Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinfation. However, there is no consensus in the literature about the real benefts of EPAP in reducing dynamic hyperinfation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the efects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the efect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of efort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (− 2.33 bpm; 95% CI: − 4.56 to− 0.10) (very low evidence) when using a pressure level of 5 cmH2O. The other outcomes analyzed were not signifcantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential beneft of EPAP in this population

Impacts of post-radiotherapy lymphocyte count onprogression-free and overall survival in patients with stage III lung cancer

Background: We evaluated the impact of thoracic radiation in patients withnon-small cell lung cancer (NSCLC), considering the depletion of total lympho-cytes, use or not of chemotherapy, and radiation doses in healthy lung tissue.Methods: Patients with stage III NSCLC, ECOG 0 to 2, receiving radiothera pywith or without chemotherapy were prospectively evaluated. All patients shouldbe treated with three-dimensional radiotherapy and received biologically effectivedoses (BED10α/β 10) of 48 to 80 Gy. Peripheral blood lymphocyte total countswere measured at the start of radiotherapy and at 2, 6 and 12 months after radio-therapy. Along with lymphocytes, PTV and doses of 5 Gy and 20 Gy in healthylung tissue were also evaluated as potential factors inuencing overall survival(OS) and progression-free survival (PFS).Results: A total of 46 patients were prospectively evaluated from April 2016 toAugust 2019, with a median follow-up of 13 months (interquartile range, 1–39months). The median of OS of all cohort was 22,8 months (IC 95% 17,6–28,1)and the median PFS was 19,5 months (IC 95%: 14,7–24,2). Most patientsreceived concurrent or neoadjuvant chemotherapy (43; 93.4%). No patientreceived adjuvant immunotherapy. The lower the lymphocyte loss at 6 monthsafter radiotherapy (every 100 lymphocytes/mcL), the greater the chance of PFS(HR, 0.44; 95%CI, 0.25–0.77; P = 0.004) and OS (HR, 0.83; 95%CI, 0.70–0.98;P = 0.025; P = 0.025). BED was a protective factor for both PFS (HR, 0.52; 95%CI 0.33 –0.83; P = 0.0006) and OS (HR, 0.73; 95%CI 0.54–0.97; P = 0.029).Conclusions: Our results suggest that lymphocyte depletion after radiotherapyreduces tumor control and survival in patients with stage III lung cancer. Radia-tion doses equal or higher than 60 Gy (BED1072 Gy) improve PFS and OS, butthey negatively affect lymphocyte counts for months, which reduces survival andthe potential of immunotherapy

Armadilhas na interpretação de testes de função pulmonar nas doenças neuromusculares

Resumo não disponíve

Gasometria arterial no diagnóstico diferencial de hipoxemia

Resumo não disponíve

Obesidade : como os testes de função pulmonar podem nos trair

Resumo não disponíve

Integrando medidas de troca gasosa pulmonar para responder a perguntas clinicamente relevantes

Resumo não disponíve

Excesso de peso e ingestão de baixa qualidade da dieta em pacientes com hipertensão pulmonar : um perfil diferente de paciente com doença pulmonar

Background: Pulmonary hypertension (PH) is characterized by elevated blood pressure in the pulmonary artery. The literature is still scarce about nutritional approaches to this disease. However, is well known that high diet quality has a beneficial impact onquality of life,progression, and mortality of patients with chronic lung diseases, and this may apply to PH as well. Aims: To evaluate diet quality in patients with PH and characterize their comorbidities. Materials and Methods: Cross-sectional study with 35 patients. Body mass index, body fat, food intake, blood biochemical parameters were assessed. Diet quality was evaluated with the Healthy Eating Index (HEI) instrument. Results: The sample consisted predominantly of women (77.2%); 57.1% of the subjects were overweight or obese. Systemic arterial hypertension was the most prevalent comorbidity (28.6%), and one-third of the sample had glycemic changes and hypertriglyceridemia. Most subjects (82.9%) had low diet quality, and none had diet quality classified as good. Intake of fiber, calcium, and monounsaturated fatty acids was below current recommendations, while intake of protein and saturated fatty acids exceeded recommendations (p<0.05). Discussion and Conclusion: This sample of patients with PH was predominantly overweight/obese and had poor diet quality. The presence of chronic non-communicable diseases, altered glucose levels, and hyperlipidemia is consistent with these findings, possibly because of poor diet qualityIntrodução: A Hipertensão Pulmonar (HP) é caracterizada pela elevação da pressão sanguínea na artéria pulmonar. Em relação à nutrição nesta doença a literatura ainda é escassa, porém sabe-se que a dieta de alta qualidade em nutrientes desempenha papel importante na qualidade de vida, progressão e mortalidade de pneumopatias,podendo se aplicar para HP da mesma forma. Objetivos: Avaliar o Índice de alimentação saudável (IAS) de pacientes com HP e conhecer suas comorbidades. Materiais e Métodos: Estudo transversal, realizado com 35 pacientes portadores de HP. Foram avaliados índice de massa corporal, percentual de gordura corporal, exames bioquímicos, além do índice da qualidade da dieta por meio do instrumento IAS. Resultados: A amostra foi composta por 77% indivíduos do sexo feminino e 57,1% eram sobrepesos ou obesos.Hipertensão arterial sistêmica foi a principal comorbidade apresentada (28,6%), além de que 1/3 dos indivíduos possuírem alterações glicêmicas e hipertrigliceridemia. De todos os avaliados, 82,9% apresentaram alimentação de baixa qualidade. A ingestão de fibras, cálcio e ácidos graxos monoinsaturados (AGM) estavam aquém das recomendações vigentes (p<0,05), enquanto a de proteínase ácidos graxos saturados excederam estas mesmas recomendações (p<0,05). Conclusão: A amostra avaliada forampredominantemente de obesos e sobrepesos e tem baixa qualidade da dieta. A presença de doenças crônicas não-transmissíveis, alterações glicêmicas e de triglicerídeos complementam esses achados, possivelmente como consequências dele