Brazilian Journal of Pulmonology

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

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Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal® versus Miflasona Aerolizer®

Avaliação da eficácia clínica, aceitabilidade e preferência de dois sistemas inalatórios de beclometasona no tratamento da asma : Pulvinal versus Aeroliser.

Jussara Fiterman, Waldo Mattos, Alberto Cukier, Márcia Pizzichinni, Rodnei Frare e Silva, Fabiane Kahan, José Roberto Jardim, Armando Brancatelli

J Bras Pneumol.2004;30(5):413-418

Abstract PDF PT PDF EN

Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal versus Miflasona Aerolizer Background: Approximately half of all asthmatic patients adhere to their prescribed treatment regimen, which makes noncompliance with treatment one of the main problems associated with the disease. It is possible that inhalation devices combining technological advances with comfort and simplicity of use could increase treatment compliance. Objective: To compare the acceptability of and preference for two inhalation devices (Pulvinal and Aerolizer), as well as to evaluate the efficacy of and tolerance for beclomethasone dipropionate when delivered by these two systems. Method: A multicenter, randomized, crossover parallel study was carried out involving 83 patients with stable asthma. Patients received 500-1000 g/day of beclomethasone dipropionate. After a 2-week run in, the patients were randomized to begin a 4-week crossover treatment period with equivalent doses of Clenil Pulvinal (CP) or Miflasona Aerolizer (MA). Results: Both groups showed improvement in dyspnea and FEV1, and acceptability was considered good or excellent in both groups. Of the patients studied, 50.6% preferred CP, and 39% preferred MA. In their future treatment regimes, 54.5% would choose the CP and 37.7% the MA. Conclusion: Clinical efficacy and acceptability were comparable between CP and MA.

 


Keywords: Asthma/therapy. Beclomethasone/ administration & dosage. Randomized controlled trials. Treatment Outcome.

 


Poor perception of dyspnea following methacholine challenge test in patients with asthma

Baixo grau de percepção da dispneia após teste de broncoprovocação induzida por metacolina em pacientes com asma

Cláudia Loss Reck, Daniel Fiterman-Molinari, Sérgio Saldanha Menna Barreto, Jussara Fiterman

J Bras Pneumol.2010;36(5):539-544

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the proportion of asthma patients with a poor perception of dyspnea, correlating the level of that perception with the severity of acute bronchoconstriction, bronchial hyperresponsiveness, use of maintenance medication, and asthma control. Methods: Uncontrolled clinical trial involving asthma patients treated at the Pulmonology Outpatient Clinic of the São Lucas Hospital, in Porto Alegre, Brazil. Methacholine challenge testing was performed using a five-breath dosimeter protocol. The perception of dyspnea after each breath was determined using the Borg scale. Data concerning asthma control, medication in use, and use of rescue short-acting bronchodilators were recorded. Results: Of the 65 patients included in the study, 53 completed the evaluation. Of those, 32 (60.5%) showed adequate perception of dyspnea after the methacholine challenge test, whereas 21 (39.5%) did not perceive any changes in the degree of dyspnea even after a 20% fall in FEV1. There were no significant differences between the two groups regarding baseline FEV1, percentage fall in FEV1, and the dose of methacholine causing a 20% fall in FEV1. The perception of dyspnea was not significantly associated with age (p = 0.247); gender (p = 0.329); use of maintenance medication (p = 0.152); asthma control (p = 0.562), bronchial hyperresponsiveness (p = 0.082); or severity of acute bronchoconstriction (p = 0.749). Conclusions: A significant proportion of asthma patients have a poor perception of dyspnea. The factors related to the inability of these patients to identify changes in pulmonary function have not yet been well defined. In order to reduce asthma-related morbidity and mortality, it is essential that this group of patients be identified and counseled.

 


Keywords: Asthma; Dyspnea; Airway obstruction.

 


Langerhans-cell histiocytosis: rapid resolution after smoking cessation

Histiocitose de células de Langerhans: rápida resolução após cessação do tabagismo

José Miguel Chatkin, Vinicius D. Silva, Carlos C. Fritscher, Jussara Fiterman, Cláudia Reck

J Bras Pneumol.2005;31(2):173-176

Abstract PDF PT PDF EN Portuguese Text

We describe a case of pulmonary Langerhans cell histiocytosis with a close temporal relationship between smoking cessation and radiological improvement. High-resolution computed tomography revealed multiple small nodules located in the upper and middle lobes of both lungs. Microscopy of these lesions showed histiocytic infiltration that reacted strongly to staining for S100 protein. The histiocytes resembling Langerhans cells showed strong reactivity for S100 protein. Smoking cessation was recommended and the patient complied. Chest X-ray and computed tomography performed 6 and 24 months later revealed almost complete resolution of the radiographic abnormalities. Despite the possibility that this evolution was attributable to spontaneous remission, in this case, the lesions did, in fact, disappear rapidly after smoking cessation.

 


Keywords: Key words: Histiocytosis. Langerhans-Cell. Tabaco use cessation.

 


Change in asthma mortality trends in children and adolescents in Rio Grande do Sul: 1970-1998

Mudança da tendência da mortalidade por asma em crianças e adolescentes no Rio Grande do Sul: 1970-1998

José Miguel Chatkin, Jussara Fiterman, Nivalvo Almeida Fonseca, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(2):89-93

Abstract PDF PT

Introduction: During the period from 1970 to 1992, mortality from asthma in children and young adults increased in Rio Grande do Sul. The present study aimed at assessing this phenomenon in patients of the same age group, now extending the time period to 1998. Methods: The death certificates of 157 patients aged between 5 and 19 years in which asthma was reported to be the cause of death during 1970-80 were reviewed. Testing for trends was conducted using the log-linear, S-curve, and quadratic models. Results: Asthma mortality rate ranged from 0.04 to 0.399/100,000. Among the tested models, S curve trend model showed the best accuracy for the adjusted time series: r2=0.59; mean absolute percentage error (MAPE) = 23.48; mean absolute deviation (MAD) = 0.035; mean square deviation (MSD) = 0.0021. These results suggest that a plateau has probably been reached. The quadratic model also showed good accuracy values suggesting that a decrease in the coefficients probably started to occur. In this model, the estimated maximal point value was found in the 25th year (1994). Conclusions: Stabilization of asthma death rates is starting to occur in Rio Grande do Sul and it is likely that a decrease will take place.

 


Keywords: Asthma. Mortality. Brazil.

 


The role of the FEF50%/0.5FVC ratio in the diagnosis of obstructivelung diseases

O papel da razão FEF50%/0,5CVF no diagnóstico dosdistúrbios ventilatórios obstrutivos

Marcelo Tadday Rodrigues, Daniel Fiterman-Molinari, Sérgio Saldanha Menna Barreto, Jussara Fiterman

J Bras Pneumol.2010;36(1):44-50

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the contribution of a new coefficient, the FEF50%/0.5FVC ratio, obtained from the maximal expiratory flow-volume curve, to the diagnosis of obstructive lung disease (OLD); to test this coefficient in differentiating among patients considered normal, those with OLD and those with restrictive lung disease (RLD); and to determine cut-off points for each functional diagnosis, as well as the probability for each diagnosis based on individual values. Methods: A prospective, cross-sectional study analyzing the pulmonary function of patients referred to the Porto Alegre Hospital de Clínicas, in Porto Alegre, Brazil, between January and December of 2003. We collected demographic and spirometric data. The patients were divided into three groups: normal; OLD; and RLD. We calculated the FEV1/FVC and FEF50%/0.5FVC ratios, and we compared the mean FEF50%/0.5FVC values among the groups. We used Pearson's correlation test in order to compare FEF50%/0.5FVC with FEV1/FVC. The patients were again divided into two groups: those with OLD and those without OLD. We calculated the likelihood ratio for different cut-off points. Results: The mean age of the patients was 55.8 ± 14.7 years. There were significant differences among the groups in terms of the mean FEF50%/0.5FVC (2.10 ± 0.82, 2.55 ± 1.47 and 0.56 ± 0.29, respectively, for normal, RLD and OLD; p < 0.001). There was a positive correlation between FEF50%/0.5FVC and FEV1/FVC in the OLD group (r = 0.83). We found that an FEF50%/0.5FVC < 0.79 strongly suggests OLD, whereas an FEF50%/0.5FVC > 1.33 practically excludes this diagnosis. Conclusions: The FEF50%/0.5FVC ratio is a potentially useful parameter in the differential diagnosis of OLD and correlates positively with the FEV1/FVC ratio.

 


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

 


Pesquisar é um ato de coragem!

Jussara Fiterman Molinari

J Bras Pneumol.1999;25(5):5-

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Nodular measles pneumonia: a case report

Pneumonia nodular por sarampo: relato de caso

Eduardo Walker Zettler, Jussara Fiterman Molinari

J Bras Pneumol.1998;24(6):379-381

Abstract PDF PT

The authors report the case of an adolescent with bilateral interstitial bronchopneumonia caused by measles. They discuss this rare presentation and the usefulness of thorax CT scan for the diagnosis of this disease.

 


Keywords: Measles. Pneumonia. CT scan.

 


Pneumonias em portadores da síndrome de imunodeficiência adquirida (sida/aids)

Sérgio Menna Barreto, Jussara Fiterman Molinari

J Bras Pneumol.1998;24(2):95-100

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Prevalence of asthma symptoms and treatment of children and adolescents from 2 to 14 years of age in Porto Alegre, Rio Grande do Sul, Brazil

Prevalência de sintomas de asma e tratamento de crianças e adolescentes de 2 a 14 anos no Campus Aproximado da PUCRS

Brasília Itália C. S. Ache, Fabiane Kahan, Jussara Fiterman

J Bras Pneumol.2005;31(2):103 -110

Abstract PDF PT PDF EN Portuguese Text

Background: In recent decades, the prevalence of asthma has increased. Objectives: To determine the prevalence of asthma symptoms in children and adolescents from 2 to 14 years of age living in Porto Alegre (in the state of Rio Grande do Sul, Brazil) and to determine any potential correlations with socioeconomic profile, treatment and smoking in the home. Methods: A transversal study based on interviews of all families seeking medical attention in June of 2000. Results: The prevalence of asthma symptoms was 49.5%. In 66.8% of families, total income was less than four times the minimum wage, and in more than 50% of homes, the parents had had less than five years of schooling. In 98.5%, prophylactic asthma treatment was not used. In the 174 families studied, 38.7% of mothers and 43.7% of fathers were smokers (32.7% overall). Correlations were found between the following variables: exposure to smoking in the home and number of asthma attacks in the last year (p = 0.02; RR = 2.9; CI: 1.1 - 4.5); maternal level of education and number of attacks in the last year (p = 0.03; RR = 2.03; CI: 1.01 - 4.19); close living quarters and number of attacks in the last year among children exposed to second-hand smoke (p = 0.04; RR = 2.7; CI: 1.4 - 5.1); hospitalization and number of attacks in the last year (p = 0.004; RR = 1.46; CI: 1.15 -1.86); hospitalization and close living quarters (p = 0.03; RR = 1.47; CI: 1.15 -1.86). In children below the age of five, there was correlation between maternal smoking and number of attacks in the last year (p = 0.03; RR = 1.79; CI: 1.04 - 3.08). Conclusion: The prevalence of asthma symptoms was high. The community studied has limited socioeconomic resources, and there is therefore a lack of adequate treatment for asthma. Our results demonstrate the need for prioritized, standardized treatment programs that would give healthcare workers access to the appropriate materials and means of evaluation necessary for asthma control.

 


Keywords: Key words: Asthma. Prevalence. Smoking in the home. Treatment between episodes of asthma.

 


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.

 


 

 


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