Respiratory muscles: myths and secrets

Universidade Federal de São Paulo, EPM, Serv Funcao Pulmonar & Fisiol Clin Excercicio, Grp Circulacao Pulmonar,Disciplina Pneumol, São Paulo, SP, BrazilUniversidade Federal de São Paulo, EPM, Serv Funcao Pulmonar & Fisiol Clin Excercicio, Grp Circulacao Pulmonar,Disciplina Pneumol, São Paulo, SP, BrazilWeb of Scienc

Contrasting Cardiopulmonary Responses to Incremental Exercise in Patients with Schistosomiasis-Associated and Idiopathic Pulmonary Arterial Hypertension with Similar Resting Hemodynamic Impairment

It has been reported that schistosomiasis-associated PAH (Sch-PAH) has a more benign clinical course compared with idiopathic PAH (IPAH). We therefore hypothesized that Sch-PAH subjects would present with less impaired cardiopulmonary and metabolic responses to exercise than IPAH patients, even with similar resting pulmonary hemodynamic abnormalities. the aim of this study was to contrast physiologic responses to incremental exercise on cycle ergometer between subjects with Sch-PAH and IPAH. We performed incremental cardiopulmonary exercise tests (CPET) in subjects newly diagnosed with IPAH (n = 9) and Sch-PAH (n = 8), within 1 month of the hemodynamic study and before the initiation of specific therapy for PAH. There were no significant between-group differences in cardiac index, pulmonary vascular resistance or mean pulmonary artery pressure. However, mean peak oxygen uptake (VO2) was greater in Sch-PAH than IPAH patients (75.5 +/- 21.4 vs 54.1 +/- 16.1% predicted, p = 0.016), as well as the ratio of increase in VO2 to work rate (8.1 +/- 1.0 vs 6.8 +/- 1.8 mL/min/W, p = 0.03). Additionally, the slope of the ventilatory response as a function of CO2 output was lower in Sch-PAH (40.3 +/- 3.9 vs 55.6 +/- 19.8; p = 0.04), and the heart rate response for a given change in VO2 was also diminished in Sch-PAH compared to IPAH (80.1 +/- 20.6 vs 123.0 +/- 39.2 beats/L/min; p = 0.02). in conclusion, Sch-PAH patients had less impaired physiological responses to exercise than IPAH subjects with similar resting hemodynamic dysfunction. Our data suggest a more preserved cardiopulmonary response to exercise in Sch-PAH which might be related to its better clinical course compared to IPAH.Fed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, São Paulo, BrazilQueens Univ, Dept Med, Div Resp & Crit Care Med, Kingston, ON K7L 3N6, CanadaFed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, São Paulo, BrazilWeb of Scienc

Recomendações para oxigenoterapia domiciliar prolongada da Sociedade Brasileira de Pneumologia e Tisiologia (2022)

Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years later, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.Algumas doenças respiratórias crônicas podem evoluir com hipoxemia e, nessas situações, a oxigenoterapia domiciliar prolongada (ODP) está indicada como opção terapêutica com o objetivo principal de melhorar a qualidade e a expectativa de vida desses pacientes. O oxigênio domiciliar é usado há mais de 70 anos, e a ODP tem como base dois estudos da década de oitenta que demonstraram que o uso de oxigênio melhora a sobrevida de pacientes com DPOC. Existem evidências de que a ODP tem outros efeitos benéficos como melhora da função cognitiva e da capacidade de exercício e redução de hospitalizações. A ODP está indicada para outras doenças respiratórias que cursam com hipoxemia, segundo os mesmos critérios estabelecidos para a DPOC. Tem sido observado aumento no uso da ODP provavelmente pela maior expectativa de vida, maior prevalência de doenças respiratórias crônicas e maior disponibilidade de ODP no sistema de saúde. O primeiro consenso sobre ODP da Sociedade Brasileira de Pneumologia e Tisiologia foi publicado em 2000; após 22 anos, apresentamos esta versão atualizada. Este documento é uma revisão não sistemática da literatura, realizada por pneumologistas que avaliaram evidências científicas e diretrizes internacionais sobre ODP nas diversas doenças que cursam com hipoxemia e em situações específicas (exercício, sono e viagens aéreas). Estas recomendações, tendo em vista a prática clínica, oferecem diversos quadros com informações sobre indicações, fontes de oxigênio, acessórios e estratégias para melhor eficiência, efetividade e uso seguro da ODP, assim como um modelo para sua prescrição

Teste cardiopulmonar de exercício na DPOC: indo além do consumo máximo de oxigênio Cardiopulmonary exercise testing: beyond maximal oxygen uptake

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Grupo de Circulação PulmonarUNIFESP, EPM, Grupo de Circulação PulmonarSciEL

Baseline patient characteristics.

<p><i>Definition of Abbreviations: BMI, body mass index; NYHA, New York Heart Association; FVC, forced vital capacity; FEV, forced expiratory volume; DL_CO, carbon monoxide diffusing capacity; PaCO₂, arterial carbon dioxide partial pressure; PaO₂, arterial oxygen partial pressure.</i></p

Correlation coefficients between resting CI and key exercise variables obtained during CPET, NYHA-FC and 6MWT in patients with Sch-PAH and IPAH.

*<p>p<0.05;</p><p><i>Definition of Abbreviations: NYHA-FC, New York Heart Association functional class; VO₂, oxygen uptake; WR, work rate; VE, minute ventilation; VCO₂, carbon dioxide uptake.</i></p