Camila Isabel da S. Santos

Effects of swimming on spirometric parameters and bronchial hyperresponsiveness in children and adolescents with moderate persistent atopic asthma

OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA). METHODS A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months. Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed. The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions. Both groups underwent spirometric assessment and methacholine challenge test--provocative concentration of methacholine causing a 20% fall in FEV1 (PC₂₀)--before and after the study period. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group. RESULTS Significant increases in PC₂₀ (pre-training, 0.31±0.25; post-training, 0.63±0.78; p = 0.008), MIP (pre-training, 67.08±17.13 cm H₂O; post-training 79.46±18.66; p < 0.001), and MEP (pre-training, 71.69±20.01 cm H₂O; post-training, 78.92±21.45 cm H₂O; p < 0.001) were found in the swimming group. CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC₂₀ values, when compared with asthmatic controls who did not undergo swim training. Participants in the swimming group also showed improvement in elastic recoil of the chest wall.

Ocorrência de desvios posturais em escolares do ensino público fundamental de Jaguariúna, São Paulo

OBJECTIVE: Evaluate the posture of students from a public school in Brazil and to identify the differences between normal deviation during growth and compensatory alterations. METHODS: Students from first to fourth grade of a public school in the city of Jaguariuna, Sao Paulo, Brazil, were evaluated. The students were positioned at sagital anterior and posterior coronal planes for postural assessment. Kendall points were used as the normal reference. RESULTS: 247 students were evaluated, 131 boys and 116 girls, and the main postural deviations found were: shoulder unbalance (50.2%), protracted shoulder (39.7%), abducted scapula (40.5%), knock-knee (29.6%), pelvic unbalance (21.5%), pelvic anteversion (19%), knee hyperextension (19%), medial rotation of hip (12.9%), protracted cervical (11.7%), head tilt (15.4%), thoracic hyperkyphosis (9.7%) and lumbar hyperlordosis (26.3%). CONCLUSIONS: A high incidence of postural alterations was detected in school children. Some of the postural alterations, such as abducted scapula, unbalance and protraction of the shoulders, knock-knee and lumbar hiperlordosis, normally occur and they are naturally corrected during growth. However, some postural problems, such as protraction and inclination of the cervical spine, were also prevalent and they require early intervention.

Avaliação espirométrica e da hiper-responsividade brônquica de crianças e adolescentes com asma atópica persistente moderada submetidos a natação

OBJECTIVE: To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA). METHODS: A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clinicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months. Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed. The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions. Both groups underwent spirometric assessment and methacholine challenge test - provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) - before and after the study period. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group. RESULTS: Significant increases in PC20 (pre-training, 0.31±0.25; post-training, 0.63±0.78; p = 0.008), MIP (pre-training, 67.08±17.13 cm H2O; post-training 79.46±18.66; p < 0.001), and MEP (pre-training, 71.69±20.01 cm H2O; post-training, 78.92±21.45 cm H2O; p < 0.001) were found in the swimming group. CONCLUSION: Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness, as determined by increased PC20 values, when compared with asthmatic controls who did not undergo swim training. Participants in the swimming group also showed improvement in elastic recoil of the chest wall.

Utilização do teste de caminhada de 6 minutos no manejo da hipertensão pulmonar

O teste de caminhada de 6 minutos (T6) e utilizado na avaliacao de doencas cardiopulmonares por sua capacidade prognostica, facilidade de realizacao e reprodutibilidade. A hipertensao pulmonar (HP) e definida e classificada como uma consequencia hemodinâmica que leva ao aumento da pressao arterial pulmonar, podendo resultar em uma falencia ventricular direita e com consequente morte. Este relato de caso retrata a indicacao do T6 pela equipe de cardiologia de um hospital universitario como forma de controle funcional de um paciente com HP, pos-introducao e inicio da terapeutica.The 6-minute walk test (T6) is used to assess cardiopulmonary diseases due to its prognosis capacity, easy performance and reproducibility. Pulmonary hypertension (PH) is defined and classified as a hemodynamic consequence leading to increased pulmonary arterial pressure and may result in right ventricular failure and consequent death. This case reports the prescription of T6 by the cardiology team at a university hospital as a means of physical control of a patient with HP, after the introduction and initiation of therapy.

Efectos de la antibioterapia y la técnica fisioterápica respiratoria en pacientes con fibrosis quística tratados por exacerbación pulmonar aguda: estudio experimental

INTRODUCTION Intravenous antibiotics in combination with intensive respiratory physiotherapy were evaluated for acute lung exacerbations in chronic infections of Pseudomonas aeruginosa in cystic fibrosis patients. Forced expiratory technique (FET) was assessed during hospital stay and discharge. The aim of this study was 1) to evaluate the immediate effects of FET and of 2) Intravenous antibiotics in combination with daily respiratory physiotherapy (IA+RPT) on parameters of lung function, body anthropometry and clinical scores of cystic fibrosis patients with acute lung exacerbation with chronic infection by Pseudomonas aeruginosa, during hospital stay and at hospital discharge after clearing the infection. PATIENTS AND METHOD Eighteen patients between 7-28 years old were included in a prospective non-controlled clinical study. Body anthropometry values, Cystic Fibrosis Clinical Score (CFCS) exacerbation, Cystic Fibrosis Foundation Score (CFFS), and severity scores (SS) were evaluated before and after admission. Oxygen saturation (SpO(2)), heart (HR) and respiratory rate (RR) were evaluated before and after FET. RESULTS CFCS (32.4+7.2) and CFFS (6.4+1.7) had decreased at hospital discharge for 18.9+3.3 and 0.3+0.5, respectively (p<0.001). IA+ RPT reduced RR means (p=0.003) and increased SpO(2) (p=0.006), forced expiration volume at 1min (FEV(1)) (p=0.021) and nutritional values (p=0.002). During admission, FET immediately improved HR (p=0.028), RR (p=0.001) and SpO(2) (p=0.015), despite significant maximum voluntary ventilation reduction (p=0.028); after the infection was treated the FET did not significantly alter parameters. CONCLUSION IA+RPT improved clinical conditions of cystic fibrosis patients. FET improved cardiorespiratory variables of patients at risk for infection.

Antibiotic therapy and Effects of Respiratory Physiotherapy Techniques Cystic Fibrosis Patients Treated for Acute Lung Exacerbation: an Experimental Study

a b s t r a c t Introduction: Intravenous antibiotics in combination with intensive respiratory physiotherapy were evaluated for acute lung exacerbations in chronic infections of Pseudomonas aeruginosa in cystic fibrosis patients. Forced expiratory technique (FET) was assessed during hospital stay and discharge. The aim of this study was 1) to evaluate the immediate effects of FET and of 2) Intravenous antibiotics in combination with daily respiratory physiotherapy (IA+RPT) on parameters of lung function, body anthropometry and clinical scores of cystic fibrosis patients with acute lung exacerbation with chronic infection by Pseudomonas aeruginosa, during hospital stay and at hospital discharge after clearing the infection. Patients and method: Eighteen patients between 7-28 years old were included in a prospective non- controlled clinical study. Body anthropometry values, Cystic Fibrosis Clinical Score (CFCS) exacerbation, Cystic Fibrosis Foundation Score (CFFS), and severity scores (SS) were evaluated before and after admission. Oxygen saturation (SpO2), heart (HR) and respiratory rate (RR) were evaluated before and after FET. Results: CFCS (32.4+7.2) and CFFS (6.4+1.7) had decreased at hospital discharge for 18.9+3.3 and 0.3+0.5, respectively (p < 0.001). IA+ RPT reduced RR means (p = 0.003) and increased SpO2 (p = 0.006), forced expiration volume at 1 min (FEV1) (p = 0.021) and nutritional values (p = 0.002). During admission, FET immediately improved HR (p = 0.028), RR (p = 0.001) and SpO2 (p = 0.015), despite significant maximum voluntary ventilation reduction (p = 0.028); after the infection was treated the FET did not significantly alter parameters. Conclusion: IA+RPT improved clinical conditions of cystic fibrosis patients. FET improved cardiorespiratory variables of patients at risk for infection.

Utilización del test de caminata de 6 minutos en el manejo de la hipertensión pulmonar

O teste de caminhada de 6 minutos (T6) e utilizado na avaliacao de doencas cardiopulmonares por sua capacidade prognostica, facilidade de realizacao e reprodutibilidade. A hipertensao pulmonar (HP) e definida e classificada como uma consequencia hemodinâmica que leva ao aumento da pressao arterial pulmonar, podendo resultar em uma falencia ventricular direita e com consequente morte. Este relato de caso retrata a indicacao do T6 pela equipe de cardiologia de um hospital universitario como forma de controle funcional de um paciente com HP, pos-introducao e inicio da terapeutica.The 6-minute walk test (T6) is used to assess cardiopulmonary diseases due to its prognosis capacity, easy performance and reproducibility. Pulmonary hypertension (PH) is defined and classified as a hemodynamic consequence leading to increased pulmonary arterial pressure and may result in right ventricular failure and consequent death. This case reports the prescription of T6 by the cardiology team at a university hospital as a means of physical control of a patient with HP, after the introduction and initiation of therapy.

Use of 6-minute walk test in pulmonary hypertension management

O teste de caminhada de 6 minutos (T6) e utilizado na avaliacao de doencas cardiopulmonares por sua capacidade prognostica, facilidade de realizacao e reprodutibilidade. A hipertensao pulmonar (HP) e definida e classificada como uma consequencia hemodinâmica que leva ao aumento da pressao arterial pulmonar, podendo resultar em uma falencia ventricular direita e com consequente morte. Este relato de caso retrata a indicacao do T6 pela equipe de cardiologia de um hospital universitario como forma de controle funcional de um paciente com HP, pos-introducao e inicio da terapeutica.The 6-minute walk test (T6) is used to assess cardiopulmonary diseases due to its prognosis capacity, easy performance and reproducibility. Pulmonary hypertension (PH) is defined and classified as a hemodynamic consequence leading to increased pulmonary arterial pressure and may result in right ventricular failure and consequent death. This case reports the prescription of T6 by the cardiology team at a university hospital as a means of physical control of a patient with HP, after the introduction and initiation of therapy.