ABSTRACT: Although respiratory physical therapy is considered fundamental in the treatment of hypersecretive patients, there is little evidence of its physiological and therapeutic effects in bronchiectasis patients.
To evaluate the acute physiological effects of ELTGOL and Flutter VRP1® in dynamic and static lung volumes in patients with bronchiectasis and, secondarily, to study the effect of these techniques in sputum elimination. Methods: Patients with clinical and radiological diagnosis of bronchiectasis were included. Patients underwent three interventions in a randomized order and with a one-week washout interval between them. Before all interventions patients inhaled two puffs of 100 mcg of salbutamol. There was a cough period of five minutes before and after the control protocol and the interventions (ELTGOL and Flutter VRP1®). After each cough series patients underwent assessments of dynamic and static lung volumes by spirometry and plethysmography. The expectorated secretions were collected during the interventions and during the second cough series, and quantified by its dry weight.
We studied 10 patients, two males and eight females (mean age: 55.9±18.1 years). After using Flutter VRP1®and ELTGOL there was a significant decrease in residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) (p<0.05). There was a higher sputum production during ELTGOL compared with Control and Flutter VRP1® (p<0.05).
The ELTGOL and Flutter VRP1® techniques acutely reduced lung hyperinflation, but only the ELTGOL increased the removal of pulmonary secretions from patients with bronchiectasis.
Revista Brasileira de Fisioterapia 04/2012; 16(2):108-13. · 0.44 Impact Factor
ABSTRACT: BACKGROUND: Tuberculosis (TB) remains an important public health problem worldwide, as its residual lesions result in functional and quality of life impairments. Few studies have investigated multi-drug-resistant pulmonary tuberculosis (MDR-TB), and the literature regarding the functional parameters of this group of patients is scarce. Functional characterization may point to the need for post-treatment intervention measures that optimize the quality of life in patients with MDR-TB. Thus, this study sought to analyze the respiratory function, functional capacity and quality of life of patients who were treated for multi-drug-resistant pulmonary tuberculosis. METHODS: This study investigated a cross-sectional cohort of MDR-TB patients who underwent drug treatment for at least 18 months. The patients who had associated diseases (HIV, severe heart disease and hypertension) or disabilities that prevented them from walking were excluded. The patients underwent the following assessments: forced spirometry, a chest radiograph, the 6-minute walk distance test, a bioelectrical impedance analysis, maximal inspiratory and expiratory pressures, and a health-related quality of life questionnaire. RESULTS: Eighteen patients who met the eligibility criteria were enrolled. Spirometric evaluation showed that 78% of the patients had abnormal patterns. The maximal respiratory pressures were significantly decreased in all patients, despite the fact that their nutritional status was within the normal range. The distance completed in the 6-minute walk distance test was less than expected in 72% of the patients. All of the patients who were evaluated had residual lesions, and 78% reported a worsening in their quality of life. CONCLUSION: In conclusion, MDR-TB cured patients exhibit impaired respiratory function and a mildly reduced functional capacity and quality of life, suggesting that a portion of these patients may require a pulmonary rehabilitation approach.
Respiratory care 03/2012; · 2.01 Impact Factor
ABSTRACT: The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery. The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection, as well as to evaluate if CPAP prolongs air leak through the chest drain.
Thirty patients in the postoperative period of lung resection were allocated into 2 groups: an experimental group, consisting of 15 patients who underwent a 10 cm H(2)O CPAP, and a 15 patient control group, who performed breathing exercises. Arterial blood gas analysis, peak expiratory flow (PEF), respiratory muscle strength, spirometry, and 6-min walk test (6MWT) were assessed in the preoperative period, and repeated postoperatively on the first and on the seventh day (6MWT was repeated only on the seventh day).
Significant increases in PEF, muscle strength, and FEV(1) between the first and seventh postoperative day were observed, both in the experimental and in the control group, whereas FVC and P(aO(2)) increased significantly between the first and seventh postoperative day only in the experimental group. The average loss in 6-min walk distance (6MWD) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group. When comparing the 2 groups, only 6MWD was statistically different (P < .001). There was no air leakage increase through the drain with the early use of CPAP.
When compared to breathing exercises, CPAP increases the 6MWD in postoperative lung resection patients, without prolonging air leak through the chest drain.
Respiratory care 03/2012; 57(3):363-9. · 2.01 Impact Factor
ABSTRACT: Dynamic hyperinflation, caused by expiratory flow limitation, markedly increases resting end-expiratory lung volume (functional residual capacity) in many COPD patients.
To determine the impact and duration of impact of CPAP on hyperinflation and airway resistance in patients with stable COPD.
In a case series, 21 patients underwent CPAP at 8 cm H(2)O for 15 min, then whole-body plethysmography immediately after, and at 15 and 30 min after CPAP.
The cohort's mean ± SD age was 70 ± 9 y, and the mean FEV(1) was 41 ± 8% of predicted. Residual volume, functional residual capacity, total lung capacity, the ratio of residual volume to total lung capacity, and airway resistance decreased after CPAP and did not significantly change at 15 min (P < .001), but returned to baseline at 30 min.
In patients with severe to very severe stable COPD, CPAP reduces lung volumes and airway resistance for 15 min, but the lung volumes return to baseline by 30 min.
Respiratory care 04/2011; 56(8):1164-9. · 2.01 Impact Factor