Obesity increases eosinophil activity in asthmatic children and adolescents

A clear relationship between asthma and obesity has been reported, but the mechanisms remain unclear. The aim of this study was to evaluate the influence of obesity on eosinophil activity (chemotaxis and adhesion) in asthmatic children and adolescents compared with cells from healthy volunteers. Methods: Asthmatic obese (AO), asthmatic non-obese (ANO), non-asthmatic obese (NAO) and non-asthmatic non-obese (NANO) individuals were included in the present study. The chemotaxis of eosinophils after stimulation with eotaxin (300 ng/ml), platelet-activating factor (10 mu M; PAF) and RANTES (100 ng/ml) was performed using a microchemotaxis chamber. The eosinophil peroxidase activity was measured to determine the adhesion activity of eosinophils cultivated on fibronectin-coated plates. The serum leptin, adiponectin, TNF-alpha and IgE levels were quantified using ELISA assays. Results: The serum IgE levels and eosinophil counts were significantly higher in asthmatic (obese and non-obese) individuals compared with non-asthmatic individuals (obese and non-obese). Spontaneous eosinophil chemotaxis was greater in the AO group compared with either the ANO or NANO groups. The activation of eosinophils using eotaxin and PAF increased eosinophil chemotaxis in the AO group. RANTES treatment increased eosinophil chemotaxis in the NAO group compared with the NANO or ANO groups. The activation of eosinophils using eotaxin significantly increased eosinophil adhesion in the AO group compared with other groups. The serum leptin and TNF-alpha levels were higher in obese subjects (asthmatic and non-asthmatic), whereas the levels of adiponectin did not significantly differ among these groups. Conclusion: This study is the first to show increased eosinophilic activity (chemotaxis and adhesion) associated with high serum leptin and TNF-alpha levels in atopic asthmatic obese children and adolescents compared with non-obese healthy volunteers133

Spirometry And Volumetric Capnography In Lung Function Assessment Of Obese And Normal-weight Individuals Without Asthma

To analyze and compare lung function of obese and healthy, normal-weight children and adolescents, without asthma, through spirometry and volumetric capnography. Methods: Cross-sectional study including 77 subjects (38 obese) aged 5-17 years. All subjects underwent spirometry and volumetric capnography. The evaluations were repeated in obese subjects after the use of a bronchodilator. Results: At the spirometry assessment, obese individuals, when compared with the control group, showed lower values of forced expiratory volume in the first second by forced vital capacity (FEV1/FVC) and expiratory flows at 75% and between 25 and 75% of the FVC (p <0.05). Volumetric capnography showed that obese individuals had a higher volume of produced carbon dioxide and alveolar tidal volume (p <0.05). Additionally, the associations between dead space volume and tidal volume, as well as phase-3 slope normalized by tidal volume, were lower in healthy subjects (p <0.05). These data suggest that obesity does not alter ventilation homogeneity, but flow homogeneity. After subdividing the groups by age, a greater difference in lung function was observed in obese and healthy individuals aged >11 years (p <0.05). Conclusion: Even without the diagnosis of asthma by clinical criteria and without response to bronchodilator use, obese individuals showed lower FEV1/FVC values and forced expiratory flow, indicating the presence of an obstructive process. Volumetric capnography showed that obese individuals had higher alveolar tidal volume, with no alterations in ventilation homogeneity, suggesting flow alterations, without affecting lung volumes. © 2017 Sociedade Brasileira de Pediatria

Pulsed Direct And Constant Direct Currents In The Pilocarpine Iontophoresis Sweat Chloride Test

Background: The classic sweat test (CST) is the golden standard for cystic fibrosis (CF) diagnosis. Then, our aim was compare the production and volume of sweat, and side effects caused by pulsed direct current (PDC) and constant direct current (CDC). To determine the optimal stimulation time (ST) for the sweat collection. To verify the PDC as CF diagnosis option. Methods: Prospective study with cross-sectional experimental intervention. Experiment 1 (right arm): PDC and CDC. ST at 10 min and sweat collected at 30 min. Currents of 0.5; 0.75; 1.0 and 1.5 mA and frequencies of 0, 200, 1,000 and 5,000 Hz applied. Experiment 2 (left arm): current of 1.0 mA, ST at 5 and 10 min and sweat collected at 15 and 30 min with frequencies of 0; 200; 1,000 and 5,000 Hz applied Experiments 1 and 2 were performed with current density (CD) from 0.07 to 0.21 mA/cm2. Experiment 3: PDC was used in typical CF patients with two CFTR mutations screened and or with CF diagnosis by rectal biopsy and patients with atypical CF. Results: 48 subjects (79.16% female) with average of 29.54 ± 8.87 years old were enrolled. There was no statistical difference between the interaction of frequency and current in the sweat weight (p = 0.7488). Individually, positive association was achieved between weight sweat and stimulation frequency (p = 0.0088); and current (p = 0.0025). The sweat production was higher for 10 min of stimulation (p = 0.0023). The sweat collection was better for 30 min (p = 0.0019). The skin impedance was not influenced by ST and sweat collection (p > 0.05). The current frequency was inversely associated with the skin impedance (p < 0.0001). The skin temperature measured before stimulation was higher than after (p < 0.0001). In Experiment 3 (29 subjects) the PDC showed better kappa index compared to CDC (0.9218 versus 0.5205, respectively). Conclusions: The performance of the CST with CDC and PDC with CD of 0.14 to 0.21 mA/cm2 showed efficacy in steps of stimulation and collection of sweat, without side effects. The optimal stimulation time and sweat collection were, respectively, 10 and 30 min.141Di Sant'S Agnese, P.A., Darling, R.C., Perara, G.A., Shea, E., Abnormal electrolyte composition of sweat in cystic fibrosis of the pancreas (1953) Am J Dis Child, 86, pp. 618-619Gibson, L.E., Cooke, R.E., A test for concentration of electrolytes in sweat in cystic fibrosis of the pancreas utilizing pilocarpine by iontophoresis (1959) Pediatrics, 23, pp. 545-549Taylor, C.J., Hardcastle, J., Southern, K.W., Physiological measurements confirming the diagnosis of cystic fibrosis. The sweat test and measurements of transepithelial potential difference (2009) Paedia Resp Rev, 10, pp. 220-226Rosenstein, B.J., What is a cystic fibrosis diagnosis? 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Correlation between parameters of volumetric capnography and spirometry during a submaximal exercise protocol on a treadmill in patients with cystic fibrosis and healthy controls

Introduction: Spirometry is the most frequently used test to evaluate the progression of lung damage in cystic fibrosis (CF). However, there has been low sensitivity in detecting early lung changes. In this context, our objective was to identify the correlation between parameters of volumetric capnography (VCap) and spirometric parameters during a submaximal treadmill exercise test. Methods: A cross-sectional and controlled study which included 64 patients with CF (CFG) and 64 healthy control subjects (CG) was performed. The CFG was from a university hospital and the CG from local schools. All participants underwent spirometry and VCap before, during and after the submaximal treadmill exercise test. The main variable analyzed by VCap was the slope of phase 3 (slope 3), which indicates the [exhaled carbon dioxide] at the end of expiration, and expresses the heterogeneity of gas emptying in pulmonary periphery. The correlation analysis between spirometry and VCap was conducted using the Spearman correlation test, considering α = 0.05. Results: The indices analyzed by VCap showed correlation with parameters of VCap. Slope 3 showed an inverse correlation with forced expiratory volume in the first second of forced vital capacity (FEV1) in both groups and at all moments of the submaximal treadmill exercise test. Forced vital capacity (FVC) and FEV1/FVC ratio showed an inverse correlation with slope 3 only for CFG. Values of slope 3 corrected by the spontaneous tidal volume (VT) and end-tidal carbon dioxide tension (PetCO2) showed results similar to slope 3 analyzed separately. Conclusion: Parameters of VCap such as slope 3, slope 3/VT and slope 3/PetCO2 correlated with sensitive variables of spirometry such as FEV1, FVC and FEV1/FVC ratio. For the evaluated variables, there was consistency in the correlation between the two tests, which may indicate the impact of CF on pulmonary physiology. Keywords: Capnography, Exercise test, Lung function, Spirometr

Functional Performance On The Six-minute Walk Test In Patients With Cystic Fibrosis [desempenho Funcional De Pacientes Com Fibrose Cística E Indivíduos Saudáveis No Teste De Caminhada De Seis Minutos]

RibeiroAbstractObjective: To compare patients with cystic fibrosis and healthy individuals in terms of their functional performance on the six-minute walk test (6MWT). Methods: A prospective, cross-sectional study involving healthy individuals and patients with cystic fibrosis treated at a referral university hospital in the city of Campinas, Brazil. The 6MWT was administered in accordance with the American Thoracic Society guidelines, and it was repeated after a 30-min rest period. For all of the participants, RR, HR, SpO2, and Borg scale scores were obtained. For the cystic fibrosis patients, nutritional status and spirometric values were determined. Patients with pulmonary exacerbation were excluded. Spearman's correlation coefficient and repeated measures ANOVA were used. Results: The cystic fibrosis group comprised 55 patients, and the control group comprised 185 healthy individuals. The mean ages were 12.2 ± 4.3 and 11.3 ± 4.3 years, respectively. The six-minute walk distance (6MWD) was significantly shorter in the cystic fibrosis group than in the control group for both tests (547.2 ± 80.6 m vs. 610.3 ± 53.4 m for the first and 552.2 ± 82.1 m vs. 616.2 ± 58.0 m for the second; p < 0.0001 for both). The 6MWD correlated with age, weight, and height only in the cystic fibrosis group. During the tests, SpO2 remained stable, whereas HR and RR increased. Conclusions: In our sample, functional performance on the 6MWT was poorer among the cystic fibrosis patients than among the healthy controls in the same age bracket, and we found immediate repetition of the test to be unadvisable.376735744ATS statement: Guidelines for the six-minute walk test (2002) Am J Respir Crit Care Med., 166 (1), pp. 111-117. , ATS Committee on Proficiency Standards for Clinical Pulmonary Function LaboratoriesEnright, P.L., McBurnie, M.A., Bittner, V., Tracy, R.P., McNamara, R., Arnold, A., The 6-min walk test: A quick measure of functional status in elderly adults (2003) Chest., 123 (2), pp. 387-398Gulmans, V.A., van Veldhoven, N.H., de Meer, K., Helders, P.J., The six-minute walking test in children with cystic fibrosis: Reliability and validity (1996) Pediatr Pulmonol., 22 (2), pp. 85-89Noonan, V., Dean, E., Submaximal exercise testing: Clinical application and interpretation (2000) Phys Ther., 80 (8), pp. 782-807Ribeiro, J.D., Ribeiro, M.A., Ribeiro, A.F., Controversies in cystic fibrosis--from pediatrician to specialist [Article in Portuguese] (2002) J Pediatr (Rio J), 78 (SUPPL. 2), pp. S171-S186Klijn, P.H., van der Net, J., Kimpen, J.L., Helders, P.J., van der Ent, C.K., Longitudinal determinants of peak aerobic performance in children with cystic fibrosis (2003) Chest., 124 (6), pp. 2215-2219Li, A.M., Yin, J., Au, J.T., So, H.K., Tsang, T., Wong, E., Standard reference for the six-minute-walk test in healthy children aged 7 to 16 years (2007) Am J Respir Crit Care Med., 176 (2), pp. 174-180Priesnitz, C.V., Rodrigues, G.H., Stumpf Cda, S., Viapiana, G., Cabral, C.P., Stein, R.T., Reference values for the 6-min walk test in healthy children aged 6-12 years (2009) Pediatr Pulmonol., 44 (12), pp. 1174-1179Santos, C.I.S., Ribeiro, J.D., Ribeiro, A.F., Hessel, G., Critical analysis of scoring systems used in the assessment of cystic fibrosis severity: State of the art (2004) J Bras Pneumol., 30 (3), pp. 286-298Kuczmarski, R.J., Ogden, C.L., Guo, S.S., Grummer-Strawn, L.M., Flegal, K.M., Mei, Z., 2000 CDC Growth Charts for the United States: Methods and development (2002) Vital Health Stat, 11 (246), pp. 1-190Diretrizes para testes de função pulmonar (2002) J Pneumol., 28 (SUPPL. 3), pp. S1-S238. , Sociedade Brasileira de Pneumologia e TisiologiaCunha, M.T., Rozov, T., de Oliveira, R.C., Jardim, J.R., Six-minute walk test in children and adolescents with cystic fibrosis (2006) Pediatr Pulmonol., 41 (7), pp. 618-622Bland, J.M., Altman, D.G., Statistical methods for assessing agreement between two methods of clinical measurement (1986) Lancet., 1 (8476), pp. 307-310Prasad, S.A., Randall, S.D., Balfour-Lynn, I.M., Fifteen-count breathlessness score: An objective measure for children (2000) Pediatr Pulmonol., 30 (1), pp. 56-62Lesser, D.J., Fleming, M.M., Maher, C.A., Kim, S.B., Woo, M.S., Keens, T.G., Does the 6-min walk test correlate with the exercise stress test in children? (2010) Pediatr Pulmonol., 45 (2), pp. 135-140Gruber, W., Orenstein, D.M., Braumann, K.M., Hüls, G., Health-related fitness and trainability in children with cystic fibrosis (2008) Pediatr Pulmonol., 43 (10), pp. 953-964Chetta, A., Pisi, G., Zanini, A., Foresi, A., Grzincich, G.L., Aiello, M., Six-minute walking test in cystic fibrosis adults with mild to moderate lung disease: Comparison to healthy subjects (2001) Respir Med., 95 (12), pp. 986-991Gruet, M., Brisswalter, J., Mely, L., Vallier, J.M., Use of the peak heart rate reached during six-minute walk test to predict individualized training intensity in patients with cystic fibrosis: Validity and reliability (2010) Arch Phys Med Rehabil., 91 (4), pp. 602-607Troosters, T., Langer, D., Vrijsen, B., Segers, J., Wouters, K., Janssens, W., Skeletal muscle weakness, exercise tolerance and physical activity in adults with cystic fibrosis (2009) Eur Respir J., 33 (1), pp. 99-106de Meer, K., Gulmans, V.A., van der Laag, J., Peripheral muscle weakness and exercise capacity in children with cystic fibrosis (1999) Am J Respir Crit Care Med., 159 (3), pp. 748-754Thin, A.G., Dodd, J.D., Gallagher, C.G., Fitzgerald, M.X., Mcloughlin, P., Effect of respiratory rate on airway deadspace ventilation during exercise in cystic fibrosis (2004) Respir Med., 98 (11), pp. 1063-1070McKone, E.F., Barry, S.C., Fitzgerald, M.X., Gallagher, C.G., Role of arterial hypoxemia and pulmonary mechanics in exercise limitation in adults with cystic fibrosis (2005) J Appl Physiol., 99 (3), pp. 1012-1018Lammers, A.E., Hislop, A.A., Flynn, Y., Haworth, S.G., The 6-minute walk test: Normal values for children of 4-11 years of age (2008) Arch Dis Child., 93 (6), pp. 464-468Limsuwan, A., Wongwandee, R., Khowsathit, P., Correlation between 6-min walk test and exercise stress test in healthy children (2010) Acta Paediatr., 99 (3), pp. 438-441Hommerding, P.X., Donadio, M.V., Paim, T.F., Marostica, P.J., The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis (2010) Respir Care., 55 (6), pp. 729-733Dourado, V.Z., Reference Equations for the 6-Minute Walk Test in Healthy Individuals. [Article in Portuguese] (2011) Arq Bras Cardiol., , Epub ahead of printGeiger, R., Strasak, A., Treml, B., Gasser, K., Kleinsasser, A., Fischer, V., Six-minute walk test in children and adolescents (2007) J Pediatr., 150 (4), pp. 395-39

Influence Of Thoracic Spine Postural Disorders On Cardiorespiratory Parameters In Children And Adolescents With Cystic Fibrosis

Objectives: To assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity. Method: This was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV1, FVC and FEV 1/FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression. Results: Forty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV1, FVC, FEV1/FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV 1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088). Conclusions: There was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function. 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Mouth Breathing And Forward Head Posture: Effects On Respiratory Biomechanics And Exercise Capacity In Children [respiração Bucal E Anteriorização Da Cabeça: Efeitos Na Biomecânica Respiratória E Na Capacidade De Exercício Em Crianças]

Objective: To evaluate submaximal exercise tolerance and respiratory muscle strength in relation to forward head posture (FHP) and respiratory mode in children, comparing mouth-breathing (MB) children with nasal-breathing (NB) children. Methods: This was a controlled, analytical cross-sectional study involving children in the 8-12 year age bracket with a clinical otorhinolaryngology diagnosis of MB, recruited between October of 2010 and January of 2011 from the Mouth Breather Clinic at the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. The exclusion criteria were obesity, asthma, chronic respiratory diseases, heart disease, and neurological or orthopedic disorders. All of the participants underwent postural assessment and the six-minute walk test (6MWT), together with determination of MIP and MEP. Results: Of the 92 children in the study, 30 presented with MB and 62 presented with NB. In the MB group, the differences between those with moderate or severe FHP and those with normal head posture, in terms of the mean MIP, MEP and six-minute walk distance (6MWD), were not significant (p = 0.079, p = 0.622, and p = 0.957, respectively). In the NB group, the mean values of MIP and MEP were higher in the children with moderate FHP than in those with normal head posture (p = 0.003 and p = 0.004, respectively). The mean MIP, MEP, and 6MWD were lower in the MB group than in the NB group. Values of MIP and MEP were highest in the children with moderate FHP. Conclusions: Respiratory biomechanics and exercise capacity were negatively affected by MB. 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