Análise das alterações da mecânica respiratória associadas à Doença de Parkinson

Abstract

Parkinson´s Disease (PD) is caused by the death of dopaminergic neurons in substantia nigra, causing motor symptoms such as bradyknesia, joint stiffness and resting tremor, in addition to non-symptoms such as respiratory dysfunction. Manovacuometry assesses respiratory muscle function and spirometry provides information on pulmonary function. Respiratory oscillometry assesses the mechanical properties of respiratory system, through impedance analysis, in a non-invasive way and requiring few cooperation. In this context, the present study aimed to: Improve knowledge about pathophysiological changes in the respiratory system of patients with PD, smokers or non-smokers, in different degrees of evolution through respiratory oscillometrics; Compare the results between respiratory oscillometry and spirometry; To evaluate the strength of the respiratory muscles of patients with PD. To compare the facility of performing respiratory oscillometry and spirometry in patients with PD. This is na observational case-control study with 67 individuals, 20 in the control group (CG) and 47 with PD divided in two non-smoking groups with different motor impairment, Parkinson´s group 1-1.5 (PG 1-1.5) and group Parkinson´s 2-3 (PG 2-3), and Parkinsons´s smoker group (PG smo). There was a significant reduction in maximal expiratory pressure in all Parkinson´s group and in maximal inspiratory pressure in PG 2-3 compared to predicted. No significant differences were observed according to the progression of PD in relation to spirometry. However, an increse in elastic properties was seen in respiratory oscillometry, due to the rigidity of the rib cage, reflected in a significant reduction in dynamics compliance, a significant reduction in mean reactance, a significant increase in the resonance frequency as the disease progresses, characterizing a ventilatory pattern restrictive, which was also observed when comparing the CG with the PG smo, with the exception of the reduction in dynamic compliance. Regarding the resistive properties, a significant increase in resistance at 4 hertz (Hz) minus resistance at 20 Hz was found according to the progression of PD, indicating inhomogeneity of ventilation, in addition to changes in resistances of peripheral airways, possibly due to chest stiffness leading to less air in the airway and consequently, a reduction in its caliber. These results demonstrate that oscilometry can help in the diagnosis of respiratory disorders in PD, increasing knowledge about changes in respiratory mechanics in these individuals