370 research outputs found
Implicaciones de la calidad de vida en las decisiones quirúrgicas del cáncer de pulmón
Available evidence suggests that the patients with a forced expiratory volume in 1 second [FEV1] over 60% or in which a postoperative FEV1 is predicted over 45%, they do not develop severe disability after lung resection surgery; nevertheless, currently some groups are operating patients with EPOC and FEV1 less than 35%. In emphysema patients can occur that the function improve, as in the volume reduction lung surgery, but in the cases that it does not occur, they can remain with chronic shortness of breath until a 10%. At present, there are not any functional or effort test that be able to predict what patients will present satisfactory residual pulmonary function or chronic shortness of breath or important exercise limitations. It has been noticed that medical team opinion is not satisfactory to predict defi cit in postoperative quality of life. Nevertheless, long-term survivors (more than one year) inform relatively good quality of life, even in which they have pulmonary function reduced. In comparison with other chronic respiratory diseases, the survivors of lung cancer seem to be in better psychological state, the defi cit in quality of life is caused mainly by depression, and not for physical limitation. Therefore, empirical evidence does not justify excluding undergoing surgery on basis of medical team suppositions about a postoperative poor Quality of life. In addition, studies about Quality of Life suggests patients who is undergo lung cancer surgery are willing to assume risks for their survival, although, they want to receive information about how surgery may affect them
Implicaciones de la calidad de vida en las decisiones quirúrgicas del cáncer de pulmón
Available evidence suggests that the patients with a forced expiratory volume in 1 second [FEV1] over 60% or in which a postoperative FEV1 is predicted over 45%, they do not develop severe disability after lung resection surgery; nevertheless, currently some groups are operating patients with EPOC and FEV1 less than 35%. In emphysema patients can occur that the function improve, as in the volume reduction lung surgery, but in the cases that it does not occur, they can remain with chronic shortness of breath until a 10%. At present, there are not any functional or effort test that be able to predict what patients will present satisfactory residual pulmonary function or chronic shortness of breath or important exercise limitations. It has been noticed that medical team opinion is not satisfactory to predict defi cit in postoperative quality of life. Nevertheless, long-term survivors (more than one year) inform relatively good quality of life, even in which they have pulmonary function reduced. In comparison with other chronic respiratory diseases, the survivors of lung cancer seem to be in better psychological state, the defi cit in quality of life is caused mainly by depression, and not for physical limitation. Therefore, empirical evidence does not justify excluding undergoing surgery on basis of medical team suppositions about a postoperative poor Quality of life. In addition, studies about Quality of Life suggests patients who is undergo lung cancer surgery are willing to assume risks for their survival, although, they want to receive information about how surgery may affect them
Recomendações sobre o uso dos testes de exercício na prática clínica
Resumo: A elaboração deste documento pelo grupo de trabalho da European Respiratory Society tem como objectivo apresentar as recomendações sobre o uso clÃnico dos testes de exercÃcio em doentes com patologia cardiorrespiratória, dando particular ênfase à avaliação funcional, à avaliação do prognóstico e à avaliação das intervenções terapêuticas.A intolerância ao esforço fÃsico é um dos sintomas mais frequentes, condicionando a perda de qualidade de vida do doente com patologia cardiorrespiratória crónica. Pode definir-se âintolerância ao exercÃcioâ numa perspectiva clÃnica à incapacidade que o doente apresenta para realizar tarefas que os indivÃduos saudáveis considerariam toleráveis.A intolerância ao exercÃcio, considerada em termos do pico de consumo de oxigénio atingido no esforço máximo (VâO2pico) não pode ser prevista por parâmetros avaliados em repouso, como o volume expiratório máximo no primeiro segundo (FEV1), a transferência alvéolo-capilar do monóxido de carbono (DLCO), a fracção de ejecção do ventrÃculo esquerdo ou o Ãndice de massa corporal (IMC). A avaliação em exercÃcio impõe alguns desafios técnicos: a aplicação de protocolos especÃficos de incremento de carga de forma precisa e reprodutÃvel, com o recurso habitual a ergómetros, tais como a bicicleta ergométrica e o tapete rolante.A prova de exercÃcio cardiorrespiratória (CPET) é considerada o gold standard na avaliação das causas de intolerância ao exercÃcio em doentes com doença cardÃaca e pulmonar e é baseado no princÃpio de que a falência do sistema ocorre tipicamente quando o sistema (seja ele músculo-energético, cardiovascular ou pulmonar) se encontra sob stress. A CPET compreende a imposição de um exercÃcio com cargas crescentes (ou seja, incremental) limitado por sintomas, enquanto se monitorizam as variáveis cardiopulmonares (exemplo: consumo de oxigénio (VâO2), produção de dióxido de carbono (VâCO2), ventilação minuto (VâE), frequência cardÃaca (fC)), a percepção de sintomas (exemplo: a dispneia e o desconforto nos membros inferiores) e, quando necessárias, as avaliações da dessaturação arterial do oxigénio relacionada com o esforço, da hiperinsuflação dinâmica e da força muscular dos membros. Os sistemas são forçados até ao seu limite tolerável, de forma controlada, o que permite detectar respostas que identificam padrões de alteração e que podem ser relacionadas com padrões de referência previamente estudados e publicados pelas sociedades respiratórias europeia e americanas1-3.Neste documento, é descrito o papel da CPET como auxiliar no diagnóstico e na avaliação funcional e prognóstica. A CPET pode: â Fornecer uma medição objectiva da capacidade para o exercÃcio; â Identificar os mecanismos que limitam a tolerância ao exercÃcio; â Estabelecer Ãndices de prognóstico; â Monitorizar a progressão da doença e a resposta à s intervenções terapêuticas. â Auxiliar no diagnóstico, em situações de broncoconstrição induzida pelo exercÃcio e de dessaturação arterial do oxigénio. Na identificação das causas de intolerância ao exercÃcio, a CPET pode detectar: â Alterações na entrega de oxigénio (desde a sua entrada nas vias aéreas, passando pelo sistema de transporte cardiocirculatório, até à entrega à s mitocôndrias das fibras musculares); â Limitação ventilatória no exercÃcio; â Alteração do controlo ventilatório; â Alteração das trocas gasosas pulmonares; â Percepção excessiva de sintomas (exemplos: dispneia, precordialgia, fadiga muscular periférica); â Disfunção metabólica muscular; â Descondicionamento; â Fraco esforço dispendido. Com um bom esforço realizado, se o valor do pico do consumo de oxigénio atingido foi normal e o motivo para parar a prova foi dispneia ou fadiga muscular, então pode considerar-se que o indivÃduo estudado tem uma normal tolerância ao exercÃcio. Este cenário irá excluir doença pulmonar (DPOC, doença intersticial pulmonar, doença vascular pulmonar) ou cardÃaca (insuficiência cardÃaca congestiva) significativas como causa de intolerância.A prova de exercÃcio cardiopulmonar pode auxiliar no diagnóstico diferencial entre limitação no esforço de origem pulmonar ou cardiocirculatória. Pode fornecer um perfil de respostas que caracterizam determinadas doenças; exemplo: na DPOC são frequentes a limitação ventilatória, a hiperinsuflação dinâmica, a dessaturação arterial com o exercÃcio, a dispneia, a disfunção dos músculos periféricos; na doença intersticial pulmonar são frequentes a dispneia, a restrição ventilatória mecânica e as alterações graves das trocas gasosas. Outros padrões de respostas podem ser encontrados na broncoconstrição induzida pelo exercÃcio, na doença vascular pulmonar, na insuficiência cardÃaca e em cardiopatias congénitas. A avaliação cardiorrespiratória no exercÃcio fornece ainda indicadores prognósticos em várias doenças. Descrevem-se neste documento vários trabalhos que estudaram os parâmetros indicadores de prognóstico em doenças como a DPOC, a doença intersticial pulmonar, a hipertensão pulmonar primária, a fibrose quÃstica e a insuficiência cardÃaca.Este documento demonstra ainda a utilidade dos testes de exercÃcio na definição das respostas à s intervenções terapêuticas, em avaliações seriadas.O grupo de trabalho envolvido neste documento considerou importante apresentar as indicações baseadas na evidência para a realização dos testes de exercÃcio na prática clÃnica. A evidência actual é clara quanto à utilidade da prova de exercÃcio cardiopulmonar, das provas de marcha e das provas de carga constante na avaliação do grau de intolerância ao exercÃcio, do prognóstico e dos efeitos das intervenções terapêuticas em doentes adultos com doença pulmonar crónica (DPOC, doença intersticial pulmonar, hipertensão pulmonar primária), em crianças e adultos com fibrose quÃstica, em crianças e adultos com broncospasmo induzido pelo exercÃcio, em adultos com insuficiência cardÃaca congestiva e em crianças e adolescentes com cardiopatias congénitas.Na elaboração deste documento, os autores pretenderam fornecer as respostas à s perguntas que se colocam com frequência na prática clÃnica: â Quando se deve pedir uma avaliação da intolerância ao esforço? â Qual o teste mais adequado? â Quais as variáveis a seleccionar na avaliação do prognóstico de determinada doença ou na avaliação do efeito de uma intervenção terapêutica particular? O documento contém ainda um suplemento que pode ser obtido on-line e que descreve as bases fisiológicas subjacentes aos parâmetros avaliados nas provas de exercÃcio cardiopulmonar
A simple method to derive speed for the endurance shuttle walk test
Background: The original method for determining endurance shuttle walk test (ESWT) speed involves components that are time consuming for clinicians. We sought to determine: (i) whether components described in the original method for determining ESWT speed held true and; (ii) the agreement between speeds derived using the original method and that equivalent to 85% of the peak speed achieved during the incremental shuttle walk test (ISWT). Methods: Patients with chronic obstructive pulmonary disease (COPD) performed two ISWTs and one ESWT on separate days, wearing a calibrated portable gas analysis unit. A retrospective analysis of these data allowed us to determine whether: (i) the peak rate of oxygen uptake (VO2peak) can be accurately estimated from the incremental shuttle walk distance (ISWD) and; (ii) ESWTs performed at a speed derived using the original method elicited 85% of VO2peak. Agreement between walks speeds was determined using Bland–Altman analysis. Results: Twenty-two participants (FEV1 48 ± 13% predicted, age 66 ± 8 yr) completed the study. The VO2peak estimated from the ISWD was less than that measured during the ISWT (mean difference −4.4; 95% confidence interval (CI), −6.0 to −2.9 ml• kg−1•min−1). The ESWT and ISWT elicited similar VO2peak (mean difference −0.2; 95% CI, −1.5 to 1.2 ml•kg−1•min−1). The mean difference (±limits of agreement) between ESWT speeds was 0.15 (±0.34) km•h−1. Conclusions: Components of the original method for determining the ESWT speed did not hold true in our sample. ESWT speed can be derived by calculating 85% of the peak speed achieved during the ISWT
The Impact of Homogeneous Versus Heterogeneous Emphysema on Dynamic Hyperinflation in Patients With Severe COPD Assessed for Lung Volume Reduction
Dynamic hyperinflation (DH) is a pathophysiologic hallmark of Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to investigate the impact of emphysema distribution on DH during a maximal cardiopulmonary exercise test (CPET) in patients with severe COPD. This was a retrospective analysis of prospectively collected data among severe COPD patients who underwent thoracic high-resolution computed tomography, full lung function measurements and maximal CPET with inspiratory manouvers as assessment for a lung volume reduction procedure. ΔIC was calculated by subtracting the end-exercise inspiratory capacity (eIC) from resting IC (rIC) and expressed as a percentage of rIC (ΔIC %). Emphysema quantification was conducted at 3 predefined levels using the syngo PULMO-CT (Siemens AG); a difference >25% between best and worse slice was defined as heterogeneous emphysema. Fifty patients with heterogeneous (62.7% male; 60.9 ± 7.5 years old; FEV(1)% = 32.4 ± 11.4) and 14 with homogeneous emphysema (61.5% male; 62.5 ± 5.9 years old; FEV(1)% = 28.1 ± 10.3) fulfilled the enrolment criteria. The groups were matched for all baseline variables. ΔIC% was significantly higher in homogeneous emphysema (39.8% ± 9.8% vs.31.2% ± 13%, p = 0.031), while no other CPET parameter differed between the groups. Upper lobe predominance of emphysema correlated positively with peak oxygen pulse, peak oxygen uptake and peak respiratory rate, and negatively with ΔIC%. Homogeneous emphysema is associated with more DH during maximum exercise in COPD patients
No effect of glutamine ingestion on indices of oxidative metabolism in stable COPD
COPD patients have reduced muscle glutamate which may contribute to an impaired response of oxidative metabolism to exercise. We hypothesised that prior glutamine supplementation would enhance View the MathML source peak, View the MathML source at lactate threshold and speed pulmonary oxygen uptake kinetics in COPD. 13 patients (9 males, age 66 ± 5 years, mean ± SD) with severe COPD (mean FEV1 0.88 ± 0.23 l, 33 ± 7% predicted) performed on separate days ramp cycle-ergometry (5–10 W min−1) to volitional exhaustion and subsequently square-wave transitions to 80% estimated lactate threshold (LT) following consumption of either placebo (CON) or 0.125 g kg bm−1 of glutamine (GLN) in 5 ml kg bm−1 placebo. Oral glutamine had no effect on peak or View the MathML source at LT, {View the MathML source peak: CON = 0.70 ± 0.1 l min−1 vs. GLN = 0.73 ± 0.2 l min−1; LT: CON = 0.57 ± 0.1 l min−1 vs. GLN = 0.54 ± 0.1 l min−1} or View the MathML source kinetics {tau: CON = 68 ± 22 s vs. GLN = 68 ± 16 s}. Ingestion of glutamine before exercise did not improve indices of oxidative metabolism in this patient group
WITHDRAWN: La enfermedad pulmonar obstructiva crónica como factor de riesgo cardiovascular
This article has been withdrawn at the request of the author(s) and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy
Ecuaciones de referencia de la capacidad aeróbica máxima ciclo-ergoespirometría para la población española adulta
[EN] Background: Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake ( ̇VO2 ) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women.
Methods: 182 men and women, 20–85 years old, were included and exercised on cycle-ergometer to exhaustion. ( ̇VO2 ) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced.
Results: Height, sex and age resulted predictive of both ̇VO2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas ̇VO2 peak = 0.017 · height (cm) − 0.023 · age (years) + 0.864 · sex (female = 0/male = 1) ± 179 l min−1 , and peak WR = 1.345 · height (cm) − 2.074
· age (years) + 76.54 · sex (female = 0/male = 1) ± 21.2 W were the best compromise between accuracy and parsimony.
Conclusions: This study provides new and accurate ̇VO2 peak and WR rate reference values for individuals of European Spanish descent[ES] Antecedentes: Los valores de referencia utilizados con frecuencia para las pruebas de esfuerzo clínicas derivan de muestras no aleatorias y los criterios máximos para algunos de ellos están mal definidos. Nuestro objetivo fue obtener valores de referencia basados en la población general para el consumo
máximo de oxígeno (VO 2 ) y la carga de trabajo (CT) para las pruebas de ejercicio cardiopulmonar a partir de una muestra representativa de varones y mujeres caucásicos españoles.
Métodos: Se incluyeron 182 varones y mujeres, de entre 20 y 85 a ̃nos, que realizaron ejercicio en el cicloergómetro hasta el agotamiento. Se midieron el VO 2 y la CT. Las ecuaciones obtenidas de esta muestra se validaron en una cohorte independiente de 69 individuos, seleccionados aleatoriamente de la misma
población. A continuación, se creó una ecuación final que fusionó las dos cohortes (n = 251).
Resultados: La altura, el sexo y la edad resultaron predictivos tanto del ̇VO2 máximo como de la CT. El peso y la actividad física contribuyeron muy poco a la precisión de las ecuaciones. Las fórmulas ̇VO2 máximo = 0,017 × altura (cm) − 0,023 × edad (a ̃nos) + 0,864 × sexo (mujer = 0/varón = 1) ± 179 L × min−1 ; y CT máxima = 1,345 × altura (cm) − 2,074 × edad (a ̃nos) + 76,54 × sexo (mujer = 0/varón = 1) ± 21,2 W fueron
el mejor equilibrio entre precisión y parsimonia.
Conclusiones: Este estudio proporciona valores de referencia del ̇VO 2 máximo y la CT nuevos y precisos para personas de ascendencia espa ̃nola europea.This study was supported by a SEPAR (Sociedad Española de Neumología y Cirugía Torácica/Spanish society of Pulmonology and Thoracic Surgery) grant and NEUMOMADRD (Sociedad Madrileña de Neumología y Cirugía Torácica/Madrilenian Society of Pulmonology and Thoracic Surgery) research award
Reproducibility of onset and recovery oxygen uptake kinetics in moderately impaired patients with chronic heart failure
Oxygen (O2) kinetics reflect the ability to adapt to or recover from exercise that is indicative of daily life. In patients with chronic heart failure (CHF), parameters of O2 kinetics have shown to be useful for clinical purposes like grading of functional impairment and assessment of prognosis. This study compared the goodness of fit and reproducibility of previously described methods to assess O2 kinetics in these patients. Nineteen CHF patients, New York Heart Association class II–III, performed two constant-load tests on a cycle ergometer at 50% of the maximum workload. Time constants of O2 onset- and recovery kinetics (τ) were calculated by mono-exponential modeling with four different sampling intervals (5 and 10 s, 5 and 8 breaths). The goodness of fit was expressed as the coefficient of determination (R2). Onset kinetics were also evaluated by the mean response time (MRT). Considering O2 onset kinetics, τ showed a significant inverse correlation with peak-
\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
\ifmmode\expandafter\dot\else\expandafter\.\fi{V}{\text{O}}_{2} \end{document} (R = −0.88, using 10 s sampling intervals). The limits of agreement of both τ and MRT, however, were not clinically acceptable. O2 recovery kinetics yielded better reproducibility and goodness of fit. Using the most optimal sampling interval (5 breaths), a change of at least 13 s in τ is needed to exceed normal test-to-test variations. In conclusion, O2 recovery kinetics are more reproducible for clinical purposes than O2 onset kinetics in moderately impaired patients with CHF. It should be recognized that this observation cannot be assumed to be generalizable to more severely impaired CHF patients
Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations
This work is licensed under a Creative Commons Attribution 4.0
International License. The images or other third party material in this
article are included in the article’s Creative Commons license, unless indicated
otherwise in the credit line; if the material is not included under the Creative Commons
license, users will need to obtain permission from the license holder to reproduce the
material. To view a copy of this license, visit http://creativecommons.org/licenses/
by/4.0
- …