Brazilian Journal of Pulmonology

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

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International collaboration among medical societies is an effective way to boost Latin American production of articles on tuberculosis

A colaboração internacional entre sociedades médicas é uma forma eficaz de aumentar a produção de artigos sobre tuberculose na América Latina

Giovanni Battista Migliori1,a, Rosella Centis1,b, Lia D'Ambrosio2,c, Denise Rossato Silva3,d, Adrian Rendon4,e

J Bras Pneumol.2019;45(2):e20180420-e20180420

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: Most studies of tuberculosis originate from high-income countries with a low incidence of tuberculosis. A review of the scientific production on tuberculosis in Latin American countries, most of which are low- or middle-income countries (some with high or intermediate tuberculosis incidence rates), would improve the understanding of public health challenges, clinical needs, and research priorities. The aims of this systematic review were to determine what has been published recently in Latin America, to identify the leading authors involved, and to quantify the impact of international collaborations. Methods: We used PubMed to identify relevant manuscripts on pulmonary tuberculosis (PTB), drug-resistant tuberculosis (DR-TB), or multidrug-resistant tuberculosis (MDR-TB), published between 2013 and 2018. We selected only studies conducted in countries with an annual tuberculosis incidence of ≥ 10,000 reported cases and an annual MDR-TB incidence of ≥ 300 estimated cases, including Brazil, Peru, Mexico, Colombia, and Argentina. Articles were stratified by country, type, and topic. Results: We identified as eligible 395 studies on PTB and 188 studies on DR/MDR-TB-of which 96.4% and 96.8%, respectively, were original studies; 35.5% and 32.4%, respectively, had an epidemiological focus; and 52.7% and 36.2%, respectively, were conducted in Brazil. The recent Latin American Thoracic Association/European Respiratory Society/Brazilian Thoracic Association collaborative project boosted the production of high-quality articles on PTB and DR/MDR-TB in Latin America. Conclusions: Most of the recent Latin American studies on tuberculosis were conducted in Brazil, Mexico, or Peru. Collaboration among medical societies facilitates the production of scientific papers on tuberculosis. Such initiatives are in support of the World Health Organization call for intensified research and innovation in tuberculosis.

 


Keywords: Tuberculosis, pulmonary; Tuberculosis, multidrug-resistant; Latin America.

 


The importance of molecular characterization in lung cancer

A importância da caracterização molecular no câncer de pulmão

Gilberto de Castro Junior1,2,a, Guilherme Harada2,b, Evandro Sobroza de Mello3,c

J Bras Pneumol.2019;45(3):e20190139-e20190139

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Chest CT findings in patients with dysphagia and aspiration: a systematic review

Achados de TC de tórax em pacientes com disfagia e aspiração pulmonar: uma revisão sistemática

Betina Scheeren1, Erissandra Gomes2, Giordano Alves3, Edson Marchiori3, Bruno Hochhegger1

J Bras Pneumol.2017;43(4):313-318

Abstract PDF PT PDF EN Portuguese Text

The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.

 


Keywords: Respiratory aspiration; Tomography, X-ray computed; Lung.

 


Longitudinal follow-up of cardiac vagal activity in individuals undergoing endoscopic thoracic sympathectomy

Acompanhamento longitudinal da atividade vagal cardíaca de indivíduos submetidos à simpatectomia torácica endoscópica

Ana Paula Ferreira1,2,3,a, Plinio dos Santos Ramos1,2,3,b, Jorge Montessi2,3,4,c, Flávia Duarte Montessi2,3,d, Eveline Montessi Nicolini3,4,e, Edmilton Pereira de Almeida4,f, Djalma Rabelo Ricardo1,2,3,g

J Bras Pneumol.2018;44(6):456-460

Abstract PDF PT PDF EN Portuguese Text

Objective: To conduct a longitudinal investigation of cardiac vagal activity (CVA) by measuring resting HR and calculating the cardiac vagal index (CVI) in individuals undergoing sympathectomy for the treatment of primary hyperhidrosis. Methods: This was a descriptive longitudinal study involving 22 patients, 13 of whom were female. The mean age was 22.5 ± 8.8 years. The palms, soles, and axillae were the most commonly affected sites. Resting HR was measured by an electrocardiogram performed 20 min before the 4-second exercise test (4sET), which was used in order to evaluate CVA at three different time points: before surgery, one month after surgery, and four years after surgery. Results: Resting HR (expressed as mean ± SE) was found to have decreased significantly at 1 month after surgery (73.1 ± 1.6 bpm before surgery vs. 69.7 ± 1.2 bpm at one month after surgery; p = 0.01). However, the HR values obtained at four years after surgery tended to be similar to those obtained before surgery (p = 0.31). The CVI (expressed as mean ± SE) was found to have increased significantly at one month after surgery (1.44 ± 0.04 before surgery vs. 1.53 ± 0.03 at one month after surgery; p = 0.02). However, the CVI obtained at four years after surgery tended to be similar to that obtained before surgery (p = 0.10). Conclusions: At one month after sympathectomy for primary hyperhidrosis, patients present with changes in resting HR and CVA, both of which tend to return to baseline at four years after surgery.

 


Keywords: Hyperhidrosis; Sympathectomy; Autonomic nervous system; Exercise test;

 


Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery

Acurácia da ausculta torácica na detecção de mecânica respiratória anormal no pós-operatório imediato de cirurgia cardíaca

Glaciele Xavier1,2,a, César Augusto Melo-Silva1,3,b, Carlos Eduardo Ventura Gaio dos Santos1,4,c, Veronica Moreira Amado1,4,d

J Bras Pneumol.2019;45(5):e20180032-e20180032

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the accuracy of chest auscultation in detecting abnormal respiratory mechanics. Methods: We evaluated 200 mechanically ventilated patients in the immediate postoperative period after cardiac surgery. We assessed respiratory system mechanics - static compliance of the respiratory system (Cst,rs) and respiratory system resistance (R,rs) - after which two independent examiners, blinded to the respiratory system mechanics data, performed chest auscultation. Results: Neither decreased/abolished breath sounds nor crackles were associated with decreased Cst,rs (≤ 60 mL/cmH2O), regardless of the examiner. The overall accuracy of chest auscultation was 34.0% and 42.0% for examiners A and B, respectively. The sensitivity and specificity of chest auscultation for detecting decreased/abolished breath sounds or crackles were 25.1% and 68.3%, respectively, for examiner A, versus 36.4% and 63.4%, respectively, for examiner B. Based on the judgments made by examiner A, there was a weak association between increased R,rs (≥ 15 cmH2O/L/s) and rhonchi or wheezing (ϕ = 0.31, p < 0.01). The overall accuracy for detecting rhonchi or wheezing was 89.5% and 85.0% for examiners A and B, respectively. The sensitivity and specificity for detecting rhonchi or wheezing were 30.0% and 96.1%, respectively, for examiner A, versus 10.0% and 93.3%, respectively, for examiner B. Conclusions: Chest auscultation does not appear to be an accurate diagnostic method for detecting abnormal respiratory mechanics in mechanically ventilated patients in the immediate postoperative period after cardiac surgery.

 


Keywords: Diagnostic tests, routine; Physical examination; Respiratory sounds; Respiratory mechanics; Data accuracy; Respiration, artificial.

 


Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia

Adaptación transcultural de la escala Cambridge Pulmonary Hypertension Outcome Review en pacientes con hipertensión pulmonar en Colombia

Claudio Villaquirán1,2,a, Socorro Moreno3,b, Rubén Dueñas4,c, Paola Acuña5,d, Juan Ricardo Lutz2,e, Jeanette Wilburn6,f, Alice Heaney6,g

J Bras Pneumol.2019;45(6):e20180332-e20180332

Abstract PDF PT PDF EN Portuguese Text

Objective: To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. Methods: The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. Results: A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. Conclusions: The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.

 


Keywords: Quality of life; Hypertension, pulmonary; Pulmonary embolism; Psychometrics.

 


Speeding up the diagnosis of multidrug-resistant tuberculosis in a high-burden region with the use of a commercial line probe assay

Agilizando o diagnóstico da tuberculose multirresistente em uma região endêmica com o uso de um teste comercial de sondas em linha

Angela Pires Brandao1,2,a, Juliana Maira Watanabe Pinhata1,b, Rosangela Siqueira Oliveira1,c, Vera Maria Neder Galesi3,d, Helio Hehl Caiaffa-Filho1,e, Lucilaine Ferrazoli1,f

J Bras Pneumol.2019;45(2):e20180128-e20180128

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the rapid diagnosis of multidrug-resistant tuberculosis, by using a commercial line probe assay for rifampicin and isoniazid detection (LPA-plus), in the routine workflow of a tuberculosis reference laboratory. Methods: The LPA-plus was prospectively evaluated on 341 isolates concurrently submitted to the automated liquid drug susceptibility testing system. Results: Among 303 phenotypically valid results, none was genotypically rifampicin false-susceptible (13/13; 100% sensitivity). Two rifampicin-susceptible isolates harboured rpoB mutations (288/290; 99.3% specificity) which, however, were non-resistance-conferring mutations. LPA-plus missed three isoniazid-resistant isolates (23/26; 88.5% sensitivity) and detected all isoniazid-susceptible isolates (277/277; 100% specificity). Among the 38 (11%) invalid phenotypic results, LPA-plus identified 31 rifampicin- and isoniazid-susceptible isolates, one isoniazid-resistant and six as non-Mycobacterium tuberculosis complex. Conclusions: LPA-plus showed excellent agreement (≥91%) and accuracy (≥99%). Implementing LPA-plus in our setting can speed up the diagnosis of multidrug-resistant tuberculosis, yield a significantly higher number of valid results than phenotypic drug susceptibility testing and provide further information on the drug-resistance level.

 


Keywords: Tuberculosis, multidrug-resistant; Molecular diagnostic techniques; Microbial sensitivity tests; Mycobacterium tuberculosis.

 


Clusters of small nodules with no confluence

Aglomerados de pequenos nódulos sem confluência

Edson Marchiori1,2, Bruno Hochhegger3,4, Gláucia Zanetti2,5

J Bras Pneumol.2016;42(6):402-402

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Cocaine-induced pulmonary changes: HRCT findings

Alterações pulmonares induzidas pelo uso de cocaína: avaliação por TCAR de tórax

Renata Rocha de Almeida1, Gláucia Zanetti1,2, Arthur Soares Souza Jr.3, Luciana Soares de Souza4, Jorge Luiz Pereira e Silva5, Dante Luiz Escuissato6, Klaus Loureiro Irion7, Alexandre Dias Mançano8, Luiz Felipe Nobre9, Bruno Hochhegger10, Edson Marchiori1,11

J Bras Pneumol.2015;41(4):323-330

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.

 


Keywords: Cocaine, Cocaine-related disorders; Tomography, X-ray computed; Lung diseases.

 


Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

Análise de custos de um teste de amplificação de ácido nucleico para o diagnóstico da tuberculose pulmonar sob a perspectiva do Sistema Único de Saúde

Márcia Pinto1, Aline Piovezan Entringer1,Ricardo Steffen2, Anete Trajman2,3

J Bras Pneumol.2015;41(6):536-538

Abstract PDF PT PDF EN Portuguese Text

We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil

 


Keywords: Costs and cost analysis; Tuberculosis; Nucleic acid amplification techniques.

 


Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

Análise de custos de um teste de amplificação de ácido nucleico para o diagnóstico da tuberculose pulmonar sob a perspectiva do Sistema Único de Saúde.

Márcia Pinto1; Aline Piovezan Entringer1; Ricardo Steffen2; Anete Trajman2; 3

J Bras Pneumol.2016;42(1):79-79

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Subgroup analysis and interaction tests: why they are important and how to avoid common mistakes

Análise de subgrupos e testes de interação: por que são importantes e como evitar erros comuns

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino1,3

J Bras Pneumol.2017;43(3):162-162

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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.

 


Sequential analysis as a tool for detection of amikacin ototoxicity in the treatment of multidrug-resistant tuberculosis

Análise sequencial como ferramenta na detecção da ototoxicidade da amicacina no tratamento da tuberculose multirresistente

Karla Anacleto de Vasconcelos1, Silvana Maria Monte Coelho Frota2, Antonio Ruffino-Netto3, Afrânio Lineu Kritski4

J Bras Pneumol.2018;44(2):85-92

Abstract PDF PT PDF EN Portuguese Text

Objetivo: Verificar a detecção precoce de ototoxicidade causada pelo uso de amicacina numa população tratada para tuberculose multirresistente (TBMR) por meio da realização de três testes distintos: audiometria tonal liminar (ATL), audiometria de altas frequências (AAF) e pesquisa de emissões otoacústicas por produto de distorção (EOAPD). Métodos: Estudo longitudinal de coorte prospectiva incluindo pacientes de ambos os sexos, com idade entre 18 e 69 anos, com diagnóstico de TBMR pulmonar e que necessitaram utilizar amicacina por seis meses em seu esquema medicamentoso antituberculose pela primeira vez. A avaliação auditiva foi realizada antes do início do tratamento e depois de dois e seis meses do início do tratamento. A análise dos resultados foi realizada por meio de análise estatística sequencial. Resultados: Foram incluídos 61 pacientes, mas a população final foi constituída de 10 pacientes (7 homens e 3 mulheres), em razão da análise sequencial. Ao se comparar os valores das respostas dos testes com aqueles encontrados na avaliação basal, foram verificadas mudanças nos limiares auditivos compatíveis com ototoxicidade após dois meses de tratamento através da AAF e após seis meses de tratamento através da ATL. Entretanto, essas mudanças não foram verificadas através da pesquisa de EOAPD. Conclusões: Ao se considerar o método estatístico utilizado nessa população, é possível concluir que mudanças nos limiares auditivos foram associadas ao uso da amicacina no período de seis meses por meio de AAF e ATL e que a pesquisa de EOAPD não se mostrou eficiente na identificação dessas mudanças.

 


Keywords: Tuberculosis; Hearing loss; Aminoglycosides/toxicity.

 


Temporal analysis of reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012*

Análise temporal dos casos notificados de tuberculose e de coinfecção tuberculose- -HIV na população brasileira no período entre 2002 e 2012

Renato Simões Gaspar1, Natália Nunes1, Marina Nunes2, Vandilson Pinheiro Rodrigues3

J Bras Pneumol.2016;42(6):416-422

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012. Methods: This was an observational study based on secondary time series data collected from the Brazilian Case Registry Database for the 2002-2012 period. The incidence of tuberculosis was stratified by gender, age group, geographical region, and outcome, as was that of tuberculosis-HIV co-infection. Results: Nationally, the incidence of tuberculosis declined by 18%, whereas that of tuberculosis-HIV co-infection increased by 3.8%. There was an overall decrease in the incidence of tuberculosis, despite a significant increase in that of tuberculosis-HIV co-infection in women. The incidence of tuberculosis decreased only in the 0- to 9-year age bracket, remaining stable or increasing in the other age groups. The incidence of tuberculosis-HIV co-infection increased by 209% in the ≥ 60-year age bracket. The incidence of tuberculosis decreased in all geographical regions except the south, whereas that of tuberculosis-HIV co-infection increased by over 150% in the north and northeast. Regarding the outcomes, patients with tuberculosis-HIV co-infection, in comparison with patients infected with tuberculosis only, had a 48% lower chance of cure, a 50% greater risk of treatment nonadherence, and a 94% greater risk of death from tuberculosis. Conclusions: Our study shows that tuberculosis continues to be a relevant public health issue in Brazil, because the goals for the control and cure of the disease have yet to be achieved. In addition, the sharp increase in the incidence of tuberculosis-HIV co-infection in women, in the elderly, and in the northern/northeastern region reveals that the population of HIV-infected individuals is rapidly becoming more female, older, and more impoverished.

 


Keywords: Tuberculosis/epidemiology; HIV infections/epidemiology; Comorbidity.

 


Primary epithelioid angiosarcoma of the chest wall complicating calcified fibrothorax and mimicking empyema necessitatis

Angiossarcoma epitelioide primário da parede torácica complicando um fibrotórax calcificado e simulando empiema necessitatis

Luis Gorospe1, Ana Patricia Ovejero-Díaz2, Amparo Benito-Berlinches3

J Bras Pneumol.2017;43(1):71-71

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Long-acting muscarinic antagonists vs. long-acting &#946;2 agonists in COPD exacerbations: a systematic review and meta-analysis

Antagonistas muscarínicos de longa duração vs. β2-agonistas de longa duração em exacerbações da DPOC: revisão sistemática e meta-análise

Israel Silva Maia1, Mariângela Pimentel Pincelli1, Victor Figueiredo Leite2, João Amadera3, Anna Maria Buehler4

J Bras Pneumol.2017;43(4):302-312

Abstract PDF PT PDF EN Portuguese Text Appendix

The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.

 


Keywords: Respiratory aspiration; Tomography, X-ray computed; Lung.

 


Staphylococcal superantigen-specific IgE antibodies: degree of sensitization and association with severity of asthma

Anticorpos IgE específicos para superantígenos estafilocócicos: grau de sensibilização e associação com a gravidade da asma

José Elabras Filho1,2, Fernanda Carvalho de Queiroz Mello2, Omar Lupi1,3, Blanca Elena Rios Gomes Bica1, José Angelo de Souza Papi1, Alfeu Tavares França1

J Bras Pneumol.2016;42(5):356-361

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. Methods: This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma based on the Global Initiative for Asthma criteria: mild asthma (MA), comprising patients with mild intermittent or persistent asthma; and moderate or severe asthma (MSA). We determined the serum levels of staphylococcal toxin-specific IgE antibodies, comparing the results and performing a statistical analysis. Results: The study included 142 patients: 72 in the MA group (median age = 46 years; 59 females) and 70 in the MSA group (median age = 56 years; 60 females). In the sample as a whole, 62 patients (43.7%) presented positive results for staphylococcal toxin-specific IgE antibodies: staphylococcal enterotoxin A (SEA), in 29 (20.4%); SEB, in 35 (24.6%); SEC, in 33 (23.2%); and toxic shock syndrome toxin (TSST), in 45 (31.7%). The mean serum levels of IgE antibodies to SEA, SEB, SEC, and TSST were 0.96 U/L, 1.09 U/L, 1.21 U/L, and 1.18 U/L, respectively. There were no statistically significant differences between the two groups in terms of the qualitative or quantitative results. Conclusions: Serum IgE antibodies to SEA, SEB, SEC, and TSST were detected in 43.7% of the patients in our sample. However, neither the qualitative nor quantitative results showed a statistically significant association with the clinical severity of asthma.

 


Keywords: Asthma; Immunoglobulin E; Superantigens; Bacterial toxins; Staphylococcus aureus.

 


Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia

Aplicação do Sarcoidosis Health Questionnaire em pacientes com sarcoidose na Sérvia

Violeta Mihailović-Vučinić1,2, Branislav Gvozdenović3, Mihailo Stjepanović2, Mira Vuković4, Ljiljana Marković-Denić5, Aleksandar Milovanović6, Jelica Videnović-Ivanov2, Vladimir Zugić1,2, Vesna Skodrić-Trifunović 1,2, Snezana Filipović2, Maja Omčikus2

J Bras Pneumol.2016;42(2):99-105

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

 


Keywords: Sarcoidosis; Health status; Validation studies; Questionnaires; Self report; Serbia.

 


Obstructive sleep apnea and quality of life in elderly patients with a pacemaker

Apneia obstrutiva do sono e qualidade de vida em idosos portadores de marca-passo

Tatiana Albuquerque Gonçalves de Lima1,a, Evandro Cabral de Brito2,b, Robson Martins2,c, Sandro Gonçalves de Lima3,d, Rodrigo Pinto Pedrosa2,e

J Bras Pneumol.2019;45(1):e20170333-e20170333

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. Methods: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. Results: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). Conclusions: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.

 


Keywords: Quality of life; Aged; Sleep apnea, obstructive.

 


Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features.

Apneia obstrutiva do sono relacionada ao sono rapid eye movement ou ao sono non-rapid eye movement: comparação de aspectos demográficos, antropométricos e polissonográficos.

Aysel Sunnetcioglu1, Bunyamin Sertogullarından1, Bulent Ozbay2, Hulya Gunbatar1, Selami Ekin1

J Bras Pneumol.2016;42(1):48-54

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Objective: To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods: This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results: The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions: We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture.

 


Keywords: Sleep, REM; Sleep stages; Sleep apnea, obstructive; Apnea; Sleep apnea syndromes.

 


Clinical aspects in patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex, in the Brazilian Amazon

Aspectos clínicos em pacientes com infecção pulmonar por micobactérias do complexo Mycobacterium abscessus na Amazônia brasileira

José Tadeu Colares Monteiro1, Karla Valéria Batista Lima2, Adriana Rodrigues Barretto3, Ismari Perini Furlaneto1,2, Glenda Moraes Gonçalves3, Ana Roberta Fusco da Costa2, Maria Luiza Lopes2, Margareth Pretti Dalcolmo4,5

J Bras Pneumol.2018;44(2):93-98

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Objective: To describe the clinical manifestations of patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex (MABSC), and to compare these manifestations with those of patients infected with other nontuberculous mycobacteria (NTM). Methods: This was a retrospective cohort study involving 43 patients divided into two groups: the MABSC group, consisting of patients with pulmonary infection caused by MABSC (n = 17); and the NTM group, consisting of patients with pulmonary infection caused by NTM other than MABSC (n = 26). Patients were previously treated with a regimen of rifampin, isoniazid, pyrazinamide, and ethambutol before the diagnosis of NTM was confirmed by two culture-positive sputum samples. The nucleotide sequences of the hsp65, 16S rRNA, and/or rpoB genes were analyzed to identify the mycobacteria. Data were collected on demographic, clinical, and radiological characteristics, as well as on treatment responses and outcomes. Results: Loss of appetite was the only clinical manifestation that was significantly more common in the MABSC group than in the NTM group (p = 0.0306). The chance of having to use a second treatment regimen was almost 12 times higher in the MABSC group than in the NTM group. Treatment success was significantly higher in the NTM group than in the MABSC group (83.2% vs. 17.6%; p < 0.0001). The chance of recurrence was approximately 37 times higher in the MABSC group than in the NTM group. Conclusions: In the study sample, treatment response of pulmonary disease caused by MABSC was less favorable than that of pulmonary disease caused by other NTM.

 


Keywords: Nontuberculous mycobacteria/classification; Nontuberculous mycobacteria/drug effects; Lung diseases.

 


Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy

Aspectos epidemiológicos, manifestações clínicas e prevenção da tuberculose pediátrica sob a perspectiva da Estratégia End TB

Anna Cristina Calçada Carvalho1,a, Claudete Aparecida Araújo Cardoso2,b, Terezinha Miceli Martire3,c, Giovanni Battista Migliori4,d, Clemax Couto Sant'Anna5,e

J Bras Pneumol.2018;44(2):134-144

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Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.

 


Keywords: Tuberculosis, pulmonary/prevention & control; Mycobacterium tuberculosis; Lung diseases/etiology; Child; Adolescent.

 


Patient-ventilator asynchrony

Assincronia paciente-ventilador

Marcelo Alcantara Holanda1,2,a, Renata dos Santos Vasconcelos2,b, Juliana Carvalho Ferreira3,c, Bruno Valle Pinheiro4,d

J Bras Pneumol.2018;44(4):321-333

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Patient-ventilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.

 


Keywords: Respiration, artificial; Respiratory insufficiency; Interactive ventilatory support.

 


Patient-ventilator asynchrony. Ahead of print

Assincronia paciente-ventilador. Versão ahead of print

Marcelo Alcantara Holanda1,2,a, Renata dos Santos Vasconcelos2,b, Juliana Carvalho Ferreira3,c, Bruno Valle Pinheiro4,d

J Bras Pneumol.2018;44(4):339-339

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Association between the display of cigarette packs at the point of sale and smoking susceptibility among adolescents in Brazil

Associação entre a exposição a maços de cigarros em pontos de venda e susceptibilidade ao tabagismo entre adolescentes brasileiros

Ana Luiza Curi Hallal1, Andreza Madeira Macario1, Roberto Hess de Souza2, Antônio Fernando Boing1, Lúcio Botelho1, Joanna Cohen3

J Bras Pneumol.2018;44(1):49-51

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This was a cross-sectional study aimed at determining the association between exposure to tobacco displays at the point of sale and susceptibility to smoking in schoolchildren in the 14- to 17-year age bracket. Of the participating students, 69.0%, 21.3%, and 9.7% were classified as never smokers, experimenters, and smokers, respectively. Of the participants who were classified as being exposed to smoking, 18.9% were susceptible to smoking. Of the participants who were classified as being unexposed to smoking, 12.9% were susceptible to smoking (OR = 1.56; 95% CI: 1.04 -2.35; p = 0.029). Exposure to point-of-sale tobacco displays is associated with smoking susceptibility in Brazilian adolescents.

 



Association between severe asthma and changes in the stomatognathic system

Associação entre asma grave e alterações do sistema estomatognático

Mayra Carvalho-Oliveira1,2, Cristina Salles3, Regina Terse4, Argemiro D'Oliveira Júnior2,5

J Bras Pneumol.2016;42(6):423-428

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Objective: To describe orofacial muscle function in patients with severe asthma. Methods: This was a descriptive study comparing patients with severe controlled asthma (SCA) and severe uncontrolled asthma (SUA). We selected 160 patients, who completed a sociodemographic questionnaire and the 6-item Asthma Control Questionnaire (ACQ-6), as well as undergoing evaluation of orofacial muscle function. Results: Of the 160 patients evaluated, 126 (78.8%) and 34 (21.2%) presented with SCA and SUA, respectively, as defined by the Global Initiative for Asthma criteria. Regardless of the level of asthma control, the most frequent changes found after evaluation of muscle function were difficulty in chewing, oronasal breathing pattern, below-average or poor dental arch condition, and difficulty in swallowing. When the sample was stratified by FEV1 (% of predicted), was significantly higher proportions of SUA group patients, compared with SCA group patients, showed habitual open-mouth chewing (24.8% vs. 7.7%; p < 0.02), difficulty in swallowing water (33.7% vs. 17.3%; p < 0.04), and voice problems (81.2% vs. 51.9%; p < 0.01). When the sample was stratified by ACQ-6 score, the proportion of patients showing difficulty in swallowing bread was significantly higher in the SUA group than in the SCA group (66.6% vs. 26.6%; p < 0.01). Conclusions: The prevalence of changes in the stomatognathic system appears to be high among adults with severe asthma, regardless of the level of asthma control. We found that some such changes were significantly more common in patients with SUA than in those with SCA.

 


Keywords: Speech/physiology; Stomatognathic system/physiopathology; Asthma/complications; Deglutition disorders; Mastication/physiology.

 


Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome

Associação entre função pulmonar, força muscular respiratória e capacidade funcional de exercício em indivíduos obesos com síndrome da apneia obstrutiva do sono

Thays Maria da Conceição Silva Carvalho1,a, Anísio Francisco Soares2,b, Danielle Cristina Silva Climaco3,c, Isaac Vieira Secundo3,d, Anna Myrna Jaguaribe de Lima2,e

J Bras Pneumol.2018;44(4):279-284

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Objective: To evaluate lung function and inspiratory muscle strength, correlating them with exercise tolerance, in obese individuals with obstructive sleep apnea syndrome (OSAS). Methods: The sample comprised 31 adult subjects with moderate-to-severe OSAS diagnosed by polysomnography. We used spirometry to measure FVC, FEV1, and FVC/FEV1 ratio, using pressure manometry to measure MIP and MEP. The incremental shuttle walk test (ISWT) and the six-minute walk test (6MWT) were used in order to determine functional exercise capacity. Results: In this sample, the mean values for FVC (% of predicted), FEV1 (% of predicted): MIP, and MEP were 76.4 ± 12.3%, 80.1 ± 6.3%, 60.0 ± 21.9 cmH2O, and 81.3 ± 22.2 cmH2O, respectively. The mean distances covered on the ISWT and 6MWT were 221 ± 97 m and 480.8 ± 67.3 m, respectively. The ISWT distance showed moderate positive correlations with FVC (r = 0.658; p = 0.001) and FEV1 (r = 0.522; p = 0.003). Conclusions: In this sample of obese subjects with untreated OSAS, lung function, inspiratory muscle strength, and exercise tolerance were all below normal. In addition, we found that a decline in lung function, but not in respiratory muscle strength, was associated with exercise tolerance in these patients.

 


Keywords: Sleep apnea syndromes; Exercise tolerance; Respiratory function tests; Respiratory muscles.

 


Meeting the assumptions of statistical tests: an important and often forgotten step to reporting valid results

Atender as premissas dos testes estatísticos: um passo importante e muitas vezes negligenciado na comunicação de resultados válidos

Cecilia Maria Patino1,2,a Juliana Carvalho Ferreira1,3,b

J Bras Pneumol.2018;44(5):353-353

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Update on the approach to smoking in patients with respiratory diseases

Atualização na abordagem do tabagismo em pacientes com doenças respiratórias

Maria Penha Uchoa Sales1,a, Alberto José de Araújo2,b, José Miguel Chatkin3,c, Irma de Godoy4,d, Luiz Fernando Ferreira Pereira5,e, Maria Vera Cruz de Oliveira Castellano6,f, Suzana Erico Tanni4,g, Adriana Ávila de Almeida7,h, Gustavo Chatkin3,i, Luiz Carlos Côrrea da Silva8,j, Cristina Maria Cantarino Gonçalves9,k, Clóvis Botelho12,13,l, Ubiratan Paula Santos14,m, Carlos Alberto de Assis Viegas15,n, Maristela Rodrigues Sestelo16,o, Ricardo Henrique Sampaio Meireles10,11,p, Paulo César Rodrigues Pinto Correa17,q, Maria Eunice Moraes de Oliveira18,r, Jonatas Reichert19,s, Mariana Silva Lima6,t, Celso Antonio Rodrigues da Silva20,u

J Bras Pneumol.2019;45(3):e20180314-e20180314

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Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

 


Keywords: Respiratory tract diseases/therapy; Respiratory tract diseases/drug therapy; Tobacco use disorder/epidemiology; Smoking cessation; Counseling; Lung neoplasms.

 


Control measures to trace &#8804; 15-year-old contacts of index cases of active pulmonary tuberculosis

Atualização no diagnóstico e tratamento da fibrose pulmonar idiopática

José Baddini-Martinez1, Bruno Guedes Baldi2, Cláudia Henrique da Costa3, Sérgio Jezler4, Mariana Silva Lima5, Rogério Rufino3,6

J Bras Pneumol.2015;41(5):454-466

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Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.

 


Keywords: Idiopathic pulmonary fibrosis/diagnosis; Idiopathic pulmonary fibrosis/therapy; Idiopathic pulmonary fibrosis/rehabilitation.

 


Critical appraisal of the literature. Why do we care?

Avaliação crítica da literatura. Por que nos importamos?

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2018;44(6):448-448

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Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test

Avaliação da capacidade funcional: equações de referência para o teste Glittre Activities of Daily Living

Cardine Martins dos Reis1,2,a, Manuela Karloh1,3,b, Fernanda Rodrigues Fonseca1,2,c, Roberta Rodolfo Mazzali Biscaro1,2,d, Giovana Zarpellon Mazo4,5,e, Anamaria Fleig Mayer1,2,3,5,f

J Bras Pneumol.2018;44(5):370-377

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Objective: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. Methods: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. Results: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (−0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). Conclusions: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.

 


Keywords: Activities of daily living; Exercise test; Reference values.

 


Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer

Avaliação da fadiga utilizando a Escala de Identificação e Consequências da Fadiga em pacientes com câncer de pulmão

Ingrid Correia Nogueira1,2, Amanda Souza Araújo1,2, Maria Tereza Morano1,2,3, Antonio George Cavalcante1, Pedro Felipe de Bruin1, Johana Susan Paddison4, Guilherme Pinheiro da Silva1,3, Eanes Delgado Pereira1,2

J Bras Pneumol.2017;43(3):169-175

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To evaluate the properties of the Identity-Consequence Fatigue Scale (ICFS) in patients with lung cancer (LC), assessing the intensity of fatigue and associated factors. Methods: This was a cross-sectional study involving LC patients, treated at a teaching hospital in Brazil, who completed the ICFS. Patients with chronic heart disease (CHD) and healthy controls, matched for age and gender, also completed the scale. Initially, a Brazilian Portuguese-language version of the ICFS was administered to 50 LC patients by two independent interviewers; to test for reproducibility, it was readministered to those same patients. At baseline, the LC patients were submitted to spirometry and the six-minute walk test, as well as completing the Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and Fatigue Severity Scale (FSS). Inflammatory status was assessed by blood C-reactive protein (CRP) levels. To validate the ICFS, we assessed the correlations of its scores with those variables. Results: The sample comprised 50 patients in each group (LC, CHD, and control). In the LC group, the intraclass correlation coefficients for intra-rater and inter-rater reliability regarding ICFS summary variables ranged from 0.94 to 0.76 and from 0.94 to 0.79, respectively. The ICFS presented excellent internal consistency, and Bland-Altman plots showed good test-retest reliability. The ICFS correlated significantly with FSS, HADS, and SF-36 scores, as well as with CRP levels. Mean ICFS scores in the LC group differed significantly from those in the CHD and control groups. Conclusions: The ICFS is a valid, reliable instrument for evaluating LC patients, in whom depression, quality of life, and CRP levels seem to be significantly associated with fatigue.

 


Keywords: Fatigue; Lung neoplasms; Symptom assessment.

 


Evaluation of quality of life according to asthma control and asthma severity in children and adolescents.

Avaliação da qualidade de vida de acordo com o nível de controle e gravidade da asma em crianças e adolescentes

Natasha Yumi Matsunaga1, Maria Angela Gonçalves de Oliveira Ribeiro2, Ivete Alonso Bredda Saad3, André Moreno Morcillo4, José Dirceu Ribeiro2,5, Adyléia Aparecida Dalbo Contrera Toro2,5

J Bras Pneumol.2015;41(6):502-508

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Objective: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. Methods: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. Results: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. Conclusions: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.

 


Keywords: Asthma; Quality of life; Child; Adolescent.

 


Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility

Avaliação da resposta ao broncodilatador em pacientes pediátricos com bronquiolite obliterante pós-infecciosa: uso de diferentes critérios de identificação de reversibilidade das vias aéreas

Rita Mattiello1, Paula Cristina Vidal2, Edgar Enrique Sarria3, Paulo Márcio Pitrez1, Renato Tetelbom Stein1, Helena Teresinha Mocelin4, Gilberto Bueno Fischer4, Marcus Herbert Jones1, Leonardo Araújo Pinto1

J Bras Pneumol.2016;42(3):174-178

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Objective: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. Methods: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. Results: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25‑75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Conclusions: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications.

 


Keywords: Bronchiolitis obliterans; Infection/complications; Airway obstruction; Bronchodilator agents.

 


Evaluation of bone disease in patients with cystic fibrosis and end-stage lung disease

Avaliação de doença óssea em pacientes com fibrose cística e doença pulmonar terminal

Cécile A. Robinson1,a, Markus Hofer2,b, Christian Benden1,c, Christoph Schmid3,d

J Bras Pneumol.2019;45(1):e20170280-e20170280

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Objective: Bone disease is a common comorbidity in patients with cystic fibrosis (CF). We sought to determine risk factors and identify potential biochemical markers for CF-related bone disease (CFBD) in a unique cohort of CF patients with end-stage lung disease undergoing lung transplantation (LTx) evaluation. Methods: All of the CF patients who were evaluated for LTx at our center between November of 1992 and December of 2010 were included in the study. Clinical data and biochemical markers of bone turnover, as well as bone mineral density (BMD) at the lumbar spine and femoral neck, were evaluated. Spearman's rho and multivariate logistic regression analysis were used. Results: A total of 102 adult CF patients were evaluated. The mean age was 28.1 years (95% CI: 26.7-29.5), and the mean body mass index was 17.5 kg/m2 (95% CI: 17.2-18.2). Mean T-scores were −2.3 and −1.9 at the lumbar spine and femoral neck, respectively, being lower in males than in females (−2.7 vs. −2.0 at the lumbar spine and −2.2 vs. −1.7 at the femoral neck). Overall, 52% had a T-score of < −2.5 at either skeletal site. The homozygous Phe508del genotype was found in 57% of patients without osteoporosis and in 60% of those with low BMD. Mean T-scores were not particularly low in patients with severe CFTR mutations. Although the BMI correlated with T-scores at the femoral neck and lumbar spine, serum 25-hydroxyvitamin D and parathyroid hormone levels did not. Conclusions: CFBD is common in CF patients with end-stage lung disease, particularly in males and patients with a low BMI. It appears that CF mutation status does not correlate with CFBD. In addition, it appears that low BMD does not correlate with other risk factors or biochemical parameters. The prevalence of CFBD appears to have recently decreased, most likely reflecting increased efforts at earlier diagnosis and treatment.

 


Keywords: Lung transplantation; Cystic fibrosis; Bone density; Osteoporosis.

 


Evaluation of smoking cessation treatment initiated during hospitalization in patients with heart disease or respiratory disease

Avaliação de um tratamento para cessação do tabagismo iniciado durante a hospitalização em pacientes com doença cardíaca ou doença respiratória

Thaís Garcia1,a, Sílvia Aline dos Santos Andrade2, Angélica Teresa Biral1, André Luiz Bertani1,b, Laura Miranda de Oliveira Caram1,c, Talita Jacon Cezare3, Irma Godoy4,d, Suzana Erico Tanni3,e

J Bras Pneumol.2018;44(1):42-48

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Objective: To evaluate the effectiveness of a smoking cessation program, delivered by trained health care professionals, in patients hospitalized for acute respiratory disease (RD) or heart disease (HD). Methods: Of a total of 393 patients evaluated, we included 227 (146 and 81 active smokers hospitalized for HD and RD, respectively). All participants received smoking cessation treatment during hospitalization and were followed in a cognitive-behavioral smoking cessation program for six months after hospital discharge. Results: There were significant differences between the HD group and the RD group regarding participation in the cognitive-behavioral program after hospital discharge (13.0% vs. 35.8%; p = 0.003); smoking cessation at the end of follow-up (29% vs. 31%; p < 0.001); and the use of nicotine replacement therapy (3.4% vs. 33.3%; p < 0.001). No differences were found between the HD group and the RD group regarding the use of bupropion (11.0% vs. 12.3%; p = 0.92). Varenicline was used by only 0.7% of the patients in the HD group. Conclusions: In our sample, smoking cessation rates at six months after hospital discharge were higher among the patients with RD than among those with HD, as were treatment adherence rates. The implementation of smoking cessation programs for hospitalized patients with different diseases, delivered by the health care teams that treat these patients, is necessary for greater effectiveness in smoking cessation.

 


Keywords: Smoking; Smoking cessation; Hospitalization; Respiratory tract diseases; Heart diseases.

 


Biomarkers in community-acquired pneumonia: can we do better by using them correctly?

Biomarcadores na pneumonia adquirida na comunidade: podemos fazer melhor utilizando-os corretamente?

Otavio Tavares Ranzani1,a, Luis Coelho2,3,b, Antoni Torres4,c

J Bras Pneumol.2019;45(4):e20190189-e20190189

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CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy

Biópsia percutânea com agulha grossa, guiada por TC, de nódulos pulmonares menores que 2 cm: aspectos técnicos e fatores que influenciam a precisão

Juliano Ribeiro de Andrade1,a, Rafael Dahmer Rocha1,b, Priscila Mina Falsarella1,c, Antonio Rahal Junior1,d, Ricardo Sales dos Santos2,e, Juliana Pereira Franceschini3,f, Hiran Chrishantha Fernando4,g, Rodrigo Gobbo Garcia1,h

J Bras Pneumol.2018;44(4):307-314

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Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.

 


Keywords: Image-guided biopsy; Neoplasms; Lung.

 


Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography

Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

Juliana Fischman Zampieri1,a, Gabriel Sartori Pacini1,b, Matheus Zanon1,c, Stephan Philip Leonhardt Altmayer1,2,d, Guilherme Watte1,2,e, Marcelo Barros1,2,f Evandra Durayski2,g, Gustavo de Souza Portes Meirelles3,h, Marcos Duarte Guimarães4,5,i, Edson Marchiori6,j, Arthur Soares Souza Junior7,k, Bruno Hochhegger1,2,l

J Bras Pneumol.2019;45(4):e20180168-e20180168

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Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

 


Keywords: Calcification, physiologic; Thorax/diagnostic imaging; Tomography, X-ray computed; Magnetic resonance imaging.

 


Lung cancer in Brazil

Câncer de pulmão no Brasil

Luiz Henrique Araujo1,2,a, Clarissa Baldotto1,2,b, Gilberto de Castro Jr3,4,c, Artur Katz4,d, Carlos Gil Ferreira5,6,e, Clarissa Mathias7,f, Eldsamira Mascarenhas7,g, Gilberto de Lima Lopes8,9,h, Heloisa Carvalho4,10,i, Jaques Tabacof8, Jeovany Martínez-Mesa11,j, Luciano de Souza Viana12,k, Marcelo de Souza Cruz13,l, Mauro Zukin1,2,m, Pedro De Marchi12,n, Ricardo Mingarini Terra3,o, Ronaldo Albuquerque Ribeiro14, Vladmir Cláudio Cordeiro de Lima15,p, Gustavo Werutsky16,q, Carlos Henrique Barrios17,r; Grupo Brasileiro de Oncologia Torácica

J Bras Pneumol.2018;44(1):55-64

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Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

 


Keywords: Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil.

 


Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil

Câncer de pulmão: mudanças na histologia, sexo e idade nos últimos 30 anos no Brasil

Maria Teresa Ruiz Tsukazan1,2, Álvaro Vigo2, Vinícius Duval da Silva3, Carlos Henrique Barrios4, Jayme de Oliveira Rios1, José Antônio de Figueiredo Pinto1

J Bras Pneumol.2017;43(5):363-367

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Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women.

 


Keywords: Lung neoplasms; Epidemiology; Histology; Adenocarcinoma; Carcinoma, non-small-cell lung; Carcinoma, squamous cell.

 


Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil

Características clínicas de crianças e adolescentes brasileiros com asma grave resistente a terapia

Andrea Mendonça Rodrigues1, Cristian Roncada1, Giovana Santos2, João Paulo Heinzmann-Filho1, Rodrigo Godinho de Souza2, Mauro Henrique Moraes Vargas1, Leonardo Araújo Pinto3, Marcus Herbert Jones3, Renato Tetelbom Stein3, Paulo Márcio Pitrez3

J Bras Pneumol.2015;41(4):343-350

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Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.

 


Keywords: Arthritis, rheumatoid; Lung diseases, interstitial; Spirometry; Radiography, thoracic; Airway ob-struction.

 


Sleep characteristics in an adult with sleep complaints in three cities at different altitudes

Características do sono em um adulto com queixas de sono em três cidades a diferentes altitudes

Julio Cesar Castellanos-Ramírez1,a, Alvaro J Ruíz2,3,b, Patricia Hidalgo-Martínez1,2,c, Liliana Otero-Mendoza4,d

J Bras Pneumol.2018;44(1):65-68

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Sleep studies conducted at an altitude that is different from the home altitude can yield misleading results regarding the severity of obstructive sleep apnea (OSA). The objective of the present study was to determine the sleep characteristics of a patient undergoing polysomnography (PSG) in three Colombian cities at different altitudes (Bogotá, at 2,640 m above sea level [ASL]; Bucaramanga, at 959 m ASL; and Santa Marta, at 15 m ASL). The patient was an obese man with diabetes and suspected OSA. All PSG recordings were scored and interpreted in accordance with American Academy of Sleep Medicine criteria. In Bogotá, PSG revealed moderate OSA (an apnea-hypopnea index [AHI] of 21 events/h); in Bucaramanga, PSG revealed increased upper airway resistance (an AHI of 2 events/h); in Santa Marta, PSG revealed mild OSA (an AHI of 7 events/h). The reduction in the AHI was predominantly a reduction in hypopneas and obstructive apneas. The respiratory events were shorter in duration in the city at an intermediate altitude. Given that the AHI varied widely across cities, we can assume that the patient is normal or has moderate OSA depending on the city where he is. Central apneas were found to have no influence on the AHI.

 


Keywords: Sleep apnea, obstructive; Polysomnography; Altitude.

 


Genetic and phenotypic traits of children and adolescents with cystic fibrosis in Southern Brazil

Características genéticas e fenotípicas de crianças e adolescentes com fibrose cística no Sul do Brasil

Katiana Murieli da Rosa1,a, Eliandra da Silveira de Lima2,b, Camila Correia Machado3,c, Thaiane Rispoli4,d, Victória d'Azevedo Silveira3,e, Renata Ongaratto2,f, Talitha Comaru2,g, Leonardo Araújo Pinto5,h

J Bras Pneumol.2018;44(6):498-504

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Objectives: To characterize the main identified mutations on cystic fibrosis transmembrane conductance regulator (CFTR) in a group of children and adolescents at a cystic fibrosis center and its association with the clinical and laboratorial characteristics. Method: Descriptive cross-sectional study including patients with cystic fibrosis who had two alleles identified with CFTR mutation. Clinical, anthropometrical, laboratorial and pulmonary function (spirometry) data were collected from patients' records in charts and described with the results of the sample genotyping. Results: 42 patients with cystic fibrosis were included in the study. The most frequent mutation was F508del, covering 60 alleles (71.4%). The second most common mutation was G542X (six alleles, 7.1%), followed by N1303K and R1162X mutations (both with four alleles each). Three patients (7.14%) presented type III and IV mutations, and 22 patients (52.38%) presented homozygous mutation for F508del. Thirty three patients (78.6%) suffered of pancreatic insufficiency, 26.2% presented meconium ileus, and 16.7%, nutritional deficit. Of the patients in the study, 59.52% would be potential candidates for the use of CFTR-modulating drugs. Conclusions: The mutations of CFTR identified more frequently were F508del and G542X. These are type II and I mutations, respectively. Along with type III, they present a more severe cystic fibrosis phenotype. More than half of the sample (52.38%) presented homozygous mutation for F508del, that is, patients who could be treated with Lumacaftor/Ivacaftor. Approximately 7% of the patients (7.14%) presented type III and IV mutations, therefore becoming candidates for the treatment with Ivacaftor.

 


Keywords: Cystic fibrosis; Mutations; Genetics; Phenotype; Child

 


Pulmonary large-cell neuroendocrine carcinoma presenting as multiple cutaneous metastases

Carcinoma neuroendócrino de grandes células do pulmão diagnosticado a partir de múltiplas metástases cutâneas

Tiago Mestre1, Ana Maria Rodrigues2, Jorge Cardoso3

J Bras Pneumol.2015;41(3):289-291

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Celebrating World Asthma Day in Brazil: is the glass half full or half empty?

Celebrando o Dia Mundial da Asma no Brasil: o copo está meio cheio ou meio vazio?

Marcia Margaret Menezes Pizzichini1,a, Álvaro Augusto Cruz2,3,b

J Bras Pneumol.2019;45(3):e20190130-e20190130

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Writing an effective response to reviewers: the goal is to improve the study and get it published!

Como escrever uma resposta eficaz aos revisores: o objetivo é melhorar o estudo e publicá-lo!

Cecilia Maria Patino1,2,a, Juliana Carvalho Ferreira1,3,b

J Bras Pneumol.2019;45(1):e20190020-e20190020

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How to prepare and present a poster at a conference and communicate your research findings effectively

Como preparar e apresentar um pôster em uma conferência e comunicar resultados de pesquisa de forma eficaz

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2019;45(3):e20190167-e20190167

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Comparison of diaphragmatic mobility between COPD patients with and without thoracic hyperkyphosis: a cross-sectional study

Comparação da mobilidade diafragmática em pacientes com DPOC com e sem hipercifose torácica: um estudo transversal

Márcia Aparecida Gonçalves1, Bruna Estima Leal1, Liseane Gonçalves Lisboa2, Michelle Gonçalves de Souza Tavares3, Wellington Pereira Yamaguti4, Elaine Paulin1

J Bras Pneumol.2018;44(1):5-11

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Objective: To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods: Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results: A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions: Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

 


Keywords: Pulmonary disease, chronic obstructive; Kyphosis; Diaphragm.

 


Comparison of two smoking cessation interventions for inpatients

Comparação de duas intervenções de cessação do tabagismo em pacientes internados

Antonio Carlos Ferreira Campos1,a, Angela Santos Ferreira Nani2,b, Vilma Aparecida da Silva Fonseca3,c, Eduardo Nani Silva1,2,d, Marcos César Santos de Castro2,4,e, Wolney de Andrade Martins1,2,f

J Bras Pneumol.2018;44(3):195-201

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Objective: This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge. Methods: This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO). Results: Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = −0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001). Conclusions: The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.

 


Keywords: Smoking cessation; Tobacco use disorder; Inpatients; Hospitalization.

 


Complexity of autonomic nervous system function in individuals with COPD

Complexidade do sistema nervoso autônomo em indivíduos com DPOC

Laís Manata Vanzella1,f, Aline Fernanda Barbosa Bernardo1,d, Tatiana Dias de Carvalho3,e, Franciele Marques Vanderlei2,a, Anne Kastelianne França da Silva1,c, Luiz Carlos Marques Vanderlei2,b

J Bras Pneumol.2018;44(1):24-30

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Objective: To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. Methods: We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. Results: In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. Conclusions: Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.

 


Keywords: Pulmonary disease, chronic obstructive; Autonomic nervous system; Nonlinear dynamics; Recurrence; Heart rate; Sympathetic nervous system.

 


Left main coronary artery compression in a patient with portopulmonary hypertension

Compressão de tronco de artéria coronária esquerda em paciente com hipertensão portopulmonar

Iara Teixeira de Araújo1,a, Pammela Jacomeli Lembi1,b, Eduardo Belisario Falchetto2,c, Ricardo de Amorim Corrêa3,4,d

J Bras Pneumol.2018;44(4):337-338

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Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis

Conhecimento e percepção de médicos e enfermeiros em três capitais brasileiras com alta incidência de tuberculose a respeito da transmissão e prevenção da doença

Jonas Ramos1,a, Maria F Wakoff-Pereira1,b, Marcelo Cordeiro-Santos2,3,c, Maria de Fátima Militão de Albuquerque4,d, Philip C Hill5,e, Dick Menzies6,f, Anete Trajman,6,7,g

J Bras Pneumol.2018;44(2):168-170

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Brazilian consensus on non-cystic fibrosis bronchiectasis

Consenso brasileiro sobre bronquiectasias não fibrocísticas

Mônica Corso Pereira1,a, Rodrigo Abensur Athanazio2,b, Paulo de Tarso Roth Dalcin3,4,c, Mara Rúbia Fernandes de Figueiredo5,d, Mauro Gomes6,7,e, Clarice Guimarães de Freitas8,f, Fernando Ludgren9,g, Ilma Aparecida Paschoal1,h, Samia Zahi Rached2,i, Rosemeri Maurici10,j

J Bras Pneumol.2019;45(4):e20190122-e20190122

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Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.

 


Keywords: Bronchiectasis; Tomography, X-ray; Radiography, thoracic.

 


Dense consolidation

Consolidação densa

Edson Marchiori1,2, Gláucia Zanetti2,3, Bruno Hochhegger4,5

J Bras Pneumol.2015;41(4):388-388

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Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem

Contaminação microbiológica de nebulizadores usados por pacientes com fibrose cística: um problema subestimado

Barbara Riquena1,a, Luciana de Freitas Velloso Monte2,b, Agnaldo José Lopes3,c, Luiz Vicente Ribeiro Ferreira da Silva-Filho4,5,d, Neiva Damaceno6,e, Evanirso da Silva Aquino7,f, Paulo Jose Cauduro Marostica8,9,g, José Dirceu Ribeiro10,h

J Bras Pneumol.2019;45(3):e20170351-e20170351

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Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

 


Keywords: Cystic fibrosis; Pseudomonas aeruginosa; Nebulizers and vaporizers; Equipment contamination; Decontamination.

 


Asthma control, lung function, nutritional status, and health-related quality of life: differences between adult males and females with asthma

Controle da asma, função pulmonar, estado nutricional e qualidade de vida relacionada à saúde: diferenças entre homens e mulheres adultos com asma

Gabriele Carra Forte1,a, Maria Luiza Hennemann2,b, Paulo de Tarso Roth Dalcin1,3,c

J Bras Pneumol.2018;44(4):273-278

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Objective: To evaluate health-related quality of life in asthma patients treated at a referral center in southern Brazil, identifying differences between male and female patients, as well as to evaluate differences between the males and females in terms of asthma control, lung function, and nutritional status. Methods: This was a cross-sectional study involving patients ≥ 18 years of age treated at an asthma outpatient clinic. We evaluated clinical parameters, lung function, nutritional status, and quality of life. Results: A total of 198 patients completed the study. The mean age was 56.2 ± 14.8 years, and 81.8% were female. The proportion of patients with uncontrolled asthma was higher among females than among males (63.0% vs. 44.4%; p = 0.041). The body mass index (BMI) and percentage of body fat were higher in females than in males (30.2 ± 5.8 kg/m2 vs. 26.9 ± 4.5 kg/m2 and 37.4 ± 6.4% vs. 26.5 ± 7.4%; p = 0.002 and p < 0.001, respectively). Quality of life was lower in females than in males in the following domains: symptoms (3.8 ± 1.5 vs. 4.6 ± 1.7; p = 0.006); activity limitation (3.6 ± 1.3 vs. 4.4 ± 1.5; p = 0.001); emotional function (3.6 ± 1.9 vs. 4.5 ± 1.7; p = 0.014); and environmental stimuli (3.2 ± 1.6 vs. 4.3 ± 1.9; p = 0.001). Conclusions: Male asthma patients appear to fare better than do female asthma patients in terms of health-related quality of life, asthma control, BMI, percentage of body fat, and comorbidities.

 


Keywords: Asthma; Nutritional status; Quality of life; Adult.

 


Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

Correlação entre a gravidade de pacientes críticos e preditores clínicos de risco para a broncoaspiração

Gisele Chagas de Medeiros1, Fernanda Chiarion Sassi2, Lucas Santos Zambom3, Claudia Regina Furquim de Andrade2

J Bras Pneumol.2016;42(2):114-120

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

 


Keywords: Deglutition; Deglutition disorders; Intubation, intratracheal; Pneumonia, aspiration; Intensive care units.

 


Correspondence about the article - Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

Correspondência sobre o artigo - Ecobroncoscopia radial para o diagnóstico de lesões pulmonares periféricas

Juliana Guarize1, Stefano Donghi1, Maurício Guidi Saueressig1,2,3

J Bras Pneumol.2017;43(1):76-76

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Growth, lung function, and physical activity in schoolchildren who were very-low-birth-weight preterm infants

Crescimento, função pulmonar e atividade física em escolares nascidos prematuros e com muito baixo peso

Aline Dill Winck1,2, João Paulo Heinzmann-Filho3, Deise Schumann4, Helen Zatti4, Rita Mattiello3,5, Marcus Herbert Jones3,5, Renato Tetelbom Stein3,

J Bras Pneumol.2016;42(4):254-260

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Objective: To compare somatic growth, lung function, and level of physical activity in schoolchildren who had been very-low-birth-weight preterm infants (VLBWPIs) or normal-birth-weight full-term infants. Methods: We recruited two groups of schoolchildren between 8 and 11 years of age residing in the study catchment area: those who had been VLBWPIs (birth weight < 1,500 g); and those who had been normal-birth-weight full-term infants (controls, birth weight ≥ 2,500 g). Anthropometric and spirometric data were collected from the schoolchildren, who also completed a questionnaire regarding their physical activity. In addition, data regarding the perinatal and neonatal period were collected from the medical records of the VLBWPIs. Results: Of the 93 schoolchildren screened, 48 and 45 were in the VLBWPI and control groups, respectively. No significant differences were found between the groups regarding anthropometric characteristics, nutritional status, or pulmonary function. No associations were found between perinatal/neonatal variables and lung function parameters in the VLBWPI group. Although the difference was not significant, the level of physical activity was slightly higher in the VLBWPI group than in the control group. Conclusions: Among the schoolchildren evaluated here, neither growth nor lung function appear to have been affected by prematurity birth weight, or level of physical activity.

 


Keywords: Premature birth; Birth weight; Respiratory function tests; Motor activity; Pediatrics.

 


Inclusion and exclusion criteria in research studies: definitions and why they matter

Critérios de inclusão e exclusão em estudos de pesquisa: definições e por que eles importam

Cecilia Maria Patino1,2,a, Juliana Carvalho Ferreira1,3,b

J Bras Pneumol.2018;44(2):84-84

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Psychological criteria for contraindication in lung transplant candidates: a five-year study

Critérios psicológicos para contraindicação em candidatos a transplante pulmonar: um estudo de cinco anos

Elaine Marques Hojaij1, Bellkiss Wilma Romano1, André Nathan Costa2, Jose Eduardo Afonso Junior3, Priscila Cilene Leon Bueno de Camargo3, Rafael Medeiros Carraro3, Silvia Vidal Campos4, Marcos Naoyuki Samano5, Ricardo Henrique de Oliveira Braga Teixeira6

J Bras Pneumol.2015;41(3):246-249

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Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.

 


Keywords: Lung transplantation; Interview, psychological; Psychological tests; Preoperative care.

 


Disability and its clinical correlates in pulmonary hypertension measured through the World Health Organization Disability Assessment Schedule 2.0: a prospective, observational study

Deficiência e seus correlatos clínicos na hipertensão pulmonar medidos pelo World Health Organization Disability Assessment Schedule 2.0: um estudo prospectivo e observacional

Abílio Reis1,a, Mário Santos1,2,3,b, Inês Furtado4,c, Célia Cruz4,d, Pedro Sa-Couto5,e, Alexandra Queirós6,7,f, Luís Almeida8,g, Nelson Rocha7,9,h

J Bras Pneumol.2019;45(4):e20170355-e20170355

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To characterise the degree of disability in pulmonary hypertension (PH) patients based on the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Method: A prospective and observational study of patients with documented PH (N = 46). Patients completed the WHODAS 2.0 questionnaire during a scheduled routine clinical visit, and their demographic and clinical characteristics were retrieved from electronic medical records (EMR). In subsequent visits, selected clinical variables were registered to assess disease progression. Results: WHODAS 2.0 scores were indicative of mild to moderate disability for the domains of mobility (22.0 ± 23.2), life activities (23.7 ± 25.5), and participation in society (17.2 ± 15.9), as well as total WHODAS 2.0 score (15.3 ± 15.2). For the domains of cognition (9.1 ± 14.1), self-care (8.3 ± 14.4), and interpersonal relationships (11.7 ± 15.7), scores were lower. Disability scores were, generally, proportional to the PH severity. The main baseline correlates of disability were World Health Organisation (WHO) functional class, fatigue, dyspnoea, 6-minute walking distance (6MWD), and N-terminal pro b-type natriuretic peptide (NT-proBNP). Baseline WHODAS 2.0 scores showed significant associations with disease progression. However, this effect was not transversal to all domains, with only a few domains significantly associated with disease progression variables. Conclusions: This PH population shows mild disability, with higher degree of disability in the domains of mobility and life activities. This study is the first one to assess disability in PH using WHODAS 2.0. Further studies should apply this scale to larger PH populations with suitable representations of more severe PH forms.

 


Keywords: Pulmonary hypertension; International Classification of Functioning, Disability and Health; Disability evaluation; Quality of Life.

 


Depression, anxiety, stress, and motivation over the course of smoking cessation treatment

Depressão, ansiedade, estresse e motivação em fumantes durante o tratamento para a cessação do tabagismo

Maritza Muzzi Cardozo Pawlina1, Regina de Cássia Rondina2, Mariano Martinez Espinosa3, Clóvis Botelho4

J Bras Pneumol.2015;41(5):433-439

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Objective: To evaluate changes in the levels of patient anxiety, depression, motivation, and stress over the course of smoking cessation treatment. Methods: This cohort study involved patients enrolled in a smoking cessation program in Cuiabá, Brazil. We selected patients who completed the program in six months or less (n = 142). Patient evaluations were conducted at enrollment (evaluation 1 [E1]); after 45 days of treatment with medication and cognitive-behavioral therapy (E2); and at the end of the six-month study period (E3). Patients were evaluated with a standardized questionnaire (to collect sociodemographic data and determine smoking status), as well as with the University of Rhode Island Change Assessment scale, Beck Anxiety Inventory, Beck Depression Inventory, and Lipp Inventory of Stress Symptoms for Adults. The data were analyzed with the nonparametric Wilcoxon test for paired comparisons. To compare treatment success (smoking cessation) with treatment failure, the test for two proportions was used. Results: Among the 142 patients evaluated, there were improvements, in terms of the levels of anxiety, depression, motivation, and stress, between E1 and E2, as well as between E1 and E3. In addition, treatment success correlated significantly with the levels of motivation and anxiety throughout the study period, whereas it correlated significantly with the level of depression only at E2 and E3. Conclusions: We conclude that there are in fact changes in the levels of patient anxiety, depression, motivation, and stress over the course of smoking cessation treatment. Those changes appear to be more pronounced in patients in whom the treatment succeeded.

 


Keywords: Anxiety; Depression; Motivation; Cognitive therapy; Smoking cessation.

 


Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation

Desempenho ao exercício e diferenças na resposta fisiológica à reabilitação pulmonar em doença pulmonar obstrutiva crônica grave com hiperinsuflação

Andre Luis Pereira de Albuquerque1, Marco Quaranta2, Biswajit Chakrabarti3, Andrea Aliverti2, Peter M. Calverley3

J Bras Pneumol.2016;42(2):121-129

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Objective: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. Methods: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV1 = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. Results: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO2), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO2 during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. Conclusions: In severe COPD, PR appears to improve oxygen consumption and reduce VCO2, with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program.

 


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise therapy; Respiratory therapy.

 


Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing

Desempenho de testes para o diagnóstico de tuberculose pulmonar em populações indígenas no Brasil: a contribuição do Teste Rápido Molecular

Jocieli Malacarne1,a, Alexsandro Santos Heirich2,b, Eunice Atsuko Totumi Cunha3,c, Ida Viktoria Kolte4,d, Reinaldo Souza-Santos4,e, Paulo Cesar Basta4,f

J Bras Pneumol.2019;45(2):e20180185-e20180185

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Objective: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. Methods: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). Results: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. Conclusions: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.

 


Keywords: Tuberculosis; Molecular diagnostic testing; Diagnostic tests, routine; Indians, South American.

 


Developing research questions that make a difference

Desenvolvendo perguntas do estudo que fazem a diferença

Cecilia Maria Patino1,2, Juliana Carvalho Ferreira2,3

J Bras Pneumol.2016;42(6):403-403

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Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Devemos utilizar escores prognósticos para tromboembolia pulmonar aguda na prática clínica?

Marcelo Basso Gazzana1,2,3,a, Igor Gorski Benedetto1,2,3,b

J Bras Pneumol.2019;45(1):e20190036-e20190036

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Diagnosis of primary ciliary dyskinesia

Diagnóstico de discinesia ciliar primária

Mary Anne Kowal Olm1, Elia Garcia Caldini2, Thais Mauad3

J Bras Pneumol.2015;41(3):251-263

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Primary ciliary dyskinesia (PCD) is a genetic disorder of ciliary structure or function. It results in mucus accumulation and bacterial colonization of the respiratory tract which leads to chronic upper and lower airway infections, organ laterality defects, and fertility problems. We review the respiratory signs and symptoms of PCD, as well as the screening tests for and diagnostic investigation of the disease, together with details related to ciliary function, ciliary ultrastructure, and genetic studies. In addition, we describe the difficulties in diagnosing PCD by means of transmission electron microscopy, as well as describing patient follow-up procedures.

 


Keywords: Kartagener Syndrome; Cilia; Mucociliary clearance; Ciliary motility disorders; Diagnosis.

 


Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

Diagnósticos alternativos corroborados por angiotomografia computadorizada de tórax em pacientes com suspeita de tromboembolia pulmonar

Eleci Vaz Ferreira1,2, Marcelo Basso Gazzana2,3, Muriel Bossle Sarmento4, Pedro Arends Guazzelli4, Mariana Costa Hoffmeister4, Vinicius André Guerra2, Renato Seligman4,5, Marli Maria Knorst2,3,4

J Bras Pneumol.2016;42(1):35-41

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Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

 


Keywords: Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Angiography.

 


Brazilian guidelines for the diagnosis and treatment of cystic fibrosis

Diretrizes brasileiras de diagnóstico e tratamento da fibrose cística

Rodrigo Abensur Athanazio1*, Luiz Vicente Ribeiro Ferreira da Silva Filho2,3*, Alberto Andrade Vergara4, Antônio Fernando Ribeiro5, Carlos Antônio Riedi6, Elenara da Fonseca Andrade Procianoy7, Fabíola Villac Adde2, Francisco José Caldeira Reis4, José Dirceu Ribeiro5, Lídia Alice Torres8, Marcelo Bicalho de Fuccio9, Matias Epifanio10, Mônica de Cássia Firmida11, Neiva Damaceno12, Norberto Ludwig-Neto13,14, Paulo José Cauduro Maróstica7,15, Samia Zahi Rached1, Suzana Fonseca de Oliveira Melo4; Grupo de Trabalho das Diretrizes Brasileiras de Diagnóstico e Tratamento da Fibrose Cística.

J Bras Pneumol.2017;43(3):219-245

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Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions.

 


Keywords: Cystic fibrosis/diagnosis; Cystic fibrosis/therapy; Cystic fibrosis/complications; Practice guideline.

 


Six-minute walk distance and survival time in patients with idiopathic pulmonary fibrosis in Brazil

Distância no teste de caminhada de seis minutos e sobrevida na fibrose pulmonar idiopática no Brasil

Eliane Viana Mancuzo1,2,a, Maria Raquel Soares3,b, Carlos Alberto de Castro Pereira4,c

J Bras Pneumol.2018;44(4):267-272

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Objective: To determine the cut-off point for the six-minute walk distance (6MWD) that indicates lower survival time in patients with idiopathic pulmonary fibrosis (IPF) in Brazil. Methods: This was retrospective study carried out in two referral centers for IPF. The 6MWT was performed twice, considering the highest value of the 6MWD. Various cut-off points were estimated, in absolute values and in percentage of predicted values, using ROC curves, the Kaplan-Meier method, and data from other studies. Results: The sample comprised 70 patients with IPF. The mean age was 71.9 ± 6.4 years, and 50 patients (71.4%) were male. The mean FVC was 76.6 ± 18.2% of predicted value. The mean SpO2 at rest before and after 6MWT were 93.8 ± 2.5% and 85.3 ± 6.5%, respectively. The median survival time was 44 months (95% CI: 37-51 months). The mean 6MWD was 381 ± 115 m (79.2 ± 24.0% of predicted). After the analyses, the best cut-off points for estimating survival were 6MWD < 330 m and < 70% of predicted. The median survival time of patients with a 6MWD < 330 m was 24 months (95% CI: 3-45 months), whereas that of those with a 6MWD ≥ 330 m was 59 months (95% CI: 41-77 months; p = 0.009). Similarly, the median survival times of those with a 6MWD < 70% and ≥ 70% of predicted, respectively, were 24 months (95% CI: 13-35 months) and 59 months (95% CI: 38-80 months; p = 0.013). Cox multivariate regression models including age, sex, smoking status, SpO2 at the end of the 6MWT, and FVC% showed that 6MWD remained significantly associated with survival (p = 0.003). Conclusions: Values of 6MWD < 330 m and < 70% of predicted value were associated with lower survival time in IPF patients in Brazil.

 


Keywords: Lung diseases, interstitial; Pulmonary fibrosis; Exercise tolerance.

 


Sleep-disordered breathing in patients with cystic fibrosis

Distúrbios respiratórios do sono em pacientes com fibrose cística

Jefferson Veronezi1,2, Ana Paula Carvalho3, Claudio Ricachinewsky4, Anneliese Hoffmann4, Danielle Yuka Kobayashi5, Otavio Bejzman Piltcher6, Fernando Antonio Abreu e Silva7, Denis Martinez1,2,8

J Bras Pneumol.2015;41(4):351-357

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Objective: To test the hypothesis that disease severity in patients with cystic fibrosis (CF) is correlated with an increased risk of sleep apnea. Methods: A total of 34 CF patients underwent clinical and functional evaluation, as well as portable polysomnography, spirometry, and determination of IL-1β levels. Results: Mean apnea-hypopnea index (AHI), SpO2 on room air, and Epworth Sleepiness Scale score were 4.8 ± 2.6, 95.9 ± 1.9%, and 7.6 ± 3.8 points, respectively. Of the 34 patients, 19 were well-nourished, 6 were at nutritional risk, and 9 were malnourished. In the multivariate model to predict the AHI, the following variables remained significant: nutritional status (β = −0.386; p = 0.014); SpO2 (β = −0.453; p = 0.005), and the Epworth Sleepiness Scale score (β = 0.429; p = 0.006). The model explained 51% of the variation in the AHI. Conclusions: The major determinants of sleep apnea were nutritional status, SpO2, and daytime sleepiness. This knowledge not only provides an opportunity to define the clinical risk of having sleep apnea but also creates an avenue for the treatment and prevention of the disease.

 


Keywords: Cystic fibrosis; Oxygenation; Sleep apnea, obstructive.

 


Niemann-Pick disease type B: HRCT assessment of pulmonary involvement

Doença de Niemann-Pick tipo B: avaliação do comprometimento pulmonar por TCAR

Heloisa Maria Pereira Freitas1, Alexandre Dias Mançano2, Rosana Souza Rodrigues1,3, Bruno Hochhegger4, Pedro Paulo Teixeira e Silva Torres5, Dante Escuissato6, Cesar Augusto Araujo Neto7, Edson Marchiori1

J Bras Pneumol.2017;43(6):451-455

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Objective: To analyze HRCT findings in patients with Niemann-Pick disease (NPD) type B, in order to determine the frequency of HRCT patterns and their distribution in the lung parenchyma, as well as the most common clinical characteristics. Methods: We studied 13 patients (3 males and 10 females) aged 5 to 56 years. HRCT images were independently evaluated by two observers, and disagreements were resolved by consensus. The inclusion criteria were presence of abnormal HRCT findings and diagnosis of NPD type B confirmed by histopathological examination of a bone marrow, lung, or liver biopsy specimen. Results: The most common clinical findings were hepatosplenomegaly and mild to moderate dyspnea. The most common HRCT patterns were smooth interlobular septal thickening and ground-glass opacities, which were both present in all patients. Intralobular lines were present in 12 patients (92.3%). A crazy-paving pattern was observed in 5 patients (38.4%), and areas of air trapping were identified in only 1 case (7.6%). Pulmonary involvement was bilateral in all cases, with the most affected area being the lower lung zone. Conclusions: Smooth interlobular septal thickening, with or without associated ground-glass opacities, in patients with hepatosplenomegaly is the most common finding in NPD type B.

 


Keywords: Niemann-Pick diseases; Tomography, X-ray computed; Lung diseases.

 


Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry

Doença pulmonar em pacientes com artrite reumatoide: avaliação radiográfica e espirométrica

Alexandre Melo Kawassaki1, Daniel Antunes Silva Pereira1, Fernando Uliana Kay2, Ieda Maria Magalhães Laurindo3, Carlos Roberto Ribeiro Carvalho4, Ronaldo Adib Kairalla1

J Bras Pneumol.2015;41(4):331-342

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Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.

 


Keywords: Arthritis, rheumatoid; Lung diseases, interstitial; Spirometry; Radiography, thoracic; Airway ob-struction.

 


Hard metal lung disease: a case series

Doença pulmonar por metal duro: uma série de casos

Rafael Futoshi Mizutani1, Mário Terra-Filho1,2, Evelise Lima1, Carolina Salim Gonçalves Freitas1, Rodrigo Caruso Chate3, Ronaldo Adib Kairalla1,2, Regiani Carvalho-Oliveira4, Ubiratan Paula Santos1

J Bras Pneumol.2016;42(6):447-452

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Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis.

 


Keywords: Lung diseases, interstitial; Cobalt; Tungsten; Occupational exposure; Hard metal.

 


Nontuberculous mycobacterial lung disease in a high tuberculosis incidence setting in Brazil

Doença pulmonar por micobactérias não tuberculosas em uma região de alta incidência de tuberculose no Brasil

Maiara dos Santos Carneiro1,2, Luciana de Souza Nunes2,3, Simone Maria Martini De David4, Claudia Fontoura Dias5, Afonso Luís Barth1,2, Gisela Unis5

J Bras Pneumol.2018;44(2):106-111

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Objective: The incidence of lung disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. In Brazil, there are few studies about nontuberculous mycobacterial lung disease (NTMLD), and its prevalence is yet to be known. Our objective was to determine the specific etiology of the disease in the state of Rio Grande do Sul, Brazil, as well as the frequency and diversity of NTM species in our sample of patients. Methods: This is a retrospective analysis of the medical records of patients diagnosed with NTMLD treated in a referral center located in the city of Porto Alegre, Brazil, between 2003 and 2013. Results: Our sample comprised 100 patients. The most prevalent NTM species were Mycobacterium avium complex (MAC), in 35% of the cases; M. kansasii, in 17%; and M. abscessus, in 12%. A total of 85 patients had received previous treatment for tuberculosis. Associated conditions included structural abnormalities in the lungs, such as bronchiectasis, in 23% of the cases; COPD, in 17%; and immunosuppressive conditions, such as AIDS, in 24%. Conclusions: MAC and M. kansasii were the most prevalent species involved in NTMLD in the state, similarly to what occurs in other regions of Brazil. Data on regional epidemiology of NTMLD, its specific etiology, and associated conditions are essential to establish appropriate treatment, since each species requires specific regimens. Most patients with NTMLD had received previous tuberculosis treatment, which might lead to development of resistance and late diagnosis.

 


Keywords: Nontuberculous mycobacteria; Mycobacterium infections, nontuberculous; Lung diseases.

 


Diffuse cystic lung diseases: differential diagnosis

Doenças pulmonares císticas difusas: diagnóstico diferencial

Bruno Guedes Baldi1, Carlos Roberto Ribeiro Carvalho1, Olívia Meira Dias1, Edson Marchiori2,3, Bruno Hochhegger4,5,6

J Bras Pneumol.2017;43(2):140-149

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Diffuse cystic lung diseases are characterized by cysts in more than one lung lobe, the cysts originating from various mechanisms, including the expansion of the distal airspaces due to airway obstruction, necrosis of the airway walls, and parenchymal destruction. The progression of these diseases is variable. One essential tool in the evaluation of these diseases is HRCT, because it improves the characterization of pulmonary cysts (including their distribution, size, and length) and the evaluation of the regularity of the cyst wall, as well as the identification of associated pulmonary and extrapulmonary lesions. When combined with clinical and laboratory findings, HRCT is often sufficient for the etiological definition of diffuse lung cysts, avoiding the need for lung biopsy. The differential diagnoses of diffuse cystic lung diseases are myriad, including neoplastic, inflammatory, and infectious etiologies. Pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis, lymphocytic interstitial pneumonia, and follicular bronchiolitis are the most common diseases that produce this CT pattern. However, new diseases have been included as potential determinants of this pattern.

 


Keywords: Cysts; Diagnosis, differential; Lung diseases, interstitial; Tomography, X-ray computed.

 


Twelve tips to write an abstract for a conference: advice for young and experienced investigators

Doze dicas para escrever um resumo para uma conferência: conselhos para investigadores iniciantes e experientes

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2018;44(4):260-260

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COPD: more treatment will translate to better breathing. Will it?

DPOC: quanto mais tratar, melhor vai respirar. Será?

Paulo José Zimermann Teixeira1,2,3,a, Marcelo Ferreira Nogueira2,3,b

J Bras Pneumol.2019;45(1):e20190037-e20190037

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Multidisciplinary education with a focus on COPD in primary health care

Educação multiprofissional com foco na DPOC na atenção primária à saúde

Erikson Custódio Alcântara1,2,a, Krislainy de Sousa Corrêa2,3,b, José Roberto Jardim4,c, Marcelo Fouad Rabahi5,d

J Bras Pneumol.2019;45(6):e20180230-e20180230

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Objective: To evaluate the use of video lessons on the topic of COPD as a training tool for a multidisciplinary team working in the primary health care sector. Methods: This was a quasi-experimental study involving a multidisciplinary team working at a primary health care clinic. The level of knowledge about COPD was measured by applying a specific, 16-item questionnaire - before, immediately after, and three months after the video lessons. In a set of six structured video lessons, the training focused on the prevention, case-finding, treatment, and monitoring of cases of COPD. The data were analyzed with the Friedman test, the Kruskal-Wallis test, Tukey's post hoc test, Dunnett's test, and the Bonferroni test. Results: There was a significant difference between the periods before and immediately after the training in terms of the scores on 15 of the 16 items on the questionnaire regarding the level of knowledge about COPD. The median total score of the participants increased significantly, from 60 points before the training to 77 points immediately thereafter and 3 months thereafter (p < 0.001 for both). Before the training, 23 (63.9%) and 13 (36.1%) of the members of the multidisciplinary team presented strong and very strong levels of agreement, respectively, among the 16 questionnaire items. After the training, 100% of the individuals presented a very strong degree of agreement. Conclusions: Multidisciplinary education through video lessons increased the knowledge of COPD on the part of a primary health care team, and the knowledge acquired was retained for at least three months after the intervention.

 


Keywords: Instructional films and videos; Pulmonary disease, chronic obstructive; Inservice training; Primary health care; Education, medical.

 


Educational interventions to improve inhaler techniques and their impact on asthma and COPD control: a pilot effectiveness-implementation trial

Educação para a melhora da técnica inalatória e seu impacto no controle da asma e DPOC: um estudo piloto de efetividade-intervenção

Tiago Maricoto1, Sofia Madanelo2, Luís Rodrigues3, Gilberto Teixeira3, Carla Valente3, Lília Andrade3, Alcina Saraiva3

J Bras Pneumol.2016;42(6):440-443

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To assess the impact that educational interventions to improve inhaler techniques have on the clinical and functional control of asthma and COPD, we evaluated 44 participants before and after such an intervention. There was a significant decrease in the number of errors, and 20 patients (46%) significantly improved their technique regarding prior exhalation and breath hold. In the asthma group, there were significant improvements in the mean FEV1, FVC, and PEF (of 6.4%, 8.6%, and 8.3% respectively). Those improvements were accompanied by improvements in Control of Allergic Rhinitis and Asthma Test scores but not in Asthma Control Test scores. In the COPD group, there were no significant variations. In asthma patients, educational interventions appear to improve inhaler technique, clinical control, and functional control.

 


Keywords: Asthma, Pulmonary disease, chronic obstructive; Nebulizers and vaporizers.

 


Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

Efeito do exercício passivo em cicloergômetro na força muscular, tempo de ventilação mecânica e internação hospitalar em pacientes críticos: ensaio clínico randomizado

Aline dos Santos Machado1, Ruy Camargo Pires-Neto2, Maurício Tatsch Ximenes Carvalho3, Janice Cristina Soares4,5, Dannuey Machado Cardoso6, Isabella Martins de Albuquerque3

J Bras Pneumol.2017;43(2):134-139

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Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/])

 


Keywords: Physical therapy modalities; Intensive care units; Early ambulation; Muscle strength.

 


Effect of vaporized perfluorocarbon on oxidative stress during the cold ischemia phase of lung graft preservation

Efeito do perfluorocarbono vaporizado sobre o estresse oxidativo no período de isquemia fria durante a preservação pulmonar

Renata Salatti Ferrari1,a, Leonardo Dalla Giacomassa Rocha Thomaz2,b, Lucas Elias Lise Simoneti2,c, Jane Maria Ulbrich1,3,d, Cristiano Feijó Andrade1,3,e

J Bras Pneumol.2019;45(4):e20170288-e20170288

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Liquid perfluorocarbon (PFC) instillation has been studied experimentally as an adjuvant therapy in the preservation of lung grafts during cold ischemia. The objective of this study was to evaluate whether vaporized PFC is also protective of lung grafts at different cold ischemia times. We performed histological analysis of and measured oxidative stress in the lungs of animals that received only preservation solution with low-potassium dextran (LPD) or vaporized PFC together with LPD. We conclude that vaporized PFC reduces the production of free radicals and the number of pulmonary structural changes resulting from cold ischemia.

 


Keywords: Ischemia; Reperfusion; Fluorocarbons; Lung transplantation; Oxidative stress.

 


Effects of manual chest compression on expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure maneuver in patients on mechanical ventilation

Efeitos da compressão torácica manual sobre o flow bias expiratório durante a manobra positive end-expiratory pressure-zero end-expiratory pressure em pacientes sob ventilação mecânica invasiva

Ana Carolina Otoni Oliveira1,a, Daiane Menezes Lorena1,b, Lívia Corrêa Gomes2,c, Bianca Lorrane Reges Amaral2,d, Márcia Souza Volpe3,e

J Bras Pneumol.2019;45(3):e20180058-e20180058

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Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF). Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor. Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF − PIF difference > 33 L/min): a mean PEF − PIF difference of 49.1 ± 9.4 L/min was achieved. The mean PEF/PIF ratio achieved was 3.3 ± 0.7. Using MCC with PEEP-ZEEP increased the mean PEF − PIF difference by 6.7 ± 3.4 L/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found. Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.

 


Keywords: Physical therapy modalities; Critical care; Respiration, artificial; Bodily secretions.

 


Effects of passive inhalation of cigarette smoke on structural and functional parameters in the respiratory system of guinea pigs

Efeitos da inalação passiva da fumaça de cigarro em parâmetros estruturais e funcionais no sistema respiratório de cobaias

Thiago Brasileiro de Vasconcelos1, Fernanda Yvelize Ramos de Araújo1, João Paulo Melo de Pinho2, Pedro Marcos Gomes Soares1, Vasco Pinheiro Diógenes Bastos3

J Bras Pneumol.2016;42(5):333-340

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Objective: To evaluate the effects of passive inhalation of cigarette smoke on the respiratory system of guinea pigs. Methods: Male guinea pigs were divided into two groups: control and passive smoking, the latter being exposed to the smoke of ten cigarettes for 20 min in the morning, afternoon and evening (30 cigarettes/day) for five days. After that period, inflammatory parameters were studied by quantifying mesenteric mast cell degranulation, as well as oxidative stress, in BAL fluid. In addition, we determined MIP, MEP, and mucociliary transport (in vivo), as well as tracheal contractility response (in vitro). Results: In comparison with the control group, the passive smoking group showed a significant increase in mast cell degranulation (19.75 ± 3.77% vs. 42.53 ± 0.42%; p < 0.001) and in the levels of reduced glutathione (293.9 ± 19.21 vs. 723.7 ± 67.43 nM/g of tissue; p < 0.05); as well as a significant reduction in mucociliary clearance (p < 0.05), which caused significant changes in pulmonary function (in MIP and MEP; p < 0.05 for both) and airway hyperreactivity. Conclusions: Passive inhalation of cigarette smoke caused significant increases in mast cell degranulation and oxidative stress. This inflammatory process seems to influence the decrease in mucociliary transport and to cause changes in pulmonary function, leading to tracheal hyperreactivity.

 


Keywords: Inflammation; Inhalation exposure; Tobacco smoke pollution.

 


Melatonin effects on pulmonary tissue in the experimental model of Hepatopulmonary Syndrome

Efeitos da melatonina sobre o tecido pulmonar no modelo experimental de Síndrome Hepatopulmonar

Adriane Dal Bosco1,a, Filipe Boeira Schedler2,b, Josieli Raskopf Colares2,c, Elisângela Gonçalves Schemitt2,3,d, Renata Minuzzo Hartmann2,3,e, Luiz Alberto Forgiarini Junior4,f, Alexandre Simões Dias2,3,g, Norma Possa Marroni2,3,h

J Bras Pneumol.2019;45(3):e20170164-e20170164

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Objective: To evaluate the pulmonary alterations of animals with Hepatopulmonary Syndrome (HPS) submitted to Biliary Duct Ligature (BDL), as well as the antioxidant effect of Melatonin (MEL). Methods: Sixteen male Wistar rats, divided into four Sham groups: BDL group, Sham + MEL group and BDL + MEL. The pulmonary and hepatic histology, lipoperoxidation and antioxidant activity of lung tissue, alveolar-arterial O2 difference and lung / body weight ratio (%) were evaluated. Results: When comparing the groups, could be observed an increase of vasodilation and pulmonary fibrosis in the BDL group and the reduction of this in relation to the BDL + MEL group. It was also observed significant changes in the activity of catalase, ApCO2, ApO2 in the LBD group when compared to the other groups. Conclusion: The use of MEL has been shown to be effective in reducing vasodilation, fibrosis levels and oxidative stress as well as gas exchange in an experimental HPS model.

 


Keywords: Bile duct; Hepatopulmonary Syndrome; Melatonin; Lung.

 


Effects of N-acetylcysteine and pentoxifylline on remote lung injury in a rat model of hind-limb ischemia/reperfusion injury

Efeitos da N-acetilcisteína e pentoxifilina na lesão pulmonar remota em um modelo de lesão de isquemia/reperfusão de membro posterior em ratos

Hamed Ashrafzadeh Takhtfooladi1, Saeed Hesaraki1, Foad Razmara2, Mohammad Ashrafzadeh Takhtfooladi3, Hadi Hajizadeh4

J Bras Pneumol.2016;42(1):9-14

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Objective: To investigate the effects of N-acetylcysteine (NAC) and pentoxifylline in a model of remote organ injury after hind-limb ischemia/reperfusion (I/R) in rats, the lungs being the remote organ system. Methods: Thirty-five male Wistar rats were assigned to one of five conditions (n = 7/group), as follows: sham operation (control group); hind-limb ischemia, induced by clamping the left femoral artery, for 2 h, followed by 24 h of reperfusion (I/R group); and hind-limb ischemia, as above, followed by intraperitoneal injection (prior to reperfusion) of 150 mg/kg of NAC (I/R+NAC group), 40 mg/kg of pentoxifylline (I/R+PTX group), or both (I/R+NAC+PTX group). At the end of the trial, lung tissues were removed for histological analysis and assessment of oxidative stress. Results: In comparison with the rats in the other groups, those in the I/R group showed lower superoxide dismutase activity and glutathione levels, together with higher malondialdehyde levels and lung injury scores (p < 0.05 for all). Interstitial inflammatory cell infiltration of the lungs was also markedly greater in the I/R group than in the other groups. In addition, I/R group rats showed various signs of interstitial edema and hemorrhage. In the I/R+NAC, I/R+PTX, and I/R+NAC+PTX groups, superoxide dismutase activity, glutathione levels, malondialdehyde levels, and lung injury scores were preserved (p < 0.05 for all). The differences between the administration of NAC or pentoxifylline alone and the administration of the two together were not significant for any of those parameters (p > 0.05 for all). Conclusions: Our results suggest that NAC and pentoxifylline both protect lung tissue from the effects of skeletal muscle I/R. However, their combined use does not appear to increase the level of that protection.

 


Keywords: Skeletal muscle; Ischemia; Reperfusion injury; Lung injury; Acetylcysteine; Pentoxifylline.

 


Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

Efeitos da pressão expiratória positiva na depuração pulmonar do ácido dietilenotriaminopentacético marcado com tecnécio-99m em aerossol em indivíduos saudáveis

Isabella Martins de Albuquerque1, Dannuey Machado Cardoso2, Paulo Ricardo Masiero3, Dulciane Nunes Paiva4, Vanessa Regiane Resqueti5, Guilherme Augusto de Freitas Fregonezi5, Sérgio Saldanha Menna-Barreto6

J Bras Pneumol.2016;42(6):404-408

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Objective: To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects.

 


Keywords: Lung/metabolism; Technetium Tc 99m pentetate/pharmacokinetics; Radiopharmaceuticals; Positive-pressure respiration.

 


Effects of emissions from sugar cane burning on the trachea and lungs of Wistar rats

Efeitos das emissões geradas pela queima da cana-de-açúcar em traqueia e pulmões de ratos Wistar

Verena Sampaio Barbosa Matos1, Felipe da Silva Gomes2, Tarcio Macena Oliveira2, Renata da Silva Schulz1, Lídia Cristina Villela Ribeiro3, Astria Dias Ferrão Gonzales3,4, Januário Mourão Lima4, Marcos Lázaro da Silva Guerreiro3,4

J Bras Pneumol.2017;43(3):208-214

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Objective: To evaluate the effects of exposure to emissions from sugar cane burning on inflammatory mechanisms in tissues of the trachea and lung parenchyma in Wistar rats after different periods of exposure. Methods: This was an experimental open randomized study. The animals were divided into four groups: a control group (CG) underwent standard laboratory conditions, and three experimental groups were exposed to emissions from sugar cane burning over different periods of time, in days-1 (EG1), 7 (EG7), and 21 (EG21). After euthanasia with 200 mg/kg of ketamine/xylazine, fragments of trachea and lung were collected and fixed in 10% formalin. Histological analyses were performed with H&E and picrosirius red staining. Results: No inflammatory infiltrates were found in the tissues of CG rats. The histological examination of tissues of the trachea and lung parenchyma revealed that the inflammatory process was significantly more intense in EG7 than in the CG (p < 0.05 and p < 0.01, respectively). In comparison with the CG and EG1, angiogenesis in the lung parenchyma and collagen deposition in tracheal tissues were significantly greater only in EG21 (p < 0.001 and p < 0.01, respectively). Conclusions: In this sample, emissions from sugar cane burning induced acute focal and diffuse inflammation in the lamina propria of tracheal tissues, with no loss of ciliated epithelial tissue. In the lung parenchyma of the animals in the experimental groups, there was interstitial and alveolar edema, together with polymorphonuclear cell infiltrates.

 


Keywords: Saccharum; Smoke; Inflammation; Respiratory system.

 


Effects of exercise on sleep symptoms in patients with severe obstructive sleep apnea

Efeitos do exercício nos sintomas do sono em pacientes com apneia obstrutiva do sono

Roberto Pacheco da Silva1,a, Denis Martinez1,2,3,b, Kelly Silveira da Silva Bueno1,c, Jhoana Mercedes Uribe-Ramos2,d

J Bras Pneumol.2019;45(3):e20180085-e20180085

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Objective: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). Methods: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. Results: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. Conclusions: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.

 


Keywords: Sleep apnea syndromes; Exercise; Sleepiness; Polysomnography.

 


Effects of indacaterol versus tiotropium on exercise tolerance in patients with moderate COPD: a pilot randomized crossover study

Efeitos do indacaterol versus tiotrópio na tolerância ao exercício em pacientes com DPOC moderada: estudo cruzado randomizado piloto

Danilo Cortozi Berton1, Álvaro Huber dos Santos2, Ivo Bohn Jr.2, Rodrigo Quevedo de Lima2, Vanderléia Breda2, Paulo José Zimermann Teixeira2,3,4

J Bras Pneumol.2016;42(5):362-366

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Objective: To compare a once-daily long-acting β2 agonist (indacaterol 150 µg) with a once-daily long-acting anticholinergic (tiotropium 5 µg) in terms of their effects on exercise endurance (limit of tolerance, Tlim) in patients with moderate COPD. Secondary endpoints were their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Methods: This was a randomized, single-blind, crossover pilot study involving 20 patients (mean age, 60.9 ± 10.0 years; mean FEV1, 69 ± 7% of predicted). Spirometric parameters, Transition Dyspnea Index scores, Tlim, and exertional dyspnea were compared after three weeks of each treatment (with a one-week washout period between treatments). Results: Nineteen patients completed the study (one having been excluded because of COPD exacerbation). Improvement in Tlim from baseline tended to be greater after treatment with tiotropium than after treatment with indacaterol (96 ± 163 s vs. 8 ± 82 s; p = 0.06). Tlim significantly improved from baseline after treatment with tiotropium (having increased from 396 ± 319 s to 493 ± 347 s; p = 0.010) but not after treatment with indacaterol (having increased from 393 ± 246 to 401 ± 254 s; p = 0.678). There were no differences between the two treatments regarding improvements in Borg dyspnea scores and lung hyperinflation at "isotime" and peak exercise. There were also no significant differences between treatments regarding Transition Dyspnea Index scores (1.5 ± 2.1 vs. 0.9 ± 2.3; p = 0.39). Conclusions: In patients with moderate COPD, tiotropium tends to improve Tlim in comparison with indacaterol. No significant differences were observed between the two treatments regarding their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Future studies, including a larger number of patients, are required in order to confirm our findings and explore mechanistic explanations. (ClinicalTrials.gov identifier: NCT01693003 [http://www.clinicaltrials.gov/])

 


Keywords: Pulmonary disease, chronic obstructive; Exercise; Bronchodilator agents.

 


Eliminating tuberculosis in Latin America: making it the point

Eliminação da tuberculose na América Latina: considerações

Raquel Duarte1,2,3,a, Denise Rossato Silva4,b, Adrian Rendon5,c, Tatiana Galvẫo Alves6,d, Marcelo Fouad Rabahi7,e, Rosella Centis8,f, Afrânio Kritski9,g, Giovanni Battista Migliori8,h

J Bras Pneumol.2018;44(2):73-76

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Near-fatal pulmonary embolism: capnographic perspective

Embolia pulmonar quase fatal: perspectiva capnográfica

Marcos Mello Moreira1,2,a, Luiz Claudio Martins3,b, Konradin Metze4,c, Marcus Vinicius Pereira2,d, Ilma Aparecida Paschoal1,e

J Bras Pneumol.2018;44(6):525-528

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Probe-based confocal laser endomicroscopy of the airways: physiological and pathological characteristics of preneoplastic and neoplastic lesions

Endomicroscopia confocal a laser das vias aéreas: características normais e patológicas de lesões pré-neoplásicas e neoplásicas

Juliana Rocha Mol Trindade1,a, Viviane Rossi Figueiredo2,b, Paulo Manuel Pêgo-Fernandes3,c, Ricardo Mingarini Terra1,d

J Bras Pneumol.2019;45(1):e20180103-e20180103

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Understanding diagnostic tests. Part 1.

Entendendo os testes diagnósticos. Parte 1.

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino1,3

J Bras Pneumol.2017;43(5):330-330

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Understanding diagnostic tests. Part 3.

Entendendo os testes diagnósticos. Parte 3.

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2018;44(1):4-4

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Understanding diagnostic tests. Part 2.

Entendendo os testes diagnósticos: parte 2

Cecilia Maria Patino1,2, Juliana Carvalho Ferreira1,3

J Bras Pneumol.2017;43(6):408-408

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Choosing wisely between randomized controlled trials and observational designs in studies about interventions

Escolhendo sabiamente entre ensaios clínicos randomizados e desenhos observacionais em estudos sobre intervenções

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino2,3

J Bras Pneumol.2016;42(3):165-165

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Propensity scores: a tool to help quantify treatment effects in observational studies

Escores de propensão: uma ferramenta para ajudar a quantificar os efeitos de tratamento em estudos observacionais

Cecilia Maria Patino1,2 Juliana Carvalho Ferreira,1,3

J Bras Pneumol.2017;43(2):86-86

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Interlobular septal thickening

Espessamento de septos interlobulares

Edson Marchiori1,2, Gláucia Zanetti2,3, Bruno Hochhegger4,5

J Bras Pneumol.2016;42(2):161-161

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Study of inhaler technique in asthma patients: differences between pediatric and adult patients

Estudio sobre la técnica inhalatoria en pacientes asmáticos: diferencias entre pacientes pediátricos y adultos

Pablo Manríquez1, Ana María Acuña2, Luis Muñoz3, Alvaro Reyes4

J Bras Pneumol.2015;41(5):405-409

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Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients.

 


Keywords: Administration, inhalation; Aerosols/administration & dosage; Asthma/prevention & control.

 


Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion

Exactitud de la biopsia pleural cerrada para el diagnóstico de derrame pleural maligno

Renata Báez-Saldaña1,2, Uriel Rumbo-Nava1, Araceli Escobar-Rojas2, Patricia Castillo-González1, Santiago León-Dueñas1, Teresa Aguirre-Pérez1, María Eugenia Vázquez-Manríquez3

J Bras Pneumol.2017;43(6):424-430

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Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

 


Keywords: Biopsy; Pleural effusion, malignant/diagnosis; Pleural effusion, malignant/epidemiology.

 


Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

Existe razão para reabilitação pulmonar após o tratamento quimioterápico bem-sucedido para tuberculose?

Marcela Muñoz-Torrico1, Adrian Rendon2, Rosella Centis3, Lia D'Ambrosio3,4, Zhenia Fuentes5, Carlos Torres-Duque6, Fernanda Mello7, Margareth Dalcolmo8, Rogelio Pérez-Padilla9, Antonio Spanevello10,11, Giovanni Battista Migliori3

J Bras Pneumol.2016;42(5):367-373

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The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements"). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae.

 


Keywords: Tuberculosis/complications; Tuberculosis/rehabilitation, Tuberculosis/therapy; Quality of life; Diagnostic imaging; Respiratory function tests.

 


An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery

Experiência inicial com um sistema de drenagem digital no pós-operatório de cirurgia torácica pediátrica

Altair da Silva Costa Jr1,2,3, Thiago Bachichi1, Caio Holanda1, Luiz Augusto Lucas Martins De Rizzo4

J Bras Pneumol.2016;42(6):444-446

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Objective: To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. Methods: This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks.

 


Keywords: Drainage; Thoracic surgery; Pediatrics.

 


Occupational exposure to dust: an underestimated health risk?

Exposição ocupacional a poeira: um risco à saúde subestimado?

Sandra Saleiro1,a, Luís Rocha1,2,b, João Bento1,2,c, Luís Antunes3,d, José Torres da Costa4,e

J Bras Pneumol.2019;45(4):e20170396-e20170396

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Factors associated with malnutrition in adolescent and adult patients with cystic fibrosis

Fatores associados à desnutrição em pacientes adolescentes e adultos com fibrose cística

Gabriela Cristofoli Barni1, Gabriele Carra Forte1, Luis Felipe Forgiarini1,2, Claudine Lacerda de Oliveira Abrahão3, Paulo de Tarso Roth Dalcin1,4

J Bras Pneumol.2017;43(5):337-343

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Objective: To determine the prevalence of malnutrition in patients attending an adult cystic fibrosis (CF) program and to investigate the associations of malnutrition with the clinical characteristics of those patients. Methods: This was a cross-sectional study involving patients with clinically stable CF patients (16 years of age or older). The patients underwent clinical assessment, nutritional assessments, pulmonary function tests, and pancreatic function assessment. They also completed a questionnaire regarding diet compliance. On the basis of their nutritional status, the patients were classified divided into three groups: adequate nutrition; at nutritional risk; and malnutrition. Results: The study has included 73 patients (mean age, 25.6 ± 7.3 years), 40 of whom (54.8%) were female. The mean body mass index was 21.0 ± 3.0 kg/m2 and the mean FEV1 was 59.7 ± 30.6% of predicted. In this sample of patients, 32 (43.8%), 23 (31.5%), and 18 (24.7%) of the patients were allocated to the adequate nutrition, nutritional risk, and malnutrition groups, respectively. The logistic regression analysis identified three independent factors associated with the risk of malnutrition: Shwachman-Kulczycki score, percent predicted FEV1; and age. Conclusions: Malnutrition remains a common complication in adolescents and adults with CF, despite dietary advice. Malnutrition is associated with age, clinical severity, and lung function impairment.

 


Keywords: Cystic fibrosis; Malnutrition; Exocrine pancreatic insufficiency; Respiratory function tests.

 


Factors associated with disease-specific survival of patients with non-small cell lung cancer

Fatores associados à sobrevida doença-específica em pacientes com câncer de pulmão de células não pequenas

Mirian Carvalho de Souza1, Oswaldo Gonçalves Cruz2, Ana Glória Godoi Vasconcelos3

J Bras Pneumol.2016;42(5):317-325

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Objective: Lung cancer is a global public health problem and is associated with high mortality. Lung cancer could be largely avoided by reducing the prevalence of smoking. The objective of this study was to analyze the effects of social, behavioral, and clinical factors on the survival time of patients with non-small cell lung cancer treated at Cancer Hospital I of the José Alencar Gomes da Silva National Cancer Institute, located in the city of Rio de Janeiro, Brazil, between 2000 and 2003. Methods: This was a retrospective hospital cohort study involving 1,194 patients. The 60-month disease-specific survival probabilities were calculated with the Kaplan-Meier method for three stage groups. The importance of the studied factors was assessed with a hierarchical theoretical model after adjustment by Cox multiple regression. Results: The estimated 60-month specific-disease lethality rate was 86.0%. The 60-month disease-specific survival probability ranged from 25.0% (stages I/II) to 2.5% (stage IV). The performance status, the intention to treat, and the initial treatment modality were the major prognostic factors identified in the study population. Conclusions: In this cohort of patients, the disease-specific survival probabilities were extremely low. We identified no factors that could be modified after the diagnosis in order to improve survival. Primary prevention, such as reducing the prevalence of smoking, is still the best method to reduce the number of people who will suffer the consequences of lung cancer.

 


Keywords: Lung neoplasms/epidemiology; Carcinoma, non-small-cell lung; Survival analysis.

 


Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea

Fatores de risco para complicações respiratórias após adenotonsilectomia em crianças com apneia obstrutiva do sono

Renato Oliveira Martins1, Nuria Castello-Branco2, Jefferson Luis de Barros1, Silke Anna Theresa Weber3

J Bras Pneumol.2015;41(3):238-245

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Objective: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). Methods: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. Results: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3  2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). Conclusions: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.

 


Keywords: Postoperative complications; Tonsillectomy; Sleep apnea, obstructive.

 


Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs

Fatores de risco para tuberculose: diabetes, tabagismo, álcool e uso de outras drogas

Denise Rossato Silva1,a, Marcela Muñoz-Torrico2,b, Raquel Duarte3,4,c, Tatiana Galvão5,d, Eduardo Henrique Bonini6,7,e, Flávio Ferlin Arbex6,f, Marcos Abdo Arbex6,g, Valéria Maria Augusto8,h, Marcelo Fouad Rabahi9,i, Fernanda Carvalho de Queiroz Mello10,j

J Bras Pneumol.2018;44(2):145-152

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Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.

 


Keywords: Tuberculosis/epidemiology; Tuberculosis/prevention & control; Diabetes mellitus/prevention & control; Smoking/adverse effects; Alcohol drinking/adverse effects; Street drugs/adverse effects.

 


Idiopathic pleuroparenchymal fibroelastosis: incidental findings in a patient with suspected pneumonia

Fibroelastose pleuroparenquimatosa idiopática: achados incidentais em uma paciente com suspeita de pneumonia

Gaetano Rea1, Venerino Poletti2, Carlo Iadevaia3, Marialuisa Bocchino4, Gennaro Mazzarella3

J Bras Pneumol.2015;41(5):478-479

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Pleuroparenchymal fibroelastosis: report of two cases in Brazil

Fibroelastose pleuroparenquimatosa: relato de dois casos no Brasil

Paula Silva Gomes1, Christina Shiang2, Gilberto Szarf3, Ester Nei Aparecida Martins Coletta4,5, Carlos Alberto de Castro Pereira6

J Bras Pneumol.2017;43(1):72-75

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Pleuroparenchymal fibroelastosis (PPFE) is a rare lung disease. It can be idiopathic or associated with any one of various conditions. To our knowledge, this is the first report of two cases of PPFE in Brazil. Our first patient presented with pleural and subpleural fibrosis in the upper lobes; a spiculated nodule in the left upper lobe; and a mild reticular pattern in the lower lobes. Surgical lung biopsy revealed PPFE in the upper lobes, including the nodule, and unclassified interstitial pneumonia in the left lower lobe. Our second patient had a history of exposure to domestic birds, indicating a risk of hypersensitivity pneumonitis, and presented with advanced lung disease, predominantly in the upper lobes, together with subpleural fibrosis.That patient underwent lung transplantation. In the explant specimen, PPFE and granulomas were identified, suggesting hypersensitivity pneumonitis as an associated cause.

 


Keywords: Lung diseases, interstitial/diagnosis; Lung diseases, interstitial/etiology; Alveolitis, extrinsic allergic.

 


Familial pulmonary fibrosis: a heterogeneous spectrum of presentations

Fibrose pulmonar familiar: um espectro heterogêneo de apresentações

Ana Beatriz Hortense1,a, Marcel Koenigkam dos Santos2,b, Danilo Wada3,c, Alexandre Todorovic Fabro4,d, Mariana Lima5, Silvia Rodrigues5,e, Rodrigo Tocantins Calado2,f, José Baddini-Martinez2,g

J Bras Pneumol.2019;45(5):e20180079-e20180079

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Objective: To describe the clinical, functional, and radiological features of index cases of familial pulmonary fibrosis (FPF) in Brazil. Methods: We evaluated 35 patients with FPF - of whom 18 (51.4%) were women - with a median age of 66.0 years (range, 35.5-89.3 years). All of the patients completed a standardized questionnaire, as well as undergoing pulmonary function tests and HRCT of the chest. In 6 cases, lung tissue samples were obtained: from surgical biopsies in 5 cases; and from an autopsy in 1 case. Results: A history of smoking and a history of exposure to birds or mold were reported in 45.7% and 80.0% of the cases, respectively. Cough and marked dyspnea were reported by 62.8% and 48.6% of the patients, respectively. Fine crackles were detected in 91.4% of the patients. In 4 patients, the findings were suspicious for telomere disease. The median FVC and DLCO, as percentages of the predicted values, were 64.9% (range, 48.8-105.7%) and 38.9% (range, 16.0-60.0%), respectively. Nine patients had reduced DLCO despite having normal spirometry results. Regarding HRCT, patterns typical of usual interstitial pneumonia were found in 6 patients (17.1%). In 25 cases (71.5%), the HRCT features were consistent with a diagnosis other than idiopathic pulmonary fibrosis. In 11 cases (31.4%), the radiological patterns were uncharacteristic of interstitial lung disease. Of the six lung tissue samples analyzed, four showed interstitial pneumonia with bronchiolocentric accentuation, and, on the basis of the clinical and radiological data, the corresponding patients were diagnosed with hypersensitivity pneumonitis. Conclusions: Patients with FPF can present with a wide variety of clinical features. Most HRCT scans of these patients exhibit patterns not typical of usual interstitial pneumonia. The family history of fibrotic lung diseases should be investigated in all patients under suspicion, regardless of their age.

 


Keywords: Idiopathic pulmonary fibrosis; Respiratory function tests; Tomography, X-ray computed.

 


Respiratory therapy: a problem among children and adolescents with cystic fibrosis.

Fisioterapia respiratória: um problema de crianças e adolescentes com fibrose cística

Taiane dos Santos Feiten1, Josani Silva Flores2, Bruna Luciano Farias3, Paula Maria Eidt Rovedder2,3, Eunice Gus Camargo4, Paulo de Tarso Roth Dalcin2,5, Bruna Ziegler1,2

J Bras Pneumol.2016;42(1):29-34

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Objective: To evaluate the level of self-reported adherence to physical therapy recommendations in pediatric patients (6-17 years) with cystic fibrosis (CF) and to ascertain whether the different levels of adherence correlate with pulmonary function, clinical aspects, and quality of life. Methods: This was a cross-sectional study. The patients and their legal guardians completed a questionnaire regarding adherence to physical therapy recommendations and a CF quality of life questionnaire. We collected demographic, spirometric, and bacteriological data, as well as recording the frequency of hospitalizations and Shwachman-Kulczycki (S-K) clinical scores. Results: We included 66 patients in the study. Mean age, FEV1 (% of predicted), and BMI were 12.2 ± 3.2 years, 90 ± 24%, and 18.3 ± 2.5 kg/m2, respectively. The patients were divided into two groups: high-adherence (n = 39) and moderate/poor-adherence (n = 27). No statistically significant differences were found between the groups regarding age, gender, family income, and total S-K clinical scores. There were statistically significant differences between the high-adherence group and the moderate/poor-adherence group, the latter showing lower scores for the "radiological findings" domain of the S-K clinical score (p = 0.030), a greater number of hospitalizations (p = 0.004), and more days of hospitalization in the last year (p = 0.012), as well as lower scores for the quality of life questionnaire domains emotion (p = 0.002), physical (p = 0.019), treatment burden (p < 0.001), health perceptions (p = 0.036), social (p = 0.039), and respiratory (p = 0.048). Conclusions: Low self-reported adherence to physical therapy recommendations was associated with worse radiological findings, a greater number of hospitalizations, and decreased quality of life in pediatric CF patients.

 


Keywords: Cystic fibrosis; Patient compliance; Physical therapy modalities; Quality of life.

 


Formation of multiple pulmonary nodules during treatment with leflunomide

Formação de múltiplos nódulos pulmonares durante tratamento com leflunomida

Gilberto Toshikawa Yoshikawa1, George Alberto da Silva Dias1, Satomi Fujihara1, Luigi Ferreira e Silva2, Lorena de Britto Pereira Cruz3, Hellen Thais Fuzii4, Roberta Vilela Lopes Koyama1

J Bras Pneumol.2015;41(3):281-284

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Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis and can be due to the disease itself or secondary to the medications used in order to treat it. We report the case of a 60-year-old woman who had been diagnosed with rheumatoid arthritis and developed multiple pulmonary nodules during treatment with leflunomide.

 


Keywords: Arthritis, rheumatoid; Immunosuppressive agents; Rheumatoid nodule; Lung.

 


Frequency of COPD in health care workers who smoke

Frequência de DPOC em profissionais de saúde que fumam

Ivan Kopitovic1,2, Aleksandar Bokan1,2, Ilija Andrijevic1,2, Miroslav Ilic1,2, Sanja Marinkovic3, Dragana Milicic1,2, Marija Vukoja1,2

J Bras Pneumol.2017;43(5):351-356

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Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

 


Keywords: Pulmonary disease, chronic obstructive/prevention & control; Smoking; Health personnel.

 


Lung function and left ventricular hypertrophy in morbidly obese candidates for bariatric surgery

Função pulmonar e hipertrofia ventricular esquerda em obesos mórbidos candidatos a cirurgia bariátrica

Paulo de Tarso Müller1,2, Hamilton Domingos3, Luiz Armando Pereira Patusco1,2, Gabriel Victor Guimarães Rapello1

J Bras Pneumol.2015;41(5):427-432

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Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. Results: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area). Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.

 


Keywords: Obesity; Spirometry; Echocardiography; Body mass index.

 


Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

Função pulmonar em crianças e adolescentes com doença falciforme: temos dado atenção adequada a esse problema?

Ana Karine Vieira1, Cristina Gonçalves Alvim2, Maria Cristina Marquez Carneiro3, Cássio da Cunha Ibiapina4

J Bras Pneumol.2016;42(6):409-415

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Objective: To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. Methods: This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. Results: Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. Conclusions: In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter.

 


Keywords: Anemia, sickle cell; Respiratory function tests; Exercise test.

 


Management of COPD within the Brazilian Unified Health Care System in the state of Bahia: an analysis of real-life medication use patterns

Gerenciamento da DPOC no Sistema Único de Saúde do estado da Bahia: uma análise do padrão de utilização de medicamentos na vida real

Charleston Ribeiro Pinto1,2,3,a, Antônio Carlos Moreira Lemos3,b, Lindemberg Assunção-Costa4,c, Aramis Tupiná de Alcântara5,d, Laira Lorena Lima Yamamura6,e, Gisélia Santana Souza4,f, Eduardo Martins Netto1,7,g

J Bras Pneumol.2019;45(1):e20170194-e20170194

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Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient's pharmacological treatment was evaluated by comparing the patient's current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.

 


Keywords: Pulmonary disease, chronic obstructive/therapy; Drug therapy; Clinical protocols

 


Global TB Network: working together to eliminate tuberculosis

Global TB Network: trabalhando juntos para eliminar a tuberculose

Denise Rossato Silva1,a, Adrian Rendon2,b, Jan-Willem Alffenaar3,c, Jeremiah Muhwa Chakaya4,5,d, Giovanni Sotgiu6,e, Susanna Esposito7,f, Giovanni Battista Migliori8,g

J Bras Pneumol.2018;44(5):347-349

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Pulmonary foreign body granulomatosis in a chronic user of powder cocaine

Granulomatose pulmonar de corpo estranho em um usuário crônico de cocaína em pó

Shruti Khurana1, Ankit Chhoda2, Sandeep Sahay3, Priyanka Pathania4

J Bras Pneumol.2017;43(4):320-321

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We describe the case of a 33-year-old man, a chronic user of powder cocaine, who presented with dyspnea, fever, night sweats, and significant weight loss. Chest HRCT revealed centrilobular nodules, giving an initial impression of miliary tuberculosis. Therefore, he was started on an empirical, four-drug antituberculosis treatment regimen. Four weeks later, despite the tuberculosis treatment, he continued to have the same symptoms. We then performed transbronchial lung biopsy. Histopathological analysis of the biopsy sample revealed birefringent foreign body granuloma. A corroborative history of cocaine snorting, the presence of centrilobular nodules, and the foreign body-related histopathological findings led to a diagnosis of pulmonary foreign body granulomatosis. This report underscores the fact that pulmonary foreign body granulomatosis should be included in the differential diagnosis of clinical profiles resembling tuberculosis.

 


Keywords: Lung; Granuloma, foreign-body; Cocaine-related disorders.

 


Tracheal lobular capillary hemangioma treated with laser photocoagulation

Hemangioma capilar lobular da traqueia tratado com fotocoagulação a laser

Hans Dabó1, Rita Gomes2, Nelson Teixeira1, Gilberto Teixeira3, Gabriela Fernandes1, Adriana Magalhães1

J Bras Pneumol.2016;42(1):72-73

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Hemoptysis in recurrent respiratory papillomatosis: also think about aspergillosis

Hemoptise na papilomatose respiratória recorrente: pense também em aspergilose

Giorgia Dalpiaz1,a, Sofia Asioli2,b, Stefania Damiani2,c, Gaetano Rea3,d, Edson Marchiori4,e

J Bras Pneumol.2018;44(3):247-248

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Sternal and pectoral musculature hydatidosis

Hidatidose do esterno e musculatura peitoral

NILTON HAERTEL GOMES1, DÉCIO VALENTE RENCK2, DANIEL ENGEL DA CUNHA3, LEANDRO PRETTO ORLANDINI3

J Bras Pneumol.2001;27(4):223-226

Abstract PDF PT

Hydatidosis is a cyclezoonotic infection caused by taenia Echinococcus granulosus, whose larval form accidentally affects men by forming hydatic cysts preferably in the lungs and liver. Osseous hydatidosis is a rare event characterized by slow growth and few symptoms. It is reported on a 36-year-old man who had presented nodes in the anterior thorax for nine years. Imaging diagnostic examinations revealed thick, loculated, expansive masses in the pectoral muscles and sternal lytic lesions. The diagnosis of hydatidosis was established by exploratory surgery. The patient showed good clinical-surgical evolution and was discharged receiving albendazole, 2,400 mg/day, for 28 days.

 


Keywords: Diagnostic techniques and procedures. Pulmonary echinococcosis. Surgery.

 


Hyperhidrosis: prevalence and impact on quality of life

Hiperidrose: prevalência e impacto na qualidade de vida

Erica Nishida Hasimoto1,a, Daniele Cristina Cataneo2,b, Tarcísio Albertin dos Reis3,c, Antonio José Maria Cataneo2,d

J Bras Pneumol.2018;44(4):292-298

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Objective: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. Methods: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis. Results: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life. Conclusions: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.

 


Keywords: Hyperhidrosis/epidemiology; Hyperhidrosis/diagnosis; Quality of life.

 


Is suicidal ideation associated with allergic asthma and allergic rhinitis?

Ideação suicida apresenta associação com asma e rinite alérgicas?

Martín Bedolla-Barajas1,a, Norma Angélica Pulido-Guillén2,b, Bolívar Vivar-Aburto3,c, Jaime Morales-Romero4,d, José Raúl Ortiz-Peregrina5,e, Martín Robles-Figueroa3,f

J Bras Pneumol.2018;44(1):31-35

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Objective: To investigate whether there is an association between suicidal ideation (SI) and allergic diseases in adults. Methods: This was a comparative cross-sectional study involving individuals ranging from 20 to 50 years of age recruited from a university hospital in the city of Guadalajara, Mexico. We included patients with a confirmed diagnosis of allergic asthma, those with a confirmed diagnosis of allergic rhinitis, and healthy controls. All subjects completed the Beck Depression Inventory-II (BDI-II), which includes an item that evaluates the presence of suicidal thoughts or desires within the last two weeks, in order to identify SI. Results: The sample comprised 115 patients with allergic asthma, 111 patients with allergic rhinitis, and 96 healthy controls. The number of individuals identified with SI in the three groups were, respectively, 17 (14.8%), 13 (11.7%), and 8 (8.3%). Regarding the presence of SI, no statistically significant association was found in the allergic asthma group (OR = 1.98; 95% CI: 0.78-4.64; p = 0.154) or in the allergic rhinitis group (OR = 1.46; 95% CI: 0.58-3.68; p = 0.424) when they were compared with the control group. However, the presence of depression was associated with SI in the three groups: allergic asthma (OR = 12.36; 95% CI: 2.67-57.15; p = 0.001); allergic rhinitis (OR = 6.20; 95% CI: 1.66-23.14; p = 0.006); and control (OR = 21.0; 95% CI: 3.75-117.36; p < 0,001). Conclusions: In comparison with the control group, no association was found between SI and the groups with allergic diseases. In contrast, there was association between SI and depression in the three groups.

 


Keywords: Suicidal ideation; Asthma; Rhinitis, allergic; Adult.

 


Identifying activating mutations in the EGFR gene: prognostic and therapeutic implications in non-small cell lung cancer

Identificação de mutações ativadoras no gene EGFR: implicações no prognóstico e no tratamento do carcinoma pulmonar de células não pequenas

Gabriel Lima Lopes1, Edoardo Filippo de Queiroz Vattimo2, Gilberto de Castro Junior2,3

J Bras Pneumol.2015;41(4):365-375

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Lung cancer is the leading cause of cancer-related deaths worldwide. Promising new therapies have recently emerged from the development of molecular targeted drugs; particularly promising are those blocking the signal transduction machinery of cancer cells. One of the most widely studied cell signaling pathways is that of EGFR, which leads to uncontrolled cell proliferation, increased cell angiogenesis, and greater cell invasiveness. Activating mutations in the EGFR gene (deletions in exon 19 and mutation L858R in exon 21), first described in 2004, have been detected in approximately 10% of all non-squamous non-small cell lung cancer (NSCLC) patients in Western countries and are the most important predictors of a response to EGFR tyrosine-kinase inhibitors (EGFR-TKIs). Studies of the EGFR-TKIs gefitinib, erlotinib, and afatinib, in comparison with platinum-based regimens, as first-line treatments in chemotherapy-naïve patients have shown that the EGFR-TKIs produce gains in progression-free survival and overall response rates, although only in patients whose tumors harbor activating mutations in the EGFR gene. Clinical trials have also shown EGFR-TKIs to be effective as second- and third-line therapies in advanced NSCLC. Here, we review the main aspects of EGFR pathway activation in NSCLC, underscore the importance of correctly identifying activating mutations in the EGFR gene, and discuss the main outcomes of EGFR-TKI treatment in NSCLC.

 


Keywords: Molecular targeted therapy; Receptor, epidermal growth factor; Lung neoplasms/drug therapy; Mutation; Oncogenes.

 


Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year

Impacto da adesão à oxigenoterapia de longa duração em pacientes com DPOC e hipoxemia decorrente do esforço acompanhados durante um ano

Carolina Bonfanti Mesquita1,a, Caroline Knaut1,b, Laura Miranda de Oliveira Caram1,c, Renata Ferrari1,d, Silmeia Garcia Zanati Bazan2,e, Irma Godoy1,f, Suzana Erico Tanni3,g

J Bras Pneumol.2018;44(5):390-397

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Objective: To determine the impact of adherence to long-term oxygen therapy (LTOT) on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia followed for one year. Methods: Patients experiencing severe hypoxemia during a six-minute walk test (6MWT) performed while breathing room air but not at rest were included in the study. At baseline and after one year of follow-up, all patients were assessed for comorbidities, body composition, SpO2, and dyspnea, as well as for anxiety and depression, having also undergone spirometry, arterial blood gas analysis, and the 6MWT with supplemental oxygen. The Saint George's Respiratory Questionnaire (SGRQ) was used in order to assess quality of life, and the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index was calculated. The frequency of exacerbations and the mortality rate were noted. Treatment nonadherence was defined as LTOT use for < 12 h per day or no LTOT use during exercise. Results: A total of 60 patients with COPD and exertional hypoxemia were included in the study. Of those, 10 died and 11 experienced severe hypoxemia during follow-up, 39 patients therefore being included in the final analysis. Of those, only 18 (46.1%) were adherent to LTOT, showing better SGRQ scores, higher SpO2 values, and lower PaCO2 values than did nonadherent patients. In all patients, SaO2, the six-minute walk distance, and the BODE index worsened after one year. There were no differences between the proportions of adherence to LTOT at 3 and 12 months of follow-up. Conclusions: Quality of life appears to be lower in patients with COPD and exertional hypoxemia who do not adhere to LTOT than in those who do. In addition, LTOT appears to have a beneficial effect on COPD symptoms (as assessed by SGRQ scores). (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR‑9b4v63 [http://www.ensaiosclinicos.gov.br])

 


Keywords: Respiratory insufficiency; Pulmonary disease, chronic obstructive; Patient compliance; Hypoxia; Oxygen inhalation therapy.

 


Impact of long-term treatment with inhaled corticosteroids and bronchodilators on lung function in a patient with post-infectious bronchiolitis obliterans

Impacto do tratamento de longo prazo com corticosteroides e broncodilatadores inalatórios na função pulmonar em um paciente com bronquiolite obliterante pós-infecciosa

Cecilia Calabrese1, Nadia Corcione1, Gaetano Rea2, Francesco Stefanelli3, Ilernando Meoli3, Alessandro Vatrella4

J Bras Pneumol.2016;42(3):228-231

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Post-infectious bronchiolitis obliterans (PIBO) is a small airways disease characterized by fixed airflow limitation. Therefore, inhaled bronchodilators and corticosteroids are not recommended as maintenance therapy options. The management of PIBO currently consists only of close monitoring of affected patients, aimed at the prevention and early treatment of pulmonary infections. In recent years, there has been an increase in the incidence of PIBO in the pediatric population. Patients with PIBO are characterized by a progressive decline in lung function, accompanied by a decrease in overall functional capacity. Here, we report the case of a relatively young man diagnosed with PIBO and followed for three years. After short- and long-term therapy with an inhaled corticosteroid/long-acting β2 agonist combination, together with an inhaled long-acting antimuscarinic, the patient showed relevant improvement of airway obstruction that had been irreversible at the time of the bronchodilator test. The lung function of the patient worsened when he interrupted the triple inhaled therapy. In addition, a 3-week pulmonary rehabilitation program markedly improved his physical performance.

 


Keywords: Bronchiolitis obliterans/therapy; Infection/complications; Adrenergic beta-2 receptor antagonists/therapeutic use; Administration, inhalation; Anti-inflammatory agents/therapeutic use; Muscarinic antagonists/therapeutic use; Lung diseases/rehabilitation.

 


Incidence of pulmonary embolism during COPD exacerbation

Incidência de embolia pulmonar durante exacerbação da DPOC

Eylem Akpinar, Derya Hoşgün, Serdar Akpinar, Gökçe Kaan Ataç, Beyza, Doğanay, Meral Gülhan

J Bras Pneumol.2014;40(1):38-45

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Objective: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE. Methods: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels. Results: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively). Conclusions: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese.

 


Keywords: Pulmonary disease, chronic obstructive; Pulmonary embolism; Risk factors.

 


Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

Incidência e características morfológicas do sinal do halo invertido em pacientes com tromboembolismo pulmonar agudo e infarto pulmonar submetidos a angiotomografia de artérias pulmonares

Alexandre Dias Mançano1,a, Rosana Souza Rodrigues2,3,b, Miriam Menna Barreto2,c, Gláucia Zanetti2,d, Thiago Cândido de Moraes1,e, Edson Marchiori2,f

J Bras Pneumol.2019;45(1):e20170438-e20170438

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Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

 


Keywords: Pulmonary embolism; Pulmonary infarction; Computed tomography angiography.

 


The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

Índice de respiração rápida e superficial como previsor de sucesso de desmame da ventilação mecânica: utilidade clínica quando mensurado a partir de dados do ventilador

Leonardo Cordeiro de Souza1,2,3,4, Jocemir Ronaldo Lugon1,5

J Bras Pneumol.2015;41(6):530-535

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Objective: The use of the rapid shallow breathing index (RSBI) is recommended in ICUs, where it is used as a predictor of mechanical ventilation (MV) weaning success. The aim of this study was to compare the performance of the RSBI calculated by the traditional method (described in 1991) with that of the RSBI calculated directly from MV parameters. Methods: This was a prospective observational study involving patients who had been on MV for more than 24 h and were candidates for weaning. The RSBI was obtained by the same examiner using the two different methods (employing a spirometer and the parameters from the ventilator display) at random. In comparing the values obtained with the two methods, we used the Mann-Whitney test, Pearson's linear correlation test, and Bland-Altman plots. The performance of the methods was compared by evaluation of the areas under the ROC curves. Results: Of the 109 selected patients (60 males; mean age, 62 ± 20 years), 65 were successfully weaned, and 36 died. There were statistically significant differences between the two methods for respiratory rate, tidal volume, and RSBI (p < 0.001 for all). However, when the two methods were compared, the concordance and the intra-observer variation coefficient were 0.94 (0.92-0.96) and 11.16%, respectively. The area under the ROC curve was similar for both methods (0.81 ± 0.04 vs. 0.82 ± 0.04; p = 0.935), which is relevant in the context of this study. Conclusions: The satisfactory performance of the RSBI as a predictor of weaning success, regardless of the method employed, demonstrates the utility of the method using the mechanical ventilator.

 


Keywords: Respiration, artificial; Ventilator weaning; Spirometry.

 


Latent tuberculosis infection in patients with rheumatic diseases

Infecção latente por tuberculose em pacientes com doenças reumatológicas

Camila Anton1,2,a, Felipe Dominguez Machado1,2,b, Jorge Mario Ahumada Ramirez1,2,c, Rafaela Manzoni Bernardi1,2,d, Penélope Esther Palominos3,e, Claiton Viegas Brenol3,f, Fernanda Carvalho de Queiroz Mello4,g, Denise Rossato Silva1,2,h

J Bras Pneumol.2019;45(2):e20190023-e20190023

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Most people infected by Mycobacterium tuberculosis (Mtb) do not have any signs or disease symptoms, a condition known as latent tuberculosis infection (LTBI). The introduction of biological agents, mainly tumor necrosis factor (TNF) inhibitors, for the treatment of immune-mediated diseases such as Rheumatoid Arthritis (RA) and other rheumatic diseases, increased the risk of reactivation of LTBI, leading to development of active TB. Thus, this review will approach the aspects related to LTBI in patients with rheumatologic diseases, especially those using iTNF drugs. For this purpose it will be considered the definition and prevalence of LTBI, mechanisms associated with diseases and medications in use, criteria for screening, diagnosis and treatment. Considering that reactivation of LTBI accounts for a large proportion of the incidence of active TB, adequate diagnosis and treatment are crucial, especially in high-risk groups such as patients with rheumatologic diseases.

 


Keywords: Tuberculosis; Latent tuberculosis; Tuberculin skin test; Anti-TNF therapy; Tumor necrosis factor-alpha; Rheumatoid arthritis.

 


Tuberculosis infection among primary health care workers

Infecção por tuberculose entre profissionais de saúde da atenção básica

Thamy Carvalho Lacerda1,2,3, Fernanda Mattos de Souza1, Thiago Nascimento do Prado1,2,4,5, Rodrigo Leite Locatelli1,2, Geisa Fregona1,3, Rita de Cássia Duarte Lima2,5, Ethel Leonor Maciel1,2,5

J Bras Pneumol.2017;43(6):416-423

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Objective: To estimate the prevalence of and determine the risk factors associated with latent Mycobacterium tuberculosis infection (LTBI) among primary health care workers in the city of Vitória, Brazil. Methods: This was a cross-sectional study with data collected through a survey regarding socio-demographic, occupational, clinical, and exposure characteristics, as well as knowledge about tuberculosis, conducted between 2011 and 2012. All participants underwent a tuberculin skin test (TST), and TSTs were read at 72 h by a trained professional. Results: A total of 218 primary health care workers participated in the study. The prevalence of TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points was, respectively, 39.4% (95% CI: 32.9-45.9) and 54.1% (95% CI: 47.4-60.7). Regarding occupational categories, community health agents had the highest proportion of TST positivity, regardless of the cut-off point (≥ 10 mm: 47.5%; and ≥ 5 mm: 60.5%). Regarding factors associated with TST results, "having had a previous TST" showed a statistically significant association with TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points (OR = 2.5 [95% CI: 1.17-5.30] and OR = 2.18 [95% CI: 1.23-3.87], respectively). Conclusions: The prevalence of LTBI was found to be high among the primary health care workers in this sample. Therefore, we recommend the establishment of a periodic screening program for LTBI and implementation of effective biosafety policies for the prevention of this infection among primary health care workers.

 


Keywords: Health personnel; Tuberculin test; Latent tuberculosis; Primary health care.

 


Influence of emphysema distribution on pulmonary function parameters in COPD patients

Influência da distribuição do enfisema nos parâmetros de função pulmonar em pacientes com DPOC

Helder Novais e Bastos1,2,3, Inês Neves1, Margarida Redondo1, Rui Cunha4,5, José Miguel Pereira4,5, Adriana Magalhães1, Gabriela Fernandes1,5

J Bras Pneumol.2015;41(6):489-495

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Objective: To evaluate the impact that the distribution of emphysema has on clinical and functional severity in patients with COPD. Methods: The distribution of the emphysema was analyzed in COPD patients, who were classified according to a 5-point visual classification system of lung CT findings. We assessed the influence of emphysema distribution type on the clinical and functional presentation of COPD. We also evaluated hypoxemia after the six-minute walk test (6MWT) and determined the six-minute walk distance (6MWD). Results: Eighty-six patients were included. The mean age was 65.2 ± 12.2 years, 91.9% were male, and all but one were smokers (mean smoking history, 62.7 ± 38.4 pack-years). The emphysema distribution was categorized as obviously upper lung-predominant (type 1), in 36.0% of the patients; slightly upper lung-predominant (type 2), in 25.6%; homogeneous between the upper and lower lung (type 3), in 16.3%; and slightly lower lung-predominant (type 4), in 22.1%. Type 2 emphysema distribution was associated with lower FEV1, FVC, FEV1/FVC ratio, and DLCO. In comparison with the type 1 patients, the type 4 patients were more likely to have an FEV1 < 65% of the predicted value (OR = 6.91, 95% CI: 1.43-33.45; p = 0.016), a 6MWD < 350 m (OR = 6.36, 95% CI: 1.26-32.18; p = 0.025), and post-6MWT hypoxemia (OR = 32.66, 95% CI: 3.26-326.84; p = 0.003). The type 3 patients had a higher RV/TLC ratio, although the difference was not significant. Conclusions: The severity of COPD appears to be greater in type 4 patients, and type 3 patients tend to have greater hyperinflation. The distribution of emphysema could have a major impact on functional parameters and should be considered in the evaluation of COPD patients.

 


Keywords: Pulmonary disease, chronic obstructive; Pulmonary emphysema; Respiratory function tests; Tomography, X-ray computed.

 


Influence of the ventilatory mode on acute adverse effects and facial thermography after noninvasive ventilation

Influência do modo ventilatório nos efeitos adversos agudos e na termografia da face após ventilação não invasiva

Suzy Maria Montenegro Pontes1, Luiz Henrique de Paula Melo2, Nathalia Parente de Sousa Maia3, Andrea da Nóbrega Cirino Nogueira3, Thiago Brasileiro Vasconcelos4, Eanes Delgado Barros Pereira5, Vasco Pinheiro Diógenes Bastos3, Marcelo Alcantara Holanda5

J Bras Pneumol.2017;43(2):87-94

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Objective: To compare the incidence and intensity of acute adverse effects and the variation in the temperature of facial skin by thermography after the use of noninvasive ventilation (NIV). Methods: We included 20 healthy volunteers receiving NIV via oronasal mask for 1 h. The volunteers were randomly divided into two groups according to the ventilatory mode: bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP). Facial thermography was performed in order to determine the temperature of the face where it was in contact with the mask and of the nasal dorsum at various time points. After removal of the mask, the volunteers completed a questionnaire about adverse effects of NIV. Results: The incidence and intensity of acute adverse effects were higher in the individuals receiving BiPAP than in those receiving CPAP (16.1% vs. 5.6%). Thermographic analysis showed a significant cooling of the facial skin in the two regions of interest immediately after removal of the mask. The more intense acute adverse effects occurred predominantly among the participants in whom the decrease in the mean temperature of the nasal dorsum was lower (14.4% vs. 7.2%). The thermographic visual analysis of the zones of cooling and heating on the face identified areas of hypoperfusion or reactive hyperemia. Conclusions: The use of BiPAP mode was associated with a higher incidence and intensity of NIV-related acute adverse effects. There was an association between acute adverse effects and less cooling of the nasal dorsum immediately after removal of the mask. Cutaneous thermography can be an additional tool to detect adverse effects that the use of NIV has on facial skin.

 


Keywords: Masks; Noninvasive ventilation; Thermography.

 


Sport-specific influences on respiratory patterns in elite athletes.

Influências específicas do esporte nos padrões respiratórios em atletas de elite

Tijana Durmic1,2, Biljana Lazovic2,3, Marina Djelic2,4, Jelena Suzic Lazic5, Dejan Zikic2,6, Vladimir Zugic2,7, Milica Dekleva2,8, Sanja Mazic2,4

J Bras Pneumol.2015;41(6):516-522

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Objective: To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows. Methods: This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21 ± 4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry). Results: Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV1, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV1 (r = −0.386; p < 0.001). Conclusions: Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.

 


Keywords: Athletes; Sports; Spirometry; Respiratory function tests.

 


Confidence intervals: a useful statistical tool to estimate effect sizes in the real world

Intervalos de confiança: uma ferramenta útil para estimar o tamanho do efeito no mundo real

Cecilia Maria Patino,1,2 Juliana Carvalho Ferreira2,3

J Bras Pneumol.2015;41(6):565-566

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Jornal Brasileiro de Pneumologia and Sociedade Brasileira de Pneumologia e Tisiologia: perspectives for the next four years

Jornal Brasileiro de Pneumologia e Sociedade Brasileira de Pneumologia e Tisiologia: perspectivas para os próximos quatro anos

Bruno Guedes Baldi1,2,a, José Miguel Chatkin3,4,b

J Bras Pneumol.2019;45(1):e20190028-e20190028

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Inflammatory lung injury in rabbits: effects of high-frequency oscillatory ventilation in the prone position

Lesão inflamatória pulmonar em coelhos: efeitos da ventilação oscilatória de alta frequência em posição prona

Jose Roberto Fioretto1,a, Rafaelle Batistella Pires2,b, Susiane Oliveira Klefens1,c, Cilmery Suemi Kurokawa1,d, Mario Ferreira Carpi1,e, Rossano César Bonatto1,f, Marcos Aurélio Moraes1,g, Carlos Fernando Ronchi1,3,h

J Bras Pneumol.2019;45(5):e20180067-e20180067

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Objective: To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI). Methods: Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue. Results: After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores. Conclusions: Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.

 


Keywords: Respiration, artificial/adverse effects; Prone position; Lung/physiopathology; Pneumonia; Respiratory distress syndrome, adult; Acute lung injury; Disease models, animal; Rabbits.

 


Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations

Limiares auditivos em pacientes com tuberculose resistente: configurações do audiograma basal e associações

Olusola Ayodele Sogebi1, Muse Olatunbosun Fadeyi2, Bolanle Olufunlola Adefuye3, Festus Olukayode Soyinka4

J Bras Pneumol.2017;43(3):195-201

Abstract PDF PT PDF EN Portuguese Text

Objective: To use baseline audiogram parameters in order to ascertain whether drug-resistant tuberculosis (DR-TB) has effects on hearing, as well as to describe the configurations of the audiograms and to determine whether there are parameters that can be associated with those configurations. Methods: This was a prospective study involving patients diagnosed with DR-TB at a tuberculosis treatment center in the state of Ogun, in Nigeria. The patients included in the study were submitted to pure tone audiometry at baseline (within two weeks after treatment initiation). For comparative analyses, data regarding demographic and clinical characteristics were collected from the medical records of the patients. Results: The final sample comprised 132 patients. The mean age of the patients was 34.5 ± 12.6 years (range, 8-82 years), and the male:female ratio was 2:1. Of the 132 patients, 103 (78.0%) resided in neighboring states, 125 (94.7%) had previously experienced antituberculosis treatment failure, and 18 (13.6%) were retroviral-positive. Normal audiograms were found in 12 patients (9.1%), whereas sensorineural hearing loss was identified in 104 (78.8%), the two most common configurations being ascending, in 54 (40.9%), and sloping, in 26 (19.7%). Pure-tone averages at low frequencies (0.25-1.0 kHz) and high frequencies (2.0-8.0 kHz) were 33.0 dB and 40.0 dB, respectively. Regarding the degree of hearing loss in the better ear, 36 patients (27.3%) were classified as having normal hearing and 67 (50.8%) were classified as having mild hearing loss (26-40 dB), whereas 29 (21.9%) showed moderate or severe hearing loss. Among the variables studied (age, gender, retroviral status, previous treatment outcome, and weight at admission), only male gender was associated with audiometric configurations. Conclusions: In this sample of patients with DR-TB, most presented with bilateral, mild, suboptimal sensorineural hearing loss, and ascending/sloping audiometric configurations were associated with male gender.

 


Keywords: Audiometry, pure-tone; Hearing loss, high-frequency; Drug-related side effects and adverse reactions; Tuberculosis, multidrug-resistant.

 


Congenital thoracic malformations in pediatric patients: two decades of experience

Malformações torácicas congênitas na infância: experiência de duas décadas

Tatiane da Anunciação Ferreira1, Isabella Santana Santos Chagas2, Regina Terse Trindade Ramos3, Edna Lúcia Souza4

J Bras Pneumol.2015;41(2):196-199

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Respiratory manifestations in late-onset Pompe disease: a case series conducted in Brazil

Manifestações respiratórias na doença de Pompe de início tardio: uma série de casos no Brasil

Bruna de Souza Sixel1,2, Luanda Dias da Silva3, Nicolette Celani Cavalcanti4, Glória Maria Cardoso de Andrade Penque5, Sandra Lisboa3, Dafne Dain Gandelman Horovitz6, Juan Clinton Llerena Jr6

J Bras Pneumol.2017;43(1):54-59

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe respiratory function in a series of patients with late-onset Pompe disease after the definitive diagnosis and before enzyme replacement therapy. Methods: This was a cross-sectional study involving patients with a definitive molecular diagnosis of late-onset Pompe disease. The data analyzed included age at symptom onset; age at definitive diagnosis; type of initial symptoms; time from symptom onset to diagnosis; FVC in the sitting and supine positions; six-minute walk distance; and locomotor ability. Analyses were carried out using frequencies, medians, minimum values, and maximum values. Results: Six patients were included in the study. The median age at symptom onset was 15 years (range, 13-50 years), and the median age at diagnosis was 39.5 years (range, 10-64 years). The median time from symptom onset to diagnosis was 8 years (range, 0-45 years). In all cases, the initial manifestation of the disease had been motor weakness. The median FVC in percentage of the predicted value (FVC%) in the sitting and supine positions was 71.0% (range, 22.9-104.6%) and 58.0% (range, 10.9-106.9%), respectively. The median ΔFVC% was 24.5% (range, −4.59 to 52.40%).The median six-minute walk distance was 391.7 m (range, 97-702 m). Conclusions: In this case series, the time from symptom onset to diagnosis was long. Although respiratory signs or symptoms were not the initial manifestations of the disease, 66.7% of the patients showed reduced FVC% in the sitting and supine positions at diagnosis.

 


Keywords: Glycogen storage disease type II; Respiratory function tests; Respiratory muscles/pathology.

 


Control measures to trace &#8804; 15-year-old contacts of index cases of active pulmonary tuberculosis

Medidas de controle dispensadas a contatos ≤ 15 anos de casos índices com tuberculose pulmonar ativa

Cláudia Di Lorenzo Oliveira1, Angelita Cristine de Melo2, Lílian Ruth Silva de Oliveira3, Emerson Lopes Froede1, Paulo Camargos3

J Bras Pneumol.2015;41(5):449-453

Abstract PDF PT PDF EN Portuguese Text

This was descriptive study carried out in a medium-sized Brazilian city. In ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis, we assessed compliance with the Brazilian national guidelines for tuberculosis control. We interviewed 43 contacts and their legal guardians. Approximately 80% of the contacts were not assessed by the municipal public health care system, and only 21% underwent tuberculin skin testing. The results obtained with the Chi-square Automatic Interaction Detector method suggest that health care teams have a biased attitude toward assessing such contacts and underscore the need for training health professionals regarding tuberculosis control programs.

 


Keywords: Tuberculosis, pulmonary\epidemiology, Tuberculosis, pulmonary\prevention and control; Contact tracing.

 


Nontuberculous mycobacteria in respiratory specimens: clinical significance at a tertiary care hospital in the north of Portugal

Micobactérias não tuberculosas em espécimes respiratórios: significado clínico em um hospital terciário no norte de Portugal

Hans Dabó1, Vanessa Santos1, Anabela Marinho2, Angélica Ramos3, Teresa Carvalho3, Manuela Ribeiro3, Adelina Amorim2

J Bras Pneumol.2015;41(3):292-294

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Asthma mortality in Brazil, 1980-2012: a regional perspective

Mortalidade por asma no Brasil, 1980-2012: uma perspectiva regional

Thaís de Sá Brito1,a, Ronir Raggio Luiz2,b, José Roberto Lapa e Silva3,c, Hisbello da Silva Campos4,5,d

J Bras Pneumol.2018;44(5):354-360

Abstract PDF PT PDF EN Portuguese Text

Objective: To estimate asthma mortality rates in Brazil for the period 1980-2012. Methods: On the basis of data from the Brazilian National Ministry of Health Mortality Database, we estimated mortality rates by calculating moving averages from a municipal perspective that would allow an evaluation differentiating between urban, rural, and intermediate (rurban) Brazil during the period 2002-2012. Trends were assessed using simple linear regression. Results: On average, 2,339 asthma-related deaths were reported per year during the study period. Asthma ranged from the 53rd to 95th leading cause of death. There was a decrease in asthma mortality rates in the country, from 1.92/100,000 population in 1980 to 1.21/100,000 population in 2012. From the municipal perspective, rates fell in urban and rurban Brazil, but increased in rural Brazil, except in the 5-34-year age group. Asthma mortality rates fell in the population under 25 years of age and increased among those over 74 years of age. Rates were always higher in females. Conclusions: Asthma mortality rates in Brazil have been decreasing slightly, with the decrease being more marked in the decade 2002-2012. Only the northeastern region of Brazil showed the opposite trend. Asthma mortality rates in urban and rurban Brazil showed a downward trend similar to that of the national scenario, whereas rural Brazil showed the opposite behavior. Analysis by age group showed that rates decreased among younger individuals and increased among the elderly aged ≥ 75 years.

 


Keywords: Asthma/mortality; Brazil; urban population; rural population.

 


Cutaneous focal mucinosis of the scalp and adenocarcinoma of the lung: association or coincidence?

Mucinose cutânea focal do couro cabeludo e adenocarcinoma do pulmão: associação ou coincidência?

Tiago Mestre1, Fernando Assis-Pacheco2, Jorge Cardoso3

J Bras Pneumol.2015;41(2):206-208

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Serum pyrazinamide concentrations in patients with pulmonary tuberculosis

Níveis sanguíneos de pirazinamida no tratamento da tuberculose pulmonar

Stefania de Medeiros Araujo Lucena1,a, Carlos Augusto Abreu Alberio2,b, Ana Carla Godinho Pinto3,c, José Luiz Fernandes Vieira2,4,d

J Bras Pneumol.2019;45(2):e20180254-e20180254

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Rapidly growing pulmonary ground-glass nodule caused by metastatic melanoma lacking uptake on 18F-FDG PET-CT.

Nódulo em vidro fosco de crescimento rápido, causado por melanoma metastático e sem captação de 18F fluordesoxiglicose na tomografia por emissão de pósitrons com 18F fluordesoxiglicose/tomografia computadorizada

Giorgia Dalpiaz1,a, Sofia Asioli2,b, Stefano Fanti3,c, Gaetano Rea4,d, Edson Marchiori5,e

J Bras Pneumol.2018;44(2):171-172

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Intracavitary nodule

Nódulo intracavitário

Edson Marchiori1,2, Bruno Hochhegger3,4, Gláucia Zanetti2,5

J Bras Pneumol.2016;42(5):309-309

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Intracavitary nodule in active tuberculosis: differential diagnosis of aspergilloma

Nódulo intracavitário em tuberculose em atividade: diagnóstico diferencial de aspergiloma

Edson Marchiori1,2, Bruno Hochhegger3,4, Gláucia Zanetti2,5

J Bras Pneumol.2015;41(6):562-563

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Multiple calcified nodules

Nódulos múltiplos calcificados

Edson Marchiori1,2, Gláucia Zanetti2,3, Bruno Hochhegger4,5

J Bras Pneumol.2016;42(3):164-164

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Multiple cavitated nodules

Nódulos múltiplos escavados

Edson Marchiori1, Bruno Hochhegger2,3, Gláucia Zanetti1

J Bras Pneumol.2017;43(2):85-85

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New and repurposed drugs to treat multidrug- and extensively drug-resistant tuberculosis

Novos fármacos e fármacos repropostos para o tratamento da tuberculose multirresistente e extensivamente resistente

Denise Rossato Silva1,a, Margareth Dalcolmo2,b, Simon Tiberi3,c, Marcos Abdo Arbex4,5,d, Marcela Munoz-Torrico6,e, Raquel Duarte7,8,9,f, Lia D'Ambrosio10,11,g, Dina Visca12,h, Adrian Rendon13,i, Mina Gaga14,j, Alimuddin Zumla15,k, Giovanni Battista Migliori10,l

J Bras Pneumol.2018;44(2):153-460

Abstract PDF PT PDF EN Portuguese Text

Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB, respectively) continue to represent a challenge for clinicians and public health authorities. Unfortunately, although there have been encouraging reports of higher success rates, the overall rate of favorable outcomes of M/XDR-TB treatment is only 54%, or much lower when the spectrum of drug resistance is beyond that of XDR-TB. Treating M/XDR-TB continues to be a difficult task, because of the high incidence of adverse events, the long duration of treatment, the high cost of the regimens used, and the drain on health care resources. Various trials and studies have recently been undertaken (some already published and others ongoing), all aimed at improving outcomes of M/XDR-TB treatment by changing the overall approach, shortening treatment duration, and developing a universal regimen. The objective of this review was to summarize what has been achieved to date, as far as new and repurposed drugs are concerned, with a special focus on delamanid, bedaquiline, pretomanid, clofazimine, carbapenems, and linezolid. After more than 40 years of neglect, greater attention has recently been paid to the need for new drugs to fight the "white plague", and promising results are being reported.

 


Keywords: Tuberculosis/therapy; Tuberculosis, multidrug-resistant; Extensively drug-resistant tuberculosis; Antitubercular agents.

 


Does methylene blue attenuate inflammation in nonischemic lungs after lung transplantation?

O azul de metileno atenua a inflamação em pulmões não isquêmicos após transplante pulmonar?

Marcus da Matta Abreu1,a, Francine Maria de Almeida1,b, Kelli Borges dos Santos2,c, Emílio Augusto Campos Pereira de Assis3,d, Rafael Kenji Fonseca Hamada4,e, Fabio Biscegli Jatene1,f, Paulo Manuel Pêgo-Fernandes1,g, Rogerio Pazetti1,h

J Bras Pneumol.2018;44(5):378-382

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate whether methylene blue (MB) could minimize the effects of ischemia-reperfusion injury in the nonischemic lung on a lung transplantation rodent model. Methods: Forty female Sprague-Dawley rats were divided into 20 donors and 20 recipients. The 20 recipient rats were divided into two groups (n = 10) according to the treatment (0.9% saline vs. 1% MB solutions). All animals underwent unilateral lung transplantation. Recipients received 2 mL of saline or MB intraperitoneally prior to transplantation. After 2 h of reperfusion, the animals were euthanized and histopathological and immunohistochemical analyses were performed in the nonischemic lung. Results: There was a significant decrease in inflammation-neutrophil count and intercellular adhesion molecule-1 (ICAM-1) expression in lung parenchyma were higher in the saline group in comparison with the MB group-and in apoptosis-caspase-3 expression was higher in the saline group and Bcl-2 expression was higher in MB group. Conclusions: MB is an effective drug for the protection of nonischemic lungs against inflammation and apoptosis following unilateral lung transplantation in rats.

 


Keywords: Reperfusion injury; Methylene blue; Lung transplantation; Apoptosis; Inflammation.

 


Is the COPD Assessment Test sensitive for differentiating COPD patients from active smokers and nonsmokers without lung function impairment? A population-based study

O COPD Assessment Test é sensível para diferenciar pacientes com DPOC de indivíduos tabagistas e não tabagistas sem a doença? Um estudo de base populacional

Manuela Karloh1,2,a, Simone Aparecida Vieira Rocha1,b, Marcia Margaret Menezes Pizzichini1,3,c, Francine Cavalli1,d, Darlan Laurício Matte1,2,4,e, Emilio Pizzichini1,3,f; The Respira Floripa Group

J Bras Pneumol.2018;44(3):213-219

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess COPD Assessment Test (CAT) scores in adults with and without COPD, as well as to compare the CAT scores for nonsmokers, former smokers, and smokers without COPD with those for patients with COPD. Methods: This was a cross-sectional population-based study (the Respira Floripa study). The study included adults ≥ 40 years of age residing in the city of Florianópolis, Brazil. A total of 846 households were surveyed. In addition to completing the Respira Floripa questionnaire and the CAT, participants underwent pulmonary function testing. Results: We analyzed data on 1,057 participants (88.1% of the predicted sample size). A functional diagnosis of COPD was made in 92 participants (8.7%). Of those, 72% were unaware that they had COPD. The mean CAT score was higher in the group of COPD patients than in that of individuals without COPD (10.6 [95% CI: 8.8-12.4] vs. 6.6 [95% CI: 6.1-7.0]; p < 0.01). Individual item scores were significantly higher in the patients with COPD than in the individuals without COPD (p < 0.001), the exception being the scores for the items related to sleep (p = 0.13) and energy (p = 0.08). The mean CAT score was higher in the group of COPD patients than in nonsmokers (5.8 [95% CI: 5.3-6.4]) and former smokers (6.4 [95% CI: 5.6-7.2]; p < 0.05). However, there were no significant differences in the mean CAT score between the group of COPD patients and smokers without COPD (9.5 [95% CI: 8.2-10.8]; p > 0.05), the exception being the mean scores for confidence leaving home (p = 0.02). Conclusions: CAT scores were higher in the group of patients with COPD than in nonsmokers and former smokers without COPD. However, there were no significant differences in CAT scores between COPD patients and smokers without COPD. Smokers with an FEV1/FVC ratio > 0.70 have impaired health status and respiratory symptoms similar to those observed in COPD patients.

 


Keywords: Respiratory function tests; Pulmonary disease, chronic obstructive; Smoking.

 


The challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of São Paulo, Brazil: a report of three cases

O desafio do tratamento da tuberculose extensivamente resistente em um hospital de referência no estado de São Paulo: um relato de três casos

Marcos Abdo Arbex1,2, Hélio Ribeiro de Siqueira3,4, Lia D'Ambrosio5,6, Giovanni Battista Migliori5

J Bras Pneumol.2015;41(6):554-559

Abstract PDF PT PDF EN Portuguese Text Appendix

Here, we report the cases of three patients diagnosed with extensively drug-resistant tuberculosis and admitted to a referral hospital in the state of São Paulo, Brazil, showing the clinical and radiological evolution, as well as laboratory test results, over a one-year period. Treatment was based on the World Health Organization guidelines, with the inclusion of a new proposal for the use of a combination of antituberculosis drugs (imipenem and linezolid). In the cases studied, we show the challenge of creating an acceptable, effective treatment regimen including drugs that are more toxic, are more expensive, and are administered for longer periods. We also show that treatment costs are significantly higher for such patients, which could have an impact on health care systems, even after hospital discharge. We highlight the fact that in extreme cases, such as those reported here, hospitalization at a referral center seems to be the most effective strategy for providing appropriate treatment and increasing the chance of cure. In conclusion, health professionals and governments must make every effort to prevent cases of multidrug-resistant and extensively drug-resistant tuberculosis.

 


Keywords: Tuberculosis, multidrug-resistant; Extensively drug-resistant tuberculosis; Antitubercular agents; Antibiotics, antitubercular.

 


The impact of anti-smoking laws on high school students in Ankara, Turkey

O impacto das leis antifumo em alunos do ensino médio em Ancara, Turquia

Melike Demir1, Gulistan Karadeniz2, Fikri Demir3, Cem Karadeniz4, Halide Kaya1, Derya Yenibertiz5, Mahsuk Taylan1, Sureyya Yilmaz1, Velat Sen3

J Bras Pneumol.2015;41(6):523-529

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the factors affecting the smoking habits of high school students, their thoughts about changes resulting from anti-smoking laws, and how they are affected by those laws. Methods: In this cross-sectional study, 11th-grade students at eight high schools in Ankara, Turkey, were invited to complete a questionnaire. Results: A total of 1,199 students completed the questionnaire satisfactorily. The mean age of the respondents was 17.0 ± 0.6 years; 56.1% were female, of whom 15.3% were smokers; and 43.9% were male, of whom 43.7% were smokers (p < 0.001). The independent risk factors for smoking were male gender, attending a vocational school, having a sibling who smokes, having a friend who smokes, and poor academic performance. Of the respondents, 74.7% were aware of the content of anti-smoking laws; 81.8% approved of the restrictions and fines; and 8.1% had quit smoking because of those laws. According to the respondents, the interventions that were most effective were the (television) broadcast of films about the hazards of smoking and the ban on cigarette sales to minors. The prevalence of smoking was highest (31.5%) among students attending vocational high schools but lowest (7.5%) among those attending medical vocational high schools. Although 57.1% of the smokers were aware of the existence of a smoking cessation helpline, only 3.7% had called, none of whom had made any attempt to quit smoking. Conclusions: Although most of the students evaluated were aware of the harmful effects of smoking and approved of the anti-smoking laws, only a minority of those who smoked sought professional help to quit.

 


Keywords: Smoking/prevention & control; Smoking/trends; Smoking/psychology; Students/statistics & numerical data; Adolescent; Young Adult.

 


The role of the Brazilian Tuberculosis Research Network in national and international efforts to eliminate tuberculosis

O papel da Rede Brasileira de Pesquisas em Tuberculose nos esforços nacionais e internacionais para a eliminação da tuberculose

Afranio Kritski1,a, Margareth Pretti Dalcolmo2,b, Fernanda Carvalho Queiroz Mello3,c, Anna Cristina Calçada Carvalho4,d, Denise Rossato Silva5,e, Martha Maria de Oliveira6,f, Julio Croda7,8,g

J Bras Pneumol.2018;44(2):77-81

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What is survival analysis, and when should I use it?

O que é análise de sobrevida e quando devo utilizá-la?

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino2,3

J Bras Pneumol.2016;42(1):77-77

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Obesity and asthma: clinical and laboratory characterization of a common combination

Obesidade e asma: caracterização clínica e laboratorial de uma associação frequente

Juliana Pires Viana de Jesus1,2,a, Aline Silva Lima-Matos2,3,b, Paula Cristina Andrade Almeida2,c, Valmar Bião Lima2,d, Luane Marques de Mello4,e, Adelmir Souza-Machado2,5,f, Eduardo Vieira Ponte5,6,g, Álvaro Augusto Cruz2,7,h

J Bras Pneumol.2018;44(3):207-212

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the relationship between obesity and asthma. Methods: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. Results: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). Conclusions: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.

 


Keywords: Asthma; Obesity; Overweight; Eosinophilia.

 


Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

Os níveis de pró-peptídeo natriurético cerebral N-terminal determinam o prognóstico de pneumonia adquirida na comunidade?

Evrim Eylem Akpınar1,a, Derya Hoşgün2,b, Serdar Akpınar3,c, Can Ateş4,d, Ayşe Baha5,e, Esen Sayın Gülensoy1,f, Nalan Ogan1,g

J Bras Pneumol.2019;45(4):e20180417-e20180417

Abstract PDF PT PDF EN Portuguese Text

Objective: Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores. Methods: Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission. Results: The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

 


Keywords: Pneumonia/diagnosis; Pneumonia/mortality; Natriuretic peptide, brain; Community-acquired infections.

 


Crazy-paving pattern

Padrão de pavimentação em mosaico

Bruno Hochhegger1,2, Roberto Schumacher Neto1, Edson Marchiori3,4

J Bras Pneumol.2016;42(1):76-76

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Pediatric Asthma Control and Communication Instrument: translation into Portuguese and cross-cultural adaptation for use in Brazil

Pediatric Asthma Control and Communication Instrument: tradução e adaptação transcultural para a língua portuguesa falada no Brasil

Thayla Amorim Santino1,a, João Carlos Alchieri2,b, Raquel Emanuele de França Mendes1,c, Ada Cristina Jácome1,d, Tácito Zaildo de Morais Santos1,e, Linda Kahn-D'Angelo3,f, Cecilia M. Patino4,g, Karla Morganna Pereira Pinto de Mendonça1,h

J Bras Pneumol.2019;45(3):e20180169-e20180169

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Pediatric Asthma Control and Communication Instrument (PACCI) to Portuguese and adapt it for use in Brazil, ensuring the cultural validity of the content and semantic equivalence of the target version. Methods: The Brazilian Portuguese-language version of the PACCI was developed according to the most commonly used methodology, which included the following steps: translation; synthesis of the translation; review by the author of the original questionnaire; back-translation; synthesis of the back-translation; review by a native external researcher who is a native speaker of English; approval of the author of the original questionnaire; review by a specialist in Portuguese; review by a multidisciplinary committee of experts to determine the agreement of the items, considering the clarity of each and its appropriateness in the cultural context; cognitive debriefing; and development of the final version. The cognitive debriefing involved 31 parents/legal guardians of children 1-21 years of age with a clinical diagnosis of asthma, as defined by the Global Initiative for Asthma, with the objective of determining the comprehensibility and clarity of the items for the target population. Results: The multidisciplinary committee of experts indicated that the items on the questionnaire were clear and comprehensible, with kappa values above 0.61, indicating substantial agreement. In the cognitive debriefing, the parents/legal guardians presented no difficulties in understanding any of the items (agreement > 0.90); therefore, no further changes were needed.Conclusions: The translation and cross-cultural adaptation of the PACCI for use in Brazil were successful.

 


Keywords: Surveys and questionnaires; Translating; Asthma; Child; Adolescent.

 


Small interstitial nodules

Pequenos nódulos intersticiais

Edson Marchiori1, Gláucia Zanetti2, Bruno Hochhegger3

J Bras Pneumol.2015;41(3):250-250

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Proportional weight loss in six months as a risk factor for mortality in stage IV nonsmall cell lung cancer

Perda de peso proporcional em seis meses como fator de risco para mortalidade no câncer de pulmão de células não pequenas estádio IV

Guilherme Watte1,2,5,a, Claudia Helena de Abreu Nunes1,b, Luzielio Alves Sidney-Filho3,c, Matheus Zanon2,4,d, Stephan Philip Leonhardt Altmayer4,5,e, Gabriel Sartori Pacini4,f, Marcelo Barros5,g, Ana Luiza Schneider Moreira4,h, Rafael José Vargas Alves1,i, Alice de Medeiros Zelmanowicz4,j, Bashir Mnene Matata2,k, Jose da Silva Moreira1,l

J Bras Pneumol.2018;44(6):505-509

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate different weight loss (WL) cut-off points as prognostic markers of 3-month survival after diagnosis of stage IV non-small cell lung cancer (NSCLC). Methods: This was a prospective study involving 104 patients with metastatic (stage IV) NSCLC who were admitted to a cancer treatment center in southern Brazil between January of 2014 and November of 2016. We evaluated total WL and WL per month, as well as WL and WL per month in the 6 months preceding the diagnosis. The patients were followed for 3 months after diagnosis. A Cox proportional hazards regression model and Kaplan-Meier curves were used in order to evaluate 3-month survival. Results: The median WL in the 6 months preceding the diagnosis was 6% (interquartile range, 0.0- 12.9%). Patients with WL ≥ 5% had a median survival of 78 days, compared with 85 days for those with WL < 5% (p = 0.047). Survival at 3 months was 72% for the patients with WL ≥ 5% (p = 0.047), 61% for those with WL ≥ 10% (p < 0.001), and 45% for those with WL ≥ 15% (p < 0.001). In the multivariate analysis, the hazard ratio for risk of death was 4.51 (95% CI: 1.32-15.39) for the patients with WL ≥ 5%, 6.34 (95% CI: 2.31-17.40) for those with WL ≥ 10%, and 14.17 (95% CI: 5.06-39.65) for those with WL ≥ 15%. Conclusions: WL in the 6 months preceding the diagnosis of NSCLC is a relevant prognostic factor and appears to be directly proportional to the rate of survival at 3 months.

 


Keywords: Weight loss; Carcinoma, non-small-cell lung; Prognosis.

 


Loss to follow-up and missing data: important issues that can affect your study results

Perda de seguimento e dados faltantes: questões importantes que podem afetar os resultados do seu estudo

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2019;45(2):e20190091-e20190091

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Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

Perfil clínico, epidemiológico e etiológico de pacientes internados com pneumonia adquirida na comunidade em um hospital público do interior do Brasil

Laura Fuchs Bahlis1,2,3,a, Luciano Passamani Diogo3,b, Ricardo de Souza Kuchenbecker4,c, Sandra Costa Fuchs4,d

J Bras Pneumol.2018;44(4):261-266

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Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.

 


Keywords: Community-acquired infections; Pneumonia; Hospital mortality; Risk factors.

 


Multidisciplinary education with a focus on COPD in primary health care

Perfil molecular do carcinoma pulmonar de células não pequenas no Nordeste brasileiro

Ana Claudia da Silva Mendes de Oliveira1,a, Antonio Vinicios Alves da Silva2,b, Marclesson Alves3,c, Eduardo Cronemberger3,d, Benedito Arruda Carneiro4,e, Juliana Carneiro Melo5,f, Francisco Martins Neto6,g, Fabio Tavora1,7,h

J Bras Pneumol.2019;45(3):e20180181-e20180181

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Objective: To investigate the histological subtypes and mutational profiles of non-small cell lung cancer in Brazil, looking for correlations among histological subtypes, expression of anaplastic lymphoma kinase (ALK), EGFR mutation status, and programmed death-ligand 1 (PD-L1) expression. Methods: We evaluated 173 specimens obtained from patients with lung adenocarcinoma in northeastern Brazil. Expression of PD-L1 and ALK was evaluated by immunohistochemistry; EGFR mutation status was evaluated by sequencing. We categorized the histological subtypes in accordance with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Results: The most common histological subtypes of lung adenocarcinoma were solid predominant (in 46.8%), acinar predominant (in 37.0%), and lepidic predominant (in 9.8%). ALK expression was detected in 10.4% of the samples, and 22.0% of the tumors harbored EGFR mutations. The most common EGFR mutation was an exon 21 L858R point mutation (in 45.5%), followed by an exon 19 deletion (in 36.3%). The tumor proportion score for PD-L1 expression was ≥ 50% in 18.2% of the samples, 1-49% in 32.7%, and 0% in 49.5%. The solid predominant subtype was significantly associated with wild-type EGFR status (p = 0.047). Positivity for PD-L1 expression was not found to be significantly associated with ALK expression or EGFR mutation status. Conclusions: Our results suggest that the molecular profile of non-small cell lung cancer in northeastern Brazil differs from those of populations in other regions of the country, with ALK positivity being higher than the other biomarkers. Further studies including clinical and genetic information are required to confirm these differences, as well as studies focusing on populations living in different areas of the country.

 


Keywords: Anaplastic lymphoma kinase; ErbB receptors; B7-H1 antigen; Carcinoma, non-small-cell lung; Brazil.

 


Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil

Perme Intensive Care Unit Mobility Score e ICU Mobility Scale: tradução e adaptação cultural para a língua portuguesa falada no Brasil

Yurika Maria Fogaça Kawaguchi1, Ricardo Kenji Nawa2,3, Thais Borgheti Figueiredo4, Lourdes Martins5, Ruy Camargo Pires-Neto1,6

J Bras Pneumol.2016;42(6):429-431

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. Methods: The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. Results: The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement (κ > 0.90) and reliability (α > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (−0.048 ± 0.350 and −0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from −0.73 to 0.64 and −1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). Conclusions: In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability.

 


Keywords: Physical therapy modalities; Intensive care units; Translations; Validation studies.

 


PET/CT imaging in lung cancer: indications and findings

PET/TC em câncer de pulmão: indicações e achados

Bruno Hochhegger1, Giordano Rafael Tronco Alves2, Klaus Loureiro Irion3, Carlos Cezar Fritscher4, Leandro Genehr Fritscher5, Natália Henz Concatto6, Edson Marchiori7

J Bras Pneumol.2015;41(3):264-274

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The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.

 


Keywords: Carcinoma, non-small-cell lung; Small cell lung carcinoma; Positron-emission tomography; Tomography, X-ray computed; Neoplasm staging.

 


Reflex cough PEF as a predictor of successful extubation in neurological patients

Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

Fernanda Machado Kutchak1,2, Andressa Maciel Debesaitys2, Marcelo de Mello Rieder2,3, Carla Meneguzzi2, Amanda Soares Skueresky3, Luiz Alberto Forgiarini Junior3,4, Marino Muxfeldt Bianchin5

J Bras Pneumol.2015;41(4):358-364

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Objective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation. Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters. Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure. Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

 


Keywords: Weaning; Intensive care units; Cough.

 


Organizing pneumonia: chest HRCT findings

Pneumonia em organização: achados da TCAR de tórax

Igor Murad Faria1, Gláucia Zanetti2, Miriam Menna Barreto3, Rosana Souza Rodrigues4, Cesar Augusto Araujo-Neto5, Jorge Luiz Pereira e Silva5, Dante Luiz Escuissato6, Arthur Soares Souza Jr7, Klaus Loureiro Irion8, Alexandre Dias Mançano9, Luiz Felipe Nobre10, Bruno Hochhegger, Edson Marchiori11

J Bras Pneumol.2015;41(3):231-237

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Objective: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. Methods: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. Results: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. Conclusions: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs.

 


Keywords: Cryptogenic organizing pneumonia; Respiratory tract diseases; Tomography, X-ray computed.

 


Eosinophilic pneumonia: remember topical drugs as a potential etiology

Pneumonia eosinofílica: lembre-se de medicamentos tópicos como possível etiologia

Olívia Meira Dias1,a, Ellen Caroline Toledo do Nascimento2,b, Rodrigo Caruso Chate3,c, Ronaldo Adib Kairalla1,d, Bruno Guedes Baldi1,e

J Bras Pneumol.2018;44(6):522-524

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Usual interstitial pneumonia: typical, possible, and

Pneumonia intersticial usual: padrões típico, possível e inconsistente

Pedro Paulo Teixeira e Silva Torres1, Marcelo Fouad Rabahi2, Maria Auxiliadora Carmo Moreira2, Gustavo de Souza Portes Meirelles3, Edson Marchiori4

J Bras Pneumol.2017;43(5):393-398

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Idiopathic pulmonary fibrosis is a severe and progressive chronic fibrosing interstitial lung disease, a definitive diagnosis being established by specific combinations of clinical, radiological, and pathological findings. According to current international guidelines, HRCT plays a key role in establishing a diagnosis of usual interstitial pneumonia (UIP). Current guidelines describe three UIP patterns based on HRCT findings: a typical UIP pattern; a pattern designated "possible UIP"; and a pattern designated "inconsistent with UIP", each pattern having important diagnostic implications. A typical UIP pattern on HRCT is highly accurate for the presence of histopathological UIP, being currently considered to be diagnostic of UIP. The remaining patterns require further diagnostic investigation. Other known causes of a UIP pattern include drug-induced interstitial lung disease, chronic hypersensitivity pneumonitis, occupational diseases (e.g., asbestosis), and connective tissue diseases, all of which should be included in the clinical differential diagnosis. Given the importance of CT studies in establishing a diagnosis and the possibility of interobserver variability, the objective of this pictorial essay was to illustrate all three UIP patterns on HRCT.

 


Keywords: Tomography, X-ray computed; Lung diseases, interstitial; Pulmonary fibrosis.

 


Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

Pneumonia por Streptococcus pneumoniae complicada por pericardite purulenta: uma série de casos

Catia Cillóniz1, Ernesto Rangel2, Cornelius Barlascini3, Ines Maria Grazia Piroddi4, Antoni Torres1, Antonello Nicolini4

J Bras Pneumol.2015;41(4):389-394

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Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

 


Keywords: Pneumonia, pneumococcal/complications; Pneumonia, pneumococcal/mortality; Pericarditis/therapy; Cardiac tamponade; Streptococcus pneumoniae/pathogenicity.

 


Bronchodilator response cut-off points and FEV0.75 reference values for spirometry in preschoolers

Pontos de corte da resposta ao broncodilatador e valores de referência para VEF0,75 em espirometria de pré-escolares

Edjane Figueiredo Burity1, Carlos Alberto de Castro Pereira2, Marcus Herbert Jones3, Larissa Bouwman Sayão4, Armèle Dornelas de Andrade4, Murilo Carlos Amorim de Britto1

J Bras Pneumol.2016;42(5):326-332

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Objective: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. Methods: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. Results: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Conclusions: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children.

 


Keywords: Spirometry; Bronchodilator agents; Reference values; Child, preschool.

 


Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV

Preditores de mortalidade em pacientes da unidade de terapia intensiva coinfectados por tuberculose e HIV

Marcia Danielle Ferreira1,2,a, Cynthia Pessoa das Neves1,3,b, Alexandra Brito de Souza3,c, Francisco Beraldi-Magalhães1,3,d, Giovanni Battista Migliori4,e, Afrânio Lineu Kritski5,f, Marcelo Cordeiro-Santos1,3,g

J Bras Pneumol.2018;44(2):118-124

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Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

 


Keywords: Mycobacterium tuberculosis; Critical care; Respiration, artificial; Acquired immunodeficiency syndrome.

 


Presence of gas in an unusual place: spontaneous pneumomediastinum (Hamman's syndrome)

Presença de gás em um local incomum: pneumomediastino espontâneo (síndrome de Hamman)

Nicholas Oliveira Duarte1,a, Camila Hino Verdelho1,b, Rodolfo Mendes Queiroz2,3,c

J Bras Pneumol.2018;44(4):334-334

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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

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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.

 


Prevalence of latent Mycobacterium tuberculosis infection in prisoners

Prevalência da infecção latente por Mycobacterium tuberculosis em pessoas privadas de liberdade

Pedro Daibert de Navarro1,2, Isabela Neves de Almeida1, Afrânio Lineu Kritski3, Maria das Graças Ceccato4, Mônica Maria Delgado Maciel1, Wânia da Silva Carvalho4, Silvana Spindola de Miranda5

J Bras Pneumol.2016;42(5):348-355

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Objective: To determine the prevalence of and the factors associated with latent Mycobacterium tuberculosis infection (LTBI) in prisoners in the state of Minas Gerais, Brazil. Methods: This was a cross-sectional cohort study conducted in two prisons in Minas Gerais. Tuberculin skin tests were performed in the individuals who agreed to participate in the study. Results: A total of 1,120 individuals were selected for inclusion in this study. The prevalence of LTBI was 25.2%. In the multivariate analysis, LTBI was associated with self-reported contact with active tuberculosis patients within prisons (adjusted OR = 1.51; 95% CI: 1.05-2.18) and use of inhaled drugs (adjusted OR = 1.48; 95% CI: 1.03-2.13). Respiratory symptoms were identified in 131 (11.7%) of the participants. Serological testing for HIV was performed in 940 (83.9%) of the participants, and the result was positive in 5 (0.5%). Two cases of active tuberculosis were identified during the study period. Conclusions: Within the prisons under study, the prevalence of LTBI was high. In addition, LTBI was associated with self-reported contact with active tuberculosis patients and with the use of inhaled drugs. Our findings demonstrate that it is necessary to improve the conditions in prisons, as well as to introduce strategies, such as chest X-ray screening, in order to detect tuberculosis cases and, consequently, reduce M. tuberculosis infection within the prison system.

 


Keywords: Prisons; Tuberculin test; Latent tuberculosis, HIV.

 


Prevalence of latent Mycobacterium tuberculosis infection in renal transplant recipients

Prevalência da infecção latente por Mycobacterium tuberculosis em transplantados renais

Mônica Maria Moreira Delgado Maciel1,2,a, Maria das Graças Ceccato3,b, Wânia da Silva Carvalho3,c, Pedro Daibert de Navarro1,d, Kátia de Paula Farah1,e, Silvana Spindola de Miranda1,f

J Bras Pneumol.2018;44(6):461-467

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Objective: To estimate the prevalence of latent Mycobacterium tuberculosis infection (LTBI) in renal transplant recipients and to assess sociodemographic, behavioral, and clinical associations with positive tuberculin skin test (TST) results. Methods: This was a cross-sectional study of patients aged ≥ 18 years who underwent renal transplantation at the Renal Transplant Center of the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. We included renal transplant recipients who underwent the TST between January 2011 and July 2013. If the result of the first TST was negative, a second TST was administered. Bivariate and multivariate analyses using logistic regression were used to determine factors associated with positive TST results. Results: The sample included 216 patients. The prevalence of LTBI was 18.5%. In the multivariate analysis, history of contact with a tuberculosis case and preserved graft function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2) were associated with positive TST results. TST induration increased by 5.8% from the first to the second test, which was considered significant (p = 0.012). Conclusions: The prevalence of LTBI was low in this sample of renal transplant recipients. The TST should be administered if renal graft function is preserved. A second TST should be administered if the first TST is negative.

 


Keywords: Tuberculosis; Tuberculin test; Immunocompromised host.

 


Prevalence of vitamin D deficiency and its relationship with factors associated with recurrent wheezing

Prevalência de deficiência de vitamina D e sua relação com fatores associados à sibilância recorrente

Mirna Brito Peçanha1,2,a, Rodrigo de Barros Freitas1,b, Tiago Ricardo Moreira1,c, Luiz Sérgio Silva1,2,d, Leandro Licursi de Oliveira3,4,e, Silvia Almeida Cardoso1,2,f

J Bras Pneumol.2019;45(1):e20170431 -e20170431

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Objective: To determine the prevalence of vitamin D deficiency/insufficiency in children 0-18 years of age with recurrent wheezing and/or asthma residing in the microregion of Viçosa, Minas Gerais, Brazil, and treated at a referral center, and to determine its association with major risk factors for wheezing. Methods: A cross-sectional study was performed using a semi-structured questionnaire, which was administered by trained interviewers to the legal guardians of the study participants. Data were obtained regarding general characteristics of recurrent wheezing; general sociodemographic, environmental, and biologic factors; and atopy-related factors. The magnitude of the statistical association was assessed by calculating ORs and their corresponding 95% CIs by using multiple logistic regression. Results: We included 124 children in the study. The prevalence of vitamin D deficiency/insufficiency in the sample was 57.3%. Vitamin D deficiency/insufficiency was found to be associated with wheezing in the first year of life, personal history of atopic dermatitis, environmental pollution, and vitamin D supplementation until 2 years of age. Conclusions: The prevalence of vitamin D deficiency/insufficiency was high in our sample. Vitamin D concentrations were directly associated with vitamin D supplementation until 2 years of age and were inversely associated with wheezing events in the first year of life, personal history of atopic dermatitis, and environmental pollution.

 


Keywords: Vitamin D; Asthma; Respiratory sounds; Minors.

 


Prevalence of smoking and reasons for continuing to smoke: a population-based study

Prevalência de tabagismo e motivos para continuar a fumar: estudo de base populacional

Simone Aparecida Vieira Rocha1,a, Andréa Thives de Carvalho Hoepers1,b, Tânia Silvia Fröde2,c, Leila John Marques Steidle3,d, Emilio Pizzichini3,e, Márcia Margaret Menezes Pizzichini3,f

J Bras Pneumol.2019;45(4):e20170080-e20170080

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Objective: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. Methods: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. Results: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). Conclusions: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.

 


Keywords: Smoking/epidemiology; Tobacco use disorder/psychology; Smoking cessation/methods; Prevalence.

 


Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

Prevalência e variáveis preditivas de distúrbios respiratórios do sono em pacientes com DPOC e hipoxemia leve

José Laerte Rodrigues Silva Júnior1,4, Marcus Barreto Conde2,3, Krislainy de Sousa Corrêa4, Helena Rabahi4, Arthur Alves Rocha5, Marcelo Fouad Rabahi1,4

J Bras Pneumol.2017;43(3):176-182

Abstract PDF PT PDF EN Portuguese Text

Objective: To infer the prevalence and variables predictive of isolated nocturnal hypoxemia and obstructive sleep apnea (OSA) in patients with COPD and mild hypoxemia. Methods: This was a cross-sectional study involving clinically stable COPD outpatients with mild hypoxemia (oxygen saturation = 90-94%) at a clinical center specializing in respiratory diseases, located in the city of Goiânia, Brazil. The patients underwent clinical evaluation, spirometry, polysomnography, echocardiography, arterial blood gas analysis, six-minute walk test assessment, and chest X-ray. Results: The sample included 64 patients with COPD and mild hypoxemia; 39 (61%) were diagnosed with sleep-disordered breathing (OSA, in 14; and isolated nocturnal hypoxemia, in 25). Correlation analysis showed that PaO2 correlated moderately with mean sleep oxygen saturation (r = 0.45; p = 0.0002), mean rapid eye movement (REM) sleep oxygen saturation (r = 0.43; p = 0.001), and mean non-REM sleep oxygen saturation (r = 0.42; p = 0.001). A cut-off point of PaO2 ≤ 70 mmHg in the arterial blood gas analysis was significantly associated with sleep-disordered breathing (OR = 4.59; 95% CI: 1.54-13.67; p = 0.01). The model showed that, for identifying sleep-disordered breathing, the cut-off point had a specificity of 73.9% (95% CI: 51.6-89.8%), a sensitivity of 63.4% (95% CI: 46.9-77.9%), a positive predictive value of 81.3% (95% CI: 67.7-90.0%), and a negative predictive value of 53.1% (95% CI: 41.4-64.4%), with an area under the ROC curve of 0.69 (95% CI: 0.57-0.80), correctly classifying the observations in 67.2% of the cases. Conclusions: In our sample of patients with COPD and mild hypoxemia, the prevalence of sleep-disordered breathing was high (61%), suggesting that such patients would benefit from sleep studies.

 


Keywords: Pulmonary disease, chronic obstructive/complications; Sleep wake disorders/epidemiology; Anoxia/etiology.

 


Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis

Procedimentos diagnósticos broncoscópicos e exames microbiológicos para a confirmação de tuberculose endobrônquica

Abdullah Şimşek1 , İlhami Yapıcı1 , Mesiha Babalık1 , Zekiye Şimşek2 , Mustafa Kolsuz1

J Bras Pneumol.2016;42(3):191-195

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB) subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both). Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%). Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%). Smear microscopy of BAL fluid (BALF) was performed in 16 patients and was positive for AFB in 10 (62.5%). Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%). Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%); bronchial brushing, in 7 (38.8%); fine-needle aspiration biopsy, in 2 (11.1%); and BAL, in 2 (11.1%). Bronchial anthracofibrosis was observed in 5 (27.7%) of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.

 


Keywords: Tuberculosis, pulmonary; Mycobacterium tuberculosis; Diagnostic techniques and procedures; Bronchoscopy.

 


NACHT, LRR, and PYD domains-containing Protein 3 and LL-37: prognostic value of new biomarkers in community-acquired pneumonia

Proteína 3 contendo um domínio NACHT, porção C-terminal rica em repetições de leucina e de domínio pirina e LL-37: valor prognóstico de novos biomarcadores em pneumonia adquirida na comunidade

Chuanan Zhu1,a, Yingfan Zhou2,b, Jiabin Zhu3,c, Ye Liu1,d, Mengyi Sun1,e

J Bras Pneumol.2019;45(4):e20190001-e20190001

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to determine the serum levels of NACHT, Leucine-rich repeat (LRR), and Pyrin (PYD) domains-containing Protein 3 (NLRP3) and cathelicidin LL-37, and investigate their prognostic significance in community-acquired pneumonia (CAP). Methods: The sample of this prospective study was composed of 76 consecutive patients with CAP. Demographic data and clinical characteristics were collected. Serum levels of NLRP3 and LL-37 were determined by ELISA. Spearman's analysis was used to evaluate the correlation between NLRP3 and LL-37. Association of NLRP3 and LL 37 with 30-day survival and mortality rates was assessed using the Kaplan-Meier curve and logistic regression analysis. Results: Serum NLRP3 significantly increased whereas serum LL-37 significantly decreased in patients with severe CAP. Significant correlation was observed between serum NLRP3 and LL-37 in CAP patients. Patients with higher levels of NLRP3 and lower levels of LL-37 showed lower 30-day survival rate and higher mortality compared with those with lower NLRP3 and higher LL-37 levels. Conclusion: Severe CAP patients tend to present higher serum NLRP3 and lower serum LL-37, which might serve as potential biomarkers for CAP prognosis.

 


Keywords: Community-acquired pneumonia; Prognosis; Biomarkers; Prospective study.

 


What is the importance of calculating sample size?

Qual a importância do cálculo do tamanho amostral?

Cecilia Maria Patino1,2, Juliana Carvalho Ferreira1,3

J Bras Pneumol.2016;42(2):162-162

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When is the use of contrast media in chest CT indicated?

Quando é indicado o uso de meios de contraste na TC de tórax?

Bruno Hochhegger1,2,3, Robson Rottenfusser4,5, Edson Marchiori6

J Bras Pneumol.2017;43(5):400-400

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The Quebec Sleep Questionnaire on quality of life in patients with obstructive sleep apnea: translation into Portuguese and cross-cultural adaptation for use in Brazil

Quebec Sleep Questionnaire sobre qualidade de vida em pacientes com apneia obstrutiva do sono: tradução e adaptação cultural para uso no Brasil

José Tavares de Melo Júnior1, Rosemeri Maurici1,2, Michelle Gonçalves de Souza Tavares3, Marcia Margareth Menezes Pizzichini1,4, Emilio Pizzichini1,2,5

J Bras Pneumol.2017;43(5):331-336

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Quebec Sleep Questionnaire (QSQ), a specific instrument for the assessment of quality of life in patients with sleep obstructive apnea, into Portuguese and to create a version that is cross-culturally adapted for use in Brazil. Methods: The Portuguese-language version was developed according to a rigorous methodology, which included the following steps: preparation; translation from English into Portuguese in three versions; reconciliation to a single version; back-translation of that version into English; comparison and harmonization of the back-translation with the original version; review of the Portuguese-language version; cognitive debriefing; text review; and arrival at the final version. Results: The Portuguese-language version of the QSQ for use in Brazil had a clarity score, as measured by cognitive debriefing, ranging from 0.81 to 0.99, demonstrating the consistency of translation and cross-cultural adaptation processes. Conclusions: The process of translating the QSQ into Portuguese and creating a version that is cross-culturally adapted for use in Brazil produced a valid instrument to assess the quality of life in patients with obstructive sleep apnea.

 


Keywords: Obstructive sleep apnea, Quality of life; Translations; Validation studies.

 


Who are the patients with tuberculosis who are diagnosed in emergency facilities? An analysis of treatment outcomes in the state of São Paulo, Brazil

Quem são os pacientes com tuberculose diagnosticados no pronto-socorro? Uma análise dos desfechos do tratamento no Estado de São Paulo, Brasil

Otavio Tavares Ranzani1,2,a, Laura Cunha Rodrigues2,b, Eliseu Alves Waldman3,c, Elena Prina1,d, Carlos Roberto Ribeiro Carvalho1,e

J Bras Pneumol.2018;44(2):125-133

Abstract PDF PT PDF EN Portuguese Text

Objective: Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs. Methods: We analyzed data from the São Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes. Results: Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs. Conclusions: In the state of São Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.

 


Keywords: Tuberculosis/diagnosis; Emergency treatment; Treatment outcome; Delivery of health care.

 


Stereotactic body radiotherapy in lung cancer: an update

Radioterapia estereotáxica extracraniana em câncer de pulmão: atualização

Carlos Eduardo Cintra Vita Abreu1, Paula Pratti Rodrigues Ferreira1, Fabio Ynoe de Moraes1, Wellington Furtado Pimenta Neves Jr1, Rafael Gadia2, Heloisa de Andrade Carvalho1,3

J Bras Pneumol.2015;41(4):376-387

Abstract PDF PT PDF EN Portuguese Text

For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique.

 


Keywords: Radiation oncology; Lung neoplasms/radiotherapy; Lung neoplasms/surgery; Respiratory function tests.

 


Randomization: beyond tossing a coin

Randomização: mais do que o lançamento de uma moeda

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino1,3

J Bras Pneumol.2016;42(5):310-310

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Mobility therapy and central or peripheral catheter-related adverse events in an ICU in Brazil

Realização de fisioterapia motora e ocorrência de eventos adversos relacionados a cateteres centrais e periféricos em uma UTI brasileira

Natália Pontes Lima1, Gregório Marques Cardim da Silva1, Marcelo Park2, Ruy Camargo Pires-Neto3

J Bras Pneumol.2015;41(3):225-230

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether mobility therapy is associated with central or peripheral catheter-related adverse events in critically ill patients in an ICU in Brazil. Methods: A retrospective analysis of the daily medical records of patients admitted to the Clinical Emergency ICU of the University of São Paulo School of Medicine Hospital das Clínicas Central Institute between December of 2009 and April of 2011. In addition to the demographic and clinical characteristics of the patients, we collected data related to central venous catheters (CVCs), hemodialysis (HD) catheters and indwelling arterial catheters (IACs): insertion site; number of catheter days; and types of adverse events. We also characterized the mobility therapy provided. Results: Among the 275 patients evaluated, CVCs were used in 49%, HD catheters were used in 26%, and IACs were used in 29%. A total of 1,268 mobility therapy sessions were provided to patients while they had a catheter in place. Catheter-related adverse events occurred in 20 patients (a total of 22 adverse events): 32%, infection; 32%, obstruction; and 32%, accidental dislodgement. We found that mobility therapy was not significantly associated with any catheter-related adverse event, regardless of the type of catheter employed: CVC-OR = 0.8; 95% CI: 0.7-1.0; p = 0.14; HD catheter-OR = 1.04; 95% CI: 0.89-1.21; p = 0.56; or IAC-OR = 1.74; 95% CI: 0.94-3.23; p = 0.07. Conclusions: In critically ill patients, mobility therapy is not associated with the incidence of adverse events involving CVCs, HD catheters, or IACs.

 


Keywords: Physical therapy modalities; Intensive care units; Catheters; Early ambulation.

 


2018 recommendations for the management of community acquired pneumonia

Recomendações para o manejo da pneumonia adquirida na comunidade 2018

Ricardo de Amorim Corrêa1,a, Andre Nathan Costa2,b, Fernando Lundgren3.c, Lessandra Michelim4,d, Mara Rúbia Figueiredo5,e, Marcelo Holanda6,f, Mauro Gomes7,g, Paulo José Zimermann Teixeira8,h, Ricardo Martins9,i, Rodney Silva10,j, Rodrigo Abensur Athanazio2,k, Rosemeri Maurici da Silva11,l, Mônica Corso Pereira12,m

J Bras Pneumol.2018;44(5):405-423

Abstract PDF PT PDF EN Portuguese Text

Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.

 


Keywords: Pneumonia/diagnosis; Pneumonia/prevention & control; Pneumonia/therapy; Pneumonia/drug therapy.

 


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

Abstract PDF PT PDF EN Portuguese Text

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.

 


Tuberculosis recurrence in a priority city in the state of São Paulo, Brazil

Recorrência de tuberculose em município prioritário do estado de São Paulo

Amadeu Antonio Vieira1,2, Danila Torres Leite3, Solange Adreoni2

J Bras Pneumol.2017;43(2):106-112

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe cases of tuberculosis recurrence (TBR), stratified by temporal classification (early or late TBR), and to identify possible predictors of such recurrence. Methods: This was an analytical retrospective observational epidemiological study involving a cohort of 963 new cases of pulmonary tuberculosis, reported and treated via the Tuberculosis Control Program in the city of Carapicuíba, Brazil. The study period was from 2000 to 2010. All of the pulmonary tuberculosis patients who successfully completed the treatment (with or without confirmation of cure) were selected and followed until December 31, 2012. Results: Of the 963 cases, TBR occurred in 47 (4.88%). The mean time between the first and second tuberculosis episodes was 36.12 months. Of the 47 TBR cases, 16 (34.04%) occurred within the first 18 months after the completion of the initial treatment (early TBR) and 31 (65.96%) occurred thereafter (late TBR). There were statistically significant differences between the early and late TBR groups only regarding level of education (≤ 3 vs. > 3 years of schooling; p < 0.004) and weight gain at completion of the initial treatment (1.78 kg vs. 5.31 kg; p < 0.045)-not regarding any of the other variables studied. Conclusions: A low level of education might translate to poor treatment adherence, which impedes the killing of bacilli and facilitates their survival in a latent state, making it appear as if the treatment was effective. Minimal or no weight gain at completion of the initial treatment might be a reliable biomarker to be used by health care facilities that provide tuberculosis treatment.

 


Keywords: Recurrence; Tuberculosis; Risk factors.

 


Reflections upon the article "Evaluation of the impact that the changes in tuberculosis treatment implemented in Brazil in 2009 have had on disease control in the country"

Reflexões sobre o artigo "Avaliação do impacto das mudanças do tratamento da tuberculose implantadas em 2009 no controle da tuberculose pulmonar no Brasil"

Ethel Leonor Maciel1,a, José Ueleres Braga2,3,b, Adelmo Inácio Bertolde4,c, Eliana Zandonade4,d

J Bras Pneumol.2018;44(3):249-252

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Relationship between availability of physiotherapy services and ICU costs

Relação entre a disponibilidade de serviços de fisioterapia e custos de UTI

Bruna Peruzzo Rotta1,2,a, Janete Maria da Silva2,3,b, Carolina Fu2,4,c, Juliana Barbosa Goulardins4,5,d, Ruy de Camargo Pires-Neto2,4,e, Clarice Tanaka2,4,f

J Bras Pneumol.2018;44(3):184-189

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

 


Keywords: Intensive care units; Respiration, artificial; Respiratory therapy; Hospital costs.

 


Case reports: narratives highlighting clinical experiences that inform practice and future research studies

Relatos de caso: narrativas destacando experiências clínicas que contribuem para a prática e para futuros estudos

Cecilia Maria Patino1,2,a, Juliana Carvalho Ferreira1,3,b

J Bras Pneumol.2019;45(4):e20190251-e20190251

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Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer

Rendimiento diagnóstico de la ultrasonografía endobronquial con aspiración transbronquial por aguja fina en el estudio de etapificación mediastínica en pacientes con cáncer pulmonar

Sebastián Fernández-Bussy1; Gonzalo Labarca2; Sofia Canals3; Iván Caviedes4; Erik Folch5; Adnan Majid6

J Bras Pneumol.2015;41(3):219-224

Abstract PDF PT PDF EN Portuguese Text

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. Methods: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). Results: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. Conclusions: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions.

 


Keywords: Lung neoplasms; Bronchoscopy; Endosonography; Neoplasm staging.

 


Between-occasion repeatability of fractional exhaled nitric oxide measurements in children

Repetibilidade de medidas da fração de óxido nítrico exalado em crianças em duas ocasiões

Kamil Barański1,a, Jan E. Zejda1,b

J Bras Pneumol.2018;44(1):52-54

Abstract PDF PT PDF EN Portuguese Text

The aim of the study was to assess short-term repeatability of measurements of fractional exhaled nitric oxide (FENO) and its correlates in children in the 6- to 9-year age bracket participating in a respiratory epidemiological survey. FENO was measured in two sessions one week apart in 101 children. Participants were divided into three groups: asymptomatic (n = 76); symptomatic (n = 14); and asthma (n = 11). Absolute and relative differences between the measurements, as well as concordance correlation coefficients, were used in order to assess repeatability. The two FENO measurements were strongly correlated (0.98). Although intragroup comparisons of the two measurements were not significantly different (p = 0.2), intergroup comparisons were. FENO measurements are reproducible in children in epidemiological settings.

 


Keywords: Nitric oxide; Exhalation; Asthma.

 


Response to cytotoxic chemotherapy and overall survival in non-small cell lung cancer patients with positive or negative ERCC1 expression

Resposta à quimioterapia citotóxica e sobrevida global em pacientes com câncer de pulmão não pequenas células com expressão positiva ou negativa para ERCC1

Helen Naemi Honma1,a, Maurício Wesley Perroud Jr1,b, André Moreno Morcillo2,c, José Vassallo3,d, Lair Zambon1,e

J Bras Pneumol.2018;44(3):245-246

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Authors' reply

Resposta dos autores

Marcelo Fouad Rabahi1,a, José Laerte Rodrigues da Silva Júnior2,3,b, Marcus Barreto Conde4,5,c

J Bras Pneumol.2018;44(3):251-252

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AUTHORS' REPLY

Resposta dos autores

Juçara Gasparetto Maccari1,2, Cassiano Teixeira1,2,3

J Bras Pneumol.2016;42(3):236-236

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Author's replay

Resposta dos autores

Fábio José Fabrício de Barros Souza1, Anne Rosso Evangelista2, Juliana Veiga Silva2, Grégory Vinícius Périco3, Kristian Madeira4,5

J Bras Pneumol.2016;42(5):396-396

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Author's replay

Resposta dos autores

Andre Luis Pereira de Albuquerque1,2, Marco Quaranta3, Biswajit Chakrabarti4, Andrea Aliverti3, Peter M. Calverley4

J Bras Pneumol.2016;42(5):398-398

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Authors' reply - Reflections on the article "Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome"

Resposta dos autores sobre o artigo Reflexões sobre o artigo

Thays Maria da Conceição Silva Carvalho1,a, Anísio Francisco Soares2,b, Danielle Cristina Silva Climaco3,c, Isaac Vieira Secundo3,d, Anna Myrna Jaguaribe de Lima2,e

J Bras Pneumol.2019;45(2):e20180327-e20180327

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Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study)

Ressecção pulmonar anatômica por videotoracoscopia: experiência brasileira (VATS Brasil)

Ricardo Mingarini Terra1, Thamara Kazantzis1, Darcy Ribeiro Pinto-Filho2, Spencer Marcantonio Camargo3, Francisco Martins-Neto4,5, Anderson Nassar Guimarães6, Carlos Alberto Araújo7, Luis Carlos Losso8, Mario Claudio Ghefter9, Nuno Ferreira de Lima10, Antero Gomes-Neto5, Flávio Brito-Filho10, Rui Haddad11, Maurício Guidi Saueressig12, Alexandre Marcelo Rodrigues Lima13, Rafael Pontes de Siqueira5, Astunaldo Júnior de Macedo e Pinho14, Fernando Vannucci15

J Bras Pneumol.2016;42(3):215-221

Abstract PDF PT PDF EN Portuguese Text

Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

 


Keywords: Thoracic surgery, video-assisted; Thoracoscopy; Pneumonectomy.

 


False-negative newborn screening result for immunoreactive trypsinogen: a major problem in children with chronic lung disease

Resultado falso-negativo de tripsinogênio imunorreativo no teste de triagem neonatal: um problema relevante a considerar em crianças com doença pulmonar crônica

Magali Santos Lumertz1,a, Thaiane Rispoli2,b, Katiana Murieli da Rosa3,c, Leonardo Araújo Pinto3,4,d

J Bras Pneumol.2019;45(3):e20180062-e20180062

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Sarcopenia in COPD: relationship with COPD severity and prognosis

Sarcopenia na DPOC: relação com a gravidade e o prognóstico da DPOC

Tatiana Munhoz da Rocha Lemos Costa1,2, Fabio Marcelo Costa3, Carolina Aguiar Moreira1,2, Leda Maria Rabelo3, César Luiz Boguszewski1, Victória Zeghbi Cochenski Borba1,2

J Bras Pneumol.2015;41(5):415-421

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD. Methods: A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index. Results: We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage. Conclusions: In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.

 


Keywords: Sarcopenia; Body composition; Pulmonary disease, chronic obstructive; Severity of illness index.

 


Tuberculosis series

Série tuberculose

Denise Rossato Silva1,a, Fernanda Carvalho de Queiroz Mello2,b, Afrânio Kritski3,c, Margareth Dalcolmo4,d, Alimuddin Zumla5,e, Giovanni Battista Migliori6

J Bras Pneumol.2018;44(2):71-72

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Tuberculosis series 2019

Série tuberculose 2019

Denise Rossato Silva1,a, Giovanni Battista Migliori2,b, Fernanda Carvalho de Queiroz Mello3,c

J Bras Pneumol.2019;45(2):e20190064-e20190064

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The halo sign

Sinal do halo

Edson Marchiori1,2, Bruno Hochhegger3,4, Gláucia Zanetti2,5

J Bras Pneumol.2017;43(1):4-4

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Reversed halo sign

Sinal do halo invertido

Edson Marchiori1,2, Gláucia Zanetti2,3, Bruno Hochhegger4,5

J Bras Pneumol.2015;41(6):564-564

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Reversed halo sign in acute schistosomiasis

Sinal do halo invertido em esquistossomose aguda

Arthur Soares Souza Jr.1, Antonio Soares Souza2, Luciana Soares-Souza3, Gláucia Zanetti4, Edson Marchiori5

J Bras Pneumol.2015;41(3):286-288

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The reversed halo sign: also think about chronic eosinophilic pneumonia

Sinal do halo invertido: pense também em pneumonia eosinofílica crônica

Gaetano Rea1, Giorgia Dalpiaz2, Alessandro Vatrella3, Stefania Damiani4, Edson Marchiori5,6

J Bras Pneumol.2017;43(4):322-323

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The halo sign: HRCT findings in 85 patients

Sinal do halo: achados de TCAR em 85 pacientes

Giordano Rafael Tronco Alves1, Edson Marchiori1, Klaus Irion2, Carlos Schuler Nin3, Guilherme Watte3, Alessandro Comarú Pasqualotto3, Luiz Carlos Severo3, Bruno Hochhegger1,3

J Bras Pneumol.2016;42(6):435-439

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Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.

 


Keywords: Tomography, X-ray computed; Aspergillosis; Lung neoplasms.

 


Fat embolism syndrome: chest CT findings

Síndrome da embolia gordurosa: achados de TC de tórax

Alessandro Graziani1,a, Chiara Carli Moretti2,b, Federica Mirici Cappa3,c

J Bras Pneumol.2018;44(3):244-244

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Hyperimmunoglobulin E syndrome (Job syndrome): chest CT findings

Síndrome de hiperimunoglobulina E (síndrome de Jó): achados da TC de tórax

Pablo Rydz Pinheiro Santana1,2,a, Augusto Kreling Medeiros1,b, Cinthia Callegari Barbisan1,c, Antônio Carlos Portugal Gomes1,d, Edson Marchiori3,e

J Bras Pneumol.2018;44(4):335-336

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Sleep in the intensive care unit

Sono na unidade de terapia intensiva

Flávia Gabe Beltrami1, Xuân-Lan Nguyen2, Claire Pichereau3, Eric Maury3, Bernard Fleury4, Simone Fagondes1,5

J Bras Pneumol.2015;41(6):539-546

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Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

 


Keywords: Sleep; Sleep deprivation; Intensive care units.

 


Extracorporeal respiratory support in adult patients

Suporte respiratório extracorpóreo em pacientes adultos

Thiago Gomes Romano1,3, Pedro Vitale Mendes2,3, Marcelo Park2, Eduardo Leite Vieira Costa3,4

J Bras Pneumol.2017;43(1):60-70

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In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.

 


Keywords: Extracorporeal membrane oxygenation; Respiratory distress syndrome, adult; Hypoxia; Hypercapnia.

 


Smoking among female sex workers: prevalence and associated variables

Tabagismo em mulheres profissionais do sexo: prevalência e variáveis associadas

Ligia Lopes Devóglio1, José Eduardo Corrente2, Maria Helena Borgato3, Ilda de Godoy3

J Bras Pneumol.2017;43(1):6-13

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Objective: To assess the prevalence of smoking and associated variables in female sex workers (FSWs). Methods: This was a quantitative cross-sectional study involving FSWs in the city of Botucatu, Brazil, who completed a sociodemographic questionnaire, including data regarding smoking status, motivational stage of change, and degree of nicotine dependence, as well as the Perceived Stress Scale and the Hospital Anxiety and Depression Scale. Results: We included 83 FSWs. The mean age was 26.8 years. Among the participants, 58 (69.8%) had at least a high school education, only 26 (31.3%) resided in the city of Botucatu, 59 (71.1%) were smokers, 5 (6.0%) were former smokers, 74 (89.2%) regularly consumed alcohol, and 43 (51.8%) used illicit drugs. The majority of the women were classified as having an intermediate stress level, and 51 (61.4%) were classified as having possible or probable anxiety, whereas depression was found to be improbable in 57 (68.7%). The level of nicotine dependence was high among the smokers, the majority of whom showed no intention to quit smoking. Smoking was associated with illicit drug use (p = 0.0271) and with alcohol consumption (p = 0.0001), although not with the levels of stress, anxiety, or depression; nor was the age at smoking initiation associated with the length of time as an FSW (p = 0.4651). Conclusions: The prevalence of smoking among the FSWs evaluated here was much higher than the 8.3% reported for the overall female population of Brazil. Our findings show that FSWs are exposed to various risk factors inherent to their profession. Therefore, harm reduction is an important strategy to be adopted.

 


Keywords: Women, Smoking, Sex workers; Prevalence; Risk factors.

 


Self-reported smoking status and urinary cotinine levels in patients with asthma

Tabagismo entre asmáticos: avaliação por autorrelato e dosagem de cotinina urinária

Gabriela Pimentel Pinheiro1,2,a, Carolina de Souza-Machado1,3,b, Andréia Guedes Oliva Fernandes4,c, Raquel Cristina Lins Mota5,d, Liranei Limoeiro Lima2,e, Diego da Silva Vasconcellos6,f, Ives Pereira da Luz Júnior7,g, Yvonbergues Ramon dos Santos Silva7,h, Valmar Bião Lima1,4,i, Sérgio Telles de Oliva8,j, Luane Marques de Mello9,k, Ricardo David Couto10,l, José Miguel Chatkin11,m, Constança Margarida Sampaio Cruz12,13,n, Álvaro Augusto Cruz1,14,o

J Bras Pneumol.2018;44(6):477-485

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Objective: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. Methods: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. Results: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. Conclusions: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.

 


Keywords: Asthma; Smoking; Cotinine.

 


Smoking and pulmonary tuberculosis treatment failure: a case-control study

Tabaquismo y fracaso del tratamiento de la tuberculosis pulmonar. Un estudio de casos y controles

Juan Pablo Aguilar1,a, María B Arriaga2,3,b, Monica Ninet Rodas1,4,c, Eduardo Martins Netto1,3,5,d

J Bras Pneumol.2019;45(2):e20180359-e20180359

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Objective: To determine the association between smoking and pulmonary tuberculosis treatment failure. Methods: This was a case-control study conducted at the Brazilian Institute for Tuberculosis Research in the city of Salvador, Brazil, between 2007 and 2015. We evaluated 284 patients treated for pulmonary tuberculosis, comparing 50 cases of treatment failure with 234 control cases in which the final outcome was cure. Results: Treatment failure was attributed to smoking and age rather than to gender, income, level of education, alcohol consumption, or marital status. Therefore, even after adjustment for age, the risk of treatment failure was 2.1 times (95% CI: 1.1-4.1) higher among the patients with a history of smoking. In addition, being over 50 years of age was found to increase the likelihood of treatment failure by 2.8 times (95% CI: 1.4-6.0). Conclusions: Smoking and aging are both associated with pulmonary tuberculosis treatment failure. Therefore, as part of a tuberculosis control program, health personnel should be prepared to offer strategies to promote smoking cessation and should be more careful with older patients.

 


Keywords: Tobacco use disorder; Tuberculosis; Treatment failure.

 


Pulmonary talcosis caused by intravenous methadone injection

Talcose pulmonar causada por injeção intravenosa de metadona

Dante Luiz Escuissato1, Rimarcs Gomes Ferreira2, João Adriano de Barros1, Edson Marchiori3

J Bras Pneumol.2017;43(2):154-155

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Simple motor tasks independently predict extubation failure in critically ill neurological patients

Tarefas motoras simples predizem independentemente a falha de extubação em pacientes neurológicos críticos

Fernanda Machado Kutchak1,2,3,4, Marcelo de Mello Rieder1,2,4, Josué Almeida Victorino1,4, Carla Meneguzzi4, Karla Poersch3, Luiz Alberto Forgiarini Junior5, Marino Muxfeldt Bianchin1,2,6

J Bras Pneumol.2017;43(3):183-189

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Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. Results: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. Conclusions: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation.

 


Keywords: Ventilator weaning; Airway extubation/adverse effects; Critical care; Neurosurgery.

 


Frequency of indeterminate results from an interferon-gamma release assay among HIV-infected individuals

Taxa de resultados indeterminados de ensaio de liberação de interferon-gama entre pessoas infectadas pelo HIV

Sandra Maria do Valle Leone de Oliveira1,2, Anete Trajman3,4, Anamaria Mello Miranda Paniago1, Ana Rita Coimbra Motta-Castro1,2, Antonio Ruffino-Netto5, Ethel Leonor Noia Maciel6, Julio Croda2,7, Maria da Gloria Bonecini-Almeida8

J Bras Pneumol.2017;43(3):215-218

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Objective: To evaluate the frequency of and factors associated with indeterminate interferon-gamma release assay (IGRA) results in people living with HIV/AIDS (PLWHA). Methods: We tested 81 PLWHA in the central-west region of Brazil, using the tuberculin skin test and an IGRA. Information on sociodemographic and clinical variables was gathered through the use of questionnaires and from medical records. The association of those variables with indeterminate results was analyzed by calculating the adjusted ORs in a multivariate logistic regression model. Concordance was evaluated by determining the kappa statistic. Results: Among the 81 patients evaluated, the tuberculin skin test results were positive in 18 (22.2%) of the patients, and the IGRA results were positive in 10 (12.3%), with a kappa of 0.62. The IGRA results were indeterminate in 22 (27.1%) of the patients (95% CI: 17.8-38.1%). The odds of obtaining indeterminate results were significantly higher in smokers (adjusted OR = 6.0; 95% CI: 1.4-26.7) and in samples stored for less than 35 days (adjusted OR = 14.0; 95% CI: 3.1-64.2). Patients with advanced immunosuppression (CD4+ T-cell count < 200 cells/mm3) were at a higher risk for indeterminate results (OR adjusted for smoking and inadequate duration of sample storage = 4.7; 95% CI: 0.91-24.0), although the difference was not significant. Conclusions: The high prevalence of indeterminate results can be a major limitation for the routine use of IGRAs in PLWHA. The need to repeat the test increases its costs and should be taken into account in cost-effectiveness studies. The processing of samples can significantly alter the results.

 


Keywords: Interferon-gamma release tests; Interferon-gamma; Tuberculosis; HIV; Latent tuberculosis; Tuberculin test.

 


HRCT in smoking-related interstitial lung diseases: a kaleidoscopic overlap of patterns

TCAR em doenças pulmonares intersticiais relacionadas ao tabagismo: uma superposição caleidoscópica de padrões

Gaetano Rea1, Tullio Valente1, Edson Marchiori2,3

J Bras Pneumol.2016;42(2):157-157

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Palmar telangiectasia is associated with the intensity of smoking

Telangiectasia palmar está associada à intensidade do tabagismo

Dragica Petar Pesut1,2,a, Ana Milan Samardzic2,b, Milica Vojin Bulajic3,c, Tijana Tatjana Cvok-Debeljak2,d

J Bras Pneumol.2019;45(2):e20180273-e2018273

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Prescribing trends in and perceptions of the treatment of asthma: a survey among pulmonologists in Brazil

Tendências prescritivas e percepções no tratamento da asma: um inquérito entre pneumologistas brasileiros

José Eduardo Delfini Cançado1,a, Rodrigo Abensur Athanazio2,b, Luis Fernando Rensi Cunha3,c, Marcia Margaret Menezes Pizzichini4,d

J Bras Pneumol.2019;45(5):e20190083-e20190083

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Inhalation therapy in mechanical ventilation

Terapia inalatória em ventilação mecânica

Ângelo Roncalli Miranda Rocha1,2,3, Caio Henrique Veloso da Costa1

J Bras Pneumol.2016;42(3):235-235

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Bronchial thermoplasty in a patient with difficult-to-control asthma

Termoplastia brônquica em paciente com asma de difícil controle

Adalberto Rubin1,2, Suzana Zelmanovitz1, Manuela Cavalcanti1, Fernanda Spilimbergo1, Paulo Goldenfum1, José Felicetti3, Paulo Cardoso4

J Bras Pneumol.2016;42(2):155-156

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Six-minute walk test and respiratory muscle strength in patients with uncontrolled severe asth-ma: a pilot study

Teste de caminhada de seis minutos e força muscular respiratória em pacientes com asma grave não controlada: um estudo piloto

Luiz Fernando Ferreira Pereira1, Eliane Viana Mancuzo2, Camila Farnese Rezende3, Ricardo de Amorim Côrrea4

J Bras Pneumol.2015;41(3):211-218

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Objective: To evaluate respiratory muscle strength and six-minute walk test (6MWT) variables in patients with uncontrolled severe asthma (UCSA). Methods: This was a cross-sectional study involving UCSA patients followed at a university hospital. The patients underwent 6MWT, spirometry, and measurements of respiratory muscle strength, as well as completing the Asthma Control Test (ACT). The Mann-Whitney test was used in order to analyze 6MWT variables, whereas the Kruskal-Wallis test was used to determine whether there was an association between the use of oral corticosteroids and respiratory muscle strength. Results: We included 25 patients. Mean FEV1 was 58.8  21.8% of predicted, and mean ACT score was 14.0  3.9 points. No significant difference was found between the median six-minute walk distance recorded for the UCSA patients and that predicted for healthy Brazilians (512 m and 534 m, respectively; p = 0.14). During the 6MWT, there was no significant drop in SpO2. Mean MIP and MEP were normal (72.9  15.2% and 67.6  22.2%, respectively). Comparing the patients treated with at least four courses of oral corticosteroids per year and those treated with three or fewer, we found no significant differences in MIP (p = 0.15) or MEP (p = 0.45). Conclusions: Our findings suggest that UCSA patients are similar to normal subjects in terms of 6MWT variables and respiratory muscle strength. The use of oral corticosteroids has no apparent impact on respiratory muscle strength.

 



Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil

Teste do suor e fibrose cística: panorama da realização do teste em centros públicos e privados do estado de São Paulo

Maria Fátima Servidoni1,2, Carla Cristina Souza Gomez1, Fernando Augusto Lima Marson1,3, Adyléia Aparecida Dalbo Contrera Toro1, Maria Ângela Gonçalves de Oliveira Ribeiro1, José Dirceu Ribeiro1, Antônio Fernando Ribeiro1; Grupo Colaborativo de Estudos em Fibrose Cística

J Bras Pneumol.2017;43(2):121-128

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: The sweat test (ST) measures chloride levels in sweat and is considered the gold standard for the diagnosis of cystic fibrosis (CF). However, the reliability of a ST depends on their being performed by experienced technicians and in accordance with strict guidelines. Our aim was to evaluate how sweat stimulation, sweat collection, and chloride measurement are performed at 14 centers (9 public centers and 5 private centers) that routinely perform STs in the state of São Paulo, which has the highest frequency of CF in Brazil. Methods: This was a cross-sectional cohort study, using a standardized questionnaire administered in loco to the staff responsible for conducting STs. Results: No uniformity regarding the procedures was found among the centers. Most centers were noncompliant with the international guidelines, especially regarding the collection of sweat (the samples were insufficient in 10-50% of the subjects tested); availability of stimulation equipment (which was limited at 2 centers); modernity and certification of stimulation equipment (most of the equipment having been used for 3-23 years); and written protocols (which were lacking at 12 centers). Knowledge of ST guidelines was evaluated at only 1 center. Conclusions: Our results show that STs largely deviate from internationally accepted guidelines at the participating centers. Therefore, there is an urgent need for standardization of STs, training of qualified personnel, and acquisition/certification of suitable equipment. These are essential conditions for a reliable diagnosis of CF, especially with the increasing demand due to newborn screening nationwide, and for the assessment of a possible clinical benefit from the use of modulator drugs.

 


Keywords: Cystic fibrosis/diagnosis; Cystic fibrosis/prevention & control; Sweat.

 


Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

Teste rápido molecular para tuberculose: avaliação do impacto de seu uso na rotina em um hospital de referência

Marilda Casela1,a, Silvânia Maria Andrade Cerqueira1,b, Thais de Oliveira Casela2,c, Mariana Araújo Pereira3,d, Samanta Queiroz dos Santos3,e, Franco Andres Del Pozo4,f, Songeli Menezes Freire3,g, Eliana Dias Matos5,h

J Bras Pneumol.2018;44(2):112-117

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Objective: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.

 


Keywords: Tuberculosis/diagnosis; Molecular diagnostic techniques; Sputum.

 


The Manchester Respiratory Activities of Daily Living questionnaire for use in COPD patients: translation into Portuguese and cross-cultural adaptation for use in Brazil

The Manchester Respiratory Activities of Daily Living questionnaire para o uso em pacientes com DPOC: tradução e adaptação cultural para a língua portuguesa falada no Brasil

Maíra Junkes-Cunha1, Anamaria Fleig Mayer2,3, Cardine Reis1, Abebaw M. Yohannes4, Rosemeri Maurici1

J Bras Pneumol.2016;42(1):15-21

Abstract PDF PT PDF EN Portuguese Text

Objective: To translate The Manchester Respiratory Activities of Daily Living (MRADL) questionnaire into Portuguese and to create a version of the MRADL that is cross-culturally adapted for use in Brazil. Methods: The English-language version of the MRADL was translated into Portuguese by two health care researchers who were fluent in English. A consensus version was obtained by other two researchers and a pulmonologist. That version was back-translated into English by another translator who was a native speaker of English and fluent in Portuguese. The cognitive debriefing process consisted in having 10 COPD patients complete the translated questionnaire in order to test its understandability, clarity, and acceptability in the target population. On the basis of the results, the final Portuguese-language version of the MRADL was produced and approved by the committee and one of the authors of the original questionnaire. Results: The author of the MRADL questioned only a few items in the translated version, and some changes were made to the mobility and personal hygiene domains. Cultural differences regarding the domestic activities domain were found, in particular regarding the item "Do you have the ability to do a full clothes wash and hang them out to dry?", due to socioeconomic and climatic issues. The item "Do you take care of your garden?" was questioned by the participants who lived in apartments, being modified to "Do you take care of your garden or plants in your apartment?" Conclusions: The final Portuguese-language version of the MRADL adapted for use in Brazil was found to be easy to understand and easily applied.

 


Keywords: Activities of daily living; Questionnaires; Translations; Pulmonary disease, chronic obstructive.

 


Types of outcomes in clinical research

Tipos de desfecho em pesquisa clínica

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino1,3

J Bras Pneumol.2017;43(1):5-5

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Does everyone who quit smoking gain weight? A real-world prospective cohort study

Todos os que param de fumar ganham peso? Estudo prospectivo de coorte do mundo real

Edna Jeremias-Martins1,2,a, José Miguel Chatkin1,3,b

J Bras Pneumol.2019;45(1):e20180010-e20180010

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate weight changes after 12 months of biochemically confirmed smoking abstinence, comparing patients who lost weight or maintained their baseline weight with those who gained weight. Methods: This was a real-world prospective cohort study conducted at the Outpatient Smoking Cessation Clinic of São Lucas Hospital, in the city of Porto Alegre, Brazil, between 2010 and 2016. The patients evaluated received intensive smoking cessation counseling, focused especially on weight issues, together with pharmacotherapy, and were followed for 12 months. The baseline and final weights were measured. Continuous abstinence was confirmed by determining the concentration of exhaled carbon monoxide (eCO). Results: Of a total of 348 patients evaluated, 161 (46.2%) achieved continuous abstinence (eCO < 10 ppm) over the 12-month follow-up period. Of those 161 patients, 104 (64.6%) maintained their initial weight or had a weight change of no more than 5% in relation to their baseline weight, whereas the remaining 57 (35.4%) had a weight gain of more than 5%, 18 of those patients showing a > 10% increase over their baseline weight. The number needed to harm (i.e., the number of patients required in order to detect one patient with a weight increase) was calculated to be 3.6 (95% CI: 2.8-5.4). Conclusions: Weight gain is not necessarily associated with smoking cessation, and smokers who are motivated to quit should be informed of that fact. This information could also be useful for addressing smokers who are still undecided because of possibility of weight gain.

 


Keywords: Weight loss; Smoking cessation; Tobacco smoking; Treatment outcome.

 


Cervical computed tomography in patients with obstructive sleep apnea: influence of head elevation on the assessment of upper airway volume

Tomografia computadorizada cervical em pacientes com apneia obstrutiva do sono: influência da elevação postural na avaliação do volume das vias aéreas superiores

Fábio José Fabrício de Barros Souza1, Anne Rosso Evangelista2, Juliana Veiga Silva2, Grégory Vinícius Périco3, Kristian Madeira4,5

J Bras Pneumol.2016;42(1):55-60

Abstract PDF PT PDF EN Portuguese Text

Objective: Obstructive sleep apnea syndrome (OSAS) has a high prevalence and carries significant cardiovascular risks. It is important to study new therapeutic approaches to this disease. Positional therapy might be beneficial in reducing the apnea-hypopnea index (AHI). Imaging methods have been employed in order to facilitate the evaluation of the airways of OSAS patients and can be used in order to determine the effectiveness of certain treatments. This study was aimed at determining the influence that upper airway volume, as measured by cervical CT, has in patients diagnosed with OSAS. Methods: This was a quantitative, observational, cross-sectional study. We evaluated 10 patients who had been diagnosed with OSAS by polysomnography and on the basis of the clinical evaluation. All of the patients underwent conventional cervical CT in the supine position. Scans were obtained with the head of the patient in two positions (neutral and at a 44° upward inclination), and the upper airway volume was compared between the two. Results: The mean age, BMI, and neck circumference were 48.9 ± 14.4 years, 30.5 ± 3.5 kg/m2, and 40.3 ± 3.4 cm, respectively. The mean AHI was 13.7 ± 10.6 events/h (range, 6.0-41.6 events/h). The OSAS was classified as mild, moderate, and severe in 70%, 20%, and 10% of the patients, respectively. The mean upper airway volume was 7.9 cm3 greater when the head was at a 44° upward inclination than when it was in the neutral position, and that difference (17.5 ± 11.0%) was statistically significant (p = 0.002). Conclusions: Elevating the head appears to result in a significant increase in the caliber of the upper airways in OSAS patients.

 


Keywords: Sleep apnea, obstructive/prevention and control; Sleep apnea, obstructive/therapy; Tomography.

 


Translation of the quality-of-life measure for adults with primary ciliary dyskinesia and its application in patients in Brazil

Tradução do questionário de qualidade de vida para pacientes adultos com discinesia ciliar primária no Brasil

Ana Paula Lima de Queiroz1,a, Rodrigo Abensur Athanazio2,b, Mary Anne Kowal Olm3,c, Bruna Rubbo4,5,d, Yuri Reis Casal1,e, Jane Lucas4,5,f, Laura Behan4,5,6,g

J Bras Pneumol.2019;45(3):e20170358-e20170358

Abstract PDF PT PDF EN Portuguese Text Appendix

Primary ciliary dyskinesia (PCD) is a genetic disorder that is typically inherited in an autosomal recessive manner. It is clinically characterized by recurrent respiratory infections. However, its repercussions for patient quality of life should not be overlooked. Studies have shown that PCD has a significant impact on the lives of patients, although there are as yet no PCD-specific markers of quality of life. To address that problem, researchers in the United Kingdom developed a quality-of-life questionnaire for patients with PCD. The present communication focuses on the process of translating that questionnaire into Brazilian Portuguese, through a partnership between researchers in Brazil and those in the United Kingdom, as well as its subsequent application in patients in Brazil.

 


Keywords: Quality of life; Kartagener syndrome; Surveys and questionnaires.

 


Translation and cultural adaptation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module for quality of life assessment in patients with lung cancer in Brazil

Tradução e adaptação cultural do Quality of Life Questionnaire-Lung Cancer Module da European Organisation for Research and Treatment of Cancer para avaliação da qualidade de vida relacionada à saúde em pacientes com câncer de pulmão no Brasil

Ana Paula Ramos Marinho1,2,a, Gracielle Fin3,4,b, Antuani Rafael Baptistella3,c, Rudy José Nodari Júnior3,d, Magnus Benetti4,e

J Bras Pneumol.2019;45(4):e20170458-e20170458

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Objective: To translate the European Organisation for Research and Treatment of Cancer (EORTC) 29-item Quality of Life Questionnaire-Lung Cancer Module (QLQ-LC29, developed for the assessment of quality of life in patients with lung cancer) to Portuguese, conducting a pilot study of the Portuguese-language version and adapting it for use in Brazil. Methods: For the translation, cultural adaptation, and pilot testing of the QLQ-LC29, we followed the guidelines established by the EORTC. The translation (English → Portuguese) and back-translation (Portuguese → English) were both carried out by translators, working independently, who were native speakers of one language and fluent in the other. After review, a draft version was created for pilot testing in lung cancer patients in Brazil. Results: A total of 15 patients diagnosed with lung cancer completed the Portuguese-language version of the questionnaire. At the end of the process, we conducted a structured interview to identify any patient difficulty in understanding any of the questions. The final versions were sent to the EORTC and were approved. Conclusions: The Portuguese-language version of the EORTC QLQ-LC29 appears to be a useful, important, reliable questionnaire that is a valid tool for assessing quality of life in patients with lung cancer in Brazil.

 


Keywords: Surveys and Questionnaires; Lung neoplasms; Quality of Life; Brazil; Translations.

 


Translation, cross-cultural adaptation, and reliability of the Understanding COPD questionnaire for use in Brazil

Tradução, adaptação transcultural e confiabilidade do questionário Understanding COPD para uso no Brasil

Anamaria Fleig Mayer1,2,a, Aline Almeida Gulart1,2,b, Karoliny dos Santos1,c, Katerine Cristhine Cani1,2,d, Manuela Karloh1,2,e, Brenda O'Neill3,f

J Bras Pneumol.2018;44(4):285-291

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Understanding COPD (UCOPD) questionnaire into Portuguese, adapt it for use in Brazil, and assess its reliability. Methods: The UCOPD questionnaire consists of two sections, designated section A and section B. Section A comprises 18 items divided into three domains: "About COPD", "Managing Symptoms of COPD", and "Accessing Help and Support". Section B includes five questions regarding patient satisfaction with the educational component of pulmonary rehabilitation programs. The UCOPD questionnaire was applied twice on the same day by two different raters (with a 10-min interval between applications) and once again 15-20 days later. The Wilcoxon test was used in order to compare the scores among applications. Reliability was assessed by the intraclass correlation coefficient and Bland-Altman plots. Results: The study sample consisted of 50 COPD patients (35 men; mean age, 65.3 ± 7.91 years; mean FEV1, 36.4 ± 16.2% of the predicted value). Inter-rater intraclass correlation coefficients for section A total scores and domain scores ranged from moderate to high. Section A scores and domain scores had no significant differences regarding test-retest reliability (p < 0.05). The test-retest and inter-rater Cronbach's alpha coefficients for section A total scores were 0.93 and 0.86, respectively (p < 0.001). There were no floor or ceiling effects. Conclusions: The Brazilian Portuguese version of the UCOPD questionnaire is reliable.

 


Keywords: Pulmonary disease, chronic obstructive; reproducibility of results; Health knowledge, attitudes, practice.

 


Lung transplantation with extracorporeal membrane oxygenation as intraoperative support

Transplante pulmonar com oxigenação extracorpórea por membrana como suporte intraoperatório

Mariana Schettini-Soares1,a, Pedro Henrique Cunha Leite1,b, Ludhmila Abrahão Hajjar2,c, André Nathan Costa3,d, Paulo Manuel Pêgo-Fernandes1,e, Marcos Naoyuki Samano1,f

J Bras Pneumol.2018;44(5):442-444

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Tracheobronchomalacia in a patient on invasive mechanical ventilation: the role of electrical impedance tomography in its detection and positive end-expiratory pressure titration

Traqueobroncomalácia em paciente sob ventilação mecânica invasiva: o papel da tomografia de impedância elétrica na sua detecção e na titulação da pressão expiratória final positiva

Olívia Meira Dias1, Eduardo Leite Vieira Costa2, Daniel Antunes Silva Pereira3, Caroline Nappi Chaves3, Samia Zahi Rached3, Carmen Silvia Valente Barbas2

J Bras Pneumol.2015;41(2):203-205

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Tuberculosis treatment

Tratamento da tuberculose

Marcelo Fouad Rabahi1,2, José Laerte Rodrigues da Silva Júnior2, Anna Carolina Galvão Ferreira1,3, Daniela Graner Schuwartz Tannus-Silva1, Marcus Barreto Conde4,5

J Bras Pneumol.2018;44(4):340-340

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Tuberculosis treatment

Tratamento da tuberculose

Marcelo Fouad Rabahi1,2, José Laerte Rodrigues da Silva Júnior2, Anna Carolina Galvão Ferreira1,3, Daniela Graner Schuwartz Tannus-Silva1, Marcus Barreto Conde4,5

J Bras Pneumol.2017;43(6):472-486

Abstract PDF PT PDF EN Portuguese Text

Tuberculosis treatment remains a challenge due to the need to consider, when approaching it, the context of individual and collective health. In addition, social and economic issues have been shown to be variables that need to be considered when it comes to treatment effectiveness. We conducted a critical review of the national and international literature on the treatment of tuberculosis in recent years with the aims of presenting health care workers with recommendations based on the situation in Brazil and better informing decision-making regarding tuberculosis patients so as to minimize morbidity and interrupt disease transmission.

 


Keywords: Tuberculosis/drug therapy; Tuberculosis/prevention & control; Tuberculosis/surgery; Tuberculosis/classification.

 


Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

Tratamento da tuberculose grave e suas sequelas: da terapia intensiva à cirurgia e reabilitação

Simon Tiberi1,2,a, Marcela Muñoz Torrico3,b, Ananna Rahman1,c, Maria Krutikov1,d, Dina Visca4,e, Denise Rossato Silva5,f, Heinke Kunst2,g, Giovanni Battista Migliori4,h

J Bras Pneumol.2019;45(2):e20180324-e20180324

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Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.

 


Keywords: Extensively drug-resistant tuberculosis; Tuberculosis, multidrug-resistant; Critical care; Smoking cessation.

 


Management and outcomes of severe childhood tuberculosis in the pediatric intensive care setting: can we identify best practices?

Tratamento e desfechos da tuberculose grave em crianças na unidade de terapia intensiva pediátrica: é possível identificar as melhores práticas?

Svetlana Velizarova1,a, Natalia Gabrovska1,b, Albena Spasova1,c, Ben Marais2,3,d, Elizabeth Page Harausz4,e, Simon Tiberi5,6,f, Giovanni Battista Migliori7,g, Davide Manissero8,h

J Bras Pneumol.2019;45(2):e20190043-e20190043

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Cutaneous tuberculosis as metastatic tuberculous abscess

Tuberculose cutânea como abscesso tuberculoso metastático

Cecília Pacheco1, Eloísa Silva2, José Miranda3, Raquel Duarte4

J Bras Pneumol.2015;41(2):200-202

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Tuberculosis: where are we?

Tuberculose: onde estamos?

Fernanda Carvalho de Queiroz Mello1,a, Denise Rossato Silva2,b, Margareth Pretti Dalcolmo3,c

J Bras Pneumol.2018;44(2):82-82

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Solitary fibrous tumor of the pleura: a rare cause of elevation of the right lung base

Tumor fibroso solitário da pleura: uma causa rara de elevação da base pulmonar direita

Arthur Soares Souza Jr1,2,a, Luciana Volpon Soares Souza1,b, Gláucia Zanetti3,c, Edson Marchiori3,d

J Bras Pneumol.2019;45(1):e20180006-e20180006

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Endobronchial ultrasound in esophageal cancer - when upper gastrointestinal endoscopy is not enough

Ultrassonografia endobrônquica no câncer de esôfago - quando a endoscopia digestiva alta não é suficiente

Lília Maia Santos1,2,a, Márcia Jacomelli1,b, Paulo Rogério Scordamaglio1,c, Paulo Francisco Guerreiro Cardoso3,d, Viviane Rossi Figueiredo1,e

J Bras Pneumol.2019;45(3):e20180312-e20180312

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A rare case of hemorrhagic pneumonia due to Cladosporium cladosporioides

Um caso raro de pneumonia hemorrágica por Cladosporium cladosporioides

Sérgio Grava1,2, Francisco Antonio Dias Lopes3, Rodrigo Silva Cavallazzi4, Melyssa Fernanda Norman Negri Grassi5, Terezinha Inez Estivalet Svidzinski1,2,5

J Bras Pneumol.2016;42(5):392-394

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An uncommon tomographic association: amiodarone pulmonary toxicity and adenocarcinoma

Uma associação tomográfica incomum: toxicidade pulmonar por amiodarona e adenocarcinoma

Arthur Soares Souza Jr1,2, Gláucia Zanetti3, Edson Marchiori3

J Bras Pneumol.2016;42(6):465-465

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Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey

Uso atual e aceitabilidade de novos testes diagnósticos para tuberculose ativa: um inquérito mundial

Massimo Amicosante1,2A, Lia D'Ambrosio3,4, Marcela Munoz5, Fernanda Carvalho de Queiroz Mello6, Marc Tebruegge7,8,9, Novel Njweipi Chegou10, Fouad Seghrouchni11, Rosella Centis3, Delia Goletti12, Graham Bothamley13, Giovanni Battista Migliori3; TB Diagnostic Survey Working Group

J Bras Pneumol.2017;43(5):380-392

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the current use and potential acceptance (by tuberculosis experts worldwide) of novel rapid tests for the diagnosis of tuberculosis that are in line with World Health Organization target product profiles. Methods: A multilingual survey was disseminated online between July and November of 2016. Results: A total of 723 individuals from 114 countries responded to the survey. Smear microscopy was the most commonly used rapid tuberculosis test (available to 90.9% of the respondents), followed by molecular assays (available to 70.7%). Only a small proportion of the respondents in middle- and low-income countries had access to interferon-gamma-release assays. Serological and lateral flow immunoassays were used by more than a quarter (25.4%) of the respondents. Among the respondents who had access to molecular tests, 46.7% were using the Xpert assay overall, that proportion being higher in lower middle-income countries (55.6%) and low-income countries (76.6%). The data also suggest that there was some alignment of pricing for molecular assays. Respondents stated they would accept novel rapid tuberculosis tests if available, including molecular assays (acceptable to 86.0%) or biomarker-based serological assays (acceptable to 81.7%). Simple biomarker-based assays were more commonly deemed acceptable in middle- and low-income countries. Conclusions: Second-generation molecular assays have become more widely available in high- and low-resource settings. However, the development of novel rapid tuberculosis tests continues to be considered important by tuberculosis experts. Our data also underscore the need for additional training and education of end users.

 


Keywords: Tuberculosis/diagnosis; Surveys and questionnaires; Income; Mycobacterium tuberculosis/isolation & purification; Molecular diagnostic techniques/methods; Serologic tests/methods.

 


Use of sirolimus in the treatment of lymphangioleiomyomatosis: favorable responses in patients with different extrapulmonary manifestations

Uso de sirolimo no tratamento de linfangioleiomiomatose: resposta favorável em pacientes com diferentes manifestações extrapulmonares

Carolina Salim Gonçalves Freitas1, Bruno Guedes Baldi2, Mariana Sponholz Araújo1, Glaucia Itamaro Heiden1, Ronaldo Adib Kairalla3, Carlos Roberto Ribeiro Carvalho4

J Bras Pneumol.2015;41(3):275-280

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Objective: Lymphangioleiomyomatosis (LAM) is a rare disease that is currently considered a low-grade neoplasm with metastatic potential and variable progression. Mammalian target of rapamycin (mTOR) inhibitors, such as sirolimus and everolimus, have recently become a treatment option for LAM patients, especially those with extrapulmonary manifestations. The objective of the present study was to describe a case series of four patients with LAM in Brazil who showed significant improvement, particularly in their extrapulmonary manifestations, after treatment with sirolimus (at 1-4 mg/day). Methods: We describe four cases of LAM patients with different extrapulmonary manifestations who were treated with sirolimus. Results: After treatment with sirolimus for 12 months, one patient presented resolution of severe chylothorax; one had a significant reduction in renal angiomyolipoma volume; and one showed significant regression of retroperitoneal lymphangioleiomyomas and abdominal lymph node enlargement. After treatment with sirolimus for 6 months, the remaining patient had a significant reduction in the volume of a massive retroperitoneal lymphangioleiomyoma. Conclusions: Our findings confirm that mTOR inhibitors are beneficial for patients with LAM, especially those with extrapulmonary manifestations, such as renal angiomyolipoma, lymphangioleiomyomas, and chylous effusions. However, certain aspects, such as the optimal dose, duration of treatment, and long-term adverse effects, have yet to be sufficiently clarified for mTOR inhibitors to be incorporated into LAM management protocols.

 


Keywords: Neoplasms; Lymphangioleiomyomatosis/therapy; TOR serine-threonine kinases; Sirolimus.

 


Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery

Usos da sala híbrida em cirurgia torácica: de procedimentos multidisciplinares à cirurgia toracoscópica videoassistida guiada por imagem

Ricardo Mingarini Terra1,2, Juliano Ribeiro Andrade2, Alessandro Wasum Mariani1,2, Rodrigo Gobbo Garcia2, Jose Ernesto Succi2,3, Andrey Soares2,4, Paulo Marcelo Zimmer2

J Bras Pneumol.2016;42(5):387-390

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The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.

 


Keywords: Thoracic surgery, video-assisted; Bronchoscopy; Thoracoscopy; Radiology, interventional.

 


The value of antibody-coated bacteria in tracheal aspirates for the diagnosis of ventilator-associated pneumonia: a case-control study

Utilidade da avaliação de bactérias revestidas por anticorpos em aspirados traqueais para o diagnóstico de pneumonia associada à ventilação mecânica: um estudo caso-controle

Otavio Tavares Ranzani1, Daniel Neves Forte2, Antonio Carlos Forte3, Igor Mimica3, Wilma Carvalho Neves Forte3

J Bras Pneumol.2016;42(3):203-210

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Objective: Ventilator-associated pneumonia (VAP) is the leading type of hospital-acquired infection in ICU patients. The diagnosis of VAP is challenging, mostly due to limitations of the diagnostic methods available. The aim of this study was to determine whether antibody-coated bacteria (ACB) evaluation can improve the specificity of endotracheal aspirate (EA) culture in VAP diagnosis. Methods: We conducted a diagnostic case-control study, enrolling 45 patients undergoing mechanical ventilation. Samples of EA were obtained from patients with and without VAP (cases and controls, respectively), and we assessed the number of bacteria coated with FITC-conjugated monoclonal antibodies (IgA, IgM, or IgG) or an FITC-conjugated polyvalent antibody. Using immunofluorescence microscopy, we determined the proportion of ACB among a fixed number of 80 bacteria. Results: The median proportions of ACB were significantly higher among the cases (n = 22) than among the controls (n = 23)-IgA (60.6% vs. 22.5%), IgM (42.5% vs. 12.5%), IgG (50.6% vs. 17.5%), and polyvalent (75.6% vs. 33.8%)-p < 0.001 for all. The accuracy of the best cut-off points for VAP diagnosis regarding monoclonal and polyvalent ACBs was greater than 95.0% and 93.3%, respectively. Conclusions: The numbers of ACB in EA samples were higher among cases than among controls. Our findings indicate that evaluating ACB in EA is a promising tool to improve the specificity of VAP diagnosis. The technique could be cost-effective and therefore useful in low-resource settings, with the advantages of minimizing false-positive results and avoiding overtreatment.

 


Keywords: Pneumonia, ventilator-associated/diagnosis; Immunohistochemistry; Fluorescent antibody technique; Antibodies, bacterial/analysis; Trachea/microbiology; Intensive care units.

 


Validation of scores of use of inhalation devices: valoration of errors

Validação de escores de uso de dispositivos para inalação: valoração dos erros cometidos

Letícia Zambelli-Simões1, Maria Cleusa Martins2, Juliana Carneiro da Cunha Possari3, Greice Borges Carvalho4, Ana Carla Carvalho Coelho5, Sonia Lucena Cipriano6, Regina Maria de Carvalho-Pinto7, Alberto Cukier7, Rafael Stelmach7

J Bras Pneumol.2015;41(4):313-322

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Objective: To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices. Methods: This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria. Results: The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05). Conclusions: The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.

 


Keywords: Asthma; Dry powder inhalers; Metered dose inhalers; Validation studies.

 


Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD

Validação de um sistema de análise de impedância bioelétrica para a avaliação da composição corporal de pacientes com DPOC

Fernanda Rodrigues Fonseca1,2,a, Manuela Karloh2,3,b, Cintia Laura Pereira de Araujo1,2,c, Cardine Martins dos Reis1,2,d, Anamaria Fleig Mayer1,2,3,e

J Bras Pneumol.2018;44(4):315-320

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Objective: To investigate the validity of an eight-contact electrode bioelectrical impedance analysis (BIA) system within a household scale for assessing whole body composition in COPD patients. Methods: Seventeen patients with COPD (mean age = 67 ± 8 years; mean FEV1 = 38.6 ± 16.1% of predicted; and mean body mass index = 24.7 ± 5.4 kg/m2) underwent dual-energy X-ray absorptiometry (DEXA) and an eight-contact electrode BIA system for body composition assessment. Results: There was a strong inter-method correlation for fat mass (r = 0.95), fat-free mass (r = 0.93), and lean mass (r = 0.93), but the correlation was moderate for bone mineral content (r = 0.73; p < 0.01 for all). In the agreement analysis, the values between DEXA and the BIA system differed by only 0.15 kg (−6.39 to 6.70 kg), 0.26 kg (−5.96 to 6.49 kg), −0.13 kg (−0.76 to 0.50 kg), and −0.55 kg (−6.71 to 5.61 kg) for fat-free mass, lean mass, bone mineral content, and fat mass, respectively. Conclusions: The eight-contact electrode BIA system showed to be a valid tool in the assessment of whole body composition in our sample of patients with COPD.

 


Keywords: Pulmonary disease, chronic obstructive; Body composition; Electric impedance.

 


Validity and reliability of assessing diaphragmatic mobility by area on X-rays of healthy subjects

Validade e confiabilidade da avaliação da mobilidade diafragmática pelo método da área radiográfica em sujeitos saudáveis

Aline Pedrini1,a, Márcia Aparecida Gonçalves1,b, Bruna Estima Leal1,c, Michelle Gonçalves de Souza Tavares2,d, Wellington Pereira Yamaguti3,e, David Luiz Góes4,f, Elaine Paulin1,g

J Bras Pneumol.2018;44(3):220-226

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Objective: To investigate the concurrent validity, as well as the intra- and inter-rater reliability, of assessing diaphragmatic mobility by area (DMarea) on chest X-rays of healthy adults. Methods: We evaluated anthropometric parameters, pulmonary function, and diaphragmatic mobility in 43 participants. Two observers (rater A and rater B) determined diaphragmatic mobility at two time points. We used Pearson's correlation coefficient to evaluate the correlation between DMarea and the assessment of diaphragmatic mobility by distance (DMdist). To evaluate intra- and inter-rater reliability, we used the intraclass correlation coefficient (ICC [2,1]), 95% CI, and Bland-Altman analysis. Results: A significant correlation was found between the DMarea and DMdist methods (r = 0.743; p < 0.0001). For DMarea, the intra-rater reliability was found to be quite high for the right hemidiaphragm (RHD)-ICC (2,1) = 0.92 (95% CI: 0.86-0.95) for rater A and ICC (2,1) = 0.90 (95% CI: 0.84-0.94) for rater B-and the left hemidiaphragm (LHD)-ICC (2,1) = 0.96 (95% CI: 0.93-0.97) for rater A and ICC (2,1) = 0.91 (95% CI: 0.81-0.95) for rater B-(p < 0.0001 for all). Also for DMarea, the inter-rater reliability was found to be quite high for the first and second evaluations of the RHD-ICC (2,1) = 0.99 (95% CI: 0.98-0.99) and ICC (2,1) = 0.95 (95% CI: 0.86-0.97), respectively-and the LHD-ICC (2,1) = 0.99 (95% CI: 0.98-0.99) and ICC (2,1) = 0.94 (95% CI: 0.87-0.97)-(p < 0.0001 for both). The Bland-Altman analysis showed good agreement between the mobility of the RHD and that of the LHD. Conclusions: The DMarea method proved to be a valid, reliable measure of diaphragmatic mobility.

 


Keywords: Diaphragm/physiology; Validation studies; Reproducibility of results; Radiography.

 


Internal and external validity: can you apply research study results to your patients?

Validade interna e externa: você pode aplicar resultados de pesquisa para seus pacientes?

Cecilia Maria Patino1,2,a, Juliana Carvalho Ferreira1,3,b

J Bras Pneumol.2018;44(3):183-183

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Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases

Valor diagnóstico da punção aspirativa por agulha guiada por ultrassom endobrônquico em diferentes doenças pulmonares

Mediha Gonenc Ortakoylu1, Sinem Iliaz1, Ayse Bahadir1, Asuman Aslan1, Raim Iliaz2, Mehmet Akif Ozgul1, Halide Nur Urer3

J Bras Pneumol.2015;41(5):410-414

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Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value. Methods: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up. Results: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases. Conclusions: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.

 


Keywords: Sarcoidosis; Tuberculosis, pulmonary; Lung neoplasms; Bronchoscopy; Mediastinoscopy; Endosonography.

 


Spirometry reference values for Black adults in Brazil

Valores de referência para espirometria forçada em adultos negros no Brasil

Tarciane Aline Prata1,a, Eliane Mancuzo2,3,b, Carlos Alberto de Castro Pereira4,c,Silvana Spíndola de Miranda2,d, Larissa Voss Sadigursky5,e, Camila Hirotsu6,f, Sérgio Tufik6,g

J Bras Pneumol.2018;44(6):449-455

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Objective: To derive reference equations for spirometry in healthy Black adult never smokers in Brazil, comparing them with those published in 2007 for White adults in the country. Methods: The examinations followed the standards recommended by the Brazilian Thoracic Association, and the spirometers employed met the technical requirements set forth in the guidelines of the American Thoracic Society/European Respiratory Society. The lower limits were defined as the 5th percentile of the residuals. Results: Reference equations and limits were derived from a sample of 120 men and 124 women, inhabitants of eight Brazilian cities, all of whom were evaluated with a flow spirometer. The predicted values for FVC, FEV1 , FEV1 /FVC ratio, and PEF were better described by linear equations, whereas the flows were better described by logarithmic equations. The FEV1 and FVC reference values derived for Black adults were significantly lower than were those previously derived for White adults, regardless of gender. Conclusions: The fact that the predicted spirometry values derived for the population of Black adults in Brazil were lower than those previously derived for White adults in the country justifies the use of an equation specific to the former population.

 


Keywords: Spirometry; Reference values; African continental ancestry group.

 


Reference values for the six-minute pegboard and ring test in healthy adults in Brazil

Valores de referência para o teste de argolas de seis minutos em adultos saudáveis no Brasil

Vanessa Pereira Lima1,2,a, Fabiana Damasceno Almeida3,4,b, Tania Janaudis-Ferreira5,6,c, Bianca Carmona3,4,d, Giane Amorim Ribeiro-Samora3,4,e, Marcelo Velloso3,4,f

J Bras Pneumol.2018;44(3):190-194

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Objective: To determine reference values for the six-minute pegboard and ring test (6PBRT) in healthy adults in Brazil, correlating the results with arm length, circumference of the upper arm/forearm of the dominant arm, and the level of physical activity. Methods: The participants (all volunteers) performed two 6PBRTs, 30 min apart. They were instructed to move as many rings as possible in six minutes. The best test result was selected for data analysis. Results: The sample comprised 104 individuals, all over 30 years of age. Reference values were reported by age bracket. We found that age correlated with 6PBRT results. The number of rings moved was higher in the 30- to 39-year age group than in the > 80-year age group (430.25 ± 77.00 vs. 265.00 ± 65.75), and the difference was significant (p < 0.05). The 6PBRT results showed a weak, positive correlation with the level of physical activity (r = 0.358; p < 0.05) but did not correlate significantly with any other variable studied. Conclusions: In this study, we were able to determine reference values for the 6PBRT in healthy adults in Brazil. There was a correlation between 6PBRT results and age.

 


Keywords: Upper extremity; Physical endurance; Exercise tolerance; Exercise test.

 


Reference values for pulmonary volumes by plethysmography in a Brazilian sample of white adults

Valores de referência para volumes pulmonares por pletismografia em uma amostra brasileira de adultos da raça branca

Thamine Lessa1,a, Carlos Alberto de Castro Pereira2,b, Maria Raquel Soares2,c, Renato Matos3,d, Virgínia Pacheco Guimarães4,e, Giancarlo Sanches5,f, Roberto Helou Rassi6,g, Israel Maia7,h

J Bras Pneumol.2019;45(3):e20180065-e20180065

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Objective: To derive reference values for healthy white Brazilian adults who have never smoked and to compare the obtained values with reference values derived by Crapo and by Neder. Methods: Reference equations by quantile regressions were derived in 122 men and 122 women, non-obese, living in seven cities in Brazil. Age ranged from 21 to 92 years in women and from 25 to 88 years in men. Lung function tests were performed using SensorMedics automated body plethysmographies according ATS/ERS recommendations. Lower and upper limits were derived by specific equations for 5 and 95 percentiles. The results were compared to those suggested by Crapo in 1982, and Neder in 1999. Results: Median values for total lung capacity (TLC) were influenced only by stature in men, and by stature and age in women. Residual volume was influenced by age and stature in both genders. Weight was directly related to inspiratory capacity and inversely with functional residual capacity and expiratory reserve volume in both genders. A comparison of observed TLC data with values predicted by Neder equations showed significant lower values by the present data. Mean values were similar between data from present study and those derived by Crapo. Conclusion: New predicted values for lung volumes were obtained in a sample of white Brazilians. The values differ from those derived by Neder, but are similar to those derived by Crapo.

 


Keywords: Pulmonary volumes; Pulmonary function tests; Reference values; Pulmonary plethysmography

 


Variation in lung function is associated with worse clinical outcomes in cystic fibrosis

Variação na função pulmonar está associada com piores desfechos clínicos em indivíduos com fibrose cística

João Paulo Heinzmann-Filho1,2, Leonardo Araujo Pinto1,2, Paulo José Cauduro Marostica3, Márcio Vinícius Fagundes Donadio1,2,4

J Bras Pneumol.2015;41(6):509-515

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Objective: To determine whether the variation in lung function over one year is associated with worse clinical outcomes, as well as with a decline in lung function in the following years, in patients with cystic fibrosis (CF). Methods: This was a retrospective study involving CF patients (4-19 years of age), evaluated over a three-year period. We evaluated demographic characteristics, chronic Pseudomonas aeruginosa infection, antibiotic use, hospitalization, six-minute walk distance (6MWD), and lung function. The inclusion criterion was having undergone pulmonary function testing at least three times in the first year and at least once in each of the next two years. Results: We evaluated 35 CF patients. The variation in FEV1 in the first year (ΔFEV1) was greater among those who, in the third year, showed reduced FEV1, had a below-average 6MWD, or were hospitalized than among those with normal FEV1, normal 6MWD, or no hospital admissions, in that same year (p < 0.05), although no such difference was found for antibiotic use in the third year. Subjects showing a ΔFEV1 ≥ 10% also showed a greater decline in FEV1 over the two subsequent years (p = 0.04). The ΔFEV1 also showed an inverse correlation with absolute FEV1 in the third year (r = −0.340, p = 0.04) and with the rate of FEV1 decline (r = −0.52, p = 0.001). Linear regression identified ΔFEV1 as a predictor of FEV1 decline (coefficient of determination, 0.27). Conclusions: Significant variation in lung function over one year seems to be associated with a higher subsequent rate of FEV1 decline and worse clinical outcomes in CF patients. Short-term ΔFEV1 might prove useful as a predictor of CF progression in clinical practice.

 


Keywords: Cystic fibrosis; Respiratory function tests; Disease progression; Hospitalization; Forced expiratory volume.

 


Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry

Velhice extrema em um centro diagnóstico respiratório: frequência e qualidade técnica da espirometria

Saulo Maia d'Avila Melo1,a, Larissa Alves de Oliveira2,b, José Lucas Farias Wanderley3,c, Rodrigo dos Anjos Rocha4,d

J Bras Pneumol.2019;45(4):e20180232-e20180232

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Objective: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. Methods: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. Results: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). Conclusions: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.

 


Keywords: Spirometry; Aging; Aged, 80 and over.

 


Viability of gait speed test in hospitalized elderly patients

Viabilidade do teste de velocidade de marcha em idosos hospitalizados

Bruno Prata Martinez1,2, Anne Karine Menezes Santos Batista3, Isis Resende Ramos3, Júlio Cesar Dantas3, Isabela Barboza Gomes3, Luiz Alberto Forgiarini Jr4, Fernanda Rosa Warken Camelier1, Aquiles Assunção Camelier1,5

J Bras Pneumol.2016;42(3):196-202

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Objective: The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. Methods: This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = −0.27 to 0.15). Conclusions: The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance.

 


Keywords: Disability evaluation; Reproducibility of results; Hospitalization; Mobility limitation; Health of the elderly.

 


Tuberculosis surveillance in an endemic area of northeastern Brazil. What do the epidemiological indicators reveal?

Vigilância da tuberculose em uma área endêmica do Nordeste brasileiro: O que revelam os indicadores epidemiológicos?

Carlos Dornels Freire de Souza1,2,a, Thais Silva Matos3,4,b, Victor Santana Santos5,c, Franklin Gerônimo Bispo Santos2,d

J Bras Pneumol.2019;45(2):e20180257-e20180257

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Lung volumes and airway resistance in patients with a possible restrictive pattern on spirometry

Volumes pulmonares e resistência das vias aéreas em pacientes com possível padrão restritivo à espirometria

Kenia Schultz1,2, Luiz Carlos D'Aquino3, Maria Raquel Soares4, Andrea Gimenez5, Carlos Alberto de Castro Pereira4,5

J Bras Pneumol.2016;42(5):341-347

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Objective: Many patients with proportional reductions in FVC and FEV1 on spirometry show no reduction in TLC. The aim of this study was to evaluate the role that measuring lung volumes and airway resistance plays in the correct classification of patients with a possible restrictive pattern on spirometry. Methods: This was a prospective study involving adults with reduced FVC and FEV1, as well as an FEV1/FV(C) ratio within the predicted range. Restrictive lung disease (RLD) was characterized by TLC below the 5th percentile, as determined by plethysmography. Obstructive lung disease (OLD) was characterized by high specific airway resistance, significant changes in post-bronchodilator FEV1, or an FEF25-75% < 50% of predicted, together with a high RV/TLC ratio. Nonspecific lung disease (NLD) was characterized by TLC within the predicted range and no obstruction. Combined lung disease (CLD) was characterized by reduced TLC and findings indicative of airflow obstruction. Clinical diagnoses were based on clinical suspicion, a respiratory questionnaire, and the review of tests of interest. Results: We included 300 patients in the study, of whom 108 (36%) were diagnosed with RLD. In addition, 120 (40%) and 72 (24%) were diagnosed with OLD/CLD and NLD, respectively. Among the latter, 24 (33%) were clinically diagnosed with OLD. In this sample, 151 patients (50.3%) were obese, and obesity was associated with all patterns of lung disease. Conclusions: Measuring lung volumes and airway resistance is often necessary in order to provide an appropriate characterization of the pattern of lung disease in patients presenting with a spirometry pattern suggestive of restriction. Airflow obstruction is common in such cases.

 


Keywords: Spirometry; Airway resistance; Lung volume measurements.

 


 

 


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