Luiz Osório Cruz Portela

Broncoespasmo induzido pelo exercício em crianças e adolescentes com diagnóstico de asma

INTRODUCTION: In asthmatic children and adolescents a high incidence of temporary bronchospasm is perceived after physical exertion. OBJECTIVE: To investigate incidence and severity of exercise-induced bronchospasm in children and adolescents with a clinical diagnosis of mild, moderate or severe asthma. METHOD: A descriptive, cross-sectional, not controlled study was carried out. The sample encompassed follow-up of 40 asthmatic patients of both genders, between 7 and 18 years of age who were not regularly using anti-inflammatory medication. A standardized exercise provocation test that consisted of steady running on a treadmill with a 10% inclination was administered Pulmonary function was tested with forced spirometry using six expiratory maneuvers repeated at approximately 1, 5 ,10,15, 20 and 30 minutes after the exercise. The highest of six FEV1 readings was used for analysis. The FEV1 was employed to evaluate the presence and to classify the severity of positive exercise induced bronchospasm (EIB). The asthmatic patients presented adequate clinical and spirometric conditions for testing (FEV1 at least 70 % of the predicted value). A drop of > 10% in relation to FEV1 before exercise was adopted as a criterion for (EIB). RESULTS: 26 (65 %) patients developed EIB. The proportion by category was: mild asthma 44%, moderate and severe asthma 100%. There was a significant association between proportion of EIB and severity of asthma (p<0.05), and a significant difference between severity of EIB (confirmed by a recorded decrease in the 1 second forced expiratory volume) and asthma severity (p<0.05). CONCLUSION: The proportion and severity of EIB were clearly related to the clinical severity of asthma.

Efeito do exercício físico sobre os parâmetros hemodinâmicos fetais

PURPOSE To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Students t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed.

Capacidade aeróbica em crianças e adolescentes com asma intermitente e persistente leve no período intercrises

OBJECTIVE To assess children and adolescents diagnosed with mild intermittent or mild persistent asthma, in terms of their aerobic capacity between attacks. METHODS We included 33 children and adolescents recently diagnosed with asthma (mild intermittent or mild persistent) and 36 healthy children and adolescents. Those with asthma were evaluated between attacks. All participants underwent clinical evaluation; assessment of baseline physical activity level; pre- and post-bronchodilator spirometry; and a maximal exercise test, including determination of maximal voluntary ventilation, maximal oxygen uptake, respiratory quotient, maximal minute ventilation, ventilatory equivalent, ventilatory reserve, maximal HR, SpO2, and serum lactate. RESULTS No significant differences were found among the groups (intermittent asthma, persistent asthma, and control) regarding anthropometric or spirometric variables. There were no significant differences among the groups regarding the variables studied during the maximal exercise test. CONCLUSIONS A diagnosis of mild intermittent/persistent asthma has no effect on the aerobic capacity of children and adolescents between asthma attacks.

Análise de variáveis fisiológicas de adolescentes com diagnóstico clínico de asma leve intermitente ou leve persistente quando submetidos a hipóxia aguda e teste de esforço máximo

OBJECTIVE To analyze adolescents clinically diagnosed with asthma, in terms of the physiological changes occurring during acute hypoxia and during a maximal stress test. METHODS This was a descriptive, cross-sectional study involving 48 adolescents (12-14 years of age) who were divided into three groups: mild intermittent asthma (MIA, n = 12); mild persistent asthma (MPA, n = 12); and control (n = 24). All subjects were induced to acute hypoxia and were submitted to maximal stress testing. Anthropometric data were collected, and functional variables were assessed before and after the maximal stress test. During acute hypoxia, the time to a decrease in SpO2 and the time to recovery of SpO2 (at rest) were determined. RESULTS No significant differences were found among the groups regarding the anthropometric variables or regarding the ventilatory variables during the stress test. Significant differences were found in oxygen half-saturation pressure of hemoglobin prior to the test and in PaO2 prior to the test between the MPA and control groups (p = 0.0279 and p = 0.0116, respectively), as was in the oxygen extraction tension prior to the test between the MIA and MPA groups (p = 0.0419). There were no significant differences in terms of the SpO2 times under any of the conditions studied. Oxygen consumption and respiratory efficiency were similar among the groups. The use of a bronchodilator provided no significant benefit during the hypoxia test. No correlations were found between the hypoxia test results and the physiological variables. CONCLUSIONS Our findings suggest that adolescents with mild persistent asthma have a greater capacity to adapt to hypoxia than do those with other types of asthma.

ALTERAÇÕES HEMODINÂMICAS MATERNAS E REPERCUSSÕES FETAIS APÓS EXERCÍCIO FÍSICO EM GESTANTES – NOTA PRÉVIA

Objetivo: avaliar as alteracoes metabolicas maternas bem como as repercussoes fetais ao estudo Doppler e a cardiotocografia em gestantes de baixo risco submetidas a exercicio fisico aerobico. Metodo: pesquisa longitudinal experimental a ser realizada com gestantes higidas entre a 26 e 34 semanas gestacionais, avaliando parâmetros hemodinâmicos maternos e fetais pre e pos exercicio fisico em esteira. Resultados Esperados: nao evidenciar alteracoes maternas e/ou fetais apos a atividade aerobica, garantindo maior seguranca na prescricao dessa durante o periodo gestacional.

Efeito do exercício físico sobre os parâmetros hemodinâmicos

PURPOSE To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Students t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed.

Cortisol, resposta glicêmica e secreção de insulina em equinos clinicamente sadios submetidos a sessões de hipóxia normobárica

The cortisol levels, glycemic response and insulin secretion were evaluated in non-exercised horses submitted to sessions of normobaric hypoxia. Healthy adult horses (n=8) were selected after physical examination and underwent an intravenous glucose tolerance test (0.5g kg-1) (IVGTT). Blood samples (n=11) were collected between 0 and 180 minutes after glucose administration to evaluate glycemic response and insulin secretion. Then, they were exposed to 1-hour hypoxia sessions twice a day, reaching a total of 43 hypoxia sessions, with [O2] decreasing from 17 to 12%. Heart rate and serum samples to measure cortisol were collected before and every 15 minutes during the sessions 1, 4, 6, 8, 10, 14, 22 and 43. The IVGTT was repeated at the end of the study. The serum cortisol levels were higher in session 1 (S1) (17% O2) when compared to the levels of S10 (13% O2) and S43 (12% O2) (P<0.05). The glycemic curve in resting healthy horses is not altered by exposure to 43 normobaric hypoxia sessions. The increase in insulin secretion, followed by decreased heart rate and serum cortisol suggest an adaptation of the horses to the hypoxia model used.

Ergoespirometria em indivíduos com escoliose idiopática

Escoliose idiopatica e uma disfuncao na coluna vertebral que tende a diminuir os diâmetros, a flexibilidade e a excursao da caixa toracica, com possiveis efeitos deleterios na funcao pulmonar. O objetivo deste estudo foi verificar se ha relacao entre o grau de curvatura escoliotica e a funcao pulmonar e capacidade de exercicio em individuos com escoliose idiopatica de grau leve e moderado. Dezessete individuos com escoliose idiopatica leve e moderada e 19 controles foram submetidos a teste pulmonar em repouso e exercicio em esteira. As medias das variaveis pulmonares em repouso encontraram-se dentro da normalidade nos dois grupos; as variaveis de exercicio consumo de oxigenio de pico (p=0,81), tempo de exercicio (p=0,68), frequencia cardiaca (p=0,39), ventilacao minuto (p=0,82), producao de dioxido de carbono (p=0,95), quociente respiratorio (p=0,09), equivalente ventilatorio para o oxigenio (p=0,90), lactato sanguineo (p=0,98) nao mostraram diferenca estatisticamente significante entre os grupos. Nao foi possivel estabelecer relacao de causa e efeito entre o grau de escoliose, funcao pulmonar e capacidade aerobia, sugerindo que a escoliose nao implica necessariamente perdas funcionais, sendo o treinamento uma importante medida de prevencao.