Brazilian Journal of Pulmonology

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


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Year 2008 - Volume 34  - Number 4  (/April)

Original Article

2 - Educational camp for children with asthma

Acampamento educacional para crianças asmáticas

Maria do Rosario da Silva Ramos Costa, Maria Alenita Oliveira, Ilka Lopes Santoro,Yara Juliano, José Rosado Pinto, Ana Luisa Godoy Fernandes

J Bras Pneumol.2008;34(4):191-195

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of a 5-day educational camp program for children with asthma in terms of improving their knowledge of asthma and enhancing their performance in the use of inhaled medication and in physical activities. Methods: Every day, the children received 20-min interactive educational sessions, the technique for using the metered-dose inhaler was reviewed, two peak flow readings were recorded, and the children performed physical activities that included breathing and relaxation exercises. A questionnaire regarding knowledge of asthma, as well as asthma triggers, asthma medications, misconceptions regarding asthma, and the use of spacers, was administered before and after the intervention. Correct use of inhaled medication and exercise-related symptoms were also evaluated before and after the intervention. Results: A total of 37 children with asthma, aged 8-10 years (15 females and 22 males), were included in this study. Of those, 25% showed an improvement in the level of knowledge of asthma after the educational camp program, as evidenced by the greater number of correct answers on three of the twelve questions analyzed (p < 0.05). The exercise-related dyspnea scores decreased significantly (p < 0.05). The ability to use inhaled medication correctly was significantly improved after the intervention (p < 0.05). Conclusions: The asthma educational camp program can improve knowledge about specific questions, encourage participation in physical activities, and improve the asthma management skills of children.


Keywords: Asthma; Asthma/prevention & control; Models, educational; Child.


3 - Prevalence of emotional and behavioral disorders in adolescents with asthma

Prevalência de transtornos emocionais e comportamentais em adolescentes com asma

Cristina Gonçalves Alvim, Janete Ricas, Paulo Augusto Moreira Camargos, Laura Maria Belizário de Lima Facury Lasmar, Cláudia Ribeiro de Andrade, Cássio da Cunha Ibiapina

J Bras Pneumol.2008;34(4):196-204

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of emotional and behavioral disorders in adolescents with asthma and to compare it with that of adolescents without asthma. Methods: A transversal study using the Strengths and Difficulties Questionnaire, administered to adolescents with or without asthma, ranging from 14 to 16 years of age and randomly selected from schools in the city of Belo Horizonte, Brazil. Results: The prevalence of emotional and behavioral disorders in adolescents with and without asthma was 20.4% (95% CI: 14.5-27.8%) and 9.0% (95% CI: 6.1-12.8%), respectively. Among adolescents with asthma, 56.6% (95% CI: 48.3-64.5%) presented normal scores, and 23.0% (95% CI 16.8-30.7%) presented borderline scores. Among adolescents without asthma, 75.0% (95% CI: 69.7-79.6%) presented normal scores, and 16.0% (95% CI: 12.2-20.7%) presented borderline scores. The median total score on the questionnaire was 14 and 12 among subjects with and without asthma, respectively (p < 0.01). In the final logistic regression model, adjusted for socioeconomic variables, the association between emotional/behavioral disorders and the following variables remained significant: being female (OR = 1.98; 95% CI: 1.10-3.56; p = 0.02) and having asthma (OR = 2.66; 95% CI: 1.52-4.64; p = 0.001). Conclusions: The prevalence of emotional and behavioral disorders is higher in adolescents with asthma than in those without asthma, underscoring the need for a holistic, interdisciplinary approach.


Keywords: Asthma; Epidemiology; Prevalence; Adolescent; Psychology; Behavioral symptoms.


4 - Thoracoscopy in the treatment of pleural empyema in pediatric patients

Toracoscopia no tratamento do empiema pleural em pacientes pediátricos

Davi Wen Wei Kang, José Ribas Milanez de Campos, Laert de Oliveira Andrade Filho, Fabiano Cataldi Engel, Alexandre Martins Xavier, Maurício Macedo, Karine Meyer

J Bras Pneumol.2008;34(4):205-211

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the results of thoracoscopy for the treatment of pleural empyema in pediatric patients. Methods: A retrospective study of 117 patients who underwent mediastinoscopy or video-assisted thoracoscopy for pleural empyema treatment. General anesthesia and single-lumen oral intubation were used. Surgery was indicated when there was pleural effusion and no clinical and radiological response to clinical treatment (antibiotics, physiotherapy and thoracocentesis) or severe sepsis, together with loculated pleural effusion (confirmed through ultrasound or computed tomography of the chest). Results: Between February of 1983 and July of 2006, 117 thoracoscopies were performed in patients ranging in age from 5 months to 17 years (mean, 4 years). Mean time for thoracic drainage was 9 days (range, 2-33 days), and mean period of hospitalization was 16.4 days (range, 4 to 49 days). One patient (0.8%) died after surgery, and persistent fistula was observed in 33 patients (28%). In 7 cases (6%), open thoracotomy with pulmonary decortication was performed due to the disposition of the empyema. Conclusions: Management of pleural empyema in this age bracket is still controversial, and surgical indication is often delayed, particularly when there are multiple loculations or severe sepsis. Early thoracoscopy yields a better clinical outcome for pediatric patients with pleural empyema, with apparent decreased morbidity and mortality, earlier chest tube removal, earlier hospital discharge and improved response to antibiotic therapy.


Keywords: Empyema, pleural; Pediatrics/instrumentation; Thoracoscopy; Thoracic surgery, video-assisted.


5 - Oxygen outflow delivered by manually operated self-inflating resuscitation bags in patients breathing spontaneously

Fluxo de saída de oxigênio fornecido por reanimadores manuais com balão auto-inflável em pacientes com ventilação espontânea

Armando Carlos Franco de Godoy, Ronan José Vieira, Ronan José Vieira Neto

J Bras Pneumol.2008;34(4):212-216

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the oxygen outflow delivered by seven different models of manually operated self-inflating resuscitation bags (with and without an oxygen reservoir connected), which were tested using different oxygen supply rates without manipulating the bag, by simulating their use in patients breathing spontaneously. Methods: The oxygen outflow was measured using a wall oxygen flow meter and a flow meter/respirometer attached to the bag, together with another flow meter/respirometer attached to the patient connection port. The resuscitation bags that allow the connection of an oxygen reservoir were tested with and without this device. All resuscitation bags were tested using oxygen supply rates of 1, 5, 10, and 15 L/min. Statistical analyses were performed using analysis of variance and t-tests. Results: The resuscitation bags that allow the connection of an oxygen reservoir presented a greater oxygen outflow when this device was connected. All resuscitation bags delivered a greater oxygen outflow when receiving oxygen at a rate of 15 L/min. However, not all models delivered a sufficient oxygen outflow even when the two previous conditions were satisfied. Conclusions: Of the resuscitation bags studied, those that allow the connection of an oxygen reservoir must have this reservoir connected to the bag when used as a source of oxygen in nonintubated spontaneously breathing patients. All of the models studied should receive oxygen at a rate ≥ 15 L/min. It is not safe to use manually operated self-inflating resuscitation bags for this purpose without knowing their characteristics.


Keywords: Oxygen/administration & dosage; Resuscitation; Equipment and supplies; Respiration; Intensive care.


6 - Evaluation of adenosine deaminase in the diagnosis of pleural tuberculosis: a Brazilian meta-analysis

Avaliação da adenosina desaminase no diagnóstico da tuberculose pleural: uma metanálise brasileira

Patrizio Morisson, Denise Duprat Neves

J Bras Pneumol.2008;34(4):217-224

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate Brazilian studies by summarizing the accuracy of adenosine deaminase in the diagnosis of the pleural tuberculosis, with the objective of lending support to the movement to make the test part of the routine in the investigation of pleural effusions. Methods: A search for Brazilian studies related to the determination of adenosine deaminase levels in the pleural liquid was carried out. These studies were evaluated and included in this study. The data were analyzed using summary receiver operating characteristic (SROC) curves, which enabled the studies to be collected and evaluated regarding the accuracy of the diagnosis. As for the global values of sensitivity and specificity, the Bayes' theorem was applied to calculate the post-test probabilities in different prevalences of the disease. Results: Twenty-five studies dating from 1987 to 2005 and including enough information to be used in the meta-analysis were identified. After evaluation, nine studies were included, totaling 1674 patients. According to the SROC curve, a sensitivity of 91.8% (95% CI: 89.8‑93.6%) and a specificity of 88.4% (95% CI: 86.0-90.5%) were found, with an area of 0.969 below the curve. The overall odds ratio was 112.0 (95% CI: 51.6-243.2). Considering a prevalence of tuberculosis of 50% (considered neutral), the post-test probability was 88.7% for a positive test and 91.5% for a negative test. Conclusion: Despite the differences found among studies, it is possible to conclude that the determination of adenosine deaminase levels has high accuracy in the diagnosis of the pleural tuberculosis and should be used as a routine test in its investigation.


Keywords: Pleural effusion; Tuberculosis; Diagnosis; Adenosine deaminase; Meta-analysis.


7 - Completeness of tuberculosis control program records in the case registry database of the state of Espírito Santo, Brazil: analysis of the 2001-2005 period

Completude dos dados do Programa de Controle da Tuberculose no Sistema de Informação de Agravos de Notificação no Estado do Espírito Santo, Brasil: uma análise do período de 2001 a 2005

Cláudia Maria Marques Moreira, Ethel Leonor Noia Maciel

J Bras Pneumol.2008;34(4):225-229

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the completeness of tuberculosis control program records for the 2001-2005 period in the case registry database of the state of Espírito Santo, Brazil. Methods: A descriptive study using secondary data analysis. The following variables were studied: race/color; educational level, supervised treatment, sputum culture at treatment outcome, HIV status, smear sputum microscopy at the sixth month of treatment and treatment outcome. Results: Using technical parameters of the case registry database of the Brazilian National Ministry of Health regarding the percentage of completeness of data on the reporting forms, the tuberculosis database of the state of Espírito Santo can be classified as fair to excellent. The state of Espírito Santo has 78 cities, 8 of which are considered priorities for tuberculosis control. For the variables studied, the cities not considered priorities presented better completeness of records than did those considered priorities, the exception being the variable treatment outcome, for which the percentage of completeness was comparable among all of the cities. Conclusions: Since the cities that are considered priorities accounted for 70.2% of the total number of reports, the responsible officials in those cities should improve the quality of those reports in terms of the completeness of forms and the updating of data, which are fundamental to the reliability of epidemiological analyses. That will make it possible to plan activities aimed at the prevention and control of tuberculosis in the state.


Keywords: Tuberculosis; Disease notification; Information systems; Databases as topic.


Review Article

8 - Allergic Rhinitis: epidemiological aspects, diagnosis and treatment

Rinite alérgica: aspectos epidemiológicos, diagnósticos e terapêuticos

Cássio da Cunha Ibiapina, Emanuel Savio Cavalcanti Sarinho, Paulo Augusto Moreira Camargos, Cláudia Ribeiro de Andrade, Álvaro Augusto Souza da Cruz Filho

J Bras Pneumol.2008;34(4):230-240

Abstract PDF PT PDF EN Portuguese Text

This study was a review of the literature on the epidemiological, clinical, diagnostic and therapeutic aspects of allergic rhinitis. Bibliographic searches were based on the information contained within the Medline, Latin American and Caribbean Health Sciences Literature and HighWire databases, covering the last thirty years and using the following search terms: 'allergic rhinitis', 'epidemiology', 'diagnosis' and 'treatment'. Sixty articles were selected. This study describes the increase in the prevalence of allergic rhinitis, its relationship with asthma, the diagnostic criteria and the treatment. The classification of allergic rhinitis and strategies for its treatment are presented. Therapeutic modalities presented and discussed include the administration of antihistamines, corticosteroids, immunotherapy, anti-leukotrienes, sodium cromoglycate and anti-IgE antibodies, as well as minimizing exposure to inhaled allergens. Finally, the importance of the management of allergic rhinitis in public health is emphasized.


Keywords: Rhinitis/therapy; Hypersensitivity; Epidemiology; Diagnosis.


Case Report

9 - Video-assisted thoracoscopic removal of foreign bodies from the pleural cavity

Videotoracoscopia para remoção de corpo estranho da cavidade pleural

Giovanni Antonio Marsico, André Luiz de Almeida, Dirceo Edson de Azevedo, Gustavo Carvalho Venturini, Alexandre Edson de Azevedo, Paula dos Santos Marsico

J Bras Pneumol.2008;34(4):241-244

Abstract PDF PT PDF EN Portuguese Text

Video-assisted thoracoscopy is a minimally invasive surgical technique. It is the procedure of choice for the treatment of certain lung and pleural diseases. It has been increasingly used in the acute phase of thoracic trauma. Another indication for its use, which is rarely described in the literature, is for the removal of retained intrathoracic foreign bodies. We report the cases of two hemodynamically stable gunshot victims in whom the bullet was removed from the pleural cavity through video-assisted thoracoscopy, thereby avoiding the need for thoracotomy.


Keywords: Thoracic injuries; Wounds, penetrating; Thoracic surgery, video-assisted; Foreign bodies.


10 - Treatment of pulmonary actinomycosis with levofloxacin

Tratamento da actinomicose pulmonar com levofloxacina

Diva de Fátima Gonçalves Ferreira, Joana Amado, Sofia Neves, Natália Taveira, Aurora Carvalho, Rosete Nogueira

J Bras Pneumol.2008;34(4):245-248

Abstract PDF PT PDF EN Portuguese Text

Actinomycosis is a chronic suppurative bacterial infection characterized by multiple abscesses, fistulous pathways, and fibrosis involving the face, neck, chest, and abdomen. It is caused by an anaerobic Gram-positive saprophytic bacterium ( Actinomyces). Primary actinomycosis of the lung is a rare disease that probably results from aspiration of oropharyngeal secretions. It can present as a chronic respiratory disease. The treatment of choice is antibiotic therapy with penicillin. The authors report the case of a 55-year-old female diagnosed with pulmonary actinomycosis and successfully treated with levofloxacin.


Keywords: Actinomycosis; Infection; Ofloxacin; Medical records.



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