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No. of bitstreams: 1 Tese Ale Vaccari ap?s banca vers?o final.pdf: 1728521 bytes, checksum: a91cc3687893439b4a2fd3465256d84d (MD5) Previous issue date: 2017-11-07 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: the prevalence of asthma is increasing worldwide; today it is considered a public health problem; is often underdiagnosed and its severity is also underestimated, greatly increasing morbidity and mortality, especially in the lower socioeconomic and educational classes. In childhood, asthma is the most frequent among chronic diseases and can adversely affect the quality of life of patients and their families. The assessment of lung function may help in the diagnosis and assessment of asthma severity, there are several methods available, however some are inadequate for young children or for people with motor coordination difficulties or cognitive deficits. One method that has a high success rate in situations of poor patient collaboration is the forced oscillation technique (FOT); is a noninvasive procedure that applies airway oscillations through the mouth and measures the impedance of the respiratory system. The real part of the impedance is called the resistance of the respiratory system that reflects the resistance to friction; while the imaginary part is called the reactance of the respiratory system, which reflects the elastic and inertial properties of the lung. Modified FOT measures respiratory mechanics variables, in addition to multi-frequency applications (6 to 32 hertz), checks within breath variables at a 10 hertz monofrequency. Objective: to explore the applicability of FOT in patients with asthma, as a tool for diagnosis and assessment of the severity of obstruction. Methods: observational, cross-sectional study with quantitative approach. The population was composed of subjects from 3 years old to 18 years of age, recruited for convenience from May 2016 to July 2017, at the Pediatric Pulmonology and Pediatrics Service at a school hospital in southern Brazil. The equipment used for the FOT acquisition was built specifically for this study. The measured parameters include impedance, resistance and reactance in the frequencies between 6 to 32 hertz and within-breath variables in the monofrequency of 10 hertz. The analyzes were performed with the Statistical Package for the Social Sciences program with a significance level of 5%. The data were presented in mean and standard deviation or in median and interquartile range, depending on the normal distribution of the variables. For the analysis of the performance of the variables regarding the diagnosis of asthma the individuals were divided into an Asthma group and Control group, formed by healthy individuals from the respiratory point of view from the clinical questionnaire. To analyze the associations of the variables obtained with FOT with the different levels of asthma severity and clinical status, subjects were divided into: controls, mild asthma, moderate asthma and asthma exacerbation. The Spearman rank correlation test was used in the exploratory analysis of lung function data and dichotomous asthma. Comparisons between the Asthma and Control groups were made using the Mann-Whitney test; in the analyzes in which asthma was classified by severity in three levels according to the treatment or clinical state, Kruskal-Wallis was used per stations, not parametric. To examine the ordering of these differences in the different levels of asthma we used the non-parametric Jonckheere-Terpstra trend test. The Receiver Operating Characteristic Curve was used to evaluate the sensitivity, specificity and accuracy of the variables obtained in the pulmonary function test for the correct classification of subjects as controls or asthmatics. The study was approved by the institution's Ethics Committee. Results: 204 subjects were included, after removing the losses, 189 FOT tests with a performance of 95.45% of success in the test were analyzed. For statistical analyzes, the subjects were divided into four groups: healthy controls, mild asthma, moderate asthma and asthma exacerbation. The FOT variables with the highest sensitivity for distinguishing subjects are: X6, X8, ReE-ReI, XeE, XeI, Xmax,E, Xmax,I, Xmean,E and Xmean,I. Conclusions: The study findings indicate that the FOT test has a high success rate and seems to be an adequate method for assessing respiratory impedance in children and adolescents, differentiating subjects with asthma and healthy individuals. / Introdu??o: a preval?ncia da asma est? aumentando em todo o mundo; hoje ? considerada um problema de sa?de p?blica; ? frequentemente subdiagnosticada e sua gravidade ? tamb?m subestimada, aumentando consideravelmente morbidade e mortalidade, principalmente nas classes socioeconomicas e educacionais mais baixas. Na inf?ncia, a asma ? a mais frequente entre as doen?as cr?nicas e pode prejudicar a qualidade de vida dos pacientes e suas fam?lias. A avalia??o da fun??o pulmonar pode auxiliar no diagn?stico e avalia??o da gravidade da asma, (1) (1) h? v?rios m?todos dispon?veis, entretanto alguns s?o inadequados para crian?as pequenas ou para pessoas com dificuldades de coordena??o motora ou d?ficit cognitivo. Um m?todo que tem alto ?ndice de sucesso em situa??es de pouca colabora??o por parte do paciente ? a t?cnica de oscila??es for?adas (FOT); ? um procedimento n?o invasivo que aplica oscila??es na via a?rea pela boca e mede a imped?ncia do sistema respirat?rio. A parte real da imped?ncia ? chamada de resist?ncia do sistema respirat?rio que reflete a resist?ncia ao atrito; enquanto que a parte imagin?ria ? chamada de reat?ncia do sistema respirat?rio, que reflete propriedades el?sticas e inerciais do pulm?o. O FOT modificado mede vari?veis da mec?nica respirat?ria, al?m das aplica??es de multifrequ?ncias (6 a 32 hertz), verifica as vari?veis within breath em uma monofrequ?ncia de 10 hertz. Objetivo: explorar a aplicabilidade do FOT em portadores de asma, como ferramenta de diagn?stico e de avalia??o de gravidade da obstru??o. M?todos: estudo observacional, do tipo transversal com abordagem quantitativa. A popula??o foi composta por sujeitos de 3 anos completos at? 18 anos incompletos, recrutadas por conveni?ncia nos meses de maio de 2016 a julho de 2017, no Servi?o de Pneumologia Pedi?trica e Pediatria em um hospital escola no sul do Brasil. O equipamento utilizado para a aquisi??o do FOT foi constru?do especificamente para este estudo. Os par?metros medidos incluem imped?ncia, resist?ncia e reat?ncia nas frequ?ncias entre 6 a 32 hertz e vari?veis within-breath na monofrequ?ncia de 10 hertz. As an?lises foram realizadas com o programa Statistical Package for the Social Sciences com um n?vel de signific?ncia de 5%. Os dados foram apresentados em m?dia e desvio-padr?o ou em mediana e intervalo interquart?lico, dependendo da normalidade da distribui??o das vari?veis. Para a an?lise da performance das vari?veis quanto ao diagn?stico de asma os indiv?duos foram divididos em um grupo Asma e grupo Controle, formado por indiv?duos saud?veis do ponto de vista respirat?rio a partir do question?rio clinico. Para analisar as associa??es das vari?veis obtidas com o FOT com os diferentes n?veis de gravidade da asma e estado cl?nico, os sujeitos foram divididos em: controles, asma leve, asma moderada e asma exacerba??o. O teste de correla??o em postos Spearman foi usado na an?lise explorat?ria dos dados de fun??o pulmonar e asma dicot?mico. As compara??es entre os grupos Asma e Controles foram feitas atrav?s do teste de Mann-Whitney; nas an?lises em que a asma foi classificada por gravidade em tr?s n?veis acordo com o tratamento ou estado cl?nico, foi utilizado Kruskal-Wallis por postos, n?o param?trico. Para examinar o ordenamento destas diferen?as nos diferentes n?veis de asma utilizamos o teste n?o param?trico de tend?ncia Jonckheere-Terpstra. A Receiver Operating Characteristic Curve foi utilizada para avaliar a sensibilidade, especificidade e precis?o das vari?veis obtidas no teste de fun??o pulmonar para a classifica??o correta dos sujeitos como controles ou asm?ticos. O estudo foi aprovado pelo Comit? de ?tica da institui??o. Resultados: foram inclu?dos 204 sujeitos, ap?s retirada as perdas, foram analisados 189 testes de FOT com um desempenho de 95,45% de sucesso na realizado do teste. A fim das an?lises estat?sticas, os sujeitos foram separados em quatro grupos: controles saud?veis, asma leve, asma moderada e asma exacerba??o. As vari?veis do FOT com maior sensibilidade para a distin??o dos sujeitos s?o: X6, X8, ReE-ReI, XeE, XeI, Xmax,E, Xmax,I, Xmean,E e Xmean,I. Conclus?es: os achados do estudo indicam que o teste de FOT tem alto ?ndice de sucesso e parece ser um m?todo adequado para a avalia??o da imped?ncia respirat?ria em crian?as e adolescentes, diferenciando sujeitos com asma e indiv?duos saud?veis.