Danilo C Berton

Danilo C Berton
Federal University of Rio Grande do Sul | UFRGS · Departamento de Medicina Interna

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175
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Publications

Publications (175)
Article
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The latest pulmonary function guideline from the Brazilian Thoracic Association was published in 2002, since which there have been updates to international guidelines (mainly those from the European Respiratory Society and the American Thoracic Society), as well as new national and international publications on various aspects of the performance, i...
Article
Background: Pulmonary function testing (PFT) is paramount in assessing patients with respiratory symptoms and chronic cardiopulmonary diseases. Although seminal studies have demonstrated that PFT generates aerosols, this simple observation does not confirm the potential for enhanced pathogen transmission. / Objective: We aimed to describe the frequ...
Conference Paper
Full-text available
Introdução: A espirometria alterada (VEF1 e/ou CVF < limite inferior do normal) com relação VEF1/CVF preservada (PRISm) é uma característica fisiopatológica cada vez mais descrita em tabagistas. Apesar do impacto em morbidade e mortalidade, dados sobre seus mecanismos fisiopatológicos permanecem limitados. Objetivo: Comparar parâmetros funcionais r...
Article
Purpose of review Exertional dyspnea and exercise intolerance remain key patient-related outcomes in chronic obstructive pulmonary disease (COPD). Improvement in treatment strategies is pendant further understand of their underpinnings across the spectrum of disease severity. Recent findings Emerging literature has been reviewed based on a concept...
Article
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The respiratory and gastrointestinal (GI) systems share several embryogenic, anatomical, and physiological features. Pulmonary function tests (PFTs) are beneficial in detecting respiratory consequences of advanced liver disease and inflammatory bowel diseases (IBDs, mainly Crohn’s disease and ulcerative colitis), which have potential implications f...
Article
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Pulmonary complications can occur in up to 40-60% of patients with hematologic disorders. Although acute manifestations such as infection and hemorrhage are a major concern because of their life-threatening nature, chronic respiratory complications often also increase morbidity and mortality in such patients. In this context, pulmonary function tes...
Conference Paper
Background: Isolated measurements of dyspnoea and leg effort at peak exercise may provide an imperfect picture of the actual symptom burden in patients with COPD. Aim: To investigate whether assessing submaximal symptom burden across progressively higher exercise intensities adds value to discrete peak symptom scores. Methods: After developing se...
Article
Excess exercise ventilation (high ventilation (V̇E)/carbon dioxide output (V̇CO2)) contributes significantly to dyspnea and exercise intolerance since the earlier stages of chronic obstructive pulmonary disease (COPD). A selective pulmonary vasodilator (inhaled nitric oxide) has shown to increase exercise tolerance secondary to lower V̇E/V̇CO2 and...
Article
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BACKGROUND The respiratory system is variably affected by the systemic consequences of connective tissue diseases (CTDs). These abnormalities contribute to morbidity and mortality and are ascribed to direct autoimmune effects, drug toxicity, and/or opportunist infections. Pulmonary function tests might help recognize respiratory involvement, consti...
Preprint
BACKGROUND This study evaluated the effectiveness of a virtual reality (VR) high-intensity interval training (HIIT) boxing protocol compared to traditional high-intensity circuit training (HICT) in improving exercise motivation, engagement, and physiological responses among thirty healthy medical students. OBJECTIVE The objective of the study was...
Article
Background This study evaluated the effectiveness of a virtual reality (VR) high-intensity interval training (HIIT) boxing protocol compared to traditional high-intensity circuit training (HICT) in improving exercise motivation, engagement, and physiological responses among 30 healthy medical students. Objective The purpose was to compare the VR H...
Article
Spirometry remains pivotal to the diagnosis and classification of functional impairment in patients with COPD. A growing emphasis has been placed on using z-scores to grade dysfunction as it appropriately considers the age- and height-related variability in the forced expiratory volume in one second (FEV1) within comparable healthy individuals. Rec...
Article
Background: Continuous monitoring of pulse oximetry (SpO2 ) is recommended during the 6-min walk test (6MWT) to ensure that the lowest SpO2 is recorded. In this case, severe exercise induced desaturation (EID; SpO2 < 80%) triggers walking interruption by the examiner. Our main objective was to assess the impact of this approach on 6MWT distance in...
Article
Activity-related dyspnea in chronic lung disease is centrally related to dynamic (dyn) inspiratory constraints to tidal volume expansion. Lack of reference values for exertional inspiratory reserve (IR) has limited the yield of cardiopulmonary exercise testing in exposing the underpinnings of this disabling symptom. One hundred fifty apparently hea...
Article
Full-text available
Heightened sensation of leg effort contributes importantly to poor exercise tolerance in patient populations. We aim to provide a sex‐ and age‐adjusted frame of reference to judge symptom's normalcy across progressively higher exercise intensities during incremental exercise. Two‐hundred and seventy‐five non‐trained subjects (130 men) aged 19–85 pr...
Article
The causes and consequences of excess exercise ventilation (EEV) in patients with fibrosing interstitial lung disease (f-ILD) were explored. Twenty-eight adults with f-ILD and 13 controls performed an incremental cardiopulmonary exercise test. EEV was defined as ventilation-carbon dioxide output (⩒E-⩒CO2) slope ≥36L/L. Patients showed lower pulmona...
Article
Rationale: Ventilatory demand-capacity imbalance - as inferred by a low ventilatory reserve - is currently assessed only at peak cardiopulmonary exercise testing (CPET). Peak ventilatory reserve, however, is poorly sensitive to the submaximal, dynamic mechanical-ventilatory abnormalities which are key to dyspnea genesis and exercise intolerance. Ob...
Article
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Chronic dyspnea (i.e., dyspnea for at least 3 months) negatively impacts the health-related quality of life of ~10% of the general population. In a sizable fraction of these individuals, the underlying cause remains unclear after detailed clinical assessment, basic pulmonary function tests, and chest imaging, characterizing dyspnea of unknown origi...
Article
Background: Dysfunctional breathing (DB) is a common, but largely underappreciated, cause of chronic dyspnea. Under visual inspection, most subjects with DB present with larger sequential changes in ventilation (V̇E) and breathing pattern (tidal volume (VT) and breathing frequency (f)) before and/or during incremental cardiopulmonary exercise test...
Article
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Radiotherapy is the most common local treatment for lung cancer. The spectrum of its use ranges from the treatment of early-stage tumors in patients who are not candidates for surgery to the treatment of advanced, unresectable tumors and, very frequently, of metastatic lesions. With great interest, radiotherapy has also been currently cited as a so...
Article
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Oscillatory ventilation detected on incremental cardiopulmonary exercise testing might be found in subjects without heart failure reporting exertional dyspnoea despite the best available therapy for their underlying cardiopulmonary disease https://bit.ly/3Tyl7bE.
Article
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The human airways consist of approximately 23 generations of dichotomously branching tubes from the trachea to the alveoli. From generation 8 downstream, the small airways (< 2 mm in diameter) lack cartilaginous support, being more easily compressible/collapsible. Given the exponential increase in airway numbers, there is a rapid increase in the to...
Article
Background: Continuous monitoring of SpO2 throughout the 6-min walk test (6MWT) unveiled that some subjects with respiratory diseases may present values across the test < SpO2 measured at the end of the test. Nevertheless, it remains unclear whether this approach improves the yield of walk-induced desaturation detection in predicting mortality and...
Article
Full-text available
Pulmonary function tests (PFTs) are frequently repeated to judge whether potential changes, either spontaneously or after treatment, exceed test variability or surpass the effects of aging. Although cutoffs for “significant” changes over time are available, assessing their clinical relevance is substantially more complex. The reader should also con...
Article
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There is well established evidence that the minute ventilation ( V ′ E )/carbon dioxide output ( V ′ CO 2 ) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V ′ E / V ′ CO 2 reflects an enlarged physiological dead space (“wasted” ventilation), although alveolar hyperventilation (largely d...
Article
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Objective: Impaired respiratory mechanics and gas exchange may contribute to sleep disturbance in patients with COPD. We aimed to assess putative associations of different domains of lung function (airflow limitation, lung volumes, and gas exchange efficiency) with polysomnography (PSG)-derived parameters of sleep quality and architecture in COPD....
Article
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Background Respiratory muscle unloading through proportional assist ventilation (PAV) may enhance leg oxygen delivery, thereby speeding off-exercise oxygen uptake (V.⁢O2) kinetics in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Methods Ten male patients (HFrEF = 26 ± 9%, age 50 ± 13 years, and body mass inde...
Article
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This study aimed to investigate the walking economy and possible factors influencing self-selected walking speed (SSWS) in patients with fibrotic interstitial lung disease (ILD) compared to controls. In this study, 10 patients with ILD (mean age: 63.8 ± 9.2 years, forced expiratory volume in the first second: 56 ± 7% of predicted) and 10 healthy co...
Article
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Several shortcomings on cardiopulmonary exercise testing (CPET) interpretation have shed a negative light on the test as a clinically useful tool. For instance, the reader should recognize patterns of dysfunction based on clusters of variables rather than relying on rigid interpretative algorithms. Correct display of key graphical data is of foremo...
Article
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Hypoxemia (low PaO2) is a hallmark of moderate-to-severe interstitial lung disease (ILD). Ventilation/perfusion (V̇/Q̇) mismatch is a dominant mechanism, with a secondary role for diffusion limitation (at least at rest).(1) In some patients, intrapulmonary shunting and impaired alveolar exchange of oxygen (O2) can occur (“physiological” shunt [Shun...
Article
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Chronic unexplained dyspnea and exercise intolerance represent common, distressing symptoms in outpatients. Clinical history taking and physical examination are the mainstays for diagnostic evaluation. However, the cause of dyspnea may remain elusive even after comprehensive diagnostic evaluation-basic laboratory analyses; chest imaging; pulmonary...
Article
In 15 pulmonary arterial hypertension patients, the relation of functional capacity to their peripheral endothelial function and sympathaovagal modulation was studied by carrying out brachial artery ultrasound and electrocardiogram spectral analysis, respectively. The functional capacity was assessed by cardiopulmonary exercise testing and six-minu...
Article
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ISSN 1981-9919 versão eletrônica P e r i ó d i c o do I n s t i t u t o B r a s i l e i r o de P e s q u i s a e E n s i n o e m F i s i o l o gi a do E x e r c í c i o w w w. i b p e f e x. c o m. b r-w w w. r b o n e. c o m. b r Revista Brasileira de Obesidade, Nutrição e Emagrecimento, São Paulo. v. 15. n. 92. p.25-34. Jan./Fev. 2021. ABSTRACT B...
Article
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Background: We evaluated the impact of thoracic radiation in patients with non-small cell lung cancer (NSCLC), considering the depletion of total lymphocytes, use or not of chemotherapy, and radiation doses in healthy lung tissue. Methods: Patients with stage III NSCLC, ECOG 0 to 2, receiving radiotherapy with or without chemotherapy were prospe...
Article
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Introduction Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under‐appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work‐up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterize...
Article
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Background This study aimed to determine the value of phase angle (PhA) in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) and its association with nutritional and functional parameters. Methods A cross-sectional study of 77 patients under follow-up at the pulmonary outpatient clinic of a public hospital....
Article
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Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with c...
Article
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Exercise intolerance is characteristically multi-factorial in patients with COPD. At least in symptomatic patients with moderate-to-severe airflow limitation, higher operating lung volumes assume a relevant role in decreasing patients’ tolerance to sustain “prolonged” exercise. As a consequence of the dynamic increase in the end-expiratory lung vol...
Article
Assessment of dyspnoea severity during incremental cardiopulmonary exercise testing (CPET) has long been hampered by the lack of reference ranges as a function of work rate (WR) and ventilation (V̇E). This is particularly relevant to cycling, a testing modality which overtaxes the leg muscles leading to a heightened sensation of leg discomfort. Ref...
Article
The lung function laboratory frequently provides relevant information to the practice of Pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has more recently been complicated by temporal changes in demographics (higher life expectancy) and anthropometric attributes (increased obesity prevalence) and the surge of...
Article
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The human body is primarily concerned with the stability of pH. The lungs are the organs responsible for maintaining an adequate PaCO2 for the level of CO2 production (VCO2) while avoiding critical decrements in PaO2. Most of the pulmonary function tests, however, explore potential abnormalities in a step that precedes alveolar gas exchange, i.e.,...
Article
Purpose: The present study compared the level of agreement of anaerobic threshold (AT) between ventilatory and near-infrared spectroscopy (NIRS) techniques in patients with chronic heart failure (CHF) and healthy subjects. Methods: Patients with CHF (n = 9) and a control group (CG; n = 14) underwent cardiopulmonary exercise testing on a cycle er...
Article
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The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents sta...
Article
Activity-related dyspnoea is a key cause of physical impairment in cardiovascular and respiratory diseases. Despite the remarkable diagnostic advances in the past decades, discriminating “the heart” versus “the lungs” as a cause of exertional dyspnoea remains a challenge for cardiologists and pulmonologists. Cardiopulmonary exercise testing (CPET)...
Conference Paper
Background: Excess exertional ventilation (V̇E/CO2 output (V̇E/V̇CO2) nadir>34) is associated with exercise intolerance and shortness of breath in patients with COPD. Unfortunately, however, a sizeable fraction of these patients is unable to perform incremental cardiopulmonary exercise testing (CPET) either due to severe disability or a limiting c...
Article
Background: Hyperinflation has been associated with negative cardiocirculatory consequences in patients with chronic obstructive pulmonary disease (COPD). These abnormalities are likely to worsen when the demands for O2 increase, e.g., under the stress of exercise. Thus, pharmacologically-induced lung deflation may improve cardiopulmonary interact...
Article
Background: Exertional dyspnoea increases when the mechanical output of the respiratory muscles becomes uncoupled from increases in neural respiratory drive. Combining measurements of inspiratory constraints and ventilatory inefficiency may better uncover the role of mechanical-ventilatory abnormalities on exertional dyspnoea than the currently-rec...
Conference Paper
Increased chemostimulation and abnormal pulmonary mechanics are key determinants of inspiratory neural drive, the closest correlate of exertional dyspnea in both cardiac and pulmonary diseases. Owing to the marked pathophysiological differences between COPD and chronic heart failure (CHF), it is conceivable that the relative contribution of the for...
Article
BACKGROUND: Expiratory flow limitation (EFL) is a key physiological abnormality in COPD. Comparing tidal-to-maximum flow-volume (F-V) loops is a simple and widely available method to assess EFL in patients with COPD. We aimed to investigate whether subjects with COPD showing significant resting tidal F-V enveloping (ie, > 50% tidal volume) would pr...
Article
Full-text available
Combining measurements of impaired lung mechanics (inspiratory constraints) with an index of increased respiratory stimuli to metabolic demand (poor ventilatory efficiency) might enhance the ability of cardiopulmonary exercise testing (CPET) in exposing a mechanistic role for ventilation on exertional dyspnea in COPD. In addition to the standard ap...