Maximal Expiratory Pressure Values Research Articles

Respiratory changes in Parkinson's disease may be unrelated to dopaminergic dysfunction

To investigate the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in patients with Parkinson's disease (PD) during the on and off periods of levodopa and to compare with healthy controls. Twenty-six patients were analyzed with Hoehn and Yahr scores (2-3) and 26 age and gender matched-controls. Statistical analysis was performed with Student's t-test for paired and independent samples. MIP and MEP values in patients were significantly lower than the values obtained in controls both for off and on stages -excepted for MIP in women (p=0.28). For patients with PD, the studied parameters did not differ between stages on and off, with the exception of MEP in women (p=0.00). Patients with PD have respiratory pressure lower than controls, even in early stages of the disease, and dopamine replacement has little impact over these respiratory pressures. These findings suggest that respiratory changes in PD may be unrelated to dopaminergic dysfunction.

Assessment of the Respiratory Muscles Function in Chronic Obstructive Pulmonary Disease patients

Chronic Obstructive Pulmonary Disease (COPD) is a public health problem worldwide. It is a polygenic disease and a classical example of gene-environment interaction. Of the many inhalational exposures that may be encountered over a lifetime, only tobacco smoke and occupational dusts and chemicals (vapors, irritants, and fumes) are known to cause COPD on their own. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) may be impaired in patients with COPD. Aim of the study: to assess respiratory muscle function in male COPD patients by measuring MIP and MEP values and to identify possible correlation between MIP and MEP and the anthropometric parameters as well as degree of airflow obstruction among COPD patients. Subjects and methods: A case-control study was carried out on 50 COPD male patients and 50 of age and sex matched healthy subjects as a control group. All participants were subjected to assessment of respiratory muscle (RM) strength by MIP and MEP, pulmonary function tests {flow/volume spirometry, and MVV}, as well as the functional exercise capacity (6MWT) and the anthropometric measurements. Results: the values of MIP and MEP in COPD cases were lower than those of the control group with a statistically significant difference. In COPD cases the MIP and MEP were positively correlated with VC%, FEV1\FVC, FEV1%, FVC%, PEF%, MVV%, and 6MWD (p<0.00). Furthermore, COPD patients were subdivided according to the presence of respiratory muscle (RM) affection into two subgroups: Group A (patients with RM affection) and Group B (patients without RM affection). There was a significant difference between the two subgroups concerning smoking index , disease duration, VC% , FVC% ,FEV1\FVC, FEV1%, PEF%, MVV%, and 6MWD (P< 0.05). Conclusion: RM is affected in patients with COPD. Measurement of MIP and MEP indicates the state of RM which is related to smoking index, disease duration, and spirometric-indices (VC%, FVC%, FEV1\FVC, FEV1%, PEF%, and MVV %). Recommendation: Health care workers involved in the diagnosis and management of COPD patients especially those with severe airflow obstruction should consider the possibility of RM deterioration and should have an access to RM function assessment.

Avaliação da frequência cardíaca à medida de pressão expiratória máxima estática e à manobra de Valsalva em jovens saudáveis

The measure of the maximal expiratory pressure (MEP) has some contraindications, as it is believed that the responses obtained in this measure are similar to the Valsalva maneuver (VM). The main purpose of this study was to evaluate the heart rate responses (HR) during the MEP and the VM measures in healthy young men into different postures aiming to identify whether and in which situation the MEP reproduces the responses obtained in the VM. Additionally we aim to estimate the workload realized during the maneuvers. Twelve healthy young men were evaluated, instructed and familiarized with the maneuvers. The VM was characterized by an expiratory effort (40 mmHg) against a manometer for 15 seconds. The MEP measure has been performed according to the American Thoracic Society. Both measures were performed at sitting and supine positions. ANOVA two-way with Holm-Sidak post-hoc test (p<0.05) was used to analyse the heart rate variation (∆HR); Valsalva index (VI); MEP index (MEPI), and the estimated workload of the maneuvers (Wtotal, Wisotime, Wtotal/∆HRtotal and Wisotime/∆HRisotime ). The ∆HR during the maneuvers was not influenced by the supine and sitting positions. However, the ∆HR during the VM and VI were higher (supine: 47±9 bpm, 2.3±0.2; sitting: 41±10 bpm, 2.0±0.2, respectively) than ∆HR during the MEP and MEPI values (supine: 23±8 bpm, 1.5±0.2; sitting 24±8 bpm, 1.6±0.3, respectively) (p<0.001). The estimated workload of the maneuvers was statistically different (p<0.001) between the maneuvers, except to Wtotal/∆HR. In the studied conditions the MEP does not reproduces the HR response observed in the VM in healthy young men.

Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus

BackgroundFlexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures.MethodsOne hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated.ResultsSignificant decreases in both MIP and MEP values were observed following FB (p < 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups.ConclusionsIt was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.

Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus

Background: Flexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures. Methods: One hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated. Results: Significant decreases in both MIP and MEP values were observed following FB (p &lt; 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups. Conclusions: It was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.

Normal Values of the Maximal Respiratory Pressures in Healthy People Older than 20 Years Old in the City of Manizales – Colombia

The Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) are global measures of the maximal strength of the respiratory muscles. To determine the values of MIP and MEP in healthy subjects aged 20 years old from the urban area of Manizales, Colombia and to correlate them with sociodemographic and anthropometric variables. This is an observational descriptive study. The population of the study was 203,965 healthy people from Manizales, a Colombian city located at 2,150 meters above sea level. The sample size was 308 subjects, selected using simple random sampling. The maximal respiratory pressures were determined in the sample chosen and were then considered according to the variables of age, gender, size, weight, Body Mass Index (BMI), and BMI classification. Finally a predictive model was created. The average MIP value among the subjects of the study was 75±27 cmH20 and the MEP value was 96.4±36 cmH20. Both averages were higher in men than in women. Predictive equations were established for the normal values of MIP and MEP in healthy subjects; the best model for MIP was the resultant one among age, gender and BMI classification and for the MEP among gender, weight and height. Maximal respiratory pressure values were lower among the population of Manizales than those found in international studies. Gender and anthropometric characteristics (weight, height and BMI classification) are the explanatory variables that better support the average values of MIP and MEP in the predictive models proposed.

Predicted preoperative maximal static respiratory pressures in adult cardiac surgeries: evaluation of two formulas

Cardiac surgery (CC) determines systemic and pulmonary changes that require special care. Awareness of the importance of respiratory muscle dysfunction in the development of respiratory failure motivated several studies conducted in healthy subjects to assess muscle strength. These studies were carried out by evaluating the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) values. This study examined the concordance among the values predicted by the equations proposed by Black & Hyatt and Neder, and the measured values in cardiac surgery (CS) patients. Data were collected from preoperative evaluation forms. The Lin coefficient and Bland-Altman plots were used for statistical concordance analysis. The multiple linear regression and analysis of variance (ANOVA) were used to produce new formulas. There were weak correlations of 0.22 and 0.19 in the MIP analysis and of 0.10 and 0.32 in the MEP analysis, for the formulas of Black & Hyatt and Neder, respectively. The ANOVA for both MIP and MEP were significant (P <0.0001), and the following formulas were developed: MIP = 88.82 - (0.51 x age) + (19.86 x gender), and MEP = 91.36 - (0.30 x age) + (29.92 x gender). The Black and Hyatt and Neder formulas predict highly discrepant values of MIP and MEP and should not be used to identify muscle weakness in CS patients.

Ansiedade e parâmetros funcionais respiratórios de idosos praticantes de dança

INTRODUÇÃO: A ansiedade é um diagnóstico comum encontrado em idosos e se associa comumente a anormalidades respiratórias. Ligado ao envelhecimento, encontra-se também o sedentarismo, o qual é um importante fator de risco para diversas patologias. A prática de atividade física regular melhora a ansiedade e a condição cardiorrespiratória. Entre os tipos de atividades físicas, a dança destaca-se como uma boa opção para os idosos. OBJETIVO: Descrever os parâmetros respiratórios de idosas praticantes de dança quando comparadas com idosas sedentárias e a influência da prática regular de dança sobre a ansiedade. MATERIAIS E MÉTODOS: Foram avaliadas 18 idosas, divididas em dois grupos: praticantes de dança (grupo G1) e sedentárias (grupo G2). Nos grupos G1e G2, foram aplicados o inventário de ansiedade traço-estado IDATE, a cirtometria, a espirometria e a manovacuometria, além de ser utilizado o questionário de Baecke modificado para idosos, apenas para o grupo G2, a fim de garantir o sedentarismo dos participantes. Foi realizada a estatística descritiva para sintetizar os dados. RESULTADOS: As participantes do grupo G1 apresentaram valores superiores em relação à ansiedade-estado e à pressão expiratória máxima. A cirtometria em nível basal foi maior nas participantes do grupo G1, enquanto em nível xifoide foi maior nas idosas do grupo G2. Todas as participantes obtiveram valores de espirometria dentro da normalidade, sem diferenças entre os grupos. CONCLUSÃO: Observaram-se nas idosas que praticam dança de forma regular menor nível de ansiedade-traço, valores adequados de pressão expiratória máxima e maior valor na cirtometria em nível basal.

Equações preditivas e valores de normalidade para pressões respiratórias máximas na infância e adolescência

OBJETIVO: Pesquisar equações preditivas e valores de normalidade para pressões respiratórias máximas disponíveis na literatura para a faixa etária compreendida entre a infância e a adolescência. FONTES DE DADOS: Estudos publicados em inglês e em português no período entre 1980 e 2009. As bases de dados eletrônicas Lilacs e Medline foram consultadas utilizando-se as palavras-chave "capacidade respiratória máxima", "músculos respiratórios", "valores de referência", "adolescente" e "criança". SÍNTESE DOS DADOS: Foram incluídos oito artigos na revisão, totalizando 1.463 crianças e adolescentes avaliados. A faixa etária da população estudada variou de sete a 18 anos. Geralmente o indivíduo é avaliado na posição sentada e com um clipe nasal. Os esforços máximos são realizados a partir do volume residual e da capacidade pulmonar total e sustentados por um a três segundos. Valores de normalidade e equações de predição foram propostos em oito e dois estudos, respectivamente. Nestes, demonstra-se incremento nas pressões respiratórias máximas desde a infância à adolescência e a ocorrência de maiores valores de pressão expiratória máxima quando comparados à pressão inspiratória máxima em crianças e adolescentes de ambos os sexos. CONCLUSÕES: As pressões respiratórias máximas constituem um meio efetivo para avaliar a força muscular respiratória e diversos fatores contribuem para a grande variedade de equações preditivas e de valores de normalidade disponíveis. É preciso buscar um consenso para normatizar os métodos requeridos ao avaliar a força muscular respiratória em crianças e adolescentes.

Validation of a protocol to evaluate maximal expiratory pressure using a pressure transducer and a signal conditioner

The respiratory muscles can present fatigue and even chronic inability to generate force. So, reliable devices are necessary to their evaluation. The aim of this study is to evaluate the MEP (Maximal Expiratory Pressure) values of individuals between 20 and 25 years old and to validate a protocol using a pressure transducer and a signal conditioner comparing it with the digital manometer. We evaluated the MEP of 10 participants. They remained seated and made six respiratory maneuvers from Total Lung Capacity (TLC) to Residual Volume (RV). The results in the study showed no statistically significant differences when compared to values reported in the literature, and that the pressure transducer provides reliable values for MEP.

An evaluation of diaphragmatic movements in hemiplegic patients

The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p<0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.

Comparison of Surface Electromyography in Respiratory Muscles of Healthy and Liver Disease Patients: Preliminary Studies

Introduction Surface electromyography (SEMG) is described as a technique to detect voluntary muscle activity. In the respiratory muscles, diaphragm and the rectus abdominis—are especially important for respiratory compliance. Objective We sought to study the activity of muscles using SEMG of the right diaphragm and the right rectus abdominis in healthy subjects versus liver disease patients (LDS). Method Each group of 30 male patients underwent SEMG with electrodes attached to the dermis surface at the xiphoid and below the right costal margin (channel 1). For the rectus abdominis, we placed the electrodes on the right 5 cm below the umbilicus. The variables studied were: root mean square (RMS), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). We also evaluated age, weight, body mass index, smoking history lifestyle sedentary preexistent chronic lung disease. Nonparametric tests were used for statistical analysis. Results There were significant differences ( P > 0001) between the groups regarding MEP and MIP values showing low pressures in the LDS group. RMS of the rectus abdominis showed a trend ( P = .059) toward compliance in the LDS group. Compared with the healthy subjects, there were 18% versus 5% sedentary individuals; only 10% versus 27.3% were smokers or former smokers and chronic lung disease was present in 2% versus 4%. Conclusion The respiratory muscle evaluation using SEMG detected decreased respiratory muscle strength and a trend to rectus abdominis compliance among LDS.

Influência de diferentes tipos de bocais e diâmetros de traqueias na manovacuometria

OBJETIVO: Este estudo teve como objetivo comparar a força muscular respiratória (FMR) obtida por meio de manovacuômetros analógicos, utilizando diferentes tipos de bocais e traqueias. METODOLOGIA: Foram avaliados 50 voluntários sedentários ou insuficientemente ativos saudáveis (25 homens e 25 mulheres), com média de idade de 25 ± 5 anos, média de altura de 167 ± 8 cm e média de peso de 65 ± 12 kg, pertencentes à comunidade de São Carlos, SP, e região. Para a avaliação da FMR foram realizadas as medidas de pressão inspiratória máxima (PI MÁX) e pressão expiratória máxima (PE MÁX) de acordo com o método preconizado por Black e Hyatt (1969). Os voluntários foram submetidos à anamnese e exame físico, e, posteriormente, as pressões respiratórias máximas foram medidas com os indivíduos em posição ortostática, utilizando-se dois manovacuômetros analógicos com limite operacional de ± 300 cmH2O, com uso de clipe nasal, um bocal circular e um retangular, com traqueias de mesmo comprimento e diâmetros internos diferentes, sendo estes de 1 cm e 1,5 cm. RESULTADOS: Observou-se que não houve diferenças significativas (Teste de Wilcoxon: p &lt; 0,05) entre os diâmetros das traqueias, e que os valores obtidos da PE MÁX com o bocal retangular foram significativamente maiores em ambos os sexos. CONCLUSÃO: Os resultados deste estudo mostram que não houve interferência dos diâmetros das traqueias nos valores obtidos de PE MÁX e PI MÁX, no entanto, os tipos de bocais utilizados no manovacuômetro analógico interferem nos valores obtidos de PE MÁX. O formato mais anatômico do bocal retangular colaborou para a obtenção de maiores valores de PE MÁX.

Expiratory Muscle Training in Spinal Cord Injury: A Randomized Controlled Trial

Roth EJ, Stenson KW, Powley S, Oken J, Primack S, Nussbaum SB, Berkowitz M. Expiratory muscle training in spinal cord injury: a randomized controlled trial. Objective To assess the effectiveness of expiratory muscle training on the pulmonary function of spinal cord injured patients. Design Randomized controlled trial. Setting Acute inpatient rehabilitation hospital. Participants Patients (N=29, 22 men and 7 women) with recent traumatic, motor complete, spinal cord injury (SCI) at or above level T1 consecutively admitted to an SCI rehabilitation service. Subjects were randomized to either resistance training (n=16) or sham training (n=13). Interventions The subjects completed either sham training or expiratory muscle resistive training with maximal expiratory force using a small handheld device, which is a tube with an aperture at the distal end, for 10 repetitions twice a day 5 days a week for a total of 6 weeks. Main Outcome Measures Pulmonary function tests were measured before and after the training program and included forced vital capacity (FVC); forced expiratory volume in 1 second (FEV1); maximum expiratory pressure (MEP), which is often referred to as forced expiratory pressure; maximum inspiratory pressure (MIP), which is often referred to as negative inspiratory force; inspiratory capacity (IC); expiratory reserve volume (ERV); total lung capacity (TLC); functional residual capacity (FRC); and residual volume (RV). Results FVC, FEV1, and ERV improved in both groups. Although exit values of MEP were improved in both groups compared with entry values, this increase was statistically significant only in the resistance training group. No significant improvements occurred in IC, TLC, FRC, or RV from entry to exit. MIP improved in both groups, but this increase was statistically significant only in the resistance training group. There was also a significant between-group difference in MEP exit values (98cmH 2O for the resistance training group and 59cmH 2O for the sham training group, t=3.45, P=.002). Multivariate analyses failed to reveal significant effects of treatment for any of the pulmonary function tests. Conclusions The resistance training group had significantly greater exit MEP values than the sham training group in univariate analysis only. However, improvements in pulmonary function were noted in both the resistance training and sham training groups. Although multivariate analysis failed to reveal a significant difference between groups, these findings offer some indication that expiratory training may benefit people with SCI.

Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central São Paulo State

To evaluate respiratory muscle strength (RMS) in a sample composed exclusively of healthy sedentary individuals and to compare with predicted values, to investigate the relationship between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and age, weight and height, and propose predictive equations of MIP and MEP for this population.Subjects were 140 healthy and sedentary individuals: 70 males (55+/-20 years) and 70 females (54+/-21 years), separated into groups according to age. The RMS was obtained with an aneroid vacuum manometer (+/-300 cmH2O).There was a significant reduction in RMS with increasing age (ANOVA one-way, p<0.05). Moreover, the RMS values decreased significantly from age 40 compared to the predicted values (Student t test, p<0.05). There were also significant correlations of RMS with age, weight and height (Pearson correlation, p<0.05). The predictive equations using linear regression for maximal respiratory pressures according to sex showed that age in males and females and weight in females influenced the prediction of the MIP and MEP values.Our results showed that age and anthropometric characteristics influence RMS values. In addition, the RMS values were lower compared to the predicted values from age 40 because the sample was composed exclusively of sedentary individuals. In this context, we propose equations to predict the MIP and MEP values exclusively for healthy, sedentary individuals from 20 to 89 years of age.

The Effect(s) of a Six-Week Home-Based Exercise Program on the Respiratory Muscle and Functional Status in Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Involvement of costovertebral and costotransverse joints results in rigidity of the chest wall and inability to expand the chest fully on inspiration. Also significant reduction in exercise capacity in the AS patients was reported. To determine the effects of a 6-week home-based exercise program on the respiratory muscle and energy cost in AS. Twenty-two AS patients were included. Chest expansion, tragus-wall distance, modified Schober test, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking distance, physiologic cost index and functional status Bath Ankylosing Spondylitis Functional Index of patients were measured at baseline and repeated at the end of an open 6-week home-based exercise program. Breathing exercises and upper extremity exercises were taught to all the patients. The patients were then asked to practice these exercises at home individually for 6 weeks. Chest expansion, maximal inspiratory pressure, and maximal expiratory pressure values and Bath Ankylosing Spondylitis Functional Index scores of patients significantly increased after 6 weeks (P < 0.001). Six-minute walking distance and physiologic cost index values did not change at the end of the 6 weeks (P > 0.05). A home-based exercise program can have an effect on some measures respiratory muscle and functional status. Greater emphasis should be placed on maintaining cardiorespiratory fitness as well as spinal mobility to encourage patients with AS.

Força muscular e mortalidade na lista de espera de transplante de fígado

OBJETIVO: Avaliar a forca de musculos respiratorios e de mao em pacientes na lista de espera para o transplante de figado e associa-los a mortalidade. MATERIAIS E METODOS: Foram estudados retrospectivamente 132 pacientes submetidos a avaliacao fisioterapeutica de rotina e que esperavam o transplante de figado. A forca dos musculos ventilatorios foi avaliada por meio das pressoes inspiratoria e expiratoria maximas e a forca do membro superior por meio de dinamometria. Os pacientes foram divididos em dois grupos: grupo A, com 51 pacientes (14 mulheres, 50,1±12,3 anos) que morreram enquanto estavam na lista de espera e grupo B, com 81 pacientes (31 mulheres, 45,0±3,8 anos) que sobreviveram ate o transplante de figado. Foi utilizado o teste de t de Student com nivel de significância de 5%. RESULTADOS: Os valores medios da pressao inspiratoria maxima (PImax) dos grupos A e B foram 65,7±28,0 e 77,5±33,8mmHg (p=0,04), respectivamente, e as pressoes expiratorias maximas foram 72,9±32,9 e 84,4±33,1mmHg (p=0,07), respectivamente. Os valores medios da forca da mao esquerda dos grupos A e B foram 18,5±8,1 e 21,5±10,5kgf (p=0,08), respectivamente, e da forca da mao direita foram 20,2±9,7 e 23,5±12,5kgf (p=0,10), respectivamente. CONCLUSOES: A PImax e menor nos pacientes que morreram enquanto aguardavam o transplante. No mesmo grupo, foi observado que a pressao expiratoria maxima e a forca da mao direita e esquerda foram menores, apesar de nao apresentarem diferencas estatisticamente significante.

Repercussões da insuficiência renal crônica na capacidade de exercício, estado nutricional, função pulmonar e musculatura respiratória de crianças e adolescentes

OBJECTIVE: To evaluate functional capacity, pulmonary function, respiratory musculature and nutritional status among children and adolescents with chronic renal insufficiency (CRI) undergoing conservative treatment. METHODS: This study was conducted with 30 volunteers, divided into two groups: a group of children and adolescents with CRI undergoing conservative therapy (CRI Group) and a group without renal disease (Control Group). The volunteers underwent physical therapy evaluation, spirometry, strength and resistance tests on their respiratory musculature, nutritional status evaluation and functional capacity assessment. The data were analyzed using the Mann-Whitney test with a significance level of 5%. RESULTS: The Tiffeneau index was significantly lower in the CRI Group (p= 0.003). In relation to respiratory muscle function, the maximum expiratory pressure values were lower (p= 0.010) and the time values of the resistance test were greater (p= 0.003). In the functional assessment, the variables that differed statistically were: lower distance walked (p< 0.001), greater mean arterial pressure (p< 0.001), final respiratory rate (p< 0.001) and Borg scale (p= 0.048). Regarding nutritional status, all the statistically significant variables were lower. CONCLUSIONS: Children and adolescents with CRI undergoing conservative treatment may present significantly impaired functional capacity, respiratory musculature and nutritional status.

Maximal respiratory static pressures in patients with different stages of COPD severity.

BackgroundIn this study, we analyzed maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) values in a stable COPD population compared with normal subjects. We evaluated the possible correlation between functional maximal respiratory static pressures and functional and anthropometric parameters at different stages of COPD. Furthermore, we considered the possible correlation between airway obstruction and MIP and MEP values.Subject and methods110 patients with stable COPD and 21 age-matched healthy subjects were enrolled in this study. Patients were subdivided according to GOLD guidelines: 31 mild, 39 moderate and 28 severe.ResultsBoth MIP and MEP were lower in patients with severe airway impairment than in normal subjects. Moreover, we found a correlation between respiratory muscle function and some functional and anthropometric parameters: FEV1 (forced expiratory volume in one second), FVC (forced vital capacity), PEF (peak expiratory flow), TLC (total lung capacity) and height. MIP and MEP values were lower in patients with severe impairment than in patients with a slight reduction of FEV1.ConclusionThe measurement of MIP and MEP indicates the state of respiratory muscles, thus providing clinicians with a further and helpful tool in monitoring the evolution of COPD.

Pressões respiratórias máximas: valores encontrados e preditos em indivíduos saudáveis

Maximal respiratory pressures: actual and predicted values in healthy subjects Objective: To compare actual values for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) found in a sample of healthy individuals from the State of Minas Gerais (Brazil) with the values predicted from the equations put forward by Neder et al. 3 . Method: Using an analog manovacuometer, 100 healthy subjects (54 women and 46 men aged 20-80 years old) were studied. Statistical analysis was performed using parametric or non-parametric tests, depending on the distribution of the variables, and p< 0.05 was considered to be significant. Results: For MIP in women, the mean of the actual values was significantly lower than the mean of the predicted values (68.24 ± 29.48 vs. 86.53 ± 8.76; p= 0.000) and there was a moderate and significant correlation (r= 0.557; p< 0.000). For MIP in men, no significant difference was observed between the actual and predicted values (104.67 ± 42.66 vs. 116.78 ± 14.02; p= 0.055) and there was a low and non-significant correlation (r= 0.236; p= 0.115). For MEP in women, there was no significant difference between the actual and predicted values (80.37 ± 33.32 vs. 85.88 ± 10.90; p= 0.164) and there was a low and non-significant correlation (r= 0.149; p= 0.283). For MEP in men, the mean of the actual values was significantly higher than the mean of the predicted values (142.28 ± 43.89 vs. 126.30 ± 14.19; p= 0.017) and there was a low and non-significant correlation (r= 0.159; p= 0.290). Conclusion: Considering that concordance between actual and predicted values requires the lack of difference and the existence of correlation between them, the equations proposed by Neder et al. 3 were not successful in predicting MIP and MEP values in the population studied.