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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
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
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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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
While administration of medical aerosols with heliox and positive airway pressure are both used clinically to improve aerosol delivery, few studies have differentiated their separate roles in treatment of asthmatics. The aim of this randomized, double blinded study is to differentiate the effect of heliox and oxygen with and without positive expiratory pressure (PEP), on delivery of radiotagged inhaled bronchodilators on pulmonary function and deposition in asthmatics. 32 patients between 18 and 65 years of age diagnosed with stable moderate to severe asthma were randomly assigned into four groups: (1) Heliox + PEP (n = 6), (2) Oxygen + PEP (n = 6), (3) Heliox (n = 11) and (4) Oxygen without PEP (n = 9). Each group received 1 mg of fenoterol and 2 mg of ipratropium bromide combined with 25 mCi (955 Mbq) of Technetium-99m and 0.9% saline to a total dose volume of 3 mL placed in a Venticis II nebulizer attached to a closed, valved mask with PEP of 0 or 10 cm H2O. Both gas type and PEP level were blinded to the investigators. Images were acquired with a single-head scintillation camera with the longitudinal and transverse division of the right lung as regions of interest (ROIs). While all groups responded to bronchodilators, only group 1 showed increase in FEV1%predicted and IC compared to the other groups (p < 0.04). When evaluating the ROI in the vertical gradient we observed higher deposition in the middle and lower third in groups 1 (p = 0.02) and 2 (p = 0.01) compared to group 3. In the horizontal gradient, a higher deposition in the central region in groups 1 (p = 0.03) and 2 (p = 0.02) compared to group 3 and intermediate region of group 2 compared to group 3. We conclude that aerosol deposition was higher in groups with PEP independent of gas used, while bronchodilator response with Heliox + PEP improved FEV1 % and IC compared to administration with Oxygen, Oxygen with PEP and Heliox alone. Trial registration NCT01268462.