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Objective: to identify factors associated to sedentary behavior and physical inactivity in individuals with stable chronic obstructive pulmonary disease (COPD) non-infected by SARS-CoV-2 during the COVID-19 pandemic, and to identify possible favorable conditions during social isolation in individuals who performed pulmonary rehabilitation in the pre-pandemic period. Method: time/day in sedentary activities and moderate/vigorous physical activities (SA and MVPA, respectively), history of previous rehabilitation, laboural activity, symptoms, insecurity and quality of life (Medical Outcomes Study 36-item Short-Form Health Survey [SF-36]) were assessed during strict social isolation due to the COVID-19 pandemic. Individuals were classified as sedentary if presenting time/day in SA >8.5 h/day and physically inactive if presenting time/day in MVPA

ABSTRACT Purpose Swallowing impairment is a serious extra-pulmonary manifestation of Chronic Obstructive Pulmonary Disease (COPD). Previous studies suggest that individuals with stable COPD show atypical values for several videofluoroscopy measures of swallowing, compared to healthy adults under age 60. However, it is unclear to what degree these changes are attributable to healthy aging. In this study, we aimed to clarify how swallowing in people with stable COPD differs from age-matched healthy controls. Methods We performed a retrospective analysis of videofluoroscopy data from two previously-collected datasets: a) a sample of 28 adults with stable COPD (18 male); b) a sample of 76 healthy adults, from which 28 adults were selected, matched for sex and age to participants in the COPD cohort. In both prior studies, participants swallowed 20% w/v liquid barium prepared in different consistencies (thin; mildly, moderately, and extremely thick). Blinded duplicate ratings were performed according to a standard procedure, yielding measures of laryngeal vestibule closure (LVC) integrity and timing, swallow timing, upper esophageal sphincter (UES) opening, pharyngeal constriction and pharyngeal residue. Mann-Whitney U tests and odds ratios were performed to determine significant group differences (p

COPD has physical inactivity as a factor that worsens the physical condition. The importance of knowledge about the disease is noted so that patients can achieve adequate self-management and achieve the best quality of life. The objective is to compare the level of physical activity and knowledge of the disease between men and women with COPD. This is an analytical cross-sectional study, carried out in a pulmonology clinic in Goiânia-GO. The Bristol instructor was applied to assess the degree of knowledge about COPD and the pedometer to assess the level of daily physical activity. It had 38 men and 32 women, of which 60.5% of the men and 59.4% of the women were severely inactive, but no woman was classified as active, while 23.7% of the men received this classification. Regarding knowledge of COPD, there was no difference between men and women (p>0.05), they know more about the symptoms (3.45 ± 1.06 vs 3.37 ± 1.16) and the etiology (3. 58 ± 0.95 vs 3.59 ± 1.10) and know less about the medications: inhaled bronchodilators (0.71 ± 1.04 vs 1.03 ± 1.00) and inhaled corticosteroids (0.39 ± 0. 68 vs 0.53± 0.88). It was concluded that there was no statistical difference between men and women regarding the level of physical activity and knowledge about the disease. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the functional capacity through the 6-minutes walk test and the body mass level in patients with Chronic Pulmonary Obstructive Disease, Pulmonary Rehabilitation Program participants, in pre moments, 18 sessions and in the end of 36 sessions. Materials and Methods: In the Pulmonary Rehabilitation Program with 3 weekly sessions per a period of 12 weeks of combine exercises (aerobic and strength), it was realized the 6-minutes walk test, to check the functional capacity, before, 18 sessions and after 36 sessions of Pulmonary Rehabilitation; 20 patients diagnosed with CPOD (15 with moderate CPOD and 5 with grave CPOD) were evaluated; it was also checked the Body Mass Index (BMI) from patients in the same time. Results: It was checked distance covered increase in the 6-minutes walk test, in 18 sessions and in the end of 36 sessions from the program; it was checked the patients’ BMI decrease in the end of 36 sessions from rehabilitation program. Discussion: In 18 sessions, it was observed an improvement of 18.75%, as well as in 36 sessions the improvement was 29.47% of covered distance by patients in the 6-minutes walk test; after 18 sessions it has already happened a 3% decrease in BMI and also, with 36 sessions this decrease was 6.24%, showing that way the Pulmonary Rehabilitation Program’s efficiency. Conclusion: After 36 sessions, the pulmonary rehabilitation is effective in the improvement of functional capacity and in BMI decrease on patients with COPD.

Diabetes mellitus, smoking, and dyslipidemia are more prevalent in patients with chronic obstructive pulmonary disease (COPD), the fourth leading cause of mortality worldwide. This study employed a model of lung disease in Wistar rats that incorporated these three risk factors, and investigated the effects of Baccharis trimera, a widely used medicinal plant, since no previous studies have evaluated its pulmonary effects. The diabetic and dyslipidemic rats were exposed to smoke for 4 weeks and treated with vehicle (C-group), an extract of B. trimera (HEBT), or simvastatin+insulin, for 2 weeks. The bronchoalveolar lavage was performed to evaluate inflammation. The lungs were collected for histopathological and redox state analyses. A decrease in body weight, an increase in oxidative stress, inflammation, and histopathological changes were observed in C-group. HEBT reversed these alterations and had a moderate antiinflammatory effect. Treatment with HEBT present promising effects for COPD. [ABSTRACT FROM AUTHOR]

The work sought to find results consistent with the literature, which shows a cognitive and memory deficit in COPD patients. A cross-sectional study was carried out in patients with the pathology treated at a University Hospital. Group I, 40 patients with COPD according to GOLD criteria, Group II (control) of 40 individuals without respiratory pathologies. In Group I, the Peak Expiratory Flow averaged 249.7 L/min SpO2 presented an average of 97%, showing below 95% in 7.5% of the cases. Cognitive deficit was observed in 35% of patients with COPD; for memory, we observed 22.5% with low impairment, 32% with moderate impairment and 45% with severe impairment. In the control group, the Maximum Expiratory Flow had an average of 412.6 L/min and the average SpO2 of 98%. This group presented Cognitive Deficit in 12.5% of those analyzed. Evaluating the Memory Deficit in Group II, it was found that 57.5% had low impairment, 32.5% had moderate impairment and 10% had significant memory impairment. An inversely proportional variation was observed between COPD severity and Peak Expiratory Flow, Oximetry, Memory and Cognition data. Where lower values of Peak Expiratory Flow corresponded to a greater deficit in cognition and memory. [ABSTRACT FROM AUTHOR]

Pulmonary Rehabilitation is the non-pharmacological treatment indicated for people with COPD, with physical exercise and health education focused on the development of self-care and self-management, promoting physical, emotional condition, adherence to the therapeutic regime and quality of life. It is intended to demonstrate the effectiveness of a home PR program. Method: Quantitative case study that took place over 8 weeks, with biweekly multidisciplinary intervention, using exercise training, education sessions and telephone follow-up. Functional assessment was performed at admission and discharge, using the instruments Clinical CCQ Questionnaire, Sit and Stand Test (T S&L) and Barthel Index. Results: A 70-year-old man, diagnosed with COPD, performed 16 face-to-face training sessions as planned. It presented significant functional evolution: initial CCQ 4.5, final 3.2; T S&L initial 5, final 14; Initial Barthel index 55, final 90. Conclusion: The outlined pulmonary rehabilitation program demonstrated effectiveness and safety, promoting significant functional improvement.

ABSTRACT Objective To evaluate the association between adherence to treatment and mortality among Chronic Obstructive Pulmonary Disease (COPD) patients treated in the Brazilian public health system. Methods This is cohort study of moderate-to-severe COPD patients monitored in a public pharmaceutical care-based Disease Management Program (DMP). All subjects who died one year after the beginning of the cohort were age-matched with those who remained alive at the end of the cohort period. Treatment adherence was measured through pharmacy records. Patients who received at least 90% of the prescribed doses were considered adherent to treatment. Results Of the 333 patients (52.8% age ≥ 65 years, 67.9% male), 67.3% were adherent to treatment (adherence rate, 87.2%). Mortality was associated with lack of adherence (p = 0.04), presence of symptoms (mMRC ≥ 2) and COPD treatment use. The death was associated with non-adherence, presence of symptoms and previous hospitalization. After adjustment, non-adherent patients to treatment were almost twice times likely to die compared to those adherents (Hazard Ratio (HR) 1.86; CI 1.16-2.98, p = 0.01). Conclusion Non-adherence to treatment was associated with higher mortality among moderate-to-severe COPD patients treated in the Brazilian public health system. Strategies to monitor and optimize adherence should be strengthened to reduce COPD-related mortality.

Introduction: It is considered that the variability of respiratory symptoms in chronic obstructive pulmonary disease (COPD) is low or nonexistent; however, some authors state that there may be fluctuations. Objectives: To describe the variability of symptoms in patients with COPD throughout the day and night during four weeks using a patient diary, and to validate a questionnaire created for such purpose (the Colombian instrument for symptoms variability in COPD - COPD-CoVaSy). Materials and methods: Cohort study conducted in 96 patients with COPD treated between June and December, 2016, at the Centro de Atención Pulmonar - CAP, in Barranquilla, Colombia, who completed the patient diary for four weeks and, after this period, the self-administered COPD-CoVaSy instrument. The independence and comparison of frequencies of categorical and continuous variables were established using the chi-square and the Fisher's exact tests and the Pearson's correlation coefficient, respectively. A MANOVA was performed, using linear regression models, to determine the correlations between the results of the diary and those of the instrument. Results: Participants’ mean age was 73.3±8.3 years and 71.87% were male. According to the analysis of the diaries, the average scores (visual analog scale) for all symptoms and the performance of daily activities ranged between 0.5 and 2.5, being higher in the morning (with average scores between 1.5 and 2.5) than in the afternoon and evening (with average scores between 0.5 and 1.5); however, symptom variability was minimal. These results were similar to those obtained in the COPD-CoVaSy instrument, evidencing a high correlation between both instruments, which allowed confirming that COPD-CoVaSy is useful tool to measure such variability. Conclusions. Based on the findings of the present study, it can be concluded that there is a slight variability in COPD symptoms throughout the day, which should be considered when establishing treatment regimens for this disease. Likewise, it was determined that the COPD-CoVaSy is valid to measure such variability in Colombian patients with COPD.

Randomized controlled trials together with systematic reviews and meta-analyses have been the cornerstone of clinical research. Some studies, because of the size of the sample, the use of randomization and well-defined measurements, the participation of multiple institutions, or long-term follow-up, are able to give a significant level of evidence. We chronologically describe and comment on a group of trials on chronic obstructive pulmonary disease (COPD) that have significantly influenced the scientific and medical community in understanding and managing the disease in the first years of the XXI century. They contributed to the different versions of the GOLD strategy.

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Copyright of Revista Brasileira de Prescrição e Fisiologia do Exercício is the property of Instituto Brasileiro de Pesquisa e Ensino em Fisiologia do Exercicio and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic Obstructive Pulmonary Disease (COPD) is a common disease characterized by progressive airflow limitation, causing important functional impairment with repercussions on self-care. Previously characterized only by dyspnea, it is now recognized that a more comprehensive assessment is needed leading GOLD to recommend the COPD Assessment Test (CAT). Pulmonary Rehabilitation (PR) is the non-pharmacological treatment recommended in this context, and for that reason the goal of this investigation is to understand its effect on CAT as well as its relation with CF. Quasi-Experimental study that includes COPD patients admitted to PR and the impact of CAT and CF was assessed at the beginning and at the end of the PR program. Forty five patients were included (80% men), mean age 65.82 years and mean FEV1% of 40%. Statistical and clinically significant improvements were found (p < 0.001) in both CAT and CF, with a moderate negative correlation. We conclude that this PR program reduces symptoms and increases functional capacity in people with COPD.

Abstract Background and objectives: Ultrasound-guided thoracic paravertebral block is usually considered a good alternative to epidural thoracic for anesthesia and pain control in thoracic and breast surgery. Furthermore it has also been used during abdominal surgery lately, especially hepatic and renal surgery. However, its role is poorly defined in this context. The purpose of this report was to highlight the role of thoracic paravertebral block in providing effective anesthesia and analgesia during both the abdominal surgical intervention and pain control in post-operative period, avoiding possible complications which general anesthesia may arise, which are fairly common in patients with chronic obstructive pulmonary disease and similar comorbidities. Case report: The authors present a case of abdominal surgery successfully performed on a woman affected by severe chronic obstructive pulmonary disease requiring closed loop ileostomy repair performed with ultrasound guided thoracic paravertebral block without any complications. Conclusions: Thoracic paravertebral block may be a safe anesthetic method for abdominal surgery in those patients who would undergo potential severe complications by using general anesthesia.

Objective: To translate, culturally adapt the hospital discharge checklist proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and develop a form that allows a standardized assessment of important items at hospital discharge of patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: A methodological study performed in patients at the time of hospital discharge after decompensation for Chronic Obstructive Pulmonary Disease (COPD) in three hospitals in the city of Goiânia. The translation and cultural adaptation of the checklist proposed by GOLD was carried out, containing seven items to be evaluated at the time of hospital discharge for two pulmonologists, then the retranslation of the same by English-speaking professional and then created a final version in Portuguese. To assess the reproducibility and responsiveness of the document created, the same was applied in ten patients by two researchers. The kappa coefficient for statistical analysis of reliability was used. Results: After the translation and cultural adaptation of the discharge checklist proposed by GOLD, a standardized form was prepared for measuring all seven items in the checklist. The kappa coefficient is equal to 1 for all seven items of the document. Conclusion: The standardized form for evaluating the items of the hospital discharge checklist proposed by GOLD was reproducible, reliable and fast to use, and can be used by a multidisciplinary team at discharge from patients hospitalized for COPD, thus allowing a standardized verification of Essential for the best management of these patients.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is defined as a chronic airflow obstruction. Objective: To evaluate the level of physical activity, quality of life, dyspnea and degree of obstruction in patients with COPD. Methods: The research is observational, descriptive and prospective. Patients with COPD were evaluated. Anthropometric and clinical data were collected and the Medical Research Council (MRC), International Questionnaire of Physical Activity (IPAQ) and the Saint George's Respiratory Questionnaire (SGRQ) quality of life questionnaire were applied. Results: Sixtyfive participants (55%) (33) were male and 45% (27) were female, mean age 69.1(9.67) years, height 1.63(0.09)cm and weight of 67.01(16.56) kg. Regarding the stage of the disease, 13.3% (8) had stage 1, 35% (21) stage 2, 31.6% (19) stage 3 and 20% (4) stage 4. They were sedentary 81, 6% (49) and only 18.3% (11) assets. In the degree of dyspnea given by MRC, 16.6% (10) had grade I, 16.6% (10) grade II, 35% (21) grade III, 23.3% (14) grade IV and 8% (5) grade V. Regarding quality of life assessed by the SGRQ, a significant reduction is observed in all domains. Being the scores found for the domain symptom was 45.56(25.64), for the activity was 64.50(23.33), for the impact was 45.02(23.04), and the overall was 51.01(23,25). Conclusion: It was possible to observe that the majority of the patients with COPD evaluated are in stage II of the disease, are sedentary, have an important degree of dyspnea and poor quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Ciência e Movimento: RBCM is the property of Revista Brasileira de Ciencia e Movimento and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To review the literature on the influence of physical training on dyspnea, functional capacity and quality of life of patients with COPD. Methods: We conducted literature in Scielo databases, Lilacs and Google Scholar using the terms: COPD, quality of life, physical training, dyspnoea and functional capacity. Three books available at the College of Higher Education Catalão were also used Discussion: Scientific evidence found in the survey showed that among different therapeutic modalities for patients with COPD, exercise is a behavior that has been proven effective in treating these individuals, since it generates several benefits that result in improving the quality of life of the . Conclusion: Physical training is effective in rehabilitation of patients with COPD, acting in improving peripheral muscle strength, decreased dyspnea and muscle fatigue, increased exercise tolerance, improvement in functional capacity and quality of life of these individuals.

Objective: To determine the prevalence and predictors of incorrect use of inhalers in ambulatory patients with chronic obstructive pulmonary disease (COPD). Methods: We conducted a crosssectional study in COPD patients attending an out-patient primary health unit of in Anápolis- Goiás. Results: The average number of errors was statistically different in relation to the number of devices in use (p = 0.02). It was observed that the mean error between the group that used one inhaled device was significantly lower than the group that used three inhalers devices. A correlation analysis showed that there was a negative correlation between the number of errors and post BD FEV1 in liters (r = 0.55; p = 0.004), and a linear regression showed that the number of errors can be predicted using pos-BD FEV1 in liters (p = 0.004), being inversely related to number of errors when using the device. Conclusion: We conclude that the number of inhalers and severity of respiratory disease are predictors of incorrect use of inhalation devices in patients with COPD

COPD (chronic obstructive pulmonary disease) is a disease in which occurs an obstruction of respiratory tracts. The aim of the present paper is to determine the occurrence and to compare the epidemiologic profile of patients diagnosed with COPD in Caratinga, Minas Gerais, between September 2016 and September 2017. The method used was a cross-sectional epidemiologic research, which is an individual analytic study with the patents from Caratinga. The results obtained show that considering the socioeconomic profile of the sample studied, there is a predominance of women, which represents 55% of the cases. Additionally, the predominance of the disease occurs at their 70s (40%). Based on the data obtained, most patients (45%) were attended by the partnership with the city of Caratinga. It is also observed that most patients diagnosed with COPD were smokers (65%). It is also noteworthy to add that 55% of the patients presented Systemic Arterial Hypertension (SAH). Furthermore, it was possible to observe a high percentage of thoracic X-ray solicitation, corresponding to 41,7% of the exams requested. [ABSTRACT FROM AUTHOR]

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Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic disease related to various systemic manifestations including dyspnea, exercise intolerance and peripheral muscular dysfunction, with a direct impact on functional capacity. Objectives: To describe a whole body vibration exercises (WBVE) protocol to verify the clinical benefits, and the potential of exacerbation of the disease. Methods: Individuals diagnosed with COPD, aged = 40 years, will be randomly distributed into 4 groups: control group (CG) who will not undergo WBVE, with their normal daily routine, group who will be exposed to WBVE in the sitting position in an auxiliary chair once a week (GS1) and twice a week (GS2) and WBVE group twice a week in the standing position with knee flexion (GP2). The protocol will last 6 weeks, each session will have 5 sets of 1 min vibration with 1 min rest, frequency 25 Hz and peak-to-peak displacement 2.5 mm. Muscle strength and function will be assessed through manual dynamometry and surface electromyography and dyspnea using the Modified Borg Scale (MBS) and the Medical Research Council (MRC) Scale. Discussion: WBVE, due to the various effects already described, seem to be a promising exercise modality for individuals with COPD, potentially being used as an instrument for pulmonary rehabilitation. Conclusions: The results of this study may provide evidence to justify a WBVE program to the improvement on the physical performance and on neuromuscular function of individuals with COPD. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a clinical entity characterized by the presence of airflow obstruction, presenting slow and irreversible progression, characterized by being a multisystemic condition that leads to a decrease in the tolerance to the exercise of the patient pneumopath. Due to all these damages, a physical exercise program is needed that aims both to improve the quality of life and the exercise capacity of these patients. The aim of this study was to compare the exercise capacity of patients with COPD and healthy individuals. The study was carried out at the Ambulatory of Cardiopulmonary Physiotherapy of the University of Paranaense in the city of Umuarama Campus - Headquarters, where 20 individuals of both sexes were studied, 10 of whom had COPD who underwent a physical exercise program with a mean age of 65, 7 - 4.70 years and 10 healthy individuals, who practiced physical activity for the elderly, with a mean age of 66.9 - 9.92 years. Exercise capacity was assessed through the 6-Minute Walk Test (TC6min). Both groups were anthropometrically similar. Regarding exercise capacity, the distance covered in meters in patients with COPD was 481.90 - 100.06, while in healthy subjects it was 556.90 - 46.93, but COPD patients are above Of the predicted average. It can be concluded that a physical exercise program, in the present study, has shown to be efficient in the treatment of patients with COPD, maintaining their physical fitness within the parameters of normality. [ABSTRACT FROM AUTHOR]

Objectivo: Identificar o estado da arte acerca da influência da percepção da doença na promoção do auto controlo em doentes com DPOC. Métodos: Realizamos uma revisão sistemática da literatura, recorrendo ao método PICOS; a revisão sistemática da literatura engloba os anos 2004 a 2009 e foi realizada entre Agosto e Setembro de 2009. Resultados: Quatro artigos preencheram os critérios de inclusão, dos quais um de revisão da literatura e três estudos qualitativos. Doentes com maior percepção de controlo da doença e com maior auto-eficácia, com situações emocionais estáveis, apresentam melhores resultados no autocontrolo da doença. A avaliação, discussão e clarificação das crenças, atitudes e do impacto destas sobre a autoconfiança e auto controlo, devem ser integradas na prática clínica. Conclusão: A percepção da falta de controlo sobre a evolução da doença contribui para a menor qualidade de vida, gera ansiedade, leva ao isolamento social, pode conduzir à depressão e reduz a motivação para a aquisição de conhecimentos e capacidades para o autocontrolo da doença. A desmotivação, a incapacidade em reconhecer, as capacidades cognitivas, instrumentais ou de suporte social e suporte dos profissionais de saúde, potencia o fraco autocontrolo da doença e a não adesão ao regime terapêutico.Objective: Identify the state of the art about the influence of illness perceptions in the promotion of self-management in patients with COPD. Method: We conducted a systematic review of the literature, using the method of PICOS, the systematic literature review includes the years 2004 to 2009 and was conducted between August and September 2009. Results: Four articles met the inclusion criteria, including a review of the literature and three qualitative studies. Clients with higher perception of disease control and greater self-efficacy, with stable emotional situations, have better results in self-control of the disease. The evaluation, discussion and clarification of beliefs, attitudes and their impact on self-confidence and self -control should be integrated into clinical practice. Conclusion: The perceived lack of control over the course of the disease contributes to reduced quality of life, creates anxiety, leads to social isolation, can lead to depression, and reduces the motivation to acquire knowledge and skills for self -control disease. The lack of motivation, the inability to recognize the cognitive, instrumental capabilities, social support and support of health professionals, power the low self -control of the disease and non -adherence to therapy.

Introducción: Las enfermedades cardio respiratorias están entre las entidades con mayor carga en incapacidad y muerte en el mundo. La administración de oxigeno a largo plazo en hipoxemia crónica severa mejora la sobrevida, sin embargo, es una terapia costosa e implica una carga económica para los sistemas de salud. En Colombia los costos de esta terapia no han sido cuantificados. Objetivo: Describir los costos de la administración de oxígeno a largo plazo en un grupo de pacientes inscritos en un programa de oxigeno domiciliario en Pereira, Colombia. Materiales y métodos: Estudio descriptivo prospectivo. Se describen las características clínicas y se calculan los costos de la administración de: oxígeno, medicamentos, vacunación, nebulizaciones y atención hospitalaria. Resultados: Un total de 215 pacientes fueron evaluados con una mediana de edad de 70 años, el 78,1% tenían enfermedad pulmonar obstructiva crónica, la mediana de PaO2 fue de 50 mmHg. El promedio del consumo mensual de oxígeno fue 4 cilindros al mes, 28,3% de los pacientes cumplían con las 15 horas de utilización al día. Finalmente el costo anual por consumo de oxígeno fue 322,200 US y del programa 561,555 US (Hospitalización 188,650 US, Medicamentos 17,670 US, Urgencias 16,445 US, Nebulizaciones 14,040 US, Vacunación 2,550 US). Conclusión: Los costos de la terapia con oxígeno domiciliario a largo plazo son altos, debe optimizarse la prescripción, la adherencia de los pacientes al tratamiento y la aplicación de las guías de práctica clínica para lograr una adecuada utilización de los recursos evitando costos excesivos. Salud UIS 2010; 42: 48-54Introduction: Cardio-respiratory diseases are the largest causes of death and disability in the world. Long-term oxygen therapy in severe chronic hypoxemic improves survival, however, it is one expensive therapy and exert a large burden on the health systems. In Colombia the cost of this therapy are not quantified. Objective: Describe the costs of the administering long-term oxygen in a group of patients enrolled in a program of domiciliary oxygen in Pereira, Colombia. Material and methods: Study prospective descriptive. We describe the clinical characteristics and calculated the costs of administration of: oxygen, medication, vaccination, nebulization and hospital care. Results: A total of 215 patients were evaluated with a median age of 70 years, 78.1%% had chronic obstructive pulmonary disease, median PaO2 was 50 mmHg. The average monthly consumption of oxygen was 4 cylinders per month, 28.3% of patients met the 15 hours of use per day. Finally, the annual cost of oxygen consumption was 322,200 US. and 561.555 US. program (Hospitalization 188,650 US, 17.670 US Drugs, Emergency 16.445US, Nebulization 14.040 US, Vaccinations 2.550 US). Conclusion: The costs of therapy with long-term home oxygen are high, needs to be optimized prescription, patient adherence to treatment and application of clinical practice guidelines to ensure proper utilization of resources by avoiding excessive costs. Salud UIS 2010; 42: 48-54.

Com o objectivo de identificar parâmetros funcionais respiratórios que contribuam para o diagnóstico diferencial entre asma e DPOC, estudámos 20 asmáticos e 30 bronquíticos, com ou sem enfisema, com os exames usuais de função pulmonar: espirografia, pletismografia e DLCO, pré e pós-broncodilatação para os dois primeiros exames. Os grupos apresentam diferenças significativas na sua constituição. Os asmáticos são mais jovens, média de 48 anos, contra 59 anos no grupo com DPOC, e o grupo é constituído predominantemente por mulheres, 65% contra 40%, respectivamente. Os exames funcionais pulmonares, realizados conforme as directrizes internacionais, mostram, pela espirografia, que os asmáticos têm obstrução mais intensa, VEF1/CVF de 59 versus 66 e maior resposta broncodilatadora pelo VEF1, quer em valor absoluto, quer por variação percentual, do basal (%) ou do valor previsto (%P). A DLCO mostra-se, em média, normal entre os asmáticos, 103%P, e diminuída no grupo com DPOC, 69%P. Na pletismografia constatámos que os asmáticos têm maior volume residual (%P) e resistência de vias aéreas. Concluímos que vários parâmetros funcionais diferenciam a asma da DPOC, como um grupo; na análise individual, a DLCO é o parâmetro que melhor discrimina as duas doenças, possuindo maior especificidade para o diagnóstico de DPOC, seguida pelas variações de VEF1 na broncodilatação, com maior sensibilidade para o diagnóstico de asma. Desta forma, estes dois exames são destaque no diagnóstico diferencial das doenças obstrutivas.The aim of this study was to identify the respiratory function parameters that help in the accurate diagnosis of asthma and COPD. We studied 20 asthma and 30 COPD patients who underwent lung function tests including spirometry and plethysmography both with bronchodilator test and diffusion with carbon monoxide (DLCO). The tests were performed according to International Guidelines (ATS/ERS). The asthma patients were younger (mean age = 48) than those in the COPD group (mean age = 59) and this group also had more female patients (65%) than theCOPD group (40%). The results showed a more severe obstruction in the asthma group: FEV1/FVC= 59% versus 66% for COPD. There was also a greater bronchodilator response as shown by changes in absolute and percentage values for FEV1 in the asthma group. Average DLCO values were normal in the asthma group (103%P) and lower in the COPD (69%). In plethysmography the asthma group had a higher residual volume (%P) and a higher airway resistance. We concluded that many functional parameters were useful in distinguishing the asthma and COPD groups. In individual analysis, DLCO was the parameter which best aided in an accurate diagnosis in both groups, with a higher specificity for COPD. The bronchodilator response measured by changes in FEV1 showed a higher sensitivity for asthma. Thus, these two tests are highlighted in the differential diagnosis of obstructive diseases.

Os autores apresentam o caso de uma doente de 45 anos, portadora de síndroma de Down, com antecedentes conhecidos de DPOC e múltiplos internamentos hospitalares, no contexto de agudização da sua doença pulmonar de base. Os factos reportam-se ao seu último internamento, cujo motivo, interpretado a priori como mais um episódio de agudização, depois da reavaliação clínica cuidadosa e da utilização de meios complementares de diagnóstico apropriados, se revelou ficar a dever-se a causa pouco usual. Com a apresentação deste caso, os autores pretendem alertar para a dificuldade diagnóstica posta por situações particulares, bem como para os riscos da aceitação acrítica de diagnósticos comuns.The authors present the case of a 45-year-old female patient with Down syndrome, and known past medical history of COPD with multiple hospital admissions in the context of exacerbation of his lung disease. The facts refer to his latest hospitalization, whose motive, prior interpreted as a further exacerbation episode, after careful clinical reassessment and use of appropriate additional means of diagnosis, appeared to be due to an unusual cause. By presenting this case, the authors call the attention to the difficulty presen ted by particular situations, as well as to the risks of uncritical acceptance of common diagnoses.

A espirometria não atingiu ainda a divulgação que se justificaria em patologia respiratória, ou indivíduos que se encontram em risco relativamente a esta patologia, cujo diagnóstico é insuficiente, havendo um escasso conhecimento, e consequente controlo, dos custos atribuíveis a estas doenças, com destaque para a doença pulmonar obstrutiva crónica (DPOC). O PNEUMOBIL, iniciativa que visa esta divulgação entre fumadores e ex-fumadores, foi reactivado, após 10 anos de aplicação em Portugal, revelando agora, numa amostra de 5324 indivíduos, em que cerca de 50% ainda mantêm os hábitos tabágicos, sejam do sexo masculino ou feminino, que houve uma elevada prevalência de obstrução detectada por espirometria (30% e 25%, respectivamente) nas pessoas rastreadas perto de centros de saúde (grupo público) e em empresas (grupo privado). Este risco não se explica em regra por exposição ocupacional, nem se relaciona com a maioria dos sintomas respiratórios, muito frequentes nos rastreados. Apenas a dispneia (OR=1,28; p=0,02) e os episódios frequentes de expectoração (OR=1,21; p=0,008) ou de bronquite aguda (OR=1,31; p=0,05) revelam alguma relação com a obstrução. O reconhecimento prévio da DPOC é muito reduzido e a presença de obstrução não se correlaciona (p=0,204) com o assumir da condição de portador.The use of spirometry is not yet widespread enough in chronic respiratory or at-risk patients whose diagnosis is incomplete. There is scarce knowledge and inadequate management of the burden of these diseases, particularly chronic obstructive pulmonary disease (COPD). Pneumobil, an initiative aimed at raising awareness among smokers and ex-smokers, was reactivated 10 years after its launch in Portugal. It found a large prevalence of bronchial obstruction as measured by spirometry (30% and 25% in men and women respectively) in a sample of 5324 smoke-exposed individuals, 50% current smokers, screened at state or business (private company group) health institutions. This risk is neither mainly attributable to occupational exposure nor mainly related to respiratory symptoms, which were very common in our population. Only dyspnoea (OR=1.28; p=0.02) and frequent episodes of sputum production (OR=1.21; p=0.008) or acute bronchitis (OR=1.31; p=0.05) were somewhat related to bronchial obstruction. Prior knowledge of COPD is rare and bronchial obstruction is not correlated (p=0.204) to a possible diagnosis of COPD.

Objectivo: Determinar que variável entre o volume expirado forçado no primeiro segundo (VEF1), a pressão parcial do oxigénio no sangue arterial (PaO2), a hipoxemia nocturna e a força muscular do quadricípite femoral pode predizer a distância percorrida no teste de caminhada de seis minutos (TC6) em doentes com DPOC. Doentes e métodos: Um estudo observacional do tipo transversal, envolvendo trinta doentes encaminhados a um programa de reabilitação pulmonar de um hospital universitário. A função pulmonar foi avaliada por espirometria, gasometria arterial e oximetria nocturna. A função muscular pela força muscular do quadricípite femoral e a avaliação da capacidade funcional pelo TC6. Resultados: A análise de regressão bivariada mostrou que a força do quadricípite femoral foi a única variável que se mostrou estatisticamente significativa (p = 0,002) em predizer a distância, sendo responsável por 38% da variância do TC6. Para essas variáveis a relação estabelecida estatisticamente foi que para cada quilo de força do quadricípite femoral, os doentes caminharam 5,9 metros no TC6. Conclusão: Os resultados indicam a importância da força muscular do MI em testes de esforço submáximo. Entre as variáveis estudadas, apenas a força muscular do quadricípite femoral pôde predizer a distância percorrida no TC6 em portadores de doença pulmonar obstrutiva crónica.Aim: To determine which variable (forced expiratory volume in 1 second (FEV1), partial pressure of oxygen in arterial blood (PaO2), nocturnal hypoxaemia and muscular strength of femoral quadriceps) can predict the distance walked in the six-minute walk test (6MWT) by COPD patients. Methods: A cross-sectional and observational study of thirty patients referred to a pulmonary rehabilitation programme at a university hospital. Lung function was evaluated by spirometry, arterial blood gas analysis and nocturnal oximetry. Muscle function was evaluated by quadriceps strength and functional capacity by the 6MWT. Results: Bivariate regression analysis showed that quadriceps strength, was the only variable to correlate significantly with the distance walked in the 6MWT (p=0.002), accounting for 38% of the 6MWT variance. The statistical relationship established for these variables was 1kg of quadriceps strength equalled 5.9 metres walked in the 6MWT. Conclusions: Our results showed the importance of lower limb muscle strength in submaximal exercise testing. We conclude that femoral quadriceps muscle strength is the only one of the variables studied which can predict the distance COPD patients walk in the 6MWT.

Introdução: A capacidade de exercício em portadores de DPOC depende da gravidade da limitação ao fluxo aéreo, do grau de hipoxemia e da função muscular esquelética. Nesses doentes, a atrofia e a fraqueza da musculatura periférica são consideradas consequências sistémicas da DPOC e estão associadas à redução da capacidade de exercício. Objectivos: Investigar a possível correlação entre hipoxemia moderada e o comprometimento muscular periférico na DPOC. Doentes e métodos: Dez doentes encaminhados ao Programa de Reabilitação Pulmonar do Hospital Universitário de Brasília foram incluídos neste estudo. A função pulmonar foi avaliada por espirometria, gasometria arterial e avaliação funcional pelo teste de caminhada de seis minutos, sinal electromiográfico e força de deltóide e quadricípetes. Resultados: As correlações entre PaO2 e a força quadricíptica (r2 = 0,61 e p = 0,007) e a distância percorrida no TC6 (r2 = 0,96 e p = 0,001) foram positivas e significativas. Houve correlação negativa e significativa entre PaO2 e a frequência mediana de quadricípetes (r2 = -0,42 e p = 0,04). Observámos também correlação significativa entre força de quadricípetes e o TC6 (r2 = 0,67 e p = 0,001). Assim como houve correlação negativa e significativa entre a frequência mediana de quadricípetes, e o TC6 (r2 = -0,42 e p = 0,04). Não encontrámos correlação significativa entre a PaO2 e força ou frequência mediana do músculo deltóide. Conclusão: A PaO2 tem correlação importante e significativa com variáveis de função muscular periférica. A hipoxemia moderada e a disfunção muscular periférica precoce possuem como principal impacto negativo a deterioração da capacidade funcional de portadores de DPOC.Rationale: Exercise capacity in COPD patients depends on the degree of airflow obstruction, the severity of the hypoxaemia and skeletal muscle function. Muscle atrophy and weakness are considered systemic consequences of COPD and are associated with reduced exercise capacity. Aims: To investigate the correlation between mild hypoxaemia and muscular strength, muscular fatigue and functional capacity in COPD patients. Methods: Ten patients enrolled on a PRP at the Hospital Universitário de Brasília - HUB were included in this study. Lung function was evaluated by spirometry and arterial blood gas analysis. Functional evaluation was made using the 6MWT and using isometric contraction of deltoid and quadriceps muscles. Results: There were positive correlations between PaO2, quadriceps strength (r2 = 0.61 and p = 0.007) and PaO2 and the 6MWT (r2 = 0.96, p = 0.001). There were negative correlations between PaO2 and median frequency of quadriceps (r2 = -0.42 and p = 0.04). We observed significant correlation between quadriceps strength and the 6MWT (r2 = 0.67 and p = 0.001). There was negative correlation between median frequency of quadriceps and the 6MWT (r2 = -0.42 and p = 0.04). We did not observe any correlation between PaO2 and strength or median frequency of deltoid muscle. Conclusions: PaO2 has important correlations with muscular function variables. The main negative impact of mild hypoxaemia and precocious limb muscular disability on COPD patients is decreased functional capacity.

Objectivo: Pretendemos investigar os efeitos de um protocolo específico de treino dos músculos inspiratórios (TMI) no comportamento da dispneia, da função pulmonar, da força dos músculos respiratórios, da tolerância ao exercício e da qualidade de vida, num grupo de doentes com doença pulmonar obstrutiva crónica (DPOC). Amostra: Constituída por treze doentes com DPOC moderada a muito grave distribuídos por um grupo de controlo (n=5) com um valor médio de FEV1 de 43,9 ± 10,1% do valor teórico e um grupo experimental (n=8) com um valor médio de FEV1 de 57,8 ± ± 12,1 % do valor teórico. O grupo experimental foi sujeito a TMI por cinco semanas consecutivas e o grupo de controlo não efectuou qualquer tipo de treino, sendo apenas aconselhado a continuar com as actividades diárias até então praticadas. Resultados: A aplicação do protocolo específico de TMI melhorou significativamente a pressão máxima inspiratória (PImax) no grupo experimental (Pimax inicial - 83,3± 21,4 versus Pimax final- 98,4±17,8 cmH2O; pAim: The aim of this study was to evaluate the impact a specific inspiratory muscle training (IMT) protocol had on dyspnoea, lung function, respiratory muscle pressure, tolerance to exercise and quality of life in a group of patients with ch ronic obstructive pulmonary disease (COPD). Population: We studied 13 patients with moderate to very severe COPD divided into a control group (n=5) with an average FEV1 43.9 ± 10.1% of predicted value and an IMT group (n=8) with FEV1 57.8 ± 12.1 % of predicted value. While this study group underwent IMT for five consecutive weeks, the control group did not undergo any kind of training. Results: Using a specific IMT protocol significantly improved maximal inspiratory pressure (MIP) in the study group (initial MIP - 83.3± 21.4 versus final MIP- 98.4±17.8 cmH2O; p

JUSTIFICATIVA E OBJETIVOS: Em 2000, foi publicado o II Consenso Brasileiro de Ventilação Mecânica. Desde então, o conhecimento na área da ventilação mecânica avançou rapidamente, com a publicação de numerosos estudos clínicos que acrescentaram informações importantes para o manejo de pacientes críticos em ventilação artificial. Além disso, a expansão do conceito de Medicina Baseada em Evidências determinou a hierarquização das recomendações clínicas, segundo o rigor metodológico dos estudos que as embasaram. Essa abordagem explícita vem ampliando a compreensão e a aplicação das recomendações clínicas. Por esses motivos, a AMIB - Associação de Medicina Intensiva Brasileira - e a SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - julgaram conveniente a atualização das recomendações descritas no Consenso anterior. Dentre os tópicos selecionados a Ventilação Mecânica Não-Invasiva foi um dos temas propostos. O objetivo deste estudo foi descrever os pontos mais importantes relacionados à ventilação mecânica na forma não-invasiva (VMNI) e sugerir as principais indicações dessa modalidade. MÉTODO: Objetivou-se chegar a um documento suficientemente sintético, que refletisse a melhor evidência disponível na literatura. A revisão bibliográfica baseou-se na busca de estudos através de palavras-chave e em sua gradação conforme níveis de evidência. As palavras-chave utilizadas para a busca foram: Ventilação mecânica não invasiva: Non-invasive mechanical ventilation. RESULTADOS: São apresentadas recomendações quanto à utilização da VMNI nas diversas formas de insuficiência respiratória e no desmame da ventilação mecânica. CONCLUSÕES: A VMNI está indicada como o tratamento preferencial na exacerbação da DPOC, assim como, na assistência de pacientes em edema agudo de pulmão.BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Non-Invasive Mechanical ventilation has been one of the updated topics. Describe the most important topics on the non-invasive mechanical ventilation and suggest the main therapeutic approaches of this modality. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the keywords "non-invasive mechanical ventilation". RESULTS: Recommendations on the non-invasive mechanical ventilation during respiratory failure and weaning are presented. CONCLUSIONS: Non-invasive mechanical ventilation is the main form of ventilatory support during exacerbation of chronic obstructive pulmonary disease and in acute pulmonary edema patients.

JUSTIFICATIVA E OBJETIVOS: Em 2000, foi publicado o II Consenso Brasileiro de Ventilação Mecânica. Desde então, o conhecimento na área da ventilação mecânica avançou rapidamente, com a publicação de numerosos estudos clínicos que acrescentaram informações importantes para o manejo de pacientes críticos em ventilação artificial. Além disso, a expansão do conceito de Medicina Baseada em Evidências determinou a hierarquização das recomendações clínicas, segundo o rigor metodológico dos estudos que as embasaram. Essa abordagem explícita vem ampliando a compreensão e a aplicação das recomendações clínicas. Por esses motivos, a AMIB - Associação de Medicina Intensiva Brasileira - e a SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - julgaram conveniente a atualização das recomendações descritas no Consenso anterior. Dentre os tópicos selecionados a Ventilação Mecânica na Agudização da DPOC foi um dos temas propostos. O objetivo deste estudo foi descrever os pontos mais importantes relacionados à ventilação mecânica durante a agudização da doença pulmonar obstrutiva crônica (DPOC) e sugerir as principais abordagens terapêuticas. MÉTODO: Objetivou-se chegar a um documento suficientemente sintético, que refletisse a melhor evidência disponível na literatura. A revisão bibliográfica baseou-se na busca de estudos através de palavras-chave e em sua gradação conforme níveis de evidência. As palavras-chave utilizadas para a busca foram: ventilação mecânica na DPOC: COPD and mechanical ventilation. RESULTADOS: São apresentadas recomendações quanto aos modos ventilatórios e aos parâmetros a serem aplicados quando do ajuste do ventilador, além da monitoração recomendada. Apresentam-se ainda, técnicas alternativas que possam ser utilizadas. CONCLUSÕES: Estratégias protetoras de ventilação mecânica são recomendadas durante a ventilação mecânica de um paciente DPOC agudizado.BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Mechanical ventilation in COPD exacerbation has been one of the updated topics. Describe the most important topics on the mechanical ventilation during the COPD exacerbation and suggest the main therapeutic approaches. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the keywords "mechanical ventilation" and "COPD". RESULTS: We present recommendations on the ventilatory modes and settings to be adopted when ventilating a patient during an asthma attack, as well as the recommended monitoring. Alternative ventilation techniques are also presented. CONCLUSIONS: Protective ventilatory strategies are recommended when ventilating a patient during a.

A doença pulmonar obstrutiva crónica (DPOC) é uma patologia comum, afectando 4-9% da população adulta. Em comparação com outras doenças, a mortalidade relacionada com a DPOC continua a aumentar na população em geral. É uma doença progressiva que conduz, usualmente, a insuficiência respiratória e à morte. A oxigenioterapia de longa duração constitui o único tratamento eficaz no aumento da esperança de vida de indivíduos com DPOC e insuficiência respiratória crónica. No entanto, esta continua a ser pequena (aproximadamente 40% aos 5 anos). Apesar de terem sido efectuados numerosos estudos, permanece alguma controvérsia sobre os factores de risco relacionados com a mortalidade destes indivíduos. Entre eles encontram-se os parâmetros funcionais respiratórios (FEV1), gases arteriais (PaO2, PaCO2), hipertensão pulmonar, sexo, idade e índice de massa corporal (IMC). Contudo, nenhuma destas variáveis revelou ter um valor predictivo claro. Esta discrepância pode resultar, em parte, da metodologia utilizada. O objectivo do presente estudo foi investigar a associação entre as variáveis clínicas e a mortalidade por causas respiratórias e outras, em doentes com DPOC sob oxigenioterapia de longa duração. Foram avaliados retrospectivamente todos os doentes que iniciaram oxigenioterapia de longa duração entre 1992 e 1999 no Hospital Vall d’Hebram (Barcelona). A prescrição de oxigénio foi a seguinte: >15h/ /dia a um débito de 1-3L/min, fornecido por um concentrador. A indicação para oxigenioterapia de longa duração foi determinada por uma PaO2 60 mmHg sob oxigenioterapia. O cor pulmonale foi definido pela presença de dois ou mais dos seguintes itens: hipertrofia ventricular direita; engurgitamento das artérias pulmonares na radiografia do tórax; edema dos MI. A comorbilidade foi avaliada utilizando o índice de Charlson desenvolvido para determinar o seu impacto no prognóstico, atribuindo a cada doença um score de 1 a 6 proporcional ao risco de morte relacionado com a referida patologia. O score 1 é atribuído ao EAM, insuficiência cardíaca congestiva, doença vascular periférica, doença cerebrovascular, demência, conectivopatia, doença péptica, doença hepática ligeira e diabetes. O score 2 é conferido à diabetes com lesão orgânica múltipla, hemiplegia, doença renal e neoplasias, incluindo leucemia e linfomas. O score 3 é atribuído à doença hepática moderadamente grave, enquanto o score 6 às doenças neoplásicas metastizadas e à SIDA. A DPOC foi excluída desta lista. No presente estudo foram incluídos 128 doentes de um total de 202 indivíduos com DPOC sob oxigenioterapia domiciliária de longa duração. A maioria dos doentes era do sexo masculino (98%) com uma idade média de 68,9±9,7 anos. A distribuição de acordo com o índice de massa corporal (IMC) foi a seguinte: IMC 45mmHg em 81 casos - 63%). As patologias associadas mais frequentes foram a diabetes e a doença cardiovascular. O follow-up foi efectuado por pneumologistas em 73% dos indivíduos e clínicos gerais nos restantes, ao longo de 3,2 anos. Em 6 indivíduos, o follow-up terminou antes da referida data pela instituição de outra medida terapêutica: ventiloterapia não invasiva (3); transplante pulmonar (2) e cirurgia de redução de volume (1). O follow-up incluía o controlo da oxigenioterapia de forma a avaliar a compliance do doente e a necessidade de ajuste de aporte do oxigénio. As causas de morte foram obtidas através do registo de mortalidade catalão baseado na informação contida nas certidões de óbito e codificadas de acordo com a 10.ª Revisão da Classificação de Doenças internacional (ICD). Um total de 78 indivíduos (61%) faleceu no decurso do período de follow-up. A taxa de sobrevivência aos 3 anos foi de 55%. A mortalidade por patologia respiratória foi de 77%. A comorbilidade avaliada pelo índice de Charlson estava presente em 38% dos doentes. Um IMC

O fenótipo da doença pulmonar obstrutiva crónica (DPOC) pode ser definido como a manifestação física exteriorizada pelos doentes com DPOC, ou seja, tudo o que faça parte da estrutura, função ou comportamento, que possa ser observado. A caracterização do doente com DPOC tem vindo a ser modificada, deixando de se limitar ao grau da obstrução brônquica para passar a incluir as manifestações de diferentes fenótipos da doença. Estes incluem, entre outros, a hipoxemia persistente, a hiperinsuflação com enfisema de distribuição heterogénea, os doentes com múltiplas exacerbações e os doentes com disfunção dos músculos periféricos. Cada um destes fenótipos obriga a diferentes abordagens terapêuticas e implica diferentes prognósticos. A limitação dos débitos aéreos: o elemento definidor O grau de obstrução definido pelo volume expiratório máximo no primeiro segundo (FEV1) apresentado por Fletcher e Peto tem permitido o estadiamento da gravidade da DPOC, orientando as intervenções terapêuticas de acordo com cada estádio. O estadiamento espirométrico da DPOC pode prever o estado de saúde, o uso dos recursos de saúde, a ocorrência de exacerbações e a mortalidade. Contudo, embora se trate de uma ferramenta diagnóstica e prognóstica útil, o FEV1 é um parâmetro que tem sido usado de forma limitativa, já que os doentes com DPOC que apresentam reversibilidade com o broncodilatador são habitualmente excluídos dos estudos clínicos. A presença de hiperreactividade brônquica confere aos doentes com DPOC uma expressão fenotípica associada a uma função pulmonar mais grave. O FEV1 e a sua variação não representam todo o espectro das manifestações clínicas complexas da DPOC. A presença de enfisema e hiperinsuflação, a importância crescente da malnutrição, a disfunção dos músculos periféricos e a dispneia reflectem diferentes factores predictivos da evolução da doença. Também as co-morbilidades e o sexo são características fenotípicas da doença que não se correlacionam com o FEV1. Enfisema e hiperinsuflação O enfisema, definido como o alargamento permanente das vias aéreas distais ao bronquíolo terminal, associado à destruição das paredes alveolares e sem fibrose significativa, pode traduzir-se num fenótipo clínico evidenciado no estudo funcional respiratório pela hiperinsuflação pulmonar. A hiperinsuflação pulmonar estática (elevação do volume pulmonar no final da expiração, com redução da capacidade inspiratória) e a hiperinsuflação pulmonar dinâmica com o exercício (redução progressiva da capacidade inspiratória) têm sido associadas à limitação da capacidade funcional dos doentes com DPOC. Segundo Casanova e colaboradores, a relação entre a capacidade inspiratória e a capacidade pulmonar total (IC/TLC) prediz a mortalidade global e a mortalidade devida a causas respiratórias melhor do que o FEV1. A redução da difusão (transferência alvéolo-capilar do monóxido de carbono) e, em particular, a tomografia axial computorizada têm permitido avaliar a extensão, a gravidade e a distribuição da destruição pulmonar. A presença de hiperinsuflação e o grau e distribuição do enfisema definem um fenótipo de doente que pode beneficiar de medidas de redução de volume pulmonar, independentemente do grau de obstrução. Envolvimento sistémico e inflamação O desenvolvimento de manifestações extra-pulmonares não apresenta uma correlação directa com o grau de obstrução. Uma destas manifestações, a hipoxemia grave, confere um mau prognóstico e a sua correcção, quando os valores de PaO2 são inferiores a 55 mmHg, tem sido associada a uma maior sobrevida. Este facto vem demonstrar que o prognóstico da doença pode ser alterado mesmo quando não se consegue modificar a taxa de declínio do FEV1. A malnutrição, avaliada pelo índice de massa corporal (IMC) quando este índice é inferior a 21 kg/ /m², é um factor preditivo de mortalidade independente da obstrução brônquica. Apontam-se como causas da desnutrição a inflamação (níveis elevados de factor de necrose tumoral ou TNF-α), o stress oxidativo e o aumento do trabalho ventilatório. A correcção da desnutrição pode ter um impacto prognóstico positivo. A intolerância ao exercício físico evidenciada na prova de esforço cardiopulmonar ou nos testes de terreno (prova de marcha e prova de shuttle) pode ser consequência, entre outras, da alteração da mecânica ventilatória e/ou da disfunção dos músculos periféricos. Esta pode resultar ainda das alterações inflamatórias presentes nesta doença. A redução da capacidade para o exercício é um factor preditivo da sobrevida e a sua correcção com o treino de exercício tem um impacto muito positivo no prognóstico e na qualidade de vida destes doentes. Em 10 a 20% dos doentes com DPOC é detectada anemia que parece ter origem na inflamação crónica, à semelhança de outras doenças crónicas de causa inflamatória. A inflamação parece assim ser crítica no aparecimento de múltiplas manifestações sistémicas. Pode ser evidenciada pela presença a nível do plasma ou dos órgãos- alvo (pulmão, músculo, etc.) de células inflamatórias ou dos seus mediadores. São encontrados na DPOC níveis séricos elevados de proteína C reactiva, interleucina (IL-6), leucotrieno B4, TNF-a e outros marcadores biológicos. O estudo dos mecanismos subjacentes à inflamação e a utilização terapêutica de moléculas que, de forma selectiva, antagonizem estes processos poderão constituir abordagens eficazes na reversão da doença. Sexo Têm sido detectadas diferenças nas manifestações clínicas da DPOC entre doentes do sexo masculino e feminino. Para o mesmo grau de obstrução, as mulheres referem mais dispneia, apresentam parâmetros de menor qualidade de vida avaliada pelos questionários, apresentam vias aéreas mais reactivas e maior número de exacerbações e respondem de forma menos significativa ao treino de exercício a longo prazo dos que os homens. Estes factos indicam que deve ser dada mais atenção à forma como a exposição a partículas inaladas (fumo do tabaco ou outros poluentes) afecta as mulheres. Frequência das exacerbações Para além do impacto na qualidade de vida e na sobrevida dos doentes, as exacerbações representam um elevado peso económico em consumo de recursos de saúde. Após uma exacerbação, os doentes referem uma redução significativa do seu estado de saúde e quando são internados em insuficiência respiratória, a mortalidade no primeiro ano pode elevar-se a 50%. Os doentes que apresentam elevado número de exacerbações têm pior qualidade de vida e um prognóstico mais reservado. Deve, por isso, ser feito um esforço para identificar o fenótipo de "exacerbadores frequentes" e tratar os factores que estão na origem das múltiplas exacerbações. Avaliação multidimensional Já que o FEV1 não caracteriza de forma completa todas as manifestações respiratórias e sistémicas da DPOC, torna-se importante categorizar esta doença através de uma avaliação multidimensional. Utilizando parâmetros que de forma independente demonstrem importância prognóstica, a sua avaliação integrada irá fornecer um score de gravidade com maior relevância clínica e prognóstica. O índice de BODE é uma avaliação multidimensional proposta por Celli e colaboradores e inclui a avaliação nutricional (índice de massa corporal), o grau de obstrução brônquica (FEV1), a dispneia (escala do Medical Research Council) e a capacidade para o exercício de endurance (Prova de marcha dos 6 minutos). A incorporação de vários elementos fenotípicos num sistema de score integrado tem vantagens práticas: permite agrupar os doentes de acordo com o seu prognóstico e, neste caso em particular, cada um dos seus quatro componentes pode ser potencialmente melhorado com a terapêutica dirigida. Implicações clínicas A avaliação multidimensional dos doentes com DPOC não tem apenas interesse científico. Ela permite integrar diferentes fenótipos com importância clínica e prognóstica e, o que é mais relevante, determinar diferentes respostas às abordagens terapêuticas. A oxigenoterapia para os doentes hipoxémicos, a ventilação mecânica não invasiva nos doentes com insuficiência respiratória hipercápnica e acidose e a redução de volume pulmonar em doentes com doença dos lobos superiores e redução da capacidade para o exercício, são medidas terapêuticas que demonstraram redução da mortalidade. Também a reabilitação pulmonar tem melhorado o prognóstico em doentes sintomáticos com redução da capacidade para o exercício e a intervenção nutricional tem demonstrado ter impacto na mortalidade. O futuro afasta-nos cada vez mais da definição da DPOC apenas assente no grau de obstrução das vias aéreas e abre perspectivas a uma compreensão das diferentes expressões clínicas mais abrangente e que pode contar com as vertentes da genómica, da proteómica e da metabonómica ou, mesmo, de outros factores relevantes para a evolução da doença e muitas vezes esquecidos, como os aspectos psicológicos.

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Introdução: No teste de caminhada dos seis minutos, o principal parâmetro é a distância percorrida. Não se considera o peso corporal, embora se conheça a sua influência na capacidade de exercício. Por outro lado, existem evidências de que o grau de obstrução não se correlaciona com a distância caminhada. Objectivo: Verificar se existe correlação entre o grau de obstrução do fluxo aéreo e o trabalho de caminhar obtido a partir do produto distância x x peso (DxP). Materiais e métodos: Foram estudados 60 doentes portadores de doença pulmonar obstrutiva crónica. As variáveis fisiológicas e funcionais foram correlacionadas com a distância percorrida e com o produto distância/peso. Resultados: Não se encontraram correlações entre o trabalho de caminhar e o grau de obstrução ao fluxo aéreo, nem com os volumes pulmonares. Encontrou-se correlação positiva e significativa da distância com a difusão de monóxido de carbono (DLCO) (r=0,6; pIntroduction: The six-minute walking test distance, despite being considered the main parameter, does not consider body weight which is known to influence exercise capacity. A body of evidence shows the degree of airflow obstruction does not correlate to walking distance and the body weight affects the work/energy required to perform the walk. Objective: To verify if the degree of airflow obstruction correlates to six-minute walk work obtained by weight - walking distance product. Patient and methods: A total of 60 patients with chronic obstructive pulmonary disease were evaluated. The physiological and functional variables were correlated to distance and body weight - walking distance product (WxW). Results: There were no correlations between six-minute walk work and the degree of airflow obstruction. A positive and significant correlation were observed between the distance and Carbon Monoxide Diffusing Capacity (DLCO) (r=0.6; p

This study aims to evaluate the acute effects of continuous positive airway pressure (CPAP) in patients with exacerbated chronic obstructive pulmonary disease (COPD; post-acute phase), as well as the influence on the outcome of hospitalization. A total of 30 patients with exacerbated COPD were selected, oriented and submitted to the use of CPAP for 60 minutes in the semi-fowler position (45o), have been checked the respiratory rate (f), arterial oxygen saturation (SpO2), heart rate (HR) and arterial pressure (AP) connected to CPAP with orofacial mask. Later, they were accompanied for checking the outcome of hospitalization. The patients mean age was 68.7 ± 10.94 years and showed the following classifications: GOLD 10%, moderate 43% and serious 47%. Regarding the outcome of hospitalization, it has been observed that 11 individuals died (36.67%), 16 were admitted to the ICU for an average of 4.0 ± 3.0 days. The indication of CPAP in patients with exacerbated COPD, included in this study, produced positive acute effect by the improvement of SpO2. However, there was no influence in the outcome of hospitalization. [ABSTRACT FROM AUTHOR]