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OBJETIVO: O presente estudo investigou se pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) atingem a mínima atividade física recomendada pelos guidelines do American College of Sports Medicine (ACSM), assim como as consequências da não-aderência a esses guidelines. MÉTODOS: Atividade física na vida diária (DynaPort activity monitor), função pulmonar, força muscular, capacidade de exercício, qualidade de vida, estado funcional e diferentes índices de severidade (GOLD, BODE, MRC) foram avaliados em 23 pacientes (61[59-69] anos; VEF1 39[34-53]%predito; IMC 24[21-27]kg/m²; mediana [intervalo interquartílico 25-75%]). RESULTADOS: De acordo com a aderência aos guidelines (andar no mínimo 30 minutos todo dia), 12 pacientes foram considerados "fisicamente ativos", e 11 "fisicamente inativos". Não foram observadas diferenças significativas entre os dois grupos em termos de idade, sexo, composição corporal, força muscular, reserva ventilatória, hiperinsuflação e qualidade de vida. O grupo inativo tinha pior função pulmonar, capacidade de exercício, MRC e BODE (pOBJECTIVE: The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. METHODS: This study involved 23 patients (median age: 61 - range, 59-69 years; FEV1: 39% of predicted - range, 34-53%; BMI: 24 kg/m² - range, 21-27 kg/m²). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). RESULTS: Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. CONCLUSION: A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether patients are physically inactive in their daily lives.

A avaliação hemodinâmica é parte essencial tanto para a definição diagnóstica e prognóstica dos quadros de hipertensão pulmonar, quanto para a definição do tratamento inicial, ou mesmo na avaliação da resposta terapêutica. De acordo com a fase em que a avaliação é realizada, alguns aspectos mais relevantes merecem especial atenção, como o valor da pressão de oclusão da artéria pulmonar e do débito cardíaco, ou ainda a resposta aguda aos vasodilatadores. Embora formas não invasivas de avaliação da circulação pulmonar estejam cada vez mais desenvolvidas, a avaliação hemodinâmica ainda é mandatória nos quadros de hipertensão arterial pulmonar.Hemodynamic evaluation is an essential part of making the diagnosis and determining the prognosis in pulmonary hypertension. Analyzing changes in hemodynamic parameters can aid in devising the initial therapeutic approach, as well as in assessing response to treatment. Depending on the disease stage at which the hemodynamic evaluation is performed, some aspects, such as pulmonary artery occlusion pressure, cardiac index, or even the acute response to vasodilators, merit special attention. Although noninvasive methods of evaluating pulmonary circulation are under development, hemodynamic evaluation is still mandatory for patients presenting signs of or diagnosed with pulmonary hypertension.

Com o advento de novas terapias para o tratamento da hipertensão arterial pulmonar, surge a necessidade de se definir marcadores prognósticos que, em última análise, reflitam a melhora da qualidade de vida e da sobrevida dos pacientes frente a essas novas opções terapêuticas. Até o momento, o teste de caminhada de seis minutos foi o principal marcador utilizado para a definição do benefício das terapias disponíveis. Porém, marcadores clínicos, de qualidade de vida e biológicos apresentam grande potencial para o manuseio dos pacientes portadores de hipertensão pulmonar.With the advent of new therapies for pulmonary hypertension, the need arises to define prognostic markers that definitively predict the improvement in quality of life and survival of patients treated with these new alternatives. To date, the 6-minute walk test has been the marker most widely used to determine the benefit gained from the various treatment strategies available. However, clinical, biochemical and quality of life markers present great potential for the management of patients with pulmonary hypertension.