Dissertations / Theses on the topic 'Spirometry'

La ventilation est une fonction complexe, avec des variabilités naturelles intra- et inter-individuelles imprévisibles, parfois inhomogènes dans le volume pulmonaire. La spirométrie standard est l'examen de référence pour évaluer la fonction ventilatoire à partir de courbes débit-volume mesurées à la bouche et en respiration forcée. Cette technique simple et fiable est limité par la nécessaire coopération du patient, ainsi que par la nature globale de sa mesure. Étant donné que la respiration est intrinsèquement un phénomène tridimensionnel et que les maladies pulmonaires sont généralement régionales, la ventilation devrait être sondée localement. Malgré les difficultés inhérentes à l'application de l'IRM au poumon, de récent progrès ont permis de révéler le potentiel de l'IRM fonctionnelle pulmonaire à partir d'acquisitions standards facilement transposables en clinique. Depuis une quinzaine d'années des développements évaluent la ventilation à partir de la variation du signal IRM au cours de la respiration. Ces techniques reposent sur une hypothèse forte de linéarité du signal IRM avec la densité de tissus pulmonaire. Une nouvelle méthode évaluant la ventilation localement et dynamiquement à partir des déformations a été développée : la spirométrie 3D par IRM. A partir d'un cycle respiratoire moyen, le Jacobien des déformations et sa dérivée temporelle permettent d'inférer les courbes débit-volume locales. Cette thèse s'attache à valider la spirométrie 3D par IRM, à l'amener à la recherche clinique, et à approfondir la compréhension de la mécanique ventilatoire. Le caractère multidimensionnel de la spirométrie 3D par IRM intègre la complexité de la fonction respiratoire mais la technique encore neuve doit être développée et éprouvée. Les évolutions méthodologiques entreprises durant cette thèse incluent une reconstruction optimisée de la dynamique pulmonaire, une segmentation précise des structures lobaires, la définition de biomarqueurs quantitatifs, ainsi qu'une normalisation des cartes fonctionnelles pour permettre des comparaison intra- et inter-sujets. Une étude prospective sur 25 volontaires (10 femmes, 45 ± 17 ans) respirant librement a été menée, avec des acquisitions répétées en position allongée. La fiabilité de la technique a été approchée selon deux critères : sa répétabilité et son exactitude. Les mesures de volumes courants locaux intégrés sur le volume pulmonaire correspondent à ce qui peut être mesuré par segmentation des volumes pulmonaires. Une excellente répétabilité globale a été trouvée, avec une variabilité résiduelle induite par celle intrinsèque à la respiration.La sensibilité de la spirométrie 3D par IRM a été d'abord étudiée sur 25 volontaires sains en position allongée sur le dos puis sur le ventre. Les cartes fonctionnelles mettent en évidence un gradient de ventilation vers les régions les plus dépendantes à la gravité, démontrant la sensibilité de la technique à la physiologie. Des atlas fonctionnels ont été établis à partir des cartes individuelles normalisées, révélant les motifs nominaux de la ventilation pulmonaire reproductibles sur la cohorte de volontaire. Les distributions spatiales mettent en évidence l'inhomogénéité de la ventilation en respiration libre.Enfin, la sensibilité de la spirométrie 3D aux pathologies obstructives et restrictives est évaluée à travers plusieurs études de cas de maladies neuromusculaires, COVID-19 longue durée, asthme et bronchopneumopathie chronique obstructive (BPCO). Ces recherches soulignent l'importance de caractériser les modes de respiration avec les contributions des muscles respiratoires. La réversibilité de l'asthme à l'administration d'un bronchodilatateur a été trouvé, avec une augmentation marquée des débits après bronchodilatateurs. Une étude longitudinale sur un cas d'asthme sévère a aussi mis en évidence l'efficacité de la biothérapie pour améliorer la fonction ventilatoire, réduisant le volume résiduel ainsi que l'obstruction
Ventilation is a complex function, with unpredictable natural intra- and inter-individual variabilities, sometimes heterogeneous in lung volume. Standard spirometry is the reference exam to assess the ventilatory function from flow-volume loops measured at the mouth during forced expiration. This simple and reliable technique is limited by the necessary cooperation of the patient, as well as by the global nature of its measurement. Since breathing is inherently a three-dimensional phenomenon and lung diseases are generally regional, ventilation should be probed locally.Despite the inherent difficulties in applying MRI to the lung, recent advancements have revealed the potential of functional pulmonary MRI from easily translatable standard acquisitions in clinical settings. Over the past fifteen years, developments have evaluated ventilation based on MRI signal variation during respiration. These techniques rely on a strong assumption of linearity of the MRI signal with lung tissue density. A new method evaluating ventilation locally and dynamically from deformations has been developed: 3D spirometry by MRI. From an average respiratory cycle, the deformation Jacobian and its temporal derivative allow inference of local flow-volume curves. This thesis aims to validate 3D spirometry by MRI, bring it into clinical research, and deepen the understanding of ventilatory mechanics.The multidimensional nature of 3D spirometry by MRI integrates the complexity of respiratory function, but the new technique must still be developed and tested. Methodological developments undertaken during this thesis include optimized reconstruction of pulmonary dynamics, precise segmentation of lobar structures, definition of quantitative biomarkers, as well as normalization of functional maps to enable intra- and inter-subject comparisons. A prospective study on 25 volunteers (10 females, 45 ± 17 years old) breathing freely was conducted, with repeated acquisitions in the supine position. The reliability of the technique was approached by two criteria: its repeatability and accuracy. Measures of local tidal volumes integrated over the lung volume agreed to the measured lung volumes from segmentation. Excellent overall repeatability was found, with residual variability induced by that intrinsic to respiration.The sensitivity of 3D MR spirometry was first studied in 25 healthy volunteers in lying supine and prone positions. Functional maps highlight a gradient of ventilation toward the more gravity-dependent regions, demonstrating the sensitivity of the technique to physiology. Functional atlases were established from normalized individual maps, revealing reproducible nominal patterns of pulmonary ventilation across the volunteer cohort. Spatial distributions highlight the heterogeneity of ventilation during free breathing.Finally, the sensitivity of 3D MR spirometry to obstructive and restrictive pathologies is evaluated through several case studies of neuromuscular diseases, long COVID-19, asthma, and chronic obstructive pulmonary disease (COPD). These studies emphasize the importance of characterizing breathing patterns with contributions from respiratory muscles. Reversibility of asthma with bronchodilator administration was found, with a marked increase in flow rates after bronchodilators. A longitudinal study on a case of severe asthma also demonstrated the effectiveness of biotherapy in improving ventilatory function and reducing residual volume and obstruction

Background Children with neuromuscular disorders (NMD) have progressive loss of muscle strength and function which can lead to respiratory failure. Postural change in spirometry has been previously used in adult patients to detect diaphragmatic dysfunction, sleep disordered breathing and early respiratory failure. Postural spirometry changes in children with NMD have been advocated in guidelines for the assessment of NMD but not extensively studied. Aim To explore the relationship between postural changes in forced vital capacity [FVC] and polysomnography (PSG) in the assessment of early sleep disordered breathing in children with NMD. Method In this prospective cross sectional study, children with NMD from neurogenetic and respiratory clinics performed spirometry in sitting (si) and supine (su) position. Control group consisting of age and gender matched healthy children also underwent lung function testing. PSG was performed within 6 months of spirometry. Spirometry was acceptable according to ATS standards and PSGs scored according to AASM guidelines. Results Of 40 children with NMD who performed spirometry, 30 were able to perform acceptable supine spirometry. Underlying diagnoses were heterogeneous, with majority having Duchenne Muscular dystrophy (n=17). Mean age was 12.3 years (range 8 to 17yrs,SD ±3) with 21 males and 9 females. Mean FEV1sit and FVCsit were 78% (SD ±22) and 75%(SD±20.4) respectively. SpO2 mean 96% [92 to 98%] and SpO2 nadir was 87% (84 to 96%). Mean% ΔFVC (sit – sup) in these children was 9% (range +6 to -28%,SD±11). When compared with control group, there was a significant difference in supine spirometry between the two groups (p<0.001). PSG data was available on 30 children with NMD. Mean total AHI 6.9/hr (0.3 to 29,±5.9), obstructive AHI 5.2/hr (0.2 to 10), REM AHI 14.3/hr (0.1 to 34.7). On comparing supine spirometry with Total AHI, there was a moderate correlation with with presence of sleep disordered breathing (r=0.62, p=0.001) in those breathing spontaneously. Children established on non-invasive ventilation (NIV) showed a poor correlation with supine spirometry. In order to demonstrate the relationship of supine spirometry with evidence of hypoventilation, correlation was performed between change in postural spirometry and rise in CO2 from non-Rem to REM sleep. The mean (SD) rise was 6mmHg (±1.9) with a range of 4 mmHg to 11 mmHg. Coefficient of correlation was 0.04 (p=0.8) and therefore was not significant. When the NMD group was split between those spontaneously breathing and those established on NIV, there was a poor correlation between supine spirometry and rise in CO2 in both the groups spontaneously breathing (r=0.02,p=0.9) NIV (r=0.13,p=0.74) Conclusion In this cohort study, children with NMD with mild restrictive lung disease have postural changes in spirometry which are significantly greater than healthy controls. The changes in supine spirometry however do not correlate with nocturnal hypoventilation on polysomnography in patients with mild neuromuscular disease

Thesis (M.S.)--Georgia Southern University, 2006.
"A dissertation submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Master of Science" ETD. Includes bibliographical references (p. 23-27) and appendices.

At least 11 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and there is a high likelihood millions more suffer from the disease but are undiagnosed. Spirometry is a medical test to determine how well a patient’s lungs work, and is used to diagnosis COPD. Despite this test’s utility, resident providers may be uneducated about or uncomfortable with administering spirometry. Past research has demonstrated that brief educational interventions can lead to clinically significant improvements in knowledge of spirometry. The purpose of this study is to compare family medicine residents’ responses regarding the use of spirometry in a rural Family Medicine Residency clinic before and after an educational program on the topic. Researchers will administer a survey to resident physicians at the Family Physicians of Bristol clinic about their knowledge regarding spirometry; residents will then be resurveyed after an educational program. It is expected that resident providers will show significant gains in their knowledge of spirometry after the completion of the educational program. Results of this project will be useful in identifying methods to increase medical providers’ awareness and comfort with spirometry, which will hopefully lead to increased accurate diagnosis of airway diseases.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death worldwide and requires close monitoring and follow up to prevent exacerbations that lead to hospitalizations (CDC, 2015). COPD is often underdiagnosed or misdiagnosed for asthma and also under-treated because providers are not utilizing the recommended diagnostic tool, spirometry, for patients who present with chronic respiratory symptoms (Decramer et al., 2015). The purpose of this study is to assess perceived barriers to spirometry use among primary care providers (PCP) including nurse practitioners (NP) and physician assistants (PA) within Arizona. The aim of this project is to assess for commonalities in barriers and determine practice and educational implications and areas for future research to increase knowledge about the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines so that spirometry is performed more frequently. A survey was administered to PCPs (NPs and PAs) in Arizona through medical professional organizations. Basic demographic data was collected, in addition to questions assessing practice assessment, perceived barriers to spirometry, and utilization of smoking cessation methods and COPD prevention methods. A total of 47 responses were used for the data analysis. Females accounted for 87% (n=41) of the total sample size, and males accounted for 13% (n=6). There were 89% (n=42) NPs and 11% (n=5) PAs. Only 53% (n=25) stated that they have access to a spirometer and 47% (n=22) stated they did not have access to the tool. The most common barriers to spirometry use were concerns about testing quality and accuracy (28%, n=13), cost of the tool (23%, n=11), uncertainty about interpretation (21%, n=10), and unfamiliarity (21%, n=10). Other causes include concerns for reimbursement (11%, n=6), not enough time with patient (11%, n=5), preference to send for pulmonary function tests (11%, n=5), and lastly uncertain about impact of results on clinical practice (6%, n=3). In conclusion, the results call for further practice and educational interventions to mitigate these barriers and provide better support to providers who care for those with chronic respiratory symptoms. Further research into this issue can help lead to interventions and increase knowledge about the GOLD guidelines to improve patient outcomes.

This work presents spirometric measurements on a group of volunteers. First of all the physiology of respiration is explained. Further the theory necessary for measurement and analysis of respiration parameters is mentioned. A separate chapter contains information about ventilation disorders with focus on obstructive diseases. The measurement methodology is described in the analysis section. The program developed for automatic spirometric signal analysis is described in the next section. Parameters obtained from the program are statistically analysed and compared for physiological and obstructive state. Changes, which the individual parameters represent in relation to the simulated obstruction, are discussed. The appendix section contains a report to be used for laboratory lessons together with the developed program.

This thesis is the first to demonstrate the most appropriate spirometry and FeNO reference values for use amongst Aboriginal and Torres Strait Islander children and young adults. Availability of this data will lead to improved accuracy of spirometry and FeNO interpretation which will aid in more timely diagnosis and management of respiratory conditions for this population. Results from this study also suggest that healthy Australian Indigenous lung function data may not be as low as previously reported in earlier studies.

Medical certification of workers for respirator use is an important activity of occupational medicine health professionals. Spirometry is a diagnostic tool to evaluate respiratory distress/insufficiency that may affect respirator use. In this study, we analyzed the pulmonary function data of 337 workers from different occupations which required medical evaluation to wear a respirator. The American Thoracic Society and National Fire Protection Association criteria were used to evaluate employees. Of 337 workers who were cleared for respiratory use on the basis of medical questionnaires for respirator compliance, 14 (4.15%) failed to pass respirator compliance on the basis of NFPA criteria and 5 (1.48%) failed to pass respirator compliance criteria on the basis of ATS criteria. We compared the use of different Spirometric equations to evaluate these criteria and we found the Crapo equation cleared more workers for respirator use as compared to the Knudson and NHANES III equations. We also measured repeated Forced Expiratory Volume in 1st Second (FEV1) and Forced Vital Capacity (FVC) and compared the results longitudinally over time. Age was the only significant factor affecting the reduction in the lung function in longitudinal analysis. Longitudinal spirometry results suggested that workers were protected while using a respirator in the workplace, but age is the significant factor in reducing their lung function. As some workers were able to qualify for respirator use based on questionnaire alone but failed respirator clearance subsequent to pulmonary function testing, it is recommended that spirometry be used to evaluate clearance for all workers who will use a respirator in the workplace. As well, using different Spirometric equations can affect the outcome on passing or failing clearance for respirator use, and this should be considered in a respiratory medical certification program.

The overall aim of this thesis was to describe subjects with chronic obstructive pulmonary disease (COPD) from different perspectives. Focus was on patients at the time of diagnosis, impact of the disease in comparison to other chronic diseases, factors associated with good health and quality of life (QoL), and diagnostic spirometry in clinical practice. Methods: Qualitative method, grounded theory, was used to analyse patients´ perspectives at the time of diagnosis in a primary care setting (n=10). Public health surveys in the general population were used to compare chronic diseases (n=10,755) and analyse factors associated with health outcomes in COPD (n=1,475). Medical records and spirometry reports, from primary and secondary care, were analysed to assess diagnosis of COPD in clinical practice (n=533). Results: In clinical practice, 70% of patients at the time of diagnosis of COPD lacked spirometry results confirming the diagnosis. Factors related to consequences of smoking, shame and restrictions in physical activity (PA) in particular, were described by patients at the time of diagnosis of COPD. In general subjects with COPD (84%), rheumatoid arthritis (74%) and diabetes mellitus (72%) had an activity level considered too low to maintain good health. In COPD, the most important factor associated with good health and quality of life was a high level of PA. Odds ratios (OR (95%CI)) varied from 1.90 (1.47-2.44) to 7.57 (4.57-12.55) depending on the degree of PA, where subjects with the highest PA level had the best health and QoL. Conclusions: Subjects with COPD need to be diagnosed at an early stage, and health professionals should be aware that feelings of shame could delay patients from seeking care and thus obtaining a diagnosis. The use of spirometry and the diagnostic quality should be emphasised. In patients with COPD greater attention should be directed on increasing the physical activity level, as patients with a low level of physical activity display worse health and quality of life.

Målet med detta examensarbete har varit att utveckla en app med en algoritm för att mäta rotationshastigheten hos en prototyp för en spirometerlösning till en låg kostnad för smart- telefoner. En förstudie har gjorts av smarttelefoners användbarhet för att mäta hälsotillstånd och vilka alternativa lösningar och algoritmer som finns för att mäta rörelsedetektion. I detta arbete har en app med en algoritm utvecklats för att detektera rörelser och mäta rotations- hastigheten hos spirometerprototypens turbin filmad med en smarttelefonkamera. För att metoden ska fungera är det viktigt att rotationshastigheten understiger hälften av kamerans fps (bilder per sekund). Rotationshastigheten hos turbinen måste därför begränsas och det behövs en kamera som klarar minst 120 fps för att fånga rörelserna i prototypens turbin.Arbetet har resulterat i en fungerande algoritm för att bestämma turbinens rotationshastighet. Den utvecklade algoritmen detekterar topparna i en PPG (photoplethysmogram). För att minska beräkningstiden och för att öka noggrannheten analyserar algoritmen färgintensiteten i ett begränsat område, ett s.k. ROI (Region of Interest) i varje bild. Det finns stora möjligheter att använda denna algoritm för att fortsätta utvecklingen av detta alternativa sätt att utföra spirometritester.
The goal with this bachelor thesis was to develop an application with an algorithm to measure the rotation speed of a prototype, as a low-cost solution for measuring spirometry with a smartphone. In a pilot study it was investigated how a smartphone can be used to measure health and what algorithms there are to detect motion in videos. After the pilot study an app with the function to record a video by using the camera of a smartphone and then use an algorithm to detect the rotation speed in the spirometry-prototype’s turbine was developed. To make it work it is important that the rotation speed is low enough so it does not exceed half of the cameras fps. Therefore, to capture the rotation speed of the spirometry-prototype’s turbine the rotation needs to be limited and a smartphone with a camera with at least 120 fps is required.The result of this work is an algorithm that can measure the rotation speed in the spirometry prototype turbine. The algorithm is detecting the peaks in a PPG. To minimize the computation time and to increase the accuracy the algorithm analyses the colour intensity over a ROI in every frame. There is great potential to use this algorithm to further develop this alternative method of measuring spirometry.

INTRODUCTION The deployment of new health care models based on the coordination between different levels is a priority at European level to manage the dysfunctions generated by health and social impact of chronic diseases. The transfer of complexity from specialized health care in general hospital-based, to primary care professionals is one of the central elements of change in the health model. This involves the redesign of clinical processes and preparing the workforce for the new environment. The potential of Information and Communications Technology (ICT) as a facilitator element of collaboration between levels of care and greater patient accessibility, have an important role in the deployment and coordination of Integrated Care Services (ICS) that configure the new health model. In this context, the transfer of specialized diagnostic interventions to primary care is a highly relevant area in the change process. The central hypothesis of this thesis is the transfer of functional testing from specialized to primary care within a coordinated care scenario will improve the efficiency of delivery of care and will generate cross-fertilization between levels of care. The general hypothesis is that extensive deployment of different, well-articulated ICS-ICTs covering the entire spectrum of severity of chronic patients generates efficiencies at a system level. This PhD thesis focuses on functional testing and specifically addresses forced spirometry as a use case. This PhD thesis aims to identify the key factors that seem to modulate success of the transfer of forced spirometry (FS) testing to primary care and to other non-specialized professionals and to explore the deployment of services with potential for scalability. The thesis is structured around four specific objectives: OBJECTIVE 1 – TRANSFERABILITY OF FS TO PRIMARY CARE AND PHARMACY OFFICES The first objective is to assess the deployment of the transfer of FS in two scenarios, each with different purposes. The first manuscript analyzes the sustainability of a service to ensure high-quality forced spirometry in primary care. The two other manuscripts under Objective 1 examine the potential of transferability to pharmacy offices, to generate a COPD case-finding program. In the first study "Telemedicine Enhances Quality of Forced Spirometry in Primary Care" efficacy was demonstrated over time (12 m) for quality control of the FS performed by non specialist in five Spanish regions. It was shown that remote collaboration between primary care and specialists has a sustained positive effect on the quality of the FS performed by non-expert personnel. A significant difference between the intervention group (71.5% high quality FS) and the control group (59.5% high quality FS) during the 12 months of the study (p <0.001) was observed. The research generated valuable information to plan properly scalability of the program at regional level, and facilitate the redesign of the role of diagnostic tests in the management of chronic patients in an environment of integrated care. Studies 2 “Early detection of COPD in customers of urban community pharmacies: a pilot-study” and 3 “Spirometry in community-pharmacies: a novel strategy to reduce COPD underdiagnosis”. Results clearly indicate the potential of the community pharmacy as a health partner in close collaboration with primary care. Note that both studies only provide information about feasibility. The efficiency analysis is planned as an activity beyond this thesis, under the EU Project Synergy-COPD and the Master Plan for Respiratory Diseases (PDMAR) of the Department of Health of the Generalitat de Catalunya. OBJECTIVE 2 - ASSESSMENT OF REQUIREMENTS FOR SCALABILITY AT REGIONAL LEVEL Within objective 2, we performed two clusters of studies. The first two (manuscripts 4 and 5) “Survey about the use of Lung Function Testing in Public Hospitals in Catalonia in 2009” and “Estudio de la función pulmonar básica en los centros de atención primaria de Cataluña” analyze the status and needs of FS testing in Catalonia. The second cluster includes two studies (manuscripts 6 and 7) “Design of a basic training program to get quality spirometry” and “HERMES Spirometry: the European Spirometry Driving Licence” with specific proposals for training programs for deployment in Catalonia and at a European level. All these studies were performed directly under the auspices of the Catalan Master Plan of Respiratory Diseases. OBJETIVE 3 - TECHNOLOGICAL CONTRIBUTIONS In this PhD thesis, two areas were identified in which specific technological contributions were needed to ensure the success of the deployment. Firstly, “Technical Requirements of Spirometers in the Strategy for Guaranteeing the Access to Quality Spirometry” the design and production of a FS-CDA for structured data transfer using the protocol HL7 and Clinical Document Architecture (CDA) with the R2 standard supporting interoperability across healthcare tiers (manuscript 8) and, secondly, “Improving quality control of forced spirometry: a new algorithm for automatic evaluation” the development of an automatic tool (algorithm) for remote FS quality control (manuscript 9). The results of the validation with 778 spirometric curves indicated that the sensitivity and specificity of the algorithm was of 96.1 and 94.9%, respectively. The validation of the algorithm provided a second technology element necessary for scalability transfer program of FS to primary care and community pharmacies. The algorithm has been integrated in the ICT management platform for chronic patients. The clinical validation process will be within the EU project Synergy-COPD and scalability in Catalonia plan will materialize in the short term under the PDMAR. CONCLUSIONS 1. The potential for transferability of Forced Spirometry testing to Primary Care was demonstrated by the effectiveness of the web-based collaborative tool that showed sustainable enhancement of high-quality testing performed by non-specialized professionals (manuscript 1). 2. The feasibility of having pharmacy offices play a complementary role to primary care in early diagnosis of chronic respiratory disorders has been proven. Moreover, the potential of pharmacy offices in a future COPD case-finding program has been identified and will be developed beyond this PhD thesis (manuscripts 2 & 3). 3. The lung function testing map in Catalonia was drawn up and requirements for the deployment of high-quality FS within a coordinated care scenario were identified (manuscripts 4 & 5). 4. Conventional and novel coaching strategies to be further developed and integrated into the ICT-supported platform were analyzed (manuscripts 6 & 7) 5. Technological contributions to health system interoperability aimed at facilitating adoption of a high quality FS service supported by ICT were developed and validated, namely: Clinical Document Architecture and an algorithm for automatic assessment of FS quality.
INTRODUCCIÓ El desplegament de nous models de salut basats en la coordinació entre nivells assistencials constitueixen una prioritat a nivell europeu davant la necessitat de gestionar les disfuncions generades per l’elevat impacte sanitari i social de les malalties cròniques. La transferència de la complexitat des de l’atenció sanitària especialitzada, en general de base hospitalària, a professionals d’Atenció Primària constitueix un dels elements centrals del canvi en el model de salut. Això implica el redisseny de processos clínics i la preparació del personal sanitari pel nou entorn. L’ús eficient del potencial que ofereixen les Tecnologies de la Informació i la Comunicació (TIC), com a element facilitador de la col•laboració entre nivells assistencials i d’una major accessi­bilitat del pacient, té un rol important en el desplegament i l’articulació dels Serveis d’Atenció Integrada (SAI) que configuren el nou model de salut. En aquest context, la transferència de les intervencions diagnòstiques especialitzades a l’atenció primària constitueix un àrea molt rellevant en el procés de canvi. L’hipòtesi central de la present tesi doctoral és que la transferència de determinades proves diagnòstiques a l’atenció primària genera eficiències a nivell del sistema de salut. Els diferents estudis realitzats en la tesi es centren en l’espirometria forçada (EF), seleccionada, per les seves característiques, com una prova de concepte. Els objectius generals són explorar aquells fac­tors que s’han identificat com a claus en la modulació del procés de la transferència de l’EF, així com definir estratègies per a la seva escalabilitat regional. La tesi s’estructura en base a 3 objectius específics: OBJECTIU 1 - ANÀLISI DE LA TRANSFERÈNCIA DE LA EF A ATENCIÓ PRIMÀRIA I A OFICINES DE FARMÀCIA. En el primer estudi “Telemedicine enhances Quality of Forced Spirometry in Primary Care” es va demostrar l’eficàcia en el temps (12 m) d’un servei centralitzat pel control de qualitat de l’EF efectuada per professionals no especialitzats de tres regions espanyoles. Es va demostrar que la col•laboració remota entre professionals de primària i especialistes de funció pulmonar tenen un efecte positiu sostingut sobre la qualitat de l’EF realitzada per personal no expert. Es va observar una diferència significativa entre el grup d’intervenció (71.5% EF d’alta qualitat) i el grup control (59.5% EF d’alta qualitat) durant els 12 mesos de l’estudi (p<0.001). La investigació va generar informació valuosa per planejar de forma adient l’escalabilitat del programa a nivell regional. Els resultats d’aquest estudi, junt amb altres apartats de la tesi i d’altres investigacions en curs, facilitaran el redisseny del rol de les proves diagnòstiques en la gestió dels pacients crònics en un entorn d’atenció integrada. Els estudis 2 (Early detection of COPD in customers of urban community pharmacies: a pilot­study) i 3 (Spirometry in community-pharmacies: a novel strategy to reduce COPD underdiag­nosis) de la tesi responen de forma afirmativa a la següent pregunta: Poden les oficines de farmàcia tenir un rol rellevant en un programa de detecció de casos de MPOC? Els resultats són clarament indicatius del potencial de les oficines de farmàcia com a agent sanitari en estreta col•laboració amb Atenció Primària. Cal senyalar que amdos estudis sola­ment aporten informació sobre factibilitat. L’anàlisi d’eficiència es planeja com a una activitat més enllà d’aquesta tesi doctoral, en el marc del projecte EU Synergy-COPD i del Pla Director de Malalties de l’Aparell Respiratori (PDMAR) del Departament de Salut de la Generalitat de Catalunya. OBJECTIU 2 – AVALUACIÓ DE REQUERIMENTS PER A L’ESCALABILITAT REGIONAL A NIVELL DE CATALUNYA En els estudis 4 (Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009) y 5 (Estudio de la función pulmonar básica en los centros de atención pri­maria de Cataluña. Atención Primaria) s’analitzà la situació i necessitats futures de les proves de funció pulmonar a Catalunya a nivell hospitalari i extra-hospitalari en el marc del PDMAR. Els resultats obtinguts confirmen la necessitat de desplegar l’EF a l’Atenció Primària i d’incrementar l’homogeneïtat territorial en el que respecta a l’accés a les proves de funció pul­monar per a pacients i professionals. Es confirma la necessitat del programa de transferència de l’EF plantejat en la tesi doctoral. En un segon grup d’estudis en el Objectiu 2 de la tesi, efectuats en el marc del PDMAR, s‘analitzaren les necessitats i estratègies pel que fa a l’entrenament dels professionals no es­pecialitzats tant en l’àmbit català, estudi 6 (Disseny d’un programa de formació basic para aconseguir espirometries de qualitat), com a nivell europeu, estudi 7 (HERMES Spirometry: the European Spirometry Driving Licence). OBJECTIU 3 – CONTRIBUCIONS TECNOLÒGIQUES A L’ESCALABILITAT L’estudi 8 (Requerimientos técnicos de los espirómetros en la estrategia para garantizar el acceso a una espirometría de calidad) va aportar un element essencial per assegurar l’interoperabilitat de les dades de l’EF al assegurar l’estandardització de la transferència d’informació utilitzant el protocol HL7 v3 i CDA (Clinical Document Architecture) amb estàndard R2. Efectuat amb el suport de l’Oficina d’Estàndards i Interoperabilitat del Departament de Salut de la Generalitat de Catalunya dins el Pla de Digitalizació de la Imatge Mèdica. L’estàndard de transferència de l’EF ha estat ja adoptat per alguns fabricants d’equips de medició i és un requeriment per als concursos públics a nivell regional. A més, a l’estudi 9 (Clinical Decision Support System to Enhance Quality Control of Forced Spi­rometry) es va generar i validar un algoritme per el control automàtic de la qualitat de l’EF. Els resultats de la validació amb 778 corbes espiromètriques varen indicar que la sensibilitat i especificitat de l’algoritme era del 96.1 i 94.9%, respectivament. La validació de l’algoritme aportà un segon element tecnològic necessari per a l’escalabilitat del programa de transfer­ència de l’EF a Atenció Primària i a les oficines de farmàcia. L’algoritme ha estat integrat a la plataforma TIC de gestió de malalts crònics. La validació del procés clínic s’efectuarà dins del projecte EU Synergy-COPD i el pla d’escalabilitat a Catalunya es materialitzarà a curt termini en el marc del PDMAR. CONCLUSIONS 1. Es demostra el potencial de transferibilitat de l’EF a Atenció Primària amb el suport d’una aplicació web de treball col•laboratiu que va facilitar un augment significatiu i sostenible de la qualitat de les proves efectuades per personal no especialitzat (manuscrit 1). 2. Es verificà la factibilitat del rol de les oficines de farmàcia per a la detecció de casos de MPOC en un programa coordinat amb Atenció Primària. Les oficines de Farmàcia podrien tenir un rol complementari a l’Atenció Primària en el diagnòstic de MPOC oculta. El desenvolupament i validació del programa es completarà una vegada finalitzada la present tesi doctoral (manuscrits 2 i 3). 3. L’elaboració del mapa de proves de funció pulmonar a Catalunya va permetre la identifi­cació dels requeriments per a l’escalabilitat regional del programa de transferència de l’EF en el marc d’un model de atenció integrada (manuscrits 4 i 5). 4. Es va verificar el rol essencial de les estratègies d’entrenament dels professionals no espe­cialitzats com a component essencial d’un programa de transferència d’EF de qualitat a l’ Atenció Primària (manuscrits 6 i 7). 5. Es van efectuar dos contribucions tecnològiques rellevants per assegurar la interoperabilitat de l’EF a nivell del sistema de salut: l’elaboració del CDA (manuscrit 8) i el desenvolupament i validació d’un algoritme per l’avaluació automàtica de la qualitat de l’EF (manuscrit 9).
INTRODUCCIÓN El despliegue de nuevos modelos de salud basados en la coordinación entre niveles asisten­ciales constituye una prioridad a nivel Europeo ante la necesidad de gestionar las disfunciones generadas por elevado impacto sanitario y social de las enfermedades crónicas. La transferencia de complejidad desde la atención sanitaria especializada, en general de base hospitalaria, a profesionales de Atención Primaria, constituye uno de los elementos centrales del cambio en el modelo de salud. Ello implica el rediseño de procesos clínicos y la preparación del personal sanitario para el nuevo entorno. El uso eficiente del potencial que ofrecen las Tecnologías de la Información y la Comunicación (TIC), como elemento facilitador de la colaboración entre niveles asistenciales y de una mayor accesibilidad del paciente, tiene un papel importante en el despliegue y articulación de los Servicios de Atención Integrada (SAI) que configuran el nuevo modelo de salud. En este con­texto, la transferencia de las intervenciones diagnósticas especializadas a la atención primaria constituye un área muy relevante en el proceso de cambio. La hipótesis central de la presente tesis doctoral es que la transferencia de determinadas pruebas diagnósticas a la atención primaria genera eficiencias a nivel del sistema de salud. Los dife­rentes estudios realizados en la tesis se centran en la espirometría forzada (EF), seleccionada, por sus características, como una prueba de concepto. Los objetivos generales son explorar aquellos factores que se han identificado como claves en la modulación del proceso de la transferencia de la EF, así como definir estrategias para su escalabilidad regional. La tesis se estructura en base a 3 objetivos específicos: OBJETIVO 1 - ANÁLISIS DE LA TRANSFERENCIA DE LA EF A ATENCIÓN PRIMARIA Y A OFICINAS DE FARMACIA. En el primer estudio “Telemedicine enhances Quality of Forced Spirometry in Primary Care” se demostró la eficacia en el tiempo (12 m) de un servicio centralizado para control de calidad de la EF efectuada por profesionales no especializados de tres regiones españolas. Se demostró que la colaboración remota entre profesionales de primaria y especialistas de función pulmonar tiene un efecto positivo sostenido sobre la calidad de la EF realizada por personal no experto. Se observó una diferencia significativa entre el grupo intervención (71.5% EF de alta calidad) y el grupo control (59.5% EF de alta calidad) durante los 12 meses del estudio (p<0.001). La investigación generó información valiosa para planear de forma adecuada la escalabilidad del programa a nivel regional. Los resultados de este estudio, junto con otros apartados de la tesis y otras investigaciones en curso, facilitarán el rediseño del papel de las pruebas diagnósticas en la gestión de los pacientes crónicos en un entorno de atención integrada. Los estudios 2 (Early detection of COPD in customers of urban community pharmacies: a pilot­study) y 3 (Spirometry in community-pharmacies: a novel strategy to reduce COPD underdiag­nosis) de la tesis responden de forma afirmativa a la siguiente pregunta: Pueden las oficinas de farmacia tener un papel relevante en un programa de detección de casos de EPOC? Los resultados son claramente indicativos del potencial de las oficinas de farmacia como agente sanitario en estrecha colaboración con Atención Primaria. Cabe señalar que ambos estudios solo aportan información sobre factibilidad. El análisis de eficiencia se planea como una actividad más allá de esta tesis doctoral, en el marco del proyecto EU Synergy-COPD y del Plan Director de Enfermedades de Aparato Respiratorio (PDMAR) del Departamento de Salud de la Generalitat de Catalunya. OBJETIVO 2 – EVALUACIÓN DE REQUERIMIENTOS PARA LA ESCALABILIDAD REGIONAL A NIVEL DE CATALUNYA En los estudios 4 (Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009) y 5 (Estudio de la función pulmonar básica en los centros de atención primaria de Cataluña. Atención Primaria) se analizó la situación y necesidades futuras de las pruebas de función pulmonar en Catalunya a nivel hospitalario y extra-hospitalario en el marco del PDMAR. Los resultados obtenidos confirman la necesidad de desplegar la EF en Atención Primaria y de incrementar la homogeneidad territorial en lo que respecta al acceso a las pruebas de función pulmonar para pacientes y profesionales. Se confirma la necesidad del programa de transferencia de la EF planteado en la tesis doctoral. En un segundo grupo de estudios en el Objetivo 2 de la tesis, efectuados en el marco del PDMAR, se analizaron las necesidades y estrategias en lo que respecta al entrenamiento de profesionales no especializados tanto en el ámbito catalán, estudio 6 (Diseño de un programa de formación básico para conseguir espirometrías de calidad), como a nivel Europeo, estudio 7 (HERMES Spirometry: the European Spirometry Driving Licence). OBJETIVO 3 – CONTRIBUCIONES TECNOLÓGICAS A LA ESCALABILIDAD El estudio 8 (Requerimientos técnicos de los espirómetros en la estrategia para garantizar el ac­ceso a una espirometría de calidad) aportó un elemento esencial para asegurar la interopera­bilidad de los datos de EF al asegurar la estandarización de la transferencia de información uti­lizando el protocolo HL7 v3 y CDA (Clinical Document Architecture) con estándar R2. Efectuado con el soporte de la Oficina de Estándares e Interoperabilidad del Departament de Salut de la Generalitat de Catalunya dentro del Plan de Digitalización de la Imagen Médica. El estándar de transferencia de la EF ha sido ya adoptado por algunos fabricantes de equipos de medición y es un requerimiento para los concursos públicos a nivel regional. Además, en el estudio 9 (Clinical Decision Support System to Enhance Quality Control of Forced Spirometry) se generó y validó un algoritmo para el control automático de la calidad de la EF. Los resultados de la validación con 778 curvas espirométricas indicaron que la sensibilidad y especificidad del algoritmo era del 96.1 y 94.9%, respectivamente. La validación del algoritmo aportó un segundo elemento tecnológico necesario para la escalabilidad del programa de transferencia de la EF a Atención Primaria y a oficinas de farmacia. El algoritmo ha sido inte­grado a la plataforma TIC de gestión de pacientes crónicos. La validación del proceso clínico se efectuará dentro del proyecto EU Synergy-COPD y el plan de escalabilidad en Catalunya se materializará a corto plazo en el marco del PDMAR. CONCLUSIONES 1. Se demostró el potencial de transferibilidad de la EF a Atención Primaria con el soporte de una aplicación web de trabajo colaborativo que facilitó un aumento significativo y sostenible de la calidad de las pruebas efectuadas por personal no especializado (manuscrito 1). 2. Se verificó la factibilidad del rol de las oficinas de farmacia para la detección de casos de EPOC en un programa coordinado con Atención Primaria. Las oficinas de Farmacia podrían tener un rol complementario a la Atención Primaria en el diagnóstico de EPOC oculta. El desarrollo y validación del programa se completará una vez finalizada la presente tesis doc­toral (manuscritos 2 y 3). 3. La elaboración del mapa de pruebas de función pulmonar en Catalunya permitió la identi­ficación de los requerimientos para la escalabilidad regional del programa de transferencia de la EF en el marco de un modelo de atención integrada (manuscritos 4 y 5). 4. Se verificó el papel esencial de las estrategias de entrenamiento de profesionales no espe­cializados como componente esencial de un programa de transferencia de EF de calidad a Atención Primaria (manuscritos 6 y 7). 5. Se efectuaron dos contribuciones tecnológicas relevantes para asegurar la interoperabi­lidad de la EF a nivel del sistema de salud: la elaboración del CDA (manuscrito 8) y el desarrollo y validación de un algoritmo para la evaluación automática de la calidad de la EF (manuscrito 9).

Early detection of chronic obstructive pulmonary disease (COPD) is crucial since the protective effect from smoking cessation diminishes when the disease becomes severe. Little is known about early changes before the onset of airflow limitation. In addition, the natural history of COPD has not been extensively investigated in longitudinal studies. In this work, I firstly compared quantitative CT densitometry between low- and regular-dose CT images, and between different CT scanners. I found a significant overestimation of “emphysema” using densitometry measurements from low-dose CT images, while measurements were comparable between the two scanners. Secondly, I validated a CT measurement of %overinflation using both a dynamic cutoff (maximal lung inflation) and CT cluster analysis, by comparing them to the histological gold standard for emphysema, the lung surface area to volume ratio. In addition, CT cluster analysis supplemented CT lung density in quantifying pulmonary emphysema. Thirdly, I tested the contributions of parenchymal overinflation and airways’ remodeling to airflow limitation in a cross-sectional study design. In COPD subjects, the “airway-dominant” phenotype had less severe airflow limitation but smaller airway lumen area compared to the “emphysema-dominant” phenotype. Smokers who had normal spirometry showed less parenchymal overinflation but there was considerable overlap with those who had established COPD. The fourth original investigation is a longitudinal study of spirometry and CT analyses in heavy smokers without COPD. I found that baseline parenchymal overinflation was significantly associated with the subsequent rate of decline in lung function. This novel finding suggests that CT analysis could serve as a useful biomarker to identify those “susceptible” smokers who will develop COPD. Lastly, I showed that progressive airflow limitation was associated with worsening airway abnormalities only in smokers without COPD at baseline, whereas it was only associated with progression in parenchymal destruction in smokers with pre-existing COPD. In addition, smokers who had, or did not have, established COPD at baseline showed a comparable rate of progression of airflow limitation and parenchymal overinflation. In summary, these cross sectional and longitudinal studies of a unique cohort of smokers, using validated CT measurement tools, provide important insights regarding the onset and natural history of COPD.

Purpose: Lung function is typically characterized by spirometer measurements, which do not offer spatially specific information. Imaging during exhalation provides spatial information but is challenging due to large movement over a short time. The purpose of this work is to provide a solution to lung imaging during forced expiration using accelerated magnetic resonance imaging. The method uses radial golden angle stack-of-stars gradient echo acquisition and compressed sensing reconstruction. Methods: A technique for dynamic three-dimensional imaging of the lungs from highly undersampled data is developed and tested on six subjects. This method takes advantage of image sparsity, both spatially and temporally, including the use of reference frames called bookends. Sparsity, with respect to total variation, and residual from the bookends, enables reconstruction from an extremely limited amount of data. Results: Dynamic three-dimensional images can be captured at sub-150 ms temporal resolution, using only three (or less) acquired radial lines per slice per timepoint. The images have a spatial resolution of 4.6 x 4.6 x 10 mm. Lung volume calculations based on image segmentation are compared to those from simultaneously acquired spirometer measurements. Conclusion: Dynamic lung imaging during forced expiration is made possible by compressed sensing accelerated dynamic three-dimensional radial magnetic resonance imaging. (C) 2015 Wiley Periodicals, Inc.

Orientadores: Ilma Aparecida Paschoal, Mônica Corso Pereira
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-26T20:34:20Z (GMT). No. of bitstreams: 1 Veronez_LilianideFatima_D.pdf: 6581224 bytes, checksum: 21912792a141bd85146488626d2e9e24 (MD5) Previous issue date: 2014
Resumo: As doenças pulmonares obstrutivas de diferentes etiologias se apresentam com envolvimento progressivo das vias aéreas periféricas. As vias aéreas periféricas, conhecidas como zona silenciosa do pulmão, não são adequadamente avaliadas com testes convencionais de função pulmonar. O princípio do gás "washout" eliminação de gases tem sido utilizado para detectar heterogeneidade da ventilação pulmonar e para estimar a localização do processo da doença subjacente. A capnografia volumétrica (CV) analisa o padrão de eliminação de CO2 como uma função do volume expirado. Objetivo: medir os "slopes" da fase 3 normalizados pelo volume corrente expiratório em pacientes com bronquiectasia não-fibrose cística (BQNF ) e em pacientes com bronquite crônica tabágica obstrutiva (BCTO), a fim de comparar os slopes obtidos para os grupos. Métodos: Pacientes com BQNF e com BCTO foram incluídos sequencialmente a partir dos ambulatórios de Insuficiência Respiratória Crônica do HC-Unicamp. Um grupo controle foi estabelecido para grupo BQNF, pareados por sexo e idade. Todos os indivíduos realizaram espirometria, CV e teste da caminhada dos seis minutos (TC6). Duas comparações foram feitas: grupo BQNF vs o grupo controle, e BQNF vs o grupo BCTO. O projeto foi aprovado pelo comitê de ética da nossa instituição. Os testes estatísticos utilizados foram Wilcoxon ou teste t de Student diferenças estatisticamente significativas foram consideradas com p < 0,05. Resultados: na comparação do grupo BQNF (N = 20) vs grupo controle (N = 20), foram encontradas diferenças significativas no IMC e em diversas variáveis funcionais (espirometria, CV, TC6) com os piores resultados observados no grupo BQNF. Na comparação entre o grupo BCTO (N = 20) vs grupo BQNF, embora os pacientes com BCTO tivessem piores valores na espirometria e TC6, as variáveis capnograficas Slp2, Slp3/Ve e Slp3/EtCO2 foram semelhantes. Conclusão: Estes resultados podem indicar que as curvas de eliminação de gás não são suficientemente sensíveis para monitorizar a gravidade das anormalidades estruturais. O papel do slope normalizado da fase 3 pode se explorado como o mais sensível índice de doença das pequenas vias aéreas, embora possa não ser igualmente sensível em discriminar a gravidade das alterações
Abstract: Background: Obstructive lung diseases of different etiologies present with progressive peripheral airway involvement. The peripheral airways, known as silent lung zone, are not adequately evaluated with conventional function tests. The principle of gas washout has been used to detect pulmonary ventilation inhomogeneity and to estimate the location of the underlying disease process. Volumetric capnography (VC) analyses the pattern of CO2 elimination as a function of expired volume. Objective: to measure normalized phase 3 slopes with VC in patients with non-cystic fibrosis bronchiectasis (NCB) and in bronchitic patients with chronic obstructive pulmonary disease (COPD) in order to compare the slopes obtained for the groups. Methods: NCB and severe COPD were enrolled sequentially from an outpatient clinic (Universitary Hospital). A control group was established for NCB group, paired by sex and age. All subjects performed spirometry, VC and Six-Minute Walk Test (6MWT). Two comparisons were made: NCB group vs its control group, and NCB group vs COPD group. The project was approved by the ethical committee of the institution. Statistical tests used were Wilcoxon or Student t-test; statistically significant difference considered with p<0.05. Results: Concerning NCB group (N=20) vs control group (N=20), significant differences were found in BMI and in several functional variables (spirometric, CV, 6MWT) with the worse results observed in NCB group. In the comparison between the COPD group (N=20) vs NCB group, although patients with COPD have had worse spirometric and 6MWT values, the capnographic variables Slp2, Slp3/Ve and Slp3/EtCO2 were similar. Conclusion: These findings may indicate that the gas elimination curves are not sensitive enough to monitor the severity of structural abnormalities. The role of normalized phase 3 slope may be worth explore as a more sensitive index of small airway disease, even though it may not be equally sensitive in discriminating the severity of the alterations
Doutorado
Clinica Medica
Doutora em Clínica Médica

Introdução: Os distúrbios ventilatórios decorrente do comprometimento pulmonar da tuberculose ainda é incerto. A importância da tuberculose na população carcerária é motivo de preocupação mundial. As condições precárias de confinamento favorecem tanto a evolução da infecção para doença, como a sua transmissão. Mesmo antes da prisão, muitos detentos estão expostos a fatores de alto risco para a doença, como desnutrição, higiene escassa, aglomeração de pessoas, residência com pouca ventilação. Objetivo: Estudar a função pulmonar através da espirometria em uma amostra de detentos de duas penitenciárias do município de Guarulhos. Metodologia: Estudo descritivo realizado em duas penitenciárias no município de Guarulhos no período de março de 2008 a maio de 2008. Este estudo fez parte do projeto de pesquisa: A Tuberculose no sistema prisional estudo em duas penitenciárias da cidade de Guarulhos SP, com o objetivo de avaliar diferentes métodos de busca de casos de tuberculose pulmonar, neste sentido foi realizado, aproveitando a população, uma avaliação da capacidade pulmonar através da espirometria. Após a realização do questionário e exames previsto no estudo principal, os detentos que relatavam história de tuberculose no passado ou atualmente, algum comprometimento respiratório, foram indicados para realizar o exame de espirometria. Resultados: Dos 2.436 presos foram indicados 629 indivíduos, 486 não conseguiram realizar a espirometria ,sendo que 143 foram incluídos no estudo. A população estudada constitui-se de homens com a idade media de 34 anos. Cerca de 55,2 por cento da população estudada está em regime fechado há mais de 12 meses. Dos indivíduos que relataram tuberculose no passado, 40,9 por cento apresentaram resultado espirométrico restritivo. Os que relataram doenças pulmonares 22,9 por cento apresentaram resultado espirométrico restritivo. Conclusão: Apesar de muitos detentos apresentarem resultado espirometrico normal, foi identificado que 38,9 por cento dos detentos que relataram doença pulmonar apresentam distúrbio ventilatório. A descoberta do distúrbio ventilatório apresentado pelo preso é de grande importância, pois, deste modo pode ser iniciado o tratamento de doenças respiratórias, melhora dos sintomas e da qualidade de vida desta população.
Introduction: Ventilatory disorders due to pulmonary tuberculosis damage are yet uncertain. The relevance of tuberculosis among prison population is a reason of world concern. The precarious conditions of confinement promote as the evolution of the infection through a disease as its transmission.Even before prison, many prisoners are exposed to high risk factors of getting ill, such as malnutrition, lousy hygiene, people agglomeration, and bad ventilation. Objective: To study the pulmonary function through spirometry in a sample formed by prisoners of two prisions from the municipality of Guarulhos.Methodology: Descriptive study made in two prisions of the municipality of Guarulhos. Data were collected between March and May of 2008. This study has composed the project The tuberculosis in prision system Study in two prisions city Guarulhos (SP), aiming to evaluate different methods of search of pulmonary tuberculosis. In view of this, it was made an evaluation with the same population of their pulmonary capacity through spirometry. After the questionnaire and medical examinations expected in the main study, the subjects reported history of tuberculosis in the past or recently, some with respiratory damages have been selected to the spirometric evaluation.Results: Of the 2.436 prisoners have been selected 629 male being than it is to 143 have been inclusive at this study. The population studied it is man with medium age 34 years old. About 55,2 per cent from the population studied is well into regime closed for more than 12 months. Of individuals who reported tuberculosis 40,9 per cent they presented result spirometric restrictive , the reported that the lung disease 22,9 per cent they presented result spirometric restrictive. Conclusion: Though many prisoners present result normal spirometric, therefore identified 38,9 per cent the many prisoners present Ventilatory disorders. The discovery of ventilatory disorders it´s of great importance because this way can be initiated the tratament of pulmonary disease, improvement of respiratory symptoms and quality of life this population.

Background: Lung function assessments have become the cornerstone of understanding the ever-increasing burden of non-communicable respiratory conditions worldwide. The introduction of pulmonary function testing (PFT) has made maximal expiratory flow/volume (MEFV) measurements the basis of lung function assessments and spirometry the most widely used diagnostic tool for lung function testing. The effectiveness of spirometry to distinguish between normal and abnormal lung function has been realised in adults; however, there is an observed history of misinterpretation in children. The quality of measurements remains a major concern in children and good quality measurements are critical in the diagnosis of any health condition as well as understanding the burden of abnormal lung function in children in low and middleincome countries (LMICs). Objective: This study describes the quality and variation of spirometry reads for evaluating lung function in children in a Malawian population. Methods: This study was conducted according to a protocol developed and granted ethical approval by the Faculty of Health Sciences Human Research Ethics Committee, University of Cape Town (HREC REF 669/2018). The protocol describes the parent study data collection, project analysis plans and ethical and other considerations. Current literature on lung function using spirometry was systematically reviewed and synthesised. The literature review included primary studies and review articles that included spirometry measurement in children from settings in Africa and other low- and middle- income countries. The descriptive study involves secondary analysis of data contributed by the Children Lung Health study, a cross-sectional survey conducted in Malawi. Spirometry measurements from 802 healthy children aged 6-8 years, inexperienced in performing MEFV manoeuvres, are evaluated. Data in the primary study were collected by means of a structured questionnaire which included items on socio-demographic characteristics and spirometry was performed according to the American Thoracic Society and European Respiratory Society (ATS/ERS) guidelines using an Easy on-PC spirometer in the participant‘s home. The ATS/ERS standards for adults and the modified recommendations for children were applied to evaluate quality. Descriptive statistics were used to describe the quality of spirometry indices and univariable logistic regression to identify and describe variables that are predictors of quality. Results: The findings of the study were that many children (34%) failed to reach the complete ATS/ERS quality standards. The end-of-test criteria (forced expiratory time) was the most difficult to meet for children and if this is not met (i.e. exhalation is not complete), the forced vital capacity (FVC) will be underestimated leading to it being misinterpreted. More than 30% of the children failed to meet the repeatability criteria when the relative differences for FVC and forced expiratory volume in the first second (FEV1) was used, yet they are the most appropriate in paediatric practice as compared to absolute differences. Young children were more likely to produce poor quality spirometry as compared to older children. Conclusion: Young children may perform acceptable spirometry according to the modified ATS/ERS recommendations; however, the quality remains suboptimal. Further modification of the already lowered quality standards, seems to be the viable option, but the implications of this clinically has not been evaluated. Other alternatives need to be explored for this group.

Inhalation of organic dust, including endotoxin, has been associated with inflammatory response of the pulmonary system. Limited studies have evaluated the work shift effects of endotoxin on respiratory outcomes for workers in the dairy industry, such as spirometry changes. Measurement techniques for exhaled nitric oxide (eNO) have been standardized by the American Thoracic Society (ATS) and used as a biomarker to identify diseases marked with lung inflammation. Dairy parlor workers are known to work long hours in one location with little job variability. The objectives of this study were to quantify exposure concentrations of inhalable dust and endotoxin among dairy parlor workers, evaluate acute cross-shift changes in respiratory status using spirometry, and assess the effectiveness of exhaled nitric oxide for detecting cross-shift bronchial inflammation changes. The cross-sectional study recruited 62 dairy parlor workers from 10 large herd dairy farms across Iowa, Minnesota, Wisconsin, and South Dakota. Data collected before and after the work shifts included spirometry tests, eNO measurements, and pulmonary symptom questionnaires. Personal breathing zone exposure to inhalable dust was assessed during the shift using Button Aerosol Samplers. Gravimetric analysis was used to determine airborne concentrations of inhalable dust and endotoxin concentration was determined using the recombinant factor C assay. Inhalable dust concentrations ranged from 0.09 - 4.95 mg/m3 with a geometric mean of 0.58 mg/m3. Inhalable endotoxin concentrations ranged from 4-1968 EU/m3 with a geometric mean of 117 EU/m3. The study participants pre-shift forced expiratory volume in the first second (FEV1) as a percentage of predicted was an average of 93.4%. Study group cross-shift FEV1 decreased by -1.16%. Six participants with moderate post-shift concentrations of eNO had an average FEV1 cross-shift change of -3.19%. Dairy parlor workers are exposed to concentrations of organic dusts that may adversely impact health. Future studies should test interventions in milking parlors to reduce dust exposure among dairy workers.

Introduktion: En av de vanligaste undersökningsmetoderna för att bedöma den respiratoriska funktionen är spirometri. Det är en undersökning som mäter lungvolymer och lungvolymsförändringar över tid. En fullständig lungfunktionsundersökning består av statisk och dynamisk spirometri samt mätning av diffusionskapacitet. Studiens syfte var att jämföra två olika utrustningar, en gammal (Jaeger MasterScreen Body och PFT) och en ny utrustning (Vyntus Body och One) om det fanns någon signifikant skillnad på mätresultatet mellan utrustningarna. Metod och material: Studien bestod av 24 testpersoner, 16 kvinnor och 8 män, alla undersökningar utfördes på Fysiologiska kliniken på Västerås sjukhus under februari och april 2020. Variablerna som undersöktes och bearbetades var vitalkapacitet (VK), forcerad vitalkapacitet (FVK), forcerad exspiratorisk volym på en sekund (FEV1), forcerad exspiratorisk volym uttryck i procent med vitalkapacitet (FEV%VK), total lungkapacitet (TLK), residualvolym (RV), mätning av diffusionskapacitet (DLCO) samt alveolär ventilation (VA). Resultat: Resultatet från studien visade att det förelåg en statistisk signifikant skillnad mellan utrustningarna Jaeger och Vyntus. Lungfunktionsutrustningen Vyntus påvisade ett lägre mätresultat på samtliga variabler. Att det förelåg en statistisk signifikant skillnad kan bero på att utrustningarna använder olika mätmetoder, Jaeger har en pneumotach medan Vyntus har en ultraljudssensor. Slutsats: Slutsatsen är att det föreligger systematisk skillnad på den nya utrustningen Vyntus. Vyntus visade lägre värden på samtliga variabler.
Introduction: One of the most common measurements for assessment of pulmonary function is spirometry. It is a method that measures lung volumes and changes in lung volume over time. A complete lung function test consists of static and dynamic spirometry as well as measurement of diffusion capacity. The purpose of the study was to compare two different equipment, an older (Jaeger MasterScreen Body and PFT) and the contemporary (Vyntus Body and One) if there was any significant difference in the measurement result between the two equipment. Method and materials: The study consisted of 24 test subjects, 16 women and 8 men, all examinations were performed at the Physiological Clinic at Västerås Hospital between February and April 2020. The variables investigated and processed were vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume expression as a percentage with vital capacity (FEV%VC), total lung capacity (TLC), residual volume (RV), diffusion capacity measurement (DLCO) and alveolar ventilation (VA). Result: The results of the study showed that there was a statistical significant difference between the two equipments Jaeger and Vyntus. The lung function equipment Vyntus showed a lower measurement result on all variables. This statistical significant difference may be due to the fact that the equipment uses different measurement methods. Jaeger has a pneumotach while Vyntus has an ultrasonic sensor. Conclusion: The conclusion is that there is a systematic difference in the new Vyntus equipment. Vyntus showed lower values for all variables.

Background Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with a substantial burden in terms of morbidity, mortality and costs. Smoking is the single most important risk factor for COPD, and is associated with incident asthma. It is important to know if the prevalence of asthma and COPD is increasing or decreasing in the population in order to effectively allocate health care resources. The definitions of these diseases have varied over time which makes it difficult to measure changes in prevalence. The preferred method is to estimate the prevalence with the same procedures and definitions based on cross-sectional population samples with identical age distributions in the same geographical area at different time points. Measurements of lung function (spirometry) are required to diagnose COPD, and spirometry is used to evaluate disease severity and progress of both asthma and COPD, where observed values are compared to reference values. The most commonly used reference values in Sweden are published during the mid 1980s, and there are few evaluations of how appropriate they are today based on Swedish population samples. The aim of the thesis was to estimate trends in the prevalence of asthma and COPD in relation to smoking habits, and to evaluate and estimate reference values for spirometry. Methods The project was based on population-based samples of adults from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Postal questionnaires were sent to large cohorts, recruited in 1992 (n=4851, 20-69 years), 1996 (n=7420, 20-74 years) and 2006 (n=6165, 20-69 years), respectively. The questionnaire included questions on respiratory symptoms and diseases, their comorbidities and several possible risk factors including smoking habits. Structured interviews and spirometry were performed in random samples of the responders to the 1992 and 2006 surveys, of which n=660 (in 1994) and n=623 (in 2009) were within identical age-spans (23-72 years). The trend in asthma prevalence was estimated by comparing the postal questionnaire surveys in 1996 and 2006, and the trend in COPD prevalence was estimated by comparing the samples participating in dynamic spirometry in 1994 and 2009, respectively. The prevalence of COPD was estimated based on two different definitions of COPD. Commonly used reference values for spirometry were evaluated based on randomly sampled healthy non-smokers defined in clinical examinations of participants in the 2006 postal questionnaire (n=501). The main focus of the evaluation was the global lung function initiative (GLI) reference values published in 2012, for which Z-scores and percent of predicted values were analysed. New sex-specific reference values for spirometry were estimated by linear regression, with age and height as predictors. These new OLIN reference values were also evaluated on a sample of healthy non-smokers identified in the population-based West Sweden Asthma Study. Results Although the prevalence of smoking decreased from 27.4% to 19.1%, p<0.001, between 1996 and 2006, the prevalence of physician-diagnosed asthma increased from 9.4% to 11.6%, p<0.001. The prevalence of symptoms common in asthma such as recurrent wheeze did not change significantly between the surveys or tended to decrease, while bronchitis symptoms such as cough and sputum production decreased significantly. The evaluation of the GLI reference values showed that the predicted values were significantly lower compared to the observed values in Norrbotten, which makes the percent of predicted too high. This was especially true for FVC percent predicted with a mean of 106%. In general, the deviations were more pronounced among women. New OLIN reference values valid for the Norrbotten sample were modelled and showed a high external validity when applied on the sample from western Sweden. The prevalence of moderate to severe COPD decreased substantially over the 15-year period between 1994 and 2009, regardless of definition. Conclusions In parallel with substantially decreased smoking habits in the population between 1996 and 2006, the prevalence of several airway symptoms decreased while the prevalence of physician-diagnosed asthma increased. These results suggest increased diagnostic activity for asthma, but may also suggest that the asthma prevalence has continued to increase. In contrast to asthma, the prevalence of COPD tended to decrease and moderate to severe COPD decreased substantially. The continuous decrease in smoking in Sweden during several decades prior to the study period is most likely contributing to these results. The evaluation of reference values showed that the GLI reference values were lower than the observed spirometric values in the population, especially for women, why the new up-to date reference values may be of importance for disease evaluation in epidemiology and in the health care as well.

Orientador: Eros Antonio de Almeida
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-17T09:50:38Z (GMT). No. of bitstreams: 1 DeBiasi_CarlaPatriciaSantoro_M.pdf: 728047 bytes, checksum: 7236f0abe166e5dd7e4cd5a7ca53519d (MD5) Previous issue date: 2010
Resumo: Causada pelo parasito Tripanossoma cruzi, a doença de Chagas é responsável pela morte de 50 mil brasileiros por ano. Possui grande impacto na produtividade do trabalhador e mostra-se capaz de provocar incapacidade precoce em aproximadamente 670 mil pessoas em todo o mundo anualmente. A reação aguda iniciada pelo parasito pode desencadear desde um quadro de febre, sudorese, cefaléia, hepatoesplenomegalia e adenomegalia, até um quadro grave de miocardite ou encefalite. Na fase crônica podem ocorrer insuficiência cardíaca congestiva de caráter progressivo, arritmias ou bloqueios cardíacos, perda de força muscular respiratória, aumento da freqüência respiratória, ineficácia ventilatória ou aumento do espaço morto. Tendo em vista tais alterações, os objetivos deste trabalho foram investigar o grau de acometimento da força muscular respiratória e o impacto desta sobre o padrão respiratório de chagásicos e avaliar o reflexo do acometimento cardíaco sobre a capacidade funcional. Para a análise dos dados do presente estudo foi realizado exame de ecocardiografia e eletrocardiograma para classificar os indivíduos chagásicos em grupo A e B. Prova de função pulmonar por meio da espirometria, teste de caminhada de seis minutos e verificação da força muscular máxima por meio de um manovacuômetro também foram realizados. A partir da avaliação proposta, observou-se que, apesar de apresentarem alteração da função cardíaca em diferentes níveis de acometimento, indivíduos idosos portadores de doença de Chagas, quando avaliados em níveis submáximos, não evidenciaram alteração alguma de força muscular e padrão respiratório, bem como do desempenho funcional. O padrão respiratório mostrou-se alterado apenas nos pacientes portadores de doença pulmonar concomitante à Doença Chagas. Conclui-se, portanto, que a presença de cardiopatia secundária à doença de Chagas, nos graus de gravidade estudados, não foi capaz de alterar, por si só, tanto a força muscular e padrão respiratórios, como o desempenho funcional submáximo. Além disso, apenas os pacientes que apresentaram doença pulmonar associada demonstraram alteração do padrão respiratório
Abstract: Caused by Tripanossama Cruzi parasite, the Chagas disease is responsible by death of 50 thousand brazilians every year. It causes considerable impact on workers' productivity and it is able to lead to premature incapacity in almost 670.000 people around the world every year. The acute reaction started by the parasite can cause fever, sweating, headache, hepatosplenomegaly, adenomegaly, or even a serious situation of myocarditis and encephalitis. In the chronic phase can occur progressive congestive heart failure, arrhythmias or heart blocks, loss of respiratory muscle strength, increase of respiratory frequency, ventilatory inefficiency or dead space increased. Considering these changes caused by the disease, the objectives of this work were investigate the level of respiratory strength damage and its impact on the respiratory pattern in Chagas patients, and also evaluate the repercussion of the heart disease in the functional capacity. To analyze the datas of this work, echocardiography and eletrocardiography were done in order to classify the Chagas Patients into two groups: "A" and "B". Pulmonar function test through the spirometry, walking six minutes test, and evaluation of maximum respiratory muscle strength using a manometer were also performed. With the proposed evaluation, we observed that, in spite of showing heart dysfunction in many levels of damage, elderly patients with Chagas disease, when evaluated in submaximal levels of physical efforts, showed no changes in strength respiratory muscle, pattern respiratory and functional performance. The pattern respiratory was damaged only in patients with associted lung disease. In conclusion, the presence of cardiopaty, secondarily to Chagas disease on the levels presented by the patients of this study, was not able to change the respiratory muscle strenght, the respiratory pattern and the submaximum functional performance by itself. Moreover, only patients with associated lung disease had damaged respiratory pattern
Mestrado
Gerontologia
Mestre em Gerontologia

Introduktion: Spirometri är en metod som utförs för att utesluta eller bekräfta en lungsjukdom. Dynamisk spirometri innebär mätning av lungvolymsförändringar över tid och omfattar både långsam och forcerad spirometri. Vid långsam spirometri mäts vitalkapacitet (VK). Vid forcerad spirometri mäts forcerad exspiratorisk volym på en sekund (FEV1), forcerad vitalkapacitet (FVK) och FEV%. Spirometri utförs i sittande position men den kan också utföras i stående position. Syftet med studien var att jämföra och se om det föreligger en signifikant skillnad för VK, FVK, FEV1 och FEV% vid dynamisk spirometri mellan sittande och stående position hos studenter utan känd lungsjukdom.  Material och Metod: Studien bestod av 21 frivilliga studenter med åldrarna 21-32 år, där 18 var kvinnor och tre män. Datainsamlingen utfördes vid Örebro universitet och variablerna som mättes vid undersökningen var: VK, FVK, FEV1 och FEV%. Mätningarna upprepades minst tre gånger i både sittande och stående position och de fick inte skilja sig åt mer än 150 ml. Ett parat t- test användes för att se om det förelåg en statistisk signifikant skillnad i mätvärdena mellan sittande och stående position. Resultat: Det parade t-testet visade att det inte föreligger någon statistiskt signifikant skillnad i variablerna VK (p = 0,19), FVK (p = 0,87), FEV1 (p = 0,37) och FEV% (p = 0,26) mellan sittande och stående position. Slutsats: Det föreligger ingen statistiskt signifikant skillnad för dynamisk spirometri mellan sittande och stående position. För att få en uppfattning om hur kroppsposition påverkar spirometri behövs en större population.
Introduction: Spirometry is a method performed to rule out or confirm a lung disease. Dynamic spirometry involves measuring lung volume changes over time. The dynamic spirometry includes slow and forced spirometry. With slow spirometry, vital capacity (VC) is measured. In forced spirometry, forced exspiratory volume of one second (FEV1), forced vital capacity (FVC) and FEV% are measured. Spirometry is performed in a sitting position but can also be performed in a standing position. The aim of the study was to compare whether there is a significant difference for VC, FVC, FEV1 and FEV% in dynamic spirometry between sitting and standing position in students without known lung disease. Method and Materials: The study consisted of 21 volunteer students aged 21-32, of whom 18 were women and three men. The data collection was performed at Örebro University and the variables that were taken into account when performing it were: VC, FVC, FEV1 and FEV%. The maneuvers were repeated at least three times in both sitting and standing positions and they did not differ more than 150ml. A paired t-test was performed to see if there is a statistically significant difference in the measured values between sitting and standing position. Result: The paired t-test showed that there is no statistically significant difference in the variables VC (p = 0.19), FVC (p = 0.87), FEV1 (p = 0.37) and FEV% (p = 0, 26) between sitting and standing position. Conclusion: There is no statistically significant difference for dynamic spirometry between sitting and standing position. To get an idea of how body position affects spirometry, a larger population is needed.

Orientador: Wilson Nadruz Júnior
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-25T13:35:23Z (GMT). No. of bitstreams: 1 Kiyota_TatianaAlves_M.pdf: 1139967 bytes, checksum: 0c3fa607148dd5318d2176edb791c325 (MD5) Previous issue date: 2014
Resumo: Pacientes hipertensos exibem aumento do risco para desenvolvimento de eventos cardiovasculares e redução da função pulmonar quando comparados com a população geral. Contudo, ainda não está claro se esta associação se origina da coexistência de doenças altamente prevalentes ou de ações diretas ou indiretas de mecanismos fisiopatológicos em comum. Este estudo investigou a associação entre características das artérias carótidas e função pulmonar em hipertensos não fumantes com função pulmonar supostamente normal. Pacientes hipertensos (n=67) foram avaliados transversalmente por análises clínicas, hemodinâmicas, laboratoriais e ultrassom de carótidas. A capacidade vital forçada (CVF), o volume expiratório forçado no primeiro segundo (VEF1) e no sexto segundo (VEF6) e a idade pulmonar foram medidos por espirometria. Os indivíduos com anormalidades ventilatórias de acordo com o consenso da American Thoracic Society/ European Respiratory Society foram excluídos. Análises bivariadas mostraram que a idade pulmonar e o percentual do previsto para parâmetros espirométricos correlacionaram-se com espessura íntima-média, diâmetro e rigidez da artéria carótida comum. Níveis séricos de Proteína C-reativa e metaloproteinases 2 e 9 não influenciaram esta relação. Na análise de regressão tipo stepwise, a idade pulmonar foi o parâmetro espirométrico que exibiu os coeficientes de regressão mais significativos com as características carotídeas. Em conclusão, o declínio da função pulmonar, particularmente quando avaliado pela idade pulmonar, está independentemente associado com alterações estruturais carotídeas em indivíduos hipertensos não fumantes com função pulmonar supostamente normal
Abstract: Hypertensive patients exhibit higher cardiovascular risk and reduced lung function compared to the general population. Whether this association stems from the coexistence of two highly prevalent diseases or from direct or indirect links of pathophysiological mechanisms is presently unclear. This study investigated the association between lung function and carotid features in non-smoking hypertensive subjects with supposed normal lung function. Hypertensive patients (n=67) were cross-sectionally evaluated by clinical, hemodynamic, laboratory and carotid ultrasound analysis. Forced vital capacity, forced expired volume in 1s and in 6s and lung age were estimated by spirometry. Subjects with ventilatory abnormalities according to current guidelines were excluded. Bivariate analysis showed that lung age and the percentage of predicted spirometric parameters correlated with common carotid intima-media thickness, diameter and stiffness. C-reactive protein and matrix-metalloproteinases-2/9 levels did not influence this relationship. At stepwise regression analyses, lung age was the spirometric parameter exhibiting the most significant regression coefficients with carotid features. In conclusion, decline in lung function, particularly when assessed by lung age, is independently associated with carotid structural alterations in non-smoking hypertensive subjects with supposed normal lung function
Mestrado
Clinica Medica
Mestra em Clínica Médica

Objetivos: avaliar o efeito dos padrões ventilatórios reexpansivos associados ao biofeedback respiratório (BFR) sobre a função pulmonar, força muscular respiratória e hábitos em respiradores bucais funcionais. Métodos: foram avaliadas 60 crianças respiradoras bucais funcionais (RBF), divididas em Grupo Experimental e Controle, sendo o Grupo Experimental submetido a 15 sessões de padrões ventilatórios reexpansivos associados ao BFR por meio do biofeedback pletsmovent (MICROHARD® V1.0), o qual proporciona o biofeedback dos movimentos tóraco-abdominais e o Grupo Controle submetido ao mesmo número de sessões realizando apenas o biofeedback. Espirometria, medidas das pressões respiratórias máximas estáticas e questões para avaliação de hábitos, respondidas pelos responsáveis pelas crianças, foram realizadas antes e após a terapia. Teste t de Student para dados pareados e testes não paramétricos, com nível de significância de 5%, foram utilizados para análise. Resultados: Foram observados alterações significativas na capacidade vital forçada (FVC), índice de Tiffeneau (IT), pressão expiratória máxima (PEmáx), pressão inspiratória máxima (PImáx) e nos hábitos avaliados em RBF com o uso do BFR associado aos padrões reexpansivos. Não foram observadas diferenças significantes quando comparados o Grupo Experimental e o Controle. Conclusão: Os resultados permitem concluir que o BFR associado aos padrões reexpansivos melhora a capacidade vital forçada, IT, força da musculatura respiratória e hábitos em RBF, podendo ser, portanto, utilizado como uma das formas de terapia nesses indivíduos
Objectives: Assess the effect of re-expansive respiratory patterns associated to respiratory biofeedback (RBF) on pulmonary function, respiratory muscle strength and habits in individuals with functional mouth breathing (FMB). Methods: Sixty children with FMB were divided into experimental and control groups. The experimental group was submitted to 15 sessions of re-expansive respiratory patterns associated to RBF (biofeedback pletsmovent; MICROHARD® V1.0), which provided biofeedback of the thoracic and abdominal movements. The control group was submitted to 15 sessions using biofeedback alone. Spirometry, maximum static respiratory pressure measurements and questions regarding habits (answered by parents/guardians) were carried out before and after therapy. The Student\'s t-test for paired data and non-parametric tests were employed for statistical analysis at a 5% level of significance. Results: Significant changes were found in forced vital capacity, Tiffeneau index scores, maximum expiratory pressure, maximum inspiratory pressure and habits assessed in FMB with the use of RBF associated to the re-expansive patterns. No significant differences were found comparing the experimental and control groups. The results allow the conclusion that RBF associated to re-expansive patterns improves forced vital capacity, Tiffeneau index scores, respiratory muscle strength and habits in FMB and can therefore be used as a form of therapy for such individuals.

As deformidades dentofaciais (DDF) compreendem alterações no equilíbrio dentofacial que comprometem a estética e a funcionalidade do sistema estomatognático. O crescimento e desenvolvimento craniofacial são influenciados pela respiração, porém as condições respiratórias nesses indivíduos são pouco abordadas na literatura. O presente trabalho teve por objetivo caracterizar a função respiratória de indivíduos com deformidade dentofacial em relação às vias aéreas superiores e inferiores, bem como aos aspectos da respiração voltados para a fonação, neste mesmo grupo de indivíduos. Para isso foram avaliados 40 indivíduos adultos, divididos em três grupos equilibrados de acordo com gênero e idade: GC (14 indivíduos com equilíbrio dentofacial, Classe I e Padrão I); DDFII (12 indivíduos com DDF, Classe II e Padrão II) e DDFIII (14 indivíduos, Classe III e Padrão III), estando os dois últimos em tratamento ortodôntico preparatório para a cirurgia ortognática. Os pacientes foram submetidos ao exame miofuncional orofacial para avaliação de tipo e modo respiratório, fluxo nasal e possibilidade de uso nasal, utilizando o Protocolo MBGR, bem como à espirometria para avaliação da capacidade respiratória. Foi realizada, ainda, a medida de fluxo aéreo expiratório utilizando espelho milimetrado e calculada a área de embaçamento provocado pelo fluxo. Também foi obtido tempo de fonação de /s/. Na comparação entre os grupos foram utilizados os testes Kruskall-Wallis e teste t; para a comparação entre os aspectos estudados foram aplicados os testes estatísticos Qui Quadrado e ANOVA; para correlações, utilizou-se Pearson e Spearman. Os resultados demonstraram maior ocorrência do tipo respiratório médio superior para os diferentes grupos. No que diz respeito ao modo, mais da metade dos participantes com DDF apresentou respiração oronasal ou oral, sendo que ao realizar a comparação entre os grupos, foi encontrada diferença entre o DDFII e os demais grupos estudados (p<0,001). Quanto ao fluxo expiratório nasal, a maioria dos indivíduos dos grupos DFFII e DDFIII apresentou fluxo reduzido unilateralmente, enquanto para o GC foi simétrico, tendo-se verificado diferença significante entre os grupos com DDF e GC (p=0,011). Quanto à possibilidade de uso nasal, os grupos DFFII e DFFIII apresentaram semelhanças, porém o grupo DFFII apresentou menor tempo de uso nasal em relação aos outros grupos (p<0,001). No escore do Protocolo MBGR, o grupo DFFII apresentou os escores mais altos, ou seja, os piores resultados, ao comparar com os demais grupos (p<0,001). Com relação aos exames objetivos (área do embaçamento do espelho de Altmann, capacidade vital e suporte de ar disponível), a análise estatística não evidenciou diferença significante entre os grupos para todos os aspectos considerados (p>0,05). Por fim, foi encontrada correlação negativa quanto ao tempo fonatório de /s/ e o escore do MBGR correspondente à função respiratória. Concluiu-se que os grupos com DDF apresentam semelhante tipo respiratório, capacidade vital e menor suporte respiratório para a fonação, se comparados ao GC. Além disso, foi verificado que os indivíduos com DDF apresentam modo respiratório oral/oronasal, possibilidade de uso nasal reduzida e menor fluxo expiratório nasal, sendo que os prejuízos na função respiratória influenciaram a utilização do ar para a fonação.
Dentofacial deformities (DFD) are comprised of alterations of the dentofacial balance that compromise the aesthetics and functionality of the stomatognathic system. Craniofacial growth and development are influenced by breathing, however, the conditions of the upper and lower airways in these individuals are poorly addressed in the literature. The present study aimed to characterize the respiratory function in individuals with dentofacial deformities in relation to the upper and lower airways, as well as the aspects of breathing focused on phonation in this same group of individuals. To do so, we evaluated 40 adult individuals who were divided into three groups, balanced by gender and age: GC (14 individuals with dentofacial balance, Class I and Standard I); DFDII (12 individuals, Class II and Standard II) and DFDIII (14 individuals, Class III and Standard III), the latter two in preparatory orthodontic treatment for orthognathic surgery. The subjects were submitted to an Orofacial Myofunctional examination for the evaluation of respiratory type and mode, nasal flow and potential of nasal ability as well as spirometry to evaluate the respiratory capacity. We even performed a measure of expiratory airflow using a graded mirror and calculated the area of haze caused by the flow in cm2, utilizing the Image Pro Plus program. A phonation time of /s/ was also obtained. The qualitative and quantitative variables were submitted to the statistical Chi Square and ANOVA tests, respectively, for the comparison between the groups we utilized the Kruskal-Wallis and t-test, and for the correlations we utilized the Pearson and Spearman tests. The results showed that regarding the respiratory tract, the most prevalent was the upper middle for the different groups. With respect to the mode, more than half of the participants with dentofacial deformities presented oro-nasal or oral breathing, and when performing a comparison between the groups, a difference was found between the DFDII and the other studied groups (p<0.001). With regards to the nasal expiratory flow, most individuals from the DFFII and DDFIII groups showed a reduced flow to the right or to the left, while the GC group was symmetrical, and significant differences were verified between the groups with DFD and GC (p=0.011). Regarding the possibility of nasal use, the DFDII and DFDIII groups presented similarities, however, the DFDII group presented the highest occurrence of possibility of nasal use under one minute when compared to the other groups (p<0.001). In the MBGR Protocol score, the DFDII group had the highest scores, in other words, the worst results when compared to the other groups (p<0.001). With regard to the objective tests (area of haze of the Altmann mirror, vital capacity and available air support), the statistical analysis presented no significant differences between the groups for all aspects considered (p>0.05). Finally, a negative correlation was found regarding the phonation time of /s/ and the MBGR score. It was concluded that individuals with DFD presented an oral / oronasal respiratory mode, a possibility of reduced nasal use, reduced expiratory nasal flow and medium / high respiratory type. Furthermore, it was verified that groups with DFD presented similar vital capacity and lower respiratory support for phonation, when compared to the GC group.

Trabalho apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Objectivo: Determinar o efeito do treino dos músculos inspiratórios na função pulmonar de atletas de futebol. Metodologia: Dezanove futebolistas foram aleatoriamente divididos em grupo não treinado e treinado. O grupo treinado realizou treino de músculos inspiratórios recorrendo a um treshold durante duas semanas, em treinos diários, onde os atletas eram submetidos a três series de trinta repetições a 50% da pressão inspiratória máxima estivada. Ambos os grupos realizaram testes de espirometria onde foram avaliados FEV1, CVF, e PFE antes do início do período de treino e duas semanas depois. Resultados: Verificamos um aumento estatisticamente significativo do PFE antes e depois do treino inspiratório no grupo treinado. Conclusão: O treino dos músculos inspiratórios parece exercer algum efeito sobre a função pulmonar de atletas de futebol. Objectives: determine de effects of inspiratory muscle training on the lung function of soccer players. Methods: Nineteen soccer players were randomly divided in a untrained and trained groups. The trained group was submitted to an inspiratory muscle training using a threshold during a period of two weeks with daily sessions of three series of 30 repetions at 50% of estimated maximal inspiratory muscle pressure. Both groups prior to the beginning of the training program were submitted to spirometric testing for FEV1, FVC, and PEF and two weeks after. Results: There were significant changes in PFE before and after training in the trained group. Conclusion: Inspiratory muscle training seems to have some effect on pulmonary function of soccer players.

Objective: Pulmonary disease is a common cause of morbidity and mortality; however a large number of individuals remain undiagnosed. Reasons for this include the inconsistent use of spirometry and the inability to produce acceptable and reproducible results. Chest circumference measurements have been positively correlated with pulmonary function in healthy individuals and those with pulmonary pathologies, thus potentially offering an additional method for assessing pulmonary function. Regular participation in endurance activities appears to increase VO2 max and the strength of the respiratory muscles. Thus, the aim of the study was to determine whether a strong, significant correlation between chest circumference measurements and spirometry measures existed in a young healthy active population, and whether this relationship remained consistent with changes in physical fitness. Methods: A total of 235 military recruits (136 male; 99 female; 18–28 years old) were recruited in the study. In weeks 1, 12 and 19 of the Basic Military Training (BMT) programme, each participant voluntarily participated in a testing session which included anthropometric measurements (height, weight and chest circumference), spirometry tests and the multistage shuttle run test. Overall 26 participants complied with all spirometry inclusion criteria and completed all measures in all three testing sessions. Parametric descriptive and inferential statistics were used. Alpha was set at 0.05. Results: The correlational analysis showed weak and non-significant correlations (r<0.4) between chest circumference measurements and spirometry measures over the 19 weeks of BMT, except for a moderate, positive and significant correlation between FVC and ICC in the male sample (r=0.522; p<0.05) in week 12. Strong, positive and statistically significant correlations between FVC and VO2 max were observed in weeks 1, 12 and 19 (r=0.682, p<0.01; r=0.616, p<0.01 and r=0.697; p<0.01, respectively) and between FEV1 and VO2 max in week 1 and week 19 (r=0.628; p<0.01 and r=0.658; p<0.01, respectively). A moderate, positive and statistically significant correlation between FEV1 and VO2 max in week 12 (r=0.554; p<0.01) was noted. There were no statistically significant changes in chest circumference measures over time (p=0.401). Statistically significant changes in FVC between week 1 and week 12, week 1 and week 19 and week 12 and week 19 (p=0.021; p<0.001 and p=0.025, respectively) were observed, as well as in FEV1 between week 1 and week 12 and week 1 and week 19 (p=0.027 and p<0.001). There were no statistically significant changes in FEV1/FVC between all testing sessions. Changes in VO2 max were statistically significant between week 1 and week 12 and week 1 and week 19 (p≤0.001 and p≤0.001, respectively). When controlled for by gender, the overall changes in FVC, FEV1 and relative VO2 max remained statistically significant (p=0.001; p=0.002 & p<0.001, respectively) and FEV1/FVC remained statistically non-significant (p=0.806). Conclusion: This study did not find a statistically significant correlation between chest circumference measurements and pulmonary function, despite the statistically significant increase in the VO2 max; thus the hypothesis that chest circumference measurements could be used as a measurement of pulmonary function in a young healthy active population was not supported. Future research should be aimed at exploring this relationship using a larger sample.
Dissertation (MA)--University of Pretoria, 2014.
Sport And Leisure Studies
MA
Unrestricted

60 children with bronchial asthma were investigated of the age of 11-15. Children, who were investigated, were divided into 2 groups: the first group consisted of 30 children, who did exercises in the sport hall; the second group consisted of 30 children, who did exercises in the water. Physical therapy for both groups was provided for 30 minutes 6 days a week 1 time per day. Physical therapy included active gymnastic exercises using various physical therapy tools. It was provided two lung ventilation tests with spirometer “Spiromed 250”: the first test was taken before starting to do physical therapy, the second one was taken in the end of physical therapy. We examined the forced expiratory vital capacity (FVC), volume of forced expiration within the first second (FEVı), Gaensler index (FEVı/FVC), peak expiratory flow (PEF), maximum expiratory flow, when 50% of the forced vital capacity has been exhaled (MEF50%). The results of our investigation showed that gymnastic exercises in the water have more positive effect than gymnastic exercises in the sport hall for children with bronchial asthma.

Orientadores: Carlos Roberto Ribeiro de Carvalho, Desanka Dragosavac
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-10T10:34:34Z (GMT). No. of bitstreams: 1 Soares_SilviaMariadeToledoPiza_D.pdf: 3044628 bytes, checksum: e56b8278750420c568f9132a7938bd95 (MD5) Previous issue date: 2007
Resumo: Introdução: Limitação ao fluxo e hiperinsuflação dinâmica são fteqüentemente observadas em pacientes com DPOC. A capacidade inspiratória (CI) tem sido sugerida como um método simples para verificar as alterações no volume pulmonar expiratório final e hiperinsuflação pulmonar. Entretanto, poucos estudos verificaram se a aplicação de pressão positiva contínua nas vias aéreas (CP AP) poderia diminuir a hiperinsuflação pulmonar. Objetivo: Verificar os efeitos imediatos da CP AP no volume pulmonar expiratório final em pacientes com DPOC estável. Método:' Trata-se de um estudo prospectivo, com 21 pacientes, idade 63 + ou - 9 anos, com volume expirado forçado no primeiro segundo de 40,7 + ou - 11,7%, que foram submetidos a um teste gradual de CP AP (4, 7 e 11 cmH20 - Drãger SA VINA ventilator). A CI foi mensurada pela espirometria, antes e depois de cada valor de CPAP. Nos pacientes nos quais os três valores de CPAP resultaram em redução da CI, uma pressão de 2 cmH20 também foi aplicada. Para cada paciente, um valor de CP AP "ótimo" foi definido como o valor correspondente a melhor CI obtida com o teste gradual da CP AP. Este valor "ótimo" de CP AP foi, então, aplicado por 10 min e uma espirometria foi posteriormente realizada. Resultados: Durante o teste gradual da CPAP, seis pacientes (grupo não respondedor) não apresentaram qualquer melhora na CI. Quando o valor de CP AP "ótimo" foi então aplicado nesses indivíduos, foi observado piora significativa da CI de 83,7 + ou - 19,4% para 74 + ou 22,8% (p = 0,0341). Em 15 pacientes (grupo respondedor), a CI aumentou significativamente de 68,6 + ou - 17,9% para 75,3 + ou - 18,0% (p = 0,0002). A capacidade vital lenta foi o único parâmetro espirométrico que também aumentou após a CPAP "ótima" no grupo respondedor (240 rnL, 7,4% do valor predito, p < 0,01). Nenhuma diferença significativa foi observada após a CP AP "ótima" nos pacientes com limitação ao fluxo expiratório (CI pré-CPAP '< ou =' 80% do valor predito) versus pacientes não limitados ao fluxo expiratório (CI pré-CPAP > 80% do valor predito). Entretanto, os pacientes com enfisema pulmonar e CI:S 80%,do valor predito demonstraram um aumento significativo na CI após a CPAP "ótima" (220 rnL, 8,9% do valor predito, p < 0,01). Conclusão: A CPAP pode aumentar a capacidade inspiratória em pacientes selecionados, sugerindo redução no volume pulmonar expiratório final, conseqüente da diminuição na hiperinsuflação pulmonar
Abstract: Bachground: Flow limitation and dynamic hyperinflation are common findings in COPD patients. Inspiratory capacity (IC) has been proposed as a simple method to assess changes in end-expiratory lung volume (EEL V) and lung hyperinflation. However, few studies verified if the application of continuous positive airway pressure (CP AP) could decrease lung hyperinflation. Objective: To assess the immediate effect of the CP AP in EEL V in stable COPD patients. Method: Prospective study of 21 stable COPD patients, age 63 + ou - 9 years, with forced expiratory volume in first second (FEV1) of 40.7 + ou - 11.7%, who were submitted to the gradual test of CP AP (4, 7 and 11 CmH20 - Drãger - SA VINA ventilator). The IC was measured by spirometry, before and after each CP AP leveI. In patients in whom all three CP AP levels resulted in a decreased IC, an additional CP AP test at 2 cmH20 was conducted. For each patient, a "best" CPAP leveI was defined as the one associated with the greater IC observed. This "best" CP AP leveI was then applied during 10 min and subsequent spirometry was performed. Results: During the gradual test of CP AP, 6 patients (non responder group) did not present any improvement of the IC. When the "best" CPAP was then applied in these cases, a significant worsening of the IC was observed of 83.7 + ou - 19.4% to 74 + ou - 22.8% (p = 0.0341). In 15 patients (responder group), the IC increased significantly from 68.6 + ou - 17.9% to 75.3 + ou - 18.0% (p = 0.0002). The slow vital capacity was the only other' spirometric parameter that also increased post "best" CP AP in the responder group (240 mL, 7.4% of the predicted value, p < 0.01). No significant differences in IC were observed after "best" CP AP in patients with expiratory flow limitation (IC pre CP AP '< ou =' 80% of predicted value) versus non EFL patients (IC pre CPAP> 80% ofpredicted value). However, the patients with pulmonary emphysema and IC '< ou =' 80% of predicted value demonstrated a significaht increase in IC after "best' CP AP (220 mL, 8.9% ofthe predicted value, p < 0.01). Conclusion: The CPAP can increase the inspiratory capacity in selected patients, suggesting decrease in the end-expiratory lung volume, consequent of reduction in pulmonary hyperinflation
Doutorado
Pesquisa Experimental
Doutor em Cirurgia

Orientadores: Ilma Aparecida Paschoal, Mônica Corso Pereira, Lilian Tereza Lavras Costallat
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-19T08:01:04Z (GMT). No. of bitstreams: 1 Leite_MarivoneArruda_M.pdf: 553765 bytes, checksum: 523c010d8a4b64d307b61b14f6c9b8d4 (MD5) Previous issue date: 2011
Resumo: Objetivo: avaliar os pacientes com LES sem sintomas respiratórios significativos, por meio do teste de caminhada de 6 minutos (TC6). Casuística e Métodos: foram selecionados 45 pacientes com LES estáveis. Os pacientes foram avaliados quanto à dispneia (MRC), foram submetidos a testes de função pulmonar (espirometria e manovacuometria) e realizaram TC6 (protocolo da ATS/ERS). Dois parâmetros de TC6 (distância e dessaturação) foram comparados com as outras variáveis estudadas. Resultados: Dos 45 pacientes, 42 eram mulheres com idade média de 39±11.4 anos; a média do tempo de doença foi 121±93.1 meses; valor da média do MRC 2±0; a média da CVF foi 85.9±34.2%; a média do VEF1 67.5±21.6%; média PiMáx 82±58.4%; média PeMáx 78±37.3%; média FC em repouso 75±12.8 bpm; FR em repouso 19±5.3bpm; média da distância caminhada no TC6 foi 478±82m; média SpO2 em repouso foi 98±0.8%; média da queda da SpO2 foi de 4±6 pontos. Quando a população de estudo foi dividida de acordo com o valor da distância caminhada, a FC antes do TC6 foi significantemente menor no grupo que caminhou '> ou =' 400m quando comparados com o grupo que caminhou < 400m (p=0.0043), assim como o valor da Escala de Borg (p=0.0036); de acordo com a presença de dessaturação, a FC ao final do teste foi significantemente maior no grupo que dessaturou (p=0.0170), PeMáx (p=0.0282) e a distância caminhada no TC6 (p=0.0291) foi significativamente menor, enquanto que a PiMáx mostrou uma tendência para também ser menor (p=0.0504). CVFAbstract: Objective: to evaluate SLE patients without overt respiratory symptoms by means of six-minute walk test (6MWT). Casuistic and Methods: 45 stable SLE patients were enrolled. Patients were evaluated for dyspnoea (MRC), underwent pulmonary function tests (spirometry and manovacuometry ) and performed the 6MWT protocol (ATS / ERS). Two parameters of the 6MWT (distance anddesaturation) were compared with the other variables. Results: Of the 45 patients, 42 were women with mean age 39±11.4 years; mean duration of disease was 121±93.1 months; mean value of MRC was 2±0; mean FVC 85.9±34.2%; mean FEV1 was 67.5±21.6%; mean MIP was 82±58.4%; mean MEP was 78±37.3%; mean heart rate at rest was 75±12.8 bpm; mean respiratory rate at rest was 19±5.3bpm; mean 6MWD was 478±82m; mean SpO2 at rest was 98±0.8%; mean fall in SpO2 was 4±6 points. When the study population was divided according to the cut-off value of 400m of walk distance heart rate immediately before the test was significant smaller in those who walked less than 400m (p=0.0043) as was the value of Borg scale(p=0.0036); according to the presence of desaturation '> or =' 4, heart rate at the end of the test was significant higher in those who desaturate (p=0.0170), MEP (p=0.0282) and 6MWD (p=0.0291) were significantly smaller, MIP showed a tendency towards being smaller(p=0.0504). FVC < inferior limit of normal was significantly associated with the group that desaturates (p=0.0274). Conclusion: compared with 6MWD, desaturation was better suited to find the patients with the most compromised indexes in respiratory function tests
Mestrado
Clinica Medica
Mestre em Clinica Medica

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Objectivo: Determinar a eficácia da Técnica Respiratória de Buteyko (BBT) na função ventilatória de nadadores de competição. Metodologia: 21 atletas da equipa de natação do Ginásio Clube de Vila Real foram seleccionados, de acordo com idade (categoria) e aleatoriamente divididos em dois grupos (grupo C - grupo controlo; grupo B – grupo experimental). No grupo B foram aplicados alguns exercícios da Técnica Respiratória de Buteyko, o grupo C ficou como grupo de controlo. Ambos realizaram testes de espirometria, onde foram avaliados o volume expiratório forçado ao 1º segundo (VEF1), a capacidade vital forçada (CVF), o pico de fluxo expiratório (PFE) e a capacidade vital inspiratória (IVC), antes e após a aplicação da técnica (que teve a duração de duas semanas). Resultados: Houve um aumento de 8,81% no VEF1, 13,63% na CVF, 18,91% no PFE e uma diminuição 2,18% na IVC. Conclusão: Ainda que sem significância estatística, a BBT parece exercer uma influência positiva na força dos músculos respiratórios pois os parâmetros espirométricos do grupo experimental aumentaram ligeiramente relativamente ao grupo controlo após a aplicação da técnica. Objective: To determine the effectiveness of Buteyko Breathing Technique (BBT) on the ventilatory function of competitive swimmers. Methodology: 21 athletes from the Ginásio Clube de Vila Real’s swimming team were selected according to age (category) and randomly divided into two groups (group C - control group, group B - experimental group). In group B were applied some exercises from the Buteyko Breathing Technique, group C stayed as a control group. Both underwent spirometry tests where were evaluated the forced expiratory volume at 1st second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and inspiratory vital capacity (IVC) before and after the application of the method (which lasted two weeks). Results: There was an increase of 8.81% in FEV1, 13.63% in CVF, 18.91% in PEF and a 2.18% decrease in the IVC. Conclusion: Although not statistically significant, the BBT seems to exert a slight positive influence on muscle strength as spirometric parameters of the experimental group increased relative to the control group after the application of the technique.

BAKGRUND: Personer med cystisk fibros (CF) har bland annat på grund av tjockt slem i lungorna försämrad lungfunktion och lungkapacitet. Den nedsatta hälsan leder i många fall till en nedsatt livskvalitet.  SYFTE: Syftet med den här litteraturstudien var att ta reda på hur fysisk aktivitet påverkar lungfunktionen och livskvaliteten hos patienter med cystisk fibros. METOD: Sökningar i databaserna Pubmed, Cochrane och Cinahl utfördes för att hitta relevanta artiklar som tog upp sambandet mellan lungfunktion, fysisk aktivitet och livskvalitet. RESULTAT: Med regelbunden träning kan de olika måtten på lungfunktion och kapacitet förbättras. Vissa träningsformer ger bättre resultat på lungkapacitet, och vissa visar större resultat på FEV1. Deltagarna skattade även högre på enkäter om livskvalitet efter avslutat intervention. SLUTSATS: Fysisk aktivitet är positivt för patienter med cystisk fibros och bör rekommenderas för alla. Även om det i sällsynta fall sker en initial försämring kan det vända och bli positivt sedan. Ett roterande schema med olika typer av fysisk aktivitet kan ge patienterna en generell förbättring av sin lungfunktion. En ökad lungfunktion kan även leda till en ökad livskvalitet.
BACKGROUND: People diagnosed with cystic fibrosis (CF) have a lower lung function and capacity partially due to thick mucus. The declining health can also lead to a lower quality of life. AIM: The aim with this review was to find out how physical activity affects the lung function and quality of life in patients with cystic fibrosis. METHODS: Searches in the databases Pubmed, Cochrane and Cinahl were executed to find relevant articles that brought up the connection between lung function, physical activity and quality of life. RESULTS: With regular exercise the different variables measuring lung function and capacity can improve. Some forms of physical activity gave better results on lung capacity, while some showed bigger results on FEV1. The participants scored higher on questionnaires about quality of life after completed intervention. CONCLUSIONS: Physical activity is positive for all patients with cystic fibrosis and should be recommended for everyone. Even when there are rare cases that show an initial decrease in health in the beginning, the positive effects will come later. A rotating schedule of different types of exercise could give the patients an over all improvement of their lung function. An increase in lung function could also lead to an increased quality of life.

IntroduktionSpirometri är en vanlig undersökningsmetod för att bedöma en persons lungfunktion och lungkapacitet, där total lungkapacitet (TLC) är av stort värde. Kroppspletysmografi och kvävgasutsköljning är två metoder som mäter statiska lungvolymer, däribland TLC. Syftet med studien var att jämföra kroppspletysmografi med kvävgasutsköljning och se om det förelåg någon signifikant skillnad på mätresultaten mellan metoderna. Material och metod Studien bestod av 32 försökspersoner, varav 22 kvinnor och 10 män där samtliga undersökningar utfördes på Fysiologkliniken på Västmanlands sjukhus Västerås under februari och mars 2021. Variablerna TLC, funktionell residualkapacitet/intrathorakal gasvolym (FRC/ITGV) och vitalkapacitet (VC) uppmättes och beräknades. Resultatet jämfördes mot Hedenströms referensmaterial. Ett parat t-test med signifikansnivå p<0,05 användes för att se om det förelåg signifikant skillnad.  Resultat och slutsats Vid jämförelse av kroppspletysmografi och kvävgasutsköljning föreligger signifikant skillnad mellan samtliga variabler (p<0,001). Där kvävgasutsköljning uppmäter lägre volymer än kroppspletysmografi.
Introduction Spirometry is a commonly used examination method for validating pulmonary function and lung capacities, where total lung capacity (TLC) is of great value. Body plethysmography and multiple breath nitrogen washout are two methods that measure statical lung volumes, including TLC. The purpose of the study was to compare body plethysmography and multiple breath nitrogen washout to examine if there was a significant difference between the two methods. Material and method The study consisted of 32 test subjects, 22 women and 10 men, all examinations were performed at the Physiological Clinic at Västmansland´s Hospital Västerås between February and Mars 2021. The variables TLC, functional residual capacity/intrathoracic gas volume (FRC/ITGV) and vital capacity (VC) were measured and calculated. The result was compared against Hedenströms reference material. A paired t-test with significance level p<0,05 was used to evaluate if there was a significant difference.  Result and conclusion When comparing body plethysmography and multiple breath nitrogen washout, there is a significant difference between all variables (p<0,001). Where multiple breath nitrogen washout measures lower volumes than body plethysmography.

More spirometric analysis needs to be performed in order to discover lung diseases like chronic obstructive pulmonary disease (COPD). A mini spirometer can quickly and easily be used for screening. Today, a plethysmograph is used at the hospital in Helsingborg at the department of clinically physiology. However, they also have a mini spirometer, which is seldom used. By comparing the mini spirometer with the reference (the plethysmograph), results may indicate whether it could be possible to use the mini spirometer for screening or in other situations at the department when immediate and reliable information about lung function is needed. As a total of 45 patients participated in this study. All were examined with the mini spirometre after the conventional spirometry using a reversibility test. Of these there were 41 who were used in the study. After the conventional spirometry, they performed 4 - 7 forced expirations followed by inspirations. Theparameters investigated were FVC (forced vital capacity), FEV1 (forced expiratory vital capacity in 1 second), and FEV1/FVC. For the conventional spirometry slow VC was used, according to clinical routine. With 95 % CI the mean ・} SD was calculated to be for FVC between the 2 methods -0,19 ・} 0,30 litre. For FEV1 the results were 0,04 ・} 0,13 litre and for FEV1/FVC 0,05 ・} 0,05 litre. Paired t-test resulted for FVC in t = 4,1. FEV1 gave t= 1,79 and for FEV1/FVC was t= 6,28. The t-values were compared with t critical= 2,03 which were taken from a table. A lower t- value than t critical suggests that the methods are comparable. When comparing the difference between the both methods, FEV1 agreed well, while FVC and FEV1/FVC was too large.
Fler spirometrier behover genomforas for att upptacka lungsjukdomar som t.ex. kronisk obstruktiv lungsjukdom (KOL). En minispirometer kan snabbt och enkelt screena for detta. Pa Helsingborgs lasarett pa avdelningen for klinisk fysiologi anvands rutinmassigt enbart en plethysmograf-spirometer, trots att det dar aven finns en minispirometer. Genom att undersoka hur noggrann minispirometern ar jamfort med den vanligtvis anvanda spirometern, kan den lilla varianten i vissa fall anvandas vid t.ex. screening eller i samband med andra undersokningar dar information om lungfunktion behovs. Sammanlagt stallde 45 konsekutiva patienter upp pa analys via minispirometri efter genomford konventionell spirometri med reversibilitetstest. Av dessa anvandes 41 stycken i undersokningen. Efter den konventionella spirometrin fick de utfora 4 - 7 forcerade expirationer direkt foljt av inspirationer. De parametrar som anvandes var forcerad expiratorisk volym under den forsta sekunden (FEV1), forcerad vital kapacitet (FVC) och kvoten FEV1/FVC. For den konventionella spirometrin anvandes langsam VC enligt klinisk rutin. Med 95 % KI beraknades medelvardet och SD for skillnaden i FVC mellan de bada metoderna till -0,19 ・} 0,30 liter. For FEV1 var resultatet 0,04 ・} 0,13 liter och kvoten FEV1/FVC gav 0,05 ・} 0,05. Parat t-test gav for FVC t= 4,1. For FEV1 t= 1,79 och for kvoten FEV1/FVC t= 6,28. T- vardena jamfordes med t kritiskt = 2,03 som erholls ur en tabell. Ett lagre t- varde an tkritiskt antyder att metoderna ar tillrackligt lika. FEV1 stamde bra overens mellan de bada metoderna. Det fanns en signifikant skillnad for FVC och forkvoten FEV1/FVC.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-19Bitstream added on 2014-06-13T20:28:23Z : No. of bitstreams: 1 pancieri_mvc_me_botfm.pdf: 239148 bytes, checksum: a5902957edfc937e637168981fdf6667 (MD5)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A ressecção de tecido pulmonar funcionante leva a uma redução definitiva dos volumes e capacidades pulmonares, podendo seus valores serem preditos para o pós-operatório (ppo) através de uma regra de três simples. Como os valores espirométricos só avaliam os pulmões em repouso e não a real capacidade física do indivíduo, partiu-se da hipótese de que os testes de escada (TE) e de caminhada de 6 minutos (TC6) poderiam também se alterar proporcionalmente ao pulmão funcionante ressecado. Verificar se os testes usados como preditores de risco cirúrgico (VEF1, TC6, TE) se alteram proporcionalmente ao pulmão funcionante ressecado. O estudo incluiu pacientes candidatos a toracotomia para ressecção pulmonar que preenchiam os critérios de inclusão e concordaram em participar da pesquisa. No pré-operatório (pré) e no mínimo 3 meses após a cirurgia (pós), realizaram espirometria, teste de escada e teste de caminhada, no mesmo dia, com intervalo mínimo de 20 minutos entre os testes. A curva de capacidade vital foi realizada com o paciente sentado, pelo menos por três vezes, escolhendo-se aquela em que o VEF1 foi maior. O TC6 foi realizado segundo as normas da American Thoracic Society, em corredor plano de 120 metros à sombra. O TE foi realizado em escada com uma inclinação de 30°, à sombra, composta por 6 lances, com 12 degraus por lance (72 degraus), cada degrau medindo 16,9cm, num total de 12,16m de altura. O paciente foi orientado a subir todos os degraus no menor tempo possível, com incentivo verbal, padronizado a cada lance. O tempo em segundos percorrido na subida da altura total foi denominado tempo de escada (tTE). Os cálculos dos valores preditos para o pós-operatório (ppo) para o VEF1 e TC6 foram realizados por regra de três simples direta, a partir dos resultados...
Resection of the functioning lung tissue leads to a definite reduction in the lung volumes and capacities, and postoperative (ppo) values can be predicted through a simple rule of three. As spirometric values only evaluate lungs at rest and not the individual’s real physical capacity, stair-climbing test (SCT) and 6-minute walk test (6MW) were suggested to change proportionally to the resected functioning lung. To verify whether tests used as predictors of surgical risk (FEV1, 6MW, SCT) change proportionally to the resected functioning lung. The study included patients candidate for thoracotomy for lung resection and who fulfilled the inclusion criteria, agreeing to participate in the investigation. In the preoperative period (pre) and at least three months after surgery (pos), the patients were subjected to spirometry, stair-climbing and walk tests on the same day, with a minimal interval of 20 minutes between tests. The vital capacity curve was done with the patient sit and repeated at least three times; the curve with the highest FEV1 was chosen. 6MW was carried out, according to the American Thoracic Society standards, in a 120m plain alley in the shade. SCT was also done in the shade in a 30°-inclination staircase of 12 steps in each of the six sets (72 steps) and each step measured 16.9cm in a total of 12.16m height. The patient was instructed to climb up all steps as fast as possible, being verbally stimulated, which was standardized for each set of steps. The time in seconds for total climb-up was named stair-climbing time (tSCT). The predicted postoperative (ppo) values for FEV1 and 6MW were calculated through direct simple rule of three, based on the results obtained in the preoperative tests and according to the number of lost functioning segments; for tSCT, values were determined through inverse rule of three. The values of pre,... (Complete abstract click electronic access below)

Orientador: Ilma Aparecida Paschoal
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-24T07:53:53Z (GMT). No. of bitstreams: 1 Seixas_DanielMachado_M.pdf: 1848962 bytes, checksum: 80ebf21f0114a4503b21846263f7ad6d (MD5) Previous issue date: 2012
Resumo: O "Shuttle Walking Test" (SWT), padronizado na literatura como um teste de esforço submáximo e utilizado em pacientes com DPOC (Doença Pulmonar Obstrutiva Crônica), foi aplicado em indivíduos saudáveis para verificar se a dessaturação, após a realização deste teste, é um evento provável. Foram selecionados indivíduos saudáveis, praticantes de atividade física pelo menos 2 vezes por semana em academia de ginastica. Os indivíduos que tivessem antecedentes de doenças pulmonares e/ou cardíacas ou qualquer outra condição de saúde que impossibilitassem a realização do teste foram excluídos do estudo. Os valores de fluxo expiratório do primeiro segundo e do sexto segundo (VEF1 e VEF6) foram determinados antes da realização dos testes através de um medidor digital de pico de fluxo (Peck Flow). Outros parâmetros avaliados antes do SWT foram frequência cardíaca basal e saturação de oxigênio inicial. Logo após o final do teste foram verificados os mesmos parâmetros do início do teste. A versão do SWT utilizada neste trabalho foi a modificada, com 12 níveis de intensidade. Oitenta e três indivíduos (55 homens) foram selecionados (apenas um fumante). A idade média foi 35,05 ± 12,53. O índice de massa corporal (IMC) foi de 24,30 ± 3,47. A média de frequência cardíaca de repouso foi de 75,12 ± 12,48. A média da saturação periférica de O2 (SpO2) em repouso foi 97,96% ± 1,02%. A média do VEF1 foi de 3,75 ± 0,81 L; a média de VEF6 foi de 4,45 ± 0,87 L. A média VEF1/VEF6 foi de 0,83 ± 0,08 (sem restrição e / ou obstrução). A média de distância percorrida foi 958,30 ± 146.32m. A média da frequência cardíaca após SWT foi 162,41 ± 18,24. A média da SpO2 final foi 96,27% ± 2,21%. Onze indivíduos apresentaram maiores valores de SpO2 final; 17 indivíduos tiveram quedas na SpO2 final, igual ou superior a 4 pontos. A comparação entre os grupos, com e sem dessaturação, não mostraram diferenças em idade, sexo, VEF1, VEF6, VEF1/VEF6, saturação inicial, distância caminhada, frequência cardíaca e percentual da frequência cardíaca máxima. O IMC foi maior naqueles que dessaturaram (p = 0,01) e SpO2 final foi menor (p <0,0001). Estes resultados permitem concluir que pessoas saudáveis podem dessaturar após SWT e desta forma, a utilização do SWT para predição de doenças respiratórias leves pode não ser adequada. Dessaturação é comum em indivíduos saudáveis após o SWT, como na atividade física intensa, e pode ter efeitos deletérios.
Abstract: Aim. To perform the shuttle walk test in healthy individuals to determine if desaturation at the end of the test is a probable finding. Healthy subjects were enrolled. Antecedents of pulmonary and/or cardiac diseases or any other health condition were exclusion criteria. FEV1 and FEV6 were determined before the SWT (digital peak flow meter). Baseline heart rate and oxygen saturation were determined with a pulse oxymeter. The SWT was the 12-level version. Saturation was measured after the SWT. Results. 83 subjects (55men) were enrolled (one smoker). Mean age was 35.05±12.53. Mean body mass index (BMI) was 24.30±3.47. Mean rest heart rate was 75.12±12.48. Mean rest SpO2 was 97.96%±1.02%. Mean FEV1 was 3.75±0.81 L; mean FEV6 was 4.45±0.87 L. Mean FEV1/FEV6 was 0.83±0.08 (no restriction and/or obstruction). Mean walk distance was 958.30±146.32m. Mean heart after SWT was 162.41±18.24. Mean final SpO2 was 96.27%±2.21%. Eleven subjects had greater values of final SpO2; 17 subjects had falls in final SpO2 ? 4 points. The comparison between the groups with and without desaturation showed no differences in age, sex, FEV1, FEV6, FEV1/FEV6, initial saturation, walk distance, heart rate and percentage of maximum heart rate. BMI was higher in those who desaturate (p=0.01) and final SpO2 was smaller (p<0.0001). Conclusion. Healthy people may desaturate after SWT; its use to predict the presence of subtle respiratory disorders, may be misleading. Desaturation is common in healthy subjects after the SWT as in intense physical activity and may have deleterious effects.
Mestrado
Clinica Medica
Mestre em Clinica Medica

Orientador: José Dirceu Ribeiro
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-26T23:03:29Z (GMT). No. of bitstreams: 1 Oliveira_PricilaMaraNovaisde_D.pdf: 1258403 bytes, checksum: 7846e1b92c8fe1c6ba25524109c50608 (MD5) Previous issue date: 2015
Resumo: Introdução: Estudos recentes indicam que a espirometria não é uma ferramenta sensível para avaliar a função pulmonar em pacientes com fibrose cística (FC). A tomografia computadorizada de alta resolução (TCAR) de tórax é considerada o padrão ouro para avaliação do dano estrutural pulmonar nesses pacientes. Já a capnografia volumétrica (VCap) tem demonstrado ser uma ferramenta promissora na avaliação da homogeneidade da ventilação pulmonar. No nosso conhecimento não existem estudos comparando esses exames. Por isso o objetivo desse estudo foi avaliar e comparar os testes de VCap, espirometria e TCAR pontuada pelo escore de Bhalla modificado na avaliação da doença pulmonar em crianças e adolescentes com FC. Método: Realizou-se avaliação transversal e longitudinal de pacientes com FC de ambos os sexos fora de exacerbação pulmonar aguda. A VCap e espirometria foram realizadas no mesmo dia. A TCAR foi obtida na avaliação de rotina realizada por esses pacientes e as imagens foram pontuadas por 2 avaliadores através do escore de Bhalla modificado. Os resultados da VCap e espirometria foram correlacionados com o escore de TCAR. Os resultados obtidos pelo grupo de pacientes com espirometria normal e alterada foram comparados. Além disso, a progressão da doença pulmonar foi avaliada e comparada através dos três exames realizados. Resultados: A tese é apresentada no formato de três artigos. No capitulo 1, realizou-se uma revisão da literatura sobre VCap. No capítulo 2, realizou-se um estudo transversal com 41 pacientes com FC com idade média de 13,8 anos. O escore de TCAR médio foi 20,64 (6,5-33,5) e 14 pacientes (34,1%) tiveram espirometria normal. O índice capnográfico (KPIv) apresentou correlação com o escore de TCAR (r=0,52; p=0,001), VEF1% (r=-0,70; p<0,001) e FEF25-75% (r=-0,65; p<0,001). Porém o FEF25-75% demonstrou maior correlação com o escore de TCAR (r= -0,65; p<0,001).O KPIv e o slope III (SIII) da VCap foram maiores nos pacientes com espirometria alterada (p=0,01 e p=0,04, respectivamente). No capítulo 3, realizou-se um estudo longitudinal com 23 pacientes avaliados pelas ferramentas propostas. Tanto a espirometria, quanto o escore da TCAR e a VCap demonstraram piora da doença pulmonar no período estudado. A variação anual do escore de TCAR (+7,38%) foi maior do que a variação do KPIv (+0,32%), do FEF25-75% (-5,71%) e do VEF1% (4,39%). Pacientes com comprometimento leve da função pulmonar apresentaram maior declínio do VEF1 e menor aumento da pontuação do escore de TCAR quando comparados aos moderados e graves (p=0,02). Conclusão: A VCap é uma ferramenta útil na monitorização das doenças pulmonares em crianças e adolescentes com FC. O KPIv derivado da Vcap correlaciona-se com o escore de TCAR e espirometria. Porém, o escore de TCAR se correlaciona melhor com a espirometria do que com a VCap. Mais estudos são necessários para avaliar a habilidade do SIII e KPIv para discriminar pacientes com espirometria normal e alterada. A espirometria, VCap e TCAR detectaram piora da doença pulmonar nos pacientes avaliados. Porém, a variação anual do escore de TCAR foi maior do que a piora da função pulmonar medida pela espirometria e da homogeinidade da ventilação avaliada pela VCap. A espirometria apresentou maior declínio nos pacientes classificados como leves, enquanto o escore de TCAR variou mais em pacientes com comprometimento moderado/grave. Nossos resultados reforçam o caráter complementar das ferramentas testadas na avaliação funcional e estrutural da doença pulmonar
Abstract: Introduction: Recent studies have indicated that spirometry is not a sensitive tool to evaluate lung disease in cystic fibrosis (CF) patients. High-resolution computed tomography (HRCT) is considered the gold standard to evaluate structural lung disease. Volumetric capnography (VCap) is a promising clinical tool used to evaluate ventilation homogeneity. In our knowledge, there is no study comparing those tools. Therefore, our study aimed to evaluate and to compare the spirometry test, with VCap, and HRCT punctuated by modified Bhalla score in children and adolescents with CF. Methods: It were conducted a cross-sectional and a longitudinal study of CF patients from both genders out of acute pulmonary exacerbation. They performed VCap and spirometry in a single test occasion. HRCT was obtained in routine evaluation and images were punctuated by 2 observers with modified Bhalla score. VCap and spirometry results were correlated with HRCT scores. Patients¿ groups with normal and abnormal spirometry were compared. Besides, the progression of lung disease was assessed and compared between those three exams. Results: The thesis is presented in three papers format. In chapter 1, we presented a review of VCap. In chapter 2, we presented the cross-sectional study with 41 CF patients with mean age of 13.8 years. HRCT score mean was 20.64 (6.5-33.5) and 14 patients (34.1%) had normal spirometry values. Capnographic index (KPIv) was correlated with the HRCT score (r=0.52; p=0.001), FEV1% (r=-0.70; p<0.001), and FEF25-75% (r=-0.65; p<0.001). Although, FEF25-75% showed stronger correlation with the HRCT score (r= -0.65; p<0.001). KPIv and slope III (SIII) from VCap were higher in patients with abnormal than normal spirometry (p=0.01 and p=0.04 respectively). In chapter 3, we presented the longitudinal study of 23 patients testes with all tests proposed. Spirometry, HRCT score, and VCap demonstrated deterioration of lung disease during the period studied. The annual variation rate of HRCT score (+7.38%) was higher than KPIv (+0.32%), FEF25-75% (-5.71%), and FEV1% (4.39%). Patients with mild lung function had higher decline of FEV1% and less improvement in HRCT score when compared to patients with moderated and severe lung disease (p=0.02). Conclusions: VCap is a useful tool in monitoring lung disease in children and adolescents with CF. KPIv from VCap correlates with HRCT score and spirometry. Still, the HRCT score correlates better with spirometry than with VCap. Further studies are needed to assess the ability of SIII and KPIv to discriminate between patients with normal and abnormal spirometry. Spirometry, VCap and HRCT were able to detect deterioration in lung disease. Although, the annual variation rate of HRCT score were higher than functional decline evaluated by spirometry and ventilation inhomogeneity assessed by VCap. Spirometry had higher annual rate decline in patients with mild lung function, while HRCT score had higher improvement in moderate/severe patients. Our results reinforce the complementary role of those tested tools in functional and structural evaluation of lung disease
Doutorado
Saude da Criança e do Adolescente
Doutora em Ciências

Made available in DSpace on 2016-08-10T10:53:30Z (GMT). No. of bitstreams: 1 FABIOLA CURADO.pdf: 968004 bytes, checksum: 6b4b82075a1b0e1f620232a1879668f9 (MD5) Previous issue date: 2010-11-05
Silicosis, respiratory disease associated with occupational exposure to crystalline silica represents a serious public health problem, since, in spite of being potentially avoidable, presents high rates of incidense and prevalence, especially in less developed countries. Objectives: measure values of Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1) and Peak Expiratory Flow (PEF), verify the occurrence of respiratory symptoms characteristic of silicosis; test whether there is relevant differences between spirometric values and occurrence of respiratory symptoms length of employment, workers' age and smoking factor; test whether there is correlation between spirometric rates and length of employment, age and smoking habit. Methodology: The study was applied by descriptive analytical transversal methods. The studied sample was composed of workers from six companies in the field of stone processing industry (quarries / marble), one in Goiânia-GO district and the other five in the city of Pirenopolis-GO, totaling 56 workers. The method of data collection consisted in two questionnaires and a portable spirometry equipment. Results: Regarding the use of Collective Protection Equipment (CPE), 100% of the employees answered that there was collective protection, 73% related to ventilation with open shelter shed and 27% with semi-open shelter. Regarding to the exhaust ventilation, 100% of the employees related that there was not this kind of ventilation. Regarding the use of Personal Protective Equipment (PPE), specifically in the case of respiratory protection, the mask filter was used by 20 employees and mask without filter (made of fabric) by 36 employees. It can be stated that 100% of the workers wore masks for personal protection, covering any kind of mask, including inappropriate types. The result of the averages of the three spirometric rates presented a highly significant difference when compared to t normal average of reference (P < 0.0001). In the universe of 56 men surveyed, 40 men were symptomatic (71%). There was no statistically significant differences between spirometric values and exposure time (at about 5 years); symptomatic and asymptomatic; and between smokers and nonsmokers. There was statistically significant differences between spirometric values and age (at about 45 years old). At the correlation test showed that there was no statistically differences between spirometric rates and exposure time, number of cigarettes smoked and length of smoking habit. There was negative correlation between spirometric values and age. Conclusion: it was verified that the employees present a high percentage of symptomatic factor; for spirometric values changed significantly for the three indices studied compared with the reference literature.
Silicose, doença respiratória associada à exposição ocupacional ao cristalino, sílica, representa um sério problema de saúde pública, uma vez que, apesar de ser potencialmente evitável, apresenta altos índices de incidência e prevalência, especialmente nos países menos desenvolvidos. Objetivos: mensurar valores de Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no 1º segundo (VEF) e Pico Fluxo Expiratório (PEF); verificar a presença de sintomas respiratórios, característicos de Silicose; testar se há diferença significativa entre os valores espirométricos e presença de sintomas respiratórios, tempo de serviço, idade dos trabalhadores e fator tabagismo; testar se há correlação entre os índices espirométricos e tempo de serviço, idade e hábito tabagista. Metodologia: o estudo foi do tipo descritivo - analítico, transversal. A população estudada foi composta por trabalhadores de seis empresas do ramo de beneficiamento de pedras (pedreiras/marmorarias), uma no município de Goiânia-GO e as outras cinco no município de Pirenópolis-GO, totalizando 56 trabalhadores. Os instrumentos de coleta de dados foram dois questionários e um equipamento de espitometria portátil. Resultados: em relação ao uso de Equipamento de Proteção Coletiva (EPC), 100% dos funcionários respondeu que existia proteção coletiva; 73% referente à ventilação do galpão aberto e 27% com galpão semi-aberto. Em relação à ventilação exaustora, 100% dos funcionários afirmou que não existia esse tipo de ventilação. Referente ao uso de Equipamento de Proteção individual (EPI), tratando-se especificamente de proteção respiratória, a máscara com filtro era utilizado por 20 funcionários e a máscara sem filtro (tecido) por 36 funcionários. Pode-se afirmar que 100% dos trabalhadores usavam máscaras de proteção individual, abrangendo qualquer tipo de máscara, inclusive não apropriadas. O resultado das médias dos três índices espirométricos apresentou uma diferença altamente significativa quando comparado às médias normais de referência (p < 0,0001). Dos 56 homens pesquisados, 40 homens apresentam-se sintomáticos (71%). Não houve diferença estatística significativa entre valores espirométricos e tempo de exposição (mais ou menos de 5 anos), sintomáticos e assintomáticos e tabagistas e não tabagistas. Houve diferença estatística significativa entre valores espirométricos e idade (mais ou menos de 45 anos). No teste de correlação verificou-se que não houve diferença estatística significativa entre os índices espirométricos e tempo de exposição, número de cigarros fumados e tempo de hábito tabágico. Houve correlação negativa entre os valores espirometricos e idade. Conclusão: verificou-se que os funcionários apresentam um alto percentual de fator sintomático; para os valores espirométricos houve alteração significativa para os três índices pesquisados comparados com a literatura de referência.

Resumo: A ressecção de tecido pulmonar funcionante leva a uma redução definitiva dos volumes e capacidades pulmonares, podendo seus valores serem preditos para o pós-operatório (ppo) através de uma regra de três simples. Como os valores espirométricos só avaliam os pulmões em repouso e não a real capacidade física do indivíduo, partiu-se da hipótese de que os testes de escada (TE) e de caminhada de 6 minutos (TC6) poderiam também se alterar proporcionalmente ao pulmão funcionante ressecado. Verificar se os testes usados como preditores de risco cirúrgico (VEF1, TC6, TE) se alteram proporcionalmente ao pulmão funcionante ressecado. O estudo incluiu pacientes candidatos a toracotomia para ressecção pulmonar que preenchiam os critérios de inclusão e concordaram em participar da pesquisa. No pré-operatório (pré) e no mínimo 3 meses após a cirurgia (pós), realizaram espirometria, teste de escada e teste de caminhada, no mesmo dia, com intervalo mínimo de 20 minutos entre os testes. A curva de capacidade vital foi realizada com o paciente sentado, pelo menos por três vezes, escolhendo-se aquela em que o VEF1 foi maior. O TC6 foi realizado segundo as normas da American Thoracic Society, em corredor plano de 120 metros à sombra. O TE foi realizado em escada com uma inclinação de 30°, à sombra, composta por 6 lances, com 12 degraus por lance (72 degraus), cada degrau medindo 16,9cm, num total de 12,16m de altura. O paciente foi orientado a subir todos os degraus no menor tempo possível, com incentivo verbal, padronizado a cada lance. O tempo em segundos percorrido na subida da altura total foi denominado tempo de escada (tTE). Os cálculos dos valores preditos para o pós-operatório (ppo) para o VEF1 e TC6 foram realizados por regra de três simples direta, a partir dos resultados... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Resection of the functioning lung tissue leads to a definite reduction in the lung volumes and capacities, and postoperative (ppo) values can be predicted through a simple rule of three. As spirometric values only evaluate lungs at rest and not the individual's real physical capacity, stair-climbing test (SCT) and 6-minute walk test (6MW) were suggested to change proportionally to the resected functioning lung. To verify whether tests used as predictors of surgical risk (FEV1, 6MW, SCT) change proportionally to the resected functioning lung. The study included patients candidate for thoracotomy for lung resection and who fulfilled the inclusion criteria, agreeing to participate in the investigation. In the preoperative period (pre) and at least three months after surgery (pos), the patients were subjected to spirometry, stair-climbing and walk tests on the same day, with a minimal interval of 20 minutes between tests. The vital capacity curve was done with the patient sit and repeated at least three times; the curve with the highest FEV1 was chosen. 6MW was carried out, according to the American Thoracic Society standards, in a 120m plain alley in the shade. SCT was also done in the shade in a 30°-inclination staircase of 12 steps in each of the six sets (72 steps) and each step measured 16.9cm in a total of 12.16m height. The patient was instructed to climb up all steps as fast as possible, being verbally stimulated, which was standardized for each set of steps. The time in seconds for total climb-up was named stair-climbing time (tSCT). The predicted postoperative (ppo) values for FEV1 and 6MW were calculated through direct simple rule of three, based on the results obtained in the preoperative tests and according to the number of lost functioning segments; for tSCT, values were determined through inverse rule of three. The values of pre,... (Complete abstract click electronic access below)
Orientador: Jair Cortez Montovani
Coorientador: Daniele Cristina Cataneo
Banca: Paulo Eduardo Oliveira de Carvalho
Banca: Antonio J. M. Catâneo.
Mestre

Orientador: Dionei Ramos
Resumo: Introdução: Entre as condições crônicas de saúde, cerca de um terço dos atendimentos nas unidades de atenção básica em todo o mundo se devem às Doenças Respiratórias Crônicas. Entre elas, a asma e doença pulmonar obstrutiva crônica (DPOC) são as mais comuns. É necessário, portanto, que os profissionais das equipes da saúde da família estejam preparados para lidar com a doença, e que possam ofertar um melhor tratamento e acompanhamento do doente. Objetivos: verificar a associação das variáveis espirométricas e sintomas respiratórios com diagnóstico clínico prévio de doença respiratória crônica em idosos na atenção primária à saúde; avaliar a eficácia de três questionários de sintomas respiratórios para indicar a possibilidade de distúrbio ventilatório obstrutivo de idosos com diagnóstico prévio de DPOC. Métodos: estudo transversal, observacional com idosos com diagnóstico clínico de doença respiratória crônica como enfisema, bronquite crônica, DPOC e asma brônquica, em oito unidades de Estratégia Saúde da Família randomizadas no interior de São Paulo. Os idosos com DPOC foram divididos em dois grupos a partir dos critérios espirométricos: grupo controle com espirometria normal (G1) e grupo DPOC com distúrbio ventilatório obstrutivo (G2). Foram avaliados dados socioeconômicos, medicação prescrita e exacerbações, função pulmonar por espirometria e o impacto dos sintomas por COPD Assessment Test (CAT), dispneia pela escala do Medical Research Council modificada (mMRC) e percepção... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Among chronic health conditions, about one third of primary care units around the world are due to Chronic Respiratory Diseases. Among them, asthma and chronic obstructive pulmonary disease (COPD) are the most common. Therefore, it is necessary that family health team professionals are prepared to deal with the disease, and that they can offer better treatment and monitoring of the patient. Objectives: to verify the association of spirometric variables and respiratory symptoms with a previous clinical diagnosis of chronic respiratory disease in elderly in primary health care; to evaluate the efficacy of three respiratory symptom questionnaires to indicate obstructive ventilatory disorder in elderly with a previous diagnosis of COPD. Methods: cross-sectional, observational study of elderly with clinical diagnosis of chronic respiratory disease as emphysema, chronic bronchitis, COPD and bronchial asthma, in eight Family Health Strategy units randomized in the interior of Sao Paulo. The elderly with COPD were divided into two groups based on spirometric criteria: control group with normal spirometry (G1) and COPD group with obstructive ventilatory disorder (G2). Socioeconomic data, prescribed medication and exacerbations, lung function by spirometry and the impact of symptoms by COPD Assessment Test (CAT), dyspnea to Medical Research Council modified scale (mMRC) and perception of quality of life by Chronic Respiratory Questionnaire (CRQ). Results: 89 elderly were ... (Complete abstract click electronic access below)
Doutor

This study investigated the effect of caffeine on airway resistance. The subjects were drawn from volunteers (18-90 years old) in good health, with no major cardiopulmonary conditions. We found no association between the consumption of a single cup of the caffeinated beverage coffee and a decrease in airway resistance within one hour in a normal sample of subjects as measured by impulse oscillometry nor with conventional spirometry . It appears that any possible bronchodilatory effect of the caffeine from a single cup of coffee in a normal population is below the limit of detection of spirometry and impulse oscillometry or is not sufficiently expressed in the one hour time frame of the study. The study did validate currently accepted methods of using the Jaeger impulse oscillometry (IOS) measurement for use at the University of South Florida (USF). The impulse oscillometry technique was found to be a useful adjunct to conventional pulmonary function testing. Conventional pulmonary function testing provides a useful measure of a person's ability to breathe yet is difficult to perform and only indirectly guides the physician to the diagnosis of the pathology behind the person's breathing difficulties. The impulse oscillometry technique may help the physician to noninvasively determine the location of a pulmonary obstruction by measurement of the dynamics of sound wave travel through the airways of the lungs.

Spirometry (lung function assessment) is an essential tool for the chronic disease management of chronic obstructive pulmonary disease (COPD). Chronic disease monitoring for COPD was introduced in 2004 and included spirometry for target achievement and financial remuneration within the Quality and Outcomes Framework of the General Medical Services Contract. However, practice nurses have anecdotally struggled to gain competence and expertise with the spirometric procedure and interpretation post 2004, despite the successful achievement of financial targets within the general practice setting. A sequential exploratory mixed methods study (Tashakkori and Teddlie, 2003) was undertaken within a University Health Board in Wales to determine what, if any, barriers exist for practice nurses undertaking spirometry assessment and interpretation for the chronic disease management of COPD. Quantitative data were collected via an online questionnaire. Qualitative interviews were conducted and analysed using an analysis framework method (Ritchie et al, 2003). The methodological framework of the feminist transformative lens (Caracelli and Greene, 1997) was utilised to gain an understanding of the barriers practice nurses faced in the gaining of competence with spirometry assessment and interpretation within the wider professional context. The quantitative results confirmed the anecdotal reports of difficulty with spirometry and demonstrated that lack of training was the greatest reason for lack of confidence in spirometric interpretation, followed by lack of clinical time and lack of general practitioner (GP) support. The qualitative results demonstrated that practice nurses are commonly working as disenfranchised isolated practitioners within general practice teams, and are commonly undertaking a procedure in which they are not highly confident. Recommendations for development of future clinical practice are: mandatory training with assessment of competency to improve skills with spirometry, in addition to supervisory support and training of GP colleagues. Other recommendations include: a greater focus on inter-professional team working to reduce professional isolation and disenfranchisement of practice nurses, and for practice nurses to actively contribute to local and national initiatives to improve spirometry services in the long term.

Syftet med studien var att jämföra livskvalitet, kunskap om KOL och antal patienter som inlett ett rökstopp där en grupp erhöll standard vård och en annan grupp förutom standard vård även fick ett strukturerat omhändertagande på en distriktssköterskeledd KOL- mottagning med undervisning i egenvård.Studien genomfördes med kvasiexperimentell design. Urvalet var 52 patienter från primärvården med diagnosen KOL. Patienterna matchades utifrån kön, sjukdomens svårighetsgrad och slumpades sen till två grupper, en interventionsgrupp och en jämförandegrupp. Jämförandegruppen erhöll standardvård medan interventionsgruppen utöver standardvård erhöll två utbildningsbesök i egenvård hos astma KOL-sjuksköterskan på en vårdcentral i mellansverige.Som datainsamlingsmetod har två enkäter använts. En enkät som innehöll frågor om kön, ålder, civilstånd, utbildning, upplevd kunskap om KOL och rökstatus samt en enkät som hade till syfte att ge information om hur andningsbesvären påverkar patientens livskvalitet. Båda grupperna har svarat på enkäterna vid två tillfällen, vid det första besöket och vid det sista besöket efter tre månader. Interventionsgruppen har däremellan fått två utbildningsbesök.Resultaten visade statistiskt säkerställda skillnader mellan grupperna gällande livskvalitet, rökstopp och kunskaper om KOL. Interventionsgruppen hade fått minskade andningsbesvär, hade ökat sin fysiska aktivitet och fått en bättre psykosocial hälsa. Medan jämförande gruppen hade försämrats något i alla dessa avseenden. I interventionsgruppen hade sex av sexton rökande patienter slutat att röka, medan ingen hade slutat av de fjorton rökande patienterna i jämförandegruppen. Patienterna i interventions- gruppen hade också väsentligen större kunskaper om sin sjukdom jämfört med patienterna i jämförandegruppen.