Oxygen and Ventilatory Output during Several Activities of Daily Living Performed by COPD Patients Stratified According to Disease Severity

Objectives: To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity.Materials and Methods: Metabolic (VO2 and VCO2), ventilatory (f and V-E), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts.Results: the activities with the highest proportional metabolic and ventilatory output (VO2/VO(2)max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05).Conclusions: COPD patients present an increased proportion of energy expenditure while performing activities of daily living. the activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD's reduced ventilatory reserve.Fed Univ São Paulo Unifesp, Pulm Rehabil Ctr, São Paulo, BrazilFed Univ Pampa Unipampa, Uruguaiana, RS, BrazilAdventist Univ, São Paulo, BrazilNove de Julho Univ, São Paulo, BrazilPulm Rehabil Ctr Unifesp, São Paulo, BrazilUniversidade Federal de São Paulo, Pulm Rehabil Ctr, São Paulo, BrazilFed Univ São Paulo Unifesp, Pulm Rehabil Ctr, São Paulo, BrazilPulm Rehabil Ctr Unifesp, São Paulo, BrazilUniversidade Federal de São Paulo, Pulm Rehabil Ctr, São Paulo, BrazilWeb of Scienc

Anaerobic power and capacity assessments of upper extremities in COPD patients

Introduction: Important daily living activities are accomplished with upper extremities and COPD patients are usually limited in this field. However, it remains to be determined the behavior of the anaerobic metabolism of COPD patients when accomplishing exercises of high intensity and short duration with the arms. Objective: The purpose of this study was to explore arm anaerobic metabolic profile and lactate concentration of mild to moderate COPD patients accomplishing a 30-s Wingate anaerobic test. Methods: 24 male COPD patients (FEV1 73.2±15.2% pred, age 65.8±10) and 17 health subjects (FEV1 103.6±11.5% pred, age 66.2±7.2) underwent an arm 30-s Wingate anaerobic test to compare peak power, mean power, fatigue index and lactate concentration. Measurements and main results: Peak power and mean power output were significantly lower in COPD than in control group (211±119 vs.281±80W p<0.04 and 124±59 vs.182±35 W p<0.02, respectively). Blood lactate concentration in the control group was significantly higher than in COPD at the end of the test (7.0±1.5 vs. 5.5±2 mmol-1; p<0.01) and at the peak concentration (11±1.9 vs. 8.7±2.6 mmol-1; p<0.02). The ratio mean power/muscle area (W/cm2) was lower in COPD than the control group (p<0.01). Conclusions: COPD showed a lower anaerobic peak and mean power output compared to a control group. The Wingate anaerobic test was shown to be useful for measuring the anaerobic metabolism during an arm exercise in patients with COPD. The impairment in the glicolytic system may have some impact on patient’s independence to perform activities of daily living and our results suggest that there must be a structural muscle dysfunction at an early stage of the disease.Introdução: Atividades importantes da vida diária (AVD) são realizadas com o auxílio dos membros superiores e, freqüentemente os pacientes com DPOC têm dificuldade para realizá-las. Contudo, até o momento, pouco é conhecido sobre o fornecimento de energia oriundo do metabolismo anaeróbio para os músculos dos braços para a realização destas atividades como: varrer, carregar sacolas pesadas e colocar objetos em prateleiras. Objetivo: Avaliar o comportamento do metabolismo anaeróbio dos membros superiores utilizando o teste anaeróbio de Wingate de 30 segundos e a concentração de lactato em pacientes com DPOC e em um grupo controle. Métodos: 24 pacientes com DPOC (VEF1 73,2 ± 15,2% prev., idade 65,8 ± 10 anos, IMC 27,0±5,0 Kg/m2, IMM 20,2±4 Kg/m2) e 17 indivíduos saudáveis (VEF1 103,6±11,5% prev., idade 66,2 ± 7,2 anos, IMC 26,3± 3,6 Kg/m2, IMM 19,8±1,4 Kg/m2). Ambos os grupos realizaram o teste de Wingate em um cicloergômetro isocinético para membros superiores. Os índices de potência pico (PP), potência média (PM), índice de fadiga (IF) e a concentração do lactato sanguíneo foram medidas antes e seriadamente após o final do teste, respectivamente. Resultados: A potência pico e a potência média foram significantemente mais baixas no grupo DPOC comparadas com o grupo controle (PP = 211,8±119,0 e 281,0±80,8 Watts, p<0,04 e MP = 124,2 ± 59,1 x 182,4 ± 35,3 Watts, p<0,02, respectivamente). A concentração de lactato medida ao término do teste e no quinto minuto da recuperação passiva foram significantemente maiores no grupo controle do que no grupo de pacientes com DPOC (11±1,9 x 8,7±2,6 mmol-1; p <0,02; e 11±1,9 x 8.7±2,6 mmol-1; p<0,02, respectivamente). A relação potência média pela área muscular do braço foi significantemente menor no grupo com DPOC do que no grupo controle (2,9 x 3,9 W/cm2; p<0,01). Conclusão: Pacientes com DPOC apresentam menor potência pico e potência média comparado ao grupo controle. O teste anaeróbio de Wingate é uma boa ferramenta para medir a capacidade do metabolismo anaeróbio dos braços de pacientes com DPOC. O prejuízo apresentado pelo sistema glicolítico poderia acarretar em prejuízos na independência funcional do paciente para a realização de atividades do cotidiano de alta intensidade e curta duração com o auxilio dos braços. Nossos resultados sugerem que deve uma alteração muscular, de ordem estrutural, pode estar presente nos músculos do braço de pacientes com DPOC, ainda nos estádios iniciais da doença.TEDEBV UNIFESP: Teses e dissertaçõe

Influence Of Dynamic Lung Hyperinflation On Maximal Inspiratory And Expiratory Pressures At Rest And During A Submaximal Exercise Test In COPD

Sao Paulo Adventist Univ, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Why Some COPD Patients Improve Quality Of Life (HRQL) More Than Others After A Comprehensive Pulmonary Rehabilitation Program?

Univ Fed Sao Paulo, Sao Paulo, BrazilSao Paulo Adventist Univ, Sao Paulo, BrazilSt Elizabeths Med Ctr, Boston, MA USAUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Diagnostic methods to assess inspiratory and expiratory muscle strength

Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength

Diagnostic methods to assess inspiratory and expiratory muscle strength

Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength