Brazilian Journal of Pulmonology

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


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Year 2016 - Volume 42  - Number 4  (July/August)


Continuing Education: Imaging

2 - Conglomerate masses

Massas conglomeradas

Edson Marchiori, Bruno Hochhegger, Gláucia Zanetti

J Bras Pneumol.2016;42(4):239

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Continuing Education : Scientific Methodology

Original Article

4 - Inflammatory and immunological profiles in patients with COPD: relationship with FEV1 reversibility

Perfil inflamatório e imunológico em pacientes com DPOC: relação com a reversibilidade do VEF1

Cleriston Farias Queiroz, Antonio Carlos Moreira Lemos, Maria de Lourdes Santana Bastos, Margarida Célia Lima Costa Neves, Aquiles Assunção Camelier, Natália Barbosa Carvalho, Edgar Marcelino de Carvalho

J Bras Pneumol.2016;42(4):241-274

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls). Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL) group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL) group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%). The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01), and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05). However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5) were higher in patients than in controls (p < 0.001) but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile.


Keywords: Pulmonary disease, chronic obstructive; Cytokines; Chemokines; Eosinophils; Sputum/cytology; Forced expiratory volume.


5 - Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

Ecobroncoscopia radial para o diagnóstico de lesões pulmonares periféricas

Marcia Jacomelli, Sergio Eduardo Demarzo, Paulo Francisco Guerreiro Cardoso, Addy Lidvina Mejia Palomino, Viviane Rossi Figueiredo

J Bras Pneumol.2016;42(4):248-253

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Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm) and 19 masses (mean diameter, 4.1 ± 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.


Keywords: Diagnostic techniques, respiratory system; Lung/ultrasonography; Bronchoscopy/methods; Bronchoscopy/instrumentation.


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

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

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

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

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


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


7 - Lack of association between viral load and severity of acute bronchiolitis in infants

Falta de associação entre carga viral e gravidade da bronquiolite aguda em lactentes

Ana Paula Duarte de Souza, Lidiane Alves de Azeredo Leitão, Fernanda Luisi, Rodrigo Godinho Souza, Sandra Eugênia Coutinho, Jaqueline Ramos da Silva, Rita Mattiello, Paulo Márcio Condessa Pitrez, Renato Tetelbom Stein, Leonardo Araújo Pinto

J Bras Pneumol.2016;42(4):261-265

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Objective: To investigate the correlation between respiratory syncytial viral load and length of hospitalization in infants with acute wheezing episodes. Methods: This was a two-year, cross-sectional study of infants ≤ 12 months of age with bronchiolitis at the time of admission to a tertiary hospital. For the identification of respiratory viruses, nasopharyngeal secretions were collected. Samples were analyzed (throughout the study period) by direct immunofluorescence and (in the second year of the study) by quantitative real-time PCR. We screened for three human viruses: rhinovirus, respiratory syncytial virus, and metapneumovirus. Results: Of 110 samples evaluated by direct immunofluorescence, 56 (50.9%) were positive for a single virus, and 16 (14.5%) were positive for two or more viruses. Among those 72 samples, the most prevalent virus was respiratory syncytial virus, followed by influenza. Of 56 samples evaluated by quantitative real-time PCR, 24 (42.8%) were positive for a single virus, and 1 (1.7%) was positive for two viruses. Among those 25 samples, the most prevalent virus was again respiratory syncytial virus, followed by human rhinovirus. Coinfection did not influence the length of the hospital stay or other outcome s. In addition, there was no association between respiratory syncytial virus load and the length of hospitalization. Conclusions: Neither coinfection nor respiratory syncytial viral load appears to influence the outcomes of acute bronchiolitis in infants.


Keywords: Bronchiolitis; Coinfection; Viral load; Hospitalization; Respiratory syncytial virus, human.


8 - STOP-Bang questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil

Tradução e adaptação transcultural do questionário STOP-Bang para a língua portuguesa falada no Brasil

Lorena Barbosa de Moraes Fonseca, Erika Aparecida Silveira, Nathalia Meireles Lima, Marcelo Fouad Rabahi

J Bras Pneumol.2016;42(4):266-272

Abstract PDF PT PDF EN Portuguese Text

Objective: To translate and perform a cross-cultural adaptation of the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) questionnaire so that it can be used as a screening tool for the diagnosis of obstructive sleep apnea in Brazil. Methods: Based on the principles of good practice for the translation and cross-cultural adaptation of such instruments, the protocol included the following steps: acquisition of authorization from the lead author of the original questionnaire; translation of the instrument to Brazilian Portuguese, carried out by two translators; reconciliation; back-translation to English, carried out by two English teachers who are fluent in Portuguese; review of the back-translation; harmonization; review and approval of the questionnaire by the original author; cognitive debriefing involving 14 patients who completed the questionnaire; analysis of the results; and review and preparation of the final version of the instrument approved by the review committee. Results: The final version of the STOP-Bang questionnaire for use in Brazil showed a clarity score > 9 (on a scale of 1-10) for all of the questions. The Cronbach's alpha coefficient was 0.62, demonstrating the internal consistency of the instrument. The means and standard deviations of the age, body mass index, and neck circumference of the patients studied were 46.8 ± 11.2 years, 43.7 ± 8.5 kg/m2, and 41.3 ± 3.6 cm, respectively. Conclusions: The STOP-Bang questionnaire proved to be understandable, clear, and applicable. The original instrument and the translated version, cross-culturally adapted for use in Brazil, were consistently equivalent. Therefore, it can become a widely used screening tool for patients with suspected obstructive sleep apnea.


Keywords: Sleep apnea, obstructive; Questionnaires; Translations.


9 - Influence of heart failure on resting lung volumes in patients with COPD

Influência da insuficiência cardíaca nos volumes pulmonares de repouso em pacientes com DPOC

Aline Soares de Souza, Priscila Abreu Sperandio, Adriana Mazzuco, Maria Clara Alencar, Flávio Ferlin Arbex, Mayron Faria de Oliveira, Denis Eunan O'Donnell, José Alberto Neder

J Bras Pneumol.2016;42(4):273-278

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Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil.


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


10 - Evaluation of pulmonary function and respiratory symptoms in pyrochlore mine workers

Avaliação da função pulmonar e sintomas respiratórios em trabalhadores da mineração de pirocloro

Ritta de Cássia Canedo Oliveira Borges, José Cerqueira Barros Júnior, Fabrício Borges Oliveira, Marisa Andrade Brunherotti, Paulo Roberto Veiga Quemelo

J Bras Pneumol.2016;42(4):279-285

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Objective: To identify respiratory symptoms and evaluate lung function in mine workers. Methods: This was a cross-sectional observational study involving production sector workers of a pyrochlore mining company. The subjects completed the British Medical Research Council questionnaire, which is designed to evaluate respiratory symptoms, occupational exposure factors, and smoking status. In addition, they underwent pulmonary function tests with a portable spirometer. Results: The study involved 147 workers (all male). The mean age was 41.37 ± 8.71 years, and the mean duration of occupational exposure was 12.26 ± 7.09 years. We found that 33 (22.44%) of the workers had respiratory symptoms and that 26 (17.69%) showed abnormalities in the spirometry results. However, we found that the spirometry results did not correlate significantly with the presence of respiratory symptoms or with the duration of occupational exposure. Conclusions: The frequencies of respiratory symptoms and spirometric changes were low when compared with those reported in other studies involving occupational exposure to dust. No significant associations were observed between respiratory symptoms and spirometry results.


Keywords: Spirometry; Mining; Niobium; Occupational exposure.


Brief Communication

11 - Recent transmission of drug-resistant Mycobacterium tuberculosis in a prison population in southern Brazil

Transmissão recente de Mycobacterium tuberculosis resistentes aos antimicrobianos em população carcerária no sul do Brasil

Ana Julia Reis, Simone Maria Martini de David, Luciana de Souza Nunes, Andreia Rosane de Moura Valim, Lia Gonçalves Possuelo

J Bras Pneumol.2016;42(4):286-289

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We conducted a cross-sectional, retrospective study, characterized by classical and molecular epidemiology, involving M. tuberculosis isolates from a regional prison in southern Brazil. Between January of 2011 and August of 2014, 379 prisoners underwent sputum smear microscopy and culture; 53 (13.9%) were diagnosed with active tuberculosis. Of those, 8 (22.9%) presented with isoniazid-resistant tuberculosis. Strain genotyping was carried out by 15-locus mycobacterial interspersed repetitive unit-variable-number tandem-repeat analysis; 68.6% of the patients were distributed into five clusters, and 87.5% of the resistant cases were in the same cluster. The frequency of drug-resistant tuberculosis cases and the rate of recent transmission were high. Our data suggest the need to implement an effective tuberculosis control program within the prison system.


Keywords: Tuberculosis; Prisons; Molecular epidemiology.


Review Article

12 - Smoking control: challenges and achievements

Controle do tabagismo: desafios e conquistas

Luiz Carlos Corrêa da Silva, Alberto José de Araújo, Ângela Maria Dias de Queiroz, Maria da Penha Uchoa Sales, Maria Vera Cruz de Oliveira Castellano; Comissão de Tabagismo da SBPT

J Bras Pneumol.2016;42(4):290-298

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Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.


Keywords: Tobacco products; Smoking; Health policy; Smoking cessation; Health personnel.


Letters to the Editor

13 - Resistance profile of strains of Mycobacterium fortuitum isolated from clinical specimens

Perfil de resistência de cepas de Mycobacterium fortuitum isoladas de espécimes clínicos

Debora Ribeiro de Souza Santos, Maria Cristina Silva Lourenço, Fábrice Santana Coelho, Fernanda Carvalho Queiroz Mello, Rafael Silva Duarte

J Bras Pneumol.2016;42(4):299-301

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