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Archivos de Bronconeumología 12/2011; 48(4):105-6. · 2.17 Impact Factor
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ABSTRACT: The influence of gender in the clinical expression of COPD has received important attention. Limited information exists regarding gender differences in the skeletal muscle characteristics in COPD subjects. The present study was aimed to determine the differences in the skeletal muscle characteristics in men and women with and without COPD.
For comparison we studied 24 female (61 ± 9 years) and 30 male (65 ± 8 years) COPD patients with similar disease severity. In addition healthy subjects, 17 women (58 ± 8 years), and 9 men (57 ± 8 years) were studied. Pulmonary function, health status, six minute walk distance test (6MWD) and vastus lateralis muscle biopsy were assessed. Fiber type proportion, fiber type cross sectional area (CSA), capillary counts, and activity of citrate synthase (CS), 3-hydroxyacyl-CoA-dehydrogenase (HAD) and lactate-dehydrogenase (LDH) were determined.
Pulmonary function, health status and 6MWD were similar in male and female COPD patients. Fiber type distribution was similar between women (I = 42 ± 9%, IIA = 39 ± 13%, IIX = 19 ± 7%) and men (I = 39 ± 13%, IIA = 38 ± 9%, IIX = 29 ± 10%) with COPD, as well as CSA, capillarity and enzymes (CS 8.59 ± 1.6 vs.9.74 ± 2.6, HAD 9.03 ± 1.9 vs. 9.84 ± 2.5, LDH 124 ± 48 vs. 151 ± 68 μmol min(-1) g(-1)). In normal subjects a decrease in type IIX fibers CSA was found in women compared with men (3703 ± 1478 vs. 5426 ± 1386 μm(2), respectively).
Female and male with COPD have similar skeletal muscle characteristics; it is possible that the disease blurs the gender differences. On the other hand, there seems to be fewer differences in muscle characteristics between older men and women, perhaps due to lower male testosterone levels and physical inactivity.
Respiratory medicine 01/2011; 105(1):88-94. · 2.33 Impact Factor
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ABSTRACT: In patients with chronic obstructive pulmonary disease (COPD), lactate dehydrogenase (LDH) levels in skeletal muscles are normal or tend to be elevated; on exercise, these levels increase more rapidly than in individuals without COPD. As it is likely that concentrations of LDH isozymes LDH(4) and LDH(5) are elevated in such patients, we measured those isozymes in peripheral muscle of patients with COPD.
Eighteen patients with COPD and 10 healthy nonsmokers were included in the study. Spirometry and the 6-minute walk test were performed, and a biopsy of the quadriceps muscle was taken to measure levels of both total LDH and LDH isozymes by agarose gel electrophoresis and to classify the types of muscle fibers.
Controls and patients had similar concentrations of total LDH (mean [SE], 130 [30]micromol/min/g vs 152 [50]micromol/min/g, respectively) and LDH isozymes. A subgroup of 5 patients showed increased levels of isozymes LDH(1), LDH(2), and LDH(3), with decreased LDH(5) levels; these patients were women and had a lower oxygen saturation. The LDH(5) level was directly correlated with the 6-minute walk test and oxygen saturation. The percentage of type IIA fibers correlated directly with LDH(3) and LDH(4) concentrations whereas type IIX fibers were inversely correlated with LDH(3) concentration.
Measurement of LDH isozyme concentrations enabled a subgroup of patients to be identified with a higher concentration of cardiac isoenzymes and lower concentration of muscle isoenzymes, a situation which might indicate adaptation that favors aerobic metabolism.
Archivos de Bronconeumología 03/2009; 45(2):75-80. · 2.17 Impact Factor
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ABSTRACT: PLATINO project is a population-based study designed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in São Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago de Chile, Chile; and Caracas, Venezuela. The objective of this portion of PLATINO was to describe preventive and pharmacological treatment of COPD patients and factors associated with such treatment.
Eligible subjects completed a questionnaire and underwent postbronchodilator spirometry.
Of the total of 5529 individuals who answered items referring to treatment, 758 had COPD (ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity of <0.7), and 86 of them had been previously diagnosed by a physician. Among all COPD patients, only half of smokers or former smokers had been advised to quit and 24.7% had received some type of respiratory medication. Only 13.5% had used inhaled corticosteroids, and those were the patients with the most severe disease. In the group of patients who had a previous medical diagnosis of COPD, 69% of the smokers or former smokers had been advised to quit by a physician and 75.6% had received respiratory medication in the preceding year: 43% reported having used inhaled medication and 36% had used bronchodilators. Rates of vaccination against influenza and the use of mucolytic drugs and inhalers varied from one health care facility to another. All drug prescriptions were based on previous spirometry.
Spirometry emerged not only as a diagnostic tool, but also as a factor associated with treatment, against a background of uneven use of available health care resources in these 5 Latin American cities.
Archivos de Bronconeumología 02/2008; 44(2):58-64. · 2.17 Impact Factor
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Rogelio Pérez-Padilla,
Luis Torre Bouscoulet,
Juan Carlos Vázquez-García,
Adriana Muiño,
María Márquez,
María Victorina López, María Montes de Oca,
Carlos Tálamo,
Gonzalo Valdivia,
Julio Pertuze,
José Jardim,
Ana María B Menezes
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ABSTRACT: The criteria for disease severity established by the Global Initiative for Chronic Obstructive Lung Disease are based on forced expiratory volume in 1 second (FEV1) expressed as a percentage of the predicted value after application of a bronchodilator. This study aims to determine postbronchodilator spirometry reference values.
A cluster sample of subjects aged 40 years or over was chosen to be representative of the metropolitan areas of 5 Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, and Caracas). Spirometry was performed on 5183 subjects following the recommendations of the American Thoracic Society before and after inhalation of 200 microg of salbutamol. Multiple linear regression equations were fitted for the postbronchodilator spirometric values-FEV1, forced expiratory volume in 6 seconds (FEV6), peak expiratory flow rate, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). These were adjusted for sex, age, and height in 887 asymptomatic subjects with no history of lung disease.
The postbronchodilator reference values for FEV1, FEV1/FVC, and FEV1/FEV6 were on average 3% higher than those obtained before bronchodilation. This apparently small difference caused an upward shift in the 5th percentile (lower limit of normal) of the predicted values. When prebronchodilation instead of postbronchodilation reference values were used, 3.2% of the results for airflow obstruction in our population of over-40-year-olds were false negatives.
The reported reference values are more appropriate for postbronchodilator spirometry and make it possible to reduce the number of misclassifications.
Archivos de Bronconeumología 11/2007; 43(10):530-4. · 2.17 Impact Factor
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Rogelio Pérez-Padilla,
Pedro Curi Hallal,
Juan Carlos Vázquez-García,
Adriana Muiño,
María Máquez,
María Victorina López, María Montes de Oca,
Carlos Tálamo,
Gonzalo Valdivia,
Julio Pertuzé,
Jose Jardim,
Ana Maria B Menezes
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ABSTRACT: The aim of this study was to describe the impact of using bronchodilators on the prevalence of Chronic Obstructive Pulmonary Disease in a population-based survey (Platino study). A cluster sampling of subjects 40 years of age or older, representative of the metropolitan areas of 5 Latin American cities (Sao Paulo, Mexico, Montevideo, Santiago and Caracas) was chosen. Spirometry according to ATS standards was done before and after inhalation of 200 micrograms of salbutamol in 5183 subjects. Prevalences of airflow obstruction were estimated using different criteria, in tests done before and after bronchodilator use, and with reference values for pre- or post-bronchodilator use. Bronchodilator testing reduced the overall prevalence of FEV(1)/FVC% < 0.70 from 21.7% to 14% (35%). In the group with FEV(1)/FVC < 0.70 after bronchodilator use, 21% were asymptomatic from the respiratory point of view, and lacked significant adverse exposures. Subjects below the 5th percentile for FEV(1)/FVC and FEV(1)/FEV(6) were fewer than those with FEV(1)/FVC < 0.70, especially among the elderly. More subjects are below the 5th percentile of FEV(1)/FVC and FEV(1)/FEV(6) using reference values for tests after bronchodilator use than using the reference values determined without bronchodilator testing. Testing after bronchodilator use reduces the prevalence of airflow obstruction from 32 to 39% depending on the definition used. In addition, the subjects who were still obstructed after bronchodilator use were the ones who showed more respiratory symptoms and exposure to tobacco and other smokes and dusts, than subjects with reversible obstruction, suggesting an increased specificity for COPD.
COPD Journal of Chronic Obstructive Pulmonary Disease 07/2007; 4(2):113-20. · 1.79 Impact Factor
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Rogelio Pérez-Padilla,
Juan Carlos Vázquez-García,
María Nelly Márquez,
José Roberto B Jardim,
Julio Pertuzé,
Carmen Lisboa,
Adriana Muiño,
María Victorina López,
Carlos Tálamo, María Montes de Oca,
Gonzalo Valdivia,
Ana Maria B Menezes
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ABSTRACT: We report the performance of an ultrasound-based portable spirometer (EasyOne) used in a population-based survey of the prevalence of chronic obstructive pulmonary disease, conducted in 5 Latin American cities: São Paulo, Brazil; México City, México; Montevideo, Uruguay; Santiago, Chile; and Caracas, Venezuela (the Latin American COPD Prevalence Study [PLATINO]).
During the survey period (which ranged from 3 months to 6 months in the various locations) we collected daily calibration data from the 70 EasyOne spirometers used in the 5 survey cities. The calibrations were conducted with a 3-L syringe, and the calibration data were stored in the spirometer's database.
Ninety-seven percent of the calibration volumes were within +/- 64 mL (2.1%) of the 3-L calibration signal. Excluding data from the first city studied (São Paulo), where one calibration syringe had to be replaced, 98% of the calibration checks were within +/- 50 mL (1.7%). The measured volume was affected only minimally by the syringe's peak flow or emptying time.
In these 70 EasyOne spirometers neither calibration nor linearity changed during the study. Such calibration stability is a valuable feature in spirometry surveys and in the clinical setting.
Respiratory care 11/2006; 51(10):1167-71. · 2.01 Impact Factor
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ABSTRACT: The present study evaluated the relationship between health status (HS) and peripheral muscle histochemical characteristics in chronic obstructive pulmonary disease (COPD), and identified selected independent respiratory and extrapulmonary variables that predicted the HS of these patients.
Cross-sectional study.
Outpatient respiratory clinic of a university hospital.
We studied 29 patients (63+/-10 yrs) with a forced expiratory volume in 1s (FEV1) of 39+/-12%. All patients underwent vastus lateralis muscle biopsies for histochemical analysis. They also had spirometry, arterial blood gas analysis, body mass index (BMI), dyspnea determined with the MMRC scale and responded to the St. George's Respiratory Questionnaire (SGRQ) for HS assessment.
SGRQ total score correlated with fiber type distribution. A stepwise multiple regression identified three independent predictors of SGRQ total score: type I fiber proportion, BMI, and FEV1; r = 0.78 and r2 = 0.61.
These results indicate that impaired HS in COPD is related to the peripheral muscle changes characterized by less type I fibers proportion. The findings argue in favor of an important contribution of the systemic consequences on the HS in COPD independently from the airflow limitation severity, and help to explain the observation of the poor correlation between the degree of airflow limitation and SGRQ total score.
Respiratory Medicine 11/2006; 100(10):1800-6. · 2.47 Impact Factor
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Rogelio Pérez-Padilla,
Gonzalo Valdivia,
Adriana Muiño,
María Victorina López,
María Nelly Márquez, María Montes de Oca,
Carlos Tálamo,
Carmen Lisboa,
Julio Pertuzé,
José Roberto B Jardim,
Ana María B Menezes
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ABSTRACT: In clinical practice, spirometry is a extremely useful test that requires strict quality control, an appropriate strategy for interpretation, and reliable reference values. The aim of this study was to report spirometric reference values for 5 cities in Latin America.
From data for 5315 subjects who had undergone spirometry in the PLATINO study in Caracas, Mexico City, Santiago, São Paulo, and Montevideo, we selected information for 906 (17%) individuals aged between 40 years and 90 years to provide reference values. The chosen subjects had never smoked, were asymptomatic, had not been diagnosed with lung disease, and were not obese. Multiple regression models were constructed with the following spirometric parameters: forced expiratory volume in 1 second (FEV1) and in 6 seconds (FEV6), peak expiratory flow, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC, and forced midexpiratory flow rate. Height, sex, and age were also included in the model.
Average values for the subjects studied were similar to those for the white North American population and the Mexican-American population of the third National Health and Nutrition Examination Survey, but exceeded those of the black population of the same survey by 20%.
The proposed reference values are an improvement on those currently available for Latin America because the participants were chosen by population sampling methods and standardized up-to-date methodology was used.
Archivos de Bronconeumología 08/2006; 42(7):317-25. · 2.17 Impact Factor
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ABSTRACT: The damage to skeletal muscle capillaries in advanced Chagas' disease (stages II and III) was investigated in the vastus lateralis muscle of six patients and compared to that of six normal subjects. Capillaries were visualized by the PAS-amylase reaction and muscle fibres were classified by the ATPase histochemical method. Transmission electron microscopy was used to look for capillary alterations. The capillary-to-fibre ratio and number of capillaries adjacent to type I and type IIa fibres were decreased in the patient group. At the ultrastructural level, all patients showed capillary abnormalities, mainly basement membrane thickening and reduplication, capillary occlusion, proliferative endothelial cell cytoplasm with dense bodies, large vacuoles, altered mitochondria and prominent rough endoplasmic reticulum, as well as pericyte abnormalities. Capillary alterations are similar to those in patients affected by autoimmune diseases, suggesting an autoimmune component in the chronic phase of this disease. The reduction in capillarity may contribute to altered muscle performance in these patients.
Parasitology Research 09/2004; 93(5):364-8. · 2.15 Impact Factor
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ABSTRACT: This study was designed to evaluate the peripheral muscle metabolic and structural characteristics in patients with advanced Chagas disease (ChD), and whether they were related with exercise performance.
Cross-sectional study.
Outpatient cardiomyopathy clinic of a university hospital.
We studied 11 stage II patients, 8 stage III patients, and 11 healthy volunteers. All patients underwent exercise testing and peripheral muscle biopsies. The muscles were also studied in control subjects. Muscle biopsy specimens were analyzed for histochemical characteristics. In six patients, the muscle was studied ultrastructurally.
The data demonstrate more glycolytic and less oxidative capacity of the peripheral muscle in patients with advanced ChD (increased proportion of type IIb fibers, increased proportion of fibers with low nicotinamide adenine dinucleotide diaphorase activity, high proportion of darkly stained fibers for alpha-glycerophosphate dehydrogenase activity, and lower levels of citrate synthase). Many capillaries in patients with ChD had an abnormal aspect: they were either closed or showed a thicker wall. The ultrastructural study also showed fiber atrophy and abnormal capillaries even in patients with normal functional capacity. Some muscle characteristics (enzyme activity, mean cross-sectional area of the fiber, and capillarity) related with exercise parameters (anaerobic threshold, and peak oxygen pulse).
These findings indicate that patients with advanced ChD have decreased oxidative capacity and a shift to anaerobic metabolism in the skeletal muscle. They also suggest that muscular abnormalities are related to oxygen delivery, which is probably reduced in part by the abnormal muscle microvasculature. Those changes could affect oxygen extraction, and therefore exercise tolerance in these patients.
Chest 05/2004; 125(4):1306-14. · 5.25 Impact Factor
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Rogelio Pérez-Padilla,
Luis Torre Bouscoulet,
Juan Carlos Vázquez-García,
Adriana Muiño,
María Márquez,
María Victorina López, María Montes de Oca,
Carlos Tálamo,
Gonzalo Valdivia,
Julio Pertuze,
José Jardim,
Ana María B. Menezes
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ABSTRACT: ObjectiveThe criteria for disease severity established by the Global Initiative for Chronic Obstructive Lung Disease are based on forced expiratory volume in 1 second (FEV1) expressed as a percentage of the predicted value after application of a bronchodilator. This study aims to determine postbronchodilator spirometry reference values.SUBJECTS AND METHODSA cluster sample of subjects aged 40 years or over was chosen to be representative of the metropolitan areas of 5 Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, and Caracas). Spirometry was performed on 5183 subjects following the recommendations of the American Thoracic Society before and after inhalation of 200 μg of salbutamol. Multiple linear regression equations were fitted for the postbronchodilator spirometric values–FEV1, forced expiratory volume in 6 seconds (FEV6), peak expiratory flow rate, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). These were adjusted for sex, age, and height in 887 asymptomatic subjects with no history of lung disease.RESULTSThe postbronchodilator reference values for FEV1, FEV1/FVC, and FEV1/FEV6 were on average 3% higher than those obtained before bronchodilation. This apparently small difference caused an upward shift in the 5th percentile (lower limit of normal) of the predicted values. When prebronchodilation instead of postbronchodilation reference values were used, 3.2% of the results for airflow obstruction in our population of over-40-year-olds were false negatives.CONCLUSIONSThe reported reference values are more appropriate for postbronchodilator spirometry and make it possible to reduce the number of misclassifications.ObjetivoLa clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica (EPOC) se basa, de acuerdo con la iniciativa GOLD, en el volumen espiratorio forzado en el primer segundo (FEV1) después de usar broncodilatador, expresado como porcentaje del esperado. El propósito de este trabajo ha sido determinar los valores de referencia para la espirometría después de la administración de broncodilatador.SUJETOS Y MÉTODOSSe realizó un muestreo por conglomerados de sujetos de 40 años o más, representativos de las zonas metropolitanas de São Paulo, Ciudad de México, Montevideo, Santiago y Caracas. Se realizó una espirometría a 5.183 sujetos de acuerdo con las recomendaciones de la American Thoracic Society, antes y después de la inhalación de 200 μg de salbutamol. Se efectuaron regresiones lineales múltiples para los valores espirométricos –FEV1, volumen espiratorio forzado en 6 s (FEV6), índice de flujo espiratorio máximo, capacidad vital forzada (FVC), FEV1/FEV6, FEV1/FVC y flujo mesoespiratorio forzado– después del uso del broncodilatador, ajustando por sexo, edad y altura, en 887 sujetos sin evidencia de enfermedad pulmonar previa.RESULTADOSLos valores de referencia tras broncodilatador para FEV1, FEV1/FVC y FEV1/FEV6 fueron en promedio un 3% mayores que los obtenidos con la espirometría realizada antes de la inhalación del broncodilatador. Esta diferencia, que parece pequeña, causa un desplazamiento hacia arriba en el percentil 5 (límite inferior de la normalidad) de los valores esperados. Si se utiliza el valor de referencia prebroncodilatador, en lugar del posbroncodilatador, se genera un 3,2% de falsos negativos para obstrucción al flujo aéreo en el total de la población de 40 o más años de edad.CONCLUSIONESLos valores de referencia indicados son más apropiados para espirometrías realizadas después de la inhalación del broncodilatador y permiten minimizar los errores de clasificación.
Archivos de Bronconeumología ((English Edition)).
