INTRODUÇÃO: As doenças pulmonares intersticiais fibrosantes (DPIFs) se caracterizam por dispneia, intolerância aos esforços e prejuízo da qualidade de vida. Apesar de existirem vários mecanismos implicados, a fisiopatologia da dispneia e limitação aos esforços não é completamente elucidada. A disfunção da musculatura ventilatória tem sido postulada como um fator envolvido. O objetivo do estudo foi investigar a ocorrência de disfunção muscular ventilatória em pacientes com DPIF comparados a indivíduos sadios, e correlacionar a disfunção muscular com a qualidade de vida, dispneia e intolerância ao exercício. METODOLOGIA: Foi realizado um estudo prospectivo, caso-controle envolvendo 62 indivíduos, sendo 31 pacientes com DPIF e 31 voluntários sadios. Os indivíduos foram avaliados em 2 visitas. Na visita 1 foram avaliados o grau de dispneia (escala de MRCm), a qualidade de vida (SGRQ), a função pulmonar, e o desempenho num teste de caminhada de 6 minutos (TC6M) além de caracterização da mobilidade e espessura do diafragma ao ultrassom (US). Na visita 2, foram avaliadas:1) a força muscular ventilatória estática volitiva (PImáx, PEmáx, SNIP, PesSniff, PgaSniff, PdiSniff, e PgaTosse) e não volitiva através da estimulação magnética bilateral do nervo frênico (TwPes, TwPga e TwPdi) e das raízes dorsais em T10 (TwT10Pga); 2) a sincronia toracoabdominal (por pletismografia de indutância); 3) o recrutamento dos músculo inspiratórios (eletromiografia de superfície do musculo escaleno) e expiratórios (eletromiografia de superfície do musculo obliquo externo). A seguir foi realizado um teste de exercicio cardiopulmonar (TECP) em cicloergômetro limitado por sintomas. As medidas de força muscular não volitiva foram repetidas após o TECP para investigar a ocorrência de fadiga muscular ventilatória. RESULTADOS: os pacientes com DPIFs apresentavam: dispneia aos esforços; limitação do desempenho no TC6M e prejuízo de qualidade de vida. Os pacientes com DPIF apresentaram redução da mobilidade diafragmática na respiração profunda, aumento da espessura na CRF e redução da fração de espessamento do diafragma ao US. Não houve diferenças entre pacientes e controles na força muscular volitiva e não volitiva e na proporção de fadiga ins e expiratória após o esforço. Contudo, os pacientes apresentaram fadiga ventilatória em cargas menores de exercicio. Nos pacientes com DPIF houve uma redução no desempenho do exercicio associada a uma limitação ventilatória, dessaturação e dispneia. Os pacientes com DPIF apresentaram uma proporção maior de assincronia no pico do exercício além de maior recrutamento do musculo escaleno. As relações entre a força ventilatória inspiratória e o os volumes pulmonares indicaram um desacoplamento neuromecânico (DNM) que se correlacionou com a dispneia nos pacientes com DPIF. CONCLUSÕES: Os pacientes com DPIF apresentam disfunção muscular ventilatória ao repouso caracterizado pela redução da mobilidade do diafragma na respiração profunda, aumento da espessura e redução da fração de espessamento. Ao esforço, na DPIF, a disfunção muscular ventilatória foi caracterizada pela ocorrência de fadiga ventilatória em baixas cargas de exercicio, recrutamento predominante dos músculos inspiratórios acessórios, assincronia toracoabdominal e desacoplamento neuromecânico que contribuíram para limitação do desempenho e dispneia / INTRODUCTION: fibrosing interstitial lung diseases (FILDs) are characterized by dyspnea, exercise intolerance and impaired quality of life. While there are several mechanisms involved, the occurrence of dyspnea and exercise limitation is not fully elucidated. The dysfunction of the respiratory muscles has been postulated as a contributing factor. The aim of the study was to investigate the occurrence of respiratory muscle dysfunction in patients with FILDs compared to healthy subjects and to correlate respiratory muscle dysfunction with quality of life, dyspnea and exercise intolerance. METHODS: A prospective, case-control study involving 62 subjects, 31 patients with FILD and 31 healthy volunteers. Subjects were evaluated in two visits. At visit 1, subjects underwent clinical evaluation to access dyspnea (MRCm), quality of life (SGRQ), pulmonary function and also characterization of mobility and thickness of the diaphragm on ultrasound (US). Subjects performed a 6-minute walk test (6MWT). In the second visit were evaluated: 1) maximum static respiratory pressures through volitional (MIP, MEP, SNIP, PesSniff, PgaSniff, PdiSniff and PgaCough) and non-volitional methods - cervical Twitchs (TwPes, TwPga and TwPdi) and T10 Twitchs (TwT10Pga); 2) thoracoabdominal synchrony (by respiratory inductance plethysmography); 3) recruitment of inspiratory muscle (surface electromyography of scalene muscle) and expiratory (surface electromyography of the external oblique muscle). Then, subjects performed an incremental cardiopulmonary exercise testing (CPET). The non-volitional muscle strength measures were repeated after the CPET to investigate the occurrence of fatigue. RESULTS: The patients with FILDs exhibited dyspnea on exertion; limited performance on 6MWT and impaired quality of life. On ultrasound, patients with FILD had decreased diaphragmatic mobility during deep breathing, increased thickness in the functional residual capacity (FRC) and reduced diaphragm thickness fraction. Between patients and controls, there were no differences in volitional and non-volitional strength and in the occurrence of respiratory fatigue. However, patients presented respiratory fatigue under lower exercise loads. In patients with FILD there was a decrease in exercise performance associated with ventilatory limitation, desaturation and dyspnea. Patients with FILD had a higher proportion of asynchrony at exercise peak and greater recruitment of the scalene muscle. In patients with FILD, higher inspiratory effort- displacement ratios indicated a neuromechanical uncoupling (DNM) that correlated with dyspnea. CONCLUSIONS: Patients with FILD exhibited respiratory muscle dysfunction at rest characterized by the reduction of diaphragmatic mobility in deep breathing, increased thickness on FRC and reduced thickness fraction. In FILD, exercise was associated with respiratory muscle dysfunction characterized by the occurrence of respiratory fatigue, thoracoabdominal asynchrony, greater recruitment of inspiratory muscles and neuromechanical uncoupling that contributed to limiting the performance and dyspnea

INTRODUÇÃO: As doenças pulmonares intersticiais fibrosantes (DPIFs) se caracterizam por dispneia, intolerância aos esforços e prejuízo da qualidade de vida. Apesar de existirem vários mecanismos implicados, a fisiopatologia da dispneia e limitação aos esforços não é completamente elucidada. A disfunção da musculatura ventilatória tem sido postulada como um fator envolvido. O objetivo do estudo foi investigar a ocorrência de disfunção muscular ventilatória em pacientes com DPIF comparados a indivíduos sadios, e correlacionar a disfunção muscular com a qualidade de vida, dispneia e intolerância ao exercício. METODOLOGIA: Foi realizado um estudo prospectivo, caso-controle envolvendo 62 indivíduos, sendo 31 pacientes com DPIF e 31 voluntários sadios. Os indivíduos foram avaliados em 2 visitas. Na visita 1 foram avaliados o grau de dispneia (escala de MRCm), a qualidade de vida (SGRQ), a função pulmonar, e o desempenho num teste de caminhada de 6 minutos (TC6M) além de caracterização da mobilidade e espessura do diafragma ao ultrassom (US). Na visita 2, foram avaliadas:1) a força muscular ventilatória estática volitiva (PImáx, PEmáx, SNIP, PesSniff, PgaSniff, PdiSniff, e PgaTosse) e não volitiva através da estimulação magnética bilateral do nervo frênico (TwPes, TwPga e TwPdi) e das raízes dorsais em T10 (TwT10Pga); 2) a sincronia toracoabdominal (por pletismografia de indutância); 3) o recrutamento dos músculo inspiratórios (eletromiografia de superfície do musculo escaleno) e expiratórios (eletromiografia de superfície do musculo obliquo externo). A seguir foi realizado um teste de exercicio cardiopulmonar (TECP) em cicloergômetro limitado por sintomas. As medidas de força muscular não volitiva foram repetidas após o TECP para investigar a ocorrência de fadiga muscular ventilatória. RESULTADOS: os pacientes com DPIFs apresentavam: dispneia aos esforços; limitação do desempenho no TC6M e prejuízo de qualidade de vida. Os pacientes com DPIF apresentaram redução da mobilidade diafragmática na respiração profunda, aumento da espessura na CRF e redução da fração de espessamento do diafragma ao US. Não houve diferenças entre pacientes e controles na força muscular volitiva e não volitiva e na proporção de fadiga ins e expiratória após o esforço. Contudo, os pacientes apresentaram fadiga ventilatória em cargas menores de exercicio. Nos pacientes com DPIF houve uma redução no desempenho do exercicio associada a uma limitação ventilatória, dessaturação e dispneia. Os pacientes com DPIF apresentaram uma proporção maior de assincronia no pico do exercício além de maior recrutamento do musculo escaleno. As relações entre a força ventilatória inspiratória e o os volumes pulmonares indicaram um desacoplamento neuromecânico (DNM) que se correlacionou com a dispneia nos pacientes com DPIF. CONCLUSÕES: Os pacientes com DPIF apresentam disfunção muscular ventilatória ao repouso caracterizado pela redução da mobilidade do diafragma na respiração profunda, aumento da espessura e redução da fração de espessamento. Ao esforço, na DPIF, a disfunção muscular ventilatória foi caracterizada pela ocorrência de fadiga ventilatória em baixas cargas de exercicio, recrutamento predominante dos músculos inspiratórios acessórios, assincronia toracoabdominal e desacoplamento neuromecânico que contribuíram para limitação do desempenho e dispneia / INTRODUCTION: fibrosing interstitial lung diseases (FILDs) are characterized by dyspnea, exercise intolerance and impaired quality of life. While there are several mechanisms involved, the occurrence of dyspnea and exercise limitation is not fully elucidated. The dysfunction of the respiratory muscles has been postulated as a contributing factor. The aim of the study was to investigate the occurrence of respiratory muscle dysfunction in patients with FILDs compared to healthy subjects and to correlate respiratory muscle dysfunction with quality of life, dyspnea and exercise intolerance. METHODS: A prospective, case-control study involving 62 subjects, 31 patients with FILD and 31 healthy volunteers. Subjects were evaluated in two visits. At visit 1, subjects underwent clinical evaluation to access dyspnea (MRCm), quality of life (SGRQ), pulmonary function and also characterization of mobility and thickness of the diaphragm on ultrasound (US). Subjects performed a 6-minute walk test (6MWT). In the second visit were evaluated: 1) maximum static respiratory pressures through volitional (MIP, MEP, SNIP, PesSniff, PgaSniff, PdiSniff and PgaCough) and non-volitional methods - cervical Twitchs (TwPes, TwPga and TwPdi) and T10 Twitchs (TwT10Pga); 2) thoracoabdominal synchrony (by respiratory inductance plethysmography); 3) recruitment of inspiratory muscle (surface electromyography of scalene muscle) and expiratory (surface electromyography of the external oblique muscle). Then, subjects performed an incremental cardiopulmonary exercise testing (CPET). The non-volitional muscle strength measures were repeated after the CPET to investigate the occurrence of fatigue. RESULTS: The patients with FILDs exhibited dyspnea on exertion; limited performance on 6MWT and impaired quality of life. On ultrasound, patients with FILD had decreased diaphragmatic mobility during deep breathing, increased thickness in the functional residual capacity (FRC) and reduced diaphragm thickness fraction. Between patients and controls, there were no differences in volitional and non-volitional strength and in the occurrence of respiratory fatigue. However, patients presented respiratory fatigue under lower exercise loads. In patients with FILD there was a decrease in exercise performance associated with ventilatory limitation, desaturation and dyspnea. Patients with FILD had a higher proportion of asynchrony at exercise peak and greater recruitment of the scalene muscle. In patients with FILD, higher inspiratory effort- displacement ratios indicated a neuromechanical uncoupling (DNM) that correlated with dyspnea. CONCLUSIONS: Patients with FILD exhibited respiratory muscle dysfunction at rest characterized by the reduction of diaphragmatic mobility in deep breathing, increased thickness on FRC and reduced thickness fraction. In FILD, exercise was associated with respiratory muscle dysfunction characterized by the occurrence of respiratory fatigue, thoracoabdominal asynchrony, greater recruitment of inspiratory muscles and neuromechanical uncoupling that contributed to limiting the performance and dyspnea

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

Patienter med kronisk obstruktiv lungsjukdom (KOL) upplever ofta oro relaterat till dyspné. Syftet med studien var att undersöka vilka icke-farmakologiska åtgärder som kan vidtas för att lindra patienters oro relaterat till dyspné vid KOL.  En litteraturstudie genomfördes där vetenskapliga artiklar granskades och sammanställdes. Resultatet visade att det finns ett flertal icke-farmakologiska åtgärder så som andningstekniker, fysisk träning, avledning, nutrition och kommunikation som sjuksköterskan kan undervisa och informera om för att lindra oro relaterad till dyspné. Åtgärderna bör vara individanpassade, eftersom varje patient är unik. Sjuksköterskan bör själv eller tillsammans med andra vårdinstanser försäkra sig om att patienten får den information och utbildning om sin sjukdom som krävs för att lindra patientens oro i möjligast mån. Informationen och utbildningen bör vara omfattande, för att patienten ska kunna finna de strategier och hjälpmedel som hjälper just dem vid oro. Lungrehabiliteringsprogram visade sig vara av betydelse för patienternas möjlighet att finna strategier för att lindra oro relaterad till dyspné. Ytterligare forskning men även utbildning av sjuksköterskor behövs angående specifika icke-farmakologiska åtgärder som kan lindra oro relaterad dyspné. Det behövs även forskning om vilka icke-farmakologiska åtgärder som bör ingå i ett lungrehabiliteringsprogram. / Patients with chronic obstructive pulmonary disease (COPD) often experience anxiety related to dyspnea. The purpose of this study was to investigate the non-pharmacological interventions that can be performed to alleviate patients' anxiety related dyspnea. A literature review was conducted and scientific articles were reviewed and summarized. The results showed that there are several non-pharmacological interventions that nurses can conduct to relieve anxiety related dyspnea, such as breathing techniques, physical exercise, diversion, nutrition and communication. Every patient is unique and therefore should the nurse interventions be individualized. It is the nurse task together with other health care professionals to ensure that the patients receives and understands the information that is given. The information and education should be extensive so that the patient will be able to find the right strategies that will help them to alleviate their anxiety. Pulmonary rehabilitation programs proved to be of great importance to patients' ability to find strategies to relieve anxiety related to dyspnea. Further research and education to nurses are needed on specific non- pharmacological interventions that can relieve anxiety related dyspnea. Research is also needed on which non-pharmacological interventions that should be part of a pulmonary rehabilitation program.

Fatigue is a distressing, complex, and multidimensional sensation, that is common in individuals with chronic obstructive pulmonary disease (COPD), and impacts negatively on their functioning and quality of life. Limited research has been conducted to examine how various factors may influence the different dimensions of subjective fatigue experienced in these individuals. Four dimensions of subjective fatigue including: emotional, behavioural, cognitive, and physical, were examined in a convenience sample of 42 participants with COPD who attended an outpatient pulmonary rehabilitation program. The primary purpose of this feasibility study was to determine the proportion of individuals experiencing the four dimensions of fatigue, and to examine the relationships between these dimensions of fatigue and various influencing factors (dyspnea, depression, anxiety, sleep quality, activity limitation, heart rate, and oxygen saturation). The secondary purpose was to compare the four dimensions of fatigue by sex, supplemental oxygen use, smoking status, and severity of dyspnea, and to examine the relationships between the four dimensions of fatigue and age, the number of co-morbidities, and the amount of pulmonary rehabilitation received. Self-report questionnaires were used to measure fatigue (Multidimensional Fatigue Inventory MFI), anxiety and depression (Hospital Anxiety and Depression Scale HADS), and sleep quality (Pittsburgh Sleep Quality Index PSQI). Pulmonary rehabilitation health records were accessed to collect data on the remaining variables. The majority of the participants (61.9% - 81.0%) experienced moderate levels of subjective fatigue in all four dimensions. Moderate to severe levels of physical fatigue were experienced in 95.3% of the participants. The only significant relationship was between anxiety and emotional fatigue; all other relationships were statistically insignificant. There were no significant differences between sex, supplemental oxygen use, smoking status, and severity of dyspnea on the four dimensions of subjective fatigue. Many of the participants had probable presence of clinical anxiety (42.9%), where the prevalence of anxiety was nearly twice as high as depression (21.4%). Findings from this study can be used by healthcare professionals to gain a better understanding of fatigue in individuals with COPD who attend pulmonary rehabilitation, and help in developing effective interventions for reducing the distressing effects of fatigue.

Background: Pulmonary artery sarcoma is a rare tumor with a poor prognosis. Case Report: We report the case of a 64-year-old man with an intimal pulmonary artery sarcoma presenting with severe high oxygen flow-demanding dyspnea and weight loss of 12 kg in the last 6 months. On echocardiography, right heart insufficiency, markedly elevated right ventricular pressure, a pressure gradient along the right outflow tract, and a tumor mass adherent to the wall of the truncus pulmonalis were detected. The tentative diagnosis by echocardiographic findings was pulmonary artery sarcoma. Computed tomography of the thorax and 18-fluorodeoxyglucose positron emission tomography showed an advanced local tumor manifestation. Surgical resection of the tumor to improve hemodynamics confirmed the diagnosis. Conclusions: Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients with dyspnea due to right heart failure, particular in the case of additional weight loss, and echocardiographic examination is a useful first diagnostic approach in establishing the diagnosis. / Hintergrund: Das Pulmonalarteriensarkom ist eine seltene Erkrankung mit einer schlechten Prognose. Fallbericht: Wir berichten über einen 64-jährigen Mann mit einem intimalen Pulmonalarteriensarkom, der sich mit starker Luftnot trotz hoher Sauerstoffsubstitution und einem Gewichtsverlust von 12 kg in den letzten 6 Monaten vorstellte. Echokardiographisch fielen eine Rechtsherzinsuffizienz, ein deutlich erhöhter rechtsventrikulärer Druck, ein Druckgradient über dem rechten Ausflusstrakt und eine Tumormasse im Bereich des Trunkus pulmonalis mit Kontakt zur Gefäßwand auf. Die mittels Echokardiographie erhobene Verdachtsdiagnose lautete Pulmonalarteriensarkom. Die Computertomographie des Thorax und die 18-Flur-Desoxyglukose-Positron-Emissionstomographie erbrachten den Befund eines lokal fortgeschrittenen Tumors. Die chirurgische Resektion des Tumors, die zur Verbesserung der Hämodynamik durchgeführt wurde, bestätigte die Diagnose. Schlussfolgerungen: Das Pulmonalarteriensarkom sollte differenzialdiagnostisch als eine seltene Ursache der Luftnot im Rahmen einer Rechtsherzinsuffizienz, insbesondere bei zusätzlichem Gewichtsverlust, in Erwägung gezogen werden. Die Echokardiographie stellt eine wertvolle initiale Untersuchungsmethode bei der Diagnosestellung dar. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Introdução: Estudos têm mostrado a magnitude das cargas resistivas inspiratórias adicionadas externamente segue uma relação previsível com a percepção de dispneia, na qual a magnitude psicológica cresce conforme o aumento das cargas adicionadas. O efeito de medidas repetidas de percepção de dispneia utilizando o sistema de cargas resistivas não está claro na literatura. Objetivo: Estudar a repetibilidade da percepção da dispneia avaliada através de um sistema de carga resistiva inspiratória em indivíduos normais. Métodos: Estudo transversal, com coleta de dados prospectiva, realizado em indivíduos sadios com idade ≥ 18 anos. A percepção da dispneia foi avaliada através de um sistema de cargas resistivas inspiratórias, utilizando dispositivo que compreende uma válvula unidirecional (Hans-Rudolph) e um circuito de reinalação. A sensação de dispneia foi mensurada durante ventilação com o aumento na carga resistiva inspiratória (≅0, 6,7, 15, 25, 46,7, 67, 78 e ≅0 L/s/cmH2O) para um fluxo de 300 mL/s. Após respirar em cada nível de resistência por dois minutos, o indivíduo expressava sua sensação de falta de ar (dispneia) usando a escala de Borg modificada. Os indivíduos foram submetidos a dois testes (intervalos de 3 a 7 dias). Resultados: Foram incluídos no estudo 16 indivíduos sadios, sendo 8 homens e 8 mulheres, todos da raça branca. A média de idade foi 36,3 ± 11,9 anos. A média do índice de massa corporal foi de 23,9 ± 2,8 kg/m2. As medianas dos escores da Escala de Borg no primeiro teste foram 0, 2, 3, 4, 5, 7, 7 e 1 ponto, respectivamente para os momentos de aplicação de carga resistiva de ≅ 0, 6,7,15, 25, 46,7, 67, 78 e ≅ 0 L/s/cmH2O. As medianas dos escores no segundo teste foram, respectivamente, 0, 0, 2, 2, 3, 4, 4 e 0,5 pontos. A concordância pelo coeficiente de correlação intraclasse foi, respectivamente para cada momento, 0,57, 0,80, 0,74, 0,80, 0,83, 0,86, 0,91 e 0,92. Observou-se diferença estatisticamente significativa entre momentos de cargas resistiva (p < 0,001) e entre os testes (p = 0,003), através do modelo de análise linear generalizada. Os valores dos escores de dispneia entre os diferentes momentos foram significativamente menores no segundo teste. As pressões inspiratórias resistivas (p=0,59) e as frequências respiratórias (p=0,81) não foram diferentes entre os testes. Conclusão: A concordância entre os dois testes de percepção de dispneia foi apenas moderada e os escores de dispneia foram menores no segundo teste. Estes resultados sugerem um efeito de aprendizagem. A sensação de dispneia pode ser modificada por uma experiência prévia. O indivíduo poderia controlar melhor o sentido de aferência cortical e/ou aprender a ventilar no sistema com medidas repetidas. / Introduction: Studies have shown that the magnitude of externally added inspiratory resistive loads follows a predictable relationship with dyspnea perception, in which the psychological magnitude grows as a power of the added loads. The effect of repeated measures of dyspnea perception using resistive loading system is not clear in literature. Objective: To study the repeatability of the dyspnea perception using an inspiratory resistive loading system in normal subjects. Methods: Cross sectional study conducted in healthy individuals aged ≥ 18 years, with data collected prospectively. Dyspnea perception was assessed using an inspiratory resistive load system previously described that comprises a unidirectional valve (Hans-Rudolph) and a rebreathing circuit. The sensation of dyspnea was assessed during ventilation with increasing in inspiratory resistive loads (≅ 0, 6.7, 15, 25, 46.7, 67, 78 and ≅ 0 L/s/cmH2O), for a flow 300 ml/s, returning to the resistance of 0. After breathing in each level of resistance for two minutes, the subject expressed the feeling of shortness of breath (dyspnea) using the modified Borg scale. Subjects were tested twice (intervals from 3 to 7 days). Results: The study included 16 healthy individuals, 8 men and 8 women and all were white. The mean age was 36.3 ±11.9 years. The body mass index averaged 23.9±2.8 kg/m2. The median scores dyspnea perception in the first test were 0, 2, 3, 4, 5, 7, 7 and 1 point, respectively, during ventilation with resistive loads of ≅ 0, 6.7,15, 25, 46.7, 67, 78 and ≅ 0 L/s/cmH2O. The median scores in the second test were, respectively, 0, 0, 2, 2, 3, 4, 4 and 0.5 points. The agreement assessed by intraclass correlation coefficient was, respectively, for each resistive load, 0.57, 0.80, 0.74, 0.80, 0.83, 0.86, 0.91, and 0.92. In a generalized linear model analysis, there was a statistically significant difference between the moments of resistive loads (p<0.001) and between tests (p=0.003). Dyspnea scores were significantly lower in the second test. There were no difference for inspiratory pressures (p=0.59) and respiratory frequency (p=0.81) between two tests. Conclusion: The agreement between the two tests of dyspnea perception was only moderate and dyspnea scores were lower in the second test. These findings suggested an evidence for a learning effect. Dyspnea perception may be modified by previous experience. The subject could control better the sense of cortical afference and/or learn to ventilate in the system with repeated measures.

Introdução: A doença pulmonar obstrutiva crônica (DPOC) se caracteriza por limitação crônica ao fluxo aéreo, dispneia e redução da capacidade de exercício. Na doença avançada o desempenho das atividades de vida diária (AVDs) pode estar comprometido. Objetivo: Estudar a relação entre atividades de vida diária, capacidade funcional e gravidade em pacientes com DPOC. Material e Métodos: Estudo transversal, com realização de dois questionários (London Chest Activity of Daily Living - LCADL e International Physical Activity Questionnaire – IPAQ), exames de função pulmonar e teste de caminhada de 6 minutos (TC6m). A dispneia foi avaliada pela escala Modified Medical Research Council (MMRC) e a gravidade da doença pelo VEF1 e pelo índice BODE. Resultados: Dos 95 pacientes avaliados, 62 eram homens (65,3%). O VEF1 médio foi de 1,05±0,43 litros (DP), 40,7±15,9% do previsto. A distância percorrida no TC6m foi de 386±115 m. A média do MMRC foi de 2,5±1,3, do índice BODE 4,3±2,3, do LCADL foi de 23,4±12,2 e do IPAC 837 (0 - 3.493). Em 47,4% dos pacientes o nível de atividade física medido pelo IPAC foi baixo. A pontuação total do LCADL mostrou correlação negativa com a distância caminhada (r=-0,51; p<0,001) e positiva com o MMRC (r=0,50; p<0,001) e com o índice BODE (r=0,46; p<0,001). A melhor correlação entre IPAC e índice BODE e domínios do LCADL foi com o lazer. A associação do LCADL com as demais variáveis funcionais pulmonares foi fraca ou inexistente. Conclusões: Nosso estudo demonstrou uma importante redução do nível de atividade física em pacientes com DPOC e um impacto significativo da doença sobre as AVDs. Houve uma correlação moderada entre o escore total do LCADL e a distância caminhada, a dispneia e o índice BODE. / Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, dyspnea, and reduced exercise capacity. In advanced disease, the performance of activities in daily life (ADLs) can be reduced. Aim: To investigate the relationship between ADLs, functional capacity and disease severity in patients with COPD. Material and Methods: Cross-sectional study. Two questionnaires (London Chest Activity of Daily Living - LCADL and International Physical Activity Questionnaire – IPAQ), lung function testing and six-minute walk test (SMWT) were performed. Dyspnea was evaluated by the Modified Medical Research Council (MMRC) scale and the COPD severity by FEV1 and BODE index. Results: Out of the 95 patients studied, 62 were men (65.3%). Mean FEV1 was 1.05±0.43 liters (SD), 40.7±15.9 % of predicted. The walked distance on SMWT was 386±115m. Mean MMRC value was 2.5±1.3, BODE index was 4.3±2.3, LCADL score was 23.4±12.2 and IPAC was 837 (0 - 3.493). In 47.4% of patients the activity level evaluated by IPAC was low. There was negative correlation between total score of LCADL and walked distance (r=-0.51; p<0.001) and positive with MMRC (r=0.50; p<0.001) and BODE index (r=0.46; p<0.001). The best correlation scores of IPAC and BODE index were seen with the leisure time domain of LCADL. Associations of LCADL with other lung function variables were weak or inexistent. Conclusions: Our study demonstrated an important reduction on physical activity level in COPD patients and a significant impact of the disease on ADLs. There was a moderate correlation between total score of LCADL and walked distance, dyspnea and BODE index.

Introdução: Estudos têm mostrado a magnitude das cargas resistivas inspiratórias adicionadas externamente segue uma relação previsível com a percepção de dispneia, na qual a magnitude psicológica cresce conforme o aumento das cargas adicionadas. O efeito de medidas repetidas de percepção de dispneia utilizando o sistema de cargas resistivas não está claro na literatura. Objetivo: Estudar a repetibilidade da percepção da dispneia avaliada através de um sistema de carga resistiva inspiratória em indivíduos normais. Métodos: Estudo transversal, com coleta de dados prospectiva, realizado em indivíduos sadios com idade ≥ 18 anos. A percepção da dispneia foi avaliada através de um sistema de cargas resistivas inspiratórias, utilizando dispositivo que compreende uma válvula unidirecional (Hans-Rudolph) e um circuito de reinalação. A sensação de dispneia foi mensurada durante ventilação com o aumento na carga resistiva inspiratória (≅0, 6,7, 15, 25, 46,7, 67, 78 e ≅0 L/s/cmH2O) para um fluxo de 300 mL/s. Após respirar em cada nível de resistência por dois minutos, o indivíduo expressava sua sensação de falta de ar (dispneia) usando a escala de Borg modificada. Os indivíduos foram submetidos a dois testes (intervalos de 3 a 7 dias). Resultados: Foram incluídos no estudo 16 indivíduos sadios, sendo 8 homens e 8 mulheres, todos da raça branca. A média de idade foi 36,3 ± 11,9 anos. A média do índice de massa corporal foi de 23,9 ± 2,8 kg/m2. As medianas dos escores da Escala de Borg no primeiro teste foram 0, 2, 3, 4, 5, 7, 7 e 1 ponto, respectivamente para os momentos de aplicação de carga resistiva de ≅ 0, 6,7,15, 25, 46,7, 67, 78 e ≅ 0 L/s/cmH2O. As medianas dos escores no segundo teste foram, respectivamente, 0, 0, 2, 2, 3, 4, 4 e 0,5 pontos. A concordância pelo coeficiente de correlação intraclasse foi, respectivamente para cada momento, 0,57, 0,80, 0,74, 0,80, 0,83, 0,86, 0,91 e 0,92. Observou-se diferença estatisticamente significativa entre momentos de cargas resistiva (p < 0,001) e entre os testes (p = 0,003), através do modelo de análise linear generalizada. Os valores dos escores de dispneia entre os diferentes momentos foram significativamente menores no segundo teste. As pressões inspiratórias resistivas (p=0,59) e as frequências respiratórias (p=0,81) não foram diferentes entre os testes. Conclusão: A concordância entre os dois testes de percepção de dispneia foi apenas moderada e os escores de dispneia foram menores no segundo teste. Estes resultados sugerem um efeito de aprendizagem. A sensação de dispneia pode ser modificada por uma experiência prévia. O indivíduo poderia controlar melhor o sentido de aferência cortical e/ou aprender a ventilar no sistema com medidas repetidas. / Introduction: Studies have shown that the magnitude of externally added inspiratory resistive loads follows a predictable relationship with dyspnea perception, in which the psychological magnitude grows as a power of the added loads. The effect of repeated measures of dyspnea perception using resistive loading system is not clear in literature. Objective: To study the repeatability of the dyspnea perception using an inspiratory resistive loading system in normal subjects. Methods: Cross sectional study conducted in healthy individuals aged ≥ 18 years, with data collected prospectively. Dyspnea perception was assessed using an inspiratory resistive load system previously described that comprises a unidirectional valve (Hans-Rudolph) and a rebreathing circuit. The sensation of dyspnea was assessed during ventilation with increasing in inspiratory resistive loads (≅ 0, 6.7, 15, 25, 46.7, 67, 78 and ≅ 0 L/s/cmH2O), for a flow 300 ml/s, returning to the resistance of 0. After breathing in each level of resistance for two minutes, the subject expressed the feeling of shortness of breath (dyspnea) using the modified Borg scale. Subjects were tested twice (intervals from 3 to 7 days). Results: The study included 16 healthy individuals, 8 men and 8 women and all were white. The mean age was 36.3 ±11.9 years. The body mass index averaged 23.9±2.8 kg/m2. The median scores dyspnea perception in the first test were 0, 2, 3, 4, 5, 7, 7 and 1 point, respectively, during ventilation with resistive loads of ≅ 0, 6.7,15, 25, 46.7, 67, 78 and ≅ 0 L/s/cmH2O. The median scores in the second test were, respectively, 0, 0, 2, 2, 3, 4, 4 and 0.5 points. The agreement assessed by intraclass correlation coefficient was, respectively, for each resistive load, 0.57, 0.80, 0.74, 0.80, 0.83, 0.86, 0.91, and 0.92. In a generalized linear model analysis, there was a statistically significant difference between the moments of resistive loads (p<0.001) and between tests (p=0.003). Dyspnea scores were significantly lower in the second test. There were no difference for inspiratory pressures (p=0.59) and respiratory frequency (p=0.81) between two tests. Conclusion: The agreement between the two tests of dyspnea perception was only moderate and dyspnea scores were lower in the second test. These findings suggested an evidence for a learning effect. Dyspnea perception may be modified by previous experience. The subject could control better the sense of cortical afference and/or learn to ventilate in the system with repeated measures.

Introdução: A doença pulmonar obstrutiva crônica (DPOC) se caracteriza por limitação crônica ao fluxo aéreo, dispneia e redução da capacidade de exercício. Na doença avançada o desempenho das atividades de vida diária (AVDs) pode estar comprometido. Objetivo: Estudar a relação entre atividades de vida diária, capacidade funcional e gravidade em pacientes com DPOC. Material e Métodos: Estudo transversal, com realização de dois questionários (London Chest Activity of Daily Living - LCADL e International Physical Activity Questionnaire – IPAQ), exames de função pulmonar e teste de caminhada de 6 minutos (TC6m). A dispneia foi avaliada pela escala Modified Medical Research Council (MMRC) e a gravidade da doença pelo VEF1 e pelo índice BODE. Resultados: Dos 95 pacientes avaliados, 62 eram homens (65,3%). O VEF1 médio foi de 1,05±0,43 litros (DP), 40,7±15,9% do previsto. A distância percorrida no TC6m foi de 386±115 m. A média do MMRC foi de 2,5±1,3, do índice BODE 4,3±2,3, do LCADL foi de 23,4±12,2 e do IPAC 837 (0 - 3.493). Em 47,4% dos pacientes o nível de atividade física medido pelo IPAC foi baixo. A pontuação total do LCADL mostrou correlação negativa com a distância caminhada (r=-0,51; p<0,001) e positiva com o MMRC (r=0,50; p<0,001) e com o índice BODE (r=0,46; p<0,001). A melhor correlação entre IPAC e índice BODE e domínios do LCADL foi com o lazer. A associação do LCADL com as demais variáveis funcionais pulmonares foi fraca ou inexistente. Conclusões: Nosso estudo demonstrou uma importante redução do nível de atividade física em pacientes com DPOC e um impacto significativo da doença sobre as AVDs. Houve uma correlação moderada entre o escore total do LCADL e a distância caminhada, a dispneia e o índice BODE. / Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, dyspnea, and reduced exercise capacity. In advanced disease, the performance of activities in daily life (ADLs) can be reduced. Aim: To investigate the relationship between ADLs, functional capacity and disease severity in patients with COPD. Material and Methods: Cross-sectional study. Two questionnaires (London Chest Activity of Daily Living - LCADL and International Physical Activity Questionnaire – IPAQ), lung function testing and six-minute walk test (SMWT) were performed. Dyspnea was evaluated by the Modified Medical Research Council (MMRC) scale and the COPD severity by FEV1 and BODE index. Results: Out of the 95 patients studied, 62 were men (65.3%). Mean FEV1 was 1.05±0.43 liters (SD), 40.7±15.9 % of predicted. The walked distance on SMWT was 386±115m. Mean MMRC value was 2.5±1.3, BODE index was 4.3±2.3, LCADL score was 23.4±12.2 and IPAC was 837 (0 - 3.493). In 47.4% of patients the activity level evaluated by IPAC was low. There was negative correlation between total score of LCADL and walked distance (r=-0.51; p<0.001) and positive with MMRC (r=0.50; p<0.001) and BODE index (r=0.46; p<0.001). The best correlation scores of IPAC and BODE index were seen with the leisure time domain of LCADL. Associations of LCADL with other lung function variables were weak or inexistent. Conclusions: Our study demonstrated an important reduction on physical activity level in COPD patients and a significant impact of the disease on ADLs. There was a moderate correlation between total score of LCADL and walked distance, dyspnea and BODE index.