Navegando por Palavras-chave "chronic obstructive pulmonary disease"

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    Additive effects of non-invasive ventilation to hyperoxia on cerebral oxygenation in COPD patients with exercise-related O2 desaturation
    (Wiley-Blackwell, 2013-07-01) Rodrigues, Miguel K. [UNIFESP]; Oliveira, Mayron F. [UNIFESP]; Soares, Aline [UNIFESP]; Treptow, Erika [UNIFESP]; Alberto Neder, J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Queens Univ
    Background It is currently unknown whether potential haemodynamic improvements induced by non-invasive ventilation (NIV) would positively impact upon cerebral oxygenation (COx) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). Objective To investigate the effects of NIV on exercise COx in COPD patients presenting with exercise-related O2 desaturation. Methods On a double-blind trial, 13 males (FEV1=48 center dot 8 +/- 15 center dot 1% predicted) were randomly assigned to NIV (16 cmH2O IPS and 5 cmH2O PEEP) plus HOx (FiO2= 0 center dot 4) or sham NIV (7 cmH2O IPS and 5 cmH2O PEEP to overcome breathing circuit resistance) plus HOx during ramp-incremental exercise performed on different days. Near-infrared spectroscopy and impedance cardiography assessed changes () in COx and cardiac output (QT), respectively. Results There were no significant between-intervention differences in peak work rate, ventilation and reported symptoms (0 center dot 05). Peripheral oxyhaemoglobin saturation remained above 98% throughout the tests. NIV+HOx was associated with larger increases in COx, QT and stroke volume at maximal and submaximal exercise (P<0 center dot 05). Increases in the area under the curve (to an iso-work rate) of COx under NIV+HOx were significantly (P<0 center dot 01) correlated with improvements in QT (r=0 center dot 82) and stroke volume (r=0 center dot 87). There was, however, no significant correlation between enhancement in these physiological responses with changes in peak work rate with NIV+HOx (0 center dot 05). Conclusions NIV added benefit to HOx in improving central haemodynamics and COx in O2 desaturators' with COPD. the clinical relevance of such beneficial effects on exercise tolerance, however, remains to be demonstrated.
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    The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study
    (European Respiratory Soc Journals Ltd, 2012-07-01) Montes de Oca, Maria; Halbert, Ronald J.; Victorina Lopez, Maria; Perez-Padilla, Rogelio; Talamo, Carlos; Moreno, Dolores; Muino, Adrianna; Jardim, Jose Roberto [UNIFESP]; Valdivia, Gonzalo; Pertuze, Julio; Menezes, Ana Maria B.; Cent Univ Venezuela; UCLA Sch Publ Hlth; Univ Republica; Inst Resp Dis; Universidade Federal de São Paulo (UNIFESP); Univ Fed Pelotas; Pontificia Univ Catolica Chile
    Little information exists regarding the epidemiology of the chronic bronchitis phenotype in unselected chronic obstructive pulmonary disease (COPD) populations. We examined the prevalence of the chronic bronchitis phenotype in COPD and non-COPD subjects from the PLATINO study, and investigated how it is associated with important outcomes.Post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70 was used to define COPD. Chronic bronchitis was defined as phlegm on most days, at least 3 months per year for >= 2 yrs. We also analysed another definition: cough and phlegm on most days, at least 3 months per year for >= 2 yrs.Spirometry was performed in 5,314 subjects (759 with and 4,554 without COPD). the proportion of subjects with and without COPD with chronic bronchitis defined as phlegm on most days, at least 3 months per year for >= 2 yrs was 14.4 and 6.2%, respectively. Using the other definition the prevalence was lower: 7.4% with and 2.5% without COPD. Among subjects with COPD, those with chronic bronchitis had worse lung function and general health status, and had more respiratory symptoms, physical activity limitation and exacerbations.Our study helps to understand the prevalence of the chronic bronchitis phenotype in an unselected COPD population at a particular time-point and suggests that chronic bronchitis in COPD is possibly associated with worse outcomes.
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    Chronic obstructive pulmonary disease and body mass index in five Latin America cities: the PLATINO study
    (W B Saunders Co Ltd, 2008-05-01) Oca, Maria Montes de; Talamo, Carlos; Pérez-Padilla, Rogelio; Jardim, José Roberto [UNIFESP]; Muino, Adriana; Lopez, Maria Victorina; Valdivia, Gonzalo; Pertuze, Julio; Moreno, Dolores; Halbert, Ronald J.; Menezes, Ana Maria Baptista; Platino Team; Cent Univ Venezuela; Inst Resp Dis; Universidade Federal de São Paulo (UNIFESP); Univ Republica; Pontificia Univ Catolica Chile; Univ Calif Los Angeles; Univ Fed Pelotas Duque Caxias
    Background: the body mass index (BMI) is a prognostic factor for chronic obstructive pulmonary disease (COPD). Despite its importance, little information is available regarding BMI alteration in COPD from a population-based study. We examined characteristics by BMI categories in the total and COPD populations in five Latin-American cities, and explored the factors influencing BMI in COPD.Methods: COPD was defined as a postbronchodilator forced expiratory volume in the first second/forced vital capacity (FEV(1)/FVC)< 0.70. BMI was categorized as underweight (< 20 kg/m(2)), normal weight (20 - 24.9 kg/m(2)), overweight (25.0 - 29.9 kg/m(2)), and obese (>= 30.0 kg/m(2)).Results: Interviews were completed in 5571 subjects from 6711 eligible individuals, and spirometry was performed in 5314 subjects. There were 759 subjects with COPD and 4555 without COPD. Compared with the non-COPD group, there was a higher proportion of COPD subjects in the underweight and normal weight categories, and a lower proportion in the obese category. Over one-half COPD subjects had BMI over 25 kg/m(2). No differences in BMI strata among countries were found in COPD subjects. Factors associated with lower BMI in mates with COPD were aging, current smoking, and global initiative for chronic obstructive lung disease (GOLD) stages III - IV, whereas wheeze and residing in Santiago and Montevideo were associated with higher BMI. in females with COPD, current smoking, lower education, and GOLD stages II - IV were associated with lower BMI, while dyspnea and wheeze were associated with higher BMI.Conclusions: BMI alterations are common in COPD with no significant differences among countries. Current smoking, age, GOLD stages, education level, residing in Santiago and Montevideo, dyspnea and wheeze were independently associated with BMI in COPD. (c) 2008 Elsevier B.V. All rights reserved.
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    Clinical value of anthropometric estimates of leg lean volume in nutritionally depleted and non-depleted patients with chronic obstructive pulmonary disease
    (Cambridge Univ Press, 2008-08-01) Villaca, Debora Strose [UNIFESP]; Lerario, Maria Cristina [UNIFESP]; dal Corso, Simone [UNIFESP]; Napolis, Lara [UNIFESP]; Pereira de Albuquerque, Andre Luiz [UNIFESP]; Lazaretti-Castro, Marize [UNIFESP]; Sachs, Anita [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This study aimed to investigate the clinical usefulness of an anthropometrically based method for estimating leg lean volume (LLV) in patients with chronic obstructive pulmonary disease (COPD) who presented or not with nutritional depletion. We prospectively evaluated a group of forty-eight patients (thirty-eight males) with moderate to severe COPD (Global Initiative for Chronic Obstructive Lung disease stages II-IV) who underwent a 6 min walking test and knee isokinetic dynamometry. Leg lean mass (muscle mass plus bone) was determined by dual-energy X-ray absorptiometry (DEXA) with derivation of its respective volume: these values were compared with those obtained by the truncated cones method first described by Jones and Pearson in 1969. As expected, depleted patients (n 19) had reduced exercise capacity and impaired muscle performance as compared to non-depleted subjects (P<0.01). the mean bias of the LLV differences between anthropometry and DEXA were 0.40 litre (95 % CI - 0.59, 1.39) and 0.50 litre (95% CI - 1.08, 2.08) for depleted and non-depleted patients, respectively. Anthropometrically and DEXA-based estimates correlated similarly with muscle functional attributes. A ROC curve analysis revealed that leg height-corrected LLV values had acceptable sensitivity and specificity to identify depleted patients (area under the curve 0.93 (range 0.86-1.00); P<0.001). Moreover, patients with LLV <= 9.2 litres/m (the best cut-off value according to the ROC curve) had significantly lower exercise capacity and muscle performance than their counterparts (P<0.05). in conclusion. an anthropometrically based method of estimating LLV (Jones and Pearson method) was shown to present with clinically acceptable accuracy and external validity in depleted and non-depleted patients with stable COPD.
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    A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease
    (Elsevier B.V., 2006-01-01) Solano, Joao Paulo [UNIFESP]; Gomes, Barbara; Higginson, Irene J.; Universidade Federal de São Paulo (UNIFESP); Kings Coll London
    Little attention has been paid to the symptom management needs of Patients with life-threatening diseases other than cancer. in this study, we aimed to determine to what extent patients with progressive chronic diseases have similar symptom profiles. A systematic search of medical databases (MEDLINE, EMBASE, and PsycINFO) and textbooks identified 64 original studies reporting the prevalence of 11 common symptoms among end-stage patients with cancer, acquired immunodeficiency syndrome (AIDS), heart disease, chronic obstructive pulmonary disease, or renal disease. Analyzing the data in a comparative table (a grid), we found that the prevalence of the 11 symptoms was often widely but homogeneously spread across the five diseases. Three symptoms-pain, breathlessness, and fatigue- were found among more than 50% of patients, for all five diseases. There appears to be a common pathway toward death for malignant and nonmalignant diseases. the designs of symptom prevalence studies need to be improved because of methodological disparities in symptom assessment. and designs.
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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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    Desenvolvimento e validação da escala copas - chronic obstructive pulmonary disease activity scale em pacientes com doença pulmonar obstrutiva crônica (dpoc) no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2014-03-31) Gomes, Luiza Gabriela Pessoa de Carvalho [UNIFESP]; Nascimento, Oliver Augusto Nascimento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, which is characterized by persistent obstruction of airflow and is usually progressive and associated with a chronic inflammatory response of the lungs to noxious particles or gases. Although COPD affects the lungs, it also produces significant systemic consequences, including physical limitation. Objective: To develop a scale of physical activity, to assess its reproducibility and validate this instrument by comparing it to the test of six-minute walk and the results of the pedometer. Materials and Methods: The study included patients who did not undergo pulmonary rehabilitation in the past two years and who were treated as outpatients with COPD Pulmonary Rehabilitation Center of Pulmonology UNIFESP. Pulmonary function test, walk test six minutes and applied questionnaires on quality of life, anxiety and depression and physical activity was performed. The proposed scale of physical activity in this study - Chronic Obstructive Pulmonary Disease Activity Scale - COPAS was compared with objective measures of physical activity. The scale score was divided into three domains, resulting in a total score. Results: Through factor analysis it was observed that 13 of the 27 questions, had affinities between them and determined linear score 0-76 points. The COPAS showed good test-retest reproducibility in relation (with a variation of r: 0.78 to 0.94 ). Also showed a weak correlation with 6MWT (r= 0.28 ) , number of steps (r= 0.36 ) and moderate correlation with IPAQ (r: 0.44 ). The overall average steps per day was 7.290 ± 4.341, with women walking 8,099 ± 4,868 and 6,742 ± 3,890 men steps. Conclusion: The COPAS is reproducible and correlated with 6MWT and the number of steps by pedometer reviews.
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    Discriminative properties and validity of a health status questionnaire in obstructive airway disease patients: the Airway Questionnaire 20
    (Ediciones Doyma S/l, 2007-12-01) Camelier, Aquiles; Rosa, Fernanda W.; Nascimento, Oliver A. [UNIFESP]; Ferrandes, Ana Luiza G. [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal da Bahia (UFBA); Univ Estadual Bahia; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate the discriminative properties and validity of the Airways Questionnaire 20 (AQ20) in a sample of patients with airway obstruction and to compare its properties with those of the St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36).PATIENTS and METHODS: A convenience sample of 47 subjects was recruited from among 61 consecutive patients referred to an outpatient clinic specialized in obstructive airway diseases. All subjects completed the AQ20, SGRQ, and SF-36. Other measures were the baseline dyspnea index (BDI), 6-minute walk test (6MWT) distance, spirometry, results of arterial blood gas analysis, and body mass index.RESULTS: the AQ20 showed very good correlation with the SGRQ total score (rho=0.84, P <.001) and moderate correlation with all SF-36 domains (physical capacity, rho=-0.53; physical functioning, rho=-0.61; bodily pain, rho=-0.55; general health, rho=4.59; vitality, rho=-0.55; social functioning, rho=-0.57; emotional role functioning, rho=-0.51; mental health, rho=-0.61; all P <.001). the BDI and the 6MWT distance were the best predictors of AQ20 score (r(2)=0.31) in the regression model. An area under the receiver operating characteristic curve of 0.91 (P <.001) indicated a high level of accuracy for the AQ20, using the SGRQ as the gold standard.CONCLUSION: This study shows that the AQ20 is an accurate health status questionnaire in patients with moderate-to-severe airway obstruction. It could be an alternative to longer, traditional questionnaires such as the SGRQ.
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    Does impaired O-2 delivery during exercise accentuate central and peripheral fatigue in patients with coexistent COPD-CHF?
    (Frontiers Research Foundation, 2015-01-07) Oliveira, Mayron Faria [UNIFESP]; Zelt, Joel T. J.; Jones, Joshua H.; Hirai, Daniel M. [UNIFESP]; O'Donnell, Denis E.; Verges, Samuel; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Queens Univ; Grenoble Alpes Univ
    Impairment in oxygen (O-2) delivery to the central nervous system (brain) and skeletal locomotor muscle during exercise has been associated with central and peripheral neuromuscular fatigue in healthy humans. From a clinical perspective, impaired tissue O-2 transport is a key pathophysiological mechanism shared by cardiopulmonary diseases, such as chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). in addition to arterial hypoxemic conditions in COPD, there is growing evidence that cerebral and muscle blood flow and oxygenation can be reduced during exercise in both isolated COPD and CHF. Compromised cardiac output due to impaired cardiopulmonary function/interactions and blood flow redistribution to the overloaded respiratory muscles (i.e., up arrow work of breathing) may underpin these abnormalities. Unfortunately, COPD and CHF coexist in almost a third of elderly patients making these mechanisms potentially more relevant to exercise intolerance. in this context, it remains unknown whether decreased O-2 delivery accentuates neuromuscular manifestations of central and peripheral fatigue in coexistent COPD-CHF If this holds true, it is conceivable that delivering a low-density gas mixture (heliox) through non-invasive positive pressure ventilation could ameliorate cardiopulmonary function/interactions and reduce the work of breathing during exercise in these patients. the major consequence would be increased O-2 delivery to the brain and active muscles with potential benefits to exercise capacity (i.e.,,central and peripheral neuromuscular fatigue, respectively). We therefore hypothesize that patients with coexistent COPD-CHF stop exercising prematurely due to impaired central motor drive and muscle contractility as the cardiorespiratory system fails to deliver sufficient O-2 to simultaneously attend the metabolic demands of the brain and the active limb muscles.
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    The effect of posture on asynchronous chest wall movement in COPD
    (Amer Physiological Soc, 2013-04-01) Priori, Rita; Aliverti, Andrea; Albuquerque, Andre L. [UNIFESP]; Quaranta, Marco; Albert, Paul; Calverley, Peter M. A.; Politecn Milan; Universidade Federal de São Paulo (UNIFESP); Univ Liverpool
    Priori R, Aliverti A, Albuquerque AL, Quaranta M, Albert P, Calverley PM. the effect of posture on asynchronous chest wall movement in COPD. J Appl Physiol 114: 1066-1075, 2013. First published February 14, 2013; doi:10.1152/japplphysiol.00414.2012.-Chronic obstructive pulmonary disease (COPD) patients often show asynchronous movement of the lower rib cage during spontaneous quiet breathing and exercise. We speculated that varying body position from seated to supine would influence rib cage asynchrony by changing the configuration of the respiratory muscles. Twenty-three severe COPD patients (forced expiratory volume in 1 s = 32.5 +/- 7.0% predicted) and 12 healthy age-matched controls were studied. Measurements of the phase shift between upper and lower rib cage and between upper rib cage and abdomen were performed with opto-electronic plethysmography during quiet breathing in the seated and supine position. Changes in diaphragm zone of apposition were measured by ultrasounds. Control subjects showed no compartmental asynchronous movement, whether seated or supine. in 13 COPD patients, rib cage asynchrony was noticed in the seated posture. This asynchrony disappeared in the supine posture. in COPD, upper rib cage and abdomen were synchronous when seated, but a strong asynchrony was found in supine. the relationships between changes in diaphragm zone of apposition and volume variations of chest wall compartments supported these findings. Rib cage paradox was noticed in approximately one-half of the COPD patients while seated, but was not related to impaired diaphragm motion. in the supine posture, the rib cage paradox disappeared, suggesting that, in this posture, diaphragm mechanics improves. in conclusion, changing body position induces important differences in the chest wall behavior in COPD patients.
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    Effectiveness and Safety of Hypertonic Saline Inhalation Combined With Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Trial
    (Daedalus Enterprises Inc, 2009-03-01) Valderramas, Silvia Regina [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Evangel Univ Parana; Universidade Federal de São Paulo (UNIFESP); Brasilian Cochrane Ctr
    BACKGROUND: Inhaled hypertonic saline is used for bronchial challenge and sputum induction in patients with chronic obstructive pulmonary disease (COPD). We studied the effects of saline aerosol inhalation before each exercise session in an 8-week pulmonary rehabilitation program. METHODS: This was a double-blind randomized parallel controlled trial, conducted at an outpatient clinic. Sixty-eight subjects with COPD (mean age 67 +/- 6.5 y, percent of predicted FEV(1) 47 +/- 21) were randomized to inhale either 3% hypertonic saline (34 subjects) or normal saline (34 subjects) before each exercise session in an 8-week exercise program that had 3 sessions per week. We measured 6-min walk distance, dyspnea, and quality of life (with the Medical Outcomes Study 36-item short-form health survey). RESULTS: After the 8-week exercise program, both groups' mean 6-min walk distance had significantly increased: from 195 +/- 92 m to 251 +/- 97 m (P <.001) in the hypertonic-saline group, and from 237 +/- 93 m to 441 +/- 121 m in the normal-saline group (P <.001). The normal-saline group had greater improvement than the hypertonic-saline group (P <.001). Dyspnea score improved from 3.1 +/- 0.9 to 2.3 +/- 0.8 (P <.01) in the hypertonic-saline group, and from 3.5 +/- 0.2 to 2.3 +/- 1.0 (P <.01) in the normal-saline group. Quality of life also significantly improved, except for the physical-functioning and social aspect domains in the hypertonic-saline group. Adverse effects (cough or bronchospasm) occurred in 4 patients (12%) in the hypertonic-saline group. CONCLUSIONS: The improvement in 6-min walk distance was greater with normal saline than with hypertonic saline. Hypertonic saline was associated with adverse effects. It is unclear whether the only predictor of improved functional exercise capacity was exercise training.
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    Effects of oxygen supplementation on cerebral oxygenation during exercise in chronic obstructive pulmonary disease patients not entitled to long-term oxygen therapy
    (Wiley-Blackwell, 2012-01-01) Oliveira, Mayron F. [UNIFESP]; Rodrigues, Miguel K. [UNIFESP]; Treptow, Erika [UNIFESP]; Cunha, Thulio M. [UNIFESP]; Ferreira, Eloara M. V. [UNIFESP]; Neder, J. Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: the rate of change (Delta) in cerebral oxygenation (COx) during exercise is influenced by blood flow and arterial O-2 content (CaO2). It is currently unclear whether Delta COx would (i) be impaired during exercise in patients with chronic obstructive pulmonary disease (COPD) who do not fulfil the current criteria for long-term O-2 therapy but present with exercise-induced hypoxaemia and (ii) improve with hyperoxia (FIO2 = 0.4) in this specific sub-population.Methods: A total of 20 non-hypercapnic men (FEV1 = 47.2 +/- 11.5% pred) underwent incremental cycle ergometer exercise tests under normoxia and hyperoxia with Delta COx (fold-changes from unloaded exercise in O(2)Hb) being determined by near-infrared spectroscopy. Pulse oximetry assessed oxyhaemoglobin saturation (SpO(2)), and impedance cardiography estimated changes in cardiac output (Delta QT).Results: Peak work rate and Delta COx in normoxia were lower in eight O-2 'desaturators' compared with 12 'non-desaturators' (P<0.05). Area under Delta COx during sub-maximal exercise was closely related to SpO2 decrements in 'desaturators' (r = 0.92, P<0.01). These patients showed the largest improvement in peak exercise capacity with hyperoxia (P<0.05). Despite a trend to lower sub-maximal Delta QT and mean arterial pressure with active intervention, Delta COx was significantly improved only in this group (0.57 +/- 0.20 versus 2.09 +/- 0.42 for 'non-desaturators' and 'desaturators', respectively; P<0.05).Conclusions: Delta COx was impaired in non-hypoxaemic patients with COPD who desaturated during exercise. Hyperoxic breathing was able to correct for these abnormalities, an effect related to enhanced CaO2 rather than improved central haemodynamics. This indicates that O-2 supplementation ameliorates exercise COx in patients with COPD who are not currently entitled to ambulatory O-2 therapy.
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    Estudo da relação entre doença pulmonar obstrutiva crônica e exacerbações e doença do refluxo gastroesofágico, diagnosticada por phmetria
    (Universidade Federal de São Paulo (UNIFESP), 2014-10-31) Bigatao, Amilcar Marcelo [UNIFESP]; Jardim, Jose Roberto de Brito Jardim [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The gastroesophageal reflux disease (GERD) has a great association with respiratory diseases. Based on symptoms, GERD seems to be very prevalent in chronic obstructive pulmonary disease (COPD) patients and is associated with COPD exacerbations. However, GERD has not been extensively studied with pH monitoring in these patients, correlating with their exacerbations. This study aims to: (1) evaluate the prevalence of GERD diagnosed by ambulatory pH monitoring in COPD patients, (2) correlate GERD with COPD exacerbations and (3) compare GERD symptoms with pH monitoring. Methods: Transversal study to evaluate stable COPD outpatients. COPD exacerbations in the last 12 months were recorded. Patients were questioned regarding the presence and frequency of pulmonary and GERD symptoms in the last year. High resolution esophageal manometry and pH monitoring were performed in all patients. Results: We evaluated 50 patients (56% females, mean age 66 years) with COPD. The prevalence of GERD was 44% and a higher number of COPD exacerbations were noticed in the group with GERD. There was no correlation between GERD and symptoms. Heartburn and regurgitation combined had a sensitivity and specificity of 48%. Almost half of the patients with GERD had no symptoms reported. Conclusion: There is a high prevalence of GERD in COPD patients, and patients with COPD and GERD have more exacerbations than those without GERD. Symptoms are unreliable for predict GERD diagnosis. We believe GERD must be objectively tested in these patients since the outcomes of the treatment for GERD in these individuals is still elusive.
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    Excess Ventilation in Chronic Obstructive Pulmonary Disease-Heart Failure Overlap Implications for Dyspnea and Exercise Intolerance
    (Amer Thoracic Soc, 2017) Rocha, Alcides [UNIFESP]; Arbex, Flavio F. [UNIFESP]; Sperandio, Priscilla A. [UNIFESP]; Souza, Aline [UNIFESP]; Biazzim, Ligia [UNIFESP]; Mancuso, Frederico [UNIFESP]; Berton, Danilo C.; Hochhegger, Bruno; Alencar, Maria Clara N. [UNIFESP]; Nery, Luiz E. [UNIFESP]; O'Donnell, Denis E.; Neder, J. Alberto
    Rationale: An increased ventilatory response to exertional metabolic demand (high V-E/V-CO2 relationship) is a common finding in patients with coexistent chronic obstructive pulmonary disease and heart failure. Objectives: We aimed to determine the mechanisms underlying high V-E/V-CO2 and its impact on operating lung volumes, dyspnea, and exercise tolerance in these patients. Methods: Twenty-two ex-smokers with combined chronic obstructive pulmonary disease and heart failure with reduced left ventricular ejection fraction undertook, after careful treatment optimization, a progressive cycle exercise test with capillary (c) blood gas collection. Measurements and Main Results: Regardless of the chosen metric (increased V-E-V-CO2 slope, V-E/V-CO2 nadir, or end-exercise V-E/V-CO2), ventilatory inefficiency was closely related to Pc-CO2 (r values from -0.80 to -0.84; P < 0.001) but not dead space/tidal volume ratio. Ten patients consistently maintained exercise Pc-CO2 less than or equal to 35 mm Hg (hypocapnia). These patients had particularly poor ventilatory efficiency compared with patients without hypocapnia (P < 0.05). Despite the lack of between-group differences in spirometry, lung volumes, and left ventricular ejection fraction, patients with hypocapnia had lower resting Pa-CO2 and lung diffusing capacity (P < 0.01). Excessive ventilatory response in this group was associated with higher exertional Pc-O2. The group with hypocapnia, however, had worse mechanical inspiratory constraints and higher dyspnea scores for a given work rate leading to poorer exercise tolerance compared with their counterparts (P < 0.05). Conclusions: Heightened neural drive promoting a ventilatory response beyond that required to overcome an increased "wasted" ventilation led to hypocapnia and poor exercise ventilatory efficiency in chronic obstructive pulmonary disease-heart failure overlap. Excessive ventilation led to better arterial oxygenation but at the expense of earlier critical mechanical constraints and intolerable dyspnea.
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    Geometric index of heart rate variability in chronic obstructive pulmonary disease
    (Elsevier B.V., 2011-11-01) Carvalho, Tatiana Dias de [UNIFESP]; Pastre, Carlos Marcelo; Rossi, Renata Claudino; Abreu, Luiz Carlos de; Valenti, Vitor Engrácia [UNIFESP]; Vanderlei, Luiz Carlos Marques; Univ Estadual Paulista UNESP; Universidade Federal de São Paulo (UNIFESP); Fac Med ABC
    Background: It was already evidenced decreased heart rate variability (HRV) in chronic obstructive pulmonary disease (COPD) patients at rest.Objective: in order to insert new elements in the literature regarding this issue, we evaluated geometric index of HRV in COPD subjects.Method: We analyzed data from 34 volunteers, divided into two groups according to spirometric values: COPD (17 volunteers, FEV1/FVC = 47.3 +/- 10.2; FEV1 = 50.8 +/- 15.7) and control (17 volunteers, FEV1/FVC = 78.8 +/- 10.8; FEV1 = 100.1 +/- 14.7). for analysis of HRV indexes the volunteers remained in the supine position for 30 minutes. We analyzed the following indexes: triangular index (RRtri), triangular interpolation of RR intervals (TINN) and Poincare plot (SD1, SD2 and SD1/SD2). Student t test for unpaired samples and Mann-Whitney test were used for data analysis.Results: We observed statistically significant reductions in geometric indexes in the COPD group: RRtri (0.043 +/- 0.01 vs. 0.059 +/- 0.02; p = 0.018), TINN (105.88 +/- 51.82 vs. 151.47 +/- 49.9; p=0.014), SD1 (9.76 +/- 4.66 vs. 14.55 +/- 6.04; p = 0.014) and SD2 (34.86 +/- 17.02 vs. 51.51 +/- 18.38; p = 0.010). SD1/5D2 (0.30 +/- 0.11 vs. 0.28 +/- 0.07; p = 0.605) were not significantly different between groups. Patients with COPD presented a visual analysis of Poincare plot of lower dispersion of RR intervals both beat to beat and the long term.Conclusion: Subjects with COPD present reduction of geometric indexes of HRV, indicating reduced heart rate variability. (C) 2010 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L. All rights reserved.
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    Haemodynamic effects of proportional assist ventilation during high-intensity exercise in patients with chronic obstructive pulmonary disease
    (Wiley-Blackwell, 2010-11-01) Carrascossa, Claudia R. [UNIFESP]; Oliveira, Cristino C. [UNIFESP]; Borghi-Silva, Audrey [UNIFESP]; Ferreira, Eloara M. V. [UNIFESP]; Maya, Joyce [UNIFESP]; Queiroga, Fernando [UNIFESP]; Berton, Danilo C. [UNIFESP]; Nery, Luiz E. [UNIFESP]; Alberto Neder, J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de São Carlos (UFSCar)
    Background and objective: Proportional assist ventilation (PAV) has been proposed as a more physiological modality of non-invasive ventilation, thereby reducing the potential for deleterious cardio-circulatory effects during exercise, in patients with COPD. We therefore evaluated whether PAV modulates the kinetic and 'steady-state' haemodynamic responses to exercise in patients with moderate-to-severe COPD.Methods: Twenty patients underwent constant-load (75-80% peak work rate) cycle ergometer exercise testing to the limit of tolerance (T(lim)), while receiving PAV or breathing spontaneously. Stroke volume (SV), heart rate (HR) and cardiac output (CO) were monitored by impedance cardiography.Results: Compared with unassisted breathing, PAV increased T(lim) in 8/20 patients (median improvement 113% (range 8 to 212) vs -20% (range -40 to -9)). PAV had no significant effects on 'steady-state' haemodynamic responses either in patients with or those without increased T(lim) (P > 0.05). However, at the onset of exercise, SV kinetics were slowed with PAV, in 13/15 patients with analysable data. HR dynamics remained unaltered or failed to accelerate sufficiently in nine of these patients, thereby slowing CO kinetics (T(1/2) 61 s (range 81-30) vs 89 s (range 100-47)). These deleterious effects were not, however, associated with PAV-induced changes in T(lim) (P > 0.05).Conclusions: PAV slowed the SV and CO kinetics at the onset of high-intensity exercise in selected patients with moderate-to-severe COPD. However, these adverse effects of PAV disappeared during the stable phase of exercise, and were not related to the ergogenic potential of PAV in this patient population.
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    Heliox Improves Oxygen Delivery and Utilization during Dynamic Exercise in Patients with Chronic Obstructive Pulmonary Disease
    (Amer Thoracic Soc, 2009-06-01) Chiappa, Gaspar Rogério da Silva [UNIFESP]; Queiroga, Fernando [UNIFESP]; Meda, Ethiane [UNIFESP]; Ferreira, Leonardo Franklin [UNIFESP]; Diefenthaeler, Fernando; Nunes, Marcos [UNIFESP]; Vaz, Marco A.; Machado, Maria Christina Lombardi Oliveira [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Kentucky; Univ Fed Rio Grande do Sul
    Rationale: Normoxic heliox (mixture of 79% He and 21% O(2)) may enhance exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). It remains to be determined whether part of these beneficial effects could be ascribed to increased O(2) delivery (O(2)DEL) to locomotor muscles.Objectives: To investigate the effects of heliox on peripheral O(2)DEL and utilization during exercise in moderate to severe COPD.Methods: Twelve mildly hypoxic or nonhypoxemic men (FEV(1) = 45.0 +/- 13.0% predicted) underwent constant-work rate tests (70-80% peak) to the limit of tolerance while receiving heliox or room air. Near-infrared spectroscopy determined changes (Delta) in leg muscle deoxygenation (deoxyhemoglobin concentration [HHb], an index of fractional O(2) extraction), and surface electromyography estimated muscle fiber recruitment (n = 5). Q and Spo(2) were monitored by impedance cardiography and pulse oximetry, respectively.Measurements and Main Results: Heliox significantly decreased dynamic hyperinflation and increased exercise tolerance compared with room air (640 +/- 95 s vs. 371 +/- 100 s; P < 0.01). Heliox also accelerated on-exercise dynamics of (, which were accompanied by faster O(2) uptake kinetics and slower Delta[HHb] responses (P < 0.05). During steady-state exercise, Spo(2)-corrected Delta[HHb] values decreased with heliox despite no significant changes in cardiac output. Muscle fiber recruitment and leg effort scores were also diminished (P < 0.05). On a multiple regression analysis, reductions in dynamic hyperinflation, dyspnea, and Delta[HHb] were independently related to improvements in exercise tolerance with heliox (R(2) = 0.91; p < 0.01).Conclusions: Heliox increases lower limb O(2)DEL and utilization during dynamic exercise in patients with moderate to severe COPD. These effects enhance exercise tolerance in this patient population.
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    Home-Based Pulmonary Rehabilitation for Subjects With COPD: A Randomized Study
    (Daedalus Enterprises Inc, 2015-04-01) Pradella, Cristiane Oliveira [UNIFESP]; Belmonte, Graziela Monari [UNIFESP]; Maia, Marcilene Nogueira [UNIFESP]; Delgado, Cionéia Silva [UNIFESP]; Luize, Ana Paula Tfardowski [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Gazzotti, Mariana Rodrigues [UNIFESP]; Jardim, Jose Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: the aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test. METHODS: Twenty-nine subjects with COPD (FEV1 = 62.4 +/- 10.7% of predicted, 62.4 +/- 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. the control group included 15 subjects (FEV1 = 54 +/- 26.2% of predicted, 65.3 +/- 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. the home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise. RESULTS: the 2 groups were similar regarding age, FEV1, and FVC. the home-based pulmonary rehabilitation group increased by 65 m in the 6MWT (P <.05) and 316.6 +/- 81.8 m in the endurance test (P <.05) and decreased by > 4 units in all SGRQ domains. the control group showed no difference in any variable. CONCLUSIONS: This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.
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    Impacto da dpoc na função pulmonar e resultados clínicos após cirurgia de revascularização do miocárdio sem circulação extracorpórea
    (Universidade Federal de São Paulo (UNIFESP), 2016-06-07) Viceconte, Marcela [UNIFESP]; Guizilini, Solange [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: The aim of this investigation was to analyze the impact and severity of chronic obstructive pulmonary disease (COPD) on pulmonary function and postoperative clinical outcome based on the Global initiative for Obstructive Lung Disease criteria in patients undergoing off-pump coronary artery bypass grafting. Methods: Patients were allocated into three groups according to presence and severity of COPD: 1) Non- to Mild-COPD group, n=144; 2) Moderate COPD, n=77; and 3) Severe COPD, n=30. Spirometry values were obtained preoperatively and on 2nd and 5th postoperative days. The incidence of pneumonia, reintubation, duration of mechanical ventilation and postoperative length of hospital stay were recorded. Results: A significant impairment in pulmonary function was observed in all groups on 2nd and 5th postoperative days (p<0.05). However, postoperative pulmonary dysfunction were significantly higher in moderate and severe COPD groups compared to non- to mild-COPD group (p<0.05). Multivariate analysis showed that severe COPD was associated with higher risk for prolonged mechanical ventilation, reintubation, pneumonia and delayed hospital discharge. A preoperative forced expiratory volume in first second<60% of the predicted value was associated with poor outcome in the moderate COPD group. A significant negative correlation was found between forced expiratory volume in first second at 5th postoperative day and postoperative length of stay (p=0.0001). Conclusion: COPD severity determined higher impairment in pulmonary function and worse clinical outcomes after off-pump coronary artery bypass grafting. A preoperative forced expiratory volume in first second<60% of predicted value seems to be an important predictor of postoperative complications.
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    O impacto da insuficiência cardíaca crônica na avaliação funcional respiratória de pacientes com doença pulmonar obstrutiva crônica
    (Universidade Federal de São Paulo (UNIFESP), 2014-11-26) Souza, Aline Soares de [UNIFESP]; Serafini, Jose Alberto Neder Serafini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Cardiovascular comorbidity is the most prevalent and relevant clinical condition in chronic obstructive pulmonary disease (COPD), and thus the increased interest in understanding the functional alterations arising from overlapping heart failure (HF) with reduced left ventricular ejection fraction. Our aim is to investigate the impact of heart failure with reduced left ventricular ejection fraction on COPD patients’ pulmonary function. Seventy-five patients of both genders, over forty-five years-old, at a stable phase of the disease, presenting with forced expiratory volume in one second/ forced vital capacity (FEV1/FVC) ratio < 0,7 either or not associated to stable HF with EF ≤ 45% were considered. The following parameters were evaluated:dynamic and static lung volumes, small airways closure (given by the difference between slow vital capacity (SVC) and FVC), ventilation distribution by inert gases,carbon monoxide lung diffusion capacity (DLCO), and blood gases (via arterialized sample). The COPD+HF group presented with lower airflow obstruction (FEV1/FVC ratio = 44 ± 12 % vs 28 ± 11%), dynamic and static lung volumes (total lung capacity (TLC) = 6.7 ± 1.1 L vs 5.9 ± 0.9 L e FEV1 1.4 ± 0.16 L vs 1.8 ± 0.6 L), besides lower bronchodilator flow and volume responses (23 vs 3% e 44 vs 28%, espectively) (P<0.05). The inspiratory volumes were higher in CPOD+HF group, due to a higher tidal volume (1.0 ± 0.2 L vs 0.8 L ± 0.5 L; P=0.08) and higher inspiratory-to-total lung capacity (IC/TLC) ratio (42 ± 10 % vs 36 ± 10 %; P<0.05). There was no significant difference between groups concerning to DLCO and arterial oxygen tension in arterialised blood (p>0.05). Further post-hoc analyses matched by the severity of FEV1 found such results. The study results reveal an important lung volume reduction effect of HF over COPD, which lead to higher inspiratory reserve volumes and keeping of (or preserving the) intrapulmonary gas exchange.