Antonio Fernando Brunetto

Validação do Modified Pulmonary Functional Status and Dyspnea Questionnaire e da escala do Medical Research Council para o uso em pacientes com doença pulmonar obstrutiva crônica no Brasil

OBJECTIVE: To determine the validity and reproducibility of two subjective instruments to assess limitations in activities of daily living (ADLs) in patients with chronic obstructive pulmonary disease (COPD) in Brazil: the Pulmonary Functional Status and Dyspnea Questionnaire - Modified version (PFSDQ-M) and the Medical Research Council (MRC) scale. METHODS: Thirty patients with COPD (age, 67 ± 10 years; males, 17; forced expiratory volume in one second, 42% ± 13% of predicted) completed the Portuguese-language versions of the two instruments on two occasions, one week apart. The PFSDQ-M has three components: influence of dyspnea on ADLs, influence of fatigue on ADLs change in ADLs experienced by the patient. The MRC scale is simple, with only five items, in which patients report the degree to which dyspnea limits their performance of ADLs. The traditional Saint Georges Respiratory Questionnaire (SGRQ), previously validated for use in Brazil, was used as a validation criterion. RESULTS: The test-retest reliability (intraclass correlation coefficient) of the PFSDQ-M was 0.93,xa00.92xa0and 0.90 for dyspnea, fatigue and change components, respectively, compared with 0.83 for the MRC scale. Bland-Altman plots showed good test-retest agreement for the PFSDQ-M. The components of the PFSDQ-M and the MRC scale correlated significantly with all of the domains and the total score of the SGRQ (0.49 < r < 0.80; p < 0.01 for all). CONCLUSIONS: The Portuguese-language versions of the PFSDQ-M and the MRC scale proved reproducible and valid for use in patients with COPD in Brazil.

Perfil do nível de atividade física na vida diária de pacientes portadores de DPOC no Brasil

OBJECTIVE: To evaluate characteristics of physical activities in daily life in COPD patients in Brazil, correlating those characteristics with physiological variables. METHODS: Physical activities in daily life were evaluated in 40 COPD patients (18 males; 66 ± 8 years of age; FEV1 = 46 ± 16 % of predicted; body mass index = 27 ± 6 kg/m2) and 30 healthy age- and gender-matched subjects, using a multiaxial accelerometer-based sensor for 12 h/day on two consecutive days. We also assessed maximal and functional exercise capacity, using the incremental exercise test and the six-minute walk test (6MWT), respectively; MIP and MEP; peripheral muscle force, using the one-repetition maximum test and the handgrip test; quality of life, using the Saint Georges Respiratory Questionnaire (SGRQ); functional status, using the London Chest Activity of Daily Living questionnaire; and dyspnea sensation, using the Medical Research Council (MRC) scale. RESULTS: Mean walking time/day was shorter for COPD patients than for the controls (55 ± 33 vs. 80 ± 28 min/day; p = 0.001), as movement intensity was lower (1.9 ± 0.4 vs. 2.3 ± 0.6 m/s2; p = 0.004). The COPD patients also tended to spend more time seated (294 ± 114 vs. 246 ± 122 min/day, p = 0.08). Walking time/day correlated with the 6MWT (r = 0.42; p = 0.007) and maximal workload (r = 0.41; p = 0.009), as well as with age, MRC scale score and SGRQ activity domain score (-0.31 < r < -0.43; p < 0.05 for all). CONCLUSIONS: This sample of Brazilian patients with COPD, although more active than those evaluated in studies conducted in Europe, were less active than were the controls. Walking time/day correlated only moderately with maximal and functional exercise capacity.

Relationship between pulmonary function and physical activity in daily life in patients with COPD

BACKGROUNDnIt remains unclear how closely the physical inactivity observed in patients with Chronic Obstructive Pulmonary Disease (COPD) relates to the severity of their airflow limitation. Furthermore, it is unknown whether spirometric variables such as maximal voluntary ventilation (MVV) and inspiratory capacity (IC) reflect the level of physical activity in daily life better than the forced expiratory volume in the first second (FEV(1)), the main spirometric variable used to determine the severity of COPD. The objective of the present study was to investigate the relationship between physical activity in daily life and the severity of COPD assessed by different spirometric variables: MVV, IC and FEV(1).nnnMETHODSnForty patients with COPD (21 men; 68+/-7 years; FEV(1) 41+/-14% predicted) were performed spirometry and assessment of the physical activity level in daily life using an accelerometer (SenseWear Armband).nnnRESULTSnMVV was significantly correlated to total energy expenditure per day, energy expenditure per day in activities demanding more than 3 metabolic equivalents (METs), number of steps per day and time spent per day in moderate and vigorous activities (0.42<or=r<or=0.52; p<0.01 for all). Correlation of these variables with IC and especially FEV(1) was more modest, borderline or not statistically significant. There was no difference in time spent in vigorous activities among patients classified according to the FEV(1)-based GOLD stages II, III and IV, differently than that observed when patients were classified in groups according to their MVV.nnnCONCLUSIONnIn COPD patients, MVV better reflects the physical activity level in daily life than FEV(1) and IC.

Step Counting and Energy Expenditure Estimation in Patients With Chronic Obstructive Pulmonary Disease and Healthy Elderly: Accuracy of 2 Motion Sensors

OBJECTIVEnTo compare the accuracy of 2 motion sensors (a pedometer and a multisensor) in terms of step counting and estimation of energy expenditure (EE) in patients with chronic obstructive pulmonary disease (COPD) and in healthy elderly.nnnDESIGNnIn this descriptive study, all participants wore both motion sensors while performing a treadmill walking protocol at 3 different speeds corresponding to 30%, 60%, and 100% of the average speed achieved during a six-minute walk test. As criterion methods, EE was estimated by indirect calorimetry, and steps were registered by videotape.nnnSETTINGnResearch laboratory at a university hospital.nnnPARTICIPANTSnPatients with COPD (n=30; 17 men; mean age +/- SD, 67+/-8 y; mean forced expiratory volume in the first second [FEV(1)] predicted +/- SD, 46%+/-17%; mean body mass index [BMI] +/- SD, 24+/-4 kg.m(2)) and matched healthy elderly (n=30; 15 men; mean age +/- SD, 68+/-7 y; mean FEV(1) predicted +/- SD, 104%+/-21%; mean BMI +/- SD, 25+/-3 kg.m(2)).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASUREnStep counting and EE estimation during a treadmill walking protocol.nnnRESULTSnThe pedometer was accurate for step counting and EE estimation in both patients with COPD and healthy elderly at the higher speed. However, it showed significant underestimation at the 2 slower speeds in both groups. The multisensor did not detect steps accurately at any speed, although it accurately estimated EE at all speeds in healthy elderly and at the intermediate and higher speeds in patients with COPD.nnnCONCLUSIONSnIn both patients with COPD and healthy elderly, the multisensor showed better EE estimates during most walking speeds than the pedometer. Conversely, for step counting, accuracy is observed only with the pedometer during the higher walking speed in both groups.

Heart Rate Variability and Disease Characteristics in Patients with COPD

Heart rate variability (HRV) is reduced in patients with chronic obstructive pulmonary disease (COPD). However, the relationships among HRV and characteristics of COPD are unknown. The aim of this study was to characterize HRV in patients with COPD and to verify the correlation of HRV measured during rest with disease severity and pulmonary, muscular, and functional impairment. Thirty-one patients with COPD (16 male; 66xa0±xa08xa0years; BMIxa0=xa024xa0±xa06xa0kg/m2; FEV1xa0=xa046xa0±xa016% predicted) without severe cardiac dysfunction were included. HRV assessment was performed by the head-up tilt test (HUTT), and the main variables used for analysis were SDNN index, LF/HF ratio, and R-R intervals. Other tests included spirometry, bioelectrical impedance, cardiopulmonary exercise test, 6-minute walk test, respiratory and peripheral muscle force, health-related quality of life and functional status questionnaires, and objective quantification of physical activity level in daily life with the DynaPort® and SenseWear® armband activity monitors, besides calculation of the BODE index. There was a statistical difference in all variables of HRV between the HUTT positions (lying and standing). There was no correlation of HRV with BODE index or FEV1. Out of the BODE index, just the BMI was correlated with SDNN and R-R intervals (rxa0=xa00.44; pxa0<xa00.05 and rxa0=xa00.37; pxa0<xa00.05, respectively). There was correlation between HRV reduction and a lower level of physical activity in daily life, besides worse health-related quality of life, functional status, and respiratory and peripheral muscle force. Cardiac autonomic function of patients with COPD is not related to disease severity but mainly to the level of physical activity in daily life.

Comparison of daily physical activity between COPD patients from Central Europe and South America

BACKGROUNDnIn healthy elderly and adults, lower physical activity level in daily life has been associated with lower socio-economic level and non-Caucasian race. The objective of this study was to determine if this is also applicable in chronic obstructive pulmonary disease (COPD) by comparing physical activity levels in daily life in stable patients from two countries (Austria and Brazil) with different socio-economic and ethnic characteristics.nnnMETHODSnPhysical activity in daily life was objectively assessed in 40 Austrian and 40 Brazilian COPD patients. Groups were matched for age, gender, body mass index, disease severity, smoking history, presence of concomitant heart disease, lung function, dyspnea and functional exercise capacity. In addition, climatic conditions were similar during the period of data collection in the two groups.nnnRESULTSnIn comparison to Brazilian patients, Austrian patients had a significantly lower walking time (p=0.04), higher sitting time (p=0.02) and lower movement intensity (p=0.0001). The proportion of patients who did not reach an average of 30min of walking per day was 48% in the Austrian group and 23% in the Brazilian group.nnnCONCLUSIONSnAustrian patients with COPD showed a significantly lower daily physical activity level in comparison to matched Brazilian patients. Socio-economic and ethnic factors appear to influence stable COPD patients differently than described in previous studies including healthy subjects.

Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

OBJECTIVE: To evaluate pulmonary function and respiratory muscle strength in chronic renal failure patients, correlating these variables with hemodialysis-related weight fluctuation; to study the correlation between the duration hemodialysis and potential respiratory alterations. METHODS: Seventeen patients (median age, 47 years; interquartile range, 41-52 years), submitted to three weekly hemodialysis sessions for a median of 27 months (interquartile range, 14-55) were evaluated. Twelve of the patients were male. The patients underwent spirometry. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured prior to and after the first hemodialysis session of the week. Body weight was quantified prior to and after each of the three weekly sessions. RESULTS: Before the first hemodialysis session of the week, 8 patients presented mild restrictive defect, which normalized after the session in 2 of those patients. After dialysis, there was a significant increase in forced vital capacity (p = 0.02) and a significant decrease in body weight (p = 0.0001). Weight fluctuation over 3 days without hemodialysis tended to correlate with the variation in forced vital capacity in the first weekly session (r = 0.47; p = 0.055). Duration of hemodialysis correlated with predialysis MIP (r = -0.3; p = 0.03) and MEP (r = -0.63; p = 0.006). CONCLUSIONS: More pronounced weight gain in the interdialytic period is associated with worsening of lung function, which is almost fully reversible by hemodialysis. In addition, longer duration of hemodialysis is associated with decreased respiratory muscle strength.

Nutritional status is related to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients

INTRODUCTION: Being overweight or obese is associated with a higher rate of survival in patients with advanced chronic obstructive pulmonary disease (COPD). This paradoxical relationship indicates that the influence of nutritional status on functional parameters should be further investigated. OBJECTIVE: To investigate the impact of nutritional status on body composition, exercise capacity and respiratory muscle strength in severe chronic obstructive pulmonary disease patients. METHODS: Thirty-two patients (nine women) were divided into three groups according to their body mass indices (BMI): overweight/obese (25 ≤ BMI ≤ 34.9 kg/m2, n=8), normal weight (18.5 ≤ BMI ≤ 24.9 kg/m2, n=17) and underweight (BMI <18.5 kg/m2, n=7). Spirometry, bioelectrical impedance, a six-minute walking distance test and maximal inspiratory and expiratory pressures were assessed. RESULTS: Airway obstruction was similar among the groups (p=0.30); however, overweight/obese patients had a higher fat-free mass (FFM) index [FFMI=FFM/body weight2 (mean±SEM: 17±0.3 vs. 15±0.3 vs. 14±0.5 m/kg2, p<0.01)], exercise capacity (90±8 vs. 79±6 vs. 57±8 m, p=0.02) and maximal inspiratory pressure (63±7 vs. 57±5 vs. 35±8 % predicted, p=0.03) in comparison to normal weight and underweight patients, respectively. In addition, on backward multiple regression analysis, FFMI was the unique independent predictor of exercise capacity (partial r=0.52, p<0.01). CONCLUSIONS: Severe chronic obstructive pulmonary disease (COPD) patients who were overweight or obese had a greater FFM, exercise capacity and inspiratory muscle strength than patients with the same degree of airflow obstruction who were of normal weight or underweight, and higher FFM was independently associated with higher exercise capacity. These characteristics of overweight or obese patients might counteract the drawbacks of excess weight and lead to an improved prognosis in COPD.

Efeitos negativos da insuficiência renal crônica sobre a função pulmonar e a capacidade funcional

OBJECTIVEnTo evaluate lung function and functional capacity in patients with chronic kidney failure (CKF) undergoing dialysis and in patients after kidney transplant.nnnMETHODSnSeventy-two participants were evaluated: 32 patients with CKF on dialysis (DG) for at least six months, ten patients who had kidney transplants (TG) at least six months earlier, and 30 healthy subjects as a control group (CG). All groups were evaluated using spirometry, with maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and using the six-minute walking test (6MWT). The SPSS 12.0 software was used for statistical analysis, with a minimum significance level of alpha<0.05.nnnRESULTSnThere was a decreased lung function in the DG for FVC, FEV1, MVV, VC, MIP and MEP, and decreased FEV1 and MVV in the TG compared to the CG (one-way ANOVA/Fishers post-hoc; p<0.01). There was also an association (chi-square) between decreased MIP and belonging to the DG (alpha=0.5, p<0.001), between lower performance in the 6MWT for the DG and TG (p<0.01) compared to the CG (one-way ANOVA/Fishers post-hoc), and between MIP and MEP (Pearsons coefficient; r=0.752; p<0.01).nnnCONCLUSIONSnPatients with CKF undergoing dialysis showed impaired functional capacity and lung function that were not completely reverted in the kidney transplant patients.

Validation of the Portuguese version of the London Chest Activity of Daily Living Scale (LCADL) in chronic obstructive pulmonary disease patients

INTRODUCTIONnWhile there are several subjective English tools, such as the London Chest Activity of Daily Living scale (LCADL), aimed at assessing dyspnoea during activities of daily living (ADL) in patients with Chronic Obstructive Pulmonary Di- sease (COPD), none of these questionnaires has ever been translated into Portuguese. The aim of this study was to investigate the validity and reproducibility of the LCADLs Portuguese version in patients with COPD.nnnMETHODSn31 patients with COPD (17 male; 69+/-7 years; FEV1 44+/-15 %predicted) completed the Portuguese version of the LCADL twice with a 1-week interval. The traditional Saint George Respiratory Questionnaire (SGRQ), already validated in Portuguese, was used as the criterion method.nnnRESULTSnThere were no significant differences between test and retest of the LCADL. Intraclass Correlation Coefficient between test and retest concerning the different scale components was Self-care r=0.96; Domestic r=0.99; Physical r=0.92; Leisure r=0.95; Total Score r=0.98. There were significant correlations of the LCADL Total Score with the SGRQs different components and total score (0.36<r<0.74; p<0.05 for all). The LCADL Total Score was also significantly correlated with the 6-minute walking distance test (r= -0.48; p=0.006).nnnCONCLUSIONnThe Portuguese version of the LCADL is valid and reproducible in patients with COPD, making this study a new and important tool for assessing the limitations of performing ADL in this population.