Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Chronic Dyspnea and Altered Respiratory Function in Former Workers with Asbestosis Evaluated to Determine Benefits

Dispnéia crônica e alterações funcionais respiratórias em ex-trabalhadores com asbestose avaliados para concessão de benefício

Lara M. Nápolis, Andréa Ap. Sette, Ericson Bagatin, Mário Terra Filho, Reynaldo T. Rodrigues, Jorge Issamu Kavakama, José Alberto Neder, Luiz Eduardo Nery

J Bras Pneumol.2004;30(6):528-534

Abstract PDF PT PDF EN

Background: Dyspnea is a symptom that is difficult to evaluate, especially in occupational diseases. Objective: To evaluate the relationship between chronic dyspnea, in its varying degrees of severity, and the functional repercussions for dysfunction or incapacitation in former workers with asbestosis. Method: A total of 40 former workers diagnosed with asbestosis were evaluated. Dyspnea scores were determined using the modified Medical Research Council scale, the 1984 and 1993 American Medical Association scales, and the Baseline Dyspnea Index. Spirometry, measurement of diffusion capacity for carbon monoxide and cardiopulmonary exercise tests (incremental and submaximal) were also performed. Results: Based on scores obtained using the Medical Research Council and 1984 American Medical Association scales, respectively, 72.5% and 67.5% of the subjects were classified as dyspneic, compared with 37.5% and 31.6%, respectively, using the 1993 American Medical Association and Baseline Dyspnea Index scales. There was greater concordance between the Medical Research Council and 1993 American Medical Association scales, as well as between the 1984 and 1993 American Medical Association scales, when the categories of "absent" and "mild" were grouped. No significant relation was found between dyspnea, as determined by each of the scales, and functional abnormalities - either at rest or during exercise. Conclusion: In individuals with asbestosis, the degree of concordance among the available dyspnea scales varies significantly. There is a real need for dyspnea indices that evaluate respiratory dysfunction at rest and during exercise.

 


Keywords: Asbestosis/diagnosis. Dyspnea/physiopathology. Spirometry/methods.

 


Distúrbios do sono: o que os pneumologistas têm a ver com isto?

Luiz Eduardo Nery

J Bras Pneumol.1997;23(5):223-224

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Distúrbios do sono: o que os pneumologistas têm a ver com isto?

Luiz Eduardo Nery

J Bras Pneumol.1999;25(1):1-2

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Pulmonary rehabilitation: factors related to aerobic improvement in COPD patients

Reabilitação pulmonar: fatores relacionados ao ganho aeróbio de pacientes com DPOC

José Alberto Neder, Luiz Eduardo Nery, Sônia Perez Cendon Filha, Ivone Martins Ferreira, José Roberto Jardim

J Bras Pneumol.1997;23(3):115-123

Abstract PDF PT

Objective: To establish clinical and functional baseline characteristics related to aerobic improvement (AI) after supervised training, in COPD patients submitted to a comprehensive pulmonary rehabilitation program (PR). Material and methods: Before and after PR was performed in 36 male COPD patients (25 with mild to moderate disease): clinical and anthropometric evaluation, 6-minute walking test, spirometry, arterial blood gas analysis, maximum inspiratory and expiratory pressure measurement, and a symptom-limited incremental cardiopulmonary exercise testing (MGC-CPX System). Supervised training intensity was targeted at the heart rate (HR) corresponding to anaerobic threshold (AT) or at 90% of the maximum HR attained. Results: Initial maximum oxygen consumption (VO2max) was negatively correlated with age and positively with the body mass index (BMI), the maximum inspiratory pressure (MIP) and the forced expiratory volume in one second (FEV1 ) - p < 0.05. After PR, an increment on submaximal exercise tolerance was found in 29 patients (80.5%); however, AI was only found in 15 individuals (41.6%). AI was associated to the following baseline variables: age < 65 years, AT < 40% of VO2max pred, BMI > 18.5, FEV1 > 60% pre and MIP > 60% pred (p < 0.05). Improvement in MIP and BMI and decrease in the maximum dyspnea score were found only in patients with AI (p < 0.05). Conclusion: Supervised pulmonary rehabilitation in a group of COPD patients was able to increase the submaximal exercise tolerance in most of them. Aerobic improvement was more prevalent in the younger, eutrophic, detrained and least obstructed patient; it was associated with an increment in BMI and MIP and decrease in the maximal dyspnea score after training.

 


Keywords: COPD. Pulmonary rehabilitation. Exercise training. COPD. Pulmonary rehabilitation. Exercise training.

 


Relationship between aerobic fitness and clinical indicators of asthma severity in children

Relação entre capacidade aeróbia e indicadores clínicos da gravidade da asma em crianças

José Alberto Neder, Ana Luíza Godoy Fernandes, Antônio Carlos Silva, Anna Lúcia de Barros Cabral, Luiz Eduardo Nery

J Bras Pneumol.1998;24(1):3-10

Abstract PDF PT

In order to assess the relationship between the physical fitness of asthmatics and the clinical expression of the underlying disease, the authors studied 39 physically active children with moderate to severe but stable asthma. The patients (25 boys and 14 girls, aged between 9 and 16 years) were submitted to clinical evaluation; spirometry before and after bronchodilator (BD); maximal cardiopulmonary exercise test in cycle ergometer with breath-by-breath analysis of ventilatory and gas exchange variables; and, on a separate day, an exercise challenge test. As expected by the clinical stability, FEV1 post-BD was in the normal range in most of the children (mean ± SD = 93.8 ± 13.7% predicted). Maximal oxygen uptake (VO2max) was higher than the lower 95% confidence interval in 31/39 children; and in 29/39, the oxygen uptake at the anaerobic threshold (VO2AT) showed values above the lower limit of normality. Seven patients with low tolerance to exercise (reduced VO2max) presented suggestions of circulatory limitation (cardiovascular and/or peripheral) and only 1 had ventilatory limitation. There was no association or correlation between the lower ventilatory reserve (VEmax/MVV% ratio > 80%) and the decreased VO2max. Reduction in VO2AT, but not VO2max, was associated with some clinical indicators of asthma severity, e.g. (i) higher daily inhaled beclomethasone and frequent courses of oral steroids (p < 0.05) and (ii) higher exercise-induced bronchospasm occurrence (p < 0.01). The results show that (i) most patients with moderate to severe asthma, when clinically stable and physically active, present an adequate level of exercise tolerance; (ii) in estimation of the clinical severity of bronchial asthma in children, VO2AT is a better aerobic index than VO2max.

 


Keywords: Asthma in children. Exercise tolerance. Maximal oxygen uptake. Anaerobic threshold. Physical fitness. Exercise-induced

 


 

 


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