Air Stacking em pacientes com esclerose lateral amiotrófica: uma revisão bibliográfica

Abstract

Introduction: Within the classifications of neuromuscular diseases (NMD), the amyotrophic lateral sclerosis (ALS) is defined as a neurodegenerative syndrome characterized by progressive muscular paralysis, reflecting the degeneration of motor neurons in the primary motor cortex, brainstem and spinal cord. Respiratory muscle impairment reduces lung expandability and decreases the ability to produce an effective cough peak flow (CPF), favoring retention of secretions and respiratory infections, as well as increasing morbidity and mortality. The air stacking (AS) technique favors pulmonary insufflation, which can result in optimization of pulmonary retraction pressure, increase in CPF and elimination of secretions. Objectives: To carry out a literature review on the use of AS technique and its benefits in patients with ALS. Methodology: We searched for complete articles of the following types: clinical trials, observational, longitudinal or cross-sectional, cross-over, or case-control; published between the years 1980 to 2019 and indexed in the Medline, Lilacs, Pubmed or SciELO databases. The following keywords were included: "amyotrophic lateral sclerosis", "lou gehrig disease", "air stacking", "peak cough flow", "vital capacity" and "neuromuscular disease". Results: A total of 628 articles were found, of which 512 were excluded because they were not related to the AS technique, 60 because they were literature reviews and 45 because they were animal studies. At the end, 11 articles covered the keywords. Of these, 8 were excluded after analysis because they were not performed with patients with ALS or because they did not include AS in the study, leaving 3 articles that included the objective of this study. A cross - sectional analytical study was performed to verify the acute benefits of AS technique on CPF and compartmental volumes of the chest wall in 12 patients with ALS and 12 healthy individuals matched by age and gender. In this, the authors concluded that the AS technique is effective in increasing CPF, compartmental inspiratory capacity (IC) and vital capacity (VC) in patients with ALS without causing hyperinflation. In another cross-sectional study, the authors objectified to investigate the effects of the AS technique on maximal insufflation capacity (MIC) and CPF of patients with DNM. A total of 43 patients participated, including 6 with ALS who underwent AS maneuver three times a day. At the end of the study, training with AS increased CIM, also improving cough efficacy. Finally, a cross-sectional study was carried out with 287 individuals with NMD (among them 81 with 7 ALS), whose objective was to compare passive maximal instillation capacity with MIC and VC through AS technique, in addition to exploring the relationships between these variables and correlate with glottal function and CPF. After the analysis, it was concluded that the AS technique performed regularly, either in an active or passive way, elevates the MIC and PFT in patients with NMD, especially those with ALS. Conclusion: The AS technique is effective in promoting the increase of the CPF, IC and VC of patients with ALS, consequently improving the elimination of pulmonary secretions, reducing serious respiratory disorders and interfering positively in the increase of survival. We note, however, that there is a lack of controlled and randomized studies that address the benefits of AS in patients with ALS