Maria do Rosário da Silva Ramos Costa

Treinamento muscular inspiratório e exercícios respiratórios em crianças asmáticas

OBJECTIVE The aim of the present study was to evaluate the effects that inspiratory muscle training (IMT) and respiratory exercises have on muscle strength, peak expiratory flow (PEF) and severity variables in children with asthma. METHODS This was a randomized analytical study involving 50 children with asthma allocated to one of two groups: an IMT group, comprising 25 children submitted to IMT via an asthma education and treatment program; and a control group, comprising 25 children who were submitted only to monthly medical visits and education on asthma. The IMT was performed using a pressure threshold load of 40% of maximal inspiratory pressure (MIP). The results were evaluated using analysis of variance, the chi-square test and Fishers exact test, values of p > 0.05 being considered significant. RESULTS In the comparative analysis, pre- and post-intervention values of MIP, maximal expiratory pressure (MEP) and PEF increased significantly in the IMT group: MIP from -;48.32 +/- 5.706 to -;109.92 +/- 18.041 (p < 0.0001); MEP from 50.64 +/- 6.55 to 82.04 +/- 17.006 (p < 0.0001); and PEF from 173.6 +/- 50.817 to 312 +/- 54.848 (p < 0.0001). In the control group, however, there were no significant differences between the two time points in terms of MIP or MEP, although PEF increased from 188 +/- 43.97 to 208.80 +/- 44.283 (p < 0.0001). There was a significant improvement in the severity variables in the IMT group (p < 0.0001). CONCLUSIONS Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles, as well as improving PEF and severity variables.

Correlação entre parâmetros clínicos e qualidade de vida relacionada à saúde em mulheres com DPOC

OBJECTIVE To correlate health-related quality of life (HRQL) of women with COPD with clinical parameters and with the six-minute walk distance (6MWD; six-minute walk test). METHODS Cross-sectional study involving 30 female patients diagnosed with mild or moderate COPD treated at the Respiratory Outpatient Clinic of the Presidente Dutra University Hospital. Patients completed the Saint Georges Respiratory Questionnaire (SGRQ) and were evaluated in terms of respiratory pressures, spirometry parameters and 6MWD. Descriptive statistical analysis was carried out, as were Students t-tests for dependent variables, together with Pearsons and Spearmans correlation coefficients for numerical and ordinal variables, respectively. RESULTS According to the SGRQ total scores, HRQL was impaired, to some extent, in most of the participants. Most SGRQ total scores were between the second and the third quartiles, reflecting poor HRQL. The participants also presented poor functional capacity. Mean 6MWD (317.7 m), inspiratory muscle strength (-53.48 cmH2O) and expiratory muscle strength (69.5 cmH2O) were all below reference values. We found that HRQL was not correlated with body mass index or pulmonary function. However, HRQL presented a negative linear correlation with age, MIP and 6MWD, as well as a positive correlation with the sensation of dyspnea and fatigue. CONCLUSIONS In this study, HRQL, determined using the SGRQ, was severely impaired in COPD patients, who presented severe limitations in functional capacity, breath control and personal life.

Asma e fatores associados em adolescentes de 13 e 14 anos em São Luís, Maranhão, Brasil

The aim of this study was to estimate the prevalence of asthma and associated factors among students 13 and 14 years of age in São Luís, Maranhão State, Brazil. A cross-sectional study was conducted using the questionnaire developed by ISAAC (International Study of Asthma and Allergies in Childhood) and an additional questionnaire from July 2008 to May 2009, including 3,069 adolescents. Asthma prevalence (wheezing in the previous 12 months) was 12.7%, lifetime prevalence was 32.4%, 3.9% reported difficulty speaking due to wheezing, and 9.8% reported wheezing after exercise. In the multivariate analysis, factors associated with increased asthma prevalence were family history of asthma, respiratory infection and wheezing in early life, eczema, allergic rhinitis, and passive smoking. Asthma prevalence was lower than for Brazil as a whole. Factors most strongly associated with asthma prevalence in these adolescents were family history of asthma (PR = 3.86), wheezing in early childhood (PR = 4.58), and allergic rhinitis (PR = 3.21).

Respiratory allergy to airborne fungi in São Luís – MA: clinical aspects and levels of IgE in a structured asthma program

Abstract Introduction: Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20–30% of the world’s population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. Methods: In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007–2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. Results: Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p = 0.01) and Penicillium (p = 0.005) and between cough and seropositivity for Aspergillus (p = 0.007). Conclusions: Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.

Time Required to Achieve Asthma Control in Not Previously Inhaled Corticosteroid Treated Adult Patients

Background. To achieve the best health possible, asthma patients require targeted education to understand the disease and how it may affect them, and what they need to do to keep it controlled. Aim. To measure the length of time needed in a structured educational training program to achieve well-controlled asthma status. Methods. This 5-month clinical trial enrolled previously untreated adult asthma patients at the Asthma Center of the President Dutra Public Hospital/Federal University of Maranhão–Brazil. At the first visit, patients were stratified according to their pre-bronchodilator peak expiratory flow rate (PEFR) measurements: Class I was defined as PEFR > 80% of the predicted value; Class II as PEFR 50–80% of predicted value, and Class III as PEFR < 50% of predicted value. At enrollment and each follow-up visit patients were assessed for asthma symptoms and health care utilization. In the educational program, sessions covered signs and symptoms of asthma exacerbation, triggering factors, environmental control, and asthma drug effects. The time required to achieve well-controlled status and the total time free of asthma symptoms were evaluated by Kaplan-Meier curves. The log-rank test was used to compare PEFR classes, with significance being measured as p-values ≤ 0.05. Results. A total of 121 patients met the eligibility criteria and underwent the 6-month follow-up. The first six-month Kaplan-Meier curve demonstrated that Class I patients had a significantly better probability of achieving well-controlled asthma than the other classes (log rang = 6.78, p = 0.03), The second 6-month Kaplan-Meier curve analyzed the total time free of asthma symptoms according to PEFR class (log rank = 11, 22 p = 0.003). The time required to reach a well-controlled status was 2 or 3 months, depending on the baseline level of airway obstruction: patients in PEFR classes I and II achieved good control earlier than patients in PEFR Class III. Education and targeted training remain a key element of doctor-patient interactions and success of asthma control efforts.

Effect of urinary incontinence on the quality of life of asthmatic women.

Abstract Objectives: Urinary incontinence (UI) has been associated with chronic respiratory symptoms, and it affects quality of life. This study evaluated the quality of life of asthmatic patients from the Assistance Program for Asthmatic Patients (PAPA) with and without UI. Methods: This is an analytical descriptive cross-sectional study using a sample of 358 women with asthma. Data were collected via the International Consultation Incontinence Questionnaire-Simplified Form (ICIQ-SF), Quality of Life in Asthma Questionnaire (QLAQ-ASTHMA) and Short Form 36 Health Survey (SF-36). Results: We found a general prevalence of UI of 55.3%. Overall quality of life scores in the SF-36 and QLAQ-ASTHMA were not related to the presence of UI. However, the amount of urine lost was significantly correlated with the subdomains physical aspects, general health, social functioning and mental health of the SF-36 and with socioeconomic and psychosocial domains of the QLAQ-ASTHMA. Conclusions: Urinary incontinence may affect a large proportion of older women with asthma. This study demonstrates the importance of routinely evaluating the occurrence of UI in order to improve the quality of life of asthmatic patients.