Susan Martins Lage

Chest wall volumes during inspiratory loaded breathing in COPD patients.

Chest wall volumes and breathing patterns of 13 male COPD patients were evaluated at rest and during inspiratory loaded breathing (ILB). The sternocleidomastoid (SMM) and abdominal muscle activity was also evaluated. The main compartment responsible for the tidal volume at rest and during ILB was the abdomen. During ILB patients exhibited, in addition to increases in the ratio of inspiratory time to total time of the respiratory cycle and minute ventilation, increases (p<0.05) in the chest wall tidal volume by an increase in abdomen tidal volume as a result of improvement of end chest wall inspiratory volume without changing on end chest wall expiratory volume. The SMM and abdominal muscle activity increased 63.84% and 1.94% during ILB. Overall, to overcome the load imposed by ILB, COPD patients improve the tidal volume by changing the inspiratory chest wall volume without modifying the predominant mobility of the abdomen at rest and without affecting the end chest wall expiratory volume.

Chest wall regional volume in heart failure patients during inspiratory loaded breathing.

Were evaluated individuals divided into two groups: we studied chronic heart failure (CHF) (19 patients with CHF plus cardiomegaly) and control (12 healthy volunteers) during performance of inspiratory loaded breathing (ILB). We evaluated: spirometry, functional capacity through the six-minute walk test (6MWT), and distribution of thoracoabdominal volumes via optoelectronic plethysmography (OEP), namely volume variations of pulmonary rib cage (Vrc,p), abdominal rib cage (Vrc,a), and abdomen (Vab). In each compartment, the percentage contributions of right and left sides were also calculated. During ILB, patients with heart failure were characterized by a significant reduction of the Vrc,a volume variations compared to the control group. Correlations were found between left %Vrc,a on the left side measured during ILB and left ventricular ejection fraction (r=0.468; p=0.049), and dyspnea after the 6MWT (r=-0.878; p<0.01).Then, patients with CHF and cardiomegaly are characterized by a reduced mobility in left part of the lower part of the rib cage, that contributes leading to increased perception of dyspnea during submaximal exercise.

Capacidade funcional de indivíduos com insuficiência cardíaca avaliada pelo teste de esforço cardiopulmonar e classificação da New York Heart Association

The purpose of this study was to evaluate the capacity of the New York Heart Association (NYHA) classification to discriminate heart failure (HF) individuals classes II and III using cardiopulmonary exercise test (CPET) variables. Seventeen patients class II (age 44.47±10.11 years; ejection fraction 32.11±10.37%) and 15 class III (age 46.73±8.74 years; ejection fraction 30.46±10.23%) of NYHA participated in this study. They did a maximal CPET in a treadmill ergometer. According to the distribution of data, correlation of Pearson or Spearman was performed and, to compare the functional classes of NYHA, the Students t-test was used. Significant correlations (p<0.05) between oxygen consumption (VO2) and oxygen pulse (r=0.76), age (r=0.35) and body mass index (r=0.45) were found. There was no significant correlation between ventricular ejection fraction and the others studied variables. Comparing the functional classes of NYHA, significantly differences were found to VO2 and oxygen pulse (p<0.05). In this study, the correlations reflect the complexity in analyzing and understanding the process of disfunction in HF, once probably other factors influence each of the variables studied. The classification of NYHA was effective to differentiate the patients with HF, reinforcing the indication of this stratification to identify different groups of HF patients to scientific researches and therapeutic interventions.

Reprodutibilidade da determinação do limiar anaeróbico em pacientes com insuficiência cardíaca

BACKGROUND The anaerobic threshold (AT) provides information on functional capacity in heart failure (HF). However, the visual determination of the AT by ventilatory methods is subjective, being susceptible to differences between examiners. OBJECTIVE To evaluate the inter- and intra-examiner reproducibility in the determination of the AT in patients with mild to moderate HF, using visual-graphic and V-slope methods. To compare and correlate the results. METHODS After performing a cardiopulmonary exercise test on a treadmill, visual-graphic and V-slope methods were used for the analysis of the AT. To assess the reproducibility, three examiners determined the AT twice by each method, on different days. For statistical analysis, we used intra-class correlation coefficient (ICC) with p <0.05. RESULTS We evaluated a total of 16 subjects, with a mean age of 45.9 +/- 9.7 years, left ventricle ejection fraction of 20.5 +/- 8.1%, and peak exercise oxygen consumption of 20.6 +/- 7.8 mL/kgmin-1. The intra-examiner reproducibility was high in both methods for the three examiners, with ICC values between 0.87 and 0.99. The inter-examiner reproducibility was moderate in both visual-graphic method (ICC = 0.69) and V-slope method (ICC = 0.64). When comparing methods, the ICC found was 0.91. CONCLUSION AT determination by visual-graphic and V-slope methods showed high and moderate inter- and intra-examiner reproducibility, respectively. Moreover, both methods showed good agreement when compared with each other. These results suggest that both methods can be used in a reproducible way in AT assessment of patients with mild to moderate HF.

Reliability, validity, and minimal detectable change of computerised respiratory sounds in patients with Chronic Obstructive Pulmonary Disease

Computerized respiratory sounds (CRS) are closely related to the movement of air within the tracheobronchial tree and are promising outcome measures in patients with chronic obstructive pulmonary disease (COPD). However, CRS measurement properties have been poorly tested.

Can diaphragmatic breathing modify chest wall volumes during inspiratory loaded breathing in patients with heart failure

BACKGROUND Some inspiratory muscle training protocols for patients with heart failure report the request of diaphragmatic breathing during inspiratory loaded breathing. However, it is unclear whether this condition modifies the chest wall volumes. OBJECTIVE The primary purpose was to evaluate chest wall volumes during inspiratory loaded breathing as well as during inspiratory loaded breathing associated with diaphragmatic breathing in patients with heart failure. METHODS Sixteen men with heart failure functional class I to III, aged 50(SD=7) years were evaluated. Volumes of the pulmonary rib cage, abdominal rib cage and abdomen, as well as other breathing pattern variables, were assessed by optoelectronic plethysmography during quiet breathing, inspiratory loaded breathing, and inspiratory loaded breathing associated with diaphragmatic breathing. RESULTS Chest wall tidal volume significantly increased from quiet breathing 0.53(SD=0.14)L to inspiratory loaded breathing 1.33(SD=0.48)L and to inspiratory loaded breathing associated with diaphragmatic breathing 1.36(SD=0.48)L. A significant volume variation was observed on the three compartments (p<0.05 for all). During inspiratory loaded breathing associated with diaphragmatic breathing, patients showed increased abdominal volume compared to quiet breathing [0.28(SD=0.05) to 0.83(SD=0.47)L, p<0.001]; as well as from inspiratory loaded breathing [0.63(SD=0.23) to 0.83(SD=0.47)L, p=0.044]. No significant changes were observed between the two inspiratory loaded breathing conditions on the percentages of the contribution of each chest wall compartment for the tidal volume, respiratory rate, minute ventilation, and duty cycle. CONCLUSION When inspiratory loaded breathing was associated with diaphragmatic breathing, a higher volume in the abdominal compartment was obtained without significant changes in other breathing pattern variables.

Validation of the International Classification of Functioning, Disability and Health Core Set for obstructive pulmonary diseases in the perspective of adults with asthma

Abstract Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma. Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient’s life were performed. The meaning condensation procedure was used for analysis. Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions (n = 168), Body Structures (n = 22), Activities and Participation (n = 33), Environmental Factors (n = 125). These concepts were linked to 61 categories: second level (n = 25), third level (n = 33), fourth level (n = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification. Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates. Implications for rehabilitation The use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring. The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma. The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma.