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Foy, Brody Harry. "Applied mathematical modelling of pulmonary function tests". Thesis, University of Oxford, 2018. http://ora.ox.ac.uk/objects/uuid:e38c3275-fe54-424d-bc54-153e83ceaf15.
Pełny tekst źródłaCotter, Nicholas James. "The Effect of Seasonality on Pulmonary Function Tests". Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6693.
Pełny tekst źródłaBrådvik, Ingela. "Lung functions studies in diagnostics and follow-up of pulmonary sarcoidosis". Lund : Dept. of Lung Medicine and the Dept. of Clinical Physiology, University of Lund, 1994. http://catalog.hathitrust.org/api/volumes/oclc/39781480.html.
Pełny tekst źródłaMai, Shiqi, i 麦诗琪. "Respiratory symptoms and pulmonary function among welders : a cross-sectional study in an automobile assembly factory in Guangzhou". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206956.
Pełny tekst źródłapublished_or_final_version
Public Health
Master
Master of Public Health
Silva, Elaine Caetano. "Correlação entre testes de cabeceira e testes de função pulmonar em quatro grupos: controle, gestante, obeso e idoso". Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-01102008-121642/.
Pełny tekst źródłaThe objective of this study was to investigate the degree of correlation between bed side tests and tests of pulmonary function in four groups of individuals: healthy, pregnant (36ª week), obese (IMC > 40 Kg/m2) and elderly (> 60 years). Twenty individuals for group had been studied. The carried through tests had been: test of ventilation (ventilometry, VVM, spirometry, Measures of Pimax and Pemáx) and bed side tests (Test of the Candle, Test of Apnea, thoracic and abdominal circunference). For the measure of ventilometry and VVM, a ventilometer was used one and for the measures of CVF, VEF1, VEF1/CVF and PFE one was used portable espirometer. For the measures of Pimax and Pemáx one was used analogical manavacuometer. In the Test of the candle it was considered in the distance where the flame was extinguished. In the distance initial it was of 60 cm and this was diminished of 10 in 10 centimeters until the success was reached. In the apnea test, after 3 tests, were considered the biggest time. In the group obese, the correlations of the Test of Apnea with the VVM, CVF, VEF1, PFE and Pemáx had been statistical significant. It had significant correlation of the Test of the Apnea with the VVM, CVF, VEF1, PFE and Pemáx. In the test of the candle, the coefficients had been all positives, with exception of the pregnant group in which they had been negative. toracic inspiratory in almost all had significant correlation of all the groups. thoracic expiratory with only the VVM in the group had correlation of obese. In abdominal inspiratory, the coefficients had been all positives, but without significance statistics. In the correlation of abdominal expiratory, had positive correlation with all the ventilation tests, except in the group has control, that it showed to negative correlation of abdominal expiratory with VVM and PFE. The bed side tests possess correlation with the spirometrics tests.
Dimich-Ward, Helen D. "A comparison of longitudinal statistical methods in studies of pulmonary function decline". Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/32386.
Pełny tekst źródłaGraduate and Postdoctoral Studies
Graduate
Odendal, Elsabe. "Pulmonary function and acid-base balance high intensity constant-load exercise". Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/27123.
Pełny tekst źródłaAllamenos, Christodoulos. "Techniques assessing infant lung function and their application in the assessment of response to inhaled #beta#-2 agonist". Thesis, University of Bristol, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262811.
Pełny tekst źródłaThamrin, Cindy. "Measurement of lung function using broadband forced oscillations /". Connect to this title, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0103.
Pełny tekst źródłaCowell, Lynda L. (Lynda Lea). "Development and Validation of a Ramping Treadmill Protocol for the On-Line Measurement of Four Aerobic Parameters". Thesis, University of North Texas, 1990. https://digital.library.unt.edu/ark:/67531/metadc500392/.
Pełny tekst źródłaFilho, Flávio Brito. "Efeitos da sobrecarga hemodinâmica pulmonar experimental no sistema cardiovascular e na estrutura e função pulmonar". Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-21062010-173210/.
Pełny tekst źródłaINTRODUCTION: The pulmonary hemodynamic overload (PHO) is associates to high mortality and morbidity clinical entities as: postpneumonectomy pulmonary edema, pulmonary thromboembolism, lung transplantation and physiological situations as physical exercise. Some pathophysiological aspects related to PHO are not elucidated. OBJECTIVES: To study pulmonary and cardiac pathopysiological alterations induced by PHO. METHODS: Twenty Large White pigs were anesthetized, intubated and subjected to volume controlled mechanical ventilation followed to median sternotomy. Pulmonary lobes structures were isolated by surgical dissection and pulmonary arteries of left lung, right lower lobe and mediastinal lobe were completely isolated. The animals were randomized into 4 groups (n=5 each) with one control (C) and three of PHO (LI, LII and LIII) induced by pulmonary arterial occlusions specifics for each group. In the control group (C), all lobes were perfused, ie none of arteries were occluded. In the LI group, only the right lung was perfused; in the LII group, the right lung but the lower lobe; in LIII group, the right lung but the lower and mediastinal lobes, obstructing the pulmonary vasculature in 42, 76 and 82% respectively. Hemodynamics and gas exchange variables were monitored during 60 minutes of PHO. At the end of the study, the middle lobe was resected for analysis of structural variables: morphometry (alveolar and vascular) and calculation of the wet weight / dry weight ratio. Statistical analysis settings were used with mixed linear models of variance and covariance structure, a one-way ANOVA, simple linear regression and mixed effects linear regression with random intercept and trend. RESULTS: In intergroup comparisons there were significant differences during the 60 minutes of PHO in hemodynamic variables: Heart rate (p=0, 004), Systemic arterial pressure (p=0,01), Systolic index (p=0,002), Pulmonary arterial pressure (p=0,001) and Pulmonary capillary pressure (p <0,0001). Gas exchange: for PaO2/FiO2 ratio (p=0,002), PaCO2 (p<0,0001), arterial pH (p<0,0001), O2 consumption index (p=0,02), Shunt (p=0,03). Structural: perivascular and alveolar edema (p<0,0001) in both and the wet weight / dry weight ratio (p=0,005). There were no significant differences in intergroup comparisons of variables: Cardiac index (p=0,94), arterial HCO3 (p=0,63), O2 offer index (p=0,89) and O2 extraction (p=0,08). CONCLUSIONS: The PHO promoted significant pulmonary dysfunction in previously healthy lungs with structural changes (alveolar and perivascular edema) and increased arterial and pulmonary capillary pressures. Cardiac function was preserved despite the large reduction in pulmonary vascular bed (82% in group LIII). In LII group occurred reverse of pulmonary dysfunction with past of PHO time
Camilo, Gustavo Bittencourt. "Quantificação e correlação do volume pulmonar de pacientes com acromegalia por meio de tomografia computadorizada e testes de função pulmonar". Universidade do Estado do Rio de Janeiro, 2015. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=9512.
Pełny tekst źródłaViecili, Raqueli Biscayno. "Análise dos tempos de apneia voluntária máxima como teste de função pulmonar em pacientes com distúrbios ventilatórios obstrutivos e normais". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/31960.
Pełny tekst źródłaIntroduction: Breath-holding test has been tested in some clinical scenarios and has proved to be of clinical utility. Objectives: To determine the maximum voluntary breath-holding time in patients with obstructive ventilator defects and in normal subjects and to correlate the breathholding times with pulmonary function tests. Methods: We conducted a case-control study including patients with obstructive ventilator defects and a control group consisted of volunteers recruited in the same hospital, with normal spirometry. Spirometry was performed using a computerized spirometer. The Breath-holding test was conducted using an electronic microprocessor and a (Hans Rudolph ® – Kansas OH, EUA)pneumotachograph and flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal voluntary apnea inspiratory and expiratory times (MVAIT and MVAET) were determined from the acquired signal. Results: A total of 35 patients with obstructive ventilatory defects and 16 controls met the inclusion criteria and were included in the analysis. The MVAIT was lower in cases (22.3 ± 11.8 seconds) than in controls (31.5 ± 15.7 seconds) (p=0.025). MVAET was also lower in cases than in controls (16.9 ± 6.6 vs. 22.1 ± 7.9; p=0.017). We found positive and significant correlations between MVAIT and FVC (L) (r=0.476; p=0.004) and between MVAIT and FEV1 (L) (r=0.383; p=0.023). Conclusions: MVAIT and MVAET were significant lower in patients with obstructive ventilatory defects than in controls, and that MVAIT was correlated positively with FVC and FEV1 in cases. Our results provide additional evidence of usefulness of MVAIT as a pulmonary function test.
Barks, Lee. "Wheelchair positioning and pulmonary function in children with cerebral palsy". [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002107.
Pełny tekst źródłaHafezi, Nazila. "An integrated software package for model-based neuro-fuzzy classification of small airway dysfunction". To access this resource online via ProQuest Dissertations and Theses @ UTEP, 2009. http://0-proquest.umi.com.lib.utep.edu/login?COPT=REJTPTU0YmImSU5UPTAmVkVSPTI=&clientId=2515.
Pełny tekst źródłaHellström, Lars Gösta. "Respiratory drive assessment : an evaluation of the breath-by-breath occlusion pressure method in man /". Stockholm, 2002.
Znajdź pełny tekst źródłaBaldi, Bruno Guedes. "Avaliação de hiperinsuflação dinâmica em pacientes com linfangioleiomiomatose através de teste de exercício cardiopulmonar e verificação da resposta à broncodilatação". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5150/tde-14012013-143812/.
Pełny tekst źródłaBACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare disease that is characterized by the proliferation of atypical smooth muscle cells around the airways, blood vessels and lymphatics, with diffuse pulmonary cyst formation. An obstructive pattern, with air trapping, and a reduction in the diffusion capacity of the lungs for carbon monoxide (DLCO) are found in pulmonary function tests (PFTs), and there may be a positive response to the bronchodilation test. In the cardiopulmonary exercise testing (CPET), a lower exercise tolerance is frequent, secondary to multiple causes, with a greater emphasis on ventilatory limitation. However, not all potentially exercise limiting factors were evaluated. The aims of this study were to evaluate the prevalence and predictors of dynamic hyperinflation (DH) in patients with LAM in comparison with healthy women. The response to bronchodilator was also evaluated. METHODS: A cross-sectional study with 42 patients with LAM was conducted, with evaluation of a quality of life questionnaire, PFTs and a ramp CPET on cycle, with serial measurements of inspiratory capacity (IC) to establish DH. Data were compared with the healthy control subjects. The patients also performed the six-minute walk test (6MWT). Then, the patients were included in a randomized, placebo-controlled, doubleblind, crossover evaluation (inhaled salbutamol vs. placebo). After each intervention, they performed PFTs and endurance CPET with serial measurements of IC. RESULTS: In comparison with the healthy individuals, the patients with LAM experienced an impaired quality of life, mainly in the physical and emotional domains. They also had obstructive pattern, air trapping and lower DLCO in the PFTs. LAM was associated with diminished exercise performance, in association with ventilatory limitation, greater dyspnea intensity and exercise desaturation. DH occurred at a higher prevalence (55%) in patients with LAM, even in those with mild spirometric abnormalities, compared with no occurrence in the normal subjects. DH correlated with airflow obstruction, air trapping, DLCO impairment and dyspnea. The patients who developed DH (DH subgroup) had a longer duration since diagnosis and were characterized by airflow obstruction, air trapping and reduced DLCO, compared with those who did not have DH (non-DH subgroup). Although there was no difference in the exercise performance, DH subgroup had ventilatory limitation, with a higher desaturation and greater dyspnea intensity in the CPET and in the 6MWT. There was no reduction of DH or increase in exercise duration after use of inhaled salbutamol, even in the DH subgroup. CONCLUSIONS: DH is frequent in patients with LAM, even in those with mild spirometric abnormalities, and it is associated with the duration since diagnosis, the severity of disease, augmented dyspnea and lower oxygen saturation. Ventilatory limitation and gas exchange impairment are important reasons for exercise cessation in patients with LAM. DH is also associated with desaturation and greater dyspnea intensity in the 6MWT. Inhaled salbutamol does not reduce DH or improve exercise duration on cycle.
Silva, Leonardo Silveira da. "Relação entre a massa livre de gordura e a hiperinsuflação pulmonar dinâmica durante o exercício em portadores de doença pulmonar obstrutiva crônica". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/72919.
Pełny tekst źródłaPurposes: Investigate if the amount of fat free mass (FFM) has direct effects in dynamic hyperinflation during exercise in COPD patients. Methods: 38 patients with moderate to severe COPD performed treadmill incremental cardiopulmonary exercise test to the limit of tolerance with serial measurements of inspiratory capacity (IC). FFM was measured by whole-body bioelectrical impedance. Results: Patients were 66.5±7.3 years-old with mean FEV1 of 0.98±0.05L (42±15% of predicted). Peak exercise values of IC (a variable inversely related with operational lung volumes, i.e. the greater IC lower is pulmonary hyperinflation) was significantly (p<0.05) correlated with IC at rest (r=0.78), FEV1 (r=0.66), FVC (r=0.56), FFM (r=0.46) and FFM index (r=0.39). However, in multivariable analyzes only FEV1 and IC at rest remained predictive of peak IC. Peak IC was a significant predictor of peak aerobic capacity. Conclusion: FFM was directly related with measurements of dynamic hyperinflation. Nonetheless, this association disappeared when adjustments were made for indicators of expiratory airflow limitation (FEV1) and lung hyperinflation at rest (rest IC).
Fernandes, Suelen do Couto 1982. "Avaliação da função pulmonar por espirometria e capnografia volumétrica em crianças e adolescentes verticalmente expostos ao vírus da imunodeficiência humana e não infectados". [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313713.
Pełny tekst źródłaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A exposição intra uterina ao vírus da imunodeficiência humana (HIV) pode levar a corioaminionite e déficit no desenvolvimento pulmonar. Há evidências crescentes de que muitas alterações possam persistir até a infância tardia ou mesmo até a idade adulta. Objetivo: Avaliar a função pulmonar de crianças e adolescentes verticalmente expostas ao HIV e não infectados através de Espirometria e Capnografia Volumétrica (CapV), e comparar os resultados obtidos com grupos de crianças e adolescentes saudáveis e de infectados pelo HIV por transmissão vertical. Casuística e métodos: Estudo observacional, analítico, do tipo corte transversal, envolvendo crianças e adolescentes com idade entre 6 à 19 anos de ambos os sexos, que foram expostas verticalmente ao HIV e acompanhadas no Serviço de Imunodeficiência Pediátrica do Hospital de Clínicas da Universidade Estadual de Campinas. Todos os indivíduos realizaram espirometria e CapV. Três comparações foram feitas: pacientes filhos de mães HIV, mas não infectados pelo vírus HIV (Grupo I) pacientes infectados pelos vírus HIV sem doença pulmonar (Grupo II) indivíduos saudáveis (Grupo III). Os testes estatísticos foram: teste exato de Fisher, teste de Mann-Whitney, teste de Wilcoxon, teste de Kruskal-Wallis e o teste de Comparações Múltiplas Não-paramétrico. Em todos os casos adotou-se o nível de significância de 5% (p=0,05). Resultados: Foram incluídos 122 indivíduos, destes, 24 eram pacientes filhos de mães HIV, mas não infectados pelo vírus HIV (Grupo I); 21 pacientes infectados pelos vírus HIV sem doença pulmonar (Grupo II) e 77 indivíduos saudáveis (Grupo III). A idade foi maior no Grupo II (14,9 ± 3,1) quando comparado ao Grupo I e ao Grupo III respectivamente (9,7 ± 2,3; 11,2 ± 1,7) p< 0,001. O z-escore da altura e do IMC foram significativamente menores nos pacientes do Grupo II (-0,72 ± 0,99; -0,50 ± 1,14) quando comparados ao Grupo I (0,65 ± 1,05; 0,56 ± 1,34) p <0,001. As variáveis VEF1% (p=0,007) e FEF25-75% (p=0,007) do Grupo I foram significativamente menores quando comparados ao Grupo III. Os resultados capnográficos não mostraram diferenças estatisticamente significativas entre os grupos estudados.Em relação as variáveis espirométricas pré e pós broncodilatador, o Grupo I não apresentou nenhuma diferença. Já o Grupo II após broncodilatador apresentou maiores valores de VEF1% (p=0,014), de VEF1%/CVF% (p=0,025) e de FEF25-75% (p=0,001) que foram estatisticamente significativos. Houve redução nos valores do Slope 2 (p=0,004 e p=0,025) no Grupo I e no Grupo II respectivamente após broncodilatador. Conclusões: Os pacientes sororeversores (Grupo I), apresentaram valores espirométricos de VEF1, FEF 25-75 menores que os seus controles (Grupo III), porém não apresentaram diferenças significativas quando comparados aos pacientes com HIV (Grupo II). Portanto os pacientes filhos de mães infectadas pelo vírus HIV apresentaram volumes e fluxos alterados que podem ser secundários ao menor calibre da via aérea, mas dentro do padrão da normalidade. Os resultados capnográficos não mostraram diferenças estatisticamente significativas entre os grupos estudados
Abstract: The intra uterine exposure to human immunodeficiency virus (HIV) can lead to corioaminionite and a lung development deficit. There is increasing evidence that many changes may persist until late childhood or even adulthood. Objective: To evaluate pulmonary function in children and adolescents vertically HIV-exposed and not infected by Spirometry and Volumetric Capnography (VC), and compare the results with groups of healthy children and adolescents and vertically HIV-infected. Patients and methods: Observational and analytical transversal cohort study, with children and adolescents aged 6-19 years of both genders who were vertically exposed to HIV and followed at Immunodeficiency Pediatric Clinical Hospital of the State University of Campinas, and a control group of healthy children. All subjects underwent spirometry and VC. Three comparisons were made: uninfected HIV children born of HIV-infected mothers (Group I) vs patients infected by the HIV virus without pulmonary disease (Group II) vs healthy subjects (Group III). The tests used were: Fisher's exact test, Mann-Whitney test, Wilcoxon test, Kruskal-Wallis test and the Test of Nonparametric Multiple Comparisons (TMC). In all cases we adopted the significance level of 5% (? = 0.005). Results: We included 122 individuals. Group I contained 24 patients; Group II contained 21 and Group III, 77 patients. The age was higher in Group II (14.9 ± 3.1) when compared to Group I and Group III respectively (9.7 ± 2.3, 11.2 ± 1.7) p <0.001. The z-score of height and BMI were significantly lower in Group II (-0.72 ± 0.99, -0.50 ± 1.14) when compared to Group I (0.65 ± 1.05; 0, 56 ± 1.34) p <0.001; p = 0,002. As variables FEV1% (p = 0.007) and FEF 25-75% (p = 0.007) in Group I were lower with statistically significant differences when compared to Group III. Capnographic results showed no statistically significant differences between studied groups. In comparison with the pre and post bronchodilator spirometry variables, Group I showed no difference. Group II showed higher FEV1% (p = 0.014), FEV1/FVC% (p = 0.025) and FEF 25-75% values (p = 0.001) which were statistically significant after bronchodilator. There was a reduction in slope 2 values (p = 0.004 and p = 0.025) in Group I and Group II respectively. Conclusions: The seroreverter patients (Group I) had spirometry FEV1, FEF 25-75 lower than their controls (Group III), but not significantly different when compared to HIV-patients (Group II). Therefore patients born to mothers infected with HIV had altered volumes and flows that may be secondary to the lower airway diameter, but within the normality standard. Capnographic results showed no statistically significant differences between the studied groups, because the patients are not sick and they do not show changes in the ventilation-perfusion relationship in the lung
Mestrado
Saude da Criança e do Adolescente
Mestra em Ciências
Gonçalves, Junia Rezende. "Doença obstrutiva grave = similaridades e diferenças em pacientes portadores de doença pulmonar obstrutiva cronica (DPOC) e/ou bronquiectasias". [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309664.
Pełny tekst źródłaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Pacientes com defeito obstrutivo podem responder aos broncodilatadores (BD) na espirometria com aumento do volume expiratório forçado no 1° segundo (VEFi) e/ou da capacidade vital forçada (CVF), sendo chamados respondedores de fluxo e/ou de volume, respectivamente. No entanto, ainda acontece debate considerável na definição de resposta ao BD, com a existência de critérios distintos propostos pelas sociedades de pneumologia. Estudos prévios demonstraram que a doença pulmonar obstrutiva crônica (DPOC) grave caracteriza-se por uma maior resposta de volume (RV) e menor resposta de fluxo (RF). Os objetivos principais deste trabalho foram descrever e comparar pacientes portadores de doença obstrutiva grave, com ou sem história prévia de tabagismo (> 10 anos/maço), por meio da análise de seus parâmetros funcionais, de repercussão sistêmica, e estruturais; testar se os respondedores de volume são pacientes mais graves que os respondedores de fluxo e os não respondedores, de acordo com as definições da SBPT (Sociedade Brasileira de Pneumologia e Tisiologia), da ATS/ERS (American Thoracic Society/European Respiratory Society), e de Paré et al. (AVEF1/ACVF > 1 = RF ou < 1 = RV). Sessenta e oito pacientes (idade 55,9 ± 13,7 anos; VEF1 31,9 ± 10,2 % do previsto) realizaram espirometria pré e pós-BD, manovacuometria, bioimpedância, teste de caminhada dos 6 minutos (TC6), radiograma e tomografia de alta resolução do tórax (TCAR), e responderam a um questionário clínico. Dos 68 incluídos, 37 tinham o diagnóstico clínico de DPOC e 31, de bronquiectasias extensas. Comparando os 33 fumantes aos 35 não fumantes, não houve diferença estatisticamente significativa nas variáveis clínicas, funcionais e de repercussão sistêmica, exceto pela capacidade vital, significativamente menor nos não fumantes (p = 0,000). No radiograma, o diafragma rebaixado na incidência em perfil foi mais frequentemente encontrado nos fumantes (p = 0,0470). Na TCAR, bronquiectasias foram encontradas em 48,5% dos fumantes. Os sinais de bronquiolite foram significativamente mais pronunciados nos não fumantes (p = 0,0004), visualizados em 94,3% da amostra. Contudo, eles foram expressivos também nos fumantes, encontrados nas tomografias de 57,6% deles. Encontramos 16, 20 e 29 pacientes com RV de acordo com a SBPT, ATS/ERS e Paré et al., respectivamente. Segundo os critérios de Paré et al., houve 18 pacientes com VEF1 < 30% do previsto entre 29 com RV, e 12 com VEF1 < 30% do previsto entre 39 sem RV (p = 0,0101). Os 32 pacientes com distância caminhada > 350 metros no TC6 apresentaram a mediana da relação massa magra/massa gorda significativamente maior que os 18 com distância caminhada < 350 metros (p = 0,0076). A abordagem conjunta de doenças de via aérea de várias etiologias mostrou-se corroborada por vários dos achados deste estudo. Os critérios de Paré et al. detectaram mais RV entre os pacientes com doença brônquica grave do que os critérios tradicionais. A RV associou-se à maior gravidade da obstrução brônquica quando os critérios de Paré et al. foram empregados. O aumento proporcional da massa gorda, e não somente a perda de massa magra, pode ser um precursor do desenvolvimento de limitação funcional
Abstract: Patients with obstructive disease in spirometry can respond to inhaled bronchodilators (BD) with an increase in forced expiratory volume in the first second (FEVi) and/or in forced vital capacity (FVC) what makes them flow and/or volume responders. However, there is still considerable discordance in the definition of bronchodilator response, with the existence of distinct criteria proposed by the societies of Pulmonology. Previous studies have demonstrated that a large volume response (VR) is accompanied by a small flow response (FR) in patients with severe chronic obstructive pulmonary disease (COPD). The main purposes of this study were to describe and compare patients with severe obstructive disease, with or without previous history of smoking (> 10 pack/years), by means of the evaluation of their functional, systemic and structural features; to test the hypothesis that patients with volume response are more severe than that with flow response or without response, according to the criteria of SBPT (Brazilian Society of Pulmonology and Phthisiology), ATS/ERS (American Thoracic Society/European Respiratory Society) and Paré et al. (AFEV1/AFVC > 1 = FR or < 1 = VR). Sixty-eight patients with stable bronchial disease (age 55.9 ± 13.7 years; FEV1 31.9% ± 10.2 predicted) underwent spirometry before and after BD, manovacuometry, evaluation of body mass composition, six-minute-walk test (6MWT), radiological and thorax high-resolution CT scanning (HRCT), and answered to a clinical questionnaire. Of 68 enrolled patients, 37 had chronic obstructive pulmonary disease (COPD) and 31, extensive bronchiectasis. Comparing 33 smokers to 35 not smokers, there weren't statistically significant differences in clinical, functional and systemic features, except for vital capacity, significantly smaller in non smokers (p = 0.000). A flattened diaphragm in lateral chest radiograms was more frequently found in smokers (p = 0.0470). Eighteen of 37 patients with COPD (48.6%) had bronchiectasis on HRCT. CT signs of bronchiolar disease were more frequently found in not smokers (p = 0.0004), and they were detected in 94.3% of them. However, they were also important in smokers and were found on HRCT of 57.6% of them. There were 16, 20 and 29 patients with VR according to SBPT, ATS/ERS, and Pare et al., respectively. We found 18 patients with FEV1 < 30% predicted among 29 with volume response, and 12 patients with FEV1 < 30% predicted among 39 without volume response (p = 0.0101), considering Pare et al. criteria. The 32 patients with walk distance > 350 meters in 6MWT had median of lean-to-fat body mass ratio significantly higher than the 18 with walk distance < 350 meters (p = 0.0076). The analysis of airway diseases of several etiologies as a whole was supported by many findings of this study. Pare et al. criteria can detect more VR among patients with severe bronchial disease. According to these criteria, a greater degree of airflow obstruction was associated with volume response. The proportional increase of fat mass, and not simply the loss of lean mass, is an important precursor for the development of functional limitation
Mestrado
Clinica Medica
Mestre em Clinica Medica
Montmerle, Stéphanie. "Lung function in micro- and in hypergravity /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-332-9/.
Pełny tekst źródłaBrasil, Santos Dante. "Nouvelles méthodes d'exploration de la fonction respiratoire des patients neuromusculaires". Thesis, Université Paris-Saclay (ComUE), 2016. http://www.theses.fr/2016SACLV025/document.
Pełny tekst źródłaNeuromuscular disorders are liable to induce a restrictive syndrome. The weakness of respiratory muscles andthe associated spinal deformities lead the patients into a vicious circle, which progressively worsens the restrictivesyndrome and evolves into respiratory failure. This respiratory failure may be associated to additional factors such aschronic reduction of thoracic cage motion, sleep disordered breathing, bulbar dysfunction and ineffective cough. Therefore,dysfunction of respiratory system may have multiples origins and requires precise evaluations targeted on thecomprehension of the physiopathologic mechanisms for each disease, as they may not only allow to adapt specificallytreatment, but also to assess the new therapeutics targeted for muscle restoration that are emerging for some neuromusculardiseases. Accordingly, it is essential to acquire knowledge about the specific evolution of the different disorder, with andwithout classic treatments, and also to improve the understanding of the physiopathologic mechanisms of respiratoryfailure, combining the classic evaluation tools of respiratory function with new evaluation techniques which could provideadditional information.This thesis aims to increase the knowledge of respiratory dysfunction of some neuromuscular disorders using classicevaluation tools and also to propose new exploration methods of respiratory function for neuromuscular patients.Thus, we explored data of two specific neuromuscular disorders patients, regularly followed: FacioscapulohumeralMuscular Dystrophy (FSHD) and Duchenne Muscular Dystrophy (DMD). The analysis of FSHD seemed important asrespiratory failure is not well known and described for this disease. On the other hand, while the evolution of DMD is wellknown, the impact of noninvasive ventilation (NIV) on the evolution of respiratory function has been poorly described,whereas new therapeutic trials will be soon proposed to these patients, some of which are already under NIV.Next, to better predict the improvement of the restrictive syndrome that could be potentially obtained with muscle repairtherapies, we developed a measure of pulmonary volumes, using assistance for inspiratory and/or expiratory muscles.We also developed and validated a painless, noninvasive, non-volitional and indirect method of measurement of thediaphragmatic force, in order to obtain results independent of patients’ motivation.Hence, this thesis was able to advance knowledge of the evolution of respiratory function of some neuromuscular diseases,using traditional evaluation tools of respiratory function. Moreover, it validated new pulmonary function measuresindependent of patient’s voluntary efforts
Müller, Alice Mânica. "Avaliação da qualidade de vida e função pulmonar nos pacientes com câncer de pulmão". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/115604.
Pełny tekst źródłaBackground: Lung cancer is a disease very prevalent and highly fatal. Most patients are already diagnosed with late-stage disease. But there are resources that contribute to improving patient survival, and is necessary to evaluate how this disease affects quality of life of these patients, as well as in its functionality. Objectives: To assess the quality of life and lung function of patients with lung cancer of the “Hospital de Clinicas” of Porto Alegre that underwent surgery and / or chemo-radiotherapy. Methods: We conducted a cohort study, prospective, observational. The study included 92 outpatients / admissions diagnosed with lung cancer at diagnosis and who had not yet started treatment, to undergo assessment of QOL using the SF-36, spirometry and 6MWT before starting treatment, after 60 days and 120 days of start date. Results: It predominated adenocarcinoma and advanced stages disease; totals of 27 surgical and 60 nonsurgical patients. There was no difference in QOL between the three moments, but a significant increase in FVC% in the first 60 days. There was significant correlation between FEV1 and the physical and functional capacity in both groups, and distance and vitality in nonsurgical group. As such, higher chances of survival of surgical patients than nonsurgical. Survival decreased 50% in the first 12 months. Conclusions: Our results demonstrated that patients with lung cancer, surgical and nonsurgical, have obtained positive correlations between FEV1(%) and quality of life in both groups, as well as with walking distance and vitality in nonsurgical group.
Ziegler, Bruna. "Percepção da dispneia em pacientes com fibrose cística". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/52963.
Pełny tekst źródłaObjectives: To evaluate dyspnea perception in cystic fibrosis (CF) patients compared with normal subjects, during inspiratory resistive loading and the six-minute walk test (6MWT). Secondarily, to assess the correlation between dyspnea scores induced by resistive loads and those induced by the 6MWT. Methods: cross-sectional study in patients with CF (≥15 years old) and normal subjects. Volunteers underwent inspiratory resistive loading, measurement of maximal respiratory pressures, spirometry, nutritional evaluation, and the 6MWT. Results: Thirty-one CF patients and 31 paired normal subjects were included in the study. As the magnitude of the inspiratory loads increased, dyspnea scores increased (p<.001), but there was no difference between groups in dyspnea score (p=.654) and no group interaction effect (p=.654). SpO2 was lower in CF patients (p<.001) and increased as the magnitude of the loads increased (p<.001), with no interaction effect (p=.364). Twenty-six (84%) normal subjects completed the whole test, compared to only 12 (39%) CF patients (p<.001). Dyspnea scores were higher post-6MWT than at rest (p<.001), but did not differ between groups (p=.080) with no interaction effect (p=.091). SpO2 was lower in CF patients (p<.001) and decreased from resting to post-6MWT in CF patients (p<.001) with an interaction effect (p=.004). Post-6MWT dyspnea scores were significantly correlated with dyspnea scores induced by resistive loads. Conclusion: dyspnea perception in CF patients induced by inspiratory resistive loading and by 6MWT did not differ from normal subjects. However, CF patients discontinued inspiratory resistive loading more frequently. In addition, there were significant correlations between dyspnea perception score induced by inspiratory resistance loading and by the 6MWT.
Pereira, Marcella Cristiane Silveira [UNIFESP]. "Comparação das equações de valores de referência da função pulmonar mais utilizadas no Brasil: impacto no estadiamento da DPOC". Universidade Federal de São Paulo (UNIFESP), 2010. http://repositorio.unifesp.br/handle/11600/9210.
Pełny tekst źródłaObjetivo: Comparar os valores absolutos da CVF e VEF1 de uma amostra randomizada da populacao de Sao Paulo com mais de 40 anos de idade com os valores previstos das equacoes mais utilizadas no Brasil. Comparar os valores em percentuais do previstos da CVF e VEF1 das equacoes selecionadas com os da equacao PLATINO. Avaliar a mudanca de estadio da DPOC ao se utilizar as diferentes equacoes de referencia. Material e Metodos: Estudo retrospectivo, com 178 pessoas normais da amostra de moradores da regiao metropolitana de Sao Paulo, com idade .40 anos, proveniente do estudo PLATINO. Para a comparacao da CVF e do VEF1, foram subtraidos dos valores previstos a partir de cada equacao os valores absolutos obtidos de cada individuo, considerando uma diferenca de ate 0,15L, como definida pela ATS. Tambem foi realizada a diferenca entre os valores do percentual do previsto da CVF e VEF1 das equacoes com os da equacao PLATINO, com diferenca . 3% (ATS). O diagnostico de DPOC foi definido pela relacao VEF1/CVF < 0,70 pos-broncodilatador e a comparacao do estadiamento foi realizada utilizando a variavel VEF1 em porcentagem do previsto de cada equacao, tendo como referencia o percentual previsto da equacao PLATINO. As equacoes foram aplicadas de acordo com os seus limites de idade e altura. Teste t-student, Qui-quadrado e coeficiente de correlacao intraclasse foram utilizados para avaliar o comportamento da CVF e VEF1 nas diferentes equacoes e os dados foram apresentados em media, desvio padrao, erro padrao e intervalo de confianca de 95%. Resultados: Observamos que as equacoes que apresentam menor diferenca entre o valor previsto e o valor absoluto para CVF e VEF1, em ambos os sexos, foram Roca et al. (n=151), Pereira et al. 2007 (n=176), Enright et al (n=43) e PLATINO (n=178). A equacao Knudson et al (n=177). subestimou os valores absolutos para CVF e VEF1. Na comparacao com a equacao PLATINO, em percentual do previsto para CVF e VEF1, a equacao que apresentou menor diferenca foi a NHANES III (n=172), exceto para CVF masculina, que apresentou grande variabilidade. Foram avaliados 152 pacientes com DPOC, estadiados pelo VEF1, segundo a equacao PLATINO, observando-se mudanca no estadiamento em 29,6% dos pacientes em relacao as equacoes, tendo a equacao Knudson et al. apresentado o maior numero de alteracoes. Conclusao: Existe uma grande variabilidade nos valores previstos entre as equacoes de referencia. As equacoes que apresentaram menor variabilidade e melhor coeficiente de correlacao intraclasse foram Roca et al., NHANES III caucasiano et al., Enright et al. e PLATINO, recomendando-se o seu uso para a populacao brasileira. Existe mudanca no estadio da DPOC quando diferentes equacoes sao aplicadas, sugerindo-se o uso de uma unica equacao durante o tratamento do mesmo paciente para evitar eventuais alteracoes no tratamento.
Objective: To compare the absolute values of FVC and FEV1 found in a random sample of a Brazilian population over 40 years of age with values of equations most used in Brazil. To compare the values in percentage of predicted of FVC and FEV1 of the selected equations with the PLATINO equation ones. To evaluate the change in COPD staying when using different reference equations. Material and Methods: We conducted a retrospective study from a representative sample of residents in the metropolitan region of Sao Paulo, aged .40 years, from the PLATINO study. For comparison of the FVC and FEV1, were subtracted from the predicted values of each equation the absolute values obtained from each individual, considering the equation inadequate wherever there was a difference of up to 0.15 L as defined by ATS. We also evaluated the difference between the values of FVC and VEF1 in percentage of predicted of the equations with the PLATINO equation, considering as a limit a difference .3% (ATS). The diagnosis of COPD was defined as FEV1/FVC <0.70 after bronchodilator, and the comparison of staging was performed using the FEB1 in percentage of predicted in each equation, with reference to the percentage expected from the PLATINO equation. T-student test, chi-squared and the intraclass correlation coefficient were used to evaluate the performance of FVC and FEV1 in different equations and data are presented as mean, standard deviation, standard error and confidence interval of 95%. Results: After evaluating 178 healthy subjects, we observed that the equations that show less difference between the predicted value and the absolute value for both FEV1 and FVC in both sexes were Roca et al., Pereira et al. 2006, Enright et al. and PLATINO. The Knudson et al. equation underestimated the absolute values for both FVC and FEV1. In comparison with PLATINO equation, the percentage of predicted for FVC and FEV1, the equation showing the lowest difference was NHANES III, except for FVC male, who showed a wide variability. We evaluated 152 patients with COPD, observing staging changes in 29.6% in relation to the difference equations, being Knudson et al. the equation that showed the greatest number of changes. Conclusion: There is a great variability among the reference equations. The equations showing less variability and better intraclass correlation coefficient were Roca et al., Caucasian NHANES III et al., Enright et al. and PLATINO, which are the ones that should be recommended to be used for the Brazilian population. There is a change in the COPD staging when different equations are applied, suggesting that the use of a single equation for the treatment of the patient would avoid possible alterations in treatment.
TEDE
BV UNIFESP: Teses e dissertações
Cross, Martyn. "Occupational respiratory health surveillance at Minara Resources, Murrin Murrin mine site". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2011. https://ro.ecu.edu.au/theses/418.
Pełny tekst źródłaGangell, Catherine Louise. "Evaluation of the forced oscillation technique for clinical assessment of young children with cystic fibrosis". University of Western Australia. School of Paediatrics and Child Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0213.
Pełny tekst źródłaSilva, Luiz Fernando Ferraz da. "Efeito da exposição à queima de biomassa na prevalência de sintomas e na função respiratória em uma comunidade do interior do Brasil". Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-31082010-104952/.
Pełny tekst źródłaIntroduction: The use of biomass fuels for cooking and heating is considered an important factor associated with respiratory symptoms and loss of pulmonary function. We report the respiratory effects of chronic exposure to biomass (BM) combustion in a Brazilian population and compared the results with those of individuals from the same community using Liquefied Petroleum Gas (LPG). Methods: 1,402 individuals in 260 residences were divided into three groups according to exposure (LPG, indoor-BM, outside-BM). Respiratory symptoms were assessed using questionnaires. Reflectance of paper filters was used to assess BM. In 48 residences the amount of PM2.5 was also quantified. Pulmonary function tests (PFT) were performed in 120 individuals. Results: Reflectance-index correlated directly with PM2.5 (r=0.92, p<0.001) and was used to estimate exposure (ePM2.5). There was a significant increase in ePM2.5 in Indoor-BM and Outside-BM, compared to LPG (p<0.001). There was a significantly increased odds ratio (OR) for cough with sputum, sneezing and dyspnea in adults exposed to Indoor-BM (OR=2.93, 2.33, 2.59, respectively) and Outside-BM (OR=1.78, 1.78, 1.80, respectively) compared to LPG. PFTs revealed both non-smoker-BM and smoker-LPG individuals to have decreased %predicted-FEV1 and FEV1/FVC as compared to non-smoker-LPG (p=0.022). Reduction was also observed in both parameters between smoker-BM and other groups (p<0.05). The prevalence of chronic obstructive pulmonary disease was 20% for both non-smoker-BM and smoker-LPG and smaller than that observed for smoker-BM (33%). PFT data was inversely correlated with duration and ePM2.5 (p<0.001). The prevalence of airway obstruction was 20% in both non-smoker-BM and smoker-LPG subjects. Conclusions: Chronic exposure to BM is associated with increased prevalence of respiratory symptoms, reduced lung function and development of chronic obstructive pulmonary disease. These effects are associated with the duration and magnitude of exposure and are exacerbated by tobacco smoke.
Çobanoğlu, Hafize Şahin Ünal. "Sigaranın kemik mineral yoğunluğu ve kolesterol üzerindeki etkilerinin solunum yolları obstrüksiyonu ile korele olarak incelenmesi /". Isparta : SDÜ Tıp Fakültesi, 2005. http://tez.sdu.edu.tr/Tezler/TT00185.pdf.
Pełny tekst źródłaDias, Davi José 1983. "Avaliação de três estratégias de ventilação pulmonar mecânica durante cirurgias cardíacas com circulação extracorpórea". [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312970.
Pełny tekst źródłaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A disfunção pulmonar durante cirurgias cardíacas ocorre pelos efeitos combinados da anestesia geral, circulação extracorpórea (CEC), trauma cirúrgico e isquemia pulmonar. A manobra de recrutamento alveolar (MRA) e a manutenção da pressão positiva no final da expiração (PEEP) durante a CEC são procedimentos que podem reverter o colapso alveolar e melhorar as trocas gasosas no pós-operatório. O objetivo deste estudo foi avaliar o efeito da manobra de recrutamento alveolar e da manutenção da PEEP durante a CEC na mecânica respiratória e nos parâmetros de oxigenação, em pacientes submetidos à cirurgia cardíaca com utilização de CEC. Métodos: Foram incluídos 90 pacientes (57 masculino/ 33 feminino) consecutivos, divididos em três grupos: grupo controle (GC), grupo recrutamento (GR) e grupo PEEP (GP), submetidos à cirurgia cardíaca com utilização de CEC. O GC recebeu ventilação mecânica com volume corrente de 8 ml/kg e frequência respiratória de 12 ciclos por minuto; o GR foi submetido ao mesmo tipo de ventilação mecânica e acrescido ao recrutamento alveolar imediatamente após a saída de CEC, já o GP foi submetido ao mesmo tipo de ventilação mecânica durante o ato cirúrgico, porém no momento da CEC, os pacientes não foram desconectados da ventilação mecânica, onde foi mantido uma PEEP contínua de 8 cmH2O. Os pacientes foram seguidos do momento pré-operatório até a alta hospitalar. Os pacientes foram avaliados quanto a distância caminhada no teste de caminhada de 6 minutos (TC6), complacência e resistência pulmonar, e mecânica respiratória. Resultados: A distância percorrida no TC6 no pós-operatório foi maior no GP comparado aos dois outros grupos no pós-operatório imediato e 2 meses após a cirurgia. A mecânica respiratória avaliada pela pressão inspiratória máxima (PImáx), pressão expiratória máxima (PEmáx) e pico de fluxo expiratório (PFE) variou igualmente nos três grupos não havendo diferença entre eles. A complacência pulmonar foi maior no GP no período pré-extubação comparado aos dois outros grupos. A saturação de oxigênio foi maior no grupo submetido ao recrutamento e no grupo PEEP, logo após a intervenção, mas este efeito não foi duradouro. Conclusão: A manobra de recrutamento alveolar no período intraoperatório e a manutenção de pressão positiva contínua nas vias aéreas durante a CEC proporcionaram melhora da saturação de oxigênio e da complacência pulmonar, mas estes efeitos não foram duradouros. A utilização da PEEP a CEC proporcionou maior distância percorrida no teste de caminhada de seis minutos
Abstract: Introduction: Pulmonary dysfunction related to cardiac surgery may occurs as consequence of several factors such as general anesthesia , cardiopulmonary bypass (CPB) , surgical trauma, and pulmonary ischemia . The alveolar recruitment maneuver (ARM ) or the maintenance of PEEP (Positive Expiratory End Pressure) throughout the CPB period may preclude the alveolar collapse and improve gas exchange at the postoperative period. The aim of this work was evaluate the effects of two different ventilatory strategies on mechanical respiratory physiology and oxygenation parameters in patients undergoing open heart surgeries using CPB. Methods: Ninety patients ( 57 male / 33 female) were allocated to three different groups named: control group (CG ), recruitment group (GR ) and PEEP group ( GP ). The CG were ventilated with a tidal volume of 8 mL/ kg and respiratory rate of 12 breaths per minute, GR were ventilated with the same parameters with additional alveolar recruitment right after weaning from CPB,, and the GP where the patients received a positive airways pressure of 8 cmH2O for the duration of the CPB time. Patients were followed-up up to 2 months of post-operative period. They were evaluated with 6-minute walk test (6MWT), pulmonary compliance resistance and respiratory muscle strength tests. Results: The GP showed longer distance walked in the 6MWT compared to GC and GR groups. The three groups were similar regarding respiratory muscle strength tests. There was an increase of lung compliance in GP at pre-extubation time compared to two other groups. The GR and GP groups showed a slight higher oxygen saturation compared to GC right after the intervention. However, these beneficial effects did not last until first day after surgery. Conclusion: Intraoperative recruitment maneuver and maintenance of PEEP during CPB produced to slight improvements on oxygen saturation and lung compliance, but these effects were not durable. The use of positive pressure during CPB improved the distance walked in six-minute walk test
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências
Pithon, Karla Rocha. "Avaliação cardiorrespiratoria e da densidade mineral ossea de pacientes com lesão medular". [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313751.
Pełny tekst źródłaTese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas
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Resumo: Pacientes com lesão medular reconhecidamente desenvolvem muitas adaptações sistêmicas. Condições, como fraqueza da musculatura respiratória, paralisia e alterações na função pulmonar e conseqüentemente o aumento do índice de doenças pulmonares, são observadas. Recentemente, o aumento de doenças cardiovasculares também tem ocorrido entre esses pacientes, além das complicações provenientes da osteoporose que já são bem conhecidas. O objetivo deste trabalho foi avaliar as alterações do sistema cardiorrespiratório e esquelético de pacientes com lesão medular em 4 estudos. O estudo 1 avaliou a variabilidade da frequência cardíaca na posição supina e sentada e arritmia sinusal respiratória (ASR) de 37 homens com e sem lesão medular. Os pacientes tetraplégicos apresentaram uma redução dos valores máximos da frequência cardíaca durante ASR. O estudo 2 avaliou a função pulmonar de 23 pacientes com tetraplegia. Os valores de capacidade vital forçada, volume expiratório forçado 1s e ventilação voluntária máxima mostraram que a capacidade pulmonar dos pacientes com lesão medular foi reduzida. O estudo 3 propôs a adaptação do teste de caminhada de 6 minutos para 9 pacientes com paraplegia completa auxiliados por marcha artificial com eletroestimulação neuromuscular e andador. O estudo 4 investigou a densidade mineral óssea e fatores de risco cardiovascular de 44 homens com e sem lesão medular. Os pacientes com lesão medular apresentaram osteoporose e/ou osteopenia e o espessamento da camada íntima-média da carótida, porém os valores do lipidograma e triglicérides foram dentro da faixa de normalidade. A pressão arterial foi menor nos pacientes tetraplégicos. Análise estatística: Os dados foram apresentados em mediana (intervalo interquartil) e/ou média (±DP) e em Box-plot. Diferenças entre grupos foram demonstradas pelo intervalo de confiança da mediana, nível de significância em 5% ou teste t pareado. Conclusões: A atuação simpática e parassimpática no coração alcançou a homeostase, quando os pacientes foram mantidos nas posições supina ou sentada e o teste de ASR mostrou uma diminuição da atuação parassimpática no coração dos pacientes tetraplégicos, possivelmente para compensar uma diminuição ou ausência da atuação simpática, devido ao comprometimento do sistema autonômico pela lesão medular. O teste de caminhada de 6 minutos foi adaptado para avaliar os pacientes com lesão medular completa e se mostrou eficiente. Já a avaliação da função pulmonar dos pacientes mostrou a necessidade de novas equações de predição baseadas em uma população específica e suas características. Por último, os resultados obtidos através da densitometria mineral óssea comprovaram a presença de osteoporose e/ou osteopenia nos pacientes com lesão medular. E um aumento na espessura da camada intima-média da carótida foi observado através da ultrassonografia de carótida. Esses dados reforçam a hipótese de uma possível associação entre essas duas patologias.
Abstract: It is known that individuals with Spinal Cord Injury (SCI) present systemic adaptation. SCI causes respiratory muscle weakness, paralysis and abnormal pulmonary function. Cardiovascular disease is also increased in spinal cord injured subjects and osteoporosis as well. The aim of this study was to assess cardio respiratory and bone diseases in subjects with SCI. Four studies were performed. The first study assessed heart rate variability in supine and seated position and respiratory sinus arrhythmia (RSA) maneuver in 37 subjects with and without SCI. Tetraplegic subjects showed the lowest values of maximal heart rate during RSA. The second study assessed pulmonary function in 23 tetraplegic subjects. Forced vital capacity, maximal voluntary ventilation, forced expired volume showed that the SCI subjects' pulmonary capacity was reduced when compared with able body subjects. The third study adapted the "6 minutes' walk test" to assess complete patients with SCI during gait therapy. The fourth study investigated the clinical presence of osteoporosis and cardiovascular risk factors in 44 subjects with and without SCI. Subjects showed osteoporosis or osteopenia and increased intima-media thickness, although lipids and triglycerides were with normal ranges. Blood pressure in tetraplegic subjects was lower than in paraplegic and control groups. Statistical Analysis: Data are expressed as median (interquartile interval) and presented in box-plot (median, 1st and 3rd quartiles, minimum and maximum). Differences between groups were demonstrated by confidence interval of median, significance level set at ? = 0.05, or mean (±SD) and paired t test. Conclusions: Sympathetic and parasympathetic nervous system allow homeostasis when the subjects are kept in supine or seated position; RSA maneuver showed a reduction in parasympathetic system action in the heart of tetraplegic subjects to compensate a reduction or loss of sympathetic action in spinal cord lesion. "Six minutes walk test" was well adapted and efficient. Pulmonary function showed the necessity to create new predicts equations based on local population characteristics. Finally, bone mineral density showed osteoporosis or osteopenia in paraplegic and tetraplegic individuals as well as increased carotid intima-media thickness measured through ultrasound exam.
Doutorado
Pesquisa Experimental
Doutor em Cirurgia
Yamaguti, Wellington Pereira dos Santos. "Mobilidade diafragmática em pacientes com DPOC: avaliação ultra-sonográfica do deslocamento crânio-caudal do ramo esquerdo da veia porta". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-16082007-151208/.
Pełny tekst źródłaThe purpose of this study was to use ultrasound to measure the craniocaudal displacement of the left branch of the portal vein in order to evaluate the relationship between pulmonary function and diaphragm mobility, as well as that between respiratory muscle strength and diaphragm mobility, in COPD patients. We studied 54 COPD patients with pulmonary hyperinflation, together with 20 healthy subjects. Pulmonary function, maximal respiratory pressures, and diaphragm mobility were evaluated. COPD patients presented less diaphragm mobility than did healthy individuals (36.46 +/- 10.90 mm vs. 46.33 +/- 9.47 mm, respectively) (p = 0.001). In COPD patients, we found that diaphragm mobility correlated strongly with pulmonary function parameters that quantify air trapping (RV: r = -0.60; p < 0.001; RV/TLC: r = -0.76; p < 0.001), moderately with airway obstruction (FEV1: r = 0.55, p < 0.001; airway resistance: r = -0.32, p = 0.02), and weakly with pulmonary hyperinflation (TLC: r = -0.28, p = 0.04). No relationship was observed between diaphragm mobility and respiratory muscle strength (maximal inspiratory pressure: r = -0.11 and p = 0.43; maximal expiratory pressure: r = 0.03 and p = 0.80). The results of this study suggest that the reduction in diaphragm mobility in COPD patients occurs mainly due to air trapping and is not influenced by respiratory muscle strength or pulmonary hyperinflation.
Borges, Flávia Kessler. "Avaliação do valor prognóstico dos biomarcadores cardíacos perioperatórios em pacientes de moderado a alto risco cardiovascular submetidos à cirurgia não-cardíaca". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/31877.
Pełny tekst źródłaIntroduction: Breath-holding test has been tested in some clinical scenarios and has proved to be of clinical utility. Objectives: To determine the maximum voluntary breath-holding time in patients with obstructive ventilator defects and in normal subjects and to correlate the breathholding times with pulmonary function tests. Methods: We conducted a case-control study including patients with obstructive ventilator defects and a control group consisted of volunteers recruited in the same hospital, with normal spirometry. Spirometry was performed using a computerized spirometer. The Breath-holding test was conducted using an electronic microprocessor and a (Hans Rudolph ® – Kansas OH, EUA)pneumotachograph and flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal voluntary apnea inspiratory and expiratory times (MVAIT and MVAET) were determined from the acquired signal. Results: A total of 35 patients with obstructive ventilatory defects and 16 controls met the inclusion criteria and were included in the analysis. The MVAIT was lower in cases (22.3 ± 11.8 seconds) than in controls (31.5 ± 15.7 seconds) (p=0.025). MVAET was also lower in cases than in controls (16.9 ± 6.6 vs. 22.1 ± 7.9; p=0.017). We found positive and significant correlations between MVAIT and FVC (L) (r=0.476; p=0.004) and between MVAIT and FEV1 (L) (r=0.383; p=0.023). Conclusions: MVAIT and MVAET were significant lower in patients with obstructive ventilatory defects than in controls, and that MVAIT was correlated positively with FVC and FEV1 in cases. Our results provide additional evidence of usefulness of MVAIT as a pulmonary function test.
Maduko, Elizabeth. "Development and testing of a neuro-fuzzy classification system for IOS data in asthmatic children". To access this resource online via ProQuest Dissertations and Theses @ UTEP, 2007. http://0-proquest.umi.com.lib.utep.edu/login?COPT=REJTPTU0YmImSU5UPTAmVkVSPTI=&clientId=2515.
Pełny tekst źródłaCarvalho, Elisete Mendes. "Xarope de cumaru como terapia complementar na asma persistente leve". Universidade Federal do CearÃ, 2009. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2983.
Pełny tekst źródłaA Amburana cearensis à uma planta nativa do sertÃo nordestino, popularmente conhecida como imburana de cerejeira e cumaru, utilizada empiricamente nas afecÃÃes do trato respiratÃrio. O presente estudo duplo-cego, randomizado, paralelo e controlado por placebo, teve como objetivo avaliar a eficÃcia terapÃutica do xarope de Cumaru como terapia complementar em asmÃticos sob tratamento regular com corticÃide inalatÃrio associado ao broncodilatador nas crises. Os pacientes foram incluÃdos no estudo com base na histÃria clÃnica, exame fÃsico e laboratorial foram randomizados em Grupo teste, que recebeu o Xarope de Cumaru e Grupo Placebo, que recebeu o placebo sendo ambos os grupos compostos por 21 pacientes, que ingeriram o xarope na dose de 15 mL trÃs vezes ao dia durante um perÃodo de 15 dias consecutivos. O estudo teve como desfecho primÃrio a mudanÃa na qualidade de vida avaliada atravÃs do questionÃrio de qualidade de vida em asma com atividades padronizadas - AQLQ(S) distribuÃdos em quatro domÃnios: sintomas, limitaÃÃo das atividades, estimulo ambiental e funÃÃo emocional e como desfechos secundÃrios a avaliaÃÃo das provas de funÃÃo pulmonar e a seguranÃa da formulaÃÃo sob investigaÃÃo mediante exames laboratoriais no perÃodo prÃ-tratamento e no primeiro dia apÃs a finalizaÃÃo do tratamento de 15 dias com o Xarope. Todos os pacientes eram procedentes da cidade de Fortaleza, com 96% pertencentes ao sexo feminino. O grau de escolaridade mÃnimo foi o ensino fundamental completo representado por 94,3% da amostra. A fase prÃ-estudo nÃo evidenciou diferenÃas estatisticamente significativas entre os grupos quanto ao gÃnero, IMC, VEF1, PFE, uso de medicaÃÃo resgate, escore total da qualidade devida mensurado pelo AQLQ (S) e presenÃa de comorbidade (p>0,05), entretanto observou-se diferenÃa estatisticamente significante quanto à mÃdia de idade, onde o grupo Cumaru (46,619  10,351) apresentou resultado significativamente maior que o grupo Placebo (37,238  10,319). A melhora na qualidade de vida foi estatisticamente significante no grupo Cumaru quando comparada ao grupo Placebo tanto no aspecto global como para o domÃnio sintomas, limitaÃÃo das atividades, estimulo ambiental e funÃÃo emocional mensurados pelo AQLQ(S) (p<0,05). No grupo Cumaru a proporÃÃo de pacientes com melhora global da qualidade de vida foi significativamente maior (61,90%) que a verificada no grupo placebo (9,52%), com risco relativo de 6,500. A CVF, VEF1; RelaÃÃo VEF1/ CVF e FEF 25-75% da CVF nÃo sofreram modificaÃÃes significativas nos dois grupos estudados (p>0,05) em nenhuma das etapas estudadas. A anÃlise hematolÃgica e bioquÃmica dos pacientes em ambos os grupos nÃo apresentou diferenÃas estatisticamente significantes entre os mesmos em nenhuma das fases estudadas. O xarope de Cumaru foi bem tolerado pelos pacientes e os efeitos adversos observados foram equivalentes aos do grupo placebo. Conclui-se que a administraÃÃo do xarope de Cumaru, na dose 45mL/dia por 15 dias, como terapia complementar proporcionou melhora significativa da qualidade de vida, sem causar toxicidade sistÃmica embora nÃo tenha modificado os parÃmetros espiromÃtricos representando uma alternativa segura para o tratamento da asma.
Amburana cearensis is a medicinal plant common to the Brazilian Northeastern and empirically used as bronchodilatador in respiratory tract diseases including asthma. A clinical trial double blind, placebo-controlled, randomized, parallel analyzed in the Unit of Clinical Pharmacology, Ceara, Brazil, the therapeutic efficacy of Cumaru syroup as complementar therapy in patients with mild asthma on regular treatment with inhaled corticosteroids. The study had three phases, pre, treatment and post treatment. The patients were included in the study based on clinical history, physical examination and laboratory test and were randomized into group that received Cumaru syrup and the placebo group who received the placebo and both groups consisting of 21 patients who ingested the syrup in the dose 15 mL three times daily for a period of 15 consecutive days. The study had as primary outcome the change in quality of life assessed by questionnaire of quality of life in asthma - with standardized activities - AQLQ (S) distributed in four areas: symptoms, activity limitation, emotional function and environmental stimuli and secondary outcome evaluation made by pulmonary function tests and safety of the formulation under investigation by laboratory tests in the pre-treatment and the first day after completion of treatment for 15 days with the syrup. All patients were from the city of Fortaleza, with 96% belonging to the female and The level of education was the least complete basic education represented 54% of the sample. The pre-study showed no statistically significant differences between groups regarding gender, IMC, FEV1, PEF, use of rescue medication, overall quality score measured by the AQLQ(S) and the presence of hypertension (p> 0.05), however there was statistically significant difference in mean age, where the placebo group showed significantly lower results (37,238 Â 10,319) than the group Cumaru (46,619 Â 10,351). The improvement in quality of life was statistically significant in group Cumaru when compared to the placebo group both in terms of global and for each domain: symptoms, activity limitation, environmental exposure and emotional function measured by the AQLQ(S) (p <0.05). Cumaru group in the proportion of patients with global improvement of quality of life was significantly higher (61.90%) that seen in the placebo group (9.52%), with relative risk of 6500. The FVC, FEV1, for FEV1 / FVC and FEF 25-75% of FVC did not suffer significant changes in both groups (p> 0.05) in any of the stages studied. The Cumaru syrup was well tolerated by patients and adverse events did not show any clinical relevance. The haematological and biochemical analysis of patients in both groups showed no statistically significant differences between them in any of the stages studied. Cumaru syrup was well tolerated by patients and adverse effects observed were equivalent to those in the placebo group. It is concluded that the administration of 45mL/day of Cumaru syrup during 15 days as complementary therapy provided significant improvement in quality of life, without causing systemic toxicity but has not modified the spirometric parameters representing a safe alternative for the treatment of asthma.
Gupta, Nishant. "The NHLBI Lymphangioleiomyomatosis (LAM) Registry: Longitudinal Analysis to Determine the Natural History of LAM". University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504879473662385.
Pełny tekst źródłaNoal, Ricardo Bica. "Estado nutricional, asma e função pulmonar em adolescentes coorte de nascimentos de 1993, Pelotas RS". Universidade Federal de Pelotas, 2011. http://repositorio.ufpel.edu.br/handle/ri/1979.
Pełny tekst źródłaObesity, as well as impaired lung function, is associated with significant morbidity and mortality. Few studies have evaluated the effect of adiposity on lung function in adolescents. This study was conducted to evaluate the effect of body mass index and sum of skinfolds (triceps and subscapular) on pulmonary function (forced expiratory volume in one second and forced vital capacity) of adolescents in the study there longitudinal live births in 1993, Pelotas - Brazil. Teenagers aged between 14 and 15 years were interviewed (n = 4349), follow-up rate of 85.7% of the original cohort, measured (n = 4110) and their lung function measured (n = 4006). It was observed through a cross-sectional analysis, after controlling for confounding factors during the gestational period, the body mass index presents. Overall direct effect on lung function while the sum of skinfolds opposite effect. The longitudinal analysis allowed us to observe that adolescents, regardless of sex, which remained in the lower tertiles of body mass index during follow-up had lower levels of lung function than those who remained in the middle tercile. The boys who remained in the highest tertile of skinfold thickness had lower lung function values. These findings suggest that low body mass index and the large sum of skinfold thicknesses have negative impact on lung function in adolescents.
A obesidade, assim como a redução da função pulmonar, esta associada à morbidade e mortalidade. Poucos estudos avaliaram o efeito da adiposidade sobre a função pulmonar em adolescentes. Esse estudo foi realizado com objetivo de avaliar o efeito do índice de massa corporal e do somatório das pregas cutâneas (tricipital e subescapular) sobre a função pulmonar (volume expiratório forçado no primeiro segundo e capacidade vital forçada) de adolescentes pertencentes ai estudo longitudinal dos nascidos vivos em 1993, Pelotas Brasil. Os adolescentes com idade entre 14 e 15 anos foram entrevistados (n=4349), taxa de acompanhamento de 85,7% da coorte original, medidos (n=4110) e sua função pulmonar avaliada (n=4006). Observou-se através de uma análise transversal que, após controle para fatores de confusão desde o período gestacional, o índice de massa corporal apresenta de maneira geral efeito direto sobre a função pulmonar ao passo que o somatório de pregas cutâneas efeito inverso. A análise longitudinal permitiu observar que os adolescentes, independentemente do sexo, que permaneceram nos menores tercis do índice de massa corporal durante o acompanhamento apresentaram menores valores de função pulmonar em relação aos que permaneceram no tercil médio. Os meninos que permaneceram no maior tercil de pregas cutâneas apresentaram menores valores de função pulmonar. Esses achados sugerem que o baixo índice de massa corporal e o elevado somatório de pregas cutâneas apresentam impacto negativo sobre a função pulmonar de adolescentes.
Rocha, Alessandra. "Avaliação da resistência das vias aéreas através da técnica do interruptor em pacientes com fibrose cística". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2010. http://hdl.handle.net/10183/24265.
Pełny tekst źródłaFew studies have been published on airway resistance measurements using the interrupter technique (IT). We performed a cross-sectional study, evaluating 38 children and adolescents with Cystic Fibrosis (CF), followed at the outpatient CF clinic of Hospital São Lucas from Pontifícia Universidade Católica do Rio Grande do Sul. Airway resistance (Rint) was measured by the IT, followed by spirometry in all patients. Measurements were repeated after inhalation of salbutamol in order to evaluate bronchodilator response. There was a strong corelation between inverse Rint and forced expiratory volume in one second (FEV1) (r=0.8, p<0.001) and fair correlations between the inverse Rint and mid expiratory flow (MEF) (r=0.74 p<0.001) and between inverse Rint and body mass index (BMI) (r=0.62 p<0.001). The accuracy of bronchodilator response by the IT was tested through the ROC (reciever operating curve), comparing results with spirometry bronchodilator response. An area of 0.75 under the curve was obtained, for the cutoff point of -28% of Rint, achieving a sensitivity of 66% and a specificity of 82%. The findings suggest that Rint shows good correlation with spirometry parameters, although the IT is not sufficiently acurate to replace spirometry in the evaluation of bronchodilator response.
Kassaye, Tarik. "Association between vitamin A status and lung function in children aged 6-9 years in northern Ethiopia". Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=36964.
Pełny tekst źródłaThe first study determined the magnitude of vitamin A deficiency in the target population in Wukro wereda, Northern Ethiopia. Of the 1339 eligible children identified by house to house surveys, 824 had complete data for vitamin A indicators and anthropometry. Xerophthalmia was detected in 5.8% of the children, 8.4% had serum retinol levels <0.35 mumol/L and 51.1% between 0.35--0.70 mumol/L. Liver vitamin A reserve was also found to be low in 41.0% of the children using the Modified Relative Dose Response (MRDR) and in about 85% of the children, the daily vitamin A intake was below the FAO/WHO basal requirement (<250 RE/day).
The second study found that in comparison with children with adequate vitamin A reserve (MRDR < 0.06), those with low reserve (MRDR ≥ 0.06) had forced expiratory volume in one second (FEV1) 48.8 ml (p = 0.006) lower when unadjusted, 23.1 ml (p = 0.04) when partially adjusted for age, gender and height and 14.1 ml (p = 0.20) when fully adjusted for demographic, general health, lung function and household related characteristics.
The third study describes the results of a randomized controlled trial (RCT) to evaluate the impact of vitamin A supplementation on respiratory health as assessed by change in FEV1 at 4 months. The average change was 53.3 ml (n = 496) and 53.8 ml (n = 501) in the vitamin A and placebo groups respectively. After adjusting for baseline covariates, the difference between them was -3.6 ml (95%CI: -21.6, 14.4). In sub-analysis of the data, gender and vitamin A status subcategories were found to be effect modifiers.
In conclusion, high dose vitamin A supplementation did not show an effect on change in FEV1 at 4 months in children aged 6--9 years with high prevalence of vitamin A deficiency. Sub-analysis findings suggest that the benefits to vitamin A intervention in the study setting can probably be achieved if the other nutritional deficiencies such as zinc are addressed. Moreover, the results also suggest that the effects of vitamin A supplementation on respiratory health status are complex and these need to be taken into account in future studies to assess the clinical and public health implications of vitamin A supplementation in this age group.
Marija, Vukoja. "Impulsna oscilometrija u evaluaciji astme i hronične opstruktivne bolesti pluća". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2014. http://www.cris.uns.ac.rs/record.jsf?recordId=87680&source=NDLTD&language=en.
Pełny tekst źródłaAsthma and chronic obstructive pulmonary disease (COPD) are most common chronic noninfectious diseases of the respiratory system, representing a major health issue. Spirometry and body plethysmography are the procedures which are most often performed to diagnose these diseases and evaluate the lung function impairment of the affected patients. Impulse oscillometry is a novel procedure to establish the lung function impairment. It is easy to perform, and minimally depends on a patient's cooperation. The major objective of this Ph. D. thesis is to compare the parameters obtained by impulse oscillometry, spirometry and body plethysmography in patients with asthma and COPD, establish the sensitivity of these procedures in detecting an obstructive ventilation disorder, and correlate the parameters of impulse oscillometry, spirometry and body plethysmpography to the severity of dyspneic symptoms in adult asthma and COPD patients. Correlating the parameters obtained by impulse oscillometry and spirometry, a moderate negative correlation of R5 values to FEV1 in asthma (r= -0.47, р<0.001) and COPD patients (r= -0.50, р<0.001) has been obtained, as well as a moderate positive correlation of X5 to FEV1 (r= 0.54, р<0.001, in asthmatics; r= 0.56, р<0.001 in COPD patients). A good correlation of Rt to R5 (r=0.63, р<0.001) and Х5 values (r= -0.55, р<0.001) has been registered in asthmatics, as well as a good correlation of Rt to R5 (r=0.73, р<0.001) and Х5 (r= -0.74, р<0.001) in COPD patients. In asthma patients, the three analysed procedures exhibited no difference in detecting an obstructive ventilation disorder in the patients with manifested symptoms, while the sensitivity improved when the procedures were complementary performed. Any of the three procedures correlated poorly to the severity of dyspneic symptoms in asthma patients. All COPD patients had a spirometry-registered airway obstruction. The sensitivity of impulse oscillometry increased with the severity of the airway obstruction, so its capacity to detect an obstructive ventilation disorder in the patients with FEV1%<80 % was 55%, 95% CI 43-67 %, and in the patients with FEV1%<70 %, it amounted to 61%, 95% CI 47-73%. A statistically significant difference in the values of all oscillometry parameters was registered depending on the spirometric COPD stage. In COPD patients, all the three procedures were moderately correlated to the severity of dyspenic symptoms. In conclusion, there is a moderate correlation of impulse oscillometry to spirometry and body plethysmography in asthma and COPD patients. Impulse oscillometry correlates better to body plethysmography than to spirometry. The correlation of the three procedures increases with the severity of the airway obstruction. The complementary application of these three procedures provides a more accurate assessment of the respiratory function in asthma and COPD patients.
Costa, Gerusa Maritimo da. "Efeito do uso de salbutamol nas propriedades mecânicas do sistema respiratório de indivíduos saudáveis, tabagistas e portadores de doença pulmonar obstrutiva crônica". Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=6359.
Pełny tekst źródłaA doença pulmonar obstrução crônica (DPOC) é caracterizada pela limitação de fluxo parcialmente reversível, classificada por níveis de obstrução pós-broncodilatador. Há várias evidências de que o FEV1 sozinho não é capaz de mostrar a broncodilatação de pacientes com DPOC, mesmo naqueles que apresentam melhora clínica. A técnica de oscilações forçadas (TOF) tem mostrado alta sensibilidade na detecção precoce de alterações mecânicas na DPOC, contudo o efeito broncodilatador na impedância respiratória de pacientes com DPOC ainda não está esclarecido. Objetiva avaliar a utilidade da TOF nos diferentes estágios de obstrução das vias aéreas; (2) avaliar a resposta da impedância respiratória ao salbutamol em indivíduos saudáveis ao exame espirométrico e pacientes com DPOC em diferentes graus de gravidade. Foram avaliados 25 indivíduos saudáveis sem história de tabagismo, 24 tabagistas e 151 pacientes com DPOC classificados em graus I, II, III e IV. Todos os sujeitos foram avaliados pela TOF seguida da espirometria, antes e após o uso do salbutamol spray. As curvas de resistência e reatância demonstraram alteração em todos os estágios de obstrução das vias aéreas após o uso do salbutamol. O grupo de risco apresentou alterações mecânicas semelhantes ao grupo leve (p=ns). Os parâmetros R0, Rm, Csr,din e Z4Hz apresentam desempenho diagnóstico adequado (AUC > 0,85) em todos os estágios de gravidade da doença. Todos os parâmetros de TOF e espirometria apresentaram diminuição após uso do salbutamol. Os indivíduos saudáveis apresentaram uma pequena diminuição comparada aos subgrupos de DPOC. A variação em termos absolutos da ΔZ4Hz e das derivadas da resistência, ΔR0, ΔRm, ΔS, apresentaram variação significativa (p<0,0001, p<0,003; p<0,04; p<0,0002, respectivamente) com o aumento da obstrução brônquica. Nas derivadas da reatância o ΔXm aumentou com a gravidade da doença (p<0,0002). Por outro lado, a ΔCrs,dyn não demonstrou diferença significativa com a gravidade da DPOC. Em termos percentuais os parâmetros da TOF apresentaram variação expressiva em ΔRm% (p<0,02), ΔS% (p<0,02) e ΔXm% (p<0,004) com o aumento da obstrução nas vias aéreas. Por outro lado, ΔR0%, ΔCrs,dyn% e ΔZ4Hz% não variaram entre os estágios da DPOC. A associação entre a broncodilatação nas vias aéreas e a impedância pulmonar foi fraca entre ΔXm vs ΔFVC (r=0,32, p<0,0001) e ΔZ4Hz% vs ΔFEV1% vs ΔFVC% (r=0.28, p<0,0005; r=0,29, p<0,0003, respectivamente). A TOF é útil na avaliação das alterações mecânicas nos diferentes níveis de obstrução das vias aéreas na DPOC. Demonstramos o benefício da medicação broncodilatadora, quantificando a melhora da ventilação através da TOF. A impedância respiratória diminui em todos os estágios da DPOC, o estágio leve melhorou tanto quanto o estágio muito grave. Isto sugere que a medida da impedância pulmonar não é dependente do volume como ocorre na espirometria e que a broncodilatação ocorre em todas as fases da progressão da DPOC.
Chronic obstructive pulmonary disease (COPD) is characterized by partially reversible flow limitation, classified by the post-bronchodilator level of airway obstruction. There is abundant evidence that FEV1 alone is not able to show bronchodilation in COPD patients, even in patients with clinical improvement. The forced oscillation technique (FOT) has shown high sensitivity for early detection of mechanical changes in COPD. However, the bronchodilator effect on respiratory impedance is still unclear. Objective to evaluate the utility of FOT in the diagnosis of different stages of airway obstruction, (2) to investigate the response to salbutamol in healthy, smoking and COPD patients in different degrees of severity. We evaluated 25 healthy subjects with no history of smoking, 24 smokers and 151 COPD patients classified into grades I, II, III and IV of severity. All subjects were assessed by the FOT followed by spirometry before and after the use of salbutamol spray. The resistance and reactance curves showed change at all stages of airway obstruction after the use of salbutamol. The smoking group showed similar mechanical changes to the mild group (p=ns). The parameters R0, Rm, Csr,din and Z4Hz presented adequate diagnostic accuracy (AUC>0.85) in all stages of disease severity. All FOT and spirometry parameters showed decreased after salbutamol use. Healthy individuals showed a small decrease compared with the subgroups of COPD. The variations of the impedance module (ΔZ4Hz) and resistance parameters, (ΔR0, ΔRm, Δs) were significant (p<0.0001, p<0.003, p<0.04 and p<0.0002, respectively) with increased bronchial obstruction. Mean reactance (ΔXm) increased with disease severity (p<0.0002). The ΔCrs,dyn showed no significant change with the severity of COPD. In percentage terms, FOT parameters showed significant variation in ΔRm% (p<0.02), Δs (p<0.02) and ΔXm% (p<0.004) with increased airway obstruction. ΔR0% ΔCrs,dyn% and ΔZ4Hz% did not vary between different stages of COPD. The association between bronchodilation in the airways and lung impedance was weak between ΔXm vs ΔFVC (r=0.32, p<0.0001) and ΔZ4Hz% vs ΔFEV1% vs ΔFVC% (r=0.28, p<0.0005, r=0.29, p<0.0003, respectively). The FOT is useful in the evaluation of the mechanical changes at different levels of airway obstruction in COPD. We demonstrate the benefit of a bronchodilator, quantifying the improvement of ventilation through the FOT. The respiratory impedance decreases in all stages of COPD. This suggests that the impedance changes are not dependent on lung volume as in spirometry and that bronchodilation occurs at all stages of the progression of COPD.
Smith, Johan. "A comparison of synthetic surfactants : evaluation of a novel surfactant (1,2-dipalmitoyl-sn-phosphatidycholine and trehalose [C12H22O11]) and comparison with other synthetic formulations". Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52624.
Pełny tekst źródłaThesis (PhD)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: The aim of this study was to test a synthetic protein-free surfactant preparation, LPM-l, with the same chemical composition as commercially available Exosurf (Glaxo Wellcome), but containing in addition, a sugar, trehalose (TRE). Towards this end, a study was designed to firstly test the hypothesis that the true difference in acute physiological effects between a mixture of oppe, tyloxapol, hexadecanol and trehalose (LPM-l), and Exosurf, (Oppe, tyloxapol and hexadecanol) is zero, in a surfactantdeficient animal model. A second study addressed the physiological effects of oppe, hexadecanol, tyloxapol and trehalose (LPM-l) compared to treatment with trehalose (TRE) or saline, in order to determine (1) the contribution of TRE to the mixture of oppe, hexadecanol and tyloxapol, and (2) to assess the effect of the LPM-l surfactant replacement on the epithelial lining fluid composition by means of analysing bronchoalveolar lavage fluid. Thirdly, the effects of TRE and / or calcium were studied on the surface properties of oppe suspensions, by in vitro analysis using the ring detachment method of Du Nouy The in vivo research comprised of two studies, performed in randomised controlled fashion. In the first study, 24 New Zealand White adult rabbits were randomised into 4 groups, while in the second study, 15 animals were randomised into 3 groups. In the first in vivo study, three synthetic surfactants, LPM-l, Exosurf and LPM-2, and a saline group were tested. LPM-l is a new formulation that consists ofa mixture of Df'PC, TRE, hexadecanol and tyloxapol. LPM-2 is a formulation with a composition equivalent to that of commercially available Exosurf, prepared on site. In both studies animals were subjected to repeated lavage with large volumes of warm saline (25 ml/kg) in order to establish surfactant deficiency and acute lung injury. Five minutes after the last lavage, vehicle, i.e. surfactants LPM-l, Exosurf, or LPM-2, or saline, in the first in vivo study, and LPM-l, TRE or saline in the second in vivo study, was instilled, and the course of the animals followed over the next 3 hours. Ventilator settings were standardized before and after lavage. The effects of surfactant treatment on gas exchange (arterial Pa02, oxygenation index (Ol), arterial-alveolar oxygen (a/A) ratio), percentage calculated shunt, and total dynamic respiratory compliance (CRSdyn), and histopathological changes were compared with changes in saline treated controls. Arterial blood gases in 100% oxygen and CRSdynwere measured before and after lavage, at 15 minute intervals for the first 30 min, then at 60, 90, 120, and 180 min after vehicle instillation. Oxygenation improved to a similar extent after LPM-l and Exosurf instillation, surpassing that of LPM-2 or saline. Overall, intratracheal instillation of both Exosurf and LPM-l, rapidly improved the gas exchange and reduced the intrapulmonary shunt, but did not restore the lung to its pre-lavage condition. From the 2nd in vivo study it was evident that trehalose-only, was inefficient as a lung surfactant, failing to improve oxygenation indices or the calculated percentage shunt, or influencing respiratory compliance. The addition of the sugar, trehalose (TRE), to the on-site 'Exosurf mixture (LPM-2) brought the activity of the resultant LPM-l to the same level as that of commercial Exosurf, but failed to raise the activity above that of Exosurf. These physiological improvements were sustained for up to 3 hours. Saline-treated animals had no improvement in gas exchange despite management with variable PIP (to maintain a tidal volume of -1 0 ml / kg) and constant PEEP of 5 cm H20. In-vitro results, obtained by the Ou Nouy tensiometer, showed higher mean ordinate surface tension values for the OPPC-only and DPPC + TRE mixtures, and the slopes of their respective graphs smaller in magnitude than those of the other formulations, suggesting that these formulations had less surface tension-lowering capability than the other surfactants. At 20°C (20 mg / ml DPPC-surfactants) the mean ordinate values of OPPC and OPPC + TRE, 70.13 and 69.47 dyne / cm, respectively, were not significantly different from each other. The mean ordinate values of LPM-l and the formulation containing OPPC + TRE + tyloxapol + CaCh were lower, but similar, as were the values of LPM-2 (on-site Exosurf) and LPM-2 + CaCho Thus, three internally homogeneous subgroups could be identified which differed significantly, namely: DPPC and DPPC + TRE, LPM-2 and LPM-2 + CaCh, and DPPC + TRE + tyloxapol + CaCh and LPM-l. Similar conclusions apply to the ordinate values of the surfactants at 37°C, and to the mean slope values at 20°C, with the exception that the subgroups, LPM-2 and LPM-2 + CaCh, and LPM-l and OPPC + TRE + tyloxapol + CaCh are not so clearly separated. A similar analysis of mean slope values was performed. Here too a significant difference between substances was found, OPPC alone or in combination with TRE, again being significantly different from the other surfactants. The most prominent light microscopy findings of the lungs of animals included general lymphatic dilatation, congestion and lung polymorphonuclear infiltration, with no difference between study groups. Hyaline membranes were present in all surfactant groups, but significantly more so in the saline treated group. In the first in vivo study, the presence of neutrophils in the lung interstitiwn as well as alveoli, was a common finding in all of the study groups towards the end of the study protocol. A significant increase in the BAL-fluid neutrophil count occurred in all animals, concurrent with a significant decrease in the BAL macrophage count. No significant change occurred in the peripheral neutrophil count during the 3-hour study, suggesting recruitment of neutrophils from storage pools. Treatment with synthetic surfactant (LPM -1) did not have a significant effect on modifying the inflammatory response, since there was no significant difference in the BAL-derived cell counts between the LPM-1 and -saline groups. Epithelial damage was a consistent finding in all groups. The damage was more evident by electron microscopy examination and included hydropic changes, most readily observed in the mitochondria. The airspaces of study subjects showed the presence of oedema fluid. This luminal oedema appeared to be more prominent in the control group and LPM-2 (on site 'Exosurf') group. Organellar debris, probably originating from lysis of epithelial cells, was present, despite treatment with synthetic surfactant. The electron microscopical appearance of the epithelial-lined substance ("hyaline membranes") in the present study showed a marked variability within groups as well as within the same case. The majority of cases showed a mix of membrane types with both granular and fibrillar materials present within the same membrane. In some cases there were layering of the membranes into distinct bands. The instillation of LPM-l resulted in the formation of a slightly different type of epithelial lining fluid after lavage, when compared to the prelavage composition. The most pronounced changes occurred within the fatty acids, whilst the phosphatidylcholine values remained unchanged. Palmitic acid concentrations (C16:0) increased significantly, suggesting enrichment of the epithelial lining fluid after instillation of LPM-l. This increase in C16:0 was concurrent with significant decreases in the percentage C16:1, C18:0, and C18:2. In contrast to previous studies, we describe higher levels for phosphatidyldimethylethanolarnine (PEA). An explanation may be that the lipid identified as PEA, was in fact partly phosphatidylglycerol (PG)-a lipid whose accurate identification was precluded for technical reasons. After surfactant instillation, the PC/SM ratio, a reflection of the lecithin / sphingomyelin (LIS), decreased significantly in the TRE-group between the first and final lavage, but remained statistically unchanged in the animals treated with LPM-l or saline. The change in ratio was mainly accounted for by a decrease in BAL-fluid PC content together with a rise in SM content. A poor correlation existed between the BAL-derived PC/SM ratio and indices reflecting oxygenation status (a/A ratio, Ol), as well as the CRSdynat the time of the final lavage. In conclusion, the primary hypothesis was accepted, LPM-l performed similarly to Exosurf in vivo, improving oxygenation, but not CRSdyn.None was clearly superior to the other. Some questions remain. The reason why LPM-l (LPM-2 + TRE) did not behave in a superior manner, in vivo, to Exosurf, is partly unclear. This finding was somewhat surprising since the chemical composition of Exosurf and LPM-2 did not differ, and the addition of TRE to LPM-2 (on-site Exosurf), did improve the in vivo activity of the resultant LPM-l, above that of LPM-2. A possible explanation for observed differences in performance include methodological issues, i.e. the preparation of the on-site formulations, especially that of LPM-2 (on-site Exosurf), may differ from the way in which true commercial Exosurf is prepared.
AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n sintetiese proteïn vrye surfaktant te ontwikkel en die produk te vergelyk met 'n kunsmatige surfaktant reeds in kliniese gebruik. Die bekende uit die literatuur en die onbekende van die produk wat evalueer sou word, lei op tot die samestelling van die nul hipotese van die PhD naamlik dat geen verskil in longfunksie sou gewys word tussen die toetsproduk en reeds gebruikte kommersiële surfaktant nie. Die hipotese was dat 'n suiker (trehalose), in kombinasie met Dipalmitoiel fosfatidielcholine (DPPC), gaswisseling en longfunksies sal verbeter vir 'n long met 'n lae surfaktant konsentrasie. Vir die studie is jong volwasse wit New Zealand konyne gebruik en is hulle met 'n gestandaardiseerde en menslike manier gebruik in eksperimentele werk. Die diere is onder intraveneuse narkose geplaas en verskillende kardiovaskulêre en pulmonologiese aspekte is gemeet. Die long surfaktant is uitgewas deur middel van fisiologiese soutoplossing wat tot liggaam temperatuur verhit is en daarna is die diere prospektief gerandomiseer tot eksperimentele groepe. Met vooraf bepaalde tydsintervalle is die fisiologiese metings herhaal en was die metings toegespits daarop om longmeganiese funksie en gasoordrag vermoë te evalueer. Lig mikroskopiese en elektron mikroskopiese studies is ook op die longe gedoen en verder is brongoalveolêre vloeistof ook ontleed. Die groepe met ondersoek was: I. oppe, heksadekanol, tyloxapol en trehalose (LPM-I). 2. oppe, heksadekanol, tyloxapol (LPM-2 :. LPM-I sonder trehalose). Hierdie is 'n proteïnvrye surfaktant plaaslik berei ( dieselfde samestelling as Exosurf). 3. Exosurf®. (Kommersiële preperaat reeds in gebruik). Hierdie is 'n proteïnvrye sintetiese surfaktant. 4. Trehalose, 'n non-reduserende disakklaried van glukose. Addisioneel is daar ook in vitro studies gedoen waann die oppervlakte spanmngs aktiwiteite van die verskillende surfaktant oplossings vergelyk is. Die statistiese analise is gedoen in samewerking met Prof. J. Maritz wat 'n unieke metode ontwikkel en gepubliseer het om herhalende veranderlikes op 'n statisties verantwoordbare manier te ontleed. In die eerste van die studies, is LPM-I, Exosurf®, fisiologiese soutoplossing en 'n plaaslik bereide "Exosurf" (LPM-2), met 'n chemiese samestelling identies aan dié van kommersiële Exosurf®, evalueer. In 'n tweede studie is die fisologiese effekte van LPM-I vergelyk met trehalose of fisiologiese soutoplossing om die volgende te ondersoek: 1) Die bydrae van trehalose tot 'n mengsel van oppe, heksadekanol en tyloxapol (LPM-2). 2) Die gevolg van LPM-l surfaktant toediening op die konyn se brongo-alveolêre vloeistof samestelling. 'n Derde, in vitro studie, het die oppervlaktespannings-effekte van trehalose en of kalsiumbyvoegings tot DPPC-oplossings gemeet deur middel van die ring metode van Du Nouy, In die eerste in vivo studie verbeter oksigenasie en persentasie longaftakking tot dieselfde mate na LPM-l en Exosurf® toediening en word die hipotese van die proefskrif bevestig. In die breë gesien, is die tydsprofiele van LPM-l en Exosurf® ten opsigte van oksigenasie en persentasie longaftakking statisties betekenisvol beter en van 'n sneller aard, as die tydsprofiele van dieselfde indekse na die toediening van fisiologiese soutoplossing of LPM-2. Die tydsprofiel van dinamiese longvervormbaarheid, na die toediening van LPM-I of Exosurf®, is dieselfde, maar betekenisvol beter as die vervormbaarheid na toediening van LPM-2 of fisiologiese soutoplossing. Alhoewel die oksigenasie indekse in die geval van LPM-l en Exosurf® betekenisvol verbeter oor die studietydperk, vind volkome herstel tot die basislynwaardes (voor spoeling) nie plaas nie. Bykomend, geen van die surfaktante het na toediening enige noemenswaardige verbetering in longvervormbaarheid tot gevolg gehad nie. Die rede vir die swakker vertoning van LPM-2 en Exosurf is onbekend en sal in opvolg studie ondersoek word. In die tweede in vivo studie is dit duidelik dat trehalose op sy eie, 'n oneffektiewe surfaktant is aangesien die preperaat na toediening geen verbetering teweegbring ten opsigte van oksigenasie indekse, persentasie longaftakking, of long-dinamiese vervormbaarheid nie. Die toevoeging van trehalose tot LPM-2, om LPM-l te lewer, neem wel die aktiwiteit van LPM-l tot dieselfde in vivo vlak as dié van kommersiële Exosurf®, maar slaag nie daarim om 'n hoër fisiologiese in vivo aktiwiteit as dié produk te bereik nie. Die diere wat met fisiologiese soutoplossing behandel is toon geen verbetering in enige fisiologiese parameter nie. Die in vitro resultate wat verkry is deur die Du Nouy tensiometer toon hoër gemiddelde ordinaat oppervlaktespannings waardes vir 'n formule wat slegs uit DPPC bestaan, asook vir 'n mengsel van DPPC + trehalose. Die helling van die grafieke van hierdie oplossings is ook kleiner as die van die ander formulas wat daarop dui dat DPPC op sigself, en DPPC + trehalose, weinig vermoë het om oppervlaktespanning te verminder. Daarteenoor verlaag die volgende oplossings die oppervlaktespanning ten opsigte van gedistilleerde water betekenisvol en wel in In konsentrasie afhanklike manier by beide 21°C en 3rc: LMP-I-, LPM-2-, DPPC + trehalose + tyloxapol + CaCf2-, en LPM-2 + CaCf2. Die prominentste ligmikroskopiese bevindinge van die longe van die diere sluit in: Algemene limfvat dilatasie, stuwing, en long neutrofiel infiltrasie. Betreffende hierdie histologiese bevindinge is daar geen verskille aangetoon tussen die groepe nie. Hialienmembrane was teenwoordig in al die groepe, maar betekenisvol meer in die groep wat fisiologiese soutoplossing ontvang as vervangingsterapie. In die tweede in vivo studie is daar 'n betekenisvolle styging in die neutrofiel- en daling in makrofaagtelling, van die brongoalveolêre vloeistof spoeling in al drie die groep aangetoon. Terselfdertyd vind geen noemenswaardige daling in die perifêre (sistematiese) neutrofieltelling plaas nie. Hierdie bevindinge dui daarop dat die brongoalveolêre selveranderinge toegeskryf kan word aan verwerwing van neutrofiele vanuit 'n longstoringspoel eerder as rekrutering vanuit die sistemiese sirkulatoriese poel. Surfaktant (LPM-l), behandeling het geen betekenisvolle vermindering in long inflammasie teweeggebring nie. Epiteelskade was 'n algemene ligmikroskopiese bevinding in al die groepe. Die samestelling van die brongoalveolêre vloeistof verander na installering van LPM-I. Die prominentste verandering word waargeneem in die vetsuur samestelling terwyl die DPPC waardes onveranderd bly. Die vetsuur, palmitiensuur (palmitic acid), (CI6:0), verhoog betekenisvol na toediening van LPM-l. Daarteenoor verminder die konsentrasie van C16:1, C18:0 en C18:2. In kontras met vorige studies, beskryf die huidige studie hoër konsentrasies van fosfatidieletanolamien, moontlik as gevolg van tegniese verskille in die metingsmetodes. 'n Betekenisvolle verlaging in die fosfatidielcholine:sfingomiëlien (PC/SM) verhouding word waargeneem tussen die eerste en die finale longspoeling van die trehalose-groep, terwyl dit onveranderd bly in die diere wat LPM-1 of fisiologiese soutoplossing ontvang.
Vermaak, Ernst. "The influence of a nutritional supplement on lung function and immune status of hiv-positive patients in the Mangaung metropolitan". Thesis, Bloemfontein: Central University of Technology, Free State, 2013. http://hdl.handle.net/11462/252.
Pełny tekst źródłaThe HIV pandemic in South-Africa has created a new form of vulnerability for households with regards to food security and nutritional status which are vital components in the general care of HIV-infected individuals. The risk of nutritional deficiencies and malnutrition are predictors of disease progression and treatment in resource limited settings. Furthermore, HIV affects nutritional status by increasing the energy requirements, reducing food intake, affecting nutrient absorption and metabolism inadequacies due to cytokine activity and diarrhea. Several vitamins and minerals are important in fighting HIV infection because they are required by the immune system and major organs to attack infectious pathogens. Many of these micronutrients have been found to be deficient in HIVinfected persons and several studies were launched worldwide to investigate the feasibility of food assistance and nutrient supplementation. Nutritional supplementation has been advocated in HIV-infected persons especially in lowincome countries such as South Africa. Therefore, a study to evaluate the role of nutritional supplementation in HIV-positive patients becomes necessary, especially in a developing country such as South Africa. It is against this background that the present research was initiated to examine the influence of a nutritional supplement on the immune status and health status of HIVpositive/ AIDS adult individuals. The aim of the investigation was to determine if supplementation with a mixture comprised from specific minerals, vitamins and herbs over a period of one year, affected the haematological status, immune status, viral load and pulmonary function in forty (40) HIV-infected individuals living in the Mangaung Metropolitan, RSA. viii A quantitative, open-labeled, before-after clinical trial was conducted at the Central University of Technology, in Bloemfontein, Free State Province in the RSA. Socio-demographic and dietary intake questionnaires were completed. All data pertaining to anthropometric measurements, haematological status, immune status, viral load and pulmonary function were obtained my means of using standard procedures and technological equipment. The data were subjected to parametric and non-parametric statistical analysis. The results of the present investigation show that the eating pattern of this urbanized group of individuals reflects high energy (KJ) and macronutrient intakes coinciding with sub-optimal intake of Vitamin D and iodine. Of all the haematological variables the only statistical significant changes observed were increases in the median erythrocyte sedimentation rate (ESR) (p=0.0219) and mean cell haemoglobin concentration (MCHC) (p=0.0245) after six months of nutritional supplementation. At 12 months a statistical significant decrease in the median CD/CD8 ratio (p<0.0048), median Hematocrit concentration (p<0.0312), median mean cell volume (MCV) (p<0.0359), and median RDW (p<0.0273) accompanied a statistically significant increase in the MCHC (p<0.0003) at 12 months after supplementation. At 6 months 89% (CI95%: 73%; 96%) of the individuals showed a decline in viral load counts with a median percentage decline of 34% (CI95%: 73%; 96%). At 12 months 85% [CI95%: 68%; 94%] of the individuals show a decrease in viral load counts with a median percentage decline of 62.9% (CI95%: 50%; 78.6%) following the intake of the supplement. The main findings of the present investigation reveal that 68% (50%-81%) of the individuals show a statistical median increase (p=0.0302) of 16.9% (11.5%; ix 36.1%) in the Peak Expiratory Flow (PEF) at six months. A significant decrease (p=0.0484) in the median FEF75 of 28.1% (14%; 35.3%) is observed in 70% (53%-83%) of the individuals after 12 months of exposure to the supplement. No statistical significant changes are observed for FVC, FEV1, FEV1/FVC and FEF50 over the entire trial period. The present results suggest that a significant measurable decrease in viral load in HIV-infected individuals can be obtained by means of subjecting individuals to a nutritional fortification supplement strategy for 6 months or more.
Yamaguti, Wellington Pereira dos Santos. "Efeitos de um programa de exercícios diafragmáticos de curta duração na mecânica respiratória e capacidade funcional de pacientes com DPOC: ensaio clínico controlado e aleatorizado". Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-02082011-143720/.
Pełny tekst źródłaBackground: Impairment of diaphragm mechanics and enhanced activity of the chest wall muscles are associated with increased dyspnea in COPD patients. Diaphragmatic breathing (DB) has been suggested to improve abdominal motion but only during voluntarily DB, and no controlled studies have investigated the naturally adopted change in abdominal motion. The aim of this study was to investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion, diaphragmatic mobility and functional capacity in COPD patients. Methods: Thirty subjects (FEV1 42+/-13% predicted) were randomly allocated to either training (TG) or control group (CG). TG completed a 4-week supervised DBTP (3 individualized weekly sessions). Effectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio; primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntarily DB and natural breathing (NB). Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test (6MWT) and health-related quality of life (HRQoL) were also evaluated. Results: Only COPD patients from the TG demonstrated an improvement in diaphragmatic mobility (18.8%) and a reduction of the RC/ABD ratio during both NB (26.1%) and voluntarily DB (28.3%), suggesting that the abdominal motion improved in both conditions. An improvement in the 6MWT and in HRQoL was also observed in the TG. No differences were found in the CG for any measured outcome. Conclusions: We concluded that DBTP for COPD patients induced increased diaphragm recruitment during natural breathing resulting in an improvement in functional capacity
Kristina, Tot Vereš. "Prediktivni faktori za neželjeni događaj tokom jednogodišnjeg praćenja pacijenata obolelih od hronične opstruktivne bolesti pluća". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2017. https://www.cris.uns.ac.rs/record.jsf?recordId=104740&source=NDLTD&language=en.
Pełny tekst źródłaChronic obstructive pulmonary disease is one of the most common chronic lung diseases and is an important cause of morbidity and mortality in the world. Exacerbations are an important event in the course of the disease, as they have a negative impact on mortality, quality of life, lung function decline and increased costs of treatment. The aim of study is to identify risk factors for exacerbation or death during the one-year follow-up of patients with chronic obstructive pulmonary disease, and creation of predictive models for exacerbation and mortality during the follow-up period. The study included 200 patients with a confirmed diagnosis of chronic obstructive pulmonary disease who have had the therapy according to the Global initiative for chronic obstructive airway diseases guidelines. Patients were followed for one year, evaluated the number of exacerbations on the basis of emergency visits and eventual death. With statistical data processing there were identified independent predictors of exacerbations (age > 65 years, COPD Assessment Test > 9, modified Medical Research Council scale >2, oxygen saturation ≤ 93%) and death (age > 65 years, the need for application of antiplatelet therapy, the rate of maximum expiratory flow at 25% of vital capacity ≤ 1,16 l, modified Medical Research Council scale >2, heart rate > 89th). Of these independent factors was created a models for the prediction of adverse events during the one-year mark of COPD patients. Internal validation showed good predictive value of both models. No difference between the observed and the expected percentage of occurrence of exacerbations or death during the the follow-up period.
Paula, Mayara Holtz de. "Efeitos dos diferentes decúbitos sobre a resistência do sistema respiratório em sujeitos eutróficos e obesos". Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/17/17152/tde-20062018-142528/.
Pełny tekst źródłaBackground: It is known that changes in gravity force action, promoted by change of posture, influence volumes and capacities lung, but the behavior of lung elastic and plastic properties, has not yet well clarified in literature. Aim: To evaluate the effect of different positions on respiratory system resistance. Methods: Participants were allocated to different groups, according to the body mass index (BMI Kg/m2 ). The positions were evaluated by Impulse Oscillometry System (IOS) in a random order: seated (Se), supine (Su), left lateral (LL) or right lateral decubitus (RL) and following parameters was obtained: total, central and peripheral resistance, reactance and resonant frequency. Spirometry was then performed to analyze the following variables: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC and mean forced expiratory flow (FEF25-75%). Results: A total of 110 volunteers were recruited, 36 with BMI<25 kg/m2 (26.8 years, 21.7 kg/m2 ), 19 with BMI between 25-29kg/m2 (26.1 years, 26.6 kg/m2 ), 21 with BMI between 30-39 kg/m2 (30 years, 34.5 kg/m2 ), 21 with BMI between 40-49 kg/m2 (35.4 years, 45 kg/m2 ) and 13 with BMI> 50 kg/m2 (35.5 years, 54.2 kg/m2 ). No ventilatory disturbances were detected by spirometry, all higher than predicted (80%). The groups began to differentiate from the range of 30-39 kg/m 2 , there were important differences between individuals with BMI>50 and 40-49 with those with BMI <25 and 25-29, mainly in peripheral pathways (p<0.0001). The supine position presented higher resistance values for all groups. These differences compared to changes in decubitus are more frequent in the lower BMI ranges (<25 to 29 kg/m 2 ). It was also observed that overweight individuals tend to follow the same pattern as those with BMI within normal range. Conclusion: The respiratory impedance is higher in obese than eutrophic subjects, with more contribution of peripheral resistance, but with smaller variations related to position change when compared to eutrophic ones.
Silva, Paulo Roberto da. "Engenharia clínica aplicada à análise da variabilidade de parâmetros de referência para classificação da função pulmonar de adultos brasileiros". Universidade Tecnológica Federal do Paraná, 2016. http://repositorio.utfpr.edu.br/jspui/handle/1/2668.
Pełny tekst źródłaOne of the basic applications of biomedical engineering refers to the testing of clinical use equipment, the assessment of its nature, accessibility and / or its features. In the evaluation of the respiratory system, are available different parameters of reference (PR) for the spirometry test, one of the main pulmonary function tests, which can measure: volumes, capacities and pulmonary flows. These PR based mainly on ethnic data, age and gender in healthy subjects, but with differences between populations studied, as in Brazil with its great diversity of races and ethnic groups, there may be misdiagnosis. Because of this, the objective of this study was to analyze in this population, three of the most used PR: PR-P (Pereira et al., 2007), PR-K (Knudson et al., 1983) and PR-Q (Quanjer et al., 2012). The procedure was a descriptive exploratory study with 683 subjects (180 men and 503 women) between 24 and 59 years, in good health, regular physical exercises practitioners with minimum frequency of twice a week. Anamnesis was applied, collected data of mass and height, performed forced spirometry (bidirectional spirometer - Care Fusion Microloop) and the following respiratory variables were measured, FEV1, FVC, PEF and FEF75. With the main results it was found that the average age was 42 years (male: 40.6 years; women: 44.4 years); BMI average of 26 kg / m² (male: 26.26 kg / m²; female: 26.44 kg / m²); and time the average physical exercises practice 52 months (male: 66.9 months; female: 37.9 months). When analyzing the variation of the reference parameters for pulmonary function classification between the three protocols tested, we found a statistically significant difference (p <0.05) between FVC, FEV1, PEF and FEF75 to the levels required and achieved in all PR, as well as restrictive and obstructive signs. For the PR-P, even with individuals with asymptomatic characteristics and practitioners of physical exercises, 17.2% of subjects were classified with some degree of restriction and 17.3% with obstruction, away from the PR-K and PR-Q which respectively had values for restrictive of 7.0% and 12.8% and for obstruction of 7.1% and 4.8%. We conclude that these PR may induce to errors, leading to different rating, where one individual can be considered in normal state, restrictive or obstructive, depending on the chosen protocol. It was identified that nutritional status interfere with respiratory function, demonstrating significant association between nutritional status and pulmonary function test for males, x² = 9.80 (p = 0.04). Thus, overweight men had 1.9 times more risk to have the insufficient lung function test, even practicing regular physical exercises. There was no significant association in any of the genres between the pulmonary function test and the time of physical activity. The Pearson correlation test confirmed the lack of correlation between the FEV1, FVC and PEF with practice time for both genders.
Neves, Laura Maria Tomazi. "Caracterização da força e resistência muscular inspiratória de pacientes pós-infarto do miocárdio". Universidade Federal de São Carlos, 2011. https://repositorio.ufscar.br/handle/ufscar/5272.
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The dissertation consisted of two works. The aim of the first study was to evaluate respiratory muscle endurance (RME) in post myocardial infarction (MI) patients without respiratory muscle weakness [maximal inspiratory pressure (MIP)≥60% of predicted] and its correlation with exercise tolerance. Participated in this study ten recent post-MI (<1.5 month post-MI [RIG]), nine late post-MI (>6 months post-MI [LIG]) and twelve healthy (control group [CG]) middle-aged men. They underwent spirometric evaluation, cardiopulmonary exercise test and two RME protocols (incremental [IP] and constant pressure [CP]). There were differences (p0.05) in endurance pressure (PTHMAX) between the RIG and CG. There was a positive correlation for RIG between PTHMAX and maximal voluntary ventilation (MVV) (r=0.67) and peak oxygen consumption (VO2peak) (r=0.59). We conclude that RME seems to be reduced and related to peak exercise tolerance in recent MI patients without inspiratory muscle weakness. Similarly, in the second study, with nine subjects in RIG, ten in LIG and ten in CG, the aim was to characterize the metabolic and ventilatory behavior during testing of RME with IP and CP. In 70 and 80% of MIP (IL) and in the middle and final of CP test, the RIG had lower MET and higher VE/VCO2 compared CG. At 90% of MIP (IL), the RIG had lower VO2 and MET compared to CG. Moreover, RIG achieved lower pressure and product pressure-time using a similar percentage of VO2peak and oxygen consumption at anaerobic threshold (VO2AT) to sustain a 20% lower pressure than the CG. We conclude that the reduced capacity of RME in recent MI patients without inspiratory muscle weakness seems to occur due to lower ventilatory efficiency in the second part of the protocols, even in the presence of lower pressure overload.
A dissertação constou de 2 estudos descritos a seguir. O estudo I teve por objetivo avaliar a resistência dos músculos respiratórios (RMR) de indivíduos pós-infarto do miocárdio (IM) sem fraqueza muscular inspiratória [pressão inspiratória máxima (PIMAX)≥60% do predito] e sua correlação com a tolerância ao exercício. Participaram deste estudo dez homens pós-IM recente (<1 mês e meio pós-IM [GIR]), nove pós-IM tardio (>6 meses pós-IM [GIC]) e doze homens saudáveis (grupo controle [GC]) de meia-idade. Estes foram submetidos a espirometria, teste cardiopulmonar e a dois protocolos de RMR [pressão incremental (RPI) e constante (RPC)]. Houve diferença (p0,05) na pressão de resistência (PTHMAX) entre o GIR e o GC. Houve correlação positiva no GIR entre PTHMAX e ventilação voluntária máxima (VVM) (r=0,67) e o consumo de oxigênio no pico de exercício (VO2pico) (r=0,59). Concluímos que a RMR parece estar reduzida e relacionada a tolerância no pico do exercício em indivíduos pós-IM recente sem fraqueza muscular respiratória. Também foi realizado o estudo II, com nove indivíduos no GIR, dez no GIC e dez no GC, que teve por objetivo caracterizar o comportamento ventilatório e metabólico durante os testes de RPI e RPC. Em 70 e 80% da PIMAx (RPI) e no meio e final do teste de RPC, o GIR apresentou menor MET e maior VE/VCO2 em relação ao GC. Em 90% da PIMAx (RPI), o GIR apresentou menor VO2 e MET em relação ao GC. Além disto, GIR apresentou menor pressão e produto pressãotempo de RMR, utilizando semelhante percentual do VO2pico e do consumo de oxigênio no limiar de anaerobiose (VO2LAV) para pressões 20% menores em relação ao GC. Concluímos que a redução da capacidade de RMR em indivíduos na fase recente pós-IM e sem fraqueza muscular inspiratória parece ocorrer em virtude da menor eficiência ventilatória na segunda metade dos protocolos, mesmo na presença de menor sobrecarga pressórica.
Alencar, Ana Maria Cartaxo de. "Estudo da resposta funcional ao exercício na vigência de derrame pleural e o impacto da toracocentese de alívio". Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5150/tde-21122010-121949/.
Pełny tekst źródłaIntroduction: Pleural effusion reducing pulmonary functional capacity hinders patients in carrying out their habitual activities. Pleural fluid removal by thoracentesis reverts the clinical situation but its impact especially on exercise capacity has not yet been determined. Objectives: To evaluate the impact of thoracentesis in functional exercise capacity on pulmonary function and on muscle strength 48 hours after thoracentesis. Methods: Twenty five patients with unilateral pleural effusion documented by chest X-ray were included. The 6 minute walk test (TC6M), Borg\'s modified dyspnea scale, spirometric variables: CVF (forced vital capacity), VEF1 (forced expiratory volume in the first second), Maximum Inspiratory Pressure (Pimax) and Maximum Expiratory Pressure (Pemax) were analyzed before and 48 hours after the removal of volumes greater than 600 mL. Results: The mean of pleural effusion removed was 1564 + 695 mL. After the procedure values of walked distance, CVF, VEF1, Pimax and Pemax covered increased (p < 0.001) while dyspnea decreased (p < 0.001). Statistical correlations (p < 0.001) between the walked distance and FVC (r = 0.725) and VEF1 (r = 0.661) were established noted measured 48 hours post thoracentesis and between the variation of the distance walked and the percentage of variation of CVF (r = 0.450) and VEF1 (r = 0.472), corrected by the volume of fluid removed (p < 0.05). Conclusions: Despite an improvement in lung function after thoracentesis, the benefits noted are more evident in effort situations of exertion, allowing a better readaptation of patients to their routine activities.
Silva, Karla Kristine Dames da. "Análise em tempo real da impedância do sistema respiratório e da mobilidade toracoabdominal em portadores de DPOC com obstrução brônquica acentuada". Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=10036.
Pełny tekst źródłaIntroduction: COPD is carachterized by airflow limitation associated abnormal inflammatory response of the lung to noxious particles or gases. The mechanical alterations associated with COPD have been related with dysfunction of the diaphragm, observed since the initial phases of the disease. Several studies have confirmed the high potential of FOT in the assessment of the mechanics modifications related to COPD. However, such studies did not allow a real-time analysis of the changes in the respiratory system, and the thoracoabdominal mobility of these individuals. Thus, the goals of the present study were to analyze, in real-time, the impedance alterations of the respiratory system in different phases of the respiratory cycle of COPD patients. Methodology: This research consists of a controlled observational study where 48 individuals were analyzed, 23 controls and 25 individuals with COPD and severe airway obstruction. Firstly, they performed simultaneous analysis of impedance of the respiratory system and thoracoabdominal motion. In subsequent examinations, these subjects were submitted to spirometry. Results: The results demonstrated an increase of the respiratory system impedance in individuals with COPD compared with the control group in all of the studied parameters (Zt, Zi, Ze, Zii, Zie, ΔZrs e Zpp) (p<0.0001). Considering the different phases of the respiratory cycle, higher impedances were observed in the inspiratory phase (p<0.004). Only 10% of individuals with COPD showed thoracoabdominal asynchrony (φ≥ 45), and the mean values showed no statistical difference when compared to the control group. Discussions: The total impedance of the respiratory system increased in individuals with COPD, which describes the increase of the mechanic load of the respiratory system in these individuals. These alterations are coherent with the physiopathology of COPD, associated with airflow obstruction and lung parenchyma destruction. The increase of the impedance in the inspiratory phase suggests an increase of the resistive and elastic work. There were not signals of thoracoabdominal asynchrony in the major part of the studied individuals, suggesting that some adaptation mechanisms act to compensate respiratory muscle fatigue. Conclusion: The COPD results in the increase of the mechanic load of the respiratory system. These alterations were identified by the increase of the respiratory system impedance, which was more evidence in the inspiratory phase. The thoracoabdominal asynchrony was not usual in individuals with COPD. Those results are consistent with previously published data and physiopathological fundamentals, confirming the potential of monofrequency FOT in the assessment of the modifications related to COPD.