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1. Age-associated phenotypic imbalance in TCD4 and TCD8 cell subsets: comparison between healthy aged, smokers, COPD patients and young adults

Author

Juliana Ruiz Fernandes, Thalyta Nery Carvalho Pinto, Liã Barbara Arruda, Cibele Cristine Berto Marques da Silva, Celso Ricardo Fernandes de Carvalho, Regina Maria Carvalho Pinto, Alberto José da Silva Duarte, and Gil Benard

Subjects
Immunosenescence, COPD, Cellular senescence, Immunophenotyping, Aging, Cigarette smoke, Immunologic diseases. Allergy, RC581-607, Geriatrics, RC952-954.6
Abstract

Abstract Background COPD 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. Results Here, we evaluated the naive, CM, EM and TEMRA subsets 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 TEMRA T-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. Conclusion Our 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.

Published
2022
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3. Development and evaluation of physical properties of a low-cost handheld device for airway clearance therapy

Author

Cibele Cristine Berto Marques da Silva, Alba Rebeca Nery Comin, Paulo Hilario Nascimento Saldiva, Milton de Arruda de Martins, and Celso Ricardo Fernandes de Carvalho

Subjects
Respiratory Therapy, Airway Management, Chest Wall Oscillation, Therapeutics. Pharmacology, RM1-950
Abstract

ABSTRACT 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.

Published
2019
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4. Desaturation-Distance Ratio During Submaximal and Maximal Exercise Tests and Its Association With Lung Function Parameters in Patients With Lymphangioleiomyomatosis

Author

Douglas Silva Queiroz, Cibele Cristine Berto Marques da Silva, Alexandre Franco Amaral, Martina Rodrigues Oliveira, Henrique Takachi Moriya, Carlos Roberto Ribeiro Carvalho, Bruno Guedes Baldi, and Celso R. F. Carvalho

Subjects
lymphangioleiomyomatosis, exercise tests, respiratory function tests, lung volume measurements, lung diseases, Medicine (General), R5-920
Abstract

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.

Published
2021
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5. Thoracoabdominal asynchrony: Two methods in healthy, COPD, and interstitial lung disease patients.

Author

Mayra Caleffi Pereira, Desiderio Cano Porras, Adriana Claudia Lunardi, Cibele Cristine Berto Marques da Silva, Renata Cléia Claudino Barbosa, Letícia Zumpano Cardenas, Renata Pletsch, Jeferson George Ferreira, Isac de Castro, Celso Ricardo Fernandes de Carvalho, Pedro Caruso, Carlos Roberto Ribeiro de Carvalho, and André Luis Pereira de Albuquerque

Subjects
Medicine, Science
Abstract

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.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.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.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.

Published
2017
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7. Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD

Author

Celso R. F. Carvalho, Adriana Claudia Lunardi, João Marcos Salge, Rafael Stelmach, Thiago Fernandes Pinto, Regina Maria Carvalho-Pinto, Vinicius Torsani, Renato Vitorasso, Henrique Takachi Moriya, Rafaella Fagundes Xavier, Marcelo Brito Passos Amato, and Cibele Cristine Berto Marques da Silva

Subjects
Male, Randomization, Physiology, Respiratory physiology, 030204 cardiovascular system & hematology, Severe chronic obstructive pulmonary disease, law.invention, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Physiology (medical), medicine, Humans, Exercise, COPD, Cross-Over Studies, Exercise Tolerance, business.industry, Mechanics, Exercise capacity, medicine.disease, Physical activity level, Dyspnea, medicine.anatomical_structure, 030228 respiratory system, Exercise Test, Abdomen, business
Abstract

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.

Published
2020

8. Desarrollo y evaluación de propiedades físicas de un dispositivo portátil de bajo costo para la higiene bronquial

Author

Cibele Cristine Berto Marques da Silva, Alba Rebeca Nery Comin, Paulo Hilario Nascimento Saldiva, Milton de Arruda de Martins, and Celso Ricardo Fernandes de Carvalho

Subjects
Oscilação da Parede Torácica, 030506 rehabilitation, Airway clearance, Respiratory Therapy, Materials science, Future studies, Terapia Respiratória, Terapia Respiratoria, Manuseio das Vias Aéreas, Manejo de la Vía Aérea, RM1-950, 030229 sport sciences, Positive expiratory pressure, Chest Wall Oscillation, Oscilación de la Pared Torácica, 03 medical and health sciences, 0302 clinical medicine, Flutter, Therapeutics. Pharmacology, Clinical efficacy, Shaker, Airway Management, 0305 other medical science, Biomedical engineering
Abstract

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.

Published
2019

9. Comparison between the phase angle and phase shift parameters to assess thoracoabdominal asynchrony in COPD patients

Author

Denise M. Paisani, Desiderio Cano Porras, Celso R. F. Carvalho, Henrique Takachi Moriya, Adriana Claudia Lunardi, Cibele Cristine Berto Marques da Silva, and Rafael Stelmach

Subjects
Male, medicine.medical_specialty, Physiology, Copd patients, Rest, 030204 cardiovascular system & hematology, Air trapping, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Internal medicine, Abdomen, PULMÃO, medicine, Humans, Thoracoabdominal asynchrony, Thoracic Wall, Exercise, business.industry, Phase angle, Middle Aged, Plethysmography, Cross-Sectional Studies, 030228 respiratory system, Exercise Test, Respiratory Mechanics, Cardiology, Physical therapy, Female, medicine.symptom, business
Abstract

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.

Published
2017

10. Pulmonary rehabilitation in Brazil

Author

Celso R. F. Carvalho, Cibele Cristine Berto Marques da Silva, and Rafaella Fagundes Xavier

Subjects
03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Therapeutics. Pharmacology, RM1-950, 030212 general & internal medicine
Published
2017

11. Effect of an Exercise Program on Lymphocyte Proliferative Responses of COPD Patients

Author

Cibele Cristine Berto Marques da Silva, Gil Benard, Alberto José da Silva Duarte, Celso R. F. Carvalho, Regina Carvalho Pinto, Juliana Ruiz Fernandes, and Aline Grandi Silva

Subjects
0301 basic medicine, Pulmonary and Respiratory Medicine, CD4-Positive T-Lymphocytes, Male, Lymphocyte, T-Lymphocytes, Vital Capacity, Cytomegalovirus, Walk Test, CD8-Positive T-Lymphocytes, medicine.disease_cause, Peripheral blood mononuclear cell, Haemophilus influenzae, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Immune system, Antigen, Forced Expiratory Volume, Medicine, Humans, Lymphocytes, Phytohemagglutinins, Antigens, Viral, Aged, Cell Proliferation, IMUNIDADE, COPD, Antigens, Bacterial, business.industry, Standard treatment, CD28, Middle Aged, medicine.disease, Exercise Therapy, 030104 developmental biology, medicine.anatomical_structure, Dyspnea, Ki-67 Antigen, 030228 respiratory system, Immunology, Quality of Life, Female, business
Abstract

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.

Published
2017

12. Thoracoabdominal asynchrony: Two methods in healthy, COPD, and interstitial lung disease patients

Author

Carlos Roberto Ribeiro de Carvalho, Pedro Caruso, Mayra Caleffi Pereira, Letícia Zumpano Cardenas, Celso R. F. Carvalho, Adriana Claudia Lunardi, Renata Cléia Claudino Barbosa, Cibele Cristine Berto Marques da Silva, André Luis Pereira de Albuquerque, Renata Pletsch, Jeferson George Ferreira, Isac de Castro, and Desiderio Cano Porras

Subjects
Male, Pulmonology, Physiology, lcsh:Medicine, 030204 cardiovascular system & hematology, Pulmonary function testing, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Abdomen, Medicine and Health Sciences, Public and Occupational Health, Respiratory system, lcsh:Science, Musculoskeletal System, Abdominal Muscles, COPD, Multidisciplinary, Respiration, Muscles, Interstitial lung disease, Middle Aged, Thorax, Sports Science, Healthy Volunteers, Plethysmography, medicine.anatomical_structure, Breathing, Cardiology, Female, Anatomy, Research Article, Adult, medicine.medical_specialty, Chronic Obstructive Pulmonary Disease, Ribs, Respiratory physiology, Interstitial Lung Diseases, 03 medical and health sciences, Internal medicine, medicine, Plethysmograph, Humans, Respiratory Physiology, Sports and Exercise Medicine, Exercise, Skeleton, business.industry, lcsh:R, Biology and Life Sciences, Physical Activity, medicine.disease, Surgery, Cross-Sectional Studies, 030228 respiratory system, Physical Fitness, Respiratory Mechanics, lcsh:Q, business, Physiological Processes, Lung Diseases, Interstitial
Abstract

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.

Published
2017

13. Volume Rather Than Flow Incentive Spirometry Is Effective in Improving Chest Wall Expansion and Abdominal Displacement Using Optoelectronic Plethysmography

Author

Desiderio Cano Porras, Clarice Tanaka, Denise M. Paisani, Cibele Cristine Berto Marques da Silva, Adriana Claudia Lunardi, and Celso R. F. Carvalho

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Electromyography, Respiratory physiology, Critical Care and Intensive Care Medicine, Young Adult, Statistical significance, Internal medicine, medicine, Humans, Respiratory system, Thoracic Wall, Abdominal Muscles, medicine.diagnostic_test, business.industry, Biomechanics, Repeated measures design, General Medicine, Respiratory Muscles, Surgery, Plethysmography, Muscles of respiration, Cross-Sectional Studies, medicine.anatomical_structure, Spirometry, Respiratory Mechanics, Cardiology, Abdomen, Female, business
Abstract

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

Published
2012

14. Evaluation of a multimedia online tool for teaching bronchial hygiene to physical therapy students

Author

Celso R. F. Carvalho, Cibele Cristine Berto Marques da Silva, Sonia L. P. Toledo, and Paulo Sérgio Panse Silveira

Subjects
Adult, Male, Physical Therapy Specialty, education, MEDLINE, Physical therapy education, Computer-Assisted Instruction, Bronchi, Physical Therapy, Sports Therapy and Rehabilitation, computer.software_genre, law.invention, Resource (project management), Randomized controlled trial, law, Health care, Humans, Orthopedics and Sports Medicine, Physical Therapy Modalities, Internet, Multimedia, business.industry, Rehabilitation, Test (assessment), Female, The Internet, business, Psychology, computer
Abstract

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.

Published
2012

15. Objective structured clinical evaluation as an assessment method for undergraduate chest physical therapy students: a cross-sectional study

Author

Celso R. F. Carvalho, Flávia Souza, Cibele Cristine Berto Marques da Silva, Felipe A. R. Mendes, and Adriana Claudia Lunardi

Subjects
Program evaluation, fisioterapia, Respiratory Therapy, medicine.medical_specialty, Educational measurement, educational measurement, Cross-sectional study, education, Physical Therapy, Sports Therapy and Rehabilitation, avaliação educacional, Chest Physical Therapy, Cronbach's alpha, Internal consistency, medicine, Humans, physical therapy, Orthopedics and Sports Medicine, Medical physics, Physical Therapy Modalities, business.industry, Rehabilitation, competência clínica, projetos de saúde, program evaluation, competência profissional, Cross-Sectional Studies, avaliação de programas, professional competence, Assessment methods, Physical therapy, Clinical Competence, Educational Measurement, business, Clinical evaluation, clinical competence
Abstract

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.

Published
2011

16. Desenvolvimento de um recurso didático multimídia para o ensino de higiene brônquica

Author

Celso R. F. Carvalho, Cibele Cristine Berto Marques da Silva, and Sonia Lucia Pacheco de Toledo Carvalho

Subjects
Multimedia, business.industry, Bronchial hygiene, Information technology, Multimídia, Collaborative learning, computer.software_genre, Instrução por computador, Terapia respiratória/educação, Health care, Medicine, The Internet, business, computer, Materiais de ensino, Random access
Abstract

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.

Published
2009

17. Desenvolvimento de um recurso didático multimídia para o ensino de higiene brônquica Development of a multimedia tool for teaching bronchial hygiene

Author

Cibele Cristine Berto Marques da Silva, Sonia Lucia Pacheco de Toledo Carvalho, and Celso Ricardo Fernandes de Carvalho

Subjects
lcsh:Therapeutics. Pharmacology, Multimedia, Instrução por computador, Teaching materials, lcsh:RM1-950, Multimídia, Respiratory therapy, Materiais de ensino, Computer-assisted instruction, Terapia respiratória
Abstract

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.

Published
2009

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