Avaliação metabólica e ventilatória de pacientes com doença pulmonar obstrutiva crônica durante a realização de dois testes de membros superiores

Abstract

Introduction: Individuals with Chronic Obstructive Pulmonary Disease (COPD) usually present progressive dyspnea on exertion, which may be exacerbated by simple activities performed by the unsupported upper limbs. Therefore, the evaluation of the functional capacity of the upper limbs has been on the subject of the study. The unsupported upper limb exercise test (UULEX) and the 6-minute pegboard and ring test (PBRT) were considered the most effective to mimic the ADLs using an elevated and unsupported upper limb, as well as being practical, low cost, with validity and reliability. However, even though they are used as measures to assess the functional capacity of the upper limbs, there is no consensus about the mechanisms that cause limitations during the activities that use the unsupported upper limbs. General Aim: To investigate the possible mechanisms that limit the individuals with COPD during two unsupported upper limbs tests (UULEX and 6PBRT).Specifics Aim: To verify the existence of dynamic hyperinflation (DH) during the PBRT and UULEX, in addition to associating it with the UULEX execution time and the number of rings that moved during PBRT (article 1) and also to investigate the metabolic and ventilatory variables on individuals with COPD during UULEX and PBRT (article 2). Methods: This is a cross-sectional study carried out in a convenience sample of 14 individuals (article 1) and 15 individuals (article 2) with COPD selected at the Pulmonology Outpatient Clinic of the Messejana Hospital - Dr. Carlos Alberto Studart Gomes located in the city of Fortaleza - Ceará between January and April 2019. Initially the individuals were submitted to the evaluation to characterize the sample and record sociodemographic, anthropometric and clinical variables and the Pulmonary Functional Status and Dyspnea Questionnaire - (PFSDQ-M). Then each individual performed two tests in randomized form. The evaluation of ventilatory and metabolic variables during the execution of UULEX and PBRT was performed by the expired gas analyzer Cortex Metalyzer® 3B (Leipzig / Germany) before, immediately after tests and after two minutes of rest. The peripheral oxygen saturation (SpO2), dyspnea and fatigue of the upper limbs were also measured by a modified Borg scale. Inspiratory capacity (IC) was measured by slow vital capacity maneuver before (rest) and immediately after the completion of tests. Results: The results of article 1 showed DH in the PBRT in only 6 subjects (42.9%) (1.60 ± 0.62 ml versus 1.62 ± 0.72 ml, p = 0.6) and in the UULEX of 9 individuals (64.3%) (1.58 ± 0.76 ml vs 1.53 ± 0.68 ml, p = 0.2), however without any statistical significance on both tests. A positive correlation was found between DH in the ULLEX, the test time (r = 0.576, p = 0.031) and the maximum load (r = 0.617, p = 0.019), however, the correlation between the DH during the PBRT and number of moved rings (r = -0.088; p = 0.756) was not evidenced. When analyzing the correlation between the DH and the ergospirometric variables, a positive correlation was found for ULLEX between DH and VO2 peak (r = 0.755, p = 0.002), %VO2 máx (r = 0.587; p = 0.027), VCO2 (r = 0.718, p = 0.004) and VE (r = 0.722, p = 0.004). Regarding the PBRT, a negative correlation with VO2 relative (r = -0.547; p = 0.035) was evidenced. The results of article 2, showed that all ergospirometric variables were higher during the UULEX when compared to the PBRT, however the variables of VO2peak, %VO2max, VCO2 and VE presented a significant statistic difference (p≤0.005). When comparing the expected value of VO2 peak in the population along with the VO2 peak after the test result, there was a significant statistic difference in both groups (p≤0,000), with the UULEX having a higher VO2 peak. Besides that, when correlating the functional status of the subjects with VO2 peak, we noticed that only the domain influence of changes in the ADL did not correlate with the PBRT and the UULEX. Conclusion: The two tests of the upper limb studied (UULEX and PBRT) promoted a significant increase in the metabolic, ventilatory and dyspnea responses in individuals with COPD, however the UULEX promoted greater responses when compared to the PBRT. Both UULEX and PBRT leads to a reduction of IC and, therefore, to the DH after the test, but this reduction was not statistically significant. In addition, it was observed that the longer the UULEX time, the greater the DH. Regarding the PBRT, we observed that there is no correlation between the number of rings moved with DH.