Estimulação elétrica transcutânea diafragmática pela corrente russa em portadores de DPOC

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Abstract

RESUMO A doença pulmonar obstrutiva crônica (DPOC) ocasiona prejuízos na mecânica pulmonar, interferindo na atuação, mobilidade e conformidade do diafragma. A estimulação elétrica diafragmática tradicional é capaz de gerar benefícios ao pneumopata; poderia a corrente russa ser outra opção? Objetivou-se identificar as alterações após estimulação diafragmática elétrica transcutânea pela corrente russa em indivíduos portadores de DPOC. Trata-se de estudo prospectivo, quase experimental, com os seguintes critérios de inclusão: estabilidade medicamentosa, cessação tabágica, DPOC grau III e IV e manutenção do estilo de vida. Foram avaliadas medidas antropométricas, respiratórias e funcionais. A estimulação diafragmática se deu pelo Endophasys R ET 9701 por quatro meses, duas vezes por semana, com 30 sessões. O tempo de terapia e frequência para cada sessão foram: 18 min. (20 a 30 Hz) e 12 min. (70 a 100 Hz), respectivamente. Para análise dos dados foi aplicado teste “t” de Student (p<0,05). Participaram do tratamento 13 DPOC, sendo 11 (84,6%) do sexo masculino, todos brancos com idade de 68,46±11,11 anos e carga tabágica de 74,03±56,2 maços-ano. Ao final da intervenção houve mudanças no: volume minuto de 14,47±4,72 para 13,03±4,00 L/min.; índice BODE de 3,92±2,10 para 3,23±1,87; e distância no teste de caminhada de 6 minutos (TC6) de 336±76,36 para 402,76±51,29 m. Concluiu-se que a estimulação elétrica diafragmática por meio da corrente russa promove benefícios significativos ao portador de DPOC, proporcionando melhora respiratória e funcional.

Translated abstract

RESUMEN La enfermedad obstructiva crónica (EPOC) perjudica la mecánica pulmonar, interfiriendo en la acción, movilidad y conformidad del diafragma. La estimulación diafragmática eléctrica tradicional es benéfica a los portadores de enfermedades pulmonares, ¿es posible ser otra opción la corriente rusa? El propósito de este trabajo es identificar los resultados tras la estimulación diafragmática eléctrica transcutánea por corriente rusa en pacientes con EPOC. Se trata de un estudio prospectivo, casi experimental, con los siguientes criterios de inclusión: la estabilidad de fármaco, el abandono del tabaco, la EPOC grados III y IV y el mantenimiento del estilo de vida. Se evaluaron medidas antropométricas, respiratorias y funcionales. La estimulación diafragmática fue realizada por el Endophasys R ET 9701 durante cuatro meses, dos veces semanales, con 30 sesiones. El tiempo de terapia y la frecuencia de cada sesión fueron los siguientes: 18 min. (20 a 30 Hz) y 12 min. (70 a 100 Hz), respectivamente. En el análisis de datos se empleó la prueba t de Student (p<0,05). Del estudio participaron 13 portadores de EPOC, siendo 11 (84,6%) varones, blancos, cuya edad fue de 68,46±11,11 años y el tiempo del tabaco fue de 74,03±56,2 paquetes-año. Al final de la intervención ocurrieron cambios: en el volumen minuto de 14,47±4,72 a 13,03±4,00 L/min.; en el índice BODE de 3,92±2,10 a 3,23±1,87; y en la distancia de la prueba de caminata de 6 minutos (TC6) de 336±76,36 a 402,76±51,29 m. Se concluye que la estimulación diafragmática eléctrica por corriente rusa es benéfica a los portadores de EPOC y les proporciona mejoras respiratoria y funcional.

Translated abstract

ABSTRACT Chronic Obstructive Pulmonary Disease (COPD) causes losses in lung mechanics, interfering in performance, mobility and conformity of the diaphragm, and traditional diaphragmatic electrical stimulation is able to generate benefits to the lung patient. Could Russian current be another option? We aimed to identify changes after transcutaneous diaphragmatic electrical stimulation through the Russian current in individuals with COPD. Prospective and nearly experimental study with inclusion criteria: drug stability, smoking interruption, COPD degrees III and IV and lifestyle maintenance. Anthropometric and functional measurements have been evaluated. Diaphragmatic stimulation occurred by Endophasys R ET 9701 for four months, twice a week, 30 sessions. Therapy time and frequency for each session were: 18 min. (20 to 30 Hz) and 12 min. (70 to 100 Hz), respectively. For data analysis Student’s t-test was applied (p<0.05). Thirteen individuals participated in the COPD treatment being 11 (84.6%) male, all white, aged 68.46±11.11 years and with tobacco load of 74.03±56.2 per year. At the end of the intervention, there were changes on minute volume from 14.47 min ± 4.72 to 13.03±4.00 l/min; BODE index from 3.92±2.10 to 3.23±1.87 and distance on the 6-minute walk test from 336±76.36 to 402.76±51.29 m. As a conclusion, diaphragmatic electrical stimulation through Russian current promotes significant benefits to COPD patients, providing respiratory and functional improvement.

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Most cited references 26

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The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.

Bartolome R Celli, Claudia Cote, José M. Marin … (2004)

Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible limitation in airflow. A physiological variable--the forced expiratory volume in one second (FEV1)--is often used to grade the severity of COPD. However, patients with COPD have systemic manifestations that are not reflected by the FEV1. We hypothesized that a multidimensional grading system that assessed the respiratory and systemic expressions of COPD would better categorize and predict outcome in these patients. We first evaluated 207 patients and found that four factors predicted the risk of death in this cohort: the body-mass index (B), the degree of airflow obstruction (O) and dyspnea (D), and exercise capacity (E), measured by the six-minute-walk test. We used these variables to construct the BODE index, a multidimensional 10-point scale in which higher scores indicate a higher risk of death. We then prospectively validated the index in a cohort of 625 patients, with death from any cause and from respiratory causes as the outcome variables. There were 25 deaths among the first 207 patients and 162 deaths (26 percent) in the validation cohort. Sixty-one percent of the deaths in the validation cohort were due to respiratory insufficiency, 14 percent to myocardial infarction, 12 percent to lung cancer, and 13 percent to other causes. Patients with higher BODE scores were at higher risk for death; the hazard ratio for death from any cause per one-point increase in the BODE score was 1.34 (95 percent confidence interval, 1.26 to 1.42; P<0.001), and the hazard ratio for death from respiratory causes was 1.62 (95 percent confidence interval, 1.48 to 1.77; P<0.001). The C statistic for the ability of the BODE index to predict the risk of death was larger than that for the FEV1 (0.74 vs. 0.65). The BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD. Copyright 2004 Massachusetts Medical Society

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Donald Redelmeier, Fatehia Bayoumi, Thalia R. Goldstein … (1997)

Functional status measurements are often difficult to interpret because small differences may be statistically significant but not clinically significant. How much does the Six Minute Walk test (6MW) need to differ to signify a noticeable difference in walking ability for patients with chronic obstructive pulmonary disease (COPD)? We studied individuals with stable COPD (n = 112, mean age = 67 yr, mean FEV1 = 975 ml) and estimated the smallest difference in 6MW distances that was associated with a noticeable difference in patients' subjective comparison ratings of their walking ability. We found that the 6MW was significantly correlated with patients' ratings of their walking ability relative to other patients (r = 0.59, 95% confidence interval [CI]: 0.54 to 0.63). Distances needed to differ by 54 m for the average patient to stop rating themselves as "about the same" and start rating themselves as either "a little bit better" or "a little bit worse" (95% CI: 37 to 71 m). We suggest that differences in functional status can be statistically significant but below the threshold at which patients notice a difference in themselves relative to others; an awareness of the smallest difference in walking distance that is noticeable to patients may help clinicians interpret the effectiveness of symptomatic treatments for COPD.

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COPD in the general population: prevalence, incidence and survival.

Ana Afonso, Katia M.C. Verhamme, Miriam C.J.M. Sturkenboom … (2011)

Worldwide, COPD is a leading cause of chronic morbidity and mortality. Although its prevalence is already well documented, very few studies have measured its incidence. We therefore investigated the prevalence, incidence and lifetime risk of COPD in the general population. In a population-based study including subjects ≥ 40, with 12 months of history available in the Dutch IPCI database, we identified COPD cases by a two-step validation algorithm. Among 185,325 participants with 601,283 years of follow-up, 7308 subjects with COPD were identified, and 1713 had incident COPD. The overall IR of physician-diagnosed COPD was 2.92/1000PY (95%CI 2.78-3.06). The incidence of COPD was higher in men (3.54; 95%CI 3.33-3.77) than in women (2.34; 95%CI 2.17-2.52), and the overall baseline prevalence of COPD was 3.02% (95%CI 2.94-3.10). For people who had entered the study free of COPD at the age of 40, the risk of developing COPD within the next 40 years was 12.7% for men and 8.3% for women. In patients with very severe COPD, 26% died after 1 year of follow-up, whereas 2.8% died among the non-COPD subjects. In the general population in the Netherlands, three on 1000 subjects were diagnosed with COPD per year. The incidence increased rapidly with age and was higher in men than in women. One in eight men and one in 12 women, being COPD free at the age of 40, will develop COPD during their further life. Mortality rates differed substantially between COPD patients and non-COPD subjects of the same age, underlining the burden of this disease.