Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713


Publication continuous and bimonthly

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Getting to know our pneumococcus

Conhecimento do nosso pneumococo

Fernando Luiz Cavalcanti Lundgren1,2,a

J Bras Pneumol.2018;44(5):343-344

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Determination of the efficacy of FEV6 as a surrogate for FVC in the diagnostic screening for chronic obstructive pulmonary disease through the comparison of FEV1/FVC and FEV1/FEV6 ratios

Determinação da eficiência do VEF6 como substituto da CVF na triagem diagnóstica da doença pulmonar obstrutiva crônica através da comparação entre as relações VEF1/CVF e VEF1/VEF6

Fernando Luiz Cavalcanti Lundgren, Marília Montenegro Cabral, Danielle Cristina Silva Clímaco, Liana Gonçalves de Macedo, Marta de Andrade Lima Coelho, Ana Lúcia Pereira Lima Alves Dias

J Bras Pneumol.2007;33(2):148-151

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Objective: To determine the efficacy of using forced expiratory volume in six seconds (FEV6) as a surrogate for forced vital capacity (FVC) in the diagnostic screening for chronic obstructive pulmonary disease (COPD) by comparing FEV1/FVC ratios with FEV1/FEV6 ratios. Methods: In November of 2003, on World COPD Day, we conducted a campaign of diagnostic screening for COPD. The participants completed the clinical questionnaire of the Global Initiative for Obstructive Lung Disease, and those who responded affirmatively to at least three questions underwent spirometry. Results: A total of 134 individuals responded to three questions affirmatively and underwent spirometry. Of those, 59 were excluded: 45 for being non-smokers and 14 due to the fact that their tests did not meet the American Thoracic Society criteria for satisfactory spirometry. The number of tests in which the FEV1/FEV6 ratio was below 70% was similar to that found for the FEV1/FVC ratio. The sensitivity of FEV1/FEV6 in diagnosing airway obstruction (defined as FEV1/FVC below 70%) was 92%, and its specificity was 99%. The positive predictive value was 100%, and the negative predictive value was 98%. The Kendall correlation test revealed r = 0.99 (p < 0.0001). The t-test for paired samples revealed a negative correlation: t = −5.93 (p < 0.0001). Conclusion: The FEV1/FEV6 proved efficient for use in the diagnostic screening for COPD. There is a strong correlation between FEV1/FVC and FEV1/FEV6.


Keywords: Pulmonary disease, Chronic obstructive; Diagnosis; Spirometry; Forced expiratory volume; Vital capacity.


Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

Ricardo de Amorim Corrêa, Fernando Luiz Cavalcanti Lundgren, Jorge Luiz Pereira-Silva, Rodney Luiz Frare e Silva (editores); Grupo de Trabalho da Diretriz

J Bras Pneumol.2009;35(6):574-601

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Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.


Keywords: Pneumonia; Diagnosis; Epidemiology; Practice guideline; Primary prevention.


BTA distance learning course in pulmonology

Educação a Distância-SBPT para a formação de especialistas em Pneumologia

Irma Godoy, Fernando Luiz Cavalcanti Lundgren

J Bras Pneumol.2017;43(3):157-158

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Hemoptysis in a referral hospital for pulmonology

Hemoptise em hospital de referência em pneumologia

Fernando Luiz Cavalcanti Lundgren, Ana Maria Costa, Lícia Caldas Figueiredo, Paola Colares Borba

J Bras Pneumol.2010;36(3):-

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Objective: To determine the main causes of hemoptysis and to classify this symptom, in terms of the amount of blood expectorated, in patients hospitalized at a referral hospital for pulmonology. Methods: The study included 50 patients with hemoptysis admitted to the pulmonology ward of a general hospital in the city of Recife, Brazil, between July of 2005 and February of 2006. The data of interest were analyzed and compared with those in the literature. Results: The most common cause of hemoptysis was infection-in 39 patients (78%)-mostly related to tuberculosis sequelae or active tuberculosis. Regarding the severity of hemoptysis, moderate hemoptysis, diagnosed in 28 patients (56%), was the most common. Conclusions: Our results suggest that all patients who present with hemoptysis should be investigated for infection.


Keywords: Hemoptysis/classification; Hemoptysis/etiology; Comorbidity.


Recommendations for the pharmacological treatment of COPD: questions and answers

Recomendações para o tratamento farmacológico da DPOC: perguntas e respostas

Frederico Leon Arrabal Fernandes1, Alberto Cukier1, Aquiles Assunção Camelier2,3, Carlos Cezar Fritscher4, Cláudia Henrique da Costa5, Eanes Delgado Barros Pereira6, Irma Godoy7, José Eduardo Delfini Cançado8, José Gustavo Romaldini8, Jose Miguel Chatkin4, José Roberto Jardim9, Marcelo Fouad Rabahi10, Maria Cecília Nieves Maiorano de Nucci11, Maria da Penha Uchoa Sales12, Maria Vera Cruz de Oliveira Castellano13, Miguel Abidon Aidé14, Paulo José Zimermann Teixeira15,16, Renato Maciel17, Ricardo de Amorim Corrêa18, Roberto Stirbulov8, Rodrigo Abensur Athanazio1, Rodrigo Russo19, Suzana Tanni Minamoto7, Fernando Luiz Cavalcanti Lundgren20

J Bras Pneumol.2017;43(4):290-301

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The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.


Keywords: Pulmonary disease, chronic obstructive/drug therapy; pulmonary disease, chronic obstructive/prevention & control; pulmonary disease, chronic obstructive/therapy.


Trends in morbidity and mortality from COPD in Brazil, 2000 to 2016

Tendências da morbidade e mortalidade da DPOC no Brasil, de 2000 a 2016

Liana Gonçalves-Macedo1,a, Eliana Mattos Lacerda2,b, Brivaldo Markman-Filho3,c, Fernando Luiz Cavalcanti Lundgren1,d, Carlos Feitosa Luna4,e

J Bras Pneumol.2019;45(6):e20180402-e20180402

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Objective: To examine the trends in overall COPD mortality, as well as trends in in-hospital morbidity and mortality due to COPD, in Brazil, and to validate predictive models. Methods: This was a population-based study with a time-series analysis of cause-specific morbidity and mortality data for individuals ≥ 40 years of age, obtained from national health information systems for the 2000-2016 period. Morbidity and mortality rates, stratified by gender and age group, were calculated for the same period. We used regression analyses to examine the temporal trends and double exponential smoothing in our analysis of the predictive models for 2017. Results: Over the study period, COPD mortality rates trended downward in Brazil. For both genders, there was a downward trend in the southern, southeastern, and central-western regions. In-hospital morbidity rates declined in all regions, more so in the south and southeast. There were significant changes in the number of hospitalizations, length of hospital stay, and hospital expenses. The predictive models for 2017 showed error rates below 9% and were therefore validated. Conclusions: In Brazil, COPD age-adjusted mortality rates have declined in regions with higher socioeconomic indices, where there has been an even sharper decrease in all in-hospital morbidity and mortality variables. In addition to factors such as better treatment adherence and reduced smoking rates, socioeconomic factors appear to be involved in controlling COPD morbidity and mortality. The predictive models estimated here might also facilitate decision making and the planning of health policies aimed at treating COPD.


Keywords: Pulmonary disease, chronic obstructive/mortality; Pulmonary disease, chronic obstructive/epidemiology; Socioeconomic factors.


Pharmacological treatment of COPD

Terapêutica medicamentosa da DPOC

Roberto Stirbulov, Fernando Luiz Cavalcanti Lundgren

J Bras Pneumol.2011;37(4):419-421

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