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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.

The postural imbalance is an extra-pulmonary condition, associated with chronic obstructive pulmonary disease (COPD). COPD affects older individuals and it is unclear whether balance abnormalities can be described as pathophysiological mechanism or aging. The present study aimed to evaluate the influence of age or disease on postural balance of patients with COPD. Patients with COPD over 50 years old were compared with age- and sex-matched healthy adults, and with sex-matched younger healthy adults (

Objective: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. Methods: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. Results: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). Conclusions: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.

Objectives To identify clusters of chronic obstructive pulmonary disease (COPD) patients with distinct beliefs about their illness in terms of symptoms, health-related quality of life (HRQoL), self-efficacy, and daily life physical activity (DLPA). Methods This cross-sectional study included 150 COPD outpatients. The patients’ illness perceptions, clinical control, HRQoL, self-efficacy, and DLPA (accelerometry) were evaluated. A cluster analysis was conducted using data from the Illness Perceptions Questionnaire - Revised to establish groups of patients with distinct illness perceptions. Differences between clusters were tested using a T-test or a Mann–Whitney U test. Results The cluster analysis revealed two groups: distressed ( n = 95) and coping ( n = 55). Despite the fact that both clusters presented similar pulmonary function, between-cluster differences were observed in their self-efficacy, dyspnea, HRQoL, clinical control ( p Discussion We observed that clinically stable COPD patients who displayed higher emotional representations and less coherence had heightened symptoms, poorer HRQoL, worse self-efficacy, and lower educational levels. These results emphasize the need to routinely evaluate illness perceptions in COPD patients to target and tailor the proper treatment to improve these important health outcomes.

People with chronic obstructive pulmonary disease (COPD) present high prevalence of falls and sedentary behaviour. Objectives: To identify clusters of COPD patients according to postural balance, quadriceps muscle strength, physical activity and sedentary behaviour. Methods: This observational with a 12-month follow-up study included 70 COPD outpatients. A cluster analysis was conducted using the following variables: postural balance (Mini-BESTest), quadriceps muscle strength (dynamometer), physical activity and sedentary behaviour (accelerometry). Lung function), body composition (body mass index), health status (COPD assessment test), and incidence of falls during 12 months (self-reported falls diary) were also evaluated. Differences between clusters were tested using a T-test or a Mann-Whitney U test. Results: The cluster analysis revealed two groups: “better postural balance” (n=23) and “fallers” (n=47). Both groups presented a similar lung fucntion; however, the “faller cluster” presented higher incidence of falls (46 vs 18%; P Conclusions: Our results show two distinct functional phenotypes in COPD patients based on postural balance, quadriceps muscle strength, physical activity and sedentary behavior.

Made available in DSpace on 2019-10-04T12:42:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction People with chronic obstructive pulmonary disease (COPD) present high prevalence of physical inactivity that leads to a negative effect on health-related quality of life (HRQoL). The present study investigated COPD phenotypes according to their levels of physical activity and sedentary behaviour, as well as body composition and skeletal muscle strength. Methods This is an observational and cross-sectional study. Anthropometric data and COPD clinical control were collected and all participants underwent assessments of lung function, HRQoL, dyspnoea, levels of physical activity and sedentary behaviour, body composition and skeletal muscle strength. Participants were classified using hierarchical cluster analysis. Age, dyspnoea and obstruction (ADO) index was used to determine prognosis and calculated for each cluster. Results One hundred and fifty-two participants were included. Three distinct phenotypes were identified. Participants in phenotype 1 were more physically active, less sedentary and had better body composition and lower ADO index (p < 0.0001 for all variables). Overall, participants in phenotypes 2 and 3 were less physically active, more sedentary having a higher ADO index. However, participants in phenotype 2 were older, whereas participants in phenotype 3 had worse HRQoL, clinical control and body composition. Lung function did not differ across the three phenotypes. Conclusions Our results show that physical activity, sedentary behaviour and body composition should be considered to determine phenotypes in people with COPD and are involved in the prognosis of the disease. Less sedentary patients have better prognosis while age, body composition and clinical control seems to differentiate physically inactive patients. Univ Sao Paulo, Sch Med, Dept Phys Therapy, Sao Paulo, Brazil Curtin Univ, Sch Physiotherapy & Exercise Sci, Perth, WA, Australia Sir Charles Gairdner Hosp, Inst Resp Hlth, Nedlands, WA, Australia Univ Sao Paulo, Med Sch, Clin Hosp, Pulm Div,Heart Inst InCor, Sao Paulo, Brazil State Univ Sao Paulo, Dept Phys Therapy, Sao Paulo, Brazil Univ Sao Paulo, Sch Med, Dept Med, Av Dr Arnaldo 455,Room 1210, BR-01246903 Sao Paulo, SP, Brazil State Univ Sao Paulo, Dept Phys Therapy, Sao Paulo, Brazil FAPESP: 2013/20676-9

The impairment of physical activity on the health status and the high prevalence of sedentary behaviour among patients with COPD are established. The understanding of COPD phenotypes can properbly establish the better treatment strategy. Aim: We investigated the phenotypes in subjects with COPD patients according to physical activity, sedentary behaviour, body composition and muscle force. Methods: One-hundred and ninety subjects with COPD were enrolled in a cohort study. COPD was diagnosed according to GOLD guidelines and patients were under optimal medical treatment for at least 6 months. All patients underwent assessments related to anthropometrical data, clinical history, lung function, COPD clinical control, health-related quality of life, dyspnea, physical activity level, sedentary behavior, skeletal muscle strength and body composition. After that, the patients were followed for 12 months to investigate the occurrence of exacerbation and hospitalization. Patients were classified using hierarchical cluster analysis. Results: Three distinct (clusters) phenotypes were identified. Patients in the phenotype 1 presented more exacerbation, more comorbidities, were younger and with worse clinical control compared to phenotypes 2 e 3. Patients in the phenotype 3 had lower physical activity level, more sedentary behaviour and higher hospitalization. Conclusion: Our results describe a phenotype with higher sedentary behaviour presenting higher hospitalization and while it seems that neither physical activity nor sedentary behaviour is related to exacerbation.

Introdução: A doença pulmonar obstrutiva crônica (DPOC) apresenta repercussões sistêmicas que contribuem negativamente para a evolução da doença e aumentam a mortalidade nestes indivíduos. O nível de atividade física e a força muscular periférica têm sido evidenciados como fatores de morbi-mortalidade em pacientes com DPOC, entretanto os fenótipos previamente descritos na literatura não incluem estes fatores como determinante dos fenótipos. Objetivo: Identificar fenótipos em indivíduos com DPOC considerando o nível de atividade física, a composição corporal e a disfunção muscular esquelética. Casuísticas e Métodos: Foram avaliados 190 indivíduos em relação à função pulmonar (espirometria), ao controle clínico da DPOC (CCQ), aos fatores de saúde relacionados à qualidade de vida (CRQ), ao nível de atividade física na vida diária (acelerômetro - Actigraph GT3X), à força dos músculos esqueléticos (isometria máxima) e à composição corporal (biompedância). Após 3, 6, 9 e 12 meses destas avaliações, os indivíduos foram questionados quanto à ocorrência de exacerbações e hospitalizações. Para a identificação dos fenótipos foi realizada análise de agrupamento de cluster. As comparações entre os fenótipos identificados foram realizadas por meio do teste de one-way ANOVA seguido do pos teste de Tukey para dados paramétricos e do teste de Kruskal-Wallis seguido do teste de Dunn para dados não paramétricos. A normalidade dos dados foi avaliada por meio do teste de Kolmogorov-Smirnov. Para comparação das variáveis categóricas foi utilizado o teste de qui-quadrado. O nível de significância foi ajustado para 5%. Resultados: Foram identificados 3 fenótipos (clusteres) distintos de acordo com a idade, atividade física, composição corporal, força muscular, qualidade de vida e controle clínico. O fenótipo 1 englobou indivíduos mais jovens, com pior controle clínico e maior número de comorbidades, os indivíduos deste grupo apresentaram maior frequência de exacerbação comparados aos fenótipos 2 e 3. Os indivíduos do fenótipo 3 apresentaram menores valores de atividade física, maior tempo em comportamento sedentário e maior frequência de hospitalização nos indivíduos que exacerbaram. Conclusão: O presente estudo demonstrou a existência de diferentes fenótipos em pacientes com DPOC em relação à atividade física. Estes resultados são relevantes para o manejo clínico de indivíduos com DPOC e para a escolha de estratégias para aumentar o nível de atividade física destes pacientes Rationale: The chronic obstructive pulmonary disease (COPD) has systemic repercussions that contribute negatively to the evolution of the disease and increase mortality in these individuals. The level of physical activity and peripheral muscle strength have been evidenced as morbidity and mortality factors in individuals with COPD, however the phenotypes previously described in the literature do not include these factors as determinant of the phenotypes. Objective: To identify phenotypes in individuals with COPD according to their levels of physical activity in daily life, body composition and skeletal muscle force. Methods: We evaluated 190 individuals in relation to pulmonary function (spirometry), clinical control of COPD (CCQ), health factors related to quality of life (CRQ), physical activity in daily life (Actigraph GT3X), skeletal muscle force (maximal isometry) and body composition (bioimpedance). After 3, 6, 9 and 12 months of these evaluations, subjects were questioned about the occurrence of exacerbations and hospitalizations. Participants were classified using hierarchical cluster analysis. The comparisons between the identified phenotypes were performed using the ANOVA one-way test followed by Tukey\'s post test for parametric data and the Kruskal-Wallis test followed by the Dunn test for non-parametric data. The normality of the data was evaluated using the Kolmogorov-Smirnov test. The chi-square test was used to compare the categorical variables. The level of significance was adjusted to 5%. Results: Three distinct phenotypes (clusters) were identified according to age, physical activity, body composition, muscle strength, quality of life and clinical control. The individuals in phenotype 1 were younger, with worse clinical control, with more comorbidities and with higher frequency of exacerbation compared to phenotypes 2 and 3. Subjects of phenotype 3 had lower values of physical activity, sedentary status and greater frequency of hospitalization after exacerbations. Conclusions: The present study demonstrated the existence of different phenotypes in patients with COPD according to physical activity. These results are relevant for the clinical management of individuals with COPD and for the choice of strategies to increase the level of physical activity of these patients

Made available in DSpace on 2019-10-04T12:37:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01. Added 1 bitstream(s) on 2019-10-09T18:34:04Z : No. of bitstreams: 1 S1809-48642019000200229.pdf: 294742 bytes, checksum: 65636b53e7350893d0df7a843c2bdf7d (MD5) Introduction The importance of mucociliary clearance (MCC) for the respiratory system homeostasis is clear. Therefore, evaluating this defense mechanism is fundamental in scientific research and in the clinical practice of pulmonology and of associated areas. However, MCC evaluation has not been so usual due to the complexity of methods that use radiolabeled particles. Nevertheless, as an interesting alternative, there is the saccharin transit time (STT) test. This method is reproducible, simple to perform, noninvasive, does not demand high costs, and has been widely used in studies of nasal MCC. Although the STT test is widely used, there is still lack of a detailed description of its realization. Objective The present literature review aims to provide basic information related to the SIT test and to present the findings of the previous studies that used this method, discussing variations in its execution, possible influences on the obtained results and limitations of the method, as well as to relate our experience with the use of STT in researches. Data Synthesis There are several factors that can alter the results obtained from STT tests, which would raise difficulties with proper interpretation and with the discussion of the results among different studies. Conclusions Saccharin transit time is a widely used method for the evaluation of nasal MCC, and therefore, the standardization related to the previous and concurrent to test orientations, and also its execution, become essential to improve its accuracy, and allow comparisons among different studies. Univ Estadual Paulista, Dept Physiotherapy, Campus Presidente Prudente, Presidente Prudente, SP, Brazil Univ Estadual Paulista, Dept Physiotherapy, Campus Presidente Prudente, Presidente Prudente, SP, Brazil

Several COPD phenotypes have been described; however, the influence of physical activity, skeletal muscle strength and bod composition remains unclear. Aim: To investigate the phenotypes in COPD patients according to physical activity, body composition and muscle strength. Methods: 152 COPD patients were enrolled in a cross-sectional study. Patients were assessed by: lung function, clinical control, health related quality of life, physical activity, skeletal muscle strength and body composition. Patients were classified by hierarchical cluster analysis and Kruskall-wallis followed by Dunn9s test for between clusters comparison. P Results: Three distinct (clusters) phenotypes were identified. Patients in phenotype 1 were more physically active (6108[3749-7468] steps.day-1) compared to phenotype 2 (1543[1741-3344] steps.day-1) and phenotype 3 (2919[2117-3639] steps.day-1); and phenotype 1 also presented a better body composition, (68 [61-75] % of muscle mass and 18[10-25] % of fat mass). Although phenotypes 2 and 3 were also less physical active, patients in phenotype 2 were older (73[68-78] years), while patients in phenotype 3, presented a worse quality of life (51[46-61] CRQ total score), clinical control (3[3-4] CCQ total score) and body composition (54[51-60] % of muscle mass and 34[28-38] % of fat mass). There was no difference in the lung function between the three phenotypes. Conclusion: Our results suggest that COPD patients present distinct phenotypes according to body composition, skeletal muscle strength and physical activity independent of the lung function.

COPD patients have an impairment in the postural balance, however, the impact of this deficit on the risk of future falls remains poorly investigated. Aim: To evaluate postural balance as a predictor of falls in COPD patients. Methods: This prospective cohort study included 70 COPD patients classified according to GOLD (1.4% mild, 27.2% moderate, 55.7% severe and 15.7% very severe). Postural balance was evaluated by the Mini BESTest (Balance evaluation systems test) and the incidence of falls was followed for one year, assessed monthly by a calendar of self-report of falls and confirmed by telephone calls. For the statistical analysis, discriminative power analysis by receiver operator characteristic curve (ROC) and logistic regression analysis were used. Results: Sixty-seven individuals completed a one-year follow-up period and were analyzed. Three patients died during the follow-up and were excluded. Twenty-five patients (37.3%) had at least one fall event in the follow-up period. It was found that the Mini BESTest was able to identify falls in COPD patients at 6 and 12 months (area under the curve, AUC = 0.85 and 0.87) with good sensitivity (85.7% and 84%) and specificity (66.7 and 73.8%), respectively. In addition, higher scores of Mini BESTest were strongly associated with a lower risk of falls at 6 and 12 months (OR = 0.66 and 0.51, respectively) after evaluation. Conclusion: The postural balance assessed by Mini BESTest is a good medium and long-term predictor of future falls in COPD patients.

COPD patients have impaired balance and there are studies evaluating the role of isolated factors related to this deficit; however, the assessment of multiple factors in the same patient sample has been poorly evaluated. Aim: To determine the factors associated with balance impairment in COPD patients. Methods: Seventy COPD patients classified according to GOLD were included (1.4% mild, 27.2% moderate, 55.7% severe and 15.7% very severe). Postural balance was evaluated by the Mini BESTest (Balance evaluation systems test) and its total score was associated with: age, physical inactivity (time spent in sedentarism measured by accelerometer, Actigraph GT3x), maximal peripheral muscle strength of the lower limbs (dynamometry), sleep quality (Pittsburgh sleep quality index), fear of falling (Falls efficacy scale-international; FES-I) and maximal respiratory muscle strength (manuvacuometer). Pearson correlation and multiple linear regression analysis were used. Results: Our results show that quadriceps muscle strength, fear of falling, age, maximal inspiratory muscle strength and physical inactivity were linearly associated with postural balance (R=0.44, 0.42, 0.41, 0.41 and 0.35, respectively; p Conclusion: Our data suggest that age, quadriceps muscle strength and fear of falling can predict 49% of the balance impairment in COPD patients.

SummaryIntroductionSmoking cessation promotes health benefits and, despite cigarette smoking be an important pro inflammatory stimulus, there are few studies concerning the nasal and systemic inflammation; as well as the mucociliary clearance behavior in smokers after short period of smoking cessation.AimTo evaluate the nasal and systemic inflammatory markers and mucociliary clearance behavior after 30 days of cigarette smoking abstinence.MethodsTwenty-five smokers were included and divided into two groups: abstinent smokers (n = 14) and current smokers (n = 11). Tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-8 and IL-10 were measured on nasal lavage and blood serum samples by ELISA at baseline and after 30 days. The mucociliary clearance, exhaled carbon monoxide (exCO) and carboxyhemoglobin (HbCO) were also measured at the same moments.ResultsThere was a decrease of TNF-α level only in blood serum at 30 days of abstinence compared to current smokers. The mucociliary clearance improved and there was a reduction in exCO and HbCO (p

Background: Smoking impairs mucociliary clearance and increases respiratory infection frequency and severity in subjects with and without smoking-related chronic lung diseases. Objective: This study evaluated the effects of smoking intensity on mucociliary clearance in active smokers. Methods: Seventy-five active smokers were grouped into light (1-10 cigarettes/day; n = 14), moderate (11-20 cigarettes/day; n = 34) and heavy smokers (≥21 cigarettes/day; n = 27) before starting a smoking cessation programme. Smoking behaviour, nicotine dependence, pulmonary function, carbon monoxide in exhaled air (exCO), carboxyhaemoglobin (COHb) and mucociliary clearance measured by the saccharin transit time (STT) test were all evaluated. An age-matched non-smoker group (n = 24) was assessed using the same tests. Results: Moderate (49 ± 7 years) and heavy smokers (46 ± 8 years) had higher STT (p = 0.0001), exCO (p < 0.0001) and COHb (p < 0.0001) levels compared with light smokers (51 ± 15 years) and non-smokers (50 ± 11 years). A positive correlation was observed between STT and exCO (r = 0.4; p < 0.0001), STT and cigarettes/day (r = 0.3, p = 0.02) and exCO and cigarettes/day (r = 0.3, p < 0.01). Conclusion: Smoking impairs mucociliary clearance and is associated with cigarette smoking intensity.

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.

Patients with asthma COPD overlap syndrome (ACOS) have frequent exacerbations, poorer quality of life, higher mortality and consume large amounts of health care resources. However, the level of physical activity in this COPD phenotype remains unclear. Aim: To compare the level of daily life physical activity (DLPA) between patients with COPD and ACOS. Methods: Twenty-two patients were evaluated, 11 with ACOS and 11 with COPD (control group) matched by age and body mass index (BMI). Patients were assessed by gender, pack-years index, comorbidities (arterial hypertension and diabetes), dyspnea (MRC scale), body composition (BMI and skeletal muscle mass (SMM%), by octopolar bioimpedance), muscle strength (maximal quadriceps isometric, in %predicted), DLPA (step counts/day, steps per minute and time in moderate and vigorous physical activity (%MVPA), by GT3X accelerometer). For group comparison t-student, Mann-Whitney and Fisher´s tests were used. Results: Patients with ACOS have higher levels of total DLPA than COPD patients (respectively, 5428±1454 vs. 3599±1708 steps/day, p=0.01; 6±1 vs. 4±2 steps per minute, p=0.01;) and perform DLPA at higher intensities (2±1.6 vs. 0.6±0.5 %MVPA, p Conclusion: Our results suggest that, although both groups are sedentary individuals with ACOS are more physically active than those with COPD.

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

The need for keeping patients with COPD physically active is broadly recognized; however, the factors associated with daily life physical activity (DLPA) in COPD patients in developing countries have not been fully elucidated. Aim: To identify factors associated with DLPA in Brazilian COPD patients. Methods: This cross-sectional study included 153 COPD patients (68±8 years, 68% male and FEV 1 46±16 %predicted) recruited in a tertiary outpatient clinic in a University hospital. Patients were assessed by age, airflow obstruction (FEV 1 ), previous hospitalization, dyspnea (MRC scale), muscle strength (maximal quadriceps isometric force), body composition (skeletal muscle mass (SMM%), by octopolar bioimpedance) and DLPA (step counts per day) by accelerometer (GT3X). Pearson9s correlation was used between DPLA (step counts) and all variables. Multiple linear regression analysis was performed to identify the independent factors associated with DPLA. Results: DLPA was associated with muscle strength, age, dyspnea, hospitalization in last year and airflow obstruction (DLPA = 10424 + 95*quadriceps strength – 117*age – 37*MRC scale – 1044*hospitalization in last year + 23*airflow obstruction) (hospitalization 1=yes; 0=no); (p 2 adjusted =0.32). Conclusion: COPD patients with weaker quadriceps strength, older, having more dyspnea and previous hospitalization and worst airflow obstruction have impaired daily life physical activity. Assessing and improving these variables during the clinical management of COPD patients could help to maintain themselves physically active.

Illness perception(IP) concerns how patients evaluate living with a disease and this perceptions may influence coping, health and well-being. However, how IP is related with psychosocial distress and daily life physical activity (DLPA) in COPD patients remains poorly known. Aim: To identify possible association between patients9 illness perceptions with psycho-demographic factors and DLPA in patients with COPD. Methods: This cross-sectional study included 150 outpatients with moderate to very severe COPD in medical treatment from an University hospital. Illness perception (IPQ), social support (MOSS), clinical control (CCQ), health-related quality of life (CRQ), self-efficacy (GSE) and DPLA (GT3X, accelerometer) were evaluated. Cluster analysis of illness perceptions was used to establish groups of patients holding distinct beliefs.Differences between clusters were tested using a T-test or a Mann-Whitney-U-test. Results: Cluster analysis revealed two distinct groups. In the cluster 1 (n=95) patients presented a worst illness perceptions than cluster 2 (n=55). Between-cluster differences were observed in education level (p=0,002), self-efficacy, dyspnea, health related quality of life and clinic control (p Conclusion: Our data suggest that patients9 perception is associated with education level, self-efficacy, dyspnea, health related quality of life and clinic control in the studied population.

Background and objective: Smoking cessation (SC) is recognized as reducing tobacco-associated mortality and morbidity. The effect of SC on nasal mucociliary clearance (MC) in smokers was evaluated during a 180day period. Methods: Thirty-three current smokers enrolled in a SC intervention programme were evaluated after they had stopped smoking. Smoking history, Fagerstrom’s test, lung function, exhaled carbon monoxide (eCO), carboxyhaemoglobin (COHb) and nasal MC as assessed by the saccharin transit time (STT) test were evaluated. All parameters were also measured at baseline in 33 matched non-smokers. Results: Smokers (mean age 49 12 years, mean pack-year index 44 25) were enrolled in a SC intervention and 27% (n = 9) abstained for 180 days, 30% (n = 11) for 120 days, 49.5% (n = 15) for 90 days or 60 days, 62.7% (n = 19) for 30 days and 75.9% (n = 23) for 15 days. A moderate degree of nicotine dependence, higher education levels and less use of bupropion were associated with the capacity to stop smoking (P < 0.05). The STT was prolonged in smokers compared with non-smokers (P = 0.002) and dysfunction of MC was present at baseline both in smokers who had abstained and those who had not abstained for 180 days. eCO and COHb were also significantly increased in smokers compared with non-smokers. STT values decreased to within the normal range on day 15 after SC (P < 0.01), and remained in the normal range until the end of the study period. Similarly, eCO values were reduced from the seventh day after SC. Conclusions: A SC programme contributed to improvement in MC among smokers from the 15th day after cessation of smoking, and these beneficial effects persisted for 180 days.

The need for keeping patients with COPD physically active is broadly recognized; however the psychosocial factors related with daily life physical activity (DLPA) in COPD remains poorly known mainly in the developing countries. Aim: To assess whichpsychosocial factors were associated with DLPA in patients with COPD. Methods: 77 consecutive patients with mild to severe COPD under optimized medical treatment were assessed. DPLA was measured with a triaxial accelerometer(Actigraph, GT3X) during 6 days. Self-efficacy (General self-efficacy scale), social support (Medical outcomes study social support survey), illness perception (Illness perception questionnaire) and health-related quality of life (Chronic respiratory questionnaire) were scored. Pearson9s correlation was calculated between DPLA (step counts) and psychosocial factors. Multiple linear regression analysis was performed to identify the independent factors associated with DPLA. Results: Worst understanding of the disease (IPQ-R illness coherence subscale) was associated to higher level of DLPA (p=0.04). Patients with high levels of DLPA (64±8years, %FEV 1 =43±15 and 7,757±1,751 steps/day) also presented higher health-related quality of life (CRQemotional function=4.94±0.75 vs. 4.47±0.80, p= vs. 3.77±1.19, p=0.04; CRQtotal= 61.26 ± 9.28 vs. 55.53±10.09, p= 1 =40±14 and 2,690± 1,037 steps/day), respectively. Conclusion: Our data suggest that the lack of knowledge of the disease is associated with higher physical activity level in COPD patients.

Hospitalizations and exacerbations are related to a decline in lung function, quality of life and increase in mortality in patients with COPD. In addition, hospitalization also reduces acutely the daily life physical activity (DLPA) in COPD patients, however, the later effects remains unclear. Aim: To assess if hospitalization has a long term effect on DLPA in patients with COPD. Methods: This study included 93 patients with moderate and severe COPD during regular medical visit in a University hospital and under optimized medication. It was assessed: hospitalization in the last year as well as time of physical inactivity (in percentual of inactivity time) and step counts per day using an accelerometer (ActiGraph, GT3X) assessed during 6 days. Patients were divided into 2 groups: those that hospitalized during the last year but not in the last 60 days (PH group) and those who did not (NPH group). Mann Whitney test was used to compare both groups. Results: There was no difference in the age (71±7 vs. 67±9 years) and lung function (FEV 1 40±14 vs. 42±14 in % pred., respectively) between PH and NPH groups. However, the PH group presented longer time in physical inactivity and lower number of steps per day compared with the NPH group (respectively, 83 vs. 78%; p= 0.04 and 2,423 vs. 3,639 steps per day; p Conclusion: COPD patients who hospitalized in the last year remains physically inactive for a longer period. Therefore, physical activity should be encouraged in these patients after hospitalization.

Smoking cessation (SC) is recognized as reducing tobacco-associated mortality and morbidity. The effect of SC on nasal mucociliary clearance (MC) in smokers was evaluated during a 180-day period.Thirty-three current smokers enrolled in a SC intervention programme were evaluated after they had stopped smoking. Smoking history, Fagerström's test, lung function, exhaled carbon monoxide (eCO), carboxyhaemoglobin (COHb) and nasal MC as assessed by the saccharin transit time (STT) test were evaluated. All parameters were also measured at baseline in 33 matched non-smokers.Smokers (mean age 49 ± 12 years, mean pack-year index 44 ± 25) were enrolled in a SC intervention and 27% (n = 9) abstained for 180 days, 30% (n = 11) for 120 days, 49.5% (n = 15) for 90 days or 60 days, 62.7% (n = 19) for 30 days and 75.9% (n = 23) for 15 days. A moderate degree of nicotine dependence, higher education levels and less use of bupropion were associated with the capacity to stop smoking (P0.05). The STT was prolonged in smokers compared with non-smokers (P = 0.002) and dysfunction of MC was present at baseline both in smokers who had abstained and those who had not abstained for 180 days. eCO and COHb were also significantly increased in smokers compared with non-smokers. STT values decreased to within the normal range on day 15 after SC (P0.01), and remained in the normal range until the end of the study period. Similarly, eCO values were reduced from the seventh day after SC.A SC programme contributed to improvement in MC among smokers from the 15th day after cessation of smoking, and these beneficial effects persisted for 180 days.

Made available in DSpace on 2013-09-27T14:53:53Z (GMT). No. of bitstreams: 1 WOS000295663600026.pdf: 153288 bytes, checksum: 0a1e1c45794cf17f3eaedd95db054ac6 (MD5) Previous issue date: 2011-11-01 Made available in DSpace on 2013-09-30T18:09:39Z (GMT). No. of bitstreams: 1 WOS000295663600026.pdf: 153288 bytes, checksum: 0a1e1c45794cf17f3eaedd95db054ac6 (MD5) Previous issue date: 2011-11-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:23:14Z No. of bitstreams: 1 WOS000295663600026.pdf: 153288 bytes, checksum: 0a1e1c45794cf17f3eaedd95db054ac6 (MD5) Made available in DSpace on 2014-05-20T13:23:14Z (GMT). No. of bitstreams: 1 WOS000295663600026.pdf: 153288 bytes, checksum: 0a1e1c45794cf17f3eaedd95db054ac6 (MD5) Previous issue date: 2011-11-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Nasal mucociliary system is the first line of defense of the upper airways and may be affected acutely by exposure to particulate matter (PM) from biomass burning. Several epidemiologic studies have demonstrated a consistent association between levels of air pollution from biomass burning with increases in hospitalization for respiratory diseases and mortality. To determine the acute effects of exposure to particulate matter from biomass burning in nasal mucociliary transport by saccharin transit time (STT) test, we studied thirty-three non-smokers and twelve light smokers sugarcane cutters in two periods: pre-harvest season and 4 h after harvest at the first day after biomass burning. Lung function, exhaled carbon monoxide (CO), nasal symptoms questionnaire and mucociliary clearance (MC) were assessed. Exhaled CO was increased in smokers compared to non-smokers but did not change significantly after harvest. In contrast, SIT was similar between smokers and non-smokers and decreased significantly after harvest in both groups (p < 0.001). Exposure to PM from biomass burning did not influence nasal symptoms. Our results suggest that acute exposure to particulate matter from sugarcane burned affects mucociliary clearance in smokers and non-smokers workers in the absence of symptoms. (C) 2011 Elsevier Ltd. All rights reserved. State Univ São Paulo, Dept Physiotherapy, BR-19060900 São Paulo, Brazil State Univ São Paulo, Dept Phys Chem & Biol, BR-19060900 São Paulo, Brazil State Univ São Paulo, Dept Physiotherapy, BR-19060900 São Paulo, Brazil State Univ São Paulo, Dept Phys Chem & Biol, BR-19060900 São Paulo, Brazil