Dirceu Costa

Background and Purpose: Asthma is one of the most prevalent chronic diseases in childhood and a major cause of respiratory morbidity, school absenteeism, and restrictions in physical activity. Although asthma control is commonly assessed using clinical and inflammatory markers, its functional impact on daily activities and participation is less frequently addressed. Fractional exhaled nitric oxide (FeNO) is a well‐established biomarker of eosinophilic airway inflammation; however, its integration with quality‐of‐life measures within a biopsychosocial framework, such as the International Classification of Functioning, Disability and Health (ICF), remains limited. This study aimed to examine the associations between quality of life, airway inflammation, and functional status in children and adolescents with asthma using the ICF as a conceptual integrative framework. Methods: This cross‐sectional study included 112 children and adolescents with clinically diagnosed asthma receiving care at a pediatric respiratory physiotherapy clinic. Data collection comprised demographic and anthropometric variables, FeNO levels, and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores. Clinical and patient‐reported outcomes were conceptually linked to ICF categories related to body functions and activities and participation and expressed as functional impairment levels (0–4) for descriptive and comparative purposes. Descriptive analyses were performed, and participants were stratified according to FeNO levels (< 35 vs. ≥ 35 ppb). Group comparisons were conducted using Welch's t ‐test, with effect sizes estimated using Cohen's d ( p < 0.05). Results: The sample had a mean age of 8.9 ± 2.7 years and a mean FeNO level of 47.1 ± 38.6 ppb. Overall PAQLQ scores indicated relatively preserved perceived quality of life across domains. ICF‐based descriptive analysis indicated predominantly mild‐to‐moderate limitations in activity‐ and symptom‐related domains and minimal emotional impairment, with a mean global ICF score of 1.5 ± 0.6. Participants with FeNO ≥ 35 ppb presented lower PAQLQ scores in symptoms, emotions, and activities, as well as higher global ICF scores, compared with those with FeNO < 35 ppb (all p ≤ 0.05). Effect sizes were large (Cohen's d ≥ 0.8). Discussion: Higher FeNO levels were associated with poorer quality‐of‐life scores and greater functional impairment. The conceptual integration of FeNO and PAQLQ findings within the ICF framework facilitated the interpretation of inflammatory status in relation to functional domains relevant to physiotherapy without implying causality. This approach supports a more comprehensive understanding of asthma‐related functioning in children and adolescents.

Asthma is a condition characterized by ongoing inflammation of the lower respiratory system, leading to symptoms such as shortness of breath, wheezing, coughing, and chest tightness. Beyond acute symptoms, children with asthma may face ongoing issues, such as decreased physical fitness, sleep disturbances, and a reduced quality of life. This study aimed to explore the connections between sleep quality, asthma control, pulmonary inflammation, exercise capacity, and overall wellbeing in children aged 6 to 12 years. Forty children with varying asthma severity were evaluated for clinical control status, sleep disturbances, quality of life, and exercise ability using various questionnaires and tests. Results showed that 15% had intermittent/mild asthma while 85% had moderate/severe asthma, with 75% experiencing uncontrolled asthma. The analysis indicated a strong correlation between improved asthma control, reduced pulmonary inflammation, better sleep quality, and enhanced quality of life, accounting for 20% of the variations in the children’s quality of life scores.

Highlights Positive airway pressure may improve the severity of asthma exacerbation. A high-flow nasal cannula can improve respiratory physiotherapy outcomes. Positive airway pressure is indicated for moderate asthma exacerbation. Bilevel positive airway pressure and high-flow nasal cannula use may improve the pulmonary function. ABSTRACT Objective: To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation. Methods: During

Introduction Chronic obstructive pulmonary disease (COPD) is characterized by limited airflow associated with inflammatory response and systemic manifestations, such as dyspnea, as well as physical inactivity and intolerance to exercise. The sum of these changes can lead to peripheral muscle fatigue and exert an impact on the performance of activities of daily living (ADL). Objective To investigate the possible association between peripheral muscle fatigue and performance on ADL in individuals with COPD, and to compare the results to those of healthy age-matched individuals. Methods Individuals with a diagnosis of COPD and healthy volunteers aged 60 years or older were submitted to evaluations of peripheral muscle fatigue (using surface electromyography) and performance on the Glittre-ADL test. Results Nine individuals with COPD and ten controls were evaluated. Median isometric quadriceps contraction time was 72 [38] and 56 [51] seconds, respectively. Execution time on the ADL test was 6.1 [4] and 3.6 [1.3] minutes for COPD and control group respectively, with a significant difference between groups (p < 0.05). However, no significant correlation was found between the evaluations. Conclusion No association was found between quadriceps muscle fatigue and performance on ADL in the sample studied. In the intergroup comparison, the individuals with COPD exhibited worse ADL time execution, but no significant difference was found regarding quadriceps muscle fatigue.

Summary: Adults with obesity exhibit a restrictive pattern, whereas children with obesity exhibit an obstructive pattern. However, the transition process remains unclear. We performed a systematic search for studies reporting on body mass index and pulmonary function in children. The main outcomes were forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and their ratio (FEV₁/FVC). We compared individuals with overweight or with obesity with individuals with normal weight. Random‐effects models were used to calculate pooled estimates. A total of 17 studies were included. Individuals with obesity had a lower FEV₁/FVC ratio (mean difference [MD] = −3.61%; 95% confidence interval [CI] = −4.58%, −2.64%) and a higher percent‐predicted FVC (MD = 3.33%; 95% CI = 0.79%, 5.88%) than those with normal weight. Obesity impaired pulmonary function in the obstructive pattern during childhood to young adulthood, and the maximum obstruction was observed at the age of 16 years in boys and 20 years in girls. The effects attenuated at approximately 30 years and then shifted to the restrictive pattern after 35 years of age in men and 40 years in women. The effects of obesity on pulmonary function change from the obstructive pattern in childhood to the restrictive pattern in adulthood.

Objetivo: Realizar um levantamento bibliográfico e relatórios do aumento de casos de Febre Amarela, Chickungunya, Dengue e Zika após o rompimento das barragens de Mariana e Brumadinho (Minas Gerais). Metodologia: Foi feito um estudo bibliográfico, epidemiológico com artigos, reportagens e busca em plataformas acadêmicas e de boletins do Ministério da Saúde com o intuito de associar o aumento dos casos conforme sua localização de acordo com o período após o rompimento. Resultados: Houve um aumento evidente nos casos de arboviroses logo após o rompimento das barragens em áreas afetadas com o impacto e proximidades. Isso pode ser resultado da movimentação de pessoas e animais após as tragédias, pois com a degradação da área, pessoas foram afetadas de maneira direta e indireta, as que foram afetadas de maneira direta tiveram suas casas destruídas pela lama e as que foram afetadas de maneira indireta podem ter saído da cidade em busca de alternativas de melhora. Também há uma alteração na cadeia alimentar local, algumas populações elevam e outras diminuem, as populações de mosquitos elevam e migram para outras áreas mais populosas em busca de alimento, assim sendo um fator da disseminação de doenças. Conclusão: Observou-se ne que no período de 2015 a 2016 os casos de CHIKV foram os que mais cresceram no Brasil, tendo um aumento de quase 10x, de Febre Amarela e Dengue tendo um aumento de mais ou menos 3x. Os casos de Zika começam a ser notificados em 2015, portanto não é possível determinar se houve um aumento significativo.

To evaluate the autonomic modulation and clinical responses during testing of exercise-induced bronchoprovocation (EIB) and when applying non-invasive...

Telemetry is a key, widely used tool to understand marine megafauna distribution, habitat use, behavior, and physiology; however, a critical question remains: “How many animals should be tracked to acquire meaningful data sets?” This question has wide‐ranging implications including considerations of statistical power, animal ethics, logistics, and cost. While power analyses can inform sample sizes needed for statistical significance, they require some initial data inputs that are often unavailable. To inform the planning of telemetry and biologging studies of marine megafauna where few or no data are available or where resources are limited, we reviewed the types of information that have been obtained in previously published studies using different sample sizes. We considered sample sizes from one to >100 individuals and synthesized empirical findings, detailing the information that can be gathered with increasing sample sizes. We complement this review with simulations, using real data, to show the impact of sample size when trying to address various research questions in movement ecology of marine megafauna. We also highlight the value of collaborative, synthetic studies to enhance sample sizes and broaden the range, scale, and scope of questions that can be answered.

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.