Uso de oxigênio suplementar em indivíduos com doenças respiratórias crônicas nos programas de reabilitação pulmonar da América Latina

Abstract

Chronic respiratory diseases (CRD) impose a high burden of morbidity, mortality, and costs on healthcare systems all of the world. The CRD are the cause of exercise intolerance, limitations in daily activities, reduced quality of life, and increased risk of hospitalization and death. Pulmonary rehabilitation (PR) is essential in the care of individuals with CRD, and highintensity physical training is widely recommended. Strategies that allow for higher exercise intensity, such as the use of supplemental oxygen in individuals who desaturate during exertion, are indicated to improve outcomes. However, there is a scarcity of studies on the behavior of exercise-induced desaturation in Latin American individuals enrolled in PR programs, as well as on physiotherapists’ knowledge regarding oxygen supplementation. This thesis brings together three studies on oxygen supplementation in Latin America.The first article, a descriptive study, investigated the knowledge of physiotherapists working in PR programs regarding oxygen therapy. With 157 respondents, the study showed that although professionals are familiar with the topic, 73% demonstrated an intermediate level of knowledge, with gaps in technical and clinical aspects. The second article, also descriptive, aimed to identify characteristics associated with the knowledge of Brazilian physiotherapists working with individuals with CRD. A total of 196 professionals participated. The use of clinical guidelines was the factor associated with greater knowledge (p = 0.028). Physiotherapists working directly in PR and intensive care scored higher than those working in primary care (p = 0.037). The third article, a comparative study, investigated whether there is a difference in the pattern of oxygen desaturation during field tests among individuals with CRD, and whether this pattern changes after PR. The sample included 146 individuals, divided into two groups: normoxemic at rest (NR) and long-term oxygen therapy users (LTOT). Both groups exhibited significant desaturation at the end of the tests. The LTOT group showed worse functional outcomes: shorter distance in the six-minute walk test (313 ±118 m vs. 445 ±151 m; p < 0.001), shorter time in the Endurance Shuttle Walk Test (4.20 ±2.29 min vs. 6.13 ±4.88 min; p = 0.003), and longer time in the Glittre-ADL test (6.51 ±4.09 min vs. 3.79 ±2.51 min; p = 0.004). All participants improved their functional capacity after PR, but exercise-induced desaturation remained unchanged. The results indicate: (1) the need for continuing education programs for physiotherapists in Latin America; (2) greater investment in the knowledge of primary care professionals in Brazil; and (3) that all individuals, regardless of group, experience exerciseinduced desaturation during field tests. However, LTOT users desaturate more and have worse functional capacity. Still, all individuals, regardless of group, benefit from PR.