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Vol. 14. Issue 6.
Pages 769-785 (November - December 2008)
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Vol. 14. Issue 6.
Pages 769-785 (November - December 2008)
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Correlation between mild hypoxaemia and limb skeletal muscle function in chronic obstructive pulmonary disease – Pilot study
Correlação entre hipoxemia moderada e função muscular esquelética periférica na doença pulmonar obstrutiva crónica – Estudo-piloto
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1051
Sérgio Leite Rodrigues1,8,
, César Augusto Melo e Silva2, César Ferreira Amorim3, Terezinha Lima4, Fernanda Almeida Ribeiro5, Carlos Alberto de Assis Viegas6, Verônica Amado7
1 Fisioterapeuta, Mestre em Ciências da Saúde, Universidade de Brasília – UnB / Physiotherapist, MsC, Health Sciences, Universidade de Brasília – UnB
2 Fisioterapeuta, Doutor em Ciências Médicas, Universidade de Brasília – UnB / Physiotherapist, Doctor of Medical Sciences, Universidade de Brasília – UnB
3 Engenheiro electrónico, Mestre em Engenharia Biomédica, Universidade do Vale do Paraíba – UNIVAP / Electronic Engineer, MsC, Biomedical Engineering, Universidade do Vale do Paraíba – UNIVAP
4 Médica, Mestre em Ciências da Saúde, Universidade de Brasília / Physician, MsC, Health Sciences, Universidade de Brasília
5 Fisioterapeuta, Especialista em Fisioterapia Pneumofuncional, Universidade de Brasília / Physiotherapist, Respiratory Physiotherapy specialist, Universidade de Brasília
6 Médico, Doutor da Universidade de Brasília – UnB, Universidade de Brasília – UnB / Physician, Doctor at the Universidade de Brasília – UnB, Universidade de Brasília – UnB
7 Chefe do Serviço de Pneumologia / Head, Pulmonology Unit: Hospital Universitário de Brasília – HUB Rua L2 Norte Quadras 605 CEP 70840-901 Brasília – DF Brasil
8 Chefe do Centro de Fisioterapia / Head, Physiotherapy Unit: Sérgio Leite Rodrigues Hospital Universitário de Brasília – HUB Rua L2 Norte Quadras 605 CEP 70840-901 Brasília – DF Brasil
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Abstract
Rationale

Exercise capacity in COPD patients depends on the degree of airflow obstruction, the severity of the hypoxaemia and skeletal muscle function. Muscle atrophy and weakness are considered systemic consequences of COPD and are associated with reduced exercise capacity.

Aims

To investigate the correlation between mild hypoxaemia and muscular strength, muscular fatigue and functional capacity in COPD patients.

Methods

Ten patients enrolled on a PRP at the Hospital Universitário de Brasília – HUB were included in this study. Lung function was evaluated by spirometry and arterial blood gas analysis. Functional evaluation was made using the 6MWT and using isometric contraction of deltoid and quadriceps muscles.

Results

There were positive correlations between PaO2, quadriceps strength (r2=0.61 and p=0.007) and PaO2 and the 6MWT (r2=0.96, p=0.001). There were negative correlations between PaO2 and median frequency of quadriceps (r2=-0.42 and p=0.04). We observed significant correlation between quadriceps strength and the 6MWT (r2=0.67 and p=0.001). There was negative correlation between median frequency of quadriceps and the 6MWT (r2 = -0.42 and p=0.04). We did not observe any correlation between PaO2 and strength or median frequency of deltoid muscle.

Conclusions

PaO2 has important correlations with muscular function variables. The main negative impact of mild hypoxaemia and precocious limb muscular disability on COPD patients is decreased functional capacity.

Key-words:
Six-minute walk test
muscle strength
hypoxaemia
COPD
pulmonary rehabilitation
electromyography
Resumo
Introdução

A capacidade de exercício em portadores de DPOC depende da gravidade da limitação ao fluxo aéreo, do grau de hipoxemia e da função muscular esquelética. Nesses doentes, a atrofia e a fraqueza da musculatura periférica são consideradas consequências sistémicas da DPOC e estão associadas à redução da capacidade de exercício.

Objectivos

Investigar a possível correlação entre hipoxemia moderada e o comprometimento muscular periférico na DPOC.

Doentes e métodos

Dez doentes encaminhados ao Programa de Reabilitação Pulmonar do Hospital Universitário de Brasília foram incluídos neste estudo. A função pulmonar foi avaliada por espirometria, gasometria arterial e avaliação funcional pelo teste de caminhada de seis minutos, sinal electromiográfico e força de deltóide e quadricípetes.

Resultados

As correlações entre PaO2 e a força quadricíptica (r2=0,61 e p=0,007) e a distância percorrida no TC6 (r2=0,96 e p=0,001) foram positivas e significativas. Houve correlação negativa e significativa entre PaO2 e a frequência mediana de quadricípetes (r2=-0,42 e p=0,04). Observámos também correlação significativa entre força de quadricípetes e o TC6 (r2=0,67 e p=0,001). Assim como houve correlação negativa e significativa entre a frequência mediana de quadricípetes, e o TC6 (r2=-0,42 e p=0,04). Não encontrámos correlação significativa entre a PaO2 e força ou frequência mediana do músculo deltóide.

Conclusão

A PaO2 tem correlação importante e significativa com variáveis de função muscular periférica. A hipoxemia moderada e a disfunção muscular periférica precoce possuem como principal impacto negativo a deterioração da capacidade funcional de portadores de DPOC.

Palavras-chave:
Teste de caminhada de seis minutos
força muscular
hipoxemia
DPOC
reabilitação pulmonar
electromiografia
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Bibliography/Bibliografia
[1.]
K.F. Rabe, S. Hurd, A. Anzueto, P.J. Barnes, S.A. Buist, P. Calverley, et al.
Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease – GOLD Executive Summary.
Am J Respir Crit Care Med, 176 (2007), pp. 532-555
[2.]
A. Couillard, C. Prefaut.
From muscle disuse to myopathy in COPD: potential contribution of oxidative stress.
Eur Respir J, 26 (2005), pp. 703-719
[3.]
F. Pitta, T. Troosters, M.A. Spruit, V.S. Probst, M. Decramer, R. Gosselink.
Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 171 (2005), pp. 972-977
[4.]
M. Decramer, R. Gosselink, M.R. Mölken, J. Buffels, O.V. Schayck, P.A. Gevenois, et al.
Assessment of progression of COPD: report of a workshop held in Leuven, 11–12 March 2004.
Thorax, 60 (2005), pp. 335-342
[5.]
A.G.N. Agustí, A. Noguera, A.J. Sauleda, E. Sala, J. Pons, X. Busquets.
Systemic effects of chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 347-360
[6.]
A.X. Bigard, H. Sanchez, O. Birot, B. Serrurier.
Myosin heavy chain composition of skeletal muscles in young rats growing under hypobaric hypoxia conditions.
J Appl Physiol, 88 (2000), pp. 479-486
[7.]
F. Maltais, J. Jobin, M.J. Sullivan, S. Bernard, F. Whitton, K.J. Killian, et al.
Metabolic and hemodynamic responses of lower limb during exercise in patients with COPD.
J Appl Physio, 84 (1998), pp. 1573-1580
[8.]
B.R. Celli, C.G. Cote, J.M. Marin, C. Casanova, M. Montes de Oca, R.A. Mendez, et al.
The body -mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[9.]
C.G. Cote, B.R. Celli.
Pulmonary rehabilitation and the BODE index in COPD.
Eur Respir J, 26 (2005), pp. 630-636
[10.]
A. Chaouat, E. Weitzenblum, R. Kessler, C. Charpentier, M. Ehrhart, P. Levi-Valensi, et al.
Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia.
Eur Respir J, 10 (1997), pp. 1730-1735
[11.]
Lung function testing.
Selection of reference values and interpretative strategies American Thoracic Society.
Am Rev Respir Dis, 144 (1991), pp. 1202-1218
[12.]
R.J. Knudson, M.D. Lebowitz, C.J. Holberg, B. Burrows.
Changes in the normal expiration flow-volume curve with growth and aging.
Am Rev Respir Dis, 127 (1983), pp. 725-734
[13.]
American Thoracic Society.
ATS statement: guidelines for six-minute walk test.
Am J Respir Crit Care Med, 166 (2002), pp. 111-117
[14.]
N. Gosselin, F. Durand, M. Poulain, K. Lambert, F. Ceugniet, C. Préfaut, et al.
Electrophysiologic changes during exercise testing in patients with chronic obstructive respiratory disease.
Muscle Nerve, 27 (2003), pp. 170-179
[16.]
Oxigenoterapia domiciliar prolongada (ODP) – Sociedade Brasileira de Pneumologia e Tisiologia – SBPT.
J Pneumol, 26 (2000), pp. 341-350
[17.]
AARC Clinical Practice Guideline – Oxygen Therapy in the Home or Extended Care Facility.
Respir Care, 37 (1992), pp. 918-922
[18.]
M.L. Romer, H.C. Haverkamp, M. Amann, A.T. Lovering, D.F. Pegelow, J.A. Dempsey.
Effect of acute severe hypoxia on peripheral fatigue and endurance capacity in healthy humans.
Am J Physiol Regul Integr Comp Physiol, 292 (2007), pp. 598-606
[19.]
M. Amann, M.L. Romer, D.F. Pegelow, J. Anthony, A.J. Jacques, C.J. Hess, J.A. Dempsey.
Effects of arterial oxygen content on peripheral locomotor muscle fatigue.
J Appl Physiol, 101 (2006), pp. 119-127
[20.]
Merletti R, Rainoldi A, Farina D. In: Merletti R, Parker PA, editors. Electromyography – physiology, engineering and noninvasive applications New Jersey: Wiley Inter-Science 2004; 233–41.
[21.]
N. Gosselin, K. Lambert, M. Poulain, A. Martin, C. Préfaut, A. Varray, et al.
Endurance training improves skeletal muscle electrical activity in active COPD patients.
Nuscle Nerve, 28 (2003), pp. 744-753
[22.]
R. Carter, D.B. Holiday, C. Nwasuruba, J. Stocks, C. Grothues, B. Tiep.
6-Minute Walk Work for Assessment of Functional Capacity in Patients With COPD.
Chest, 123 (2003), pp. 1408-1415
[23.]
S. Solway, D. Brooks, Y. Lacasse, S. Thomas.
A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.
Chest, 119 (2001), pp. 256-270
[24.]
F. Maltais, P. LeBlanc, F. Whittom, C. Simard, K. Marquis, M. Bélanger, et al.
Oxidative enzyme activities of the vastus lateralis muscle and the functional status in patients with COPD.
Thorax, 55 (2000), pp. 848-853
[25.]
R. Gosselink, T. Troosters, M. Decramer.
Peripheral muscle weakness contributes to exercise limitation in COPD.
Am J Respir Crit Care Med, 153 (1996), pp. 976-980
[26.]
S. Bernard, P. Le -Blanc, F. Whittom, G. Carrier, J. Jobin, R. Belleau, et al.
Peripheral muscle weakness in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 158 (1998), pp. 629-634
[27.]
J.M. Marin, S.J. Carrizo, M. Gascon, A. Sanchez, B. Gallego, B.R. Celli.
Inspiratory capacity, dynamic hyperinflation, breathlessness and exercise performance during the 6-minutes-walk test in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 163 (2001), pp. 1395-1399

Trabalho realizado no Serviço de Pneumologia do Hospital Universitário de Brasília e no Centro de Fisioterapia e Reabilitação do Hospital Universitário de Brasília / Work carried out at the Serviço de Pneumologia do Hospital Universitário de Brasília and at the Centro de Fisioterapia e Reabilitação do Hospital Universitário de Brasília.

Copyright © 2008. Sociedade Portuguesa de Pneumologia
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