The purpose of this study was to compare power output and ventilatory measurements between the steep ramp test (SR) and both the 30-second Wingate anaerobic (WAT) and standard cardiopulmonary exercise tests (CPET) in chronic obstructive pulmonary disease (COPD). 11 patients (7 males and 4 females) underwent spirometry, a CPET, WAT and SR test. Repeated measures ANOVA was used to compare the differences between the peak work rate of the CPET (CPET_peak), SR (SR_peak), and the average power of the WAT (W_avg). The W_avg was higher than the SR_peak, which was higher than the CPET (231.2 ± 113.4, 156.8 ± 67.9, 65.9 ± 35.9, p>0.05 respectively). There were no differences found between the tests at end-exercise for inspiratory reserve volume (IRV), ventilation (V_E), and end-expiratory lung volume (EELV). Tidal volume (V_T) was also compared between the tests as a percentage of the inspiratory capacity (IC) remaining at end-exercise and no differences were found. The similarity between the ventilatory measures indicates a similar level of constraint, despite the large difference in work rates achieved, in all 3 tests. This shows that a standard CPET underestimates leg power in COPD patients, and the WAT and SR may be better indicators of leg muscle power and anaerobic type exercise.

The purpose of this study was to compare power output and ventilatory measurements between the steep ramp test (SR) and both the 30-second Wingate anaerobic (WAT) and standard cardiopulmonary exercise tests (CPET) in chronic obstructive pulmonary disease (COPD). 11 patients (7 males and 4 females) underwent spirometry, a CPET, WAT and SR test. Repeated measures ANOVA was used to compare the differences between the peak work rate of the CPET (CPET_peak), SR (SR_peak), and the average power of the WAT (W_avg). The W_avg was higher than the SR_peak, which was higher than the CPET (231.2 ± 113.4, 156.8 ± 67.9, 65.9 ± 35.9, p>0.05 respectively). There were no differences found between the tests at end-exercise for inspiratory reserve volume (IRV), ventilation (V_E), and end-expiratory lung volume (EELV). Tidal volume (V_T) was also compared between the tests as a percentage of the inspiratory capacity (IC) remaining at end-exercise and no differences were found. The similarity between the ventilatory measures indicates a similar level of constraint, despite the large difference in work rates achieved, in all 3 tests. This shows that a standard CPET underestimates leg power in COPD patients, and the WAT and SR may be better indicators of leg muscle power and anaerobic type exercise.

A doença pulmonar obstrutiva crônica (DPOC) é uma doença progressiva e, que interfere na qualidade de vida (QV) de seus portadores. Foi identificado na literatura internacional um instrumento específico para medir a QV de pacientes com DPOC, o Seattle Obstructive Lung Disease Questionnaire (SOLDQ). É um instrumento com 29 itens que abordam quatro domínios: a função física, a função emocional, a habilidade de “coping" e a satisfação com o tratamento. Para o processo de tradução e validação do instrumento, foi utilizado o modelo proposto por GUILLEMIN (1995), que consiste das seguintes fases: tradução inicial do instrumento original; a retrotradução; revisão por comitê de juízes, pré teste e validação transcultural realizado por meio de análise da consistência interna e validação discriminante. O SOLDQ foi aplicado a 47 pacientes portadores de DPOC, assistidos no Ambulatório de Clínica Médica do HU-USP e em 48 indivíduos referidos como “sadios". Os resultados obtidos por meio do coeficiente alfa de Cronbach, para a verificação da consistência interna em cada domínio foram: função física = 0,94; função emocional = 0,64; habilidade de “coping" = 0,63 , nesse domínio foi excluída uma questão do instrumento original e satisfação com o tratamento = 0,72. O teste “t" de Student mostrou que há diferença estatiscamente significante entre as médias dos domínios: função física; função emocional e habilidade de “coping" entre os dois grupos estudados, definindo sua função discriminante em pacientes portadores de DPOC. O instrumento final SOLDQ validado para o português constitui-se de seis questões e 28 itens. / The chronic obstructive pulmonary disease (COPD) is a progressive disease and interferes in the quality of life (QoL) of the patients with disease. There is in the international literature a specific instrument to measure the patients' QoL. with COPD, the Seattle Obstructive Lung Disease Questionnaire (SOLDQ). It is an instrument with 29 items that approaches four domains: the physical function, the emotional function, the coping skills and treatment satisfaction. The model proposed by GUILLEMIN was used (1995) for the translation process and validation of the instrument. That consists of the following phases: translation of the original instrument, the back-translation, committee review, pre-testing and cross-cultural validity accomplished by means of analysis of the consistency interns and its validation discriminate. SOLDQ was applied to two different groups: 47 patient with COPD, attended in the out-standing patients of internal medicine of University Hospital, University of Sao Paulo and to 48 individuals referred as “healthy." The results obtained by means of the coefficient alpha of Cronbach, for the verification of the consistency intern in each domain were: physical function  = 0,94; emotional function = 0,64; coping skills = 0,63. In the domain coping skills were excluded one question of the original instrument and treatment satisfaction = 0,72. The test “t" of Student showed that there is a significant statistical difference in the averages of the domains: physical function, emotional function and coping skills between the two studied groups, defining its function discriminate in patients with COPD. The final instrument SOLDQ validity for the Portuguese idiomatic was of questions and 28 items.

Lėtinė obstrukcinė plaučių liga pasireiškia nevisiškai išnykstančia kvėpavimo takų obstrukcija, kuri įprastai progresuoja ir sutrikdo kvėpavimo takų pralaidumą bei dujų apykaitą plaučiuose ir audiniuose. Pasaulinės sveikatos organizacijos (PSO) duomenimis lėtine obstrukcine plaučių liga serga apie 600 mln. žmonių. Lietuvoje statistikos duomenimis 2012 metais sirgo apie 60 tūkstančių žmonių. Šie skaičiai verčia jieškoti lėtinės obstrukcinės plaučių ligos problemų sprendimo būdų. Vienas iš tokių būdų yra plaučių ligomis sergančiųjų reabilitacija. Moksliniais tyrimais įrodyta, kad efektyviausia reabilitacija yra tuomet , kai ji pradedama iš karto po ligos paūmėjimo. Garsų mankšta mažina bronchų reaktyvumą ir bronchospazmą, aktyvūs kvėpavimo pratimai stiprina kvėpavimo raumenis, gerina atsikosėjimą, stiprina kvėpavimo raumenis bei skatina širdies ir kraujagyslių veiklą, o tuo pačiu ir plaučių kraujotaką. Tyrimo tikslas : Įvertinti skirtingų kineziterapijos metodų efektyvumą gydant sergančiuosius lėtine obstrukcine plaučių liga ūmiu ligos laikotarpiu. Uždaviniai : 1. Išanalizuoti tiriamųjų rizikos veiksnius, būdingus lėtinei obstrukcinei plaučių ligai. 2. Įvertinti tiriamųjų dusulio laipsnį. 3. Nustatyti tiriamųjų plaučių ventiliacijos rodiklius, kraujo spaudimo bei krūtinės ląstos ekskursiją prieš ir po kineziterapijos. 4. Palyginti tiriamųjų, kuriems buvo taikyta garsų mankšta ir tiriamųjų, kuriems buvo taikyti aktyvūs kvėpavimo pratimai, visus... [toliau žr. visą tekstą] / The chronic obstructive lung disease is characterized by presence of airways obstruction which, as a rule, would be progressing and disturbing airflow passing and gas exchange in lungs and tissues. According to the World Health Organisation (WHO) data approximately 600 million people suffer from chronic obstructive lung disease. The Lithuanian statistic data show that in 2012 about 60 thousand Lithuanian residents had this disease. The above figures make us look for solutions to the problems created by chronic obstructive lung disease. One of the ways is rehabilitation of patients with lung diseases. The scientific research proved that the rehabilitation was most efficient when commenced immediately following exacerbation of the disease. Speech-language exercises reduce bronchi reactivity and bronchospasm, active breathing exercises strengthen the breathing muscles, improve expectoration, strengthen breathing muscles and stimulate better heart and blood vessels performance at the same time resulting in better blood circulation in lungs. Goal of the study: to assess the effectiveness of different physiotherapy methods in treatment of chronic obstructive lung disease in the acute stage. Objectives: 1. to analyse the risk factors in patients under study typical of the chronic obstructive lung disease; 2. to evaluate the degree of dyspnoea in patients under study; 3. to establish lung ventilation, blood pressure and thorax excursion values in patients... [to full text]

A doença pulmonar obstrutiva crônica (DPOC) é uma doença progressiva e, que interfere na qualidade de vida (QV) de seus portadores. Foi identificado na literatura internacional um instrumento específico para medir a QV de pacientes com DPOC, o Seattle Obstructive Lung Disease Questionnaire (SOLDQ). É um instrumento com 29 itens que abordam quatro domínios: a função física, a função emocional, a habilidade de “coping” e a satisfação com o tratamento. Para o processo de tradução e validação do instrumento, foi utilizado o modelo proposto por GUILLEMIN (1995), que consiste das seguintes fases: tradução inicial do instrumento original; a retrotradução; revisão por comitê de juízes, pré teste e validação transcultural realizado por meio de análise da consistência interna e validação discriminante. O SOLDQ foi aplicado a 47 pacientes portadores de DPOC, assistidos no Ambulatório de Clínica Médica do HU-USP e em 48 indivíduos referidos como “sadios”. Os resultados obtidos por meio do coeficiente alfa de Cronbach, para a verificação da consistência interna em cada domínio foram: função física = 0,94; função emocional = 0,64; habilidade de “coping” = 0,63 , nesse domínio foi excluída uma questão do instrumento original e satisfação com o tratamento = 0,72. O teste “t” de Student mostrou que há diferença estatiscamente significante entre as médias dos domínios: função física; função emocional e habilidade de “coping” entre os dois grupos estudados, definindo sua função discriminante em pacientes portadores de DPOC. O instrumento final SOLDQ validado para o português constitui-se de seis questões e 28 itens. / The chronic obstructive pulmonary disease (COPD) is a progressive disease and interferes in the quality of life (QoL) of the patients with disease. There is in the international literature a specific instrument to measure the patients' QoL. with COPD, the Seattle Obstructive Lung Disease Questionnaire (SOLDQ). It is an instrument with 29 items that approaches four domains: the physical function, the emotional function, the coping skills and treatment satisfaction. The model proposed by GUILLEMIN was used (1995) for the translation process and validation of the instrument. That consists of the following phases: translation of the original instrument, the back-translation, committee review, pre-testing and cross-cultural validity accomplished by means of analysis of the consistency interns and its validation discriminate. SOLDQ was applied to two different groups: 47 patient with COPD, attended in the out-standing patients of internal medicine of University Hospital, University of Sao Paulo and to 48 individuals referred as “healthy.” The results obtained by means of the coefficient alpha of Cronbach, for the verification of the consistency intern in each domain were: physical function  = 0,94; emotional function = 0,64; coping skills = 0,63. In the domain coping skills were excluded one question of the original instrument and treatment satisfaction = 0,72. The test “t” of Student showed that there is a significant statistical difference in the averages of the domains: physical function, emotional function and coping skills between the two studied groups, defining its function discriminate in patients with COPD. The final instrument SOLDQ validity for the Portuguese idiomatic was of questions and 28 items.

Class of 2016 Abstract / Objectives: To assess the relationship between adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for the management of chronic obstructive pulmonary disease (COPD) exacerbations and the corresponding 30-day, all-cause readmissions rate in a community hospital. Methods: A retrospective chart review was conducted on patients admitted with the primary diagnosis of a COPD exacerbation. Medications administration records relevant to the GOLD guidelines were examined as separate independent variables in relation to a readmission within 30 days of discharge. Additional factors examined included: demographic data, resident of a long-term care facility, pre-index hospitalization, pulmonary consult, vaccines, length of stay (LOS), discharge medications, and follow-up appointments. Results: Electronic health records of 120 patients were reviewed and divided into non-readmitted patients (n = 65, mean age 73.4 ± 10.1 years), all-cause readmissions (n = 55, mean age 70.15 ± 9.69 years), and COPD-related readmissions (n = 21, mean age 70.7 ± 11.1 years). Patients with heart failure (p = 0.024), a LOS >5 days (p = 0.045), a pre-index hospitalization (p = 0.001), or who were long-term care residents (p = 0.024) experienced more all-cause readmissions. Females experienced less all-cause readmissions (p = 0.035). Significantly more patients with a pre-index hospitalization had a COPD-related readmission (p = 0.027). Lastly, adherence to the GOLD treatment parameters was not significantly different across all groups. Conclusions: COPD is a complex disease and adherence to the GOLD guidelines during an exacerbation is unlikely to significantly impact 30-day readmission rates.

<p>The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; <em>the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others </em>and <em>to lose one´s identity.</em></p>

The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others and to lose one´s identity.

Introdução: O teste de apneia respiratória tem sido testado e demonstrou ser de utilidade clínica. Objetivos: Determinar o tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVO) e em indivíduos normais e correlacionar os tempos de apneia com os testes de função pulmonar. Métodos: Foi realizado um estudo caso-controle incluindo pacientes com DVO (casos) e um grupo controle, composto por voluntários com espirometria normal, recrutados no Hospital de Clínicas de Porto Alegre (HCPA). A espirometria foi realizada com espirômetro computadorizado e o teste de apneia respiratória utilizando-se um sistema eletrônico microprocessado e um pneumotacógrafo ((Hans Rudolph ® – Kansas OH, EUA)– Kansas OH, EUA) como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil e os tempos máximos de apneia voluntária inspiratória e expiratória (TAVIM e TAVEM) foram determinados a partir do sinal adquirido. Resultados: Um total de 35 pacientes com DVO (casos) e 16 controles foram incluídos no estudo. O TAVIM foi significativamente menor nos casos (22,3 ± 11,8 s) do que no grupo controle (31,5 ± 15,7 s) com p = 0,025. O TAVEM também foi significativamente menor nos casos (16,9 ± 6,6 s) do que no grupo controle (22,1 ± 7,9 s) com p = 0,017. Foram encontradas correlações positivas moderadas entre TAVIM e CVF (r = 0,476, p = 0,004) e entre TAVIM e VEF1 (r = 0,383, p = 0,023). Conclusões: As medidas de TAVIM e TAVEM foram significativamente menores nos casos do que nos controles, e o TAVIM teve correlação moderada com a CVF e VEF1. Estes resultados fornecem uma evidência adicional da utilidade clínica do tempo de apneia como teste de função pulmonar. / Introduction: Breath-holding test has been tested in some clinical scenarios and has proved to be of clinical utility. Objectives: To determine the maximum voluntary breath-holding time in patients with obstructive ventilator defects and in normal subjects and to correlate the breathholding times with pulmonary function tests. Methods: We conducted a case-control study including patients with obstructive ventilator defects and a control group consisted of volunteers recruited in the same hospital, with normal spirometry. Spirometry was performed using a computerized spirometer. The Breath-holding test was conducted using an electronic microprocessor and a (Hans Rudolph ® – Kansas OH, EUA)pneumotachograph and flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal voluntary apnea inspiratory and expiratory times (MVAIT and MVAET) were determined from the acquired signal. Results: A total of 35 patients with obstructive ventilatory defects and 16 controls met the inclusion criteria and were included in the analysis. The MVAIT was lower in cases (22.3 ± 11.8 seconds) than in controls (31.5 ± 15.7 seconds) (p=0.025). MVAET was also lower in cases than in controls (16.9 ± 6.6 vs. 22.1 ± 7.9; p=0.017). We found positive and significant correlations between MVAIT and FVC (L) (r=0.476; p=0.004) and between MVAIT and FEV1 (L) (r=0.383; p=0.023). Conclusions: MVAIT and MVAET were significant lower in patients with obstructive ventilatory defects than in controls, and that MVAIT was correlated positively with FVC and FEV1 in cases. Our results provide additional evidence of usefulness of MVAIT as a pulmonary function test.

Introdução: O teste de apneia respiratória tem sido testado e demonstrou ser de utilidade clínica. Objetivos: Determinar o tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVO) e em indivíduos normais e correlacionar os tempos de apneia com os testes de função pulmonar. Métodos: Foi realizado um estudo caso-controle incluindo pacientes com DVO (casos) e um grupo controle, composto por voluntários com espirometria normal, recrutados no Hospital de Clínicas de Porto Alegre (HCPA). A espirometria foi realizada com espirômetro computadorizado e o teste de apneia respiratória utilizando-se um sistema eletrônico microprocessado e um pneumotacógrafo ((Hans Rudolph ® – Kansas OH, EUA)– Kansas OH, EUA) como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil e os tempos máximos de apneia voluntária inspiratória e expiratória (TAVIM e TAVEM) foram determinados a partir do sinal adquirido. Resultados: Um total de 35 pacientes com DVO (casos) e 16 controles foram incluídos no estudo. O TAVIM foi significativamente menor nos casos (22,3 ± 11,8 s) do que no grupo controle (31,5 ± 15,7 s) com p = 0,025. O TAVEM também foi significativamente menor nos casos (16,9 ± 6,6 s) do que no grupo controle (22,1 ± 7,9 s) com p = 0,017. Foram encontradas correlações positivas moderadas entre TAVIM e CVF (r = 0,476, p = 0,004) e entre TAVIM e VEF1 (r = 0,383, p = 0,023). Conclusões: As medidas de TAVIM e TAVEM foram significativamente menores nos casos do que nos controles, e o TAVIM teve correlação moderada com a CVF e VEF1. Estes resultados fornecem uma evidência adicional da utilidade clínica do tempo de apneia como teste de função pulmonar. / Introduction: Breath-holding test has been tested in some clinical scenarios and has proved to be of clinical utility. Objectives: To determine the maximum voluntary breath-holding time in patients with obstructive ventilator defects and in normal subjects and to correlate the breathholding times with pulmonary function tests. Methods: We conducted a case-control study including patients with obstructive ventilator defects and a control group consisted of volunteers recruited in the same hospital, with normal spirometry. Spirometry was performed using a computerized spirometer. The Breath-holding test was conducted using an electronic microprocessor and a (Hans Rudolph ® – Kansas OH, EUA)pneumotachograph and flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal voluntary apnea inspiratory and expiratory times (MVAIT and MVAET) were determined from the acquired signal. Results: A total of 35 patients with obstructive ventilatory defects and 16 controls met the inclusion criteria and were included in the analysis. The MVAIT was lower in cases (22.3 ± 11.8 seconds) than in controls (31.5 ± 15.7 seconds) (p=0.025). MVAET was also lower in cases than in controls (16.9 ± 6.6 vs. 22.1 ± 7.9; p=0.017). We found positive and significant correlations between MVAIT and FVC (L) (r=0.476; p=0.004) and between MVAIT and FEV1 (L) (r=0.383; p=0.023). Conclusions: MVAIT and MVAET were significant lower in patients with obstructive ventilatory defects than in controls, and that MVAIT was correlated positively with FVC and FEV1 in cases. Our results provide additional evidence of usefulness of MVAIT as a pulmonary function test.