Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-17T23:18:24Z No. of bitstreams: 1 PalommaRussellySaldanhaDeAraujoOliveira_TESE.pdf: 10724965 bytes, checksum: fb9786f1f1478cf8fcd17d5aeb59d620 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-20T23:10:05Z (GMT) No. of bitstreams: 1 PalommaRussellySaldanhaDeAraujoOliveira_TESE.pdf: 10724965 bytes, checksum: fb9786f1f1478cf8fcd17d5aeb59d620 (MD5) / Made available in DSpace on 2017-04-20T23:10:05Z (GMT). No. of bitstreams: 1 PalommaRussellySaldanhaDeAraujoOliveira_TESE.pdf: 10724965 bytes, checksum: fb9786f1f1478cf8fcd17d5aeb59d620 (MD5) Previous issue date: 2016-12-12 / Os m?sculos respirat?rios constituem um dos pilares essenciais da ventila??o. Altera??es na sua estrutura e morfologia em sujeitos com Doen?a Pulmonar Obstrutiva Cr?nica (DPOC) podem influenciar sintomas e sinais cl?nicos como dispneia, tosse ineficaz, intoler?ncia ao exerc?cio e insufici?ncia respirat?ria. O Treinamento Muscular Respirat?rio (TMR), especialmente dos m?sculos inspirat?rios na modalidade limiar de carga press?rica, tem sido utilizado h? mais de 30 anos como terapia coadjuvante em indiv?duos saud?veis e pacientes com DPOC. Ampla variedade de dispositivos para TMR est?o dispon?veis comercialmente, por?m s?o importados, possuem custo elevado e suas caracter?sticas s?o destinadas ao treino individual de grupos musculares ou possuem ajustes de cargas inadequados para pacientes com DPOC. Embora, diversas revis?es sistem?ticas tenham sido realizadas desde 1992 acerca do Treinamento Muscular Inspirat?rio (TMI) em sujeitos com DPOC e postuladas algumas evid?ncias sobre o TMI, falhas metodol?gicas na estrat?gia de busca das revis?es pr?vias e a baixa qualidade metodol?gica dos estudos inclu?dos contribu?ram para o estabelecimento de uma evid?ncia vol?til sobre os benef?cios do TMI. Objetivos: desenvolver um dispositivo de Treinamento do Ciclo Respirat?rio (TCR), integrado para m?sculos inspirat?rios e expirat?rios; verificar os efeitos agudos de diferentes combina??es de cargas inspirat?rias e/ou expirat?rias sobre a atividade muscular respirat?ria, cinem?tica da caixa tor?cica e din?mica dos volumes pulmonares em sujeitos saud?veis com dispositivo semelhante ao desenvolvido; bem como verificar as evid?ncias do TMI sobre a dispneia e capacidade do exerc?cio em sujeitos com DPOC. Metodologia: envolveu tr?s modalidades de pesquisa: i) o desenvolvimento tecnol?gico do dispositivo de TCR, ii) estudo transversal e iii) revis?o sistem?tica associada ? metan?lise. Resultados: i) cria??o de um produto de inova??o tecnol?gica aplicado ? sa?de, denominado ?Equipamento de Treinamento do Ciclo Respirat?rio (TCR) com resist?ncia tipo limiar de carga press?rica?, com dep?sito de patente de inven??o no INPI (BR 1020160253047); ii) mediante estudo transversal, o equipamento comercialmente dispon?vel para treinamento de m?sculos inspirat?rios e/ou expirat?rios n?o ? capaz de deflagrar adequadamente aumento na atividade el?trica dos m?sculos respirat?rios, embora provoque altera??es nos volumes correntes da parede tor?cica e seus compartimentos; e iii) artigo cient?fico intitulado ?Inspiratory muscle training for Chronic Obstructive Pulmonary Disease? evidenciando que, embora o TMI combinado ao cuidado padronizado sozinho versus cuidado padronizado sozinho proporcione melhora na qualidade de vida e que TMI combinado ? Reabilita??o Pulmonar versus Reabilita??o Pulmonar induza ? redu??o na dispneia em sujeitos com DPOC, n?o h? evid?ncia conclusiva para suportar ou refutar o TMI em pacientes com DPOC. Conclus?o: A presente pesquisa substancia a necessidade de constru??o de um novo equipamento de TMR para m?sculos inspirat?rios e expirat?rios, bem como fornece subs?dios para o desenvolvimento de estudos futuros para investiga??o de uma nova modalidade de TMR, denominada TCR, com produ??o de conhecimento na ?rea de biotecnologia. Adicionalmente, contribui para tomada de decis?o cl?nica, pol?tica e financeira sobre a inclus?o ou n?o do TMI como modalidade terap?utica para sujeitos com DPOC. / Respiratory muscles are one of the essential cornerstone of ventilation. Alterations in its structure and morphology in subjects with Chronic Obstructive Pulmonary Disease (COPD) could influence symptoms and signs such as dyspnea, ineffective coughing, exercise intolerance and respiratory failure. Respiratory Muscular Training (RMT), especially inspiratory muscles training, as a threshold modality, has been used for more than 30 years as adjuvant therapy in healthy individuals and patients with COPD. A wide variety of RMT devices are available commercially, but they are imported, have a high cost and their characteristics are intended for the individual training of muscle groups or have inadequate loads adjustments for COPD patients. Although several systematic reviews have been carried out since 1992 on the effects of IMT in subjects with COPD and some evidence has been proposed, some considerations should be made about these revisions.The methodological failures in the search strategy for previous reviews and the low methodological quality of the included studies contributed to the establishment of weak evidence on the benefits of the IMT. Aim: to develop a Respiratory Cycle Training (RCT) device, integrated for inspiratory and expiratory muscles, to verify the acute effects of different combinations of inspiratory and/or expiratory loads in the respiratory muscle activity, kinematics of the chest wall and dynamics of pulmonary volumes in healthy subjects with a device similar to that developed, as well as to analyze the evidence of the effects of IMT on dyspnea and exercise capacity in subjects with COPD. Methodology: involved three research modalities: i) the technological development of the RCT device, ii) cross-sectional study, and iii) systematic review associated with the meta-analysis. Results: i) creation of a technological innovation product applied to health, called "Respiratory Cycle Training equipment (RCT) with threshold load", with patent filing at INPI (BR 1020160253047); ii) through a cross-sectional study, commercially available equipment for inspiratory and / or expiratory muscle training is not capable of adequately triggering an increase in the electrical activity of respiratory muscles, although it causes changes in the current volumes of the chest wall and its compartments; and (iii) a scientific paper entitled "Inspiratory muscle training for Chronic Obstructive Pulmonary Disease", showing that although IMT combined with standardized care alone versus standardized care alone provides improved quality of life and that IMT combined with Pulmonary Rehabilitation versus Pulmonary Rehabilitation induces reduction in dyspnea in individuals with COPD, but there is not conclusive evidence to support or refute IMT in patients with COPD. Conclusion: The present study substantiates the need to construct a new RMT equipment for inspiratory and expiratory muscles, as well as provides subsidies for the development of future studies to investigate a new type of RMT, called TCR, with knowledge production in the area of biotechnology. In addition, it contributes to clinical, political and financial decision making regarding the inclusion or not of IMT as a therapeutic modality for subjects with COPD. / 2018-03-02

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-10-04T22:45:46Z No. of bitstreams: 1 RudolfoHummelGurgelVieira_DISSERT.pdf: 1108627 bytes, checksum: a120294a9853b95a77ea8c276df585b6 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-10-14T00:19:17Z (GMT) No. of bitstreams: 1 RudolfoHummelGurgelVieira_DISSERT.pdf: 1108627 bytes, checksum: a120294a9853b95a77ea8c276df585b6 (MD5) / Made available in DSpace on 2017-10-14T00:19:17Z (GMT). No. of bitstreams: 1 RudolfoHummelGurgelVieira_DISSERT.pdf: 1108627 bytes, checksum: a120294a9853b95a77ea8c276df585b6 (MD5) Previous issue date: 2017-06-02 / Introdu??o: A hist?ria natural da Doen?a Pulmonar Obstrutiva Cr?nica est? associada a numerosas manifesta??es sist?micas e comorbidades que complicam sua evolu??o. Dessas, a disfun??o dos m?sculos esquel?ticos e respirat?rios destacam-se por acarretar um comprometimento na capacidade funcional. Objetivo: Avaliar e comparar a for?a muscular respirat?ria e perif?rica em pacientes com DPOC e indiv?duos saud?veis. Metodologia: Trata-se de um estudo transversal, anal?tico e observacional, no qual foram avaliados 18 indiv?duos, sendo nove com DPOC e nove saud?veis. Foram avaliados quanto ao desempenho neuromuscular do quadr?ceps femoral (avaliado por meio da dinamometria isocin?tica), for?a de preens?o manual (dinam?metro manual) e press?es respirat?rias m?ximas (manovacuometria). Os dados foram expressos por meio de m?dia e desvio padr?o, analisados no pacote estat?stico SPSS 20.0. Foi considerado um n?vel de signific?ncia de 5% e intervalo de confian?a de 95% para todas as medidas. Resultados: Os indiv?duos com DPOC apresentam desempenho neuromuscular de quadr?ceps femoral e press?es respirat?rias m?ximas inferiores aos sujeitos saud?veis, no entanto houve diferen?a estatisticamente significante apenas para pot?ncia muscular e PIm?x (p<0,05). J? a for?a de preens?o manual foi maior em indiv?duos com DPOC (p<0,05). Conclus?o: Os sujeitos com DPOC possuem altera??es neuromusculares em m?sculos perif?ricos e respirat?rios que possivelmente podem causar redu??o do desempenho funcional. / Introduction: The natural history of Chronic Obstructive Pulmonary Disease is associated with numerous systemic manifestations and comorbidities that complicate its evolution. Of these, dysfunction of the skeletal and respiratory muscles are characterized by a compromised functional capacity. Objective: To evaluate and compare respiratory and peripheral muscle strength in patients with COPD and healthy individuals. Methodology: This is a cross-sectional, analytical and observational study, in which 18 individuals were evaluated, nine of them with COPD and nine healthy. The femoral quadriceps neuromuscular performance (assessed by means of isokinetic dynamometry), hand grip strength (manual dynamometer) and maximum respiratory pressure (manovacuometry) were evaluated. The data were expressed by mean and standard deviation, analyzed in the statistical package SPSS 20.0. A significance level of 5% and a 95% confidence interval for all measures were considered. Results: Individuals with COPD had lower quadriceps femoral neuromuscular performance and lower respiratory pressures than healthy subjects; however, there was a statistically significant difference only for muscle power and MIP (p <0.05). Hand grip strength was higher in individuals with COPD (p <0.05). Conclusion: COPD subjects have neuromuscular changes in peripheral and respiratory muscles that may possibly cause reduced functional performance.

Made available in DSpace on 2014-12-17T14:13:41Z (GMT). No. of bitstreams: 1 DaniellaCB_TESE.pdf: 1456295 bytes, checksum: daf0a0f4cae3c76b4bf08c373b4a9fa4 (MD5) Previous issue date: 2011-07-13 / Introduction: Chagas Disease is a serious public health problem, with 5 million infected individuals in Brazil. Of these, approximately 30% develop chronic Chagas cardiomyopathy (CCC), where the main symptoms are fatigue and dyspnea. Objective: To correlate maximal exercise capacity with pulmonary function, inspiratory muscle strength and quality of life in patients with CCC. Methodology: Twelve individuals suffering from CCC were evaluated (7 men), with a mean age of 54.91? 8.60 years and the following inclusion criteria: functional class II and III according to the New York Heart Association (NYHA); left ventricle ejection fraction below 45%; clinical stability (> 3 months); symptom duration > 1 year, body mass index (BMI) < 35Kg/m2 and non-smokers or ex-smokers with a history of smoking <10 packs/day. All subjects were submitted to spirometry, manometer testing, maximal cardiopulmonary exercise testing (CPX) and a quality of life questionnaire (Minnesota). Results: A negative correlation was observed between VO2m?x and MLHFQ scores (r=-0.626; p=0.03) and a positive association with MIP (r=0.713; p=0.009). Positive correlations were also recorded between MIP and spirometric variables [FEV1(r=0.825;p=0.001 ), FVC(r=0.66;p=0.01 and FEF25-75%(r=0.639;p=0.02)]. Conclusion: The present study demonstrated that in patients with CCC: VO2MAX is directly related to inspiratory muscle strength and quality of life, while deteriorating lung function is directly associated with respiratory muscle weakness / O treinamento muscular inspirat?rio (TMI) realizado por meio do exerc?cio com limiar de carga inspirat?ria ? utilizado na reabilita??o de indiv?duos com insufici?ncia card?aca cr?nica (ICC). Este trabalho ser? apresentado em tr?s artigos. O primeiro artigo teve como objetivo comparar a cinem?tica ventilat?ria de pessoas saud?veis em rela??o a pacientes com ICC associada ? cardiomegalia e a fraqueza diafragm?tica; o segundo artigo teve como objetivo avaliar os dados funcionais de pacientes com ICC ap?s serem submetidos a programa de TMI e o terceiro e ?ltimo artigo teve como objetivo analisar um subgrupo de pacientes chag?sicos (CCC) durante o exerc?cio m?ximo. Foi observado que a presen?a da cardiomegalia e da fraqueza muscular inspirat?ria s?o comuns em pacientes com ICC. Mecanismos exatos de a??o destes dois fatores associados ou isolados na determina??o dos sintomas respirat?rios nestes pacientes ainda s?o desconhecidos. De acordo com este primeiro estudo, uma menor ventila??o na regi?o diafragm?tica levaria a uma maior percep??o da dispn?ia durante o exerc?cio subm?ximo nesta popula??o. Al?m disso, as mudan?as observadas no padr?o de distribui??o regional da ventila??o nos pacientes com ICC em rela??o aos indiv?duos saud?veis podem servir como base para outros estudos prospectivos utilizando o TMI. O segundo artigo original demonstrou que o TMI para pacientes portadores de ICC mostrou-se eficaz para melhora na for?a muscular, capacidade funcional e qualidade de vida para esta popula??o. Este trabalho tamb?m observou o comportamento da distribui??o dos volumes pulmonares para o sistema t?raco-abdominal nesta popula??o, elucidando que maiores volumes nos compartimentos da caixa tor?cica abdominal e abdominal podem refletir em uma maior efetividade da contra??o diafragm?tica. Concluindo, o terceiro e ?ltimo artigo trouxe elucida??es para os pacientes portadores de CCC: o VO2M?X est? diretamente relacionado com a for?a dos m?sculos inspirat?rios e a qualidade de vida nestes doentes, enquanto que a deterioriza??o da fun??o pulmonar sugere refletir em uma fraqueza dos m?sculos da inspira??o

Made available in DSpace on 2014-12-17T15:16:04Z (GMT). No. of bitstreams: 1 RafaelaP.pdf: 554087 bytes, checksum: 7d7c8a0a2087e44b60ffd98a4157a3cb (MD5) Previous issue date: 2009-03-31 / The restriction of physical fitness is directly related with hypertension and sleep disorders, while the respiratory muscle strength is associated with hypertension, but the literature is scarce regarding its relationship with sleep disorders and particularly with excessive daytime sleepiness. Objectives: To compare physical fitness and strength of respiratory muscles between people with hypertension with excessive daytime sleepiness (EDS) and non EDS people, those who do not feel excessive daytime sleepiness, in addition to relate aerobics resistance and functional mobility of patients. Methods: An observational, analytical and transversal study, evaluated 32 elderly with hypertension, divided into two groups (EDS and non EDS), in which the following topics were measured; respiratory muscular strength, functional fitness, level of physical activity, level of excessive daytime sleepiness, quality of sleep and intensity of the patients snoring. Results: There was a significant difference in the level of EDS (P=0,00) and quality of sleep (p=0,03), however, the data related to snoring intensity (p=0,18), maximum inspiratory pressure PImax (p=0,39) and maximum expiratory pressure PEmax (p=0,98) did not show any difference. Also, no significant difference was observed concerning physical fitness, presenting p=0,08 for the sitting and getting up test on the chair in 30 ; p=0,54 for the extension and flexing of the elbow test in 30 ; p=0,38 for the walking test 6 ; p=0,38 for the parking gear test 2 , p=0,08 for the sitting and reaching test; p=0,42 for the scratching the back test; p=0,49 for the getting up and walking test; and p=0,62 for the global rate of activity limitation. There was moderate positive correlation between 6MWT and 2MST, r=0,54 (p=0,01) and negative moderate correlation between 6MWT and TUG, r=-0,61 (p=0,000) and between 2MST and TUG, r=-0,60 (p=0,000). Conclusion: The presence of EDS in the hypertension people studied, showed a bad quality of sleep, however this sleepiness did not influence the strength of the respiratory muscles. The physical fitness came out diminished in all hypertension people, regardless of the presence or non presence of sleep disturbance; and there is a close relationship between cardiovascular resistance and physical mobility, since when there is less cardiovascular resistance, there is precarious physical mobility and vice-versa / A limita??o na capacidade funcional relaciona-se diretamente com a hipertens?o e com os dist?rbios do sono, j? a for?a dos m?sculos respirat?rios est? associada com a hipertens?o, mas a literatura ? escassa quanto sua rela??o com os dist?rbios do sono e, principalmente, com a sonol?ncia diurna excessiva. Objetivos: Comparar capacidade funcional e for?a dos m?sculos respirat?rios entre hipertensas com sonol?ncia diurna excessiva (SDE) e hipertensas sem SDE, al?m de relacionar resist?ncia aer?bica e mobilidade funcional das pacientes. M?todos: Estudo observacional, anal?tico e transversal, avaliou 32 idosas hipertensas, divididas em dois grupos (com SDE e sem SDE), nos quais foram mensurados for?a muscular respirat?ria, capacidade funcional, n?vel de atividade f?sica, grau de sonol?ncia diurna excessiva, qualidade do sono e intensidade do ronco. Resultados: Houve diferen?a significativa no grau de SDE (p=0,00) e qualidade do sono (p=0,03), por?m os dados relativos ? intensidade do ronco (p=0,18), press?o inspirat?ria m?xima - PIm?x (p=0,39), e press?o expirat?ria m?xima - PEm?x (p=0,98) n?o apresentaram diferen?as significativas. Tamb?m n?o foi observada diferen?a significativa quanto ? capacidade funcional, apresentando p=0,08 para o teste sentar e levantar da cadeira em 30 ; p=0,54 para o teste extens?o e flex?o do cotovelo em 30 ; p=0,38 para o teste da caminhada de 6 (TC6 ); p=0,38 para o teste da marcha estacion?ria dos 2 (TME2 ); p=0,08 para o teste sentar e alcan?ar; p=0,42 para o teste co?ar as costas; p=0,49 para o teste levantar e caminhar (TUG); e p=0,62 para o ?ndice global de limita??o das atividades. Houve correla??o positiva moderada entre TC6 e TME2 , r=0,36 (p=0,04) e correla??o negativa moderada entre TC6 e TUG, r=-0,59 (p=0,000) e entre TME2 e TUG, r=-0,66 (p=0,000). Conclus?o: A presen?a de SDE, nas hipertensas estudadas, demonstrou uma qualidade de sono ruim, entretanto essa sonol?ncia n?o influenciou a for?a dos m?sculos respirat?rios. A capacidade funcional apresentou-se diminu?da em todas as hipertensas, independentemente da presen?a ou n?o de dist?rbios do sono; e, foi ainda demonstrada a rela??o entre resist?ncia cardiovascular e mobilidade funcional, de modo que havendo menor resist?ncia cardiovascular, h? mobilidade funcional prec?ria e vice-versa

Made available in DSpace on 2014-12-17T15:16:13Z (GMT). No. of bitstreams: 1 RaissaOB_DISSERT_Parcial.pdf: 2294285 bytes, checksum: 2ed17173d1763db85e07a4cefe97886f (MD5) Previous issue date: 2011-01-20 / I ntroduction: The assessment of respiratory muscle strength is important in the diagnosis and monitoring of the respiratory muscles weakness of respiratory and neuromuscular diseases. However, there are still no studies that provide predictive equations and reference values for maximal respiratory pressures for children in our population. Aim: The purpose of this study was to propose predictive equations for maximal respiratory pressures in healthy school children. Method: This is an observational cross-sectional study. 144 healthy children were assessed. They were students from public and private schools in the city of Natal /RN (63 boys and 81 girls), subdivided in age groups of 7-8 and 9-11 years. The students presented the BMI, for age and sex, between 5 and 85 percentile. Maximal respiratory pressures were measured with the digital manometer MVD300 (Globalmed ?). The maximal inspiratory pressure (MIP) and maximal expiratory pressures (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS Statistics 15.0 software (Statistical Package for Social Science) by assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'Student test was used for unpaired comparison of averages of the variables. The comparison of measurements obtained with the predicted values in previous studies was performed using the paired t'Student test. The Pearson correlation test was used to verify the correlation of MRP's with the independent variables (age, sex, weight and height). For the equations analysis the stepwise linear regression was used. Results: By analyzing the data, we observed that in the age range studied MIP was significantly higher in boys. The MEP did not differ between boys and girls aged 7 to 8 years, the reverse occurred in the age between 9 and 11 years. The boys had a significant increase in respiratory muscle strength with advancing age. Regardless sex and age, MEP was always higher than the MIP. The reference values found in this study are similar to a sample of Spanish and Canadian children. The two models proposed in previous studies with children from other countries were not able to consistently predict the values observed in this studied population. The variables sex, age and weight correlated with MIP, whereas the MEP was also correlated with height. However, in the regression models proposed in this study, only gender and age were kept exerting influence on the variability of maximal inspiratory and expiratory pressures. Conclusion: This study provides reference values, lower limits of normality and proposes two models that allow predicting, through the independent variables, sex and age, the value of maximal static respiratory pressures in healthy children aged between 7 and 11 years old / I ntrodu??o: A avalia??o da for?a muscular respirat?ria ? importante no diagn?stico e acompanhamento de fraqueza muscular em doen?as respirat?rias e neuromusculares. No entanto, ainda inexistem estudos que disponibilizem equa??es preditivas e valores de refer?ncia para as press?es respirat?rias m?ximas para crian?as na popula??o brasileira. Objetivo: O prop?sito desse estudo foi propor equa??es preditivas para as press?es respirat?rias m?ximas de crian?as brasileiras. M?todo: Trata-se de um estudo observacional do tipo transversal. Foram avaliadas 144 crian?as saud?veis, estudantes da rede p?blica e privada do munic?pio do Natal/RN (63 meninos e 81 meninas), subdividas nas faixas et?rias de 7 a 8 e 9 a 11 anos. Os escolares apresentavam o IMC, para a idade e o sexo, entre o percentil 5 e 85. As press?es respirat?rias m?ximas foram mensuradas com o manovacu?metro digital MVD300 (Globalmed?). As press?es inspirat?rias m?ximas (PIm?x) e as press?es expirat?rias m?ximas (PEm?x) foram medidas a partir do volume residual e da capacidade pulmonar total, respectivamente. Os dados foram analisados atrav?s do software Statistics SPSS 15.0 (Statistical Package for the Social Science) atribuindo-se o n?vel de signific?ncia de 5%. A an?lise descritiva foi expressa atrav?s de m?dia e desvio padr?o. Foi utilizado o teste t Student n?o pareado para a compara??o de m?dias das vari?veis. A compara??o das m?dias obtidas com os valores preditos em estudos pr?vios foi feita atrav?s do teste t Student pareado. O teste de correla??o de Pearson foi utilizado para verificar a exist?ncia de correla??o das PRM com as vari?veis independentes (idade, sexo, peso e altura). Para obter as equa??es preditivas foi utilizada a an?lise de regress?o linear m?ltipla stepwise. Resultados: Ao analisar os dados, observou-se que nas faixas et?rias avaliadas a PIm?x foi significativamente superior nos meninos. A PEm?x n?o diferiu entre meninos e meninas de 7 a 8 anos, o inverso ocorreu na faixa compreendida entre 9 e 11 anos. Os meninos apresentaram incremento significativo da for?a muscular respirat?ria com o avan?ar da idade. Independentemente do sexo e da faixa et?ria a PEm?x foi sempre superior ? PIm?x. Os valores de refer?ncia encontrados neste estudo s?o similares aos de uma amostra de crian?as espanholas e canadenses, no entanto subestimaram os valores das medidas encontradas em outra amostra de crian?as canadenses. As equa??es propostas em dois estudos realizados anteriormente, com crian?as de outros pa?ses, n?o foram capazes de predizer consistentemente os valores observados neste estudo. As vari?veis sexo, idade e peso apresentaram correla??o com a PIm?x, enquanto que a PEm?x tamb?m apresentou correla??o com a altura. No entanto, nos modelos de regress?o propostos neste estudo, apenas o sexo e a idade permaneceram exercendo influ?ncia sobre a variabilidade das press?es inspirat?ria e expirat?ria m?ximas. Conclus?o: O presente estudo disponibiliza valores de refer?ncia, limites inferiores de normalidade e prop?e dois modelos de equa??o que permitem predizer, atrav?s das vari?veis independentes sexo e idade, o valor das press?es respirat?rias est?ticas m?ximas de crian?as brasileiras com idade entre 7 e 11 anos

Made available in DSpace on 2014-12-17T15:16:16Z (GMT). No. of bitstreams: 1 RaquelEFM_DISSERT.pdf: 2223451 bytes, checksum: 24fa0f88cb8e430d8c647958d5964582 (MD5) Previous issue date: 2012-01-04 / Introduction: The reference values and prediction equations for maximal respiratory pressures (MRP) differ significantly between the available studies. This large discrepancy can be attributed to the different methodologies proposed. Although the importance of MRP is widely recognized, there are no Brazilian studies that provide predictive equations and reference values for PRM adolescents. Objectives: The purpose of this study was to provide normal values and propose predictive equations for maximal static respiratory pressures of Brazilian adolescents. Methods: An observational cross-sectional study, which evaluated 182 adolescents of both sexes aged between 12 and 18 years, enrolled in schools of the state and private in the city of Natal / RN. The selection of schools and participants of the study was randomly through a lottery system. The spirometric evaluation was performed through the digital spirometer One Flow FVC prior to the assessment of respiratory muscle strength. The MICs were measured with MVD digital manometer 300. Statistical analysis was performed using the SPSS 17.0 software STATISTICS, assigning the significance level of 5%. The normality of data distribution was verified using the Kolmogorov-Smirnov (KS). The descriptive analysis was expressed as mean and standard deviation. We used one-way ANOVA test to verify the difference of the averages of MRPs between age and gender and comparing the averages of MRPs between levels of physical activity. The test t'Student unpaired compared the averages of MRPs being ages and sexes. The comparison of mean values obtained in this study PRM with the values predicted using the equations mentioned above was relizada by testing paired t'Student. To verify the correlation between the PRM and the independent variables (age, weight, height) was used Pearson correlation test. Levene's test evaluated the homogeneity of variance. To obtain predictive equations analysis was used stepwise multiple linear regression. Results: There was no significant difference in mean age between the PRM. The male adolescents, regardless of age, showed superiority in MRP values when compared to the opposite sex. Weight, height and sex correlated with the PRM. Regression analysis suggested in this study, pointed out that the weight and sex had an influence in MIP and MEP only in relation to sex influenced. The mean for each PRM adolescents classified as very active were superior to those observed in adolescents classified as irregularly active. Conclusion: This study provides reference values and two models of predictive equations for maximal inspiratory and expiratory pressures, and to establish the lower limits of normality that will serve as an indispensable condition for careful evaluation of respiratory muscle strength in Brazilian adolescents / Introdu??o: Os valores de refer?ncia e as equa??es preditivas para as press?es respirat?rias m?ximas (PRM) diferem significativamente entre os estudos dispon?veis. Esta grande discrep?ncia pode ser atribu?da ?s distintas metodologias propostas. Embora a import?ncia das PRM seja amplamente reconhecida, inexistem estudos brasileiros que disponibilizem equa??es preditivas e valores de refer?ncia para as PRM de adolescentes. Objetivos: O prop?sito deste estudo foi disponibilizar valores de normalidade e propor equa??es preditivas para as press?es respirat?rias est?ticas m?ximas de adolescentes brasileiros. M?todos: Estudo observacional do tipo transversal, que avaliou 182 adolescentes, de ambos os sexos com faixa et?ria entre 12 e 18 anos, matriculados em escolas da rede estadual e privada do munic?pio do Natal/RN. A sele??o das escolas e dos participantes do estudo foi realizada de maneira aleat?ria atrav?s de sorteios. A avalia??o espirom?trica foi realizada, atrav?s do espir?metro digital One Flow FVC, previamente ? avalia??o da for?a dos m?sculos respirat?rios. As PRM foram medidas com o manovacu?metro digital MVD300 da Globalmed ?. A an?lise estat?stica foi feita atrav?s do software estat?stic SPSS 17.0, atribuindo-se o n?vel de signific?ncia de 5%. A normalidade de distribui??o dos dados foi verificada por meio do teste de Kolmogorov-Smirnov (KS). A an?lise descritiva foi expressa em m?dias e desvio padr?o. Foi utilizado o teste ANOVA one way para verificar a diferen?a das m?dias das PRM entre a idade e o sexo e comparar as m?dias das PRM entre os n?veis de atividade f?sica. O teste t Student n?o pareado comparou as m?dias das PRM ente as idades e os sexos. A compara??o das m?dias dos valores de PRM obtidas no atual estudo com os valores preditos por meio das equa??es propostas anteriormente foi relizada atrav?s do teste t Student pareado. Para verificar a correla??o entre as PRM e as vari?veis independentes (idade, peso, altura), foi utilizado o teste de correla??o de Pearson. O teste de Levene avaliou a homogeneidade de vari?ncia. Para a obten??o das equa??es preditivas foi utilizada a an?lise de regress?o linear m?ltipla stepwise. Resultados: Foi observada inexist?ncia de diferen?a significativa nas m?dias das PRM entre as idades. Os adolescentes do g?nero masculino, independentemente da idade, apresentaram superioridade nos valores das PRM quando comparados ao sexo oposto. As vari?veis peso, altura e sexo apresentaram correla??o com as PRM. A an?lise de regress?o proposta neste estudo, apontou que o peso e o sexo exerceram influ?ncia na PIm?x e em rela??o a PEm?x apenas o sexo a influenciou. As m?dias obtidas para as PRM dos adolescentes classificados como Muito Ativo apresentaram superioridade ?s observadas nos adolescentes classificados como Irregularmente Ativo. Conclus?o: O presente estudo disponibiliza valores de refer?ncia e dois modelos de equa??es preditivas para as press?es inspirat?ria e expirat?ria m?ximas, al?m de estabelecer os limites inferiores de normalidade que servir?o como par?metros indispens?veis ? avalia??o criteriosa da for?a muscular respirat?ria de adolescentes brasileiros

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-01-03T20:58:46Z No. of bitstreams: 1 MorganaDeAraujoEvangelista_DISSERT.pdf: 2607941 bytes, checksum: 7cff1386828e64e1f63b7ce32b375bb0 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-01-09T14:10:37Z (GMT) No. of bitstreams: 1 MorganaDeAraujoEvangelista_DISSERT.pdf: 2607941 bytes, checksum: 7cff1386828e64e1f63b7ce32b375bb0 (MD5) / Made available in DSpace on 2017-01-09T14:10:37Z (GMT). No. of bitstreams: 1 MorganaDeAraujoEvangelista_DISSERT.pdf: 2607941 bytes, checksum: 7cff1386828e64e1f63b7ce32b375bb0 (MD5) Previous issue date: 2015-06-17 / INTRODU??O: A Distrofia Miotonica ? caracterizada por atrofia, fraqueza presen?a de miotonia nos m?sculos esquel?ticos. A presen?a de miotonia nos musculos respirat?rios ? duvidosa assim como as t?cnicas para avalia-l?s. OBJETIVOS: Avaliar a sensibilidade /especificidade da taxa m?xima de relaxamento dos m?sculos inspirat?rios (MRR), a eletromiografia de superf?cie (EMGs) dos m?sculos esternocleidomast?ideo (SCM), escaleno (ESC), paraesternal (2EIC), reto abdominal (RA) e a fun??o pulmonar/muscular respiratoria em pacientes com DM1 e sujeitos saudaveis. M?TODOS: Foram convidados a participar do estudo, 71 indiv?duos, 44 pacientes com DM1 e 27 controles. Foram inclu?dos no estudo 28 sujeitos, (18 DM1 e 10 controles). Ap?s exlcus?es a amostra final foi de 25 sujeitos, 16 pacientes com DM1 e 9 sujeitos saud?veis. Todos foram avaliados em rela??o MRR dos m?sculos inspirat?rios, (dP/dt)/Psniff*100(%10ms), a EMGs dos m?sculos respirat?rios, ? fun??o muscular e pulmonar. RESULTADOS: A MRR foi menor nos pacientes com DM1 vs. controle (p=0,003) e foi considerada sens?vel e espec?fica para identificar a doen?a na DM1 e descart?-la no grupo controle, ?rea de ROC 0,87 (95%IC, 0,729 a 1,01, p=0,003). Foi observado valores reduzidos de PIm?x (p=0,0029), PEm?x (p=0,0007) e SNIP (p=0,0030), CVF%pred. (p=0,0014) e VEF1%pred. (p=0,0003) e maior atividade da EMGs em repouso nos m?sculos SCM (p=0,004), ESC (p=0,009) e RA (p=0,045) e no m?sculo SCM (p=0,001) durante o sniff teste. CONCLUS?ES: A MRR ? sensivel e especifica para identificar atraso no relaxamento dos musculos respirat?rios e a fun??o muscular respirat?ria encontra-se alterada nos pacientes com DM1. / INTRODUCTION: Myotonic dystrophy (DM) is a neuromuscular disease characterized by unstable expansion of CTG triplet on chromosome 19. It has two forms: type 1 (DM1 or Steinert's disease); and type 2 (DM2), being the former the most frequent and showing systemic manifestations, such as myotonia (muscle relaxation difficulty), cataracts, arrhythmias, muscle weakness and atrophy, among others, respiratory failure being one of the main factors predictive of mortality and a leading cause of death. OBJECTIVES: To evaluate the sensitivity / specificity of the maximum relaxation rate of the inspiratory muscles (MRR), the surface electromyography (sEMG) of the sternocleidomastoid (SCM), scalene (SCA), parasternal (2ICS), rectus abdominis (RA) and lung function/respiratory muscle strength in patients with DM1 and healthy subjects. METHODS: We invited 74 subjects to participate in the study, 44 patients with DM1 and 30 controls. The study included 31 subjects (18 DM1 and 13 controls). After exclusions, the final sample was of 27 subjects, 16 patients with DM1 and 11 healthy subjects. All of them were assessed for MRR of inspiratory muscles, for sEMG of the respiratory muscles, muscle and lung function. RESULTS: The MRR was lower in patients with DM1 vs. control (p = 0.001) and was considered sensitive and specific to identify the disease in DM1 and discard it in the control group, ROC area of 0.87 (95% CI, 0.74 to 1.01, p=0.001). DM1 group showed lower PImax (p=0.0006), PEmax (p=0.0002), SNIP (p=0.0014), CVF%pred (p=0.0018) and FEV1%pred. (p=0.0004) and higher sEMG activity of the SCM (p=0.0022) and ESC muscles (p=0.004) at rest; of 2EIC (p=0.003) during PEmax and of SCM (p=0.02) and ESC muscles (p= 0.03) during the sniff test. CONCLUSIONS: The MRR is sensitive and specific to identify delayed relaxation of the respiratory muscles and respiratory muscle function is altered in patients with DM1.

Made available in DSpace on 2014-12-17T15:16:09Z (GMT). No. of bitstreams: 1 FernandaG_DISSERT.pdf: 1166474 bytes, checksum: 42a23625c719bb1096b1c812ac17e8f4 (MD5) Previous issue date: 2010-05-18 / The clinical importance of evaluating the respiratory muscles with a variety of tests has been proposed by several studies, once that the combination of several tests would allow a better diagnosis and therefore, a better clinical follow of disorders of the respiratory muscles. This study aimed to evaluate the feasibility of adapting a national electronic manovacuometer to measure the nasal inspiratory pressure (study 1) and analyze the level of load intensity of maximum voluntary ventilation, as well as the variables that may influence this maneuver in healthy subjects (study 2). We studied 20 healthy subjects by a random evaluation of two measures of SNIP in different equipments: a national and an imported. In study 2 it was analyzed the intensity of the load of MVV test, change in pressure developed during the maneuver, the possible differences between genders, and the correlations between the flow developed in the test and the result of MVV. In study 1 it was found the average for both measures of nasal inspiratory pressures: 125 ? 42.4 cmH2O for the imported equipment and 131.7 ? 28.7 cmH2O for the national one. Pearson analysis showed a significant correlation between the average, with a coefficient r = 0.63. The average values showed no significant differences evaluated by paired t test (p> 0.05). In the Bland-Altman analysis it was found a BIAS = 7 cmH2O, SD 32.9 and a confidence interval of - 57.5 cmH2O up to 71.5 cmH2O. In the second study it was found significant differences between the genders in the air volume moved, being higher in males 150.9 ? 13.1 l / min vs 118.5 ? 15.7 L / min for (p = 0.0002, 95% CI 44.85 to 20:05). Regarding the inspiratory and expiratory loading, they were significantly higher in men than in women, peak inspiratory pressure (34.7 ? 5.3 cmH2O vs 19.5 ? 4.2 cmH2O, 95% CI - 18.0 to -12.3, p <0.0001), peak expiratory (33.8 vs. 23.1 ? 5.9 cmH2O ? 5.4 cmH2O, 95% CI -17.1 to - 4.6, p <0.0001), and the delta pressure (59.7 ? 10 cmH2O vs 36.8 ? 8.3 cmH2O, 95% CI 14.5 to 31.2, p <0.0002). The Pearson correlation showed that the flow generated by the maneuver is strongly correlated with the delta-expiratory pressure / inspiratory (r2= 0.83,R = 0.91, 95%IC 0.72 a 0.97 e p< 0.0001).Through these results we suggest that the national electronic manovacuometer is feasible and safe to perform the sniff test in healthy subjects. For the MVV, there are differences between the genders in the intensity of pressure developed during the maneuver. We found a load intensity considered low during the MVV, and found a strong correlation between the flow generated in the test and the delta pressure expiratory / inspiratory / A import?ncia clinica de avaliar os m?sculos respirat?rios com uma variedade de testes vem sendo proposta por diversos trabalhos, pois a combina??o de v?rios testes possibilitaria um melhor diagn?stico e consequentemente um melhor seguimento cl?nico das disfun??es dos m?sculos respirat?rios. Este trabalho teve como objetivo avaliar a viabilidade da adapta??o do manovacu?metro nacional eletr?nico para a realiza??o da medida de press?o inspirat?ria nasal (estudo 1) e analisar o n?vel de intensidade de carga da ventila??o volunt?ria m?xima, assim como as vari?veis que possam influenciar a manobra em sujeitos saud?veis (estudo 2). Foram estudados 20 sujeitos saud?veis atrav?s da avalia??o aleat?ria de duas medidas de SNIP em equipamentos diferentes: um nacional e outro importado. No estudo 2 foi analisado a intensidade da carga do teste da ventila??o volunt?ria m?xima(VVM), a varia??o de press?o desenvolvida durante manobra, as poss?veis diferen?as entre g?neros, e as correla??es entre o fluxo desenvolvido no teste e o resultado da VVM. No estudo 1 as m?dias encontradas durante as duas medidas das press?es nasais foram de 125 ? 42,4 cmH2O para o aparelho importado e de 131,7 ? 28,7 cmH2O para o nacional. A an?lise de Pearson demonstrou uma correla??o significativa entre as m?dias com um coeficiente r=0.63. Os valores m?dios n?o apresentaram diferen?as significativas avaliadas pelo teste t pareado (p>0,05).Na an?lise de Bland-Altman foi encontrado um BIAS igual a 7 cmH2O, desvio padr?o 32,9 e um intervalo de confian?a de - 57,5cmH2O at? 71,5 cmH2O. No estudo 2 foi encontrada diferen?a significativa entre os g?neros para o volume de ar deslocado maior em homens 150.9 ? 13.1 l/mim vs 118.5 ? 15.7 L/mim para (p= 0.0002, IC95% 20.05 ? 44.85). Em rela??o carga inspirat?ria e expirat?ria foram significativamente maiores em homens que nas mulheres: pico inspirat?rio (34.7 ? 5.3 cmH2O vs 19.5 ? 4.2 cmH2O, IC95% - 18.0 a -12.3, p< 0.0001), pico expirat?rio (33.8 ? 5.9 cmH2O vs 23.1 ? 5.4 cmH2O, IC95% -17.1 a - 4.6, p< 0.0001), assim como o delta de press?o (59.7 ? 10 cmH2O vs 36.8 ? 8.3 cmH2O, IC95% 14.5 a 31.2 , p< 0.0002). A correla??o de Pearson mostrou que o fluxo gerado pela manobra est? fortemente correlacionado com o delta de press?o expirat?ria/inspirat?ria (r2= 0.83,R = 0.91, (95%IC 0.72 a 0.97 e p< 0.0001). Atrav?s dos resultados encontrados podemos sugerir que o manovacu?metro eletr?nico nacional ? vi?vel e seguro para realiza??o do sniff teste em sujeitos saud?veis. Em rela??o a VVM, existem diferen?as entre os g?neros na intensidade de press?o desenvolvida durante a VVM, a uma intensidade de carga durante a VVM foi considerada baixa assim como foi encontrada uma forte correla??o entre o fluxo gerado no teste e o delta de press?o expirat?rio/inspirat?rio

Made available in DSpace on 2014-12-17T15:16:09Z (GMT). No. of bitstreams: 1 PalommaRSA_DISSERT.pdf: 871286 bytes, checksum: 4918cb8370bc81a4276c15ef2770900e (MD5) Previous issue date: 2010-05-19 / Universidade Federal do Rio Grande do Norte / The strength of respiratory muscle are frequently assessed by maximal inspiratory and expiratory pressure, however, the maneuvers to assess PImax and PEmax are difficult for many patients. The sniff nasal inspiratory pressure (SNIP) is a simple and noninvasive technique use to assess inspiratory muscles strength. Reference values have been previous established for SNIP in adults but no previous studies have provided reference values for SNIP in adult Brazilian population. The main objective of this study were propose reference values of SNIP for Brazilian population through establishment of relationship between anthropometric measurements, physical activity profile and SNIP and at the same time compare the values obtained with reference values previously published. We studied 117 subjects (59 male and 58 female) distributed in different age grouped 20-80 years old. The results showed on significant positive relationship between SNIP and height and negative correlation with age (p<0.05). In the multiple linear regression analysis only age continued to have an independent predictive role for the two dependent variables that correlated with SNIP. The values of SNIP found in Brazilian population were higher when compared with predict values of previous studies. The results of this study provide reference equations of SNIP for health Brazilian population from 20 to 80 years old / Os testes de avalia??o da fun??o muscular respirat?ria como as medidas de press?o respirat?ria m?xima (Press?o Inspirat?ria m?xima - PIm?x e Press?o Expirat?ria m?xima - PEm?x) s?o testes cl?ssicos de for?a muscular respirat?ria, por?m alguns indiv?duos podem expressar certa dificuldade para a execu??o dessas manobras. A Press?o Inspirat?ria Nasal Sniff (Sniff Nasal Inspiratory Pressure - Pnsn), por se tratar de uma t?cnica f?cil e n?o-invasiva, tem sido utilizada para avaliar a for?a muscular inspirat?ria. Alguns estudos determinaram valores de refer?ncia de Pnsn em adultos, por?m n?o h? relatos na popula??o brasileira. Os principais objetivos desse estudo foram propor equa??es de refer?ncia para Pnsn na popula??o brasileira para homens e mulheres, a partir da investiga??o da rela??o entre Pnsn e idade, peso, altura, ?ndice de Massa Corp?rea - IMC e padr?o de atividade f?sica habitual, bem como avaliar a Pnsn numa amostra de volunt?rios saud?veis e comparar com os valores preditos em outras popula??es. A amostra foi composta de 117 indiv?duos (59 homens e 58 mulheres), estratificados em grupos et?rios entre 20-80 anos. Os resultados evidenciaram valores significativamente maiores da Pnsn com o aumento da altura e significativamente menores com o aumento da idade (p<0,05). Ao analisar as equa??es de regress?o linear m?ltipla, apenas a idade permaneceu exercendo influ?ncia na predi??o da Pnsn e os valores obtidos de Pnsn foram superiores quando comparados aos valores preditos em outras popula??es adultas. Nesse contexto, sugere-se equa??es preditivas para Pnsn em indiv?duos brasileiros saud?veis na faixa et?ria entre 20 e 80 anos, com o intuito de minimizar discrep?ncias diagn?sticas ao comparar indiv?duos

Made available in DSpace on 2014-12-17T15:16:17Z (GMT). No. of bitstreams: 1 IvaniziaSS_DISSERT.pdf: 831811 bytes, checksum: 8d5c9ce3de798ff5fead323295073f95 (MD5) Previous issue date: 2012-12-17 / In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma / No paciente asm?tico, a hiperinsufla??o pulmonar coloca os m?sculos inspirat?rios em uma posi??o desfavor?vel na rela??o comprimento-tens?o, reduzindo a capacidade de gerar tens?o. O aumento na ?rea de sec??o transversa dos m?sculos inspirat?rios poderia reverter ou atrasar a deteriora??o da fun??o muscular inspirat?ria. Objetivo: Avaliar a evid?ncia da efic?cia do treinamento muscular inspirat?rio (TMI) com um dispositivo externo em pacientes com asma. M?todos: O tipo de estudo utilizado foi uma revis?o sistem?tica com metan?lise. As fontes pesquisadas foram o Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov e lista de refer?ncias dos artigos. Todas as bases de dados foram pesquisadas desde seu in?cio at? novembro de 2012 e n?o houve restri??o de idioma. Foram considerados para inclus?o ensaios cl?nicos controlados e randomizados envolvendo o uso de um aparelho de treinamento muscular inspirat?rio externo versus um controle (placebo ou sem aparelho). Dois revisores independentemente selecionaram os artigos para inclus?o, avaliaram o risco de vi?s e extra?ram os dados dos estudos inclu?dos. Resultados: Um total de cinco estudos envolvendo 113 pacientes asm?ticos foram inclu?dos na revis?o, sendo 3 destes ensaios desenvolvidos pelo mesmo grupo. Os estudos inclu?dos mostraram que o TMI aumenta significativamente a press?o inspirat?ria m?xima (DM 13.34 cmH2O, 95% IC 4.70 ? 21.98), contudo existiu um largo intervalo de confian?a. N?o houve diferen?a significativa entre o grupo TMI e o grupo controle para press?o expirat?ria m?xima, taxa de pico de fluxo expirat?rio, volume expirat?rio for?ado no primeiro segundo, capacidade vital for?ada, sensa??o de dispneia e uso de beta2-agonista. Nenhum estudo investigou os seguintes desfechos: exacerba??es que requereram o uso de corticosteroides inalado ou oral ou visita ao servi?o de emerg?ncia m?dica, endurance dos m?sculos inspirat?rios, admiss?o no hospital e dias de falta ao trabalho ou escola. Conclus?es: N?o existe evid?ncia conclusiva para apoiar ou refutar o uso do TMI para a asma, uma vez que a evid?ncia foi limitada pelo pequeno n?mero de ensaios inclu?dos, reduzido n?mero de participantes e risco de vi?s. Mais estudos randomizados e controlados bem xiv conduzidos s?o necess?rios, tais ensaios devem investigar a for?a muscular respirat?ria, exacerba??es, fun??o pulmonar, sintomas, admiss?o no hospital, uso de medicamentos e dias de falta ao trabalho ou escola. O TMI deve tamb?m ser avaliado no contexto de asma mais grave