Brazilian Journal of Pulmonology

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


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Cellular composition of induced sputum in healthy adults

Composição celular do escarro induzido em adultos saudáveis

Tiago Neves Veras, Emilio Pizzichini, Leila John Marques Steidle, Cristiane Cinara Rocha, Pablo Moritz, Márcia Margarete Menezes Pizzichini

J Bras Pneumol.2011;37(3):348-353

Abstract PDF PT PDF EN Portuguese Text

Objective: To establish reference values for cellularity in induced sputum samples collected from healthy adults. Methods: Induced sputum samples were obtained from 88 healthy adult never-smokers (39 males). The mean age was 36 years (range, 18-68 years). The participants had been residing in the city of Florianópolis, Brazil (a medium-sized non-industrial city) for at least two years. After the samples had been processed, we obtained total and differential cell counts. Results: The mean total cell count was 4.8 ± 4.2 × 106 cells/g. There was a predominance of macrophages (mean, 77.5 ± 14.7%) and neutrophils (mean, 23.4 ± 14.3%). Eosinophils were virtually absent (mean, 0.1 ± 0.3%). Lymphocytes and bronchial epithelial cells were scarce. Neither age nor atopy had any effect on the total or differential cell counts. Conclusions: In the induced sputum of this healthy adult population, macrophages and neutrophils predominated. However, the proportion of neutrophils was lower than that reported in previous studies, which suggests that reference values might vary depending on geographic location.


Keywords: Sputum; Reference values; Brazil.


Reliability of a rapid hematology stain for sputum cytology

Confiabilidade da coloração hematológica rápida para citologia de escarro

Jéssica Gonçalves, Emilio Pizzichini, Marcia Margaret Menezes Pizzichini, Leila John Marques Steidle, Cristiane Cinara Rocha, Samira Cardoso Ferreira, Célia Tânia Zimmermann

J Bras Pneumol.2014;40(3):250-258

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the reliability of a rapid hematology stain for the cytological analysis of induced sputum samples. Methods: This was a cross-sectional study comparing the standard technique (May-Grünwald-Giemsa stain) with a rapid hematology stain (Diff-Quik). Of the 50 subjects included in the study, 21 had asthma, 19 had COPD, and 10 were healthy (controls). From the induced sputum samples collected, we prepared four slides: two were stained with May-Grünwald-Giemsa, and two were stained with Diff-Quik. The slides were read independently by two trained researchers blinded to the identification of the slides. The reliability for cell counting using the two techniques was evaluated by determining the intraclass correlation coefficients (ICCs) for intraobserver and interobserver agreement. Agreement in the identification of neutrophilic and eosinophilic sputum between the observers and between the stains was evaluated with kappa statistics. Results: In our comparison of the two staining techniques, the ICCs indicated almost perfect interobserver agreement for neutrophil, eosinophil, and macrophage counts (ICC: 0.98-1.00), as well as substantial agreement for lymphocyte counts (ICC: 0.76-0.83). Intraobserver agreement was almost perfect for neutrophil, eosinophil, and macrophage counts (ICC: 0.96-0.99), whereas it was moderate to substantial for lymphocyte counts (ICC = 0.65 and 0.75 for the two observers, respectively). Interobserver agreement for the identification of eosinophilic and neutrophilic sputum using the two techniques ranged from substantial to almost perfect (kappa range: 0.91-1.00). Conclusions: The use of Diff-Quik can be considered a reliable alternative for the processing of sputum samples.


Keywords: Sputum\analysis; Sputum\cytology; Azure stains.


Highlights of the Brazilian Thoracic Association Guidelines for Interstitial Lung Diseases

Destaques das Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

Bruno Guedes Baldi, Carlos Alberto de Castro Pereira, Adalberto Sperb Rubin, Alfredo Nicodemos da Cruz Santana, André Nathan Costa, Carlos Roberto Ribeiro Carvalho, Eduardo Algranti, Eduardo Mello de Capitani, Eduardo Pamplona Bethlem, Ester Nei Aparecida Martins Coletta, Jaquelina Sonoe Ota Arakaki, José Antônio Baddini Martinez, Jozélio Freire de Carvalho, Leila John Marques Steidle, Marcelo Jorge Jacó Rocha, Mariana Silva Lima, Maria Raquel Soares, Marlova Luzzi Caramori, Miguel Abidon Aidé, Rimarcs Gomes Ferreira, Ronaldo Adib Kairalla, Rudolf Krawczenko Feitoza de Oliveira, Sérgio Jezler, Sílvia Carla Sousa Rodrigues, Suzana Pinheiro Pimenta

J Bras Pneumol.2012;38(3):282-291

Abstract PDF PT PDF EN Portuguese Text

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.


Keywords: Lung diseases, interstitial; Guidelines as topic; Brazil.


Determination of the inflammatory component of airway diseases by induced sputum cell counts: use in clinical practice

Determinação do componente inflamatório das doenças das vias aéreas através do escarro induzido: utilização na prática clínica

Pablo Moritz, Leila John Marques Steidle, Manuela Brisot Felisbino, Túlia Kleveston, Marcia Margaret Menezes Pizzichini, Emilio Pizzichini

J Bras Pneumol.2008;34(11):913-921

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the usefulness of determining the inflammatory component of airway diseases (inflammometry) by induced sputum cell counts, as well as its influence on treatment decisions in a tertiary facility for the treatment of respiratory diseases. Methods: We analyzed 151 sputum samples from 132 consecutive patients referred for clinical sputum induction by five pulmonologists between July of 2006 and February of 2007. A structured questionnaire related to the reasons for requesting the test and to the therapeutic decision making based on test results was completed by each attending physician upon receiving the test results. Induced sputum was obtained and processed according to a technique previously described. Results: The principal motives for ordering the test were inhaled corticosteroid dose titration in patients with moderate-to-severe asthma (in 54.3%), investigation of chronic cough (in 30.5%), and monitoring airway inflammation in patients with bronchiectasis (in 7.3%) or chronic obstructive pulmonary disease (in 6%). Of the 82 patients with asthma, 47 (57%) presented eosinophilic bronchitis (>3% eosinophils). Nonasthmatic eosinophilic bronchitis was diagnosed in 9 (19%) of the 46 patients with chronic cough. Neutrophilic bronchitis (>65% neutrophils) was found in 13 patients, of which 5 had asthma, 2 had chronic cough, and 6 had chronic obstructive pulmonary disease/bronchiectasis. Based on the induced sputum results, the corticosteroid dose was modified in 48 asthma patients (64.7%). Conclusions: The systematic application of inflammometry using induced sputum cell counts can be beneficial for patients with airway diseases, particularly those with asthma or chronic cough.


Keywords: Sputum; Asthma; Bronchitis.


Hospitalized patients with COPD: analysis of prior treatment

Pacientes portadores de DPOC hospitalizados: análise do tratamento prévio

Irai Luis Giacomelli, Leila John Marques Steidle, Frederico Fernandes Moreira, Igor Varela Meyer, Ricardo Goetten Souza, Mariângela Pimentel Pincelli

J Bras Pneumol.2014;40(3):229-237

Abstract PDF PT PDF EN Portuguese Text

Objective: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. Methods: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook). Results: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. Conclusions: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.


Keywords: Pulmonary disease, chronic obstructive/therapy; Pulmonary disease, chronic obstructive/prevention and control; Clinical protocols.


Prevalence of smoking and reasons for continuing to smoke: a population-based study

Prevalência de tabagismo e motivos para continuar a fumar: estudo de base populacional

Simone Aparecida Vieira Rocha1,a, Andréa Thives de Carvalho Hoepers1,b, Tânia Silvia Fröde2,c, Leila John Marques Steidle3,d, Emilio Pizzichini3,e, Márcia Margaret Menezes Pizzichini3,f

J Bras Pneumol.2019;45(4):e20170080-e20170080

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. Methods: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. Results: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). Conclusions: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.


Keywords: Smoking/epidemiology; Tobacco use disorder/psychology; Smoking cessation/methods; Prevalence.


Leicester Cough Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil

Questionário de Leicester sobre tosse crônica: tradução e adaptação cultural para a língua portuguesa falada no Brasil

Manuela Brisot Felisbino, Leila John Marques Steidle, Michelle Gonçalves-Tavares, Marcia Margaret Menezes Pizzichini, Emilio Pizzichini

J Bras Pneumol.2014;40(3):213-221

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Leicester Cough Questionnaire (LCQ) to Portuguese and adapt it for use in Brazil. Methods: Cross-cultural adaptation of a quality of life questionnaire requires a translated version that is conceptually equivalent to the original version and culturally acceptable in the target country. The protocol used consisted of the translation of the LCQ to Portuguese by three Brazilian translators who were fluent in English and its back-translation to English by another translator who was a native speaker of English and fluent in Portuguese. The back-translated version was evaluated by one of the authors of the original questionnaire in order to verify its equivalence. Later in the process, a provisional Portuguese-language version was thoroughly reviewed by an expert committee. In 10 patients with chronic cough, cognitive debriefing was carried out in order to test the understandability, clarity, and acceptability of the translated questionnaire in the target population. On that basis, the final Portuguese-language version of the LCQ was produced and approved by the committee. Results: Few items were questioned by the source author and revised by the committee of experts. During the cognitive debriefing phase, the Portuguese-language version of the LCQ proved to be well accepted and understood by all of the respondents, which demonstrates the robustness of the process of translation and cross-cultural adaptation. Conclusions: The final version of the LCQ adapted for use in Brazil was found to be easy to understand and easily applied.


Keywords: Quality of life; Translations; Questionnaires; Cough.


Smoking among patients hospitalized at a university hospital in the south of Brazil: prevalence, degree of nicotine dependence, and motivational stage of change

Tabagismo entre pacientes internados em um hospital universitário no sul do Brasil: prevalência, grau de dependência e estágio motivacional

Rafael Balsini Barreto, Mariângela Pimental Pincelli, Rafael Steinwandter, André Pacheco Silva, Jóice Manes, Leila John Marques Steidle

J Bras Pneumol.2012;38(1):72-80

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence and profile of smoking among hospitalized patients at a university hospital in the south of Brazil. Methods: This was a descriptive cross-sectional study involving patients over 18 years of age hospitalized for over 24 h at the Federal University of Santa Catarina University Hospital, located in the city of Florianópolis, Brazil. The patients were interviewed on two distinct occasions. We collected demographic data, socioeconomic data, and data regarding smoking. Results: We interviewed 235 patients: 44 (18.7%) were smokers; 77 (32.8%) were former smokers; 114 (48.5%) were nonsmokers; and 109 (46.7%) were passive smokers. The mean age of the smokers was 45.7 ± 15.2 years, and 29 (65.9%) were male. Among the smokers, the median age at smoking initiation was 15 years; the mean smoking history was 32 ± 30.2 pack-years; 36 (81.9%) smoked up to 20 cigarettes/day; 20 (45.4%) had a high or very high degree of nicotine dependence; 32 (72.7%) had already tried to quit smoking; 39 (88.7%) would like to quit smoking; 32 (72.7%) would accept smoking cessation treatment; 13 (29.5%) smoked during hospitalization; and 13 (29.5%) suffered withdrawal syndrome. Regarding the motivation to quit smoking, the number of patients in the "preparation" and "action" stages of change increased from admission to discharge (from 31.8% to 54.8%). Conclusions: The prevalence of smoking in this study was similar to that reported in other studies conducted in Brazil. The results suggest that our sample was significant regarding the population of hospitalized smokers, who are motivated to quit smoking during hospitalization and require a systematized approach for doing so.


Keywords: Smoking/epidemiology; Hospitalization; Smoking cessation.


Translation and cultural adaptation of a specific instrument for measuring asthma control and asthma status: the Asthma Control and Communication Instrument

Tradução e adaptação cultural de um instrumento específico para medir o controle e estado da asma: Asthma Control and Communication Instrument

Michelle Gonçalves de Souza Tavares, Carolina Finardi Brümmer, Gabriela Valente Nicolau, José Tavares de Melo Jr, Nazaré Otilia Nazário, Leila John Marques Steidle, Cecília Maria Patino, Marcia Margaret Menezes Pizzichini, Emílio Pizzichini

J Bras Pneumol.2017;43(4):264-269

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Asthma Control and Communication Instrument (ACCI) to Portuguese and adapt it for use in Brazil. Methods: The ACCI was translated to Portuguese and adapted for use in Brazil in accordance with internationally accepted guidelines. The protocol included the following steps: permission and rights of use granted by the original author; translation of the ACCI from English to Portuguese; reconciliation; back-translation; review and harmonization of the back-translation; approval from the original author; review of the Portuguese version of the ACCI by an expert panel; cognitive debriefing (the clarity, understandability, and acceptability of the translated version being tested in a sample of the target population); and reconciliation and preparation of the final version. Results: During the cognitive debriefing process, 41 asthma patients meeting the inclusion criteria completed the ACCI and evaluated the clarity of the questions/statements. The clarity index for all ACCI items was > 0.9, meaning that all items were considered to be clear. Conclusions: The ACCI was successfully translated to Portuguese and culturally adapted for use in Brazil, the translated version maintaining the psychometric properties of the original version. The ACCI can be used in clinical practice because it is easy to understand and easily applied.


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.


Translation and cultural adaptation of the King's Brief Interstitial Lung Disease health status questionnaire for use in Brazil

Tradução e adaptação cultural do King's Brief Interstitial Lung Disease health status questionnaire

Karoline Silveira1,a, Leila John Marques Steidle2,b, Darlan Laurício Matte3,c, Pedro Heliodoro Tavares4,d, Mariangela Pimentel Pincelli2,e, Marcia Margaret Menezes Pizzichini2,f, Emilio Pizzichini2,5,6,g, Surinder Singh Birringer7,h, Michelle Gonçalves de Souza Tavares1,3,i

J Bras Pneumol.2019;45(5):e20180194-e20180194

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the King's Brief Interstitial Lung Disease (K-BILD) questionnaire to Portuguese and culturally adapt it for use in Brazil. The K-BILD quantifies the health status of patients with ILD. Methods: The process involved the following steps: authorization from the author of the original (English-language) questionnaire; translation of the questionnaire to Portuguese by three translators, working independently; merging of the translations by a committee of specialists; back-translation of the questionnaire to English; revision and readjustment of the back-translation by the committee of specialists; evaluation by the original author; revision of the back-translation; cognitive debriefing (verification of the clarity and acceptability of the Portuguese-language version in the target population-i.e., patients with ILD); and finalization of the Portuguese-language version. Results: In the cognitive debriefing step, 20 patients with ILD were interviewed. After the interviews, the clarity and acceptability index of each question was ≥ 0.8, which is considered acceptable. Conclusions: The Portuguese-language version of K-BILD appears to be easily administered to and understood by patients with ILD in Brazil. To our knowledge, this is the only instrument in Brazilian Portuguese that is designed to evaluate the impact that ILD has on the various aspects of the lives of those it affects.


Keywords: Lung diseases, interstitial; Pulmonary fibrosis; Surveys and questionnaires.




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