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      Can a physical activity similar to activities of daily living cause dynamic hyperinflation and change the thoracoabdominal configuration in patients with chronic obstructive pulmonary disease?

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          Abstract

          Introduction: COPD is characterized by the ventilatory limitation, with reduction of the inspiratory reserve volume and dynamic hyperinflation (DH), which changes the configuration of the thoracic compartment, resulting in a disadvantage in respiratory muscle kinetics, and reduced functional capacity. The optoelectronic plethysmography (OEP) has been used to monitor changes in thoracoabdominal mobility. The Glittre-ADL test is a short battery of functional tests that simulate activities of daily living. In mild and moderate COPD, the effect of Glittre-ADL on thoracoabdominal kinetics and DH is understudied.

          Objective: The aim of our study was to evaluate the acute effects of the Glittre-ADL test on lung function and thoracoabdominal mobility using OEP in patients with mild and moderate COPD.

          Materials and methods: Twenty-five male and female patients between 45 and 80 years of age with COPD were submitted to the exercises that simulated Glittre-ADL test. Spirometry and OEP were performed before and after the test.

          Results: After the Glittre test, increases were found in EV ( p=0.005), percentage of contribution of the abdominal compartment ( p=0.054) and expiratory reserve volume (ERV) ( p=0.006) and reductions were found in the contribution of the upper thoracic compartment ( p=0.008) and inspiratory capacity (IC) ( p=0.040).

          Conclusion: The acute effect of ADL was a change in thoracoabdominal kinetics, especially the percentage of contribution of the abdominal compartment, as demonstrated by OEP. These findings, together with the reduction in IC and increase in ERV, after the Glittre-ADL test suggest the occurrence of DH, even in patients with mild to moderate COPD according to the GOLD classification.

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          Most cited references 24

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          New reference values for forced spirometry in white adults in Brazil.

          To describe spirometric reference equations for healthy Brazilian adults who have never smoked and to compare the predicted values with those derived in 1992. Reference equations for spirometry were derived in 270 men and 373 women living in eight cities in Brazil. Ages ranged from 20 to 85 years in women and from 26 to 86 years in men. Spirometry examinations followed the recommendations of the Brazilian Thoracic Society. Lower limits were derived by the analysis of the fifth percentiles of the residuals. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC and FEV1/forced expiratory volume in six seconds (FEV6) were best fitted by linear regression. Flows were best fitted using log equations. For both genders, greater height resulted in lower values for FEV1/FVC, FEV1/FEV6 and flow/FVC ratios. The reference values for FEV1 and FVC in the present study were higher than those derived for Brazilian adults in 1992. New predicted values for forced spirometry were obtained in a sample of white Brazilians. The values are greater than those obtained in 1992, probably due to technical factors.
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            A field test of functional status as performance of activities of daily living in COPD patients.

            Patients with chronic obstructive pulmonary disease (COPD) frequently experience activity restrictions and discomfort during activities of daily living (ADL). Functional status refers to the capacity to perform ADL. Available tests only partly measure this domain. Our aim was therefore to establish an assessment tool for functional status in COPD, the Glittre ADL-test. This field test includes a standardised set of ADL-like activities: Walking stairs, carrying, lifting objects, bending down and rising from a seated position. The primary variable was time to complete the test (ADL-time). Validity was investigated in 57 COPD patients by correlating ADL-time to pulmonary function, 6-min walking distance (6MWD) and questionnaires addressing health-related quality of life. Responsiveness was investigated in another 40 patients comparing ADL-time before and after rehabilitation. Median ADL-time was 4.16 min (range 2.57-14.47). Spearman rho=0.93 for test-retest reliability. ADL-time correlated with forced expiratory volume in 1s (rho=-0.61), St. George's Respiratory Questionnaire activity subscore (rho=0.43), dyspnoea during ADL (rho=0.35) and hospitalisation rate (rho=0.35). Despite a close overall correlation with 6MWD (rho=-0.82), variability was substantial, particularly for the more disabled patients. ADL-time improved significantly after rehabilitation. Glittre ADL-test yields information complementary to 6MWD. It is a valid and reliable measure of functional status, useful for assessment of individual patients and rehabilitation programs.
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              Metabolic and ventilatory parameters of four activities of daily living accomplished with arms in COPD patients.

              The upper limbs are involved in the activities of daily living (ADLs). Normal subjects usually perform such activities without noticing the energy cost, but patients with COPD report tiredness when performing them. This study was designed to assess the metabolic and ventilatory demands in patients with COPD during the performance of four ADLs involving the upper limbs. The patients were tested on two different days. Oxygen uptake (O(2)), carbon dioxide output (CO(2)), minute ventilation (E), and heart rate were measured while performing four ADLs for 5 min each: sweeping, erasing a blackboard, lifting pots, and replacing lamps. Ten normal, young, male subjects (mean age, 27.9 years) were selected for testing the reproducibility of the methods, and 9 male patients with COPD (FEV(1), 32.5%; mean age, 58.9 years) entered the study. The tests were reproducible for both groups. Patients with COPD presented a significant increase (p < 0.05) in O(2) (mean, 50.2% of maximum O(2)) and in E (mean, 55.7% of maximum voluntary ventilation [MVV]) in relation to initial resting conditions for all four activities. We conclude that when performing these four activities, patients with moderate-to-severe COPD present a high O(2), which may explain the tiredness reported by them during simple activities involving the upper limbs; the high E/MVV may be associated to dyspnea.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                13 June 2019
                2019
                : 14
                : 1281-1287
                Affiliations
                [1 ] Rehabilitation Sciences Program, UNINOVE , São Paulo, Brazil
                [2 ] Spirometry and Respiratory Physiotherapy Laboratory – LEFiR, Universidade Federal de São Carlos – UFSCar , São Carlos, São Paulo, Brazil
                Author notes
                Correspondence: Dirceu CostaRehabilitation Sciences Program, UNINOVE , LARESP 235/249 Vergueiro Street, Liberdade, São Paulo01504-001, BrazilTel +5 511 366 5987Email dcosta@ 123456uni9.pro.br
                Article
                196223
                10.2147/COPD.S196223
                6578583
                © 2019 Capeletti et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 4, References: 27, Pages: 7
                Categories
                Original Research

                Respiratory medicine

                copd, dynamic hyperinflation, plethysmography

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