Navegando por Palavras-chave "COPD"

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    Acute and short-term effect of an extra dose of formoterol in COPD patients
    (W B Saunders Co Ltd, 2012-06-01) Studart, Fernando Sérgio [UNIFESP]; Izbicki, Meyer [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Oliveira, Luis Vicente Franco; Donner, Claudio F.; Jardim, José Roberto [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Mondo Med Multidisciplinary & Rehabil Outpatient; Universidade Federal de São Paulo (UNIFESP); Nove Julho Univ
    Rationale: Formoterol action may decrease progressively after its inhalation. It is unknown if this decrease of bronchodilation following formoterol use could be associated with worsening hyperinflation.Objectives: To investigate whether the use of an extra daily dose of formoterol could promote a greater reduction in lung hyperinflation and a greater improvement in inspiratory capacity (IC) compared to usual doses.Methods: 56 hyperinflated COPD patients were divided into two groups: F2 and F3. Basal evaluation was carried out after 5 days of formoterol washout. in order to evaluate the acute effect, spirometry and body plethysmography were performed 8 h after the first formoterol dose in both groups and repeated 1 h after an additional formoterol dose (F3) or placebo (F2). the short-term effect was evaluated by measuring the resting lung function after a 14-day period of formoterol t.i.d. (F3) or formoterol b.i.d. + placebo (F2).Measurements and main results: A second formoterol dose inhaled 8 h after the previous dose promoted additional improvements in lung function, as demonstrated by higher IC (118 +/- 140 mL, p < 0.001) and tower functional residual capacity (FRC) (-383 +/- 367 mL, p <0.001). On day 15, the mean differences from baseline regarding all lung function variables were similar between the groups.Conclusion: An extra daily dose of formoterol inhaled 8 h after a previous dose could result in an acute additional peak of bronchodilation. However, short-term formoterol t.i.d. showed no advantages over formoterol b.i.d. concerning reduction of hyperinflation in resting lung function. (C) 2012 Elsevier B.V. All rights reserved.
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    Adaptação cultural e reprodutibilidade do Breathing Problems Questionnaire (BPQ) em pacientes portadores de doença pulmonar obstrutiva crônica no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2010) Silva, Patricia Nobre Calheiros da [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]
    Introdução: O reconhecimento da Doenca Pulmonar Obstrutiva Cronica (DPOC) e muito baixo entre a populacao. Ambos os fumantes e ex-fumantes ignoram os principais sintomas, como tosse e expectoracao. Tornando-se preocupante a dificuldade de acesso ao diagnostico e de integracao em programas de apoio e reabilitacao. Dessa forma, busca de novas ferramentas para o monitoramento da qualidade de vida relacionada a Saúde (QVRS) desses pacientes, bem como o impacto de problemas respiratorios em suas atividades diarias. O Questionario de Problemas Respiratorios e um questionario de qualidade de vida especifico para doenca pulmonar cronica desenvolvido a partir das experiencias de pacientes com DPOC, compondo 13 areas, duas subescalas de Saúde e 33 perguntas. Quanto maior a pontuacao, maior o impacto de problemas respiratorios na qualidade de vida.Objetivo: Adaptar para a cultura brasileira e avaliar a reprodutibilidade do Breathing Problems Questionnaire (BPQ) em pacientes com doenca pulmonar obstrutiva cronica e avaliar as correlacoes com outros questionarios de qualidade de vida e variaveis fisiologicas.Metodos: Foi realizada a adaptacao para a cultura brasileira por meio de uma primeira traducao por um tradutor com dominio na lingua inglesa, posteriormente foi aplicado em 8 pacientes visando saber suas duvidas e dificuldades. O questionario foi analisado por uma comissao de experts e definido sua versao final. Foi realizada uma nova traducao para o ingles por um segundo tradutor tambem conhecedor da lingua inglesa e essa versao final foi enviada para o autor original com intuito de assegurar o sentido original do questionario. Apos a aprovacao final do autor, foi avaliada a reprodutibilidade com 50 pacientes portadores de DPOC.Resultados: O tempo medio de resposta foi 9min e 30 seg. Dos 50 pacientes que fizeram a reprodutibilidade, 21 eram do sexo feminino e 29 do sexo masculino com media de idade de 65,8 + 7,5 anos. A maioria se encontrava no estagio II (29,16%) e III (52%) da DPOC segundo o Documento GOLD. O coeficiente de correlacao intraclasse para a pontuacao total foi de 0,94. Os 11 dominios do BPQ e as suas duas subescalas tambem tiveram valor de CCI acima de 0,70. Houve correlacoes moderadas entre os dominios e subescalas do BPQ com os dominios Sintomas, Atividade do SGRQ e todos os dominios do SF-36. As melhores correlacoes obtidas foram com o dominio Impacto e pontuacao do SGRQ. Conclusao: A versao brasileira do questionario BPQ e reprodutivel para a cultura brasileira
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    Adaptação cultural e reprodutibilidade do Bristol COPD Knowledge Questionnaire em pacientes portadores de doença pulmonar obstrutiva crônica no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2010) Santos, Elenildo Aquino [UNIFESP]; Jardim, José Roberto [UNIFESP]
    Nos ultimos anos, tem havido um crescimento na enfase da educacao de pacientes e de suas familias sobre as condicoes medicas deles. Isso tem levado os pacientes a desejarem mais informacoes sobre suas condicoes, e, em parte, os profissionais de Saúde tem reconhecido que um certo auto-controle da doenca e importante para os pacientes. Objetivo: Adaptar para a cultura brasileira e avaliar a reprodutibilidade do Bristol COPD Knowledge Questionnaire em pacientes com doenca pulmonar obstrutiva cronica. Metodo: O questionario original em ingles, composto de 65 perguntas, foi traduzido para a lingua portuguesa por um profissional de Saúde com dominio na lingua inglesa. Essa primeira versao passou por uma adaptacao cultural por meio de uma comissao de especialistas. Em seguida, foi aplicada a versao adaptada a oito pacientes que responderam ao questionario e avaliadas as dificuldades com as palavras traduzidas. Essa versao em portugues, adaptada culturalmente, passou por uma traducao retrograda para o Ingles, por outro tradutor americano com dominio nas duas linguas. A segunda versao em Ingles foi comparada com a versao original pelos pesquisadores e depois pelo autor do questionario. Resultado: Encontrou-se o valor de CCI de 0,83 para a avaliacao global das duas aplicacoes do questionario. Avaliados isoladamente, seis dominios apresentaram o CCI acima de 0,70, quatro entre 0,60 - 0,69 e tres abaixo de 0,60. A menor e maior concordancia foram alcancadas nos dominios referentes a etiologia e corticoides orais, respectivamente. Conclusao: Concluimos que o Questionario Bristol e reprodutivel e que pode ser aplicado em pacientes com de DPOC no Brasil.
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    Alternative strategies for exercise critical power estimation in patients with COPD
    (Springer, 2006-01-01) Malaguti, C.; Nery, L. E.; Dal Corso, S.; De Fuccio, M. B.; Lerario, M. C.; Cendon, S.; Neder, J. A.; Universidade Federal de São Paulo (UNIFESP)
    Exercise critical power (CP) has been shown to represent the highest sustainable work rate (WR) in patients with chronic obstructive pulmonary disease ( COPD). Parameter estimation, however, depends on 4 high-intensity tests performed, on different days, to the limit of tolerance (T-lim). in order to establish a milder protocol that would be more suitable for disabled patients, we contrasted CP derived from 4, 3 and 2 tests (CP4, CP3 and CP2) in 8 males with moderate COPD. in addition, CP was calculated from 2 single-day tests performed on an inverse sequence (CP2AB and CP2BA): CP values within 5 W from CP4 were assumed as clinically-acceptable estimates. We found that [CP4-CP3] and [CP4-CP2] differences were within 5 W in 8 and 6 patients, respectively (95% confidence interval of the differences = -1.3 to 3.5 W and -11.5 to 6.5 W). There was a systematic decline on T-lim when an exercise bout was performed after a previous test on the same day (P < 0.05). Consequently, substantial differences were found between CP4 and any of the CP estimates obtained from single-day tests. in conclusion, clinically-acceptable estimates of CP can be obtained by using 3 or, in most circumstances, 2 constant WR tests in patients with moderate COPD-provided that they are not performed on the same day.
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    Anti-inflammatory actions of herbal medicines in a model of chronic obstructive pulmonary disease induced by cigarette smoke
    (Elsevier France-Editions Scientifiques Medicales Elsevier, 2018) Possebon, Lucas; Lebron, Isabella de Souza Lima; Silva, Ligia Furlan da; Paletta, Julia Tagliaferri; Glad, Bruna Gabrieli; Sant'Ana, Monielle [UNIFESP]; Iyomasa-Pilon, Melina Mizusaki; Souza, Helena Ribeiro; Costa, Sara de Souza; Rodriguesa, Giselda Pereira da Silva; Pereira, Maria de Lourdes; Moreno, Andreia de Haro; Girol, Ana Paula
    The effects of four medicinal herbs (Arctium lappa, Plantago major, Mikania glomerata Spreng and Equisetum arvense) with anti-inflammatory properties were evaluated in a chronic obstructive pulmonary disease (COPD) model. Wistar rats were exposed to cigarette smoke during 8 weeks and one of the groups was orally given a solution containing 4% of each alcoholic herbal extracts during the exposure period. Control group was not exposed to smoke or treated. Histopathological, immunohistochemical and biochemical analyzes were performed. Normal blood plasma levels of gamma glutamyl transferase indicated no toxicity of the administered herbal extracts. The treatment reduced leukocytes influx in bronchoalveolar lavage, mast cell and macrophages numbers in lungs, as well as prevented pulmonary congestion and tracheal metaplasia. Herbal mixture also decreased plasma inflammatory mediator levels and pulmonary expression of annexin A1 and nuclear factor-k beta. Our data indicate synergistic and protective effects of the used herbal medicines in animals exposed to cigarette smoke as a potential therapeutic strategy.
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    Association of oxidative stress markers and C-reactive protein with multidimensional indexes in COPD
    (Sage Publications Ltd, 2011-05-01) Folchini, F. [UNIFESP]; Nonato, N. L. [UNIFESP]; Feofiloff, E. [UNIFESP]; D'Almeida, V. [UNIFESP]; Nascimento, O. [UNIFESP]; Jardim, J. R. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    To evaluate the oxidative stress and the C-reactive protein (CRP) in chronic obstructive pulmonary disease (COPD) patients and their correlation between the severity of the disease according to GOLD criteria and multidimensional indexes such as BODE index. A blood sample was collected for thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), catalase, glutathione (GSH), homocysteine (HCY) and CRP analysis from 45 stable COPD patients. Lung function, body nutritional status, dyspnea and 6-min walk test (6MWT) were evaluated. Patients with GOLD stage IV presented a higher value for the TBARS than stage I patients (4.47 + 1.58 versus 2.27 + 1.04 nmol/mL, p < 0.05). CRP was higher for GOLD IV (2.46 + 3.68 mg/dL) than other stages (GOLD I: 0.39 + 0.25, GOLD II: 0.39 + 0.18 and GOLD III: 0.48 + 0.36 mg/dL, p < 0.05). Oxidative stress markers measured as TBARS presented a negative correlation between forced expiratory volume in the first second (FEV1) post bronchodilatador (% predicted; r = -0.39, p = 0.01) and positive correlations with Modified Medical Research Council Scale (MMRC) dyspnea index (r = 0.40, p = 0.01), multidimensional index (r = 0.49, p = 0.001) and BODE index (r = 0.51, p = 0.001).
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    Avaliação da qualidade de vida pelo SF-12 em pacientes com DPOC - no seguimento de um estudo de base populacional (PLATINO 2003-2012) em três países da América Latina
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-20) Pradella, Cristiane Oliveira [UNIFESP]; Jardim, José Roberto de Brito [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Gazzotti, Mariana Rodrigues [UNIFESP]; Oliver Augusto Nascimento : http://lattes.cnpq.br/2225674564595145; Mariana Rodrigues Gazzotti : http://lattes.cnpq.br/5901080332011696; http://lattes.cnpq.br/4320654878656075; Universidade Federal de São Paulo (UNIFESP)
    Quality of life (QoL) assessment is an important tool in the care of patients with chronic obstructive pulmonary disease (COPD). Quality of life (QoL) questionnaires have been widely used in recent years to monitor the evolution of COPD and even to evaluate the effects of treatments (GOLD, 2017). Objective: to evaluate the impact of COPD on QoL in the follow-up of individuals from the population-based study PLATINO in São Paulo (Brazil), Santiago (Chile) and Montevideo (Uruguay), with the informations obtained in 2003-2005 and 2011-2012, in relation to individuals with normal spirometry. Methods: In both occasions the SF-12 questionnaire and pre and post bronchodilator spirometry were performed. Results: A total of 1913 individuals were recruited in the follow-up: 484 from São Paulo (48.4% of Basal; COPD: 52 and normal spirometry: 432), 788 from Santiago (65.2% of Basal; COPD: 130 and normal spirometry: 658) and 641 from Montevideo (67.9% of Basal; COPD: 189 and normal spirometry: 452). The total population in the Basal evaluation in the three countries, presented quality of life below the normal value both in the physical and mental domains (PCS and MCS) (<50); taking into account the clinically important minimum difference (PCS = 1.26 and MCS = 2.28), in followup evaluation MCS showed a significant improvement while PCS remained stable. In relation to COPD, about 45% of patients in each country worsened PCS, while 40% improved MCS. Taking into consideration the Basal evaluation during the follow up, the majority of COPD patients with HRQoL <50 worsened the PCS and those with ≥ 50 tended to improve or to be stable, whereas in the MSC HRQoL <50 there was a tendency to worsen and in those with HRQoL ≥50 a tendency to improve or to be stable. Conclusions: Overall, in relation to the evolution of the HRQoL in the total population of the three countries and taking into account the average value, the physical domain was good and worsened, whereas the mental domain was poor and tended to improve or to be stable. Participants with normal spirometry and COPD patients from the three countries in the follow-up, taking into account the DMCI, presented the same behavior in relation to the "improved and equal" vs "worse" groups: in the physical domain there was no relation with the value of the initial quality of life; in the mental domain there was worsening in those who had higher value.
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    Avaliação dos efeitos dos componentes dos óleos essenciais (timol, carvacrol e p-cimeno) no enfisema pulmonar induzido por instilação de elastase em camundongos
    (Universidade Federal de São Paulo, 2016-03-23) Pereira, Ellen Games Jacob [UNIFESP]; Prado, Carla Maximo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Pulmonary emphysema is the most important component of Chronic Obstructive Pulmonary Disease (COPD) and is characterized by destruction of alveolar walls resulting in an enlargement and progressively airflow limitation. Although COPD represents the fourth leading cause of mortality in the world there is still no specific therapeutic measures for the treatment, which is still symptomatic. Phytotherapy, including essential oils, is widely used to treat various diseases, however, in most cases, there is not enough scientific evidence. Objective: To evaluate the effects of treatment with thymol, carvacrol and p-cymene, monoterpenes derived from essential oils of Brazilian plant species, the changes in respiratory mechanics and pulmonary histopathology induced by instillation of elastase. Methodology: Male C57BL6 mice were used, which were given saline or elastase. 30 minutes after instillation of elastase animals were treated with thymol, carvacrol, p-cymene or vehicle. These treatments were repeated on days 7, 14, 21 and 28. Animals that received saline were treated with vehicle only. On the 28th, after 30 minutes of treatment they were evaluated: mechanics of the respiratory system; exhaled nitric oxide (NoEx), pulmonary inflammation and cytokines in the bronchoalveolar lavage (BAL), evaluation of the content of collagen fibers and alveolar diameter and expression of MMP-9, TIMP-1, NF-kB and 8-iso-PGF- 2? by immunohistochemistry. Statistical analysis was performed using the SigmaStat using analysis of variance One way ANOVA. Results: The elastase group had pulmonary emphysema (increase of Lm), an increase of macrophages and IL-6, IL-8, IL-1? and IL-17 levels in BAL, in addition to increased deposition of fibers collagen and expression of MMP-9, TIMP-1, isoprostane and NF-kB in the lung parenchyma. Still, there was an increase of NoEx these animals. The treatments with thymol, carvacrol and p-cymene reduced pulmonary inflammation, the cytokines IL-6, IL-8, IL-17 and IL-1? the values Lm and collagen deposition in the lung parenchyma, as well as MMP-9 expression, NF-KB and isoprostane in lung tissue. TIMP 1 levels in the treated groups were higher than the control group but similar to animals receiving no treatment elastase. Treatment with thymol still reduced exhaled NO. Conclusion: These compounds reduced the inflammation and tissue destruction attenuated and reduced collagen deposition associated with MMP-9 reduced. These effects can be attributed to reduced NF-kB expression of pro-inflammatory cytokines (IL-17, IL-1?) and also reduce oxidative stress. Apparently, the position or the hydroxyl radical presence does not interfere with the biological effects of these compounds in the emphysema model. Other mechanisms of action have yet to be evaluated.
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    Brazilian version of airways questionnaire 20: a reproducibility study and correlations in patients with COPD
    (W B Saunders Co Ltd, 2005-05-01) Camelier, Aquiles Assunção [UNIFESP]; Rosa, Fernanda Warken [UNIFESP]; Jones, Paul Wyatt; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ London St Georges Hosp
    This study describes the correlations and reproducibility of AQ20, a simple health status questionnaire with 20 questions, which was designed to be useful especially in time sparing situations. A format language validation process was done, in order to validate the AQ20 before studying its reproducibility. Thirty stable COPD patients answered the final version twice within 15 days. To test the reproducibility of AQ20, the interclass correlation coefficient and Bland Altman display were used. Results were correlated with FEV1, SpO(2), BMI, Mahler BDI, and the Saint George Respiratory Questionnaire (SGRQ). Twenty-five patients (83.3%) were male, with a mean age of 68.6 years. the mean predicted FEV1 (%) was 56.8%. the interclass correlation ratio for the total score was alpha = 0.90 for the intraobserver variability and alpha = 0.93 for the interobserver variability. the correlation with total SGRQ score was 0.76, with P < 0.001. the mean application time for AQ20 was 4min and 6s, and the score calculation time, was 8s. It can be concluded that AQ20 is reproducible, with an excellent correlation with SGRQ total score, and also having the advantage of taking just a few minutes to be applied and to have its score calculated. (c) 2004 Elsevier B.V. All rights reserved.
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    Comparative efficacy of indacaterol 150 mu g and 300 mu g versus fixed-dose combinations of formoterol plus budesonide or salmeterol plus fluticasone for the treatment of chronic obstructive pulmonary disease - a network meta-analysis
    (Dove Medical Press Ltd, 2011-01-01) Cope, Shannon; Capkun-Niggli, Gorana; Gale, Rupert; Jardim, Jose Roberto [UNIFESP]; Jansen, Jeroen P.; Mapi Values; Novartis Pharma AG; Novartis Horsham Res Ctr; Universidade Federal de São Paulo (UNIFESP)
    Objective: To compare efficacy of indacaterol to that of fixed-dose combination (FDC)-formoterol and budesonide (FOR/BUD) and FDC salmeterol and fluticasone (SAL/FP) for the treatment of chronic obstructive pulmonary disease (COPD) based on the available randomized clinical trials (RCTs).Methods: Fifteen placebo-controlled RCTs were included that evaluated: indacaterol 150 mu g (n = 5 studies), indacaterol 300 mu g (n = 4), FOR/BUD 9/160 mu g (n = 2), FOR/BUD 9/320 mu g (n = 3), SAL/FP 50/500 mu g (n = 5), and SAL/FP 50/250 mu g (n = 1). Outcomes of interest were trough forced expiratory volume in 1 second (FEV1), total scores for St. George's Respiratory Questionnaire (SGRQ), and transition dyspnea index (TDI). All trials were analyzed simultaneously using a Bayesian network meta-analysis and relative treatment effects between all regimens were obtained. Treatment-by-covariate interactions were included where possible to improve the similarity of the trials.Results: Indacaterol 150 mu g resulted in a higher change from baseline (CFB) in FEV1 at 12 weeks compared to FOR/BUD 9/160 mu g (difference in CFB 0.11 L [95% credible intervals: 0.08, 0.13]) and FOR/BUD 9/320 mu g (0.09 L [0.06, 0.11]) and was comparable to SAL/FP 50/250 mu g (0.02 L [-0.04, 0.08]) and SAL/FP 50/500 mu g (0.03 L [0.00, 0.06]). Similar results were observed for indacaterol 300 mu g at 12 weeks and indacaterol 150/300 mu g at 6 months. Indacaterol 150 mu g demonstrated comparable improvement in SGRQ total score at 6 months versus FOR/BUD (both doses), and SAL/FP 50/500 mu g (-2.16 point improvement [-4.96, 0.95]). Indacaterol 150 and 300 mu g demonstrated comparable TDI scores versus SAL/FP 50/250 mu g (0.21 points (-0.57, 0.99); 0.39 [-0.39, 1.17], respectively) and SAL/FP 50/500 mu g at 6 months.Conclusion: Indacaterol monotherapy is expected to be at least as good as FOR/BUD (9/320 and 9/160 mu g) and comparable to SAL/FP (50/250 and 50/500 mu g) in terms of lung function. Indacaterol is also expected to be comparable to FOR/BUD (9/320 and 9/160 mu g) and SAL/FP 50/500 mu g in terms of health status and to SAL/FP (50/250 and 50/500 mu g) in terms of breathlessness.
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    Complicaciones pulmonares y mortalidad en el postoperatorio de pacientes con enfermedad pulmonar obstructiva crónica leve y moderada sometidos a cirugía general electiva
    (Ediciones Doyma S A, 2001-05-01) Medeiros, Renato de Albuquerque [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do Norte
    Objective: To verify the incidence of postoperative pulmonary complications (PPC) and mortality in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) who undergo elective general surgery. Incidence of PPC and mortality were studied in relation to sex, age, anesthesia, surgical incision, duration of surgery, smoking, respiratory symptoms, comorbidity, nutritional status, lung examination, abnormal electrocardiogram, and PaO2, PaCO2, FEV, and FEV1/FVC.Design: Prospective, open study.Material and methods: Fifty-nine COPD patients were enrolled (FEV1/FVC < 88% of reference for women and < 89% for men) and studied at a tertiary care university hospital. The patients were examined during the preoperative period and followed until discharge.Results: Twenty patients (33.9%) experienced PPC and 6 died, two (3.4%) from lung-related causes. Thirty-five PPC events occurred: pneumonia (37.2%), bronchospasm (22.9%), atelectasis (11.4%), acute respiratory insufficiency (11.4%), prolonged mechanical ventilation (11.4%) and bronchial infection (5.7%). Risk factors for PPC were male gender, duration of surgery over 270 minutes, low FEV1/FVC (71.9 +/- 10.9%) and surgical incision in the chest or upper abdomen. No significant difference between patients with or without PPC were found for age, presence of respiratory symptoms, comorbidity, abnormal lung examination, nutritional status, smoking, abnormal electrocardiogram, PaO2, PaCO2, FEV1 or duration of pre-operative hospitalization. The rate of PPC was higher in patients smoking more than a mean 40 packs of cigarettes per year. Patients with PPC had longer hospital stays (16.6 +/- 15.0 vs. 7.5 +/-5.7 days) and stayed longer in intensive care units (7.0 +/-5.9 vs. 1.7 +/-0.7 days) than did those with no complications (p<0.05).Conclusions: The incidence of PPC was 33.9% and lung-related mortality was 3.4%. Risk factors were male gender, amount of smoking, duration of surgery over 270 minutes, low FEV1/FVC, and chest or upper abdominal incision. No risk factor was found to predict mortality in this group.
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    Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients
    (Faculdade de Medicina / USP, 2012-01-01) Castro, Antônio Adolfo Mattos de [UNIFESP]; Kümpel, Claudia [UNIFESP]; Rangueri, Rosana Chaves [UNIFESP]; Oliveira, Maurício Dalcin; Dornelles, Rodrigo Alves; Brito, Emerson Roberto; Seki, Tânia Maria; Porto, Elias Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Federal University of Pampa; Adventist University of São Paulo Pulmonary Rehabilitation Center; Adventist University of São Paulo
    OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.
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    Demographic Characteristics and Clinical Outcomes in Patients from Latin America Versus the Rest of the World: A TIOSPIR (R) Post-Hoc Analysis
    (Elsevier Doyma Sl, 2018) Anzueto, Antonio; Calverley, Peter M. A.; Mueller, Achim; Metzdorf, Norbert; Haensel, Michaela; Jardim, José Roberto [UNIFESP]; Pizzichini, Emilio; Giraldo, Horacio; Ramirez-Venegas, Alejandra; Giugno, Eduardo R.
    Introduction: Geographical variations may impact outcomes in chronic obstructive pulmonary disease (COPD). We evaluated differences in baseline characteristics and outcomes between patients enrolled in Latin America compared with the rest of the world (RoW) in the TIOtropium Safety and Performance In Respimat (R) (TIOSPIR (R)) trial. Methods: TIOSPIR (R), a 2-3-year, randomized, double-blind trial (n = 17 116
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    Desoxigenação de músculos respiratórios e locomotor durante exercício incremental em pacientes com Doença Pulmonar Obstrutiva Crônica
    (Universidade Federal de São Paulo (UNIFESP), 2020-07-30) Freitas, Tiago Obeid De [UNIFESP]; Silva, Bruno Moreira [UNIFESP]; Universidade Federal de São Paulo
    Chronic Obstructive Pulmonary Disease (COPD) causes difficulties for physical exercise, in part, because the oxygen supply is incompatible with the oxygen demand of skeletal striated muscles in dynamic contractions. However, it is possible that the imbalance between demand and supply of oxygen for inspiratory, expiratory and locomotive muscles is not identical, which, however, remains unexplored. In addition, the mechanisms involved in the imbalance of muscle deoxygenation are not yet fully elucidated. Therefore, the objective of this dissertation project is to compare the kinetics of muscle deoxygenation between inspiratory (intercostal), expiratory (transverse) and locomotor (vastus lateralis) muscles in patients with COPD. For this purpose, during a visit, individuals with COPD underwent an exercise test on a cycle ergometer, with an incremental increase in the exercise load, where cardiorespiratory responses were measured, and, mainly, muscle deoxygenation by near infrared spectroscopy. NIRS). The behavioral analysis of the muscular deoxygenation proved to be unfeasible after evaluation by two independent researchers. The results of the comparison of the areas between the muscles showed that there were no differences between the intercostal, transverse and vastus lateralis muscles. However, the correlation analyzes between the three muscles did not show an association between the deoxygenation of each one, pointing to a heterogeneity in the variation of deoxygenation between the muscles, which suggests a different degree of involvement between them.
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    Determinação do limiar anaeróbio pela variabilidade da frequência cardíaca de pacientes com DPOC durante exercício em cicloergômetro
    (Pontifícia Universidade Católica do Paraná, 2012-12-01) Caruso, Flávia Cristina Rossi; Reis, Michel Silva; Siqueira, Ana Cristina Barroso de [UNIFESP]; Gardim, Marli; Catai, Aparecida Maria; Borghi-Silva, Audrey; Universidade Federal de São Carlos Departamento de Fisioterapia Núcleo de Pesquisa em Exercício Físico; Universidade Federal de São Carlos Fisioterapia Cardiovascular; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de São Carlos Geriatria; Universidade de Federal de São Carlos Fisioterapia
    INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is characterized by structural alterations of lung parenchyma resulting in systemic manifestations. These patients may have marked change in cardiac autonomic control. In this context, studies investigating heart rate variability (HRV) in patients with COPD during physical exercise cycloergometers have been little explored. OBJECTIVE: To determine the anaerobic threshold through HRV in order to establish parameters of evaluation and prescription of exercise intensity in these patients on a cycloergometer. MATERIALS AND METHODS: Eight male patients diagnosed with COPD, mean age 69.5 ± 7.6 years were studied. Heart rate was analyzed at rest and at different intensities of exercise. The test was performed on a cycloergometer and consisted of a warm-up period of four minutes at a minimum power. Steps were performed with initial power of 4W, with increments of 5 in 5W, until the patient reached the anaerobic threshold. RESULTS: Patients that presented higher values of FEV1 showed greater powers during the cycloergometer. Additionally, there was significant reduction in HRV during exercise compared to rest sitting p < 0.05. CONCLUSION: Patients had a severe physical deconditioning reaffirmed the impossibility determined by the anaerobic threshold of 50% of the sample.
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    Diagnostic Labeling of COPD in five Latin American cities
    (Amer Coll Chest Physicians, 2007-01-01) Talamo, Carlos; Montes de Oca, Maria; Halbert, Ron; Perez-Padilla, Rogelio; Jardim, José Roberto B. [UNIFESP]; Muino, Adriana; Lopez, Maria Victorina; Valdivia, Gonzalo; Pertuze, Julio; Moreno, Dolores; Menezes, Ana Maria B.; PLATINO Team; Hosp Univ Caracas; Univ Calif Los Angeles; Inst Resp Dis; Universidade Federal de São Paulo (UNIFESP); Univ Republica; Pontificia Univ Catolica Chile; Fed Univ Pelotas
    Background: COPD is a major worldwide problem with a rising prevalence. Despite its importance, there is a lack of information regarding underdiagnosis and misdiagnosis of COPD in different countries. As part of the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study, we examined the relationship between prior diagnostic label and airway obstruction in the metropolitan areas of five Latin American cities (S (a) over tildeo Paulo, Santiago, Mexico City, Montevideo, and Caracas).Methods: A two-stage sampling strategy was used in each of the five areas to obtain probability samples of adults aged 40 years. Participants completed a questionnaire that included questions on prior diagnoses, and prebronchodilator and postbronchodilator spirometry. A study diagnosis of COPD was based on airway obstruction, defined as a postbronchodilator FEV1/FVC < 0.70.Results: Valid spirometry and prior diagnosis information was obtained for 5,303 participants; 758 subjects had a study diagnosis of COPD, of which 672 cases (88.7%) had not been previously diagnosed. the prevalence of undiagnosed COPD was 12.7%, ranging from 6.9% in Mexico City to 18.2% in Montevideo. Among 237 subjects with a prior COPD diagnosis, only 86 subjects (36.3%) had postbronchodilator FEV1/FVC < 0.7, while 151 subjects (63.7%) had normal spirometric values. in the same group of 237 subjects, only 34% reported ever undergoing spirometry prior to our study.Conclusions: Inaccurate diagnostic labeling of COPD represents an important health problem in Latin America. One possible explanation is the low rate of spirometry for COPD diagnosis.
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    Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease
    (Associação Brasileira de Divulgação Científica, 2012-12-01) Takara, Luciana Shimizu [UNIFESP]; Cunha, Thulio Marquez [UNIFESP]; Barbosa, Priscila Boaventura [UNIFESP]; Rodrigues, Miguel Koite [UNIFESP]; Oliveira, Mayron Faria [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Queen’s University Department of Medicine Division of Respiratory and Critical Care Medicine
    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V CW) = rib cage (V RC) + abdomen (V AB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) V CW increased in relation to resting values. There was a noticeable heterogeneity in the patterns of V CW regulation as EEV CW increased non-linearly in 17/30 hyperinflators and decreased in 13/30 non-hyperinflators (P < 0.05). EEV AB decreased slightly in 8 of the hyperinflators, thereby reducing and slowing the rate of increase in end-inspiratory (EI) V CW (P < 0.05). In contrast, decreases in EEV CW in the non-hyperinflators were due to the combination of stable EEV RC with marked reductions in EEV AB. These patients showed lower EIV CW and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIV CW regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment.
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    Efeito da temperatura sobre o tempo de armazenagem e da concentração de sangue na avaliação de alfa 1 antitripsina coletado em papel filtro (dried blood spot - DBS)
    (Universidade Federal de São Paulo (UNIFESP), 2018-07-26) Silva, Shirlene Cristina da [UNIFESP]; Jardim, Jose Roberto de Brito [UNIFESP]; http://lattes.cnpq.br/5459496798874355; http://lattes.cnpq.br/4320654878656075; Universidade Federal de São Paulo (UNIFESP)
    Introduction Alpha-1 antitrypsin deficiency (DAAT) is a codominant autosomal genetic disorder that promotes a reduction in plasma levels of circulating AAT and is related to the development of early pulmonary emphysema, liver disease and panniculitis. It is known that DAAT is an underdiagnosed disease in clinical practice, although it has a high prevalence. The diagnosis of DAAT is made by quantifying reduced serum levels of AAT followed by phenotyping and / or genotyping. The Dried Blood Spot (DBS) technique is minimally invasive, easy to store and transport, and is feasible for implantation in population programs. Thus, we note that there is no objective study that evaluated the DBS card for AAT evaluation concomitantly in relation to storage time and temperature. Objectives: 1) To evaluate the measurement of the AAT concentration in two different eluates, one coming with a 6mm disc and the other with two 6mm discs and comparing them with the serum AAT dosage. 2) to evaluate the effect of storage temperature of DBS on the stability of alpha 1 antitrypsin glycoprotein stored in DBS at -20 ° C, 4 ° C and ambient air (24 ° C) after 24 hours and 3, 7, 15, 30, 60, 90 days. Methods: DBS samples of 29 subjects, two with diagnosis of DAAT without use of replacement therapy for at least fifteen days, were used for AAT dosing. For the preparation of the blood samples in DBS, we used the protocol of Zillmer et al. Results: There was a correlation of r = 0.82 between the values of the plasma AAT concentration and a peak in the DBS. There was a correlation of r = 0.86 between the values of the plasma AAT concentration and two pecks in the DBS. There was a correlation of r = 0.88 between the AAT concentration values with one pick and two picks in the DBS. By dividing by two the AAT value obtained with two 6 mm picks, we obtained a good correlation against the value of a 6mm pick (r = 0.88), all correlations evaluated 24 hours after collection. DBS values maintained in ambient air showed no significant change until day 15 at 4 ° C remained stable from baseline until day 30 and when DBS stored at -20 ° C remained stable relative to baseline to baseline up to 90 days. Conclusion: We present a good correlation between AAT plasma and DBS measurements. There was also a good correlation between the AAT measurement in the DBS with a 6mm pick and two 6mm picks. We verified that the AAT measurement in the DBS is stable in ambient air up to 15 days, at 4ºC up to 30 days and at -20ºC up to 90 days assess changes in AAT stability over time.
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    Efeito do tratamento com eugenol e deidrodieugenol em modelo experimental de enfisema pulmonar induzido por elastase
    (Universidade Federal de São Paulo, 2022-10-24) Medeiros, Laura Taguchi Perez [UNIFESP]; Taguchi, Laura [UNIFESP]; Prado, Carla Máximo [UNIFESP]; http://lattes.cnpq.br/1740478426977844; http://lattes.cnpq.br/4409788652533408; Universidade Federal de São Paulo (UNIFESP)
    A Doença Pulmonar Obstrutiva Crônica é uma doença de alta prevalência, morbidade e mortalidade, caracterizada por uma inflamação pulmonar crônica difusa. Nos períodos de exacerbação há agravamento da obstrução do fluxo aéreo e remodelamento pulmonar favorecendo redução progressiva da função pulmonar e piora na qualidade de vida. Nenhum tratamento convencional não reduz a progressão da doença e desencadeia efeitos colaterais. Os compostos foram extraídos de folhas secas de Nectandra leucanta: eugenol (4-alil-2-metoxifenol) e deidrodieugenol ou biseugenol (3,3’-dimetoxi-5,5’-di-2-propenil-1,1’-bifenil-2,2’-diol). Ambas as substâncias apresentam propriedades terapêuticas anti-inflamatórias e antioxidantes com efeitos benéficos já comprovados. Objetivo. Avaliar os efeitos do tratamento com eugenol e biseugenol nas alterações pulmonares em modelo experimental de enfisema pulmonar induzida pela elastase. Materiais e Métodos. Inicialmente realizou-se curva para avaliação da capacidade antioxidante dos compostos in vitro. Em paralelo, camundongos C57BL/6 receberam elastase intranasal no dia 0. Os tratamentos com eugenol e o seu dímero biseugenol foram realizados por injeção intraperitoneal nos dias consecutivos 21 a 28 do protocolo. No 28º dia, duas horas após a última dose, foi avaliada a função pulmonar, coletado o fluido do lavado broncoalveolar, sangue periférico e medula óssea para avaliação de células inflamatórias. Os pulmões foram retirados, fixados em pressão constante e submetidos às técnicas histológicas habituais. Por análise morfométrica, foi quantificado no tecido pulmonar o diâmetro alveolar médio (coloração de H&E) e proporção de fibras colágenas (coloração de picrosírius). Também foi realizado imuno-histoquímica para análise de citocinas inflamatórias e estresse oxidativo. A análise estatística foi realizada pelo Programa GrapPadPrisma e um p<0,05 foi considerado significativo. Resultados. O biseugenol apresentou maior capacidade em potencial antioxidante do que o eugenol. A elastase aumentou o diâmetro alveolar médio, as células inflamatórias, e aquelas que expressam citoinas IL1β, IL-6 e IL-17, iNOS e fatores de transcrição (Nrf2 e NF-κB) no tecido pulmonar quando comparados aos animais controle. Os tratamentos com eugenol e biseugenol reduziram o diâmetro alveolar médio, o número de células positivas para Nrf2, NF-kB, citocinas e iNOS no pulmão. Não foram observadas diferenças entre os grupos experimentais na contagem de células no sangue periférico e na função pulmonar (Gtis, Htis, Ers, Rsr e Raw) nem na expressão de células positivas para SOD 1 e 2 no tecido pulmonar entre os grupos avaliados. Para análise dos dados utilizou-se análise de variância um fator e Student-Newman-Keuls, por meio do programa GraphPad Prisma, considerando p<0,05 significativo. Conclusão: Estes dados indicam que o eugenol e o biseugenol foram efetivos no controle do enfisema, da inflamação e iNOS no pulmão de camundongos, podendo assim serem ferramentas importantes e eficazes, aliados a terapias farmacológicas já existente para o tratamento do enfisema pulmonar.
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    Efeitos da aplicação da Kinesio Taping nos músculos respiratórios: revisão integrativa
    (Universidade Federal de São Paulo, 2023-01-06) Schiavoni, Larissa Cristina [UNIFESP]; Yamauchi, Liria Yuri [UNIFESP]; Oliveira, Daianny Seoni de [UNIFESP]; http://lattes.cnpq.br/4811679938448350; http://lattes.cnpq.br/3898949209852523; http://lattes.cnpq.br/8129243788327888; Universidade Federal de São Paulo (UNIFESP)
    Introdução. O diafragma é o principal músculo respiratório e doenças que interferem em sua inervação, propriedade contrátil ou em seu acoplamento mecânico à caixa torácica podem ocasionar a disfunção diafragmática. Vários mecanismos fisiopatológicos da DPOC assim como tempo prolongado de ventilação mecânica se envolvem neste processo de comprometimento da função diafragmática. A técnica de Kinesio tape (KT) , desenvolvida pelo quiropraxista japonês Kenzo Kase, quando colocada sobre a pele fornece sustentação às articulações e aos músculos. Estudos acerca dos efeitos da Kinesio, em condições variadas, tem mostrado resultados benéficos de sua aplicação na musculatura respiratória. Objetivo. Realizar uma revisão integrativa de projetos experimentais e não experimentais para a compreensão completa dos efeitos da aplicação técnica de Kinesio taping nos músculos respiratórios. Método. Foi realizada uma busca nas bases de dados: LILACS, BVS, PubMed, Web of Science e PEDro. Foram utilizados, para busca dos artigos, os seguintes descritores e suas combinações nas línguas portuguesa e inglesa: “função respiratória”, “disfunção respiratória”, “insuficiência respiratória” e “kinesio tape”. Os critérios de inclusão definidos para a seleção dos artigos foram: artigos publicados em português, inglês e espanhol; artigos na íntegra que retratassem a temática referente a revisão integrativa e artigos publicados e indexados nos referidos bancos de dados nos últimos 30 anos. Resultados. Foram incluídos 6 artigos, dos quais 3 estudaram a população com DPOC, 2 estudaram pacientes oncológicos e 1 estudou com pacientes saudáveis. Os artigos mostram influência da KT nos valores de VEF1 e pico de fluxo expirarório, dispneia e dor , mas não em força muscular respiratória, saturação de oxigênio, e capacidade inspiratória. Conclusão. Essa revisão conclui que a KT parece melhorar valores de pico de fluxo, assim como os de VEF1. Não foram encontradas evidências de efeitos acerca da força muscular respiratória ou na capacidade inspiratória. Os efeitos placebos da intervenção também necessitam de mais investigações.