Total inspiratory and expiratory impedance in patients with severe chronic obstructive pulmonary disease

OBJECTIVES: Several studies have confirmed the high potential of the forced oscillation technique for the assessment of respiratory modifications related to chronic obstructive pulmonary disease. However, most of these studies did not employ within-breath analyses of the respiratory system. The aim of this study is to analyze respiratory impedance alterations in different phases of the respiratory cycle of chronic obstructive pulmonary disease patients and to evaluate their clinical use. METHODS: 39 individuals were evaluated, including 20 controls and 19 individuals with chronic obstructive pulmonary disease who experienced severe airway obstruction.Weevaluated the mean respiratory impedance (Zm) as well as values for inspiration (Zi) and expiration cycles (Ze), at the beginning of inspiration (Zbi) and expiration (Zbe). The peak-to-peak impedance (Zpp), and the impedance change (DZrs) were also analyzed. The clinical usefulness was evaluated by investigating the sensibility, specificity and the area under the receiver operating characteristic curve. RESULTS: The respiratory impedance increased in individuals with chronic obstructive pulmonary disease in all of the studied parameters (Zm, Zi, Ze, Zbi, Zbe, DZrs and Zpp). These changes were inversely associated with spirometric parameters. Higher impedanceswere observed in the expiratory phase of individualswith chronic obstructive pulmonary disease. All of the studied parameters, except for DZrs (area under the receiver operating characteristic ,0.8), exhibited high accuracy for clinical use (area under the receiver operating characteristic .0.90; Sensibility $0.85; Sp$ 0.85). CONCLUSIONS: The respiratory alterations in severe chronic obstructive pulmonary disease may be identified by the increase in respiratory system impedance, which is more evident in the expiratory phase. These results confirm the potential of within-breath analysis of respiratory impedance for the assessment of respiratory modifications related to chronic obstructive pulmonary disease

Níveis de estresse e qualidade de vida de professores do ensino superior

Aim: to evaluate the stress levels and the quality of life of professors from a federal institution of higher education. Method: A cross-sectional study, carried out with 35 professor from a Federal Institute in Rio de Janeiro, in december 2015. Participants were evaluated by the Lipp Adult Stress Symptom Inventory and the World Health Organization Quality of Life-Bref questionnaire. Correlation between stress and quality of life was performed, and values of p<0.05 were considered significant. Results: It was verified that 46% of the sample have stress symptoms. The average quality of life of the professors was considered as regular. A moderate inverse correlation was observed between stress and quality of life (r=-0,5; p<0,03). Conclusions: A portion of the sample has stress symptoms and these can cause a worsening in quality of life. These symptoms may not be related to occupational factors only.Objetivo: evaluar los niveles de estrés y de calidad de vida de profesores de una institución federal de enseñanza superior. Método: estudio transversal, realizado con 35 profesores de un Instituto Federal, en Rio de Janeiro, en diciembre de 2015. Los participantes fueron evaluados por el Inventario de Síntomas de Estrés para Adultos, de Lipp, y por el cuestionario World Health Organization Quality Of Life-Bref. Fue establecida una correlación entre estrés y calidad de vida, y se consideró significativo los valores de p <0,05. Resultados: se identificó que 46% de la muestra tienem síntomas de estrés. La media de la calidad de vida fue considerada como regular. Se observó una correlación inversa moderada entre estrés y calidad de vida (r=-0,5; p<0,03). Concluisiones: parte de la muestra presenta síntomas de estrés y estos pueden provocar empeoramiento de la calidad de vida. Estos sintomas pueden no estar exclusivamente relacionados a factores ocupacionales.Objetivo: avaliar os níveis de estresse e de qualidade de vida de professores de uma instituição federal de nível superior. Método: estudo transversal, realizado com 35 professores de um Instituto Federal, no Rio de Janeiro, em dezembro de 2015. Os participantes foram avaliados através do Inventário de Sintomas de Stress para Adultos de Lipp e do questionário World Health Organization Quality Of Life-Bref. Foi realizada correlação entre estresse e qualidade de vida, e valores de p<0,05 foram considerados significativos. Resultados: verificou-se que 46% da amostra possuem sintomas de estresse. A média da qualidade de vida dos professores foi considerada como regular.  Uma correlação inversa moderada foi observada entre estresse e qualidade de vida (r=-0,5; p<0,03). Conclusões: parte da amostra possui sintomas de estresse e estes podem proporcionar uma piora da qualidade de vida. Estes sintomas podem não estar unicamente relacionados com fatores ocupacionais

Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy individuals and 20 smokers were assessed. The study also included 74 patients with stable chronic obstructive pulmonary disease. We evaluated the mean respiratory impedance (Zm) as well as values for the inspiration (Zi) and expiration cycles (Ze) at the beginning of inspiration (Zbi) and expiration (Zbe), respectively. The peak-to-peak impedance (Zpp=Zbe-Zbi) and the respiratory cycle dependence (ΔZrs=Ze-Zi) were also analyzed. The diagnostic utility was evaluated by investigating the sensitivity, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01888705. RESULTS: Airway obstruction increased the within-breath respiratory impedance parameters that were significantly correlated with the spirometric indices of airway obstruction (R=−0.65,

Effects of manual therapy on cervicogenic headaches: a therapeutic approach

The cervical spine is considered a possible source of headaches, however there are still some controversies regarding the pathophysiology, clinical presentation, and treatment. Objective: To propose a physical therapy treatment protocol with multimodal approach for cervicogenic headache and evaluate the effects of manual therapy on such patients. Method: This was an uncontrolled experimental study in which 9 patients from the UNIFESO Physical Therapy Clinic (Teresópolis, RJ) diagnosed with cervicogenic headache underwent 10 physiotherapy interventions with manual therapy techniques. The experimental protocol included joint techniques, fascial release, and muscle recruitment. The Neck Disability Index (NDI) and a visual analogic scale (VAS) were used as measurement tools and the pain pattern was recorded. Results: Of the nine selected patients, all were female and had an average age of 43.3 years (± 15.5). Significant differences were observed between the average intensity of pain (VAS) before treatment (8.0 ± 1.3) and after (2.2 ± 0.9, p < 0.01). The NDI also showed improvement after intervention 63.9% (p < 0.01). Regarding crises frequency, a decrease of 70% was observed after the intervention (p < 0.01) and a reduction was also shown in the duration of such crises before (4 hours ± 1.5) and after treatment (1 hour ± 0.5; p < 0.01). Conclusion: A multimodal approach by manual therapy techniques was beneficial in the reduction of the patients’ symptoms and it provided a decrease in cervical disability.A coluna cervical é considerada como possível fonte de dor de cabeça, entretanto ainda existem algumas controvérsias a respeito da fisiopatogênese, quadro clínico e tratamento. Objetivo: Propor um protocolo com abordagem multimodal para tratamento fisioterápico de pacientes com cefaleia cervicogênica e avaliar os efeitos deste protocolo em tais pacientes. Método: Trata-se de um estudo experimental não controlado, no qual 9 pacientes da Clínica Escola de Fisioterapia do UNIFESO (Teresópolis, RJ) com diagnóstico de cefaleia cervicogênica foram submetidos a 10 intervenções fisioterapêuticas com técnicas de terapia manual. O protocolo experimental incluiu técnicas articulares, miofasciais e de recrutamento muscular. Como ferramentas de mensuração foram utilizadas a escala funcional Neck Disabilty Index (NDI), a escala visual analógica de dor (EVA) e o registro do padrão do quadro álgico. Resultados: Dos 9 pacientes selecionados, todos eram do gênero feminino, e possuíam média de idade de 43,3 anos (± 15,5). Observou-se diferença entre as médias da intensidade do quadro álgico (EVA) antes do tratamento (8,0 ± 1,3) e após (2,2 ± 0,9; p < 0,01). O índice de incapacidade cervical também mostrou melhora após intervenção de 63,9% (p < 0,01). Em relação à frequência das crises semanais observa-se uma diminuição de 70% após a intervenção (p < 0,01). De maneira similar, houve redução do tempo de permanência das crises antes (4 horas ± 1,5) e após (1 hora ± 0,5) (p < 0,01). Conclusão: A abordagem multimodal por meio de técnicas de terapia manual foi benéfica na redução do quadro sintomático dos pacientes e ainda proporcionou diminuição do grau de incapacidade da região cervical

Real-time analysis of respiratory system impedance and thoracoabdominal mobility of COPD patients with severe bronchial obstruction

Introdução: A DPOC caracteriza-se pela limitação ao fluxo aéreo associada à resposta inflamatória anormal dos pulmões a partículas ou gases nocivos. As alterações mecânicas decorrentes da DPOC estão relacionadas com a disfunção mecânica das fibras do diafragma, já observadas nas fases iniciais da doença. Alguns estudos têm demonstrado o elevado potencial da Técnica de Oscilações Forçadas (FOT) na detecção das alterações mecânicas da DPOC. Contudo, tais aplicações da FOT não permitiam a análise em tempo real das alterações do sistema respiratório, bem como da mobilidade toracoabdominal destes indivíduos. Desta forma, os objetivos desta pesquisa foram analisar, em tempo real, as alterações de impedância do sistema respiratório nas distintas fases do ciclo em portadores de DPOC, assim como avaliar a movimentação toracoabdominal destes indivíduos. Metodologia: Trata-se de um estudo observacional controlado, prospectivo onde foram analisados 48 indivíduos, 23 indivíduos controles e 25 portadores de DPOC com grau de obstrução acentuado. Os indivíduos realizaram exames de FOT para análise da impedância do sistema respiratório e mobilidade toracoabdominal, simultaneamente. Posteriormente aos exames da FOT os indivíduos foram submetidos à Espirometria. Resultados: Os resultados demonstraram aumento da impedância do sistema respiratório nos indivíduos com DPOC em comparação ao grupo controle, em nos parâmetros estudados (Zt, Zi, Ze, Zii, Zie, Zrs e Zpp) (p<0,0001). Em relação às distintas fases do ciclo, os indivíduos deste estudo apresentaram impedâncias maiores na fase inspiratória quando comparadas à fase expiratória (p<0,004). Somente 10% dos portadores de DPOC apresentaram assincronia toracoabdominal (&#966; &#8805; 45), sendo que os valores médios não apresentaram diferença estatística quando comparados ao grupo controle. Discussão: A impedância total do sistema respiratório (Zt) aumentada nos portadores de DPOC confirma o aumento da carga mecânica do sistema respiratório destes indivíduos. Essas alterações são coerentes com o processo fisiopatológico, evidenciado pela obstrução ao fluxo aéreo e destruição do parênquima pulmonar. O aumento da impedância na fase inspiratória quando comparada à fase expiratória, sugere um aumento no trabalho resistivo e elástico. Não foram evidenciados sinais de assincronia na mobilidade toracoabdominal na maior parte dos indivíduos, sugerindo que alguns mecanismos adaptativos atuam na tentativa de evitar a fadiga do músculo respiratório. Conclusões: A DPOC resulta no aumento da carga mecânica do sistema respiratório, alterações identificadas pelo aumento da impedância do sistema respiratório, medida pela FOT em tempo real. Este aumento foi mais evidente durante a fase inspiratória. A mobilidade toracoabdominal não se mostrou alterada na maior parte dos indivíduos com DPOC. Estes resultados são consistentes com publicações prévias e fundamentos fisiopatológicos, confirmando o potencial da FOT monofreqüência na avaliação das modificações relacionadas à DPOC.Introduction: 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, &#916;Zrs 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 (&#966;&#8805; 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