Maria Angela G. O. Ribeiro

Effect of exercise test on pulmonary function of obese adolescents

OBJECTIVE to investigate the pulmonary response to exercise of non-morbidly obese adolescents, considering the gender. METHODS a prospective cross-sectional study was conducted with 92 adolescents (47 obese and 45 eutrophic), divided in four groups according to obesity and gender. Anthropometric parameters, pulmonary function (spirometry and oxygen saturation [SatO2]), heart rate (HR), blood pressure (BP), respiratory rate (RR), and respiratory muscle strength were measured. Pulmonary function parameters were measured before, during, and after the exercise test. RESULTS BP and HR were higher in obese individuals during the exercise test (p = 0.0001). SatO2 values decreased during exercise in obese adolescents (p = 0.0001). Obese males had higher levels of maximum inspiratory and expiratory pressures (p = 0.0002) when compared to obese and eutrophic females. Obese males showed lower values of maximum voluntary ventilation, forced vital capacity, and forced expiratory volume in the first second when compared to eutrophic males, before and after exercise (p = 0.0005). Obese females had greater inspiratory capacity compared to eutrophic females (p = 0.0001). Expiratory reserve volume was lower in obese subjects when compared to controls (p ≤ 0,05). CONCLUSION obese adolescents presented changes in pulmonary function at rest and these changes remained present during exercise. The spirometric and cardiorespiratory values were different in the four study groups. The present data demonstrated that, in spite of differences in lung growth, the model of fat distribution alters pulmonary function differently in obese female and male adolescents.

Avaliação da qualidade de vida de acordo com o nível de controle e gravidade da asma em crianças e adolescentes

OBJETIVO: Avaliar a qualidade de vida de acordo com o nivel de controle e gravidade da asma em criancas e adolescentes. METODOS: Foram selecionados criancas e adolescentes com asma (7-17 anos de idade) acompanhados no Ambulatorio de Pneumologia Pediatrica do Hospital de Clinicas da Universidade Estadual de Campinas, localizado na cidade de Campinas (SP). O nivel de controle e a gravidade da asma foram avaliados pelo Teste de Controle da Asma e pelo questionario baseado na Global Initiative for Asthma, respectivamente. Os pacientes responderam o Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validado para uso no Brasil, para a avaliacao de sua qualidade de vida. RESULTADOS: A media de idade dos asmaticos foi de 11,22 ± 2,91 anos, com mediana de 11,20 (7,00-17,60) anos. Foram selecionados 100 pacientes, dos quais 27, 33 e 40, respectivamente, foram classificados com asma controlada (AC), asma parcialmente controlada (APC) e asma nao controlada (ANC). Quanto a gravidade da asma, 34, 19 e 47 foram classificados, respectivamente, com asma leve (AL), asma moderada (AM) e asma grave (AG). Os grupos AC e APC, quando comparados ao grupo ANC, apresentaram maiores valores no escore geral do PAQLQ e em seus dominios (limitacao de atividades, sintomas e funcao emocional; p < 0,001 para todos). O grupo AL apresentou os maiores escores em todos os componentes do PAQLQ quando comparado aos grupos AM e AG. CONCLUSOES: A qualidade de vida parece estar diretamente relacionada com o nivel de controle e a gravidade da asma, uma vez que as criancas e adolescentes com maior controle e menor gravidade da doenca apresentaram melhor qualidade de vida.

Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.

Walk test and school performance in mouth-breathing children

UNLABELLED In recent decades, many studies on mouth breathing (MB) have been published; however, little is known about many aspects of this syndrome, including severity, impact on physical and academic performances. OBJECTIVE Compare the physical performance in a six minutes walk test (6MWT) and the academic performance of MB and nasal-breathing (NB) children and adolescents. METHOD This is a descriptive, cross-sectional, and prospective study with MB and NB children submitted to the 6MWT and scholar performance assessment. RESULTS We included 156 children, 87 girls (60 NB and 27 MB) and 69 boys (44 NB and 25 MB). Variables were analyzed during the 6MWT: heart rate (HR), respiratory rate, oxygen saturation, distance walked in six minutes and modified Borg scale. All the variables studied were statistically different between groups NB and MB, with the exception of school performance and HR in 6MWT. CONCLUSION MB affects physical performance and not the academic performance, we noticed a changed pattern in the 6MWT in the MB group. Since the MBs in our study were classified as non-severe, other studies comparing the academic performance variables and 6MWT are needed to better understand the process of physical and academic performances in MB children.

Screening for F508del as a first step in the molecular diagnosis of cystic fibrosis

OBJECTIVE: To determine the relevance of screening for the F508del mutation of the cystic fibrosis transmembrane conductance regulator gene as a first step in the genetic diagnosis of cystic fibrosis (CF) by associating the genotype with various clinical variables. METHODS: We evaluated 180 CF patients regarding the F508del mutation. The clinical data were obtained from the medical records of the patients and from interviews with their parents or legal guardians. RESULTS: Of the 180 patients studied, 65 (36.1%) did not carry the F508del mutation (group 0 [G0]), 67 (37.2%) were F508del heterozygous (G1), and 48 (26.7%) were F508del homozygous (G2). All three groups showed associations with the clinical variables. Homozygosis was associated with younger patients, younger age at CF diagnosis, and younger age at the first isolation of Pseudomonas aeruginosa (PA), as well as with higher prevalence of pancreatic insufficiency (PI) and non-mucoid PA (NMPA) colonization. In comparison with G1+G2 patients, G0 patients were older; first experienced clinical symptoms, digestive disease, and pulmonary disease at an older age; were older at CF diagnosis and at first PA isolation; and had a lower prevalence of PI and meconium ileus, as well as of colonization by NMPA, mucoid PA, and Burkholderia cepacia. In G1 patients, values were intermediate for age at CF diagnosis; age at first PA isolation, first pulmonary symptoms, and first clinical manifestations; MPA colonization; and OR for PI. CONCLUSIONS: The identification of F508del in 63.9% of the patients studied showed that this can be a useful tool as a first step in the genetic diagnosis of CF. The F508del genotype was associated with clinical severity of the disease, especially with the variables related to CF onset.

Efeito da cisaprida e da fisioterapia respiratória sobre o refluxo gastroesofágico de lactentes chiadores segundo avaliação cintilográfica

Com o objetivo de analisar o efeito da cisaprida e dos estimulos fisicos utilizados pela fisioterapia respiratoria em pacientes com sindrome do lactente chiador (SLC), portadores de refluxo gastroesofagico (RGE), avaliamos prospectivamente a densidade nuclear em diferentes topografias esofagicas (distal, media e superior) por meio de cintilografia, em 13 lactentes, com idade media de 9,8 meses, submetidos a manobra de aceleracao de fluxo expiratorio (AFE), antes e apos tratamento com cisaprida, por via oral, na dose de O,3mg/kg,tres vezes ao dia. O tempo de tratamento com cisaprida variou de 4 a 8 meses. Os pacientes portadores de SLC sem RGE constituiram o grupo comparativo (n=12) com idade media de 8,7 meses e nao receberam tratamento farmacologico. Todos foram submetidos a investigacao clinica, incluindo historia e exame fisico, exames laboratoriais, radiologicos e cintilograficos para investigacao etiologica da SLC. Os episodiosde RGEforam analisadossegundoa topografia esofagicaatingida durante os dois periodos. sucessivos de observacao: cintilografia basal (15 minutos) e fisioterapia respiratoria (15 minutos). O tempo dos episodios de RGE foi somado para cada topografia esofagica, e os resultados expressos como tempo total (segundos) de RGE observado nos tercos esofagicos distal, medio e superior para cada paciente estudado. O tratamento com cisaprida resultou na diminuicao do tempo total de RGE nas tres topografias esofagicas, com significância estatistica somente em terco superior (p<O,05) porem, nao influenciou no tempo total de RGE nas topografias esofagicas quando os pacientes estavam sob a acao da fisioterapia. Apos tratamento com cisaprida, observamos tendencia de aumento do tempo total de RGE nas topografias esofagicas media e superior durante manobra de fisioterapia, porem sem significância estatistica. Nos pacientes com RGE durante a cintilografia basal, antes do tratamento com cisaprida, observou-se menor tempo de RGE em esofago distal durante a fisioterapia (15 minutos apos cintilografia basal) (p<O,05). Atribuimos este fenomeno ao esvaziamento gastrico. Apos o tratamento com cisaprida essa significância estatistica deixou de existir. Os pacientes do grupo comparativo tambem apresentaram menor tempo total de RGE em esofago distal durante a fisioterapia (p<0,05). A comparacao do tempo total de RGE em esofago distal dos pacientes com RGE (n=13) com o grupo comparativo (n=12), antes e apos tratamento com cisaprida, mostrou que os pacientes que apresentam RGE (n=13) somam maior tempo total de RGE em esofago distal (p<O,05)em comparacao com o grupo sem RGE (n=12), quer seja durante o tempo da cintilografia basal ou durante a fisioterapia. Desta maneira, nossos resultados mostram que a cisaprida apresenta efeito benefico no tratamento de RGE, principalmente no terco superior do esofago, e que a fisioterapia respiratoria foi potencialmente refluxogenica. Sugerimos investigar os efeitos da fisioterapia segundo posicoes corporais e submetidos a outros metodos diagnosticos conjuntamente com a cintilografia

Nasal Potential Difference in Cystic Fibrosis considering Severe CFTR Mutations

The gold standard for diagnosing cystic fibrosis (CF) is a sweat chloride value above 60 mEq/L. However, this historical and important tool has limitations; other techniques should be studied, including the nasal potential difference (NPD) test. CFTR gene sequencing can identify CFTR mutations, but this method is time-consuming and too expensive to be used in all CF centers. The present study compared CF patients with two classes I-III CFTR mutations (10 patients) (G1), CF patients with classes IV-VI CFTR mutations (five patients) (G2), and 21 healthy subjects (G3). The CF patients and healthy subjects also underwent the NPD test. A statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, χ 2, and Fishers exact tests, α = 0.05. No differences were observed between the CF patients and healthy controls for the PDMax, Δamiloride, and Δchloride + free + amiloride markers from the NPD test. For the finger value, a difference between G2 and G3 was described. The Wilschanski index values were different between G1 and G3. In conclusion, our data showed that NPD is useful for CF diagnosis when classes I-III CFTR mutations are screened. However, if classes IV-VI are considered, the NPD test showed an overlap in values with healthy subjects.

Manual therapy for childhood respiratory disease: a systematic review.

OBJECTIVE This study reviewed the scientific evidence available on the effects of manipulative techniques on children with respiratory diseases. METHOD Three databases (SciELO, PEDro, and MEDLINE) were searched for clinical trials on the effects of manual therapy techniques on children and adolescents with respiratory diseases. The relevant studies were chosen by 2 independent researchers who assessed their abstracts and selected the studies that met the criteria for a complete and structured review. RESULTS Of the 1147 relevant titles, 103 titles were selected for abstract assessment, and of these, 24 were selected for a full-text review. After critical analysis, 8 studies were included in the review and 16 were excluded for the following reasons: 1 covered only conventional therapy, 7 were not about the studied theme, and 8 included adults. Of the 8 studies included in the present review, 5 consisted of asthmatic children and the others of children with the following conditions: cystic fibrosis, bronchiolitis, recurrent respiratory infections, among others. Only 2 studies did not identify positive results with the use of manual therapy. The other 6 studies found some benefit, specifically in spirometric parameters, immunologic tests, anxiety questionnaire, or level of salivary cortisol. CONCLUSION The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.

Ventilatory abnormalities in patients with cystic fibrosis undergoing the submaximal treadmill exercise test

BackgroundExercise has been studied as a prognostic marker for patients with cystic fibrosis (CF), as well as a tool for improving their quality of life and analyzing lung disease. In this context, the aim of the present study was to evaluate and compare variables of lung functioning. Our data included: (i) volumetric capnography (VCAP) parameters: expiratory minute volume (VE), volume of exhaled carbon dioxide (VCO2), VE/VCO2, ratio of dead space to tidal volume (VD/VT), and end-tidal carbon dioxide (PetCO2); (ii) spirometry parameters: forced vital capacity (FVC), percent forced expiratory volume in the first second of the FVC (FEV1%), and FEV1/FVC%; and (iii) cardiorespiratory parameters: heart rate (HR), respiratory rate, oxygen saturation (SpO2), and Borg scale rating at rest and during exercise. The subjects comprised children, adolescents, and young adults aged 6–25 years with CF (CF group [CFG]) and without CF (control group [CG]).MethodsThis was a clinical, prospective, controlled study involving 128 male and female patients (64 with CF) of a university hospital. All patients underwent treadmill exercise tests and provided informed consent after study approval by the institutional ethics committee. Linear regression, Kruskal–Wallis test, and Mann–Whitney test were performed to compare the CFG and CG. The α value was set at 0.05.ResultsPatients in the CFG showed significantly different VCAP values and spirometry variables throughout the exercise test. Before, during, and after exercise, several variables were different between the two groups; statistically significant differences were seen in the spirometry parameters, SpO2, HR, VCO2, VE/VCO2, PetCO2, and Borg scale rating. VCAP variables changed at each time point analyzed during the exercise test in both groups.ConclusionVCAP can be used to analyze ventilatory parameters during exercise. All cardiorespiratory, spirometry, and VCAP variables differed between patients in the CFG and CG before, during, and after exercise.

Profile of children undergoing congenital heart surgery and analysis of their respiratory complications

OBJETIVO: Describir las caracteristicas demograficas y clinicas de ninos sometidos a la cirugia de correccion de cardiopatia congenita (CC) en un hospital universitario, comparando pacientes con y sin complicaciones respiratorias en el post-operatorio. METODOS: Estudio retrospectivo, realizado por medio de consulta de prontuarios de ninos sometidos a la cirugia correctiva de CC, en el Hospital de Clinicas de la Universidad Estadual de Campinas (Unicamp), en el periodo de noviembre de 2006 a septiembre de 2007. Se analizaron datos relativos a la edad, sexo, peso, comorbidades y tipo de CC de los ninos incluidos en el estudio, comparando pacientes con y sin complicaciones respiratorias en el post-operatorio. Se utilizaron el test de Mann-Whitney y el exacto de Fisher, considerandose significante p<0,05. RESULTADOS: Se analizaron 55 (95%) prontuarios disponibles de ninos sometidos a la cirugia cardiaca con mediana de edad de 37,5 meses, siendo el 49% muchachos. Presencia de tres o mas CC fue verificada en el 29,1% de los pacientes y el 53% de los casos presentaban comorbidades. Respecto a las complicaciones respiratorias en el post-operatorio, el 31% de los pacientes evolucionaron con atelectasia/derrame pleural y el 5,5% laringitis/pneumomediastino/lesion pulmonar. Otros tipos de complicaciones fueron identificadas en el 24% de los pacientes. La sobrevida fue del 89% y ninos con complicaciones respiratorias en el post-operatorio fueron sometidos a mayor tiempo de ventilacion mecanica y permanencia hospitalaria (p<0,001). CONCLUSIONES: El conocimiento de la relacion entre complicaciones respiratorias y mayor tiempo de ventilacion mecanica y hospitalizacion refuerzan la necesidad de prevenir tales complicaciones para reduccion de los costos hospitalarios.