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The first reference equations for the 6-minute walk distance over a 10 m course

As primary care practice space is mostly limited to 10 m, the 6-minute walk test (6MWT) over a 10 m course is a frequently used alternative to evaluate patients’ performance in COPD. Considering that course length significantly affects distance walked in 6 minutes (6MWD), this study aims to develop appropriate reference equations for the 10 m 6MWT.

Methods 181 healthy subjects, aged 40–90 years, performed two standardised 6MWTs over a straight 10 m course in a cross-sectional study.

Results Average distance achieved was 578±108 m and differed between males and females (p<0.001). Resulting sex-specific reference equations from multiple regression analysis included age, body mass index and change in heart rate, explaining 62% of the variance in 6MWD for males and 71% for females.

Conclusions The presented reference equations are the first to evaluate 6MWD over a 10 m course and expand the usefulness of the 6MWT.

Chronic cough: from a complex dysfunction of the neurological circuit to the production of persistent cough

Chronic cough or cough that lasts more than 8 weeks, once a chest x-ray and spirometry are confirmed normal, is caused by an alteration in a section of the route between peripheral receptors, mainly in the upper and lower airway and oesophagus, spinal cord and the cough centre in the brain stem involving the cortex. These mechanisms of cough have their homology in the circuit of chronic pain, and on that basis, should expand future research of chronic cough. Clinically chronic cough is easy to diagnose by an excessive response or hypertussia to low-intensity stimuli or banal stimuli, which we now call hypersensitivity cough syndrome, quantified by a positive reflex cough with capsaicin or citric acid. However, hypersensitivity cough syndrome can be impossible to quantify in the laboratory ...

Pneumonia and inhaled corticosteroids in COPD

Combination treatment with inhaled corticosteroids and long-acting β2-agonists decreases exacerbations and improves quality of life in patients with COPD; however; a potential concern is an increased risk of pneumonia. Although the TORCH and INSPIRE studies have shown the risk of pneumonia to increase with fluticasone/salmeterol versus placebo and tiotropium, there has been no direct comparison of fixed combinations of inhaled corticosteroids/long-acting β2-agonists. The PATHOS study compared the occurrences of pneumonia and pneumonia-related events in patients with COPD treated with either fluticasone/salmeterol (Seretide) or budesonide/formoterol (Symbicort). This was an observational retrospective cohort study matched for propensity score comparing 2734 patients in each group....

Retrospective Observational study of diagnostic accuracy of the Xpert(R) MTB/RIF assay on fiberoptic bronchoscopy sampling for early diagnosis of smear-negative or sputum-scarce patients with suspected tuberculosis

Fiberoptic bronchoscopy (FOB) is a useful diagnosis tool in low-burden countries for patients with suspected pulmonary tuberculosis (TB) who are smear-negative or sputum-scarce. This study sought to determine the accuracy of the Xpert(R) MTB/RIF (XP) assay using FOB samples.

Methods : We retrospectively reviewed clinical, radiological, and microbiological characteristics of 175 TB-suspected patients requiring diagnostic FOB (bronchial aspirate or bronchoalveolar lavage) with XP assay. Polymerase chain reaction (PCR) and smear microscopy (SM) performances were first compared to culture, then to the final diagnosis, established based on clinical or radiological evolution when cultures were negative.

Results : Of the total 162 included patients, 30 (18.5%) had a final diagnosis of pulmonary TB, with positive cultures reported in 23. As compared to culture, sensitivity and specificity values were 80.0% and 98.6% for the XP assay, and 25.0% and 95.8% for SM, respectively. As compared to final diagnosis, the corresponding performance values were 60.0% and 100.0% for the XP assay, and 66.7% and 95.5% for SM, respectively. The sensitivity of the XP assay was significantly higher than that of SM in both cases (p = 0.003 and p = 0.001). Concerning the final diagnosis, both XP assay and culture sensitivities were similar (60% vs. 66.7%). PCR assay enabled pulmonary TB to be diagnosed earlier in 13 more cases, compared to SM.

Conclusion : Our study has confirmed the clinical benefits provided by XP assay compared to SM for the early diagnosis of suspected pulmonary TB cases requiring FOB, on per procedure samples, especially in a low TB-burden country.

Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects

CONCLUSIONS: DB showed positive effects such as increase in lung volumes, respiratory motion, and SpO2 and reduction in respiratory rate. Although there were no changes in volume and time measurements during PB in COPD, this breathing pattern increased volumes in the healthy subjects and increased oxygenation in both groups. In this context, the acute benefits of DB are emphasized as a supporting treatment in respiratory rehabilitation programs. (Source: Revista Brasileira de Fisioterapia)

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