Brazilian Journal of Pulmonology

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

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Year 2010 - Volume 36  - Number 1  (January/February)

Editorial

1 - Classification of journals in the QUALIS System of CAPES - URGENT need of changing the criteria!

Classificação dos periódicos no Sistema QUALIS da CAPES - a mudança dos critérios é URGENTE!

J Bras Pneumol.2010;36(1):1-3

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2 - Prevalence of smoking in Brazil: additional measures for smoking control should be a priority in the Year of the Lung

Prevalência de tabagismo no Brasil: medidas adicionais para o controle da doença devem ser priorizadas no Ano do Pulmão

Irma Godoy

J Bras Pneumol.2010;36(1):4-5

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3 - Diffuse lung diseases and HRCT: limitations of radiologists

Doenças pulmonares difusas e TCAR: os limites do radiologista

Dante Luiz Escuissato

J Bras Pneumol.2010;36(1):6-7

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Original Article

4 - Development and validation of an asthma knowledge questionnaire for use in Brazil

Desenvolvimento e validação de um questionário de conhecimento em asma para uso no Brasil

Marcos Carvalho Borges, Érica Ferraz, Sílvia Maria Romão Pontes, Andrea de Cássia Vernier Antunes Cetlin, Roseane Durães Caldeira, Cristiane Soncino da Silva, Ana Carla Sousa Araújo, Elcio Oliveira Vianna

J Bras Pneumol.2010;36(1):

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To develop and validate an asthma knowledge questionnaire for use in adult asthma patients in Brazil. Methods: A 34-item self-report questionnaire was constructed and administered to adult asthma patients and adult controls. The maximum total score was 34. Results: The questionnaire was shown to be discriminatory, with good reliability and reproducibility. The mean score for asthma patients and controls was, respectively, 21.47 ± 4.11 (range: 9-31) and 17.27 ± 5.11 (range: 7-28; p < 0.001). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.53, and the Bartlett's test of sphericity demonstrated a satisfactory suitability of the data to factor analysis (p < 0.001). There was no significant difference between the total scores obtained in the first and in the second application of the questionnaire within a two-week interval (p = 0.43). The internal consistency reliability (KR-20 coefficient) was 0.69. Conclusions: This study has validated an asthma knowledge questionnaire for use in Brazil.

 


Keywords: Asthma; Questionnaires; Validation studies; Reproducibility of results.

 

5 - Pharmaceutical care for patients with persistent asthma: assessment of treatment compliance and use of inhaled medications

Atenção farmacêutica ao portador de asma persistente: avaliação da aderência ao tratamento e da técnica de utilização dos medicamentos inalatórios

Daiane de Oliveira Santos, Maria Cleusa Martins, Sonia Lucena Cipriano, Regina Maria Carvalho Pinto, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2010;36(1):14-22

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate treatment compliance and use of inhaled medications of patients with asthma receiving complementary pharmaceutical care. Methods: A controlled prospective parallel study involving a study group and a control group. We selected 60 patients with persistent asthma and using metered-dose inhalers (MDIs), dry powder inhalers (DPIs) or both. The patients were evaluated three times over 60 days. Instructions were provided to the patients in the study group at all visits but only at the first visit to those in the control group. The patients using < 80% or > 120% of the total number of prescribed doses were classified as noncompliant. The inhalation technique was quantified by a scoring system. A satisfactory technique was defined as a score higher than 7 (maximum, 9) for MDIs and higher than 4 (maximum, 5) for DPIs. Results: The final study sample comprised 28 study group patients and 27 control group patients, of whom 18 (64.3%) and 20 (74.7%), respectively, were considered treatment compliant. From the first to the third visits, there were increases, in the study and control groups, in the median MDI-use score (from 3 [range, 0-5] to 8 [range, 8-9]; p < 0.001; and from 5 [range, 2-6] to 7 [range, 6-8]), as well as in the median DPI-use score (from 3 [range, 2-4] to 5 [range, 4-5] and from 3 [range, 2-4] to 4 [range, 3-5]). Conclusions: The counseling provided by the pharmacist to the patient was important to assist in the implementation of the appropriate inhalation technique, especially for MDI use.

 


Keywords: Asthma; Pharmaceutical services; Administration, inhalation;Metered dose inhalers; Medication adherence.

 

6 - Serum total IgE levels and total eosinophil counts: relationship with treatment response in patients with acute asthma

Relação dos níveis séricos de IgE total e das contagens de eosinófilos com a resposta ao tratamento em pacientes com asma aguda

Ebrahim Razi, Gholam Abbass Moosavi

J Bras Pneumol.2010;36(1):23-28

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether serum total IgE levels and total eosinophil counts have any relationship with the response to routine pharmacological treatment in patients with acute asthma. Methods: A cross-sectional study involving 162 patients with acute asthma. Serum total IgE levels, peripheral blood cell counts and eosinophil counts were determined. The treatment was adjusted for each patient according to the severity of asthma. Spirometry was performed at baseline and two weeks after the treatment. The patients were divided into two groups: high IgE (≥100 IU/mL) and low IgE (<100 IU/mL). We compared the two groups in terms of the relationships between baseline values and final values (percentage change) for the following parameters: FEV1, FVC, FEF25-75%, peripheral white blood cell counts and eosinophil counts. Results: There were no significant differences between the groups regarding the percentage changes of the studied parameters. Nor were there significant differences between the groups regarding FEV1, FVC, and FEF25-75% (% of the predicted values) at baseline. Conclusions: On the basis of these findings, we conclude that serum total IgE levels, peripheral white blood cell counts and eosinophil counts cannot predict the response to the pharmacological treatment of patients with acute asthma.

 


Keywords: Asthma/drug therapy; Eosinophils; Immunoglobulin E

 

7 - 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.

 

8 - Gender differences in predictors of health status in patients with COPD

Preditores do estado de saúde em pacientes com DPOC de acordo com o gênero

Renata Ferrari, Suzana Erico Tanni, Paulo Adolfo Lucheta, Márcia Maria Faganello, Renata Antonialli Ferreira do Amaral, Irma Godoy

J Bras Pneumol.2010;36(1):37-43

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the health status (HS) of COPD patients and to identify the main predictors of HS in these patients according to gender. Methods: The study included 90 COPD patients (60 males and 30 females; mean age = 64 ± 9 years) with a wide range of airway obstruction disorders (mean FEV1 = 56 ± 19% of predicted). The men were individually matched to the women by % of predicted FEV1 (ratio: 2:1). The patients were assessed regarding body composition; six-minute walk distance; perception of dyspnea using the Modified Medical Research Council Dyspnea Scale; Saint George's Respiratory Questionnaire (SGRQ); Charlson comorbidity index; and the multidimensional Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. Multiple linear regression analysis was performed to identify the predictors of HS by gender. Results: Impairment of HS was greater among the women than among the men for SGRQ total score and for all SGRQ domains (total: 51 ± 18% vs. 38 ± 19%; p = 0.002; symptoms: 61 ± 22% vs. 42 ± 21%; p < 0.001; activity: 62 ± 18% vs. 49 ± 21%; p = 0.004; and impact: 41 ± 19% vs. 27 ± 18%; p = 0.001). The multiple linear regression showed that age and perception of dyspnea correlated with SGRQ total score for both genders (males, r² = 0.42; females, r² = 0.70; p < 0.05). Conclusions: Our results showed an association between gender and HS in COPD patients. Age and dyspnea are determinants of HS in both genders.

 


Keywords: Pulmonary disease, chronic obstructive; Health status; Dyspnea.

 

9 - 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.

 

10 - Morphological prognostic factors in nosocomial pneumonia:an autopsy study

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Luiz Mário Baptista Martinelli, Paulo José Fortes Villas Boas, Thais Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.2010;36(1):51-58

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. Methods: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. Results: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco‑associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. Conclusions: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.

 


Keywords: Autopsy; Risk factors; Prognosis; Pneumonia, aspiration; Pneumonia/mortality.

 

11 - Correlation between inflammatory mediators in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection caused by respiratory syncytial virus and disease severity

Correlação entre mediadores inflamatórios na secreção nasofaríngea e no soro de crianças com infecção do trato respiratório inferior por vírus sincicial respiratórioe a gravidade da doença

Renata Amato Vieira, Edna Maria de Albuquerque Diniz,Maria Esther Jurfest Rivero Ceccon

J Bras Pneumol.2010;36(1):59-66

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the concentrations of inflammatory mediators (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-α, IL-6 and IL-10) in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) correlate with the clinical markers of disease severity. Methods: Between July of 2004 and December of 2005, 30 children less than three months of age, diagnosed with LRTI caused by RSV and admitted to a neonatal ICU, were included in this study. Results: The severity of disease at hospital admission, as determined with a modified clinical scoring system, presented a significant positive correlation with sICAM-1 and IL-10 concentrations in the nasopharyngeal secretion, as well as with IL-6 concentrations in the serum, of the patients. In addition, serum IL-6 concentrations presented a significant positive correlation with the duration of oxygen therapy and with the length of hospital stay. Conclusions: At hospital admission, the concentrations of sICAM-1 and IL-10 in the nasopharyngeal secretion, as well as the concentration of IL-6 in the serum, could be used as markers of severity in patients with LRTI caused by RSV. The serum levels of IL-6 determined at admission could also be used to predict prolonged oxygen supplementation and hospital stay.

 


Keywords: Respiratory syncytial virus, human; Chemokine CCL5; Intercellular adhesion molecule-1; Interleukin-6; Interleukin-10; Tumor necrosis factor-alpha.

 

12 - Clinical characteristics and quality of life of smokers at a referral center for smoking cessation

Características clínicas e qualidade de vida de fumantes em um centro de referência de abordagem e tratamento do tabagismo

Márcia Regina Pizzo de Castro, Tiemi Matsuo, Sandra Odebrecht Vargas Nunes

J Bras Pneumol.2010;36(1):67-74

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare smokers and never smokers in terms of the following: quality of life; BMI; hospitalizations; functionality; family history of mental disorder; tobacco-related diseases; depression; and psychoactive substance use. Methods: We evaluated 167 smokers enrolled in a smoking cessation program at the Londrina State University Referral Center for Understanding and Treating Smoking, together with 272 never-smoking blood donors. We employed the following instruments, all validated for use in Brazil: a structured questionnaire for the collection of sociodemographic data; the Alcohol, Smoking and Substance Involvement Screening Test; the World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF); and the Fagerström Test for Nicotine Dependence. We also applied diagnostic criteria for the investigation of depressive disorders. Results: The mean age of the smokers and never smokers was, respectively, 45 and 44 years. Females predominated in both groups. Smokers more often presented with impaired work/domestic functionality, hospitalizations, depressive disorders, smoking in the household, sedative use and a family history of mental disorders, as well as scoring lower in all domains of the WHOQoL-BREF. The mean age at smoking onset was lower for smokers with depression or using psychoactive substances than for smokers without such comorbidities. Diabetes, arterial hypertension, heart disease, respiratory disease and peptic ulcer were more common in smokers than in never smokers. The mean BMI was lower in the smokers than in the never smokers. Conclusions: This study suggests that, for smoking cessation programs, subgroups of smokers with specific characteristics (early age at smoking onset, tobacco-related diseases, depressive disorders and use of psychoactive substances) should be identified.

 


Keywords: Smoking; Depressive disorder; Smoking cessation; Tobacco use disorder.

 

13 - Prevalence of smoking among adults residing in the Federal District of Brasília and in the state capitals of Brazil, 2008

Prevalência do tabagismo em adultos residentes nas capitais dos estados e no Distrito Federal, Brasil, 2008

Deborah Carvalho Malta, Erly Catarina Moura, Sara Araújo Silva, Patrícia Pereira Vasconcelos de Oliveira, Vera Luiza da Costa e Silva

J Bras Pneumol.2010;36(1):75-83

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of smoking in the adult population of Brazil, in order to propose recommendations for the reduction of tobacco use. Methods: This was a population-based, cross-sectional study including a sample composed of residents (≥ 18 years of age) of the capital cities of 26 Brazilian states and in the Federal District of Brasília, Brazil. For the determination of sample size, a 95% confidence interval and a 2% sample error were defined. The participants were selected and interviewed by means of the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL, Telephone-based System for the Surveillance of Risk and Protective Factors for Chronic Diseases).The proportion of smokers and the number of cigarettes smoked per day were estimated and stratified according to sociodemographic variables. In addition, the male/female ratio was estimated for the prevalence of smoking. Results: The prevalence of smoking was 16.1% (20.5% among males and 12.4% among females). The proportion of adults that reported smoking ≥ 20 cigarettes a day was 4.9%, being greater in males (6.5% vs. 3.6%). The prevalence of smoking was greater among individuals with a lower level of education (≤ 8 years of schooling). The number of cigarettes smoked per day by males was approximately the double that smoked by females. Conclusions: The VIGITEL estimates indicate a reduction in the prevalence of smoking, which was, however, still greater among males than among females. The VIGITEL has been fundamental to monitoring smoking, as well as to informing decisions regarding public policies for health promotion and the prevention of chronic nontransmissible diseases.

 


Keywords: Smoking/epidemiology; Smoking/prevention & control; Cross-sectional studies.

 

14 - Early versus late tracheostomy in patients with acute severe brain injury

Traqueostomia precoce versus traqueostomia tardia em pacientes com lesão cerebral aguda grave

Bruno do Valle Pinheiro, Rodrigo de Oliveira Tostes, Carolina Ito Brum,Erich Vidal Carvalho, Sérgio Paulo Santos Pinto, Júlio César Abreu de Oliveira

J Bras Pneumol.2010;36(1):84-91

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare the effects of early tracheostomy and of late tracheostomy in patients with acute severe brain injury. Methods: A retrospective study involving 28 patients admitted to the ICU of the Federal University of Juiz de Fora University Hospital in Juiz de Fora, Brazil, diagnosed with acute severe brain injury and presenting with a Glasgow coma scale (GCS) score < 8 within the first 48 h of hospitalization. The patients were divided into two groups: early tracheostomy (ET), performed within the first 8 days after admission; and late tracheostomy (LT), performed after postadmission day 8. At admission, we collected demographic data and determined the following scores: Acute Physiology and Chronic Health Evaluation (APACHE) II, GCS and Sequential Organ Failure Assessment (SOFA). Results: There were no significant differences between the groups (ET vs. LT) regarding the demographic data or the scores: APACHE II (26 ± 6 vs. 28 ± 8; p = 0.37), SOFA (6.3 ± 2.7 vs. 7.2 ± 3.0; p = 0.43) and GCS (5.4 ± 1.7 vs. 5.5 ± 1.7; p = 0.87). The 28-day mortality rate was lower in the ET group (9% vs. 47%; p = 0.04). Nosocomial pneumonia occurring within the first 7 days was less common in the ET group, although the difference was not significant (0% vs. 23%; p = 0.13). There were no differences regarding the occurrence of late pneumonia or in the duration of mechanical ventilation between the groups. Conclusions: On the basis of these findings, early tracheostomy should be considered in patients with acute severe brain injury.

 


Keywords: Tracheostomy; Pulmonary ventilation; Coma.

 

15 - Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV

Cinthia Pedrozo, Clemax Couto Sant'Anna, Maria de Fátima B. Pombo March, Sheila Cunha Lucena

J Bras Pneumol.2010;36(1):92-98

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the efficacy of the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) in children and adolescents, regardless of their HIV status. Methods: This was a cross-sectional analytical study carried out between January of 2002 and December of 2006, involving 239 individuals less than 15 years of age. The patients were divided into four groups: latent TB (LTB group; n = 81); no-TB (NTB group; n = 41); TB group (n = 104); and TB/HIV group (n = 13). We studied the clinical, radiological and laboratory findings according to the scoring system. Results: Reports of fever, cough, asthenia and weight loss for at least two weeks were significantly higher in the TB group (p < 0.0001). The proportion of cases with a history of any contact and household contact with a TB patient was, respectively, 95.0% and 86.1% in the TB group, versus 75.0% and 58.3% in the TB/HIV group. In the TB and TB/HIV groups, respectively, chest X-rays revealed parenchymal alterations in 75.0% and 53.9%, revealing combined parenchymal/lymph node alterations in 18.2% and 30.8%. There were no significant differences among the groups regarding the tuberculin skin test results. In the TB group, 16.3% of the patients were malnourished (p < 0.005 vs. the LTB group). The mean NMH system scores in the LTB, NTB, TB and TB/HIV groups were, respectively, 24.2, 18.5, 45.3 and 41.5. Conclusions: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.

 


Keywords: Tuberculosis/diagnosis; HIV seropositivity; Diagnostic techniques and procedures.

 

Special Article

16 - Illustrated Brazilian consensus of terms and fundamental patternsin chest CT scans

Consenso brasileiro ilustrado sobre a terminologia dos descritores e padrões fundamentais da TC de tórax

C. Isabela S. Silva, Edson Marchiori, Arthur Soares Souza Júnior, Nestor L. Müller, Comissão de Imagem da Sociedade Brasileirade Pneumologia e Tisiologia

J Bras Pneumol.2010;36(1):99-123

Abstract PDF PT PDF EN Portuguese Text

The objective of this new Brazilian consensus is to update and to continue the standardization of the principal terms and fundamental patterns in chest CT scans in Portuguese. There is a succinct definition of the principal terms used to describe chest CT findings, as well as illustrations of classic examples. The group of authors comprised radiologists specializing in chest radiology and holding membership in the Brazilian College of ­Radiology and Diagnostic Imaging, as well as pulmonologists having a special interest in diagnostic imaging and holding membership in the Brazilian Thoracic Association.

 


Keywords: Lung; Consensus; Tomography.

 

Review Article

17 - Allergic rhinitis: indicators of quality of life

Rinite alérgica: indicadores de qualidade de vida

Inês Cristina Camelo-Nunes, Dirceu Solé

J Bras Pneumol.2010;36(1):124-133

Abstract PDF PT PDF EN Portuguese Text

The objective of this review was to present evidence of the relationship between allergic rhinitis and impairment of quality of life. The data sources were original articles, reviews and consensus statements entered into the Medline and LILACS databases between 1997 and 2008. The following search terms were used: "allergic rhinitis"; "quality of life"; and "sleep disorders". Quality of life is often impaired in patients with allergic rhinitis, due to the classic symptoms of the disease (sneezing, pruritus, rhinorrhea and nasal obstruction). In addition, the pathophysiology of allergic rhinitis often disrupts sleep, leading to fatigue, irritability, memory deficits, daytime sleepiness and depression. The total burden of this disease goes beyond impairment of physical and social functioning. It has also a financial impact, which becomes greater when we consider the evidence that allergic rhinitis is a possible causal factor of comorbidities, such as asthma and sinusitis. Nasal obstruction, the most prominent symptom, is associated with sleep disorders, which can have a profound effect on mental health, learning, behavior and attention. Finally, allergic rhinitis-a chronic condition that affects adults, adolescents and children-is often underdiagnosed or inadequately treated. The deleterious impact that allergic rhinitis-related sleep disorders have on patient capacity to perform activities of daily living is an important component of the morbidity of the disease. With an accurate diagnosis, there are various available treatments that can reduce the burden of allergic rhinitis.

 


Keywords: Rhinitis, allergic, perennial; Rhinitis, allergic, seasonal; Quality of life; Sleep disorders.

 

Update Course - Mycoses

18 - Chapter 7 - Zygomycosis

Capítulo 7 - Zigomicose

Cecília Bittencourt Severo, Luciana Silva Guazzelli, Luiz Carlos Severo

J Bras Pneumol.2010;36(1):134-141

Abstract PDF PT PDF EN Portuguese Text

Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions.

 


Keywords: Zygomycosis; Diagnostic techniques and procedures; Mucormycosis.

 

19 - Chapter 8 - Fungal infections in immunocompromised patients

Capítulo 8 - Infecções fúngicas em imunocomprometidos

Rodney Frare e Silva

J Bras Pneumol.2010;36(1):142-147

Abstract PDF PT PDF EN Portuguese Text

Pulmonary complications are the most common cause of morbidity and mortality in immunocompromised patients, who lack of the basic mechanisms of cellular defense. Regardless of the cause of the immunodeficiency, the most common complications are infections (bacterial, viral or fungal). Among the fungal infections, aspergillosis is the most common (incidence, 1-9%; mortality, 55-92%) following organ transplant. Although pulmonary involvement is the most common form of aspergillosis, central nervous system involvement and sinusitis are not uncommon. On CT scans, the halo sign represents an area of low attenuation around the nodule, revealing edema or hemorrhage. The gold standard for the diagnosis is the culture identification of the fungus in sputum, BAL fluid or biopsy samples. Failing this identification, the detection of galactomannan, which is one of the fungal wall components, has shown sensitivity and specificity of 89% and 98%, respectively. Amphotericin B, liposomal amphotericin B, caspofungin and, especially, voriconazole are effective against the fungus. Although Pneumocystis jirovecii pneumonia can be fatal, the incidence of this disease has decreased due to the prophylactic use of trimethoprim-sulfamethoxazole. In immunocompromised patients presenting with dyspnea and hypoxemia, screening for fungi is indicated. A 14- to 21-day course of trimethoprim-sulfamethoxazole in combination with corticosteroids is usually efficacious. Another rare fungal infection is disseminated candidiasis, which is caused by Candida spp.

 


Keywords: Pneumonia; Immunosuppression; Lung diseases, fungal.

 

Case Report

20 - Hard metal pneumoconiosis with spontaneous bilateral pneumothorax

Pneumoconiose por exposição a metal duro com pneumotórax bilateral espontâneo

Maria Auxiliadora Carmo Moreira, Amanda da Rocha Oliveira Cardoso, Daniela Graner Schuwartz Tannus Silva, Maria Conceição de Castro Antonelli Monteiro de Queiroz, Albino Alegro Oliveira, Tiago Marinho Almeida Noleto

J Bras Pneumol.2010;36(1):148-151

Abstract PDF PT PDF EN Portuguese Text

Hard metal pneumoconiosis, first described in 1964, is a diffuse disease caused by the inhalation of cobalt particles. The disease can manifest as occupational asthma, interstitial disease or allergic alveolitis. We report the case of a young male, working as a tool sharpener, who presented with dry cough and progressive dyspnea for one year, as well as with spontaneous bilateral pneumothorax at admission. The diagnosis was confirmed by open lung biopsy.

 


Keywords: Lung diseases, interstitial; Pneumoconiosis; Pneumothorax.

 

21 - Tracheal lipoma mimicking obstructive lung disease

Lipoma de traqueia simulando doença pulmonar obstrutiva

Vinícius Turano Mota, José Geraldo Soares Maia, Ana Teresa Fernandes Barbosa, Diego Franco Silveira Fernandes, Emanuelly Botelho Rocha

J Bras Pneumol.2010;36(1):152-155

Abstract PDF PT PDF EN Portuguese Text

Tracheal tumors are rare and can be difficult to diagnose due to their capacity to mimic other obstructive lung diseases, such as asthma and COPD. We report the case of a female patient with a tracheal tumor. She had previously been treated for asthma and COPD, with little response to the treatment. The onset of infectious complications prompted further investigation. Chest CT images suggested the presence of a tumor, which was confirmed by fiberoptic bronchoscopy. The tumor was endoscopically resected. However, the patient evolved to death due to pneumonia and septic shock.

 


Keywords: Lipoma; Lung diseases, obstructive; Tracheal neoplasms.

 

Letters to the Editor

22 - New alternative test for Mycobacterium tuberculosis complex

Novo teste alternativo para o complexo Mycobacterium tuberculosis

Viroj Wiwanitkit

J Bras Pneumol.2010;36(1):156-

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Author's reply

23 - Author`s reply

Resposta do autor

Maria Alice da Silva Telles

J Bras Pneumol.2010;36(1):

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Year 2010 - Volume 36  - Number 2  (March/April)

Editorial

1 - Multidrug-resistant tuberculosis emergence: a renewed challenge

Emergência de tuberculose resistente: renovado desafio

Afrânio Lineu Kritski

J Bras Pneumol.2010;36(2):157-158

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Original Article

2 - Portuguese-language version of the Asthma Control Test: validation for use in Brazil

Validação do Teste de Controle da Asma em português para uso no Brasil

Jaqueline Petroni Faria Roxo, Eduardo Vieira Ponte, Daniela Campos Borges Ramos, Luciana Pimentel, Argemiro D'Oliveira Júnior, Álvaro Augusto Cruz

J Bras Pneumol.2010;36(2):159-166

Abstract PDF PT PDF EN Portuguese Text

Objective: To develop and validate a Portuguese-language version of the Asthma Control Test (ACT) for use in Brazil. Methods: The study comprised 290 asthma outpatients over 12 years of age. The patients completed the ACT questionnaire and had an appointment with a pulmonologist in order to assess asthma control in two visits. In the first visit, the patients also underwent spirometry. The second visit took place at least four weeks later. Results: We found that a cut-off score of 18 points-to differentiate between subjects with controlled asthma and those with uncontrolled asthma-had a sensitivity of 93%, a specificity of 74%, a negative predictive value of 86% and a positive predictive value of 85%. The positive and negative likelihood ratios were 3.58 and 0.09, respectively. The questionnaire has an outstanding capacity to differentiate uncontrolled asthma from controlled asthma, with an area under the ROC curve of 0.904. The patients whose symptoms remained stable between the two visits had similar scores, demonstrating good test-retest reproducibility, with an intraclass correlation coefficient of 0.93. The patients whose symptoms improved in the second visit had significantly higher scores, demonstrating good responsiveness of the questionnaire in the identification of changes in disease control. Conclusions: The Portuguese-language version of the ACT showed good test-retest reproducibility and was capable of discriminating the levels of asthma control and detecting changes in asthma control in a population of patients with a low level of education and low family income at a public health facility in Brazil.

 


Keywords: Asthma; Questionnaires; Validation studies; Signs and symptoms.

 

3 - Clinicopathological aspects of and survival in patients with clinical stage I bronchioloalveolar carcinoma

Aspectos clínico-patológicos do carcinoma bronquioloalveolar e sobrevida em pacientes no estágio clínico I

Daniel Sammartino Brandão, Rui Haddad, Giovanni Antonio Marsico, Carlos Henrique Ribeiro Boasquevisque

J Bras Pneumol.2010;36(2):167-174

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Objective: To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC) and the survival in a sample of patients at clinical stage I. Methods: A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro, Brazil, between 1987 and 2007. We analyzed clinicopathological and radiological aspects, as well as mortality and survival. The data, which were collected from the medical charts of the patients, were statistically analyzed. Results: Females predominated (n = 16). The mean age at diagnosis was 68.5 years. Most patients were active smokers (69.2%). The most common forms of presentation of BAC were the asymptomatic form (84.6%) and the nodular form (88.5%). Involvement of the upper lobes predominated (57.7%). Stage IB was the most common pathological stage, followed by stages IA and IIB (46.2%, 38.4% and 15.4%, respectively). There was no in-hospital mortality. Four patients died during the postoperative follow-up, with a mean disease-free survival time of 21.3 months. The overall five-year survival rate was 83%. The probability of survival for the patients diagnosed after 1999 showed a trend toward an increase when compared with that for those diagnosed up through 1999 (three-year survival rate: 92% vs. 68%; p = 0.07). Conclusions: The clinicopathological aspects of this study sample were similar to those of patients with BAC evaluated in previous studies.

 


Keywords: Adenocarcinoma, bronchiolo-alveolar; Carcinoma, non-small-cell lung; Lung; Smoking.

 

4 - Surgical treatment of congenital lung malformations in pediatric patients

Tratamento cirúrgico das malformações pulmonares congênitas em pacientes pediátricos

Hylas Paiva da Costa Ferreira, Gilberto Bueno Fischer, José Carlos Felicetti, José de Jesus Peixoto Camargo, Cristiano Feijó Andrade

J Bras Pneumol.2010;36(2):175-180

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Objective: To determine the main congenital lung malformations treated and the principal diagnostic methods employed, as well as the indications for surgical treatment and the results obtained, at a referral facility for pediatric thoracic surgery. Methods: We reviewed the medical charts of 52 patients anatomopathologically diagnosed with congenital lung malformations and who had been submitted to pulmonary resection between January of 1997 and December of 2006. Exclusion criteria were age ≥ 12 years and incomplete clinical data. The final sample comprised 35 patients. Results: In this sample, the mean age was 31 months, and there was a predominance of males (n = 21). The anatomopathological findings were cystic adenomatoid malformation (n = 14), congenital lobar emphysema (n = 13), pulmonary sequestration (n = 8) and arteriovenous malformation (n = 1). The most common type of lung resection was left lower lobectomy (in 25.71%) followed by different types of segmentectomy (in 22.85%), left upper lobectomy (in 22.85%), right upper lobectomy (in 14.28%), right lower lobectomy (in 8.57%) and middle lobectomy (in 5.71%). Of the 35 patients, 34 (97.14%) were submitted to closed pleural drainage, with a mean duration of thoracic drainage of 3.9 days. Ten patients (28.5%) presented with postoperative complications. There were no deaths in our sample. Conclusions: Pulmonary resection for the treatment of congenital lung malformations is a safe procedure, presenting low morbidity and no mortality at a referral facility for pediatric thoracic surgery.

 


Keywords: Cystic adenomatoid malformation of lung, congenital; Bronchopulmonary sequestration; Pneumonectomy; Pulmonary surgical procedures; Pulmonary emphysema.

 

5 - Short-term effect of tiotropium in COPD patients being treated with a β2 agonist

Efeito de curto prazo do tiotrópio nos portadores de DPOC em tratamento com β2-agonista

Frederico Leon Arrabal Fernandes, Vanessa Aparecida Leão Pavezi, Sérvulo Azevedo Dias Jr., Regina Maria Carvalho Pinto, Rafael Stelmach, Alberto Cukier

J Bras Pneumol.2010;36(2):181-189

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Objective: To evaluate the short-term impact of tiotropium in patients with severe or very severe COPD who complain of dyspnea despite being currently treated with other bronchodilators. Methods: A prospective study including patients with severe or very severe COPD and complaining of dyspnea at rest or on minimal exertion. Every 15 days, the bronchodilator treatment regimen was altered, from salmeterol to tiotropium to salmeterol+tiotropium. At the end of each regimen, pulmonary function tests and the six-minute walk test (6MWT) were performed. The degree of dyspnea and the ability to perform activities of daily living were also assessed. To evaluate patient ability to perform activities of daily living, we employed the London Chest Activity of Daily Living (LCADL), validated for use in Brazil. Results: We evaluated 52 patients, 30 of whom completed the study. The use of tiotropium in isolation resulted in significant improvement in dyspnea at baseline (mean Medical Research Council scale score reduced from 3.0 to 2.5) and at the end of 6MWT (mean Borg scale score reduced from 6.1 to 4.5), and the differences were significant (p < 0.05 for both). The use of the salmeterol+tiotropium combination resulted in a significant (81 mL) increase in FEV1 and a 5.7 point improvement in the LCADL score. Conclusions: The introduction of tiotropium into the treatment of patients with severe or very severe COPD and using long-acting β2 agonists improves pulmonary function and provides symptomatic relief, as perceived by patients in the short term. These results, obtained under real life treatment conditions, support the use of the salmeterol+tiotropium combination in specific treatment protocols for these patients.

 


Keywords: Pulmonary disease, chronic obstructive; Bronchodilator agents; Dyspnea; Activities of daily living.

 

6 - Competence of senior medical students in diagnosing tuberculosis based on chest X-rays

Competência de estudantes de medicina seniores na interpretação de radiografias de tórax para o diagnóstico de tuberculose

Vania Maria Carneiro da Silva, Ronir Raggio Luiz, Míriam Menna Barreto, Rosana Souza Rodrigues, Edson Marchiori

J Bras Pneumol.2010;36(2):190-196

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the competence of senior medical students in diagnosing tuberculosis (TB) based on their reading of chest X-rays, as well as to identify the factors associated with high scores for the overall interpretation of chest X-rays. Methods: In October 2008, a convenience sample of senior medical students who had undergone formal training in radiology at the Federal University of Rio de Janeiro School of Medicine, in the city of Rio de Janeiro, Brazil, were invited to participate in the study. Six chest X-rays (three of TB patients and three of patients without TB) were selected. Participants were asked to choose one of the three probable radiological interpretations, and one of the four subsequent suitable clinical approaches. They also completed a questionnaire designed to collect data related to demographics, career of interest, time spent in emergency rooms and year of study. The sensitivity and specificity related to competence in the radiological diagnosis of TB, as well as a score for the overall interpretation of chest X-rays, were calculated. Results: The sensitivity of the probable radiological diagnosis of pulmonary TB, based on the three chest X-rays of patients with TB (minimal, moderate and extensive) was 86.5%, 90.4% and 94.2%, respectively, and the specificity was 90%, 82% and 42%. The only factor associated with a high score for the overall radiological interpretation was the year of study. Conclusions: In this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. The year of study seems to influence overall chest X-ray reading skill.

 


Keywords: Tuberculosis, pulmonary; Radiology; Education, medical.

 

7 - Effects of breathing exercises on breathing pattern and thoracoabdominal motion after gastroplasty

Efeitos de exercícios respiratórios sobre o padrão respiratório e movimento toracoabdominal após gastroplasti

Georgia Miranda Tomich, Danielle Corrêa França, Marco Túlio Costa Diniz, Raquel Rodrigues Britto, Rosana Ferreira Sampaio, Verônica Franco Parreira

J Bras Pneumol.2010;36(2):197-204

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate breathing pattern and thoracoabdominal motion during breathing exercises. Methods: Twenty-four patients with class II or III obesity (18 women; 6 men) were studied on the second postoperative day after gastroplasty. The mean age was 37 ± 11 years, and the mean BMI was 44 ± 3 kg/m2. Diaphragmatic breathing, incentive spirometry with a flow-oriented device and incentive spirometry with a volume-oriented device were performed in random order. Respiratory inductive plethysmography was used in order to measure respiratory variables and thoracoabdominal motion. Results: Comparisons among the three exercises showed significant differences: tidal volume was higher during incentive spirometry (with the flow-oriented device or with the volume-oriented device) than during diaphragmatic breathing; the respiratory rate was lower during incentive spirometry with the volume-oriented device than during incentive spirometry with the flow-oriented device; and minute ventilation was higher during incentive spirometry (with the flow-oriented device or with the volume-oriented device) than during diaphragmatic breathing. Rib cage motion did not vary during breathing exercises, although there was an increase in thoracoabdominal asynchrony, especially during incentive spirometry with the flow-oriented device. Conclusions: Among the breathing exercises evaluated, incentive spirometry with the volume-oriented device provided the best results, because it allowed slower, deeper inhalation.

 


Keywords: Breathing exercises; Physical therapy (Specialty); Bariatric surgery; Obesity, morbid.

 

8 - Impact that positive reinforcement during spirometry has on the measurement of VC in healthy volunteers

Impacto da utilização de reforço positivo na mensuração da CV por espirometria em voluntários saudáveis

Vanessa Sales Logrado, Erili Mota Sena, Renato Júlio dos Santos Matos, Tássia Menezes Leite da Silva, Tuliane Ribeiro de Oliveira, Kristine Menezes Barberino Mendes, Kátia de Miranda Avena

J Bras Pneumol.2010;36(2):205-209

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Objective: Physiologically, VC can vary according to gender, age, body weight and posture, as well as ethnic and anthropometric characteristics. In addition, various diseases can alter VC. In order to measure VC, it is necessary to motivate the patient, to make the instructions understandable, to provide clear information and to have a capable examiner. The objective of this study was to determine the impact that positive reinforcement during spirometry has on the measurement of VC in healthy volunteers. Methods: A randomized clinical trial involving 105 healthy volunteers, randomly allocated to one of two groups: control and intervention. In both groups, VC was assessed as baseline (VC1) and again 15 days later (VC2). Positive reinforcement was provided only to patients in the intervention group and only during the determination of VC2. Results: There were no significant differences between the groups regarding the baseline characteristics. Females predominated in both groups. There was an increase in VC2 in both groups (p < 0.01), and VC2 was higher in the intervention group than in the control group (p < 0.01). Conclusions: These findings demonstrate the importance of using the behavioral strategy in combination with traditional practice in order to obtain better results. The use of positive reinforcement during the determination of VC has proven to be an effective, simple and easily applied strategy.

 


Keywords: Vital capacity; Reinforcement, verbal; Respiratory function tests.

 

9 - Respiratory symptoms in charcoal production workers in the cities of Lindolfo Collor, Ivoti and Presidente Lucena, Brazil

Sintomas respiratórios em trabalhadores de carvoarias nos municípios de Lindolfo Collor, Ivoti e Presidente Lucena, RS

Rafael Machado de Souza, Fabiana Michelsen de Andrade, Angela Beatrice Dewes Moura, Paulo José Zimermann Teixeira

J Bras Pneumol.2010;36(2):

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Objective: To determine the prevalence of respiratory symptoms and smoking, as well as pulmonary function parameters among charcoal production workers in three cities in southern Brazil. Methods: This was an observational study including 67 individuals. Data were obtained by means of interviews and spirometry. Results: Of the 67 workers, 50 (75.0%) were male; mean age, 46.52 ± 13.25 years; mean BMI, 25.7 ± 3.85 kg/m2; FEV1, 3.24 ± 0.82 L (93.2 ± 16.0% of predicted); FVC, 4.02 ± 0.92 L (95.5 ± 14.3% of predicted); and FEV1/FVC, 80.31 ± 9.82. The most common upper airway symptoms were sneezing and nasal secretion-in 24 workers (35.82%)-whereas the most common lower airway symptom was cough-in 15 (22.38%). Of the 67 workers, 21 (31.34%) were smokers. In comparison with the nonsmokers, the smokers more often presented with cough (OR = 5.00; p = 0.01), nasal obstruction (OR = 3.50; p = 0.03), nasal itching (OR = 8.80; p = 0.01) and wheezing (OR = 10.0; p = 0.03), as well as presenting with lower FEV1 values (2.93 ± 0.80 vs. 3.38 ± 0.80 L; p = 0.04). We detected occupational rhinitis in 14 workers (20.85%), asthma in 4 (5.97%) and COPD in 4 (5.97%). Conclusions: Respiratory symptoms and airflow reduction were more common in the smoking workers. Controlling the progression of the pyrolysis did not increase the prevalence of respiratory symptoms in the charcoal production workers studied.

 


Keywords: Air pollution; Spirometry; Charcoal.

 

10 - Evaluation of hospitalized patients in terms of their knowledge related to smoking

Avaliação do conhecimento sobre tabagismo em pacientes internados

Suzana Erico Tanni, Nathalie Izumi Iritsu, Masaki Tani, Paula Angeleli Bueno de Camargo, Marina Gonçalves Elias Sampaio, Ilda Godoy, Irma Godoy

J Bras Pneumol.2010;36(2):218-223

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Objective: To identify characteristics related to smoking in hospitalized patients and to assess the knowledge that such patients have regarding the relationship between nicotine dependence and smoking-related diseases. Methods: The study included 186 patients (males, 59%; mean age, 51.3 ± 16.8 years) who were evaluated regarding demographic characteristics, diagnosis at admission, smoking history and passive smoke exposure. All of the patients completed a questionnaire regarding their knowledge of the relationship between smoking and disease. Results: Of the 186 patients, 42 (22.6%) were smokers, 64 (34.4%) were former smokers and 80 (43%) stated they were never smokers; 136 (73%) reported passive smoke exposure. In the sample as a whole, 21.5% of the patients were diagnosed with a smoking-related disease at admission, compared with 39% of those who were smokers or former smokers. The proportion of individuals who were unaware of the relationship between smoking and the cause of hospitalization was similar among current smokers and former smokers (56% and 65%, respectively). Only 19% of the current smokers believed that smoking might have affected their health, compared with 32% of the former smokers (p = 0.22). The proportion of individuals who believed that quitting smoking depends on willpower was significantly higher among former smokers and never smokers than among current smokers (64% and 53%, respectively, vs. 24%; p < 0.001 and p = 0.008). Although 96% of the patients believed that smoking causes dependence, only 60% identified smoking as a disease. Conclusions: This study shows the disconnect between the recognition of smoking as a cause of dependence and the recognition of smoking as a disease, as well as the general lack of awareness that former and current smoking constitute a risk factor for the development and progression of disease.

 


Keywords: Smoking; Tobacco use disorder; Smoking cessation.

 

11 - Drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, 2000-2006

Perfil de resistência de Mycobacterium tuberculosis no estado de Mato Grosso do Sul, 2000-2006

Marli Marques, Eunice Atsuko Totumi Cunha, Antonio Ruffino-Netto, Sonia Maria de Oliveira Andrade

J Bras Pneumol.2010;36(2):224-231

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Objective: To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006. Methods: Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method. Results: Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively). Conclusions: These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.

 


Keywords: Tuberculosis; Drug resistance, multiple; Mycobacterium tuberculosis.

 

12 - Adverse effects of the new tuberculosis treatment regimen recommended by the Brazilian Ministry of Health

Efeitos adversos causados pelo novo esquema de tratamento da tuberculose preconizado pelo Ministério da Saúde do Brasil

Ethel Leonor Noia Maciel, Letícia Molino Guidoni, Juliana Lopes Favero, David Jamil Hadad, Lucilia Pereira Molino, John L. Jonhson, Reynaldo Dietze

J Bras Pneumol.2010;36(2):232-238

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Objective: To determine the principal adverse effects of the tuberculosis treatment regimen recommended by the Brazilian Ministry of Health. Methods: A prospective descriptive study involving 79 tuberculosis patients treated at the Clinical Research Center of the Cassiano Antonio Moraes University Hospital, in the city of Vitória, Brazil, between 2003 and 2006. The treatment regimen consisted of isoniazid, rifampicin, pyrazinamide and ethambutol for four months, followed by rifampicin and isoniazid for two months. During the treatment period, the patients were clinically evaluated every week and had a monthly medical visit. Results: The overall incidence of adverse effects was 83.54%. Articular/bone/muscle involvement was the most common, followed by skin involvement (24.94% and 22.09%, respectively). Adverse effects were more common in the second month of treatment (41.59%). Modification of the treatment regimen was unnecessary. One patient required concomitant medication to counter the adverse effects. The cure rate was 100%. Conclusions: The overall incidence of adverse effects related to the new treatment regimen recommended by the Brazilian Ministry of Health was high. However, none of those effects demanded a change in the regimen, which was effective in the patients evaluated.

 


Keywords: Treatment outcome;Tuberculosis; Antitubercular agents; Adverse drug reaction reporting systems.

 

Brief Communication

13 - Attitudes of Brazilian pulmonologists toward nicotine dependence: a national survey

Atitudes dos pneumologistas brasileiros em face da dependência de nicotina: inquérito nacional

Carlos Alberto de Assis Viegas, Antonio Gabriel Teles Valentim, Jaene Andrade Pacheco Amoras, Euler Junior Moreira Nascimento

J Bras Pneumol.2010;36(2):239-242

Abstract PDF PT PDF EN Portuguese Text

Smoking is a medical condition, since there is drug dependence, and health professionals should treat it as a chronic disease. In order to understand the attitudes of Brazilian pulmonologists toward smokers, we conducted a national survey, using a questionnaire posted on the Internet, of 2,800 pulmonologists, 587 (21%) of whom completed and returned the questionnaires. We found that 3.2% of the respondents did not believe that smoking is a medical condition. Only 14.7% treated smokers, and 32.4% stated that they would refer smokers to another professional for treatment. These results suggest that Brazilian pulmonologists have insufficient knowledge of smoking cessation therapies.

 


Keywords: Physicians; Tobacco use cessation; Smoking/therapy.

 

Special Article

14 - Tuberculosis in rheumatoid arthritis patients: the difficulty in making the diagnosis of latent infection

Tuberculose em pacientes com artrite reumatoide: a dificuldade no diagnóstico da forma latente

Daniela Graner Schuwartz Tannus Silva, Bruna Daniella de Souza Silva, Ana Paula Junqueira-Kipnis, Marcelo Fouad Rabahi

J Bras Pneumol.2010;36(2):243-251

Abstract PDF PT PDF EN Portuguese Text

Since the beginning of the use of anti-TNF in the treatment of rheumatoid arthritis and other inflammatory diseases, cases of pulmonary tuberculosis and extrapulmonary tuberculosis have been reported in patients receiving such treatment. In most cases, the disease develops by the time the patient has received the sixth infusion. Every patient should be evaluated for latent tuberculosis infection prior to the use of a TNF inhibitor. However, the diagnosis of latent tuberculosis infection is a challenge. The tuberculin test, which was the only test available to detect latent tuberculosis infection for nearly a century, presents a number of limitations. Tests based on the detection of the in-vitro production of IFN-γ by mononuclear cells activated by specific antigens appear to be more accurate and have been studied in patients with rheumatoid arthritis.

 


Keywords: Tuberculosis, pulmonary; Arthritis, rheumatoid; Tumor necrosis factor-alpha; Infection.

 

Review Article

15 - The educational component in an integrated approach to bronchial asthma

El componente educativo en el abordaje integral del asma bronquial

María Paola Fasciglione, Claudia Elena Castañeiras

J Bras Pneumol.2010;36(2):252-259

Abstract PDF PT PDF EN Portuguese Text

Bronchial asthma is an inflammatory chronic disease of the respiratory tract whose prevalence is increasing worldwide. Since there is no curative treatment available, the principal objective of every approach is to control the disease and to improve the quality of life of patients. Over the last few decades, intervention programs supplementing conventional medical treatments have been tested and implemented. The majority of such programs consist of educational interventions or include some type of educational component. In this study, we attempted to determine the characteristics and the impact of educational interventions on asthma by means of the following: a) an updated review of the various educational interventions developed and implemented for asthma patients; b) the identification of aspects that are common to all of these interventions; and c) the analysis of the findings in the literature regarding the impact that these interventions have on the health and quality of life of patients. We conclude that educational interventions are effective in improving the health and quality of life of asthma patients, as well as in reducing the use and costs of health resources. These findings indicate the importance of including an educational component as part of an integrated approach to this population. Likewise, the inherent complexity of the educational process highlights the importance of a complementary joint effort including various health professionals.

 


Keywords: Asthma/prevention and control; Health education; Therapeutics.

 

Case Report

16 - Usefulness of chest CT in the diagnosis of pulmonary sequestration

A utilidade da TC de tórax no diagnóstico do sequestro pulmonar

José Gustavo Pugliese, Thiago Prudente Bártholo, Heron Teixeira Andrade dos Santos, Eduardo Haruo Saito, Cláudia Henrique da Costa, Rogério Rufino

J Bras Pneumol.2010;36(2):260-264

Abstract PDF PT PDF EN Portuguese Text

Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.

 


Keywords: Hemoptysis; Bronchopulmonary sequestration; Tomography, spiral computed.

 

17 - Lung hyperinflation after single lung transplantation to treat emphysema

Hiperinsuflação pulmonar após transplante unilateral por enfisema

Marcos Naoyuki Samano, Jader Joel Machado Junqueira, Ricardo Henrique de Oliveira Braga Teixeira, Marlova Luzzi Caramori, Paulo Manuel Pêgo-Fernandes, Fabio Biscegli Jatene

J Bras Pneumol.2010;36(2):265-269

Abstract PDF PT PDF EN Portuguese Text

Despite preventive measures, lung hyperinflation is a relatively common complication following single lung transplantation to treat pulmonary emphysema. The progressive compression of the graft can cause mediastinal shift and respiratory failure. In addition to therapeutic strategies such as independent ventilation, the treatment consists of the reduction of native lung volume by means of lobectomy or lung volume reduction surgery. We report two cases of native lung hyperinflation after single lung transplantation. Both cases were treated by means of lobectomy or lung volume reduction surgery.

 


Keywords: Lung transplantation; Postoperative complications; Pulmonary emphysema; Pneumonectomy.

 

Letters to the Editor

18 - Selective digestive decontamination is superior to oropharyngeal chlorhexidine in preventing pneumonia and reducing mortality in critically ill patients

A descontaminação digestiva seletiva é superior à clorexidina via orofaringe na prevenção de pneumonia e na redução da mortalidade em pacientes criticamente enfermos

Luciano Silvestri, Hendrick K.F. van Saene, Liviano Folla, Marco Milanese

J Bras Pneumol.2010;36(2):270-273

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Author's reply

19 - Resposta do autor

Simone Macedo Amaral, Antonieta de Queiróz Côrtes, Fábio Ramôa Pires

J Bras Pneumol.2010;36(2):272-

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Letters to the Editor

20 - Classification of journals in the Qualis system: time to broaden the discussion

Classificação dos periódicos no sistema Qualis: é o momento de ampliar a discussão

Marli Maria Knorst

J Bras Pneumol.2010;36(2):274-

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Year 2010 - Volume 36  - Number 3  (May/June)

Editorial

1 - BCG vaccination and reduced risk of asthma

Vacinação com BCG e redução do risco de asma

Adelmir Souza-Machado, Álvaro A. Cruz

J Bras Pneumol.2010;36(3):

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2 - Hemoptysis

Hemoptise

Miguel Abidon Aidé

J Bras Pneumol.2010;36(3):

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Original Article

3 - Can multiple doses of BCG vaccine protect against asthma?

Múltiplas doses de vacina BCG podem proteger contra asma?

Emanuel Sarinho, Fernanda Correia Kunz, Newton Bellesi, Paula Ferdinanda Conceição de Mascena Diniz Maia, José Ângelo Rizzo, Almerinda Rego Silva

J Bras Pneumol.2010;36(3):281-285

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare BCG vaccination involving a single intradermal dose and that involving multiple doses, one given with the multiple puncture technique, in terms of the protective effect against the subsequent onset of asthma. Methods: A retrospective cohort study involving 2,311 individuals having received the BCG vaccine. The patients were classified according to the number of doses of BCG vaccine administered (one; two; or three or more). The minimum follow-up period in order to determine whether there was any protective effect of BCG vaccination regarding the diagnosis of asthma was 10 years. Results: The sample included 1,317 individuals (56.99%) who had received only one BCG dose, 644 (27.87%) who had received two doses, and 350 (15.14%) who had received three or more doses. The number of patients diagnosed with asthma among those who had received one dose, two doses and three or more doses was, respectively, 216 (16.40%), 107 (16.61%) and 50 (14.28%). There were no significant differences among the groups. Conclusions: In the study sample, the prevalence of asthma among individuals having received multiple doses of the BCG vaccine was no different than that observed among those having received a single dose.

 


Keywords: Asthma; BCG vaccine; Immunization, secondary.

 

4 - Prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil

Prevalência de sintomas de asma, rinite e eczema atópico em escolares de 6 e 7 anos na cidade de Londrina (PR)

Luci Keiko Kuromoto de Castro, Alcindo Cerci Neto, Olavo Franco Ferreira Filho

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil. Methods: A population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaire (asthma, rhinitis and atopic eczema modules), validated for use in Brazil, in public school students between 6 and 7 years of age. Results: Of the 3,963 questionnaires retrieved, 3,600 (90.8%) were appropriately completed and were used in the analysis. The prevalence of symptoms of asthma, rhinitis and atopic eczema in the last 12 months was 22.0%, 27.3% and 9.6%, respectively. The prevalence of physician-diagnosed asthma, rhinitis and atopic eczema was 10.4%, 23.4% and 11.4%, respectively. The prevalence of rhinoconjunctivitis and flexural eczema was 13.6% and 6.6%, respectively. Although symptoms of asthma and rhinitis were more common in males than in females, no gender difference was found regarding atopic eczema symptoms. Conclusions: The prevalence of symptoms of asthma, rhinitis and atopic eczema in our sample was within the range found at the facilities that participated in phases I and III of the ISAAC in Brazil. The low prevalence of physician-diagnosed asthma suggests that asthma continues to be underdiagnosed.

 


Keywords: Public health; Epidemiology; Asthma.

 

5 - Asthma and pregnancy: repercussions for neonates

Asma e gravidez: repercussões no recém-nascido

Maria Luiza Doria Almeida, Priscila Andrade Santana, Alzira Maria d'Ávila Nery Guimarães, Ricardo Queiroz Gurgel, Elcio Oliveira Vianna

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe socioeconomic and behavioral aspects of pregnant women with asthma and to analyze the effects of maternal asthma on certain perinatal parameters in a birth cohort. Methods: An observational cross-sectional analytical study using data regarding the mothers of a birth cohort at maternity hospitals in the greater metropolitan area of Aracaju, Brazil, between the 8th of March and the 15th of July of 2005. In the pregnant women, asthma was self-reported, based on previous medical diagnosis. Epidemiological, obstetric and perinatal variables were studied. Results: Of the 4,757 mothers included in the study, 299 (6.3%) had asthma. The mothers with asthma had lower family incomes and more frequently made use of the public health care system (for prenatal care and delivery) than did those without asthma. Although only 9.4% of the mothers with asthma smoked and only 27.6% consumed alcoholic beverages, these proportions were higher than were those observed for the control group. Asthma was not found to be associated with obstetric problems or with problems involving the neonates. Nor did we find asthma to be associated with cesarean delivery, prematurity or small-for-gestational-age neonates. Conclusions: Low socioeconomic level seems to be a risk factor for asthma.

 


Keywords: Asthma; Pregnancy; Socioeconomic factors; Infant, newborn.

 

6 - Necrotizing pneumonia in children submitted to thoracoscopy due to pleural empyema: incidence, treatment and clinical evolution

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

Maurício Macedo, Karine Furtado Meyer, Tatiana Cristina Miranda Oliveira

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. Methods: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). Results: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. Conclusions: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.

 


Keywords: Keywords: Empyema, pleural; Thoracoscopy; Pneumonia; Child.

 

7 - New reference values for maximal respiratory pressures in the Brazilian population

Novos valores de referência para pressões respiratórias máximas na população brasileira

Dirceu Costa, Helena Amaral Gonçalves, Luciana Peraro de Lima, Daniela Ike, Karina Maria Cancelliero, Maria Imaculada de Lima Montebelo

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare MIP and MEP determined in healthy subjects with those predicted using the equations proposed in another study, and, if necessary, to suggest new equations for MIP and MEP to be used in the Brazilian population. Methods: The study sample comprised 60 healthy males and 60 healthy females, 20-80 years of age (20 subjects per ten-year age bracket). Maximal respiratory pressures were determined following a standardized protocol. Results: Regarding MIP, the measured values were significantly lower than those predicted for both males (31%) and females (24%). There were no significant differences between measured and predicted MEP in either gender. We found that age presented the greatest power to predict MIP and MEP in both genders. New equations were proposed. Conclusions: The previously proposed equations were unable to predict MIP and MEP for all of the subjects in our sample. Therefore, the results of this study can facilitate the prediction of respiratory muscle strength in healthy adult subjects in Brazil. Further studies, involving subjects from different regions of the country, could lead to the development of better tables or equations for maximal respiratory pressures in the Brazilian population.

 


Keywords: Respiratory muscles; Muscle strength; Reference values.

 

8 - Inspiratory muscle training in quadriplegic patients

Treinamento de músculos inspiratórios em pacientes com quadriplegia

Janne Marques Silveira, Ada Clarice Gastaldi, Cristina de Matos Boaventura, Hugo Celso Souza

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether inspiratory muscle training can increase strength and endurance of these muscles in quadriplegic patients. Methods: Eight quadriplegic patients (7 males and 1 female) with injury to the lower cervical spine (segments C4-C7) were submitted to inspiratory muscle training with a threshold inspiratory muscle trainer adjusted to 30% of MIP. The training sessions were carried out with the patients in a sitting position, 5 days a week for 8 weeks. Endurance time, MIP, MEP and FVC were determined at baseline, week 4 and week 8. Results: In comparison with the mean baseline value, there was an increase in MIP, measured in the sitting position, at weeks 4 and 8 (−83.0 ± 18.9 cmH2O vs. −104.0 ± 19.4 cmH2O and −111.3 ± 22.7 cmH2O). There was an increase in MEP, also in the sitting position, at week 4 (from 36.8 ± 8.1 to 42.6 ± 8.8 cmH2O). There was an improvement in FVC at week 4 (from 2.1 ± 0.8 to 2.5 ± 0.6 L, representing an increase of 24 ± 22%). Although there was an increase in endurance (sitting) at week 8, the difference was not significant in comparison with the baseline value (29.8 ± 21.0 vs. 35.9 ± 15.5 min, an increase of 173 ± 233%). Conclusions: Quadriplegic patients can benefit from training at low loads (30% of MIP), which can improve inspiratory muscle strength, FVC and expiratory muscle performance.

 


Keywords: Respiratory mechanics; Quadriplegia; Breathing exercises.

 

9 - Hemoptysis in a referral hospital for pulmonology

Hemoptise em hospital de referência em pneumologia

Fernando Luiz Cavalcanti Lundgren, Ana Maria Costa, Lícia Caldas Figueiredo, Paola Colares Borba

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the main causes of hemoptysis and to classify this symptom, in terms of the amount of blood expectorated, in patients hospitalized at a referral hospital for pulmonology. Methods: The study included 50 patients with hemoptysis admitted to the pulmonology ward of a general hospital in the city of Recife, Brazil, between July of 2005 and February of 2006. The data of interest were analyzed and compared with those in the literature. Results: The most common cause of hemoptysis was infection-in 39 patients (78%)-mostly related to tuberculosis sequelae or active tuberculosis. Regarding the severity of hemoptysis, moderate hemoptysis, diagnosed in 28 patients (56%), was the most common. Conclusions: Our results suggest that all patients who present with hemoptysis should be investigated for infection.

 


Keywords: Hemoptysis/classification; Hemoptysis/etiology; Comorbidity.

 

10 - Factors associated with nocturnal, productive and dry cough in the young adult population of Nigeria

Fatores associados à tosse seca, tosse produtiva e tosse noturna em adultos jovens na Nigéria

Olufemi Olumuyiwa Desalu, Alakija Kazeem Salami, Olufunto Anthony Seidu, Abdulfatai Bamidele Olokoba, Abayomi Fadeyi

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to determine the factors associated with nocturnal, productive and dry cough among young adults in Nigeria. Methods: We evaluated 498 subjects, 20-44 years of age, in Ilorin, Nigeria, using the European Community Respiratory Health Survey (ECRHS) questionnaire, administered by trained interviewers. Results: Nocturnal cough was associated with asthma (OR = 10.87; p < 0.01), nasal allergy (OR = 6.33; p < 0.01), smoking (OR = 3.10; p < 0.01), skilled manual and non-manual work (OR = 2.86 and 2.10, respectively; p < 0.01 for both) and female gender (OR = 1.33; p = 0.17). Productive cough was associated with skilled manual and non-manual work (OR = 3.82 and 3.03, respectively; p < 0.01 for both), smoking (OR = 3.10; p < 0.01), asthma (OR = 3.27; p < 0.01) and nasal allergy (OR = 5.81; p < 0.01). Dry cough was associated with asthma (OR =5.18; p < 0.01) obesity (OR =1.88; p = 0.19), smoking (OR = 1.77; p = 1.44), nasal allergy (OR = 1.45; p = 0.26) and female gender (OR =1.36; p = 0.33). Age, gender, type of residence and obesity were not significantly associated with any type of cough (p > 0.05). Conclusions: Early prevention and treatment of conditions associated with cough, as well as the modification of social factors commonly associated with cough, are needed in order to reduce respiratory morbidity.

 


Keywords: Cough; Smoking; Asthma; Rhinitis; Nigeria.

 

11 - Evaluation of the exhaled carbon monoxide levels in smokers with COPD

Avaliação da concentração de monóxido de carbono no ar exalado em tabagistas com DPOC

Gustavo Chatkin, José Miguel Chatkin, Gabriel Aued, Guilherme Oliveira Petersen, Edna Thais Jeremias, Flávia Valladão Thiesen

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To measure exhaled carbon monoxide (COex) levels in smokers with and without COPD. Methods: Smokers treated at outpatient clinics of São Lucas Hospital in the city of Porto Alegre, Brazil, between September of 2007 and March of 2009 were invited to participate in this study. The participants completed a questionnaire regarding demographic and epidemiologic characteristics and were submitted to spirometry, as well as to determination of COex and urinary cotinine levels. The participants were divided into two groups: those with COPD and those without COPD. Results: The study involved 294 smokers, of whom 174 (59.18%) had been diagnosed with COPD. All of the participants presented with urinary cotinine levels > 50 ng/mL. Smokers with COPD presented significantly higher median values for age and pack-years than did those without COPD (p < 0.001 and p = 0.026, respectively). No other statistically significant differences were found. When adjusted for gender, age at smoking onset, number of cigarettes/day and urinary cotinine level, the mean values of COex were higher, but not statistically so, in the COPD group than in the non-COPD group (17.8 ± 0.6 ppm and 16.6 ± 0.7 ppm, respectively; p = 0.200). The differences remained nonsignificant when plotted logarithmically. A wide dispersion of COex values was found when the participants were classified by FEV1 level (r = −0.06; p = 0.53) or by Global Initiative for Chronic Obstructive Lung Disease classification (r = 0.08; p = 0.34). The proportions of false-negative results for smoking were 18.4% and 6.7%, respectively, in the COPD and non-COPD groups (p = 0.007). Conclusions: Since COex values did not differ significantly between smokers with COPD and those without, there seem to be no major contraindications to their use in smokers with COPD.

 


Keywords: Carbon monoxide; Smoking cessation; Pulmonary disease, chronic obstructive.

 

12 - Smoking in elderly patients admitted to long-term care facilities

Tabagismo em idosos internados em instituições de longa permanência

Anderson Albuquerque de Carvalho, Lucy Gomes, Altair Macedo Lahud Loureiro

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of smoking among elderly patients admitted to long-term care facilities (LTCFs) and to determine whether the degree of nicotine dependence is associated with sociodemographic variables, affective ties, motivation for smoking cessation and depression. Methods: Cross-sectional, population-based study involving 573 individuals over the age of 60, admitted to 13 LTCFs in the Federal District of Brasília, Brazil. We analyzed the following variables: type of LTCF, gender, age, level of education, monthly income, marital status, retirement status, affective ties, probable depression, motivation for smoking cessation and degree of nicotine dependence. In order to collect these data, the following instruments were used: a sociodemographic questionnaire; the Flanagan Quality of Life Scale; the Mini-Mental State Examination; the Geriatric Depression Scale; the Richmond test; and the Fagerström Test for Nicotine Dependence. Results: The prevalence of smokers in the study sample (573 individuals) was 23.0%. Of the 132 smokers, there were 90 males (25.8%) and 42 females (18.7%). Of these, 116 smokers were included in the study, 70 of whom (60.3%) presented with probable depression. The degree of nicotine dependence was found to be significantly associated with level of education, monthly income, affective ties, motivation for smoking cessation and probable depression, although not with the type of LTCF, gender, age, retirement status or marital status. Conclusions: Among elderly patients admitted to LTCFs in the Federal District of Brasília, the prevalence of smoking is high and the motivation for smoking cessation is low.

 


Keywords: Smoking; Homes for the aged; Health services for the aged.

 

13 - Epidemiological monitoring of tuberculosis in a general teaching hospital

Monitoramento epidemiológico da tuberculose em um hospital geral universitário

Berenice das Dores Gonçalves, Luciana Tricai Cavalini, Joaquim Gonçalves Valente

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the epidemiological monitoring of exposure to tuberculosis in a hospital environment and to analyze the profile of the disease in a general teaching hospital. Methods: A descriptive and retrospective study of tuberculosis cases diagnosed between 2000 and 2006, with the determination of indicators of morbidity and mortality, which were compared with the general population of patients treated at the hospital and with the hospital employees who developed active tuberculosis. Results: There were 763 patients who were treated for active tuberculosis (mean, 109 patients/year), 481 (63.1%) of whom were male. Most of the patients were in the 30-59 year age bracket. Tuberculosis that was exclusively pulmonary or extrapulmonary predominated. However, among the hospitalized patients, the combination of pulmonary and extrapulmonary tuberculosis, as well as exclusively noninfectious tuberculosis, predominated. Comorbidities were more prevalent among the hospitalized patients and among those who evolved to death. Only 52.8% of the cases treated at the hospital were reported. The overall hospital indicators showed longer length of hospital stay and greater mortality among the patients with tuberculosis. The incidence and prevalence show that there was a high risk of exposure to tuberculosis in the hospital during the period studied. Conclusions: The proposed indicators can potentially help standardize epidemiological monitoring procedures for nosocomial tuberculosis, and the epidemiological profile described in this study can contribute to a better understanding of the situation of tuberculosis in Brazil.

 


Keywords: Tuberculosis/epidemiology; Cross infection/prevention & control; Epidemiologic surveillance/statistics & numerical data; Risk management.

 

Case Series

14 - Association between paracoccidioidomycosis and cancer

Associação entre paracoccidioidomicose e câncer

Gustavo da Silva Rodrigues, Cecília Bittencourt Severo, Flávio de Mattos Oliveira, José da Silva Moreira, João Carlos Prolla, Luiz Carlos Severo

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. Methods: A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. Results: Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkin's lymphoma. In 16 patients (64%), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). Conclusions: A diagnosis of Pcm appears to increase the risk of lung cancer.

 


Keywords: Paracoccidioides; Paracoccidioidomycosis; Neoplasms.

 

Review Article

15 - Cytoskeleton and mechanotransduction in the pathophysiology of ventilator-induced lung injury

Citoesqueleto e mecanotransdução na fisiopatologia da lesão pulmonar induzida por ventilador

Leandro Utino Taniguchi, Elia Garcia Caldini, Irineu Tadeu Velasco, Elnara Márcia Negri

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Although mechanical ventilation is an important therapy, it can result in complications. One major complication is ventilator-induced lung injury, which is caused by alveolar hyperdistension, leading to an inflammatory process, with neutrophilic infiltration, hyaline membrane formation, fibrogenesis and impaired gas exchange. In this process, cellular mechanotransduction of the overstretching stimulus is mediated by means of the cytoskeleton and its cell-cell and cell-extracellular matrix interactions, in such a way that the mechanical stimulus of ventilation is translated into an intracellular biochemical signal, inducing endothelial activation, pulmonary vascular permeability, leukocyte chemotaxis, cytokine production and, possibly, distal organ failure. Clinical studies have shown the relationship between pulmonary distension and mortality in patients with ventilator-induced lung injury. However, although the cytoskeleton plays a fundamental role in the pathogenesis of ventilator-induced lung injury, there have been few in vivo studies of alterations in the cytoskeleton and in cytoskeleton-associated proteins during this pathological process.

 


Keywords: Respiration, artificial; Cytoskeleton; Cell adhesion molecules; Focal adhesions; Mechanotransduction, cellular

 

16 - Cell profile of BAL fluid in children and adolescents with and without lung disease

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Isabela Furtado de Mendonça Picinin, Paulo Augusto Moreira Camargos, Christophe Marguet

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators) as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%), lymphocytes (approximately 10%), neutrophils (approximately 2%) and eosinophils (< 1%). The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of various lung diseases. Less invasive than transbronchial and open lung biopsies, BAL has great clinical value. Further studies adopting standard international protocols should be carried out. Such studies should involve various age groups and settings in order to obtain reference values for BAL fluid cell profiles, which are necessary for a more accurate interpretation of findings in children and adolescents with lung diseases.

 


Keywords: Bronchoalveolar lavage; Bronchoalveolar lavage fluid/cytology; Child; Adolescent.

 

Case Report

17 - Severe acute respiratory syndrome caused by the influenza A (H1N1) virus

Síndrome respiratória aguda grave causada por influenza A (subtipo H1N1)

Sandra Aparecida Ribeiro, Graziela Sgreccia Brasileiro, Luciana Novaes Campello Soleiman, Cristiano Cruz Silva, Cláudio Shoki Kavaguti

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

In view of the pandemic caused by a new virus, influenza A (H1N1), we report the case of a 56-year-old patient without relevant risk factors and with severe acute respiratory syndrome resulting from infection with this virus. We present the results of laboratory tests and the imaging findings (chest X-ray and CT scans). The evolution was favorable, and the patient was discharged after 14 days.

 


Keywords: Influenza A virus, H1N1 subtype; Severe acute respiratory syndrome; Patient care.

 

18 - Bronchial glomus tumor with right upper lobe atelectasis

Tumor glômico endobrônquico com atelectasia de lobo superior direito

Artur Eugênio de Azevedo-Pereira, Moacyr Pezati Rigueiro, Fernando Conrado Abrão

J Bras Pneumol.2010;36(3):

Abstract PDF PT PDF EN Portuguese Text

Glomus tumors are uncommon benign soft tissue neoplasms. We report the case of a 32-year-old male who presented with right upper lobe atelectasis due to an endobronchial tumor. The patient underwent right upper lobectomy and wedge bronchoplasty. The pathological diagnosis was bronchial glomus tumor. To our knowledge, this presentation (with right upper lobe atelectasis) has never before been reported. Glomus tumor should be considered in the differential diagnosis of endobronchial lesions causing lobar atelectasis.

 


Keywords: Glomus tumor; Bronchial neoplasms; Thoracic surgical procedures.

 

Letters to the Editor

19 - Scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis

Sistema de pontuação, recomendado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar

Viroj Wiwanitkit

J Bras Pneumol.2010;36(3):

PDF PT PDF EN Portuguese Text


Author's reply

20 - Author`s reply

Resposta ao autor

Cinthia Pedrozo, Clemax Couto Sant'Anna, Maria de Fátima B. Pombo March, Sheila Cunha Lucena

J Bras Pneumol.2010;36(3):

PDF PT PDF EN Portuguese Text


Letters to the Editor

21 - Whole-body magnetic resonance imaging: a viable alternative to positron emission tomography/ CT in the evaluation of neoplastic diseases

Ressonância magnética de corpo inteiro: uma alternativa viável a tomografia por emissão de pósitrons/ TC na avaliação de doenças neoplásicas

Bruno Hochhegger, Klaus Irion, Edson Marchiori

J Bras Pneumol.2010;36(3):

PDF EN Portuguese Text


Erratum

22 - ERRATA

Volume 35, número 9, página 883.

J Bras Pneumol.2010;36(3):

PDF PT Portuguese Text


Original Article

89 - teste

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teste

J Bras Pneumol.2010;36(3):89

Abstract PDF PT Portuguese Text

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Keywords: teste

 

Year 2010 - Volume 36  - Number 4  (July/August)

Editorial

1 - Changes in the tuberculosis profile in Brazil: a new reality?

Mudanças no perfil da tuberculose no país: uma nova realidade?

Fernando Augusto Fiuza de Melo

J Bras Pneumol.2010;36(4):

PDF PT PDF EN Portuguese Text


2 - Change the Qualis Criteria!

Mudança dos critérios Qualis!

J Bras Pneumol.2010;36(4):

PDF PT PDF EN Portuguese Text


Original Article

3 - Prevalence and severity of wheezing in the first year of life

Prevalência e gravidade da sibilância no primeiro ano de vida

Ana Caroline Cavalcanti Dela Bianca, Gustavo Falbo Wandalsen, Javier Mallol, Dirceu Solé

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence and severity of wheezing in infants, using the standardized protocol devised for the "Estudio Internacional de Sibilancias en Lactantes" (EISL, International Study of Wheezing in Infants), as well as to determine the relationship between such wheezing and physician-diagnosed asthma, in the first year of life. Methods: Between March of 2005 and August of 2006, the EISL questionnaire was administered to the parents or legal guardians of infants undergoing routine procedures or immunization at public primary health care clinics in the southern part of the city of São Paulo, Brazil. Results: Our sample comprised 1,014 infants (mean age = 5.0 ± 3.0 months), 467 (46.0%) of whom had at least one wheezing episode, 270 (26.6%) having three or more such episodes, in their first year of life. The use of inhaled β2 agonists, inhaled corticosteroids, or antileukotrienes, as well as the occurrence of nocturnal symptoms, difficulty breathing, pneumonia, emergency room visits, and hospitalization due to severe wheezing, was significantly more common among those with recurrent wheezing (p < 0.05). Physician-diagnosed asthma was reported for 35 (7.5%) of the 467 wheezing infants and was found to be associated with the use of inhaled corticosteroids, difficulty breathing during the attacks, and six or more wheezing episodes in the first year of life. However, less than 40% of those infants were treated with inhaled corticosteroids or antileukotrienes. Conclusions: In this study, the prevalence of wheezing episodes among infants in their first year of life was high and had an early onset. The proportion of infants diagnosed with and treated for asthma was low.

 


Keywords: Asthma/diagnosis; Asthma/epidemiology; Respiratory sounds.

 

4 - 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. (ClinicalTrials.gov identifier: NCT00975741 [http://www.clinicaltrials.gov/])

 

5 - Field-test validation of the Brazilian version of the Paediatric Asthma Quality of Life Questionnaire

Versão brasileira do Paediatric Asthma Quality of Life Questionnaire: validação de campo

Edgar Enrique Sarria, Rosana Cardoso Manique Rosa, Gilberto Bueno Fischer, Vânia Naomi Hirakata, Neusa Sica da Rocha, Rita Mattiello

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the psychometric properties of the official Brazilian Portuguese-language version of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) in a representative group of Brazilian children and adolescents with asthma. Methods: A total of 125 individuals with asthma, aged 8-17 years and being monitored at a pediatric pulmonology outpatient clinic in the city of Porto Alegre, Brazil, completed the PAQLQ. Validity was assessed by means of convergent validity (correlation between PAQLQ domains and those of the Pediatric Quality of Life Inventory (PedsQL) 4.0. Reliability was assessed by determining internal consistency (Cronbach's alpha coefficient), reproducibility (intraclass correlation coefficient), sensitivity to change (effect size), and discriminatory power (floor/ceiling effects). Results: The mean age was 11 years, and 75 (60%) of the participants were male. The mean PAQLQ total score was 5.1, with floor/ceiling effects < 10%. Correlations between PAQLQ domains and the PedsQL 4.0 domains were acceptable (r = 0.37-0.40). The Cronbach's alpha coefficient for the total score was 0.93, ranging from 0.72 to 0.88 for the domains. The overall effect size was 0.60 (range: 0.45-0.60), whereas the overall intraclass correlation coefficient was 0.80 (range: 0.66-0.79). Conclusions: The official Brazilian Portuguese-language version of the PAQLQ showed good psychometric performance, confirming its cultural adequacy for use in Brazil.

 


Keywords: Keywords: Quality of life; Asthma; Validation studies.

 

6 - Should the bronchiectasis treatment given to cystic fibrosis patients be extrapolated to those with bronchiectasis from other causes?

Deve-se extrapolar o tratamento de bronquiectasias em pacientes com fibrose cística para aqueles com bronquiectasias de outras etiologias?

Rodrigo Abensur Athanazio, Samia Zahi Rached, Ciro Rohde, Regina Carvalho Pinto, Frederico Leon Arrabal Fernandes, Rafael Stelmach

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To profile the characteristics of adult patients with bronchiectasis, drawing comparisons between cystic fibrosis (CF) patients and those with bronchiectasis from other causes in order to determine whether it is rational to extrapolate the bronchiectasis treatment given to CF patients to those with bronchiectasis from other causes. Methods: A retrospective analysis of the medical charts of 87 patients diagnosed with bronchiectasis and under follow-up treatment at our outpatient clinic. Patients who had tuberculosis (current or previous) were excluded. We evaluated the clinical, functional, and treatment data of the patients. Results: Of the 87 patients with bronchiectasis, 38 (43.7%) had been diagnosed with CF, through determination of sweat sodium and chloride concentrations or through genetic analysis, whereas the disease was due to another etiology in 49 (56.3%), of whom 34 (39.0%) had been diagnosed with idiopathic bronchiectasis. The mean age at diagnosis was lower in the patients with CF than in those without (14.2 vs. 24.2 years; p < 0.05). The prevalence of symptoms (cough, expectoration, hemoptysis, and wheezing) was similar between the groups. Colonization by Pseudomonas aeruginosa or Staphylococcus aureus was more common in the CF patients (82.4 vs. 29.7% and 64.7 vs. 5.4%, respectively). Conclusions: The causes and clinical manifestations of bronchiectasis are heterogeneous, and it is important to identify the differences. It is crucial that these differences be recognized so that new strategies for the management of patients with bronchiectasis can be developed.

 


Keywords: Cystic fibrosis; Bronchiectasis/diagnosis; Bronchiectasis/therapy; Respiratory function tests.

 

7 - Occurrence of hepatopulmonary syndrome in patients with cirrhosis who are candidates for liver transplantation

Ocorrência de síndrome hepatopulmonar em pacientes cirróticos candidatos a transplante de fígado

Liana Gonçalves Macêdo, Edmundo Pessoa de Almeida Lopes, Maria de Fátima Pessoa Militão de Albuquerque, Brivaldo Markman-Filho, Flávio Henrique Amaral Pires Véras, Ana Carolina Chiappetta Correia de Araújo, Álvaro Antônio Bandeira Ferraz

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the occurrence of hepatopulmonary syndrome (HPS) in patients with cirrhosis who are candidates for liver transplantation; to compare demographic, clinical, laboratory, and spirometric characteristics, as well as echocardiography results, arterial blood gas analysis, and severity of liver disease between the groups of patients with and without HPS; and to describe the occurrence of HPS in the subgroup of patients with cirrhosis and schistosomiasis mansoni (mixed liver disease). Methods: Between January and November of 2007, we evaluated 44 patients under treatment at the Liver Transplant Outpatient Clinic of the Federal University of Pernambuco Hospital das Clínicas, in the city of Recife, Brazil. The diagnostic criteria for HPS were intrapulmonary vascular dilatation, identified by transthoracic echocardiography, and an alveolar-arterial oxygen tension difference ≥ 15 mmHg or a PaO2 < 80 mmHg. Results: The mean age of the patients was 52 years, and 31 patients (70%) were males. The most common cause of cirrhosis was alcohol use. Schistosomiasis was present in 28 patients (64%). Of the 44 patients, 20 (45.5%) were diagnosed with HPS. No significant differences were found between those patients and the patients without HPS in terms of any of the characteristics studied. Of the 28 patients with cirrhosis and schistosomiasis, 10 (35.7%) were diagnosed with HPS. Conclusions: In the population studied, HPS was highly prevalent and did not correlate with any of the variables analyzed.

 


Keywords: Hepatopulmonary syndrome; Liver transplantation; Liver cirrhosis; Hypertension, portal; Schistosomiasis mansoni; Echocardiography.

 

8 - Increased risk of respiratory symptoms and chronic bronchitis in women using biomass fuels in Nigeria

Risco aumentado de sintomas respiratórios e bronquite crônica em mulheres que utilizam biocombustíveis na Nigéria

Olufemi Olumuyiwa Desalu, Adebowale Olayinka Adekoya, Bolawale Adedeji Ampitan

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether respiratory symptoms and chronic bronchitis are associated with the use of biomass fuels (BMFs) among women residing in rural areas of the Ekiti State, in southwestern Nigeria. Methods: From January to June of 2009, we carried out a cross-sectional study including 269 adult women. To collect data on sociodemographic status, type of fuel used for cooking in the household, respiratory symptoms, and smoking history, we used a questionnaire adapted from the European Community Respiratory Health Survey. All of the participants were invited to undergo spirometry. Results: Of the 269 women in the study, 161 (59.9%) used BMFs for cooking. The proportion of women who reported respiratory symptoms was greater among those using BMFs than among those using a non-BMF-cough (13.7% vs. 3.7%); wheezing (8.7% vs. 2.8%); chest pain (7.5% vs. 1.9%); breathlessness (11.8% vs. 6.5%); nasal symptoms (9.3% vs. 4.6%); and chronic bronchitis (10.6% vs. 2.8%). Multivariate logistic regression analysis revealed that the use of BMFs was associated with the following variables: cough (OR = 4.82; p = 0.01); chronic bronchitis (OR = 3.75; p = 0.04); wheezing (OR = 2.22; p = 0.23); chest pain (OR = 3.82; p = 0.09); breathlessness (OR = 1.54; p = 0.35); and nasal symptoms (OR = 2.32; p = 0.20). All of the spirometric parameters evaluated (FEV1, FVC, FEV1/FVC ratio, and PEF) were lower in the women using BMFs than in those using a non-BMF. Conclusions: Our results underscore the need for women using BMFs in their households to replace them with a nontoxic type of fuel, such as electricity or gas.

 


Keywords: Signs and symptoms, respiratory; Biofuels; Bronchitis, chronic; Air pollution, indoor.

 

9 - Does the BODE index correlate with quality of life in patients with COPD?

O índice BODE correlaciona-se com a qualidade de vida em pacientes com DPOC?

Zênia Trindade de Souto Araujo, Gardenia Holanda

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index correlates with health-related quality of life in patients with COPD. Methods: We evaluated 42 patients with COPD, quantifying the following: lung function parameters; anthropometric variables; exercise capacity, with the six-minute walk test; dyspnea, with the modified Medical Research Council (MRC) scale; the BODE index; and quality of life, with the modified Saint George's Respiratory Questionnaire (mSGRQ). Patients were divided into two groups by disease severity: FEV1 ≥ 50% and FEV1 < 50%. Results: The mean BODE index was 2.58 ± 1.17 and 4.15 ± 1.81, respectively, for the FEV1 ≥ 50% and FEV1 < 50% groups. There was a significant difference between the groups in terms of FEV1 and the FEV1/FVC ratio. There were moderate to significant correlations between the BODE index scores and all of the mSGRQ domains in the group of patients with FEV1 <50%. Conclusions: The BODE index score correlated with the scores of all of the mSGRQ domains in COPD patients with FEV1 < 50%. Therefore, COPD patients with FEV1 < 50% die sooner and have a poorer quality of life.

 


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Severity of illness index; Prognosis.

 

10 - Pulmonary function in children and adolescents with postinfectious bronchiolitis obliterans

Função pulmonar de crianças e adolescentes com bronquiolite obliterante pós-infecciosa

Rita Mattiello, Javier Mallol, Gilberto Bueno Fischer, Helena Teresinha Mocelin, Belkys Rueda, Edgar Enrique Sarria

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the pulmonary function in children and adolescents with postinfectious bronchiolitis oblite­rans (PIBO), as well as to evaluate potential risk factors for severe impairment of pulmonary function. Methods: The pulmonary function of 77 participants, aged 8-18 years, was assessed by spirometry and plethysmography. The following parameters were analyzed: FVC; FEV1; FEF25-75%; FEV1/FVC; RV; TLC; RV/TLC; intrathoracic gas volume; and specific airway resistance (sRaw). We used Poisson regression to investigate the following potential risk factors for severe impairment of pulmonary function: gender; age at first wheeze; age at diagnosis; family history of asthma; tobacco smoke exposure; length of hospital stay; and duration of mechanical ventilation. Results: The mean age was 13.5 years. There were pronounced decreases in FEV1 and FEF25-75%, as well as increases in RV and sRaw. These alterations are characteristic of obstructive airway disease. For the parameters that were the most affected, the mean values (percentage of predicted) were as follows: FEV1 = 45.9%; FEF25-75% = 21.5%; RV = 281.1%; RV/TLC = 236.2%; and sRaw = 665.3%. None of the potential risk factors studied showed a significant association with severely impaired pulmonary function. Conclusions: The patients with PIBO had a common pattern of severe pulmonary function impairment, characterized by marked airway obstruction and pronounced increases in RV and sRaw. The combination of spirometric and plethysmographic measurements can be more useful for assessing functional damage, as well as in the follow-up of these patients, than are either of these techniques used in isolation. Known risk factors for respiratory diseases do not seem to be associated with severely impaired pulmonary function in PIBO.

 


Keywords: Respiratory function tests; Airway obstruction; Bronchiolitis obliterans

 

11 - 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.

 

12 - Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

Bernardo Henrique Ferraz Maranhão, Cyro Teixeira da Silva Junior, Antonio Monteiro da Silva Chibante, Gilberto Perez Cardoso

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. Methods: This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and 2006. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. Results: Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8%, 68.6%, and 94.5%, whereas the corresponding values for the diagnosis of pleural transudates were 76.1%, 90.1%, and 87.6%. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4%, 72.6%, and 99.2%, whereas the corresponding values for the diagnosis of transudates were 98.5%, 83.4%, and 90.0%. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). Conclusions: The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice.

 


Keywords: Pleural effusion/diagnosis; Pleural effusion/classification; Exudates and transudates.

 

13 - Clinical characteristics and evolution of non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Denise Rossato Silva, Diego Millán Menegotto, Luis Fernando Schulz, Marcelo Basso Gazzana, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients.

 


Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host.

 

Brief Communication

14 - Aminoguanidine reduces oxidative stress and structural lung changes in experimental diabetes mellitus

Aminoguanidina reduz o estresse oxidativo e as alterações estruturais pulmonares em diabetes mellitus experimental

Fabio Cangeri Di Naso, Luiz Alberto Forgiarini Junior, Luiz Felipe Forgiarini, Marilene Porawski, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

We evaluated the effect of aminoguanidine on pulmonary oxidative stress and lung structure in an experimental model of diabetes mellitus. Thiobarbituric acid reactive substances (TBARS), histology and arterial blood gases were evaluated in animals with diabetes mellitus (DM group), animals with diabetes mellitus treated with aminoguanidine (DM+AG group), and controls. The TBARS levels were significantly higher in the DM group than in the control and DM+AG groups (2.90 ± 1.12 vs. 1.62 ± 0.28 and 1.68 ± 0.04 nmol/mg protein, respectively), as was PaCO2 when compared with that of the control group (49.2 ± 1.65 vs. 38.12 ± 4.85 mmHg), and PaO2 was significantly higher in the control group (104.5 ± 6.3 vs. 16.30 ± 69.48 and 97.05±14.02 mmHg, respectively). In this experimental model of diabetes mellitus, aminoguanidine reduced oxidative stress, structural tissue alterations, and gas exchange.

 


Keywords: Oxidative stress; Diabetes mellitus, experimental; Lung.

 

15 - Experimental model of isolated lung perfusion in rats: technique and application in lung preservation studies

Modelo experimental de perfusão pulmonar isolada em ratos: técnica e aplicações em estudos de preservação pulmonar

Paulo Manuel Pêgo-Fernandes, Eduardo de Campos Werebe, Paulo Francisco Guerreiro Cardoso, Rogério Pazetti, Karina Andrighetti de Oliveira, Paula Roberta Otaviano Soares, Fabio Biscegli Jatene

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.

 


Keywords: Lung transplantation; Reperfusion injury; Rats; Models, animal.

 

16 - Heterogeneidade de resposta por IFN-γ a cepas clínicas de Mycobacterium tuberculosis em humanos

Heterogeneidade de resposta por IFN-γ a cepas clínicas de Mycobacterium tuberculosis em humanos

Vinícius Ribeiro Cabral, Cláudia Ferreira de Souza, Fernanda Luiza Pedrosa Guimarães, Maria Helena Feres Saad

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Mycobacterium tuberculosis is one of the most successful human pathogens. Highly virulent strains, which are more easily transmitted than are less virulent strains, elicit variable immune responses. We evaluated the Th1 responses (IFN-γ production) in healthy volunteers after stimulation with various strains. Our results show that the individuals with negative tuberculin skin test (TST) results were not necessarily naive to all of the strains tested, whereas individuals with positive TST results did not respond to all of the strains tested. Drug-resistant strains induced a lower mean level of IFN-γ production than did drug-sensitive strains. One possible practical application of this finding would be for the prediction of responses to treatment, in which it might be advantageous to have knowledge of the estimated IFN-γ production elicited by a specific isolated strain.

 


Keywords: Tuberculosis; Polymorphism, restriction fragment length; Mycobacterium tuberculosis; Immunity, cellular; Interferon-gamma.

 

Review Article

17 - Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations

Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações

Jéssica Fábia Polese, Rogério Santos-Silva, Rafael Freire Kobayashi, Indira Nunes de Paula Pinto, Sérgio Tufik, Lia Rita Azeredo Bittencourt

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.

 


Keywords: Sleep apnea, obstructive/diagnosis; Polysomnography; Diagnostic equipment; Monitoring, ambulatory.

 

18 - Bronchial thermoplasty in asthma

Termoplastia brônquica em asma

Adalberto Sperb Rubin, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Currently available treatments for asthma provide satisfactory control of the disease in most cases. However, a significant number of patients do not respond to such treatments (i.e., do not achieve effective symptom relief). One novel approach to treating asthma is bronchial thermoplasty, in which the airway smooth muscle is specifically and directly treated. This procedure delivers radiofrequency energy to the airways in order to reduce smooth muscle-mediated bronchoconstriction. In this article, we present the thermoplasty technique, summarizing the results of the major randomized clinical trials of the procedure, as well as discussing its mechanisms of action and potential adverse effects. We also propose strategies for the future clinical use of this new treatment.

 


Keywords: Asthma/prevention & control; Asthma/therapy; Bronchoscopy.

 

Case Report

19 - Severe paraquat poisoning: clinical and radiological findings in a survivor

Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente

Fábio Fernandes Neves, Romualdo Barroso Sousa, Antônio Pazin-Filho, Palmira Cupo, Jorge Elias Júnior, Marcello Henrique Nogueira-Barbosa

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning.

 


Keywords: Paraquat/poisoning; Pulmonary fibrosis; Pneumothorax.

 

20 - Giant cell tumor of the sternum

Tumor de células gigantes do esterno

Ricardo Alexandre Faria, Carlos Maciel da Silva, José Elias Abrão Miziara, Fernando Yaeda de Melo, Sandra Regina Morini da Silva, Cristiano Ribeiro Viana

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 74-year-old female patient diagnosed with a giant cell tumor of the sternum. The clinical and radiological presentation was indicative of a primary tumor of the sternum. The patient underwent complementary tests and surgery. The pathological examination confirmed the diagnosis. Commonly observed in the long bones of the appendicular skeleton, this type of tumor is characterized by its local aggressiveness and metastatic potential. We also review the literature on the topic.

 


Keywords: Sternum; Giant cell tumors; Thorax.

 

Letters to the Editor

21 - Surgical treatment of lung malformations in pediatric patients

Tratamento cirúrgico das malformações pulmonares em pacientes pediátricos

Altair da Silva Costa Jr

J Bras Pneumol.2010;36(4):

PDF PT PDF EN Portuguese Text


Year 2010 - Volume 36  - Number 5  (September/October)

Editorial

1 - Perception of asthma symptoms

Percepção de sintomas na asma

Alberto Cukier

J Bras Pneumol.2010;36(5):523-524

PDF PT PDF EN Portuguese Text


Original Article

2 - Prevalence of and risk factors for wheezing in the first year of life

Prevalência e fatores de risco para sibilância no primeiro ano de vida

João Antonio Bonfadini Lima, Gilberto Bueno Fischer, Edgar Enrique Sarria, Rita Mattiello, Dirceu Solé

J Bras Pneumol.2010;36(5):525-531

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of and the risk factors for wheezing in infants under one year of age and residing in the city of Porto Alegre, Brazil. Methods: This was a cross-sectional study and is part of a multicenter, multinational project. The parents or legal guardians of the infants were interviewed at primary health care clinics or during home visits. We used a standardized questionnaire, validated for use in Brazil. Potential risk factors were assessed by means of a Poisson regression model with robust variance estimation, using the Wald test to determine the significance of each variable in the model. Results: The sample comprised 1,013 infants. The majority of those were male (53%), and the mean age was 13.5 ± 1.2 months. In 61% of the infants, there had been at least one episode of wheezing, which had recurred at least three times in one third of those infants. The mean age at the first episode of wheezing was 5.16 months (median, 5 months). Over 40% of the infants with wheezing visited emergency rooms due to wheezing, and 17% of those were hospitalized at least once in the first year of life because of this symptom. In the multivariate analysis, the risk factors for wheezing were as follows: male gender; history of pneumonia; maternal smoking during pregnancy; day care center attendance; low maternal level of education; early weaning; multiple episodes of cold; first viral infection prior to 3 months of age; existence of siblings; and history of asthma in the nuclear family. Conclusions: The prevalence of wheezing is high among infants in the city of Porto Alegre. We identified various risk factors for wheezing in infants.

 


Keywords: Respiratory sounds/epidemiology; Asthma; Infant; Risk factors.

 

3 - Performance of a word labeled visual analog scale in determining the degree of dyspnea during exercise-induced bronchoconstriction in children and adolescents with asthma

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

Patrícia Bueno Lima, Ilka Lopes Santoro, Lilian Ballini Caetano, Anna Lúcia de Barros Cabral, Ana Luisa Godoy Fernandes

J Bras Pneumol.2010;36(5):532-538

Abstract PDF PT PDF EN Portuguese Text

Objective: There is an indirect relationship between airway obstruction in asthma and the intensity of breathlessness (dyspnea). A word labeled visual analog dyspnea scale with a 0-3 score has been widely used for the assessment of the degree of bronchoconstriction, although the perception of such obstruction varies considerably. The objective of this study was to determine whether children and adolescents are able to perceive acute exercise-induced bronchoconstriction (EIB), as well as to measure the discriminatory power of a word labeled visual analog dyspnea scale in relation to the intensity of the EIB. Methods: A cross-sectional study involving 134 children and adolescents with asthma and submitted to a six-minute steady-state exercise test on a cycle ergometer. The intensity of dyspnea was determined using a word labeled visual analog dyspnea scale prior to each determination of FEV1. The scale is scored from 0 to 3, with a logical sequence of pictures, ranging from "no symptoms" to "severe dyspnea". Variables were determined at baseline, as well as at 5, 10, and 20 min after the exercise test. The accuracy of the dyspnea scale in identifying the degree of EIB was determined by means of ROC curves for the post-exercise fall in FEV1, using cut-off points of 10%, 20%, 30%, and 40%. Results: Of the patients selected, 111 finished the study, and 52 (46.8%) presented with EIB. The area under the ROC curve increased in direct proportion to increases in the degree of bronchoconstriction. Conclusions: Among children and adolescents with asthma, the accuracy of this dyspnea scale improves as the post-exercise percentage fall in FEV1 increases. However, the predictive value of the scale is suboptimal when the percentage fall in FEV1 is lower.

 


Keywords: Asthma; Asthma, exercise-induced; Dyspnea.

 

4 - 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.

 

5 - Adhesiveness and purulence of respiratory secretions: implications for mucociliary transport in patients with bronchiectasis

Adesividade e purulência de secreções respiratórias: implicações no transporte mucociliar em pacientes com bronquiectasias

Joana Tambascio, Roberta Marques Lisboa, Rita de Cássia Vianna Passarelli, José Antonio Baddini Martinez, Ada Clarice Gastaldi

J Bras Pneumol.2010;36(5):545-553

Abstract PDF PT PDF EN Portuguese Text

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.

 

6 - Ventilation strategy and its influence on the functional performance of lung grafts in an experimental model of single lung transplantation using non-heart-beating donors

Influência da estratégia ventilatória no desempenho funcional de enxertos pulmonares em um modelo experimental de transplante pulmonar unilateral de doadores após parada cardiocirculatória

Elaine Aparecida Felix, Cristiano Feijó Andrade, Paulo Francisco Guerreiro Cardoso, Gabriela Cury Thiesen, Ana Carolina Peçanha Antonio, Lucas Krieger Martins, Tiago Antonio Tonietto

J Bras Pneumol.2010;36(5):554-561

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare the influence of two different ventilation strategies-volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV)-on the functional performance of lung grafts in a canine model of unilateral left lung transplantation using donor lungs harvested after three hours of normothermic cardiocirculatory arrest under mechanical ventilation. Methods: The study comprised 40 mongrel dogs, randomized into two groups: VCV and PCV. Of the 20 recipients, 5 did not survive the transplant, and 5 died before the end of the post-transplant assessment period. The remaining 10 survivors (5 in each group) were evaluated for 360 min after lung transplantation. The functional performance of the grafts was evaluated regarding respiratory mechanics, gas exchange, and lung graft histology. Results: There were no significant differences between the groups regarding respiratory mechanics (peak inspiratory pressure, plateau pressure, mean airway pressure, dynamic compliance, and static compliance) or gas exchange variables (PaO2, venous oxygen tension, PaCO2, venous carbon dioxide tension, and the arterial-venous oxygen content difference). The histopathological findings were consistent with nonspecific acute lung injury and did not differ between the groups. Conclusions: This model of lung transplantation showed that the functional performance of lung grafts was not influenced by the ventilation strategy employed during the first six hours after reperfusion.

 


Keywords: Pulmonary ventilation; Respiration, artificial; Lung transplantation; Dogs; Organ preservation.

 

7 - Predictors of physical and mental health-related quality of life in patients with interstitial lung disease: a multifactorial analysis

Fatores preditores da qualidade de vida relacionada à saúde física e mental em pacientes com doença pulmonar intersticial: uma análise multifatorial

Ana Cláudia Coelho, Marli Maria Knorst, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2010;36(5):562-570

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine predictors of health-related quality of life (HRQoL) in patients with interstitial lung disease (ILD). Methods: A cross-sectional study comprising 63 patients, all of whom underwent lung function testing and the six-minute walk test. The following instruments were used: the Medical Outcomes Study 36-item Short-form Survey (SF-36), the Saint George's Respiratory Questionnaire (SGRQ), the Beck Anxiety Inventory, the Beck Depression Inventory, and the Modified Medical Research Council Dyspnea Scale. Principal component analysis was used in order to reduce the dimensionality of the data, thereby identifying the predictor variables, and multiple linear regression analysis was used in order to identify the explanatory variables. Results: Of the 63 patients, 34 were female. The mean age was 60.1 ± 13.3 years, the mean FVC was 64.17 ± 15.54% of predicted, and the mean DLCO was 44.21 ± 14.47% of predicted. All of the patients evaluated had impaired HRQoL, scoring worst for the SF-36 physical functioning and SGRQ activity domains. Of the patients evaluated, 60.3% and 57.1% showed symptoms of anxiety and depression, respectively. The principal component analysis identified one predictor of physical HRQoL and one predictor of mental HRQoL. Depression had a strong influence on the predictor of mental HRQoL, and the degree of dyspnea had a strong influence on both predictors of HRQoL in the patients evaluated. Variables related to lung function, exercise capacity, and anxiety had no impact on these predictors. Conclusions: In our sample of patients with ILD, the degree of dyspnea had a major impact on the physical and mental HRQoL, and depression had an impact on mental HRQoL.

 


Keywords: Anxiety; Depression; Dyspnea; Lung diseases, interstitial; Quality of life; Respiratory function tests.

 

8 - 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.

 

9 - Lung alterations in a rat model of diabetes mellitus: effects of antioxidant therapy

Alterações pulmonares em um modelo de diabetes mellitus em ratos: o efeito da terapia antioxidante

Luiz Alberto Forgiarini Junior, Nélson Alexandre Kretzmann, Juliana Tieppo, Jaqueline Nascimento Picada, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(5):579-587

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate structural alterations of the lung in rats with diabetes mellitus (DM), by quantifying oxidative stress and DNA damage, as well as to determine the effects that exogenous superoxide dismutase (SOD) has on such alterations. Methods: A controlled experimental study involving 40 male Wistar rats, divided into four groups (10 animals each): control; SOD-only (without DM but treated with SOD); IDM-only (with streptozotocin-induced DM but untreated); and IDM+SOD (with streptozotocin-induced DM, treated with SOD). The animals were evaluated over a 60-day period, day 0 being defined as the day on which the streptozotocin-injected animals presented glycemia > 250 mg/dL. The SOD was administered for the last 7 days of that period. At the end of the study period, samples of lung tissue were collected for histopathological analysis, evaluation of tissue oxidative stress, and assessment of DNA damage. Results: There were no significant differences among the groups regarding DNA damage. In the IDM-only group, there was a significant increase in the extracellular matrix and significantly greater hyperplasia of the capillary endothelium than in the SOD-only and control groups. In addition, there were significant changes in type II pneumocytes and macrophages, suggesting an inflammatory process, in the IDM-only group. However, in the IDM+SOD group, there was a reduction in the extracellular matrix, as well as normalization of the capillary endothelium and of the type II pneumocytes. Conclusions: Exogenous SOD can reverse changes in the lungs of animals with induced DM.

 


Keywords: Diabetes mellitus, experimental; Oxidative stress; Lung; DNA damage.

 

10 - Evolution of performance status, body mass index, and six-minute walk distance in advanced lung cancer patients undergoing chemotherapy

Evolução do status de performance, índice de massa corpórea e distância percorrida no teste de caminhada de seis minutos em pacientes com câncer de pulmão avançado submetidos à quimioterapia

Luciana Machado, Ivete Alonso Bredda Saad, Helen Naemi Honma, André Moreno Morcillo, Lair Zambon

J Bras Pneumol.2010;36(5):588-594

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the effect of chemotherapy on the physical condition of patients with advanced lung cancer. Methods: We evaluated 50 patients with non-small cell lung cancer (in stages IIIB and IV) and Eastern Cooperative Oncology Group (ECOG) performance status scale scores between zero and two. All patients underwent chemotherapy using paclitaxel and platinum derivatives and were evaluated at three time points (prechemotherapy, postchemotherapy and six months after starting the treatment), at which the ECOG scale, the body mass index (BMI) and the six-minute walk distance (6MWD) were assessed. Results: Of the 50 patients included in the study, 14 died, 5 were excluded due to the worsening of their performance status, and 31 completed the six-month follow-up. There was no statistically significant difference between the time points of assessment for BMI (prechemotherapy vs. postchemotherapy, p = 1.00; and prechemotherapy vs. six months later, p = 0.218) or for 6MWD. Performance status improved, and this was especially due to the increase in the number of asymptomatic patients after the six-month follow-up (p = 0.031). Conclusions: Chemotherapy had a beneficial effect on the performance status of the patients. No significant changes in BMI or 6MWD were found during the study period, which might suggest the maintenance of the physical condition of the patients.

 


Keywords: Drug therapy; Lung neoplasms; Exercise tolerance.

 

11 - Reproducibility of the Brazilian Portuguese version of the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire used in conjunction with its lung cancerspecific module

Reprodutibilidade da versão em português do Brasil do European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire em conjunto com seu módulo específico para câncer de pulmão*

Juliana Franceschini, José Roberto Jardim, Ana Luisa Godoy Fernandes, Sérgio Jamnik, Ilka Lopes Santoro

J Bras Pneumol.2010;36(5):595-602

Abstract PDF PT PDF EN Portuguese Text

Objective: The assessment of the quality of life in patients with lung cancer has become one of the main goals in current clinical trials. To assess the quality of life of these patients, the most widely used instrument is the 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) in conjunction with its supplemental 13-item lung cancer-specific module (QLQ-LC13). The objective of this study was to assess the reproducibility of the Brazilian Portuguese version of these questionnaires. Methods: A prospective study involving 30 stable outpatients with lung cancer who completed the instruments on the first day of the study and two weeks later. Results: The test-retest reproducibility using the intraclass correlation coefficient for the EORTC QLQ-C30 and the QLQ-LC13 ranged from 0.64 to 1.00 and from 0.64 to 0.95, respectively. No correlations were found between the domains of the instruments and clinical parameters. Conclusions: Our findings show that these instruments were reproducible in this sample of patients with lung cancer in Brazil.

 


Keywords: Lung neoplasms; Reproducibility of results; Quality of life.

 

12 - Factors that motivate smokers to seek outpatient smoking cessation treatment at a university general hospital

Fatores motivacionais que contribuem para a busca de tratamento ambulatorial para a cessação do tabagismo em um hospital geral universitário

Adriana Carneiro Russo, Renata Cruz Soares de Azevedo

J Bras Pneumol.2010;36(5):603-611

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the reasons smokers give for seeking smoking cessation treatment, correlating those reasons with sociodemographic characteristics, clinical data, stage of readiness to change, and severity of nicotine dependence. Methods: Between February of 2008 and February of 2009, we evaluated 53 smokers who were naive to smoking cessation treatment and sought such treatment at the psychoactive substance abuse outpatient clinic of a university general hospital. The instruments used in the study were as follows: a form for the collection of sociodemographic and clinical data; the Fagerström Test for Nicotine Dependence; the University of Rhode Island Change Assessment scale; and a questionnaire on the smoking habit. Results: The sample comprised 34 women and 19 men, with a mean age of 48.1 years. Most of the participants had less than 8 years of schooling, had tobacco-related diseases, started smoking during adolescence, had smoked for more than 20 years, and had high nicotine dependence. The decision to quit smoking was mainly influenced by advice from family members, and the decision to seek specialized smoking cessation treatment was influenced by physicians. Most of the men were in the contemplation stage of change, whereas the women tended to have a more balanced distribution of the stages (p = 0.007). The women had attempted to quit smoking more often than had the men (p = 0.017) and also had a higher level of nicotine dependence (p = 0.053). Conclusions: The findings of this study highlight the role of health professionals in the approach to smoking cessation and suggest the importance of interventions that are more targeted, in view of the differences between men and women.

 


Keywords: Smoking; Smoking cessation; Motivation; Tobacco use disorder.

 

13 - Comparison among three cold staining methods in the primary diagnosis of tuberculosis: a pilot study

Comparação entre três métodos de coloração a frio no diagnóstico primário de tuberculose: um estudo piloto

Soham Gupta, Vishnu Prasad Shenoy, Indira Bairy, Sethumadhavan Muralidharan

J Bras Pneumol.2010;36(5):612-616

Abstract PDF PT PDF EN Portuguese Text

Objective: In developing countries, sputum smear microscopy is the main tool for pulmonary tuberculosis case finding. The objective of the present study was to evaluate the diagnostic efficacy of Gabbett's staining (GS) and modified cold staining (MCS), both of which are two-step methods, in comparison with that of fluorescent staining (FS), which is a three-step method, for the detection of AFB in sputum smears. Methods: Our sample comprised 260 sputum samples collected from individuals suspected of having pulmonary tuberculosis at Kasturba Hospital, in Manipal, India. Smears were prepared in triplicate: one each for FS, MCS, and GS. The smears were randomly numbered so that the examiner was blinded to the sample identities. Results: Of the 260 samples, 16 (6.15%), 15 (5.77%), and 13 (5.00%) showed positive AFB results with FS, MCS, and GS, respectively. The sensitivity of GS and MCS, in comparison with that of FS, was 81.25% and 93.75%, respectively. The concordance of GS and MCS with FS was good (0.988 and 0.996, respectively), and no statistically significant differences were found. Conclusions: Although MCS and GS were found to be less sensitive than was FS, which is evaluated under fluorescence microscopy, the first two are promising methods for the diagnosis of tuberculosis.

 


Keywords: Tuberculosis, pulmonary; Diagnostic techniques and procedures; Microscopy, fluorescence; Sputum.

 

Brief Communication

14 - The revised tumor-node-metastasis staging system for lung cancer: changes and perspectives

Revisão do sistema de estadiamento tumor-nódulo-metástase para câncer de pulmão: mudanças e perspectivas

Filipe Moreira de Andrade, Omar Moté Abou Mourad, Luiz Felippe Judice

J Bras Pneumol.2010;36(5):617-620

Abstract PDF PT PDF EN Portuguese Text

The tumor-node-metastasis (TNM) staging system for lung cancer has been modified since its first edition in the late 1960s. Its seventh edition has been recently published and, for the first time, a truly worldwide database was analyzed in order to propose modifications in the staging. Significant changes have been made in the tumor and metastasis descriptors. Although the recommendations for the node descriptor have remained unchanged, the analysis of the factors related to this descriptor suggests that modifications will be made in the future. The forthcoming revisions of the TNM staging system might take the molecular aspects of lung cancer into consideration, aiming at a more refined staging system.

 


Keywords: Lung neoplasms; Neoplasm staging; Epidemiologic methods.

 

15 - Tuberculosis and gender in a priority city in the state of Rio de Janeiro, Brazil

Tuberculose e gênero em um município prioritário no estado do Rio de Janeiro

Márcia Teresa Carreira Teixeira Belo, Ronir Ragio Luiz, Christy Hanson, Lia Selig, Eleny Guimarães Teixeira, Thiago Chalfoun, Anete Trajman

J Bras Pneumol.2010;36(5):621-625

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to compare gender differences among tuberculosis patients in a city with a high incidence of tuberculosis. This was a cross-sectional questionnaire-based study involving 560 tuberculosis patients (373 males and 187 females). Sociodemographic and clinical data, as well as data related to diagnostic criteria and treatment outcome, were collected (from the questionnaires and medical records) and subsequently compared between the genders. The median time from symptom onset to diagnosis was 90 days. There were no differences between the genders regarding the clinical presentation, diagnostic criteria, previous noncompliance with treatment, time from symptom onset, number of medical appointments prior to diagnosis, or treatment outcome. Gender-specific approaches are not a priority in Brazil. However, regardless of patient gender, the delay in diagnosis is a major concern.

 


Keywords: Poverty; Tuberculosis; Income.

 

Review Article

16 - Antituberculosis drugs: Drug interactions, adverse effects, and use in special situations. Part 1: First-line drugs*

Drogas antituberculose: Interações medicamentosas, efeitos adversos e utilização em situações especiais. Parte 1: Fármacos de primeira linha

Marcos Abdo Arbex, Marília de Castro Lima Varella, Hélio Ribeiro de Siqueira, Fernando Augusto Fiúza de Mello

J Bras Pneumol.2010;36(5):626-640

Abstract PDF PT PDF EN Portuguese Text

The main objectives of tuberculosis therapy are to cure the patients and to minimize the possibility of transmission of the bacillus to healthy subjects. Adverse effects of antituberculosis drugs or drug interactions (among antituberculosis drugs or between antituberculosis drugs and other drugs) can make it necessary to modify or discontinue treatment. We briefly review the new guidelines for the pharmacological treatment of tuberculosis, introduced by the Brazilian National Ministry of Health in 2009, and describe the general mechanism of action, absorption, metabolization, and excretion of the first-line drugs used in the basic regimen. We describe adverse drug reactions and interactions (with other drugs, food, and antacids), as well as the most appropriate approach to special situations, such as pregnancy, breastfeeding, liver failure, and kidney failure. We also describe the mechanisms by which the interactions among the antituberculosis drugs used in the basic regimen can cause drug-induced hepatitis, and we discuss the alternatives in this situation.

 


Keywords: Tuberculosis; Drug interactions; Antibiotics, antitubercular; Pharmacologic actions; Drug toxicity; Drug-induced liver injury.

 

17 - Antituberculosis drugs: Drug interactions, adverse effects, and use in special situations. Part 2: Second line drugs

Drogas antituberculose: Interações medicamentosas, efeitos adversos e utilização em situações especiais. Parte 2: Fármacos de segunda linha

Marcos Abdo Arbex, Marília de Castro Lima Varella, Hélio Ribeiro de Siqueira, Fernando Augusto Fiúza de Mello

J Bras Pneumol.2010;36(5):641-656

Abstract PDF PT PDF EN Portuguese Text

The main objectives of tuberculosis therapy are to cure the patients and to minimize the possibility of transmission of the bacillus to healthy subjects. Adverse effects of antituberculosis drugs or drug interactions (among antituberculosis drugs or between antituberculosis drugs and other drugs) can make it necessary to modify or discontinue treatment. We describe the general mechanism of action, absorption, metabolization, and excretion of the drugs used to treat multidrug resistant tuberculosis (aminoglycosides, fluoroquinolones, cycloserine/terizidone, ethionamide, capreomycin, and para-aminosalicylic acid). We describe adverse drug reactions and interactions (with other drugs, food, and antacids), as well as the most appropriate approach to special situations, such as pregnancy, breastfeeding, liver failure, and kidney failure.

 


Keywords: Tuberculosis; Drug interactions; Antibiotics, antitubercular; Pharmacologic actions; Drug toxicity, Tuberculosis, multidrug-resistant.

 

Case Report

18 - Lipoid pneumonia secondary to long-term use of evening primrose oil

Pneumonia lipoide secundária ao uso prolongado de óleo de prímula

Marcelo Fouad Rabahi, Andreia Alves Ferreira, João Gabriel Piccirilli Madeira, Paulo Menzel Galvao, Sebastião Alves Pinto

J Bras Pneumol.2010;36(5):657-661

Abstract PDF PT PDF EN Portuguese Text

Lipoid pneumonia is an underdiagnosed disease that is caused by the aspiration of lipid particles into the lungs. Although most of the reported cases have been associated with the use of mineral oil as a laxative, other lipid substances can also cause the disease. We report the case of a 50-year-old female patient with a complaint of productive cough who was initially diagnosed with bronchial hyperresponsiveness and gastroesophageal reflux disease (GERD). The patient was treated for GERD. Because the productive cough persisted, the patient underwent chest CT, fiberoptic bronchoscopy, and open lung biopsy. She was diagnosed with lipoid pneumonia. The patient was questioned regarding the use of lipid substances, and she reported the chronic use of evening primrose oil. After the discontinuation of the substance and the maintenance of GERD treatment, her condition improved.

 


Keywords: Pneumonia, lipid; Cough; Plant oils.

 

19 - Recurrent pulmonary hyalinizing granuloma

Granuloma hialinizante de pulmão recidivante

Guilherme D'Andréa Saba Arruda, Paulo César Ribeiro de Carvalho, Mara Patrícia Guilhermino de Andrade, Maurício Campos Cusmanich, Gustavo Bandeira, Felipe Shigueo Passos Tozaki

J Bras Pneumol.2010;36(5):662-665

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 61-year-old male patient who underwent surgical excision of a lung mass for anatomopathological study. The patient had previously presented with fever, dry cough, and chest pain, together with lung masses detected by chest X-ray, and had undergone thoracotomy for diagnostic investigation on two occasions (1976 and 1981), although a conclusive diagnosis had not been made. A CT scan of the chest revealed large masses with areas of calcification in both lung fields. The anatomopathological study was consistent with pulmonary hyalinizing granuloma. In the postoperative period, the patient experienced several episodes of bronchospasm, which was reversible with the use of symptomatic medication. At this writing, the patient was receiving maintenance therapy with prednisone (40 mg/day) and had shown clinical improvement.

 


Keywords: Glucocorticoids; Mass chest X-ray; Granuloma.

 

Letters to the Editor

20 - Paracoccidioidomycosis and cancer

Paracoccidioidomicose e câncer

Viroj Wiwanitkit

J Bras Pneumol.2010;36(5):

PDF PT PDF EN Portuguese Text


21 - New reference values for maximal respiratory pressures in the Brazilian population: Corrections

Novos valores de referência para pressões respiratórias máximas na população brasileira: Correções

Dirceu Costa, Helena Amaral Gonçalves, Luciana Peraro de Lima, Daniela Ike,Karina Maria Cancelliero, Maria Imaculada de Lima Montebelo

J Bras Pneumol.2010;36(5):667-

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Letter to the Reader

22 - The End (of one thing is always the happy beginning of something else)

Fim: o que resta é sempre o princípio feliz de alguma coisa

José Antônio Baddini Martinez

J Bras Pneumol.2010;36(5):668-

PDF PT PDF EN Portuguese Text


Year 2010 - Volume 36  - Number 6  (November/December)

Editorial

1 - Time to turn the page

A hora da virada

Carlos R. R. Carvalho

J Bras Pneumol.2010;36(6):669-670

PDF PT PDF EN Portuguese Text


2 - Smoking in adolescence: Why do youths still smoke?

Tabagismo na adolescência: Por que os jovens ainda fumam?

Alberto José de Araújo

J Bras Pneumol.2010;36(6):671-673

PDF PT PDF EN Portuguese Text


Original Article

3 - Determinants of smoking experimentation and initiation among adolescent students in the city of Salvador, Brazil

Determinantes da experimentação do cigarro e do início precoce do tabagismo entre adolescentes escolares em Salvador (BA)

Adelmo de Souza Machado Neto, Tarcisio Matos Andrade, Carlos Napoli, Lilian Carine Souza de Lima Abdon, Mônica Rocha Garcia, Francisco Inácio Bastos

J Bras Pneumol.2010;36(6):674-682

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To identify the factors associated with smoking experimentation and initiation among adolescent students (11-14 years of age). Methods: A cross-sectional, population-based study involving adolescent (middle and high school) students at public and private schools in the city of Salvador, Brazil. A multiple-stage sampling protocol was used. The participants completed an anonymous, voluntary, self-report questionnaire. The dependent variables were age at smoking experimentation and smoking initiation. Sociodemographic and educational variables, as well as those related to media influence and alcohol consumption, were considered independent variables. Multivariate logistic regression analysis was performed, followed by analysis of the fit of the final logistic regression model. Results: The prevalence of smoking experimentation was 16.1% (95% CI: 15.1-17.2). Of the 5,347 students evaluated, 757 had experimented with cigarettes, and 462 (61.2%) of those 757 had done so before the age of 15 (mean age at smoking experimentation, 13.9 ± 1.8 years). Smoking initiation was associated with paternal smoking (OR = 1.53; 83% CI = 1.07-2.19) and with media influence (OR = 2.43; 83% CI: 1.46‑4.04). Smoking experimentation was associated with alcohol consumption (OR = 6.04; 83% CI: 4.62-7.88), having friends who smoke (OR = 3.18; 83% CI: 2.54-3.99), having a boyfriend/girlfriend who smokes (OR = 3.42; 83% CI: 1.78-6.56), and coercive/aggressive educational interventions by the parents (OR = 1.60; 83% CI: 1.26‑2.04). Conclusions: Alcohol consumption and the influence of peers and relatives who smoke showed a strong association with smoking experimentation. Paternal smoking and media influence were found to increase the chances of adolescent smoking.

 


Keywords: Smoking; Adolescence; Health education; Cross-sectional studies; Epidemiologic factors; Brazil.

 

4 - The Asthma Control Scoring System: Translation and cross-cultural adaptation for use in Brazil

Tradução e adaptação cultural do Asthma Control Scoring System (Sistema de Escore para Controle Abrangente da Asma) para uso no Brasil

Michelle Gonçalves de Souza Tavares, Márcia Margaret Menezes Pizzichini, Leila John Marques Steidle, Nazaré Otília Nazário, Cristiane Cinara Rocha, Maíra Chiaradia Perraro, Emílio Pizzichini

J Bras Pneumol.2010;36(6):683-692

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: The translation and cross-cultural adaptation of a specific scoring instrument for the comprehensive control of asthma, the Asthma Control Scoring System (ACSS), for use in Brazil. Methods: The protocol included ten steps: acquisition of written permission from the author of the ACSS; translation of the instrument to Brazilian Portuguese, carried out by three separate translators; analysis and comparison of the three versions by a review committee; literal back-translation to English; review and harmonization of the back-translation; acquisition of the approval of the original author; review of the translation by specialists; cognitive debriefing: test of clarity to, understanding by, and acceptance of the target population (evaluation of the translation by 10 health care workers); second cognitive debriefing: review of the revised version by a second group of health care workers; and reconciliation and preparation of the final version by the review committee. Results: The Brazilian Portuguese-language version of the ACSS showed clarity, understandability, and acceptability. The instrument was considered to be comprehensive because it includes the clinical manifestations of asthma, as well as the functional and inflammatory aspects of the disease. Conclusions: With the use of this careful methodology in the translation and cross-cultural adaptation of the ACSS, we have ensured its cultural adequacy for Brazil. The use of this instrument could facilitate future studies on asthma control.

 


Keywords: Asthma/classification; Asthma/prevention & control; Questionnaires.

 

5 - Exhaled breath temperature, a new biomarker in asthma control: A pilot study

Temperatura do ar exalado, um novo biomarcador no controle da asma: Um estudo piloto

Raul Emrich Melo, Todor A. Popov, Dirceu Solé

J Bras Pneumol.2010;36(6):693-699

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate whether the exhaled breath temperature (EBT), measured by a noninvasive method, is an effective means of monitoring patients with uncontrolled asthma. Methods: A pilot study comprising nine patients (seven women and two men; mean age: 39 years) diagnosed with asthma at least one year prior to the beginning of the study and not having been under maintenance therapy for the last three months. In the first visit, the patients underwent spirometry and measurement of EBT. The patients were then instructed to use inhaled budesonide/formoterol (200/6 µg) every 12 h for six weeks. In addition, the patients with severe asthma (FEV1 < 60% of predicted) were instructed to use oral prednisolone (40 mg/day) for five days. After six weeks, the patients underwent the same tests. Results: All of the patients reported an improvement in the symptoms of asthma, as confirmed by a statistically significant increase in FEV1 from the first to the second visit (mean, 56.1% vs. 88.7% of predicted; p < 0.05). Five patients used oral prednisolone for the first five days of the treatment period. Six patients used additional doses of inhaled budesonide/formoterol (mean duration, 2.5 weeks). The EBT decreased significantly from the first to the second visit (mean EBT: 35.1°C vs. 34.1°C; p < 0.05). Conclusions: Uncontrolled asthma, especially during exacerbations, is followed by an increase in EBT, which decreases after appropriate asthma control, as demonstrated by an increase in FEV1 and an improvement of the reported symptoms. These preliminary results suggest that EBT can be used as a parameter for the assessment of asthma control.

 


Keywords: Asthma; Biomarkers, pharmacological; Hydroxycorticosteroids.

 

6 - Predictors of hospital admission due to asthma in children and adolescents enrolled in an asthma control program

Fatores preditores de hospitalização por asma em crianças e adolescentes participantes de um programa de controle da asma

Heli Vieira Brandão, Constança Sampaio Cruz, Armênio Guimarães, Paulo Augusto Moreira Camargos, Álvaro Augusto Cruz

J Bras Pneumol.2010;36(6):700-706

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the clinical characteristics and the predictors of hospital admission due to asthma among children and adolescents with asthma under treatment at a referral center. Methods: A retrospective cohort study comprising 151 children and adolescents with asthma, referred from the Unified Health Care System and enrolled in the Asthma and Allergic Rhinitis Control Program in the city of Feira de Santana, Brazil, followed for a period of 12 months and receiving asthma medication at no cost. The chi-square test was used in order to determine the associations between the studied variables and the occurrence of hospital admissions, whereas the Mann-Whitney test was used for the comparison between the groups of hospitalized patients and nonhospitalized patients. The level of significance was set at p < 0.05. Univariate analysis with logistic regression was performed in order to determine the predictors of hospital admission. Results: Of the 151 patients evaluated, 8 (5.2%) were hospitalized, in a total of 12 hospital admissions. In the univariate analysis, the only variable found to be a predictive factor was greater asthma severity (OR = 13.3; 95% CI: 2.55-70.1). Conclusions: The fact that, in our study sample, the principal predictor of hospital admission was greater asthma severity, calls for special attention being given to the care of these patients.

 


Keywords: Asthma; Hospitalization; Health services.

 

7 - Risk factors for pulmonary complications in patients with sarcoma after the resection of pulmonary nodules by thoracotomy

Fatores de risco de complicações pulmonares em pacientes com sarcoma após toracotomia para a ressecção de nódulos pulmonares

Rogério Santos Silva, Paulo Sérgio Siebra Beraldo, Flávia Ferretti Santiago, Daniel Sammartino Brandão, Eduardo Magalhães Mamare, Thomas Anthony Horan

J Bras Pneumol.2010;36(6):707-715

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify the risk factors for pulmonary complications after thoracotomy for the resection of pulmonary nodules in patients with sarcoma. Methods: A retrospective cohort study involving 68 consecutive patients diagnosed with sarcoma and submitted to a total of 174 thoracotomies for the resection of pulmonary nodules. The dependent variable was defined as the occurrence of any postoperative pulmonary complications. The independent variables were related to the patient, underlying diagnosis, and type of surgical procedure. We analyzed the data using a multivariate generalized estimating equations model with logistic link function and a symmetric correlation structure. Results: Complications were observed in 24 patients (13.8%, 95% CI: 9.0-19.8), and there was one death. The mean length of hospital stay was twice as long in the patients with postoperative complications as in those without (18.8 ± 10.0 days vs. 8.6 ± 6.0 days; p < 0.05). The variables that correlated with the outcome measure were the type of resection (wedge vs. anatomic; OR = 3.6; 95% CI: 1.5-8.8), the need for blood transfusion (OR = 9.8; 95% CI: 1.6-60.1), and the number of nodules resected (OR = 1.1; 95% CI: 1.0-1.1). The multivariate model showed an area under the ROC curve of 0.75 (95% CI: 0.65-0.85). Conclusions: Postoperative pulmonary complications were common after pulmonary nodule resection in patients with sarcoma, occurring in approximately 10% of the procedures. The occurrence of such complications can be expected when techniques other than wedge resection are employed, when blood transfusion is required, and when a great number of nodules are resected. Therefore, it is possible to identify patients at risk for pulmonary complications, who should be closely monitored in the immediate postoperative period. In such patients, all preventive measures should be taken.

 


Keywords: Sarcoma; Neoplasm metastasis; Risk; Thoracotomy; Thoracic surgery.

 

8 - Surgical treatment of children with necrotizing pneumonia

Tratamento cirúrgico de crianças com pneumonia necrosante

Fernando Luiz Westphal, Luís Carlos de Lima, José Corrêa Lima Netto, Eugênio Tavares, Edson de Oliveira Andrade, Márcia dos Santos da Silva

J Bras Pneumol.2010;36(6):716-723

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the results of the surgical treatment of children with necrotizing pneumonia. Methods: A retrospective analysis of the medical charts of 20 children diagnosed with necrotizing pneumonia and submitted to surgical treatment between March of 1997 and September of 2008 in the thoracic surgery departments of two hospitals in the city of Manaus, Brazil. We compiled data regarding age, gender, etiologic agent, indications for surgery, type of surgical resection performed, and postoperative complications. Results: The mean age of the patients was 30 months. Of the 20 patients studied, 12 (60%) were female. The most common etiologic agents were Staphylococcus aureus, in 5 patients (25%), and Klebsiella sp., in 2 (10%). The indications for surgery were sepsis, in 16 patients (80%), and bronchopleural fistula, in 4 (20%). The types of surgical procedures performed were lobectomy, in 12 patients (60%), segmentectomy, in 7 (35%), and bilobectomy, in 1 (5%). There were 8 patients (40%) who also underwent decortication. The postoperative complications were as follows: bronchopleural fistula, in 4 patients (20%); empyema, in 1 (5%); pneumatocele, in 1 (5%); and phlebitis of the left arm, in 1 (5%). Four (20%) of the patients died. Conclusions: Surgical resection should be considered in patients with evidence of pulmonary necrosis. Resection is indicated in cases of severe sepsis, high output bronchopleural fistula, or acute respiratory failure that are refractory to clinical treatment.

 


Keywords: Pneumonia; Necrosis; Lung abscess; Empyema, pleural.

 

9 - Thrombosis in small and medium-sized pulmonary arteries in Wegener's granulomatosis: A confocal laser scanning microscopy study

Trombose em artérias pulmonares pequenas e médias em granulomatose de Wegener: Um estudo com microscopia confocal a laser

Alfredo Nicodemos Cruz Santana, Alexandre Muxfeldt Ab`Saber, Walcy Rosolio Teodoro, Vera Luiza Capelozzi, Carmen Silvia Valente Barbas

J Bras Pneumol.2010;36(6):724-730

Abstract PDF PT PDF EN Portuguese Text

Objective: Wegener's granulomatosis (WG) can cause endothelial cell damage and thromboembolic events. Nevertheless, there have been few studies on the pulmonary microcirculation-small and medium-sized pulmonary arteries (SMSPA)-in patients with WG. The objective of this study was to quantify fibrin thrombi in the SMSPA of patients with WG. Methods: We analyzed 24 SMSPA samples collected from six patients with WG and 16 SMSPA samples collected from four patients without WG. In all samples, we used the endothelial cell marker CD34 and confocal laser scanning microscopy in order to detect intravascular fibrin thrombi. We calculated the total vessel area, the free lumen area, and the thrombotic area. Results: The mean total vessel area was similar in the WG and control groups (32,604 µm2 vs. 32,970 µm2, p = 0.8793). Thrombi were present in 22 (91.67%) of the 24 WG group samples and in none of the control group samples (p < 0.0001; OR = 297; 95% CI: 13.34-6,612). The mean thrombotic area was greater in the WG group samples than in the control group samples (10,068 µm2 vs. 0.000 µm2; p < 0.0001). In contrast, the mean free lumen area was smaller in the WG group samples than in the control group samples (6,116 µm2 vs. 24,707 µm2; p < 0.0001). Conclusions: Confocal laser scanning microscopy revealed a significant association between pulmonary microvascular thrombosis and WG. This suggests a possible role of microvascular thrombosis in the pathophysiology of pulmonary WG, evoking the potential benefits of anticoagulation therapy in pulmonary WG. However, further studies are needed in order to confirm our findings, and randomized clinical trials should be conducted in order to test the role of anticoagulation therapy in the treatment of patients with pulmonary WG.

 


Keywords: Vasculitis; Antibodies, antineutrophil cytoplasmic; Wegener granulomatosis; Thrombosis; Lung; Microscopy, confocal.

 

10 - Clinical, nutritional and spirometric evaluation of patients with cystic fibrosis after the implementation of multidisciplinary treatment

Avaliação clínica, nutricional e espirométrica de pacientes com fibrose cística após implantação de atendimento multidisciplinar

Lídia Torres, Jenny Libeth Jurado Hernandez, Giseli Barbiero de Almeida, Liana Barbaresco Gomide, Valéria Ambrósio, Maria Inez Machado Fernandes

J Bras Pneumol.2010;36(6):731-737

Abstract PDF PT PDF EN Portuguese Text

Objective: Cystic fibrosis (CF) is a chronic multisystemic hereditary disease for which a multidisciplinary approach must be taken. The objective of this study was to show the evolution of a group of patients with CF after the implementation of multidisciplinary treatment. Methods: A retrospective study involving 19 patients (6-29 years of age) under clinical follow-up treatment at the University of São Paulo at Ribeirão Preto School of Medicine Hospital das Clínicas, located in the city of Ribeirão Preto, Brazil. The patients were divided into two groups: 6-12(6-12 years of age) and 13+ (> 12 years of age). We collected data regarding body mass index (BMI), Zscore, Shwachman score (SS), number of exacerbations/year, chronic colonization by Pseudomonas aeruginosa, and spirometric measurements (FVC, FEV1, FEV1%, and FEF25-75%). Data were collected at two different time points (before and after the implementation of the multidisciplinary treatment) and were analyzed with the Wilcoxon signed rank test. Results: The median age at the onset of symptoms was 10 months. In the 6-12 group, only BMI and FVC increased significantly. Although the other spirometric values increased, the differences were not significant. In the 13+ group, there were no significant differences between the two time points. There was a borderline significant decrease in SS and less than significant decreases in the spirometric measurements. However, the number of patients with alterations in volumes and flows decreased in both groups. Conclusions: Although our patient sample was small, the lack of changes in the spirometric parameters might reflect clinical and functional stability. In all of the patients evaluated, clinical, functional, and nutritional parameters remained stable throughout the study period. The implementation of a multidisciplinary approach might have contributed to this result.

 


Keywords: Cystic fibrosis; Spirometry; Body mass index; Physical therapy modalities.

 

11 - Diaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Wellington Pereira dos Santos Yamaguti, Eliana Takahama Sakamoto, Danilo Panazzolo, Corina da Cunha Peixoto, Giovanni Guido Cerri, André Luis Pereira Albuquerque

J Bras Pneumol.2010;36(6):738-745

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare the diaphragmatic mobility of healthy subjects during incentive spirometry with a volume-oriented device, during incentive spirometry with a flow-oriented device, and during diaphragmatic breathing. To compare men and women in terms of diaphragmatic mobility during these three types of breathing exercises. Methods: We evaluated the pulmonary function and diaphragmatic mobility of 17 adult healthy volunteers (9women and 8 men). Diaphragmatic mobility was measured via ultrasound during diaphragmatic breathing and during the use of the two types of incentive spirometers. Results: Diaphragmatic mobility was significantly greater during the use of the volume-oriented incentive spirometer than during the use of the flow-oriented incentive spirometer (70.16 ± 12.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). Diaphragmatic breathing led to a greater diaphragmatic mobility than did the use of the flow-oriented incentive spirometer (69.62 ± 11.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). During all three types of breathing exercises, the women showed a higher mobility/FVC ratio than did the men. Conclusions: Incentive spirometry with a volume-oriented device and diaphragmatic breathing promoted greater diaphragmatic mobility than did incentive spirometry with a flow-oriented device. Women performed better on the three types of breathing exercises than did men.

 


Keywords: Diaphragm; Breathing exercises; Respiratory function tests; Ultrasonography; Respiratory muscles.

 

12 - Accelerated lung aging in patients with morbid obesity

Envelhecimento pulmonar acelerado em pacientes com obesidade mórbida

Saulo Maia D'Ávila Melo, Valdinaldo Aragão de Melo, Enaldo Vieira de Melo, Raimundo Sotero de Menezes Filho, Vinicius Leite de Castro, Matheus Santana Paes Barreto

J Bras Pneumol.2010;36(6):746-752

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the lung age of patients with morbid obesity and to compare it with the chronological age of these patients, emphasizing the premature damage that morbid obesity does to the lungs. Methods: An open, prospective cross-sectional study comprising 112 individuals: 78 patients with morbid obesity (study group); and 34 non-obese individuals with normal pulmonary function results (control group). All of the patients underwent spirometry for the determination of lung age. The lung age and the chronological age of the individuals in each group were compared in isolation and between the two groups. Results: The difference between lung age and chronological age in the group with morbid obesity was significant (p < 0.0001; 95% CI: 6.6-11.9 years), the mean difference being 9.1 ± 11.8 years. The difference between the study group and the control group in terms of lung age was significant (p < 0.0002; 95% CI: 7.5-16.9 years), the mean difference being 12.2 ± 2.4 years. Lung age correlated positively with chronological age and body mass index (BMI), whereas it correlated negatively with the spirometric variables (p < 0.0001 for all). Multiple linear regression analysis identified BMI and chronological age (p < 0.0001) as significant predictors of lung age. Conclusions: Lung age is increased in patients with morbid obesity, suggesting premature damage and accelerated lung aging, as evidenced by the discrepancy between chronological age and lung age. The determination of lung age might become a new tool for understanding pulmonary function results, for patients as well as for health professionals, in relation to obesity control.

 


Keywords: Spirometry; Obesity, morbid; Respiratory function tests.

 

13 - Thoracic catheter-related infections

Infecções relacionadas a cateteres torácicos

Ekrem Senturk, Murat Telli, Serdar Sen, Salih Cokpinar

J Bras Pneumol.2010;36(6):753-758

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. Methods: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. Results: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). Conclusions: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.

 


Keywords: Catheter-related infections; Thoracic surgery; Bacterial infections.

 

14 - Pleurodese nos derrames pleurais malignos: Um inquérito entre médicos em países da América do Sul e Central

Pleurodese nos derrames pleurais malignos: Um inquérito entre médicos em países da América do Sul e Central

Evaldo Marchi, Francisco Suso Vargas, Bruna Affonso Madaloso, Marcus Vinicius Carvalho, Ricardo Mingarini Terra, Lisete Ribeiro Teixeira

J Bras Pneumol.2010;36(6):759-767

Abstract PDF PT PDF EN Portuguese Text

Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.

 


Keywords: Pleural effusion, malignant; Pleura; Pleurodesis.

 

15 - University of São Paulo Reasons for Smoking Scale: a new tool for the evaluation of smoking motivation

Escala Razões para Fumar da Universidade de São Paulo: um novo instrumento para avaliar a motivação para fumar

Elisa Sebba Tosta de Souza, José Alexandre de Souza Crippa, Sonia Regina Pasian, José Antônio Baddini Martinez

J Bras Pneumol.2010;36(6):768-778

Abstract PDF PT PDF EN Portuguese Text Appendix

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.

 

Brief Communication

16 - Surgical treatment of pulmonary aspergilloma

Tratamento cirúrgico de aspergiloma pulmonar

Raul Lopes Ruiz Júnior, Frederico Henrique Sobral de Oliveira, Bruno Luiz Burgos Piotto, Felipe Antunes e Silva de Souza Lopes Muniz, Daniele Cristina Cataneo, Antonio José Maria CataneoResumo

J Bras Pneumol.2010;36(6):779-783

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to analyze the outcome of surgical treatment of pulmonary aspergilloma. To that end, we evaluated 14 adult patients so treated between 1981 and 2009 at the Botucatu School of Medicine University Hospital, in the city of Botucatu, Brazil. Data were collected from the medical records of the patients. Ten patients (71%) presented with simple pulmonary aspergilloma, and 4 (29%) presented with complex pulmonary aspergilloma. Hemoptysis was the most common symptom, and tuberculosis was the most prevalent preexisting lung disease. Two patients (14%) underwent surgery on more than one occasion. There were no intraoperative deaths. Half of the patients developed postoperative complications, prolonged air leak and empyema being the most common.

 


Keywords: Pulmonary aspergillosis; Tuberculosis, pulmonary; Thoracic surgery.

 

Review Article

17 - Occupational lung cancer

Câncer de pulmão ocupacional

Eduardo Algranti, José Tarcísio Penteado Buschinelli, Eduardo Mello De Capitani

J Bras Pneumol.2010;36(6):784-794

Abstract PDF PT PDF EN Portuguese Text

Lung cancer is a multifactorial disease. Hereditary, genetic, and environmental factors interact in its genesis. The principal risk factor for lung cancer is smoking. However, the workplace provides an environment in which there is a risk of exposure to carcinogens. The International Agency for Research on Cancer currently lists 19 substances/work situations/occupations that have been proven to be associated with lung cancer (group 1). Thorough occupational history taking is not widely practiced in patients with lung cancer, which has a negative impact on the investigation of causality and, consequently, on the identification of cases of occupational cancer. The objectives of this review were to list the agents that are recognized as causes of lung cancer, to discuss the contribution of occupation to the development of the disease, to cite national studies on the subject, and to propose a list of procedures that are essential to the appropriate investigation of causality between lung cancer and occupation.

 


Keywords: Lung neoplasms; Occupational diseases; Occupations; Carcinogens.

 

18 - Diagnosis and treatment of pulmonary hypertension: an update*

Diagnóstico e tratamento da hipertensão pulmonar: uma atualização

Susana Hoette, Carlos Jardim, Rogério de Souza

J Bras Pneumol.2010;36(6):795-811

Abstract PDF PT PDF EN Portuguese Text

Over the last five years, knowledge in the field of pulmonary hypertension has grown consistently and significantly. On the basis of various clinical studies showing the usefulness of new diagnostic tools, as well as the efficacy of new medications and drug combinations, new diagnostic and treatment algorithms have been developed. Likewise, in order to simplify the clinical management of patients, the classification of pulmonary hypertension has been changed in an attempt to group the various forms of pulmonary hypertension in which the diagnostic and therapeutic approaches are similar. The objective of this review was to discuss these modifications, based on the 2005 Brazilian guidelines for the management of pulmonary hypertension, emphasizing what has been added to the international guidelines.

 


Keywords: Hypertension, pulmonary/diagnosis; Hypertension, pulmonary/therapy; Clinical protocols.

 

Case Series

19 - Descending necrotizing mediastinitis: minimally invasive thoracic surgical treatment

Mediastinite descendente necrosante: tratamento cirúrgico torácico minimamente invasivo

Cromwell Barbosa de Carvalho Melo, Petrúcio Abrantes Sarmento, Carlos Jogi Imaeda, Danilo Félix Daud, Fábio Nishida Hasimoto, Luiz Eduardo Villaça Leão

J Bras Pneumol.2010;36(6):812-819

Abstract PDF PT PDF EN Portuguese Text

Objective: To report a case series of patients with descending necrotizing mediastinitis (DNM) who were treated with minimally invasive thoracic surgery. Methods: We report three cases of male patients with DNM who underwent mediastinal debridement by video-assisted thoracic surgery at the Hospital São Paulo, located in the city of São Paulo, Brazil, from admission to the final outcome. Results: The postoperative evolution was favorable in all three cases. The mean length of hospital stay was 16.7 days. Conclusions: We conclude that video-assisted thoracoscopy is an effective technique for mediastinal drainage in the treatment of DNM, with the benefits common to minimally invasive surgery: less postoperative pain, lower production of inflammatory factors, earlier return to activities of daily living, and better aesthetic results.

 


Keywords: Mediastinitis; Thorax; Thoracic surgery, video-assisted.

 

Case Report

20 - Castleman's disease associated with follicular dendritic cell sarcoma and myasthenia gravis

Doença de Castleman associada a sarcoma de células dendríticas foliculares e miastenia gravis

Fernando Luiz Westphal, Luís Carlos de Lima, Luiz Carlos Lopes Santana, José Corrêa Lima Netto, Vanise Campos Gomes Amaral, Márcia dos Santos da Silva

J Bras Pneumol.2010;36(6):819-823

Abstract PDF PT PDF EN Portuguese Text

Castleman's disease is an atypical lymphoproliferative disorder of unknown etiology, which might be associated with various clinical conditions, including autoimmune diseases and malignant neoplasms. We report the case of a 72-year-old female patient who was referred to the thoracic surgery department of Getúlio Vargas University Hospital, in the city of Manaus, Brazil, for the resection of a posterior mediastinal tumor. Three months prior, the patient had been admitted to the ICU with signs of severe dyspnea, at which time she was diagnosed with myasthenia gravis. After the resection of the mediastinal tumor, the histopathological examination revealed hyaline vascular-type Castleman's disease, complicated by follicular dendritic cell sarcoma. At this writing, the patient was being treated with an anticholinesterase agent and corticosteroids for the control of myasthenia gravis.

 


Keywords: Giant lymph node hyperplasia; Dendritic cell sarcoma, follicular; Myasthenia gravis; Mediastinal diseases.

 

Letter to the Reader

21 - A rare case of pyopneumothorax

Um caso raro de piopneumotórax

Vanda Areias, Jose Romero, Isabel Ruivo, Ulisses Brito

J Bras Pneumol.2010;36(6):824-825

PDF PT PDF EN Portuguese Text


Index of Issues

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J Bras Pneumol.2010;36(6):

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Index of Authors

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J Bras Pneumol.2010;36(6):

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Relationship of Reviewers

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J Bras Pneumol.2010;36(6):

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