BACKGROUND: Individuals with bronchiectasis exhibit colonization and infection of the respiratory system, with a consequent alteration of the macroscopic appearance of secretions, which ranges from mucoid to purulent. Purulence is related to the structural conformation, rheological profile, and transport indexes of mucus. We analyzed and compared the transport properties of respiratory secretions with mucoid appearance versus those with purulent appearance in patients with bronchiectasis and in subjects without lung disease. METHODS: In a simulated cough machine we assessed the mucociliary transport and contact angle of 32 mucoid and 19 purulent samples from subjects with bronchiectasis, and 21 samples from subjects without lung disease. RESULTS: Mucociliary transport was lower in the mucoid samples (0.78 ؎ 0.22) and in the purulent samples (0.73 ؎ 0.22) than in the samples from subjects without lung disease (1 ؎ 0.19). The purulent samples had less displacement in the simulated cough machine (7.57 ؎ 3 cm) than did the mucoid samples (23 ؎ 15 cm) or the samples from subjects without lung disease (34 ؎ 8.4 cm), as did the mucoid samples compared to the samples from subjects without lung disease. The purulent samples had a higher contact angle (25 ؎ 6.1°) than the mucoid samples (17 ؎ 7.8°) or the samples from subjects without lung disease (10 ؎ 2.5°), as did the mucoid samples compared to the samples from subjects without lung disease. CONCLUSIONS: Respiratory secretions in individuals with bronchiectasis have poor transport properties, which manifest as reduced mucociliary transport, reduced mucus transport by cough, and higher contact angle. These features were more accentuated in the purulent samples. This simple classification can be used by therapists to plan treatments, and by researchers to obtain more homogeneity between groups of subjects.
Mucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms.
PALAVRAS-CHAVEDPOC; Bronquiectasia; Muco respiratório; Depuração mucociliar
ResumoObjetivo: Analisar e comparar as propriedades de transporte in vitro da secreção respiratória de aspeto mucoide (M) de indivíduos sem doença respiratória e de pacientes com doença pulmonar obstrutiva crónica (DPOC) e bronquiectasias estáveis. Métodos: Foram avaliadas 21 amostras de indivíduos sem doença pulmonar submetidos a processos cirúrgicos, 10 amostras de pacientes com DPOC e 16 amostras de pacientes com bronquiectasias quanto ao transporte mucociliar (TMC), deslocamento na máquina simuladora de tosse (MST) e ângulo de contacto (AC). Resultados: Foi observado uma maior TMC das amostras de indivíduos sem doença respiratória (1,0 ± 0,19) quando comparado com o dos pacientes com DPOC (0,9 1± 0,17) e bronquiectasias (0,76 ± 0,23) (p < 0,05), enquanto que o deslocamento na MST foi maior nos pacientes com DPOC (16,31 ± 7,35 cm) quando comparado com o de pacientes com bronquiectasias (12,16 ± 6,64 cm) e de indivíduos sem doença respiratória (10,50 ± 25,8 cm) (p < 0,05). Não houve diferença envolvendo a avaliação do AC. Conclusão: O muco respiratório dos indivíduos saudáveis tem um melhor transporte ciliar do que o de pacientes com doenças respiratórias. No entanto, o muco de pacientes com DPOC tem uma melhor transportabilidade pela tosse, sugerindo que esses pacientes apresentam adaptações para tais mecanismos de defesa, enquanto que os pacientes com bronquiectasias têm deficiência no transporte ciliar, assim como no transporte pela tosse.
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