Brazilian Journal of Pulmonology

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

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Cross-cultural adaptation and assessment of reproducibility of the Duke Activity Status Index for COPD patients in Brazil

Adaptação cultural e avaliação da reprodutibilidade do Duke Activity Status Index para pacientes com DPOC no Brasil

Livia dos Anjos Tavares, José Barreto Neto, José Roberto Jardim, George Márcio da Costa e Souza, Mark A. Hlatky, Oliver Augusto Nascimento

J Bras Pneumol.2012;38(6):684-691

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To cross-culturally adapt the Duke Activity Status Index (DASI) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. Methods: We selected stable patients with clinical and spirometric diagnosis of COPD. Initially, the DASI was translated into Brazilian Portuguese, and the cross-cultural adaptation was performed by an expert committee. Subsequently, 12 patients completed the questionnaire, so that their questions and difficulties could be identified and adjustments could be made. An independent translator back-translated the final version into English, which was then submitted to and approved by the original author. The final Brazilian Portuguese-language version of the DASI was applied to 50 patients at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. Results: The mean age of the patients was 62.3 ± 10.0 years, the mean FEV1 was 45.2 ± 14.7% of the predicted value, and the mean body mass index was 26.8 ± 5.8 kg/m2. The intraclass correlation coefficients for intraobserver and interobserver reproducibility were 0.95 and 0.90, respectively. The correlations between the DASI and the Saint George's Respiratory Questionnaire (SGRQ) domains were all negative and statistically significant. The DASI correlated best with the SGRQ activity domain (r = −0.70), the total SGRQ score (r = −0.66), and the six-minute walk distance (r = 0.55). Conclusions: The Brazilian Portuguese-language version of the DASI is reproducible, fast, and simple, correlating well with the SGRQ.

 


Keywords: Activities of daily living; Pulmonary disease, chronic obstructive; Reproducibility of results.

 


Cultural adaptation and reproducibility of the Breathing Problems Questionnaire for use in patients with COPD in Brazil

Adaptação cultural e reprodutibilidade do Questionário para Problemas Respiratórios em pacientes portadores de DPOC no Brasil

Patrícia Nobre Calheiros da Silva, José Roberto Jardim, George Márcio da Costa e Souza, Michael E Hyland, Oliver Augusto Nascimento

J Bras Pneumol.2012;38(3):339-345

Abstract PDF PT PDF EN Portuguese Text

Objective: To translate the Breathing Problems Questionnaire (BPQ) into Portuguese and adapt it to the Brazilian culture, as well as to evaluate its reproducibility in patients with COPD. Methods: After the BPQ had been translated and adapted to the Brazilian culture, it was administered to a subgroup of 8 patients in order to identify their uncertainties and difficulties. The questionnaire was reviewed by an expert committee, and its final version was arrived at. A second translator back-translated the final version into English, which was sent to the original author in order to verify that the original meaning of the questionnaire had been maintained. After the approval of the original author, the final Portuguese-language version of the questionnaire was administered to 50 patients with COPD, in order to evaluate its reproducibility. Results: The mean response time was 9.5 min. Of the 50 patients, 21 were female and 29 were male. The mean age was 65.8 ± 7.5 years. Most of the patients were classified as having moderate COPD (29.16%) or severe COPD (52%). The intraclass correlation coefficient (ICC) for the total score was 0.94. The ICCs for the eleven BPQ domains and its two subscales were also above 0.70. Moderate correlations were found between the BPQ domains and subscales. Conclusions: The translation and cultural adaptation of the BPQ for use in Brazil was deemed appropriate, because the patients could easily understand and answer the questions. In addition, the Brazilian version of the BPQ questionnaire was found to be reliable, showing good reproducibility.

 


Keywords: Pulmonary disease; chronic obstructive; Quality of life; Reproducibility of results.

 


Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study

Análise evolutiva antropométrica em indivíduos com DPOC na cidade de São Paulo - estudo de base populacional

Josiane Marchioro1,a, Mariana Rodrigues Gazzotti1,b, Graciane Laender Moreira1,c, Beatriz Martins Manzano1,d, Ana Maria Baptista Menezes2,e, Rogélio Perez-Padilla3,f, José Roberto Jardim1,g, Oliver Augusto Nascimento1,4,h; PLATINO Team

J Bras Pneumol.2019;45(6):e20170157-e20170157

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). Methods: This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. Results: Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = −1.7 ± 8.1 and ΔBMI = −0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = −0.5 ± 5.4 and ΔBMI = −0.8 ± 3.3). Conclusions: Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.

 


Keywords: Pulmonary disease, chronic obstructive; Body mass index; Obesity; Waist circumference.

 


Using the Saint George's Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil

Avaliação da qualidade de vida pelo Questionário do Hospital Saint George na Doença Respiratória em portadores de doença pulmonar obstrutiva crônica: validação de uma nova versão para o Brasil

Aquiles Camelier, Fernanda Warken Rosa, Christine Salim, Oliver Augusto Nascimento, Fábio Cardoso, José Roberto Jardim

J Bras Pneumol.2006;32(2):114-122

Abstract PDF PT PDF EN Portuguese Text

Objective: The objective of this study was to evaluate the applicability of a modified version of the Saint George's Respiratory Questionnaire. The version evaluated elicits "agree" and "do not agree", rather than "yes" and "no", responses. The intention is to facilitate the comprehension of double-negative questions and to promote better recollection of symptoms by patients by shortening their symptom histories from 12 months to 3 months. Methods: A total of 30 clinically stable patients with chronic obstructive pulmonary disease were evaluated. The Saint George's Respiratory Questionnaire and the modified version of the same were administered 15 days apart. Results: All of the patients presented health-related alterations in their quality of life. Comparing mean scores between the two questionnaires, the greatest difference was seen in the Symptoms domain. No significant differences were found in any of the remaining domains or in the total scores. In a subsequent analysis, significant correlations between the two questionnaires were found in all domains: Symptoms (r = 0.71; p < 0.001); Activity (r = 0.75; p < 0.001); Impact (r = 0.73; p < 0.001) and Total (r = 0.86; p < 0.001). Conclusion: The modified version of the Saint George's Respiratory Questionnaire is as effective as the original in gauging quality of life. However, various symptoms recollection time frames should be investigated in order to determine which would be the best time frame to employ in the analysis.

 


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Reproducibility of results; Cross-cultural comparison; Questionnaires

 


Validation and development of an immunonephelometric assay for the determination of alpha-1 antitrypsin levels in dried blood spots from patients with COPD

Desenvolvimento e validação de um método de imunonefelometria em amostras de sangue em papel-filtro para a dosagem da alfa-1 antitripsina em pacientes com DPOC

Laura Russo Zillmer, Rodrigo Russo, Beatriz Martins Manzano, Ivan Ivanaga, Oliver Augusto Nascimento, Altay Alves Lino de Souza, Gildo Santos Júnior, Francisco Rodriguez, Marc Miravitlles, José Roberto Jardim

J Bras Pneumol.2013;39(5):547-554

Abstract PDF PT PDF EN Portuguese Text

Objective: To validate and develop an immunonephelometric assay for the determination of alpha-1 antitrypsin (AAT) levels in dried blood spots from COPD patients in Brazil. Methods: We determined AAT levels in serum samples and dried blood spots from 192 COPD patients. For the preparation of dried blood spots, a disk (diameter, 6 mm) was placed into a tube, eluted with 200 µL of PBS, and stored overnight at 4°C. All of the samples were analyzed by immunonephelometry in duplicate. We used the bootstrap resampling method in order to determine a cut-off point for AAT levels in dried blood spots. Results: The correlation coefficient between the AAT levels in serum samples and those in dried blood spots was r = 0.45. For dried blood spots, the cut-off value was 2.02 mg/dL (97% CI: 1.45-2.64 mg/dL), with a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 95.7%, 27.2%, and 100%, respectively. Conclusions: This method for the determination of AAT levels in dried blood spots appears to be a reliable screening tool for patients with AAT deficiency.

 



Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities

Diferenças entre os sexos na percepção de asma e sintomas respiratórios em uma amostra populacional em quatro cidades brasileiras

Laura Russo Zillmer, Mariana Rodrigues Gazzotti, Oliver Augusto Nascimento, Federico Montealegre, James Fish, José Roberto Jardim

J Bras Pneumol.2014;40(6):591-598

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil. Methods: We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication. Results: Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men. Conclusions: Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.

 


Keywords: Asthma/diagnosis; Asthma/prevention & control; Quality of life.

 


Negative impact of asthma on patients in different age groups

Impacto negativo da asma em diferentes faixas etárias

Marcela Batan Alith, Mariana Rodrigues Gazzotti, Federico Montealegre, James Fish, Oliver Augusto Nascimento, José Roberto Jardim

J Bras Pneumol.2015;41(1):16-22

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). Methods: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. Results: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). Conclusions: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance.

 


Keywords: Asthma; Age groups; Quality of life.

 


Random sample survey on the prevalence of smoking in the major cities of Brazil

Levantamento randomizado sobre a prevalência de tabagismo nos maiores municípios do Brasil

Fernando Sergio Leitão Filho, José Carlos Fernandes Galduróz, Ana Regina Noto, Solange Aparecida Nappo, Elisaldo Araújo Carlini, Oliver Augusto Nascimento, Sérgio Ricardo Santos, José Roberto Jardim

J Bras Pneumol.2009;35(12):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To provide access to the results of a randomized cross-sectional study conducted by the Brazilian Center for Information on Psychotropic Drugs in 2001. Methods: This survey involved a random sample of individuals ranging from 12 to 65 years of age and residing in the 107 largest cities (over 200,000 inhabitants) in Brazil, which represented 27.7% of the Brazilian population, estimated to be 169,799,170 inhabitants at the time. A total of 8,589 interviews were conducted. The Substance Abuse and Mental Health Services Administration questionnaire, translated and adapted for use in Brazil, was used in the interviews. Results: Of the sample as a whole, 41.1% of the interviewees reported having experimented with tobacco products. The prevalence of daily smokers was 17.4% (20.3% among males and 14.8% among females). We found that 9% of the sample (10.1% of the men and 7.9% of the women) were nicotine-dependent, according to the criteria of the National Household Survey on Drug Abuse. Conclusions: The prevalence of current smoking in the 107 largest cities of Brazil is significantly lower in this decade than was the national prevalence at the end of last century.

 


Keywords: Smoking/epidemiology; Tobacco use disorder; Smoking cessation.

 


Level of asthma control and its impact on activities of daily living in asthma patients in Brazil

Nível de controle da asma e seu impacto nas atividades de vida diária em asmáticos no Brasil

Mariana Rodrigues Gazzotti, Oliver Augusto Nascimento, Federico Montealegre, James Fish, José Roberto Jardim

J Bras Pneumol.2013;39(5):532-538

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil. Methods: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria. Results: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001). Conclusions: In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease.

 



Level of asthma control and its relationship with medication use in asthma patients in Brazil

Nível de controle da asma e sua relação com o uso de medicação em asmáticos no Brasil

Josiane Marchioro, Mariana Rodrigues Gazzotti, Oliver Augusto Nascimento, Federico Montealegre, James Fish, José Roberto Jardim

J Bras Pneumol.2014;40(5):487-494

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. Methods: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. Results: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). Conclusions: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids.

 


Keywords: Asthma/therapy; Asthma/prevention and control; Medication adherence.

 


Prevalence of alpha-1 antitrypsin deficiency and allele frequency in patients with COPD in Brazil

Prevalência da deficiência de alfa-1 antitripsina e frequência alélica em pacientes com DPOC no Brasil

Rodrigo Russo1,2, Laura Russo Zillmer1, Oliver Augusto Nascimento1, Beatriz Manzano1, Ivan Teruaki Ivanaga1, Leandro Fritscher3, Fernando Lundgren4, Marc Miravitlles5, Heicilainy Del Carlos Gondim6, Gildo Santos Junior7, Marcela Amorim Alves4, Maria Vera Oliveira8, Altay Alves Lino de Souza9, Maria Penha Uchoa Sales10, José Roberto Jardim1

J Bras Pneumol.2016;42(5):311-316

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of alpha 1-antitrypsin (AAT) deficiency (AATD), as well as allele frequency, in COPD patients in Brazil. Methods: This was a cross-sectional study involving 926 COPD patients 40 years of age or older, from five Brazilian states. All patients underwent determination of AAT levels in dried blood spot (DBS) samples by nephelometry. Those with DBS AAT levels ≤ 2.64 mg/dL underwent determination of serum AAT levels. Those with serum AAT levels of < 113 mg/dL underwent genotyping. In case of conflicting results, SERPINA1 gene sequencing was performed. Results: Of the 926 COPD patients studied, 85 had DBS AAT levels ≤ 2.64 mg/dL, and 24 (2.6% of the study sample) had serum AAT levels of < 113 mg/dL. Genotype distribution in this subset of 24 patients was as follows: PI*MS, in 3 (12.5%); PI*MZ, in 13 (54.2%); PI*SZ, in 1 (4.2%); PI*SS, in 1 (4.2%); and PI*ZZ, in 6 (25.0%). In the sample as a whole, the overall prevalence of AATD was 2.8% and the prevalence of the PI*ZZ genotype (severe AATD) was 0.8% Conclusions: The prevalence of AATD in COPD patients in Brazil is similar to that found in most countries and reinforces the recommendation that AAT levels be measured in all COPD patients.

 


Keywords: alpha 1-antitrypsin deficiency/epidemiology; pulmonary disease, chronic obstructive/epidemiology; Alleles; alpha 1-antitrypsin.

 


Translation, cross-cultural adaptation, and reproducibility of the Brazilian Portuguese-language version of the Wisconsin Smoking Withdrawal Scale

Tradução, adaptação cultural e reprodutibilidade da Wisconsin Smoking Withdrawal Scale para o português do Brasil

Boanerges Lopes de Oliveira Junior, José Roberto Jardim, Oliver Augusto Nascimento, George Márcio da Costa e Souza, Timothy B. Baker, Ilka Lopes Santoro

J Bras Pneumol.2012;38(6):716-723

Abstract PDF PT PDF EN Portuguese Text

Objective: To cross-culturally adapt the Wisconsin Smoking Withdrawal Scale (WSWS) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. Methods: The original English version of the WSWS was translated into Brazilian Portuguese. For cross-cultural adaptation, the Brazilian Portuguese-language version of the WSWS was administered to eight volunteers, all of whom were smokers. After adjustments had been made, the WSWS version was back-translated into English. The Brazilian Portuguese-language version was thereby found to be accurate. The final Brazilian Portuguese-language version of the WSWS was applied to 75 smokers at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. Intraclass correlation coefficients (ICCs) were used in order to test the concordance of the answers. The significance level was set at p < 0.05. Results: Of the 75 volunteers, 43 (57.3%) were female. The overall mean age was 46.3 years. Interobserver and intraobserver reproducibility was determined for each of the WSWS seven domains, the ICCs for which ranged from 0.87 to 0.94 and from 0.76 to 0.92, respectively. The mean time to completion of the WSWS was 6 min and 44 s, and the response time per question ranged from 4.2 to 12.6 s. Conclusions: The Brazilian Portuguese-language version of the WSWS is reproducible, fast, and simple. It can therefore be used as a tool for assessing the severity of the symptoms of nicotine withdrawal syndrome.

 


Keywords: Nicotine; Tobacco use disorder; Substance withdrawal syndrome; Reproducibility of results.

 


 

 


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