Brazilian Journal of Pulmonology

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

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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.

 


Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil

Asma e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos no Sul do Brasil

Moema Nudilemon Chatkin, Ana Maria Baptista Menezes, Silvia Elaine Cardozo Macedo, Edgar Fiss

J Bras Pneumol.2008;34(10):-

Abstract PDF PT PDF EN Portuguese Text

Objective: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. Methods: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. Results: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. Conclusions: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.

 


Keywords: Asthma; Respiratory function tests; Respiratory sounds; Signs and symptoms, respiratory.

 


Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study

Avaliação da técnica de utilização de dispositivos inalatórios no tratamento de doenças respiratórias no sul do Brasil: estudo de base populacional

Paula Duarte de Oliveira, Ana Maria Baptista Menezes, Andréa Dâmaso Bertoldi, Fernando César Wehrmeister, Silvia Elaine Cardozo Macedo

J Bras Pneumol.2014;40(5):513-520

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify incorrect inhaler techniques employed by patients with respiratory diseases in southern Brazil and to profile the individuals who make such errors. Methods: This was a population-based, cross-sectional study involving subjects ≥ 10 years of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722 households in the city of Pelotas, Brazil. Results: We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most common errors in the use of MDIs and DPIs were not exhaling prior to inhalation (66% and 47%, respectively), not performing a breath-hold after inhalation (29% and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of age more often made such errors. Among the demonstrations of the use of MDIs and DPIs, at least one error was made in 72% and 51%, respectively. Overall, there were errors made in all steps in 11% of the demonstrations, whereas there were no errors made in 13%.Among the individuals who made at least one error, the proportion of those with a low level of education was significantly greater than was that of those with a higher level of education, for MDIs (85% vs. 60%; p = 0.018) and for DPIs (81% vs. 35%; p = 0.010).Conclusions: In this sample, the most common errors in the use of inhalers were not exhaling prior to inhalation, not performing a breath-hold after inhalation, and not shaking the MDI prior to use. Special attention should be given to education regarding inhaler techniques for patients of lower socioeconomic status and with less formal education, as well as for those of advanced age, because those populations are at a greater risk of committing errors in their use of inhalers.

 


Keywords: Asthma; Pulmonary disease, chronic obstructive; Dry powder inhalers; Metered dose inhalers.

 


Epidemiologia da bronquite crônica e do enfisema (DPOC): até onde sabemos?

Ana Maria Baptista Menezes

J Bras Pneumol.1997;23(3):153-157

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Wheezing phenotypes from birth to adolescence: a cohort study in Pelotas, Brazil, 1993-2004

Padrões de sibilância respiratória do nascimento até o início da adolescência: coorte de Pelotas (RS) Brasil, 1993-2004

Adriana Muiño, Ana Maria Baptista Menezes, Felipe Fossati Reichert, Rodrigo Pereira Duquia, Moema Chatkin

J Bras Pneumol.2008;34(6):347-355

Abstract PDF PT PDF EN Portuguese Text

Objective: To study the prevalence of wheezing patterns and their associations with independent variables. Methods: Cohort study of live births in 1993 in Pelotas, Brazil. A systematic subsample (20%) of the original cohort was evaluated at 6 months, 12 months and 4 years. At 10-12 years, 87.5% of the original cohort was contacted. Wheezing was categorized: transient, wheezing at 4 years but not at 10-12; persistent, wheezing at all evaluations; late-onset, wheezing at 10-12 years. Independent variables were analyzed: gender; skin color; family income; smoking/asthma during pregnancy; breastfeeding; respiratory infection/diarrhea (during the 1st year); family members with asthma/ allergy (at 4 years and at 10-12); physician-diagnosed rhinitis/eczema (at 10-12 years). Results: The subsample comprised 897 adolescents. Wheezing patterns were expressed as prevalence (95% CI): transient, 43.9% (40.7-47.2); persistent, 6.4% (4.8-8.0); and late-onset, 3.3% (2.2-4.5). The transient pattern was more common in children from low-income families, children breastfed for less time, children with a history of respiratory infections (during the 1st year) and children with asthma in the family (at 4 years). The persistent pattern was almost twice as common in males, in children whose mothers had asthma during pregnancy, in children with respiratory infections (during the 1st year) and in children with asthma in the family (at 4 and 10-12 years). The late-onset pattern was more prevalent among those with asthma in the family (at 10-12 years) and those diagnosed with rhinitis (at 10-12 years), being less prevalent among those reporting respiratory infections (during the 1st year) and those diagnosed with eczema (at 10-12 years). Conclusions: Knowledge of the associations of wheezing patterns allows us to adopt preventive and therapeutic measures.

 


Keywords: Respiratory sounds; Asthma; Epidemiology; Hypersensitivity.

 


Scientific production of the Brazilian Society of Pulmonology and Phthisiology: 1979-2006

Produção científica da Sociedade Brasileira de Pneumologia e Tisiologia: 1979 a 2006

Ana Maria Baptista Menezes

J Bras Pneumol.2006;32(4):xv-xvii

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Pulmonary rehabilitation programs for patients with COPD

Programas de reabilitação pulmonar em pacientes com DPOC

Fernando César Wehrmeister, Marli Knorst, José Roberto Jardim, Silvia Elaine Cardozo Macedo, Ricardo Bica Noal, Jeovany Martínez-Mesa, David Alejandro González, Samuel Carvalho Dumith, Maria de Fátima Maia, Pedro Curi Hallal, Ana Maria Baptista Menezes

J Bras Pneumol.2011;37(4):544-555

Abstract PDF PT PDF EN Portuguese Text

Pulmonary rehabilitation programs are aimed at providing benefits to COPD patients, in various aspects. Our objective was to review the literature on COPD patient rehabilitation. This systematic review involved articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). The outcome measures were exercise, quality of life, symptoms, exacerbations, mortality, and pulmonary function. Treatments were classified as standard rehabilitation, partial rehabilitation, strength exercises, and resistance exercises. Of the 40 articles selected, 4, 18, and 18 were classified as grades A, B, and C, respectively. Of the 181 analyses made in these articles, 61, 50, 23, 23, 20, and 4, respectively, were related to the outcome measures quality of life, exercise, symptoms, exacerbations, pulmonary function, and mortality. The standard rehabilitation programs showed positive effects on all of the outcomes evaluated, except for mortality (because of the small number of analyses). However, we found no differences among the various rehabilitation programs regarding their effects on the outcomes studied. Rehabilitation programs can be considered important tools for the treatment of COPD. Therefore, health administrators should implement public policies including such programs in the routine of health care facilities.

 


Keywords: Rehabilitation; Pulmonary disease, chronic obstructive; Review.

 


Smoking among medical students: temporal trends and related variables

Tabagismo em estudantes de Medicina: tendências temporais e fatores associados

Ana Maria Baptista Menezes, Pedro Curi Hallal, Fernando Silva, Marcos Souza, Luciene Paiva, Aline D'Ávila, Bianca Weber, Viviane Vaz, Fernando Marques, Bernardo L. Horta

J Bras Pneumol.2004;30(3):223-228

Abstract PDF PT

Background: Although the prevalence of smoking among medical students declined steadily between the 1960s and 1980s, it seems to have stabilized in recent years. Objectives: To evaluate temporal trends, over the last 17 years, in the smoking habits of medical students at the Universidade Federal de Pelotas, in the state of Rio Grande do Sul, Brazil, and to identify some possible risk factors for smoking. Method: Cross-sectional surveys with comparable methodologies were conducted in 1986, 1991, 1996 and 2002. Self-administered questionnaires were used. Smokers were defined as those who were smoking at least one cigarette per day for at least one month. Descriptive analyses were carried out, as well as crude evaluations using chi-square tests for heterogeneity and linear trend. In addition, Poisson regression, adjusted for age, was used in order to evaluate the effect of medical school class year on the incidence of smoking. Results: The prevalence of smoking among UFPel medical students was 10.1%, statistically similar to values found in 1991 and 1996. No differences in smoking frequency were found relating to sex, age, or parental smoking. The prevalence of smoking was found to increase progressively over the course of medical school. Conclusions: The downward trend in smoking prevalence among UFPel medical students is being replaced by a stable rate of approximately 10-15%. Anti-smoking campaigns are still necessary in university environments, especially in medical schools.

 


Keywords: Smoking/trends. Smoking/epidemiology. Medical students/tobacco use cessation. Cross-sectional studies. Questionnaires.

 


Pharmacological treatment of COPD

Tratamento farmacológico da DPOC

Ana Maria Baptista Menezes, Silvia Elaine Cardozo Macedo, Ricardo Bica Noal, Jussara Fiterman, Alberto Cukier, José Miguel Chatkin, Frederico Leon Arrabal Fernandes; Grupo de Trabalho da Sociedade Brasileira de Pneumologia e Tisiologia, Grupo de Trabalho do Programa de Pós-Graduação em Epidemiologia da

J Bras Pneumol.2011;37(4):527-543

Abstract PDF PT PDF EN Portuguese Text

Approximately seven million Brazilians over 40 years of age have COPD. In recent years, major advances have been made in the pharmacological treatment of this condition. We performed a systematic review including original articles on pharmacological treatments for COPD. We reviewed articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles with a sample size < 100 individuals were excluded. The outcome measures were symptoms, pulmonary function, quality of life, exacerbations, mortality, and adverse drug effects. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). Of the 84 articles selected, 40 (47.6%), 18 (21.4%), and 26 (31.0%) were classified as grades A, B, and C, respectively. Of the 420 analyses made in these articles, 236 were regarding the comparison between medications and placebos. Among these 236 analyses, the most commonly studied medications (in 66, 48, and 42 analyses, respectively) were long-acting anticholinergics; the combination of long-acting 2 agonists and inhaled corticosteroids; and inhaled corticosteroids in isolation. Pulmonary function, adverse effects, and symptoms as outcomes generated 58, 54, and 35 analyses, respectively. The majority of the studies showed that the medications evaluated provided symptom relief; improved the quality of life and pulmonary function of patients; and prevented exacerbations. Few studies analyzed mortality as an outcome, and the role that pharmacological treatment plays in this outcome has yet to be fully defined. The medications studied are safe to use in the management of COPD and have few adverse effects.

 


Keywords: Pulmonary disease, chronic obstructive/therapy; Pulmonary disease, chronic obstructive/mortality; Review.

 


Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil

Uso de inaladores na população de adolescentes e adultos com diagnóstico médico autorreferido de asma, bronquite ou enfisema em Pelotas, RS

Paula Duarte de Oliveira, Ana Maria Baptista Menezes, Andréa Dâmaso Bertoldi, Fernando César Wehrmeister

J Bras Pneumol.2013;39(3):287-295

Abstract PDF PT PDF EN Portuguese Text

To evaluate the characteristics of users of inhalers and the frequency of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. Methods: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. Results: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. Conclusions: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.

 


Keywords: Metered dose inhalers; Asthma; Pulmonary disease, chronic obstructive; Bronchitis; Emphysema; Dry powder inhalers.

 


Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study

Variabilidade dos sintomas diários de pacientes com DPOC estável no Brasil: um estudo observacional de vida real

Alberto Cukier1, Irma de Godoy2, Claudia Henrique da Costa3, Adalberto Sperb Rubin4, Marcelo Gervilla Gregorio5, Aldo Agra de Albuquerque Neto6, Marina Andrade Lima7, Monica Corso Pereira8, Suzana Erico Tanni2, Rodrigo Abensur Athanazio1, Elizabeth Jauhar Cardoso Bessa3, Fernando Cesar Wehrmeister9, Cristina Bassi Lourenco10, Ana Maria Baptista Menezes9

J Bras Pneumol.2020;46(3):e20190223-e20190223

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV1 (r = −0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.

 


Keywords: Pulmonary disease, chronic obstructive; Signs and symptoms, respiratory; Quality of life; Disease progression; Brazil.

 


 

 


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