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- ItemAcesso aberto (Open Access)Alterações espirométricas em doenças obstrutivas: afinal, o quanto é relevante?(Sociedade Brasileira de Pneumologia e Tisiologia, 2013-02-01) Soares, André Luis Pinto; Pereira, Carlos Alberto de Castro [UNIFESP]; Rodrigues, Silvia Carla Sousa [UNIFESP]; Universidade Federal do Rio Grande do Norte; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público Estadual de São PauloOBJECTIVE: To establish the upper limits for changes in FEV1, slow vital capacity (SVC), FVC, and inspiratory capacity (IC) after placebo administration in patients with airflow obstruction. METHODS: One hundred and two adults with airflow obstruction (FEV1 = 62 ± 19% of predicted) were included in the study. All of the participants performed SVC and FVC maneuvers before and after the administration of placebo spray. The changes in FEV1, SVC, FVC, and IC were expressed as absolute values, percentage of change from baseline values, and percentage of predicted values, 95% CIs and 95th percentiles being calculated. Factor analysis was performed in order to determine how those changes clustered. RESULTS: Considering the 95% CIs and 95th percentiles and after rounding the values, we found that the upper limits for a significant response were as follows: FEV1 = 0.20 L, FVC = 0.20 L, SVC = 0.25 L, and IC = 0.30 L (expressed as absolute values); FEV1 = 12%, FVC = 7%, SVC = 10%, and IC = 15% (expressed as percentage of change from baseline values); and FEV1 = 7%, FVC = 6%, SVC = 7%, and IC = 12% (expressed as percentage of predicted values). CONCLUSIONS: In patients with airflow obstruction, IC varies more widely than do FVC and SVC. For IC, values greater than 0.30 L and 15% of change from the baseline value can be considered significant. For FVC, values greater than 0.20 L and 7% of change from the baseline value are significant. Alternatively, changes exceeding 0.20 L and 7% of the predicted value can be considered significant for FEV1 and FVC. On factor analysis, spirometric parameters clustered into three dimensions, expressing changes in flows, volumes, and dynamic hyperinflation.
- ItemAcesso aberto (Open Access)Associação entre hormônios sexuais e asma(Universidade Federal de São Paulo (UNIFESP), 2016-06-29) Baldacara, Raquel Prudente de Carvalho [UNIFESP]; Silva, Ivaldo da [UNIFESP]; http://lattes.cnpq.br/9948402316193744; Universidade Federal de São Paulo (UNIFESP)A relationship between oral contraceptive (OC) use and asthma is controversial and has been observed in previous researches. The objective of this study was to assess the relationship between combined OC use and pulmonary function in Brazilian women with or without asthma, in addition to evaluate the cytokines to verify the inflammatory process of asthma. This was case-control study involving women with and without asthma who were or not using combined OC. Seventy women were recruited from the Family Health Clinic or from the universities and 7 were excluded. Sixty-three patients were divided into four groups (I:-no asthma and no OC use; II:- no asthma and OC use; - III:- asthma and no OC use; and, IV: asthma and OC use). MANOVA (multivariate analysis of variance) were conducted. First one to evaluate the relationship between combined oral contraceptive (OC) use and changes in pulmonary function (FVC, FEV1, FEV1/FVC%) in women with or without asthma. The second MANOVA evaluated the influence of sex hormones on the immune system through the alteration of cytokins expression (IL-4, IL-5, and TNF-?). There was a lack of evidence regarding OC use?s effect on the spirometric parameters (Wilk?s ? = 0.850, F=0.757, p=0.647, ?²=0.053) and on cytokins levels (Wilk?s ? = 0.909, F=0.533, p=0.848, ?²=0.031), even when controlled by covariates. Therefore, this study returned lack of evidences concerning the relation between the use of OC use and alteration in spirometric parameters as well in cytokins dosages.
- ItemSomente MetadadadosAvaliação da correlação entre o controle clínico da asma, os valores de função pulmonar e o grau de inflamação das vias aéreas em crianças e adolescentes com asma(Universidade Federal de São Paulo (UNIFESP), 2014-11-28) Chaves, Danielle Maria de Souza [UNIFESP]; Wandalsen, Gustavo Falbo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: to evaluate in children and adolescents relations among four asthma characteristics: values of exhaled nitric oxide (FeNO), lung function, bronchodilator response (BR) and the degree of asthma control; to describe FeNO values in this population of asthmatics and to study the influence of clinical, demographic and functional aspects. Methods: cross-sectional evaluation of 147 children and adolescents with asthma followed in a reference out-patient clinic measuring FeNO values, spirometry, BR, asthma control questionnaire (ACT or C-ACT) and clinical data. Results: median age was 12.2 years (6 to 18 years) and 92 were males. Median from the time since the last asthma exacerbation was three months. Median of BMI z score was 0.73z and 122 patients had some associated disease, predominating allergic rhinitis (101 patients) and atopic dermatitis (42 patients). Ninety nine patients were in regular use of asthma control medication for at least one month. Seventy three (50%) patients had some abnormality in lung function and 34 (24%) showed positive BR (FEV1 increase of ? 12%). Uncontrolled asthma (ACT or C-ACT ? 19) was observed in 45 (31%) cases. In the total group we observed moderate correlations only between BR values and: FEV1 (r= -0.46), FEV1/FVC (r= -0.44) and FEF25-75% (r= -0.33). Among patients without regular control treatment, FeNO values correlated significantly with FEV1/FVC (r= -0.34), FEF25-75% (r= -0.34) and ACT/C-ACT (r= -0.25). Correlations observed in patients with regular asthma control treatment were, in general, weaker than those founded in patients without control treatment. In this group, FeNO values correlated significantly only with FEV1/FVC values (r= -0.18). FeNO values ranged from 1ppb to 196ppb (median 29.9ppb) and abnormal values (> 25ppb) were found in 81 (55%) patients. Those in regular use of asthma control medication had lower values than those without it (median: 23.5ppb vs 37.0ppb; p=0.006). FeNO values correlated significantly with time since the last asthma exacerbation (r= -0.24; p=0.02) and age (r= 0.19; p=0.009). Patients, when separated according to GINA steps of treatment, showed significantly different values of FeNO (p=0.04). Patients with abnormal lung function had higher BR values (median: 9% vs 5%; p<0.01) and lower values of ACT/C-ACT (median: 20 vs 22; p=0.01). Patients with positive BR had lower values of FEV1 (median: 76% vs 95%; p<0.001), FEV1/FVC (median: 76% vs 90%; p<0.001) and FEF25-75% (median: 59% vs 88%; p<0.001) than those without positive BR response. FeNO values were higher among patients with BR response (median: 45.3ppb vs 25.4ppb; p=0.01). Patients with uncontrolled asthma showed larger BR (median: 8% vs 5%; p=0.01) but without differences in FeNO values and lung function. Conclusions: FeNO, lung function, BR and asthma control scores are variables that did not correlate strongly, probably because they represent different domains of the disease. Correlations between FeNO values and these variables were stronger among asthmatics without regular control treatment. FeNO values showed a large variability and correlated significantly with age (positive) and time since the last asthma exacerbation (negative)
- ItemSomente MetadadadosAvaliação do papel mediador do nível de atividade física e aptidão cardiorrespiratória na associação entre a função pulmonar e a pressão arterial sistêmica: resultados longitudinais do estudo Epimov(Universidade Federal de São Paulo (UNIFESP), 2018-05-24) Almeida, Flavio Rossi de [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Restrictive Ventilatory Disorder (Rvd) Is A Very Prevalent Clinical Condition In Brazil And Worldwide. In Addition, Since Rvd And Cardiorespiratory Fitness (Crf) Directly Influence Systemic Arterial Hypertension (Sah), There Is A Need To Investigate The Possible Mediating Role Of Physical Activity And Crf In The Relation Between Pulmonary Function And The Systemic Blood Pressure Longitudinally. Objective: To Evaluate The Longitudinal Relationship Between Rvd And The Occurrence Of Sah In Adults And The Possible Mediating Role Of Physical Activity And Crf In The Relationship Between Spirometric Indexes And Systolic (Sbp) And Diastolic (Dbp) Arterial Pressures. Methods: We Performed A Prospective Cohort Study With 698 Adults, 279 Men And 419 Women, Aged 18-80 Years, Asymptomatic, Selected At The Beginning Of The Epidemiological Study Of Human Movement (Epimov Study). Sah Was Identified Through Questioning About The Previous Clinical Diagnosis Performed By A Physician During The Anamnesis. We Calcul
- ItemAcesso aberto (Open Access)Comparação das equações de valores de referência da função pulmonar mais utilizadas no Brasil: impacto no estadiamento da DPOC(Universidade Federal de São Paulo (UNIFESP), 2010-06-30) Pereira, Marcella Cristiane Silveira [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To compare the absolute values of FVC and FEV1 found in a random sample of a Brazilian population over 40 years of age with values of equations most used in Brazil. To compare the values in percentage of predicted of FVC and FEV1 of the selected equations with the PLATINO equation ones. To evaluate the change in COPD staying when using different reference equations. Material and Methods: We conducted a retrospective study from a representative sample of residents in the metropolitan region of Sao Paulo, aged .40 years, from the PLATINO study. For comparison of the FVC and FEV1, were subtracted from the predicted values of each equation the absolute values obtained from each individual, considering the equation inadequate wherever there was a difference of up to 0.15 L as defined by ATS. We also evaluated the difference between the values of FVC and VEF1 in percentage of predicted of the equations with the PLATINO equation, considering as a limit a difference .3% (ATS). The diagnosis of COPD was defined as FEV1/FVC <0.70 after bronchodilator, and the comparison of staging was performed using the FEB1 in percentage of predicted in each equation, with reference to the percentage expected from the PLATINO equation. T-student test, chi-squared and the intraclass correlation coefficient were used to evaluate the performance of FVC and FEV1 in different equations and data are presented as mean, standard deviation, standard error and confidence interval of 95%. Results: After evaluating 178 healthy subjects, we observed that the equations that show less difference between the predicted value and the absolute value for both FEV1 and FVC in both sexes were Roca et al., Pereira et al. 2006, Enright et al. and PLATINO. The Knudson et al. equation underestimated the absolute values for both FVC and FEV1. In comparison with PLATINO equation, the percentage of predicted for FVC and FEV1, the equation showing the lowest difference was NHANES III, except for FVC male, who showed a wide variability. We evaluated 152 patients with COPD, observing staging changes in 29.6% in relation to the difference equations, being Knudson et al. the equation that showed the greatest number of changes. Conclusion: There is a great variability among the reference equations. The equations showing less variability and better intraclass correlation coefficient were Roca et al., Caucasian NHANES III et al., Enright et al. and PLATINO, which are the ones that should be recommended to be used for the Brazilian population. There is a change in the COPD staging when different equations are applied, suggesting that the use of a single equation for the treatment of the patient would avoid possible alterations in treatment.
- ItemAcesso aberto (Open Access)Controle de tronco e função respiratória em indivíduos com distrofia muscular de Duchenne(Universidade Federal de São Paulo, 2020-05-27) Freitas, Bruna de Souza [UNIFESP]; Sá, Cristina dos Santos Cardoso de [UNIFESP]; http://lattes.cnpq.br/9259523998158401; http://lattes.cnpq.br/9632425595661669; Universidade Federal de São Paulo (UNIFESP)Introdução: A progressão da fraqueza muscular é a principal consequência da Distrofia Muscular de Duchenne (DMD). Instrumentos de avaliações específicos são necessários para a escolha correta da prática clínica. Estudos prévios apontam que o controle de tronco e uma função respiratória íntegra contribui para qualidade de vida melhor e é essencial para realização de atividades de vida diária. Objetivo: Avaliar o controle de tronco e função respiratória dos indivíduos com DMD. Método: Trata-se de um estudo transversal. A amostra foi composta por 66 indivíduos com diagnóstico de DMD, sendo 27 deambuladores e 39 cadeirantes, de seis a 26 anos. Foram submetidos à avaliação quanto ao aspecto cognitivo pelo Mini Exame do Estado Mental (MEEM); pela Avaliação Segmentar do Tronco (SATCo-Br) e por meio do escoliômetro; e aspectos respiratórios pela análise da CVF tanto em vazão volumétrica quanto em percentis por meio da espirometria, Manovacuometria e Medida de Fluxo da Tosse, e o estadiamento da doença classificado pela Escala Vignos. Resultados: Os indivíduos deambuladores tiveram melhor controle de tronco em relação aos indivíduos cadeirantes. A análise de comparação entre os grupos com as variáveis respiratórias apontou diferença significativa da CVF (l/min), da CVF (%) e dos valores de Peak Flow Meter; a análise entre os grupos, com escoliose e Peak Flow Meter e a CVF (%) apontou interação significativa; existe correlação fraca e positiva entre o nível de controle de tronco e a CVF (%) e existe correlação fraca e negativa entre o nível de controle de tronco e os valores do Peak Flow Meter. Conclusão: O controle de tronco e a função respiratória pelas variáveis da CVF (%) e PEmáx, são melhores nos indivíduos deambuladores. O nível de controle de tronco foi melhor nos deambuladores enquanto que, no grupo cadeirante, o comprometimento estava muito prejudicado. Houve correlação fraca entre o controle de tronco e a função respiratória.
- ItemAcesso aberto (Open Access)Correlation between heart rate variability and pulmonary function adjusted by confounding factors in healthy adults(Assoc Bras Divulg Cientifica, 2016) Bianchim, Mayara Silveira [UNIFESP]; Sperandio, Evandro Fornias [UNIFESP]; Martinhao, Graciana Santos [UNIFESP]; Matheus, Agatha Caveda [UNIFESP]; Lauria, Vinicius Tonon [UNIFESP]; Silva, Rodrigo Pereira da [UNIFESP]; Spadari, Regina Celia [UNIFESP]; Gagliardi, Antonio Ricardo de Toledo; Arantes, Rodolfo Leite; Romiti, Marcello; Dourado, Victor Zuniga [UNIFESP]The autonomic nervous system maintains homeostasis, which is the state of balance in the body. That balance can be determined simply and noninvasively by evaluating heart rate variability (HRV). However, independently of autonomic control of the heart, HRV can be influenced by other factors, such as respiratory parameters. Little is known about the relationship between HRV and spirometric indices. In this study, our objective was to determine whether HRV correlates with spirometric indices in adults without cardiopulmonary disease, considering the main confounders (e.g., smoking and physical inactivity). In a sample of 119 asymptomatic adults (age 20-80 years), we evaluated forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). We evaluated resting HRV indices within a 5-min window in the middle of a 10-min recording period, thereafter analyzing time and frequency domains. To evaluate daily physical activity, we instructed participants to use a triaxial accelerometer for 7 days. Physical inactivity was defined as <150 min/week of moderate to intense physical activity. We found that FVC and FEV1, respectively, correlated significantly with the following aspects of the RR interval: standard deviation of the RR intervals (r= 0.31 and 0.35), low-frequency component (r= 0.38 and 0.40), and Poincare plot SD2 (r= 0.34 and 0.36). Multivariate regression analysis, adjusted for age, sex, smoking, physical inactivity, and cardiovascular risk, identified the SD2 and dyslipidemia as independent predictors of FVC and FEV1 (R-2= 0.125 and 0.180, respectively, for both). We conclude that pulmonary function is influenced by autonomic control of cardiovascular function, independently of the main confounders.
- ItemSomente MetadadadosDescrição de um quadro músculo-esquelético fibromialgias-simile em atletas(Universidade Federal de São Paulo (UNIFESP), 2003) Vaisberg, Mauro Walter [UNIFESP]; Rosa, Luis Fernando Bicudo Pereira Costa [UNIFESP]O atleta competitivo, sempre em busca da melhora do seu desempenho, muitas vezes apresenta lesoes musculo - esqueleticas de natureza nao traumatica. Habitualmente tais lesoes sao atribuidas a fatores mecanicos. O exame clinico de atletas que apresentavam este tipo de lesao sugeria que muitos deles apresentavam um quadro que em varios aspectos lembrava fibromialgia, condicao que nao e descrita em atletas. A presente pesquisa tem como objetivo estudar um grupo composto por 55 atletas competitivos para verificar a possibilidade de ocorrencia da associacao entre lesao nao traumatica e fibromialgia. A avaliacao clinica dos sujeitos foi realizada segundo os criterios do Colegio Americano de Reumatologia e, num segundo momento, procedeu-se a obtencao de parametros laboratorias abrangendo hormonios, neurotransmissores, creatinina urinaria, citocinas e prostaglandina - e de testes fisiologicos. Os resultados permitem afirmar que em 27 por cento dos atletas estudados e possivel a caracterizacao de um quadro fibromialgiasimile. Foram encontradas algumas diferencas estatisticamente significantes. Verificou-se maior numero de queixas relativas ao sono e incidencia aumentada de lesoes musculo-esqueleticas nos atletas portadores de fibromialgia-simile. Estes mesmos atletas apresentaram aumento da producao de citocinas dosadas em cultura de celulas de sangue periferico, com concentracoes mais elevadas de IL-1, IL-2, TNF- e IFN-. Nesta mesmas culturas, foi possivel demonstrar aumento da concentracao de prostaglandina E2. A avaliacao de parametros fisiologicos por teste ergo- espirometrico revelou uma queda do V02 max e do V02 LA no grupo fibromialgia- simile
- ItemAcesso aberto (Open Access)Efeitos do calor e dos subprodutos nas vias aéreas de bombeiros após a exposição em simulador de incêndio(Universidade Federal de São Paulo, 2021-04-09) Cordeiro, Telma Gomes [UNIFESP]; Pezato, Rogério; Bachi, Andre Luís Lacerda [UNIFESP]; http://lattes.cnpq.br/2058833066289093; http://lattes.cnpq.br/8850675385685321; http://lattes.cnpq.br/5579454469289252Os bombeiros são frequentemente expostos a altas temperaturas e subprodutos da combustão, que podem comprometer sua saúde. O objetivo do trabalho foi avaliar o efeito da exposição ao fogo em simuladores de incêndio nas vias aéreas dos bombeiros em diferentes momentos. Metodologia: 37 bombeiros do sexo masculino expostos a simuladores de incêndio foram avaliados em três fases: pré-exposição, final da primeira semana e 4 semanas após. Função pulmonar por espirometria, depuração mucociliar nasal; saturação periférica de oxigênio, marcadores inflamatórios no lavado nasal e CC16 no escarro, obstrução nasal e qualidade de vida (usando os questionários NOSE e SNOT-22) foram avaliados. Resultados: Níveis mais elevados de IL-8, IL-10 e monóxido de carbono exalado foram encontrados mais na fase 2 do que na fase 1. Níveis mais altos de CC16 e menor saturação periférica de oxigênio foram observados na fase 3 como em comparação com a fase 1. Níveis mais baixos de IL-2 e saturação periférica de oxigênio foram encontrados na fase 3 do que na fase 2. Maior depuração mucociliar nasal, assim como pior qualidade de vida e obstrução, foram observadas nas fases 2 e 3 em comparação com a fase 1. Conclusões: A exposição dos bombeiros a altas temperaturas e subprodutos da combustão no simuladores de fogo provocam um processo inflamatório nas vias aéreas com comprometimento do epitélio inato barreira do revestimento das vias aéreas superiores. Além disso, as mudanças no transporte de O2 afetaram a qualidade de vida negativamente.
- ItemAcesso aberto (Open Access)Effects of vitamin D supplementation on pulmonary function in postmenopausal women following an aquatic exercise program(Sbem-Soc Brasil Endocrinologia & Metabologia, 2017) Nolasco, Rodrigo [UNIFESP]; Moreira, Linda D. F. [UNIFESP]; Bocalini, Danilo S.; Fronza, Fernanda C. A. O.; Marin, Rosangela Villa [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]Objective: This study sought to investigate the effects of vitamin D supplementation and aquatic exercise on pulmonary function in postmenopausal women. Materials and methods: This prospective and controlled study included 104 women (62 +/- 6.5 years) divided into three groups: a control group lacking vitamin D and calcium supplementation which remained sedentary (CG
- ItemAcesso aberto (Open Access)Efficacy of the FEV1/FEV6 ratio compared to the FEV1/FVC ratio for the diagnosis of airway obstruction in subjects aged 40 years or over(Associação Brasileira de Divulgação Científica, 2007-12-01) Rosa, Fernanda Warken [UNIFESP]; Pérez-Padilla, Rogelio; Camelier, Aquiles Assunção [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Menezes, Ana Maria Baptista; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Católica do Salvador; Faculdade de Tecnologia e Ciências; National Institute of Respiratory Diseases; Universidade Federal da Bahia Disciplina de Pneumologia; Universidade Federal de Pelotas Programa de Pós-graduação em Epidemiologia; PLATINO GroupThe present cross-sectional, population-based study was designed to evaluate the performance of the FEV1/FEV6 ratio for the detection of airway-obstructed subjects compared to the FEV1/FVC <0.70 fixed ratio test, as well as the lower limit of normality (LLN) for 1000 subjects ³40 years of age in the metropolitan area of São Paulo, SP, Brazil. After the exclusion of 37 (3.7%) spirometries, a total of 963 pre-bronchodilator (BD) and 918 post-BD curves were constructed. The majority of the post-BD curves (93.1%) were of very good quality and achieved grade A (762 curves) or B (93 curves). The FEV1/FEV6 and FEV1/FVC ratios were highly correlated (r² = 0.92, P < 0.000). Two receiver operator characteristic curves were constructed in order to express the imbalance between the sensitivity and specificity of the FEV1/FEV6 ratio compared to two FEV1/FVC cut-off points for airway obstruction: equal to 70 (area under the curve = 0.98, P < 0.0001) and the LLN (area under the curve = 0.97, P < 0.0001), in the post-BD curves. According to an FEV1/FVC <0.70, the cut-off point for the FEV1/FEV6 ratio with the highest sum for sensitivity and specificity was 0.75. The FEV1/FEV6 ratio can be considered to be a good alternative to the FEV1/FVC ratio for the diagnosis of airway obstruction, both using a fixed cut-off point or below the LLN as reference. The FEV1/FEV6 ratio has the additional advantage of being an easier maneuver for the subjects and for the lung function technicians, providing a higher reproducibility than traditional spirometry maneuvers.
- ItemAcesso aberto (Open Access)Estudo da correlação da deformidade torácica e da mecânica respiratória em pacientes submetidos à cirurgia de correção de escoliose idiopática(Universidade Federal de São Paulo (UNIFESP), 2010) Castro, Camila Gomes de [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; Poletto, Patrícia Rios [UNIFESP]; http://lattes.cnpq.br/7170962317109623; http://lattes.cnpq.br/0334734747375995; http://lattes.cnpq.br/7229923041367050; Universidade Federal de São Paulo (UNIFESP)Introdução: A escoliose é uma deformidade complexa da coluna vertebral, nos três planos do corpo, cujo principal componente é o desvio lateral anormal no plano frontal. As vértebras envolvidas são forçadas a realizar rotação que, quando localizada no nível torácico, causa impacto na caixa torácica. A distorção da caixa torácica associada à deformidade vertebral contribui para a mecânica ventilatória alterada no lado oposto da curva. Objetivo: Verificar as alterações da caixa torácica por meio do programa SAPO e quantificar as alterações geradas pela correção cirúrgica na distorção da caixa torácica e na função pulmonar. Método: Os pacientes com diagnóstico de escoliose idiopática provenientes do Departamento de Ortopedia e Traumatologia do Hospital Santa Casa de Misericórdia de Santos foram avaliados no pré-operatório e no 30º dia de pós-operatório. A avaliação consistia em anamnese, fotogrametria (seguindo o protocolo sugerido pelo SAPO), espirometria (CVF, VEF1%, PEF% PFT) e manovacuometria (Pimáx% e Pemáx%). Para a avaliação do tórax, foram utilizados pontos anatômicos específicos e criados ângulos e distâncias na região torácica. Os ângulos (A) e distâncias (D) criados foram: A1 (acrômio/manúbrio/acrômio), A2 (acrômio/xifóide/acrômio), A3 (inframamilar direito/xifóide/inframamilar esquerdo), A4 (desvio lateral), A5 (inclinação de tronco), A6 (inframamilar/inferior da escápula/acrômio), A7 (C7/acrômio/T3) e as distâncias D1 (xifóide-última costela inferior do lado direito e esquerdo) e D2 (manúbrio-última costela inferior do lado direito e esquerdo). Resultados: Foram avaliados nove indivíduos no pré e pós-operatório. Houve diminuição significante da CVF, (p ≤ 0,05) aumento significante (p ≤ 0,05) dos ângulos A4, A5 e A7 e da distância D2 direita e esquerda no pós-operatório. As variáveis respiratórias apresentaram correlações moderadas e fortes no pré-operatório com os ângulos A1 A5 A6 e A7. No pós-operatório, as variáveis respiratórias apresentaram correlações moderadas com os ângulos A1, A2, A3 e A5 e as distâncias D1 e D2 direito. Conclusões: Existe correlação da deformidade torácica, avaliada pelo SAPO, com alterações da função pulmonar, da força de músculos respiratórios e da tosse. Esses resultados mostram a importância de um acompanhamento da evolução da escoliose, uma vez que esse tipo de alteração pode comprometer a mecânica respiratória e sugerem que o SAPO é uma ferramenta eficaz de avaliação da distorção torácica
- ItemAcesso aberto (Open Access)Evaluation of a method for assessing pulmonary function in laryngectomees(Pacini Editore, 2011-08-01) Castro, Mario Augusto Ferrari de; Dedivitis, Rogério Aparecido [UNIFESP]; Macedo, Alex Gonçalves [UNIFESP]; Fdn Lusiada UNILUS; Ana Costa Hosp; Hosp Heliopolis; Irmandade Santa Casa da Misericordia Santos; Universidade Federal de São Paulo (UNIFESP)In total laryngectomies the impairment of pulmonary function reflects the sum of pre- and post-operative ventilatory changes. Objective information on the respiratory condition in laryngectomees, as assessed in the pulmonary function laboratory is somewhat limited, perhaps because of difficulties related to methodology. The aim of our study was to evaluate the reproducibility of a method employed to assess the pulmonary function in laryngectomized patients. The experimental extra-tracheal device was set up with a silicone adapter through a cardboard tube to the skin around the tracheostoma. Pulmonary function tests included measurements of forced vital capacity, force expiratory volume at 1 second and Tiffeneau index in 3 consecutive evaluations, in 11 patients who underwent total laryngectomy. The control group comprised 11 patients, not laryngectomized, evaluated by conventional spirometry. Those responsible for evaluating were asked to report possible technical failures and to demonstrate the reproducibility of the curves resulting from the tests. The use of the silicone adapter and skin adhesive provided a complete, airtight seal of the system, in all cases. The presence of the tracheo-oesophageal prosthesis did not negatively affect the test results. All patients attributed a maximum value, both for comfort and acceptance, of the device. The values are comparable in both groups, thus indicating the accuracy of the proposed methodology. All examinations were reproducible. After total laryngectomy, pulmonary function testing, with an extra-tracheal device, is not only reliable but also easy to perform in a routine out-patient setting. The methodology did not present air leaks and was, therefore, well accepted by all patients tested.
- ItemAcesso aberto (Open Access)Evaluation of dose-response relationship between smoking load and cardiopulmonary fitness in adult smokers: A cross-sectional study(Elsevier Doyma Sl, 2017) Lauria, Vinicius Tonon [UNIFESP]; Sperandio, Evandro Fornias [UNIFESP]; Sousa, Thiago Luis Wanderley de [UNIFESP]; Vieira, Wesley de Oliveira [UNIFESP]; Romiti, Marcello; Gagliardi, Antônio Ricardo de Toledo; Arantes, Rodolfo Leite; Dourado, Victor Zuniga [UNIFESP]Objective: To evaluate the dose-response relationship between smoking load and cardiopulmonary fitness, as measured with cardiopulmonary exercise testing (CPET), in adult smokers free of respiratory diseases. Methods: After a complete clinical evaluation and spirometry, 95 adult smokers (35 men and 60 women) underwent CPET on a treadmill. Results: The physiological responses during CPET showed lower cardiorespiratory fitness levels, regardless of smoking load, with a peak V-o2(') lower than 100% of the expected value and a lower maximum heart rate. We observed a significant moderate negative correlation between smoking load and peak V-o2('). The smoking load also presented a significant negative correlation with maximum heart rate(r=-0.36
- ItemAcesso aberto (Open Access)The impact of obesity on pulmonary function in adult women(Faculdade de Medicina / USP, 2008-01-01) Costa, Dirceu; Barbalho, Marcela Cangussu; Miguel, Gustavo Peixoto Soares [UNIFESP]; Forti, Eli Maria Pazzianotto; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Universidade Metodista de Piracicaba; Hospital Meridional de Cariacica; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Obesity can cause deleterious effects on respiratory function and impair health and quality of life. OBJECTIVE: To evaluate the effects of obesity on the pulmonary function of adult women. METHODS: An obese group, constituted of 20 women between 20 and 35 years old with a BMI of 35 - 49.99 kg/m² who were non-smokers and sedentary and had no lung disease were recruited. The non-obese group consisted of 20 women between 20 and 35 years old who were sedentary and non-smokers and had no lung disease and a body mass index between 18.5 and 24.99 kg/m². Spirometry was performed in all subjects. The statistical analysis consisted of parametric or non-parametric tests, depending on the distribution of each variable, considering p < 0.05 to be statistically significant. RESULTS: The obese group presented a mean age of 25.85 ± 3.89 years and a mean BMI of 41.1 ± 3.46 kg/m², and the non-obese group presented a mean age of 23.9 ± 2.97 years and a mean body mass index of 21.91 ± 1.81 kg/m². There were no significant differences between the obese group and the non-obese group as to the age, vital capacity, tidal volume, forced vital capacity, and forced expiratory volume in one second. However, the obese group presented a greater inspiratory reserve volume (2.44 ± 0.47 L vs. 1.87 ± 0.42 L), a lower expiratory reserve volume (0.52 ± 0.32 L vs. 1.15 ± 0.32 L), and a maximal voluntary ventilation (108.5 ± 13.3 L/min vs. 122.6 ± 19.8 L/min) than the non-obese group, respectively. CONCLUSION: The alterations evidenced in the components of the vital capacity (inspiratory reserve volume and expiratory reserve volume) suggest damage to the chest mechanics caused by obesity. These factors probably contributed to a reduction of the maximal voluntary ventilation.
- ItemAcesso aberto (Open Access)Influence of heart failure on resting lung volumes in patients with COPD(Soc Brasileira Pneumologia Tisiologia, 2016) de Souza, Aline Soares [UNIFESP]; Sperandio, Priscila Abreu [UNIFESP]; Mazzuco, Adriana [UNIFESP]; Alencar, Maria Clara [UNIFESP]; Arbex, Flavio Ferlin [UNIFESP]; de Oliveira, Mayron Faria [UNIFESP]; O'Donnell, Denis Eunan; Neder, Jose Alberto [UNIFESP]Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil.
- ItemAcesso aberto (Open Access)Oscilometria de impulso na avaliação da função pulmonar de crianças e adolescentes asmáticos(Universidade Federal de São Paulo (UNIFESP), 2019-10-25) Lima, Jales Henrique Pereira De [UNIFESP]; Wandalsen, Gustavo Falbo [UNIFESP]; http://lattes.cnpq.br/4807350957191775; http://lattes.cnpq.br/4616240489495871; http://lattes.cnpq.br/5314103949026669; Universidade Federal de São Paulo (UNIFESP)Introduction: Asthma is one of the most common chronic diseases of childhood. Its classification can be given according to frequency, intensity of symptoms and pulmonary function. Spirometry is the traditional test for pulmonary function assessment, whereas impulse oscillometry is an alternative and easy to perform tool that measures airway impedance and assists in detecting changes in lung function. Spirometry has some limitations in asthmatic children and adolescents, often requiring complementary or substitute techniques. Objective: To evaluate and describe the pulmonary function of asthmatic children and adolescents evaluated by impulse oscillometry and compare the findings with those obtained by spirometry. Methods: A cross-sectional study evaluating the pulmonary function of 130 asthmatic children and adolescents aged 6 to 18 years, divided by disease control level according to Asthma Control Test or Children Asthma Control Test in controlled (ACT/C-ACT>19; n=70) and uncontrolled subjects (ACT/C-ACT≤19; n=60). The children and adolescents who participated in the study are assisted by the Allergy and Immunology outpatient clinic of Pediatrics Department, UNIFESP-EPM. Pulmonary function tests were performed using the MasterScreenTM equipment (CareFusion, USA). Results: One hundred thirty asthmatic children and adolescents were evaluated (51% male). The medians and interquartile range of resistance values at 5 Hz (R5%), resistance at 20 Hz (R20%), reactance at 5 Hz (X5%) and resonant frequency (Fres) were, respectively: 112,4% (86,8% – 130,2%), 105,9% (88,3% – 117,8%), 109,2% (86,4% – 160%) and 23,3 Hz (17,4 Hz – 26,2 Hz). Altered oscillometry was observed in 20% of cases and spirometry in 48%. Changes in oscillometry were more frequent in patients with controlled asthma. R5%, X5% and Fres presented moderate correlation with the main spirometric parameters, being stronger between R5% and FEF25-75% (r: -0,45; p<0,05) in the studied patients, X5% and FEV1/FVC% (r: -0,58; p<0,05) in patients with controlled asthma and between R5% and FEV1% (r: -0,39; p<0,05) in patients with uncontrolled asthma. Patients with controlled asthma who had hospitalization for asthma exacerbation had lower pulmonary function values and higher bronchodilator response values on spirometry. Patients with controlled asthma who presented bronchodilator response on oscillometry and spirometry presented higher values of R20% and Fres. Patients with uncontrolled asthma who presented bronchodilator response on spirometry had higher values of X5%. Conclusions: Impulse oscillometry values showed a moderate correlation with spirometric values. Spirometry showed greater sensitivity in the assessment of pulmonary function in asthmatic children and adolescents.
- ItemSomente MetadadadosPhysical Activity Questionnaires Do Not Accurately Estimate Fitness in Older Women(Human Kinetics Publ Inc, 2018) Cabral, Aurora de Fatima Gazolin Cecilio Mafra [UNIFESP]; Pinheiro, Marcelo Medeiros [UNIFESP]; Castro, Charlles Heldan de Moura [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Tufik, Sergio [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]The objective was to compare the performance of the International Physical Activity Questionnaire (IPAQ) and Baecke questionnaire to estimate maximal oxygen uptake (VO2max) in healthy older women. One hundred healthy women aged 60 years and older answered the IPAQ and Baecke questionnaires and underwent a cardiopulmonary exercise test. The 6-min walk (6MWT), timed up and go (TUG), and handgrip strength test (HST) were also performed. Mean age and body mass index were 68.5 ± 6.3 years and 27 ± 4.7 kg/m2, respectively. No significant correlation was seen between VO2max, IPAQ and Baecke questionnaires. IPAQ did not correlate with any functional tests while Baecke correlated weakly with the 6MWT and TUG test. VO2max correlated significantly with the 6MWT (r = .38; p = .0001), HST (r = .34; p = .001), and TUG (r = −.41; p = .0001). In a multivariate regression model, TUG was the best estimator for VO2max (R2 = .217; p = .0001). In conclusion, IPAQ and Baecke questionnaires do not associate significantly with VO2max in older women.
- ItemAcesso aberto (Open Access)PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis(Sociedade Brasileira de Pneumologia e Tisiologia, 2014-01-01) Moreira, Graciane Laender; Manzano, Beatriz Martins; Gazzotti, Mariana Rodrigues; Nascimento, Oliver Augusto [UNIFESP]; Pérez-Padilla, Rogelio; Menezes, Ana Maria Baptista; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Sao Camilo University Center Department of Physical Therapy; Instituto Nacional de Enfermedades Respiratorias; Federal University of Pelotas School of Medicine Department of Clinical MedicineOBJECTIVE:To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase.METHODS:The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase.RESULTS:The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD.CONCLUSIONS:The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention.
- ItemSomente MetadadadosPontos de corte da resposta ao broncodilatador e valores de referência para VEF 0,75 em espirometria de pré-escolares(Soc Brasileira Pneumologia Tisiologia, 2016) Burity, Edjane Figueiredo; de Castro Pereira, Carlos Alberto [UNIFESP]; Jones, Marcus Herbert; Sayao, Larissa Bouwman; de Andrade, Armele Dornelas; Amorim de Britto, Murilo CarlosObjective: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. Methods: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. Results: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Conclusions: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children.