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Subjects with severe and very severe chronic obstructive pulmonary disease (COPD) present thoracoabdominal asynchrony (TAA) that reduces ventilatory efficiency and exercise capacity. However, no therapeutic intervention has focused on reducing TAA. The purpose of this study was to evaluate the effects of elastic tape (ET) on thoracoabdominal mechanics, dyspnea symptoms, exercise capacity, and physical activity level in nonobese male subjects with severe-to-very severe COPD. This crossover, randomized trial included nonobese males with severe to very severe COPD. ET was placed on the chest wall and abdomen to reduce TAA. Subjects were evaluated at three hospital visits, each 7 days apart. At visit 1, thoracoabdominal kinematic and pulmonary ventilation were evaluated by optoelectronic plethysmography and electrical impedance tomography, respectively, both at rest and during isoload exercise testing. At visit 2, a cardiopulmonary exercise test (CPET; 10 W/min) was performed until exhaustion. Between the visits, subjects used a physical activity monitor (PAM) (at least 5 days of measurement; 10 h/day). At visit 3, all the tests were repeated in the opposite order of the previous randomization. During the isoload exercise, subjects with ET presented lower tidal and minute volumes (P = 0.01) and reduced TAA (P = 0.02) and dyspnea (P = 0.04). During the CPET, subjects with ET presented an increase in peak oxygen consumption (Vo2peak; L/min and mL·kg-1·min-1; P = 0.01), test duration (P = 0.009), and maximal load (P = 0.03). Moderate and vigorous physical activity (MVPA), which was evaluated by the PAM, was also increased in subjects with ET (P = 0.01). ET reduced TAA and dyspnea and increased exercise capacity and the duration of MVPA in nonobese male subjects with severe-to-very severe COPDNEW & NOTEWORTHY Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.

BackgroundCOPD is associated with an abnormal lung immune response that leads to tissue damage and remodeling of the lung, but also to systemic effects that compromise immune responses. Cigarette smoking also impacts on innate and adaptative immune responses, exerting dual, pro- and anti-inflammatory effects. Previously, we showed that COPD patients presented accelerated telomere shortening and decreased telomerase activity, while, paradoxically, cigarette-smokers exhibited preserved telomerase activity and slower rate of telomere shortening.ResultsHere, we evaluated the naive, CM, EM and TEMRAsubsets of TCD4 and TCD8 cells according to the expression of CCR7/CD45RA. We compared age-matched COPD patients, cigarette-smokers without clinical-laboratory evidence of pulmonary compromise, and healthy individuals. They were additionally compared with a group of young adults. For each subset we analysed the expression of markers associated with late differentiation, senescence and exhaustion (CD27/CD28/CD57/KLRG1/PD1). We show that COPD patients presented a drastically reduced naive cells pool, and, paradoxically, increased fractions of naive cells expressing late differentiation, senescence or exhaustion markers, likely impacting on their immunocompetence. Pronounced phenotypic alterations were also evidenced in their three memory T-cell subsets compared with the other aged and young groups, suggesting an also dysfunctional memory pool. Surprisingly, our smokers showed a profile closer to the Healthy aged than COPD patients. They exhibited the usual age-associated shift of naive to EM TCD4 and TCD8 cells, but not to CM or TEMRAT-cells. Nonetheless, their naive T-cells phenotypes were in general similar to those of the Youngs and Healthy aged, suggesting a rather phenotypically preserved subset, while the memory T-cells exhibited increased proportions of cells with the late-differentiation or senescence/exhaustion markers as in the Healthy aged.ConclusionOur study extends previous findings by showing that COPD patients have cells expressing a full range of late differentiated, senescent or exhausted phenotypes encompassing all TCD4 and TCD8 subsets, consistent with a premature immunosenescence phenotype. Surprisingly, the smokers group’s results suggest that moderate to heavy chronic cigarette smoking did not accelerate the pace of immunosenescence as compared with the Healthy aged.

Background: The desaturation–distance ratio (DDR), the ratio of the desaturation area to the distance walked, is a promising, reliable, and simple physiologic tool for functional evaluation in subjects with interstitial lung diseases. Lymphangioleiomyomatosis (LAM) is a rare neoplastic condition frequently associated with exercise impairment. However, DDR has rarely been evaluated in patients with LAM.Objectives: To assess DDR during maximal and submaximal exercises and evaluate whether DDR can be predicted using lung function parameters.Methods: A cross-sectional study was conducted in a cohort of women with LAM. The 6-min walking test (6MWT) and the incremental shuttle walking test (ISWT) were performed, and DDR was obtained from both tests. The functional parameters were assessed at rest using spirometry and body plethysmography. The pulmonary function variables predictive of DDR were also assessed.Results: Forty patients were included in this study. The mean age was 46 ± 10 years. Airway obstruction, reduced DLCO, and air trapping were found in 60, 57, and 15% of patients, respectively. The distance walked and the DDR for the 6MWT and ISWT were, respectively, 517 ± 65 and 443 ± 127 m; and 6.6 (3.8–10.9) and 8.3 (6.2–12.7). FEV1 (airway obstruction) and reduced DLCO and RV/TLC (air trapping) were independent variables predictive of DDR during exercises field tests [DDR6MWT = 18.66–(0.06 × FEV1%pred)–(0.10 × DLCO%pred) + (1.54 × air trapping), Radjust2 = 0.43] and maximal [DDRISWT = 18.84–(0.09 × FEV1%pred)–(0.05 × DLCO%pred) + (3.10 × air trapping), Radjust2 = 0.33].Conclusion: Our results demonstrated that DDR is a useful tool for functional evaluation during maximal and submaximal exercises in patients with LAM, and it can be predicted using airway obstruction, reduced DLCO, and air trapping.

PURPOSE This study evaluated the accuracy of the Mini-Balance Evaluation System Test (Mini-BESTest) for predicting falls in patients with chronic obstructive pulmonary disease (COPD) and investigated whether postural balance is a risk factor for falls. METHODS Postural balance was evaluated by the Mini-BESTest at baseline, and the incidence of falls over a 12-mo period was prospectively measured by a self-reported falls diary and confirmed by telephone calls. A discriminative power analysis was performed using receiver operating characteristic (ROC) curve and logistic regression analysis. RESULTS Sixty-seven outpatients with COPD (mean age ± SD = 67 ± 9.3 yr) were included. Twenty-five patients (37.3%) experienced ≥1 fall, and 28.2% of the falls resulted in injuries. The Mini-BESTest predicted falls in patients with COPD at the 6- and 12-mo follow-ups with a cut-off score of 22.5 (area under the curve = 0.85 and 0.87) with good sensitivity and specificity (85.7% and 66.7%; 84% and 73.8%, respectively). Higher scores on the Mini-BESTest were associated with a lower risk of falls at 12 mo (OR = 0.50; 95% CI, 0.36-0.70; P < .001). CONCLUSIONS Postural balance assessed by the Mini-BESTest is a good predictor of falls in patients with COPD. Our results imply that impaired balance contributes to the risk of falling and that balance training and fall prevention programs may be required for this population.

Bronchodilators (BD) are prescribed for subjects with bronchiectasis (BCT). BDs improve exercise capacity in subjects with COPD; however, its effect in subjects with BCT remains unknown. Objectives: to evaluate the effect of BD in the exercise capacity and thoracoabdominal mechanics in subjects with BCT. Methods: This randomized crossover, double-blinded, placebo-controlled trial included subjects with BCT clinically stable. Subjects performed a cardiopulmonary exercise test and a constant load exercise test (CLET, 75%Wmax) to assess endurance time (Tlim) concurrently to the thoracoabdominal mechanics. BD or placebo was used in a random order, one week apart. Total and compartmental pulmonary volumes, as well as thoracoabdominal asynchrony (TAA), were evaluated. Tlim time, Borg fatigue (F) and dyspnea (D), and peripheral oxygen saturation (SpO2) were also assessed. Results: Ten subjects were included (48±11yrs, 25.6±4kg/m2). No difference in vital signs, dyspnea and SpO2 was observed before CLET between BD and placebo. At the end of CLET, Tlim and SpO2 were higher using BD compared to placebo (342±119 vs 287±102sec, p Conclusion: BD in subjects with BCT improves exercise capacity and reduces dyspnea and fatigue symptoms. However, the mechanism for such improvement remains unknown.

Several respiratory diseases are characterized by hypersecretion, requiring airway clearance therapy (ACT). Oral high-frequency oscillation (OHFO) devices are effective to enable daily ACT; however, they are still too expensive to become available for low-income patients. We sought to develop a low-cost device (OHFO-LC) and compare its physical properties with those OHFO commercially available (Shaker and Flutter). The OHFO-LC was developed from polyvinyl chloride material and one stainless steel sphere. Pressures and frequencies were measured at flows of 4, 6, 8, 10 and 15L/min. Pressures at the mouthpieces were measured by a transducer connected to a microcomputer. The oscillation frequencies were obtained from the graph of the pressure. The frequencies and pressures were compared among groups using one-way Anova and Tukey’s post hoc tests, p≤0.05. There were no differences among the frequencies of the three devices in all tested flows. The OHFO-LC device showed a higher positive expiratory pressure compared with the Shaker at all tested flows (4 L/min: 4.7±1.2 vs. 1.0±0.2 cmH2O; 6 L/min: 8.6±1.5 vs. 3.5±0.5 cmH2O; 8 L/min: 10.8±1.6 vs. 5.4±0.2 cmH2O; 10 L/min: 13.5±1.2 vs. 7.7±0.4 cmH2O; 15 L/min: 14.3±1.1 vs. 7.8±0.2 cmH2O; OHFO-LC vs. Shaker; p≤0.05) and at 10 and 15 L/min compared with Flutter (10 L/min: 13.5±1.2 vs. 7.5±1.2 cmH2O; 15 L/min: 14.3±1.1 vs. 8.2±1.2 cmH2O; OHFO-LC vs. Flutter, p≤0.05). The cost of the OHFO-LC device was much lower than both the Shaker and the Flutter. Our results showed that the OHFO-LC had physical properties with similar frequencies but higher pressures than other OHFO devices that are commercially available. Future studies are necessary to evaluate its clinical efficacy. RESUMO Diversas doenças respiratórias são caracterizadas por hipersecreção com necessidade de higiene brônquica (HB). Osciladores orais de alta frequência (OOAF) são dispositivos que promovem HB diária; entretanto, seu custo pode ser inviável para aquisição por pacientes com baixa renda. Os objetivos deste estudo foram: desenvolver um OOAF de baixo custo (OOAF-BC) e comparar suas propriedades físicas com as dos disponíveis comercialmente (Shaker e Flutter). O OOAF-BC foi desenvolvido com material de polivinil clorido e uma esfera de aço inoxidável. As pressões e frequências foram mensuradas nos fluxos de 4, 6, 8, 10 e 15 L/min. As pressões nos bocais foram medidas por um transdutor conectado ao computador. As frequências de oscilação foram derivadas do gráfico de pressão. A comparação dos dispositivos foi feita por Anova com post hoc de Tukey, p≤0.05. Não houve diferença entre as frequências dos três dispositivos em todos os fluxos testados. O OOAF-BC apresentou pressão mais alta comparado ao Shaker em todos os fluxos testados (4 L/min: 4,7±1,2 vs. 1,0±0,2 cmH2O; 6 L/min: 8,6±1,5 vs. 3,5±0,5 cmH2O; 8 L/min: 10,8±1,6 vs. 5,4±0.2 cmH2O; 10 L/min: 13,5±1,2 vs. 7,7±0.4 cmH2O; 15 L/min: 14,3±1,1 vs. 7,8±0,2 cmH2O; OOAF-BC vs. Shaker; p≤0.05) e nos fluxos de 10 e 15 L/min comparado ao Flutter (10 L/min: 13,5±1,2 vs. 7,5±1,2 cmH2O; 15 L/min: 14,3±1,1 vs. 8,2±1,2 cmH2O; OOAF-BC vs. Flutter, p≤0.05). O custo do OOAF-BC foi pelo menos seis vezes menor. O OOAF-BC apresentou frequências similares e pressões mais altas que os outros OOAF comercialmente disponíveis. Estudos futuros são necessários para avaliar sua eficácia clínica. RESUMEN Varias enfermedades respiratorias se caracterizan por hipersecreción, que requiere higiene bronquial (HB). Los osciladores orales de alta frecuencia (OOAF) son dispositivos que promueven la HB diaria; sin embargo, su costo puede no ser factible para la adquisición por parte de pacientes con bajos ingresos. Los objetivos de este estudio fueron desarrollar un OOAF de bajo costo (OOAF-BC) y comparar sus propiedades físicas con las de los disponibles comercialmente (Shaker y Flutter). El OOAF-BC se desarrolló con material de polivinilo clorado y una bola de acero inoxidable. Las presiones y frecuencias se midieron en flujos de 4, 6, 8, 10 y 15 L/min. Las presiones de la boquilla se midieron mediante un transductor conectado a la computadora. Las frecuencias de oscilación se derivaron del gráfico de presión. Se compararon los dispositivos con la utilización de Anova con post hoc de Tukey, p≤0,05. No hubo diferencias entre las frecuencias de los tres dispositivos en todos los flujos probados. El OOAF-BC mostró una presión más alta en comparación con Shaker en todos los flujos probados (4 L/min: 4,7±1,2 vs. 1,0±0,2 cmH2O; 6 L/min: 8,6±1,5 vs. 3,5±0,5 cmH2O; 8 L/min: 10,8±1,6 vs. 5,4±0,2 cmH2O; 10 L/min: 13,5±1,2 vs. 7,7±0,4 cmH2O; 15 L/min: 14,3±1,1 vs. 7,8±0,2 cmH2O; OOAF-BC vs. Shaker; p≤0,05) y con flujos de 10 y 15 L/min en comparación con Flutter (10 L/min: 13,5±1,2 vs. 7,5±1,2 cmH2O; 15 L/min: 14,3±1,1 vs. 8,2±1,2 cmH2O; OOAF-BC vs. Flutter, p≤0,05). El costo de OOAF-BC fue al menos seis veces menor. El OOAF-BC mostró frecuencias similares y presiones más altas que otros OOAF disponibles comercialmente. Se necesitan estudios futuros para evaluar su eficacia clínica.

Immunosenescence are alterations on immune system that occurs throughout an individual life. The main characteristic of this process is replicative senescence, evaluated by telomere shortening. Several factors implicate on telomere shortening, such as smoking. In this study, we evaluated the influence of smoking and Chronic Obstructive Pulmonary Disease (COPD) on cytokines, telomere length and telomerase activity. Blood samples were collected from subjects aged over 60 years old: Healthy (never smokers), Smokers (smoking for over 30 years) and COPDs (ex-smokers for ≥15 years). A young group was included as control. PBMCs were cultured for assessment of telomerase activity using RT-PCR, and cytokines secretion flow cytometry. CD4+ and CD8+ purified lymphocytes were used to assess telomere length using FlowFISH. We observed that COPD patients have accelerated telomere shortening. Paradoxically, smokers without lung damage showed preserved telomere length, suggesting that tobacco smoking may affect regulatory mechanisms, such as telomerase. Telomerase activity showed diminished activity in COPDs, while Smokers showed increased activity compared to COPDs and Healthy groups. Extracellular environment reflected this unbalance, indicated by an anti-inflammatory profile in Smokers, while COPDs showed an inflammatory prone profile. Further studies focusing on telomeric maintenance may unveil mechanisms that are associated with cancer under long-term smoking.

Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD. NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.

OBJECTIVE Lung expansion techniques (LETs) are widely used to prevent postoperative pulmonary complications (PPCs). However, the effects of each of these techniques on thoracoabdominal mechanics and PPC incidence after abdominal surgery remain unclear. The objective of this study was to compare the effects of LET on pulmonary volumes, respiratory muscle activation, and PPC incidence after major, elective upper abdominal surgery. METHODS This randomized controlled trial enrolled 137 patients who were randomly assigned into four groups: control (n = 35), flow incentive spirometry (n = 33), deep breathing (n = 35), and volume incentive spirometry (n = 34). Each intervention was performed tid during 5 consecutive days. Subsequently, PPCs (pneumonia, atelectasis, or severe hypoxemia) were analyzed by a blinded assessor until hospital discharge. Lung volumes (optoelectronic plethysmography) and inspiratory muscular activation (surface electromyography) were assessed before and 3 days after surgery. Intention-to-treat analysis was performed. RESULTS Before surgery, all groups were homogenous for age, sex, BMI, lung function, and thoracoabdominal mechanics. After surgery, no difference was observed in the lung volumes and inspiratory muscular activation during the lung expansion technique (P ≥ .05). The PPC incidence was higher in the deep breathing group (P CONCLUSIONS LETs do not modify the changes on thoracoabdominal mechanics or prevent PPCs after abdominal surgery. The indiscriminate use of LETs should not be routinely prescribed to prevent PPCs; however, more studies are required to confirm our results and to change the standard practice. TRIAL REGISTRY ClinicalTrials.gov ; No.: NCT01993602; URL: www.clinicaltrials.gov

Exercise training has been shown to reduce symptoms and exacerbations in COPD patients; however, the exercise effect on patients’ immune response is poorly known. We thus verified if an exercise program (EP) impacted on proliferative T cell response of COPD patients. Fourteen non-O2 dependent COPD patients on standard treatment were studied. EP consisted in 24 sessions of aerobic and muscular training. Peripheral blood mononuclear cells were stimulated with the mitogen phytohemagglutinin and antigens from Haemophilus influenzae and cytomegalovirus, and the lymphocyte proliferative response (LPR) was assessed through the expression of Ki67 before and after the EP. The Quality of life [COPD assessment test (CAT)], dyspnea [(modified Medical Research Council scale (mMRC)], and 6-min walk distance were also assessed. The EP program increased significantly the LPR of TCD4+ lymphocytes to phytohemagglutinin and cytomegalovirus and H. influenzae antigens, but with TCD8+ lymphocytes the increase was less marked. Consistent with this, a higher proportion of TCD8+ than TCD4+ cells did not express the costimulatory molecule CD28. The EP also resulted in improvement of the quality of life, dyspnea, and physical capacity. The improvement in TCD4+ cell function may represent an additional mechanism through which the EP results in less exacerbations and hospitalizations.

Background Thoracoabdominal asynchrony is the nonparallel motion of the ribcage and abdomen. It is estimated by using respiratory inductive plethysmography and, recently, using optoelectronic plethysmography; however the agreement of measurements between these 2 techniques is unknown. Therefore, the present study compared respiratory inductive plethysmography with optoelectronic plethysmography for measuring thoracoabdominal asynchrony to see if the measurements were similar or different. Methods 27 individuals (9 healthy subjects, 9 patients with interstitial lung disease, and 9 with chronic obstructive pulmonary disease performed 2 cycle ergometer tests with respiratory inductive plethysmography or optoelectronic plethysmography in a random order. Thoracoabdominal asynchrony was evaluated at rest, and at 50% and 75% of maximal workload between the superior ribcage and abdomen using a phase angle. Results Thoracoabdominal asynchrony values were very similar in both approaches not only at rest but also with exercise, with no statistical difference. There was a good correlation between the methods and the Phase angle values were within the limits of agreement in the Bland-Altman analysis. Conclusion Thoracoabdominal asynchrony measured by optoelectronic plethysmography and respiratory inductive plethysmography results in similar values and has a satisfactory agreement at rest and even for different exercise intensities in these groups.

Background: Incentive spirometers (IS) are widely used in clinical practice and classified as flow-oriented (FIS) and volumetric (VIS). Until recently, the respiratory inductive plethysmography used to evaluate the effects of IS on chest wall mechanics presented limitations, which may explain why the impact of VIS and FIS remains poorly known. Objective: We compared the effects of the VIS and FIS on thoracoabdominal mechanics and respiratory muscular activity in healthy volunteers. Methods: This cross-sectional trial assessed 20 subjects, 60% female, aged between 20 and 40 years and with a body mass index (BMI) between 20 and 30 kg/m2. All participants performed 8 quiet and 8 deep breaths using both FIS and VIS in a randomized order. The outcomes measured were the thoracoabdominal kinematics (i.e., chest wall, upper and lower ribcage and abdominal volumes), assessed using Optoelectronic Plethysmography, and the muscular activity of the sternocleidomastoid and superior and inferior intercostal muscles, assessed using electromyography. The statistical analysis was performed with one-way repeated measures ANOVA, and the significance level was set to 5%. Results: VIS increased 17 the chest wall volume to a greater extent than the FIS (p=0.007) and induced a larger increase in the upper and lower ribcages and abdomen (respectively, 156%, 91% and 151% p

COPD patients are susceptible to falls due to balance deficits; however, the sensory impairments due to age or disease remain poorly known. Aim: To investigate the effect of aging and pulmonary disease on the balance in COPD patients in sensory impairment conditions. Methods: 30 COPD patients (64±8 yrs; FEV 1 39±14 %predicted), 30 healthy adults matched for gender and age (64±8 yrs) and 30 young controls (25±5 yrs) were submitted to a computerized dynamic posturography. The assessment of balance control was conducted in four distinct sensory conditions: open eyes-fixed surface, closed eyes-fixed surface, open eyes-sway surface and closed eyes-sway surface. The variables evaluated were: maximal amplitude from the centre of pressure (COPamp), mean velocity of the path of the centre of pressure (COPvm) and COP asymmetry, all in the anteroposterior direction. ANOVA 3-way test was used for comparison among groups. Results: COPD patients had a worse balance compared to the healthy adult and young controls in sway surface in COPamp (8.7±3.8cm, 8.0±4cm and 6.2±3cm, respectively; p Conclusion: COPD patients have more instability in the anteroposterior direction in sensory impairment conditions as a result of age and disease, which implies a greater possibility of falling and suggests the need to therapeutic changes.

COPD patients have impaired balance and pulmonary hyperinflation could contribute to balance deficits in this population. Aim: To evaluate the relationship between postural balance and pulmonary hyperinflation in COPD patients. Methods: 67 patients were included (12% mild, 44% moderate and 44% severe COPD). Postural balance was evaluated by centre of pressure displacement analysis using a portable force platform in 3 different sensory conditions: standing with eyes open, eyes closed and on a foam surface with open eyes. The variables analysed included total path length, path velocity and amplitude, in both anteroposterior (AP) and mediolateral (ML) directions. Pulmonary hyperinflation was evaluated using body plethysmography. Participants were classified into 2 groups: hyperinflated (Total lung capacity >120% predicted) and non-hyperinflated. The Mann-Whitney-U-test was used for group comparison. Results: The hyperinflated patients (N=23; 64.8±9.7 yrs; FEV 1 35.1±12.0% predicted) presented a smaller postural balance variation compared to non-hyperinflated patients (N=44; 67.5±8.8 yrs; FEV 1 46.7±13.8% predicted) in the total path length (28.7±10.7cm vs. 32.8±8.3cm, p=0.02), in the amplitude (1.95±0.95cm vs. 2.26±0.87cm, p=0.016) and path velocity (0.74±0.26cm/s vs. 0.88±0.24cm/s, p=0.01), respectively, in the AP direction in the condition standing with eyes open. No significant difference between groups were observed in the ML direction or for the more difficult tests (p>0.05). Conclusion: Hyperinflated COPD patients present less displacement in the anteroposterior direction possibly due to change in the centre of pressure. This lower displacement may have implications for falls.

BACKGROUND: Advances in information technology have been widely used in teaching health care professionals. The use of multimedia resources may be important for clinical learning and we are not aware of previous reports using such technology in respiratory physical therapy education. Objectives: Our approach was to evaluate a conventional bronchial hygiene techniques (BHTs) course with an interactive online environment, including multimedia resources. METHODS: Previous developed audiovisual support material comprised: physiology, physiopathology and BHTs, accessible to students through the Internet in conjunction with BHTs classes. Two groups of students were compared and both attended regular classes: the on-line group (n=8) received access to online resources, while the control group (n=8) received conventional written material. Student's performance was evaluated before and after the course. RESULTS: A preliminary test (score 0 to 10) was applied before the beginning of the course, showing that the initial knowledge of both groups was comparable [online, 6.75 (SD=0.88) vs. control, 6.125 (SD=1.35); p>0.05]. Two weeks after the end of the course, a second test showed that the online group performed significantly better than the control group [respectively, 7.75 (SD=1.28) vs. 5.93 (SD=0.72); p>0.05]. CONCLUSIONS: The use of a multimedia online resource had a positive impact on student's learning in respiratory therapy field in which instrumental and manual resources are often used and can be explored using this technology.

BACKGROUND: The Objective Structured Clinical Evaluation (OSCE) has been considered a reliable method for the evaluation of students' clinical skills in health sciences, but it has been rarely applied in the teaching of physical therapy. OBJECTIVE: To assess the use of the OSCE as a tool to evaluate the abilities of undergraduate chest physical therapy students and to verify the internal consistency of the OSCE exam. METHODS: Forty-seven students were evaluated using two types of exams: the traditional exam and the OSCE. Independent educators elaborated the exams. Each question (traditional) or station (OSCE) was given a score ranging from 0.0 to 2.0; being 10.0 the highest possible score of both exams. The relationship between the total score that were obtained from both exams was analyzed using Bland-Altman analysis and Pearson's correlation coefficient. The internal consistency of the OSCE stations was evaluated by four experienced chest physical therapists and it was tested using Cronbach's alpha. RESULTS: The students' average score on the OSCE ranged from 4.4 to 9.6. The internal consistency of the OSCE stations was considered good (0.7). The agreement between exams was analyzed, and it was determined that the exams are not comparable. Examiners also observed a low agreement between the two exams (r=-0.1; p=0.9). CONCLUSION: Our results showed that OSCE and traditional exams are not interchangeable. The OSCE exam had good internal consistency and is able to evaluate aspects that the traditional exam fails to evaluate. CONTEXTUALIZAÇÃO: A avaliação clínica objetiva e estruturada (OSCE) é considerada um método confiável para avaliar as competências clínicas de estudantes na área de saúde, entretanto tem sido pouco aplicada no ensino de fisioterapia. OBJETIVO: Analisar o uso da OSCE como uma ferramenta para avaliar as habilidades dos alunos de graduação em fisioterapia respiratória e verificar sua consistência interna. MÉTODOS: Quarenta e sete alunos foram avaliados por meio de dois exames: tradicional e OSCE. As provas foram elaboradas por educadores independentes. Para cada questão (tradicional) ou estação (OSCE), atribuiu-se uma pontuação de 0 a 2. A pontuação máxima possível em ambos os exames foi de 10. As relações entre as pontuações obtidas nos dois exames foram analisadas por meio de Bland-Altman e Correlação de Pearson. A consistência interna das estações da OSCE foi avaliada por quatro fisioterapeutas experientes e foi testada pelo Alfa de Cronbach. RESULTADOS: A pontuação média dos estudantes na OSCE oscilou entre 4,4 e 9,6. A consistência interna das estações da OSCE foi considerada boa (0,7). A concordância entre os exames foi analisada, e determinou-se que os exames não são comparáveis. Os examinadores também observaram uma baixa concordância entre os dois exames (r=-0,1, p=0,9). CONCLUSÃO: Nossos resultados mostraram que a OSCE e o exame tradicional não são intercambiáveis. O exame da OSCE teve uma boa consistência interna, sendo capaz de avaliar aspectos que o exame tradicional não avalia.

The mechanical alterations related to the overload of respiratory muscles observed in adults with persistent asthma might lead to the development of chronic alterations in posture, musculoskeletal dysfunction and pain; however, these changes remain poorly understood.This study aimed to assess postural alignment, muscle shortening and chronic pain in adults with persistent asthma.This cross-sectional and controlled study enrolled 30 patients with mild (n = 17) and severe (n = 13) persistent asthma. Fifteen non-asthmatic volunteers were also assessed. Asthma was classified by the Global Initiative for Asthma (GINA) guidelines. Postural alignment and muscle shortening were evaluated by head and shoulder positions, chest wall mobility, and posterior (trunk and lower limb) muscle flexibility. In addition, the measures used were previously tested for their reproducibility. Pain complaints were also assessed.In comparison with non-asthmatic subjects, patients with mild or severe persistent asthma held their head and shoulders more forward and had lower chest wall expansion, decreased shoulder internal rotation, and decreased thoracic spine flexibility. Chronic lower thoracic, cervical, and shoulder pain was significantly increased in patients with mild or severe asthma compared with non-asthmatic subjects (p0.05).Adults with persistent asthma have musculoskeletal dysfunction and chronic pain that is independent of the severity of their disease but that might be related to their age at the onset of disease symptoms.

As novas tecnologias da informação têm sido amplamente utilizadas no ensino em saúde. No entanto, não há descrição na literatura do desenvolvimento de recurso multimídia para o ensino de fisioterapia respiratória. O objetivo deste trabalho foi desenvolver material didático multimídia para o ensino de manobras de higiene brônquica (MHB) disponibilizado na internet. O material elaborado foi dividido em três módulos: Princípios fisiológicos, Fisiopatologia e MHB. O material foi disponibilizado em diversos formatos (páginas on-line, apostila e recursos audiovisuais) e inserido no sítio da internet Ambiente Colaborativo de Aprendizagem. A página on-line de introdução contém links para acesso aleatório aos módulos e um link para acesso à apostila. No módulo Princípios fisiológicos há links para informações sobre o aparelho mucociliar, produção do muco e fatores prejudiciais à defesa pulmonar. No módulo Fisiopatologia há links para informações sobre as principais doenças ou condições causadoras de hipersecreção pulmonar. No módulo MHB há links para informações sobre as manobras e para vídeos. Este recurso didático multimídia para o ensino de MHB, disponibilizado na internet, pode facilitar o aprendizado em fisioterapia respiratória. Entretanto, há necessidade de se avaliar sua efetividade.

As novas tecnologias da informação têm sido amplamente utilizadas no ensino em saúde. No entanto, não há descrição na literatura do desenvolvimento de recurso multimídia para o ensino de fisioterapia respiratória. O objetivo deste trabalho foi desenvolver material didático multimídia para o ensino de manobras de higiene brônquica (MHB) disponibilizado na internet. O material elaborado foi dividido em três módulos: Princípios fisiológicos, Fisiopatologia e MHB. O material foi disponibilizado em diversos formatos (páginas on-line, apostila e recursos audiovisuais) e inserido no sítio da internet Ambiente Colaborativo de Aprendizagem. A página on-line de introdução contém links para acesso aleatório aos módulos e um link para acesso à apostila. No módulo Princípios fisiológicos há links para informações sobre o aparelho mucociliar, produção do muco e fatores prejudiciais à defesa pulmonar. No módulo Fisiopatologia há links para informações sobre as principais doenças ou condições causadoras de hipersecreção pulmonar. No módulo MHB há links para informações sobre as manobras e para vídeos. Este recurso didático multimídia para o ensino de MHB, disponibilizado na internet, pode facilitar o aprendizado em fisioterapia respiratória. Entretanto, há necessidade de se avaliar sua efetividade.Advances in information technology have been widely used in teaching health care providers. However, no reports were found on its use in the instruction on respiratory therapy. The purpose here was to develop audiovisual supporting material for teaching bronchial hygiene techniques (BHT) available through the internet. The material was organized into three modules: Physiological principles, Physiopathology, and BHT. Each module is available in several formats (online page, booklet and audiovisual resources) and is inserted in a collaborative learning environment at the internet. The opening online page has links for random access to the modules and to the booklet. The Physiological principles module has links to information on the mucociliary system, mucous formation and factors that affect the defence mechanisms. The Physiopathology module has links to access information on diseases that lead to hypersecretion. The BHT module has links to access information on techniques and videos. This multimedia material for teaching BHT, available through the internet, may ease respiratory therapy learning. However, an evaluation of its effectiveness is needed.

COPD patients usually present thoracoabdominal asynchrony (TAA) that occurs due to an opposite motion among chest wall compartments decreasing tidal volume; however, the proper effect of TAA on chest wall volume remains unclear. Aim: to compare chest wall volume and respiratory kinematics among healthy and COPD patients with and without TAA. Methods: In this cross-sectional study 22 COPD (FEV 1 40±10%pred) and 13 healthy controls (FEV 1 98±14%pred) were assessed during rest and exercise (70% maximum workload) in a cycle ergometer. TAA was evaluated via optoelectronic plethysmography by calculating the phase angle (Lissajous approach) among upper and lower ribcage and abdomen. COPD patients were classified in two groups: those presenting asynchrony (TAA+) or not (TAA-) based on reference values of phase angle (mean ± 2*standard-deviation from controls). Chest wall volume and compartmental contribution were estimated. ANOVA was used for comparison. Results: Controls and COPD were homogenous for age, gender and BMI. Asynchrony occurred during rest and exercise in the lower ribcage. At rest, lower ribcage contribution was decreased in TAA+ compared to controls (9±10.7 vs. 18±9.2, p Conclusion: Thoracoabdominal asynchrony decreases chest wall volume in COPD and changes respiratory kinematics, decreasing lower ribcage and increasing abdominal contributions during exercise.