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

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.

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

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

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

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

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

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

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

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