Physiotherapy: functionality and biomolecular and cellular study in the treatment of patients with cardiorespiratory dysfunctions

Abstract

PROJECT 1: Heart failure is a clinical syndrom that is the common end of several cardiac diseases with symptoms such as muscle fatigue, dispnea and reduction of quality of life. To improve respiratory and functional capacity of these patients, there are strategies that can be used such as inspiratory muscle training and peripheric muscle training by dynamic resistance training. Objective: To assess the effects of a combined program of inspiratory muscle and peripheric muscle training on functionality and quality of life in patients with severe heart failure and assessment of oxidative stress, inflammation and DNA and RNA changes. Population: 50 patients with severe heart failure (functional class from NYHA III and IV) will be included in this study. PROJECT 2: The obstructive sleep apnea (OSA) affects between 10% to 25% of the adults. Continuous positive airway pressure (CPAP) is the chosen treatment in moderate and severe OSA. However, the adherence to CPAP varies, and the interface between patient and the CPAP may interfere with adherence, comfort and efficiency. Objectives: (1) to determine which is the preferred airway flow, (2) to analyze the effects of nasal and oronasal respiration on the nasal mucosa and the airways, (3) the effects of each interface (nasal and orofacial masks) on the nasal epithelum and airways in these patients under CPAP, and (3) to assess the oxidative stress, inflammation and DNA and RNA changes. Population: 40 patients with moderate and severe OSA recruted at Sleep Laboratory of Heart Institute - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. PROJECT 3: Inhalation of cigarette smoke is deleterious to the respiratory epithelium, it changes the ciliary beating and also production and mucus composition. All together induces morphological alterations in the respiratory tract epithelium and also to loss of cilia, metaplasia, keratinization of goblet cells followed by respiratory epithelium thickening as well as submucosa inflammation. Objective: To assess the effects of smoking and smoking cessation on (1) the airways defense mechanisms and (2) to assess the oxidative stress, inflammation and DNA and RNA changes. Population: Smokers, non-smokers and quitters of both genders, aged between 18-70 years old will be recruted at Faculdade de Medicina da Universidade de São Paulo. METHODS AND INSTRUMENTS OF ANALYSIS: Maximal respiratory pressures by manovacuometer, Lung function by spirometry, functional capacity by 6 minutes walk test, peripheric muscle strength by dynamometer, Quality of life by questionnaires (Minnesota, SF-36, Epworth, Pittsburgh, SNOT20, IPAQ), physical activity classification by accelerometers, Heart rate variability and cardiac events by electrophysiological study, nasal mucociliary clearance by saccharine transit time test, mucus physical properties by contac angle por cough transportability, nasal and the airways inflammation by nasal lavage total cells and pH, pH in exhaled breath condensate. Systemic oxidative stress, inflammation by antioxidants, oxidants and cytokines in peripheric blood, and changes in DNA and RNA miRNA by PCR-microarray. (AU)