Cristiane Cenachi Coelho

Repercussões da insuficiência renal crônica na capacidade de exercício, estado nutricional, função pulmonar e musculatura respiratória de crianças e adolescentes

Objective: To evaluate functional capacity, pulmonary function, respiratory musculature and nutritional status among children and adolescents with chronic renal insufficiency (CRI) undergoing conservative treatment. Methods: This study was conducted with 30 volunteers, divided into two groups: a group of children and adolescents with CRI undergoing conservative therapy (CRI Group) and a group without renal disease (Control Group). The volunteers underwent physical therapy evaluation, spirometry, strength and resistance tests on their respiratory musculature, nutritional status evaluation and functional capacity assessment. The data were analyzed using the Mann-Whitney test with a significance level of 5%. Results: The Tiffeneau index was significantly lower in the CRI Group (p= 0.003). In relation to respiratory muscle function, the maximum expiratory pressure values were lower (p= 0.010) and the time values of the resistance test were greater (p= 0.003). In the functional assessment, the variables that differed statistically were: lower distance walked (p< 0.001), greater mean arterial pressure (p< 0.001), final respiratory rate (p< 0.001) and Borg scale (p= 0.048). Regarding nutritional status, all the statistically significant variables were lower. Conclusions: Children and adolescents with CRI undergoing conservative treatment may present significantly impaired functional capacity, respiratory musculature and nutritional status.

CPAP Has No Effect on Clearance, Sputum Properties, or Expectorated Volume in Cystic Fibrosis

BACKGROUND: Positive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects. METHODS: In this crossover study, 15 CF subjects (mean age 19 y old) were randomized to interventions, 48 hours apart: directed coughs (control), CPAP at 10 cm H2O, HTS 7%, and both CPAP and HTS (CPAP+HTS). Sputum collection was performed at baseline and after interventions. Expectorated volume was determined and in vitro sputum properties were analyzed for contact angle and cough clearability. RESULTS: There were no significant differences between any treatment in arterial blood pressure, heart rate, or pulse oximetry, between the 2 time points. HTS and CPAP+HTS improved cough clearability by 50% (P = .001) and expectorated volume secretion by 530% (P = .001). However, there were no differences between control and CPAP on sputum contact angle, cough clearability, or volume of expectorated secretion. CONCLUSIONS: CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.

Efeitos da reabilitação pulmonar sobre a qualidade de vida: uma visão das crianças asmáticas e de seus pais

Introduction: The assessment of quality of life in asthmatic children and adolescents is important, as severe asthma, or its uncontrolled symptoms, prevents the participation of these individuals in sports activities, disturbs sleep and, consequently, the regular school performance. However, the disease does not have an impact only on the patients, but it also affects the quality of life of their parents. Objective: To evaluate the quality of life of asthmatic children and the perception of their parents/tutors regarding their children’s quality of life before and after a Pulmonary Rehabilitation Program (PRP). Patients and Methods: 5 male children, with a mean age of 8.16 ±1.83 years, were studied and 6 parents/tutors, before and after a 24-session PRP. All the children had a clinical diagnosis of mild and moderate asthma. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was applied to the children, whereas a second and specific questionnaire was applied to the parents. The absolute scores of the questionnaires before and after the PRP were compared by Wilcoxon’s test with p<0.05. Results: There was no significant difference in the comparison of the results of the children’s questionnaire, before and after PRP. However, absolute improvement was verified in the majority of the questions in both questionnaires. Conclusion: The quality of life questionnaires applied to the asthmatic children and their parents did not detect any significant variation regarding the analyzed questions. However, the absolute variations in several items, involving the two instruments, suggest a clinical improvement in the quality of life shown by both questionnaires.