Different kinds of pulmonary impairment have been described in Sjögren syndrome, including rare cases of bronchiectasis. The authors report a female patient with a history of episodes of respiratory infections and progressive breathlessness whose high resolution computerized tomography revealed bronchiectasis. A former open lung biopsy showed bronchiolar inflammatory and fibrotic changes. The diagnosis of Sjögren syndrome was made only late in the evolution, although sicca syndrome symptoms had been present for years. The authors discuss the potential pathogenic mechanisms involved in the development of the bronchiectasis and the need for a high degree of clinical medical skill for the early diagnosis of such conditions.

Keywords: Sjögren syndrome; bronchiectasis; bronchiolitis

Background: The methacholine challenge test is commonly used to evaluate bronchial responsiveness in diagnosis and follow-up of asthmatic patients. Objective: To investigate late effects of methacholine challenge on induced sputum. Methods: Ten non-smoker patients with mild or moderate stable asthma were recruited. At 12:00 p.m., patients were randomly assigned to inhale either methacholine (challenge) or physiologic saline. At 6:00 p.m., sputum induction was performed. On the second visit, one week apart, patients completed their participation in the study by undergoing another inhalation and sputum induction. Results: After methacholine, 8.6 ± 9 g of sputum were expectorated with 8.6 ± 6 million cells, 78 ± 10% were viable, and 6.8 ± 7% eosinophils. These data were not different from results obtained after saline: sputum amount = 7.6 ± 6 g, total cell count = 12.4 ± 12 million, viability = 82 ± 10%, and eosinophils = 6.6 ± 9%. Expiratory flow (PF) peak fall during sputum induction was not different: 21.4 ± 12% after methacholine and 18.4 ± 15% after saline. The PF fall observed during induction correlated with the amount of expectorated sputum (p = 0.018) and eosinophil relative number (p = 0.003). No other significant correlation between lung function measurements and sputum characteristics was found. Conclusion: A methacholine challenge carried out six hours before sputum induction does not significantly alter the cellular constituents or amount of sputum.

Keywords: Asthma. Methacholine chloride. Bronchial provocation tests.

Objective: To analyze and compare the transport properties of respiratory secretions, classified by selected parameters, in individuals with bronchiectasis unrelated to cystic fibrosis. Methods: We collected mucus samples from 35 individuals with bronchiectasis unrelated to cystic fibrosis. The samples were first classified by their surface properties (adhesive or nonadhesive), as well as by their aspect (mucoid or purulent). We then tested the samples regarding relative transport velocity (RTV), displacement in a simulated cough machine (SCM), and contact angle (CA). For the proposed comparisons, we used ANOVA models, with a level of significance set at 5%. Results: In comparison with nonadhesive samples, adhesive samples showed significantly less displacement in the SCM, as well as a significantly higher CA (6.52 ± 1.88 cm vs. 8.93 ± 2.81 cm and 27.08 ± 6.13° vs. 22.53 ± 5.92°, respectively; p < 0.05 for both). The same was true in the comparison between purulent and mucoid samples (7.57 ± 0.22 cm vs. 9.04 ± 2.48 cm and 25.61 ± 6.12° vs. 21.71 ± 5.89°; p < 0.05 for both). There were no significant differences in RTV among the groups of samples, although the values were low regardless of the surface properties (adhesive: 0.81 ± 0.20; nonadhesive: 0.68 ± 0.24) or the aspect (purulent: 0.74 ± 0.22; mucoid: 0.82 ± 0.22). Conclusions: The respiratory secretions of patients with bronchiectasis showed decreased mucociliary transport. Increased adhesiveness and purulence cause the worsening of transport properties, as demonstrated by the lesser displacement in the SCM and the higher CA.

Keywords: Bronchiectasis; Mucus; Mucociliary clearance; Adhesiveness.

Objective: To investigate dyspnea in individuals with Class II or III obesity and look for correlations among the respiratory data related to such individuals. Methods: This study involved 49 subjects with a body mass index >35 kg/m2, divided into two groups (those with dyspnea and those without). The baseline dyspnea index was evaluated, as were spirometry findings, maximal respiratory pressures and arterial blood gas analysis. Results: Of the 49 subjects evaluated, 37 reported dyspnea and 12 reported no dyspnea. The baseline dyspnea index differed between the two groups. The mean values were within the range of normality for all subjects and all parameters, except for the following: ratio of residual volume to total lung capacity; expiratory reserve volume; and the alveolar-arterial oxygen gradient. The subjects with dyspnea presented significantly lower values for expiratory reserve volume, maximal expiratory pressure and arterial pH. In all subjects, body mass index correlated significantly with the following: baseline dyspnea index; the residual volume/total lung capacity ratio; the forced expiratory volume in one second/forced vital capacity ratio; forced expiratory flow between 25% and 75% of forced vital capacity; arterial oxygen tension; the alveolar-arterial oxygen gradient; and arterial carbon dioxide tension. The baseline dyspnea index was found to correlate significantly with the following parameters: residual volume/total lung capacity ratio; expiratory reserve volume; arterial oxygen tension; the alveolar-arterial oxygen gradient; and arterial carbon dioxide tension. Conclusion:  Dyspnea is a common complaint in individuals with class II or III obesity. Such individuals present a pronounced reduction in expiratory reserve volume and an increase in the alveolar-arterial oxygen gradient. The correlations found suggest that obese individuals present dysfunction of the lower airways, and that obesity itself plays a role in the genesis of dyspnea.

Keywords: Obesity/complications; Dyspnea/epidemiology; Dyspnea/physiopathology; Respiratory function tests

Objective: To investigate the effects of quercetin in a model of bleomycin-induced pulmonary inflammation and fibrosis. Methods: Seventynine adult male hamsters were randomized to receive intratracheal (IT) instillations and intraperitoneal (IP) injections in four configurations: IP vehicle/IT saline (VS group, n = 16); IP quercetin/IT saline (QS group, n = 16); IP vehicle/IT bleomycin (VB group, n = 27); and IP quercetin/ IT bleomycin (QB group, n = 20). Quercetin and bleomycin were administered at 30 mg/kg/day and 10 U/kg, respectively. Quercetin was started/discontinued 3 days before/14 days after the IT instillations. Results: The mortality rate was significantly higher in the VB group than in the other groups (44% vs. VS: 0%; QS: 0%; and QB: 15%). Lung levels of thiobarbituric acid reactive substances (× 10−2 nmol/mg) were significantly higher in the VB group (6.6 ± 1.3 vs. VS: 5.5 ± 0.8; QS: 2.5 ± 0.6; and QB: 5.8 ± 0.6). Lung levels of reduced glutathione (× 10−2 nmol/mg) were significantly lower in the VB/QB groups than in the VS/QS groups (28.9 ± 13.8/28.6 ± 14.8 vs. 43.9 ± 16.0/51.1 ± 20.3), whereas those of hydroxyproline (mg/g) were significantly higher (201.6 ± 37.3/177.6 ± 20.3 vs. 109.6 ± 26.1/117.5 ± 32.0).Mean lung septal thickness (μm) was greatest in the VB group (16.9 ± 3.2 vs. VS: 3.0 ± 0.3; QS: 3.3 ± 0.2; and QB: 5.2 ± 1.1). Conclusions: In a hamster model of lung injury, quercetin exhibited anti-inflammatory effects that are related, at least in part, to its antioxidant properties.

Keywords: Pulmonary fibrosis; Bleomycin; Flavonoids; Lipid peroxidation.

Objective: To evaluate the effects of immunization with a DNA-hsp65 vaccine in an experimental model of pulmonary fibrosis. Methods: A total of 120 male C57BL/6 mice were distributed into four groups: SS, injected with saline (placebo) and then receiving intratracheal (IT) instillation of saline; SB, injected with saline (placebo) and then receiving IT instillation of bleomycin; PB, treated with plasmid only, without bacterial genome, and then receiving IT instillation of bleomycin; and BB, treated with the vaccine and then receiving IT instillation of bleomycin. Bleomycin was instilled 15 days after the last immunization, and the animals were killed six weeks thereafter. The left and right lungs were removed, the former for morphological analysis and the latter for hydroxyproline measurements. Results: The proportion of deaths within the first 48 h after the IT instillation (deaths attributed to the surgical procedure) was higher in the SB group than in the SS group (57.7% vs. 11.1%). The mean area of pulmonary interstitial septa was greater in the SB and PB groups (53.1 ± 8.6% and 53.6 ± 9.3%, respectively) than in the SS and BB groups (32.9 ± 2.7% and 34.3 ± 6.1%, respectively). The mean area of interstitial septa stained by picrosirius was greater in the SB, PB and BB groups than in the SS group (8.2 ± 4.9%, 7.2 ± 4.2% and 6.6 ± 4.1%, respectively, vs. 2.0 ± 1.4%). The total hydroxyproline content in the lung was significantly lower in the SS group (104.9 ± 20.9 pg/lung) than in the other groups (SB: 160.4 ± 47.8 pg/lung; PB: 170.0 ± 72.0 pg/lung; and BB: 162.5 ± 39.7 pg/lung). Conclusions: Immunization with the DNA-hsp65 vaccine reduced the deposition of noncollagen matrix in a model of bleomycin-induced lung lesion.

Keywords: Pulmonary fibrosis; Bleomycin; Collagen.

Objective: To translate the Modified Reasons for Smoking Scale (MRSS) to Portuguese, to submit it to cross-cultural adaptation for use in Brazil and to evaluate the test-retest reliability of the translated version. Methods: An English-language version of the MRSS was translated to Portuguese by Brazilian doctors who have thorough knowledge of the English language. A consensus version was produced by a multidisciplinary group including two pulmonologists, a psychiatrist and a psychologist. This version was back-translated to English by an American translator. Cross-cultural adaptation of the final version was evaluated in a sample of 20 healthy smokers. Test-retest reliability was evaluated by applying the translated version of the scale in 54 healthy smokers on two distinct occasions, 15 days apart. Results: This translated version of the MRSS was well understood by 95% of the smokers, indicating excellent cross-cultural equivalence. The degree of reliability of the answers in two different occasions was almost perfect for two questions, substantial for ten questions, moderate for eight questions, and low for one question. The intraclass correlation coefficients of the motivational factors obtained on the two different occasions, calculated according to previously published theoretical models, were higher than 0.7 for six of the seven subscales. Conclusions: The Portuguese-language version of the MRSS shows satisfactory cross-cultural equivalence and test-retest reliability. It can be a useful tool in the evaluation and treatment of smokers in Brazil.

Keywords: Smoking cessation; Scales; Translations; Validation studies.

Objective: To develop a new scale aimed at evaluating smoking motivation by incorporating questions and domains from the 68-item Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) into the Modified Reasons for Smoking Scale (MRSS). Methods: Nine WISDM-68 questions regarding affiliative attachment, cue exposure/associative processes, and weight control were added to the 21 questions of the MRSS. The new scale, together with the Fagerström Test for Nicotine Dependence (FTND), was administered to 311 smokers (214 males; mean age = 37.6 ± 10.8 years; mean number of cigarettes smoked per day = 15.0 ± 9.2), who also provided additional information. We used exploratory factor analysis in order to determine the factor structure of the scale. The influence that certain clinical features had on the scores of the final factor solution was also analyzed. Results: The factor analysis revealed a 21-question solution grouped into nine factors: addiction, pleasure from smoking, tension reduction, stimulation, automatism, handling, social smoking, weight control, and affiliative attachment. For the overall scale, the Cronbach's alpha coefficient was 0.83. Females scored significantly higher for addiction, tension reduction, handling, weight control, and affiliative attachment than did males. The FTND score correlated positively with addiction, tension reduction, stimulation, automatism, social smoking, and affiliative attachment. The number of cigarettes smoked per day was associated with addiction, tension reduction, stimulation, automatism, affiliative attachment, and handling. The level of exhaled CO correlated positively with addiction, automatism, and affiliative attachment. Conclusions: The new scale provides an acceptable framework of motivational factors for smoking, with satisfactory psychometric properties and reliability.

Keywords: Smoking; Validation studies; Tobacco use cessation.

Objective: To investigate the usefulness of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) that were developed in English and translated to Brazilian Portuguese in patients with four distinct clinical conditions that can be accompanied by dyspnea. Methods: We translated, from English to Brazilian Portuguese, a list of 15 dyspnea descriptors reported in a study conducted in the USA. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. Results: The use of this set of descriptors led to a solution with nine clusters, designated expiração (exhalation), fome de ar (air hunger), sufoco (suffocating), superficial (shallow), rápido (rapid), aperto (tight), falta de ar (shortness of breath), trabalho (work), and inspiração (inhalation). Overlapping of the descriptors was quite common among the patients, regardless of their clinical condition. Asthma, COPD, and heart failure were significantly associated with the inspiração cluster. Heart failure was also associated with the trabalho cluster, whereas obesity was not associated with any of the clusters. Conclusions: In our study sample, the application of dyspnea descriptors translated from English to Portuguese led to the identification of distinct clusters, some of which were similar to those identified in a study conducted in the USA. The translated descriptors were less useful than were those developed in Brazil regarding their ability to generate significant associations among the clinical conditions investigated here.

Keywords: Dyspnea; Pulmonary disease, chronic obstructive; Asthma; Heart failure.

Objective: To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. Methods: We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. Results: The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. Conclusions: In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.

Keywords: Dyspnea; Pulmonary disease, chronic obstructive; Asthma; Heart failure.

Objective: To characterize the situation of pulmonology journals published in Latin America. Methods: A survey was conducted in a meeting sponsored by the Latin American Thoracic Society. Each journal editor presented a report and answered a questionnaire. Results: Improving information acquisition is the main motivation for pulmonology societies to edit their own journals, whereas disseminating medical knowledge and reporting experiences are the main motivations for authors to submit papers. The most common failing in the manuscripts submitted is poor compliance with the journal guidelines. Improving author-editor-reviewer relationships would be the best strategy for improving the quality of manuscripts. Suggestions for improving Latin American journals included the following: promoting professionalism in editorial tasks; encouraging manuscript reviewers to be more meticulous; and embracing international norms for editing medical journals. The following major problems were reported: a lack of regular, appropriate periodicity of issues; a shortage of original papers that are considered 'milestones' in the specialty; a low rejection rate for submitted papers; a high turnover of editors. Conclusion: Based on our findings, we can make the following recommendations: although many journals are available in electronic form, they should also be maintained in print form; each journal should divulge its subscription fee, even if it is included in the annual society membership dues; although each Latin American country might decide to publish its own pulmonology journal, the feasibility of publishing a multinational Latin American pulmonology journal should be explored.

Keywords: Periodicals; Manuscripts; Latin America; Respiratory tract diseases.

Objetivo: Investigar os efeitos agudos da administração endovenosa de extrato da fumaça do cigarro (EFC) em parâmetros funcionais respiratórios, inflamatórios e histológicos em ratos e comparar esse potencial modelo de lesão pulmonar aguda (LPA) com aquele com o uso de ácido oleico (AO). Métodos: Foram estudados 72 ratos Wistar machos divididos em quatro grupos: tratados somente com soro fisiológico (SF; grupo controle); tratados com EFC e SF (grupo EFC); tratados com SF e AO (grupo AO); e tratados com EFC e AO (grupo EFC/AO). Resultados: As médias de complacência foram significantemente menores nos grupos AO e EFC/AO (2,12 ± 1,13 mL/cmH2O e 1,82 ± 0,77 mL/cmH2O, respectivamente) do que no controle (3,67 ± 1,38 mL/cmH2O). A proporção de neutrófilos e a atividade das metaloproteinases 2 e 9 em lavado broncoalveolar foram significantemente maiores nos grupos AO e EFC/AO que no controle. O acometimento pulmonar avaliado por morfometria foi significantemente maior nos grupos AO e EFC/AO (72,9 ± 13,8% e 77,6 ± 18,0%, respectivamente) do que nos grupos controle e EFC (8,7 ± 4,1% e 32,7 ± 13,1%, respectivamente), e esse acometimento foi significantemente maior no grupo EFC que no grupo controle. Conclusões: A administração endovenosa de EFC, nas doses e tempos deste estudo, associou-se à LPA mínima. O EFC não potencializou a LPA induzida por AO. Estudos adicionais são necessários para esclarecer o papel potencial desse modelo como método de estudo dos mecanismos de agressão pulmonar pelo tabaco.

Keywords: Tabagismo; Lesão pulmonar aguda; Modelos animais.

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.