Title The effect of airway clearance techniques on patients with Chronic Obstructive Pulmonary Disease. Objective The main purpose of this study is to expose and evaluate the efficacy of airway clearance techniques on patients with Chronic Obstructive Pulmonary Disease by using pulmonary functions and Quality of Life measurements from recent studies. Methodology This thesis is literature review. The selected studies were according to inclusion and exclusion criteria. The selections of recent studies were published from the year of 2000 until 2017 in English language. The following research databases were selected to identify the relevant topic: PubMed, MEDLINE, Embase, Cochrane, PEDro, and CINAHL. The parameters' results from the articles have been also selected by evaluation the statistical differences according to the P-values. Results Twenty-three articles out of 117 have been found according to inclusion criteria, exclusion criteria, and outcome measures. The techniques were active cycle of breathing technique (ACBT), positive expiratory pressure (PEP), temporary of positive expiratory pressure (T-PEP), Oscillating positive expiratory pressure (O-PEP), high-frequency chest wall oscillation (HFCWO), slow expiration with glottis opened in lateral posture (ELTGOL), postural drainage, and autogenic...

Made available in DSpace on 2016-06-02T20:19:05Z (GMT). No. of bitstreams: 1 1354.pdf: 1194159 bytes, checksum: f55e476028028c44693b4da86ac5109f (MD5) Previous issue date: 2007-02-26 / Universidade Federal de Sao Carlos / The changes on the heart rate sympathetic-vagal balance caused to chronic obstructive pulmonary disease or chronic heart failure, as well as, the hemodynamics change induced by the non-invasive ventilation were unclear. In this context, we proposed to develop two studies. The first study was titled by The heart rate autonomic control in chronic obstructive pulmonary disease and chronic heart failure patients on the rest and during the respiratory sinusal arrhythmia maneuver . The purpose of this study was to evaluate the heart rate (HR) autonomic modulation in chronic obstructive pulmonary disease (COPD) patients as well as chronic heart failure (CHF) patients on the rest as well as during the respiratory sinus arrhythmia maneuver (M-RSA); and to correlation the HR autonomic modulation and seriousness levels of both pathologies. Twenty-seven male volunteers were subdivided in three groups: ten presented COPD (69±9 years); seven presented CHF (62±8 years) and; ten were healthy with 64±5 year-old (control). When resting, the three groups electrocardiography signal was obtained in three conditions: 1) lying position for 15 min; 2) lying position during the M-RSA for 4 min; and 3) sitting position for 15 min. The data was analyzed by the time (RMSSD and SDNN indexes) and the frequency domain, in total power, low frequency, high frequency absolute (ab) and normalized (nu) units and LF/HF ratio. Regarding the M-RSA indexes, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (∆IE) were calculated. The main results showed that the CHF and the COPD patients presented lower E/I ratio values (0,03±0,01 vs 0,09±0,04 e 0,04±0,02 vs 0,09±0,04) and ∆I/E values (0,67±0,13 vs 1,09±0,13 e 0,81±0,20 vs 1,09±0,13), when compared to control group. Strong correlations were observed between the forced expiratory volume in the first second (FEV1) and the RMSSD (r=-0,73) and between the FEV1 and the BF absolute (r=-0,71) in the COPD patients. At same, strong correlations were observed between the ejecting fraction and the RMSSD (r=0,83) in CHF patients. Concluding, the results of this study suggest that both, the COPD and the CHF patients, presented parasympathetic activity reduction and there is a relation between the seriousness levels of both pathologies and the HR autonomic activity. The second study was titled to The acute effects of the continuous positive airway pressure (CPAP) in the heart rate autonomic control of chronic obstructive pulmonary disease and chronic heart failure patients . The purpose of this study was to evaluate the acute continuous positive pressure airway over the heart rate (HR) autonomic control and the respiratory variables behavior in COPD as well as CHF patients. Twenty-eight male volunteers were sub-divided in three groups: ten presented COPD (69±9 years); eight presented CHF (62±8 years) and; ten were healthy with 64±5 year-old (control). The electrocardiography signal was obtained for 10 min in the sitting position with spontaneous breath (SB) and following randomly conditions: CPAP Sham, CPAP 5, and CPAP 10 cmH2O. Additionally, the breath rate, the endtidal of carbon dioxide, and the peripheral oxygen saturation were obtained. The HR and it variability data were analyzed by the time and the frequency domain, in according with previous describe. The main results showed that the ETCO2 reduced in all groups during the CPAP application. COPD group were significantly lower values of the RMSSD index in the Sham (1.06), CPAP 5 (1.08), and CPAP 10 (1,01) than SB (1,22). In addition, they presented increased in the LFnu (1.60 vs 1.82) and decreased in the HFab (1.90 vs 1.55) from the SB to CPAP 10. The CHF group RMSSD index and TP increased to SB (1.31 and 2.62) to CPAP 5 (1.44 and 2.87) and the CPAP 10 (1.48 and 2.97), respectively. Concluding, the CPAP caused modification in the HR autonomic control and improvement in the alveolar ventilation of COPD, CHF patients and healthy individuals. / As modificações do balanço simpato-vagal da freqüência cardíaca (FC) provocadas com o curso da doença pulmonar obstrutiva crônica (DPOC) e da insuficiência cardíaca crônica (ICC), bem como, as que ocorrem em função dos ajustes hemodinâmicos induzidos pela aplicação da ventilação não invasiva são bastante contraditórias. Neste contexto, propusemos o desenvolvimento de dois estudos que poderiam contribuir com novas informações. O primeiro intitulado por Controle autonômico da freqüência cardíaca de pacientes com doença pulmonar obstrutiva crônica ou insuficiência cardíaca crônica em repouso e durante a manobra de acentuação arritmia sinusal respiratória teve por objetivos avaliar o controle autonômico da FC de pacientes com DPOC ou ICC em repouso e durante uma manobra de acentuação da arritmia sinusal respiratória (M-ASR), bem como, relacionar a atividade autonômica da FC com a gravidade das patologias. Vinte e sete voluntários do sexo masculino foram subdivididos em três grupos: 10 com DPOC (GD) e 69±9 anos; 7 com ICC (GI) e 62±8 anos; e 10 saudáveis (GC) com 64±5 anos. Em repouso, o sinal eletrocardiográfico foi obtido em três situações: 1) 15 min na posição supina; 2) 4 min durante M-ASR na posição supina; e 3) 15 min na posição sentada. Os dados foram analisados no domínio do tempo (índices RMSSD e SDNN) e da freqüência, pela densidade espectral total (DET), bandas de baixa (BF) e alta freqüências (AF) - absolutas (ab) e normalizadas (un), e a razão BF/AF. Durante M-ASR foram calculadas a razão expiração/inspiração (E/I) e a diferença inspiração/expiração (∆IE). Os principais resultados em logaritmos decimais (média±desvio-padrão) mostraram que os pacientes com ICC e DPOC apresentaram menor razão E/I (0,03±0,01 vs 0,09±0,04 e 0,04±0,02 vs 0,09±0,04) e ∆IE (0,67±0,13 vs 1,09±0,13 e 0,81±0,20 vs 1,09±0,13), respectivamente, comparados ao GC durante a M-ASR. Correlações fortes foram observadas entre volume expiratório forçado no primeiro segundo com o RMSSD (r=-0,73) e com a BF absoluta (r=-0,71) nos pacientes com DPOC; e entre fração de ejeção e o RMSSD (r=0,83) nos pacientes com ICC. Em conclusão, os resultados sugerem que tanto a DPOC como a ICC levam a redução da atividade parassimpática e que a gravidade de ambas está relacionada com o controle autonômico da FC. O segundo estudo com o titulo: Efeitos da aplicação aguda da pressão positiva continua nas vias aéreas sobre o controle autonômico da freqüência cardíaca de pacientes com doença pulmonar obstrutiva crônica ou insuficiência cardíaca crônica , objetivou avaliar o efeito agudo da pressão positiva continua nas vias aéreas (CPAP) sobre o controle autonômico da freqüência cardíaca (FC) e o comportamento de variáveis respiratórias de pacientes com DPOC ou ICC. 28 homens foram subdivididos em três grupos: 10 com DPOC (GD) e 69±9 anos; 8 com ICC (GI) e 62±8 anos; e 10 saudáveis (GC) com 64±5 anos. O sinal eletrocardiográfico foi obtido por 10 min na posição sentada com respiração espontânea (RE) e randomicamente nas condições: CPAP sham, CPAP 5 e CPAP 10 cmH2O. Adicionalmente, foram obtidos os valores da freqüência respiratória, o volume de dióxido de carbono no final da expiração (ETCO2) e a saturação periférica de oxigênio. A FC e sua variabilidade foram analisadas no domínio do tempo e da freqüência, conforme descrito anteriormente. Os principais resultados mostraram que o ETCO2 reduziu em todos os grupos durante a aplicação da CPAP. O GD apresentou menores valores do RMSSD durante a CPAP sham (1,06), 5 (1,08) e 10 (1,01) em comparação a RE (1,22), bem como, aumento da BFun (1,60 vs 1,82) e redução da AFab (1,90 vs 1,55) da RE para a CPAP 10. No GI, o SDNN e a DET aumentaram da condição de RE (1,31 e 2,62) para CPAP 5 (1,44 e 2,87) e 10 (1.48 e 2,97), respectivamente. Os resultados sugerem que a CPAP melhorou a ventilação alveolar e provocou atenuação da atividade simpática sobre a FC de pacientes com ICC, bem como redução do tônus vagal de pacientes com DPOC.

Avaliamos as mudanças no padrão respiratório, movimento toracoabdominal e ventilação em portadores de DPOC e indivíduos sadios. Estudou-se 45 indivíduos entre 45 e 75 anos conforme o VEF1. Utilizou-se sistemas de pletismografia respiratória por indutância, análise metabólica de gases em posição semi-sentada ao repouso e radiografia de tórax para a mobilidade diafragmática. Os grupos DPOC apresentaram redução do TI, TTOT, aumento do VC/TI, f, VE, das relações VEM/VC, VE/VO2, VE/VCO2 e diminuição da SpO2. Redução da mobilidade do diafragma e aumento da VEM/VC associaram-se à ineficiência da ventilação e a alterações no modelo ventilatório utilizado, sem alterações no movimento toracoabdominal. / We assessed changes in breathing patterns, thoracoabdominal movement and ventilation in COPD sufferers and healthy individuals. Forty-five individuals between 45 and 75 were grouped by FEV1. Inductive plethysmographic equipment, respiratory metabolism measuring (with subject at rest in semi-recumbent position), and radiographic measurement of diaphragm mobility were used. The COPD groups presented reduction in TI and TTOT and increased VT/TI, f, VE, and VD/VT, VE/VO2, VE/VCO2 and decreased SpO2. Reduction in diaphragm mobility and increase of VEM/VC were associated with ventilatory inefficiency and alterations in the ventilatory model used. No alterations in thoracoabdominal movement

INTRODUÇÃO: Pacientes com doença pulmonar obstrutiva crônica (DPOC) tem atividade física reduzida. Barreiras que limitam a atividade física e a medida objetiva da limitação ainda são pouco estudadas nesta população. Conhece-las permite um planejamento adequado para incremento da atividade de vida diária (AVD). OBJETIVO: Comparar a AVD de portadores de DPOC e controles com um sensor de movimento, identificar barreiras que impedem a AVD e correlaciona-los à gravidade da dispneia, ao teste de caminhada de 6 minutos (TC6) e um escore de limitação da AVD. MÉTODOS: O número de passos, a distância percorrida em quilômetros e o tempo de caminhada foram registrados por um acelerômetro de bolso e um pedômetro durante 7 dias consecutivos. Um questionário de barreiras percebidas e a escala AVD (LCADL) foram utilizados para qualificar fatores que impedem a AVD. A dispneia foi medida por duas escalas distintas e a capacidade física submáxima pelo TC6. RESULTADOS: Foram avaliados 40 sujeitos com DPOC e 40 controles saudáveis. Os pacientes com DPOC realizaram tempo menor de caminhada (68,5 ± 25,8 minutos/dia vs. 105,2 ± 49,4; p < 0,001), menor distância (3,9 ± 1,9 km/dia vs. 6,4 ± 3,2; p < 0,001) e menor número de passos/dia. A falta de estrutura, influência social e falta de vontade foram as principais barreiras referidas para realização de AVD. O TC6 correlacionou-se com os resultados do acelerômetro, mas o LCADL não. CONCLUSÃO: Portadores de DPOC são menos ativos quando comparados a adultos saudáveis. Sedentarismo e as barreiras para atividade física tem implicação imediata na prática clínica indicando medidas de intervenção precoce / INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) have reduced physical activity. Barriers that limit physical activity and objective measures of limitation are poorly studied in this population. The knowledge of them allows a proper planning for increased physical activity. OBJECTIVES: To compare ADLs in COPD patients and controls using a motion sensor, identify perceived barriers that prevent AVD and correlate them to the severity of dyspnea, to the 6-minute walk test (6MWT) and a score of AVD limitation. METHODS: An pocket accelerometer and a pedometer recorded the number of steps, distance in Km and walking time for seven consecutive days. A survey of perceived barriers and the ADL scale (LCADL) were used to describe factors that prevent AVD. Dyspnea was measured by two different scales and submaximal exercise capacity by 6MWT. RESULTS: 40 subjects with COPD and 40 healthy controls were evaluated. Patients with COPD performed less time walking (68.5 ± 25.8 minutes / day vs. 105.2 ± 49.4; p < 0.001), shorter distance (3.9 ± 1.9 km / day vs. 6.4 ± 3.2; p < 0.001) and a smaller number of steps/day. The lack of infrastructure, social influences and unwillingness were the main barriers to performing ADLs. The 6MWT correlated with the results of the accelerometer, but not LCADL. CONCLUSION: Patients with COPD are less active compared to healthy adults. Sedentary and barriers to physical activity has immediate implications in clinical practice indicating early intervention measures

Pacientes portadores de doença pulmonar obstrutiva crônica (DPOC) podem apresentar assincronia toracoabdominal (ATA). Existem diversos métodos de estimativa da ATA, porém, não há um consenso sobre qual é o mais adequado. O objetivo deste estudo foi comparar dois métodos de estimativa da assincronia toracoabdominal e avaliar a ineficiência ventilatória em pacientes DPOC no repouso e durante o exercício. Foram avaliados 22 pacientes com DPOC (VEF1 40,2±10,5% predito) e 13 indivíduos controle (GC) pareados por idade, gênero e índice de massa corpórea. A cinemática toracoabdominal foi avaliada utilizando pletismografia optoeletrônica no repouso e durante o exercício leve e moderado (70% da carga máxima) no ciclo ergômetro. A ATA foi calculada entre a caixa torácica superior (CTS) e inferior (CTI) e o abdome (ABD) utilizando os métodos de ângulo de fase (AF) e relação de fase (RF). A ineficiência ventilatória foi calculada em cada compartimento como a diferença entre o volume máximo (VM) e o volume calculado (VC) de acordo com o ciclo respiratório (determinado pela soma de volume dos três compartimentos) dividida pelo volume máximo (VM-VC)/VM. Os pacientes com DPOC foram classificados como assíncronos (grupo AT) ou não assíncronos (grupo NA) utilizando como referência os valores do GC. Foi utilizado o teste qui-quadrado ou de Fisher para avaliar a discriminação de pacientes entre os métodos e o ANOVA de dois fatores para comparações entre os grupos. O nível de significância foi ajustado para 5%. O método AF determinou maior número de pacientes com ATA quando comparado com RF no repouso (respectivamente, 15 vs. 7) e no exercício leve (11 vs. 3) e moderado (14 vs. 8). Os valores de assincronia no grupo AT entre CTS-CTI e CTI-ABD foram maiores no repouso (AF: 35,7±45,4° e -42,2±42,5° e RF: 61,8±29,1° e -66,9±27,4°, respectivamente) e no exercício leve (AF: 53,3±35,6° e -55,8±40,4°; RF: 106,1±40,3° e - 124,8±17,2°) e moderado (AF: 61,6±55,1° e -75,9±44,8°; RF: 85,9±23,6° e -81,8±42,2°) quando comparados com os grupos NA (p < 0,05) e GC (p < 0,05). Na análise entre CTSABD não houve diferença entre os grupos. Observou-se que o grupo AT apresentou menor contribuição e maior ineficiência ventilatória da CTI em todos os momentos de avaliação e, durante o exercício moderado, menor volume corrente quando comparado com os grupos NA e GC. Os nossos resultados sugerem que o ângulo de fase apresenta maior detecção de ATA nos pacientes com DPOC. A presença de assincronia parece ocorrer principalmente na caixa torácica inferior e associada com menor contribuição e maior ineficiência ventilatória deste compartimento / Chronic obstructive pulmonary disease (COPD) patients can present thoracoabdominal asynchrony (TAA). There are several TAA estimation techniques, however, there is no consensus about which is the most appropriate. The aim of this study was to compare two thoracoabdominal asynchrony quantification techniques and to assess chest wall ventilatory inefficiency in COPD patients at rest and during exercise. We evaluated 22 COPD patients (FEV1 40,2±10,5% predicted) and 13 healthy controls (CG) matched by age, gender and body mass index. Thoracoabdominal kinematics was assessed via optoelectronic plethysmography at rest and during mild and moderate exercise (70 % maximum workload) in a cycle ergometer. TAA was calculated among upper (URC) and lower ribcage (LRC) and abdomen (ABD) by using the phase angle (PA) and phase relation (PR) approaches. Ventilatory Inefficiency was estimated in each compartment as the difference between the maximal volume (VM) and the volume (VC) calculated according to respiratory timing (sum of volume in the 3 compartments) divided by the maximal volume (VM-VC)/VM. COPD patients were classified as asynchronous (AT group) or not (NA group) by using as reference the values on the controls. Chi-square or Fisher\'s exact test was used for assessing the patients differentiation between the two TAA quantification approaches and two-way ANOVA was used to compare respiratory parameters among groups (CG, AT and NA). Statistical significance was set at 5% level. PA approach determined more patients as asynchronous when compared to RF at rest (respectively, 15 vs. 7) and during mild (11 vs. 3) and moderate (14 vs. 8) exercise. Asynchrony values in AT group among URC-LRC and LRC-ABD were greater at rest (respectively, 35.7±45.4° and -42.2±42.5° with PA and 61.8±29.1° and -66.9±27.4° with PR) and during mild (PA: 53.3±35.6° and -55.8±40.4°; PR: 106.1±40.3° and -124.8±17.2°) and moderate exercise (PA: 61.6±55.1° and - 75.9±44.8°; PR: 85.9±23.6° and -81.8±42.2°) when compared to NA (p < 0.05) and CG (p < 0.05). Analysis among URC-ABD presented no difference between groups. It was observed that AT group presented a smaller LRC contribution and greater ventilatory inefficiency during all assessing moments and, during moderate exercise, had a lower tidal volume when compared to NA and CG. Our results suggest that phase angle approach presents larger TAA detection in COPD patients. This asynchrony seems to occur mainly in the lower ribcage and be associated with decreased contribution and increased ventilatory inefficiency of this compartment

<p dir="ltr">People suffering from COPD are also known to suffer from other musculoskeletal issues like fracture risk, back pain, etc. Intervertebral disc degeneration (IVD) is a prominent cause of back pain and inflammation, influenced by factors such as aging, sudden loading, and genetics. <i>SERPINA1</i>, a common genetic variant in individuals with chronic obstructive pulmonary disease (COPD), encodes the alpha-antitrypsin protein (AAT). AAT deficiency is also associated with IVD degeneration, bone loss, and gait impairment. Currently, AAT-deficient individuals receive costly and short-lived weekly AAT injections, with no established guidelines for managing IVD degeneration and osteoporosis. Our primary research objective was to examine the effects of <i>serpinA1a/c</i> using a mouse model with global knockout (KO) of <i>serpinA1a/c</i>, generated through CRISPR technology, on intervertebral discs (IVD) and bone. We found that global deletion of <i>serpinA1a/c</i> was found to cause IVD elastin degradation, leading to a loss of mechanical properties. Moreover, <i>serpinA1</i> was associated with increased bone-resorbing cells (osteoclasts) and a reduction in bone-forming cells (osteoblasts). Notably, sexual dimorphism was observed, with female IVDs exhibiting less degeneration than male counterparts, and <i>serpinA1a/c</i> KO mice were protected from mechanically-induced tail compression. Even in human IVDs, males expressed more AAT-1 compared to female IVDs. There are no FDA-approved drugs currently existing for IVD degeneration. Since IVD degeneration frequently occurs in individuals with osteoporosis, it shows a probable cross-talk happening between IVD and bone. In our study, we found the association of <i>serpinA1 </i>with estrogen receptor alpha and osteoclasts. Hence, we investigated the potential of raloxifene, an FDA-approved selective estrogen receptor modulator (SERM) typically prescribed to post-menopausal women for osteoporosis treatment, in averting IVD degeneration and improving mechanical characteristics in IVD. Our findings suggest that raloxifene injection may retard IVD degeneration induced by AAT deficiency, particularly in male mice. Furthermore, the latter study touched upon a conditional <i>serpinA1a</i> mouse model crossed with aggrecan-cre, specifically targeting <i>serpinA1a</i>-expressing cells in the IVD while sparing bone. Conditional <i>serpinA1a</i> deletion induced mild IVD degeneration without affecting bone loss. In summary, this study serves as a foundation for testing potential treatments for AAT patients with IVD degeneration and osteoporosis. It also provides compelling evidence for considering raloxifene as a treatment option for IVD degeneration in AAT-deficient patients experiencing IVD-related pain.</p>