Publications by authors named "Fernanda M Balzan"

2 Publications

  • Page 1 of 1

Responses to progressive exercise in subjects with chronic dyspnea and inspiratory muscle weakness.

Clin Respir J 2021 Jan 15;15(1):26-35. Epub 2020 Sep 15.

Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil.

Introduction: Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under-appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work-up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterized.

Objectives: To identify the physiological and sensorial responses to progressive exercise in dyspneic patients with IMW without concomitant cardiorespiratory or neuromuscular diseases.

Methods: Twenty-three subjects (18 females, 55.2 ± 16.9 years) complaining of chronic daily life dyspnea (mMRC = 3 [2-3]) plus maximal inspiratory pressure < the lower limit of normal and 12 matched controls performed incremental cycling CPET. FEV/FVC<0.7, significant abnormalities in chest CT or echocardiography, and/or an established diagnosis of neuromuscular disease were among the exclusion criteria.

Results And Conclusion: Patients presented with reduced aerobic capacity (peak V̇O: 79 ± 26 vs 116 ± 21 %predicted), a tachypneic breathing pattern (peak breathing frequency/tidal volume = 38.4 ± 22.7 vs 21.7 ± 14.2 breaths/min/L) and exercise-induced inspiratory capacity reduction (-0.17 ± 0.33 vs 0.10 ± 0.30 L) (all P < .05) compared to controls. In addition, higher ventilatory response (ΔV̇/ΔV̇CO = 34.1 ± 6.7 vs 27.0 ± 2.3 L/L) and symptomatic burden (dyspnea and leg discomfort) to the imposed workload were observed in patients. Of note, pulse oximetry was similar between groups. Reduced aerobic capacity in the context of a tachypneic breathing pattern, inspiratory capacity reduction and preserved oxygen exchange during progressive exercise should raise the suspicion of inspiratory muscle weakness in subjects with otherwise unexplained breathlessness.
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January 2021

Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.

Prim Health Care Res Dev 2018 11 21;19(6):570-574. Epub 2018 Feb 21.

1Hospital de Clinicas de Porto Alegre (HCPA),Universidade Federal do Rio Grande do Sul (UFRGS),Porto Alegre,RS,Brazil.

AimTo investigate if cardiac/pulmonary functional tests and variables obtained from clinical practice (body mass index, dyspnea, functional class, clinical judgment of disability to perform an exercise test and previous hospitalization rate) are related to mortality in patients with overlap chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). BACKGROUND: Although the coexistence of COPD and CHF has been growingly reported, description of survival predictors considering the presence of both conditions is still scarce. METHODS: Using a cohort design, outpatients with the previous diagnosis of COPD and/or CHF that performed both spirometry and echocardiography in the same year were followed-up during a mean of 20.9±8.5 months.FindingsOf the 550 patients initially evaluated, 301 had both spirometry and echocardiography: 160 (53%) with COPD on isolation; 100 (33%) with CHF on isolation; and 41 (14%) with overlap. All groups presented similar mortality: COPD 17/160 (11%); CHF 12/100 (12%); and overlap 7/41 (17%) (P=0.73). In the overlap group (n=41), inability to exercise and hospitalization rate were the unique parameters associated with higher mortality (seven events) in univariate analyses. In conclusion, inability to exercise and hospitalization rate emerged as the unique parameters associated with mortality in our sample.
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November 2018