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- ItemSomente MetadadadosAvaliação Da Força E Fatigabilidade Muscular Periférica Por Dinamometria Isocinética Em Pacientes Com Doença Pulmonar Obstrutiva Crônica Associada À Insuficiência Cardíaca(Universidade Federal de São Paulo (UNIFESP), 2017-07-31) Medina, Luiz Antonio Rodrigues [UNIFESP]; Medeiros, Wladimir Musetti [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The coexistence of chronic obstructive pulmonary disease (COPD) and heart failure with ejection fraction reduced left ventricular (IC) is underdiagnosed and is associated with poor prognosis. Cardiocirculatory and pulmonary changes found in both diseases can impair the supply of oxygen (O2) to the peripheral muscles resulting in decreased muscle strength and endurance, resulting in the exercise intolerance and the decline in functional capacity. Fifty male patients, with twentyfive COPD + IC (age 67.8 ± 6.9; FEV1 62.5 ± 17.4% predicted; EF = 36.1 ± 10.7) and twenty-five COPD (age 66.1 ± 9.1; FEV1 51.3 ± 17.0% predicted; EF = 67.6 ± 4.7) underwent clinical evaluation, resting echocardiography, pulmonary function, cardiopulmonary test incremental exercise (CPET), step test 4 minutes, 6 minute walk test and peripheral muscle isokinetic evaluation. The groups did not differ in demographic and anthropometric characteristics (p> 0.05). The functional capacity measured in 6-minute walk test showed a trend of smaller distance in COPD + IC group (401.4 ± 92.7) compared to COPD (451.5 ± 99.4) maximum effort COPD + IC group had significantly lower values load achieved when compared with the COPD group (57.6 ± 24.3 vs. 73.5 ± 22.7; P <0.05). The muscle performance is compromised in both COPD and in COPD + IC group. The lower torque, power and work, it is most evident in COPD + IC group. The most significant findings were in the flexor muscles of the knee, the isokinetic evaluation at 60°/s and 300 °/s respectively. The 60 °/s work and the torque peak as a percentage of predicted in COPD + IC group was lower than the COPD group (54.7 ± 13.3 vs. 65.8 ± 13.1; P < 0.05), (87.0 ± 24.0 vs. 94.8 ± 22.8; P < 0.05). The COPD + HF group showed significantly lower values in the fatigue index in percentage corrected by muscle mass in the torque variables (1.5 ± 0.4 vs. 1.2 ± 0.3; P < 0.05), work (1.4 ± 0.4 vs. 1.1 ± 0.3; P < 0.05), and power (1.8 ± 0.4 vs. 1.4 ± 0.4; P < 0.05). The overlap of HF in patients with COPD worsens muscle dysfunction observed in patients with isolated COPD. However, this increase is not uniform over the entire lower limb muscles, specifically affecting the knee flexors.
- ItemAcesso aberto (Open Access)Efeitos da ventilação não invasiva nas respostas fisiológicas e sensoriais ao exercício em pacientes com insuficiência cardíaca associada à Doença Pulmonar Obstrutiva Crônica(Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Souza, Aline Soares De [UNIFESP]; Serafini, Jose Alberto Neder [UNIFESP]; Sperandio, Priscila Cristina de Abreu [UNIFESP]; http://lattes.cnpq.br/8238787131403166; http://lattes.cnpq.br/5131155111475682; http://lattes.cnpq.br/5372408065858083; Universidade Federal de São Paulo (UNIFESP)Aims: To analyze the effects of NIV on the physiological, sensorial and effort tolerance responses in patients with HF and HF associated with COPD. Methods: Incremental cardiopulmonary testing was performed in 19 patients (9 with coexisting COPD but with similar low left ventricular ejection fraction) were submitted to a constant loading protocol with different intensities (20%, 40%, 60% and 80% Wpeak) with serial measures of inspiratory capacity (CI). The last W/peak intensity was maintained up to the limit of effort tolerance (Tlim). Patients received Sham or NIV (bi-level) ventilation that was adjusted according to individual comfort. Results: Tlim increased with NIV in relation to Sham ventilation only in HF+COPD (P <0.05). NIV provided higher tidal volume and lower respiratory rate, shorter duty cycle with longer expiratory time, and higher mean inspiratory flow in both groups (P <0.05), despite the absence of changes in minute ventilation. It is important to emphasize that NIV improved IC (by ~ 0.5 l) across all exercise intensities only in HF+COPD. Assuming constant total lung capacity, NIV reduced operant lung volumes, thus decreasing inspiratory constraints. These beneficial consequences of NIV were associated with lower dyspnea Borg scores at the 80% peak and at the end of the exercise (p <0.05). Conclusion: NIV resulted in lower operative lung volumes and lower dyspnea. Tlim was higher even under high ventilatory stress, therefore, there was a better "quality" in the ventilatory responses during exercise only in the IC+COPD patients.
- ItemSomente MetadadadosEffects of heart failure on cerebral blood flow in copd: rest and exercise(Elsevier Science Bv, 2016) Oliveira, Mayron Faria [UNIFESP]; Alencar, Maria Clara [UNIFESP]; Arbex, Flavio [UNIFESP]; Souza, Aline [UNIFESP]; Sperandio, Priscila [UNIFESP]; Medina, Luiz [UNIFESP]; Medeiros, Wladimir Musetti [UNIFESP]; Hirai, Daniel Müller [UNIFESP]; O'Donnell, Denis E.; Neder, Jose Alberto [UNIFESP]Cerebral blood flow (CBF) and oxygenation (COx) are generally well-preserved in COPD. It is unknown whether prevalent cardiovascular co-morbidities, such as heart failure, may impair CBF and COx responses to exertion. Eighteen males with moderate-to-severe COPD (8 with and 10 without overlapping heart failure) underwent a progressive exercise test with pre-frontal CBF and COx measurements (indocyanine green and near-infrared spectroscopy). Mean arterial pressure and cardiac output were lower from rest to exercise in overlap. Only COPD patients demonstrated an increase in arterialized PCO2 towards the end of progressive exercise. CBF index was consistently higher and increased further by similar to 40% during exercise in COPD whereas a similar to 10% reduction was observed in overlap. COx was lower in overlap despite preserved arterial oxygenation. In conclusion, heart failure introduces pronounced negative effects on CBF and COx in COPD which may be associated with clinically relevant outcomes, including dyspnea, exercise intolerance, cerebrovascular disease and cognitive impairment. (C) 2015 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosFluxo sanguíneo microvascular muscular sob manobra simpatoexcitatória em pacientes com DPOC: comparação entre músculos respiratório e locomotor(Universidade Federal de São Paulo (UNIFESP), 2020-04-30) Ribeiro, Indyanara Cristina [UNIFESP]; Silva, Bruno Moreira [UNIFESP]; Universidade Federal de São PauloPatients with moderate-to-severe chronic obstructive pulmonary disease (COPD) have low blood flow in the intercostal and locomotor muscles during exercise, but the underlying mechanisms are unclear. Muscle blood flow adjustment during exercise depends on the balance between sympathetic vasoconstriction and local vasodilatory mechanisms, which is known as functional sympatholysis. However, this phenomenon tends to be altered in individuals who have high sympathetic activity and vascular dysfunction, which are characteristics of patients with COPD. Therefore, the objective of this project was to test the hypothesis that patients with COPD present imbalance between sympathetic-activity mediated vasoconstriction and vasodilatory mechanisms in respiratory and locomotor muscles. Patients with COPD and healthy control subjects will be assessed under three conditions: i) rest (i.e.,control), ii) isocapnic hyperpnea (i.e., increased respiratory muscle work), and iii) physical exercise on constant workload (i.e., increased work of respiratory and locomotor muscles). Ventilation during the isocapnic hyperpnea was paired with the level observed during exercise. At end of each condition, a sympathoexcitatory maneuver was conducted, called cold pressor test (CPT), which consisted of immersing one hand in cold water (0-3ºC). The microvascular blood flow of intercostal and vastus lateralis muscles were measured by near-infrared spectroscopy, associated with infusion of green indocyanine contrast, before and after the sympathoexcitatory maneuver, in each of the experimental conditions. The microvascular blood flow was analyzed by linear regression using time and ICG delta. The ensuing slope was considered as the blood flow index (BFI). Vascular conductance was estimated by division of BFI by mean arterial pressure (MAP). As result, the CPT provoked arterial blood pressure increases on three experiments and in both groups. The patients with COPD did not show changes on BFI responses when they were exposed to CPT in all experiments, however for the vascular conductance the patients did show reduction when they were exposed to CPT maneuver. Already the control group did not show changes on the BFI and vascular conductance responses on both muscles and in all experiments when they were exposed to CPT maneuver. In conclusion, our results therefore suggest that patients with COPD present imbalance between mechanisms of respiratory and locomotor muscle microvascular blood flow regulation during at rest, however it is possible that the patients have functional sympatholysis preserved during the isocapnic hyperpnea and to lower limb exercise.
- ItemAcesso aberto (Open Access)Interference of nail polish on the peripheral oxygen saturation in patients with lung problems during exercise(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2012-12-01) Shimoya-Bittencourt, Walkiria [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; Diccini, Solange [UNIFESP]; Bettencourt, Ana Rita de Cassia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)AIM: To assess the interference of nail polish on the reading of peripheral oxygen saturation in patients with chronic obstructive pulmonary disease on the step exercise. METHODS: In this study, there was the inclusion of patients with chronic obstructive pulmonary disease, current non-smokers, of both sexes. Four different colours of nail polish were used in the present study (base, light pink, red and brown), randomly distributed among the fingers of the right hand, with the corresponding fingers on the opposite hand being controls. Saturation was measured at rest, with and without the polish, and also during the 4th, 5th and 6th minutes of the exercise programme. RESULTS: The experimental universe included 42 patients with ages of 62.9±8.7 years. In the exercise considered, the red colour reduced it in the fourth minute of the exercise (p=0.047). In contrast, the brown colour reduced saturation at rest and also during the course of exercise (p=0.01). CONCLUSION: In patients with chronic obstructive pulmonary disease, the red and brown colours interfered with the reading of the peripheral oxygen saturation during exercise. This study is registered at the Brazilian Register of Clinical Trials (Registro Brasileiro de Ensaios Clínicos) under No. RBR-9vc722.
- ItemSomente MetadadadosPerda funcional após ressecção de parênquima pulmonar por câncer de pulmão: análise comparativa entre pacientes com e sem DPOC(Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Bedin, Danielle Cristine Campos [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Cardiopulmonary exercise test (CPET) is an important tool for preoperative risk assessment of lung resection for non-small cell lung cancer. However, there are still few studies that evaluated and compared the variables of this test after lung resection considering patients with and without COPD. Objectives: To evaluate respiratory function loss at rest and during exercise in patients with suspected or diagnosed lung cancer who underwent lung resection until lobectomy. We hypothesized that functional loss is lower in COPD patients according to spirometric criteria in relation to those who present normal spirometric values. Methods: Prospective cohort study. Patients were divided into COPD group and Control group according to spirometry. The study was divided in 4 phases: Preoperative - clinical and functional evaluation (spirometry, DLCO and CPET) in order to obtain surgical risk; Intraoperative - to register complications and ASA score; Early postoperative - to register complications, mortality, ICU time and length of hospital stay; Sixth month postoperative - to clinical and functional evaluation (spirometry,DLCO and CPET). The study was powered to detect a 20% difference in the V̇O2PEAK between the groups (β=0.2%; α=0.05). Student's t-test was used for comparison between two independent samples of normal distribution and Mann-Whitney test for comparison between two independent samples of non-normal distribution. For comparison between dependent samples, we used the t-test for normal distribution samples and Wilcoxon test for non-normal distribution samples. Results: Eighteen patients were selected after applying the exclusion criteria, ten to COPD group and eight to Control group. In both groups, the majority of the patients were male. In the COPD group, there were more current smokers and in the Control group more former smokers. Follow-up after six months showed no difference in FVC, FEV1 or DLCO values intra-group. Control group presented a decrease in V̇O2PEAK in the postoperative period (20.8 ± 7.1 mL/kg/min to 16.3 ± 5.3 mL/kg/min). This difference was not observed in the COPD group (15.6 ± 3.7 mL/kg/min to 14.5 ± 4.1 mL/kg/min). In both groups there were no difference in the ΔV̇E/ΔV̇CO2 values, but in COPD group an increase of the ΔV̇E/ΔV̇CO2RCP intercept was observed after surgery (2.9 ± 2.0 L/min to 4.4 ± 2.4 L/min). In the COPD group, post-operative predicted FEV1 and V̇O2PEAK were lower than observed in the postoperative period (54.9 ± 10.7% versus 62.1 ± 14.5%; 12.8 ± 3.6 mL/kg/ min versus 14.5 ± 4.1 mL/kg/ min). Conclusion: The COPD group presented a lower decrease of V̇O2PEAK after surgery, increase of the ΔV̇E/ΔV̇CO2 RCP intercept and overestimation of post-operative functional loss.
- ItemAcesso aberto (Open Access)Prevalence of chronic obstructive pulmonary disease and associated factors: the PLATINO Study in São Paulo, Brazil(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2005-10-01) Menezes, Ana Maria Baptista; Jardim, José Roberto [UNIFESP]; Pérez-Padilla, Rogelio; Camelier, Aquiles Assunção [UNIFESP]; Rosa, Fernanda Warken [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Hallal, Pedro Curi; Universidade Federal de Pelotas Programa de Pós-graduação em Epidemiologia; Universidade Federal de São Paulo (UNIFESP); Instituto Nacional de Enfermedades Respiratorias; PLATINOChronic obstructive pulmonary disease (COPD) is now a major public health concern; deaths attributable to COPD in Latin America have increased by 65.0% in the last decade. This study was aimed at evaluating COPD prevalence and associated factors in adults (> 40 years) living in Greater Metropolitan São Paulo, Brazil. The study is part of the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (The PLATINO Project), a multi-center survey on COPD burden in Latin America, with São Paulo as the first center where the project has been carried out. A population-based sample was selected in multiple stages. Spirometry tests were performed in each subject pre- and post-bronchodilator and COPD was mainly defined as the ratio of forced expiratory volume to forced vital capacity below 70.0% (fixed ratio definition). Other spirometric criteria were also used for the diagnosis of COPD. COPD prevalence was 15.8% (95%CI: 13.5-18.1) using the fixed ratio definition. COPD was positively associated with age and smoking and inversely with body mass index. Utilization of different COPD spirometry criteria resulted in different percentages of COPD, but similar associated factors.
- ItemEmbargoPrevalência de doença pulmonar obstrutiva crônica e distribuição da contagem de eosinófilos sanguíneos em pacientes com fator de risco para DPOC (tabagismo e/ou exposição à biomassa) atendidos em quatro unidades básicas de saúde de três estados brasileiros(Universidade Federal de São Paulo, 2024-04-23) Barros, Juliana Oliveira [UNIFESP]; Jardim, José Roberto de Brito [UNIFESP]; http://lattes.cnpq.br/4320654878656075; http://lattes.cnpq.br/2625355140965779Objetivos: Descrever prevalência de DPOC e distribuição da contagem de eosinófilos em pacientes com fatores de risco para DPOC, atendidos em quatro UBS de três estados brasileiros. Métodos: Estudo multicêntrico transversal em quatro UBS (Porto Alegre, Londrina, Araraquara, Botucatu). Após avaliação médica, incluímos pacientes com ≥35 anos, tabagistas e/ou expostos à biomassa que chegaram consecutivamente à UBS por qualquer motivo e que não tinham contraindicação aos procedimentos. As variáveis avaliadas foram: dados clínicos e sociodemográficos, exposição ambiental, história tabagística, mMRC, CAT, hemograma e espirometria. O diagnóstico de DPOC foi espirométrico pela relação fixa (RF) e limite inferior da normalidade (LIN). Resultados: Foram avaliados 737 pacientes consecutivos que compareceram às UBS do estudo. A prevalência de DPOC foi de 23,7% (RF) e 26,1% (LIN). O LIN diagnosticou mais pacientes com DPOC na faixa etária entre 35 e 39 anos (7,3% LIN vs 4,6% RF) e a RF diagnosticou mais pacientes com DPOC >70 anos (30,3% RF vs 24,5% LIN). Pelo menos 50% tinham DPOC grave a muito grave. Os pacientes eram bastante sintomáticos, porém a carga de sintomas era maior no grupo DPOC (p<0,01). A RF alcançou 76% de subdiagnóstico e 12% de sobrediagnóstico. A distribuição da contagem de eosinófilos no sangue foi semelhante a estudos internacionais em países desenvolvidos (228,4 ± 260,5). No grupo DPOC, ter utilizado antiparasitários nos últimos 3 meses foi associado a contagem de eosinófilos <100 (p=0,04). Não houve associação significante entre o número de eosinófilos e as exacerbações moderadas/graves nos 12 ou 24 meses prévios, porém indivíduos com contagem >300 células apresentam 20% mais exacerbações que as demais contagens. Conclusões: Um em cada quatro pacientes tinha diagnóstico de DPOC, com alto percentual de subdiagnóstico e alta carga de sintomas. A maioria apresentava doença moderada ou grave. A contagem de eosinófilos nos pacientes com/sem DPOC apresentou distribuição semelhante em todas as categorias de contagem de eosinófilos, porém pacientes com DPOC e >300 células apresentam 20% mais exacerbações.
- ItemSomente MetadadadosPrevalência E Fatores De Risco Para Osteoporose E Fraturas Por Fragilidade Em Pacientes Com Doença Pulmonar Obstrutiva Crônica(Universidade Federal de São Paulo (UNIFESP), 2017-12-08) Graumam, Roberta Queiroz [UNIFESP]; Castro, Charlles Heldan De Moura [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: Osteoporosis is frequently ignored in patients with chronic obstructive pulmonary disease (COPD). This study aimed at evaluating the rate of osteoporosis, fragility fractures and body composition abnormalities in COPD patients. Patients and methods: A total of ninety-nine COPD patients (53 women, 64.5±9.6 years old and 46 men, 65.9±8.0 years old) underwent DXA with body composition analyses. Healthy individuals (not exposed to tabaco) matched by sex, age and body mass index (BMI) were used as controls (N=57). Patients answered a structured questionnaire on medical history, previous diagnosis and treatment of osteoporosis and performed spirometry, routine laboratory workout and conventional thoracolumbar radiography surveying for vertebral deformities. Timed up and go (TUG) test and Baecke questionnaire were used to measure physical activity. Results: Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p=0.001). Only six patients had previous diagnosis of osteoporosis. Vertebral fractures (Genant’s Grade II and III) were seen in 24.4% of the men and 22.0% of the women with COPD. Patients with higher disease severity (GOLD 3 and 4) had higher rate of osteoporosis than patients GOLD 1 and 2 at the femoral neck (p=0.012) and total femur (p=0.02). Accordingly, BMD measurements were significantly lower in GOLD 3 and 4 patients as compared to healthy controls (p<0.001 for both men and women, ANOVA). GOLD 3 and 4 patients had also lower appendicular lean mass (ALM, p=0.002, for both men and women) and lower skeletal mass index (p=0.005, for women). Significant correlation between FEV1 and BMD at all skeletal sites was observed for women with COPD (p<0.001). Femoral neck and total femur BMD were significantly correlated to FEV1 in COPD men (r=0.409; p=0.006 and r=0.459; p=0.003, respectively) and women (r=0.638, p<0.001 and r=0.612, p=0.001, respectively). Multiple logistic regression analyses demonstrated that age was the main predictor of vertebral fracture in both men and women with COPD (OR=1.164 (1.078- 9.297); p<0.001), while plasma iPTH (OR=1.045 (1.005 – 1.088); p=0.029) and ALM (OR=0.99965 (0.99933 – 0.99997; p=0.031) were the main predictors of non-vertebral xvii fractures. ROC curve analysis showed that age above 63.5 years old was a good predictor of vertebral fractures (sensibility=77.5% and specificity=65.5%). Conclusion: A high prevalence of osteoporosis, vertebral fractures and low lean mass was observed in patients with COPD. More severe disease was associated with higher risk of low bone mass, low lean mass and fractures. Age, low ALM, high iPTH and osteoporosis were all significantly associated with fractures in COPD patients.
- ItemSomente MetadadadosQualidade De Vida E Intolerância Ao Exercício Em Pacientes Portadores Da Doença Pulmonar Obstrutiva Crônica Associada À Insuficiência Cardíaca(Universidade Federal de São Paulo (UNIFESP), 2017-06-29) Santos, Rita De Cassia Lima Dos [UNIFESP]; Sperandio, Priscila Cristina De Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The coexistence of chronic obstructive pulmonary disease (COPD) and heart failure (HF) is highly prevalent, and both diseases negatively affect patients' functional status and quality of life (QOL). High QOL scores are strongly associated to high mortality in these populations and high scores on specific QOL questionnaires such as the St George's Respiratory Questionnaire (SRGQ) for COPD and the Minnesota Living Heart Failure Questionnaire (MLHFQ) for HF are independent predictors of mortality. Therefore, our objective was to verify if there is an association between the severity of functional capacity and the score of QOL questionnaires in patients with coexistent COPD and HF. Twenty-one male and female patients over 45 years of age, with stable disease, forced expiratory volume in the first second and forced vital capacity (FEV1 / FVC < 0.7) were associated to stable HF with ejection fraction of the left ventricle ≤ 50%. The QOL was assessed by the SGRQ and MLHFQ specific questionnaires; the symptoms by mMRC, NYHA and COPD Assessment Test (CAT); and the functional capacity by cardiopulmonary exercise test (CPT), six-minute walk test (6MWT), and four-minute step test (4MST).The majority of patients were male, elderly, with a mean age of 66±8 years. The mean ejection fraction was 35±8% and 76% of the patients had moderate airflow limitation (GOLD II). In addition, it was found a moderate reduction in exercise capacity measured by oxygen consumption at the peak of exercise (VO2peak: 63 ± 15% predicted) and reduced distance in the 6MWT (77% predicted, mean 394 ± 93 meters), in addition to 58 ± 13 steps on average in the 4MST. The total MLHFQ score in the studied population ranged from 0 to 64 (mean of 24 ± 19). The most affected area of the SGRQ was activity, with an average of 59%, and a score of 41%. The MLHFQ was associated to the distance covered in the 6MWT (p <0.05), to the load at the peak of exercise (p <0.01) and to the VO2peak in percentage of predicted (p <0.05). In contrast, there was no association between SGRQ and functional capacity tests.