Brazilian Journal of Pulmonology

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


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Histological features and survival in idiopathic pulmonary fibrosis

Achados histológicos e sobrevida na fibrose pulmonar idiopática

Ester Nei Aparecida Martins Coletta, Carlos Alberto de Castro Pereira, Rimarcs Gomes Ferreira, Adalberto Sperb Rubin, Lucimara Sonja Villela, Tatiana Malheiros, João Norberto Stávale

J Bras Pneumol.2003;29(6):371-378

Abstract PDF PT

Background: Idiopathic pulmonary fibrosis was recently redefined as usual interstitial pneumonia of unknown etiology. Consequently, the prognostic value of histological findings needs to be reassessed. Objective: To correlate clinical, functional and histological findings with survival in patients with idiopathic pulmonary fibrosis. Method: Patients (n = 51; mean age: 66 ± 8 years; gender: 21 females/30 males) were evaluated. Of the 51, 26 were smokers or ex-smokers. Duration of symptoms, forced vital capacity and smoking habits were recorded. All patients presented usual interstitial pneumonia verified through histology. Degree of honeycombing, established fibrosis, desquamation, cellularity, myointimal thickening of blood vessels and number of fibroblastic foci were graded according to the semiquantitative method. Results: Median duration of symptoms was 12 months and initial forced vital capacity was 72 ± 21%. Cox multivariate analysis revealed that survival correlated inversely and significantly (p < 0.05) with duration of symptoms and fibroblastic foci score, as well as with myointimal thickening of blood vessels. Limited numbers of fibroblastic foci, as well as myointimal thickening involving less than 50% of blood vessels, were predictive of greater survival. No correlation with survival was found for gender, age, forced vital capacity, inflammation or degree of cellularity. Conclusion: Semiquantitative analysis of lung biopsies yields relevant prognostic information regarding patients with usual interstitial pneumonia.


Keywords: Pulmonary fibrosis. Lung diseases, interstitial. Survival analysis.


Lung adenocarcinoma, dermatomyositis, and Lambert-Eaton myasthenic syndrome: a rare combination

Adenocarcinoma pulmonar, dermatomiosite e síndrome miastênica de Lambert-Eaton: uma rara associação

Fernanda Manente Milanez, Carlos Alberto de Castro Pereira, Pedro Henrique Duccini Mendes Trindade, Ricardo Milinavicius, Ester Nei Aparecida Martins Coletta

J Bras Pneumol.2008;34(5):333-336

Abstract PDF PT PDF EN Portuguese Text

The incidence of lung neoplasms is increasing in Brazil and in the world, probably as a result of the increase in smoking. Due to the greater number of cases, atypical presentations appear. We report the case of a 66-year-old hypertensive male smoker who presented progressive proximal muscular weakness and, in two months, evolved to dysphagia, dysphonia, and V-shaped skin lesions on the chest. A chest X-ray showed a spiculated pulmonary nodule in the right upper lobe. The biochemical analysis revealed elevated creatine kinase levels. After complementary tests and biopsies, the patient underwent right upper lobectomy. Histopathology showed a moderately differentiated adenocarcinoma. The overall analysis of the case and a review of the literature allow us to suggest that the clinical profile of the patient was a result of an overlap of two paraneoplastic syndromes (dermatomyositis and Lambert-Eaton myasthenic syndrome) secondary to lung adenocarcinoma.


Keywords: Lung neoplasms; Paraneoplastic syndromes; Dermatomyositis; Lambert-Eaton myasthenic syndrome; Adenocarcinoma.


Spirometric changes in obstructive disease: after all, how much is significant?

Alterações espirométricas em doenças obstrutivas: afinal, o quanto é relevante?

André Luis Pinto Soares, Carlos Alberto de Castro Pereira, Silvia Carla Rodrigues

J Bras Pneumol.2013;39(1):56-62

Abstract PDF PT PDF EN

Objective: To establish the upper limits for changes in FEV1, slow vital capacity (SVC), FVC, and inspiratory capacity (IC) after placebo administration in patients with airflow obstruction. Methods: One hundred and two adults with airflow obstruction (FEV1 = 62 ± 19% of predicted) were included in the study. All of the participants performed SVC and FVC maneuvers before and after the administration of placebo spray. The changes in FEV1, SVC, FVC, and IC were expressed as absolute values, percentage of change from baseline values, and percentage of predicted values, 95% CIs and 95th percentiles being calculated. Factor analysis was performed in order to determine how those changes clustered. Results: Considering the 95% CIs and 95th percentiles and after rounding the values, we found that the upper limits for a significant response were as follows: FEV1 = 0.20 L, FVC = 0.20 L, SVC = 0.25 L, and IC = 0.30 L (expressed as absolute values); FEV1 = 12%, FVC = 7%, SVC = 10%, and IC = 15% (expressed as percentage of change from baseline values); and FEV1 = 7%, FVC = 6%, SVC = 7%, and IC = 12% (expressed as percentage of predicted values). Conclusions: In patients with airflow obstruction, IC varies more widely than do FVC and SVC. For IC, values greater than 0.30 L and 15% of change from the baseline value can be considered significant. For FVC, values greater than 0.20 L and 7% of change from the baseline value are significant. Alternatively, changes exceeding 0.20 L and 7% of the predicted value can be considered significant for FEV1 and FVC. On factor analysis, spirometric parameters clustered into three dimensions, expressing changes in flows, volumes, and dynamic hyperinflation.


Keywords: Respiratory function tests; Spirometry; Bronchospirometry.


Congenital bronchial atresia: report of two cases. Contribution of CT scan to diagnosis

Atresia brônquica congênita: relato de dois casos. Contribuição da tomografia computadorizada ao diagnóstico

Alecsandra Calil Moyses Faure, Ana Paula Andrade Barreto, Carlos Alberto de Castro Pereira, Clystenes Odyr Soares Silva

J Bras Pneumol.2000;26(3):142-144

Abstract PDF PT

Bronchial atresia is a rare, congenital anomaly characterized by the presence of bronchocele with distal hyperinflation. The authors report two cases of segmental bronchial atresia and describe the clinical and roentgenographic findings supporting the diagnosis in the absence of other invasive diagnostic modalities or surgical exploration.


Keywords: pulmonary atresia; bronchi; X-ray computed tomography


Avaliação propedêutica da dispnéia crônica de etiologia indefinida: desafios atuais

Carlos Alberto de Castro Pereira

J Bras Pneumol.1999;25(2):137-140


Bronchiolitis associated with exposure to artificial butter flavoring in workers at a cookie factory in Brazil

Bronquiolite associada à exposição a aroma artificial de manteiga em trabalhadores de uma fábrica de biscoitos no Brasil

Zaida do Rego Cavalcanti, Alfredo Pereira Leite de Albuquerque Filho, Carlos Alberto de Castro Pereira, Ester Nei Aparecida Martins Coletta

J Bras Pneumol.2012;38(3):395-399

Abstract PDF PT PDF EN Portuguese Text

Objective: To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil. Methods: We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. Results: All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. Conclusions: Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.


Keywords: Diacetyl; Flavoring agents; Bronchiolitis.


Bronchiolitis obliterans with organizing pneumonia (BOOP)

Bronquiolite obliterante com pneumonia em organização (BOOP) aguda

José Eduardo Delfini Cançado, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(5):331-334

Abstract PDF PT

Most interstitial lung diseases (ILD) are indolent in nature, producing subacute or chronic symptoms that progress at various rates and are usually present for months to years before a diagnosis is established. This report describes a case of a fulminating and life-threatening variant of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP). Early suspicion, histologic diagnosis, and prompt initiation of corticosteroid therapy is important to prevent mortality.


Keywords: Bronchiolitis obliterans with organizing pneumonia (BOOP). Interstitial lung disease.


Inspiratory capacity, exercise limitation, markers of severity, and prognostic factors in chronic obstructive pulmonary disease

Capacidade inspiratória, limitação ao exercício, e preditores de gravidade e prognóstico, em doença pulmonar obstrutiva crônica

Clarice Guimarães de Freitas, Carlos Alberto de Castro Pereira, Carlos Alberto de Assis Viegas

J Bras Pneumol.2007;33(4):389-396

Abstract PDF PT PDF EN Portuguese Text

Objective: To correlate the postbronchodilator (post-BD) inspiratory capacity (IC), % of predicted, with other markers of severity and prognostic factors in chronic obstructive pulmonary disease (COPD). Methods: Eighty stable patients with COPD performed forced vital capacity and slow vital capacity maneuvers, as well as the 6-min walk test, prior to and after receiving albuterol spray (400 μg). Patients were divided into four groups, based on post-BD forced expiratory volume in one second. Several variables were tested to establish correlations with the post-BD distance walked, using univariate and multivariate analysis. Post-BD IC was found to correlated with Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging and with the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. Results: Multivariate regression analysis revealed that the distance walked, % predicted, correlated significantly with the IC post-BD, % predicted (p = 0.001), long-term oxygen use (p = 0.014), and number of medications used in the treatment (p = 0.044). IC ≤ 70% was observed in 56% patients in GOLD stages 3 or 4 vs. 20% in GOLD 1 or 2 (p < 0.001). IC ≤ 70% was observed in (60%) patients with BODE score 3 or 4 vs. (33%) BODE score 1 or 2 (p = 0.02). Conclusion: Post-BD IC% predicted is the best functional predictor of distance walked and is significantly associated with GOLD staging and BODE index. Therefore, We propose that the inspiratory capacity should be added to the routine evaluation of the COPD patients.


Keywords: Pulmonary disease, chronic obstructive; Walking; Respiratory function tests; Inspiratory capacity.


Comparison of spirometric changes in the response to bronchodilators of patients with asthma or chronic obstructive pulmonary disease

Comparação da variação de resposta ao broncodilatador através da espirometria em portadores de asma ou doença pulmonar obstrutiva crônica

Isabella Correia Silvestri, Carlos Alberto de Castro Pereira, Sílvia Carla Sousa Rodrigues

J Bras Pneumol.2008;34(9):675-682

Abstract PDF PT PDF EN Portuguese Text

Objective: Making the differential diagnosis between asthma and chronic obstructive pulmonary disease (COPD) based on the response to inhaled bronchodilators by means of spirometry is controversial.The objective of this study was to identify the most useful spirometric variables in order to distinguish between asthma and COPD. Methods: Retrospective study conducted from April of 2004 to January of 2006, comparing the spirometric parameters of 103 nonsmoking patients with asthma to those of 108 patients with COPD who were smokers for more than 10 pack-years. All of the patients included in the study were older than 40 and presented stable disease at the time of the test. Results: Initial forced expiratory volume in one second (FEV1) was the same in the two groups (pre-bronchodilator FEV1 = 51%). However, patients with COPD were older (66 ± 9 years vs. 59 ± 11 years, p < 0.001) and more frequently male (73% vs. 27%, p < 0,001).After the use of the bronchodilator, the median absolute difference in FEV1 was 0.25 L (range, −0.09 to 1.13 L) in patients with asthma and 0.09 L (range, −0.1 to 0.73 L) in those with COPD (p < 0.001).The highest sensitivity (55%), specificity (91%) and likelihood ratio (6.1) for asthma diagnosis was obtained when the percentage increase in postbronchodilator FEV1 in relation to the predicted FEV1 (Δ%predFEV1) was equal to or greater than 10%.Isolated significant increases in forced vital capacity were more common in patients with COPD. Conclusions: In patients over the age of 40 and presenting obstructive lung disease, a Δ%predFEV1 ≥ 10% is the best spirometric parameter to distinguish asthma from COPD.


Keywords: Spirometry; Respiratory function tests; Lung diseases, obstructive.


Comparison between reference values for FVC, FEV1, and FEV1/FVC ratio in White adults in Brazil and those suggested by the Global Lung Function Initiative 2012

Comparação entre os valores de referência para CVF, VEF1 e relação VEF1/CVF em brasileiros caucasianos adultos e aqueles sugeridos pela Global Lung Function Initiative 2012

Carlos Alberto de Castro Pereira, Andrezza Araujo Oliveira Duarte, Andrea Gimenez, Maria Raquel Soares

J Bras Pneumol.2014;40(4):397-402

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the spirometry values predicted by the 2012 Global Lung Function Initia-tive (GLI) equations, which are recommended for international use, in comparison with those obtained for a sample of White adults used for the establishment of reference equations for spirometry in Brazil. Methods: The sample comprised 270 and 373 healthy males and females, respectively. The mean differences between the values found in this sample and the predicted values calculated from the GLI equations for FVC, FEV1, and VEF1/FVC, as well as their lower lim-its, were compared by paired t-test. The predicted values by each pair of equations were com-pared in various combinations of age and height. Results: For the males in our study sample, the values obtained for all of the variables studied were significantly higher than those predicted by the GLI equations (p < 0.01 for all). These differences become more evident in subjects who were shorter in stature and older. For the females in our study sample, only the lower limit of the FEV1/FVC ratio was significantly higher than that predicted by the GLI equation. Conclusions: The predicted values suggested by the GLI equations for White adults were significantly lower than those used as reference values for males in Brazil. For both genders, the lower limit of the FEV1/FVC ratio is significantly lower than that predicted by the GLI equations.


Keywords: Respiratory function tests/statistics and numerical data; Respiratory function tests/diagnosis; Reference values.


Observer agreement in the diagnosis of interstitial lung diseases based on HRCT scans

Concordância entre observadores no diagnóstico das doenças pulmonares intersticiais por imagens de TCAR

Viviane Baptista Antunes, Gustavo de Souza Portes Meirelles, Dany Jasinowodolinski, Carlos Alberto de Castro Pereira, Carlos Gustavo Yuji Verrastro, Fabíola Goda Torlai, Giuseppe D'Ippolito

J Bras Pneumol.2010;36(1):29-36

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement. Methods: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used. Results: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4% and 82.8% of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3% (κ = 0.42) and 62.1% (κ = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9% (κ = 0.32) and 36.2% (κ = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. Conclusions: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.


Keywords: Lung diseases, interstitial; Tomography, X-ray computed; Observer variation.


Highlights of the Brazilian Thoracic Association Guidelines for Interstitial Lung Diseases

Destaques das Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

Bruno Guedes Baldi, Carlos Alberto de Castro Pereira, Adalberto Sperb Rubin, Alfredo Nicodemos da Cruz Santana, André Nathan Costa, Carlos Roberto Ribeiro Carvalho, Eduardo Algranti, Eduardo Mello de Capitani, Eduardo Pamplona Bethlem, Ester Nei Aparecida Martins Coletta, Jaquelina Sonoe Ota Arakaki, José Antônio Baddini Martinez, Jozélio Freire de Carvalho, Leila John Marques Steidle, Marcelo Jorge Jacó Rocha, Mariana Silva Lima, Maria Raquel Soares, Marlova Luzzi Caramori, Miguel Abidon Aidé, Rimarcs Gomes Ferreira, Ronaldo Adib Kairalla, Rudolf Krawczenko Feitoza de Oliveira, Sérgio Jezler, Sílvia Carla Sousa Rodrigues, Suzana Pinheiro Pimenta

J Bras Pneumol.2012;38(3):282-291

Abstract PDF PT PDF EN Portuguese Text

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.


Keywords: Lung diseases, interstitial; Guidelines as topic; Brazil.


Delayed diagnosis of sarcoidosis is common in Brazil

Diagnóstico tardio da sarcoidose é comum no Brasil

Mauri Monteiro Rodrigues, Ester Nei Aparecida Martins Coletta, Rimarcs Gomes Ferreira, Carlos Alberto de Castro Pereira

J Bras Pneumol.2013;39(5):539-546

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. Methods: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed ( 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment). Results: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis ( 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively). Conclusions: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.


Keywords: Sarcoidosis; Sarcoidosis, pulmonary/diagnosis; Tuberculosis.


Chronic dyspnea with unexplained cause: evaluation of an investigation protocol with 90 patients

Dispnéia crônica de causa indeterminada: avaliação de um protocolo de investigação em 90 pacientes

Sílvia Helena Bersácola, Carlos Alberto de Castro Pereira, Rita de Cássia Cruz da Silva, Ricardo M. Ladeira

J Bras Pneumol.1998;24(5):283-297

Abstract PDF PT

Chronic dyspnea has a wide range of causes. The aim of the authors was to evaluate a diagnostic approach applied to patients with unexplained chronic (> 30 days) dyspnea, or when multiple causes were present. Methods: An algorithm for the work-up was applied: 1) complete history and physical examination; 2) bronchoprovocation test (BPT) and serial measurements of echocardiography; 3) cardiopulmonary exercise testing (CPET) and doppler echocardiography; 4) special tests: FRCT, V/Q scan, DCO, lung volumes, MIP, and others, as indicated. Results: Ninety patients were included, mean age of 51 ± 16 yr. Hyperventilation symptoms were present in 48, but associated with BHR or asthma in 19. Obstructive defect was present in 24 (asthma, 11; COPD, 8). Reduced FVC with normal FEV1/FVC was found in 10; explanations were asthma in 4, heart disease in 4. BPT was performed in 71 and was verified to be normal in 20; PEF variation was evaluated in 71, and was abnormal in 28, isolated in 16, and in 7 with asthma as final diagnosis. Echocardiography was performed in 44, and showed diastolic dysfunction in 11 out of 16 patients with final diagnosis of heart disease. CPET showed cardiovascular limitation in 19, hyperventilation in 19, and ventilatory defect in 12. CPET was decisive in 33 (38%), specially for heart diseases and to exclude causes suspected by clinical data. Respiratory disease was the explanation for dyspnea in 51 (59%): asthma (31), BHR (8), COPD (8), interstitial lung disease (4); other causes found were: heart disease (16), primary hyperventilation syndrome (8), obesity (5), neuromuscular disease (6), psychogenic dyspnea (2), and others (7). Multiple causes were found in 13 patients. Eight patients had non-recognizable etiology. Conclusion: An algorithm approach to chronic dyspnea resulted in diagnosis of 91% of the cases; spirometry, tests for BHR including PEF measurements, echocardiography, and CPET are essential for the investigation.


Keywords: Chronic dyspnea. Exercise test. Spirometry. Respiratory function tests. Bronchoprovocation tests. Peak expiratory flow. Echocardiography. Chest X-ray. Heart failure, congestive.


Dyspnea in COPD: Beyond the modified Medical Research Council scale

Dispneia em DPOC: Além da escala modified Medical Research Council

Lilia Azzi Collet da Rocha Camargo, Carlos Alberto de Castro Pereira

J Bras Pneumol.2010;36(5):571-578

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the correlations among various dyspnea scales, spirometric data, exercise tolerance data, and the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index in patients with COPD. Methods: Between March of 2008 and July of 2009, 79 patients with COPD were recruited, and 50 of those patients were included in the study. After being regularly treated with formoterol for one month, the patients completed the modified Medical Research Council (mMRC, dyspnea scale), Baseline Dyspnea Index (BDI), Oxygen Cost Diagram (OCD), and Shortness Of Breath Questionnaire (SOBQ). Subsequently, the patients underwent spirometry and six-minute walk tests (6MWTs), with determination of the six-minute walk distance (6MWD), as well as initial and final SpO2. All patients also completed the Visual Analogue Scale (VAS) and the Borg scale. Results: The best correlations were between the Borg scale and the VAS (rs = 0.79) and between the BDI and the SOBQ (rs = −0.73). Among the one-dimensional scales (the VAS, mMRC, OCD, and Borg scale), only the VAS correlated with the spirometric parameters, whereas the multidimensional scales BDI and SOBQ did correlate, but poorly. The MRC, BDI, and SOBQ correlated well with 6MWD. Among the spirometric data, inspiratory capacity (IC) and FVC had the strongest correlations with 6MWD. In the multivariate analysis, BDI and IC were selected as the best predictors of 6MWD. Conclusions: Multidimensional dyspnea scales should be applied in the evaluation of COPD patients.


Keywords: Pulmonary disease, chronic obstructive; Spirometry; Dyspnea; Exercise tolerance.


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

Abstract PDF PT PDF EN Portuguese Text

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.


Dores articulares, pleurite, dispnéia, nódulos broncovasculares, centrolobulares e padrão em mosaico em paciente de 47 anos

Veronica Moreira Amado, Roseli Rocha Brito, Jaquelina Sonoe Ota, Rimarcs G. Ferreira, Carlos Alberto de Castro Pereira

J Bras Pneumol.1998;24(1):57-60


Early termination of exhalation: effect on spirometric parameters in healthy preschool children

Efeito da terminação precoce da expiração nos parâmetros espirométricos em crianças pré-escolares saudáveis

Edjane Figueiredo Burity, Carlos Alberto de Castro Pereira, José Ângelo Rizzo, Emanuel Sávio Cavalcanti Sarinho, Marcus Herbert Jones

J Bras Pneumol.2011;37(4):464-470

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the acceptability and reproducibility of spirometry in preschool children; to estimate the effect size of early termination of exhalation (ETE) on FVC, FEV1 and FEV0.5; and to evaluate the validity of FEV0.5 in curves with ETE. Methods: Spirometric data were obtained from 240 healthy preschool children, who were selected by simple sampling. On the basis of the best curve from each child according to the end of exhalation, three groups were formed: no ETE (nETE); ETE and flow ≤ 10% of the highest PEF (ETE≤10); and ETE and flow > 10% of the highest PEF value (ETE>10). The reproducibility of FVC, FEV1 and FEV0.5 was compared among the three groups. The effect of ETE on FVC, FEV1, and FEV0.5 was assessed. Results: Of the 240 children tested, 112 (46.5%)-82 (34.0%) of those in the nETE group and 30 (12.5%) of those in the ETE≤10 group-had acceptable curves for all the parameters. In 64 (27.0%) of those in the ETE>10 group, the curves were acceptable only for FEV0.5, increasing the proportion of children with valid FEV0.5 to 73.0%. There were no significant differences between the nETE and ETE≤10 groups in terms of the mean values of the parameters assessed. Conclusions: Maneuvers with ETE and flow ≤ 10% of the highest PEF are valid. In individuals with a flow > 10% of the highest PEF value, these maneuvers are only valid for FEV0.5.


Keywords: Spirometry; Child, preschool; Vital capacity; Forced expiratory volume; Reproducibility of results.


Bronchodilating effect with two spacer devices: Jet® and Fisonair®

Efeito de broncodilatador através das câmaras de suspensão "Jet" e "Fisonair

Maria Amélia Carvalho da Silva Santos, Carlos Alberto de Castro Pereira

J Bras Pneumol.1997;23(3):137-140

Abstract PDF PT

Two spacer devices for aerosol inhalation were compared by a crossover study of FEV 1 response to 200 μg of salbutamol in 20 asthmatics evaluated in separate days. Fisonair ® (750 ml reservoir) use led to an average 0.32 L increase in FEV 1, which was significantly higher than the 0.26 L obtained with Jet® (103 ml reservoir) (p = 0.02). Bronchodilator response with Jet® was 21% lower (CI: -7 to -35%) than with Fisonair ® .


Keywords: Asthma. Aerosols. Delivery systems.


Efficacy and safety of two dry-powder inhalers for the administration of mometasone furoate in asthma patients

Eficácia e segurança de dois inaladores de pó seco usados para a aplicação de furoato de mometasona em pacientes com asma

Carlos Alberto de Castro Pereira, Flávia Fillardo Vianna, Alberto Cukier, Rafael Stelmach, Júlio César Abreu de Oliveira, Erich Vidal Carvalho, Edimar Pedrosa Gomes, Suzete Varela Mayo, Antônio Monteiro da Silva Chibante, Cláudia Patrícia Domingues

J Bras Pneumol.2010;36(4):-

Abstract PDF PT PDF EN Portuguese Text

Objective: Mometasone furoate (MF) is a new potent synthetic inhaled corticosteroid. Internationally, MF is administered via a dry-powder inhaler that contains multiple doses. As a preparation that would be more cost-effective, single-dose MF capsules were developed in Brazil. The objective of the present study was to evaluate the efficacy and safety of the two inhalers for MF administration in patients with asthma. Methods: A randomized, multicenter, open-label, parallel-group clinical trial involving 74 adult patients with moderate persistent asthma who were randomized into two groups to receive approximately 400 µg of MF once a day for 60 days, either via the multiple-dose inhaler or via the newly developed single-dose inhaler. Results: No significant differences were observed between the two groups regarding the primary endpoints (FEV1 and rescue medication use) or the secondary endpoints (morning PEF, tolerability, and safety, the last as assessed on the basis of hypothalamic-pituitary-adrenal axis function). Conclusions: The use of the single-dose inhaler developed in Brazil for MF administration is as effective and safe as is that of a standard inhaler in the treatment of patients with asthma. Keywords: Anti-asthmatic agents; Pregnadienediols; Metered dose inhalers.


Keywords: Anti-asthmatic agents; Pregnadienediols; Metered dose inhalers. ( identifier: NCT00975741 [])


Open, controlled clinical assay of the addition of ipratropium bromide to fenoterol in the treatment of acute asthma crisis in adults

Ensaio clínico, aberto, controlado sobre a adição de brometo de ipratrópio ao fenoterol no tratamento da crise de asma em adultos

Solange Diccini, Clystenes Odyr Soares Silva, Jorge Nakatani, Carlos Alberto de Castro Pereira

J Bras Pneumol.1999;25(6):301-308

Abstract PDF PT

Repeated dosis of inhaled β2-agonists have been used in the treatment of acute asthma. The effect of added ipratropium bromide (IB) to β2-agonist is controversial in adults. Objective: To evaluate if addition of IB to fenoterol, in repeated doses, induces a greater bronchodilation, a greater reversion of the attack, and discharge from emergency unit in adults with acute severe asthma. Setting: Pneumology Emergency Department, Unifesp-Hospital São Paulo, in the period from July 1995 to February 1997. Type of study: Open, randomized and parallel study. Discharge from the hospital: FEV1 and PEF ≥ 60% of the predicted value. Methods: 120 patients with FEV1 and PEF ≤ 50% of the predicted value were divided into two groups (N = 60): fenoterol (F) and ipratropium bromide + fenoterol (IBF). Each group received inhalation treatment through a metered-dose inhaler (MDI) attached to a holding chamber, administered at 30-minute interval, for a total of three treatments. In the group F four puffs of fenoterol (400 μg) were administered, and in the IBF group, 160 μg of BI and 400 μg of fenoterol (four puffs). Results: The patients did not differ from basal PEF (F = 36 ± 7% vs IBF = 35 ± 9% predicted) and basal FEV1 (F = 33 ± 9% vs IBF = 32 ± 9% predicted). Thirty-two patients of group F and 33 of group IBF were discharged from hospital after the inhalation treatment. The final FEV1 and PEF after inhalation treatments were F = 60 ± 13% vs IBF = 61 ± 11% e F = 74 ± 18% vs IBF = 77 ± 13% (NS). Conclusion: The addition of ipratropium bromide to fenoterol results in insignificant functional effect and without clinical impact in the treatment of acute asthma in adults.


Keywords: Fenoterol. Ipratropium. Status asthmaticus. Respiratory therapy.


Clinical phenotypes of severe asthma

Fenótipos clínicos de asma grave

Roseliane de Souza Araújo Alves, Flávia de Almeida Filardo Vianna, Carlos Alberto de Castro Pereira

J Bras Pneumol.2008;34(9):646-653

Abstract PDF PT PDF EN Portuguese Text

Objective: To characterize clinical phenotypes of severe asthma. Methods: A total of 111 patients were retrospectively evaluated at a specialized outpatient clinic. A systematic protocol for patient evaluation and follow-up was applied. Treatment compliance and control of the disease at the end of follow-up were defined by clinical and functional data. Patients who did not meet asthma control criteria after six months despite compliance with treatment and correct use of medication were characterized as treatment-resistant. Phenotypes were determined by factorial analysis and compared using various tests. Results: At the end of follow-up, 88 patients were considered treatment compliant and 23 were considered noncompliant. Factorial analysis of the compliant patients identified four phenotypes: phenotype 1 (28 patients) comprised patients who were treatment-resistant, more often presenting nocturnal symptoms and exacerbations, as well as more often using rescue bronchodilators; phenotype 2 (48 patients) comprised patients with persistent airflow limitation, lower ratios of forced expiratory volume in one second/forced vital capacity at baseline, more advanced age and longer duration of symptoms; phenotype 3 (42 patients) comprised patients with allergic rhinosinusitis who were nonsmokers and presented predominantly reversible airflow obstruction; and phenotype 4 (15 patients) comprised cases with a history of aspirin intolerance to acetylsalicylic acid associated with near-fatal asthma. Conclusions: A significant number of patients with severe asthma are noncompliant with treatment. Although many patients with severe asthma have persistent airflow obstruction, the most relevant clinical phenotype comprises patients who are resistant to the typical treatment.


Keywords: Asthma; Asthma/prevention & control; Asthma/treatment.


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

Abstract PDF PT PDF EN Portuguese Text

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.


Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia accompanied by airflow obstruction

Hiperplasia de células neuroendócrinas pulmonares difusas com obstrução ao fluxo aéreo

Ester Nei Aparecida Martins Coletta, Larissa Rêgo Voss, Mariana Silva Lima, Jaquelina Sonoe Ota Arakaki, Juvêncio Câmara, Carlos D'Andretta Neto, Carlos Alberto de Castro Pereira

J Bras Pneumol.2009;35(5):489-494

Abstract PDF PT PDF EN Portuguese Text

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia with airflow obstruction is a rare form of lung injury. All of the reported cases have been diagnosed by surgical lung biopsy. Only three of the reported cases presented with diffuse interstitial lung opacities on HRCT scans. We report three additional cases of this entity. All of the patients were female and presented with mild-to-moderate airflow obstruction. In the first case, transbronchial biopsy and imaging data were sufficient to make the diagnosis. Although the HRCT scans of all three cases revealed a mosaic pattern, that of the third patient also revealed diffuse interstitial infiltrate. In extremely rare cases, HRCT findings can simulate those seen in other interstitial lung diseases.


Keywords: Neuroendocrine cells; Carcinoid tumor; Bronchiolitis obliterans.


Jornal Brasileiro de Pneumologia

Carlos Alberto de Castro Pereira

J Bras Pneumol.2004;30(1):1-1


Jornal de Pneumologia 1995-1998

Jornal de Pneumologia 1995-1998

Carlos Alberto de Castro Pereira1

J Bras Pneumol.2015;41(5):399-399

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Airflow limitation in brazilian caucasians: FEV1/FEV6 vs. FEV1/FVC

Limitação ao fluxo aéreo em brasileiros da raça branca: VEF1/VEF6 vs. VEF1/CVF

André Luis Pinto Soares, Sílvia Carla Sousa Rodrigues, Carlos Alberto de Castro Pereira

J Bras Pneumol.2008;34(7):468-472

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the use of the forced expiratory volume in one second/forced expiratory volume in six seconds (FEV1/FEV6) ratio as an alternative to the FEV1/forced vital capacity (FVC) ratio in the detection of mild airway obstruction. Methods: Reference equations for the Brazilian population in 2006 were used in order to determine the lower limits of normality for the FEV1/FEV6 and FEV1/FVC ratios. The spirometry findings of 155 patients from 20 to 84 years of age were analyzed. All of the patients presented the following: a < 15% difference between predicted and observed FEV1/FVC ratio; an FEV1 ≥ 60% of predicted; and an exhalation time of at least 6 s. The Brazilian Thoracic Society criteria for acceptability and reproducibility in spirometry were met. Results: Mean values (± SD) for FEV1/FEV6 and FEV1/FVC were 73 ± 4% and 75 ± 3%, respectively. Using the FEV1/FVC ratio, we identified airflow obstruction in 61 patients, compared with only 46 patients when we used the FEV1/FEV6 ratio, showing a sensitivity of 75% (p < 0.001). Conclusions: The FEV1/FEV6 ratio has poor sensitivity and should not be used to replace the FEV1/FVC ratio in the diagnosis of mild airway obstruction.


Keywords: Forced expiratory volume; Vital capacity; Airway obstruction; Spirometry; Respiratory function tests.


New reference values for forced spirometry in white adults in Brazil

Novos valores de referência para espirometria forçada em brasileiros adultos de raça branca

Carlos Alberto de Castro Pereira, Taeko Sato, Sílvia Carla Rodrigues

J Bras Pneumol.2007;33(4):397-406

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe spirometric reference equations for healthy Brazilian adults who have never smoked and to compare the predicted values with those derived in 1992. Methods: Reference equations for spirometry were derived in 270 men and 373 women living in eight cities in Brazil. Ages ranged from 20 to 85 years in women and from 26 to 86 years in men. Spirometry examinations followed the recommendations of the Brazilian Thoracic Society. Lower limits were derived by the analysis of the fifth percentiles of the residuals. Results: Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC and FEV1/forced expiratory volume in six seconds (FEV6) were best fitted by linear regression. Flows were best fitted using log equations. For both genders, greater height resulted in lower values for FEV1/FVC, FEV1/FEV6 and flow/FVC ratios. The reference values for FEV1 and FVC in the present study were higher than those derived for Brazilian adults in 1992. Conclusion: New predicted values for forced spirometry were obtained in a sample of white Brazilians. The values are greater than those obtained in 1992, probably due to technical factors.


Keywords: Spirometry; Reference Values; Respiratory Function Tests.


High-resolution computed tomography patterns of diffuse interstitial lung disease with clinical and pathological correlation

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

Brett Elicker, Carlos Alberto de Castro Pereira, Richard Webb, Kevin O. Leslie

J Bras Pneumol.2008;34(9):715-744

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High-resolution computed tomography (HRCT) is the radiological imaging technique best suited to revealing changes in lung structure. Various HRCT findings, taken together, can represent typical patterns. These patterns, in conjunction with the anatomical distribution of findings and with clinical data, can narrow the differential diagnosis of diffuse interstitial lung disease and, in many cases, indicate the correct diagnosis with a high degree of accuracy. The most common HRCT patterns seen in cases of diffuse interstitial lung diseases are the nodular pattern, linear/reticular opacities, cystic lesions, ground-glass opacities and consolidations. This article reviews the correlations between HRCT patterns and pathologic findings, summarizing the most common causes, as well as detailing the methods of investigation employed in order to diagnose the most common types of chronic diffuse lung disease.


Keywords: Lung diseases, interstitial/pathology; Tomography, X-Ray computed; Diagnostic techniques, respiratory system.


Community-acquired pneumonia in outpatients: epidemiological, clinical and radiographic features between atypical and non-atypical pneumonia

Pneumonia adquirida na comunidade em pacientes tratados ambulatorialmente: aspectos epidemiológicos, clínicos e radiológicos das pneumonias atípicas e não atípicas

Rosali Teixeira Rocha, Anna Cristina Vital, Clystenes Odyr Santos Silva, Carlos Alberto de Castro Pereira, Jorge Nakatani

J Bras Pneumol.2000;26(1):5-14

Abstract PDF PT

Aim: To evaluated the etiologic percentage of the atypical pneumoniae in outpatients and to identify the epidemiologic, clinical and radiographic features that permit to distinguish between atypical and non-atypical pneumonia. Methods: All patients underwent clinical and radiographic evaluation. Serum and sputum samples were obtained to serological tests including Legionella sp, Chlamydia sp, M. pneumoniae, Influenza A and Influenza B virus, and Gram stain, respectively. These procedures were performed on the first and 21 days after inclusion. Three independent observers reviewed chest X-rays. Results: During 22 months, 129 patients were evaluated. The final population under study comprised 69 patients (46 men - 23 women) with a mean age of 37 years. The etiologic diagnosis was defined in 34 (50%) of the patients. Etiologic agents included Chlamydia sp, 11 (16%) isolated cases; M. pneumoniae 7 (10%) cases. Influenza A was the third more frequent agent in 4 (6%) patients, and Legionella sp in 4 (6%). Mixed infections were observed with association of Chlamydia sp and M. pneumoniae in 5 (7.3%) cases, Chlamydia sp and Influenza B one (1.5%) case, and another of M. pneumoniae and Influenza A. The atypical pneumonia and non-atypical pneumonia groups were compared to respiratory symptoms and signs. There were no differences between them. The three independent observers' radiographic evaluation showed disagreement among them as to the type of pneumonia. Radiographic diagnoses of individual observers were compared to the clinical diagnoses, and no significant association was obtained for any observer. Conclusion: Pneumonia caused by "atypical" agents occurs in 50% of the outpatients with community acquired pneumonia. It is not possible to distinguish atypical pneumonia from non-atypical pneumonia. The clinical and radiographic presentations are similar in both groups.


Keywords: pneumonia; etiology; diagnosis; epidemiology


Organized pneumonia secondary to amiodarone use

Pneumonia em organização secundária ao uso de amiodarona

Lia Augusta de Souza Gulmini, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.2001;27(3):167-170

Abstract PDF PT

Organized pneumonia secondary to amiodarone use is rare. Only eight cases have been reported in the literature. It is reported on the case of a 75-year-old female who, after a cumulative dose of 43 g of amiodarone, presented coughing, progressive dyspnea and bilateral infiltrates seen at thoracic radiographs. Transbronchial biopsy confirmed the diagnosis. As the drug was discontinued, there was functional and clinical improvement.


Keywords: Bronchiolitis obliterans organizing pneumonia. Amiodarone. Drug therapy. Drug toxicity.


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

Abstract PDF PT PDF EN Portuguese Text

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.


Predicting reduced TLC in patients with low FVC and a normal or elevated FEV1/FVC ratio

Predizendo redução da CPT em pacientes com CVF reduzida e relação VEF1/CVF normal ou elevada

Luiz Carlos D'Aquino, Sílvia Carla Sousa Rodrigues, João Adriano de Barros, Adalberto Sperb Rubin, Nelson Augusto Rosário Filho, Carlos Alberto de Castro Pereira

J Bras Pneumol.2010;36(4):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To use clinical and spirometry findings in order to distinguish between the restrictive and nonspecific patterns of pulmonary function test results in patients with low FVC and a normal or elevated FEV1/FVC ratio. Methods: We analyzed the pulmonary function test results of 211 adult patients submitted to spirometry and lung volume measurements. We used the clinical diagnosis at the time spirometry was ordered, together with various functional data, in order to distinguish between patients presenting with a "true" restrictive pattern (reduced TLC) and those presenting with a nonspecific pattern (normal TLC). Results: In the study sample, TLC was reduced in 144 cases and was within the normal range in 67. The most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was ≥ 90%. In males, an FVC ≤ 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC ≤ 50% of predicted. A difference of ≥ 0% between the FEV1% and the FVC% had a PPV for restriction of 89.5%. After performing logistic regression, we developed a point scale for predicting the restrictive pattern. Conclusions: In many patients with reduced FEV1, reduced FVC, and a normal FEV1/FVC ratio, the restrictive pattern can be identified with confidence through the use of an algorithm that takes the clinical diagnosis and certain spirometry measurements into account.


Keywords: Spirometry; Airway resistance; Respiratory function tests; Vital capacity.


Publicações em Pneumologia - Novos ou velhos rumos?

Carlos Alberto de Castro Pereira

J Bras Pneumol.2003;29(1):1-


Publicações secundárias e instruções redatoriais

Carlos Alberto de Castro Pereira

J Bras Pneumol.1997;23(3):9-


Spirometric response to bronchodilators: which parameters and values are clinically relevant in obstructive diseases?

Resposta a broncodilatador na espirometria: que parâmetros e valores são clinicamente relevantes em doenças obstrutivas?

Roberto Rodrigues Jr., Carlos Alberto de Castro Pereira

J Bras Pneumol.2001;27(1):35-47

Abstract PDF PT

In lung function laboratories, statistical responses after bronchodilators (Bd) administration are widely used in patients with airflow limitation. However, their clinical relevance is debatable. Objective: To determine which spirometric parameters best reflect improvement in both exercise tolerance and exertional dyspnea in response to bronchodilators in obstructive lung diseases. Methods: Fifty patients with persistent asthma and/or COPD (FEV1/FVC = 41 ± 11%) were submitted to slow and forced vital capacity testing, MVV and a six-minute walking test (6 MW) following practice, before and after a 400 mg dose of salbutamol was given by MDI. Responses to Bd were expressed in absolute values and considered as increments to the initial values and predicted values. Responses to Bd were considered clinically significant if distance was longer than 30 m in the 6 MW test and/or if there was a 2-point decrease in the Borg scale in the walking distance. Results: 32 patients were responsive (R) to Bd and 18 were non-responsive (NR). As DMW correlated with age, (rs = -0.38 - p < 0.01) an analysis on spirometric data, including age as covariant, was performed and expressed as x ± SE. No difference in FEV1 was observed between the groups (R = 255 ± 57 ml; NR = 256 ± 43 ml). The same occurred regarding MVV (R = 11± 2 L/min; NR = 10 ± 2 L/min.). The best separation (p < 0.01) was given by changes in inspiration capacity (IC) followed by changes in slow vital capacity (SVC): IC% of initial R = 23 ± 3% and NR = 3 ± 4%; absolute IC = 411 ± 58 ml and NR = 163 ± 77 ml; predicted IC%: R = 19 ± 3% and NR = 3 ± 4%. For SVC, the values were: % initial - R = 18 ± 2% and NR = 9 ± 3%; absolute changes - R = 448 ± 52 ml and NR = 256 ± 70 ml. Increases in IC > 15% of the initial values and 0.3 L and increases in SVS > 15% of the initial values and 0.4 L determined responsive patients with positive predicted values as approximately 90%. Conclusion: Variations in FEV1, FVC and MVV do not predict improvement in exercise capacity after Bd. This is best reflected by 15% of increases in IC and/or in the SVC initial values.


Keywords: Obstructive lung diseases. Spirometry. Predictive value of tests. Bronchodilator agents. Exercise tolerance. Dyspnea.


Safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis in Brazil

Segurança e tolerabilidade de Nintedanibe em pacientes com fibrose pulmonar idiopática no Brasil

Carlos Alberto de Castro Pereira1,a, José Antonio Baddini-Martinez2,b, Bruno Guedes Baldi3,c, Sérgio Fernandes de Oliveira Jezler4,d, Adalberto Sperb Rubin5,e, Rogerio Lopes Rufino Alves6,f, Gilmar Alves Zonzin7,g, Manuel Quaresma8,h, Matthias Trampisch9,i, Marcelo Fouad Rabahi10,j

J Bras Pneumol.2019;45(5):e20180414-e20180414

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Objective: Clinical trials have shown that nintedanib 150 mg twice daily (bid) reduces disease progression in patients with idiopathic pulmonary fibrosis (IPF), with an adverse event profile that is manageable for most patients. Prior to the approval of nintedanib as a treatment for IPF in Brazil, an expanded access program (EAP) was initiated to provide early access to treatment and to evaluate the safety and tolerability of nintedanib in this patient population. Methods: Patients with a diagnosis of IPF within the previous five years, forced vital capacity (FVC) ≥ 50% predicted and diffusing capacity of the lungs for carbon monoxide (DLco) 30% to 79% predicted were eligible to participate in the EAP. Patients received nintedanib 150 mg bid open-label. Safety assessments included adverse events leading to permanent discontinuation of nintedanib and serious adverse events. Results: The EAP involved 57 patients at eight centers. Most patients were male (77.2%) and white (87.7%). At baseline, mean (SD) age was 70.7 (7.5) years and FVC was 70.7 (12.5) % predicted. Mean (SD) exposure to nintedanib was 14.4 (6.2) months; maximum exposure was 22.0 months. The most frequently reported adverse events considered by the investigator to be related to nintedanib treatment were diarrhea (45 patients, 78.9%) and nausea (25 patients, 43.9%). Adverse events led to permanent discontinuation of nintedanib in 16 patients (28.1%). Sixteen patients (28.1%) had a serious adverse event. Conclusion: In the Brazilian EAP, nintedanib had an acceptable safety and tolerability profile in patients with IPF, consistent with data from clinical trials.


Keywords: Drug tolerance; Expanded access program; Interstitial lung disease; Tyrosine kinase inhibitor.


The importance of appropriate reference values in patients suspected of having obstructive lung disease.

Suspeita de doença obstrutiva: importância dos valores de referência adequados.

Carlos Alberto de Castro Pereira1,a, Maria Raquel Soares1,b, Andréa Gimenez2,c

J Bras Pneumol.2019;45(6):e20190299-e20190299

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Smoking among hospitalized patients in a general hospital

Tabagismo em pacientes internados em um hospital geral

Maria Vera Cruz de Oliveira, Tatiana Riera de Oliveira, Carlos Alberto de Castro Pereira, Alexandre Vidal Bonfim, Fernando Studart Leitão Filho, Larissa Rego Voss

J Bras Pneumol.2008;34(11):936-941

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Objective: To determine the frequency of smoking among hospitalized patients in a general hospital, and to evaluate their profile. Methods: A random representative sample of 111 patients, classified as nonsmokers, former smokers or smokers, was evaluated. The smokers were submitted to the Fagerström test and measurement of expired carbon monoxide. Expired carbon monoxide higher than 6 ppm was considered a significant indicator of recent smoking. Results: Of the 111 patients in the sample, 60 (54%) were female. The mean age was 70 years. Of the 111 patients, 56 (51%) had never smoked, 36 (32%) were former smokers, and 19 (17%) were smokers. All of the smokers were male. The smokers were younger (58 ± 17 years) than the nonsmokers (68 ± 12 years) and the former smokers (73 ± 14 years)-ANOVA: F = 6.57 (p = 0.002). Among the smokers, the mean tobacco intake was 43 pack-years and the mean Fagerström score was 5.0. Of the 19 smokers, 11 (58%) had respiratory symptoms and 3 had withdrawal symptoms. The mean expired carbon monoxide in the smokers was 5.0 ppm. Expired carbon monoxide levels were higher than 6 ppm in 8 (42%) of the smokers. There was a higher prevalence of smokers in some wards: 70% of all smokers were hospitalized on only five wards. Conclusions: In a large tertiary hospital, 17% of the hospitalized patients were smokers, and 7% had smoked within the last 8 h. The smokers were younger men, hospitalized on specific wards.


Keywords: Smoking; Hospitalization; Carbon monoxide/diagnostic use.


Six-minute walk test: reference values for healthy adults in Brazil

Teste de caminhada de seis minutos: valores de referência para adultos saudáveis no Brasil

Maria Raquel Soares, Carlos Alberto de Castro Pereira

J Bras Pneumol.2011;37(5):576-583

Abstract PDF PT PDF EN Portuguese Text

Objective: To develop regression equations for six-minute walk distance (6MWD) in healthy adults (20-80 years of age) in Brazil. Methods: We included 132 volunteers (66 males) without respiratory disease, cardiac disease, or comorbidities that affect ambulation. The volunteers completed three six-minute walk tests. Prior to and at the end of each test, we obtained SpO2 and maximal HR, as well as the Borg scale scores for sensation of dyspnea and lower limb fatigue. The data included in the final analysis were derived from the test with the greatest 6MWD. Results: The mean 6MWD values were 566 ± 87 m and 538 ± 95 m in males and females, respectively (p = 0.08). The 6MWD was greater in taller individuals and decreased in parallel with increases in age or body index mass (BMI). The best adjusted model was the quadratic model. We derived the following equation (valid for both genders): 6MWD = 511 + stature2 (cm) × 0.0066 − age2 × 0.030 − BMI2 × 0.068. This equation explained 55% of the variance in 6MWD. Conclusions: Reference values explaining a high proportion of the variance were derived by a quadratic regression model in healthy adults (of a wide range of ages) in Brazil. Keywords: Reference values; Exercise test; Walking.


Keywords: Reference values; Exercise test; Walking.


Validation of new Brazilian predicted values for forced spirometry in Caucasians and comparison with predicted values obtained using other reference equations

Validação de novos valores previstos brasileiros para a espirometria forçada na raça branca e comparação com os valores previstos obtidos por outras equações de referência

Andrezza Araújo de Oliveira Duarte, Carlos Alberto de Castro Pereira, Silvia Carla Sousa Rodrigues

J Bras Pneumol.2007;33(5):527-535

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Objective: To compare the most recent (2006) predicted values of forced vital capacity and forced expiratory volume in one second for spirometry in Brazilians with those obtained using other reference equations and to validate the findings through comparisons with a new sample of normal Brazilians. Methods: Forced spirometry was performed, in accordance with the Brazilian Thoracic Society guidelines, in 643 nonsmoking adult Caucasians. The predicted values obtained by Brazilian researchers in 1992 and those obtained by four groups of foreign researchers were compared with the new Brazilian predicted values obtained in 2006. In the second phase, the mean values obtained in 65 adult females and 79 adult males were compared with the predicted values obtained using the various reference equations. Results: A t-test for paired samples revealed significant differences between the predicted values obtained using the six equations and those obtained using the 2006 Brazilian equation. In the second phase, the mean predicted values obtained by Crapo et al., as well as those obtained by Hankinson et al. for Mexican-Americans, were similar to those found in the new sample. However, when the predicted values obtained in the new sample were compared with those obtained by those authors, discrepancies were found, with high and low predicted values. The mean values obtained using the 2006 Brazilian equation presented the smallest differences in comparison with the mean values obtained in the new sample. Conclusions: These results underscore the importance of using prediction equations for spirometry that are appropriate for our population.


Keywords: Spirometry; Reference values; Respiratory function tests.


Reference values for the carbon monoxide diffusion (transfer factor) in a brazilian sample of white race

Valores de referência para a difusão do monóxido de carbono (fator de transferência) em uma amostra brasileira da raça branca

Virgínia Pacheco Guimarães1,a, Débora Marques de Miranda2,b, Marco Antônio Soares Reis1,c, Thamine Lessa Andrade3,d, Renato Lopes Matos4,e, Maria Raquel Soares5,6,f, Carlos Alberto de Castro Pereira5,6,g

J Bras Pneumol.2019;45(5):e20180262-e20180262

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Objective: To derive reference values from white race adults, for DCO in a sample from different sites in Brazil, through the same equipment model (Sensormedics), and compare the results with the derivatives from Crapo, Miller, Neder equations and from the Global Lung Initiative (GLI) proposal. Methods: The tests were performed according to the norms suggested by ATS/ERS in 2005 in six Brazilian cities, with 120 adult volunteers of each gender, non-smokers, without referred anemia and without lung or cardio diseases. The expected values were derived from linear regressions and the differences between the values forecasted by some authors and the ones observed in the current study were calculated. Results: Among men, the age varied between 25 and 88 years old, and the height varied between 140 and 176 cm. DCO was correlated significantly and positively with the height and negatively with the age. The values forecasted by Crapo, Neder, and Miller equations were higher in comparison with the ones obtained by the current study (p<0.01) in both genders. Among men, the values did not differ when compared to the ones calculated by GLI (p=0.29); among women, the values derived by GLI were slightly higher: 0.99 ml/min/mmHg (p<0.01). Conclusion: new values forecasted for DCO were derived in a sample of white adults in Brazil. The forecasted values are similar to the ones complied by GLI equations and differ from the previously proposed equations.


Keywords: Transfer factor; Pulmonary diffusing capacity; Diffusion; Carbon monoxide; Reference values; Lung function tests.


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 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


Forced expiratory volume in one second and bronchodilator response in chronic obstructive pulmonary disease - a needless ritual?

Volume expiratório forçado no primeiro segundo e resposta a broncodilatador em doença pulmonar obstrutiva crônica - um ritual inútil?

Carlos Alberto de Castro Pereira

J Bras Pneumol.2005;31(5):4-6

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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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