Darlan L. Matte

Prevalence of depression in COPD: A systematic review and meta-analysis of controlled studies

BACKGROUND Depression is frequently reported in association with COPD. However, the prevalence of depression in these patients ranges largely. This study aimed to systematically review the prevalence of depression in COPD and controls and to explore remaining causes of inter-study variability in the reported prevalence. METHODS A systemic review of the literature and a meta-analysis was performed to evaluate the source of variability in the reported rates of depression in stable COPD. Main eligibility criteria were: controlled studies with a sample size >100, outpatients with COPD diagnosed by spirometry and, use of a validated depression screening instrument. RESULTS From 1613 studies identified, eight controlled studies were included in the review. The number of participants in the pooled studies was of 5.552 COPD subjects and 5.211 controls. Using stricter criteria for study selection reduced the variability of the depression prevalence in COPD and controls, which was 27.1% [25.9-28.3] in COPD subjects and 10.0% [9.2-10.8] in the control group. The pooled odds ratio and 95% CI was 3.74 [2.4-5.9]. However, the heterogeneity across studies was high. Possible explanatory factor included sample sizes, COPD/controls ratio, smokers/nonsmokers ratio and qualitative differences (source of subjects, instruments to screen depression, COPD severity, smoking status, and comorbidities). CONCLUSION The study highlights the variability in estimates of depression prevalence in COPD. It could be explained by methodological differences across the included studies. This suggests that a standardization is critical to improve precision of the estimates.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects

BACKGROUND the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients.

Ansiedade e parâmetros funcionais respiratórios de idosos praticantes de dança

INTRODUCTION: Anxiety is a common diagnosis found in elderly and is commonly associated with breathing abnormalities. Associated with aging, it is also found a sedentary lifestyle, which is an important risk factor for diseases. The practice of regular physical activities improves anxiety and cardiorespiratory condition. Between the types of physical activities, dance stands out as a good option for elderly. OBJECTIVE: To describe the influence of regular dance on anxiety and respiratory parameters of elderly dancers when compared with sedentary elders. METHODOLOGY: Were evaluated 18 elders, divided into two groups: dancers (G1 group) and sedentary (G2 group). In G1 and G2 groups it was applied the State-Trait Anxiety Inventory, cirtometry, spirometry and manovacuometry, in addition of the questionnaire of Baecke modified to elders, only for the group G2, in order to ensure the sedentary lifestyle of the participants. Descriptive statistics were used to synthesize the data. RESULTS: The participants in group G1 had higher values in relation of state-anxiety and maximal expiratory pressure. Cirtometry at basal level was higher in participants of group G1, while the xiphoid level was greater in group G2. All participants had spirometry values within the normal ranges, with no differences between groups. CONCLUSION: We observed on elders who practice dance regularly lower level of trait-anxiety, appropriate values of maximal expiratory pressure and higher values on cirtometry at basal level.

Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review

BACKGROUND: Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. METHODS: This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. RESULTS: The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (PEmax 21.49 cm H2O, 95% CI 13.39–29.59) and maximum inspiratory pressure (PImax 7.68 cm H2O, 95% CI 0.90–14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI −39.62 to 97.65) and dyspnea (0.15, 95% CI −0.77 to 1.08). In relation to EMT plus IMT, we observed that PEmax (31.98 cm H2O, 95% CI 26.93–37.03) and PImax (27.98 cm H2O, 95% CI 20.10–35.85) presented higher values compared to control groups. CONCLUSIONS: EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.

Does the COPD assessment test reflect functional status in patients with COPD

The aim of this study was to investigate whether the chronic obstructive pulmonary disease (COPD) assessment test (CAT) reflects the functional status of patients with COPD. Forty-seven patients underwent anthropometric assessment, spirometry, the 6-minute walk test (6MWT), the Glittre-activity of daily living (ADL) test (TGlittre), the London Chest ADL (LCADL) scale, and the CAT. The total score of the CAT correlated with 6MWT distance, TGlittre time spent, and LCADL%total (r = −0.56, 0.52, and 0.78, respectively; p < 0.05 for all). There was significant difference in 6MWT distance (490 ± 85.4 m vs. 387 ± 56.8 m), TGlittre time spent (3.67 ± 1.07 min vs. 5.03 ± 1.32 min), and LCADL%total (24.2 ± 3.02% vs. 44.4 ± 13.3%) between the low and high impacts of COPD on health status (respectively, p < 0.05 for all) as well as in the LCADL%total between medium and high impact of COPD on health status (31.3 ± 7.35% vs. 44.4 ± 13.3%; p = 0.001). In conclusion, the CAT reflects the functional status of patients with COPD.

Reliability of the five-repetition sit-to-stand test in patients with chronic obstructive pulmonary disease on domiciliary oxygen therapy

ABSTRACT Objectives: To evaluate the reliability and learning effect of the five-repetition sit-to-stand test (5STSt) in severe and very severe chronic obstructive pulmonary disease (COPD) patients on domiciliary oxygen therapy compare the results with those of COPD patients not on such therapy. Methods: Twenty-eight COPD patients were included in the domiciliary oxygen therapy group (DOTG) and 17 in the control group (CG). The participants of the groups were paired by age, sex, body mass index, and lung function. The groups performed two 5STSt (5STSt1 and 5STSt2). Results: In total, 96% of the patients in the DOTG performed better on the second 5STSt (5STSt2) (17.1 ± 4.63s), with an average reduction of 3.87 ± 3.50 s (p < 0.001) and a learning effect of 18.4%. In the CG, 82.3% of patients had better performance on the 5STSt2 (15.06 ± 3.45 s), with an average reduction of 1.38 ± 2.51 s (p = 0.035) and a learning effect of 8.39%. The 5STSt had an ICC of 0.79 (95%CI: 0.02–0.93; p < 0.001) in the DOTG and of 0.89 (95%CI: 0.65–0.96; p < 0.001) in the CG. Conclusion: The 5STSt is reliable in patients with severe and very severe COPD on domiciliary oxygen therapy, with learning effect of nearly 18% in the DOTG. Thus, performing two tests is recommended to achieve the patient´s best performance in this population.

Vivências e expectativas de obesos mórbidos pós programa de prehabilitação cirúrgica

Objetivo: Investigar as vivencias e expectativas de individuos obesos morbidos que participaram de um programa fisioterapeutico pre-operatorio e que se submeterao a cirurgia bariatrica (ou cirurgia de gastroplastia redutora). Materiais e Metodos: Estudo exploratorio descritivo com abordagem qualitativa, utilizando a tecnica de grupo focal tematico com amostragem por saturacao de dados. O grupo foi formado por individuos obesos participantes do programa de Extensao PREPARA – Nucleo de Ensino, Pesquisa e Extensao em Fisioterapia Pre e Pos-Operatoria de Cirurgias de Grande Porte, da Universidade do Estado de Santa Catarina. Resultados: Foi constatado que esses individuos possuem expectativas sobre a melhora do estado geral de saude e qualidade do sono, principalmente a melhora na qualidade de vida, incluindo aspectos familiares, comportamentos sexuais e atividade fisica. Conclusao: As vivencias e expectativas apresentadas pelos individuos apontam as dificuldades vividas pelos obesos morbidos e tendem a ser minimizados com a realizacao da cirurgia bariatrica. Acompanhar o comportamento dos aspectos do cotidiano avaliados quando os individuos realizarem a cirurgia bariatrica pode ser um interessante e necessario futuro tema de investigacao.

EFEITOS DA COLECISTECTOMIA ABERTA NA MOBILIDADE DO DIAFRAGMA E NOS PARÂMETROS VENTILATÓRIOS - SÉRIE DE CASOS

O objetivo deste estudo foi verificar os efeitos da colecistectomia aberta na mobilidade do diafragma, nos volumes pulmonares e na capacidade vital. Participaram quatro pacientes com idade entre 25 a 55 anos, candidatos a colecistectomia aberta, internados na Enfermaria de Cirurgia Toracica e Abdominal do Hospital Regional de Sao Jose Dr. Homero de Miranda Gomes (HRHMG). Os instrumentos utilizados para coleta de dados foram: radiografias de torax para avaliacao da mobilidade diafragmatica; ventilometro para avaliacao do volume corrente, volume minuto e capacidade vital; oximetro para medir a saturacao de oxigenio; e escala visual analogica da dor. Os pacientes foram avaliados no periodo pre-operatorio e no segundo dia de pos-operatorio. Todos os pacientes apresentaram no pos-operatorio aumento dos seguintes parâmetros: volume minuto, frequencia respiratoria e dor. Os valores referentes ao volume corrente, capacidade vital, saturacao de oxigenio e mobilidade do diafragma apresentaram reducao no segundo dia de pos-operatorio. A colecistectomia aberta interferiu na mecânica pulmonar dos pacientes estudados, reduzindo a ventilacao pulmonar e a mobilidade do diafragma.