSIONS: The CFG exhibited a compromised nutrition status assessed by anthropometric and BIA parameters. Nutrition screening, anthropometric and BIA parameters, and hydration status were associated with lung function.