Fabiana Sobral Peixoto-Souza

Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery

BACKGROUND AND OBJECTIVE To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

Pulmonary Function after Weight Loss in Obese Women Undergoing Roux-en-Y Gastric Bypass: One-Year Followup

Introduction. Obesity is a condition that causes damage to the respiratory function. However, studies have demonstrated that weight loss due to bariatric surgery has resulted in a huge improvement on some lung volumes, but controversy still persists regarding the behavior of the respiratory muscle strength and IRV (inspiratory reserve volume). Objective. To evaluate the effect of weight loss, after 1 year of the Roux-en-Y gastric bypass surgery (RYGB), on the lung volumes and the respiratory muscle strength in obese women. Methods. 24 obese women candidates were recruited for RYGB. Lung volumes (spirometry) and respiratory muscle strength were evaluated in preoperative period and one year after surgery. Results. There was a significant increase in some lung volumes. However, when examining the components of the VC (vital capacity) separately, an increase in ERV (expiratory reserve volume) and reduction of IRV were observed. Moreover, a statistically significant reduction in the values of respiratory muscle strength was recorded: MIP (maximal inspiratory pressure) and MEP (maximal expiratory pressure). Conclusion. Weight loss induced by bariatric surgery provides an increase in some lung volumes of obese women, but reduction in IRV. Additionally, there was also a reduction in the respiratory muscle strength.

Comportamento da força muscular respiratória de obesas mórbidas por diferentes equações preditivas

BACKGROUND: Studies on the behavior of respiratory muscle strength (RMS) in morbidly obese patients have found conflicting results. OBJECTIVES: To evaluate RMS in morbidly obese women and to compare the results by using different predictive equations. METHOD: This is a cross-sectional study that recruited 30 morbidly obese women and a control group of 30 normal-weight women. The subjects underwent anthropometric and maximal respiratory pressure measurement. Visual inspection of the Bland-Altman plots was performed to evaluate the correlation between the different equations, with a p value lower than 0.05 considered as statistically significant. RESULTS: The obese women showed a significant increase in maximal inspiratory pressure (MIP) values (-87.83±21.40 cmH2O) compared with normal-weight women (-72±15.23 cmH2O) and a significant reduction of MIP (-87.83±21.40 cmH2O) according to the values predicted by the EHarik equation (-130.71±11.98 cmH2O). Regarding the obtained maximal expiratory pressure (MEP), there were no between-group differences (p>0.05), and no agreeement was observed between obtained and predicted values of MEP and the ENeder and ECosta equations. CONCLUSIONS: Inspiratory muscle strength was greater in the morbidly obese subjects. The most appropriate equation for calculating the predicted MIP values for the morbidly obese seems to be Harik-Khan equation. There seem to be similarities between the respiratory muscle strength behavior of morbidly obese and normal-weight women, however, these findings are still inconclusive.

Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is characterized by pulmonary and systemic inflammation. However, increases in the levels of inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study was to evaluate whether a home-based pulmonary rehabilitation (HBPR) program improves exercise tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of health-related quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers (interleukin [IL]-6 and IL-8). At the end of the evaluations, patients received a booklet containing the physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25 patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant increase in the walked distance and the maximal inspiratory pressure, improvements on two components from the health-related quality-of-life questionnaire, and a decrease in plasma IL-8 levels after the intervention. The HBPR is an important and viable alternative to pulmonary rehabilitation for the treatment of patients with COPD; it improves exercise tolerance, inspiratory muscle strength, quality of life, and systemic inflammation in COPD patients.

Lung age in women with morbid obesity

OBJECTIVE To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables. METHODS This was a cross-sectional study with 72 morbidly obese women and a control group consisting of 37 normal weight women. The subjects performed a pulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes. RESULTS The morbidly obese group had significantly higher lung age (50.1±6.8 years) than the control group (38.8±11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r=0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lung age (r=-0.7565, -0.8769, --0.2723, and -0.2417, respectively). CONCLUSION Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.

Influence of Body Composition on Lung Function and Respiratory Muscle Strength in Children With Obesity

Background Obesity affects lung function and respiratory muscle strength. The aim of the present study was to assess lung function and respiratory muscle strength in children with obesity and determine the influence of body composition on these variables. Methods A cross-sectional study was conducted involving 75 children (40 with obesity and 35 within the ideal weight range) aged 6 - 10 years. Body mass index, z score, waist circumference, body composition (tetrapolar bioimpedance), respiratory muscle strength and lung function (spirometry) were evaluated. Results Children with obesity exhibited larger quantities of both lean and fat mass in comparison to those in the ideal weight range. No significant differences were found between groups regarding the respective reference values for respiratory muscle strength. Male children with obesity demonstrated significantly lower lung function values (forced expiratory volume in the first second % (FEV1%) and FEV1/forced vital capacity % (FVC%) : 93.76 ± 9.78 and 92.29 ± 3.8, respectively) in comparison to males in the ideal weight range (99.87 ± 9.72 and 96.31 ± 4.82, respectively). The regression models demonstrated that the spirometric variables were influenced by all body composition variables. Conclusion Children with obesity demonstrated a reduction in lung volume and capacity. Thus, anthropometric and body composition characteristics may be predictive factors for altered lung function.

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial.

OBJECTIVE The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma. DESIGN A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function. RESULTS No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05). Although the mean energy expenditure at rest and during exercise training was similar for both groups, the maximum energy expenditure was higher in the VGG. CONCLUSION The present findings strongly suggest that aerobic training promoted by an active video game had a positive impact on children with asthma in terms of clinical control, improvement in their exercise capacity and a reduction in pulmonary inflammation. TRIAL REGISTRATION Clinicaltrials.gov NCT01438294.

Comparative analysis of autonomic modulation in children with acute and controlled asthma

Material/Methods: Twenty-five children aged 5 to 13 years participated in the study: 19 with asthma analyzed both during an attack (acute asthma group) and after controlling the condition (controlled asthma group), and 6 without asthma (control group). Peak flow, spirometric variables and C-reactive protein were analyzed. Heart rate variability (HRV) was evaluated at rest for 10 min in the supine position using frequency and time domains as well as non-linear variables. Asthma was characterized as persistent/moderate based on the classification of severity.

Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica

Analisar volume corrente (VC), volume minuto (VM) e frequencia respiratoria (FR) de obesas morbidas no pos-operatorio de cirurgia bariatrica (CB), apos a fisioterapia respiratoria convencional (FRC) associada ou nao a pressao positiva continua nas vias aereas (CPAP) no pre-operatorio. Foram estudadas 36 mulheres, com idade de 40,1±8,41 anos, que seriam submetidas a CB por laparotomia e que realizaram FRC (exercicios respiratorios diafragmaticos, de inspiracoes profundas, fracionadas e associados a movimentos de membros superiores, 1 serie de 10 repeticoes de cada exercicio) por 30 dias antes da cirurgia. Apos internacao, 18 delas foram submetidas a 20 minutos de CPAP, 1 hora antes da inducao anestesica e compuseram o grupo FRC+CPAP. As outras 18 nao receberam o CPAP e compuseram o grupo FRC. Foram avaliados VM, VC e FR por meio do ventilometro, no momento da internacao e 24 horas apos a realizacao da cirurgia. Constatou-se que as medidas de VC, VM e FR nao apresentaram significância estatistica quando comparados os resultados do pre e pos-operatorio em ambos os grupos, bem como quando comparados os dois grupos entre si tanto no pre como no pos-operatorio. Os resultados sugerem que a tanto a aplicacao da FRC como a aplicacao da FRC+CPAP no periodo pre-operatorio contribui para a manutencao das variaveis respiratorias no pos-operatorio. A aplicacao do CPAP antes da inducao anestesica nao promoveu beneficios adicionais no pos-operatorio de CB no que se refere aos volumes pulmonares.

Improvement in lung function and functional capacity in morbidly obese women subjected to bariatric surgery

OBJECTIVE: To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics. METHODS: Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery. RESULTS: Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes. CONCLUSION: The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.