Intervenções de reeducação funcional respiratória na pessoa com doença respiratória: revisão sistemática da literatura

Dias, Pedro Miguel Martins; Teixeira, Helena Margarida dos Santos; Palma, Magali Cavaco; Messias, Patrícia Alexandra Lopes; Vieira, João Vítor da Silva; Ferreira, Rogério Manuel Ferrinho

Pedro Miguel Martins Dias Corresponding author: Pedro Miguel Martins Dias E-mail: pedrodias_vrsa@hotmail.com

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0002-2351-6961

Helena Margarida dos Santos Teixeira

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0002-3362-2215

Magali Cavaco Palma

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0002-9458-6246

Patrícia Alexandra Lopes Messias

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0001-5336-2396

João Vítor da Silva Vieira

Instituto Politécnico de Beja. Beja, Baixo Alentejo, Portugal.

http://orcid.org/0000-0002-3905-4802

Rogério Manuel Ferrinho Ferreira

Instituto Politécnico de Beja. Beja, Baixo Alentejo, Portugal.

http://orcid.org/0000-0001-5180-2036

Autor Correspondente: Pedro Miguel Martins Dias E-mail: pedrodias_vrsa@hotmail.com

EDITOR CHEFE: Antonio José de Almeida Filho

EDITOR ASSOCIADO: Maria Itayra Padilha

População	Intervenção	Outcomes
Pessoas com doença respiratória	Intervenções de enfermagem em reabilitação, no âmbito da RFR	Promoção da melhoria da função respiratória

Título, autores e ano	Nível de evidência	Qualidade metodológica
E1: Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Muñoz et al., 2018(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).	1.c - ERC	12/13
E2: High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Ozalp et al., 2018(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).	1.c - ERC	11/13
E3: Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Liao et al., 2015(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).	1.c - ERC	12/13
E4: Effects of treadmill exercise versus Flutter^®on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. Dwyer et al., 2017(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).	1.c - ERC	10/13
E5: Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Nicolini et al., 2018(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).	1.c - ERC	10/13
E6: A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Marques et al., 2020(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).	1.c - ERC	10/13
E7: Comparison of effectiveness of temporary positive expiratory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Nicolini et al., 2017(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).	1.c - ERC	11/13
E8: Effects of exercise and airway clearance (PEP) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Dwyer et al., 2019(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).	1.c - ERC	10/13
E9: Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Simoni et al., 2019(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).	1.c - ERC	10/13

Identificação do estudo	Objetivo do estudo e participantes	Intervenções destacadas	Resultados obtidos
E1: Muñoz et al., 2018(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ) Estudo randomizado controlado	Avaliar a eficácia da técnica de ELTGOL na função respiratória e eliminação de secreções(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ). n = 44. Grupo experimental (GE): n = 22; idade: 63,1±13,5 anos. Grupo de controle (GC) / placebo: n = 22; idade: 66,8±8,4 anos(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).	GE: técnica ELTGOL com compressões toracoabdominais(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ). GC / placebo: exercícios de alongamento dos membros superiores(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).	- Maior eliminação de secreções, nas 24 horas após a primeira avaliação e menos exacerbações no GE; - Melhoria significativa na qualidade de vida (QV) e impacto da tosse no GE(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).
E2: Ozalp et al., 2018(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ) Estudo randomizado controlado	Avaliar o impacto do treino de alta intensidade dos músculos inspiratórios (H-IMT)(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ). n = 45. GE: n = 23; idade: 42,22±14,3 anos. GC: n = 22; idade: 45,95±11,26 anos(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).	Grupo experimental: HIMT com aumento gradual da intensidade ao longo dos treinos(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ). Grupo de controle: treino de baixa intensidade dos músculos inspiratórios, mantendo sempre a mesma intensidade(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).	- Valores mais baixos na escala de dispneia; valores mais altos nos aspectos sociais da escala da QV e maior número de hospitalizações no GE; - Diminuição da fadiga em ambos os grupos(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).
E3: Liao et al., 2015(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ) Estudo randomizado controlado	Avaliar os efeitos da RFR no tocante à dispneia, tosse, tolerância ao exercício e produção de expectoração(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ). n = 61. GE: n = 30; idade: 68 anos (44%-89%). GC: n = 31; idade: 70 anos (52%-91%)(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).	Grupo experimental (componentes da RFR): educação para a saúde, drenagem postural associada a percussões, respiração com lábios semicerrados, mobilização dos membros superiores e treino de andar / mobilização dos membros inferiores com controle da respiração(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ). Grupo de controle: cuidados de saúde usuais e sessões de educação para a saúde(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).	- Dispneia e acessos de tosse diminuíram, e tolerância ao exercício e capacidade de expectorar aumentaram no GE(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).
E4: Dwyer et al., 2017(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ) Estudo randomizado controlado cruzado	Avaliar os efeitos dos exercícios realizadas numa esteira ergométrica e com o Flutter^®na limpeza das vias aéreas(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). n = 25. Idade: 30±8 anos (19%-48%)(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).	Intervenção numa esteira ergométrica: 20 minutos de exercício constante(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). Intervenção com Flutter^®: respirar 15 vezes pelo dispositivo, seguido de uma respiração profunda, tosse e huffing. Ciclo repetido 6 vezes(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). Intervenção de controle: sentados calmamente durante 20 minutos(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). Os participantes foram distribuídos aleatoriamente pelas três intervenções, realizando-as(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).	- A intervenção na esteira e com o Flutter^®revelaram melhorias idênticas e significativas no pico de fluxo expiratório e na redução do mecanismo de impedimento de expectorar; - O Flutter^®criou uma tendência para o fluxo de ar expiratório; - A intervenção na esteira promoveu a hidratação da expectoração(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).
E5: Nicolini et al., 2018(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ) Estudo randomizado controlado	Avaliar se a terapêutica farmacológica em combinação com duas técnicas de percussão, produzem benefícios adicionais em termos de função respiratória e realização de atividades de vida diária (AVD)(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ). n = 63. Grupo IPV: n = 20; idade 72,8±6,1 anos. Grupo HFCWO: n = 21; idade: 73,8±5,9 anos. GC: n = 22; idade: 74,9±2,7 anos(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).	Grupo IPV (intrapulmonary percussive ventilation): tratamento farmacológico juntamente com o dispositivo IPV(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ). Grupo HFCWO (high-frequency chest wall oscillation): tratamento farmacológico juntamente com o dispositivo HFCWO(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ). Grupo de controle: tratamento farmacológico(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).	- Melhoria significativa nos grupos IPV e HFCWO em relação à dispneia e à realização das AVDs e função pulmonar (valores de gases no sangue arterial); - Melhoria significativa na pressão máxima inspiratória e expiratória, no grupo IPV, bem como maior eficácia na desobstrução das vias aéreas e fortalecimento muscular pulmonar; - Resultados semelhantes nas alterações citológicas da expectoração com diminuição das células inflamatórias(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).
E6: Marques et al., 2020(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ) Estudo randomizado controlado	Verificar os efeitos da RFR, comparativamente aos cuidados farmacológicos tradicionais na sintomatologia e funcionalidade de pessoas com infecção do trato respiratório inferior (ITRI)(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ). n = 115. GE: n = 55; idade: 56,02±18,5 anos. GC: n = 60; idade: 54,1±17,3 anos(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).	Grupo experimental: tratamento farmacológico convencional combinado com RFR, que inclui: controle da respiração (respiração com os lábios semicerrados, posições de descanso e relaxamento e respiração diafragmática); EDIC e ELTGOL; técnica do CATR, treino de exercícios (mobilização dos membros superiores, inferiores e tronco, fortalecimento muscular e exercícios de alongamento) e sessões de educação para a saúde(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ). Grupo de controle: tratamento farmacológico convencional(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).	- Ambos os grupos melhoraram em todas as variáveis estudadas, à exceção dos valores obtidos na escala modificada de Borg; - Melhoria em termos de crepitação pulmonar, valores de saturação de oxigénio, da escala mMRC e da prova de marcha de 6 minutos no GE(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).
E7: Nicolini et al., 2017(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ) Estudo randomizado controlado	Comparar a eficácia entre dois dispositivos que usam a PEP na redução das exacerbações e melhoria da função respiratória(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ). n = 120. Grupo T-PEP: n = 40; idade: 72,15±1,2 anos. Grupo O-PEP: n = 40; idade: 70,67±2,1 anos. GC: n = 40; idade: 71,13±1,9(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).	Grupo O-PEP: terapêutica farmacológica juntamente com dispositivo gerador de pressão expiratória positiva oscilatória (O-PEP)(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ). Grupo T-PEP: terapêutica farmacológica juntamente com dispositivo gerador de pressão expiratória positiva temporária (T-PEP)(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ). Grupo de controle: terapêutica farmacológica(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).	- Só o grupo T-PEP reduziu estatisticamente as exacerbações; - A utilização dos dois dispositivos obteve melhorias na escala de dispneia, na função pulmonar e no teste de avaliação da DPOC; - Ambas as intervenções foram bem toleradas(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).
E8: Dwyer et al., 2019(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ) Estudo randomizado controlado cruzado	Comparar o efeito do exercício numa esteira ergométrica com a utilização da PEP em repouso, na limpeza das vias aéreas(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). n = 15. Idade: 27 anos (18%-48%)(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).	Intervenção numa esteira ergométrica: 20 minutos de exercício constante(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). Intervenção com PEP: respirar 15 vezes pelo dispositivo, seguido de uma respiração profunda, tosse e huffing. Ciclo repetido 6 vezes, durante 20 minutos(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). Intervenção de controle: controle da respiração sentados calmamente, durante 20 minutos(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). Os participantes foram distribuídos aleatoriamente pelas três intervenções, realizando-as(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).	- O exercício na esteira ergométrica aumentou a eliminação de secreções, mas foi significativamente menos eficaz do que a intervenção com PEP; - Após a intervenção da esteira, eliminou-se menos expectoração da região central do pulmão, em comparação com a intervenção com PEP; - A PEP possibilitou mais acessos de tosse do que a intervenção na esteira(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).
E9: Simoni et al., 2019(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ) Estudo randomizado cruzado	Avaliar o efeito em curto prazo da O-PEP e das compressões torácicas na limpeza das vias aéreas(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ). n = 40. GE: n = 20; idade: 57±14 anos. GC: n = 20; idade: 56±10 anos(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).	Criaram-se dois grupos: pessoas com bronquiectasia (grupo bronquiectasia / GE) e pessoas saudáveis (grupo de controle). Cada grupo realizou 3 sessões aleatoriamente, ou seja, 3 tipos de intervenção: intervenção com O-PEP (Flutter^®); intervenção de reeducação costal inferior; intervenção de controle (sentados calmamente)(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).	- A intervenção de reeducação costal inferior aumentou a quantidade de expectoração eliminada, mas a O-PEP foi mais eficaz no GE; - No GE, houve uma diminuição da resistência à passagem do ar pelas vias aéreas; - Não houve diferenças significativas na aceitação, tolerância, dispneia e saturação de oxigénio(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).

[1] Autor Correspondente: Pedro Miguel Martins Dias E-mail: pedrodias_vrsa@hotmail.com

Brasil

Brasil

Intervenções de reeducação funcional respiratória na pessoa com doença respiratória: revisão sistemática da literatura

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