Clinical and genetic markers in disease progression – a study among subjects with obstructive lung diseases

Asthma, COPD, and asthma and COPD overlap syndrome (ACOS) are chronic pulmonary diseases with an obstructive component. In COPD, the obstruction is irreversible and the disease is progressive. The aim of the study was to define and analyze factors that affected disease progression and patients’ well-being, prognosis and mortality in Chronic Airway Disease (CAD) cohort. The main focus was on COPD and ACOS patients. Retrospective data from medical records was combined with genetic and prospective follow-up data. Smoking is the biggest risk factor for COPD and even after the diagnosis of the disease, smoking plays an important role in disease development and patient’s prognosis. Sixty percent of the COPD patients had succeeded in smoking cessation. Patients who had managed to quit smoking had lower mortality rates and less psychiatric diseases and alcohol abuse although they were older and had more cardiovascular diseases than patients who continued smoking. Genetic polymorphism rs1051730 in the nicotinic acethylcholine receptor gene (CHRNA3/5) associated with heavy smoking, cancer prevalence and mortality in two Finnish independent cohorts consisting of COPD patients and male smokers. Challenges in smoking cessation and higher mortality rates may be partly due to individual patient’s genetic composition. Approximately 50% of COPD patients are physically inactive and the proportion was higher among current smokers. Physically active and inactive patients didn’t differ from each other in regard to age, gender or comorbidities. Bronchial obstruction explained inactivity only in severe disease. Subjective sensation of dyspnea, however, had very strong association to inactivity and was also associated to low health related quality of life (HRQoL). ACOS patients had a significantly lower HRQoL than either the patients with asthma or with COPD even though they were younger than COPD patients, had better lung functions and smaller tobacco exposure.

Effet d’une orthèse d’avancement mandibulaire neutre combinée à un masque facial et nasal dans le traitement de l’apnée obstructive du sommeil par CPAP

Le traitement de première ligne de l’apnée obstructive du sommeil est l’appareil à pression positive, soit le CPAP, qui est le plus souvent utilisé avec un masque nasal. Certains patients, incapables de tolérer le masque nasal, doivent se tourner vers le masque facial, qui peut parfois requérir une pression supérieure à celle utilisée avec le masque nasal pour éliminer tous les événements respiratoires. Nous supposons que l’ajustement serré du masque facial, dans le but de réduire les fuites, entraîne une pression de recul sur la mandibule; ceci diminuerait le calibre des voies aériennes supérieures, nécessitant donc une pression effective thérapeutique supérieure pour rétablir un passage de l’air. Nos objectifs étaient : 1) de démontrer s’il y avait une différence de pression effective entre le masque nasal et le masque facial, 2) de quantifier la fuite entre les deux masques, 3) d’évaluer l’effet d’une orthèse de rétention mandibulaire neutre (OMN), qui empêche le recul mandibulaire, sur la pression effective des deux masques et 4) d’évaluer s’il existait un lien entre la céphalométrie et les réponses variables des individus. Méthodologie : Lors de cette étude expérimentale croisée, huit sujets (2 femmes, 6 hommes) avec une moyenne d’âge de 56,3ans [33ans-65ans] ont reçu un examen orthodontique complet incluant une radiographie céphalométrique latérale. Ils ont ensuite passé deux nuits de polysomnographie au laboratoire du sommeil en protocole « split-night » où les deux masques ont été portés, seuls, la première nuit, et avec l’OMN, la deuxième nuit. Résultats : Nous avons trouvé que la pression effective thérapeutique était supérieure avec le masque facial comparativement au masque nasal de manière statistiquement significative. Nous avons observé une fuite supérieure avec le masque nasal, ce qui permet de dire que la fuite n’explique probablement pas cette différence de pression entre les deux masques. L’OMN n’a pas donné d’effet statistiquement significatif lorsque combinée au masque nasal, mais il aurait probablement été possible de trouver un effet positif avec le masque facial si le Bi-PAP avait été inclus dans le protocole de recherche. Conclusion : Nos résultats ne permettent pas de confirmer le rôle du recul mandibulaire, causé par la force exercée avec le masque facial, dans l’obtention de pressions supérieures avec ce masque, mais nous ne pouvons toutefois pas éliminer l’hypothèse. Les résultats suggèrent également que ce phénomène est peut-être plus fréquent qu’on ne le croit et qu’il pourrait y avoir un lien avec certains facteurs anatomiques individuels.

Quality of life and Chronic Obstructive Pulmonary Disease

The Chronic Obstructive Pulmonary Disease (COPD) has a progressive and irreversible character and it’s associated to the triad of dyspnea, exercise limitation and the evident deterioration of quality of life. In the United States the prevalence of COPD in adult population is approximately of 6% in men, and 1 to 3% in women and it’s the fourth cause of mortality by no transmissible chronic diseases. In 1993, the National Health Interview Surgery considered that 12 millions of Americans suffer from chronic bronchitis and 2 million had emphysema. These two affections are responsible for more than 13% of the hospitalizations. As this affection progresses, patients experience a diminution in quality of life related to health (CVRS), their capacity to work get worse and their participation in physical and social activities reduces. Nevertheless, it has been confirmed that the isolated evaluation of COPD seriousness, defined by the reduction of the Forced Expiratory Volume in the First Second (FEV1), does not provide enough information to know the health state perceived by the patients. The fact that the CVRS is the result of the interaction of multiple physical, psychological and social factors, unique for each individual, can explain this finding. This paper is a general and updated approach to the integral handling of patients with COPD, and it discusses the concept of quality of life, related to health improvement.

Influence of pursed-lip breathing on heart rate variability and cardiorespiratory parameters in subjects with chronic obstructive pulmonary disease (COPD)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Step Counting and Energy Expenditure Estimation in Patients With Chronic Obstructive Pulmonary Disease and Healthy Elderly: Accuracy of 2 Motion Sensors

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estimation of Maximal Work Rate Based on the 6-Minute Walk Test and Fat-Free Mass in Chronic Obstructive Pulmonary Disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Is walking in daily life a moderate intensity activity in patients with chronic obstructive pulmonary disease?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fractal correlation property of heart rate variability in chronic obstructive pulmonary disease

Background: It was reported that autonomic nervous system function is altered in subjects with chronic obstructive pulmonary disease (COPD). We evaluated short-and long-term fractal exponents of heart rate variability (HRV) in COPD subjects.Patients and methods: We analyzed data from 30 volunteers, who were divided into two groups according to spirometric values: COPD (n = 15) and control (n = 15). For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 30 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal] and RMSSD [root-mean square of differences]) and frequency domains (low frequency [LF], high frequency [HF], and LF/HF), and the short-and long-term fractal exponents were obtained by detrended fluctuation analysis. We considered P < 0.05 to be a significant difference.Results: COPD patients presented reduced levels of all linear exponents and decreased short-term fractal exponent (alpha-1: 0.899 +/- 0.18 versus 1.025 +/- 0.09, P = 0.026). There was no significant difference between COPD and control groups in alpha-2 and alpha-1/alpha-2 ratio.Conclusion: COPD subjects present reduced short-term fractal correlation properties of HRV, which indicates that this index can be used for risk stratification, assessment of systemic disease manifestations, and therapeutic procedures to monitor those patients.

Echocardiographic abnormalities in children with obstructive breathing disorders during sleep

Objectives: To assess cardiac morphology and function by means of echocardiograms of children with obstructad breathing while asleep.Methods: the study enrolled 40 children of both sexes, aged from 3 to 11 years; 30 of them had obstructed breathing during sleep (group I) and 10 children were healthy controls (group II). The two groups were similar in terms of sex, age, weight and height. The 40 children underwent echocardiogram, viewing all four chambers during systole and diastole, paying special attention to the right ventricle (RV). These data were compared by means of Student's t test (p < 0.05).Results: In group I, increased diameter and area of the right ventricle were observed during both systole and diastole. There was less variation in RV area between systole and diastole. Reduced left ventricle (LV) diastolic diameter was also observed, together with reduced ejection fraction and reduced contraction.Conclusions: the morphological and functional cardiac abnormalities observed in the RV and LV suggest that, in children, obstructed breathing during sleep can lead to cardiovascular repercussions. These abnormalities may expose these children to increased anesthetic and surgical risks.

Effects of isolated cycle ergometer training on patients with moderate-to-severe chronic obstructive pulmonary disease

Background: Pulmonary rehabilitation (PR) programs are beneficial to patients with chronic obstructive pulmonary disease (COPD), and lower-extremity training is considered a fundamental component of PR. Nevertheless, the isolated effects of each PR component are not well established. Objective: We aimed to evaluate the effects of a cycle ergometry exercise protocol as the only intervention in a group of COPD patients, and to compare these results with a control group. Methods: 25 moderate-to-severe COPD patients were evaluated regarding pulmonary function, respiratory muscle strength, exercise capacity, quality of life and body composition. Patients were allocated to one of two groups: (a) the trained group (TG; n=13; 6 men) was submitted to a protocol of 24 exercise sessions on a cycle ergometer, with training intensity initially set at a heart rate (HR) close to 80% of maximal HR achieved in a maximal test, and load increase based on dyspnea scores, and (b) the control group (CG; n=12; 6 men) with no intervention during the protocol period. Results: TG showed within-group significant improvements in endurance cycling time, 6-min walking distance test, maximal inspiratory pressure and in the domain 'dyspnea' related to quality of life. Despite the within-group changes, no between-group significant differences were observed. Conclusion: In COPD patients, the results of isolated low-to-moderate intensity cycle ergometer training are not comparable to effects of multimodality and high-intensity training programs. Copyright (C) 2004 S. Karger AG, Basel.

Effects of low fat and babassu fat diets on nutritional status in obstructive cholestasis in young rats

OBJETIVO: Testar os efeitos de uma dieta com baixo teor de gordura comparada a uma dieta com gordura de babaçu sobre o estado nutricional em ratos jovens com colestase obstrutiva. MÉTODOS: Submetemos 40 ratos divididos em quatro grupos de 10 animais a partir do P21 (21º dia pós-natal) até o P49 a dois dos seguintes tratamentos: ligadura e ressecção do ducto biliar comum ou operação simulada e dieta com baixo teor de gordura (óleo de milho fornecendo 4,5% da quantidade total de calorias) ou dieta com gordura de babaçu (essa gordura fornecendo 32,7% e óleo de milho fornecendo 1,7% da quantidade total de calorias). Foi mensurado o ganho de peso a cada 4 dias do P25 ao P49. A função de crescimento de Verhulst foi ajustada aos valores de ganho de peso. A velocidade e a aceleração de crescimento nos mesmos momentos foram estimadas usando a mesma equação. Foram mensurados: quantidade de ração ingerida e ingestão energética total do P21 ao P49, utilização de energia do P25 ao P49, gordura absorvida e balanço de nitrogênio (BN) do P42 ao P49. A ANOVA com dois fatores e o método de S.N.K para comparações pareadas foram utilizados para estudar os efeitos, sobre as variáveis, da colestase e das dietas e sua interação (p<0,05). RESULTADOS: em ratos com colestase e dieta com baixo teor de gordura, houve maior velocidade de crescimento no P45, maior aceleração de crescimento no P41 e P45, maior utilização de energia, maior percentual de gordura absorvida e maior BN do que em ratos com colestase e dieta com gordura de babaçu. CONCLUSÃO: A dieta com baixo teor de gordura atenua a restrição de crescimento provocada pela colestase e proporciona melhor aproveitamento da dieta e maior incorporação da proteína ingerida do que a dieta com gordura de babaçu.

Anthropometric midarm measurements can detect systemic fat-free mass depletion in patients with chronic obstructive pulmonary disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of three exercise programs on patients with chronic obstructive pulmonary disease

We compared the effect of three different exercise programs on patients with chronic obstructive pulmonary disease including strength training at 50_80% of one-repetition maximum (1-RM) (ST; N = 11), low-intensity general training (LGT; N = 13), or combined training groups (CT; N = 11). Body composition, muscle strength, treadmill endurance test (TEnd), 6-min walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and baseline dyspnea (BDI) were assessed prior to and after the training programs (12 weeks). The training modalities showed similar improvements (P > 0.05) in SGRQ-total (ST = 13 ± 14%; CT = 12 ± 14%; LGT = 11 ± 10%), BDI (ST = 1.8 ± 4; CT = 1.8 ± 3; LGT = 1 ± 2), 6MWT (ST = 43 ± 51 m; CT = 48 ± 50 m; LGT = 31 ± 75 m), and TEnd (ST = 11 ± 20 min; CT = 11 ± 11 min; LGT = 7 ± 5 min). In the ST and CT groups, an additional improvement in 1-RM values was shown (P < 0.05) compared to the LGT group (ST = 10 ± 6 to 57 ± 36 kg; CT = 6 ± 2 to 38 ± 16 kg; LGT = 1 ± 2 to 16 ± 12 kg). The addition of strength training to our current training program increased muscle strength; however, it produced no additional improvement in walking endurance, dyspnea or quality of life. A simple combined training program provides benefits without increasing the duration of the training sessions.