Efeitos do apoio dos membros superiores sobre a força muscular respiratória e função pulmonar de doentes com doença pulmonar obstrutiva crónica

Resumo: Objetivo: Analisar o efeito do apoio de membros superiores sobre a força muscular respiratória e função pulmonar de pacientes com Doença Pulmonar Obstrutiva Crónica (DPOC). Métodos: Vinte pacientes com DPOC (11 homens) com idade de 67 ± 8 anos e IMC 24 ± 3 Kg · mâ2, foram submetidos a avaliações de Pressão Inspiratória e Expiratória Máximas (PImax e PEmax, respectivamente) e espirometria com e sem apoio dos membros superiores em ordem aleatória. A avaliação com apoio dos membros superiores foi realizada em posição ortostática, com o apoio dos membros superiores na altura do processo estilóide da ulna, flexão de cotovelos e tronco inclinado à frente, ambos em aproximadamente 30 graus, de modo a promover descarga de peso em membros superiores. A avaliação sem apoio de membros superiores foi realizada também em posição ortostática, porém com os membros superiores relaxados ao lado do corpo. O intervalo entre as avaliações foi de uma semana. Resultados: A PImax, PEmax e Ventilação Voluntária Máxima (VVM) foram maiores com a utilização do apoio do que sem o apoio (PImax 64 ± 22 cmH2O versus 54 ± 24 cmH2O, p = 0,00001; PEmax 104 ± 37 cmH2O versus 92 ± 37 cmH2O, p = 0,00001 e VVM 42 ± 20 L/min versus 38 ± 20 L/min, p = 0,003). As demais variáveis não apresentaram diferenças estatisticamente significativas. Conclusão: O apoio de membros superiores resultou em maior capacidade de gerar força e endurance dos músculos respiratórios em pacientes com DPOC. Abstract: Objective: To analyze the effect of arm bracing posture on respiratory muscle strength and pulmonary function in patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: 20 patients with COPD (11 male; 67 ± 8 years; BMI 24 ± 3 Kg · mâ2) were submitted to assessments of Maximal Inspiratory and Expiratory Pressures (MIP and MEP, respectively) and spirometry with and without arm bracing in a random order. The assessment with arm bracing was done on standing position and the height of the support was adjusted at the level of the ulnar styloid process with elbow flexion and trunk anterior inclination of 30 degrees promoting weight discharge in the upper limbs. Assessment without arm bracing was also performed on standing position, however with the arms relaxed alongside the body. The time interval between assessments was one week. Results: MIP, MEP and maximal voluntary ventilation (MVV) were higher with arm bracing than without arm bracing (MIP 64 ± 22 cmH2O versus 54 ± 24 cmH2O, p = 0,00001; MEP 104 ± 37 cmH2O versus 92 ± 37 cmH2O, p = 0,00001 and MVV 42 ± 20 L/min versus 38 ± 20 L/min, p = 0,003). Other variables did not show statistical signifi cant difference. Conclusion: The arm bracing posture resulted in higher capacity to generate force and endurance of the respiratory muscles in patients with COPD. PALAVRAS-CHAVE: Extremidade superior, Músculos respiratórios, Espirometria, Doença Pulmonar Obstrutiva Crónica, KEYWORDS: Upper limb, Respiratory muscles, Pulmonary function test, Chronic Obstructive Pulmonary Diseas

Agreement of different reference equations to classify patients with COPD as having reduced or preserved 6MWD

Background: Interpretation of the six-minute walk distance (6MWD) is enhanced by using recommended reference equations. Whenever possible, the choice of equation should be region-specific. A potential problem is that different equations for the 6MWD may have been developed for the same population, and it may be complicated to choose the most suitable. Objective: To verify the agreement of different reference equations in classifying patients with Chronic Obstructive Pulmonary Disease (COPD) as having reduced or preserved 6MWD. Methods: 159 patients with COPD performed the six-minute walk test according to international standardization. They were classified as having reduced 6MWD if it was below the lower limit of normal. Five Brazilian equations (Iwama; Britto1; Britto2; Dourado; Soares) and the two non-Brazilian equations most cited worldwide (Troosters; Enright) were used. The agreement for patients classified as reduced or preserved 6MWD was verified by Cohen's Kappa (pair-to-pair) analysis. The proportion of patients classified as having reduced walked distance was compared by the Chi-squared test. Results: Agreement between equations varied largely in classifying subjects as having reduced or preserved 6MWD (Kappa: 0.10–0.82). Brazilian equations with the highest agreement were Iwama, Britto1 and Britto2 (Kappa > 0.75). The proportion of patients classified as having reduced 6MWD was statistically similar only between equations in which the agreement was higher than 0.70. Conclusion: Even reference equations from the same country vary considerably in the classification of reduced or preserved 6MWD, and it is recommended that the region-specific ones be used as they give with higher agreement for similar and comparable interpretation of the patients’ functional exercise capacity. Keywords: Pulmonary disease, Chronic obstructive, Exercise tolerance, Exercise test, Walk test, Reference value

Comparison of daily physical activity between COPD patients from Central Europe and South America.

SummaryBackgroundIn healthy elderly and adults, lower physical activity level in daily life has been associated with lower socio-economic level and non-Caucasian race. The objective of this study was to determine if this is also applicable in chronic obstructive pulmonary disease (COPD) by comparing physical activity levels in daily life in stable patients from two countries (Austria and Brazil) with different socio-economic and ethnic characteristics.MethodsPhysical activity in daily life was objectively assessed in 40 Austrian and 40 Brazilian COPD patients. Groups were matched for age, gender, body mass index, disease severity, smoking history, presence of concomitant heart disease, lung function, dyspnea and functional exercise capacity. In addition, climatic conditions were similar during the period of data collection in the two groups.ResultsIn comparison to Brazilian patients, Austrian patients had a significantly lower walking time (p=0.04), higher sitting time (p=0.02) and lower movement intensity (p=0.0001). The proportion of patients who did not reach an average of 30min of walking per day was 48% in the Austrian group and 23% in the Brazilian group.ConclusionsAustrian patients with COPD showed a significantly lower daily physical activity level in comparison to matched Brazilian patients. Socio-economic and ethnic factors appear to influence stable COPD patients differently than described in previous studies including healthy subjects