Avaliação da modulação do sistema nervoso autonômico e reprodutibilidade do teste de caminhada com velocidade controlada (Shuttle Walk Test) em pacientes asmáticos

Abstract

Asthma is a chronic inflammatory disease characterized by airway hyperresponsiveness of the lower airways, whether caused by endogenous or exogenous agents and variable limitation to resolve spontaneously or through medical treatment airflow . Some respiratory diseases can lead to imbalance of the autonomic nervous system (ANS), and this represents a primary role in the control of airway caliber and its dysfunction may contribute to the pathogenesis of respiratory diseases. The functional capacity evaluation is done by means of field test , where several tests can be used to evaluate it , and the chosen test will depend on the materials available to be used . An interesting method is the incremental motion controlled test, which until now has not reviewed reproducibility. Thus this study had two articles that present the following objectives: STUDY I: evaluating the modulation of autonomic nervous system of patients with difficult to control asthma in supine and upright position and II STUDY II: to evaluate the reproducibility of gait speed controlled incremental controlled test in asthmatic severe and difficult to control . The study population of patients with asthma is difficult to control (± 47 years), Incremental controlled gait test pulmonary function test, Assessment of pulmonary inflammation (FeNO) measurement of tangible characteristics and heart rate variability (HRV): The following procedures were performed. As a result I STUDY statistically significant differences were found in spirometric variables , BMI , a difference in HRV compared intra - group BF + AF during supine position (13.9 ± 4.75) and standing (0.80 ± 0,19) in GA, intergroup in the standing position in AF (0.13 ± 0.07) , AF + BF (0.47 ± 0.13), BF % (0.68 ± 0.17) % HF bands (0.31 ± 0.17), AF / BF% (2.75 ± 2.51) , r = 0.72 and p 0.069 in correlation orthostatic LF / HF vs FeNO . AND STUDY II: Only 39 of the initial 55 patients planned for the experiments were included in the study . the average distance traveled in the first test was 322 meters with a variation 50-569 meters, the average distance of the second test was 337 meters, with a variation 60-558 meters. Of the 39 asthmatics analyzed four walked more in the first test (10.25%) , walked 24 more in the second test (61.53%) and 11 walked the same distance (28.20%) in both tests. The graphical statistical analysis by the Bland - Altman test the distance between the two tests showed a mean difference of -15.2 meters and a confidence interval of 57.2 meters to 87.5 meters. Thus it is concluded that asthmatics unwieldy exhibit an altered SNA with postural change and inflammatory response contributes to this imbalance of sympathetic- vagal response response. And TMCI proved to be reproducible for patients with asthma is difficult to control , and evaluation of functional capacity .