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

Association Of Tgf-β1, Cd14, Il-4, Il-4r And Adam33 Gene Polymorphisms With Asthma Severity In Children And Adolescents

Objective: To verify the association of transforming growth factor-β1(TGF-β1) (C-509T and T869C), CD14(C-159T), IL-4 (C-590T), IL-4R (ILe50Val) and ADAM33 (S_2) gene polymorphisms with asthma severity in a sample of patients with mild, moderate and severe persistent atopic asthma. Methods: A clinical, laboratory, prospective study was performed in patients with persistent atopic asthma, compared to a control group at Hospital Universitário da Universidade Estadual de Campinas between 2006 and 2007. Analysis of the TGF- β1 T869C gene polymorphismwas performed using the technique polymerase chain reaction (PCR) + amplification refractory mutation system (ARMS). TGF-β1 C-509T, CD14 C-159T, IL-4 C-590T, IL-4Ra ILe50Val, and ADAM33 S2 gene polymorphisms were detected by PCR and restriction enzyme. Results: This study included 88 patients with persistent atopic asthma (27 mild, 23 moderate and 38 severe) and 202 healthy blood donors. As to T869C polymorphism (TGF-β1), there was an association between the CC genotype and patients with severe asthma. There was no association in polymorphisms C-509T (TGF-β1), C-590T (IL-4) and S_2 (ADAM33). When distribution of C-159T polymorphism genotype frequency (CD14) in severe asthma was compared with the control group, there was a significant result with the TT genotype. There was significant association of the Val/Val genotype (IL-4R) with mild asthma. Conclusion: Our results indicate that T869C (TGF-β1), C-159T (CD14) and Val/Val (IL-4R) polymorphisms might be involved in modulation of asthma severity. 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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). 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Erratum To: Quality Of Sweat Test (st) Based On The Proportion Of Sweat Sodium (na) And Sweat Chloride (cl) As Diagnostic Parameter Of Cystic Fibrosis: Are We On The Right Way?

During production of the original article [1] the Methods section included an incorrect sentence. The following sentence "For the analysis of variables with numerical distribution, Fisher's exact test and one-way analysis of variance were used" should be corrected as "For the analysis of variables with numerical distribution, Student's t-test and one-way analysis of variance were used". © The Author(s).12

Antileukotrienes In The Treatment Of Asthma And Allergic Rhinitis

Objective: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment. Sources: MEDLINE, LILACS and Cochrane Library. Keywords: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic Summary of the findings: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting β2 agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. Conclusion: Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II). Copyright © 2006 by Sociedade Brasileira de Pediatria.82SUPPL. 2S213S221Bisgaard, H., Szefler, S., Long-acting beta2 agonists and paediatric asthma (2006) Lancet, 367, pp. 286-288(2005) Global Strategy for Asthma Management and Prevention NHLBI/WHO Workshop Report, , http://www.ginasthma.org/Guidelineitem.asp??l1=2&l2=1&intId=60, Updated Access: 17/09/2006British guideline on the management of asthma (2003) Thorax, 58 (SUPPL. 1), pp. i1-94. , British Thoracic SocietyScottish Intercollegiate Guidelines Network(1997) Guidelines for Diagnosis and Management of Asthma, , http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm, (NIH) National Asthma Education and Prevention Program. Publication No. 97-4051, Updated 2002. Access: 17/09/2006Salpeter, S.R., Ormiston, T.M., Salpeter, E.E., Cardiovascular effects of β-agonists in patients with asthma and COPD: A metaanalysis (2004) Chest, 125, pp. 2309-2321Bisgaard, H., Long-acting 2-agonists in management of childhood asthma: A critical review of the literature (2000) Pediatr Pulmonol, 29, pp. 221-234Bisgaard, H., Effect of long-acting 2-agonists on exacerbation rates of asthma in children (2003) Pediatr Pulmonol, 36, pp. 391-398Mann, M., Chowdhury, B., Sullivan, E., Nicklas, R., Anthracite, R., Meyer, R.J., Serious asthma exacerbations in asthmatics treated with high-dose formoterol (2003) Chest, 124, pp. 70-74Wooltorton, E., Long-acting B2 agonists in asthma: Safety concerns (2005) CMAJ, 173, pp. 1030-1031Nelson, H.S., Weiss, S.T., Bleecker, E.R., Yancey, S.W., Dorinsky, P.M., Is there a problem with inhaled long-acting b-adrenergic agonists? 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No.: CD002314. DOI:10.1002/14651858.CD002314Szefler, S.J., Phillips, B.R., Martinez, F.D., Chinchilli, V.M., Lemanske, R.F., Strunk, R.C., Characterization of within-subject responses to fluticasone and montelukast in childhood asthma (2005) J Allergy Clin Immunol, 115, pp. 233-242Zeiger, R.S., Szefler, S.J., Phillips, B.R., Schatz, M., Martinez, F.D., Chinchilli, V.M., Childhood asthma research and education network of the National Heart, Lung, and Blood Institute. Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma (2006) J Allergy Clin Immunol, 117, pp. 45-52Vaquerizo, M.J., Casan, P., Castillo, P., Perpina, P., Sanchis, J., Sobradillo, V., Effect of montelukast added to inhaled budesonide on control of mild to moderate asthma (2003) Thorax, 58, pp. 204-210Price, D.B., Hernandez, D., Magyar, P., Fiterman, J., Beeh, K.M., James, I.G., Randomised controlled trial of montelukast plus inhaled budesonide versus double dose inhaled budesonide in adult patients with asthma (2003) Thorax, 58, pp. 211-216Ducharme, F., Schwartz, Z., Hicks, G., Kakuma, R., Addition of antileukotriene agents to inhaled corticosteroids for chronic asthma (2004) Cochrane Database Syst Rev, (2), pp. CD003133Bjermer, L., Bisgaard, H., Bousquet, J., M Fabbri, L.M., Greening, A.P., Haahtela, T., Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults: One year, double blind, randomised, comparative trial (2003) BMJ, 327, pp. 891-897Bjermer, L., Bisgaard, H., Bousquet, J., Fabbri, L.M., Greening, A., Haahtela, T., Montelukast or salmeterol combined with an inhaled steroid in adult asthma: Design and rationale of a randomized, double-blind comparative study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial) (2000) Respir Med, 94, pp. 612-621Ringdal, N., Eliraz, A., Pruzinec, R., Weber, H.H., Mulder, P.G., Akveld, M., The salmeterol/fluticasone combination is more effective than fluticasone plus oral montelukast in asthma (2003) Respir Med, 97, pp. 234-241Ram, F.S., Cates, C.J., Ducharme, F.M., Long-acting beta2-agonists versus anti-leukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma (2005) Cochrane Database Syst Rev, 25, pp. CD003137Harmanci, K., Bakirtas, A., Turktas, I., Degim, T., Oral montelukast treatment of preschool-aged children with acute asthma (2006) Ann Allergy Asthma Immunol, 96, pp. 731-735Rodrigo, G.J., Yañez, A., The role of antileukotriene therapy in seasonal allergic rhinitis: A systematic review of randomized trials (2006) Ann Allergy Asthma Immunol, 96, pp. 779-786Peters-Golden, M., Henderson Jr., W.R., The role of leukotrienes in allergic rhinitis (2005) Ann Allergy Asthma Immunol, 94, pp. 609-618Volovitz, B., Welliver, R.C., De Castro, G., Krystofik, D.A., Ogra, P.L., The release of leukotrienes in the respiratory tract during infection with respiratory syncytial virus: Role in obstructive airway disease (1988) Pediatr Res, 24, pp. 504-507Volovitz, B., Faden, H., Ogra, P.L., Release of leukotriene C4 in respiratory tract during acute viral infection (1988) J Pediatr, 112, pp. 218-222Van Schaik, S.M., Tristram, D.A., Nagpal, I.S., Hintz, K.M., Welliver II, R.C., Welliver, R.C., Increased production of IFN-gamma and cysteinyl leukotrienes in virus-induced wheezing (1999) J Allergy Clin Immunol, 103, pp. 630-636Bisgaard, H., A randomized trial of montelukast in respiratory syncytial virus postbronchiolitis (2003) Am J Respir Crit Care Med, 167, pp. 379-383. , Study Group on Montelukast and Respiratory Syncytial VirusWedde-Beer, K., Hu, C., Rodriguez, M.M., Piedimonte, G., Leukotrienes mediate neurogenic inflammation in lungs of young rats infected with respiratory syncytial virus (2002) Am J Physiol Lung Cell Mol Physiol, 282, pp. L1143-50Harmanci, K., Bakirtas, A., Turktas, I., Degim, T., Oral montelukast treatment of preschool-aged children with acute asthma (2006) Ann Allergy Asthma Immunol, 96, pp. 731-735Guilbert, T.W., Morgan, W.J., Zeiger, R.S., Mauger, D.T., Boehmer, S.J., Szefler, S.J., Long-term inhaled corticosteroids in preschool children at high risk for asthma (2006) N Engl J Med, 354, pp. 1985-1997Becker, A.B., Kuznetsova, O., Vermeulen, J., Soto-Quiros, M.E., Young, B., Reiss, T.F., Linear growth in prepubertal asthmatic children treated with montelukast, beclomethasone, or placebo: A 56-week randomized 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Risk Factors For Gastroesophageal Reflux Disease In Very Low Birth Weight Infants With Bronchopulmonary Dysplasia

Objective: To assess risk factors for gastroesophageal reflux disease (GERD) in very low birth weight infants with bronchopulmonary dysplasia. Methods: A case-control study was carried out in 23 cases and 23 control subjects with bronchopulmonary dysplasia submitted to 24-hour esophageal pH monitoring between January 2001 and October 2005. Cases and controls were compared for gestational age, birth weight, gender, use of antenatal steroids, duration of assisted ventilation, duration of oxygen therapy, length of gastric tube use, administration of xanthines, postconceptual age, and weight at esophageal pH monitoring. Multiple logistic regression analysis was used to establish the odds ratio (OR) with a 95% confidence interval (95%CI). Results: None of the groups (with and without GERD) showed statistically significant differences in terms of demographic variables and postnatal outcome, use of antenatal and postnatal corticosteroids, or in terms of caffeine use and duration of mechanical ventilation and oxygen therapy. However, feeding intolerance (OR = 6.55; 95%CI 1.05-40.8) and length of gastric tube use (OR = 1.67; 95%CI 1.11-2.51) turned out to be risk factors for GERD. Postconceptual age at the time of pH monitoring (OR = 0.02; 95%CI < 0.001-0.38) was regarded as a protective factor against GERD. Conclusion: The data obtained allow inferring that prolonged gastric tube use and feeding intolerance increase the risk for GERD. On the other hand, older postconceptual age at the time of pH monitoring reduces the risk for GERD in preterm infants with bronchopulmonary dysplasia weighing less than 1,500 g. Copyright © 2008 by Sociedade Brasileira de Pediatria.842154159Vanderhoof, J.A., Zach, T.L., Adrian, T.E., (1999) Gastrointestinal disease, pp. 739-763. , Avery GB, Fletcher MA, MacDonald MG. Neonatology, pathophysiology & management of the newborn. 5th ed, Lippincott Williams & Wilkins;Frakaloss, G., Burke, G., Sanders, M.R., Impact of gastroesophageal reflux on growth and hospital stay in premature infants (1998) J Pediatr Gastroenterol Nutr, 26, pp. 146-150Ferlauto, J.J., Walker, M.W., Martin, M.S., Clinically significant gastroesophageal reflux in the at-risk premature neonate: Relation to cognitive scores, days in the NICU, and total hospital charges (1998) J Perinatol, 18, pp. 455-459Orenstein, S.R., Gastroesophageal reflux (1991) Curr Probl Pediatr, 21, pp. 193-241Hrabovsky, E.E., Mullett, M.D., Gastroesophageal reflux and the premature infant (1986) J Pediatr Surg, 21, pp. 583-587Campfield, T.J., Shah, B., Angelides, A., Hirsch, B., Incidence of gastroesophageal reflux (GER) in VLBW infants (1992) Pediatr Res, 31, pp. 106AYeo KL. Gastroesophageal reflux (GER) and chronic lung disease (CLD) in very low birth weight (VLBW) infants. Pediatr Res. 1998;43. (Abstract, 1189)Akinola, E., Rosenkrants, T.S., Pappagallo, M., Mckay, K., Hussain, N., Gastroesophageal reflux in infants < 32 weeks gestacional age at birth: Lack of relationship to chronic lung disease (2004) Am J Perinatol, 21, pp. 57-62Giuffre, R.M., Rubin, S., Mitchell, I., Antireflux surgery in infants with bronchopulmonary dysplasia (1987) Am J Dis Child, 141, pp. 648-651St Cyr, J.A., Ferrara, T.B., Thompson, T., Johnson, D., Foker, J.E., Treatment of pulmonary manifestations of gastroesophageal reflux in children two years of age or less (1989) Am J Surg, 157, pp. 403-404Farhath, S., Aghai, Z.H., Nakhla, T., Saslow, J., He, Z., Soundar, S., Pepsin, a reliable marker of gastric aspiration, is frequently detected in tracheal aspirates from premature ventilated neonates: Relationship with feeding and methylxantine therapy (2006) J Pediatr Gastroenterol Nutr, 43, pp. 336-341Molloy, E.J., Di Fiore, J.M., Martin, R.J., Does gastroesophageal reflux cause apnea in preterm infants? (2005) Biol Neonate, 87, pp. 254-261Sindel, B.D., Maisels, M.J., Ballantine, T.V., Gastroesophageal reflux to the proximal esophagus in infants with bronchopulmonary dysplasia (1989) Am J Dis Child, 143, pp. 1103-1106Ribeiro, J.D., Gastroesophageal reflux and respiratory diseases in children (2001) J Pediatr (Rio J), 77, pp. 65-66López-Alonso, M., Moya, M.J., Cabo, J.A., Ribas, J., del Carmen Macías, M., Silny, J., Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: Rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux (2006) Pediatrics, 118, pp. e299-e308Dhillon, A.S., Ewer, A.K., Diagnosis and management of gastro-oesophageal reflux in preterm infants in neonatal intensive care units (2004) Acta Paediatr, 93, pp. 88-93Ward, R.M., Lemons, J.A., Molteni, R.A., Cisapride: A survey of the frequency of use and adverse events in premature newborns (1999) Pediatrics, 103, pp. 469-472Bancalari, E., Abnenour, G.E., Feller, R., Gannon, J., Bronchopulmonary dysplasia: Clinical presentation (1979) J Pediatr, 95, pp. 819-823Vandenplas, Y., Goyvaerts, H., Helven, R., Sacre, L., Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome (1991) Pediatrics, 88, pp. 834-840Siegel, S., (1975) Estatística não-paramétrica (para as ciências do comportamento), , São Paulo: McGraw-Hill;Hosmer, D.W., Lemeshow, S., (1989) Applied logistic regression, , New York NY: John Wiley & Sons;Neu, J., Zhang, L., Feeding intolerance in very-low-birthweight infants: What is it and what can we do about it? 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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. 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(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. 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