Introdução: A Distrofia Muscular de Duchenne (DMD) é uma doença genética que causa limitações físicas e motoras progressivas, além de alterações da função pulmonar em fase mais tardia. A escala da medida da função motora (MFM) e do teste de caminhada de 6 minutos (TC6) são ferramentas confiáveis e precisas para avaliar pacientes com DMD. A capacidade de realização desses testes pode ser influenciada pela condição cardiorrespiratória, resistência e força muscular, mas ainda não está bem definido qual, ou quais, destas variáveis podem interferir de forma mais significativa na função motora e na capacidade funcional de exercício. Objetivo: Avaliar a função motora por meio da MFM e correlacionar com a função pulmonar e capacidade funcional de exercício em pacientes com DMD. Métodos: Trata-se de um estudo transversal que envolveu 61 voluntários com DMD submetidos a um protocolo de avaliação composto por informações pessoais, antropometria, escala MFM, espirometria (CVF,VEF1,VEF1/CVF, FEF25-75, PFE, CVL, VVM), ventilometria (VC, VM e CVL), pico de fluxo expiratório (PFE) e pico de fluxo de tosse (PFT) no medidor portátil, pressão inspiratória máxima (PImax) e pressão expiratória máxima (PEmax), pressão inspiratória nasal (SNIP), oscilometria de impulso (R5, R20, R5-R20, X5) e TC6. Foi realizada a análise de correlação entre as variáveis e posteriormente a comparação entre os grupos de voluntários deambuladores e não deambuladores. Resultados: A média de idade dos voluntários foi de 13,70±3,93. Na espirometria, houve correlação positiva do escore total, domínios 1(D1) e 2 (D2) da MFM com a porcentagem do previsto da CVF% (r=0,58, r=0,51, r=0,57, respectivamente), correlação negativa do escore total, domínios 1, 2 e 3 com VEF1/CVF (r=-0,61, r=-0,57, r=-0,49 e r=-0,49, respectivamente), correlação negativa do escore total, domínio 1 e domínio 3 com o FEF25-75% (r=-0,48, -0,47, -0,42, respectivamente). Na manobra de PFE realizada no medidor portátil, houve correlação do PFE% com o escore total e todos os domínios da MFM. O escore total, domínio 1, 2 e 3 se correlacionaram positivamente com os valores percentuais da PEmax (r=0,67, r=0,60, r=0,63 e 0,42, respectivamente) e SNIP (r=0,56, r=0,42, r=0,64 e r=0,45, respectivamente). Na oscilometria de impulso (IOS), houve correlação da resistência total (R5) com o escore total, domínio 1 e 2 (r=0,55; r=0,52 e r=0,50, respectivamente) e resistência central (R20) com o escore total, domínios 1 e 2 (r=0,52; r=0,51 e r=0,45, respectivamente); correlação da resistência periférica (R5-R20) com o escore total (r = 0,46) e domínio 2 (r=0,49), e da reatância (X5) com o escore total, D1 e D2(r=-0,43; r=- 0,40 e r=-0,36, respectivamente). No TC6, a distância em metros foi de 294,75±96,97 e se correlacionou fortemente com a MFM, e a percepção da dispneia relatada no TC6 se correlacionou negativamente com o domínio 3 daMFM (r=-0,75). Na análise comparativa entre os grupos de deambuladores (D) e não deambuladores (ND), o IOS demonstrou valores obtidos significativamente menores no grupo ND de R5, R20, R5-R20, X5 e da porcentagem do previsto de R5-20. No mesmo grupo (ND), a espirometria demonstrou valores obtidos significativamente maiores de VVM, da VEF1/CVF, FEF25-75 e porcentagem do previsto de VEF1/CVF, além da diminuição da porcentagem do previsto da CVF, PFE no medidor portátil, PEmax, SNIP e MFM (escore total e domínios 1,2 e 3). Conclusão: A diminuição da MFM se correlacionou com a diminuição da resistência e reatância das vias aéreas, com a diminuição da PEmax, SNIP e da CVF. Além desses parâmetros, houve correlação da diminuição da MFM com o aumento dos valores de PFE, FEF25-75 e VEF1/CVF. Na comparação entre os grupos, os resultados confirmam o que foi encontrado nas correlações no grupo de pacientes que não deambulavam, com diminuição das resistências e reatância das vias aéreas, da força muscular respiratória e valores maiores de volume (VEF1/CVF) e fluxo pulmonar (FEF25-75). Apesar da forte correlação entre a distância percorrida no teste de caminhada com a função motora, não houve alteração dos dados vitais, o que pode indicar que os pacientes não atingiram o esforço submáximo estimado / Introduction: Duchenne Muscular Dystrophy (DMD) is a genetic disease which causes progressive physical and motor limitations, including alterations to the pulmonary function in later stages. The scale of the motor function measure (MFM) and of the six minute walking test (TC6) are reliable and precise tools to assess DMD patients. The possibility of performing these tests may be influenced both by the patient\'s cardiopulmonary condition, resistance and muscular strength. However, it has not been yet demonstrated which of these variables can have the most significant impact on the patient\'s motor function and functional capacity of exercise. Objective: To assess the motor function though the application of the MFM scale and correlate it with the pulmonary function and functional capacity of exercise on DMD patients. Methodology: The approach adopted in this study consisted of a transversal analysis involving sixty one DMD patients who have volunteered to submit themselves to an evaluation protocol which includes the following parameters: personal information, anthropometry, MFM scale, spirometry (CVF,VEF1,VEF1/CVF, FEF25-75, PFE, CVL, VVM), ventilometry (VC, VM e CVL), peak expiratory flow (PFE) and peak cough flow (PFT) according to the portable meter measurements, maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), nasal inspiratory pressure (SNIP), impulse oscillometry (R5, R20, R5-R20, X5) and TC6. The study focused on the analysis of the correlation between variables, followed by a comparison between two groups of patients: wanderers and non-wanderers. Results: The average age of patients was 13,70±3,93. On spirometry, there was a positive correlation between the total score, domains 1(D1) and 2 (D2) of the MFM and the expected CVF percentage (r=0,58, r=0,51, r=0,57, respectively); there was a negative correlation between the total score, domains 1, 2 and 3 and VEF1/CVF (r=-0,61, r=-0,57, r=-0,49 and r=-0,49, respectively), as well as a negative correlation between domain 1, domain 3 and FEF25-75% (r=-0,48, -0,47, -0,42, respectively). On the PFE maneuver performed using the portable meter, there was a correlation between the expected PFE percentage, the total score and all MFM domains. The total score and domains 1, 2 and 3 had a positive correlation with the percentage values of PEmax (r=0,67, r=0,60, r=0,63 and 0,42, respectively) and SNIP (r=0,56, r=0,42, r=0,64 and r=0,45, respectively). Regarding the impulse oscillometry system (IOS), there was a correlation between the total resistance (R5), the total score and domains 1 and 2 (r=0,55; r=0,52 and r=0,50, respectively); and between the central resistance (R20) and total score, domains 1 and 2 (r=0,52; r=0,51 and r=0,45, respectively); in addition, there were correlations between the peripheral resistance (R5-R20), the total score (r = 0,46) and domain 2 (r=0,49), as well as between the reactance (X5) and total score, D1 and D2(r=-0,43; r=-0,40 and r=-0,36, respectively). Thedistance in meters reached in the TC6 was of 294,75±96,97 and had a strong correlation with the MFM. The perception of dyspnoea reported through the TC6 had a negative correlation with domain 3 of the MFM (r=-0,75). On the comparative analysis between groups of wanderers (D) and non-wanderers (ND), the IOS has shown significantly lower values in the group of ND (R5, R20, R5- R20, X5), as well as on the expected percentage of R5-20. In the same group (ND), the spirometry has shown significantly higher values of VVM, VEF1/CVF, FEF25-75 and the expected percentage of VEF1/CVF; in addition to a reduction of the expected percentage of CVF and PFE on the portable meter, PEmax, SNIP e MFM (total score and domains 1, 2 and 3). Conclusion: The reduction of the MFM correlates with the reduction of airways resistance and reactance, and with the reduction of PEmax, SNIP and CVF. In addition to these parameters, there was a correlation between the MFM reduction and the increase of the PFE, FEF25- 75 e VEF1/CVF values. In the comparison between groups, the results confirm the findings in the correlations of the non-wanderers group, with reduction of the airways resistance and reactance, of the respiratory muscular strength and higher volume values (VEF1/CVF) and pulmonary flow (FEF25-75). Despite the strong correlation between the distance covered during the walking test and the motor function, there was no alteration on vital indicators, which may point out to the fact that the patients did not achieve the expected sub-maximum effort level

Introdução: Já se sabe que as alterações na atuação da força da gravidade promovidas pela mudança de postura, influenciam os volumes e capacidades pulmonares, mas o comportamento das propriedades elásticas e plásticas do pulmão ainda não está bem esclarecido na literatura. Objetivo: Avaliar a resistência do sistema respiratório em sujeitos eutróficos e obesos nos diferentes decúbitos. Métodos: Os participantes foram alocados nos diferentes grupos, de acordo com o índice de massa corpórea (IMC Kg/m2 ), sendo eles: 18-25, 25-29, 30-39, 40-49 e >50. As posições foram avaliadas pelo Sistema de Oscilometria de Impulso (IOS) em ordem aleatória: sentada (Se), supina (Su) e decúbitos laterais, esquerdo (DLE) e direito (DLD), sendo obtidos os seguintes parâmetros: resistências total, central e periférica, reatância e frequência de ressonância. A espirometria foi realizada em seguida para a análise das seguintes variáveis: capacidade vital forçada, volume expiratório forçado no primeiro segundo, a relação VEF1/CVF e fluxo expiratório forçado médio. Resultados: Foram recrutados 110 voluntários, 36 com IMC de 18 a 25 Kg/m2 (26,8 anos; 21,7 Kg/m2 ), 19 com IMC de 25 a 29 Kg/m2 (26,1 anos; 26,6 Kg/m2 ), 21 com IMC de 30 a 39 Kg/m2 (30 anos; 34,5 Kg/m2 ), 21 com IMC de 40 a 49 Kg/m2 (35,4anos; 45 Kg/m2 ) e 13 com IMC>50 Kg/m2 (35,5 anos; 54,2Kg/m2 ). Não foram detectados distúrbios ventilatórios pela espirometria (médias acima de 80% do previsto). Os grupos começaram a se diferenciar a partir da faixa de 30-39 Kg/m2 , houve diferenças importantes entre os indivíduos com IMC>50 e 40-49 com aqueles com IMC<25 e 25-29 principalmente em vias periféricas (p<0,0001). A posição supina apresentou maiores valores de resistência para todos os grupos. Essas diferenças frente às mudanças de decúbito são mais frequentes nas faixas de IMC menores (<25 a 29 Kg/m2 ). Conclusão: Há maior impedância do sistema respiratório em sujeitos obesos, com maior contribuição da resistência periférica, porém com menores variações relacionadas à mudança de posição em comparação aos sujeitos eutróficos. / Background: It is known that changes in gravity force action, promoted by change of posture, influence volumes and capacities lung, but the behavior of lung elastic and plastic properties, has not yet well clarified in literature. Aim: To evaluate the effect of different positions on respiratory system resistance. Methods: Participants were allocated to different groups, according to the body mass index (BMI Kg/m2 ). The positions were evaluated by Impulse Oscillometry System (IOS) in a random order: seated (Se), supine (Su), left lateral (LL) or right lateral decubitus (RL) and following parameters was obtained: total, central and peripheral resistance, reactance and resonant frequency. Spirometry was then performed to analyze the following variables: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC and mean forced expiratory flow (FEF25-75%). Results: A total of 110 volunteers were recruited, 36 with BMI<25 kg/m2 (26.8 years, 21.7 kg/m2 ), 19 with BMI between 25-29kg/m2 (26.1 years, 26.6 kg/m2 ), 21 with BMI between 30-39 kg/m2 (30 years, 34.5 kg/m2 ), 21 with BMI between 40-49 kg/m2 (35.4 years, 45 kg/m2 ) and 13 with BMI> 50 kg/m2 (35.5 years, 54.2 kg/m2 ). No ventilatory disturbances were detected by spirometry, all higher than predicted (80%). The groups began to differentiate from the range of 30-39 kg/m 2 , there were important differences between individuals with BMI>50 and 40-49 with those with BMI <25 and 25-29, mainly in peripheral pathways (p<0.0001). The supine position presented higher resistance values for all groups. These differences compared to changes in decubitus are more frequent in the lower BMI ranges (<25 to 29 kg/m 2 ). It was also observed that overweight individuals tend to follow the same pattern as those with BMI within normal range. Conclusion: The respiratory impedance is higher in obese than eutrophic subjects, with more contribution of peripheral resistance, but with smaller variations related to position change when compared to eutrophic ones.

Introdução: Já se sabe que as alterações na atuação da força da gravidade promovidas pela mudança de postura, influenciam os volumes e capacidades pulmonares, mas o comportamento das propriedades elásticas e plásticas do pulmão ainda não está bem esclarecido na literatura. Objetivo: Avaliar a resistência do sistema respiratório em sujeitos eutróficos e obesos nos diferentes decúbitos. Métodos: Os participantes foram alocados nos diferentes grupos, de acordo com o índice de massa corpórea (IMC Kg/m2 ), sendo eles: 18-25, 25-29, 30-39, 40-49 e >50. As posições foram avaliadas pelo Sistema de Oscilometria de Impulso (IOS) em ordem aleatória: sentada (Se), supina (Su) e decúbitos laterais, esquerdo (DLE) e direito (DLD), sendo obtidos os seguintes parâmetros: resistências total, central e periférica, reatância e frequência de ressonância. A espirometria foi realizada em seguida para a análise das seguintes variáveis: capacidade vital forçada, volume expiratório forçado no primeiro segundo, a relação VEF1/CVF e fluxo expiratório forçado médio. Resultados: Foram recrutados 110 voluntários, 36 com IMC de 18 a 25 Kg/m2 (26,8 anos; 21,7 Kg/m2 ), 19 com IMC de 25 a 29 Kg/m2 (26,1 anos; 26,6 Kg/m2 ), 21 com IMC de 30 a 39 Kg/m2 (30 anos; 34,5 Kg/m2 ), 21 com IMC de 40 a 49 Kg/m2 (35,4anos; 45 Kg/m2 ) e 13 com IMC>50 Kg/m2 (35,5 anos; 54,2Kg/m2 ). Não foram detectados distúrbios ventilatórios pela espirometria (médias acima de 80% do previsto). Os grupos começaram a se diferenciar a partir da faixa de 30-39 Kg/m2 , houve diferenças importantes entre os indivíduos com IMC>50 e 40-49 com aqueles com IMC<25 e 25-29 principalmente em vias periféricas (p<0,0001). A posição supina apresentou maiores valores de resistência para todos os grupos. Essas diferenças frente às mudanças de decúbito são mais frequentes nas faixas de IMC menores (<25 a 29 Kg/m2 ). Conclusão: Há maior impedância do sistema respiratório em sujeitos obesos, com maior contribuição da resistência periférica, porém com menores variações relacionadas à mudança de posição em comparação aos sujeitos eutróficos. / Background: It is known that changes in gravity force action, promoted by change of posture, influence volumes and capacities lung, but the behavior of lung elastic and plastic properties, has not yet well clarified in literature. Aim: To evaluate the effect of different positions on respiratory system resistance. Methods: Participants were allocated to different groups, according to the body mass index (BMI Kg/m2 ). The positions were evaluated by Impulse Oscillometry System (IOS) in a random order: seated (Se), supine (Su), left lateral (LL) or right lateral decubitus (RL) and following parameters was obtained: total, central and peripheral resistance, reactance and resonant frequency. Spirometry was then performed to analyze the following variables: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC and mean forced expiratory flow (FEF25-75%). Results: A total of 110 volunteers were recruited, 36 with BMI<25 kg/m2 (26.8 years, 21.7 kg/m2 ), 19 with BMI between 25-29kg/m2 (26.1 years, 26.6 kg/m2 ), 21 with BMI between 30-39 kg/m2 (30 years, 34.5 kg/m2 ), 21 with BMI between 40-49 kg/m2 (35.4 years, 45 kg/m2 ) and 13 with BMI> 50 kg/m2 (35.5 years, 54.2 kg/m2 ). No ventilatory disturbances were detected by spirometry, all higher than predicted (80%). The groups began to differentiate from the range of 30-39 kg/m 2 , there were important differences between individuals with BMI>50 and 40-49 with those with BMI <25 and 25-29, mainly in peripheral pathways (p<0.0001). The supine position presented higher resistance values for all groups. These differences compared to changes in decubitus are more frequent in the lower BMI ranges (<25 to 29 kg/m 2 ). It was also observed that overweight individuals tend to follow the same pattern as those with BMI within normal range. Conclusion: The respiratory impedance is higher in obese than eutrophic subjects, with more contribution of peripheral resistance, but with smaller variations related to position change when compared to eutrophic ones.

This study investigated the effect of caffeine on airway resistance. The subjects were drawn from volunteers (18-90 years old) in good health, with no major cardiopulmonary conditions. We found no association between the consumption of a single cup of the caffeinated beverage coffee and a decrease in airway resistance within one hour in a normal sample of subjects as measured by impulse oscillometry nor with conventional spirometry . It appears that any possible bronchodilatory effect of the caffeine from a single cup of coffee in a normal population is below the limit of detection of spirometry and impulse oscillometry or is not sufficiently expressed in the one hour time frame of the study. The study did validate currently accepted methods of using the Jaeger impulse oscillometry (IOS) measurement for use at the University of South Florida (USF). The impulse oscillometry technique was found to be a useful adjunct to conventional pulmonary function testing. Conventional pulmonary function testing provides a useful measure of a person's ability to breathe yet is difficult to perform and only indirectly guides the physician to the diagnosis of the pathology behind the person's breathing difficulties. The impulse oscillometry technique may help the physician to noninvasively determine the location of a pulmonary obstruction by measurement of the dynamics of sound wave travel through the airways of the lungs.

Blood pressure measurement has been and continues to be one of the most important measurements in clinical practice and yet, it remains one of the most inaccurately performed. The use of oscillometric blood pressure measurement monitors has become common in hospitals, clinics and even homes. Typically, these monitors assume that the heartbeat rate remains stable, which is contrary to what happens in atrial fibrillation. In this thesis, a new method that provides a more precise estimate of Mean Arterial Pressure (MAP) is proposed using anon-invasive oscillometric blood pressure monitor. The proposed method is based on calculating a ratio of peak amplitude to trough amplitude for every pulse, then identifying where the ratio first reaches a value of 2. The performance of the proposed method is assessed by comparing the accuracy and variability of the readings against reference monitors -first in healthy subjects, then in atrial fibrillation patients. In healthy subjects and in atrial fibrillation patients, the proposed method achieved a performance accuracy that is well within the ANSI/AAMI SP10 protocol requirements of the reference monitors. The presence of atrial fibrillation diminished the performance of the reference monitor by increasing the variability of the reference readings. The proposed algorithm, on the other hand, performed better by achieving substantially lower variability in the readings than the reference device.

Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry. In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65–72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices. In VI, both baPWVand cfPWVinter-correlatedwell and showed good level of agreement with bilateral baPWVmeasured byVE (baPWV[VI]– baPWV[VE]R: overall concordance correlation coefficient [OCCC]¼0.484, mean difference¼1.94 m/s; cfPWV[VI]–baPWV[- VE]R: OCCC¼0.493, mean difference¼1.0m/s). In contrast, SSBO derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r¼0.196; P¼0.04) and ipsilateral baPWV (cf/ aoPWV[VE]R–baPWV[VE]R: r¼0.166; P¼0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r¼0.725, P<0.001). AI exhibited marginal between-device agreement (right-sided: OCCC¼ 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and inter-observer concordances were similarly high except for AI yielding a trend toward better reproducibility in VE (interobserver–OCCC[VI] vs [VE]¼0.774 vs 0.844; intraobserver OCCC[VI] vs [VE]¼0.613 vs 0.769). Both diastolic oscillometry-derived PWV modes, and AI measured either with VI or VE, are comparable and reliable alternatives for the assessment of arterial stiffness. Aortic PWV assessed by SSBO in VE is not related to the corresponding indices determined by traditional diastolic oscillometry.

Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry. In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65–72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices. In VI, both baPWVand cfPWVinter-correlatedwell and showed good level of agreement with bilateral baPWVmeasured byVE (baPWV[VI]– baPWV[VE]R: overall concordance correlation coefficient [OCCC]¼0.484, mean difference¼1.94 m/s; cfPWV[VI]–baPWV[- VE]R: OCCC¼0.493, mean difference¼1.0m/s). In contrast, SSBO derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r¼0.196; P¼0.04) and ipsilateral baPWV (cf/ aoPWV[VE]R–baPWV[VE]R: r¼0.166; P¼0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r¼0.725, P<0.001). AI exhibited marginal between-device agreement (right-sided: OCCC¼ 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and inter-observer concordances were similarly high except for AI yielding a trend toward better reproducibility in VE (interobserver–OCCC[VI] vs [VE]¼0.774 vs 0.844; intraobserver OCCC[VI] vs [VE]¼0.613 vs 0.769). Both diastolic oscillometry-derived PWV modes, and AI measured either with VI or VE, are comparable and reliable alternatives for the assessment of arterial stiffness. Aortic PWV assessed by SSBO in VE is not related to the corresponding indices determined by traditional diastolic oscillometry.

Introdução: Bronquiectasias (BQC) são caracterizadas pela dilatação patológica e irreversível dos brônquios. Nestas situações pode-se observar redução da capacidade de exercício e limitações ao esforço por dispneia, aumento da frequência respiratória e hiperinsuflação dinâmica. Objetivo: Avaliar os efeitos do aumento da demanda ventilatória sobre a mecânica do sistema respiratório, simulando o que acontece no exercício, em indivíduos com BQC e em indivíduos controles. Métodos: Foram avaliados 30 voluntários com BQC (49,47±15,31 anos) e 16 SDP (40,19±15,74 anos). A capacidade vital e inspiratória foram avaliadas pela ventilometria. A resistência a 5 e 20 Hz (R5 e R20) e subtração de R5-R20, reatância a 5 Hz (X5), frequência de ressonância (Fres) e área de reatância (Ax) foram avaliadas pelo sistema de oscilometria de impulso (IOS), com respirações ao volume corrente e frequência respiratória basal (Fb); com aumento da frequência respiratória (F) a 30 e 40 incursões respiratórias por minuto (irpm) (F30 e F40), e hiperinsuflado basal (Hb) e com aumento da F (H30 e H40). Resultados: No IOS, nas comparações entre os grupos, houve diferença (p<0,05) para R5, R5-20, X5, Fres e Ax, apenas R20 não apresentou diferença significativa (p>0,05). No grupo BCQ, quando comparadas as frequências (Fb, F30 e F40) houve diferença para R5, R5-20, X5, Fres e Ax, (p<0,05). Quando comparadas a hiperinsuflação voluntária com aumento de F (Hb, H30 e H40) houve diferença para R5, R5-20, X5 e Ax, (p<0,05). Entre as situações de aumento de F, e, aumento de volume, houve diferença para R5, R20, R5-20, X5, Fres e Ax, (p<0,05). No grupo controle, para a R20, houve diferença entre H30 e H40 com F40. A X5 apresentou diferença entre Hb e as frequencias (Fb, F30 e F40) e aumento volume (H30 e H40), p<0,05. Conclusão: A taquipneia aumentou a resistência total, central e periférica das vias aéreas em indivíduos com BQC e a resistência central no grupo controle. Por outro lado, a hiperinsuflação voluntária promoveu um efeito protetor sobre a resistência, aproximando-a dos valores basais, em ambos os grupos / Introduction: Bronchiectasis (NFCB) are characterized by pathological and irreversible bronchial dilation. Reduction of exercise capacity, dyspnea, increased respiratory rate, and dynamic hyperinflation can be observed in patients with this condition. Objective: To evaluate the effects of increased and ventilatory demand and increase of respiratory rate of the respiratory system, during simulation of physical exercise in individuals with NFCB and in control subjects. Methods: Thirty volunteers with NFCB (49.47±15.31 years old) and 16 control (40.19±15.74 years old) were evaluated. The vital and inspiratory capacity was evaluated by ventilometry. Resistance at 5 and 20 Hz (R5 and R20, respectively) and R5-R20, reactance at 5 Hz (X5), resonance frequency (Fres), and reactance area (Ax) were evaluated by impulse oscillometry system (IOS). Measurements included basal tidal volume (TV), basal TV and respiratory rate (R), 30 breaths (RR30) per min (bpm), basal TV and rate 40 (RR40) bpm, basal hyperinflation (bh), hyperinflation and r30 bpm (h30), and hyperinflation and r40bpm (h40). Results: In IOS, the comparisons between groups, there was difference (p<0.05) for R5, R5-20, X5, Fres and Ax, only R20 did not present significant difference (p>0.05). In the BCQ group, when comparing the frequencies (TV, RR30 and RR40) there was difference for R5, R5- 20, X5, Fres and Ax, p <0.05. When comparing the voluntary hyperinflation with increase of F (Hb, HRR30 and HRR40) there was difference for R5, R5-20, X5 and Ax, (p<0.05). Among the situations of increase of R, and increase of volume, there was difference for R5, R20, R5-20, X5, Fres and Ax, (p<0.05). In the control group, for R20, there was a difference between HRR30 and HRR40 with RR40. The X5 presented difference between Hb and the rate (TV, RR30 and RR40) and volume increase (HRR30 and HRR40), p <0.05.Conclusion: Tachypnea increased total, central and peripheral airway resistance in individuals with BQC and central resistance in the control group. And voluntary hyperinflation promoted a protective effect on resistance, approaching baseline values in both groups

Introdução: As bronquiectasias são caracterizadas patologicamente pela dilatação anormal e permanente dos brônquios, causadas, principalmente, pela perpetuação de processos inflamatórios e prejuízo da remoção de secreções. A fisioterapia é parte fundamental do tratamento destes pacientes, utilizando-se de suas diversas técnicas e dispositivas. Objetivo: Avaliar o efeito das técnicas flutter e compressão torácica sobre a remoção de secreção e alterações na resistência total do sistema respiratório em indivíduos com bronquiectasias. Métodos: Em estudo cruzado, randomizado e cego, indivíduos com bronquiectasias e saudáveis foram avaliados antes e após sessões de controle, exercícios com flutter, ou manobras de compressão torácica (CT). Foram avaliados o peso seco, peso total, adesividade e purulência das secreções expectoradas. Para impedância do sistema respiratório foi utilizado a oscilometria de impulso, que analisou a resistência a 5Hz (R5), reactância a 5Hz (X5) e frequência de ressonância (Fres). Adicionalmente, foram avaliados escala de dispneia do Medical Research Council (MRC); escala de aceitabilidade e tolerância; oximetria de pulso; dificuldade de expectoração e Índice de Severidade de Bronquiectasias (BSI). Resultados: Flutter e CT foram eficazes para remoção de secreção comparada a controle (p>0,05). A variação da resistência total do sistema respiratório foi favorável para técnica flutter no grupo bronquiectasias quando comparada ao grupo controle (p< 0,05). Ambas as técnicas foram bem aceitas pelos participantes. Conclusão: Os resultados sugerem que as técnicas flutter e compressão torácica são eficazes para a remoção de secreção, seguras e bem toleradas por pacientes com bronquiectasias, com efeito agudo na resistência total do sistema respiratório favorável à técnica flutter. / INTRODUCTION: Bronchiectasis is characterized by abnormal and permanent bronchi dilatation, mainly caused by the progression of inflammatory processes and loss of the ability to clear mucus. Physical therapy is a fundamental part of these patients\' treatment. In this study we aimed to evaluate the effects of the flutter technique and thoracic compression on the mucus clearance and alterations in the total impedance of the respiratory system in individuals with bronchiectasis. METHODS: In a crossover randomized blinded study, subjects with bronchiectasis and healthy (control) ones were evaluated before and after control sections, flutter exercises, or thoracic compression (TC) manoeuvres. Dry and total weights, adhesiveness, and purulence of the expectorated mucus secretions were evaluated. For respiratory system impedance measurements, impulse oscillometry was used to evaluate the resistance at 5Hz, reactance at 5Hz, and resonant frequency. Additional factors that were evaluated included the dyspnoea scale of the Medical Research Council, acceptability and tolerance scale, pulse oximetry, expectoration difficulty, and bronchiectasis severity index. RESULTS: The flutter technique and TC were efficient for mucus clearance when compared with control (p <0.05). Acute total respiratory system resistance variation responded more favourably to the flutter technique in the bronchiectasis group when compared to the control group (p <0.05). Both techniques were well tolerated by the participants. CONCLUSION: Results suggest that the flutter technique and thoracic compression are efficient methods for removal of mucus secretions. They are safe and well tolerated by patients; acute effects in the total respiratory system resistance respond favourably to the flutter technique.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.