Made available in DSpace on 2016-12-12T17:32:57Z (GMT). No. of bitstreams: 1 Resumo Maira.pdf: 257098 bytes, checksum: 54a59550f776b4046e6e9691bbff4ec0 (MD5) Previous issue date: 2014-08-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The impulse oscillometry system (IOS) is considered a non-invasive method for assessing respiratory mechanics which has been increasingly used in the child population. Currently there are no reference equations for IOS healthy Brazilian children. The aim of this study was to determine reference equations/values for the parameters of impulse oscillometry system in healthy children. Characterized as an observational cross-sectional analytical study, it has been conducted with healthy schoolchildren 6- to 14-years of age from educational institutions in Florianópolis/SC - Brazil. The children were characterized as healthy by questionnaire on asthma and allergies in childhood (International Study of Asthma and Allergies in Childhood - ISAAC) and a recall of structured health, in addition to spirometry. Biometric data of weight, height, body mass index and body surface area were also evaluated. All participants were subjected to analysis of respiratory mechanics with impulse oscilometry Jaeger (Master Screen IOS, Erich Jaeger, Germany®), recorded three tests, with data acquisition for at least 20 seconds. The verification of the normality of the data was performed using the Kolmogorov-Smirnov test and using the Pearson Correlation Test between the predictor variables of height, age and weight and the oscillometric variables resistances at 5 and 20 Hz (R5 and R20), reactance (X5), the respiratory 5 hertz (Z5), resonant frequency (Fres), and reactance area (AX) impedance, relations were identified. For the development of equations, models from the analyzes of simple and multiple linear regression were considered through the software SPSS version 20.0 for Windows. As a result, after recruiting 864 children, it was considered for final analysis 123 individuals healthy with mean of the boys 10.02±2.41 years in boys and 9.98±2.48years in girls. Correlations were found between oscillometric dependent variable and the predictor variable, the height identified with greater predictive power in the equations developed for boys in all parameters of oscillometry with a mean value of R2 adjusted=55.8%. Already in girls, age had a greater influence on the parameters of Fres (R2adjusted= 40.1%) and AX (R2adjusted = 48.8%). Given the above, reference equations for the female and the male were developed, the height the most influential predictor variable in most of the IOS parameters in the pediatric population studied. / O sistema de oscilometria de impulso (IOS) é considerado um método não invasivo de avaliação da mecânica respiratória que vem sendo crescentemente utilizado na população infantil. Atualmente não existem equações de referência do IOS para crianças saudáveis brasileiras. O objetivo do presente estudo foi determinar valores de equações/valores de referência para parâmetros do sistema de oscilometria de impulso em crianças saudáveis. Caracterizado como um estudo analítico observacional transversal, este foi realizado com escolares saudáveis de seis a 14 anos de idade de instituições de ensino da Grande Florianópolis/SC - Brasil. Os quais foram caracterizados como hígidos pelo questionário sobre asma e alergias na infância (International Study of Asthma and Allergies in Childhood ISAAC) e um recordatório estruturado sobre saúde, além do exame de espirometria. Também foram avaliados dados biométricos de peso, altura, índice de massa corporal e área de superfície corporal. Todos os participantes foram submetidos à análise da mecânica respiratória com oscilometro de impulso Jaeger (Master Screen IOS, Erich Jaeger, Germany®), com registro de três exames, com aquisição de dados por no mínimo 20 segundos. A verificação da normalidade dos dados foi feita pelo teste Kolmogorov-Smirnov e, através do teste de correlação de Pearson foram identificadas as relações entre as variáveis preditoras de altura, idade e peso e as variáveis oscilométricas de resistências a 5 e 20 hertz (R5 e R20), reatância (X5), impedância respiratória à 5 hertz (Z5), frequência de ressonância (Fres), e área da reatância (AX). Para o desenvolvimento das equações foram considerados os modelos resultantes das análises de regressão linear simples e múltipla através do software SPSS® versão 20.0 para Windows®. Como resultado, após o recrutamento de 864 crianças, considerou-se para análise final 123 indivíduos saudáveis com média de 10.02±2.41 anos em meninos e 9.98±2.48 anos em meninas. Foram constatadas correlações entre as variáveis oscilométricas dependentes e as preditoras, sendo a altura identificada com maior poder preditivo nas equações desenvolvidas para meninos em todos os parâmetros da oscilometria com valor médio de R2ajustado=55.8%. Já nas meninas, a idade teve maior influência nos parâmetros de Fres (R2ajustado=40.1%) e AX (R2ajustado=48.8%). Diante do exposto, foram desenvolvidas equações de referência para o sexo feminino e o masculino, sendo a altura a variável preditora mais influente na maioria dos parâmetros do IOS na população infantil estudada.

Introdução: A obesidade grau III está relacionada com o alto risco de desenvolvimento de comorbidades que afetam a qualidade de vida. Nesses indivíduos, alterações do sistema respiratório podem ocorrer pela diminuição da complacência pulmonar e/ou obstrução das vias aéreas, que podem refletir na capacidade funcional. Apesar disso, a literatura é controversa quanto ao comportamento do sistema respiratório em sujeitos com obesidade grau III. Objetivo: Avaliar a função pulmonar, força e endurance muscular respiratória, resistência do sistema respiratório e capacidade funcional de mulheres com obesidade grau III e correlacionar com a percepção de dispneia e qualidade de vida. Métodos: As pacientes foram avaliadas pela espirometria, manovacuometria, teste de endurance dos músculos inspiratórios, oscilometria de impulso e teste de caminhada de seis minutos (TC6). Também foram aplicados o Questionário Internacional de Atividade Física (IPAQ), o Questionário Short Form 36 (SF-36) e a escala modificada do Medical Research Council (mMRC). Resultados: Foram avaliadas 40 mulheres com 36,4±7,6 anos e IMC igual 47,0±6,2 kg/m2. Não foram detectados distúrbios ventilatórios pela espirometria (%CVF: 95,13±13,38; %VEF1: 92,37±14,81; %VEF1/CVF: 97,21±7,25; %FEF25-75%: 86,26±27,00) enquanto que a oscilometria de impulso identificou alterações significantes na resistência das vias aéreas (kPa/L/s) em relação ao previsto (R5: 0,56±0,15 e 0,36±0,01; R20: 0,41±0,08 e 0,30±0,01; R5-20: 0,16±0,09 e 0,06±0,00; X5: -0,24±0,10 e -0,03±0,02). A média dos valores obtidos da PImáx e PEmáx (cmH2O) foi de -114,7±24,3 e 132,0±30,1; respectivamente e, o tempo de endurance dos músculos inspiratórios foi inferior ao esperado para 47% das voluntárias. A distância percorrida no TC6 não apresentou diferença significativa em relação aos valores previstos. As participantes não tiveram queixa de dispneia importante e referiram bom estado geral de saúde no SF-36. Não foram observadas correlações fortes entre a percepção de dispneia e a qualidade de vida com os resultados dos testes da avaliação. Conclusão: Os resultados do IOS sugerem obstrução das vias aéreas centrais e periféricas, que não foram detectadas pela espirometria. As pacientes relataram boa percepção da qualidade de vida e baixa sensação de dispneia, com bom desempenho no TC6 e sem fraqueza dos músculos respiratórios, porém com limitação do tempo de endurance dos músculos inspiratórios. / Introduction: Grade III obesity is related to risk of developing comorbidities that can influence the quality of life. In this population, respiratory dysfunctions can occur by the pulmonary complacency decrease and/or airways obstruction that can affect the functional lung capacity. Despite this, there are disagreements in the literature about the respiratory system behavior in severely obese subjects. Objective: To evaluate respiratory muscle strength, inspiratory muscle endurance, respiratory system resistance and, functional capacity and to correlate these parameters with dyspnea and quality of life perceptions. Methods: The participants were evaluated by spirometry, manovacuometry, inspiratory muscle endurance test, impulse oscillometry (IOS) and the six minute walk test (6MWT). They also answered the International Physical Activity Questionnaire (IPAQ), Quality of Life Questionnaire (SF-36) and the modified Medical Research Council scale (mMRC). Results: We evaluated 40 women with mean age of 36.3±7.9 years and body mass index of 47.1±6.3 kg/m2. The spirometry exam did not detect pulmonary function dysfunctions (%FEV1: 92.4±14.8; %FVC: 95.3±13.4; %FEV1/FVC: 97.2±7.3 and %FEF25-75%: 86.3±27.0). The IOS detected alterations in the airways resistance in comparison to the predicted values (kPa/L/ s) (R5: 0.56±0.15 and 0.36±0.01, R20: 0.41±0.08 and 0.30±0.01, R5-20: 0.16±0.09 and 0.06±0.00, X5: -0.24±0.10 and -0.03±0.02, respectively) (p<0.05). The mean maximum inspiratory and expiratory pressures (cmH2O) were -114.7±24.3 and 132.0±30.1, respectively; and the inspiratory muscle endurance time was under the expected value in nearly 50% of the participants. The six minute walked distance did not show statistical differences compared to the predicted value. According to the mMRC, the participants did not have relevant dyspnea complaints and reported good quality of life perception by the SF-36. We did not find strong correlations between quality of life and dyspnea perception with the variables of protocol assessment. Conclusion: The IOS results suggest central and peripheral airway obstruction, which were not detected by spirometry. Patients reported good quality of life and low dyspnea perceptions. They had good performance in the 6MWT without respiratory muscle weakness but with limitations in inspiratory muscle endurance time.

This research presents a pulse-by-pulse analysis of Oscillometric blood pressure waveform at systolic, diastolic and mean arterial pressure points. Using a mathematical optimization technique, pulses are characterized into component harmonic by minimizing the least square error. The results at the important pressure points are analyzed and compared for different subject using different waveform extraction techniques. Blood pressure is estimated using the harmonic parameters. The approach studies changes in the parameters as oscillometric blood pressure recording is done. 8 harmonic parameters are obtained from the pulse characterization and are used to estimate Systolic arterial Blood Pressure, Mean arterial Blood Pressure, and Diastolic arterial Blood Pressure. The estimates are compared with our reference value to determine which has the best agreement. The proposed method is further compared with Maximum Amplitude Algorithm and Pulse Morphology Algorithm. The effect of oscillometric waveform extraction methods on the proposed method is observed. The experiment established the fact that the extraction technique can alter the shape of oscillometric pulses. The methods were compared and it was observed that the used extraction methods did not make any significant difference on the accuracy, using this technique.

Oscillometry is the most common measurement method used in automatic blood pressure (BP) monitors. However, most of the oscillometric algorithms are without physiological and theoretical foundation, and rely on empirically derived coefficients for systolic and diastolic pressure evaluation which affects the reliability of the technique. In this thesis, the oscillometric BP estimation problem is addressed using a comprehensive modeling approach, based on which coefficient-free estimation of BP becomes possible. A feature-based neural network approach is developed to find an implicit relationship between BP and the oscillometric waveform (OMW). The modeling approach is then extended by developing a mathematical model for the OMW as a function of the arterial blood pressure, cuff pressure, and cuff-arm-artery system parameters. Based on the developed model, the explicit relationship between the OMW and the systolic and diastolic pressures is found and a new coefficient-free oscillometric BP estimation method using the trust region reflective algorithm is proposed. In order to improve the reliability of BP estimates, the electrocardiogram signal is recorded simultaneously with the OMW, as another independent source of information. The electrocardiogram signal is used to identify the true oscillometric pulses and calculate the pulse transit time (PTT). By combining our developed model of oscillomtery with an existing model of the pulse wave velocity, a new mathematical model is derived for the PTT during the cuff deflation. The derived model is incorporated to study the PTT-cuff pressure dependence, based on which a new coefficient-free BP estimation method is proposed. In order to obtain accurate and robust estimates of BP, the proposed model-based BP estimation method sare fused by computing the weighted arithmetic mean of their estimates. With fusion of the proposed methods, it is observed that the mean absolute error (MAE) in estimation of systolic and diastolic pressures is 4.40 and 3.00 mmHg, respectively, relative to the Food and Drug Administration-approved Omron monitor. In addition, the proposed feature-based neural network was compared with auscultatory measurements by trained observers giving MAE of 6.28 and 5.73 mmHg in estimation of systolic and diastolic pressures, respectively. The proposed models thus show promise toward developing robust BP estimation methods.

Notre travail de thèse est consacré au développement d’une nouvelle approche d’analyse du signal oscillométrique pour mesurer la pression artérielle systolique et identifier les personnes dont la paroi artérielle est anormalement rigide. L’oscillométrie, largement exploitée pour la mesure automatique non-vulnérante de la pression artérielle, repose sur l’amplitude des variations dynamiques de pression du brassard pneumatique générées par l’expansion de l’artère brachiale sous l’effet de l’onde de pouls. Nous avons d’abord effectué une revue de la littérature sur les méthodes auscultatoire et oscillométrique. La méthode auscultatoire, fondée sur la détection des bruits produits par l’artère brachiale sous le brassard, reste la référence pour la validation des moniteurs oscillométriques. Depuis la description de ces bruits par Nicolaï Korotkoff en 1905, de nombreux auteurs ont tenté d’en expliquer l’origine et d’en identifier les limites et pièges en comparaison avec la mesure intra-artérielle directe. La technique oscillométrique dérive de l’invention du sphygmographe par Etienne-Jules Marey en 1859. Les constructeurs procèdent à la validation de leurs appareils en référence aux normes internationales (ISO) sans dévoiler les algorithmes mise en œuvre. De très nombreuses approches ont été proposées, depuis des rapports déterminés empiriquement jusqu’à des réseaux de neurones en passant par divers modèles mathématiques, pour déterminer les pressions systolique et diastolique à partir de la pression moyenne mesurée sur la courbe oscillométrique. Cependant, l’oscillométrie donne des résultats variables et présente des erreurs significatives, en particulier pour la détermination de la pression systolique, notamment chez les sujets ayant des facteurs de risque cardiovasculaires.Sur la base de cette analyse, considérant que la référence reste la détection des bruits de Korotkoff, nous avons cherché à en mieux comprendre les mécanismes. Nous avons enregistré les images échographiques et le signal Doppler de l’artère brachiale sous le brassard lors de la mesure de pression artérielle chez des sujets volontaires, en synchronisation avec l’ECG, la pression du brassard et les bruits de Korotkoff. Nous avons pu observer les variations cycliques du diamètre de l’artère brachiale pendant le dégonflage du brassard, et mesurer la vitesse locale de propagation de l’onde de pouls, ainsi que les délais entre le signal oscillométrique, l’ECG et les bruits de Korotkoff. Nous avons pu ainsi démontrer que les bruits de Korotkoff sont produits par la vibration de la paroi artérielle sous l’impact de l’onde de pouls, puis par la turbulence de l’écoulement flux sanguin, et nous avons montré la diminution marquée de la vitesse locale de l’onde de pouls lorsque la pression du brassard réduit la pression artérielle transmurale. L’observation de ces enregistrements nous a montré l’intérêt de l’analyse de la forme de l’onde de pouls enregistrée par oscillométrie. Nous en avons tiré une approche innovante fondée sur l’analyse temporelle pour la détermination directe de la pression artérielle systolique. Nous avons réalisé une étude clinique prospective, selon un protocole approuvé par le Comité d’éthique du CHU de Nîmes, pour valider notre nouvelle approche. Nous avons comparé notre technique à la méthode auscultatoire chez 145 sujets avec ou sans facteurs de risque cardiovasculaire, et à la pression mesurée par cathéter radial chez 35 patients hospitalisés en réanimation. Nous avons obtenu une excellente concordance avec le premier bruit de Korotkoff, avec des résultats très supérieurs à l’oscillométrie réalisée à l’aide d’un appareil validé. De plus, notre technique s’est montrée capable d’identifier les sujets porteurs de facteurs de risque cardiovasculaires, se comparant favorablement à la vitesse de l’onde de pouls aortique. / Our thesis is devoted to the development of a new oscillometric signal analysis approach to measure systolic blood pressure and identify subjects with abnormal arterial wall rigidity. Oscillometry, widely used for the non-invasive automatic measurement of blood pressure, is based on the amplitude of the dynamic cuff-pressure oscillations generated by the expansion of the brachial artery at the arrival of the pulse wave.We first conducted a literature review on the auscultatory and oscillometric methods. The auscultatory method, based on the detection of the sounds emitted by the brachial artery under the cuff, remains the reference for the validation of oscillometric monitors. Since the description of these sounds by Nicolai Korotkoff in 1905, many authors attempted to explain their origin and assess their limits and pitfalls in comparison with direct intra-arterial blood pressure measurement.Oscillometric technique derive from the sphygmograph built by Etienne-Jules Marey in 1859. Manufacturers validate their oscillometric devices in reference to the international standards (ISO) without revealing the algorithms they use. Numerous approaches have been proposed, from fixed empirical ratios to neural networks to various mathematical models, for the calculation of systolic and diastolic pressure since only the mean arterial pressure is actually measured on the oscillometric curve. However, oscillometry yields variable results and produces significant errors, especially for systolic pressure, notably in patients with cardiovascular risk factors.Based on this analysis, and considering that the reference remains the detection of Korotkoff sounds, we sought to better understand their mechanisms. We recorded ultrasound images and the Doppler signal of the brachial artery under the cuff when measuring blood pressure in volunteers, simultaneously with ECG, cuff pressure and Korotkoff sounds. We could record the systolic diameter changes of the brachial artery during cuff deflation, and measure the local pulse wave velocity, as well as the time delay between the oscillometric signal, the ECG and the Korotkoff sounds. We were able to demonstrate that the Korotkoff sounds are produced by arterial wall vibration under the impact of the pulse wave, then by blood flow turbulence, and we measured the marked decrease in local pulse wave velocity when the cuff inflation reduces the brachial artery transmural pressure.We concluded to the interest of pulse waveform analysis, and designed an innovative approach based on its temporal characteristics for the direct determination of systolic blood pressure. We conducted a prospective clinical study, according to a protocol approved by the Ethics Committee of the Nîmes University Hospital Center, to validate our new approach. We compared our technique to the auscultation method in 145 subjects with or without cardiovascular risk factors, and to direct blood pressure measurement with a radial catheter in 35 patients hospitalized in the intensive care unit. We obtained an excellent correlation with the first Korotkoff sound, with better results than conventional oscillometry. In addition, our technique has proven able to identify subjects with cardiovascular risk factors with an accuracy favorably comparable to aortic pulse wave velocity.

<p>Astma i hronična opstruktivna bolest pluća (HOBP) su najče&scaron;će hronične nezarazne bolesti respiratornog sistema i predstavljaju značajan zdravstveni problem. U dijagnostici i proceni stepena poremećaja disajne funkcije u ovih bolesnika najče&scaron;će se koriste spirometrija i telesna pletizmografija. Impulsna oscilometrija predstavlja novu metodu u dijagnostici poremećaja plućne funkcije. Ova metoda je jednostavna za izvođenje i minimalno zavisi od saradnje pacijenta.Osnovni cilj ove doktorske disertacije bio je da se uporede parametri dobijeni impulsnom oscilometrijom, spirometrijom i telesnom pletizmografijom kod pacijenata sa astmom i hroničnom opstruktivnom bolesti pluća, utvrdi senzitivnost navednih metoda u detekciji opstruktivnog poremećaja ventilacije kao i povezanost parametara impulsne oscilometrije, spirometrije i telesne pletizmografije i stepena težine dispnoičnih tegoba kod odraslih pacijenata sa astmom i HOBP. Korelacijom parametara dobijenih impulsnom oscilometrijom i spirometrijom dobijena je umerena negativna korelacija vrednosti R5 sa FEV1 kod pacijenata sa astmom (r= -0.47, r&lt;0.001) i HOBP (r= -0.50, r&lt;0.001), kao i umerena pozitivna korelacija X5 sa FEV1 (r= 0.54, r&lt;0.001, kod pacijenata sa astmom; r= 0.56, r&lt;0.001 kod pacijenata sa HOBP). Registrovana je dobra korelacija Rt sa vrednostima R5 (r=0.63, r&lt;0.001) i H5 (r= -0.55, r&lt;0.001) kod pacijenata sa astmom, kao dobra korelacija Rt sa R5 (r=0.73, r&lt;0.001) i H5 (r= -0.74, r&lt;0.001) kod pacijenata sa HOBP. Kod pacijenata sa astmom nije registrovana razlika između tri metode u detekciji opstruktivnog poremećaja ventilacije kod pacijenata sa simptomima bolesti, dok se upotrebom sve tri metode povećala se senzitivnost. Sve tri metode bile su u slaboj korelaciji sa stepenom dispnoičnih tegoba kod pacijenta sa astmom. Svi HOBP pacijenti imali su spirometrijski registrovanu opstrukciju disajnih puteva. Senzitivnost impusne oscilometrije raste sa stepenom opstrukcije disajnih puteva, te je sposobnost detekcije opstruktivnog poremećaja ventilacije kod pacijenata sa FEV1%&lt;80 % iznosila 55%, 95% CI 43-67 %, a kod pacijenata sa FEV1%&lt;70 % 61%, 95% CI 47-73%. Registrovana je statistički značajna razlika vrednosti oscilometrijskih parametara u odnosu na spirometrijski stadijum HOBP. Kod pacijenata sa HOBP, sve tri metode bile su u umerenoj korelaciji sa stepenom dispnoičnih tegoba. Zaključujemo da postoji umerena korelacija impulsne oscilometrije sa spirometrijom i telesnom pletizmografijom kod pacijenta sa astmom i HOBP. Impulsna oscilometrija bolje korelira sa telesnom pletizmografijom u poređenju sa spirometrijom. Korelacija tri metode raste sa stepenom opstrukcije disajnih puteva. Komplementarna upotreba tri metode daje sveobuhvatniju sliku respiratorne funkcije kod pacijenata sa astmom i HOBP.</p> / <p>Asthma and chronic obstructive pulmonary disease (COPD) are most common chronic noninfectious diseases of the respiratory system, representing a major health issue. Spirometry and body plethysmography are the procedures which are most often performed to diagnose these diseases and evaluate the lung function impairment of the affected patients. Impulse oscillometry is a novel procedure to establish the lung function impairment. It is easy to perform, and minimally depends on a patient&#39;s cooperation. The major objective of this Ph. D. thesis is to compare the parameters obtained by impulse oscillometry, spirometry and body plethysmography in patients with asthma and COPD, establish the sensitivity of these procedures in detecting an obstructive ventilation disorder, and correlate the parameters of impulse oscillometry, spirometry and body plethysmpography to the severity of dyspneic symptoms in adult asthma and COPD patients. Correlating the parameters obtained by impulse oscillometry and spirometry, a moderate negative correlation of R5 values to FEV1 in asthma (r= -0.47, р&lt;0.001) and COPD patients (r= -0.50, р&lt;0.001) has been obtained, as well as a moderate positive correlation of X5 to FEV1 (r= 0.54, р&lt;0.001, in asthmatics; r= 0.56, р&lt;0.001 in COPD patients). A good correlation of Rt to R5 (r=0.63, р&lt;0.001) and Х5 values (r= -0.55, р&lt;0.001) has been registered in asthmatics, as well as a good correlation of Rt to R5 (r=0.73, р&lt;0.001) and Х5 (r= -0.74, р&lt;0.001) in COPD patients. In asthma patients, the three analysed procedures exhibited no difference in detecting an obstructive ventilation disorder in the patients with manifested symptoms, while the sensitivity improved when the procedures were complementary performed. Any of the three procedures correlated poorly to the severity of dyspneic symptoms in asthma patients. All COPD patients had a spirometry-registered airway obstruction. The sensitivity of impulse oscillometry increased with the severity of the airway obstruction, so its capacity to detect an obstructive ventilation disorder in the patients with FEV1%&lt;80 % was 55%, 95% CI 43-67 %, and in the patients with FEV1%&lt;70 %, it amounted to 61%, 95% CI 47-73%. A statistically significant difference in the values of all oscillometry parameters was registered depending on the spirometric COPD stage. In COPD patients, all the three procedures were moderately correlated to the severity of dyspenic symptoms. In conclusion, there is a moderate correlation of impulse oscillometry to spirometry and body plethysmography in asthma and COPD patients. Impulse oscillometry correlates better to body plethysmography than to spirometry. The correlation of the three procedures increases with the severity of the airway obstruction. The complementary application of these three procedures provides a more accurate assessment of the respiratory function in asthma and COPD patients.</p>

INTRODUÇÃO: A pneumonite de hipersensibilidade (PH) é uma doença intersticial causada pela inalação de antígenos orgânicos específicos ou substâncias de baixo peso molecular em indivíduos geneticamente suscetíveis. A PH crônica representa seu estágio final, na qual a exposição antigênica prolongada leva à fibrose. Na PH crônica, o envolvimento das pequenas vias aéreas (PVA) é proeminente; entretanto, uma avaliação detalhada através de métodos funcionais e de avaliação quantitativa e automatizada pela tomografia computadorizada (TC) não foi realizada previamente. MÉTODOS: estudo transversal de 28 pacientes com PH crônica, com avaliação através de provas de função pulmonar (PFPs); oscilometria forçada (FOT); análise automatizada do volume pulmonar através da TC, incluindo quantificação de aprisionamento aéreo; e teste cardiopulmonar de exercício (TCPE) incremental em cicloergômetro para avaliar performance ao exercício, incluindo medidas seriadas da capacidade inspiratória e hiperinsuflação dinâmica (HD). Foram incluídos pacientes entre 18 a 75 anos, com diagnóstico confirmado pela combinação de achados tomográficos, exposição antigênica e biópsia compatível e/ou LBA com linfocitose. Foram excluídos pacientes com CVF e/ou VEF1 < 30% predito, tabagismo > 20 anos-maço, uso de oxigênio suplementar; diagnóstico prévio de asma ou DPOC, diagnóstico de hipertensão arterial pulmonar ou impossibilidade de realizar TCPE. Os dados foram comparados com controles saudáveis. RESULTADOS: 28 pacientes (16 mulheres; idade média 56 +- 11 anos; CVF 57 +- 17% predito) foram avaliados, e todos apresentavam padrão ventilatório restritivo sem resposta broncodilatadora. Na FOT, 4 pacientes apresentaram resistência aumentada a 5 Hz (R5), enquanto todos apresentaram baixa reactância (X5), sendo que nenhum apresentou resposta broncodilatadora significativa. Pacientes com PH crônica tiveram menor capacidade de exercício com menor O2 de pico, diminuição da reserva ventilatória, hiperventilação, dessaturação de oxigênio e escores de dispneia (Borg) aumentados quando comparado aos controles. A prevalência de HD foi encontrada em apenas 18% da coorte. Ao comparar pacientes com PH crônica com O2 normal e baixo (< 84% predito, LIN), o último grupo apresentou maior hiperventilação (slope E/CO2), um menor volume corrente e menores escores de capacidade física na avaliação do questionário de qualidade de vida (SF-36). A análise da curva ROC mostrou que volumes pulmonares reduzidos (CVF%, CPT% e DLCO%) foram preditores de baixa capacidade ao exercício. Na TC, a PH crônica teve aumento de áreas com alta densidade em unidades Hounsfield, inferindo maior extensão de opacidades em vidro fosco e fibrose em relação aos controles saudáveis. A extensão das áreas de atenuação reduzida (AAR) e aprisionamento aéreo em relação ao volume pulmonar total é pequena, e não se correlaciona com índices funcionais obstrutivos; entretanto, pacientes com maior percentual dessas áreas apresentam menos fibrose e função pulmonar mais preservada. CONCLUSÃO: a PH crônica se caracterizou por um acometimento eminentemente restritivo, e não de obstrução de vias aéreas, nos diferentes métodos diagnósticos aplicados. A redução da capacidade de exercício foi prevalente devido à limitação ventilatória e de troca gasosa, a exemplo de outras doenças intersticiais pulmonares, e não pela HD. Redução dos volumes pulmonares foram bons preditores das respostas ventilatórias durante o exercício / INTRODUCTION: Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Chronic HP represents its final stage, in which prolonged antigenic exposure causes fibrosis. In chronic HP, small airway involvement is prominent; however, a detailed characterization through functional evaluation and through automatic quantitative evaluation of computed tomography (CT) has not been previously assessed. METHODS: Cross-sectional study with 28 chronic HP patients, with evaluation by pulmonary function tests (PFTs), forced oscillometry (FOT), automated lung volume analysis through CT, including quantification of air trapping (AT); and incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer to evaluate exercise performance, including serial measurements of inspiratory capacity to establish dynamic hyperinflation (DH). Inclusion criteria: patients aged 18 to 75 years, with a chronic HP diagnosis confirmed by the combination of CT findings, known antigenic exposure and compatible biopsy and / or BAL with lymphocytosis. Exclusion criteria: FVC and / or FEV1 < 30% predicted, smoking > 20 pack-years, supplemental oxygen use; previous diagnosis of asthma or COPD; pulmonary arterial hypertension, or medical conditions that could interfere with CPET. Data were compared with healthy controls. RESULTS: All patients (16 women; mean age 56 +- 11 years; FVC 57 +- 17% predicted) had restrictive ventilatory pattern without bronchodilator response. In FOT, 4 patients had increased resistance at 5 Hz (R5), all patients presented low reactance (X5) values, and none presented a significant bronchodilator response. Chronic HP patients had reduced exercise performance with lower peak V?O2, diminished breathing reserve, hyperventilation, oxygen desaturation and augmented Borg dyspnea scores when compared with controls. The prevalence of DH was only found in 18% of patients. When comparing chronic HP patients with normal and low peak VO2 (< 84%predicted, LLN), the later exhibited higher hyperventilation (VE/VCO2 slope), lower tidal volumes, and poorer physical functioning scores on Short-form-36 health survey. ROC curve analysis showed that reduced lung volumes (FVC%, TLC% and DLCO%) were high predictors of poor exercise capacity. On CT, chronic HP is characterized by increased pulmonary densities (Hounsfield Units) inferring the extension of ground glass opacities and fibrosis when compared with healthy subjects. The extension of low attenuation areas (LAA) and AT in relation to the hole lung volume is low and does not correlate with PFT indexes of obstruction; however, patients with greater extension of these areas had less fibrosis and more preserved PFTs. CONCLUSIONS: Chronic HP was characterized by an imminently restrictive lung disorder, and not by airway obstruction, according to the different diagnostic methods applied in this study. Reduction of exercise capacity was prevalent due to ventilatory and gas exchange limitation, similarly to other fibrotic interstitial lung diseases, rather than due to DH. Reduced lung volumes were good predictors of ventilatory responses during exercise

Poor athletic performance of racehorses is a major and significant problem in the racing industry. Determining the definitive reason for poor-performance is however a real diagnostic challenge since many of the causative conditions are multifactorial and may only be manifested during exercise. A retrospective study, including various breeds of horses, confirmed musculoskeletal, cardiovascular and upper respiratory tract clinical problems to be the most frequently implicated in reducing athletic performance. Evaluation of the lower respiratory tract was though not performed in this study. The aim of the first part of this work were thus to determine the prevalence of different sub-clinical diseases in a population of poorly-performing Standardbred trotters, and to evaluate the sportive repercussions by comparing their physiological response to exercise with control horses. Fifty horses underwent thorough clinical and ancillary examinations, including haematological et biochemical evaluation, Doppler echocardiography, standardised exercise tests on treadmill et racetrack, treadmill video-endoscopy et collection of respiratory fluids. Most of the poorly-performing horses exhibited many concomitant diseases. The most frequently diagnosed sub-clinical problems involved the lower and upper respiratory tract. Poor-performers also exhibited higher values of blood lactate and heart rate, as well as lower values of haematological parameters and anti-oxidants, compared to control horses. Inflammatory airway disease being mostly present in poorly-performing horses, the second part of this work will mainly focus on this syndrome. The negative impact of inflammatory airway disease, as diagnosed by cytological evaluation of bronchoalveolar lavage fluid, has previously been described on respiratory function using either forced expiration or forced oscillations techniques. Sedation or bronchoprovocation were however usually required. On the other hand, the clinical significance of tracheal inflammation remains currently controversial. The aim was therefore to exhibit and define the respiratory dysfunctions present in horses subclinically suffering from inflammatory airway disease. Respiratory function was evaluated at rest by IOS in 34 Standardbred trotters, whereas tracheal mucus score, and both tracheal and bronchoalveolar lavages were performed 60 min post-exercise. According to the cytology of bronchoalveolar lavage fluid, the inflammatory group included 19 horses and 15 horses were used as control. A significant correlation was found between both cytological evaluations concerning neutrophil counts, whereas no association was found between tracheal mucus and any cytology. A significant increase of respiratory resistance at the lower frequencies (1 10 Hz) as well as a significant decrease of respiratory reactance beyond 5 Hz was observed in inflammatory compared to control horses. Both parameters were also significantly different between inspiration and expiration in the inflammatory group only. Both eosinophil and mast cell counts of the bronchoalveolar lavage fluid were significantly correlated with respectively respiratory resistance and reactance. The present work involved intensive clinical and functional evaluation of control and asymptomatic poorly-performing horses. The different studies allowed establishing the prevalence of medical subclinical diseases in these latter and evaluating its sportive impact considering the associated physiological responses to exercise. The presence of respiratory dysfunctions in horses with lower airway inflammation, the major trouble associated with disappointing performance, were also exhibited by impulse oscillometry./ La contre-performance est un problème majeur dans lindustrie des courses. En déterminer la cause exacte reste néanmoins un défi diagnostic puisque la plupart des affections présentes sont souvent subcliniques, multifactorielles et peuvent ne se manifester que pendant lexercice. Une étude rétrospective, incluant des chevaux de différentes races et disciplines, a ainsi confirmé les affections cliniques des voies respiratoires supérieures, musculo-squelettiques et cardiovasculaires comme étant les plus fréquemment impliquées dans la réduction des performances athlétiques. Cependant, lévaluation des voies respiratoires profondes navait pas été effectuée chez ces différents chevaux. Lobjectif de la première partie de ce travail était donc de déterminer la prévalence des différentes affections sub-cliniques induisant une contre-performance chez des Trotteurs Français, et den évaluer les répercussions sportives par la comparaison des réponses physiologiques à lexercice avec celle de chevaux contrôles. Cinquante chevaux ont respectivement été soumis à un examen clinique complet, une prise de sang pour analyse hémato-biochimique au repos et 60 minutes après chaque test deffort, une échocardiographie Doppler, des tests deffort standardisés sur piste et tapis roulant, une endoscopie à leffort, une évaluation locomotrice à grande vitesse, ainsi quun lavage trachéal et broncho-alvéolaire réalisés 60 minutes post-effort. La plupart des chevaux contre-performants ou intolérants à leffort présentaient plusieurs affections concomitantes. Les troubles sub-cliniques les plus fréquemment diagnostiqués concernaient respectivement les voies respiratoires profondes et supérieures. Ces chevaux présentaient par ailleurs des paramètres hématologiques (taux dhémoglobine et volume globulaire moyen) et anti-oxydants significativement inférieurs, et des paramètres pro-oxydants significativement supérieurs aux chevaux contrôles. De plus, les valeurs de fréquence cardiaque et lactatémie étaient, lors des différents tests deffort, significativement supérieures à celles des chevaux contrôles, Linflammation des voies respiratoires profondes étant majoritairement présente chez ces chevaux présentant des performances décevantes, la deuxième partie de ce travail se concentre plus spécifiquement sur ce syndrome. Limpact négatif sur la fonction respiratoire de cette affection, telle que diagnostiquée par lévaluation cytologique du liquide de lavage broncho-alvéolaire, a précédemment été décrite à laide de techniques dexpiration forcée ou doscillations forcées. Une sédation ou une bronchoprovocation étaient cependant généralement requises pour la réalisation de ces tests. Parallèlement, la signification clinique de linflammation trachéale reste actuellement controversée. Lobjectif était ainsi de mettre en évidence et définir les dysfonctions respiratoires présentes chez des chevaux souffrant sub-cliniquement de maladie inflammatoire des voies respiratoires. La fonction respiratoire a été évaluée au repos par oscillométrie à impulsions chez 34 Trotteurs Français asymptomatiques, alors que le score de mucus trachéal et les différents lavages ont été évalués 60 minutes post-effort. Sur base de la cytologie broncho-alvéolaire, le groupe inflammatoire comprenait 19 chevaux et 15 ont été utilisés comme contrôles. Une corrélation significative était observée entre les cytologies concernant le taux de neutrophiles, alors quaucune association nétait présente entre score de mucus trachéal et cytologies des différents lavages. Une augmentation significative de la résistance respiratoire aux faibles fréquences (1 à 10 Hz) et une diminution de la réactance respiratoire au-delà de 5Hz a été observée chez les chevaux inflammatoires comparativement aux contrôles. Ces deux paramètres étaient également significativement différents entre inspiration et expiration dans le groupe inflammatoire uniquement. La résistance et la réactance respiratoire étaient par ailleurs respectivement corrélées aux taux déosinophiles et de mastocytes du lavage broncho-alvéolaire. Ce travail comprenait une évaluation clinique et fonctionnelle intensive chez des chevaux contrôles et des chevaux contre-performants. Les études menées ont permis détablir la prévalence des affections médicales sub-cliniques chez ces derniers et den évaluer limpact sportif par lintermédiaire des réponses physiologiques à lexercice. La présence de dysfonctions respiratoires chez les chevaux avec inflammation des voies respiratoires profondes, premier trouble associé à des performances décevantes, a également pu être mise en évidence à laide de loscillométrie à impulsion.

Untersuchung zur Wirkung von intranasal verabreichtem Xylometazolin bei brachy- und normozephalen Hunden: Impuls-Oszillometrie und akustische Rhinometrie P. Franco, J. P. Hueber, G. U. Oechtering Klinik für Kleintiere, Arbeitsgruppe Brachyzephalie, Universität Leipzig Einleitung: Die zuchtbedingte Verkürzung des Gesichtsschädels brachy - zephaler Hunderassen hat zu einer Reihe klinisch relevanter morphologischer und physiologischer Veränderungen geführt. Hierzu zählen stenotische Naseneingänge, eine durch fehlgebildete Conchen obstruierte Nasenhöhle sowie ein verdicktes und verlängertes Gaumensegel. Diese Einengung der oberen Atemwege führt zu Atemnot und ausgeprägter Belastungsintoleranz, was als Brachyzephales Atemnotsyndrom (BAS) bezeichnet wird. Xylometazolin ist ein für den Menschen zugelassenes Alpha-Sympathomime - tikum. Topische und systemische Sympathomimetika werden beim Menschen zur Behandlung nasaler Kongestionen zum Abschwellen der Nasenschleimhaut eingesetzt. Zielstellung: Ausgehend von der Hypothese, dass Xylometazolin auch bei Hunden zu einem Abschwellen der Nasenschleimhaut führt und dass die Morphologie der Nasenmuscheln sich zwischen den zwei Zielgruppen unterscheidet, sollte der intranasale Strömungswiderstand bei brachy- und normozephalen Hunden vor und nach Xylometazolingabe mit Impuls- Oszillometrie untersucht werden. Zusätzlich wurden in der Beaglegruppe mit akustischer Rhinometrie das Nasenhöhlenvolumen und die minimale Querschnittsfläche bestimmt. Methodik: Die Messungen erfolgten nach dem Prinzip der Impuls-Oszillometrie (IOS) und akustischer Rhinometrie. In einer prospektiven klini - schen Studie wurden 10 brachyzephale Hunde (5 Möpse, 5 Französische Bulldoggen) und 6 Beagles untersucht. Bei den anästhesierten, spontan atmenden Tieren wurde der intranasale Strömungswiderstand mit Impuls- Oszillometrie unmittelbar vor und 30 Minuten nach intranasal verabreichtem Xylometazolin gemessen. Messungen mit akustischer Rhinometrie erfolgten zusätzlich vor und nach Xylometazolingabe. Bei allen Tieren wurden die oberen Atemwege endoskopisch und computertomographisch untersucht. Ergebnisse: Der aus drei Messungen gemittelte intranasale Strömungswiderstand bei Patienten mit BAS betrug vor Xylometazolingabe 0,87 ± 0,097 kPa/(L/s). Nach Xylometazolingabe reduzierte sich der intranasale Strömungswiderstand um etwa 48% auf 0,42 ± 0,55 kPa/(L/s). Vergleich - bare Ergebnisse ermittelten wir in der Beaglegruppe. Nach Xylometazolingabe ergab sich bei den Beagles eine Zunahme des Nasenvolumens und der minimalen Querschnittsfläche. Schlussfolgerungen: Wir konnten erstmals zeigen, dass Xylometazolin auch bei Hunden zum Abschwellen der Nasenschleimhaut führt und sich das Abschwellverhalten zwischen brachy- und normozephalen Hunden kaum voneinander unterscheidet. A13 Abstracts 18. Jahrestagung der DVG-FG InnLab © Schattauer 2010 Tierärztliche Praxis Kleintiere 1/2010

INTRODUÇÃO: A pneumonite de hipersensibilidade (PH) é uma doença intersticial causada pela inalação de antígenos orgânicos específicos ou substâncias de baixo peso molecular em indivíduos geneticamente suscetíveis. A PH crônica representa seu estágio final, na qual a exposição antigênica prolongada leva à fibrose. Na PH crônica, o envolvimento das pequenas vias aéreas (PVA) é proeminente; entretanto, uma avaliação detalhada através de métodos funcionais e de avaliação quantitativa e automatizada pela tomografia computadorizada (TC) não foi realizada previamente. MÉTODOS: estudo transversal de 28 pacientes com PH crônica, com avaliação através de provas de função pulmonar (PFPs); oscilometria forçada (FOT); análise automatizada do volume pulmonar através da TC, incluindo quantificação de aprisionamento aéreo; e teste cardiopulmonar de exercício (TCPE) incremental em cicloergômetro para avaliar performance ao exercício, incluindo medidas seriadas da capacidade inspiratória e hiperinsuflação dinâmica (HD). Foram incluídos pacientes entre 18 a 75 anos, com diagnóstico confirmado pela combinação de achados tomográficos, exposição antigênica e biópsia compatível e/ou LBA com linfocitose. Foram excluídos pacientes com CVF e/ou VEF1 < 30% predito, tabagismo > 20 anos-maço, uso de oxigênio suplementar; diagnóstico prévio de asma ou DPOC, diagnóstico de hipertensão arterial pulmonar ou impossibilidade de realizar TCPE. Os dados foram comparados com controles saudáveis. RESULTADOS: 28 pacientes (16 mulheres; idade média 56 +- 11 anos; CVF 57 +- 17% predito) foram avaliados, e todos apresentavam padrão ventilatório restritivo sem resposta broncodilatadora. Na FOT, 4 pacientes apresentaram resistência aumentada a 5 Hz (R5), enquanto todos apresentaram baixa reactância (X5), sendo que nenhum apresentou resposta broncodilatadora significativa. Pacientes com PH crônica tiveram menor capacidade de exercício com menor O2 de pico, diminuição da reserva ventilatória, hiperventilação, dessaturação de oxigênio e escores de dispneia (Borg) aumentados quando comparado aos controles. A prevalência de HD foi encontrada em apenas 18% da coorte. Ao comparar pacientes com PH crônica com O2 normal e baixo (< 84% predito, LIN), o último grupo apresentou maior hiperventilação (slope E/CO2), um menor volume corrente e menores escores de capacidade física na avaliação do questionário de qualidade de vida (SF-36). A análise da curva ROC mostrou que volumes pulmonares reduzidos (CVF%, CPT% e DLCO%) foram preditores de baixa capacidade ao exercício. Na TC, a PH crônica teve aumento de áreas com alta densidade em unidades Hounsfield, inferindo maior extensão de opacidades em vidro fosco e fibrose em relação aos controles saudáveis. A extensão das áreas de atenuação reduzida (AAR) e aprisionamento aéreo em relação ao volume pulmonar total é pequena, e não se correlaciona com índices funcionais obstrutivos; entretanto, pacientes com maior percentual dessas áreas apresentam menos fibrose e função pulmonar mais preservada. CONCLUSÃO: a PH crônica se caracterizou por um acometimento eminentemente restritivo, e não de obstrução de vias aéreas, nos diferentes métodos diagnósticos aplicados. A redução da capacidade de exercício foi prevalente devido à limitação ventilatória e de troca gasosa, a exemplo de outras doenças intersticiais pulmonares, e não pela HD. Redução dos volumes pulmonares foram bons preditores das respostas ventilatórias durante o exercício / INTRODUCTION: Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Chronic HP represents its final stage, in which prolonged antigenic exposure causes fibrosis. In chronic HP, small airway involvement is prominent; however, a detailed characterization through functional evaluation and through automatic quantitative evaluation of computed tomography (CT) has not been previously assessed. METHODS: Cross-sectional study with 28 chronic HP patients, with evaluation by pulmonary function tests (PFTs), forced oscillometry (FOT), automated lung volume analysis through CT, including quantification of air trapping (AT); and incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer to evaluate exercise performance, including serial measurements of inspiratory capacity to establish dynamic hyperinflation (DH). Inclusion criteria: patients aged 18 to 75 years, with a chronic HP diagnosis confirmed by the combination of CT findings, known antigenic exposure and compatible biopsy and / or BAL with lymphocytosis. Exclusion criteria: FVC and / or FEV1 < 30% predicted, smoking > 20 pack-years, supplemental oxygen use; previous diagnosis of asthma or COPD; pulmonary arterial hypertension, or medical conditions that could interfere with CPET. Data were compared with healthy controls. RESULTS: All patients (16 women; mean age 56 +- 11 years; FVC 57 +- 17% predicted) had restrictive ventilatory pattern without bronchodilator response. In FOT, 4 patients had increased resistance at 5 Hz (R5), all patients presented low reactance (X5) values, and none presented a significant bronchodilator response. Chronic HP patients had reduced exercise performance with lower peak V?O2, diminished breathing reserve, hyperventilation, oxygen desaturation and augmented Borg dyspnea scores when compared with controls. The prevalence of DH was only found in 18% of patients. When comparing chronic HP patients with normal and low peak VO2 (< 84%predicted, LLN), the later exhibited higher hyperventilation (VE/VCO2 slope), lower tidal volumes, and poorer physical functioning scores on Short-form-36 health survey. ROC curve analysis showed that reduced lung volumes (FVC%, TLC% and DLCO%) were high predictors of poor exercise capacity. On CT, chronic HP is characterized by increased pulmonary densities (Hounsfield Units) inferring the extension of ground glass opacities and fibrosis when compared with healthy subjects. The extension of low attenuation areas (LAA) and AT in relation to the hole lung volume is low and does not correlate with PFT indexes of obstruction; however, patients with greater extension of these areas had less fibrosis and more preserved PFTs. CONCLUSIONS: Chronic HP was characterized by an imminently restrictive lung disorder, and not by airway obstruction, according to the different diagnostic methods applied in this study. Reduction of exercise capacity was prevalent due to ventilatory and gas exchange limitation, similarly to other fibrotic interstitial lung diseases, rather than due to DH. Reduced lung volumes were good predictors of ventilatory responses during exercise