Introdução: A asma relacionada ao trabalho é a doença respiratória ocupacional mais comum e engloba a asma ocupacional e a asma agravada pelo trabalho. No Brasil, a legislação (NR7) determina que exames espirométricos sejam realizados periodicamente para os trabalhadores expostos a aerodispersóides. Essa determinação teria, entre seus propósitos, o de detectar doenças respiratórias, incluindo asma, mais precocemente e reduzir o risco ao trabalhador. No entanto, a capacidade dessa rotina em detectar a asma precocemente necessita de confirmação. O objetivo do estudo foi analisar a ocorrência de sintomas nos trabalhadores expostos à aerodispersóides que apresentam espirometria normal. Assim, conheceremos as possibilidades de haver doença respiratória nesses casos. O estudo foi desenvolvido com 180 trabalhadores da cidade de Franca que apresentam exposição à aerodispersóides e que tinham espirometria normal; foi aplicado um questionário testado e validado para sintomas respiratórios e relação desses sintomas com o ambiente de trabalho. Resultados: Os sintomas foram detectados em 48 (26,7%) dos trabalhadores. Algum sintoma, incluindo sintoma nasal e prurido ocular, foi detectado em 26,7% da amostra de trabalhadores com espirometria normal. Dentre os sintomas compatíveis com asma, falta de ar estava presente em 8,3% da amostra; tosse, em 7,7% da amostra e sibilos em 3,3%. O tempo médio de exposição de 67 meses e idade média de 37 anos todos com espirometria normal. Conclusão: O presente estudo permitiu identificar os sintomas respiratórios apresentados pelos trabalhadores expostos a aerodispersóides, tipo e tempo de exposição, dados esses que podem contribuir para o melhor planejamento das ações de prevenção de doenças respiratórias ocupacionais. É possível haver doença respiratória, inclusive asma, em trabalhadores com espirometria normal, o que sugere que um questionário de sintomas poderia melhorar a capacidade de detectar doença respiratória ocupacional nos trabalhadores expostos. / Introduction: Work-related asthma is the most common occupational respiratory disease and includes both occupational asthma and asthma aggravated by work. In Brazil, the legislation (NR7) determines that spirometry exams be performed on a regular basis for workers exposed to aerodispersoids. Among other purposes, this determination aims at the early detection of respiratory diseases, including asthma, in order to reduce the risks to workers. However, the effectiveness of this routine in the early detection of asthma needs to be confirmed. The objective of this study was to analyze the occurrence of symptoms in workers exposed to aerodispersoids presenting normal spirometry. This will evidence the possibilities of presence of respiratory disease in these cases. The study was developed with 180 workers from the city of Franca, presenting exposure to aerodispersoids and who had normal spirometry values; a questionnaire tested and validated in previous studies was applied in order to obtain data on respiratory symptoms and the relationship of these symptoms to the work environment. Results: The symptoms were detected in 48 (26.7%) workers. A symptom, including nasal symptom and ocular pruritus, was detected in 26.7% of the sample of workers with normal spirometry values. Among the symptoms compatible with asthma, dyspnea was present in 8.3% of the sample; cough in 7.7% of the sample, and respiratory sounds in 3.3%. The mean time of exposure was 67 months and the mean age was 37 years, all with normal spirometry values. Conclusion: The present study allowed to identify the respiratory symptoms presented by workers exposed to aerodispersoids, and type and time of exposure, which can contribute for a better planning of preventive actions for respiratory diseases. It is possible to find respiratory diseases, including asthma, in workers with normal spirometry values, which suggests that a questionnaire of symptoms could improve the ability to detect occupational respiratory diseases in exposed workers.

Les maladies neuromusculaires, sont susceptibles d’évoluer vers un syndrome restrictif. La faiblesse des muscles respiratoires ainsi que les déformations rachidiennes et thoraciques associées font entrer les patients dans un cercle vicieux qui aggrave progressivement le syndrome restrictif et mène les patients vers l’insuffisance respiratoire. À cette insuffisance respiratoire peuvent se rajouter d’autres facteurs comme la réduction chronique des mouvements de la cage thoracique, les perturbations du sommeil, le dysfonctionnement bulbaire et l’inefficacité de la toux. En conséquence, la dysfonction du système respiratoire peut être d’origine multiple et impose une évaluation précise et ciblée sur la compréhension des mécanismes physiopathologiques pour chaque maladie non seulement pour proposer pour chacune un traitement adapté mais également pour apprécier les nouvelles thérapeutiques ciblées sur la réparation musculaire en émergence pour certaines pathologies neuromusculaires. Il parait donc nécessaire de mieux connaitre l’évolution de certaines pathologies, avec et sans les traitements classiques, et d’améliorer la compréhension des mécanismes physiopathologiques de l’insuffisance respiratoire en combinant les outils classiques d’évaluation de la fonction respiratoire avec des nouvelles techniques d’évaluation qui pourraient être complémentaires.Cette thèse a, par conséquent, pour objectif de renforcer les connaissances sur les dysfonctions respiratoires de certaines pathologies neuromusculaires en utilisant des outils classiques d’évaluation et de proposer nouvelles méthodes d’exploration de la fonction respiratoire des patients neuromusculaires. Ainsi, nous avons exploité les données de deux filières de patients neuromusculaires suivies régulièrement : la Dystrophie Facioscapulohumérale (DFSH) et la Dystrophie Musculaire de Duchenne de Boulogne (DDB). L’analyse de la DFSH nous paraissait importante car l’insuffisance respiratoire est très peu connue et décrite dans cette pathologie. Si, au contraire, l’évolution de la DDB est bien connue, l’effet de la ventilation noninvasive (VNI) sur l’évolution de la fonction respiratoire a été, en revanche, très peu décrit alors que de nouveaux essais thérapeutiques vont bientôt être proposés à ces patients, dont certains sont déjà sous VNI. Ensuite, pour mieux prédire le degré d’amélioration du syndrome restrictif qu’une thérapeutique de réparation musculaire pourrait potentiellement apporter, nous avons développé une mesure des volumes pulmonaires à l’aide d’une assistance des muscles inspiratoire et/ou expiratoire. Nous avons aussi développé et validé une méthode non-invasive et non-volitionnelle de mesure indirecte de la force du diaphragme, de manière à obtenir des résultats indépendants de la motivation du patient, à partir d’un examen indolore pour le patient.De ce fait, cette thèse a pu faire progresser les connaissances sur l’évolution de la fonction respiratoire de certaines pathologies neuromusculaires grâce à l’analyse des mesures classiques de la fonction respiratoire. Elle a aussi validé des nouvelles mesures d’explorations fonctionnelles indépendantes de la force volontaire du patient. / Neuromuscular disorders are liable to induce a restrictive syndrome. The weakness of respiratory muscles andthe associated spinal deformities lead the patients into a vicious circle, which progressively worsens the restrictivesyndrome and evolves into respiratory failure. This respiratory failure may be associated to additional factors such aschronic reduction of thoracic cage motion, sleep disordered breathing, bulbar dysfunction and ineffective cough. Therefore,dysfunction of respiratory system may have multiples origins and requires precise evaluations targeted on thecomprehension of the physiopathologic mechanisms for each disease, as they may not only allow to adapt specificallytreatment, but also to assess the new therapeutics targeted for muscle restoration that are emerging for some neuromusculardiseases. Accordingly, it is essential to acquire knowledge about the specific evolution of the different disorder, with andwithout classic treatments, and also to improve the understanding of the physiopathologic mechanisms of respiratoryfailure, combining the classic evaluation tools of respiratory function with new evaluation techniques which could provideadditional information.This thesis aims to increase the knowledge of respiratory dysfunction of some neuromuscular disorders using classicevaluation tools and also to propose new exploration methods of respiratory function for neuromuscular patients.Thus, we explored data of two specific neuromuscular disorders patients, regularly followed: FacioscapulohumeralMuscular Dystrophy (FSHD) and Duchenne Muscular Dystrophy (DMD). The analysis of FSHD seemed important asrespiratory failure is not well known and described for this disease. On the other hand, while the evolution of DMD is wellknown, the impact of noninvasive ventilation (NIV) on the evolution of respiratory function has been poorly described,whereas new therapeutic trials will be soon proposed to these patients, some of which are already under NIV.Next, to better predict the improvement of the restrictive syndrome that could be potentially obtained with muscle repairtherapies, we developed a measure of pulmonary volumes, using assistance for inspiratory and/or expiratory muscles.We also developed and validated a painless, noninvasive, non-volitional and indirect method of measurement of thediaphragmatic force, in order to obtain results independent of patients’ motivation.Hence, this thesis was able to advance knowledge of the evolution of respiratory function of some neuromuscular diseases,using traditional evaluation tools of respiratory function. Moreover, it validated new pulmonary function measuresindependent of patient’s voluntary efforts.

Background: Body mass index (BMI) is the primary accepted method to determine nutrition status in children with cystic fibrosis (CF); however, lean body mass (LBM) is more strongly associated with pulmonary function. Handgrip strength (HGS) measures muscle function and is reflective of LBM. The aims of this study were to assess if there was a relationship among HGS, nutrition status, and pulmonary function, to assess if HGS changed after hospitalization, and to assess if there was a relationship between HGS and nutrient intake. Methods: Twenty-three children with CF ages 6-18 years participated. BMI z-scores, nutrition risk scores, and pulmonary function were assessed about five months before, day 5-7 of, and about six weeks after hospitalization. HGS z-scores and arm anthropometrics were measured during and after hospitalization. Nutrient intakes were assessed during hospitalization. Results: Mean dominant HGS z-score was -1.95 ± 0.92 at hospitalization and -1.59 ± 1.06 at follow-up (p=0.007). Mean BMI z-score was -0.09 ± 0.64 at hospitalization and 0.06 ± 0.54 at follow-up (p=0.178). No significant relationship was found between HGS z-scores and BMI z-scores (p=0.892) or HGS z-scores and pulmonary function (p=0.340). Conclusions: HGS z-scores were lower than the standard even though mean BMI z-scores classified participants as normal nutrition status. Further research should be done utilizing a larger sample size in order to better examine HGS's potential as a nutrition assessment tool in this population.

Problém: Obstrukce dýchacích cest a průtoková limitace, způsobená chronickou obstrukční plicní nemocí (CHOPN) nebo astma bronchiale (AB), může způsobit změny tvaru, pozice a pohybů bránice v důsledku zvýšení plicních objemů. Hypotézy: U pacientů s obstrukčním respiračním onemocněním se bude funkce bránice lišit oproti kontrolní skupině zdravých jedinců, což se projeví na jejím postavení a rozsahu pohybu. Existuje vztah mezi plicními funkcemi a polohou a pohyby bránice. Cíl: Cílem práce bylo zjistit, zda pozice, tvar a pohyby bránice u ležících pacientů s průtokovou limitací během maximálních dechových a posturálních manévrů se liší od tvaru, pozice a pohybů bránice za stejné situace u jedinců bez patologie respiračního systému. Zkoumali jsme rozdíly mezi pacienty s CHOPN, pacienty s AB a zdravými jedinci. Cílem bylo také stanovit tyto vztahy v kontextu vážnosti průtokové limitace, resp. obstrukce dechových cest. Metodika: Soubor tvořily 3 skupiny probandů, celkem 31 dospělých: 10 jedinců s klinicky stabilním AB (5 žen a 5 můžů), 11 jedinců s klinicky stabilním, středně těžkým CHOPN (7 mužu a 4 ženy) a kontrolní skupinu tvořilo 10 zdravých jedinců (5 mužů a 5 žen). Všichni probandi podstoupili komplexní měření plicních funkcí a kardiopulmonální zátežové vyšetření. Bránici jsme vyšetřovali pomocí...

http://olabout.wiley.com/WileyCDA/Section/id-820227.html / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19590号 / 医博第4097号 / 新制||医||1014(附属図書館) / 32626 / 京都大学大学院医学研究科医学専攻 / (主査)教授 山田 亮, 教授 清水 章, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Problém: Obstrukce dýchacích cest a průtoková limitace, způsobená chronickou obstrukční plicní nemocí (CHOPN) nebo astma bronchiale (AB), může způsobit změny tvaru, pozice a pohybů bránice v důsledku zvýšení plicních objemů. Hypotézy: U pacientů s obstrukčním respiračním onemocněním se bude funkce bránice lišit oproti kontrolní skupině zdravých jedinců, což se projeví na jejím postavení a rozsahu pohybu. Existuje vztah mezi plicními funkcemi a polohou a pohyby bránice. Cíl: Cílem práce bylo zjistit, zda pozice, tvar a pohyby bránice u ležících pacientů s průtokovou limitací během maximálních dechových a posturálních manévrů se liší od tvaru, pozice a pohybů bránice za stejné situace u jedinců bez patologie respiračního systému. Zkoumali jsme rozdíly mezi pacienty s CHOPN, pacienty s AB a zdravými jedinci. Cílem bylo také stanovit tyto vztahy v kontextu vážnosti průtokové limitace, resp. obstrukce dechových cest. Metodika: Soubor tvořily 3 skupiny probandů, celkem 31 dospělých: 10 jedinců s klinicky stabilním AB (5 žen a 5 můžů), 11 jedinců s klinicky stabilním, středně těžkým CHOPN (7 mužu a 4 ženy) a kontrolní skupinu tvořilo 10 zdravých jedinců (5 mužů a 5 žen). Všichni probandi podstoupili komplexní měření plicních funkcí a kardiopulmonální zátežové vyšetření. Bránici jsme vyšetřovali pomocí...

Pulmonary function testing (PFT) is recommended by guidelines for the diagnosis of chronic obstructive pulmonary disease and the diagnosis and monitoring of asthma. Portable in-office tests offer rural patients and providers information previously more difficult to obtain because of hospital closures, transportation barriers, and cost. This article describes the successful implementation and measurement of in-office PFT in 3 rural primary care offices. Providers were more likely to order a PFT for patients with asthma (33%) than a patient with chronic obstructive pulmonary disease (9.7%). Recommendations include increased staff involvement and repeat education midimplementation.

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