Comparison of five portable peak flow meters

OBJECTIVE: To compare the measurements of spirometric peak expiratory flow (PEF) from five different PEF meters and to determine if their values are in agreement. Inaccurate equipment may result in incorrect diagnoses of asthma and inappropriate treatments. METHODS: Sixty-eight healthy, sedentary and insufficiently active subjects, aged from 19 to 40 years, performed PEF measurements using Air Zone®, Assess®, Galemed®, Personal Best® and Vitalograph® peak flow meters. The highest value recorded for each subject for each device was compared to the corresponding spirometric values using Friedman's test with Dunn's post-hoc (p<0.05), Spearman's correlation test and Bland-Altman's agreement test. RESULTS: The median and interquartile ranges for the spirometric values and the Air Zone®, Assess®, Galemed®, Personal Best® and Vitalograph® meters were 428 (263-688 L/min), 450 (350-800 L/min), 420 (310-720 L/min), 380 (300-735 L/min), 400 (310-685 L/min) and 415 (335-610 L/min), respectively. Significant differences were found when the spirometric values were compared to those recorded by the Air Zone® (p<0.001) and Galemed ® (p<0.01) meters. There was no agreement between the spirometric values and the five PEF meters. CONCLUSIONS: The results suggest that the values recorded from Galemed® meters may underestimate the actual value, which could lead to unnecessary interventions, and that Air Zone® meters overestimate spirometric values, which could obfuscate the need for intervention. These findings must be taken into account when interpreting both devices' results in younger people. These differences should also be considered when directly comparing values from different types of PEF meters

Relationship of Bode Index to Functional Tests in Chronic Obstructive Pulmonary Disease

OBJECTIVE: To determine if there is a correlation between the BODE Index and variables assessed during the Activities of Daily Living assessment, performance on lower limber tests, and peripheral muscle impairment of the upper limb in patients with chronic obstructive pulmonary disease. MATERIALS AND METHODS: Ten men (aged 58 to 80 years old) with moderate to very severe obstruction were evaluated and classified by the BODE Index. They were evaluated by pulmonary ventilation (V•E), oxygen consumption (V•O2), and carbonic gas production (V•CO2) on the ADL assessment; Distance Walking (DW) in the Six Minute Walking Test (6MWT) and the Six Minute Walking Test on Treadmill (6MWTT); number of repetitions in the Sit-to-Stand Test; and the Hand Grip Strength Test. Correlations were evaluated between the classification and the tests performed (Pearson and Spearman test, p<0.05). RESULTS: The mean of the total score for the BODE Index was 2.80 (±1.03), with three patients scoring in the first quartile (Q1) and seven scoring in the second quartile (Q2). This Index showed a negative correlation with the 6MWTT (r=-0.86), the Sit-to-Stand Test (r=-0.66), and the Hand Grip Strength Test (r=-0.83). CONCLUSIONS: Our results show that there is no correlation between the BODE Index and the ventilatory and metabolic responses in the Activities of Daily Living assessment. On the other hand, a correlation was observed between the BODE Index and the variables assessed in the 6MWTT, Sit-to-Stand Test, and Hand Grip Strength Test in moderate to very severe Chronic Obstructive Pulmonary Disease patients. This suggests that these tests can be employed as predictors of physical exercise capacity, perhaps as complementary tests to the BODE Index

Comparação entre valores de força muscular respiratória medidos e previstos por diferentes equações

The aim of this study was to compare maximum inspiratory and expiratory pressure values (MIP and MEP) obtained through different predictive equations to those directly measured from sedentary, healthy adults. Subjects were 495 both-sex inhabitants of the city of São Carlos (SP) and region. Respiratory pressures were measured with subjects standing up, using a hand vacuometer with circular mouthpiece and nasal clip. Measures taken were grouped according to subjects’ age in five 10-year age-groups. The obtained values were compared to predicted values by equations proposed by Harik-Khan et al (1998), Neder et al (1999), and Black &amp; Hyatt (1969), by using Friedman Anova test and Dunn post-hoc (p&lt;0.05). Comparison results showed that predicted values usually overestimate those directly measured, except Harik-Khan et al equation for male MIP, and Neder et al’s for both sexes MEP. Hence the equations most suitable for this study sample are those of Harik-Khan et al for MIP, and of Neder et al for MEP.Este estudo teve como objetivo comparar os valores das pressões inspiratória e expiratória máximas (PImáx e PEmáx) estimados por meio de diferentes equações preditivas com aqueles obtidos diretamente pormanovacuometria. Foram avaliados 495 adultos sedentários saudáveis de ambos os sexos, moradores de São Carlos (SP) e região. As pressões respiratórias foram mensuradas com o indivíduo em posição ortostática, utilizando-se um manovacuômetro analógico com bocal circular e uso de clipe nasal. Os valores obtidos foram agrupados segunda a idade dos sujeitos, em faixas com intervalo de dez anos. Em cada faixa etária, os valores foram comparados com os previstos pelas equações elaboradas por Harik-Khan et al. (1998), Neder et al. (1999) e Black &amp; Hyatt (1969), usando-se o teste de Friedman Anova e post-hoc de Dunn (p&lt;0,05). Observou-se, de modo geral, que os valores previstos pelas equaçõessuperestimam aqueles obtidos de forma direta, com exceção das equações de Harik-Khan et al. para a PImáx no sexo masculino, e a de Neder et al. para a PEmáx em ambos os sexos. Conclui-se que as equações mais adequadas para a população deste estudo são as de Harik-Khan et al. para PImáx e Neder et al. para PEmáx

A influência da pressão positiva expiratória final (PEEP) associada à intervenção fisioterapêutica na fase I da reabilitação cardiovascular

PURPOSE: To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery. METHODS: A prospective randomized study, in which 24 patients were divided in 2 groups: a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention (GEP, n = 8) and a group that received only the physiotherapy intervention (GPI, n = 16). Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days. RESULTS: Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI, while the GEP had a significant reduction only for vital capacity (P < .05). When the treatments were compared, smaller values were observed in the GPI for peak flow on the fifth postoperative day. Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups. However, the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI (P < .05). CONCLUSIONS: These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength, pulmonary volume, and flow. The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes, in comparison to the physiotherapy intervention alone. However, in both groups, the pulmonary volumes were not completely reestablished by the fifth postoperative day, and it was necessary to continue the treatment after hospital convalescence.OBJETIVO: Avaliar os efeitos da pressão positiva expiratória final e da intervenção fisioterápica na fase I da reabilitação cardiovascular sobre o comportamento da função pulmonar e da força muscular inspiratória e sobre o pós-operatório de cirurgia cardíaca. MÉTODO: Estudo prospectivo, randomizado, com 24 pacientes, separados em 2 grupos: GEP (n=8), que realizaram exercícios respiratórios com pressão positiva expiratória nas vias aéreas associados à intervenção fisioterápica; e GFI (n=16), que realizaram somente a intervenção fisioterápica. A função pulmonar foi avaliada pela espirometria no pré e 5º dia pós-operatório; a força muscular inspiratória pela pressão inspiratória máxima no pré, 1º e 5º dias pós-operatório. RESULTADOS: As variáveis espirométricas mostraram reduções significativas do pré para o 5º dia pós-operatório no GFI, porém no GEP, observou-se redução apenas para capacidade vital (

Condicionamento físico e treino muscular respiratório aplicado a um paciente com síndrome de Sjögren primária: relato de caso

Sjogren's Syndrome (SS) is a rheumatic progressive autoimmune disorderthat has primary and secondary manifestations, the majority of patients are women, and the onset is most common in middle age. The major characteristic is the glandular dysfunction but musculoskeletal and cardiopulmonary systems can be involved in the inflammatory process. In this case study, the purpose was evaluated the efficacy of a physical conditioning and respiratory muscle training applied to a patient with primary S.S. The intervention was elaborated based on physical evaluation, effort ergometric test, spirometry, 6 minute walk test, and cardiopulmonary variables. The conditioning program with contínuosprogressive load was performed in ergometric track, and accompanying tostretching to axial and limbs muscles with expansive exercises. The protocol was to performed 3 times a week, during 6 weeks. The respiratory muscle training used was IMT and PEP with threshold. The results showed increasing on the distance walked and decreasing on the heart frequency and arterial pressure. The oxygen saturation didn't showed beneficial results with this protocol. Thus, in these experimental conditions, the studied treatment protocol was beneficial to gain in the maximal pressure inspiratory and expiratory, life quality, sleep, and physical performance.A Síndrome de Sjogren (S.S.) é uma desordem reumática auto-imuneprogressiva capaz de manifestar-se sob as formas primária ou secundária, acometendo especialmente o sexo feminino, durante a suaquarta década de vida. Sua principal característica é a disfunção glandular,podendo ainda ser acompanhada por acometimentos tanto de ordem musculoesquelética quanto cardiorrespiratória. Neste estudo de caso, o objetivo foi avaliar a eficácia de um programa de condicionamento físico e treinamento muscular respiratório aplicados a uma portadora de S.S. em sua manifestação primária. A elaboração da intervenção foi baseada emuma avaliação física, teste de esforço submáximo, espirometria, teste decaminhada de seis minutos e análise das variáveis cardiorrespiratórias. O protocolo de condicionamento foi realizado em esteira rolante, com cargas crescentes contínuas, e acompanhado por alongamentos da musculatura axial e membros, juntamente, com exercícios reexpansivos associados àmovimentação ativa de membros superiores. Foi realizado 3 vezes por semana, durante o período de 6 semanas; o mesmo acontecendo com o treinamento muscular respiratório que utilizou as modalidades IMT e PEP do threshold. Os resultados mostram que a distância percorrida no teste de caminhada aumentou e as variáveis analisadas, com exceção da saturação de oxigênio, corresponderam ao esperado na avaliação pós intervenção fisioterápica realizada. Assim, nestas condições experimentais, o protocolo de tratamento estudado foi favorável no que diz respeito as medidas de pressão inspiratória e expiratória máximas,melhora na qualidade de vida e do sono e performance física

Fatores que influenciam a capacidade física de pacientes com doença pulmonar obstrutiva crônica

Este estudo objetivou identificar fatores que influenciam a capacidade física, avaliada por meio da distância percorrida no teste de caminhada de seis minutos (TC6'), de pacientes com doença pulmonar obstrutiva crônica (DPOC). Os fatores testados foram idade, grau de obstrução das vias aéreas (pelo volume expiratório forçado no primeiro segundo (VEF1), resistência da musculatura respiratória (pela ventilação voluntária máxima (VVM) e capacidade máxima ao esforço (medida pela distância percorrida no teste cardiopulmonar limitado por sintomas, TCP). Dezoito pacientes do sexo masculino, com idade média de 69,6±8,4anos e diagnóstico de DPOC classes II e III, foram submetidos ao TC6', ao TCP e à espiromeria. Foram encontradas correlações significativas moderadas entre a distância percorrida no TC6' e o VEF1 (r=0,62), a VVM (r=0,50), e a distância percorrida no TCP (r=0,67), não havendo correlação com a idade. Conclui-se que o grau de obstrução das vias aéreas, a resistência da musculatura respiratória e a capacidade máxima ao esforço influenciam a capacidade física dos pacientes com DPOC classes II e III ao executar uma atividade cotidiana como a caminhada.The purpose of this study was to verify to what extent certain factors may influence physical capacity (as assessed by the six-minute walk test, 6MWT) of patients with chronic obstructive pulmonary disease (COPD); factors considered were age, forced expiratory volume in one second (FEV1), maximum voluntary ventilation (MVV), and distance covered in the symptom-limited cardiopulmonary exercise test (CET). Subjects were 18 male elderly (mean age 69.6±8.4 years) with II- and III-degree COPD diagnosis, submitted to spirometry and the 6MW and CE tests. Moderate significant correlations were found between distance walked at the 6MWT and FEV1 (r=0.62), MVV (r=0.50), and distance walked in CET (r=0.67); no correlation was found with age. Therefore, it may be said that the degree of airway obstruction, endurance of respiratory muscles, and maximum exertion capacity may influence physical capacity of subjects with II- and III-degree COPD when performing a daily activity such as walking

Análise da demanda metabólica e ventilatória durante a execução de atividades de vida diária em indivíduos com doença pulmonar obstrutiva crônica

Individuals with Chronic Obstructive Pulmonary Disease (COPD) report that fatigue and dyspnea are the main symptoms experienced as a result of efforts made during the realization of daily life activities (DLA). Based on this context, this study aimed to analyze and compare individuals with COPD (FEV1Individuos con Enfermedad Pulmonar Obstructiva Crónica (EPOC) relatan como principales síntomas la fatiga y disnea como resultado de los mínimos esfuerzos realizados para Actividades de Vida Diaria (AVD). Basados en este contexto, el objetivo de este estudio fue analizar y comparar individuos con DPOC - Grupo 1(G1) y individuos sanos - Grupo 2 (G2) durante la realización de cinco AVD: cambiar lámpara (L), elevar peso (P), barrer (B), escalar grada (D) y caminar en cinta mecánica (C) en los siguientes aspectos: reserva metabólica (RM) y ventilatoria (RV), de frecuencia cardiaca (RFC), oxigenación y sensación de disnea (SD). Para el G1, hubo disminución significativa de la RM con relación al reposo (R) en las 5 AVD (Friedman ANOVA; pIndivíduos com Doença Pulmonar Obstrutiva Crônica (DPOC) relatam como principais sintomas a fadiga e dispnéia aos mínimos esforços envolvidos nas Atividades de Vida Diária (AVD). Baseados nesse contexto, o objetivo deste estudo foi analisar e comparar indivíduos com DPOC (VEF

Chronic obstructive pulmonary disease Assessment Test in assessing of patients with chronic obstructive pulmonary disease: there is a relationship with activities of daily living and mortality predictor index? A cross-sectional study

The aim of this study was to investigate if there is a relationship between the impact of Chronic Obstructive Pulmonary Disease (COPD) on health status and the level of dyspnea in Activities of Daily Living (ADL) and the mortality predictor index in patients undergoing Pulmonary Rehabilitation (PR). It is a cross-sectional study in which 32 patients with moderate to very severe COPD (23 men; 66.6±12.0 years; FEV1: 40.6±15.6% predicted) were assessed by: COPD Assessment Test (CAT), Body Mass Index (BMI), six-Minute Walking Test (6MWT), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) and BODE Index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). The CAT score presented moderate correlation with the mMRC questionnaire (r=0.35; p=0.048), total score of LCADL (r=0.60; pO objetivo do estudo foi investigar se há relação entre o impacto da Doença Pulmonar Obstrutiva Crônica (DPOC) no estado de saúde com o nível de dispneia nas atividades de vida diária (AVD) e o índice preditor de mortalidade em pacientes em reabilitação pulmonar (RP). Trata-se de um estudo transversal, em que foram avaliados 32 pacientes com DPOC moderada a muito grave (23 homens; 66,6±12,0 anos; VEF1: 40,6±15,6% previsto) por meio do COPD Assessment Test (CAT), Índice de Massa Corpórea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlações positivas moderadas do CAT com o questionário mMRC (r=0,35; p=0,048), a pontuação total da LCADL (r=0,60; pEl objetivo del estudio fue investigar si hay relación entre el impacto de la Enfermedad Pulmonar Obstructiva Crónica (EPOC) en el estado de salud con el nivel de disnea en las actividades de la vida diaria (AVD) y el índice predictor de mortalidad en pacientes en rehabilitación pulmonar (RP). Se trata de un estudio transversal, en el que fueron evaluados 32 pacientes con EPOC moderada a muy grave (23 hombres; 66,6±12,0 años; VEF1: 40,6±15,6% previsto) por medio del COPD Assessment Test (CAT), Índice de Masa Corpórea (IMC), Test de Caminata de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), mo dified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Se observaron correlaciones positivas moderadas del CAT con el cuestionario mMRC (r=0,35; p=0,048), la puntuación total de la LCADL (r=0,60;

Aplicabilidade das equações de referência para o teste de caminhada de seis minutos em adultos e idosos saudáveis de um município do estado de São Paulo

O teste de caminhada de seis minutos (TC6) tem sido considerado simples, seguro, de fácil administração, além de fornecer resultados representativos sobre atividades habituais do dia a dia. Os objetivos do estudo foram avaliar e comparar a distância percorrida no TC6 com as distâncias previstas por equações disponíveis na literatura científica em adultos e idosos saudáveis do município de São Carlos (SP), e verificar a aplicabilidade dessas equações nessa população. Foram avaliados 43 indivíduos (23 homens), dos 55 aos 78 anos, por meio da avaliação física, espirometria e do TC6. Observamos que a distância percorrida no TC6 foi significativamente (teste t-pareado: pThe six-minute walk test (6MWT) has been considered simple, safe, easy administration, and provide representative results about normal activities of day-to-day. The objective of the study was to evaluate and compare the 6-min walk distance (6MWD) with predicted distance by reference equations available in the scientific literature in healthy elderly adults, and to verify the applicability of these reference equations in this population. Forty-three elderly adults apparently healthy (23 males) between 55 to 78 years old were assessed by means of general physical assessment, the spirometry and 6MWT. The 6MWT was performed twice, with 30-min interval between them. The 6MWD was significantly (paired t-test: pEl test de marcha de seis minutos (TM6) es considerado simple, seguro y de fácil administración, además de entregar resultados representativos sobre actividades habituales del día a día. Los objetivos del estudio fueron evaluar y comparar la distancia recorrida en el TM6 con las distancias previstas por ecuaciones disponibles en la literatura científica en adultos y adultos mayores saludables del municipio de Sao Carlos/SP, y verificar la aplicabilidad de esas ecuaciones en esta población. Fueron evaluados 43 individuos (23 hombres), entre los 55 a los 78 años, por medio de evaluación física, espirometría y del TM6. Observamos que la distancia recorrida en el TM6 fue significativamente (test t-pareado: