Efeitos do treinamento muscular inspiratório e dos exercícios respiratórios em crianças com asma: revisão sistemática
DOI:
https://doi.org/10.7322/jhgd.v30.10381Palavras-chave:
Asma, Exercício respiratório, CriançaResumo
Introdução: Asma é caracterizada por estreitamento e inflamação dos brônquios, com sintomas de dispneia, fadiga e limitação aos exercícios. O tratamento fisioterapêutico engloba treinamento muscular inspiratório e exercícios respiratórios, pois o aumento da força e resistência da musculatura inspiratória podem melhorar os sintomas da doença.
Objetivo: Descrever os efeitos do treinamento muscular inspiratório (TMI) e dos exercícios respiratórios na criança com asma.
Método: Revisão sistemática da literatura conduzida nas bases de dados Cochrane, PubMed, Scopus e Web of Science. Utilizou-se os descritores: asma, treinamento muscular inspiratório, exercícios respiratórios e criança e seus correlatos em inglês e espanhol. Dois avaliadores independentes elencaram estudos que realizaram intervenção com exercícios respiratórios e TMI na criança com asma.
Resultados: De um total de 312 títulos, foram incluídos oito estudos, dos quais seis são ensaios clínicos randomizados e dois observacionais. Todos os trabalhos incluíram exercícios respiratórios, com o objetivo de adequar o padrão respiratório e a ventilação pulmonar, reduzir a hiperinsuflação pulmonar, o broncoespasmo e a sensação de dispneia, porém como não foram realizados de forma isolada, comprometeu a verificação dos efeitos dessa intervenção. Dois estudos realizaram TMI e evidenciaram aumento nas pressões respiratórias máximas.
Conclusão: Exercícios respiratórios são muito utilizados na prática clínica como parte do manejo da criança com asma, entretanto ainda não é possível mensurar seus efeitos nessa população. O TMI parece melhorar a força muscular inspiratória e expiratória, mas sua indicação na população pediátrica ainda não é rotineira.
Referências
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5. IV Diretizes Brasileiras para o Manejo da Asma. J Bras Pneumol. 2006;32(Suppl 7):447-74. DOI: https://doi.org/10.1590/S1806-37132006001100002
6. Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Diretrizes da Sociedade Brasileira de Pneumologia e Tisiologia para o Manejo da Asma. J. Bras Pneumol. 2012;38 (Suppl 1):S1-46.
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11. Ruas G, Urquizo WEC, Abdalla GK, Abrahão DPS, Cardoso FAG, Pinheiro PS, et al. Relationship of muscle strength with activies of daily living and quality of life in individuals with chronic obstructive pulmonary disease. Fisioter Mov. 2016;29(1):79-86. DOI: http://dx.doi.org/10.1590/0103-5150.029.001.AO08
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13. Silva KCL, Andrade TCQ, Pessoa MF, Andrade AC. Posicionamento corporal alterando a força muscular respiratória e o grau de obstrução em crianças asmáticas. Fisiot Mov. 2012;25(3):533-40. DOI: http://dx.doi.org/10.1590/S0103-51502012000300009
14. Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saúde., 2015;24(2):335-42. DOI: https://doi.org/10.5123/S1679-49742015000200017
15. Maher, CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. DOI: https://doi.org/10.1093/ptj/83.8.713
16. Silva IS, Fregonezi GAF, Dias FAL, Ribeiro CTD, Guerra RO, Ferreira GMH. Inspiratory muscle training for asthma. Cochrane Database Syst Rev. 2013;(9):CD003792. DOI: https://doi.org/10.1002/14651858.CD003792.pub2
17. Rossi A, Aisanov Z, Avdeev S, Di Maria G, Donner CF, Izquierdo JL, et al. Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD. Respir Med. 2015;109(7):785-802. DOI: https://doi.org/10.1016/j.rmed.2015.03.010
18. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64. DOI: https://doi.org/10.1164/rccm.201309-1634ST
19. Lima EVNCL, Lima WL, Nobre A, Santos AM, Briito LMO, Costa MRSR. Treinamento muscular inspiratório e exercícios respiratórios em crianças asmáticas. J Bras Pneumol. 2008;34(8):552-8. DOI: https://doi.org/10.1590/S1806-37132008000800003
20. David MMC, Gomes ELFD, Mello MC, Costa D. Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial. Ther Adv Respir Dis. 2018;12:1753466618777723. DOI: https://doi.org/10.1177/1753466618777723
21. Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(Suppl 1):1-51. DOI: http://dx.doi.org/10.1136/thx.2008.110726
22. Bruton A, Lewith GT. The Buteyko breathing technique for asthma: a review. Complement Ther Med. 2005;13(1):41-6. DOI: https://doi.org/10.1016/j.ctim.2005.01.003
23. Burgess J, Ekanayake B, Lowe A, Dunt D, Thien F, Dhamarge SC. Systematic review of the effectiveness of breathing retraining in asthma management. Expert Rev Respir Med. 2011;5(6):789-807. DOI: https://doi.org/10.1586/ers.11.69
24. McCaully HE. Breathing exercises as play for asthmatic children. Am J Matern Child Nurs. 1980;5(5):340-4.
25. Asher MI, Douglas C, Airy M, Andrews D, Trenholme A. Effects of chest physical therapy on lung function in children recovering from acute severe asthma. Pediatr Pulmonol. 1990;9(3):146-51. DOI: https://doi.org/10.1002/ppul.1950090305
26. Seligman T, Randel HO, Stevens JJ. Conditioning program for children with asthma. Phys Ther. 1970;50(5):641-50. DOI: https://doi.org/10.1093/ptj/50.5.641
27. Bignall WJR, Luberto CM, Cornette AF, Haj-Hamed M, Cotton S. Breathing retraining for African-American adolescents with asthma: a pilot study of a school-based randomized controlled trial, J Asthma. 2015;52(9):889-96. DOI: https://doi.org/10.3109/02770903.2015.1033724
28. El-Kader SMA. Laser acupuncture therapy combined with aerobic exercise training and pursed lips breathing in treatment of asthmatic children: A comparison of two treatment protocols. Eur J Gen Med. 2011;8(3):200-6. DOI: https://doi.org/10.29333/ejgm/82731
29. Ceugniet F, Cauchefer F, Gallego J. Do voluntary changes in inspiratory-expiratory ratio prevent exercise-induced asthma? Biofeedback Self Regul. 1994;19(2):181-8. DOI: https://doi.org/10.1007/BF01776490
30. Karakoç GB, Yilmaz M, Sur S, Altintas DU, Sarpel T, Kendirli SG. The effects of daily pulmonary rehabilitation program at home on childhood asthma. Allergol Immunopathol. 2000;28(1):12-4.
31. Schenkel IC, Garcia JM, Berretta MSK, Silva MEM, Schivinski CIS. Therapeutic play as technique supporting to physiotherapeutic treatment in children with respiratory disorders. Psicol Teor Prat. 2013;15(1):130-44.
2. Solé D, Melo KC, Camelo-Nunes IC, Freitas LS, Britto M, Rosário NA, et al. Changes in the prevalence of asthma and allergic diseases among Brazilian schoolchildren (13-14 years old): Comparison between ISAAC Phases One and Three. J Trop Pediatr. 2007;53(1):13-21. DOI: https://doi.org/10.1093/tropej/fml044
3. World Health Organization (WHO). Asthma [online]. [cited 2018 Sep 22] Available from: http://www.who.int/news-room/fact-sheets/detail/asthma
4. Barreto ML, Ribeiro-Silva RC, Malta DC, Andreazzi MA, Cruz AA. Prevalence of asthma symptoms among adolescents in Brazil: national adolescent school-based health survery (PeNSE 2012). Rev Bras Epidemiol. 2014;17(Suppl 1):106-15. DOI: https://doi.org/10.1590/1809-4503201400050009
5. IV Diretizes Brasileiras para o Manejo da Asma. J Bras Pneumol. 2006;32(Suppl 7):447-74. DOI: https://doi.org/10.1590/S1806-37132006001100002
6. Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Diretrizes da Sociedade Brasileira de Pneumologia e Tisiologia para o Manejo da Asma. J. Bras Pneumol. 2012;38 (Suppl 1):S1-46.
7. Athanazio R. Airway disease: similarities and differences between asthma, COPD and bronchiectasis. Clinics (São Paulo. 2012;67(11):1335-43 DOI: http://dx.doi.org/10.6061/clinics/2012(11)19
8. Mascarenhas JMO, Silva RCR, Assis AMO, Pinto EJ, Conceição JS, Barreto ML. Symptoms of asthma and associated factors in adolescents from Salvador, Bahia. Rev Bras Epidemiol. 2016;19(1):181-93. DOI: http://doi.org/10.1590/1980-5497201600010016
9. Robles-Ribeiro PG, Ribeiro M, Lianza S. Relationship between peak expiratory flow rare and shoulders posture in healthy individuals and moderate to severe asthmatic patients. J Asthma. 2005;42(9):783-6. DOI: http://doi.org/10.1080/02770900500308411
10. Macêdo TMF, Freitas DA, Chaves GSS, Holloway EA, Mendonça KMPP. Breathing exercises for children with asthma. Cochrane Database Syst Rev. 2016;4(4):CD011017. DOI: http://doi.org/10.1002/14651858.CD011017.pub2
11. Ruas G, Urquizo WEC, Abdalla GK, Abrahão DPS, Cardoso FAG, Pinheiro PS, et al. Relationship of muscle strength with activies of daily living and quality of life in individuals with chronic obstructive pulmonary disease. Fisioter Mov. 2016;29(1):79-86. DOI: http://dx.doi.org/10.1590/0103-5150.029.001.AO08
12. Bruurs ML, van der Giessen LJ, Moed H. The effectiveness of physiotherapy in patients with asthma: a systematic review of the literature. Respir Med. 2013;107(4):483-94. DOI: http://dx.doi.org/10.1016/j.rmed.2012.12.017
13. Silva KCL, Andrade TCQ, Pessoa MF, Andrade AC. Posicionamento corporal alterando a força muscular respiratória e o grau de obstrução em crianças asmáticas. Fisiot Mov. 2012;25(3):533-40. DOI: http://dx.doi.org/10.1590/S0103-51502012000300009
14. Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: A recomendação PRISMA. Epidemiol Serv Saúde., 2015;24(2):335-42. DOI: https://doi.org/10.5123/S1679-49742015000200017
15. Maher, CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. DOI: https://doi.org/10.1093/ptj/83.8.713
16. Silva IS, Fregonezi GAF, Dias FAL, Ribeiro CTD, Guerra RO, Ferreira GMH. Inspiratory muscle training for asthma. Cochrane Database Syst Rev. 2013;(9):CD003792. DOI: https://doi.org/10.1002/14651858.CD003792.pub2
17. Rossi A, Aisanov Z, Avdeev S, Di Maria G, Donner CF, Izquierdo JL, et al. Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD. Respir Med. 2015;109(7):785-802. DOI: https://doi.org/10.1016/j.rmed.2015.03.010
18. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64. DOI: https://doi.org/10.1164/rccm.201309-1634ST
19. Lima EVNCL, Lima WL, Nobre A, Santos AM, Briito LMO, Costa MRSR. Treinamento muscular inspiratório e exercícios respiratórios em crianças asmáticas. J Bras Pneumol. 2008;34(8):552-8. DOI: https://doi.org/10.1590/S1806-37132008000800003
20. David MMC, Gomes ELFD, Mello MC, Costa D. Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial. Ther Adv Respir Dis. 2018;12:1753466618777723. DOI: https://doi.org/10.1177/1753466618777723
21. Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(Suppl 1):1-51. DOI: http://dx.doi.org/10.1136/thx.2008.110726
22. Bruton A, Lewith GT. The Buteyko breathing technique for asthma: a review. Complement Ther Med. 2005;13(1):41-6. DOI: https://doi.org/10.1016/j.ctim.2005.01.003
23. Burgess J, Ekanayake B, Lowe A, Dunt D, Thien F, Dhamarge SC. Systematic review of the effectiveness of breathing retraining in asthma management. Expert Rev Respir Med. 2011;5(6):789-807. DOI: https://doi.org/10.1586/ers.11.69
24. McCaully HE. Breathing exercises as play for asthmatic children. Am J Matern Child Nurs. 1980;5(5):340-4.
25. Asher MI, Douglas C, Airy M, Andrews D, Trenholme A. Effects of chest physical therapy on lung function in children recovering from acute severe asthma. Pediatr Pulmonol. 1990;9(3):146-51. DOI: https://doi.org/10.1002/ppul.1950090305
26. Seligman T, Randel HO, Stevens JJ. Conditioning program for children with asthma. Phys Ther. 1970;50(5):641-50. DOI: https://doi.org/10.1093/ptj/50.5.641
27. Bignall WJR, Luberto CM, Cornette AF, Haj-Hamed M, Cotton S. Breathing retraining for African-American adolescents with asthma: a pilot study of a school-based randomized controlled trial, J Asthma. 2015;52(9):889-96. DOI: https://doi.org/10.3109/02770903.2015.1033724
28. El-Kader SMA. Laser acupuncture therapy combined with aerobic exercise training and pursed lips breathing in treatment of asthmatic children: A comparison of two treatment protocols. Eur J Gen Med. 2011;8(3):200-6. DOI: https://doi.org/10.29333/ejgm/82731
29. Ceugniet F, Cauchefer F, Gallego J. Do voluntary changes in inspiratory-expiratory ratio prevent exercise-induced asthma? Biofeedback Self Regul. 1994;19(2):181-8. DOI: https://doi.org/10.1007/BF01776490
30. Karakoç GB, Yilmaz M, Sur S, Altintas DU, Sarpel T, Kendirli SG. The effects of daily pulmonary rehabilitation program at home on childhood asthma. Allergol Immunopathol. 2000;28(1):12-4.
31. Schenkel IC, Garcia JM, Berretta MSK, Silva MEM, Schivinski CIS. Therapeutic play as technique supporting to physiotherapeutic treatment in children with respiratory disorders. Psicol Teor Prat. 2013;15(1):130-44.
