4 resultados para Asthma
em Universidade Federal do Rio Grande do Norte(UFRN)
Resumo:
Objectives: To evaluate how to develop dynamic hyperinflation (DH) during exercise, the influence of pursed-lip breathing in (PLB) on breathing pattern and operating volume in patients with asthma. Methods: We studied 12 asthmatic patients in three moments: (1) anthropometry and spirometry, (2) submaximal incremental cycle ergometer test in spontaneous breathing and (3), submaximal incremental test on a cycle ergometer with PLB using the Opto-electronic plethysmography. Results: Evaluating the end-expiratory lung volume (EEV) during submaximal incremental test in spontaneous breathing, patients were divided into euvolume and hyperinflated. The RFL has increased significantly, the variation of the EEV group euvolume (1.4L) and decreased in group hyperinflated (0.272L). In group volume observed a significant increase of 140% in Vt at baseline, before exercise, comparing the RFL and spontaneous breathing. Hyperinflated group was observed that the RFL induced significant increases of Vt at all times of the test incremental baseline, 50%, 100% load and 66% recovery, 250%, 61.5% and 66% respectively. Respiratory rate decreased significantly with PLB at all times of the submaximal incremental test in the group euvolume. The speed of shortening of inspiratory muscles (VtRcp/Ti) in the hyperinflated increased from 1.6 0.8L/s vs. 2.55 0.9L/s, whereas in the RFL euvolume group ranged from 0.72 0.31L/s vs. 0.65 0.2L/s. The velocity of shortening of the expiratory muscles (VtAb/Te) showed similarity in response to RFL. In group hyperinflated varied vs. 0.89 0.47 vs. 0.80 0.36 and 1.17 1L vs. 0.78 0.6 for group euvolume. Conclusion: Different behavior in relation to EEV in patients with moderate asthma were observed, the HD and decreased EEV in response to exercise. The breathing pattern was modulated by both RFL performance as at home, making it more efficient
Resumo:
Introduo: A asma se tornou um problema de sade pblica devido aos seus grandes custos em cuidados de sade. Os exerccios respiratrios constituem uma interveno no farmacolgica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes pases no tratamento de pacientes asmticos. Objetivo: Avaliar a eficcia dos exerccios respiratrios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, nmero de exacerbaes agudas, episdios de hospitalizao, mensuraes fisiolgicas (funo pulmonar e capacidade funcional), nmero de consultas mdicas, nmero de faltas no trabalho devido a exacerbaes da doena, avaliao subjetiva do paciente em relao interveno. Mtodo: Reviso sistemtica de estudos controlados randomizados com metanlise realizada em parceria com a Colaborao Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, alm de busca manual em revistas da rea e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referncias dos estudos selecionados e registros de ensaios clnicos tambm foram consultados. A seleo dos estudos e a avaliao do risco de vis dos estudos includos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para anlise dos dados, no qual o modelo de efeito fixo foi utilizado. As variveis contnuas foram expressas como diferena de mdia ponderada com um intervalo de confiana de 95%. A heterogeneidade dos resultados dos estudos includos foi realizada por meio da anlise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significncia estatstica. O ndice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nvel substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes esto atualmente includos na reviso. Os seguintes desfechos foram mensurados pelos estudos includos: qualidade de vida, sintomas da asma, nmero de exacerbaes agudas e funo pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e nmero de exacerbaes agudas. Seis dos onze estudos que avaliaram funo pulmonar mostraram uma diferena significativa favorvel aos exerccios respiratrios. No houve relato de efeitos adversos. Devido heterogeneidade substancial encontrada entre os estudos, metanlise foi possvel apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferena significativa favorvel aos exerccios respiratrios. A avaliao do risco de vis foi prejudicada devido ao relato incompleto de aspectos metodolgicos pela maioria dos estudos includos. Concluso: Embora os resultados encontrados pelos estudos includos demonstraram individualmente que os exerccios respiratrios podem ser importantes no tratamento da asma, no h evidncia conclusiva nesta reviso para suportar ou refutar a eficcia desta interveno no tratamento de pacientes asmticos. Este fato foi devido s diferenas metodolgicas entre os estudos includos e ausncia de relato de aspectos metodolgicos por parte da maioria dos estudos includos. No h dados disponveis em relao aos efeitos dos exerccios respiratrios nos seguintes desfechos: episdios de hospitalizao, nmero de consultas mdicas, nmero de faltas no trabalho devido a exacerbaes da doena, e avaliao subjetiva do paciente em relao interveno
Resumo:
In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma
Resumo:
Asthma treatment aims to achieve and maintain the control of the disease for prolonged periods. Inspiratory muscle training (IMT) may be an alternative in the care of patients with asthma, and it is used as a complementary therapy to the pharmacological treatment. Thus, the aim of this study was to investigate the effects of a domiciliary program of IMT on the electromyographic activity of the respiratory muscles in adults with asthma. This is a clinical trial in which ten adults with asthma and ten healthy adults were randomized into two groups (control and training). The electrical activity of inspiratory muscles (sternocleidomastoid (ECM) and diaphragm) was obtained by a surface electromyography. Furthermore, we assessed lung function (spirometry), maximal inspiratory pressure - MIP - (manometer). The functional capacity was evaluated by six minute walk test. Participants were assessed before and after the IMT protocol of 6 weeks with POWERbreathe device. The training and the control groups underwent IMT with 50% and 15 % of MIP, respectively. The sample data were analyzed using SPSS 20.0, attributing significance of 5 %. Were used t test, ANOVA one way and Pearson correlation. It was observed an increase in MIP, after IMT, in both training groups and in healthy sham group (P < 0.05), which was accompanied by a significant increase in ECM activity during MIP in healthy training group (1488 %) and in asthma training group (ATG) (1186.4%). The ATG also showed a significant increase in diaphragm activity in basal respiration (48.5%). Functional capacity increased significantly in the asthma sham group (26.5 m) and in the asthma training group (45.2 m). These findings suggest that IMT promoted clinical improvements in all groups, especially the ATG, which makes it an important complementary treatment for patients with asthma
