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Vol. 57. Issue 8.
Pages 528-532 (August 2021)
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Vol. 57. Issue 8.
Pages 528-532 (August 2021)
Original Article
DOI: 10.1016/j.arbr.2020.04.015
Effects of Controlled Voluntary Increase in the Ventilatory Demand on Respiratory System Resistance in Healthy and Non-Cystic Fibrosis Bronchiectasis Subjects: A Cross-Sectional Study
Efectos del aumento voluntario y controlado de la demanda ventilatoria en la resistencia del sistema respiratorio en sujetos sanos y en pacientes con bronquiectasias no debidas a fibrosis quística: un estudio transversal
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Ricardo Grassi Morolia, Daniele Oliveira dos Santosa, Hugo Celso Dutra de Souzaa, Larissa Perossia, Maytê Assunção Ribeiroa, Jéssica Perossia, José Antônio Baddini-Martinezb, Ada Clarice Gastaldia,
Corresponding author
ada@fmrp.usp.br

Corresponding author.
a Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
b Department of Clinical Medicine, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
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Table 1. Basal data of subjects.
Table 2. IOS measurements in different breathing patterns.
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Abstract
Introduction

Bronchiectasis patients may present a reduced functional capacity due to an increase in the ventilatory demand during exercise.

Objective

To evaluate the effects of controlled voluntary hyperinflation and increased respiratory rate on the mechanics of the respiratory system, simulating what happens during exercise, in bronchiectasis and healthy subjects.

Methods

Bronchiectasis (n=30) and healthy (n=16) subjects were evaluated by impulse oscillometry (IOS) during a baseline condition, and in controlled conditions with baseline (b) tidal volume (V) and hyperinflation (H), with respiratory rates at 30(R30) and 40(R40) bpm, in a random order. The mixed effects and a significance level at 0.05 were used for comparisons.

Results

Resistance at 5Hz (R5), and at minus 20Hz (R5–R20), in kPa/L/s, were higher in subjects with bronchiectasis in all experimental conditions (p<0.05). For the bronchiectasis group, R5 and R5-20 increased with R increase at V (VRb versus VR30 and VR40; VR30 versus VR40; R5, R20 and R5-20 increased with R increase at H (HRb versus HR40; HR30 versus HR40). For the same R, there was a decrease with H compared to V (HRb versus VR30 and VR40; and HR30 versus VR30 and VR40). For the healthy group, only R20 showed differences (HR30 versus HR40; HR40 versus VR40).

Conclusion

The tachypnea increases the resistance and reactance of the respiratory system in bronchiectasis patients, and the voluntary hyperinflation caused attenuates this increase. These results can guide the development of strategies to reduce the limitation of physical activity in patients with bronchiectasis.

Keywords:
Bronchiectasis
Respiratory mechanics
Exercises therapy
Breathing exercises
Tachypnea
Respiratory rate
Resumen
Introducción

Los pacientes con bronquiectasias pueden presentar una capacidad funcional reducida debido a un aumento en la demanda ventilatoria durante el ejercicio.

Objetivo

Evaluar los efectos de la hiperinsuflación voluntaria y controlada y el aumento de la frecuencia respiratoria en la mecánica del sistema respiratorio, simulando lo que sucede durante el ejercicio, en sujetos sanos y en pacientes con bronquiectasias.

Métodos

Se evaluó a sujetos con bronquiectasia (n=30) y sujetos sanos (n=16) mediante la oscilometría de impulso (IOS) en situación basal, y en condiciones controladas con basal (b), volumen corriente (V) e hiperinsuflación (H), con frecuencias respiratorias a 30 (R30) y 40 (R40) bpm, en orden aleatorio. Para las comparaciones se utilizaron el modelo de efectos mixtos y un nivel de significación de 0,05.

Resultados

La resistencia a 5Hz (R5) y la diferencia con 20Hz (R5-R20), medida en kPa/l/s, fue mayor en sujetos con bronquiectasias en todas las condiciones experimentales (p<0,05). Para el grupo de bronquiectasias, R5 y R5-R20 aumentaron con el aumento de R en V (VRb versus VR30 y VR40; VR30 versus VR40; R5, R20 y R5-R20 aumentaron con el aumento de R en H (HRb versus HR40; HR30 versus HR40. Para el mismo R, hubo una disminución de H en comparación con V (HRb versus VR30 y VR40; y HR30 versus VR30 y VR40). Para el grupo sano, solo R20 mostró diferencias (HR30 versus HR40; HR40 versus VR40).

Conclusión

La taquipnea aumenta la resistencia y la reactancia del sistema respiratorio en pacientes con bronquiectasias, y la hiperinsuflación voluntaria generada atenúa este aumento. Estos resultados pueden guiar el desarrollo de estrategias para reducir la limitación de la actividad física en pacientes con bronquiectasia.

Palabras clave:
Bronquiectasias
Mecánica respiratoria
Terapia de entrenamiento
Ejercicios de respiración
Taquipnea
Frecuencia respiratoria

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