Brazilian Journal of Pulmonology

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


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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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Can the six-minute walk distance predict the occurrence of acute exacerbations of COPD in patients in Brazil?

A distância percorrida no teste de caminhada de seis minutos pode predizer a ocorrência de exacerbações agudas da DPOC em pacientes brasileiros?

Fernanda Kazmierski Morakami, Andrea Akemi Morita, Gianna Waldrich Bisca, Josiane Marques Felcar, Marcos Ribeiro, Karina Couto Furlanetto, Nidia Aparecida Hernandes, Fabio Pitta

J Bras Pneumol.2017;43(4):280-284

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Objective: To evaluate whether a six-minute walk distance (6MWD) of < 80% of the predicted value can predict the occurrence of acute exacerbations of COPD in patients in Brazil over a 2-year period. Methods: This was a retrospective cross-sectional study involving 50 COPD patients in Brazil. At enrollment, anthropometric data were collected and patients were assessed for pulmonary function (by spirometry) and functional exercise capacity (by the 6MWD). The patients were subsequently divided into two groups: 6MWD ≤ 80% of predicted and 6MWD > 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. Results: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). Conclusions: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted.


Keywords: Pulmonary disease, chronic obstructive; Risk groups; Exercise.


Ex vivo lung perfusion in Brazil

A experiência brasileira na perfusão pulmonar ex vivo

Luis Gustavo Abdalla1, Karina Andrighetti de Oliveira Braga1, Natalia Aparecida Nepomuceno1, Lucas Matos Fernandes1, Marcos Naoyuki Samano1, Paulo Manuel Pêgo-Fernandes1

J Bras Pneumol.2016;42(2):95-99

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Objective: To evaluate the use of ex vivo lung perfusion (EVLP) clinically to prepare donor lungs for transplantation. Methods: A prospective study involving EVLP for the reconditioning of extended-criteria donor lungs, the criteria for which include aspects such as a PaO2/FiO2 ratio < 300 mmHg. Between February of 2013 and February of 2014, the lungs of five donors were submitted to EVLP for up to 4 h each. During EVLP, respiratory mechanics were continuously evaluated. Once every hour during the procedure, samples of the perfusate were collected and the function of the lungs was evaluated. Results: The mean PaO2 of the recovered lungs was 262.9 ± 119.7 mmHg at baseline, compared with 357.0 ± 108.5 mmHg after 3 h of EVLP. The mean oxygenation capacity of the lungs improved slightly over the first 3 h of EVLP-246.1 ± 35.1, 257.9 ± 48.9, and 288.8 ± 120.5 mmHg after 1, 2, and 3 h, respectively-without significant differences among the time points (p = 0.508). The mean static compliance was 63.0 ± 18.7 mmHg, 75.6 ± 25.4 mmHg, and 70.4 ± 28.0 mmHg after 1, 2, and 3 h, respectively, with a significant improvement from hour 1 to hour 2 (p = 0.029) but not from hour 2 to hour 3 (p = 0.059). Pulmonary vascular resistance remained stable during EVLP, with no differences among time points (p = 0.284). Conclusions: Although the lungs evaluated remained under physiological conditions, the EVLP protocol did not effectively improve lung function, thus precluding transplantation.


Keywords: Lung transplantation; Organ preservation; Brain death; Donor selection.


A história da descoberta da circulação pulmonar

Rubens Bedrikow, Valdir Golin

J Bras Pneumol.2000;26(1):11-


The image of pulmonary hypertension

A imagem da hipertensão pulmonar

Anton Vonk Noordegraaf

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

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The influence of genetics on nicotine dependence and the role of pharmacogenetics in treating the smoking habit

A influência da genética na dependência tabágica e o papel da farmacogenética no tratamento do tabagismo

José Miguel Chatkin

J Bras Pneumol.2006;32(6):573-579

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Despite the considerable efforts made in the fight against smoking in the last decades, there are still substantial numbers of people who, in full knowledge of the health hazards, begin smoking or continue smoking. Recent studies have focused on the genetic bases of the nicotine addiction. Various genetic polymorphisms have been associated with smoking. However, environmental factors have also been shown to play a role. In this review, we present some of the principal data collected in genetic studies of smoking behavior. The results obtained through this line of research will eventually aid clinicians in individualizing the type, dosage and duration of treatment for patients with nicotine dependence in accordance with the genotype of each smoker, thereby maximizing the efficacy of the proposed treatment regimen.


Keywords: Smoking; Tobacco use cessation; Nicotine; Tobacco use disorder


Polymerase chain reaction used to detect Streptococcus pneumoniae resistance to penicillin

A reação em cadeia da polimerase na detecção da resistência à penicilina em Streptococcus pneumoniae

Eduardo Walker Zettler, Rosane M. Scheibe, Cícero A.G. Dias, Patricia Santafé, José da Silva Moreira, Diógenes S. Santos, Carlos Cezar Fritscher

J Bras Pneumol.2004;30(6):521-527

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Background: Streptococcus pneumoniae is the most common etiologic agent of community-acquired respiratory infections. In recent years, S. pneumoniae resistance to antimicrobial agents has increased. Minimum inhibitory concentration (MIC) is routinely used to determine resistance. Polymerase chain reaction (PCR) detects the genes responsible for Streptococcus pneumoniae resistance to penicillin within approximately 8 hours. Objective: To compare the PCR and MIC methods in determining Streptococcus pneumoniae resistance to penicillin. Method: A total of 153 Streptococcus pneumoniae samples, isolated from various anatomical sites, were evaluated in order to detect mutations in the genes encoding pbp1a, pbp2a and pbp2x, which are responsible for Streptococcus pneumoniae penicillin resistance. A correlation was found between mutations and penicillin MIP, as determined by the agar diffusion method. Results: Overal Streptococcus pneumoniae resistance to penicillin was 22.8% (16.3% intermediate resistance and 6.5% high resistance). In a statistically significant finding, we observed no mutations in the penicillin-sensitive samples and only one mutation, typically in the gene encoding pbp2x, among the samples with intermediate resistance, whereas mutations in all three genes studied were observed in the high-resistance samples. Conclusion: For determining Streptococcus pneumoniae resistance to penicillin, PCR is a rapid method of detection that could well be used in clinical practice.


Keywords: Streptococcus pneumoniae. Penicillin resistance. Polymerase chain reaction/methods.


Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

A tromboprofilaxia evita o tromboembolismo venoso após cirurgia ortopédica de grande porte?

Evrim Eylem Akpinar, Derya Hosgün, Burak Akan, Can Ates, Meral Gülhan

J Bras Pneumol.2013;39(3):280-286

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Objective: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. Methods: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. Results: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. Conclusions: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age).


Keywords: Orthopedics; Pulmonary embolism; Venous thrombosis.


A tuberculose e o casamento

Rubens Bedrikow

J Bras Pneumol.2002;28(3):173-174


Current approach to advanced non-small cell lung cancer: review

Abordagem atual no tratamento da neoplasia de pulmão não-pequenas células avançada: revisão

Mauro Zukin, Rogério Lilenbaum

J Bras Pneumol.1997;23(4):193-196

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Several advances have been made in the treatment of advanced non-small cell lung cancer in the last few years. Combined therapies using chemotherapy have improved survival of patients with locally advanced disease (stage III) when compared to either radiation or surgery. New chemotherapeutic agents, used alone or combined, have also made a strong impact with metastatic disease (stage IV). Ongoing randomized trials will certainly define new treatment standards and hopefully improve the outcome of patients with non-small cell lung cancer.


Keywords: Locally advanced. Non-small cell lung cancer.


Educational camp for children with asthma

Acampamento educacional para crianças asmáticas

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

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

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


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


Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study

Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias

Hugo Hyung Bok Yoo, Fabiana Guandalini Mendes, Christine Elisabete Rubio Alem, Alexandre Todorovic Fabro, José Eduardo Corrente, Thaís Thomaz Queluz

J Bras Pneumol.2004;30(5):426-432

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Background: Pulmonary thromboembolism (PTE) is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders. Objective: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these findings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. Method: The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. Results: The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE). Infections (p=0.0003) were associated with nonfatal PTE and trauma (p=0.007) with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001), infections (p<0.0001), diseases of the digestive system (p=0.0001), neoplasia (p=0.024) and trauma (p=0.005) were associated with unsuspected PTE. The most frequent PTE site of origin was the lower limbs (48.9%). Probable PTE sites of origin such as right-sided cardiac chambers (p=0.012) and pelvic veins (p=0.015) were associated with fatal PTE. Conclusion: A large number of cases do not have antemortem suspicion of PTE. Special attention should be paid to the possibility of PTE in patients with diseases of the circulatory system, infections, diseases of the digestive system, neoplasia, and trauma.


Keywords: Autopsy. Epidemiology. Pulmonary Thromboembolism.


Computed tomography findings of postoperative complications in lung transplantation

Achados tomográficos nas complicações pós-operatórias do transplante pulmonar

Bruno Hochhegger, Klaus Loureiro Irion, Edson Marchiori, Rodrigo Bello, José Moreira, José Jesus Camargo

J Bras Pneumol.2009;35(3):266-274

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Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post-transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.


Keywords: Tomography, X-ray computed; Lung transplantation; Postoperative complications.


Musculoskeletal involvement in sarcoidosis

Acometimento músculo-esquelético na sarcoidose

Akasbi Nessrine, Abourazzak Fatima Zahra, Harzy Taoufik

J Bras Pneumol.2014;40(2):-

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Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management.


Keywords: Sarcoidosis; Joints; Muscles; Bone and Bones.


Pulmonary involvement in Behcet's disease: a positive single-center experience with the use of immunosuppressive therapy

Acometimento pulmonar na doença de Behçet: uma boa experiência com o uso de imunossupressores

Alfredo Nicodemos Cruz Santana, Telma Antunes, Juliana Monteiro de Barros, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro de Carvalho, Carmen Silvia Valente Barbas

J Bras Pneumol.2008;34(6):362-366

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Objective: Behcet's syndrome, or Behcet's disease (BD), is a multisystem pathology, and survival is related to pulmonary involvement. However, it appears that different treatments correlate with different prognoses. The aim of this study was to evaluate clinical and tomographic evolution, as well as the survival, of patients with BD-related pulmonary involvement. Methods: A retrospective review of our experience with pulmonary manifestations in patients with BD treated at our institution between January 1, 1988 and April 30, 2006. The clinical, radiological, treatment and survival data were obtained from medical charts. Results: We identified 9 patients with BD-related pulmonary involvement. The mean age was 34 ± 11.5 years, and 7 of the patients were male. The radiological findings were as follows: pulmonary artery aneurysm (PAA) in 8 patients; pulmonary embolism in 3 (translating to an incidence of 5.11 cases/100 patient-years); alveolar hemorrhage in one; and pulmonary hypertension in one. The treatment consisted of immunosuppression with prednisone plus chlorambucil (or cyclophosphamide or mycophenolate mofetil) in all patients, with partial or complete resolution of the PAAs. One patient with a PAA and pulmonary hypertension also received sildenafil and warfarin, with good clinical and tomographic response (the first report in the English literature). In our sample, the mean duration of the follow-up period was 6.52 years. The three-year survival rate was 88.8%, as was the five-year survival rate. Conclusions: Patients with BD-related pulmonary involvement can present good survival with immunosuppressive therapy, and BD should be borne in mind as a possible cause of pulmonary hypertension and alveolar hemorrhage.


Keywords: Behcet Syndrome; Lung diseases, interstitial; Pulmonary circulation; Hypertension, pulmonary; Pulmonary embolism; Alveolar.


Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients

Acurácia diagnóstica do protocolo de ultrassom pulmonar à beira do leito em situações de emergência para diagnóstico de insuficiência respiratória aguda em pacientes com ventilação espontânea

Felippe Leopoldo Dexheimer Neto, Juliana Mara Stormovski de Andrade, Ana Carolina Tabajara Raupp, Raquel da Silva Townsend, Fabiana Gabe Beltrami, Hélène Brisson, Qin Lu, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2015;41(1):58-64

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Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2  14.7 years; APACHE II, 19.2  7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.


Keywords: Ultrasonography, interventional; Respiratory insufficiency; Intensive care units.


Accuracy of clinical examination findings in the diagnosis of COPD

Acurácia do exame clínico no diagnóstico da DPOC

Waldo Luís Leite Dias de Mattos, Leonardo Gilberto Haas Signori, Fernando Kessler Borges, Jorge Augusto Bergamin, Vivian Machado

J Bras Pneumol.2009;35(5):404-408

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Objective: Simple diagnostic methods can facilitate the diagnosis of COPD, which is a major public health problem. The objective of this study was to investigate the accuracy of clinical variables in the diagnosis of COPD. Methods: Patients with COPD and control subjects were prospectively evaluated by two investigators regarding nine clinical variables. The likelihood ratio for the diagnosis of COPD was determined using a logistic regression model. Results: The study comprised 98 patients with COPD (mean age, 62.3 ± 12.3 years; mean FEV1, 48.3 ± 21.6%) and 102 controls. The likelihood ratios (95% CIs) for the diagnosis of COPD were as follows: 4.75 (2.29-9.82; p < 0.0001) for accessory muscle recruitment; 5.05 (2.72-9.39; p < 0.0001) for pursed-lip breathing; 2.58 (1.45‑4.57; p < 0.001) for barrel chest; 3.65 (2.01-6.62; p < 0.0001) for decreased chest expansion; 7.17 (3.75-13.73; p < 0.0001) for reduced breath sounds; 2.17 (1.01-4.67; p < 0.05) for a thoracic index ≥ 0.9; 2.36 (1.22-4.58; p < 0.05) for laryngeal height ≤ 5.5 cm; 3.44 (1.92-6.16; p < 0.0001) for forced expiratory time ≥ 4 s; and 4.78 (2.13-10.70; p < 0.0001) for lower liver edge ≥ 4 cm from lower costal edge. Inter-rater reliability for those same variables was, respectively, 0.57, 0.45, 0.62, 0.32, 0.53, 0.32, 0.59, 0.52 and 0.44 (p < 0.0001 for all). Conclusions: Various clinical examination findings could be used as diagnostic tests for COPD.


Keywords: Physical examination; Diagnosis; Pulmonary disease, chronic obstructive.


Adaptation to different noninvasive ventilation masks in critically ill patients

Adaptação a diferentes interfaces de ventilação mecânica não invasiva em pacientes críticos

Renata Matos da Silva, Karina Tavares Timenetski, Renata Cristina Miranda Neves, Liane Hirano Shigemichi, Sandra Sayuri Kanda, Carla Maekawa, Eliezer Silva, Raquel Afonso Caserta Eid

J Bras Pneumol.2013;39(4):-

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Objective: To identify which noninvasive ventilation (NIV) masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. Methods: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. Results: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%). Total face masks were the most commonly used (in 74.7%), followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively). Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. Conclusions: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.


Keywords: Intermittent positive-pressure ventilation; Masks; Respiratory insufficiency.


Cross-cultural adaptation and assessment of reproducibility of the Duke Activity Status Index for COPD patients in Brazil

Adaptação cultural e avaliação da reprodutibilidade do Duke Activity Status Index para pacientes com DPOC no Brasil

Livia dos Anjos Tavares, José Barreto Neto, José Roberto Jardim, George Márcio da Costa e Souza, Mark A. Hlatky, Oliver Augusto Nascimento

J Bras Pneumol.2012;38(6):684-691

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Objective: To cross-culturally adapt the Duke Activity Status Index (DASI) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. Methods: We selected stable patients with clinical and spirometric diagnosis of COPD. Initially, the DASI was translated into Brazilian Portuguese, and the cross-cultural adaptation was performed by an expert committee. Subsequently, 12 patients completed the questionnaire, so that their questions and difficulties could be identified and adjustments could be made. An independent translator back-translated the final version into English, which was then submitted to and approved by the original author. The final Brazilian Portuguese-language version of the DASI was applied to 50 patients at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. Results: The mean age of the patients was 62.3 ± 10.0 years, the mean FEV1 was 45.2 ± 14.7% of the predicted value, and the mean body mass index was 26.8 ± 5.8 kg/m2. The intraclass correlation coefficients for intraobserver and interobserver reproducibility were 0.95 and 0.90, respectively. The correlations between the DASI and the Saint George's Respiratory Questionnaire (SGRQ) domains were all negative and statistically significant. The DASI correlated best with the SGRQ activity domain (r = −0.70), the total SGRQ score (r = −0.66), and the six-minute walk distance (r = 0.55). Conclusions: The Brazilian Portuguese-language version of the DASI is reproducible, fast, and simple, correlating well with the SGRQ.


Keywords: Activities of daily living; Pulmonary disease, chronic obstructive; Reproducibility of results.


Adapting the Bird Mark 7 to deliver noninvasive continuous positive airway pressure: a bench study

Adaptação do Bird Mark 7 para oferta de pressão positiva contínua nas vias aéreas em ventilação não-invasiva: estudo em modelo mecânico

Beatriz Mayumi Kikuti, Karen Utsunomia, Renata Potonyacz Colaneri, Carlos Roberto Ribeiro de Carvalho, Pedro Caruso

J Bras Pneumol.2008;34(3):167-172

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Objective: To test the efficiency of the Bird Mark 7 ventilator adapted to deliver continuous positive airway pressure (CPAP) in noninvasive positive pressure ventilation. Methods: This was an experimental study using a mechanical model of the respiratory system. A Bird Mark 7 ventilator was supplied with 400 and 500 kPa and tested at CPAP of 5, 10 and 15 cmH2O. The following variables were analyzed: difference between the preset CPAP and the CPAP actually attained CPAP (trueCPAP); area of airway pressure at the CPAP level employed (AREACPAP); and tidal volume generated. Results: Adapting the Bird Mark 7 to offer CPAP achieved the expected tidal volume in all situations of inspiratory effort (normal or high), ventilator pressure supply (400 or 500 kPa) and CPAP value (5, 10 or 15 cmH2O). At a CPAP of 5 or 10 cmH2O, the trueCPAP was near the preset level, and the AREACPAP was near zero. However, at a CPAP of 15 cmH2O, the value remained below the preset, and the AREACPAP was high. Conclusion: The efficiency of Bird Mark 7 adaptation in offering CPAP was satisfactory at 5 and 10 cmH2O but insufficient at 15 cmH2O. If adapted as described in our study, the Bird Mark 7 might be an option for offering CPAP up to 10 cmH2O in areas where little or no equipment is available.


Keywords: Ventilators, mechanical; Positive-pressure respiration; Continuous positive airway pressure.


Compliance with maintenance treatment of asthma (ADERE study)

Adesão ao tratamento de manutenção em asma (estudo ADERE)

José Miguel Chatkin, Daniela Cavalet-Blanco, Nóris Coimbra Scaglia, Roberto Guidotti Tonietto, Mário B. Wagner, Carlos Cezar Fritscher

J Bras Pneumol.2006;32(4):277-283

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Objective: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. Methods: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85% of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. Results: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9%. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. Conclusion: The overall rate of compliance with maintenance treatment of asthma was low.


Keywords: Asthma/drug therapy; Asthma/prevention & control; Patient compliance; Patient education; Physician-patient relations


Ethyl 2-cyanoacrylate tissue adhesive in partial lobectomy in rats

Adesivo cirúrgico de etil-2-cianoacrilato em lobectomia parcial em ratos

Ariani Cavazzani Szkudlarek, Paula Sincero, Renato Silva de Sousa, Rosalvo Tadeu Hochmuller Fogaça

J Bras Pneumol.2011;37(6):729-734

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the efficacy of ethyl 2-cyanoacrylate adhesive in repairing the lung parenchyma after partial lobectomy in rats, in terms of hemostasis/aerostasis, scarring, and surgical time. Methods: The study involved 30 Wistar rats, randomly divided into five groups (one control group and four study groups). In the study groups, the lung parenchyma was repaired with either cyanoacrylate adhesive or surgical suture following resection of a small or large fragment (25% or 50%, respectively) of the left caudal lung lobe. Results: Surgical time and hemostasis time were shorter in the two groups treated with the adhesive than in the two submitted to suture. There were no significant differences among the groups regarding specific lung compliance. Adherences and inflammatory reactions were more severe in the groups submitted to suture. Conclusions: In this study, the use of cyanoacrylate adhesive helped reduce the surgical time and the intensity of inflammatory reactions, as well as preserving lung compliance. Cyanoacrylate adhesives should be considered an option for lung parenchyma repair, decreasing the risk of complications after partial lobectomy in humans.


Keywords: Lung; Pneumonectomy; Cyanoacrylates.


Diffuse abnormalities of the trachea: computed tomography findings

Alterações difusas da traquéia: aspectos na tomografia computadorizada

Edson Marchiori, Aline Serfaty Pozes, Arthur Soares Souza Junior, Dante Luiz Escuissato, Klaus Loureiro Irion, César de Araujo Neto, Jorge Luiz Barillo, Carolina Althoff Souza, Gláucia Zanetti

J Bras Pneumol.2008;34(1):47-54

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The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.


Keywords: Thoracic diseases; Tracheal diseases; Tomography, X-ray computed; Trachea.


Morphological lesions induced by oleic acid in lungs of rats

Alterações morfológicas induzidas pelo ácido oléico em pulmões de ratos

Thais Helena A.T. Queluz, Júlio Defaveri, Silene El-Fakhouri

J Bras Pneumol.1997;23(5):245-251

Abstract PDF PT

Because it has direct and indirect action on lung tissue, oleic acid (OA) has been used experimentally as a model of fat embolism and acute respiratory distress syndrome (ARDS). The aim of this study was to describe acute and chronic pulmonary lesions induced in rats by intravenous injection of OA. Male Wistar rats were injected a 0.05 ml dose of OA. Groups of 5 animals were sacrificed 2, 24, 48 hours, and 5, 10, 30, and 90 days after injection. Diffuse alveolar edema, foci of intra-alveolar hemorrhage, and foci of ischemic necrosis were observed by light microscopic from 2 to 48 hours. At this period of time, severe endothelial injuries and type II alveolar cell lesions were observed on electron microscopy. After the fifth day, no injury was observed and discrete morphological sequelae were found. The lungs of the animals sacrificed at the thirtieth and ninetieth days were identical to those of the control groups. The present model allows animal to survive, being suitable for studies on fat embolism and on ARDS.


Keywords: Oleic acid. Fat embolism. Acute respiratory distress syndrome, ARDS. Experimental model.


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

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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.


Cocaine-induced pulmonary changes: HRCT findings

Alterações pulmonares induzidas pelo uso de cocaína: avaliação por TCAR de tórax

Renata Rocha de Almeida1, Gláucia Zanetti1,2, Arthur Soares Souza Jr.3, Luciana Soares de Souza4, Jorge Luiz Pereira e Silva5, Dante Luiz Escuissato6, Klaus Loureiro Irion7, Alexandre Dias Mançano8, Luiz Felipe Nobre9, Bruno Hochhegger10, Edson Marchiori1,11

J Bras Pneumol.2015;41(4):323-330

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Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.


Keywords: Cocaine, Cocaine-related disorders; Tomography, X-ray computed; Lung diseases.


Alterações pulmonares na macroglobulinemia de Waldenström

Renato de Albuquerque Medeiros, Jucineide Araújo, José Kerbauy, Miguel Bogossian

J Bras Pneumol.1997;23(2):110-112


Pulmonary changes on HRCT scans in nonsmoking females with COPD due to wood smokeexposure

Alterações tomográficas pulmonares em mulheres não fumantes com DPOC porexposição à fumaça da combustão de lenha

Maria Auxiliadora Carmo Moreira, Maria Alves Barbosa, Maria Conceição de Castro AntonelliMonteiro de Queiroz, Kim Ir Sen Santos Teixeira, Pedro Paulo Teixeira e Silva Torres,Pedro José de Santana Júnior, Marcelo Eustáquio Montadon Júnior, José Roberto Jardim

J Bras Pneumol.2013;39(2):155-163

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Objective: To identify and characterize alterations seen on HRCT scans in nonsmoking females with COPD due to wood smoke exposure. Methods: We evaluated 42 nonsmoking females diagnosed with wood smoke-related COPD and 31 nonsmoking controls with no history of wood smoke exposure or pulmonary disease. The participants completed a questionnaire regarding demographic data, symptoms, and environmental exposure. All of the participants underwent spirometry and HRCT of the chest. The COPD and control groups were adjusted for age (23 patients each). Results: Most of the patients in the study group were diagnosed with mild to moderate COPD (83.3%). The most common findings on HRCT scans in the COPD group were bronchial wall thickening, bronchiectasis, mosaic perfusion pattern, parenchymal bands, tree-in-bud pattern, and laminar atelectasis (p < 0.001 vs. the control group for all). The alterations were generally mild and not extensive. There was a positive association between bronchial wall thickening and hour-years of wood smoke exposure. Centrilobular emphysema was uncommon, and its occurrence did not differ between the groups (p = 0.232). Conclusions: Wood smoke exposure causes predominantly bronchial changes, which can be detected by HRCT, even in patients with mild COPD.


Palavras-chave: Biomassa; Fumaça; Tomografia computadorizada por raios X; Doença pulmonar obstrutiva crônica.


Indoor air quality, Act 3,523 of the Ministry of Health and Brazilian standards for biological indoor air contaminants

Ambientes climatizados, portaria 3.523 de 28/8/98 do Ministério da Saúde e padrões de qualidade do ar de interiores do Brasil

Paulo Pinto Gontijo Filho, Carlos Roberto Menezes Silva, Afrânio Lineu Kritski

J Bras Pneumol.2000;26(5):254-258

Abstract PDF PT

This article reviews Act 3,523 of the Brazilian Ministry of Health which regulates the indoor air quality of air-conditioned environments, focusing mainly on biological standards for contaminant particles. Additionally, a concise analysis on nosocomial air-borne infections is performed, as well as on nosocomial units where air-borne infectious diseases may be important and a special ventilation system is required. Detailed analysis of the most common biological contaminant particles, differences between countries of both Northern and Southern hemispheres, and the aspects of the methodology used to perform their analysis are considered. The authors conclude that there are no established standards for safe levels of air-borne organisms, and that there is no available data in Brazil to set up standards for biological contaminant particles


Keywords: Air pollutants. Air conditioning. Air quality standards. Indoor air pollution. Brazil.


Primary tracheobronchial amyloidosis

Amiloidose traqueobrônquica primária

José Wellington Alves dos Santos, Ayrton Schneider Filho, Alessandra Bertolazzi, Gustavo Trindade Michel, Lauro Vinícius Schvarcz da Silva, Carlos Renato Melo, Vinícius Dallagasperina Pedro, Daniel Spilmann, Juliana Kaczmareck Figaro

J Bras Pneumol.2008;34(10):881-884

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Tracheobronchial amyloidosis is an uncommon localized form of amyloidosis, characterized by amyloid deposits restricted to the trachea, main bronchi and segmental bronchi. We present the case of a retired 67-year-old man with long-term progressive dyspnea, wheezing and chest pain. A diagnosis of tracheobronchial amyloidosis was made after the third fiberoptic bronchoscopy and histological confirmation through Congo red staining of tissue samples.


Keywords: Amiloidose/traquéia; Broncoscopia; Doenças da traquéia/diagnóstico.


Primary tracheobronchial amyloidosis

Amiloidose traqueobrônquica primária

Gustavo Chatkin, Mauríco Pipkin, José Antonio Figueiredo Pinto, Vinicius Duval da Silva, José Miguel Chatkin

J Bras Pneumol.2008;34(7):528-531

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Amyloidosis is a disease characterized by extracellular deposition of fibrillar protein in organs and tissues. Primary tracheal amyloidosis is rare. We report here a case of a 55-year-old man with tracheal amyloidosis hospitalized for acute respiratory insufficiency and with a history of recent episodes of pneumonia. Chest X-ray and chest computed tomography showed tracheal obstruction due to a tumor. A passage was created in order to relieve the symptoms. Histological examination (Congo red staining) revealed amyloid deposits but no evidence of neoplasia. Although this is a rare clinical condition, its importance is discussed regarding the differential diagnosis of tracheal tumors and the repercussions for therapeutic decision-making.


Keywords: Amyloidosis; Respiratory insufficiency; Congo red; Airway obstruction.


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):-

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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.


Analysis of the stability of housekeeping gene expression in the left cardiac ventricle of rats submitted to chronic intermittent hypoxia

Análise da estabilidade da expressão de genes de referência no ventrículo cardíaco esquerdo de ratos submetidos à hipóxia intermitente crônica

Guilherme Silva Julian1, Renato Watanabe de Oliveira1, Sergio Tufik1, Jair Ribeiro Chagas1,2

J Bras Pneumol.2016;42(3):211-214

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Obstructive sleep apnea (OSA) has been associated with oxidative stress and various cardiovascular consequences, such as increased cardiovascular disease risk. Quantitative real-time PCR is frequently employed to assess changes in gene expression in experimental models. In this study, we analyzed the effects of chronic intermittent hypoxia (an experimental model of OSA) on housekeeping gene expression in the left cardiac ventricle of rats. Analyses via four different approaches-use of the geNorm, BestKeeper, and NormFinder algorithms; and 2−ΔCt (threshold cycle) data analysis-produced similar results: all genes were found to be suitable for use, glyceraldehyde-3-phosphate dehydrogenase and 18S being classified as the most and the least stable, respectively. The use of more than one housekeeping gene is strongly advised.


Keywords: Cell hypoxia; Reference standards; Sleep apnea, obstructive; Cardiovascular diseases; Models, animal; Polymerase chain reaction.


Analysis of pulmonary mechanics in an experimental model of sepsis

Análise da mecânica pulmonar em modelo experimental de sepse

Rodrigo Storck Carvalho, André Gustavo Magalhãer de Pinho, Ana Paula Alves de Andrade, César Augusto Melo e Silva, Carlos Eduardo Gaio, Paulo Tavares

J Bras Pneumol.2006;32(4):316-321

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Objective: To determine whether pulmonary mechanics are altered in mice with sepsis. Methods: A total of 40 Balb/c mice were divided into two groups: survival (n = 21) and pulmonary mechanics (n = 19). The survival group was divided into three subgroups: control (n = 7), sublethal (n = 7) and lethal (n = 7). The pulmonary mechanics group was also divided into three subgroups: control (n = 5), sublethal (n = 7) and lethal (n = 7). Sepsis was induced through cecal ligation and puncture, the latter varying in degree (sublethal or lethal). At eight hours after the intervention, pulmonary mechanics were measured through end-inflation occlusion. In the pulmonary mechanics group, the following variables were studied: total pressure, resistance, viscoelasticity, dynamic compliance and static compliance. The data obtained were analyzed using one-way ANOVA. Results: The data for the survival group indicate the efficacy of the model employed. There were no statistically significant differences among the pulmonary mechanics subgroups in terms of dynamic compliance, static compliance, total pressure, resistance or viscoelasticity. Conclusion: At eight hours after cecal ligation and puncture, there were no changes in the lung parenchyma, nor were any alterations observed in the viscous and viscoelastic components of the lung.


Keywords: Sepsis; Respiratory mechanics; Lung/injuries; Punctures/instrumentation; Respiratory distress syndrome, adult; Mice


Analysis of 39 cases of idiopathic chronic interstitial pneumonia

Análise de 39 casos de pneumonia intersticial crônica idiopática

Rogério Rufino, Leonardo Rizzo, Cláudia Henrique da Costa, Roberto José de Lima, Kalil Madi

J Bras Pneumol.2006;32(6):505-509

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Objective: To make a retrospective analysis of lung biopsy samples obtained from patients diagnosed with chronic idiopathic interstitial pneumonia, as defined in the American Thoracic Society/European Respiratory Society classification system made public in 2000. Methods: Samples from 252 open-lung biopsies of patients with interstitial lung disease, all performed between 1977 and 1999, were reviewed, and 39 cases of idiopathic interstitial lung disease were selected and re-evaluated by two pathologists in accordance with the American Thoracic Society/European Respiratory Society classification system. Results: Among those 39 cases, the diagnoses were maintained in 28 (71.8%). A new pathologic entity, nonspecific interstitial pneumonia, was included in the reclassification, and overlapping patterns were observed in 6 cases. Of the 28 cases in which the diagnosis of chronic idiopathic interstitial pneumonia remained unchanged, idiopathic pulmonary fibrosis was accompanied by cryptogenic organizing pneumonia in 4, cryptogenic organizing pneumonia was accompanied by nonspecific interstitial pneumonia in 1, and desquamative interstitial pneumonia was accompanied by nonspecific interstitial pneumonia in 1. All cases of idiopathic pulmonary fibrosis were confirmed, although 3 of those were found to be accompanied by cryptogenic organizing pneumonia. Virtually all prior diagnoses were maintained in the review of the biopsy samples (p > 0,05). Conclusion: The American Thoracic Society/European Respiratory Society system of classifying interstitial lung disease is a useful tool for pathologists who deal with lung biopsies.


Keywords: Pulmonary fibrosis; Lung diseases, interstitial


Analysis of different primers used in the PCR method: diagnosis of tuberculosis in the state of Amazonas, Brazil

Análise de diferentes primers utilizados na PCR visando ao diagnóstico da tuberculose no Estado do Amazonas

Mauricio Morishi Ogusku; Julia Ignez Salem

J Bras Pneumol.2004;30(4):433-439

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Background: Various primers are being tested for the detection of Mycobacterium tuberculosis DNA. The accuracy of the polymerase chain reaction (PCR) depends on the target sequence used and whether the test will be performed in culture or in clinical specimens. Objectives: To identify DNA sequences, specifically those commonly reported as targets for diagnosis of tuberculosis (TB), in clinical samples of M. tuberculosis strains. Method: Eighty-one clinical samples from suspected TB patients were initially processed and submitted to bacilloscopy (smear) and culture, and PCR was performed with specific primers for the following targets: IS 6110, 65 kDa, 38 kDa and MPB64. Results: Smear and culture results were negative in 24 samples, as was the PCR. The 19 samples testing smear positive, as well as the isolated strains, were 100% positive on PCR, with the exception of the 89.4% result from PCR with MPB64 primers. In the 38 smear negative and culture positive samples, PCR results were inconsistent. The primers specific for amplifying the 123 bp IS 6110 fragment gave the highest positivity (92.1%), diagnostic agreement (0.9143), co-positivity (94.7%) and co-negativity (100%). Conclusion: The IS 6110, 38 kDa, MPB64 and 65 kDa sequences were found in the genome of all M. tuberculosis strains isolated in patients from the state of Amazonas. The protocol for processing the clinical samples prior to PCR analysis and the specific primers used to amplify the 123bp IS 6110 fragment showed a greater efficiency in diagnosing pulmonary (paucibacillary) tuberculosis in comparison to published data.


Keywords: Primers/PCR. Diagnosis/Tuberculosis. Mycobacterium tuberculosis.


Descriptive analysis of and overall survival after surgical treatment of lung metastases

Análise descritiva e sobrevida global do tratamento cirúrgico das metástases pulmonares

Giana Balestro Poletti, Ivan Felizardo Contrera Toro, Thais Ferreira Alves, Eliana Cristina Martins Miranda, José Cláudio Teixeira Seabra, Ricardo Kalaf Mussi

J Bras Pneumol.2013;39(6):650-658

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Objective: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.


Keywords: Neoplasm metastasis; Survival analysis; Thoracic surgery; Metastasectomy.


Analysis and validation of probabilistic models for predicting malignancy in solitary pulmonary nodules in a population in Brazil

Análise e validação de modelos probabilísticos de malignidade de nódulo pulmonar solitário em uma população no Brasil

Cromwell Barbosa de Carvalho Melo, João Aléssio Juliano Perfeito, Danilo Félix Daud, Altair da Silva Costa Júnior, Ilka Lopes Santoro, Luiz Eduardo Villaça Leão

J Bras Pneumol.2012;38(5):559-565

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Objective: To analyze clinical and radiological findings that influence the pathological diagnosis of solitary pulmonary nodule (SPN) and to compare/validate two probabilistic models for predicting SPN malignancy in patients with SPN in Brazil. Methods: This was a retrospective study involving 110 patients diagnosed with SPN and submitted to resection of SPN at a tertiary hospital between 2000 and 2009. The clinical characteristics studied were gender, age, presence of systemic comorbidities, history of malignancy prior to the diagnosis of SPN, histopathological diagnosis of SPN, smoking status, smoking history, and time since smoking cessation. The radiological characteristics studied, in relation to the SPN, were presence of spiculated margins, maximum transverse diameter, and anatomical location. Two mathematical models, created in 1997 and 2007, respectively, were used in order to determine the probability of SPN malignancy. Results: We found that SPN malignancy was significantly associated with age (p = 0.006; OR = 5.70 for age > 70 years), spiculated margins (p = 0.001), and maximum diameter of SPN (p = 0.001; OR = 2.62 for diameters > 20 mm). The probabilistic model created in 1997 proved to be superior to that created in 2007-area under the ROC curve, 0.79 ± 0.44 (95% CI: 0.70 0.88) vs. 0.69 ± 0.50 (95% CI: 0.59-0.79). Conclusions: Advanced age, greater maximum SPN diameter, and spiculated margins were significantly associated with the diagnosis of SPN malignancy. Our analysis shows that, although both mathematical models were effective in determining SPN malignancy in our population, the 1997 model was superior.


Keywords: Solitary Pulmonary Nodule; Risk Factors; Carcinoma, Non-Small-Cell Lung.


Spatial analysis of hospitalizations for pneumonia in the Vale do Paraíba region of Brazil

Análise espacial das internações por pneumonia na região do Vale do Paraíba (SP)

Adriana de Oliveira Mukai, Kátia de Souza Costa Alves, Luiz Fernando Costa Nascimento

J Bras Pneumol.2009;35(8):753-758

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Objective: To identify spatial patterns in hospitalizations for pneumonia in infants under one year of age in the Vale do Paraíba region of Brazil. Methods: This was an ecological exploratory study using a georeferencing technique based on data from the Information Technology Department of the Brazilian Unified Health Care System on the number of hospitalizations for pneumonia among infants under one year of age in the Vale do Paraíba region between 2004 and 2005. Based on the distribution of the rates of hospitalizations for pneumonia per 1,000 live births, thematic maps were created. Moran's spatial autocorrelation coefficient was estimated, and the cities with the highest rates were identified using box maps. Results: During the study period, 2,227 infants under one year of age were hospitalized for pneumonia. Moran's coefficient was 0.37 (p = 0.02), demonstrating a spatial autocorrelation for these hospitalizations. Eight cities deserving special attention for future interventions were identified. Conclusions: The spatial analysis was successful in determining the spatial autocorrelation, as well as in identifying the cities in which an intervention is necessary regarding the number of hospitalizations for pneumonia in infants under one year of age.


Keywords: Pneumonia; Geographic information systems; Child health (Public health); Infant.


Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo

Análise exploratória de solicitações de autorização para dispensação de medicação de alto custo para portadores de DPOC:

Regina Maria Carvalho-Pinto11,a, Ingredy Tavares da Silva1,2,b, Lucas Yoshio Kido Navacchia1,c, Flavia Munhos Granja1,2,d, Gustavo Garcia Marques1,2,e, Telma de Cassia dos Santos Nery1,f, Frederico Leon Arrabal Fernandes1,g, Alberto Cukier1,h, Rafael Stelmach1,i

J Bras Pneumol.2019;45(6):e20180355-e20180355

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Objective: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting β2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.


Keywords: Pulmonary disease, chronic obstructive; Clinical protocols; Drug costs; Tiotropium bromide.


Sequential analysis as a tool for detection of amikacin ototoxicity in the treatment of multidrug-resistant tuberculosis

Análise sequencial como ferramenta na detecção da ototoxicidade da amicacina no tratamento da tuberculose multirresistente

Karla Anacleto de Vasconcelos1, Silvana Maria Monte Coelho Frota2, Antonio Ruffino-Netto3, Afrânio Lineu Kritski4

J Bras Pneumol.2018;44(2):85-92

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Objetivo: Verificar a detecção precoce de ototoxicidade causada pelo uso de amicacina numa população tratada para tuberculose multirresistente (TBMR) por meio da realização de três testes distintos: audiometria tonal liminar (ATL), audiometria de altas frequências (AAF) e pesquisa de emissões otoacústicas por produto de distorção (EOAPD). Métodos: Estudo longitudinal de coorte prospectiva incluindo pacientes de ambos os sexos, com idade entre 18 e 69 anos, com diagnóstico de TBMR pulmonar e que necessitaram utilizar amicacina por seis meses em seu esquema medicamentoso antituberculose pela primeira vez. A avaliação auditiva foi realizada antes do início do tratamento e depois de dois e seis meses do início do tratamento. A análise dos resultados foi realizada por meio de análise estatística sequencial. Resultados: Foram incluídos 61 pacientes, mas a população final foi constituída de 10 pacientes (7 homens e 3 mulheres), em razão da análise sequencial. Ao se comparar os valores das respostas dos testes com aqueles encontrados na avaliação basal, foram verificadas mudanças nos limiares auditivos compatíveis com ototoxicidade após dois meses de tratamento através da AAF e após seis meses de tratamento através da ATL. Entretanto, essas mudanças não foram verificadas através da pesquisa de EOAPD. Conclusões: Ao se considerar o método estatístico utilizado nessa população, é possível concluir que mudanças nos limiares auditivos foram associadas ao uso da amicacina no período de seis meses por meio de AAF e ATL e que a pesquisa de EOAPD não se mostrou eficiente na identificação dessas mudanças.


Keywords: Tuberculosis; Hearing loss; Aminoglycosides/toxicity.


Anemia in hospitalized patients with pulmonary tuberculosis

Anemia em pacientes internados com tuberculose pulmonar

Marina Gribel Oliveira, Karina Neves Delogo, Hedi Marinho de Melo Gomes de Oliveira, Antonio Ruffino-Netto, Afranio Lineu Kritski, Martha Maria Oliveira

J Bras Pneumol.2014;40(4):403-410

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the prevalence of anemia and of its types in hospitalized patients with pulmonary tuberculosis. Methods: This was a descriptive, longitudinal study involving pulmonary tuberculosis inpatients at one of two tuberculosis referral hospitals in the city of Rio de Janeiro, Brazil. We evaluated body mass index (BMI), triceps skinfold thickness (TST), arm muscle area (AMA), ESR, mean corpuscular volume, and red blood cell distribution width (RDW), as well as the levels of C-reactive protein, hemoglobin, transferrin, and ferritin. Results: We included 166 patients, 126 (75.9%) of whom were male. The mean age was 39.0  10.7 years. Not all data were available for all patients: 18.7% were HIV positive; 64.7% were alcoholic; the prevalences of anemia of chronic disease and iron deficiency anemia were, respectively, 75.9% and 2.4%; and 68.7% had low body weight (mean BMI = 18.21 kg/m2). On the basis of TST and AMA, 126 (78.7%) of 160 patients and 138 (87.9%) of 157 patients, respectively, were considered malnourished. Anemia was found to be associated with the following: male gender (p = 0.03); low weight (p = 0.0004); low mean corpuscular volume (p = 0.03);high RDW (p = 0; 0003); high ferritin (p = 0.0005); and high ESR (p = 0.004). We also found significant differences between anemic and non-anemic patients in terms of BMI (p = 0.04), DCT (p = 0.003), and ESR (p < 0.001). Conclusions: In this sample, high proportions of pulmonary tuberculosis patients were classified as underweight and malnourished, and there was a high prevalence of anemia of chronic disease. In addition, anemia was associated with high ESR and malnutrition.


Keywords: Tuberculosis, pulmonary; Anemia; Malnutrition; Iron.


Pulmonary artery aneurysm as a manifestation of Behçet disease: case report and review

Aneurisma de artéria pulmonar como manifestação da doença de Behçet

Marcos Naoyuki Samano, Renata Teixeira Ladeira, Luiz Pedro Meirelles, Paulo Manuel Pêgo-Fernandes

J Bras Pneumol.2002;28(3):150-154

Abstract PDF PT

Behçet disease has been associated to pulmonary manifestations and may be lethal if not treated correctly. The authors describe a case of a 53 year-old male with aneurysmatic pulmonary artery dilatation, pulmonary hypertension, and hemoptysis. A review is presented about the diagnosis and the medical and surgical treatment of this disease.


Keywords: Behcet's syndrome. Pulmonary artery. Pulmonary hypertension. Aneurysm. Hemoptysis.


Pulmonary artery aneurysms in Behçet's disease: regression after immunosuppressive treatment

Aneurismas das artérias pulmonares na doença de Behçet: regressão após tratamento imunossupressor

Isabela Fernandes de Magalhães, Iugiro R. Kuroki, Agnaldo José Lopes, Elisa M.N. Albuquerque, Evandro Mendes Klumb, Aline Elisa Goulart

J Bras Pneumol.1999;25(3):176-180

Abstract PDF PT

Behçet's disease is a systemic disease with clinical manifestations, whose underlying histopathologic lesion is a non-specific vasculitis. Pulmonary artery aneurysms and, more rarely, pleuropulmonary manifestations may be found. Some reports are available in the literature about the use of immunosuppressive agents in these conditions. The authors describe a case in whom clinical remission and radiologic resolution were observed after corticosteroid and cyclophophamide therapy.


Keywords: Behçet's disease. Pulmonary artery aneurysms.


Anxiety and depression in asthma patients: impact on asthma control

Ansiedade e depressão em pacientes com asma: impacto no controle da asma

Aline Arlindo Vieira, Ilka Lopes Santoro, Samir Dracoulakis, Lilian Ballini Caetano, Ana Luisa Godoy Fernandes

J Bras Pneumol.2011;37(1):13-18

Abstract PDF PT PDF EN Portuguese Text

Objective: There is evidence that asthma is associated with an increase in psychiatric symptoms and mental disorders. This association can make it difficult to achieve asthma control. The purpose of this study was to determine whether the level of asthma control is associated with anxiety and depression. Methods: A cross-sectional study involving 78 patients with confirmed moderate or severe asthma and under regular treatment at the Asthma Outpatient Clinic of the Federal University of São Paulo Hospital São Paulo, in the city of São Paulo, Brazil. The patients were divided into two groups by asthma control status, as assessed by the asthma control test, and were subsequently compared in terms of demographic, clinical, and spirometric data, as well as scores for asthma quality of life and hospital anxiety/depression. Results: The sample was predominantly female. Of the 78 patients, 49 (63%) were classified as having uncontrolled asthma. The prevalence of anxiety and of anxiety+depression was significantly higher among patients with uncontrolled asthma than among those with controlled asthma (78% and 100%; p = 0.04 and p = 0.02, respectively), whereas there were no differences between the two groups in terms of the prevalence of depression, spirometry results, or quality of life score. Conclusions: In this sample, the prevalence of anxiety symptoms was higher in the patients with uncontrolled asthma than in those with controlled asthma.In the evaluation of asthma patients, the negative impact of mood states ought to be taken into consideration when asthma control strategies are being outlined.


Keywords: Asthma; Anxiety; Depression; Cross-sectional studies.


Applicability of the 12-Item Short-Form Health Survey in patients with progressive systemic sclerosis

Aplicabilidade do questionário de qualidade de vida relacionada à saúde - the 12-Item Short-Form Health Survey - em pacientes portadores de esclerose sistêmica progressiva

Thamine Lessa Andrade, Aquiles Assunção Camelier, Fernanda Warken Rosa, Marcia Pina Santos, Sérgio Jezler, Jorge Luiz Pereira e Silva

J Bras Pneumol.2007;33(4):414-422

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To evaluate the applicability of the 12-Item Short-Form Health Survey (SF-12) as an instrument to measure health-related quality of life in a sample of patients with progressive systemic sclerosis (PSS) through the analysis of its reproducibility and its correlation with functional and clinical parameters. Methods: A test-retest reproducibility study for the comparative analysis of the intraclass correlation coefficients (ICCs) of the SF-12 and the SF-36. A total of 46 patients diagnosed with PSS were studied, regardless of the presence of respiratory symptoms. Results: The physical component summary 12 (PCS-12) score had an ICC of 0.47 (95%CI: 0.05-0.71; p < 0.02), whereas the mental component summary (MCS-12) score had an ICC of 0.72 (95%CI: 0.49-0.84; p < 0.001). The PCS-36 score had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001), and the MCS-36 score also had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001). Conclusion: The SF-12 is a reliable instrument for measuring health-related quality of life in patients with PSS, since it has been proven to be reproducible. However, this version of the SF-12 should only be used in clinical research settings.


Keywords: Quality of life; Questionnaires; Statistics; Scleroderma, systemic.


Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia

Aplicação do Sarcoidosis Health Questionnaire em pacientes com sarcoidose na Sérvia

Violeta Mihailović-Vučinić1,2, Branislav Gvozdenović3, Mihailo Stjepanović2, Mira Vuković4, Ljiljana Marković-Denić5, Aleksandar Milovanović6, Jelica Videnović-Ivanov2, Vladimir Zugić1,2, Vesna Skodrić-Trifunović 1,2, Snezana Filipović2, Maja Omčikus2

J Bras Pneumol.2016;42(2):99-105

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Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.


Keywords: Sarcoidosis; Health status; Validation studies; Questionnaires; Self report; Serbia.


Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features.

Apneia obstrutiva do sono relacionada ao sono rapid eye movement ou ao sono non-rapid eye movement: comparação de aspectos demográficos, antropométricos e polissonográficos.

Aysel Sunnetcioglu1, Bunyamin Sertogullarından1, Bulent Ozbay2, Hulya Gunbatar1, Selami Ekin1

J Bras Pneumol.2016;42(1):48-54

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods: This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results: The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions: We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture.


Keywords: Sleep, REM; Sleep stages; Sleep apnea, obstructive; Apnea; Sleep apnea syndromes.


Acute asthma in adults in the emergency room: clinical management in the first hour

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

Paulo de Tarso Roth Dalcin, Alan Castoldi Medeiros, Marcelo Kurz Siqueira, Felipe Mallmann, Mariane Lacerda, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2000;26(6):297-306

Abstract PDF PT

Asthma is a disease with high prevalence in our country and around the world. Although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. In this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. Diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. It is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.


Keywords: Asthma. Emergency medicine. Emergency treatment. Clinical procedures. Emergency medical services.


Comparing asthma and chronic obstructive pulmonary disease in terms of symptoms of anxiety and depression

Asma e doença pulmonar obstrutiva crônica: uma comparação entre variáveis de ansiedade e depressão

Neide Suzane Carvalho, Priscila Robles Ribeiro, Marcos Ribeiro, Maria do Patrocínio Tenório Nunes, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2007;33(1):1-6

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Objective: To evaluate the presence and severity of symptoms of anxiety and depression in individuals with asthma or chronic obstructive pulmonary disease. Methods: In order to evaluate symptoms of anxiety and depression, specific instruments of quantification (the State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively) were administered to patients at an outpatient clinic for the treatment of asthma and chronic obstructive pulmonary disease. The population comprised 189 randomly and prospectively selected patients that were divided into three study groups (each with a different therapeutic objective): 40 patients with controlled asthma, 100 patients with uncontrolled asthma, and 49 patients with chronic obstructive pulmonary disease. Included among the variables studied, as part of the methodology, were symptoms of anxiety and depression. The data obtained were compared taking into consideration demographic and functional aspects, as well as the severity of the symptoms of anxiety and depression. Results: Among the asthma patients, the prevalence of moderate or severe anxiety was significantly higher than that observed among those with chronic obstructive pulmonary disease (p <  0.001). The uncontrolled asthma group presented significantly higher rates of depressive symptoms than did the controlled asthma group (p < 0.05). Conclusion: The frequency of symptoms of anxiety and depression is greater among asthma patients than among patients with chronic obstructive pulmonary disease, which can make clinical control difficult.


Keywords: Anxiety; Depression; Asthma; Pulmonary disease; Chronic obstructive


Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil

Asma e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos no Sul do Brasil

Moema Nudilemon Chatkin, Ana Maria Baptista Menezes, Silvia Elaine Cardozo Macedo, Edgar Fiss

J Bras Pneumol.2008;34(10):-

Abstract PDF PT PDF EN Portuguese Text

Objective: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. Methods: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. Results: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. Conclusions: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.


Keywords: Asthma; Respiratory function tests; Respiratory sounds; Signs and symptoms, respiratory.


Asma grave: uma questão de prescrição ou de diagnóstico?

Afrânio Kritski

J Bras Pneumol.2003;29(4):248-250


Severe persistent asthma responsive to off-label use of omalizumab despite high and low levels of total serum IgE

Asma persistente grave com resposta ao uso off label de omalizumabe, não obstante a IgE sérica total ser alta ou baixa

Nobuhiro Asai, Yoshihiro Ohkuni, Akina Komatsu, Ryo Matsunuma, Kei Nakashima, Norihiro Kaneko

J Bras Pneumol.2011;37(4):567-570

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Clinical aspects of the Mycobacterium abscessus complex

Aspectos clínicos do complexo Mycobacterium abscessus

Beuy Joob1,a, Viroj Wiwanitkit2,b

J Bras Pneumol.2018;44(5):434-434

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Clinical aspects in patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex, in the Brazilian Amazon

Aspectos clínicos em pacientes com infecção pulmonar por micobactérias do complexo Mycobacterium abscessus na Amazônia brasileira

José Tadeu Colares Monteiro1, Karla Valéria Batista Lima2, Adriana Rodrigues Barretto3, Ismari Perini Furlaneto1,2, Glenda Moraes Gonçalves3, Ana Roberta Fusco da Costa2, Maria Luiza Lopes2, Margareth Pretti Dalcolmo4,5

J Bras Pneumol.2018;44(2):93-98

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the clinical manifestations of patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex (MABSC), and to compare these manifestations with those of patients infected with other nontuberculous mycobacteria (NTM). Methods: This was a retrospective cohort study involving 43 patients divided into two groups: the MABSC group, consisting of patients with pulmonary infection caused by MABSC (n = 17); and the NTM group, consisting of patients with pulmonary infection caused by NTM other than MABSC (n = 26). Patients were previously treated with a regimen of rifampin, isoniazid, pyrazinamide, and ethambutol before the diagnosis of NTM was confirmed by two culture-positive sputum samples. The nucleotide sequences of the hsp65, 16S rRNA, and/or rpoB genes were analyzed to identify the mycobacteria. Data were collected on demographic, clinical, and radiological characteristics, as well as on treatment responses and outcomes. Results: Loss of appetite was the only clinical manifestation that was significantly more common in the MABSC group than in the NTM group (p = 0.0306). The chance of having to use a second treatment regimen was almost 12 times higher in the MABSC group than in the NTM group. Treatment success was significantly higher in the NTM group than in the MABSC group (83.2% vs. 17.6%; p < 0.0001). The chance of recurrence was approximately 37 times higher in the MABSC group than in the NTM group. Conclusions: In the study sample, treatment response of pulmonary disease caused by MABSC was less favorable than that of pulmonary disease caused by other NTM.


Keywords: Nontuberculous mycobacteria/classification; Nontuberculous mycobacteria/drug effects; Lung diseases.


Allergic bronchopulmonary aspergillosis presenting a glove-finger shadow in radiographic images

Aspergilose broncopulmonar alérgica com imagem radiológica em "dedo de luva"

Marta Elizabeth Kalil, Ana Luiza Godoy Fernandes, Aline Cristinane da Silva Curzel, Márcio Zamuner Cortez, Gláucia Cristina Godinho Alves Lima

J Bras Pneumol.2006;32(5):472-475

Abstract PDF PT PDF EN Portuguese Text

Allergic bronchopulmonary aspergillosis is a lung disease occurring in patients with asthma or cystic fibrosis, triggered by a hypersensitivity reaction to the presence of Aspergillus fumigatus in the airways. We report herein the case of a patient presenting a clinical profile suggestive of asthma and meeting the clinical, laboratory testing and radiological criteria for a diagnosis of allergic bronchopulmonary aspergillosis. The importance of such findings is that early diagnosis can reduce the risk of respiratory exacerbations and fibrosis.


Keywords: Asthma; Bronchiectasis; Aspergillus fumigatus; Aspergillosis, allergic bronchopulmonary


Acute invasive pulmonary aspergillosis, shortly after occupational exposure to polluted muddy water, in a previously healthy subject

Aspergilose pulmonar invasiva aguda, logo após exposição ocupacional a água poluída barrenta, em indivíduo previamente saudável

Vikas Pilaniya, Kamal Gera, Rajesh Gothi, Ashok Sha

J Bras Pneumol.2015;41(5):473-477

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Invasive pulmonary aspergillosis (IPA) predominantly occurs in severely neutropenic immunocompromised subjects. The occurrence of acute IPA after brief but massive exposure to Aspergillus conidia in previously healthy subjects has been documented, although only six such cases have been reported. The diagnosis was delayed in all six of the affected patients, five of whom died. We report the case of a 50-year-old HIV-negative male, a water pipeline maintenance worker, who presented with acute-onset dyspnea and fever one day after working for 2 h in a deep pit containing polluted, muddy water. Over a one-month period, his general condition deteriorated markedly, despite antibiotic therapy. Imaging showed bilateral diffuse nodules with cavitation, some of which were surrounded by ground-glass opacity suggestive of a halo sign (a hallmark of IPA). Cultures (of sputum/bronchial aspirate samples) and serology were positive for Aspergillus fumigatus. After being started on itraconazole, the patient improved. We conclude that massive exposure to Aspergillus conidia can lead to acute IPA in immunocompetent subjects.


Keywords: Environmental exposure; Azoles; Water pollution; Immunocompetence; Invasive pulmonary aspergillosis.


Postinfectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in childhood

Associação de bronquiolite obliterante pós-infecciosa e hemossiderose pulmonar na infância

Leonardo Araújo Pinto, Anick Oliveira, Sintia Collaziol, Paulo Márcio Pitrez, Marcus Jones, João Carlos Prolla, Marisa Dolhnikoff, Renato T. Stein

J Bras Pneumol.2006;32(6):587-591

Abstract PDF PT PDF EN Portuguese Text

In the present report, we describe an unusual presentation of post-infectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in a nine-year-old boy with persistent respiratory symptoms subsequent to an episode of acute bronchiolitis occurring at the age of seven months. After the episode, the persistent respiratory symptoms worsened significantly, and, by the age of seven, the patient began to have difficulty breathing after minimal exertion. Computed tomography of the chest presented findings consistent with bronchiolitis obliterans. Open lung biopsy revealed numerous hemosiderin-laden macrophages, as well as other findings consistent with bronchiolitis obliterans. Pulmonary hemosiderosis can occasionally be accompanied by bronchiolitis obliterans in children with severe sequelae after an episode of viral infection.


Keywords: Bronchoalveolar lavage; Bronchiolitis obliterans; Hemosiderosis; Case reports [Publication type]


Association between serum selenium level and conversion of bacteriological tests during antitu-berculosis treatment

Associações entre níveis de selênio sérico e conversão de testes bacteriológicos durante o tratamento antituberculose

Milena Lima de Moraes, Daniela Maria de Paula Ramalho, Karina Neves Delogo, Pryscila Fernandes Campino Miranda, Eliene Denites Duarte Mesquita, Hedi Marinho de Melo Guedes de Oliveira, Antônio Ruffino-Netto, Paulo César de Almeida, Rachel Ann Hauser-Davis, Reinaldo Calixto Campos, Afrânio Lineu Kritski, Martha Maria de Oliveira

J Bras Pneumol.2014;40(3):269-278

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Objective: To determine whether serum selenium levels are associated with the conversion of bacteriological tests in patients diagnosed with active pulmonary tuberculosis after eight weeks of standard treatment. Methods: We evaluated 35 healthy male controls and 35 male patients with pulmonary tuberculosis, the latter being evaluated at baseline, as well as at 30 and 60 days of antituberculosis treatment. For all participants, we measured anthropometric indices, as well as determining serum levels of albumin, C-reactive protein (CRP) and selenium. Because there are no reference values for the Brazilian population, we used the median of the serum selenium level of the controls as the cut-off point. At 30 and 60 days of antituberculosis treatment, we repeated the biochemical tests, as well as collecting sputum for smear microscopy and culture from the patients. Results: The mean age of the patients was 38.4  11.4 years. Of the 35 patients, 25 (71%) described themselves as alcoholic; 20 (57.0%) were smokers; and 21 (60.0%) and 32 (91.4%) presented with muscle mass depletion as determined by measuring the triceps skinfold thickness and arm muscle area, respectively. Of 24 patients, 12 (39.2%) were classified as moderately or severely emaciated, and 15 (62.5%) had lost > 10% of their body weight by six months before diagnosis. At baseline, the tuberculosis group had lower serum selenium levels than did the control group. The conversion of bacteriological tests was associated with the CRP/albumin ratio and serum selenium levels 60 days after treatment initiation. Conclusions: Higher serum selenium levels after 60 days of treatment were associated with the conversion of bacteriological tests in pulmonary tuberculosis patients.


Keywords: Selenium; Nutritional status; Tuberculosis; Immunity.


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

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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.


Treatment of antineutrophil cytoplasmic antibody-associated vasculitis: update

Atualização do tratamento das vasculites associadas a anticorpo anticitoplasma de neutrófilos

Alfredo Nicodemos Cruz Santana, Viktoria Woronik, Ari Stiel Radu Halpern, Carmen S V Barbas

J Bras Pneumol.2011;37(6):809-816

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In its various forms, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by a systemic inflammation of the small and medium-sized arteries (especially in the upper and lower respiratory tracts, as well as in the kidneys). The forms of AAV comprise Wegener's granulomatosis (now called granulomatosis with polyangiitis), microscopic polyangiitis, renal AAV, and Churg-Strauss syndrome. In this paper, we discuss the phases of AAV treatment, including the induction phase (with cyclophosphamide or rituximab) and the maintenance phase (with azathioprine, methotrexate, or rituximab). We also discuss how to handle patients who are refractory to cyclophosphamide.


Keywords: Anti-neutrophil cytoplasmic antibody-associated vasculitis; Wegener granulomatosis; Antibodies, antineutrophil cytoplasmic.


Update on the approach to smoking in patients with respiratory diseases

Atualização na abordagem do tabagismo em pacientes com doenças respiratórias

Maria Penha Uchoa Sales1,a, Alberto José de Araújo2,b, José Miguel Chatkin3,c, Irma de Godoy4,d, Luiz Fernando Ferreira Pereira5,e, Maria Vera Cruz de Oliveira Castellano6,f, Suzana Erico Tanni4,g, Adriana Ávila de Almeida7,h, Gustavo Chatkin3,i, Luiz Carlos Côrrea da Silva8,j, Cristina Maria Cantarino Gonçalves9,k, Clóvis Botelho12,13,l, Ubiratan Paula Santos14,m, Carlos Alberto de Assis Viegas15,n, Maristela Rodrigues Sestelo16,o, Ricardo Henrique Sampaio Meireles10,11,p, Paulo César Rodrigues Pinto Correa17,q, Maria Eunice Moraes de Oliveira18,r, Jonatas Reichert19,s, Mariana Silva Lima6,t, Celso Antonio Rodrigues da Silva20,u

J Bras Pneumol.2019;45(3):e20180314-e20180314

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Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.


Keywords: Respiratory tract diseases/therapy; Respiratory tract diseases/drug therapy; Tobacco use disorder/epidemiology; Smoking cessation; Counseling; Lung neoplasms.


Audiometric evaluation of patients treated for pulmonary tuberculosis

Avaliação audiométrica de pacientes em tratamento para tuberculose pulmonar

Karla Anacleto de Vasconcelos, Afrânio Lineu Kritski, Antonio Ruffino-Netto, Silvana Frota, Marco Antonio de M Tavares de Lima

J Bras Pneumol.2012;38(1):81-87

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Objective: To evaluate the hearing status of patients being treated for pulmonary tuberculosis at referral hospitals in Brazil. Methods: This was a descriptive study involving 97 male and female inpatients/outpatients between 18 and 60 years of age who were undergoing treatment for active pulmonary tuberculosis at one of two referral hospitals in the state of Rio de Janeiro. After being interviewed, all of the patients underwent pure tone audiometry. Results: Of the 97 patients studied, 65 (67%) were male, 52 (54%) were receiving first-line treatment, and 45 (46%) were receiving second-line treatment, which included aminoglycosides. Smoking, alcohol consumption, exposure to noise, and ototoxic medication use were identified in 65 (67%), 51 (53%), 53 (55%), and 45 (46.4%) of the patients, respectively. The most common auditory and vestibular complaints were dizziness, in 28 patients (28.8%); tinnitus, in 27 (27.8%); and hypoacusis, in 23 (23.7%). Conclusions: Due to the great number of patients with hearing loss in the present study, we recommend that all patients with active pulmonary tuberculosis be submitted to auditory monitoring.


Keywords: Audiometry; Hearing loss; Tuberculosis; Drug toxicity.


Evaluating physical capacity in patients with chronic obstructive pulmonary disease: comparing the shuttle walk test with the encouraged 6-minute walk test

Avaliação da capacidade de exercício em portadores de doença pulmonar obstrutiva crônica: comparação do teste de caminhada com carga progressiva com o teste de caminhada com acompanhamento

Fernanda Warken Rosa, Aquiles Camelier, Anamaria Mayer, José Roberto Jardim

J Bras Pneumol.2006;32(2):106-113

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Objective: To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. Methods: A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. Results: The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 ± 11.4%) than on the shuttle walk test (76.4 ± 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 ± 89.3 meters on the shuttle walk test and 515.5 ± 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). Conclusion: The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise test; Motor activity; Reproducibility of results;


Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test

Avaliação da capacidade funcional: equações de referência para o teste Glittre Activities of Daily Living

Cardine Martins dos Reis1,2,a, Manuela Karloh1,3,b, Fernanda Rodrigues Fonseca1,2,c, Roberta Rodolfo Mazzali Biscaro1,2,d, Giovana Zarpellon Mazo4,5,e, Anamaria Fleig Mayer1,2,3,5,f

J Bras Pneumol.2018;44(5):370-377

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Objective: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. Methods: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. Results: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (−0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). Conclusions: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.


Keywords: Activities of daily living; Exercise test; Reference values.


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):-

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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.


Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal® versus Miflasona Aerolizer®

Avaliação da eficácia clínica, aceitabilidade e preferência de dois sistemas inalatórios de beclometasona no tratamento da asma : Pulvinal versus Aeroliser.

Jussara Fiterman, Waldo Mattos, Alberto Cukier, Márcia Pizzichinni, Rodnei Frare e Silva, Fabiane Kahan, José Roberto Jardim, Armando Brancatelli

J Bras Pneumol.2004;30(5):413-418

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Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal versus Miflasona Aerolizer Background: Approximately half of all asthmatic patients adhere to their prescribed treatment regimen, which makes noncompliance with treatment one of the main problems associated with the disease. It is possible that inhalation devices combining technological advances with comfort and simplicity of use could increase treatment compliance. Objective: To compare the acceptability of and preference for two inhalation devices (Pulvinal and Aerolizer), as well as to evaluate the efficacy of and tolerance for beclomethasone dipropionate when delivered by these two systems. Method: A multicenter, randomized, crossover parallel study was carried out involving 83 patients with stable asthma. Patients received 500-1000 g/day of beclomethasone dipropionate. After a 2-week run in, the patients were randomized to begin a 4-week crossover treatment period with equivalent doses of Clenil Pulvinal (CP) or Miflasona Aerolizer (MA). Results: Both groups showed improvement in dyspnea and FEV1, and acceptability was considered good or excellent in both groups. Of the patients studied, 50.6% preferred CP, and 39% preferred MA. In their future treatment regimes, 54.5% would choose the CP and 37.7% the MA. Conclusion: Clinical efficacy and acceptability were comparable between CP and MA.


Keywords: Asthma/therapy. Beclomethasone/ administration & dosage. Randomized controlled trials. Treatment Outcome.


Bronchial hyperresponsiveness to hypertonic saline challenge in children and adolescents

Avaliação da hiperresponsividade brônquica à solução salina hipertônica em crianças e adolescentes

Paulo Kussek, Nelson Augusto Rosário Filho, Mônica Cat

J Bras Pneumol.2006;32(3):195-201

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Objective: To assess airway hyperresponsiveness to 4.5% hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization. Methods: A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15% was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L. Results: In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4%. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9%. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80% and 92%, respectively. Conclusion: Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing hyperresponsiveness in children and adolescents.


Keywords: Bronchial provocation tests; Bronchial hyperreactivity; Saline solution, hypertonic; Administration, inhalation;


Evaluation of the limited participation by university students in a smoking cessation program

Avaliação da participação de pequeno número de estudantes universitários em um programa de tratamento do tabagismo

Wilson Paloschi Spiandorello, Liliana Zugno Filippini, Angélica Dal Pizzol, Fernanda Kreische, Diogo Sandri Soligo, Tiago Spiandorello, Raquel Boff, Mauricio Michele

J Bras Pneumol.2007;33(1):69-75

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Objective: To evaluate the limited participation by university students in a smoking cessation program. Methods: A cross-sectional, comparative study was conducted at the University of Caxias do Sul, located in Caxias do Sul, Brazil, involving students who enrolled in a smoking cessation program, together with those who did not. Results: Of the 108 student who did not enroll in the program, 102 (94.4%) stated that they had no intention to quit smoking (95% confidence interval: 88.29-97.93%. Comparisons between the enrolled and nonenrolled students revealed the following statistical differences: in mean age (35 vs. 23 years, p < 0.01); mean duration of the smoking habit (19.42 vs. 7.36 years, p < 0.01); considering oneself addicted (100% vs. 58.5%, p = 0.047); believing oneself able to stop smoking at any time (7.1% vs. 22.6%, p = 0.02); having no knowledge of any reasons to quit smoking (37.5% vs. 12%, p = 0.03); having suffered discrimination (42.9% vs. 9.3%, p < 0.01). Conclusion: Among the university students evaluated, there was a phase, classified as precontemplative or contemplative, during which they were refractory to smoking cessation. Although all of the students were aware of the diseases caused by smoking, 41.5% did not consider themselves addicted. The concept of substance dependence does not apply to these students. It would seem more appropriate to define nicotine dependence as resulting from the lifetime consumption of at least 100 cigarettes. These students do not perceive that they are passing through the initial phase of the natural history of tobacco use disorder and do not realize that they are increasing their risk of presenting smoking-related diseases in the future.


Keywords: Smoking; Students; Smoking cessation


Assessment of the quality of life of patients with lung cancer using the Medical Outcomes Study 36-item Short-Form Health Survey

Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey

Juliana Franceschini, Alecssandra Aparecida dos Santos, Inás El Mouallem, Sergio Jamnik, César Uehara, Ana Luisa Godoy Fernandes, Ilka Lopes Santoro

J Bras Pneumol.2008;34(6):387-393

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Objective: To assess the quality of life of patients with lung cancer and to compare it with that of individuals without cancer. Methods: The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was administered to 57 patients diagnosed with lung cancer, treated at the Lung Cancer Outpatient Clinic of the Hospital São Paulo, and to a control group of 57 individuals recruited from the Extra Penha workout group. The Mann-Whitney test was used to compare the groups, domain by domain. The first model of logistic regression was adjusted for male gender, nonsurgical treatment, Karnofsky performance status and smoking, which were included as predictors. The second model was adjusted for each SF-36 domain in order to identify increases in the proportions of patients in stage IIIB or IV. Results: The lung cancer group and the control group presented the following mean scores, respectively, for the SF-36 domains: role limitations due to physical health problems, 29.39 ± 36.94 and 82.89 ± 28.80; role limitations due to emotional problems, 42.78 ± 44.78 and 86.55 ± 28.77; physical function, 56.49 ± 28.39 and 89.00 ± 13.80; vitality, 61.61 ± 23.82 and 79.12 ± 17.68; bodily pain, 62.72 ± 28.72 and 81.54 ± 19.07; general health, 62.51 ± 25.57 and 84.47 ± 13.47; emotional well-being, 68.28 ± 23.46 and 82.63 ± 17.44; and social functioning, 72.87 ± 29.20 and 91.67 ± 17.44. The logistic regression model showed that role limitations due to physical health problems, physical function and emotional well-being were predictors of stages IIIB and IV. Conclusions: The patients with lung cancer had a poorer quality of life, especially regarding physical aspects, than did the control subjects.


Keywords: Lung neoplasms; Quality of life; Health status.


Using the Saint George's Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil

Avaliação da qualidade de vida pelo Questionário do Hospital Saint George na Doença Respiratória em portadores de doença pulmonar obstrutiva crônica: validação de uma nova versão para o Brasil

Aquiles Camelier, Fernanda Warken Rosa, Christine Salim, Oliver Augusto Nascimento, Fábio Cardoso, José Roberto Jardim

J Bras Pneumol.2006;32(2):114-122

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Objective: The objective of this study was to evaluate the applicability of a modified version of the Saint George's Respiratory Questionnaire. The version evaluated elicits "agree" and "do not agree", rather than "yes" and "no", responses. The intention is to facilitate the comprehension of double-negative questions and to promote better recollection of symptoms by patients by shortening their symptom histories from 12 months to 3 months. Methods: A total of 30 clinically stable patients with chronic obstructive pulmonary disease were evaluated. The Saint George's Respiratory Questionnaire and the modified version of the same were administered 15 days apart. Results: All of the patients presented health-related alterations in their quality of life. Comparing mean scores between the two questionnaires, the greatest difference was seen in the Symptoms domain. No significant differences were found in any of the remaining domains or in the total scores. In a subsequent analysis, significant correlations between the two questionnaires were found in all domains: Symptoms (r = 0.71; p < 0.001); Activity (r = 0.75; p < 0.001); Impact (r = 0.73; p < 0.001) and Total (r = 0.86; p < 0.001). Conclusion: The modified version of the Saint George's Respiratory Questionnaire is as effective as the original in gauging quality of life. However, various symptoms recollection time frames should be investigated in order to determine which would be the best time frame to employ in the analysis.


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Reproducibility of results; Cross-cultural comparison; Questionnaires


Evaluating the efficiency of polymerase chain reaction in diagnosing pulmonary tuberculosis in indigenous and non-indigenous patients

Avaliação da reação em cadeia da polimerase no diagnóstico da tuberculose pulmonar em pacientes indígenas e não indígenas

Afrânio Lineu Kritski

J Bras Pneumol.2006;32(3):13-14

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Evaluation of polymerase chain reaction in the diagnosis of pulmonary tuberculosis in indigenous and non-indigenous patients

Avaliação da reação em cadeia da polimerase no diagnóstico da tuberculose pulmonar em pacientes indígenas e não indígenas

Rose Mary Corrêa Santos, Mauricio Morishi Ogusku, José de Moraes Miranda, Maria Cristina Dos-Santos, Julia Ignez Salem

J Bras Pneumol.2006;32(3):234-240

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Objective: To evaluate the accuracy of bacteriological methods and of polymerase chain reaction (with primers specific for IS6110 of the Mycobacterium tuberculosis complex) in testing sputum samples from indigenous (Amerindian) and non-indigenous patients. Methods: A total of 214 sputum samples (154 from indigenous patients and 60 from non-indigenous patients) were analyzed in order to determine the accuracy of smear microscopy (direct and concentrated versions) for acid-fast bacilli, culture, and polymerase chain reaction. Results: Both microscopy methods presented low sensitivity in comparison with culture and polymerase chain reaction. Specificity ranged from 91% to 100%, the concentrated acid-fast smear technique being the least specific. Nontuberculous mycobacteria were isolated three times more frequently in samples from indigenous patients than in those from non-indigenous patients. False-positive and false-negative polymerase chain reaction results were more common in the indigenous population. Conclusion: Positivity and isolation of nontuberculous mycobacteria in the acid-fast smear in conjunction with polymerase chain reaction positivity raise the following hypotheses: nontuberculous mycobacteria species with DNA regions homologous to, or even still possessing, the M. tuberculosis IS6110 exist in the Amazon; colonization of the oropharynx or of a tuberculous lesion accelerates the growth of the nontuberculous mycobacteria present in the sputum samples, making it impossible to isolate M. tuberculosis; A history of tuberculosis results in positivity for M. tuberculosis DNA. The absence of bacteriological positivity in the presence of polymerase chain reaction positivity raises questions regarding the inherent technical characteristics of the bacteriological methods or regarding patient history of tuberculosis.


Keywords: Tuberculosis, pulmonary/diagnosis; Mycobacterium tuberculosis, Polymerase chain reaction/methods; Indians, south american


Evaluation of acute bacterial rhinosinusitis in asthma patients based on clinical parameters and imaging studies, together with ear, nose and throat examination

Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem

Alecsandra Calil Moises Faure, Ilka Lopes Santoro, Luc Louis Maurice Weckx, Henrique Manoel Lederman, Artur da Rocha Correa Fernandes, Ana Luisa Godoy Fernandes

J Bras Pneumol.2008;34(6):340-346

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Objective: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. Methods: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. Results: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. Conclusions: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.


Keywords: Asthma; Sinusitis; Radiography; Tomography, X-ray computed; Endoscopy.


Evaluation of the clinical utility of new diagnostic tests for tuberculosis: the role of pragmatic clinical trials

Avaliação da utilidade clínica de novos testes diagnósticos em tuberculose: o papel dos ensaios clínicos pragmáticos

Gisele Huf, Afrânio Kritski

J Bras Pneumol.2012;38(2):237-245

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Tuberculosis is one of the major infectious diseases in developing countries, and the length of time for which the chain of transmission is maintained has been implicated as a major factor in the perpetuation of the disease. In this context, regulatory agencies in such countries have approved new diagnostic tools, which have been almost immediately incorporated into the national tuberculosis control programs. Health interventions have been increasingly investigated in clinical trials, including explanatory trials (in order to evaluate the beneficial effects of such interventions) and pragmatic trials (in order to aid in the decision-making process). We argue that the evaluation of new diagnostic techniques for the detection of tuberculosis should not escape this same logic of evaluation.


Keywords: Tuberculosis/diagnosis; Tuberculosis/prevention & control; Controlled clinical trial as topic.


Evaluation of the diagnostic utility of fiberoptic bronchoscopy for smear-negative pulmonary tuberculosis in routine clinical practice

Avaliação da utilidade diagnóstica da fibrobroncoscopia óptica na tuberculose pulmonar BAAR negativa na prática clínica de rotina

Alonso Soto, Daniela Salazar, Vilma Acurio, Patricia Segura, Patrick Van der Stuyft

J Bras Pneumol.2012;38(6):761-765

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We evaluated the diagnostic yield of fiberoptic bronchoscopy for the diagnosis of smear-negative pulmonary tuberculosis in patients treated at a referral hospital in Lima, Peru. Of the 611 patients who underwent the procedure, 140 (23%) were diagnosed with tuberculosis based on the analysis of BAL samples. Being young and being male were significantly associated with positive cultures. In addition, 287 patients underwent post-bronchoscopic sputum smear testing for AFB, the results of which increased the diagnostic yield by 22% over that obtained through the analysis of BAL samples alone. We conclude that the analysis of BAL samples and post-bronchoscopic sputum samples provides a high diagnostic yield in smear-negative patients suspected of having pulmonary tuberculosis.


Keywords: Tuberculosis, pulmonary/diagnosis; Bronchoscopy; Sputum.


Evaluation of the use of transbronchial biopsy in patients with clinical suspicion of interstitial lung disease

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

Cristiano Claudino Oliveira, Alexandre Todorovic Fabro, Sérgio Marrone Ribeiro, Julio Defaveri, Vera Luiza Capelozzi, Thais Helena Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.2011;37(2):168-175

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Objective: To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB) used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD) treated at a tertiary-care university hospital. Methods: We reviewed the medical records, radiology reports, and reports of transbronchial biopsies from all patients with suspected ILD who underwent TBB between January of 1999 and December of 2006 at the Hospital das Clínicas de Botucatu, located in the city of Botucatu, Brazil. Results: The study included 56 patients. Of those, 11 (19.6%) had a definitive diagnosis of idiopathic pulmonary fibrosis (IPF), the rate of which was significantly higher in the patients in which ILD was a possible diagnosis in comparison with those in which ILD was the prime suspect (p = 0.011), demonstrating the contribution of TBB to the diagnostic confirmation of these diseases. The histopathological examination of the biopsies revealed that 27.3% of the patients with IPF showed a pattern of organizing pneumonia, which suggests greater disease severity. The most common histological pattern was the indeterminate pattern, reflecting the peripheral characteristic of IPF. However, the fibrosis pattern showed high specificity and high negative predictive value. For CT scan patterns suggestive of IPF, the ROC curve showed that the best relationship between sensitivity and specificity occurred when five radiological alterations were present. Honeycombing was found to be strongly suggestive of IPF (p = 0.01). Conclusions: For ILDs, chest CT should always be performed, and TBB should be used in specific situations, according to the suspicion and distribution of lesions.


Keywords: Lung diseases, interstitial; Diagnosis, differential; Bronchoscopy.


Evaluation of bone disease in patients with cystic fibrosis and end-stage lung disease

Avaliação de doença óssea em pacientes com fibrose cística e doença pulmonar terminal

Cécile A. Robinson1,a, Markus Hofer2,b, Christian Benden1,c, Christoph Schmid3,d

J Bras Pneumol.2019;45(1):e20170280-e20170280

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Objective: Bone disease is a common comorbidity in patients with cystic fibrosis (CF). We sought to determine risk factors and identify potential biochemical markers for CF-related bone disease (CFBD) in a unique cohort of CF patients with end-stage lung disease undergoing lung transplantation (LTx) evaluation. Methods: All of the CF patients who were evaluated for LTx at our center between November of 1992 and December of 2010 were included in the study. Clinical data and biochemical markers of bone turnover, as well as bone mineral density (BMD) at the lumbar spine and femoral neck, were evaluated. Spearman's rho and multivariate logistic regression analysis were used. Results: A total of 102 adult CF patients were evaluated. The mean age was 28.1 years (95% CI: 26.7-29.5), and the mean body mass index was 17.5 kg/m2 (95% CI: 17.2-18.2). Mean T-scores were −2.3 and −1.9 at the lumbar spine and femoral neck, respectively, being lower in males than in females (−2.7 vs. −2.0 at the lumbar spine and −2.2 vs. −1.7 at the femoral neck). Overall, 52% had a T-score of < −2.5 at either skeletal site. The homozygous Phe508del genotype was found in 57% of patients without osteoporosis and in 60% of those with low BMD. Mean T-scores were not particularly low in patients with severe CFTR mutations. Although the BMI correlated with T-scores at the femoral neck and lumbar spine, serum 25-hydroxyvitamin D and parathyroid hormone levels did not. Conclusions: CFBD is common in CF patients with end-stage lung disease, particularly in males and patients with a low BMI. It appears that CF mutation status does not correlate with CFBD. In addition, it appears that low BMD does not correlate with other risk factors or biochemical parameters. The prevalence of CFBD appears to have recently decreased, most likely reflecting increased efforts at earlier diagnosis and treatment.


Keywords: Lung transplantation; Cystic fibrosis; Bone density; Osteoporosis.


Two-year evaluation of an educational program for adult outpatients with asthma

Avaliação de dois anos de um programa educacional para pacientes ambulatoriais adultos com asma

Luciene Angelini, Priscila Games Robles-Ribeiro, Regina Maria de Carvalho-Pinto, Marcos Ribeiro, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2009;35(7):618-627

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Objective: To evaluate the understanding of asthma and the clinical improvement in patients with moderate or severe persistent asthma prior to and after their participation in an educational program presented during the routine outpatient visits. Methods: This was a prospective pilot study involving 164 patients over a two-year period. The educational program, presented to small groups on outpatient visit days, consisted of lectures divided into three parts: pathophysiology; environmental control; and treatment, including training in the inhalation technique. The program was evaluated using standardized questionnaires on clinical improvement and understanding of the disease. Results: By the end of the first year, 120 patients had completed three visits, and 51 of those patients were revaluated at the end of the second year. The mean age of the patients was 44 years, 70% were female, and 43% had up to eight years of schooling. The educational intervention significantly increased the understanding of the disease (p < 0.001), and allowed greater clinical improvement (p < 0.05) with a decrease in the use of oral corticosteroids, fewer visits to the emergency room and fewer days missed from work or school. Conclusions: The educational program offered during the routine outpatient visits of adult patients with asthma at our clinic resulted in a progressive long-term increase in knowledge, as well as in clinical improvement.


Keywords: Asthma; Adult; Patient education as topic.


Analysis of the ventilatory mechanics by forced oscillations technique: main concepts and clinical applications

Avaliação de mecânica ventilatória por oscilações forçadas: fundamentos e aplicações clínicas

Pedro Lopes de Melo, Marcelo Martins Werneck, Antonio Giannella-Neto

J Bras Pneumol.2000;26(4):194-206

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Requesting passive cooperation from the patient and supplying new parameters for the analysis of the ventilatory mechanics, the forced oscillations technique (FOT) has complementary characteristics to the classical methods of lung evaluation. In this work, a review of the principles of this technique is initially presented together with a discussion about its advantages and present limitations. The performance of the technique is compared to classical methods in the detection of breathing disorders. The main clinical applications reported previously in the literature, including the evaluation of the ventilatory mechanics in children, studies in neonates, monitoring of patients under mechanical ventilation, occupational medicine, and evaluation of respiratory sleep disturbances are reviewed and discussed. Based on this review and on the results obtained in studies made in their laboratory, the authors concluded that FOT could render a more detailed examination and facilitate the accomplishment of lung function tests under conditions in which traditional techniques are not appropriate.


Keywords: respiratory mechanics, oscillometry, respiratory function tests


Assessment of ICU readmission risk with the Stability and Workload Index for Transfer score

Avaliação de riscos de readmissão em UTI através do escore Stability and Workload Index for Transfer

Daiane Ferreira Oakes, Ingrid Nemitz Krás Borges, Luiz Alberto Forgiarini Junior, Marcelo de Mello Rieder

J Bras Pneumol.2014;40(1):69-72

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We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.


Keywords: Empyema, pleural; Pneumonia, pneumococcal; Pneumococcal infections.


Evaluation of the gauge of needles used in the collection of specimens during endobronchial ultrasound-guided transbronchial needle aspiration

Avaliação do calibre das agulhas utilizadas na coleta de espécimes por punção aspirativa por agulha guiada por ultrassom endobrônquico

Goohyeon Hong1,a, Ji Hae Koo2,b

J Bras Pneumol.2019;45(1):e20180090-e20180090

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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.


Evaluation of the diagnostic performance and cut-off value for the rapid shallow breathing index in predicting extubation failure

Avaliação do desempenho diagnóstico e do valor de corte para o índice de respiração rápida e superficial na predição do insucesso da extubação

Aline Roberta Danaga, Ana Lúcia Gut, Letícia Cláudia de Oliveira Antunes, Ana Lúcia dos Anjos Ferreira, Fábio Akio Yamaguti, José Carlos Christovan, Ubirajara Teixeira, Cristina Aparecida Veloso Guedes, Ana Beatriz Sasseron, Luis Cuadrado Martin

J Bras Pneumol.2009;35(6):541-547

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Objective: To evaluate the diagnostic performance of the rapid shallow breathing index (RSBI) in predicting extubation failure among adult patients in the intensive care unit and to determine the appropriateness of the classical RSBI cut-off value. Methods: This was a prospective study conducted in the adult intensive care unit of the Botucatu School of Medicine Hospital das Clínicas. The RSBI was evaluated in 73 consecutive patients considered clinically ready for extubation. Results: The classical RSBI cut-off value (105 breaths/min/L) presented a sensitivity of 20% and a specificity of 95% (sum = 115%). Analysis of the receiver operator characteristic (ROC) curve revealed a better cut-off value (76.5 breaths/min/L), which presented a sensitivity of 66% and a specificity of 74% (sum = 140%). The area under the ROC curve for the RSBI was 0.78. Conclusions: The classical RSBI cut-off value proved inappropriate, predicting only 20% of the cases of extubation failure in our sample. The new cut-off value provided substantial improvement in sensitivity, with an acceptable loss of specificity. The area under the ROC curve indicated that the discriminative power of the RSBI is satisfactory, which justifies the validation of this index for use.


Keywords: Adult; Intensive care; ROC curve; Ventilator weaning; Diagnosis; Respiration, artificial.


Evaluation of the risk of bacterial contamination in the patient submitted to bronchoscopy, after reprocessing the bronchoscope

Avaliação do risco de contaminação por bactérias, no paciente submetido à broncoscopia, após o reprocessamento do broncoscópio

Nancy Spekla Grande, Romilda Aparecida Nakayama, Antonia Maria de Oliveira Machado, Fábio Akio Yamaguti, Cesar Uehara

J Bras Pneumol.2002;28(5):250-260

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Introduction: Bronchoscopic is a diagnostic and therapeutic procedure performed by introducing a flexible tube in the airways that allows for the visualization even of the smallest airways. In order to prevent or reduce the risk of infection, the bronchoscope must be adequately disinfected with at least high level disinfection. Purpose: Check for the risk of bacterial contamination for patients submitted to bronchoscopy at the Hospital São Paulo of Unifesp University, State of São Paulo. Methods: From 1997 to 1998, bronchoscope reprocessing included cleaning, rinsing with sterile or potable water, followed by rinsing with 2% glutaraldehyde for 20 minutes, rinsing again with sterile or potable water, and rinsing with 70% ethyl alcohol, and forced-air drying through the suction channel. Samples of 65 patients were collected for microbiologic tests by instilling sterile saline solution through the suction channel of the bronchoscope. Results: After reprocessing, the following were found in the samples: Staphylococcus epidermidis, Enterobacter sp, Acinetobacter baumanni, Streptococcus viridans, Staphylococcus aureus, Streptococcus beta hemoliticus A, Staphylococcus coagulase negative, and mycobacterial growth was found in the culture of five samples. Conclusions: Bronchoscope disinfection with 2% glutaraldehyde was not sufficient to assured disinfection of the scope and the presence of Staphylococcus epidermidis shows that there was bronchoscope contamination due to handling after disinfection.


Evaluation of diagnostic criteria for severe asthma described in a public health directive regulating the free distribution of medications for the maintenance treatment of asthma

Avaliação dos descritores de asma grave em pacientes incluídos na portaria de saúde pública que regulamenta a distribuição gratuita de medicamentos para o tratamento de manutenção da asma

Maria Amélia Carvalho da Silva Santos, Ana Luisa Godoy Fernandes, Mara Marta Amorim, Patrícia Bueno Lima, Sonia Maria Faresin, Ilka Lopes Santoro

J Bras Pneumol.2009;35(4):310-317

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Objective: To evaluate the capacity of the criteria described in Complementary Directive SAS/MS 12, issued on November 12, 2002, to identify patients with severe asthma, describing and comparing clinical, functional and treatment data of such patients. Methods: This was a nested case-control study using a structured database for adult asthma outpatients. We defined cases as asthma patients who met the inclusion criteria described in the directive, defining controls as those who did not. We collected and compared data related to the following: demographic characteristics; history of asthma; medications in use; comorbidities; history of tobacco use; number of exacerbations within the last 12 months, asthma-related hospitalizations and intensive care unit admissions within the last 12 months; spirometry; and sputum cytology. Results: The case and control groups consisted of 29 and 31 patients, respectively. The number of asthma exacerbations and emergency room visits within the last 12 months, as well as the number of patients that received at least one pulse of oral corticosteroids, was significantly higher in the case group than in the control group. In addition, prebronchodilator FVC was lower among the cases than among the controls. Furthermore, cytology revealed that eosinophil counts were significantly higher in the induced sputum of cases than in that of controls. Conclusions: The criteria described in the directive are suited to stratifying patients with severe asthma.


Keywords: Asthma; Budesonide; Combined modality therapy.


Evaluation of serum and pleural levels of the tumor markers CEA, CYFRA21-1 and CA 15-3 in patients with pleural effusion

Avaliação dos valores sérico e pleural dos marcadores tumorais CEA, CYFRA21-1 e CA 15-3 em portadores de derrame pleural

Isabella Coimbra Wagner, Murilo José de Barros Guimarães, Lilian Karine Neves da Silva,Francisco Montenegro de Melo, Maria Tereza Cartaxo Muniz

J Bras Pneumol.2007;33(2):185-191

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Objective: To determine the levels of the tumor markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1) and carbohydrate antigen 15-3 (CA 15-3) in the blood and pleural fluid of patients with benign or malignant pleural effusion, evaluating the sensitivity of each marker in these fluids. Methods: We prospectively evaluated 85 patients with pleural effusion. The study of the pleural fluid observed the criteria established in the literature. Levels of the markers were determined using electrochemiluminescence. The sensitivity was determined on the condition that the specificity was ≥ 90%. Results: Of the 85 cases, 36 (42.4%) were malignant, 30 (35.3%) were benign, and the results were inconclusive in 19 (22.3%). In the malignant cases, the CEA and CYFRA21-1 levels were higher in the pleural fluid than in the blood, which was not observed for CA 15-3. In the benign cases, the CYFRA21-1 levels were higher in the pleural fluid than in the blood, whereas the opposite was found for CEA and CA 15-3. There were significant differences between malignant and benign cases for all markers, in pleural fluid and blood. In the pleural fluid, the sensitivity of CEA, CYFRA21-1 and CA 15-3 was 69.4, 69.4 and 66.7%, respectively, and the combined sensitivity was 80.6%. In the blood, the sensitivity was 57.1%, 71.4% and 48.6% for CEA, CYFRA21-1 and CA 15-3, respectively, and the combined sensitivity was 77%. Conclusion: The results suggest that these markers might be useful in the differentiation between malignant and benign pleural effusion.


Keywords: Biological tumor marker; Cyfra 21.1; CEA; CA 15.3; Pleural effusion.


Respiratory muscle evaluation in elective thoracotomies and laparotomies of the upper abdomen

Avaliação muscular respiratória nas toracotomias e laparotomias superiores eletivas

Laryssa Milenkovich Bellinetti, João Carlos Thomson

J Bras Pneumol.2006;32(2):99-105

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Objective: To identify any possible relation between lower than predicted preoperative respiratory muscle function and the incidence of postoperative respiratory complications and death in elective thoracotomies and laparotomies of the upper abdomen. Methods: A prospective cohort study was conducted, in which 70 patients over the age of 18 were monitored in two similar hospitals. In the preoperative evaluation performed at admission, patients were classified as presenting respiratory muscle function (as determined by measurement of maximal respiratory pressures) > 75% of the predicted value (n = 50) or < 75% of the predicted value (n = 20). Patients were monitored until discharge. In both groups, the incidence of pneumonia was determined, as was that of acute respiratory failure, bronchospasm, prolonged mechanical ventilation, atelectasis, pleural effusion, pneumothorax and death. A comparative analysis was made between the groups, and relative risk was calculated. Results: In the study sample, the overall incidence of postoperative complications was 22.86% (16/70): 55% (11/20) in the group of patients presenting < 75% of the predicted value; and 10% (5/50) in the group of patients presenting > 75% of the predicted value. Patients in the < 75% of the predicted value group presented a relative risk of 5.5 (95% confidence interval between 2.19 and 13.82). Conclusion: Respiratory muscle function below the predicted value was found to be related with higher relative risk of postoperative complications in the surgical procedures studied.


Keywords: Postoperative complications; Thoracotomy; Laparotomy; Respiratory muscles; Respiratory insufficiency


Nutritional evaluation in patients with lung cancer

Avaliação nutricional em pacientes portadores de câncer de pulmão

Sérgio Jamnik, Cesar Uehara, Ilka Lopes Santoro

J Bras Pneumol.1998;24(6):347-353

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The authors analyze the nutritional status of patients with lung cancer. 131 patients, 96 (73.3%) male and 35 (26.7%) female, were classified into three groups: I - malnourished patients; II - eutrophic patients and III - obese patients. Most of the malnourished had anorexia (59.7%), which was not seen in the eutrophic (25%) and obese patients (26.1%). More than 70% of patients reported some degree of previous weight loss at the initial evaluation, weight loss being higher among malnourished patients. Weight loss was observed in more than 60% of the patients during the follow-up period of 3 months after the first evaluation. Patients with squamous carcinoma neoplasms prevailed in the malnourished group whereas adenocarcinoma was more prevalent in the other two groups. Most patients had advanced stages of the disease.


Keywords: Lung cancer. Nutritional status.


Early prognosis of acute asthma in the emergency room

Avaliação prognóstica precoce da asma aguda na sala de emergência

Deise Marcela Piovesan, Diego Milan Menegotto, Suzie Kang, Eduardo Franciscatto, Thaís Millan, Cristine Hoffmann, Lílian Rech Pasin, Josiane Fischer, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2006;32(1):1-9

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Objective: To evaluate clinical and pulmonary function measurements taken in the first fifteen minutes of the assessment of acute asthma in the emergency room and used for prognostic purposes. Methods: A prospective cohort study involving consecutive patients with acute asthma. Only patients who were between the ages of 12 and 55 and presented peak expiratory flow rates < or = 50% of predicted were included. Evaluations were performed upon admission, then again at 15 minutes and 4 hours after the initiation of treatment. Treatment included albuterol and ipratropium delivered by metered-dose inhaler with a spacer, together with 100 mg of intravenous hydrocortisone. Favorable outcomes were defined as peak expiratory flow > or = 50% of predicted after 4 hours of treatment, and unfavorable outcomes were defined as peak expiratory flow < 50% after 4 hours of treatment. Results: Favorable outcomes were seen in 27 patients, and unfavorable outcomes were seen in 24 patients. In the multivariate analysis, peak expiratory flow as percentage of predicted was identified as the variable with the highest predictive value. A peak expiratory flow > or = 40% after 15 minutes of treatment showed significant power in predicting a favorable outcome (sensitivity = 0.74, specificity = 1.00, and positive predictive value = 1.00). A peak expiratory flow < 30% after 15 minutes of treatment was predictive of a poor outcome (sensitivity = 0.54, specificity = 0.93, and positive predictive value = 0.87). Conclusion: Our results suggest that measuring peak expiratory flow after 15 minutes of management in the emergency room is a useful tool for predicting outcomes in cases of acute asthma.


Keywords: Asthma; Acute disease; Respiratory mechanics; Prognosis; Emergency Service, Hospital; Cohort studies


Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis

Avaliação quantitativa da intensidade da transpiração palmar e plantar em pacientes portadores de hiperidrose palmoplantar primária

Bruno Yoshihiro Parlato Sakiyama, Thaís Vera Monteiro, Augusto Ishy, José Ribas Milanez de Campos, Paulo Kauffman, Nelson Wolosker

J Bras Pneumol.2012;38(5):573-578

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Objective: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. Methods: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm2. Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24°C). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. Results: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 ± 51.0 g/m2/h and 71.8 ± 40.3 g/m2/h, respectively, compared with 37.9 ± 18.4 g/m2/h and 27.6 ± 14.3 g/m2/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). Conclusions: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.


Keywords: Hyperhidrosis; Sweat; Dermatology/instrumentation.


Quantitative assessment of elastic fibers in chronic obstructive pulmonary disease

Avaliação quantitativa das fibras elásticas na doença pulmonar obstrutiva crônica

Rogerio Rufino, Kalil Madi, Heitor Siffert Pereira de Souza, Cláudia Henrique da Costa, Eduardo Haruo Saito, José Roberto Lapa e Silva

J Bras Pneumol.2007;33(5):502-509

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Objective: To quantify elastic fibers (EFs) and smooth muscle (SM) cells, as well as CD4+ and CD8+ T lymphocytes, in stable chronic obstructive pulmonary disease (COPD). Methods: Surgical specimens were obtained from 15 COPD patients, 18 smokers without airflow limitation, and 14 nonsmokers. Histological and immunohistochemical methods were employed in order to quantify EFs, SM cells, CD4+ T cells, and CD8+ T cells. Results: There was no significant difference in EF numbers among the three groups (p > 0.05). The number of EFs per unit area of lung tissue (mm2) and the percentage of EFs in the lung tissue were similar among the three groups. The numbers of SM cells were found to be higher in the COPD patients than in the smokers (p = 0.003) or in the nonsmokers (p = 0.009). There was a tendency toward an increase in CD8+ T-cell counts in the COPD patients. In specimens collected from the COPD patients, CD4+ T-cell counts were lower than in those collected from the smokers (p = 0.015) or from the nonsmokers (p = 0.003). There was a weak correlation between CD4+ T-cell count and the ratio of forced expiratory volume in one second to forced vital capacity (r2 = 0.003). Conclusions: The EF counts were similar among the three groups. Hypertrophy/hyperplasia of airway wall SM cells was found in the COPD patients and in the smokers, indicating that airway remodeling occurs in smokers. The CD4/CD8 ratio was lower in the COPD patients.


Keywords: Pulmonary disease, chronic obstructive; CD4 Lymphocyte Count; Elastic tissue; Muscle, smooth.


Semiquantitative echocardiographic evaluation of intrapulmonary vascular dilatations: correlation with evaluation of shunt levels and pulmonary function parameters

Avaliação semiquantitativa ecocardiográfica de dilatações vasculares intrapulmonares em candidatos a transplante hepático: correlação com avaliação de shunt e parâmetros funcionais pulmonares

Maria Angélica Pires Ferreira, Sérgio Saldanha Menna Barreto, Marli Maria Knorst, Mario Reis Álvares da Silva, Antonio Furlan Pinotti

J Bras Pneumol.2009;35(2):106-113

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Objective: To correlate semiquantitative evaluation of intrapulmonary vascular dilatations (IPVD) with quantitative evaluation of shunt levels, as well as to describe clinical and pulmonary function findings in a sample of liver disease patients with IPVD. Methods: Patients presenting transthoracic echocardiography (TTE) positivity for IPVD underwent clinical evaluation, pulmonary function tests and pulmonary shunt quantification (scintigraphy with technetium-99m-labeled macroaggregated albumin and blood gas analysis after pure oxygen breathing). Results: A total of 28 liver cirrhosis patients were studied (mean age, 47.5 years; 60.7% were Child-Pugh class B). A 4-point, ascending scale was used as a measure of IPVD intensity, which was scored as 1, 2, 3 and 4, respectively, in 13 (46.4%), 9 (32.1%), 2 (7.1%) and 4 (14.3%) of the patients. Patients were divided into a low-intensity group (scores 1 and 2) and a high-intensity group (scores 3 and 4). The mean shunt assessed using scintigraphy was 14.9% in the sample as a whole and was lower in the low-intensity group (11.7% vs. 26.3%; p = 0.01). The mean shunt by blood gas analysis was higher in the high-intensity group (8.3% vs. 16.3%; p < 0.001). Mean PaO2 was lower in the high-intensity group. There was a negative correlation between DLCO and IPVD severity (r = −0.406, p = 0.01). Conclusions: TTE is a safe, useful tool for assessing IPVD severity in liver disease patients. The IPVD intensity assessed using TTE correlated with the intrapulmonary shunt values obtained through the quantitative methods evaluated, as well as with pulmonary gas exchange abnormalities.


Keywords: Anoxia; Liver cirrhosis; Hepatopulmonary syndrome; Echocardiography.


Ultrasound evaluation of diaphragmatic mobility in different postures in healthy subjects

Avaliação ultra-sonográfica da mobilidade do diafragma em diferentes posturas em sujeitos saudáveis

Wellington Pereira dos Santos Yamaguti, Elaine Paulin, Simone Shibao, Sérgio Kodaira, Maria Cristina Chammas, Celso Ricardo Fernandes Carvalho

J Bras Pneumol.2007;33(4):407-413

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Objective: To assess, using ultrasound, the effects that changes in body position have on diaphragmatic mobility in healthy subjects during spontaneous breathing. Methods: The study involved seven healthy female volunteers, all of whom were nonsmokers, well nourished, and free of any cardiopulmonary disease. They were submitted to pulmonary function testing and ultrasound evaluation of the mobility of the right diaphragm by the craniocaudal displacement of the left branch of the portal vein using an ultrasound device in mode B. The mobility of the right diaphragm was evaluated in right decubitus and in left decubitus. The order of evaluation was previously determined in a random drawing. Results: The average mobility of the right diaphragm in right decubitus (51.30 ± 9.69 mm) was significantly higher (p = 0.03) than that observed in left decubitus (45.93 ± 10.37 mm). Conclusion: The results suggest that, during spontaneous ventilation, the dependent portion of the diaphragm presents greater mobility than does the nondependent portion, and that the technique used was sufficiently sensitive to detect variations in diaphragmatic mobility related to changes in posture.


Keywords: Diaphragm; Ultrasonography; Respiratory function tests; Posture.


Evaluating COPD from the perspective of the patient

Avaliando a DPOC pela perspectiva do paciente

Cláudia Adriana Sant'Anna Ferreira, Alberto Cukier

J Bras Pneumol.2006;32(2):7-8

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Advances in the radiological diagnosis of pulmonary nodules

Avanços no diagnóstico radiológico dos nódulos pulmonares

Edson Marchiori, Klaus Loureiro Irion

J Bras Pneumol.2008;34(1):2-3

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Advances in the treatment of lung cancer

Avanços no tratamento do câncer pulmonar

Teresa Yae Takagaki

J Bras Pneumol.2005;31(6):iii-v

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Low income as a protective factor against asthma in children and adolescents treated via the Brazilian Unified Health System

Baixa renda como fator de proteção contra asma em crianças e adolescentes usuários do Sistema Único de Saúde

Murilo Carlos Amorim de Britto, Emilses Fernandes de Carvalho Freire, Patrícia Gomes de Matos Bezerra, Rita de Cássia Coelho Moraes de Brito, Joakim da Cunha Rego

J Bras Pneumol.2008;34(5):251-255

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Objective: To analyze the role that low income plays in the development of asthma in children and adolescents. Methods: A case-control study using a questionnaire. Results: A total of 687 participants were studied at a tertiary hospital via the Brazilian Unified Health System. Ages ranged from 5 to 15 years, and 54.7% of the participants were male. Nearly half of the individuals (49.1%) lived in the metropolitan area of the city of Recife, and the remainder lived in the countryside. Most (98.1%) lived in concrete houses or apartments, with a mean of 5.7 rooms and 4.8 occupants per residence. Mean maternal level of education was 6.8 years of schooling. The median monthly per capita income was R$ 103.75 (Brazilian reals). The sample was stratified according to cut-off points related to the national minimum wage (R$ 350.00): <25% of minimum wage = very low income (39% of the sample); <50% of minimum wage = low income (37.3% of the sample); and ≥50% of minimum wage = satisfactory income (23.7% of the sample). There was no association between poverty and development of asthma. Conclusions: Poverty is not protective against asthma in children and adolescents treated via the Brazilian Unified Health System, as we might suppose based on the hygiene hypothesis. However, cohort studies are needed in order to confirm these findings.


Keywords: Asthma; Poverty; National health programs/Brazil; Child; Adolescent; Case-control studies.


Incremental low doses of amrubicin for the treatment of bone marrow metastasis in small cell lung cancer

Baixas doses incrementais de amrubicina para o tratamento de metástase de medula óssea em câncer de pulmão de pequenas células

Nobuhiro Asai, Yoshihiro Ohkuni, Masanori Matsuda, Makoto Narita, Norihiro Kaneko

J Bras Pneumol.2013;39(1):108-109


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

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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.


Barriers associated with reduced physical activity in COPD patients

Barreiras associadas à menor atividade física em portadores de DPOC

Priscila Batista Amorim, Rafael Stelmach, Celso Ricardo Fernandes Carvalho, Frederico Leon Arrabal Fernandes, Regina Maria Carvalho-Pinto, Alberto Cukier

J Bras Pneumol.2014;40(5):504-512

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Objective: To evaluate the ability of COPD patients to perform activities of daily living (ADL); to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT), and an ADL limitation score. Methods: In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL) scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. Results: We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5  25.8 min/day vs. 105.2  49.4 min/day; p < 0.001), as was the distance walked (3.9  1.9 km/day vs. 6.4  3.2 km/day; p < 0.001). The COPD patients also walked fewer steps/day. The most common self-reported barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. Conclusions: Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures.


Keywords: Pulmonary disease, chronic obstructive; Activities of daily living; Exercise tolerance.


Pulmonary blastoma: treatment through sleeve resection of the right upper lobe

Blastoma pulmonar: tratamento cirúrgico por lobectomia superior direita e broncoplastia

Eduardo Sperb Pilla, Pablo G. Sánchez, Gabriel Ribeiro Madke, Spencer Camargo, José de Jesus Peixoto Camargo

J Bras Pneumol.2006;32(1):75-77

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Pulmonary blastoma is a rare lung tumor that is composed of malignant epithelial and mesenchymal cells. It presents a pattern of rapid growth. Herein, we report the case of a patient with hemoptysis and a mass in the right upper lobe. The patient presented limited pulmonary function, and fiberoptic bronchoscopy revealed invasion of the intermediate bronchus. The patient underwent sleeve resection of right upper lobe, a technique never before described. After 36 months of follow-up, the patient remained asymptomatic. We also review the literature regarding treatment, clinical aspects and pathology.


Keywords: Pulmonary blastoma/surgery; Pneumonectomy; Case reports [Publication type]


Infectious giant bulla associated with lung cancer

Bolha gigante infecciosa associada a câncer de pulmão

Nobuhiro Asai, Yoshihiro Ohkuni, Ryo Matsunuma, Kei Nakashima, Takuya Iwasaki, Norihiro Kaneko

J Bras Pneumol.2011;37(3):404-408

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A 79 year-old man sought treatment in the emergency room complaining of persistent fever, chest pain, and general fatigue. A chest X-ray showed a giant infectious bulla (24 cm in diameter) in the left lung. The patient had no history of abnormalities on X-rays, and his latest medical check-up, conducted in the preceding year, had produced no abnormal findings. Diagnostic procedures, including bronchoscopy, revealed lung cancer (large cell carcinoma) in the left lower bronchus. The tumor obstructed the airway. Although there have been various reports of giant bullae, their etiology remains unknown. We suggest that an obstruction, such as that caused by the tumor in this case, can lead to air trapping, resulting in the formation of a bulla. In the case of a giant bulla that rapidly increases in size, lung cancer should be included in the differential diagnosis.


Keywords: Lung neoplasms/complications; Infection; Drainage.


Activated charcoal bronchial aspiration

Broncoaspiração de carvão ativado

Bruna Quaranta Lobão Bairral, Makoto Saito, Nelson Morrone

J Bras Pneumol.2012;38(4):533-534

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Exercise-induced bronchoconstriction in elite long-distance runners in Brazil

Broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite

Renata Nakata Teixeira, Luzimar Raimundo Teixeira, Luiz Augusto Riani Costa, Milton Arruda Martins, Timothy Derick Mickleborough, Celso Ricardo Fernandes Carvalho

J Bras Pneumol.2012;38(3):292-298

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Objective: To determine the prevalence of exercise-induced bronchoconstriction among elite long-distance runners in Brazil and whether there is a difference in the training loads among athletes with and without exercise-induced bronchoconstriction. Methods: This was a cross-sectional study involving elite long-distance runners with neither current asthma symptoms nor a diagnosis of exercise-induced bronchoconstriction. All of the participants underwent eucapnic voluntary hyperpnea challenge and maximal cardiopulmonary exercise tests, as well as completing questionnaires regarding asthma symptoms and physical activity, in order to monitor their weekly training load. Results: Among the 86 male athletes recruited, participation in the study was agreed to by 20, of whom 5 (25%) were subsequently diagnosed with exercise-induced bronchoconstriction. There were no differences between the athletes with and without exercise-induced bronchoconstriction regarding anthropometric characteristics, peak oxygen consumption, baseline pulmonary function values, or reported asthma symptoms. The weekly training load was significantly lower among those with exercise-induced bronchoconstriction than among those without. Conclusions: In this sample of long-distance runners in Brazil, the prevalence of exercise-induced bronchoconstriction was high.


Keywords: Athletes; Asthma, exercise-induced; Exercise test.


Bronchoscopy in the diagnosis of tuberculosis: their role of transbronchial biopsy in HIV-infected and in immunocompetent patients

Broncoscopia no diagnóstico de tuberculose: papel da biópsia transbrônquica em imunocompetentes e em HIV-positivos

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Maria Rita E. Araújo, Kátia R.M. Leite

J Bras Pneumol.1999;25(4):207-212

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Introduction: Bronchoscopy is useful in the diagnosis of tuberculosis suspects with a "negative" sputum smear. The objectives of this study were: to assess yield of bronchoalveolar lavage (BAL) and of transbronchial biopsy (TBB) both in HIV-positive patients (group 1) and immunocompetent individuals (group 2), based on simple and most available laboratory techniques in clinical practice. Patients and methods: The authors performed 319 bronchoscopies in 302 patients. BAL and TBB were sequentially performed in the same lung in all cases. Tuberculosis was diagnosed based on the results of acid-fast stains (AFS) from the lavage (ZN), culture for mycobacteria (LJ), and histological examination of biopsies (HE and ZN). Results: Tuberculosis was the final diagnosis in 28 exams of group 1 (n = 214) and in 35 of group 2 (n = 105). There were abnormal endoscopic findings respectively in 3 and 10 patients. In group 1, AFS were positive in 7 cases, culture of BAL in 14, and TBB in 19. In group 2, AFS were positive in 13 cases, culture in 17, and biopsies in 31. TBB results compared to BAL were in concordance for group 1 (p = 0.823) and different for group 2 (p = 0.022). Immediate results (AFS and TBB) compared to later positive results of culture were similar for group 1 (p = 0.066) but not for group 2 (p = 0.001). There were eight episodes of pneumothorax (2.5%) and one death (0.36%). Conclusions: Both BAL and TBB should be performed whenever possible, aiming towards a higher yield of bronchoscopy in the diagnosis of tuberculosis. Both methods complement each other in immunocompetent patients, whereas TBB establishes a faster diagnosis for HIV-infected patients if associated to AFS.


Keywords: Bronchoscopy/methods. Smear-negative tuberculosis/diagnosis. Opportunistic infections related to AIDS/diagnosis.


Bronchiectasis: a study of 314 cases tuberculosis x non-tuberculosis

Bronquiectasias: estudo de 314 casos tuberculose x não-tuberculose

Miguel Bogossian, Ilka Lopes Santoro, Sérgio Jamnik, Hélio Ramaldini

J Bras Pneumol.1998;24(1):11-16

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The authors studied 314 patients with bronchiectasis. An elevated percentage of sequelae of tuberculosis (42.7%) was found, and other causes of bronchiectasis represented 57.3%. Mean age was similar in both groups, around 50 years old, with predominance of females (65.0%). As to symptoms and signs, hemoptysis was sharply predominant in the tuberculosis group (37.3% x 22.8%; p < 0.05). Association between asthma and infections during childhood was similar in both groups, but sinusitis was more frequent in the non-tuberculosis group (45.0% x 23.9%; p < 0.05). The most frequent site for bronchiectasis secondary tuberculosis was the right upper lobe; in the other group, the most frequent sites were lower left lobe and lingula. The most frequent morphologic type in greater groups was cylindrical (more than 50% of patients). Lung function tests were abnormal, with reduction in both FEV 1 and FVC in the tuberculosis group. Forty-four percent of the patients in the first group and 37.2% in the second one were smokers. The authors make comments about the high number of patients with tuberculosis scars that have secondary bronchiectasis and the greater impairment of lung function in this group of patients.


Bronchiolitis obliterans organizing migratory pneumonia (BOOP) after unilateral radiotherapy for breast carcinoma treatment

Bronquiolite obliterante com pneumonia organizante (BOOP) migratória após radioterapia unilateral para tratamento de carcinoma de mama

Renata Tristão Rodrigues, Ricardo Togashi, Hugo H Bok Yoo, Júlio Defaveri, Irma de Godoy, Thais Helena A. Thomaz Queluz

J Bras Pneumol.1998;24(1):47-50

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The authors describe a case of a woman submitted to radiation therapy for breast carcinoma who presented, 40 days after the end of the treatment, fever, dry cough, dyspnea on exertion, and weight loss. Chest imaging revealed migratory opacities. The histopathological examination of transbronchial biopsy specimens showed characteristic findings of BOOP. Corticosteroid therapy resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. The authors present a brief review of the literature concerning radiation-induced lung injury, emphasizing the importance of including BOOP in the differential diagnosis in these complications. The present case, as well as the two other reports from the literature, provide further evidence for the role of irradiation injury as a cause of clinicopathological syndrome identical to idiopathic BOOP, i.e., radiation-induced BOOP.


Keywords: Bronchiolitis obliterans organizing pneumonia. BOOP. Radiation pneumonitis. Radiotherapy. Breast carcinoma.


The search for individualized smoking cessation therapy

Busca pela terapia personalizada para o tabagismo

Ilka Lopes Santoro1

J Bras Pneumol.2017;43(1):3-3

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Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography

Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

Juliana Fischman Zampieri1,a, Gabriel Sartori Pacini1,b, Matheus Zanon1,c, Stephan Philip Leonhardt Altmayer1,2,d, Guilherme Watte1,2,e, Marcelo Barros1,2,f Evandra Durayski2,g, Gustavo de Souza Portes Meirelles3,h, Marcos Duarte Guimarães4,5,i, Edson Marchiori6,j, Arthur Soares Souza Junior7,k, Bruno Hochhegger1,2,l

J Bras Pneumol.2019;45(4):e20180168-e20180168

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Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.


Keywords: Calcification, physiologic; Thorax/diagnostic imaging; Tomography, X-ray computed; Magnetic resonance imaging.


Lung cancer in Brazil

Câncer de pulmão no Brasil

Luiz Henrique Araujo1,2,a, Clarissa Baldotto1,2,b, Gilberto de Castro Jr3,4,c, Artur Katz4,d, Carlos Gil Ferreira5,6,e, Clarissa Mathias7,f, Eldsamira Mascarenhas7,g, Gilberto de Lima Lopes8,9,h, Heloisa Carvalho4,10,i, Jaques Tabacof8, Jeovany Martínez-Mesa11,j, Luciano de Souza Viana12,k, Marcelo de Souza Cruz13,l, Mauro Zukin1,2,m, Pedro De Marchi12,n, Ricardo Mingarini Terra3,o, Ronaldo Albuquerque Ribeiro14, Vladmir Cláudio Cordeiro de Lima15,p, Gustavo Werutsky16,q, Carlos Henrique Barrios17,r; Grupo Brasileiro de Oncologia Torácica

J Bras Pneumol.2018;44(1):55-64

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Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.


Keywords: Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil.


Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil

Câncer de pulmão: mudanças na histologia, sexo e idade nos últimos 30 anos no Brasil

Maria Teresa Ruiz Tsukazan1,2, Álvaro Vigo2, Vinícius Duval da Silva3, Carlos Henrique Barrios4, Jayme de Oliveira Rios1, José Antônio de Figueiredo Pinto1

J Bras Pneumol.2017;43(5):363-367

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Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women.


Keywords: Lung neoplasms; Epidemiology; Histology; Adenocarcinoma; Carcinoma, non-small-cell lung; Carcinoma, squamous cell.


Submaximal exercise capacity in adolescent and adult patients with cystic fibrosis

Capacidade submáxima de exercício em pacientes adolescentes e adultos com fibrose cística

Bruna Ziegler, Paula Maria Eidt Rovedder, Janice Luisa Lukrafka, Claudine Lacerda Oliveira, Sérgio Saldanha Menna-Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2007;33(3):263-269

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Objective: To determine the submaximal exercise capacity of patients with cystic fibrosis (CF) by means of the 6-minute walk test (6MWT), correlating the results with clinical score, nutritional status, radiographic score, and pulmonary function tests. Methods: This was a prospective, cross-sectional study involving patients aged 16 or older enrolled in a program for adults with CF. The patients were submitted to clinical evaluation, determination of maximal respiratory pressures, 6MWT, spirometry, and chest X-ray. Results: The study comprised 41 patients. The mean age was 23.7 ± 6.5 years, and the mean forced expiratory volume in one second (FEV1) was 55.1 ± 27.8%. On the 6MWT, 30 (73.2%) of the patients covered a distance (mean, 556.7 ± 76.5 m) that was less than the predicted normal value. The distance walked did not correlate significantly with body mass index, clinical score, radiographic score, maximal respiratory pressures, peripheral oxygen saturation at rest, desaturation during the 6MWT, sensation of dyspnea, or fatigue, although it did so with age at diagnosis, FEV1 in liters, and forced vital capacity in liters. Worsening of pulmonary function was associated with greater desaturation during the 6MWT. Conclusion: This study showed that most patients attending an adult CF program had reduced submaximal exercise capacity. The 6MWT can be valuable for identifying patients who might experience oxygen desaturation and physical impairment in daily activities.


Keywords: Cystic fibrosis; Respiratory function tests; Exercise tolerance.


Chapter 1 - Laboratory diagnosis of pulmonary mycoses

Capítulo 1 - Diagnóstico laboratorial das micoses pulmonares

Melissa Orzechowski Xavier, Flávio de Mattos Oliveira, Luiz Carlos Severo

J Bras Pneumol.2009;35(9):907-919

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In this era of immunosuppression and transplantation, it is imperative that laboratory scientists remain in close communication with physicians. In patients receiving immunosuppressive therapy, the diagnosis of mycoses must be rapid, which is complicated, requiring the cooperation and collaboration of a number of professionals from various fields of expertise. In this paper, the laboratory diagnosis of pulmonary fungal infection is reviewed. The following topics are included: host factors such as immunological response and predisposing anatomical features; collection, transport and storage of specimens; laboratory processing of samples; direct microscopy; staining techniques, culture and identification of fungi; laboratory biosafety; tissue tropism and reactions; serology; and antigen detection.


Keywords: Mycology; Laboratories, hospital; Diagnostic techniques and procedures; Lung diseases, fungal.


Chapter 6 - Paracoccidioidomycosis

Capítulo 6 - Paracoccidioidomicose

Bodo Wanke, Miguel Abidon Aidê

J Bras Pneumol.2009;35(12):-

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Paracoccidioidomycosis is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis. The disease is restricted to Latin America. It is the principal systemic mycosis in Brazil, with higher incidences in the southern, southeastern and central regions. The disease is acquired by inhaling fungal propagules. In endemic areas, the primary infection occurs during childhood and involves the immune system. The most common chronic form of paracoccidioidomycosis in adults is the multifocal form, in which there is dissemination to the lungs, lymph nodes, skin and mucosae. This form of the disease has a chronic progression, and the diagnosis is typically delayed. Cough, dyspnea and weight loss due to cutaneous and mucosal lesions are evident and are the principal complaints reported by paracoccidioidomycosis patients. Chest X-rays reveal diffuse reticulonodular infiltrates, which are more evident in the upper lobes. The etiologic diagnosis is based on the identification of P. brasiliensis in clinical specimens, such as lymph node aspirates or BAL fluid, by direct microscopy and culture. Histopathological testing of tissue samples reveals the thick birefringent cell wall of the fungus and the typical pattern of multiple budding around the mother cell. Double agar gel immunodiffusion is useful for the diagnosis when the fungus cannot be detected through mycological tests. Although paracoccidioidomycosis is most often treated with the sulfamethoxazole-trimethoprim combination, itraconazole is preferable. Amphotericin B is used in severe cases.


Keywords: Paracoccidioidomycosis; Mycosis; Lung diseases, fungal.


Characteristics of elderly tuberculosis patients in Recife, Brazil: a contribution to the tuberculosis control program

Características da tuberculose em idosos no Recife (PE): contribuição para o programa de controle

Zilda do Rego Cavalcanti, Maria de Fátima Pessoa Militão de Albuquerque, Antônio Roberto Leite Campelo, Ricardo Ximenes, Ulisses Montarroyos, Marianne Karel Amaral Verçosa

J Bras Pneumol.2006;32(6):535-543

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Objective: To describe the demographic characteristics, everyday habits, socio-economic conditions, clinico-epidemiological profiles and access to health care services among the elderly patients with tuberculosis diagnosed and treated in the city of Recife, Brazil, comparing them to those observed in young adults with tuberculosis. Methods: A case-control type strategy was used to evaluate a cohort of patients with tuberculosis, all of whom were treated in public health care facilities in Recife between May of 2001 and July of 2003. Results: The final cohort consisted of 1127 patients: 136 elderly patients (cases) and 991 young adults (controls). In both groups, males predominated, and the most common form of tuberculosis was the pulmonary form. Alcoholism was more common in the control group, whereas illiteracy was more common in the case group. There were fewer complaints of cough, sweats and chest pain among the patients in the case group than among those in the control group. Serological testing for the human immunodeficiency virus was performed in only 29 patients (2.6%). The percentage of positive sputum smear microscopy results, as well as that of positive cultures, was higher in the controls. Prior to being diagnosed with the disease, patients in both groups had sought treatment at more than two health care facilities and had waited more than two months (after first seeking treatment). The elderly patients presented higher indices of cure and were more often compliant with the treatment regimen, yet presented higher mortality rates. Conclusion: In the population studied, the elderly presented less cough, fewer episodes of night sweats and less chest pain, as well as less often presenting positivity on complementary exams. Nevertheless, the mortality rate was higher among the elderly patients than among the young adult patients. Elderly patients with tuberculosis constitute a population that should be given special attention in public health care facilities.


Keywords: Tuberculosis; Elderly; Case-control; Brazil


Genetic and phenotypic traits of children and adolescents with cystic fibrosis in Southern Brazil

Características genéticas e fenotípicas de crianças e adolescentes com fibrose cística no Sul do Brasil

Katiana Murieli da Rosa1,a, Eliandra da Silveira de Lima2,b, Camila Correia Machado3,c, Thaiane Rispoli4,d, Victória d'Azevedo Silveira3,e, Renata Ongaratto2,f, Talitha Comaru2,g, Leonardo Araújo Pinto5,h

J Bras Pneumol.2018;44(6):498-504

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Objectives: To characterize the main identified mutations on cystic fibrosis transmembrane conductance regulator (CFTR) in a group of children and adolescents at a cystic fibrosis center and its association with the clinical and laboratorial characteristics. Method: Descriptive cross-sectional study including patients with cystic fibrosis who had two alleles identified with CFTR mutation. Clinical, anthropometrical, laboratorial and pulmonary function (spirometry) data were collected from patients' records in charts and described with the results of the sample genotyping. Results: 42 patients with cystic fibrosis were included in the study. The most frequent mutation was F508del, covering 60 alleles (71.4%). The second most common mutation was G542X (six alleles, 7.1%), followed by N1303K and R1162X mutations (both with four alleles each). Three patients (7.14%) presented type III and IV mutations, and 22 patients (52.38%) presented homozygous mutation for F508del. Thirty three patients (78.6%) suffered of pancreatic insufficiency, 26.2% presented meconium ileus, and 16.7%, nutritional deficit. Of the patients in the study, 59.52% would be potential candidates for the use of CFTR-modulating drugs. Conclusions: The mutations of CFTR identified more frequently were F508del and G542X. These are type II and I mutations, respectively. Along with type III, they present a more severe cystic fibrosis phenotype. More than half of the sample (52.38%) presented homozygous mutation for F508del, that is, patients who could be treated with Lumacaftor/Ivacaftor. Approximately 7% of the patients (7.14%) presented type III and IV mutations, therefore becoming candidates for the treatment with Ivacaftor.


Keywords: Cystic fibrosis; Mutations; Genetics; Phenotype; Child


Mucoepidermoid carcinoma of the trachea mimicking asthma

Carcinoma mucoepidermoide da traqueia mimetizando asma brônquica

Ricardo Kalaf Mussi, Ivan Felizardo Contrera Toro, Mônica Corso Pereira

J Bras Pneumol.2009;35(3):280-284

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In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.


Keywords: Bronchial hyperreactivity; Carcinoma, mucoepidermoid; Trachea; Asthma; Lung diseases, obstructive.


Takotsubo cardiomyopathy triggered by &#61538;2 adrenergic agonist

Cardiomiopatia de takotsubo desencadeada pelo uso de agonista β2-adrenérgico

Vera Maria Cury Salemi, Edmar Atik, Ronaldo Adib Kairalla, Eduardo Lira Queiroz, Leonardo Vieira da Rosa, Roberto Kalil Filho

J Bras Pneumol.2011;37(4):560-562

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Stress cardiomyopathy following acute ischemic stroke during flexible bronchoscopy: a rare sequence of complications

Cardiomiopatia induzida por stress após acidente vascular cerebral isquêmico agudo durante broncoscopia flexível: uma rara sequência de complicações

Sonja Badovinac, Marta Korsic, Branka Cucevic, Valentina Slivnjak, Andrea Vukic Dugac, Marko Jakopovic

J Bras Pneumol.2013;39(4):-

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An unusual cause of pleural effusion in a patient with heart failure

Causa incomum de derrame pleural em paciente com insuficiência cardíaca

Daniel Bruno Takizawa1,a, Philippe de Figueiredo Braga Colares1,b, Olívia Meira Dias1,c

J Bras Pneumol.2019;45(5):e20180343-e20180343

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Deaths attributed to multiple causes and involving tuberculosis in the state of Rio de Janeiro Brazil between 1999 and 2001

Causas múltiplas de morte relacionadas à tuberculose no Estado do Rio de Janeiro entre 1999 e 2001

Augusto Hasiak Santo

J Bras Pneumol.2006;32(6):544-552

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Objective: To evaluate deaths attributed to multiple causes in which tuberculosis was one of the causes listed. Methods: All deaths among residents of the state of Rio de Janeiro, Brazil, occurring between 1999 and 2001 and for which the death certificate mentioned tuberculosis, were investigated. The World Health Organization guidelines were used in characterizing the underlying and associated (non-underlying) causes of death. Results: In deaths from tuberculosis, conditions related to its natural history were the principal associated causes, together with alcoholism and diabetes. In approximately three-fifths of all deaths for which tuberculosis was listed as an associated cause, the underlying cause of death was acquired immunodeficiency syndrome. High proportion of ill-defined causes of death, low values found for the number of causes informed per death certificate and for TB as an associated cause point towards a certain degree of underestimation of the actual number of TB-related deaths in Rio de Janeiro State. Conclusion: The study shows that the rates of tuberculosis-related mortality in the state of Rio de Janeiro, calculated based on the number of times tuberculosis was listed as a cause of death (underlying or associated), are the highest in the country. Epidemiological studies of mortality are recommended as a means of guiding the activities of the tuberculosis control program.


Keywords: Tuberculosis/mortality; Acquired immunodeficiency syndrome; Multipe cause of death; Brazil


Smoking cessation among patients at a university hospital in Curitiba, Brazil

Cessação de tabagismo em pacientes de um hospital universitário em Curitiba

Rodney Luiz Frare e Silva, Eliane Ribeiro Carmes, Alain Felipe Schwartz, Denise de Souza Blaszkowski, Raphael Henrique Déa Cirino, Renata Dal-Prá Ducci

J Bras Pneumol.2011;37(4):480-487

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Objective: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history. Methods: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil. Results: Of the 629 patients, 206 (32.7%) were male, 76 (12.1%) were smokers, 179 (28.5%) were former smokers, and 374 (59.5%) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7%) and 166 (92.7%), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket. Conclusions: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.


Keywords: Smoking/prevention & control; Smoking cessation; Hospitalization/statistics & numerical data.


The electronic cigarette: the new cigarette of the 21st century?

Cigarro eletrônico: o novo cigarro do século 21?

Marli Maria Knorst, Igor Gorski Benedetto, Mariana Costa Hoffmeister, Marcelo Basso Gazzana

J Bras Pneumol.2014;40(5):564-573

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The electronic nicotine delivery system, also known as the electronic cigarette, is generating considerable controversy, not only in the general population but also among health professionals. Smokers the world over have been increasingly using electronic cigarettes as an aid to smoking cessation and as a substitute for conventional cigarettes. There are few available data regarding the safety of electronic cigarettes. There is as yet no evidence that electronic cigarettes are effective in treating nicotine addiction. Some smokers have reported using electronic cigarettes for over a year, often combined with conventional cigarettes, thus prolonging nicotine addiction. In addition, the increasing use of electronic cigarettes by adolescents is a cause for concern. The objective of this study was to describe electronic cigarettes and their components, as well as to review the literature regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use.


Keywords: Smoking; Tobacco Products; Nicotine.


Lung cysts in chronic paracoccidioidomycosis

Cistos pulmonares na paracoccidioidomicose crônica

André Nathan Costa, Edson Marchiori, Gil Benard, Mariana Sponholz Araújo, Bruno Guedes Baldi, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2013;39(3):368-372

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On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases.


Keywords: Paracoccidioidomycosis; Cysts; Multidetector computed tomography.


Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation

Citocinas no líquido pleural após transplante pulmonar como marcadores de rejeição aguda

Priscila Cilene León Bueno de Camargo, José Eduardo Afonso Jr, Marcos Naoyuki Samano, Milena Marques Pagliarelli Acencio, Leila Antonangelo, Ricardo Henrique de Oliveira Braga Teixeira

J Bras Pneumol.2014;40(4):425-428

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Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.


Keywords: Lung transplantation; Pleural effusion; Cytokines; Graft rejection.


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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Theoretical pneumococcal vaccine coverage: analysis of serotypes isolated from inpatients at a tertiary care hospital

Cobertura vacinal pneumocócica teórica: análise de sorotipos isolados de pacientes internados em hospital terciário

Cynthia Rocha Dullius1,a, Luciana Zani2,b, José Miguel Chatkin2,c

J Bras Pneumol.2018;44(5):361-366

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Objective: To evaluate Streptococcus pneumoniae serotypes isolated from an inpatient population at a tertiary care hospital, in order to determine the theoretical coverage of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPV23). Methods: This was a cross-sectional study involving 118 inpatients at the Hospital São Lucas, in the city of Porto Alegre, Brazil, whose cultures of blood, cerebrospinal fluid, or other sterile body fluid specimens, collected between January 2005 and December 2016, yielded pneumococcal isolates. The theoretical vaccine coverage was studied in relation to the serotypes identified in the sample and their relationship with those contained in the pneumococcal vaccines available in Brazil. Results: The majority of the population was male (n = 66; 55.9%), with a median age of 57 years (interquartile range: 33-72 years). The most common manifestation was pneumonia, and the pneumococcus was most commonly isolated from blood cultures. More than one fourth of the study population had some degree of immunosuppression (n = 34; 28.8%). Of the total sample, 39 patients (33.1%) died. There were no significant associations between mortality and comorbidity type, ICU admission, or need for mechanical ventilation. The theoretical vaccine coverage of PPV23 alone and PCV13 plus PPV23 was 31.4% and 50.8%, respectively. Conclusions: If the patients in this sample had been previously vaccinated with PCV13 plus PPV23, theoretically, 50.8% of the cases of invasive pneumococcal disease that required hospital admission could potentially have been prevented. Invasive pneumococcal disease should be prevented by vaccination not only of children and the elderly but also of adults in their economically productive years, so as to reduce the socioeconomic costs, morbidity, and mortality still associated with the disease, especially in underdeveloped countries.


Keywords: Keywords: Pneumococcal infections; Serotyping; Tertiary care centers.


Pulmonary and extrapulmonary coccidioidomycosis: three cases in an endemic area in the state of Ceará, Brazil

Coccidioidomicose pulmonar e extrapulmonar: três casos em zona endêmica no interior do Ceará

Ricardo Hideo Togashi, Fernando Moreira Batista Aguiar, Dalton Barros Ferreira, Camille Matos de Moura, Monique Teixeira Montezuma Sales, Nikaelle Ximenes Rios

J Bras Pneumol.2009;35(3):275-279

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Coccidioidomycosis, a fungal illness acquired by the inhalation of arthroconidia of Coccidioides sp., was first described in 1894. Coccidioidomycosis is mainly restricted to areas with arid climate, alkaline soil and low rainfall. Consequently, most of the reported cases in Brazil have occurred in the northeastern region. We report three cases of pulmonary coccidioidomycosis occurring between 2005 and 2006 in an endemic area in the state of Ceará, Brazil. The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. All three patients presented pulmonary involvement, and one also presented cutaneous lesions. Chest X-rays and CT scans of the patients revealed characteristic coccidioidomycosis lesions. The diagnosis was confirmed by serological testing. All of the patients evolved to cure after antifungal treatment.


Keywords: Coccidioidomycosis; Lung diseases, fungal; Coccidioides.


Coccidioidomycosis: an unusual cause of acute respiratory distress syndrome

Coccidioidomicose: causa rara de síndrome do desconforto respiratório agudo

Kelson Nobre Veras, Bruno C. de Souza Figueirêdo, Liline Maria Soares Martins, Jayro T. Paiva Vasconcelos, Bodo Wanke

J Bras Pneumol.2003;29(1):45-48

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A male farmer, 20 years old, from the countryside of the State of Piauí, developed acute respiratory infection. Despite adequate antimicrobial therapy, there was worsening respiratory manifestations demanding mechanical ventilation. Radiographs showed diffuse pulmonary infiltrates. PaO2/FiO2 was 58. Direct microscopy and culture from tracheal aspirates disclosed Coccidioides immitis. Autochthonous cases of coccidioidomycosis have only recently been described in Brazil, most of them from the State of Piauí. C. immitis has been isolated from humans, dogs and armadillos (Dasypus novemcinctus), and also from soil samples of armadillo's burrows. Therapeutic failure to antimicrobials and patient's origin from recognized endemic areas should alert for the possibility of acute pulmonary coccidioidomycosis.


Lung-dominant connective tissue disease among patients with inter-stitial lung disease: prevalence, functional stability, and common extrathoracic features

Colagenose pulmão dominante em pacientes com doença pulmonar intersticial: prevalência, estabilidade funcional e manifestações extratorácicas comuns

Daniel Antunes Silva Pereira, Olívia Meira Dias, Guilherme Eler de Almeida, Mariana Sponholz Araujo, Letícia Barbosa Kawano-Dourado, Bruno Guedes Baldi, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2015;41(2):151-160

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Objective: To describe the characteristics of a cohort of patients with lung-dominant connective tissue disease (LD-CTD). Methods: This was a retrospective study of patients with interstitial lung disease (ILD), positive antinuclear antibody (ANA) results (≥ 1/320), with or without specific autoantibodies, and at least one clinical feature suggestive of connective tissue disease (CTD). Results: Of the 1,998 patients screened, 52 initially met the criteria for a diagnosis of LD-CTD: 37% were male; the mean age at diagnosis was 56 years; and the median follow-up period was 48 months. During follow-up, 8 patients met the criteria for a definitive diagnosis of a CTD. The remaining 44 patients comprised the LD-CTD group, in which the most prevalent extrathoracic features were arthralgia, gastroesophageal reflux disease, and Raynaud's phenomenon. The most prevalent autoantibodies in this group were ANA (89%) and anti-SSA (anti-Ro, 27%). The mean baseline and final FVC was 69.5% and 74.0% of the predicted values, respectively (p > 0.05). Nonspecific interstitial pneumonia and usual interstitial pneumonia patterns were found in 45% and 9% of HRCT scans, respectively; 36% of the scans were unclassifiable. A similar prevalence was noted in histological samples. Diffuse esophageal dilatation was identified in 52% of HRCT scans. Nailfold capillaroscopy was performed in 22 patients; 17 showed a scleroderma pattern. Conclusions: In our LD-CTD group, there was predominance of females and the patients showed mild spirometric abnormalities at diagnosis, with differing underlying ILD patterns that were mostly unclassifiable on HRCT and by histology. We found functional stability on follow-up. Esophageal dilatation on HRCT and scleroderma pattern on nailfold capillaroscopy were frequent findings and might come to serve as diagnostic criteria.


Keywords: Idiopathic interstitial pneumonias; Autoantibodies; Connective tissue diseases; Autoimmunity.


Pseudomonas aeruginosa colonization in the upper and lower airways of a child with cystic fibrosis: a father's meticulous approach to successful eradication

Colonização por Pseudomonas aeruginosa nas vias aéreas superiores e inferiores de uma criança com fibrose cística: abordagem meticulosa do pai para a erradicação bem-sucedida

Jochen Georg Mainz1,2,a, Michael Baier3,b, Anke Jaudszus1,2,c, Harold Tabori2,d, José Dirceu Ribeiro4,e, Michael Lorenz1,f

J Bras Pneumol.2019;45(6):e20190191-e20190191

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Comparison of two experimental models of pulmonary hypertension

Comparação de dois modelos experimentais de hipertensão pulmonar

Igor Bastos Polônio, Milena Marques Pagliarelli Acencio, Rogério Pazetti, Francine Maria de Almeida, Mauro Canzian, Bárbara Soares da Silva, Karina Aparecida Bonifácio Pereira, Rogério de Souza

J Bras Pneumol.2012;38(4):452-460

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Objective: To compare two models of pulmonary hypertension (monocrotaline and monocrotaline+pneumonectomy) regarding hemodynamic severity, structure of pulmonary arteries, inflammatory markers (IL-1 and PDGF), and 45-day survival. Methods: We used 80 Sprague-Dawley rats in two study protocols: structural analysis; and survival analysis. The rats were divided into four groups: control; monocrotaline (M), pneumonectomy (P), and monocrotaline+pneumonectomy (M+P). In the structural analysis protocol, 40 rats (10/group) were catheterized for the determination of hemodynamic variables, followed by euthanasia for the removal of heart and lung tissue. The right ventricle (RV) was dissected from the interventricular septum (IS), and the ratio between RV weight and the weight of the left ventricle (LV) plus IS (RV/LV+IS) was taken as the index of RV hypertrophy. In lung tissues, we performed histological analyses, as well as using ELISA to determine IL-1 and PDGF levels. In the survival protocol, 40 animals (10/group) were followed for 45 days. Results: The M and M+P rats developed pulmonary hypertension, whereas the control and P rats did not. The RV/LV+IS ratio was significantly higher in M+P rats than in M rats, as well as being significantly higher in M and M+P rats than in control and P rats. There were no significant differences between the M and M+P rats regarding the area of the medial layer of the pulmonary arteries; IL-1 and PDGF levels; or survival. Conclusions: On the basis of our results, we cannot conclude that the monocrotaline+pneumonectomy model is superior to the monocrotaline model.


Keywords: Monocrotaline; Hypertension, pulmonary; Pneumonectomy; Interleukin-1; Receptor, platelet-derived growth factor beta.


Comparison between PEF values obtained from a population sample in the city of São Carlos, Brazil, and reference values

Comparação de valores de PFE em uma amostra da população da cidade de São Carlos, São Paulo, com valores de referência

Cilso Dias Paes, Bruna Varanda Pessoa, Maurício Jamami, Valéria Amorim Pires Di Lorenzo, Kamilla Tays Marrara

J Bras Pneumol.2009;35(2):151-156

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Objective: To compare the reference values for PEF suggested by other authors in 1963, 1989 and 2001 (for populations in the USA, England and Cuba, respectively) with those obtained from a population sample in the city of São Carlos, Brazil, and to determine whether there is concordance among them. Methods: A total of 243 volunteers (123 females and 120 males; 20-70 years of age) participated in the study. The PEF measurements were performed with the volunteer standing, using a nose clip, by means of a portable peak flow meter. These measurements were compared with the reference values using the Friedman test and Dunn's post-hoc test (p < 0.05). Results: Significant differences were found in all age groups from both genders regarding the values predicted in 1989; the same occurred in the 20-30 and 31-40 age groups (both genders), as well as in the 61-70 age group (females only), regarding those predicted in 2001, as well as in the 20-30 age group (males only) regarding those predicted in 1963. Conclusions: The values predicted in 1963 are appropriate for a population of individuals with the same characteristics as the study sample, except for males in the 20-30 age group. Our study is relevant due to the fact that our sample was larger than that evaluated in the 1963 study. The majority of the values predicted in 1989 and 2001 overestimated the PEF values obtained in our study, proving to be inappropriate for the population studied.


Keywords: Reference values; Respiratory function tests; Airway obstruction; Peak expiratory flow rate.


Performance comparison between the mycobacteria growth indicator tube system and Löwenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial

Comparação do desempenho do sistema mycobacteria growth indicator tube e meio Löwenstein-Jensen na detecção de rotina de Mycobacterium tuberculosis em unidades do sistema único de saúde no Rio de Janeiro: resultados preliminares de um ensaio clínico pragmático

Adriana da Silva Rezende Moreira, Gisele Huf, Maria Armanda Vieira, Leila Fonseca, Monica Ricks, Afrânio Lineu Kritski

J Bras Pneumol.2013;39(3):365-367

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In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. ( Identifier: ISRCTN79888843 [])


Keywords: Controlled clinical trial; Tuberculosis; Diagnostic tests, routine.


Comparison of the effects that two different respiratory physical therapy techniques have on cardiorespiratory parameters in infants with acute viral bronchiolitis

Comparação dos efeitos de duas técnicas fisioterapêuticas respiratórias em parâmetros cardiorrespiratórios de lactentes com bronquiolite viral aguda

Melissa Karina Pupin, Adriana Gut Lopes Riccetto, José Dirceu Ribeiro, Emílio Carlos Elias Baracat

J Bras Pneumol.2009;35(9):860-867

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Objective: To compare the expiratory flow increase technique (EFIT) and vibration accompanied by postural drainage (PD) in terms of their effects on the heart rate (HR), respiratory rate (RR) and SpO2 of infants with acute viral bronchiolitis (AVB). Methods: Infants with clinical and radiological diagnosis of AVB were analyzed. The HR, RR and SpO2 were registered at four time points: prior to the procedure; and at 10, 30 and 60 min after the procedure. The patients were divided into three groups: submitted to the EFIT; submitted to vibration/PD; and control. Results: We included 81 infants, 27 per group, with a mean age of 4.52 years and a mean weight of 6.56 kg. Using ANOVA, we found that the EFIT and vibration/PD groups presented no significant differences in relation to the control group in terms of the mean values for HR, RR or SpO2 (p > 0.05). Considering only the four time points evaluated, the mean RR was significantly lower in the EFIT and vibration/PD groups than in the control group (p < 0.05). Conclusions: In terms of overall improvement of cardiorespiratory parameters, neither the EFIT nor vibration/PD provided any benefit to infants with BVA. However, over time, respiratory physical therapy seems to contribute to decreasing the RR in these patients.


Keywords: Bronchiolitis, viral; Physical therapy modalities; Infant.


Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function

Comparação entre duas técnicas de fechamento de toracotomia: dor pós-operatória e função pulmonar

Juliana Duarte Leandro, Olavo Ribeiro Rodrigues, Annie France Frere Slaets, Aurelino F. Schmidt Jr, Milton L. Yaekashi

J Bras Pneumol.2014;40(4):389-396

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Objective: To compare two thoracotomy closure techniques (pericostal and transcostal suture) in terms of postoperative pain and pulmonary function. Methods: This was a prospective, randomized, double-blind study carried out in the Department of Thoracic Surgery of the Luzia de Pinho Melo Hospital das Clínicas and at the University of Mogi das Cruzes, both located in the city of Mogi das Cruzes, Brazil. We included 30 patients (18-75 years of age) undergoing posterolateral or anterolateral thoracotomy. The patients were randomized into two groups by the type of thoracotomy closure: pericostal suture (PS; n = 16) and transcostal suture (TS; n = 14). Pain intensity during the immediate and late postoperative periods was assessed by a visual analogic scale and the McGill Pain Questionnaire. Spirometry variables (FEV1, FVC, FEV1/FVC ratio, and PEF) were determined in the preoperative period and on postoperative days 21 and 60. Results: Pain intensity was significantly greater in the PS group than in the TS group. Between the preoperative and postoperative periods, there were decreases in the spirometry variables studied. Those decreases were significant in the PS group but not in the TS group. Conclusions: The patients in the TS group experienced less immediate and late post-thoracotomy pain than did those in the PS group, as well as showing smaller reductions in the spirometry parameters. Therefore, transcostal suture is recommended over pericostal suture as the thoracotomy closure technique of choice.


Keywords: Thoracic surgery; Suture techniques; Acute pain.


Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth?

Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?

Rafael Stelmach, Frederico Leon Arrabal Fernandes, Regina Maria Carvalho-Pinto, Rodrigo Abensur Athanazio, Samia Zahi Rached, Gustavo Faibischew Prado, Alberto Cukier

J Bras Pneumol.2015;41(2):124-132

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Objective: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. Methods: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. Results: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. Conclusions: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.


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


Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study

Comparação entre os resultados de espirometria após tratamento para tuberculose pulmonar em pacientes com e sem doença pulmonar prévia: um estudo multicêntrico

Eliane Viana Mancuzo1,2, Eduardo Martins Netto3,4, Nara Sulmonett2, Vanessa de Souza Viana5, Júlio Croda6, Afranio Lineu Kritski7,8, Fernanda Carvalho de Queiroz Mello7,9, Simone de Souza Elias Nihues10, Karen Rosas Sodre Azevedo11, Silvana Spíndola de Miranda1,8,12

J Bras Pneumol.2020;46(2):e20180198-e20180198

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Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.


Keywords: Tuberculosis, pulmonary; Respiratory function tests; Airway obstruction/complications.


Comparison between the theoretical values for spirometric data in children determined by Mallozi's and Polgar's equations

Comparação entre os valores teóricos para alguns dados espirométricos em crianças determinados pelas equações de Mallozi e de Polgar

Waldemar Ladosky, Rogerson T. Andrade, Noel Guedes Loureiro, Marcos Alberto Machado Botelho

J Bras Pneumol.2002;28(3):125-130

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Objective: This paper is a continuation of the study on the validity of equations of predicted value (PV) for the Brazilian population. A comparison was made between the equations proposed by Mallozi and by Polgar for the Brazilian population, which are mainly used in the United States and Europe. Methods: PVs of 185 patients of both sexes (89 boys and 96 girls), ages between 6 and 17 years, were analyzed. For each subject, the PVs for forced vital capacity (FVC), forced expiratory volume at 1 sec. (FEV1), and the medium expiratory flow (MEF) were calculated according to the equations proposed by Mallozi and Polgar. Results were compared. Diagnoses were made according to the Brazilian Consensus of Spirometry. Results: The PV-M for FVC is 0.38% higher for boys and 2.19% higher for girls than that determined by Polgar. The PV-P for FEV1 is 6.67% (p < 0.05) lower for girls, suggesting an underassessment of the obstructive impairment. For boys, a mean lower value of 7.26% as compared to the VT-M is at the limit of significance (0.05 < p < 0.01). No significant difference between the two equations analyzed was found for MEF. Conclusions: The PVs for CVF and VEF1 for Brazilian children, according to Mallozzi, are significantly different when compared to those published by authors like Polgar. As a result, the authors found that Mallozzi's equations are more likely to detect obstructive impairment and less likely to diagnose restrictive ventilatory insufficiency.


Keywords: Spirometry. Vital capacity. Forced expiratory volume. Maximal medium expiratory flow rate. Case-control studies


Comparing reference spirometric values obtained from Knudson and Pereira equations - Adults

Comparação entre valores espirométricos de referência obtidos a partir das equações de Knudson e de Pereira - Adultos

Waldemar Ladosky, Rogerson T. Andrade, Noel Guedes Loureiro, Jesus M.B. Gandar, Marcos M. Botelho

J Bras Pneumol.2001;27(6):315-320

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In its 1991revision, the American Thorax Society (ATS) recommended that each region should define its own equations to determine the theoretical, or predicted values of the spirometric parameters that best represent the pulmonary functional reality of the local population. At that time, the United States already had various equations of its own as well as the European Community, specially Poland. In 1992, Pereira et al., analysing 4,200 spirograms on healthy Brazilians, found predicted values (PV) of forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1) and middle expiratory flow (MEF) different from those reported by American and European authors. The purpose of the present study was to compare the equations developed by Pereira et al., using a Brazilian sample population, with those determined by Knudson et al. for American populations, that are the most used by Brazilian specialists. This study included 1,070 spirograms performed in patients of both genders (389 males and 681 females) who came to our service for routine functional assessment. No pathology was excluded and the smoking status of the patients was not taken into account. For each patient the PV of FVC, FEV1 and MEF were calculated accordingly to the equations of Pereira et al. (PV-P) and Knudsen et al. (PV-K). Subsequently, the means, standard deviations and reports obtained by both methods were compared. Among females, the PV-K of FVC were 4,01% (p < 0.005) greater, leading to a higher rate of restrictive impairment whereas among males there was no significant difference. Regarding FEV1, PV-P were higher in both males (4.76%; p < 0.005) and females (5.04%; p < 0.05) resulting in a greater sensitivity in the identification of respiratory obstructions. No significant difference was observed between PV-P and PV-K as to FEF25-75 regardless of gender.


Keywords: Spirometry. Reference values. Forced expiratory flow rates.


Completeness of tuberculosis reporting forms in five Brazilian capitals with a high incidence of the disease

Completude das fichas de notificações de tuberculose em cinco capitais do Brasil com elevada incidência da doença

Normeide Pedreira dos Santos, Monique Lírio, Louran Andrade Reis Passos, Juarez Pereira Dias, Afrânio Lineu Kritski, Bernardo Galvão-Castro, Maria Fernanda Rios Grassi

J Bras Pneumol.2013;39(2):221-225

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The aim of this study was to evaluate the completeness of tuberculosis reporting forms in the greater metropolitan areas of five Brazilian capitals where the incidence of tuberculosis was high in 2010-Salvador, Rio de Janeiro, Cuiabß, Porto Alegre, and BelÚm-using tabulations obtained from the Sistema Nacional de InformaþÒo de Agravos de NotificaþÒo (National Case Registry Database). The degree of completeness was highest in Porto Alegre and Cuiabß, whereas it was lowest in Rio de Janeiro, where there are more reported cases of tuberculosis than in any other Brazilian capital. A low degree of completeness of these forms can affect the quality of the Brazilian National Tuberculosis Control Program, which will have negative consequences for health care and decision-making processes.


Keywords: Tuberculosis; Public health surveillance; Disease notification.


Complexity of autonomic nervous system function in individuals with COPD

Complexidade do sistema nervoso autônomo em indivíduos com DPOC

Laís Manata Vanzella1,f, Aline Fernanda Barbosa Bernardo1,d, Tatiana Dias de Carvalho3,e, Franciele Marques Vanderlei2,a, Anne Kastelianne França da Silva1,c, Luiz Carlos Marques Vanderlei2,b

J Bras Pneumol.2018;44(1):24-30

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Objective: To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. Methods: We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. Results: In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. Conclusions: Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.


Keywords: Pulmonary disease, chronic obstructive; Autonomic nervous system; Nonlinear dynamics; Recurrence; Heart rate; Sympathetic nervous system.


Complicações cardiovasculares da síndrome da apnéia do sono obstrutiva

Lia Rita Azeredo Bittencourt, Odair Marson, Luiz E. Nery, Sérgio Tufik

J Bras Pneumol.1998;24(5):311-316


Dynamic hyperinflation during treadmill exercise testing in patients with moderate to severe COPD

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

Priscila Kessar Cordoni, Danilo Cortozi Berton, Selma Denis Squassoni, Maria Enedina Aquino Scuarcialupi, José Alberto Neder, Elie Fiss

J Bras Pneumol.2012;38(1):13-23

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Objective: To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. Methods: This was a cross-sectional study involving 30 non-hypoxemic patients (FEV1= 43 ± 14% of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80% of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (IC) maneuvers were used in order to assess DH. Results: Of the 30 patients studied, 19 (63.3%) presented with DH (DH+ group), having greater pulmonary function impairment at rest than did those without DH (DH− group). None of the variables studied correlated with exercise tolerance in the DH− group, whereas Tlim, IC, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (ΔICTlim,2min = −0.28 ± 0.11 L vs. 0.04 ± 0.10 L; p < 0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 ± 118 s and 465 ± 178 s, respectively; p < 0.05). Conclusions: The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.


Keywords: Pulmonary disease, chronic obstructive; Exercise; Exercise test; Inspiratory capacity.


Impaired pulmonary function after treatment for tuberculosis: the end of the disease?

Comprometimento da função pulmonar após tratamento para tuberculose: o resultado final da doença?

Mikhail Ivanovich Chushkin1,2, Oleg Nikolayevich Ots1

J Bras Pneumol.2017;43(1):38-43

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Objective: To evaluate the prevalence of pulmonary function abnormalities and to investigate the factors affecting lung function in patients treated for pulmonary tuberculosis. Methods: A total of 214 consecutive patients (132 men and 82 women; 20-82 years of age), treated for pulmonary tuberculosis and followed at a local dispensary, underwent spirometry and plethysmography at least one year after treatment. Results: Pulmonary impairment was present in 102 (47.7%) of the 214 patients evaluated. The most common functional alteration was obstructive lung disease (seen in 34.6%). Of the 214 patients, 60 (28.0%) showed reduced pulmonary function (FEV1 below the lower limit of normal). Risk factors for reduced pulmonary function were having had culture-positive pulmonary tuberculosis in the past, being over 50 years of age, having recurrent tuberculosis, and having a lower level of education. Conclusions: Nearly half of all tuberculosis patients evolve to impaired pulmonary function. That underscores the need for pulmonary function testing after the end of treatment.


Keywords: Respiratory function tests; Tuberculosis, pulmonary; Spirometry; Lung diseases, obstructive.


Pulmonary involvement in Crohn's disease

Comprometimento pulmonar na doença de Crohn

Rodolfo Augusto Bacelar de Athayde1,a, Felipe Marques da Costa1,b, Ellen Caroline Toledo do Nascimento2,c, Roberta Karla Barbosa de Sales1,d, Andre Nathan Costa1,e

J Bras Pneumol.2018;44(6):519-521

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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

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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.


Concordance between clinical and pathological staging in patients with stages I or II non-small cell lung cancer subjected to surgical treatment

Concordância entre os estadiamentos clínico e patológico em pacientes com câncer de pulmão não-pequenas células, estádios I e II, submetidos a tratamento cirúrgico

Pedro Augusto Reck dos Santos, Rodrigo Sponchiado da Rocha, Maurício Pipkin, Marner Lopes da Silveira, Marcelo Cypel, Jayme Oliveira Rios, José Antonio Lopes de Figueiredo Pinto

J Bras Pneumol.2007;33(6):647-654

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Objective: To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. Methods: Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. Results: Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. Conclusions: The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.


Keywords: Neoplasm staging; Lung neoplasms/diagnosis; Lung neoplasms/surgery; Prognosis.


Sternal chondrosarcoma

Condrossarcoma de esterno

Nelson Perelman Rosenberg, Ivo Leuck Jr., Celso Schuler, Fernando Delgiovo, Eduardo Spadari de Araújo, Paula Vasconcelos Martini

J Bras Pneumol.2003;29(1):43-44

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Sternal neoplasms are very uncommon. The lack of consistent reports in the literature renders it difficult to make prospective evaluations. The authors report the case of a seventy-year old woman who presented with a chondrosarcoma of the sternum, treated at their service.


Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis

Conhecimento e percepção de médicos e enfermeiros em três capitais brasileiras com alta incidência de tuberculose a respeito da transmissão e prevenção da doença

Jonas Ramos1,a, Maria F Wakoff-Pereira1,b, Marcelo Cordeiro-Santos2,3,c, Maria de Fátima Militão de Albuquerque4,d, Philip C Hill5,e, Dick Menzies6,f, Anete Trajman,6,7,g

J Bras Pneumol.2018;44(2):168-170

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Knowledge of and practices related to smoking cessation among physicians in Nigeria

Conhecimento e práticas para a cessação do tabagismo entre médicos nigerianos

Olufemi Olumuyiwa Desalu, Adebowale Olayinka Adekoya, Adetokunbo Olujimi Elegbede, Adeolu Dosunmu, Tolutope Fasanmi Kolawole, Kelechukwu Chukwudi Nwogu

J Bras Pneumol.2009;35(12):-

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Objective: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. Methods: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. Results: Of the 436 physicians, 292 (67.0%) were aware of smoking cessation, but only 132 (30.3%) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7%. In addition, 308 physicians (70.6%) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2%) asked their patients whether they smoked, and 172 (39.4%) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5%) used brief advice/counseling (2-5 min), 12 (3.7%) prescribed antidepressants, 16 (2.8%) prescribed nicotine replacement therapy (NRT), and 76 (17.4%) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3%) cited poor knowledge of the issue, 55 (12.6%) cited a lack of time, and 20 (4.6%) cited unavailability of NRT. Conclusions: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.


Keywords: Smoking cessation; Tobacco; Physicians; Nigeria; Health knowledge, attitudes, practice.


Role of the open lung biopsy in the evaluation of undiagnosed acute lung disease in a pediatric intensive care unit

Contribuição da biópsia pulmonar a céu aberto na avaliação de pneumopatias difusas e agudas em unidade de terapia intensiva pediátrica

Albert Bousso, Evandro Roberto Baldacci, José Carlos Fernandes, Iracema de Cássia Oliveira Fernandes, Andréa Maria Gomes Cordeiro, José Pinhata Otoch, Bernardo Ejzenberg, Yassuhiko Okay

J Bras Pneumol.2002;28(1):30-40

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Introduction: The diagnosis of diffuse lung disease is still a challenge for the pediatric intensive care physician. Routine clinical examinations and laboratory tests are frequently negative. The objective of this study was to evaluate the diagnostic potential, the impact on therapy and the rate of complications of open lung biopsy in children with undiagnosed diffuse lung disease, respiratory failure and inappropriate response to initial therapy. Methods: From January 1987 to January 1997, 29 children with diffuse pulmonary disease of unknown etiology, respiratory failure (PaO2 /FiO2 < 300) and no response to previous treatments were considered for open lung biopsy. Newborns, children with known chronic pulmonary disease and children with untreatable shock or coagulopathy were excluded. All biopsies were performed by a thoracic surgeon by a microthoracotomy in the lung shown to be the most affected by X-ray examination. Tissue samples were analyzed in terms of cultures, light microscopy, electron microscopy and immunofluorescence microscopy, according to the pathologist's decision. Results: All biopsies (100%) resulted in at least one histological diagnosis and in 20 patients (68.9%) it was obtained a specific diagnosis. The most frequent histological patterns found were: non-specific interstitial pneumonitis with variable degrees of fibrosis in 18 cases; bronchiolitis in eight cases and pulmonary hypertension in three cases. Regarding the most frequent specific diagnosis, six children were found with cytomegalovirus infection, three with Pneumocystis carinii, three with adenovirus and three with respiratory syncytial virus infection. These data induced a change in therapy in 20 children (68.9%). The most frequent changes in therapy were the use of corticosteroids in 14 children and a review of the antibiotic regimen in six patients. Seven patients (24.1%) presented with complications that were easily resolved. There were 13 deaths, probably due to the critical conditions of these patients, all unrelated to the procedure. Conclusions: Open lung biopsy, though an invasive procedure, should be considered in the evaluation of selected children with undiagnosed diffuse lung disease, respiratory failure and with no satisfactory response to previous therapies.


Environmental control in asthma - to recommend or not recommend: that is the question!

Controle ambiental na asma: recomendar ou não recomendar, eis a questão!

Luisa Karla Arruda

J Bras Pneumol.2005;31(1):-

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Core biopsy; tru-cut biopsy, lance biopsy or punch biopsy with a tissue-cutting needle (punch cutting - PCut)?

Core biópsia; Tru-cut biópsia, punção lancetante ou biópsia por punção com agulha fragmentante tecidual (punção fragmentante - PFrag)?

Klaus Loureiro Irion, Bruno Hochhegger, Luciane Dreher Irion

J Bras Pneumol.2006;32(5):488-

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

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

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

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

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


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


Psychological criteria for contraindication in lung transplant candidates: a five-year study

Critérios psicológicos para contraindicação em candidatos a transplante pulmonar: um estudo de cinco anos

Elaine Marques Hojaij1, Bellkiss Wilma Romano1, André Nathan Costa2, Jose Eduardo Afonso Junior3, Priscila Cilene Leon Bueno de Camargo3, Rafael Medeiros Carraro3, Silvia Vidal Campos4, Marcos Naoyuki Samano5, Ricardo Henrique de Oliveira Braga Teixeira6

J Bras Pneumol.2015;41(3):246-249

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Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.


Keywords: Lung transplantation; Interview, psychological; Psychological tests; Preoperative care.


Oxidative damage induced by cigarette smoke exposure in mice: impact on lung tissue and dia-phragm muscle

Dano oxidativo induzido por exposição a fumaça de cigarro em camundongos: impacto sobre o pulmão e o músculo diafragma

Samanta Portão de Carlos, Alexandre Simões Dias, Luiz Alberto Forgiarini Júnior, Patrícia Damiani Patricio, Thaise Graciano, Renata Tiscoski Nesi, Samuel Valença, Adriana Meira Guntzel Chiappa, Gerson Cipriano Jr, Claudio Teodoro de Souza, Gaspar Rogério da Silva Chiappa

J Bras Pneumol.2014;40(4):411-420

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Objetivo: Avaliar o dano oxidativo (oxidação lipídica, oxidação proteica, thiobarbituric acid-reactive substances [TBARS, substâncias reativas ao ácido tiobarbitúrico], e carbonilação) e inflamação (expressão de phosphorylated AMP-activated protein kinase e de phosphorylated mammalian target of rapamycin (p-AMPK e p-mTOR, respectivamente) em tecido pulmonar e músculos do diafragma em camundongos C57BL/6 machos expostos à fumaça de cigarro (FC) por 7, 15, 30, 45 ou 60 dias. Métodos: Trinta e seis camundongos machos da espécie C57BL/6 foram divididos em seis grupos (n = 6/grupo): grupo controle e 5 grupos expostos a FC por 7, 15, 30, 45 e 60 dias, respectivamente. Resultados: Comparados aos camundongos controle, os camundongos expostos à FC apresentaram menor peso corporal em 30 dias. Nos camundongos expostos à FC (comparados aos controle) as maiores diferenças (aumentos) nos níveis de TBARS foram observados no dia 7 no músculo diafragma, comparado ao dia 45 em tecido pulmonar; as maiores diferenças (aumentos) nos níveis de carbonilas foram observados no dia 7 em ambos os tipos de tecido; e os níveis de sulfidrilas foram menores, nos dois tipos de tecidos, em todos os tempos. No tecido pulmonar e no músculo diafragma, a expressão de p-AMPK exibiu um comportamento semelhante ao dos níveis de TBARS. A expressão de p-mTOR foi maior que o valor controle nos dias 7 e 15 no tecido pulmonar, assim como no dia 45 no músculo diafragma. Conclusões: Nossos dados demonstram que a exposição à FC produz dano oxidativo tanto no tecido pulmonar quanto (primariamente) no tecido muscular, tendo um efeito adicional no músculo respiratório, como é frequentemente observado em fumantes com DPOC.


Keywords: Oxidative stress; Mice; Respiratory system; Smoking; Inflammation.


Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments

De volta para o futuro: série de casos de reparo minimamente invasivo do pectus excavatum com instrumentos comuns

Miguel Lia Tedde1,a, Silvia Yukari Togoro1,b, Robert Stephen Eisinger2,c, Erica Mie Okumura1,d, Angelo Fernandes1,e, Paulo Manuel Pêgo-Fernandes1,f, Jose Ribas Milanez de Campos1,g

J Bras Pneumol.2019;45(1):e20170373-e20170373

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Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.


Keywords: Funnel chest; Heart injuries; Thoracic wall; Intraoperative complications; Minimally invasive surgical procedures.


Alpha-1 antitrypsin deficiency: diagnosis and treatment

Deficiência de alfa-1 antitripsina: diagnóstico e tratamento

Aquiles A Camelier, Daniel Hugo Winter, José Roberto Jardim, Carlos Eduardo Galvão Barboza, Alberto Cukier, Marc Miravitlles

J Bras Pneumol.2008;34(7):514-527

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Alpha-1 antitrypsin deficiency is a recently identified genetic disease that occurs almost as frequently as cystic fibrosis. It is caused by various mutations in the SERPINA1 gene, and has numerous clinical implications. Alpha-1 antitrypsin is mainly produced in the liver and acts as an antiprotease. Its principal function is to inactivate neutrophil elastase, preventing tissue damage. The mutation most commonly associated with the clinical disease is the Z allele, which causes polymerization and accumulation within hepatocytes. The accumulation of and the consequent reduction in the serum levels of alpha-1 antitrypsin cause, respectively, liver and lung disease, the latter occurring mainly as early emphysema, predominantly in the lung bases. Diagnosis involves detection of low serum levels of alpha-1 antitrypsin as well as phenotypic confirmation. In addition to the standard treatment of chronic obstructive pulmonary disease, specific therapy consisting of infusion of purified alpha-1 antitrypsin is currently available. The clinical efficacy of this therapy, which appears to be safe, has yet to be definitively established, and its cost-effectiveness is also a controversial issue that is rarely addressed. Despite its importance, in Brazil, there are no epidemiological data on the prevalence of the disease or the frequency of occurrence of deficiency alleles. Underdiagnosis has also been a significant limitation to the study of the disease as well as to appropriate treatment of patients. It is hoped that the creation of the Alpha One International Registry will resolve these and other important issues.


Keywords: alpha 1-antitrypsin; Emphysema; Pulmonary disease, chronic obstructive.


CT densitovolumetry in children with obliterative bronchiolitis: correlation with clinical scores and pulmonary function test results

Densitovolumetria pulmonar por TC em crianças com bronquiolite obliterante: correlação com escores clínicos e testes de função pulmonar

Helena Mocelin, Gilberto Bueno, Klaus Irion, Edson Marchiori, Edgar Sarria, Guilherme Watte, Bruno Hochhegger

J Bras Pneumol.2013;39(6):701-710

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Objective: To determine whether air trapping (expressed as the percentage of air trapping relative to total lung volume [AT%]) correlates with clinical and functional parameters in children with obliterative bronchiolitis (OB). Methods: CT scans of 19 children with OB were post-processed for AT% quantification with the use of a fixed threshold of −950 HU (AT%950) and of thresholds selected with the aid of density masks (AT%DM). Patients were divided into three groups by AT% severity. We examined AT% correlations with oxygen saturation (SO2) at rest, six-minute walk distance (6MWD), minimum SO2 during the six-minute walk test (6MWT_SO2), FVC, FEV1, FEV1/FVC, and clinical parameters. Results: The 6MWD was longer in the patients with larger normal lung volumes (r = 0.53). We found that AT%950 showed significant correlations (before and after the exclusion of outliers, respectively) with the clinical score (r = 0.72; 0.80), FVC (r = 0.24; 0.59), FEV1 (r = −0.58; −0.67), and FEV1/FVC (r = −0.53; r = −0.62), as did AT%DM with the clinical score (r = 0.58; r = 0.63), SO2 at rest (r = −0.40; r = −0.61), 6MWT_SO2 (r = −0.24; r = −0.55), FVC (r = −0.44; r = −0.80), FEV1 (r = −0.65; r = −0.71), and FEV1/FVC (r = −0.41; r = −0.52). Conclusions: Our results show that AT% correlates significantly with clinical scores and pulmonary function test results in children with OB.


Keywords: Multidetector computed tomography; Respiratory function tests; Bronchiolitis obliterans.


Noncompliance with the law prohibiting the sale of cigarettes to minors in Brazil: an inconvenient truth

Descumprimento da lei que proíbe a venda de cigarros para menores de idade no Brasil: uma verdade inconveniente

André Salem Szklo1,a,Tânia Maria Cavalcante2,b

J Bras Pneumol.2018;44(5):398-404

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Objective: To draw up an up-to-date scenario of compliance with the law prohibiting the sale of cigarettes to minors. Methods: We used data about youth access to cigarette purchase that were obtained through a nationwide survey conducted in 2015 among students aged 13-17 years. We estimated simple proportions of attempts to buy cigarettes, success of attempts, purchase of cigarettes on a regular basis, and purchase of cigarettes on a regular basis in a store or bar. All estimates were stratified by gender, age group, and Brazilian macro-region. Crude absolute difference and adjusted absolute difference in the proportion of smokers in each category by variable of interest were analyzed by a generalized linear model with binomial distribution and identity link function. Results: Approximately 7 in every 10 adolescent smokers attempted to buy cigarettes at least once in the 30 days prior to the survey. Of those, approximately 9 in every 10 were successful, and individuals aged 16-17 years (vs. those aged 13-15 years) were less often prevented from buying cigarettes (adjusted absolute difference, 8.1%; p ≤ 0.05). Approximately 45% of all smokers aged 13-17 years in Brazil reported buying their own cigarettes on a regular basis without being prevented from doing so, and, of those, 80% reported buying them in a store or bar (vs. from a street vendor). Conclusions: Our findings raise an important public health concern and may contribute to supporting educational and surveillance measures to enforce compliance with existing anti-tobacco laws in Brazil, which have been disregarded.


Keywords: Smoking/epidemiology; Smoking/legislation & jurisprudence; Adolescent behavior; Public health.


Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation

Desempenho ao exercício e diferenças na resposta fisiológica à reabilitação pulmonar em doença pulmonar obstrutiva crônica grave com hiperinsuflação

Andre Luis Pereira de Albuquerque1, Marco Quaranta2, Biswajit Chakrabarti3, Andrea Aliverti2, Peter M. Calverley3

J Bras Pneumol.2016;42(2):121-129

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Objective: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. Methods: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV1 = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. Results: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO2), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO2 during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. Conclusions: In severe COPD, PR appears to improve oxygen consumption and reduce VCO2, with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program.


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise therapy; Respiratory therapy.


Performance of nested PCR in the specific detection of Mycobacterium tuberculosis complex in blood samples of pediatric patients

Desempenho da técnica nested PCR na detecção específica do complexo Mycobacterium tuberculosis em amostras sanguíneas de pacientes pediátricos

Juliana Figueirêdo da Costa Lima, Lílian Maria Lapa Montenegro, Rosana de Albuquerque Montenegro, Marta Maciel Lyra Cabral, Andrea Santos Lima, Frederico Guilherme Coutinho Abath (in memoriam), Haiana Charifker Schindler

J Bras Pneumol.2009;35(7):690-697

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Objective: To evaluate the performance of nested PCR (nPCR) in detecting the Mycobacterium tuberculosis complex in blood samples of patients suspected of having TB, in order to determine its potential for use as an auxiliary tool in the laboratory diagnosis of TB in children. Methods: Detection of the M. tuberculosis complex in blood samples using as a target the insertion sequence IS6110 of the genomic DNA of the bacillus. Blood samples of 120 patients were evaluated. All of the patients were under 15 years of age at the time of their treatment at public hospitals in the city of Recife, Brazil (between January of 2003 and August of 2005). Attending physicians at the hospitals diagnosed TB based on the criteria recommended by the American Thoracic Society. The nPCR amplified a 123-bp fragment with outer oligonucleotides (IS1/IS2) and, in the subsequent reaction, using inner oligonucleotides (IS3/IS4), generating an 81-bp amplicon. Results: Active or latent TB was found in 65 patients, TB was ruled out in 28 suspected cases, and 27 patients were TB-free (controls). The sensitivity of nPCR was 26.15% and was significantly higher for the extrapulmonary form of the disease (55.56%) than for the pulmonary form (18.18%). The specificity was 92.73%. Conclusions: Despite the difficulties in diagnosing TB in children and the low number of cases evaluated in the present study, nPCR in blood samples proved to be a rapid and specific technique, albeit one with low sensitivity. In order to establish its true usefulness in the diagnosis of paucibacillary forms, especially extrapulmonary TB, further studies need to be carried out with a larger sample of children and analyzing biological specimens other than blood.


Keywords: Tuberculosis; Diagnosis; Blood; Polymerase chain reaction.


Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing

Desempenho de testes para o diagnóstico de tuberculose pulmonar em populações indígenas no Brasil: a contribuição do Teste Rápido Molecular

Jocieli Malacarne1,a, Alexsandro Santos Heirich2,b, Eunice Atsuko Totumi Cunha3,c, Ida Viktoria Kolte4,d, Reinaldo Souza-Santos4,e, Paulo Cesar Basta4,f

J Bras Pneumol.2019;45(2):e20180185-e20180185

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Objective: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. Methods: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). Results: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. Conclusions: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.


Keywords: Tuberculosis; Molecular diagnostic testing; Diagnostic tests, routine; Indians, South American.


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

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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.


Performance of ICU ventilators during noninvasive ventilation with large leaks in a total face mask: a bench study

Desempenho de ventiladores de UTI durante ventilação não invasiva com grandes vazamentos em máscara facial total: estudo em simulador mecânico

Maria Aparecida Miyuki Nakamura, Eduardo Leite Vieira Costa, Carlos Roberto Ribeiro Carvalho, Mauro Roberto Tucci

J Bras Pneumol.2014;40(3):294-303

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Objective: Discomfort and noncompliance with noninvasive ventilation (NIV) interfaces are obstacles to NIV success. Total face masks (TFMs) are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM. Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP) levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization. Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly. Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM.


Keywords: Ventilators, mechanical; Positive-pressure Respiration; Noninvasive ventilation; Equipment safety; Equipment failure; Masks.


Development of a modified Dumon stent for tracheal applications: an experimental study in dogs

Desenvolvimento de uma órtese de Dumon modificada para aplicações traqueais: um estudo experimental em cães

Rogério Gastal Xavier, Paulo Roberto Stefani Sanches, Amarilio Viera de Macedo Neto, Gabriel Kuhl, Samanta Bianchi Vearick, Marcelo Dall'Onder Michelon

J Bras Pneumol.2008;34(1):21-26

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Objective: To describe the development of a silicone stent and perform in vivo testing for biocompatibility/applicability in the normal canine trachea. Methods: Four different densities were tested in order to obtain the silicone prototypes. The pressure required for compression considering a contact area of 1 cm2, and a 30% reduction in diameter was calculated for each density. The best density was 70-75 Shore A hardness. Powdered barium sulfate was added to the silicone to make the stent radiopaque and easily identifiable in radiological imaging. This novel stent presents a corrugated external surface with discontinuous and protruding arcs resembling the tracheobronchial rings (for intercalation and fixation in the lumen of the lower airways), a highly polished inner surface and smooth extremities (to prevent friction-related damage). The prototype considered most appropriate in terms of rigidity and flexibility was bronchoscopically implanted in normal canine tracheas. After eight weeks, the animals were euthanized, and the tracheas were removed for anatomopathological analysis. Results: There were no postimplantation complications, and none had to be removed. After eight weeks, the devices were found to be well-positioned. Histopathology revealed a well-preserved epithelial basal membrane, foci of denuded epithelium, mild submucosal inflammatory infiltrate with scattered granulation tissue, vascular neoformation, and no microorganisms. Conclusions: The stent developed proved resistant to mechanical stress, biocompatible in the canine trachea and well-preserved at the study endpoint.


Keywords: Implants, experimental; Silicones; Biocompatible materials.


Weaning from mechanical ventilation: comparison of three methods

Desmame da ventilação mecânica: comparação de três métodos

José Raimundo A. de Azevedo, Cecilma Miranda de S. Teixeira, Kivania Carla Pessoa

J Bras Pneumol.1998;24(3):119-124

Abstract PDF PT

Studies published by Brochard et al. and by Esteban et al. came to different conclusions about the best technique of weaning from mechanical ventilation. Although the association of synchronized intermittent mandatory ventilation (SIMV) with pressure support ventilation (PSV) is frequently used and considered as a physiologic form of weaning, no prospective randomized study compared this technique to synchronized intermittent mandatory ventilation or to pressure support ventilation used singly. The authors compared these three weaning methods to determine the one that is associated with the shortest weaning time and the smallest frequency of unfavorable outcome. Methods: The authors analyzed prospectively 72 consecutive patients submitted to mechanical ventilation for at least 24 hours and that had clinical, gasometric, and respiratory criteria for weaning. The patients were randomized in three groups (SIMV, PSV, SIMV+PSV). Stringent criteria were used in the application of each technique to define success or failure of the procedure. Results: The groups (SIMV = 21, PSV = 25 and SIMV+PSV = 26 patients) were similar with respect to age, score APACHE III and diseases. Mean duration of weaning was 1.7 ± 1.2 days with SIMV, 2.5 ± 1.6 days with PSV, and 2.1 ± 1.5 days with SIMV+PSV. Four (19.0 %) patients failled to wean in the SIMV group, nine (36.0%) in PSV and two (7.7%) in SIMV+PSV. Conclusions: This study shows a good performance of SIMV+PSV for weaning patients from mechanical ventilation and unfavorable results with support ventilation that can not be attributed to homogeneity between the groups, nor to the methodologies or equipments used.


Keywords: Weaning. Synchronized intermittent mandatory ventilation. Pressure support ventilation.


Maternal malnutrition during lactation in Wistar rats: effects on elastic fibers of the extracellular matrix in the trachea of offspring

Desnutrição materna durante a lactação em ratos Wistar: efeitos sobre as fibras elásticas da matriz extracelular na traqueia dos filhotes

Filipe Moreira de Andrade, Luiz Felippe Judice, Gilberto Perez Cardoso, Rafael Cisne, Cristiane da Fonte Ramos, Marcio Antonio Babinski

J Bras Pneumol.2012;38(5):588-594

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Objective: To investigate the effects of maternal protein malnutrition during lactation on the elastic fibers in the tracheas of Wistar rat pups. Methods: At delivery, 12 male pups of two Wistar rat dams were equally divided into two groups: control, in which the dam received water and standard rat chow ad libitum during lactation; and protein-restricted (PR), in which the dam received water ad libitum and an isoenergetic PR diet (8% protein). At 21 days of age, the pups were killed and their tracheas were excised. The elastic fibers were stained with Weigert's resorcin-fuchsin (after oxidation) and evaluated under light microscopy. Morphometric determinations were performed by stereology, with the point-counting method, and expressed as volumetric densities. Results: Elastic fibers, most having a longitudinal distribution, were identified beneath the tracheal mucosa. In addition, well-defined circular layers of elastic fibers were found around the inner and outer surfaces of the cartilaginous ring. There were no differences between the groups regarding the organization and distribution of the elastic fibers. The volumetric density of the elastic fibers of the pups in the control and PR groups was 2.46 ± 0.99% and 3.25 ± 1.13%, respectively (p < 0.01). Conclusions: The volumetric density of elastic fibers appears to be greater in rat pups breastfed by dams receiving a PR diet than in those breastfed by dams receiving a normal diet.


Keywords: Trachea/growth and development; Trachea/anatomy and histology; Extracellular matrix; Airway remodeling; Malnutrition.


Oxygen desaturation in healthy subjects undergoing the incremental shuttle walk test

Dessaturação em indivíduos saudáveis submetidos ao incremental shuttle walk test

Daniel Machado Seixas, Daniela Miti Tsukumo Seixas, Monica Corso Pereira, Marcos Mello Moreira, Ilma Aparecida Paschoal

J Bras Pneumol.2013;39(4):-

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Objective: To determine the probability of oxygen desaturation in healthy individuals undergoing the incremental shuttle walk test (ISWT). Methods: We enrolled 83 healthy subjects: 55 males (including 1 smoker) and 28 females. We determined pre-ISWT FEV1, FEV6, HR and SpO2, as well as post-ISWT HR and SpO2. Results: Mean values overall were as follows: age, 35.05 ± 12.53 years; body mass index, 24.30 ± 3.47 kg/m2; resting HR, 75.12 ± 12.48 bpm; resting SpO2, 97.96 ± 1.02%; FEV1, 3.75 ± 0.81 L; FEV6, 4.45 ± 0.87 L; FEV1/FEV6 ratio, 0.83 ± 0.08 (no restriction or obstruction); incremental shuttle walk distance, 958.30 ± 146.32 m; post-ISWT HR, 162.41 ± 18.24 bpm; and post-ISWT SpO2, 96.27 ± 2.21%. In 11 subjects, post-ISWT SpO2 was higher than was pre-ISWT SpO2. In 17 subjects, there was a 4% decrease in SpO2 after the ISWT. There were no statistically significant differences between the groups with and without post-ISWT oxygen desaturation in terms of age, gender, FEV1, FEV6, FEV1/FEV6, pre-ISWT SpO2, incremental shuttle walk distance, HR, or percentage of maximal HR. In the individuals with post-ISWT oxygen desaturation, the body mass index was higher (p = 0.01) and post-ISWT SpO2 was lower (p = 0.0001). Conclusions: Healthy individuals can present oxygen desaturation after the ISWT. Using the ISWT to predict subtle respiratory abnormalities can be misleading. In healthy subjects, oxygen desaturation is common after the ISWT, as it is during any intense physical activity.


Keywords: Heart function tests; Respiratory function tests; Body mass index; Oximetry


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

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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.


Detection of micrometastases in pN0 non-small cell lung cancer: an alternative method combining tissue microarray and immunohistochemistry

Detecção de micrometástases em câncer de pulmão não-pequenas células estádio pN0: um método alternativo combinando imunohistoquímica e análise em microsséries

Maíra Rovigatti Franco, Edwin Roger Parra, Teresa Yae Takagaki, Fernando Augusto Soares, Vera Luiza Capelozzi

J Bras Pneumol.2008;34(3):129-135

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Objective: To present an alternative method of detecting micrometastases in lymph nodes previously testing negative for non-small cell lung cancer (NSCLC) by routine hematoxylin-eosin staining. Methods: A total of 77 hilar and mediastinal lymph nodes resected from 18 patients with NSCLC were investigated for the presence of micrometastases using a combination of microarray analysis and immunohistochemistry. Results: Micrometastases were detected by identifying cytokeratin- and chromogranin-positive cells in lymph node microarrays. Of the 18 patients initially staged as pN0 through routine hematoxylin-eosin staining, 9 (50%) were restaged as N1, and the prognoses were re-evaluated in terms of histological and clinical parameters. The comparison of the survival curves revealed that survival was higher in the patients without micrometastases than in those with micrometastases. In addition, in the multivariate analysis adjusted for age, gender, histological type, and restaging, the presence of micrometastases proved to be an independent predictor of survival. Among patients who had been previously staged as pN0, the risk of death was found to be 7-times greater for those later diagnosed with micrometastases than for those in whom no micrometastases were identified. Conclusion: The combination of microarray analysis and immunohistochemistry might represent a low-cost and less time-consuming alternative for identifying occult micrometastases and predicting prognoses in surgically resected patients with pN0 NSCLC. Larger randomized, prospective studies are needed in order to determine the accuracy of this method.


Keywords: Lung neoplasms; Microarray analysis; Chromogranin A; Survival analysis.


Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens

Detecção do complexo Mycobacterium tuberculosis por nested polymerase chain reaction em espécimes pulmonares e extrapulmonares

Adriana Antônia da Cruz Furini, Heloisa da Silveira Paro Pedro, Jean Francisco Rodrigues, Lilian Maria Lapa Montenegro, Ricardo Luiz Dantas Machado, Célia Franco, Haiana Charifker Schindler, Ida Maria Foschiani Dias Batista, Andrea Regina Baptista Rossit

J Bras Pneumol.2013;39(6):711-718

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Objective: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens. Methods: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results. Results: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively). Conclusions: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.


Keywords: Tuberculosis/diagnosis; Tuberculosis/microbiology; Mycobacterium tuberculosis; Polymerase chain reaction.


Cord factor detection and macroscopic evaluation of mycobacterial colonies: an efficient combined screening test for the presumptive identification of Mycobacterium tuberculosis complex on solid media

Detecção do fator corda e avaliação do aspecto macroscópico das colônias de micobactérias: um eficiente teste de triagem combinado para a identificação presuntiva do complexo Mycobacterium tuberculosis em meios sólidos

Fernanda Cristina dos Santos Simeão, Erica Chimara, Rosângela Siqueira Oliveira, Jonas Umeoka Yamauchi, Fábio Oliveira Latrilha, Maria Alice da Silva Telles

J Bras Pneumol.2009;35(12):-

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Objective: The rapid differentiation between Mycobacterium tuberculosis and nontuberculous mycobacteria is fundamental for patients co-infected with tuberculosis and HIV. To that end, we use two methods in our laboratory: detection of cord factor and PCR-restriction enzyme analysis (PRA). The objective of this study was to evaluate the accuracy of a screening test on solid medium as a rapid method for the presumptive identification of M. tuberculosis complex, considering costs and turnover time. Methods: A total of 152 strains were submitted to a combined screening test, consisting of the detection of cord factor under microscopy (Ziehl-Neelsen staining) and evaluation of the macroscopic aspect of colonies, as well as to PRA, which was used as the gold standard. Costs were estimated by calculating the price of all of the materials needed for each test. Results: The overall accuracy of cord factor detection alone was 95.4% (95% CI: 90.7-98.1%), and that of the combined screening test was 99.3% (95% CI: 96.4-100%). Cord factor detection costs US$ 0.25, whereas the PRA costs US$ 7.00. Results from cord factor detection are ready in 2 days, whereas PRA requires 4 days to yield results. Conclusions: The presumptive identification of M. tuberculosis using the macroscopic evaluation of colonies combined with cord factor detection under microscopy is a simple, rapid and inexpensive test. We recommend the combined screening test to rapidly identify M. tuberculosis in resource-poor settings and in less well-equipped laboratories while awaiting a definite identification by molecular or biochemical methods.


Keywords: Tuberculosis; Mycobacterium/classification; Polymerase chain reaction; Diagnostic tests, routine.


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

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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.


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

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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.


Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Devemos utilizar escores prognósticos para tromboembolia pulmonar aguda na prática clínica?

Marcelo Basso Gazzana1,2,3,a, Igor Gorski Benedetto1,2,3,b

J Bras Pneumol.2019;45(1):e20190036-e20190036

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Detection of pulmonary nodules by computer-aided diagnosis in multidetector computed tomography: preliminary study of 24 cases

Diagnóstico auxiliado por computador na detecção de nódulos pulmonares pela tomografia computadorizada com múltiplos detectores: estudo preliminar de 24 casos

Julia Capobianco, Dany Jasinowodolinski, Gilberto Szarf

J Bras Pneumol.2008;34(1):27-33

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Objectives: To evaluate the performance of a computer program designed to facilitate the detection of pulmonary nodules using multidetector computed tomography (MDCT) scans of the chest. Methods: We evaluated 24 consecutive MDCT scans of the chest at the Fleury Diagnostic Imaging Center during the period from October 7 to October 19 of 2006, using a 64-channel CT scanner. The study comprised 12 females and 12 males, ranging from 35 to 77 years of age (mean, 57.9 years). Double reading and a computer-aided diagnosis (CAD) system were used in order to perform two independent analyses of the data. The nodules found using both methods were recorded, and the data were compared. Results: The total sensitivity of CAD for the detection of nodules was 16.5%, increasing to 55% when nodules <4 mm in diameter were excluded. Sensitivity by diameter was 6.5% for nodules <4 mm, 45% for nodules of 4-6 mm, 100% for nodules of 6 mm-1 cm, and 0% for nodules >1 cm. More than 99% of true nodules detected by CAD were registered in the image double-reading process. Conclusions: In this preliminary 24-case study, the sensitivity of computer program tested was not significantly greater than that of the double-reading process that is routinely performed in this facility.


Keywords: Image interpretation, computer-assisted; Coin lesion, pulmonary; Tomography, X-ray computed.


Diagnosis of primary ciliary dyskinesia

Diagnóstico de discinesia ciliar primária

Mary Anne Kowal Olm1, Elia Garcia Caldini2, Thais Mauad3

J Bras Pneumol.2015;41(3):251-263

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Primary ciliary dyskinesia (PCD) is a genetic disorder of ciliary structure or function. It results in mucus accumulation and bacterial colonization of the respiratory tract which leads to chronic upper and lower airway infections, organ laterality defects, and fertility problems. We review the respiratory signs and symptoms of PCD, as well as the screening tests for and diagnostic investigation of the disease, together with details related to ciliary function, ciliary ultrastructure, and genetic studies. In addition, we describe the difficulties in diagnosing PCD by means of transmission electron microscopy, as well as describing patient follow-up procedures.


Keywords: Kartagener Syndrome; Cilia; Mucociliary clearance; Ciliary motility disorders; Diagnosis.


Diagnosis and treatment of mediastinal tumors by thoracoscopy

Diagnóstico e tratamento dos tumores mediastinais por toracoscopia

José Ribas Milanez de Campos, Luís Marcelo Inaco Cirino, Angelo Fernandez, Marcos Naoyuki Samano, Paulo Pego Fernandez, Luiz Tarcísio Britto Filomeno, Fábio Biscegli Jatene

J Bras Pneumol.2000;26(4):169-174

Abstract PDF PT

Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventy-three patients were submitted to thoracoscopy for the treatment of mediastinal masses and were analyzed retrospectively, in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from two to 81 years (mean 43.8) with a slight predominance of females over males (41 versus 32). All underwent general anesthesia using simple (22) or double lumen (51) intubation. Results: The histological type of tumor was identified in all patients. For therapeutic purposes, conversion to thoracotomy was necessary in nine patients. The reasons were tumor size and invasion of nearby structures, difficulty to continue dissection, to perform an upper lobectomy, and to suture the iatrogenic diaphragm lesion. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusions: Thoracoscopy was confirmed to be an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.


Keywords: Thoracoscopy, thoracic surgery, mediastinal neoplasms, mediastinal cysts.


Immunological diagnosis of tuberculosis: problems and strategies for success

Diagnóstico imunológico da tuberculose: problemas e estratégias para o sucesso

Henrique Couto Teixeira, Clarice Abramo, Martin Emilio Munk

J Bras Pneumol.2007;33(3):323-334

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Tuberculosis remains a serious social and public health problem, affecting millions of people annually. The bacille Calmette-Guerin (BCG) vaccine, used prophylactically, does not impede the progression of the disease, which usually manifests as decreased cellular immunity. Early diagnosis, together with polychemotherapy, can control the dissemination of the tuberculosis infection. The current diagnostic methods present certain problems. Such problems include the low sensitivity of sputum smear microscopy, the fact that performing microbiological cultures is quite time-consuming, and the low specificity of the skin test with the purified protein derivative of Mycobacterium tuberculosis. New diagnostic methods, which use specific antigens such as the early secreted antigenic target 6-kDa and culture filtrate protein 10‑kDa, are being evaluated. The genes that encode these antigens are located in the DNA region of difference 1 of M. tuberculosis, M. africanum and M. bovis. However, they are absent from the M. bovis (BCG) and from most environmental mycobacteria. Diagnostic methods such as QuantiFERON-TB® and T SPOT.TB®, which are based on the production of interferon-gamma by T lymphocytes, in response to those antigens, are being tested and have been found to outstrip the purified protein derivative skin test in the following characteristics: greater sensitivity; lower cross-reactivity due to BCG vaccination or infection with environmental mycobacteria; and execution time. The introduction of diagnostic methods that are more specific and sensitive, together with gaining a better understanding of the molecular and cellular mechanisms that regulate the parasite-host interaction, can increase the efficiency of strategies devised to combat tuberculosis.


Keywords: Tuberculosis; Mycobacterium tuberculosis; Diagnosis; Antigens, bacterial/ESAT-6 protein; Immunity.


Early diagnosis of lung cancer: the great challenge. Epidemiological variables, clinical variables, staging and treatment

Diagnóstico precoce do câncer de pulmão: o grande desafio. Variáveis epidemiológicas e clínicas, estadiamento e tratamento

João Adriano Barros, Geraldo Valladares, Adriane Reichert Faria, Erika Megumi Fugita, Ana Paula Ruiz, André Gustavo Daher Vianna, Guilherme Luís Trevisan, Fabrício Augusto Martinelli de Oliveira

J Bras Pneumol.2006;32(3):221-227

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Objective: To evaluate confirmed cases of lung cancer, reviewing epidemiological variables, clinical variables, staging and treatment. Methods: The cases of 263 patients were studied. All of the patients had been treated at the Universidade Federal do Paraná (Federal University of Paraná) Hospital de Clínicas or at the Hospital Erasto Gaertner, two institutions that, together, serve a significant portion of the patients seeking treatment in the city of Curitiba, located in the state of Paraná. This was a retrospective study, involving the administration of questionnaires. The descriptive analysis of the data obtained was performed using the Epi-Info program. Results: There was a predominance of male patients (76%). At the time of diagnosis, the majority of patients (90%) were smokers or former smokers. In 87% of the cases, there was no history of lung disease. The most common initial symptoms were cough (142 cases) and chest pain (92 cases). Non-small cell lung cancer was found in 87% of the patients, and the most common histological type was spinocellular carcinoma, which was found in 49% of all of the patients. Smoking was found to be the most significant predisposing factor. Conclusion: The characteristics of lung cancer progression, such as the nonspecificity of the initial symptoms, the duration of tumor growth and the course of the tumor, together with the lack of tracking programs, are the principal factors that hinder the early detection of lung cancer, making it difficult to treat lung cancer patients and to increase their survival.


Keywords: Lung neoplasms/diagnosis; Lung neoplasms/epidemiology; Lung neoplasms/surgery; Early diagnosis; Neoplasms staging


Tomographic diagnosis of pulmonary emphysema

Diagnóstico tomográfico de enfisema pulmonar

Klaus Loureiro Irion, Edson Marchiori, Bruno Hochhegger

J Bras Pneumol.2009;35(9):-

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Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

Diagnósticos alternativos corroborados por angiotomografia computadorizada de tórax em pacientes com suspeita de tromboembolia pulmonar

Eleci Vaz Ferreira1,2, Marcelo Basso Gazzana2,3, Muriel Bossle Sarmento4, Pedro Arends Guazzelli4, Mariana Costa Hoffmeister4, Vinicius André Guerra2, Renato Seligman4,5, Marli Maria Knorst2,3,4

J Bras Pneumol.2016;42(1):35-41

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Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.


Keywords: Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Angiography.


Differences in the clinical and radiological presentation of intrathoracic tuberculosis in the presence or absence of HIV infection

Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

Pedro Dornelles Picon, Maria Luiza Avancini Caramori, Sérgio Luiz Bassanesi, Sandra Jungblut, Marcelo Folgierini, Nelson da Silva Porto, Carlos Fernando Carvalho Rizzon, Roberto Luiz Targa Ferreira, Tânia Mariza de Freitas, Carla Adriane Jarczewski

J Bras Pneumol.2007;33(4):429-436

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Objective: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. Methods: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. Results: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. 266 cells/mm3; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm3; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm3; p < 0.01). Conclusion: Atypical forms and disseminated disease predominate among patients with advanced immunosuppression. In regions where TB prevalence is high, the presence of atypical pulmonary tuberculosis or pulmonary tuberculosis accompanied by superficial lymph node enlargement should be considered an AIDS-defining condition.


Keywords: Tuberculosis, pulmonary; HIV infections; Radiography, thoracic.


Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis

Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória

Roberto de Menezes Lyra, José Ribas Milanez de Campos, Davi Wen Wei Kang, Marcelo de Paula Loureiro, Marcos Bessa Furian, Mário Gesteira Costa, Marlos de Souza Coelho

J Bras Pneumol.2008;34(11):967-977

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With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of compensatory hyperhidrosis, as well as on a review of the medical literature, the participants prepared a preliminary text, whose recommendations were revised and subsequently approved by all of the participants. The consensus text was posted on the Internet, becoming the object of further corrections and revisions prior to taking on its present form.


Keywords: Hyperhidrosis/therapy; Hyperhidrosis/surgery; Sympathectomy/methods; Postoperative complications; Thoracic surgery, video‑assisted.


Smoking cessation guidelines - 2008

Diretrizes para cessação do tabagismo - 2008

Jonatas Reichert, Alberto José de Araújo, Cristina Maria Cantarino Gonçalves, Irma de Godoy, José Miguel Chatkin, Maria da Penha Uchoa Sales, Sergio Ricardo Rodrigues de Almeida Santos e Colaboradores

J Bras Pneumol.2008;34(10):845-880

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These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, recommending measures and strategies for managing each case based on clinical evidence. Written in a simplified and objective manner, the text is divided into two principal sections: Evaluation and Treatment. The sections both present comments on and levels of evidence represented by the references cited, as well as some proposals for the reduction of damage and for intervening in specific and still poorly explored situations, such as relapse, passive smoking, physician smoking, and tobacco use in specific environments.


Keywords: Smoking/adverse effects; Smoking cessation/methods; Guideline.


Primary ciliary dyskinesia

Discinesia ciliar primária

José Wellington Alves dos Santos, Aland Waldow, Claudius Wladimir Cornelius de Figueiredo, Diego Rossi Kleinubing, Severo Salles de Barros

J Bras Pneumol.2001;27(5):262-268

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Primary ciliary dyskinesia is an autosomal recessive disorder characterized by a history of recurrent upper and lower respiratory tract infections with chronic otitis media, bronchitis and rhinosinusitis, associated with situs inversus in 50% of cases. The diagnosis is established by ciliary ultrastructural analysis of respiratory specimens, after ruling out some disorders as cystic fibrosis, a-1 anti-trypsin deficiency, immune deficiencies (IgG, neutrophils and complement) and Young's syndrome. The purpose of this paper is to review the clinical features, diagnosis and management of primary ciliary dyskinesia, including a diagnostic algorithm.


Keywords: Ciliary dyskinesia. Situs inversus. Diagnosis.


Diaphragmatic dysfunction and mortality in patients with COPD

Disfunção diafragmática e mortalidade em pacientes portadores de DPOC

Wellington Pereira dos Santos Yamaguti, Elaine Paulin, João Marcos Salge, Maria Cristina Chammas, Alberto Cukier, Celso Ricardo Fernandes de Carvalho

J Bras Pneumol.2009;35(12):-

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Objective: To determine whether COPD patients with diaphragmatic dysfunction present higher risk of mortality than do those without such dysfunction. Methods: We evaluated pulmonary function, diaphragm mobility and quality of life, as well as determining the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, in 42 COPD patients. The patients were allocated to two groups according to the degree to which diaphragm mobility was impaired: low mobility (LM; mobility ≤ 33.99 mm); and high mobility (HM; mobility ≥ 34.00 mm). The BODE index and the quality of life were quantified in both groups. All patients were followed up prospectively for up to 48 months in order to determine the number of deaths resulting from respiratory complications due to COPD. Results: Of the 42 patients evaluated, 20 were allocated to the LM group, and 22 were allocated to the HM group. There were no significant differences between the groups regarding age, lung hyperinflation or quality of life. However, BODE index values were higher in the LM group than in the HM group (p = 0.01). During the 48-month follow-up period, there were four deaths within the population studied, and all of those deaths occurred in the LM group (15.79%; p = 0.02). Conclusions: These findings suggest that COPD patients with diaphragmatic dysfunction, characterized by low diaphragm mobility, have a higher risk of death than do those without such dysfunction.


Keywords: Pulmonary disease, chronic obstructive/mortality; Diaphragm; Exercise tolerance; Quality of life.


Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension

Disfunção ventricular esquerda em pacientes com suspeita de hipertensão arterial pulmonar

Francisca Gavilanes, José Leonidas Alves Jr, Caio Fernandes, Luis Felipe Lopes Prada, Carlos Viana Poyares Jardim, Luciana Tamie Kato Morinaga, Bruno Arantes Dias, Susana Hoette, Rogerio Souza

J Bras Pneumol.2014;40(6):609-616

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Objective: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). Methods: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism-between 2008 and 2013 at our facility. Results: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3%) and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). Conclusions: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.


Keywords: Hypertension, pulmonary; Cardiac catheterization, Ventricular dysfunction, left.


Chronic Dyspnea and Altered Respiratory Function in Former Workers with Asbestosis Evaluated to Determine Benefits

Dispnéia crônica e alterações funcionais respiratórias em ex-trabalhadores com asbestose avaliados para concessão de benefício

Lara M. Nápolis, Andréa Ap. Sette, Ericson Bagatin, Mário Terra Filho, Reynaldo T. Rodrigues, Jorge Issamu Kavakama, José Alberto Neder, Luiz Eduardo Nery

J Bras Pneumol.2004;30(6):528-534

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Background: Dyspnea is a symptom that is difficult to evaluate, especially in occupational diseases. Objective: To evaluate the relationship between chronic dyspnea, in its varying degrees of severity, and the functional repercussions for dysfunction or incapacitation in former workers with asbestosis. Method: A total of 40 former workers diagnosed with asbestosis were evaluated. Dyspnea scores were determined using the modified Medical Research Council scale, the 1984 and 1993 American Medical Association scales, and the Baseline Dyspnea Index. Spirometry, measurement of diffusion capacity for carbon monoxide and cardiopulmonary exercise tests (incremental and submaximal) were also performed. Results: Based on scores obtained using the Medical Research Council and 1984 American Medical Association scales, respectively, 72.5% and 67.5% of the subjects were classified as dyspneic, compared with 37.5% and 31.6%, respectively, using the 1993 American Medical Association and Baseline Dyspnea Index scales. There was greater concordance between the Medical Research Council and 1993 American Medical Association scales, as well as between the 1984 and 1993 American Medical Association scales, when the categories of "absent" and "mild" were grouped. No significant relation was found between dyspnea, as determined by each of the scales, and functional abnormalities - either at rest or during exercise. Conclusion: In individuals with asbestosis, the degree of concordance among the available dyspnea scales varies significantly. There is a real need for dyspnea indices that evaluate respiratory dysfunction at rest and during exercise.


Keywords: Asbestosis/diagnosis. Dyspnea/physiopathology. Spirometry/methods.


Single Nucleotide Polymorphisms (SNPs) of the TNF-á (-238/-308) gene among TB and nom TB patients: Susceptibility markers of TB occurrence?

Distribuição de Polimorfismos de Base única (SNPs) no gene de TNF-a (-238/-308) entre pacientes com TB e outras pneumopatias: marcadores genéticos de susceptibilidade a ocorrência de TB?

Martha Maria de Oliveira; Jocilea C. S. da Silva; Joseane F. Costa; Lúcia Helena Amim; Carla C. S. Loredo; Hedi Melo; Luiz F. Queiroz; Fernanda C. Q. Mello; José Roberto Lapa e Silva; Afrânio Lineu Kritski; Adalberto Rezende Santos

J Bras Pneumol.2004;30(4):461-467

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Background: Host genetic factors may play a role in the susceptibility to active tuberculosis (TB), and several polymorphisms in different cytokine coding genes have been described and associated with diseases to date. Objectives: To investigate whether polymorphisms within the promoter region of the TNF-á (-238/-308) coding genes are associated to the occurrence of active TB. Methods: SNPs within the TNF-á gene were analyzed by PCR-RFLP among two groups of individuals: patients with TB (n = 234, and patients non TB (n = 113). Results: In this study, the presence of the -238A allele was associated with susceptibility to TB disease occurrence and severity (p = 0,00002; OR = 0,15; IC = 0,06-0,36. On the contrary, the -308A allele was associated with protection to the occurrence of another pulmonary diseases. Conclusions: These results suggest the importance of genetics studies on TB occurrence. Further studies are needed pursuing a better understanding of the human pathogenesis of M. tb.


Keywords: Tuberculosis/genetics. Polymorphism, single nucleotide/genetics. Tumor necrosis factor/genetics. Alleles. Genotype. Lung diseases.


Mediastinal lymph node distribution, size and number: definitions based on an anatomical study

Distribuição, tamanho e número dos linfonodos mediastinais: definições por meio de estudo anatômico

Aurelino Fernandes Schmidt Júnior, Olavo Ribeiro Rodrigues, Roberto Storte Matheus, Jorge Du Ub Kim, Fábio Biscegli Jatene

J Bras Pneumol.2007;33(2):134-140

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Objective: To create a reference map of mediastinal lymph nodes through the analysis of their size, number and distribution in various lymph node stations. Method: A total of 50 cadavers, 38 males and 12 females, were studied. Of those 50, 39 were Caucasian. The mean age was 59.9 ± 14.1 years, the mean height was 173.1 ± 7.6 cm, and the mean weight was 71.0 ± 12.0 kg. A bilateral mediastinal dissection was performed in order to resect and isolate all lymph nodes. The area, as well as the major and minor transverse diameters, of each lymph node was determined by radiographic imaging analysis. Results: In a sample of 485 chains, 1742 lymph nodes were dissected (2.58 ± 1.89 lymph nodes/station), revealing a mean number of 21.2 ± 8.5 lymph nodes on the right and 13.6 ± 6.3 on the left. The lymph node stations 1, 2R, 4R, 5, and 7 were present in more than 90% of the sample. Only the 4R and 7 lymph node stations were always present. The lymph node stations 2L, 3p, and 8 were present in 32, 36, and 54% of the sample, respectively. Mediastinal lymph nodes were present in greater numbers in the 2R, 4R and 7 lymph node stations. In addition, these stations presented the largest mediastinal lymph nodes. Conclusion: Composing a reference map for lymph node sizes was feasible. No alterations were observed in the distribution, number, or size of lymph nodes in the age brackets studied, regardless of gender, race, weight, or height.


Keywords: Lymph nodes; Mediastinum; Cadaver; Anatomy.


Sleep-disordered breathing in patients with cystic fibrosis

Distúrbios respiratórios do sono em pacientes com fibrose cística

Jefferson Veronezi1,2, Ana Paula Carvalho3, Claudio Ricachinewsky4, Anneliese Hoffmann4, Danielle Yuka Kobayashi5, Otavio Bejzman Piltcher6, Fernando Antonio Abreu e Silva7, Denis Martinez1,2,8

J Bras Pneumol.2015;41(4):351-357

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Objective: To test the hypothesis that disease severity in patients with cystic fibrosis (CF) is correlated with an increased risk of sleep apnea. Methods: A total of 34 CF patients underwent clinical and functional evaluation, as well as portable polysomnography, spirometry, and determination of IL-1β levels. Results: Mean apnea-hypopnea index (AHI), SpO2 on room air, and Epworth Sleepiness Scale score were 4.8 ± 2.6, 95.9 ± 1.9%, and 7.6 ± 3.8 points, respectively. Of the 34 patients, 19 were well-nourished, 6 were at nutritional risk, and 9 were malnourished. In the multivariate model to predict the AHI, the following variables remained significant: nutritional status (β = −0.386; p = 0.014); SpO2 (β = −0.453; p = 0.005), and the Epworth Sleepiness Scale score (β = 0.429; p = 0.006). The model explained 51% of the variation in the AHI. Conclusions: The major determinants of sleep apnea were nutritional status, SpO2, and daytime sleepiness. This knowledge not only provides an opportunity to define the clinical risk of having sleep apnea but also creates an avenue for the treatment and prevention of the disease.


Keywords: Cystic fibrosis; Oxygenation; Sleep apnea, obstructive.


Doença alveolar infreqüente em mulher de 55 anos

Maria Conceição C.A.M. Queiroz, Maria Auxiliadora Carmo Moreira, Maurício Sérgio Brasil Leite, Karla C.M.A. Curado, Fernanda Miranda de Oliveira

J Bras Pneumol.1997;23(5):271-274


Castleman disease or angiofollicular hyperplasia as a solitary pulmonary nodule: case report

Doença de Castleman ou hiperplasia angiofolicular como nódulo pulmonar solitário: relato de caso

Guilherme Andrade Krawczun, Cristiano de Morais Garcia, Kazuhiro Ito, Olavo Franco Ferreira Filho, João Carlos Thomson

J Bras Pneumol.2007;33(2):226-228

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Castleman disease is a rare disorder generally characterized by a mediastinal nodule, with a great variety of alternative presentations regarding age, clinical manifestations and evolution. This case report describes a 40-year-old female patient presenting with uncharacteristic chest pain for a few years. A chest X-ray revealed a hypotransparency on the right side. Computed tomography and pulmonary arteriography did not elucidate the diagnosis, which was made through surgical resection and anatomopathological examination of the nodule, which presented characteristics of angiofollicular hyperplasia, or Castleman disease. This article emphasizes the importance of adding this disease to the list of morbidities in the differential diagnosis of pulmonary solitary nodules.


Keywords: Giant lymph node hyperplasia; Angiography; Coin lesion, Pulmonary; Case reports [publication type].


Kikuchi-Fujimoto disease

Doença de Kikuchi-Fujimoto

Rogério Gastal Xavier, Denise Rossato Silva, Mauro Waldemar Keiserman, Maria Francisca Torres Lopes

J Bras Pneumol.2008;34(12):1074-1078

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Kikuchi-Fujimoto disease is characterized by fever and lymphadenopathy, usually localized in the cervical region. This disease principally affects young females. It can be confused with lymphoma, adenocarcinoma metastasis and tuberculosis. We report two cases of Kikuchi‑Fujimoto disease. In the first case, a 28-year-old female had been treated for tuberculosis one year prior and presented with a clinical and histological profile consistent with Kikuchi-Fujimoto disease. The second patient, a 58-year-old female, initially received treatment for Wegener's granulomatosis and, subsequently, for tuberculosis. Histopathological examination followed by immunohistochemical analysis confirmed the diagnosis of Kikuchi-Fujimoto disease in both cases. After the definitive diagnosis had been made, both patients were treated symptomatically, and both presented clinical improvement within one month. Subsequently, the latter patient developed systemic lupus erythematosus.


Keywords: Fever; Lymph nodes; Rare diseases; Tuberculosis, lymph node; Histiocytic necrotizing lymphadenitis; Lupus erythematosus, systemic.


Interstitial lung disease in scleroderma

Doença intersticial pulmonar na esclerodermia

Ronaldo Adib Kairalla

J Bras Pneumol.2005;31(4):1-3

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Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry

Doença pulmonar em pacientes com artrite reumatoide: avaliação radiográfica e espirométrica

Alexandre Melo Kawassaki1, Daniel Antunes Silva Pereira1, Fernando Uliana Kay2, Ieda Maria Magalhães Laurindo3, Carlos Roberto Ribeiro Carvalho4, Ronaldo Adib Kairalla1

J Bras Pneumol.2015;41(4):331-342

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Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.


Keywords: Arthritis, rheumatoid; Lung diseases, interstitial; Spirometry; Radiography, thoracic; Airway ob-struction.


Adalimumab-induced acute interstitial lung disease in a patient with rheumatoid arthritis

Doença pulmonar intersticial aguda induzida por adalimumabe em paciente com artrite reumatoide

Olívia Meira Dias, Daniel Antunes Silva Pereira, Bruno Guedes Baldi, André Nathan Costa, Rodrigo Abensur Athanazio, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2014;40(1):77-81

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The use of immunobiological agents for the treatment of autoimmune diseases is increasing in medical practice. Anti-TNF therapies have been increasingly used in refractory autoimmune diseases, especially rheumatoid arthritis, with promising results. However, the use of such therapies has been associated with an increased risk of developing other autoimmune diseases. In addition, the use of anti-TNF agents can cause pulmonary complications, such as reactivation of mycobacterial and fungal infections, as well as sarcoidosis and other interstitial lung diseases (ILDs). There is evidence of an association between ILD and the use of anti-TNF agents, etanercept and infliximab in particular. Adalimumab is the newest drug in this class, and some authors have suggested that its use might induce or exacerbate preexisting ILDs. In this study, we report the first case of acute ILD secondary to the use of adalimumab in Brazil, in a patient with rheumatoid arthritis and without a history of ILD.


Keywords: Lung diseases, interstitial; Arthritis, rheumatoid; Antirheumatic agents; Antibodies, monoclonal, humanized/adverse effects.


Myositis-related interstitial lung disease and antisynthetase syndrome

Doença pulmonar intersticial relacionada a miosite e a síndrome antissintetase

Joshua Solomon, Jeffrey J. Swigris, Kevin K. Brown

J Bras Pneumol.2011;37(1):100-109

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In patients with myositis, the lung is commonly involved, and the presence of anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies marks the presence or predicts the development of interstitial lung disease (ILD). A distinct clinical entity-antisynthetase syndrome-is characterized by the presence of anti-ARS antibodies, myositis, ILD, fever, arthritis, Raynaud's phenomenon, and mechanic's hands. The most common anti-ARS antibody is anti-Jo-1. More recently described anti-ARS antibodies might confer a phenotype that is distinct from that of anti-Jo-1-positive patients and is characterized by a lower incidence of myositis and a higher incidence of ILD. Among patients with antisynthetase syndrome-related ILD, the response to immunosuppressive medications is generally, but not universally, favorable.


Keywords: Lung diseases, interstitial; Pneumonia; Infection.


Hard metal lung disease: a case series

Doença pulmonar por metal duro: uma série de casos

Rafael Futoshi Mizutani1, Mário Terra-Filho1,2, Evelise Lima1, Carolina Salim Gonçalves Freitas1, Rodrigo Caruso Chate3, Ronaldo Adib Kairalla1,2, Regiani Carvalho-Oliveira4, Ubiratan Paula Santos1

J Bras Pneumol.2016;42(6):447-452

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Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis.


Keywords: Lung diseases, interstitial; Cobalt; Tungsten; Occupational exposure; Hard metal.


Pleural fluid adenosine deaminase detection for the diagnosis of pleural tuberculosis

Dosagem da atividade da adenosina deaminase no líquido pleural para o diagnóstico da tuberculose pleural

Morrys Casagrande Kaisemann, Afrânio Lineu Kritski, Maria de Fátima C Pereira, Anete Trajman

J Bras Pneumol.2004;30(6):549-556

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Background: The diagnosis of pleural tuberculosis continues to be a challenge due to the low sensitivity of traditional diagnostic methods. Histopathological examination of pleural tissue is the most accurate method, with a sensitivity of up to 80%. Determination of adenosine deaminase levels is a recently introduced method, although its usefulness in the diagnosis of pleural tuberculosis in Brazil has yet to better elucidated. Objective: To verify the sensitivity and specificity of an experimental method of measuring adenosine deaminase activity in pleural fluid in a series of patients with pleural effusion patients evaluated between August 1998 and November 2002 in Rio de Janeiro (RJ). Results: Out of 137 cases, 111 pleural fluid samples were available. Of those, 83 were from pleural tuberculosis patients. Among the 67 pleural tuberculosis patients tested, 10 (14.9%) presented human immunodeficiency virus. The adenosine deaminase cutoff value of 35U/L was determined by a receiver operator characteristic curve. The sensitivity, specificity and likelihood ratios (positive and negative) were 92.8%, 93.3%, 25.8 and 13.9, respectively. Mean adenosine deaminase in the pleural tuberculosis group was 84.7 ± 43.1 U/L, versus 15.9 ± 11.1 U/L in the group with other diseases. There was no significant difference in adenosine deaminase activity between patients with and without human immunodeficiency virus co-infection. Conclusions: Adenosine deaminase measurement in pleural fluid is a sensitive and specific method for the diagnosis of pleural tuberculosis and its use can preclude the need for pleural biopsy in the initial workup of pleural effusion patients. An adenosine deaminase cutoff value of 35U/L is recommended.


Keywords: Pleural fluid. Adenosine deaminase. Diagnosis. Tuberculosis. HIV


Doxycycline use in patients with lymphangioleiomyomatosis: safety and efficacy in metalloproteinase blockade

Doxiciclina em pacientes com linfangioleiomiomatose: segurança e eficácia no bloqueio de metaloproteinases

Suzana Pinheiro Pimenta, Bruno Guedes Baldi, Milena Marques Pagliarelli Acencio, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2011;37(4):424-430

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Objective: To determine the frequency of near-fatal asthma in a group of severe asthma patients, as well as the clinical characteristics and prognosis of these patients within a one-year follow-up period. Methods: A prospective study involving 731 low-income patients with severe asthma treated at a referral outpatient clinic located in the city of Salvador, Brazil. The patients were submitted to spirometry at admission, received medications for asthma, and were monitored regarding the frequency of asthma exacerbations during the follow-up period. A subsample of 511 patients also completed questionnaires regarding asthma symptoms and asthma-related quality of life. Results: Of the 731 patients studied, 563 (77%) were female. The median age was 47 years, and 12% were illiterate. Most of the patients had rhinitis, and 70 patients (10%) reported near-fatal asthma prior to admission. Of these 70 patients, 41 (59%) reported having been intubated previously. The patients reporting a history of near-fatal asthma at admission were more likely to have asthma exacerbations during the follow-up period and to respond poorly to therapy than were those not reporting such a history. At the end of the follow-up period, the scores on the two questionnaires were similar between the two groups of patients. Conclusions: The frequency of near-fatal asthma was high in this group of low-income patients with severe asthma. The patients with a history of near-fatal asthma had a worse prognosis than did those without such a history, although both groups had received the same kind of treatment. Curiously, the intensity of symptoms and the quality of life at the end of the study were similar between the two groups.


Keywords: Asthma/prevention and control; Asthma/complications; Quality of life; Prognosis.


Doxycycline use in patients with lymphangioleiomyomatosis: biomarkers and pulmonary function response

Doxiciclina em pacientes com linfangioleiomiomatose: biomarcadores e resposta funcional pulmonar

Suzana Pinheiro Pimenta, Bruno Guedes Baldi, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2013;39(1):5-15

Abstract PDF PT PDF EN Appendix

Objective: To assess blockade of matrix metalloproteinase (MMP)-2 and MMP-9, as well as the variation in FEV1, in patients with lymphangioleiomyomatosis (LAM) treated with doxycycline (a known MMP inhibitor) for 12 months. Methods: An open-label, single-arm, interventional clinical trial in which LAM patients received doxycycline (100 mg/day) for 12 months. Patients underwent full pulmonary function testing, a six-minute walk test, and quality of life assessment, as well as blood and urine sampling for quantification of MMP-2, MMP-9, and VEGF-D levels-at baseline, as well as at 6 and 12 months after the initiation of doxycycline. Results: Thirty-one LAM patients received doxycycline for 12 months. Although there was effective blockade of urinary MMP-9 and serum MMP-2 after treatment, there were no significant differences between pre‑and post-doxycycline serum levels of MMP-9 and VEGF-D. On the basis of their response to doxycycline (as determined by the variation in FEV1), the patients were divided into two groups: the doxycycline-responder (doxy-R) group (n = 13); and the doxycycline-nonresponder (doxy-NR) group (n = 18). The patients with mild spirometric abnormalities responded better to doxycycline. The most common side effects were mild epigastric pain, nausea, and diarrhea. Conclusions: In patients with LAM, doxycycline treatment results in effective MMP blockade, as well as in improved lung function and quality of life in those with less severe disease. However, these benefits do not seem to be related to the MMP blockade, raising the hypothesis that there is a different mechanism of action. (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-6g8yz9 [])


Keywords: Lymphangioleiomyomatosis; Doxycycline; Matrix metalloproteinases; Respiratory function tests.


Differentiating between tuberculosis-related and lymphoma&#8209;related lymphocytic pleural effusions by measuring clinical and laboratory variables: Is it possible?

É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

Leila Antonangelo, Francisco Suso Vargas, Eduardo Henrique Genofre, Caroline Maris Neves de Oliveira, Lisete Ribeiro Teixeira, Roberta Karla Barbosa de Sales

J Bras Pneumol.2012;38(2):181-187

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphoma-related lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. Methods: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. Results: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. Conclusions: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.


Keywords: Pleural effusion; Tuberculosis; Lymphoma; Adenosine deaminase; Diagnosis, differential.


Could a DNA vaccine be useful in the control of tuberculosis?

É possível uma vacina gênica auxiliar no controle da tuberculose?

José Maciel Rodrigues Júnior; Karla de Melo Lima; Arlete Aparecida Martins Coelho Castelo; Vânia Luiza Deperon Bonato Martins; Sandra Aparecida dos Santos; Lucia Helena Faccioli; Célio Lopes Silva

J Bras Pneumol.2004;30(4):468-477

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The DNA vaccines currently under pre-clinical and clinical development may prove to be important tools in combating infectious diseases, such as tuberculosis, for which no safe and effective form of prevention has yet been developed. In recent years, several studies have aimed to develop a DNA vaccine encoding mycobacterial proteins such as antigen 85 (Ag85) and the 65-kDa mycobacterial heat shock protein (hsp65). The latter is protective against virulent infection with Mycobacterium tuberculosis (including multidrugresistant strains). The hsp65 DNA vaccine, currently under clinical evaluation in Brazil for cancer therapy, is able to induce the secretion of Th1 cytokines, such as gamma-interferon, associated with disease control. Furthermore, this vaccine stimulates cytotoxic CD8 and CD4 T-cell clones that can be characterized as memory cells, which are responsible for effective and longlasting immunity against tuberculosis. When used as a therapeutic agent in inoculated mice, the hsp65 DNA vaccine promotes changes in the immunity profile, triggering the secretion of Th1 cytokines and establishing a favorable environment for the elimination of bacilli. The results also demonstrate that the route of administration, as well as the formulation in which the vaccine is administered, fundamentally influence the pattern and duration of the immune response induced. Taking all currently available data into account, we can conclude that a DNA vaccine against tuberculosis could contribute significantly to the control of the disease.


Keywords: Tuberculosis/epidemiology. Vaccines, DNA/therapeutic use. Heat shock proteins. Auto-immunity.


Negative-pressure pulmonary edema and hemorrhage associated with upper airway obstruction

Edema e hemorragia pulmonar por pressão negativa associados à obstrução das vias aéreas superiores

Ricardo Kalaf Mussi, Ivan Felizardo Contrera Toro

J Bras Pneumol.2008;34(6):420-424

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Negative-pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction is an uncommon problem that is potentially life-threatening. The principal pathophysiological mechanism involved is the generation of markedly negative intrathoracic pressure, which leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We report the case of an adult male with diffuse alveolar hemorrhage following acute upper airway obstruction caused by the formation of a cervical and mediastinal abscess resulting from the insertion of a metallic tracheal stent. The patient was treated through drainage of the abscess, antibiotic therapy, and positive pressure mechanical ventilation. This article emphasizes the importance of including this entity in the differential diagnosis of acute lung injury after procedures involving upper airway instrumentation.


Keywords: Hemorrhage; Pulmonary edema; Airway obstruction; Abscess; Prostheses and implants.


Hydrostatic pulmonary edema: high-resolution computed tomography aspects

Edema pulmonar hidrostático: aspectos na tomografia computadorizada de alta resolução

Cláudia Maria Cunha Ribeiro, Edson Marchiori, Rosana Rodrigues, Emerson Gasparetto, Arthur Soares Souza Júnior, Dante Escuissato, Luiz Felipe Nobre, Gláucia Zanetti, César de Araujo Neto, Klaus Irion

J Bras Pneumol.2006;32(6):515-522

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Objective: This study aimed to use high-resolution computed tomography scans of the chest to characterize the principal alterations occurring in cases of hydrostatic pulmonary edema. Methods: A retrospective analysis was made of the tomography scans of 15 patients presenting clinical profiles of hydrostatic pulmonary edema. The cases were divided into five groups by etiology: congestive heart failure (n = 7); acute mitral valve disease (n = 2); acute myocardial infarction (n = 2); myocarditis (n = 2); and fibrosing mediastinitis (n = 2). Results: The principal findings in the cases of hydrostatic pulmonary edema were ground-glass opacities (in 100%), interlobular septal thickening (in 100%), pleural effusion (in 87%) and peribronchovascular interstitial thickening (in 80%). Other, less common, findings were increased blood vessel diameter, consolidations and air-space nodules. Conclusion: The predominant pattern found in the patients studied was that of ground-glass opacities accompanied by interlobular septal thickening (mosaic attenuation pattern) and bilateral (predominantly right-sided) pleural effusion.


Keywords: Pulmonary edema; Tomography, X-ray computed; Lung diseases


Postpneumonectomy pulmonary edema

Edema pulmonar pós-pneumonectomia

Marcos Naoyuki Samano, Luis Miguel Melero Sancho, Ricardo Beyruti, Fábio Biesegli Jatene

J Bras Pneumol.2005;31(1):-

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Although pneumonectomy is a technically simple procedure, it has been associated with a high (60%) incidence of complications. Respiratory complications account for approximately 15% of such complications. Worldwide, the mortality rate among patients subjected to pneumonectomy is 8.6%. However, the rate among patients developing respiratory complications is 30%. Although postpneumonectomy pulmonary edema is rare (occurring in 3% to 5% of cases), it is a serious complication and is almost always fatal. It was first described twenty years ago and, despite these alarming statistics, little is known regarding the physiopathology of postpneumonectomy pulmonary edema. Once it has become entrenched, the condition is difficult to treat, and there is no proven efficient treatment. Various risk factors have been correlated with postpneumonectomy pulmonary edema onset. Fluid overload was the first to be identified as a factor to avoid. However, many studies have shown that there is no direct correlation between fluid overload and the development of edema. Prevention is the best way to avoid postpneumonectomy pulmonary edema and must be performed in a multidisciplinary fashion, involving the entire medical staff - from the initiation of anesthesia through the surgical procedure and extending into the critical care management phase. Equally important is early identification and testing of patients at risk for postpneumonectomy pulmonary edema when there is clinical suspicion of this serious complication.


Keywords: Key Words: Pulmonary edema/complications. Pneumonectomy/adverse effects. Risk factors. Pulmonary edema/prevention & control.


Multidisciplinary education with a focus on COPD in primary health care

Educação multiprofissional com foco na DPOC na atenção primária à saúde

Erikson Custódio Alcântara1,2,a, Krislainy de Sousa Corrêa2,3,b, José Roberto Jardim4,c, Marcelo Fouad Rabahi5,d

J Bras Pneumol.2019;45(6):e20180230-e20180230

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Objective: To evaluate the use of video lessons on the topic of COPD as a training tool for a multidisciplinary team working in the primary health care sector. Methods: This was a quasi-experimental study involving a multidisciplinary team working at a primary health care clinic. The level of knowledge about COPD was measured by applying a specific, 16-item questionnaire - before, immediately after, and three months after the video lessons. In a set of six structured video lessons, the training focused on the prevention, case-finding, treatment, and monitoring of cases of COPD. The data were analyzed with the Friedman test, the Kruskal-Wallis test, Tukey's post hoc test, Dunnett's test, and the Bonferroni test. Results: There was a significant difference between the periods before and immediately after the training in terms of the scores on 15 of the 16 items on the questionnaire regarding the level of knowledge about COPD. The median total score of the participants increased significantly, from 60 points before the training to 77 points immediately thereafter and 3 months thereafter (p < 0.001 for both). Before the training, 23 (63.9%) and 13 (36.1%) of the members of the multidisciplinary team presented strong and very strong levels of agreement, respectively, among the 16 questionnaire items. After the training, 100% of the individuals presented a very strong degree of agreement. Conclusions: Multidisciplinary education through video lessons increased the knowledge of COPD on the part of a primary health care team, and the knowledge acquired was retained for at least three months after the intervention.


Keywords: Instructional films and videos; Pulmonary disease, chronic obstructive; Inservice training; Primary health care; Education, medical.


Effect of a clinical protocol on the management of acute asthma in the emergency room of a university hospital

Efeito da implantação de um protocolo assistencial de asma aguda no serviço de emergência de um hospital universitário

Pérsio Mariano da Rocha, Andréia Kist Fernandes, Fernando Nogueira, Deise Marcela Piovesan, Suzie Kang, Eduardo Franciscatto, Thaís Millan, Cristina Hoffmann, Carísi Anne Polanczyk, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2004;30(2):94-101

Abstract PDF PT

Background: There is a wide variability in clinical practice for treating acute asthma (AA) in the emergency room (ER) interfering in the quality of management. Objective: To evaluate the impact of a clinical protocol for care of acute asthma in the ER of the Hospital de Clínicas de Porto Alegre. Method: In this hospital a cross-sectional study was conducted before and after implementation of the protocol, of consecutive patients presenting with acute asthma in the adult ER (age ³ 12 years). The intention was to measure the effect of recommendations on the objective assessment of severity, utilization of diagnostic tools, proposed therapy, not recommended therapy and on the outcomes. Results: The pre-protocol group comprised 108 patients and the protocol group comprised 96 patients. There was a significant increase in the use of pulse oximetry (8% to 77%, p<0.001) and PEFR (5% to 21%, p<0.001). There was an increase in the utilization of radiology (33% to 66%, p<0.001) and in that of blood tests (11% to 25%, p=0.016). There was also an increase in the number of patients receiving the three recommended nebulizations in the first hour (22% to 36%, p=0.04). Although the overall use of corticosteroids did not change, there was a significant increase in the use of oral steroids (8% to 28%, p<0.001). There was no significant difference in the not recommended therapy, time of stay and outcomes. Conclusion: The acute asthma clinical protocol used in the ER was associated to a positive effect on the objective assessment of severity of asthma and on the use of the recommended therapy. No other significant influence on the treatment or on the outcome was perceived.


Keywords: Clinical protocols. Asthma. Emergency medicine.


Short-term effect of tiotropium in COPD patients being treated with a &#946;2 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.


Effect of tramadol on lung injury induced by skeletal muscle ischemia-reperfusion: an experimental study

Efeito do tramadol na lesão pulmonar induzida por isquemia-reperfusão de músculo esquelético: um estudo experimental

Mohammad Ashrafzadeh Takhtfooladi, Amirali Jahanshahi, Amir Sotoudeh, Gholamreza Jahanshahi, Hamed Ashrafzadeh Takhtfooladi, Kimia Aslani

J Bras Pneumol.2013;39(4):-

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Objective: To determine whether tramadol has a protective effect against lung injury induced by skeletal muscle ischemia-reperfusion. Methods: Twenty Wistar male rats were allocated to one of two groups: ischemia-reperfusion (IR) and ischemia-reperfusion + tramadol (IR+T). The animals were anesthetized with intramuscular injections of ketamine and xylazine (50 mg/kg and 10 mg/kg, respectively). All of the animals underwent 2-h ischemia by occlusion of the femoral artery and 24-h reperfusion. Prior to the occlusion of the femoral artery, 250 IU heparin were administered via the jugular vein in order to prevent clotting. The rats in the IR+T group were treated with tramadol (20 mg/kg i.v.) immediately before reperfusion. After the reperfusion period, the animals were euthanized with pentobarbital (300 mg/kg i.p.), the lungs were carefully removed, and specimens were properly prepared for histopathological and biochemical studies. Results: Myeloperoxidase activity and nitric oxide levels were significantly higher in the IR group than in the IR+T group (p = 0.001 for both). Histological abnormalities, such as intra-alveolar edema, intra-alveolar hemorrhage, and neutrophil infiltration, were significantly more common in the IR group than in the IR+T group. Conclusions: On the basis of our histological and biochemical findings, we conclude that tramadol prevents lung tissue injury after skeletal muscle ischemia-reperfusion.


Keywords: Tramadol; Muscle, skeletal; Ischemic attack, transient; Lung Injury.


Effects of acute and chronic administration of methylprednisolone on oxidative stress in rat lungs

Efeitos da administração aguda e crônica de metilprednisolona no estresse oxidativo em pulmões de ratos

Ronaldo Lopes Torres, Iraci Lucena da Silva Torres, Gabriela Laste, Maria Beatriz Cardoso Ferreira, Paulo Francisco Guerreiro Cardoso, Adriane Belló-Klein

J Bras Pneumol.2014;40(3):238-243

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Objective: To determine the effects of acute and chronic administration of methylprednisolone on oxidative stress, as quantified by measuring lipid peroxidation (LPO) and total reactive antioxidant potential (TRAP), in rat lungs. Methods: Forty Wistar rats were divided into four groups: acute treatment, comprising rats receiving a single injection of methylprednisolone (50 mg/kg i.p.); acute control, comprising rats i.p. injected with saline; chronic treatment, comprising rats receiving methylprednisolone in drinking water (6 mg/kg per day for 30 days); and chronic control, comprising rats receiving normal drinking water. Results: The levels of TRAP were significantly higher in the acute treatment group rats than in the acute control rats, suggesting an improvement in the pulmonary defenses of the former. The levels of lung LPO were significantly higher in the chronic treatment group rats than in the chronic control rats, indicating oxidative damage in the lung tissue of the former. Conclusions: Our results suggest that the acute use of corticosteroids is beneficial to lung tissue, whereas their chronic use is not. The chronic use of methylprednisolone appears to increase lung LPO levels.


Keywords: Lung; Methylprednisolone; Glucocorticoids; Lipid peroxidation; Antioxidant response elements.


Effects of hyperoxia on Wistar rat lungs

Efeitos da hiperóxia sobre o pulmão de ratos Wistar

Samuel dos Santos Valença, Milena Leonarde Kloss, Frank Silva Bezerra, Manuella Lanzetti, Fabiano Leichsenring Silva, Luís Cristóvão Porto

J Bras Pneumol.2007;33(6):655-662

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Objective: To study the effects of short-term exposure to high oxygen concentrations (hyperoxia) on Wistar rat lungs. Methods: Animals were divided into three groups exposed to hyperoxia for 10', 30' and 90' (O10', O30', O90', respectively), together with a control group (exposed to room air). The animals were sacrificed 24 h after exposure. Bronchoalveolar lavage was performed, and the lungs were removed for histological and stereological analysis. Results: In the O10', O30', and O90' groups, respectively and in comparison with the controls, we observed an increase in the numbers of macrophages (2169.9 ± 118.0, 1560.5 ± 107.0, and 1467.6 ± 39.0 vs. 781.3 ± 78.3) and neutrophils (396.3 ± 35.4, 338.4 ± 17.3, and 388.7 ± 11.7 vs. 61.6 ± 4.2), concomitant with an increase in oxidative damage (143.0 ± 7.8%, 180.4 ± 5.6%, and 235.0 ± 13.7% vs. 100.6 ± 1.7%). The histological and stereological analyses revealed normal alveoli and alveolar septa in the controls (83.51 ± 1.20% and 15 ± 1.21%), in the O10' group (81.32 ± 0.51% and 16.64 ± 0.70%), and in the O30' group (78.75 ± 0.54% and 17.73 ± 0.26%). However, in the O90' group, inflammatory cell infiltration was observed in the alveoli and alveolar septa. Red blood cells extravasated from capillaries to the alveoli (59.06 ± 1.22%), with evidence of congestion, hemorrhage, and septal edema (35.15 ± 0.69%). Conclusion: Hyperoxia for 90' caused injury of the lung parenchyma, resulting in oxidative damage and inflammatory cell infiltration.


Keywords: Hyperoxia; Lung/injuries; Oxidative stress.


Melatonin effects on pulmonary tissue in the experimental model of Hepatopulmonary Syndrome

Efeitos da melatonina sobre o tecido pulmonar no modelo experimental de Síndrome Hepatopulmonar

Adriane Dal Bosco1,a, Filipe Boeira Schedler2,b, Josieli Raskopf Colares2,c, Elisângela Gonçalves Schemitt2,3,d, Renata Minuzzo Hartmann2,3,e, Luiz Alberto Forgiarini Junior4,f, Alexandre Simões Dias2,3,g, Norma Possa Marroni2,3,h

J Bras Pneumol.2019;45(3):e20170164-e20170164

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Objective: To evaluate the pulmonary alterations of animals with Hepatopulmonary Syndrome (HPS) submitted to Biliary Duct Ligature (BDL), as well as the antioxidant effect of Melatonin (MEL). Methods: Sixteen male Wistar rats, divided into four Sham groups: BDL group, Sham + MEL group and BDL + MEL. The pulmonary and hepatic histology, lipoperoxidation and antioxidant activity of lung tissue, alveolar-arterial O2 difference and lung / body weight ratio (%) were evaluated. Results: When comparing the groups, could be observed an increase of vasodilation and pulmonary fibrosis in the BDL group and the reduction of this in relation to the BDL + MEL group. It was also observed significant changes in the activity of catalase, ApCO2, ApO2 in the LBD group when compared to the other groups. Conclusion: The use of MEL has been shown to be effective in reducing vasodilation, fibrosis levels and oxidative stress as well as gas exchange in an experimental HPS model.


Keywords: Bile duct; Hepatopulmonary Syndrome; Melatonin; Lung.


Effects of methylprednisolone on inflammatory activity and oxidative stress in the lungs of brain-dead rats

Efeitos da metilprednisolona na atividade inflamatória e estresse oxidativo nos pulmões de ratoscom morte cerebral

Eduardo Sperb Pilla, Raôni Bins Pereira, Luiz Alberto Forgiarini Junior, Luiz Felipe Forgiarini,Artur de Oliveira Paludo, Jane Maria Ulbrich Kulczynski, Paulo Francisco Guerreiro Cardoso,Cristiano Feijó Andrade

J Bras Pneumol.2013;39(2):173-180

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Objective: To evaluate the effects that early and late systemic administration of methylprednisolone have on lungs in a rat model of brain death. Methods: Twenty-four male Wistar rats were anesthetized and randomly divided into four groups (n = 6 per group): sham-operated (sham); brain death only (BD); brain death plus methylprednisolone (30 mg/kg i.v.) after 5 min (MP5); and brain death plus methylprednisolone (30 mg/kg i.v.) after 60 min (MP60). In the BD, MP5, and MP60 group rats, we induced brain death by inflating a balloon catheter in the extradural space. All of the animals were observed and ventilated for 120 min. We determined hemodynamic and arterial blood gas variables; wet/dry weight ratio; histological score; levels of thiobarbituric acid reactive substances (TBARS); superoxide dismutase (SOD) activity; and catalase activity. In BAL fluid, we determined differential white cell counts, total protein, and lactate dehydrogenase levels. Myeloperoxidase activity, lipid peroxidation, and TNF-α levels were assessed in lung tissue. Results: No significant differences were found among the groups in terms of hemodynamics, arterial blood gases, wet/dry weight ratio, BAL fluid analysis, or histological score-nor in terms of SOD, myeloperoxidase, and catalase activity. The levels of TBARS were significantly higher in the MP5 and MP60 groups than in the sham and BD groups (p < 0.001). The levels of TNF-α were significantly lower in the MP5 and MP60 groups than in the BD group (p < 0.001). Conclusions:áIn this model of brain death, the early and late administration of methylprednisolone had similar effects on inflammatory activity and lipid peroxidation in lung tissue.


Palavras-chave: Ratos; Morte encefálica; Estresse oxidativo; Pulmão; Hidroxicorticosteroides.


Effects of N-acetylcysteine and pentoxifylline on remote lung injury in a rat model of hind-limb ischemia/reperfusion injury

Efeitos da N-acetilcisteína e pentoxifilina na lesão pulmonar remota em um modelo de lesão de isquemia/reperfusão de membro posterior em ratos

Hamed Ashrafzadeh Takhtfooladi1, Saeed Hesaraki1, Foad Razmara2, Mohammad Ashrafzadeh Takhtfooladi3, Hadi Hajizadeh4

J Bras Pneumol.2016;42(1):9-14

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Objective: To investigate the effects of N-acetylcysteine (NAC) and pentoxifylline in a model of remote organ injury after hind-limb ischemia/reperfusion (I/R) in rats, the lungs being the remote organ system. Methods: Thirty-five male Wistar rats were assigned to one of five conditions (n = 7/group), as follows: sham operation (control group); hind-limb ischemia, induced by clamping the left femoral artery, for 2 h, followed by 24 h of reperfusion (I/R group); and hind-limb ischemia, as above, followed by intraperitoneal injection (prior to reperfusion) of 150 mg/kg of NAC (I/R+NAC group), 40 mg/kg of pentoxifylline (I/R+PTX group), or both (I/R+NAC+PTX group). At the end of the trial, lung tissues were removed for histological analysis and assessment of oxidative stress. Results: In comparison with the rats in the other groups, those in the I/R group showed lower superoxide dismutase activity and glutathione levels, together with higher malondialdehyde levels and lung injury scores (p < 0.05 for all). Interstitial inflammatory cell infiltration of the lungs was also markedly greater in the I/R group than in the other groups. In addition, I/R group rats showed various signs of interstitial edema and hemorrhage. In the I/R+NAC, I/R+PTX, and I/R+NAC+PTX groups, superoxide dismutase activity, glutathione levels, malondialdehyde levels, and lung injury scores were preserved (p < 0.05 for all). The differences between the administration of NAC or pentoxifylline alone and the administration of the two together were not significant for any of those parameters (p > 0.05 for all). Conclusions: Our results suggest that NAC and pentoxifylline both protect lung tissue from the effects of skeletal muscle I/R. However, their combined use does not appear to increase the level of that protection.


Keywords: Skeletal muscle; Ischemia; Reperfusion injury; Lung injury; Acetylcysteine; Pentoxifylline.


Effects of prednisone on eosinophilic bronchitis in asthma: a systematic review and meta-analysis

Efeitos da prednisona na bronquite eosinofílica na asma: uma revisão sistemática e meta-análise

Thiago Mamôru Sakae, Rosemeri Maurici, Daisson José Trevisol, Marcia Margaret Menezes Pizzichini, Emílio Pizzichini

J Bras Pneumol.2014;40(5):552-563

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Objective: To evaluate the effect size of oral corticosteroid treatment on eosinophilic bronchitis in asthma, through systematic review and meta-analysis. Methods: We systematically reviewed articles in the Medline, Cochrane Controlled Trials Register, EMBASE, and LILACS databases. We selected studies meeting the following criteria: comparing at least two groups or time points (prednisone vs. control, prednisone vs. another drug, or pre- vs. post-treatment with prednisone); and evaluating parameters before and after prednisone use, including values for sputum eosinophils, sputum eosinophil cationic protein (ECP), and sputum IL-5-with or without values for post-bronchodilator FEV1-with corresponding 95% CIs or with sufficient data for calculation. The independent variables were the use, dose, and duration of prednisone treatment. The outcomes evaluated were sputum eosinophils, IL-5, and ECP, as well as post-bronchodilator FEV1. Results: The pooled analysis of the pre- vs. post-treatment data revealed a significant mean reduction in sputum eosinophils (8.18%; 95% CI: 7.69-8.67; p < 0.001), sputum IL-5 (83.64 pg/mL; 95% CI: 52.45-114.83; p < 0.001), and sputum ECP (267.60 µg/L; 95% CI: 244.57-290.63; p < 0.0001), as well as a significant mean increase in post-bronchodilator FEV1 (8.09%; 95% CI: 5.35-10.83; p < 0.001). Conclusions:In patients with moderate-to-severe eosinophilic bronchitis, treatment with prednisone caused a significant reduction in sputum eosinophil counts, as well as in the sputum levels of IL-5 and ECP. This reduction in the inflammatory response was accompanied by a significant increase in post-bronchodilator FEV1.


Keywords: Meta-analysis; Bronchitis; Asthma; Pulmonary eosinophilia; Evidence-based medicine; Prednisone.


Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials

Efeitos da pressão positiva contínua nas vias aéreas na pressão arterial em pacientes com hipertensão resistente e apneia obstrutiva do sono: revisão sistemática e meta-análise de seis ensaios clínicos controlados aleatórios

Qiang Lei1, Yunhui Lv2, Kai Li1, Lei Ma1, Guodong Du1, Yan Xiang1, Xuqing Li1

J Bras Pneumol.2017;43(5):373-379

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Objective: To evaluate systematically the effects of continuous positive airway pressure (CPAP) on blood pressure in patients with resistant hypertension and obstructive sleep apnea (OSA). Methods: The Cochrane Library, PubMed, ScienceDirect, and the Web of Science were searched for studies investigating the effects of CPAP on blood pressure in patients with resistant hypertension and OSA. The selected studies underwent quality assessment and meta-analysis, as well as being tested for heterogeneity. Results: Six randomized controlled trials were included in the meta-analysis. The pooled estimates of the changes in mean systolic blood pressure and mean diastolic blood pressure (as assessed by 24-h ambulatory blood pressure monitoring) were −5.40 mmHg (95% CI: −9.17 to −1.64; p = 0.001; I2 = 74%) and −3.86 mmHg (95% CI: −6.41 to −1.30; p = 0.00001; I2 = 79%), respectively. Conclusions: CPAP therapy can significantly reduce blood pressure in patients with resistant hypertension and OSA.


Keywords: Continuous positive airway pressure; Sleep apnea, obstructive; Hypertension; Meta-analysis.


Effects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support

Efeitos da tosse manualmente assistida sobre a mecânica do sistema respiratório de pacientes em suporte ventilatório total

Katia de Miranda Avena, Antonio Carlos Magalhães Duarte, Sergio Luiz Domingues Cravo, Maria José Junho Sologuren, Ada Clarice Gastaldi

J Bras Pneumol.2008;34(6):380-386

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Objective: Manually assisted coughing (MAC) consists of a vigorous thrust applied to the chest at the beginning of a spontaneous expiration or of the expiratory phase of mechanical ventilation. Due to routine use of MAC in intensive care units, the objective of this study was to assess the effects of MAC on respiratory system mechanics in patients requiring full ventilatory support. Methods: We assessed 16 sedated patients on full ventilatory support (no active participation in ventilation). Respiratory system mechanics and oxyhemoglobin saturation were measured before and after MAC, as well as after endotracheal aspiration. Bilateral MAC was performed ten times on each patient, with three respiratory cycle intervals between each application. Results: Data analysis demonstrated a decrease in resistive pressure and respiratory system resistance, together with an increase in oxyhemoglobin saturation, after MAC combined with endotracheal aspiration. No evidence of alterations in peak pressures, plateau pressures or respiratory system compliance change was observed after MAC. Conclusions: The use of MAC alters respiratory system mechanics, increasing resistive forces by removing secretions. The technique is considered safe and efficacious for postoperative patients. Using MAC in conjunction with endotracheal aspiration provided benefits, achieving the proposed objective: the displacement and removal of airway secretions.


Keywords: Cough; Sputum; Respiratory mechanics; Respiration, artificial.


Effects of yoga breathing exercises on pulmonary function in patients with Duchenne muscular dystrophy: an exploratory analysis

Efeitos de exercícios respiratórios de ioga na função pulmonar de pacientes com distrofia muscular de Duchenne: uma análise exploratória

Marcos Rojo Rodrigues, Celso Ricardo Fernandes Carvalho, Danilo Forghieri Santaella, Geraldo Lorenzi-Filho, Suely Kazue Nagahashi Marie

J Bras Pneumol.2014;40(2):-

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Objective: Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, and children with DMD die prematurely because of respiratory failure. We sought to determine the efficacy and safety of yoga breathing exercises, as well as the effects of those exercises on respiratory function, in such children. Methods: This was a prospective open-label study of patients with a confirmed diagnosis of DMD, recruited from among those followed at the neurology outpatient clinic of a university hospital in the city of São Paulo, Brazil. Participants were taught how to perform hatha yoga breathing exercises and were instructed to perform the exercises three times a day for 10 months. Results: Of the 76 patients who entered the study, 35 dropped out and 15 were unable to perform the breathing exercises, 26 having therefore completed the study (mean age, 9.5  2.3 years; body mass index, 18.2  3.8 kg/m2). The yoga breathing exercises resulted in a significant increase in FVC (% of predicted: 82.3  18.6% at baseline vs. 90.3  22.5% at 10 months later; p = 0.02) and FEV1 (% of predicted: 83.8  16.6% at baseline vs. 90.1  17.4% at 10 months later; p = 0.04). Conclusions: Yoga breathing exercises can improve pulmonary function in patients with DMD.


Keywords: Respiratory therapy; Forced expiratory volume; Vital capacity; Muscular dystrophy, Duchenne; Complementary therapies.


Effects of an outpatient education program in patients with uncontrolled asthma

Efeitos de um programa educativo ambulatorial em pacientes com asma não controlada

Carmen Denise Borba Rodrigues, Rosemary Petrik Pereira, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2013;39(3):272-279

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Objective: To evaluate the effects of an outpatient education program in patients with uncontrolled asthma. Methods: This was an uncontrolled study evaluating an educational intervention and involving patients with uncontrolled asthma ≥ 14 years of age. The participants completed a questionnaire designed to assess the level of asthma control, the inhalation technique, and quality of life. All of the patients underwent pulmonary function testing, after which they participated in an education program consisting of one 45-min face-to-face session, followed by phone interviews at two, four, and eight weeks. The participants were reevaluated after three months. Results: Sixty-three patients completed the study. There was a significant improvement in the level of asthma control (p < 0.001). Of the 63 patients, 28 (44.4%) and 6 (9.5%) were classified as having partially controlled asthma and controlled asthma, respectively. The mean FEV1 was 63.0 ± 20.0% and 68.5 ± 21.2% of the predicted value prior to and after the educational intervention, respectively (p = 0.002), and all of the quality of life scores improved (p < 0.05 for all). The same was true for the proportion of patients prior to and after the educational intervention using the proper inhalation technique when using metered dose inhalers (15.4% vs. 46.2%; p = 0.02) and dry powder inhalers (21.3% vs. 76.6%; p < 0.001). The logistic regression analysis revealed that an incorrect inhalation technique identified during the first evaluation was independently associated with a favorable response to the educational intervention. Conclusions: This study suggests that an outpatient education program for asthma patients improves the level of asthma control, lung function parameters, and quality of life. An incorrect inhalation technique identified during the first evaluation was predictive of a favorable response to the educational intervention.


Keywords: Asthma/prevention and control; Quality of life; Respiratory function tests; Ambulatory care; Health education.


Effects of exercise on sleep symptoms in patients with severe obstructive sleep apnea

Efeitos do exercício nos sintomas do sono em pacientes com apneia obstrutiva do sono

Roberto Pacheco da Silva1,a, Denis Martinez1,2,3,b, Kelly Silveira da Silva Bueno1,c, Jhoana Mercedes Uribe-Ramos2,d

J Bras Pneumol.2019;45(3):e20180085-e20180085

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Objective: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). Methods: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. Results: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. Conclusions: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.


Keywords: Sleep apnea syndromes; Exercise; Sleepiness; Polysomnography.


Efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in evaluating lung cancer recurrence

Eficácia da tomografia por emissão de pósitrons com 18F fluordesoxiglicose com tomografia computadorizada na avaliação de recidiva de câncer de pulmão

Nobuhiro Asai, Yoshihiro Ohkuni, Kazufusa Shoji, Norihiro Kaneko

J Bras Pneumol.2013;39(2):242-244

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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):-

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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. ( identifier: NCT00975741 [])


Eliminating tuberculosis in Latin America: making it the point

Eliminação da tuberculose na América Latina: considerações

Raquel Duarte1,2,3,a, Denise Rossato Silva4,b, Adrian Rendon5,c, Tatiana Galvẫo Alves6,d, Marcelo Fouad Rabahi7,e, Rosella Centis8,f, Afrânio Kritski9,g, Giovanni Battista Migliori8,h

J Bras Pneumol.2018;44(2):73-76

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Near-fatal pulmonary embolism: capnographic perspective

Embolia pulmonar quase fatal: perspectiva capnográfica

Marcos Mello Moreira1,2,a, Luiz Claudio Martins3,b, Konradin Metze4,c, Marcus Vinicius Pereira2,d, Ilma Aparecida Paschoal1,e

J Bras Pneumol.2018;44(6):525-528

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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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Empyema caused by infection with Clostridium septicum in a patient with lung cancer

Empiema causado por infecção por Clostridium septicum em um paciente com câncer de pulmão

Gabriel Afonso Dutra Kreling1,a, Marilia Ambiel Dagostin1,b, Marcelo Park2,c

J Bras Pneumol.2018;44(6):529-531

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Empyema and bacteremic pneumococcal pneumonia in children under five years of age

Empiema e pneumonia pneumocócica bacterêmica em menores de cinco anos de idade

Maria Regina Alves Cardoso, Cristiana Maria Costa Nascimento-Carvalho, Fernando Ferrero, Eitan Naaman Berezin, Raul Ruvinsky, Clemax Couto Sant'Anna, Maria Cristina de Cunto Brandileone, Maria de Fátima Bazhuni Pombo March, Ruben Maggi, Jesus Feris-Iglesias, Yehuda Benguigui, Paulo Augusto Moreira Camargos; the CARIBE group

J Bras Pneumol.2014;40(1):73-76

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Patient discharge from the ICU is indicated on the basis of clinical evidence and the result of strategies aimed at improving health care. Nevertheless, some patients might be discharged too early. We attempted to identify risk factors for unplanned ICU readmission, using a score for risk assessment, designated the Stability and Workload Index for Transfer (SWIFT) score. We evaluated 100 patients discharged from an ICU and found that the SWIFT score can be used as a tool for improving the assessment of ICU patients and the appropriateness of ICU discharge, thus preventing readmission.


Keywords: Intensive care units; Risk factors; Patient readmission.


Experimental pleural empyema in rats: effect of the intrapleural administration of dextran 40 during the fibrinopurulent stage

Empiema pleural experimental em ratos: avaliação dos efeitos do uso intrapleural de dextran-40 na fase fibrinopurulenta

Tulio Tonietto, Eduardo Sperb Pilla, Gabriel Ribeiro Madke, Ubirajara de Lima e Silva, José Carlos Felicetti, José de Jesus Peixoto Camargo, Marisa Ribeiro de Itapema Cardoso, Ricardo Bettiol Nonnig, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(3):-

Abstract PDF PT

Pleural empyema carries high morbidity and mortality rates. Therapy focuses on the control of the infectious process in its initial phase when parenteral antibiotics and chest drainage are likely to be most effective. The ability of dextrans in preventing peritoneal adhesions leads one to test their potential effectiveness in reducing fibrinous proliferation in a rat model of pleural empyema. Twenty-four Wistar rats weighing 250-400 grams were anesthetized, submitted to a right thoracotomy and then randomized into 3 groups (n = 8 each). Animals in group I were given intrapleural dextran 40 (1 ml/kg) + 1 ml/kg of Staphylococcus aureus extract (1010 cells/ml) in heart-brain culture media obtained from oropharyngeal swabs of the animals. Animals in group II received saline solution (1 ml/kg) +1 ml/kg of Staphylococcus aureus extract (1010 cells/ml) in heart-brain culture media. Animals in group III (controls) were given the culture media without bacteria (1 ml/kg) in addition to saline (1 ml/kg). Upon completion, the chest was deaired, the thoracotomy wound was closed, the animals recovered, observed for 4 days, and sacrificed. Only the animals in groups I and II developed pleural effusion and empyema (average volume of 9.7 ml and 8.1 ml respectively, p > 0.05, NS). There was a significant weight loss in groups I and II compared to control animals (p = 0.004). There were no significant differences in blood work-up tests between groups. The pleural fluid of all animals in groups I and II had positive cultures for Staphylococcus aureus. The biochemical analysis of the pleural fluid in animals from groups I and II did not show any significant differences. The authors concluded that in this novel and reliable model of pleural empyema in rats, the intrapleural administration of dextran 40 at time of inoculation of bacteria did not result in any measurable reduction of the pleural reaction after 96 hours of observation.


Keywords: Empyema. Pleura. Rat. Dextrans. Staphylococcus.


Air stacking and chest compression increase peak cough flow in patients with Duchenne muscular dystrophy

Empilhamento de ar e compressão torácica aumentam o pico de fluxo da tosse em pacientes com distrofia muscular de Duchenne

Magneide Fernandes Brito, Gustavo Antonio Moreira, Márcia Pradella-Hallinan, Sergio Tufik

J Bras Pneumol.2009;35(10):973-979

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Objective: To evaluate cough efficiency using two manually-assisted cough techniques. Methods: We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60% of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05). Results: The mean age of the patients was 20 ± 4 years, and the mean FVC was 29 ± 12%. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 ± 67, 231 ± 81, 225 ± 80, and 292 ± 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001). Conclusions: Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).


Keywords: Muscular dystrophy, Duchenne; Intermittent positive-pressure ventilation; Cough; Insufflation;Peak expiratory flow rate.


Use of breath carbon monoxide as an indicator of smoking status

Emprego da determinação de monóxido de carbono no ar exalado para a detecção do consumo de tabaco

Ubiratan P. Santos, Silmar Gannam, Julie M. Abe, Patricia B. Esteves, Marco Freitas Filho, Thais B. Wakassa, Jaqueline S. Issa, Mario Terra-Filho, Rafael Stelmach, Alberto Cukier

J Bras Pneumol.2001;27(5):231-236

Abstract PDF PT

Introduction: Smoking is the major preventable risk of morbidity and mortality. However, its prevalence is high in developed countries and increasing in developing countries, even though its effects are now better known. The purpose of this study was to compare the exhaled carbon monoxide concentration (exCO) between smokers and nonsmokers, evaluate the factors that influence this parameter among smokers and the potential influence of passive smoking by measuring exCO in workers and patients of Instituto do Coração HC-FMUSP. Materials and methods: This cross study included 256 volunteers who responded to a questionnaire and were submitted to exCO measuring with the MicroCo meter device. Results: There were 106 males and 150 females. Mean age was 43.4 years (Vmin-max: 15-83). There were 107 smokers, 118 nonsmokers and 31 passive smokers. Mean exCO was 14.01 ppm (Vmin-max: 1-44) among smokers, 2.03 ppm (Vmin-max: 0-5) among passive smokers and 2.50 ppm (Vmin-max: 0-9) among nonsmokers. Significant statistical difference was observed between smokers and the other groups (p < 0.001), but not between nonsmokers and passive smokers. A positive correlation was found between the number of cigarettes smoked per day and exCO values while there was a negative correlation between the exCO values and the timing of the last cigarette. For a reference limit value of 6 ppm, sensitivity was 70% and specificity was 96%. Conclusion: exCO metering is easy to perform, low-cost, noninvasive and allows the obtention of immediate results and the reference limit value of 6 ppm has good specificity to evaluate the smoking habit.


Keywords: Smoking. Carbon monoxide. Tobacco smoke pollution. Brazil.


Open, controlled clinical assay of the addition of ipratropium bromide to fenoterol in the treatment of acute asthma crisis in adults

Ensaio clínico, aberto, controlado sobre a adição de brometo de ipratrópio ao fenoterol no tratamento da crise de asma em adultos

Solange Diccini, Clystenes Odyr Soares Silva, Jorge Nakatani, Carlos Alberto de Castro Pereira

J Bras Pneumol.1999;25(6):301-308

Abstract PDF PT

Repeated dosis of inhaled β2-agonists have been used in the treatment of acute asthma. The effect of added ipratropium bromide (IB) to β2-agonist is controversial in adults. Objective: To evaluate if addition of IB to fenoterol, in repeated doses, induces a greater bronchodilation, a greater reversion of the attack, and discharge from emergency unit in adults with acute severe asthma. Setting: Pneumology Emergency Department, Unifesp-Hospital São Paulo, in the period from July 1995 to February 1997. Type of study: Open, randomized and parallel study. Discharge from the hospital: FEV1 and PEF ≥ 60% of the predicted value. Methods: 120 patients with FEV1 and PEF ≤ 50% of the predicted value were divided into two groups (N = 60): fenoterol (F) and ipratropium bromide + fenoterol (IBF). Each group received inhalation treatment through a metered-dose inhaler (MDI) attached to a holding chamber, administered at 30-minute interval, for a total of three treatments. In the group F four puffs of fenoterol (400 μg) were administered, and in the IBF group, 160 μg of BI and 400 μg of fenoterol (four puffs). Results: The patients did not differ from basal PEF (F = 36 ± 7% vs IBF = 35 ± 9% predicted) and basal FEV1 (F = 33 ± 9% vs IBF = 32 ± 9% predicted). Thirty-two patients of group F and 33 of group IBF were discharged from hospital after the inhalation treatment. The final FEV1 and PEF after inhalation treatments were F = 60 ± 13% vs IBF = 61 ± 11% e F = 74 ± 18% vs IBF = 77 ± 13% (NS). Conclusion: The addition of ipratropium bromide to fenoterol results in insignificant functional effect and without clinical impact in the treatment of acute asthma in adults.


Keywords: Fenoterol. Ipratropium. Status asthmaticus. Respiratory therapy.




Francisca Magalhães Scoralick, Luciana Paganini Piazzolla, Liana Lauria Pires, Cleudson Nery de Castro e Wladimir Kummer de Paula

J Bras Pneumol.2013;39(3):-

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Diffuse systemic sclerosis with isolated pulmonary hypertension: a case report

Esclerose sistêmica difusa com hipertensão pulmonar isolada: relato de caso

Silméia Garcia Zanati, Katashi Okoshi, Luiz Shiguero Matsubara, Roberto Minoru Tani Inoue, Marina Politi Okoshi

J Bras Pneumol.2000;26(6):313-316

Abstract PDF PT

Systemic sclerosis (SS) is an uncommon disease characterized by small blood vessel vasculopathy and increased connective tissue in the skin and in other organs. The pulmonary involvement is common in SS; however, pulmonary hypertension without interstitial fibrosis is rare. The authors present a case of the diffuse form of SS with isolated pulmonary hypertension. The diagnosis of pulmonary hypertension was suggested by physical examination and confirmed by doppler-echocardiography which allowed for the estimation of the pulmonary artery systolic pressure in 80 mmHg. The authors started treatment with nifedipine; however, as the patient presented side effects, it was not possible to increase the dose beyond 30 mg/day. In this dosage, nifedipine did not decrease the pulmonary arterial pressure.


Keywords: Systemic scleroderma. Nifedipine. Pulmonary hypertension. Vasodilatador agents. Doppler echocardiography.


Esclerose sistêmica e pneumonia intersticial idiopática: diferenças histomorfométricas em biópsias pulmonares

Esclerose sistêmica e pneumonia intersticial idiopática: diferenças histomorfométricas em biópsias pulmonares

Edwin Roger Parra, Leandro Hideki Otani, Erika Franco de Carvalho, Alexandre Ab'Saber, Vera Luiza Capelozzi

J Bras Pneumol.2009;35(6):529-540

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Objective: The aim of this study was to examine the parenchymal and extracellular matrix remodeling process in two histologic patterns-nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP)-in cases of idiopathic and sclerosis/systemic sclerosis (SSc)-associated interstitial pneumonia. Methods: We examined 15 cases of idiopathic NSIP, 10 cases of idiopathic UIP, 5 cases of SSc-UIP and 9 cases of SSc-NSIP. In the lung parenchyma, epithelial cells, endothelial cells and myofibroblasts were evaluated by immunohistochemical staining, whereas histochemical staining was used in order to evaluate collagen/elastic fibers in the extracellular matrix. Results: The percentage of surfactant protein A-positive epithelial cells was significantly greater in idiopathic NSIP than in SSc-NSIP, as well as being greater in idiopathic UIP than in SSc-UIP. Idiopathic NSIP and idiopathic UIP presented significantly higher immunoexpression of alpha smooth muscle actin in myofibroblasts than did SSc-NSIP and SSc-UIP. The percentage of CD34 endothelial cells in the pulmonary microvasculature was significant lower in idiopathic UIP than in SSc-UIP. The density of collagen fibers was significantly greater in idiopathic NSIP and idiopathic UIP than in SSc-NSIP and UIP. In contrast, the elastic fiber density was significantly lower in idiopathic UIP than in SSc-UIP. Conclusions: Increased collagen synthesis, destruction of elastic fibers, high myofibroblast proliferation and poor microvascularization might represent a remodeling process found in idiopathic interstitial pneumonia, whereas the reverse might represent a repair process in SSc-associated interstitial pneumonia.


Keywords: Epithelial cells; Neovascularization, pathologic; Collagen; Elastin; Idiopathic interstitial pneumonias; Scleroderma, systemic.


High-resolution computed tomography scores in cystic fibrosis patients colonized with Pseudomonas aeruginosa or Staphylococcus aureus

Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

Tania Wrobel Folescu, Elizabeth de Andrade Marques, Márcia Cristina Bastos Boechat, Pedro Daltro, Laurinda Yoko Shinzato Higa, Renata Wrobel Folescu Cohen

J Bras Pneumol.2012;38(1):41-49

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Objective: To compare HRCT findings in cystic fibrosis (CF) patients chronically colonized with Pseudomonas aeruginosa or Staphylococcus aureus using the modified Bhalla CT scoring system, as well as to evaluate intraobserver and interobserver reliability of the method. Methods: This was a retrospective cross-sectional study involving 41 CF patients, 26 of whom were chronically colonized with P. aeruginosa (Pa group), and 15 of whom were colonized with S. aureus (Sa group).Two independent radiologists evaluated the HRCT scans of these patients using the modified Bhalla CT scoring system in two different moments. Intraobserver and interobserver reliability was calculated using the intraclass correlation coefficient (ICC). Results: There was good intraobserver and interobserver agreement (ICC > 0.8). Scores were higher in the Pa group than in the Sa group for observer 1 (mean, 13.50 ± 3.90; median, 13.5 vs. mean, 5.00 ± 5.28; median, 3.0) and for observer 2 (mean, 11.96 ± 5.07; median, 12.0 vs. mean, 5.07 ± 5.65; median, 5.0). In addition, HRCT findings, such as bronchiectasis, bronchial wall thickening, mucus plugging, generation of bronchial divisions, and mosaic attenuation/perfusion pattern, were more prevalent in the Pa group. Conclusions: The modified Bhalla CT scoring system was reproducible and reliable for use in the evaluation of HRCT scans, allowing distinctions to be drawn between the two groups of patients under study. The higher scores in the Pa group provided evidence of greater pulmonary impairment in that group.


Keywords: Cystic fibrosis; Tomography; Staphylococcus aureus; Pseudomonas aeruginosa.


Spirometry in patients screened for coronary artery disease: is it useful?

Espirometria em pacientes submetidos a investigação para detecção de doença arterial coronariana: é útil?

Frederico Leon Arrabal Fernandes1,a, Regina Maria Carvalho-Pinto1,b, Rafael Stelmach1,c, João Marcos Salge1,d, Carlos Eduardo Rochitte2,e, Eliane Cardoso dos Santos Souza1,f, Janaina Danielle Pessi1,g, Alberto Cukier1,h

J Bras Pneumol.2018;44(4):299-306

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Objective: To determine the prevalence of spirometric abnormalities in patients screened for coronary artery disease (CAD) and the risk factors for lung function impairment. Methods: Patients referred for cardiac CT underwent spirometry and were subsequently divided into two groups, namely normal lung function and abnormal lung function. The prevalence of spirometric abnormalities was calculated for the following subgroups of patients: smokers, patients with metabolic syndrome, elderly patients, and patients with obstructive coronary lesions. All groups and subgroups were compared in terms of the coronary artery calcium score and the Duke CAD severity index. Results: A total of 205 patients completed the study. Of those, 147 (72%) had normal lung function and 58 (28%) had abnormal lung function. The median coronary artery calcium score was 1 for the patients with normal lung function and 36 for those with abnormal lung function (p = 0.01). The mean Duke CAD severity index was 15 for the former and 27 for the latter (p < 0.01). Being a smoker was associated with the highest OR for abnormal lung function, followed by being over 65 years of age and having obstructive coronary lesions. Conclusions: The prevalence of spirometric abnormalities appears to be high in patients undergoing cardiac CT for CAD screening. Smokers, elderly individuals, and patients with CAD are at an increased risk of lung function abnormalities and therefore should undergo spirometry. ( identifier: NCT01734629 [])


Keywords: Pulmonary disease, chronic obstructive; Spirometry; Coronary disease; Tomography, X-ray computed.


Tuberculous spondylitis in teenager

Espondilite tuberculosa em adolescente

Marta Maciel Lyra Cabral, Bruno Canto C. de A. Azevedo, Lílian Maria Lapa Montenegro, Rosana de Albuquerque Montenegro, Andrea Santos Lima, Haiana Charifker Schindler

J Bras Pneumol.2005;31(3):261-264

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This article presents a case report of osteoarticular tuberculosis affecting lumbar sacral column non-typical attack. The diagnosis remains a medical challenge because the symptoms and bone lesions are not specific and can be mislead with other morbidity such as inflammatory, circulatory, metabolic, traumatic, congenital and tumoral diseases. The disease is degenerative and the prognosis not satisfactory. Besides the clinical aspects and laboratory, imaging results, including computed tomography and magnetic ressonance, are discussed. A PCR system targeting the IS 6110 of M. tuberculosis was positive, strongly suggesting the presence of this pathogen. This assay would be particularly indicated when quick and sensitive diagnosis of tuberculosis is required.


Keywords: Tuberculosis. Spondylitis. PCR. Diagnostic.


Stability of the animal model of oleic acid-induced acute lung injury

Estabilidade do modelo animal de lesão pulmonar aguda induzida por ácido oleico

Eduardo Gaio, César Augusto de Melo e Silva, Flávio Brito, Marco Aurélio Pereira Firmino, Rodrigo Storck, Eduardo Freitas

J Bras Pneumol.2009;35(8):759-766

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Objective: To evaluate the stability of hemodynamic, respiratory and gas exchange variables in an animal model of oleic acid-induced acute lung injury. Methods: This was an experimental study involving 10 mongrel dogs. The variables were measured at baseline, as well as at 30, 60, 90 and 120 min after the administration of oleic acid. In order to analyze repeated measurements, linear and quadratic effects were tested. Mixed linear models with diversified variance and covariance structures were used, depending on the variable studied. Results: We found that mean arterial blood pressure stabilized at 30 min, as did heart rate, pulmonary arterial pressure and pulmonary capillary pressure at 60 min. Respiratory rate, tidal volume, minute volume and respiratory work stabilized at 30 min. Regarding gas exchange variables, PaO2, PaO2/FiO2 ratio and pulmonary shunt fraction stabilized at 30 min. The remaining variables maintained a continuous rise or fall. Conclusions: This oleic acid-induced acute lung injury model is stable for some of the variables tested, although stabilization occurs at different times. The respiratory and gas exchange variables stabilized at 30 min, whereas the hemodynamic variables stabilized at 60 min.


Keywords: Respiratory distress syndrome, adult; Models, animal; Statistical analysis.


Lung cancer staging in Brazil: an epidemiological perspective

Estadiamento do câncer de pulmão: uma visão epidemiológica brasileira

Juliana Pereira Franceschini1, Ilka Lopes Santoro1

J Bras Pneumol.2020;46(1):e20190412-e20190412

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Tumor-node-metastasis staging and treatment patterns of 73,167 patients with lung cancer in Brazil

Estadiamento tumor-nódulo-metástase e padrão de tratamento oncológico de 73.167 pacientes com câncer de pulmão no Brasil

Guilherme Jorge Costa1,2, Maria Júlia Gonçalves de Mello3, Anke Bergmann4, Carlos Gil Ferreira5, Luiz Claudio Santos Thuler4,6

J Bras Pneumol.2020;46(1):e20180251-e20180251

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Objective: To characterize the clinical and histological profile, as well as treatment patterns, of patients with early-stage, locally advanced (LA), or advanced/metastatic (AM) lung cancer, diagnosed between 2000 and 2014, in Brazil. Methods: This was an analytical cross-sectional epidemiological study employing data obtained for the 2000-2014 period from the hospital cancer registries of two institutions in Brazil: the José Alencar Gomes da Silva National Cancer Institute, in the city of Rio de Janeiro; and the São Paulo Cancer Center Foundation, in the city of São Paulo. Results: We reviewed the data related to 73,167 patients with lung cancer. The proportions of patients with early-stage, LA, and AM lung cancer were 13.3%, 33.2%, and 53.4%, respectively. The patients with early-stage lung cancer were older and were most likely to receive a histological diagnosis of adenocarcinoma; the proportion of patients with early-stage lung cancer remained stable throughout the study period. In those with LA lung cancer, squamous cell carcinoma predominated, and the proportion of patients with LA lung cancer decreased significantly over the period analyzed. Those with AM lung cancer were younger and were most likely to have adenocarcinoma; the proportion of patients with AM lung cancer increased significantly during the study period. Small cell carcinoma accounted for 9.2% of all cases. In our patient sample, the main treatment modality was chemotherapy. Conclusions: It is noteworthy that the frequency of AM lung cancer increased significantly during the study period, whereas that of LA lung cancer decreased significantly and that of early-stage lung cancer remained stable. Cancer treatment patterns, by stage, were in accordance with international guidelines.


Keywords: Lung neoplasms/epidemiology; Lung neoplasms/therapy; Neoplasm staging; Brazil.


Idiopathic tracheal stenosis. A report of four cases

Estenose idiopática de traquéia. Relato de quatro casos

Carolina Rossi, Fernanda Colombari, Alda Losi Guembarowsky, Olavo Franco Ferreira Filho, João Carlos Thomson

J Bras Pneumol.2007;33(1):101-104

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Idiopathic tracheal stenosis is uncommon. Herein, we report four cases, all presenting a similar clinical profile: diagnosed through bronchoscopy and having a history of being treated unsuccessfully for bronchospasm. Three of the patients were treated with dilatation and an oral corticosteroid. One of those three underwent tracheoplasty. In the remaining patient, the stenosis was more extensive (2 cm, with a 70% reduction in the size of the lumen), and dilatation was not an option. Therefore, that patient underwent laryngotracheal resection. In all four patients, the evolution was favorable. Idiopathic tracheal stenosis should be contemplated in cases of 'bronchitis' that are not resolved using conventional treatments. Bronchoscopy and dilatation have provided satisfactory results. Occasionally, laryngotracheal reconstruction is necessary.


Keywords: Trachea/surgery; Constriction; Pathologic; Case reports [publication type].


Experimental diabetes mellitus: oxidative stress and changes in lung structure

Estresse oxidativo e alterações estruturais pulmonares no diabetes mellitus experimental

Luiz Alberto Forgiarini Junior, Nélson Alexandre Kretzmann, Marilene Porawski, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2009;35(8):788-791

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Diabetes mellitus is an endocrine/metabolic disorder characterized by hyperglycemia. Its impact on the respiratory system is characterized by functional changes and alterations in gas exchange. The objective of this study was to evaluate the increase in oxidative stress and the potential damages to the lung structure in an experimental model of streptozotocin-induced diabetes. We conducted histological, biochemical and blood gas analyses in the lungs of diabetic rats. We concluded that the effects of experimental diabetes mellitus include oxidative stress, structural changes in the lung tissue and altered gas exchange.


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


A case-control study about indicators of non-compliance in patients with tuberculosis

Estudo caso-controle de indicadores de abandono em doentes com tuberculose

Sandra A. Ribeiro, Verônica M. Amado, Aquiles A. Camelier, Márcia M.A. Fernandes, Simone Schenkman

J Bras Pneumol.2000;26(6):291-296

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Non-compliance of tuberculosis treatment has social and epidemiological implications. Purpose: To compare characteristics of patients that were compliant (control group) and non-compliant with the treatment at the Health Care Center at the Federal University of São Paulo, Brazil, between 1995 and 1997, and to verify if patients who had joined in educational classes on tuberculosis had enhanced chances to a positive outcome after expiration of the six months of treatment. Method: The authors conducted a retrospective and controlled study with 100 patients (38 non-compliant and 62 compliant) registered for tuberculosis treatment in order to verify the variables related to non-compliance. Sixty patients (16 non-compliant and 44 compliant) had educational classes. Results: The risk factors most related to non-compliance were: male sex, cigarette smoking, alcohol and drug abuse, risk factors for HIV, and previous hospitalization. Patients who had attended educational classes had the same characteristics as all patients, but they had lower frequency of non-compliance (p < 0.05). Conclusion: The authors conclude that, if they had adequate access to means of diagnosis and follow-up for the treatment of tuberculosis, all extra efforts should be concentrated on avoiding non-compliance, mainly in patients with risk factors, as mentioned above. The patients at risk of non-compliance should have educational classes about their disease.


Keywords: Prevalence. Diagnosis-related groups.


Comparative study of prognostic factors among longer and shorter survival patients with bronchogenic carcinoma

Estudo comparativo dos fatores prognósticos entre os pacientes com maior e menor sobrevida em portadores de carcinoma broncogênico

Sérgio Jamnik, Ilka Lopes Santoro, César Uehara

J Bras Pneumol.2002;28(5):245-249

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Despite the improvements seen in the treatment of lung cancer, little has improved in the survival of these patients, and a great importance is attributed to the factors that have a role to play in such survival. Purpose: To check for possible prognostic factor differences in two populations of lung cancer patients, one of them with short survival (less than six months), and the other with longer survival (more than 24 months). Methods: From 1997 to 1999, 52 patients with histopathologic diagnosis of homogenous carcinoma were studied, and demographics, clinical parameters, smoking pattern, Karnofsky's index, disease staging, and laboratory dosing of lactic dehydrogenase, alkaline phosphatase, carcinoembryonic antigen, and calcium data were surveyed. Results: 29 patients had less than six month survival, and 23 had more than 24 month survival. The three most important factors for short survival were the low initial Karnofsky's index, loss of appetite, and high serum LDH levels. Conclusion: The three prognosis components are: current physical status, prior physical status, and current status of the disease.


Comparative study evaluating outcomes of lobectomy and extended segmentectomy used in the treatment of primary non-small cell bronchial carcinoma

Estudo comparativo entre lobectomia e segmentectomia estendida para o tratamento do carcinoma brônquico não de pequenas células em estágios iniciais

Airton Schneider, Paulo Roberto Kriese, Luiz Augusto Lopes da Costa, Tiago José Refosco, Caroline Buzzatti

J Bras Pneumol.2004;30(5):433-438

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Background: Lobectomy is still considered the most effective method of controlling primary lung tumors. Method: During the period from 1995 to 2000, 733 cases of non-small cell bronchial carcinoma. After clinical evaluation and surgical staging, 191 patients were submitted to surgical resection. Of those 191 surgeries, 63 were for locally advanced tumors and 128 (69 segmentectomies and 59 lobectomies) for primary tumors. Post-operative FEV1 of at least 800 ml was used as a measure of surgical success. Extended segmentectomies, in which the resection passes the intersegmental line, including the parenchyma of the adjoining segment, were used. Results: Among the 128 patients with primary tumors, there were 3 deaths and 10 patients fell out of contact. Therefore, 62 segmentectomies and 53 lobectomies were evaluated. There were 72 adenocarcinomas and 43 epidermoid carcinomas. The 5-year survival of lobectomy patients was 80% (T1N0), 72.7% (T2N0), 50% (T1N1) and 31.8% (T2N1), whereas that of segmentectomy patients was 80% (T1N0), 66.6% (T2N0), 41.1% (T1N1) and 30% (T2N1) (p > 0.05). Tumor size and enlarged interlobar lymph nodes were prognostically significant (p < 0.001), although method of resection influenced neither survival nor local or remote recurrence (p > 0.05). Conclusion: Extended segmentectomy represents an alternative treatment for primary tumors in patients with limited lung reserve.


Keywords: Lung Neoplasms, surgery. Pulmonary Surgical Procedures. Carcinoma, Non-Small-Cell Lung.


Comparative study of elderly inpatients clinically diagnosed with community-acquired pneumonia, with or without radiological confirmation

Estudo comparativo entre pacientes idosos internados com diagnóstico clínico de pneumonia comunitária, com ou sem confirmação radiológica

Daniel Knupp Augusto, Luís Felipe José Ravic de Miranda, Carlos Eduardo Gazinelli Cruz, Ênio Roberto Pietra Pedroso

J Bras Pneumol.2007;33(3):270-274

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Objectives: To compare clinical and radiological aspects, as well as aspects regarding the course of the disease, of elderly inpatients clinically diagnosed with community-acquired pneumonia, with or without radiological confirmation. Methods: A total of 141 patients over the age of 60 were retrospectively studied. Results: Radiological findings corroborated the clinical diagnosis in 45 patients, whereas, in 96 patients, radiology did not correlate with the clinical suspicion. The signs, symptoms, treatment, and outcomes of these two groups were compared. The findings of the study suggest that there were no significant differences between the groups according to the criteria analyzed. Conclusion: The prevalence of chest X-rays compatible with pneumonia in patients suspected of the disease was slightly higher than 30%. Having low specificity in the elderly, the clinical diagnosis of community-acquired pneumonia should be used with caution. In view of the small number of patients studied, further studies on this topic are needed in order to confirm the findings.


Keywords: Pneumonia; Aged; Diagnosis; Radiology; Hospitalization.


Comparative study of high resolution computer-assisted tomography with chest radiograph in the diagnosis of silicosis incipient cases

Estudo comparativo entre tomografia computadorizada de alta resolução e radiografia de tórax no diagnóstico da silicose em casos incipientes

Ana Paula Scalia Carneiro, Arminda Lucia Siqueira, Eduardo Algranti, Cid Sérgio Ferreira, Jorge Issamu Kavakama, Maria Luiza Bernardes, Thaís Abreu de Castro, René Mendes

J Bras Pneumol.2001;27(4):-

Abstract PDF PT

Introduction: At present, chest radiography (CR) is the main instrument used in the diagnosis of silicosis, following the International Labor Organization (ILO) recommendations. In incipient cases, the interpretation of radiographs is difficult and disagreement may occur, even among experienced readers. Recently, the possibility of evaluating incipient cases by using high resolution computed tomography (HRCT) has been considered. Objective: To compare CR with HRCT results. Patients and methods: An original group of 135 ex-miners were evaluated by CR, according to ILO recommendations, examined by three readers, from November 1997 to December 1999. HRCT was indicated to 68 patients whose median profusion readings was 1/0 or below. HRCT results were examined by two readers and, in cases of disagreement, a third reader was consulted. HRCT results were classified according to micronodule profusion into categories 0 to 3. CR and HRCT results were compared using McNemar test, weighed Kappa coefficient and log-linear models. Results and conclusion: There was good agreement among the methods in category 0, so it was concluded that both methods are similar in excluding the diagnosis of silicosis. However, in category 1 or greater (diagnosis of the disease) a good agreement among the methods was not observed.


Keywords: Silicosis. Thoracic radiography. Tomography X-ray computed. Pneumoconiosis.


Outcomes of multidrug resistant tuberculosis (MDR TB) treatment in Brasil - Partial results - As of April, 1998

Estudo de efetividade de esquemas alternativos para o tratamento da tuberculose multirresistente no Brasil

Margareth Pretti Dalcolmo, Andrea Fortes, Fernando Fiuza de Melo, Rita Motta, Jorge Ide Netto, Ninarosa Cardoso, Monica Andrade, Angela Werneck Barreto, Germano Gerhardt

J Bras Pneumol.1999;25(2):70-77

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Purpose: To determine the effectiveness of alternative regimens for treating confirmed MDR TB cases in outpatient units: Methods: MDR TB cases were defined as culture isolation of M. tuberculosis resistant in vitro to at least rifampin/isoniazide and a third drug of standard regimens in Brazil, according to both the conventional method and the BACTEC system. Design: Multicentric non-randomized controlled clinical trial. From April 95 to December 97 187 patients were enrolled. As of April 98, there were 36 patients under treatment. The authors analyzed 149 patients that had an average 14 months of treatment duration. The regimens used were chosen according to sensitivity tests: 1) streptomycin (S)/ofloxacin (OFX)/terizidon (TZ)/ethambutol (E)/clofazimine (CZ) or capreomycin (CM)/OFX/TZ/CZ/E or amicacyn/OFX/TZ/E/CZ. Demography: Male, 68.4%; female, 31.5%; mean age-36.9 years; HIV prevalence 1.9%; primary resistance rate - 8%. Outcomes: cured-treated for 12 months with six months after two consecutive negative culture; abandoned-discontinued treatment and consultations; died - deaths due to TB after two months of treatment; failed - remained positive in culture throughout the 12 months. Results: 120 (79.5%) patients converted to negative culture within 3 months. Cured: 53%, failed 31%, died 6%, abandoned 10%. Conclusions: The major predictor to MDR TB in Brazil is previous irregular and/or incomplete treatment. Sputum conversion rate was high and favorable overall response was 53%. Clinical implications: Because TB is endemic in Brazil and the number of MDR cases due to acquired resistance is increasing, greater efforts are needed to implement supervised treatment in tuberculosis particularly for non compliant patients.


Keywords: Tuberculosis, treatment. Multidrug resistant tuberculosis.


Descriptive study of the frequency of nontuberculous mycobacteria in the Baixada Santista region of the state of São Paulo, Brazil

Estudo descritivo da freqüência de micobactérias não tuberculosas na Baixada Santista

Liliana Aparecida Zamarioli, Andréa Gobetti Vieira Coelho, Clemira Martins Pereira, Ana Carolina Chiou Nascimento, Suely Yoko Mizuka Ueki, Erica Chimara

J Bras Pneumol.2008;34(8):590-594

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Objective: The present study aims at describing the frequency of nontuberculous mycobacteria (NTM) species identified through laboratory testing of samples collected from non-sterile sites (sputum), as well as its frequency in HIV-infected and non-HIV-infected individuals in the Baixada Santista region of the state of São Paulo, Brazil, in the period from 2000 to 2005. Methods: Retrospective analysis of sputum smear microscopy results and culture was conducted based on the records on file at the Instituto Adolfo Lutz-Santos, the regional tuberculosis laboratory. Results: We analyzed 194 NTM strains isolated from 125 individuals, of whom 73 (58.4%) were HIV-negative and 52 (41.6%) were HIV-positive. Thirteen different species were identified: Mycobacterium kansasii; M. avium complex; M. fortuitum; M. peregrinum; M. gordonae; M. terrae; M. nonchromogenicum; M. intracellulare; M. flavescens; M. bohemicum; M. chelonae; M. shimoidei; and M. lentiflavum. In 19.2% of the cases, the bacteriological diagnosis was confirmed by isolation of the same species in at least two consecutive samples. Conclusions: Our results show the importance of including systematic identification of NTM in the laboratory routine, and that its integration into the clinical routine could improve the characterization of the disease, thereby informing the planning of effective control measures in specific populations, such as individuals presenting tuberculosis/HIV co-infection.


Keywords: Mycobacteria, atypical; Laboratory techniques and procedures; HIV; Tuberculosis.


Phenotypic and genotypic study of macrolide resistance of Streptococcus pneumoniae strains isolated in hospitals in Porto Alegre, in the state of Rio Grande do Sul, Brazil

Estudo fenotípico e genotípico da resistência aos macrolídeos de "Streptococcus pneumoniae" isolados em hospitais de Porto Alegre - RS

Fabiana Rowe Zettler, Eduardo Walker Zettler, Virginia Minghelli Schmitt, Marina Tagliaro Jahns, Cícero Armídio Gomes Dias, Carlos Cezar Fritscher

J Bras Pneumol.2005;31(4):312-317

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Objective: The aim of this study was to determine the prevalence of macrolide-resistant S. pneumoniae and to identify its phenotypic and genotypic characteristics. Methods: Strains of S. pneumoniae isolated in the city of Porto Alegre between May 2002 and August 2004 from samples collected from different anatomical sites were analyzed. For the agar diffusion test, disks of erythromycin, clarithromycin, azithromycin and clindamycin were used. The minimum inhibitory concentrations of erythromycin were determined for macrolide-resistant isolates by the agar dilution method. Macrolide-resistant isolates were phenotyped by agar diffusion test and genotyped by polymerase chain reaction. Results: A total of 229 pneumococcal strains were evaluated, 12 (5.2%) of which were macrolide-resistant. Among the 12 resistant strains, 9 (75%) presented the MLSB phenotype, and 3 (25%) presented the M phenotype. Polymerase chain reaction testing indicated that 8 MLSB phenotype isolates harbored the ermB gene only, whereas the mefE gene was present in all 3 M phenotype isolates. One MLSB phenotype isolate presented both genes. Conclusion: In Porto Alegre, the S. pneumoniae resistance to macrolides is still low since such resistance is due primarily to the presence of the ermB gene expressing the MLSB phenotype.


Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough

Estudo radiográfico com ingestão de bário na rotina clínica: um estudo prospectivo em pacientes com tosse crônica

Carlos Shuler Nin, Edson Marchiori, Klaus Loureiro Irion, Artur de Oliveira Paludo, Giordano Rafael Tronco Alves, Daniela Reis Hochhegger, Bruno Hochhegger

J Bras Pneumol.2013;39(6):686-691

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Objective: To assess the routine use of barium swallow study in patients with chronic cough. Methods: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. Results: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. Conclusions: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies.


Keywords: Barium sulfate; Cough; Contrast media; Radiography, thoracic.


Adverse events after pneumococcal vaccination

Eventos adversos após vacinação contra o pneumococo

Maria Rita Donalisio, Somnia Marlene Cadogan Piraggini Rodrigues, Elisa Teixeira Mendes, Mariana Krutman

J Bras Pneumol.2007;33(1):51-56

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Objective: To study the occurrence of adverse events after administration of a capsular polysaccharide vaccine against 23 pneumococcal serotypes in individuals for whom such vaccination is indicated. Methods: This was a prospective study, conducted in a general hospital in the city of Sumaré, in which 152 individuals were evaluated after intramuscular vaccination with 0.5 mL of the Pneumo 23® vaccine. The study variable was subject complaint of at least one symptom forming a temporal nexus with the vaccine (appearing within 48 h after its administration). The subjects were evaluated at five to seven days after vaccination. The covariables age, gender and clinical profile were tested using the chi-square test and multiple logistic regression, with the level of significance set at 5%. Results: The age of the population ranged from 5 to 86 years (mean, 61.8 years). For nearly all (99%) of the subjects, the vaccination evaluated was their first dose of the vaccine. Events occurring at the injection site were reported in 36 subjects (23.7%). Of those 36 events, 24 (68%) were mild and had no repercussions for the daily activities of the subjects. Pain at the site of the injection was the most common symptom, being reported by 97.2% of the subjects. Erythema and localized edema were found in 6.3% and 5.1% of the subjects, respectively. Of the subjects evaluated, 12.8% reported general symptoms (malaise, fever, sleepiness and generalized pain). In the bivariate analysis, none of the covariables were found to present a statistically significant correlation with adverse events (p > 0.20). The same held true in the multivariate analysis. Conclusion: Although, the 23-valent pneumococcal vaccine provokes few reactions in the first dose, it is still rarely recommended in the region, even for patients at risk.


Keywords: Streptococcus pneumoniae; Pneumonia; Pneumococcal/prevention & control; Pneumococcal vaccines/adverse effects


Clinical evolution of a group of patients with multidrug-resistant TB treated at a referral center in the city of Rio de Janeiro, Brazil

Evolução clínica de um grupo de pacientes com TB multirresistente atendidos em um centro de referência na cidade do Rio de Janeiro

Helio Ribeiro de Siqueira, Flávia Alvim Dutra de Freitas, Denise Neves de Oliveira, Angela Maria Werneck Barreto, Margareth Pretti Dalcolmo, Rodolpho Mattos Albano

J Bras Pneumol.2009;35(1):54-62

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Objective: To analyze the clinical characteristics and evolution of a group of patients with positive sputum cultures for multidrug-resistant (MDR) Mycobacterium tuberculosis and treated at a referral center in the city of Rio de Janeiro, Brazil. Methods: Based on the positive results in sputum cultures for MDR M. tuberculosis, 50 patients were selected, and their clinical data were obtained from the Brazilian Ministry of Health MDR-TB Database. The frequencies of noncompliance, relapses, failures and previous treatments for TB up to diagnosis of MDR-TB were compiled. The radiological patterns were classified as unilateral or bilateral, and with or without cavitation. Two years after the end of the standard treatment for MDR-TB, the outcome (cure, failure, noncompliance or death) for each patient was evaluated and reassessed every two years. The post-treatment follow-up period was eight years. Results: The mean number of previous treatments was 2.3 ± 0.9. The mean interval between the initial diagnosis and the development of MDR-TB was 2.0 ± 1.7 years. Two years after the initial treatment for MDR-TB, 2 patients had abandoned treatment, 8 had died, 18 had been cured, and 22 had presented treatment failure. The bivariate analysis showed that bilateral pulmonary involvement and cavitary pattern markedly reduced the chances for cure, with a relative risk of 1-0.6 (40%) and 1-0.7 (30%), respectively. At the end of the follow-up period, 2 patients had abandoned treatment, 9 had presented treatment failure, 17 had been cured, and 22 had died. Conclusions: Bilateral pulmonary involvement and cavity pattern greatly reduced the chances for cure of the patients with MDR-TB. Most patients who presented treatment failure died within the 8-year follow-up period.


Keywords: Tuberculosis, multidrug-resistant; Treatment outcome; Disease-free survival; Treatment refusal; Treatment failure.


Evolution of pulmonary function after treatment with goserelin in patients with lymphangioleiomyomatosis

Evolução da função pulmonar após tratamento com goserelina em pacientes com linfangioleiomiomatose

Bruno Guedes Baldi, Pedro Medeiros Junior, Suzana Pinheiro Pimenta, Roberto Iglesias Lopes, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2011;37(3):375-379

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In the atypical smooth muscle cells that are characteristic of lymphangioleiomyomatosis (LAM), there are estrogen and progesterone receptors. Therefore, anti-hormonal therapy, despite having produced controversial results, can be considered a treatment option. The objective of this retrospective study was to evaluate hormonal and spirometric data for nine women with LAM after one year of treatment with goserelin. The mean increase in FEV1 and FVC was 80 mL and 130 mL, respectively. There was effective blockage of the hormonal axis. It is still not possible to exclude a potential beneficial effect of the use of gonadotropin-releasing hormone analogues in LAM patients, which underscores the need for randomized trials.


Keywords: Lymphangioleiomyomatosis; Spirometry; Goserelin.


Evolução do estado nutricional de pacientes desnutridos ou com excesso de peso candidatos a transplante pulmonar

Giuliana Bastos Esteves, Alessandra Macedo, Miyoko Nakasato, Maria Lúcia Mendes Bruno

J Bras Pneumol.2009;35(12):-

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A retrospective study using anthropometric data to assess the evolution of nutritional status in lung transplant candidates who are initially malnourished or overweight. We included patients with an initial body mass index (BMI) < 17 kg/m2 (malnourished, n = 10) or > 27 kg/m2 (overweight, n = 20). Each patient subsequently had three appointments with a nutritionist (nutritional interventions). In the malnourished group, there were no significant post-intervention changes in the anthropometric variables. In the overweight group, however, nutritional intervention had a positive impact on weight, BMI and waist circumference.


Keywords: Lung transplantation; Nutritional status; Body mass index; Anthropometry.


Patients admitted to the ICU for acute exacerbation of COPD: two-year mortality and functional status

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

Cassiano Teixeira, Cláudia da Rocha Cabral, Jaqueline Sangiogo Hass, Roselaine Pinheiro de Oliveira, Mara Ambrosina de Oliveira Vargas, Ana Paula da Rocha Freitas, Alessandra Hofstadler Deiques Fleig, Erika Cristine Treptow, Márcia Inês Boff Rizzotto

J Bras Pneumol.2011;37(3):334-340

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Objective: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. Methods: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). Results: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. Conclusions: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.


Keywords: Pulmonary disease, chronic obstructive/mortality; Quality of life; Intensive care units.


Immediate hypersensitivity to mango manifesting as asthma exacerbation

Exacerbação da asma por hipersensibilidade imediata ao consumo de manga

Richa Sareen, Ayush Gupta, Ashok Shah

J Bras Pneumol.2011;37(1):135-138

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Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis

Exacerbações de DPOC e sintomas de refluxo gastroesofágico: revisão sistemática e meta-análise

Thiago Mamôru Sakae, Márcia Margaret Menezes Pizzichini, Paulo José Zimermann Teixeira, Rosemeri Maurici da Silva, Daisson José Trevisol, Emilio Pizzichini

J Bras Pneumol.2013;39(3):259-271

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Objective: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations. Methods: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction. Results: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001). Conclusions: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.


Keywords: Pulmonary disease, chronic obstructive; Gastroesophageal reflux; Meta-analysis; Risk factors; Evidence-based medicine.


Sputum examination in the clinical management of community-acquired pneumonia

Exame do escarro no manejo clínico dos pacientes com pneumonia adquirida na comunidade

Leonardo Gilberto Haas Signori, Maurício Weyh Ferreira, Luiz Carlos Hack Radünz Vieira, Karen Reetz Müller, Waldo Luís Leite Dias de Mattos

J Bras Pneumol.2008;34(3):152-158

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Objective: To evaluate the frequency of the use of sputum examination in the clinical management of community-acquired pneumonia (CAP) in a general hospital and to determine whether its use has an impact on mortality. Methods: The medical records of CAP patients treated as inpatients between May and November of 2004 at the Nossa Senhora da Conceição Hospital, located in Porto Alegre, Brazil, were reviewed regarding the following aspects: age; gender; severity of pneumonia (Fine score); presence of sputum; sputum bacteriology; treatment history; change in treatment; and mortality. Results: A total of 274 CAP patients (134 males and 140 females) were evaluated. Using the Fine score to quantify severity, we classified 79 (28.8%) of those 274 patients as class II, 45 (16.4%) as class III, 97 (35.4%) as class IV, and 53 (19.3%) as class V. Sputum examination was carried out in 92 patients (33.6%). A valid sample was obtained in 37 cases (13.5%), and an etiological diagnosis was obtained in 26 (9.5%), resulting in a change of treatment in only 9 cases (3.3%). Overall mortality was 18.6%. Advanced age (above 65), CAP severity, and dry cough were associated with an increase in the mortality rate. Sputum examination did not alter any clinical outcome or have any influence on mortality. Conclusion: Sputum examination was used in a minority of patients and was not associated with any noticeable benefit in the clinical management of patients with CAP treated in a hospital setting.


Keywords: Pneumonia/etiology; Sputum; Diagnosis.


Occupational exposure and occurrence of pneumoconioses in Campinas, Brazil, 1978-2003

Exposição ocupacional e ocorrência de pneumoconioses na região de Campinas (SP) Brasil, 1978-2003

Alessandro Vito Lido, Satoshi Kitamura, José Inácio Oliveira, Sérgio Roberto de Lucca, Valmir Antonio Zulian de Azevedo, Ericson Bagatin

J Bras Pneumol.2008;34(6):367-372

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Objective: To develop and consolidate a comprehensive database on the occurrence of pneumoconioses in an industrialized region of Brazil, with a special focus on the activities most frequently related to these diseases. Methods: A retrospective, observational study was conducted in order to gather data on cases of pneumoconioses treated at the outpatient clinic of the State University at Campinas Hospital das Clínicas between 1978 and 2003. Individuals diagnosed with pneumoconiosis, based on their occupational history and on chest X-ray findings of abnormalities consistent with interstitial lung disease involving the parenchyma, in accordance with the 1980 and 2000 recommendations of the International Labour Organization, were included in the study. Results: A total of 1147 cases of pneumoconiosis were identified (1075 in males and 72 in females): 1061 cases of silicosis (92.5%); 51 cases of mixed-dust pneumoconiosis (4.45%); 15 cases of asbestosis (1.31%); 13 cases of phosphate rock-related pneumoconiosis (1.13%); and 7 cases of other types of pneumoconiosis (0.6%), including those related to exposure to coal, graphite and hard metals. The most common chest X-ray findings were 1/0, 1/1 or 1/2 profusion and small regular opacities (p, q or r), although 192 patients (16.74%) presented large opacities. There has been a substantial decline in the occurrence of the disease since the 1990s, and the duration of exposure was typically shorter than that observed in a study conducted in the United States. Conclusions: Our findings have been compiled into a comprehensive database for the investigation of pneumoconiosis in an industrialized area of Brazil. These data make it possible to conduct follow-up studies and develop health policies related to occupational respiratory disorders.


Keywords: Occupational medicine; Respiratory tract diseases/epidemiology; Pneumoconiosis; Epidemiology.


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):-

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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.


Factors associated with pulmonary tuberculosis among patients seeking medical attention at referral clinics for tuberculosis

Fatores associados à tuberculose pulmonar em pacientes que procuraram serviços de saúde de referência para tuberculose

Cid Carlos Soares de Alcântara, Afrânio Lineu Kritski, Valéria Goes Ferreira, Mônica Cardoso Façanha, Ricardo Soares Pontes, Rosa Salani Mota, Terezinha do Menino Jesus Silva Leitão

J Bras Pneumol.2012;38(5):622-629

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Objective: The identification of behavioral and clinical factors that are associated with pulmonary tuberculosis might improve the detection and treatment of the disease, thereby reducing its duration and transmission. Our objective was to identify sociodemographic, clinical, and behavioral factors that are associated with the diagnosis of pulmonary tuberculosis. Methods: This was a cross-sectional study conducted between April of 2008 and March of 2009 at three health care clinics in the city of Fortaleza, Brazil. We selected 233 patients older than 14 years of age who spontaneously sought medical attention and presented with cough for ≥ 2 weeks. Sociodemographic, clinical, and behavioral data were collected. Sputum smear microscopy for AFB and mycobacterial culture were also carried out, as were tuberculin skin tests and chest X-rays. The patients were divided into two groups (with and without pulmonary tuberculosis). The categorical variables were compared by the chi-square test, followed by logistic regression analysis when the variables were considered significant. Results: The prevalence of pulmonary tuberculosis was 41.2%. The unadjusted OR showed that the following variables were statistically significant risk factors for pulmonary tuberculosis: fever (OR = 2.39; 95% CI, 1.34-4.30), anorexia (OR = 3.69; 95% CI, 2.03-6.75), and weight loss (OR = 3.37; 95% CI, 1.76-6.62). In the multivariate analysis, only weight loss (OR = 3.31; 95% CI, 1.78-6.14) was significantly associated with pulmonary tuberculosis. Conclusions: In areas with a high prevalence of tuberculosis, weight loss could be used as an indicator of pulmonary tuberculosis in patients with chronic cough for ≥ 2 weeks.


Keywords: Mycobacterium tuberculosis; Tuberculosis, pulmonary/epidemiology; Risk factors.


Factors associated with delayed diagnosis of pulmonary tuberculosis in the state of Rio de Janeiro, Brazil

Fatores associados ao atraso no diagnóstico da tuberculose pulmonar no estado do Rio de Janeiro

Audry Cristina de Fátima Teixeira Machado, Ricardo Ewbank Steffen, Olivia Oxlade, Dick Menzies, Afrânio Kritski, Anete Trajman

J Bras Pneumol.2011;37(4):512-520

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Objective: To estimate the total time elapsed between symptom onset and diagnosis of pulmonary tuberculosis (patient delay plus health care system delay), analyzing the factors associated with delayed diagnosis in the state of Rio de Janeiro, Brazil. Methods: We conducted a questionnaire-based survey involving 218 pulmonary tuberculosis patients treated for two months at 20 health care clinics and 3 hospitals in eight cities within the state of Rio de Janeiro. We collected socioeconomic and demographic data, as well as data regarding the health care system and the medical history of the patients. Results: The median time elapsed from the onset of symptoms to diagnosis was 68 days (interquartile range [IQR]: 35-119 days). The median patient delay (time from symptom onset to initial medical visit) was 30 days (IQR: 15-60 days), and the median health care system delay (time from initial medical visit to diagnosis) was 21 days (IQR: 8-47 days). A cut-off point of 21 days was adopted. The factors independently associated with patient delay were female gender, cough, and unemployment [adjusted OR (95% CI) = 2.7 (1.3-5.6); 11.6 (2.3-58.8); and 2.0 (1.0-3.8), respectively], whereas only female gender was independently associated with health care system delay (OR= 3.2; 95% CI: 1.7-6.0). Conclusions: Delayed diagnosis of pulmonary tuberculosis remains a problem in Rio de Janeiro, increasing the risk of transmission and mortality, that risk being greater for women and the socioeconomically disadvantaged. Patients might not recognize the significance of chronic cough as a health problem. Tuberculosis education programs targeting women might improve this situation.


Keywords: Lung neoplasms; Neoplasm metastasis; Antineoplastic combined chemotherapy protocols; Radiotherapy, computer-assisted.


Clinical and pathological factors influencing the survival of breast cancer patients with malignant pleural effusion

Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico

Giovana Tavares dos Santos, João Carlos Prolla, Natália Dressler Camillo, Lisiane Silveira Zavalhia, Alana Durayski Ranzi, Claudia Giuliano Bica

J Bras Pneumol.2012;38(4):487-493

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Objective: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. Methods: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related to the pleural metastasis. Results: We evaluated 145 patients, 87 (60%) of whom had tested positive for malignant cells in the pleural fluid. Ductal histology was observed in 119 (82%). The triple-negative breast cancer phenotype was seen in 25 cases (17%). Those patients had the worst prognosis (with a sharp decline in the survival curve), and 20 of the 25 (80%) died during the follow-up period (through June of 2011). The mean survival after the identification of malignant pleural effusion was 6 months. Conclusions: In patients with triple-negative breast cancer who test positive for malignant cells in the pleural fluid, the prognosis is poor and survival is reduced.


Keywords: Pleural effusion, malignant/mortality; Breast neoplasms/mortality; Breast neoplasms/genetics.


Risk factors for recurrence of tuberculosis

Fatores de risco para a recidiva da tuberculose

Pedro Dornelles Picon, Sergio Luiz Bassanesi, Maria Luiza Avancini Caramori, Roberto Luiz Targa Ferreira, Carla Adriane Jarczewski, Patrícia Rodrigues de Borba Vieira

J Bras Pneumol.2007;33(5):572-578

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Objective: To identify risk factors for recurrence of tuberculosis. Methods: We studied a cohort of 610 patients with active pulmonary tuberculosis who were enrolled for treatment between 1989 and 1994 and cured using a three-drug treatment regimen of rifampin, isoniazid and pyrazinamide (RHZ). The risk factors studied were age, gender, race, duration of symptoms, lesion cavitation, extent of disease, diabetes mellitus, alcoholism, HIV infection, delayed negative sputum conversion, treatment compliance, and medication doses. In order to detect recurrence, the patients were monitored through the Rio Grande do Sul State Healt Department Information System for 7.7 ± 2.0 years after cure. Data were analyzed using the Student's t-test, the chi-square test or Fisher's exact test, and Cox regression models. Results: There were 26 cases of recurrence (4.3%), which corresponds to 0.55/100 patients-year. The recurrence rate was 5.95 and 0.48/100 patients-year in HIV-positive and HIV-negative patients, respectively (p < 0.0001). In the multivariate analysis, HIV infection [RR = 8.04 (95% CI: 2.35-27.50); p = 0.001] and noncompliance [RR = 6.43 (95% CI: 2.02-20.44); p = 0.002] proved to be independently associated with recurrence of tuberculosis. Conclusions: Recurrence of tuberculosis was more common in HIV-positive patients and in patients who did not comply with the self-administered treatment (RHZ regimen). Patients presenting at least one of these risk factors can benefit from the implementation of a post-treatment surveillance system for early detection of recurrence. An alternative to prevent noncompliance with tuberculosis treatment would be the use of supervised treatment.


Keywords: Tuberculosis; Recurrence; Risk factors.


Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea

Fatores de risco para complicações respiratórias após adenotonsilectomia em crianças com apneia obstrutiva do sono

Renato Oliveira Martins1, Nuria Castello-Branco2, Jefferson Luis de Barros1, Silke Anna Theresa Weber3

J Bras Pneumol.2015;41(3):238-245

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Objective: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). Methods: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. Results: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3  2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). Conclusions: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.


Keywords: Postoperative complications; Tonsillectomy; Sleep apnea, obstructive.


Risk factors for multiple hospital admissions among children and adolescents with asthma

Fatores de risco para readmissão hospitalar de crianças e adolescentes asmáticos

Laura Maria de Lima Belizario Facury Lasmar, Paulo Augusto Moreira Camargos, Eugênio Marcos Andrade Goulart, Emília Sakurai

J Bras Pneumol.2006;32(5):391-399

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Objective: To determine the influence that hospital admission of suckling infants with asthma has on their risk for future admissions for the same cause. Methods: A retrospective study was conducted, in which the charts of 202 patients, all less than fifteen years of age, were evaluated. All of the patients had been treated as outpatients in a pediatric pulmonology clinic and had been admitted to the hospital on one or more occasions. A multivariate analysis was conducted in order to evaluate the risk factors associated with multiple hospitalizations. Results: Virtually all of the patients evaluated were hospitalized a second time within 18 months of the first hospitalization. Among the patients first hospitalized at = 12 months of age, the second admission occurred sooner than did that recorded for those first hospitalized at > 12 months of age (p = 0.001). The risk factors found to be associated with multiple hospital admissions were as follows: age at first admission = 12 months (odds ratio: 2.55; 95% confidence interval: 1.18-5.48); age at first admission between 13 and 24 months (odds ratio: 3.54; 95% confidence interval: 1.31-9.63); and severity of asthma symptoms (odds ratio: 3.86; 95% confidence interval: 2.02-7.40). Conclusion: After the first hospitalization, children with asthma should be closely monitored, since the risk of subsequent admissions is elevated in the first months following discharge, especially among those of less than two years of age. Health care facilities should be organized to confront this problem appropriately and should dispense prophylactic medication more freely.


Keywords: Asthma; Child, hospitalized; Patient readmission; Risk factors


Fatores de risco para tuberculose multirresistente adquirida

Afrânio Lineu Kritski

J Bras Pneumol.2003;29(2):55-56


Preoperative predictive factors for intensive care unit admission after pulmonary resection

Fatores preditivos pré-operatórios de internação em unidade de terapia intensiva após ressecção pulmonar

Liana Pinheiro, Ilka Lopes Santoro, João Aléssio Juliano Perfeito, Meyer Izbicki, Roberta Pulcheri Ramos, Sonia Maria Faresin

J Bras Pneumol.2015;41(1):31-38

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Objective: To determine whether the use of a set of preoperative variables can predict the need for postoperative ICU admission. Methods: This was a prospective observational cohort study of 120 patients undergoing elective pulmonary resection between July of 2009 and April of 2012. Prediction of ICU admission was based on the presence of one or more of the following preoperative characteristics: predicted pneumonectomy; severe/very severe COPD; severe restrictive lung disease; FEV1 or DLCO predicted to be < 40% postoperatively; SpO2 on room air at rest < 90%; need for cardiac monitoring as a precautionary measure; or American Society of Anesthesiologists physical status ≥ 3. The gold standard for mandatory admission to the ICU was based on the presence of one or more of the following postoperative characteristics: maintenance of mechanical ventilation or reintubation; acute respiratory failure or need for noninvasive ventilation; hemodynamic instability or shock; intraoperative or immediate postoperative complications (clinical or surgical); or a recommendation by the anesthesiologist or surgeon to continue treatment in the ICU. Results: Among the 120 patients evaluated, 24 (20.0%) were predicted to require ICU admission, and ICU admission was considered mandatory in 16 (66.6%) of those 24. In contrast, among the 96 patients for whom ICU admission was not predicted, it was required in 14 (14.5%). The use of the criteria for predicting ICU admission showed good accuracy (81.6%), sensitivity of 53.3%, specificity of 91%, positive predictive value of 66.6%, and negative predictive value of 85.4%. Conclusions: The use of preoperative criteria for predicting the need for ICU admission after elective pulmonary resection is feasible and can reduce the number of patients staying in the ICU only for monitoring.


Keywords: Thoracic surgery; Risk factors; Intensive care units.


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

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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.


Prognostic factors in idiopathic pulmonary fibrosis

Fatores prognósticos em fibrose pulmonar idiopática

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Ssheidt

J Bras Pneumol.2000;26(5):227-234

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In order to evaluate which prognostic factors were significant to the survival of patients with idiopathic pulmonary fibrosis (IPF), 121 histologically confirmed cases of the disease were studied at the Pereira Filho Hospital from 1970 to 1996. All patients were submitted to a standard thorax X-ray and spirometry and answered a standardized questionnaire when admitted to hospital. They also underwent diffusion tests (34 cases), total lung capacity (28), blood gas analysis (106), bronchoalveolar lavage (39), rheumatoid analyses (45), and thoracic CT (24). For further analysis, the patients were classified into two groups: group A (2-year survival) with 55 patients, and group B (more than 5-year survival) with 24 patients; these features were also analyzed according to their significance to survival. Age, increased dyspnea index, long symptomatic period, FVC, DCO, PaO2 and SaO2 reduction, honeycombing intensity, and greater profusion of the reticular pattern on HRCT were considered indicative of worse prognosis. A reduced FEV1 and TLC were also associated with shorter survival. The use of those criteria which had shown statistical significance when evaluated together may determine a more accurate prognostic evaluation of IPF patients resulting in social and therapeutic benefits to patient management.


Keywords: Pulmonary fibrosis. Interstitial lung diseases. Prognosis. Prospective studies. Survival analysis.


Factors related to the incorrect use of inhalers by asthma patients

Fatores relacionados ao uso incorreto dos dispositivos inalatórios em pacientes asmáticos

Paulo de Tarso Roth Dalcin, Denis Maltz Grutcki, Paola Paganella Laporte, Paula Borges de Lima, Samuel Millán Menegotto, Rosemary Petrik Pereira

J Bras Pneumol.2014;40(1):13-20

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Objective: To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control. Methods: This was a cross-sectional study involving patients ≥ 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps. Results: We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having ≥ 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045). Conclusions: In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of ≥ 2 comorbidities were associated with incorrect inhaler technique.


Keywords: Inaladores dosimetrados; Inaladores de pó seco; Asma/terapia.


Familial pulmonary fibrosis: a heterogeneous spectrum of presentations

Fibrose pulmonar familiar: um espectro heterogêneo de apresentações

Ana Beatriz Hortense1,a, Marcel Koenigkam dos Santos2,b, Danilo Wada3,c, Alexandre Todorovic Fabro4,d, Mariana Lima5, Silvia Rodrigues5,e, Rodrigo Tocantins Calado2,f, José Baddini-Martinez2,g

J Bras Pneumol.2019;45(5):e20180079-e20180079

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Objective: To describe the clinical, functional, and radiological features of index cases of familial pulmonary fibrosis (FPF) in Brazil. Methods: We evaluated 35 patients with FPF - of whom 18 (51.4%) were women - with a median age of 66.0 years (range, 35.5-89.3 years). All of the patients completed a standardized questionnaire, as well as undergoing pulmonary function tests and HRCT of the chest. In 6 cases, lung tissue samples were obtained: from surgical biopsies in 5 cases; and from an autopsy in 1 case. Results: A history of smoking and a history of exposure to birds or mold were reported in 45.7% and 80.0% of the cases, respectively. Cough and marked dyspnea were reported by 62.8% and 48.6% of the patients, respectively. Fine crackles were detected in 91.4% of the patients. In 4 patients, the findings were suspicious for telomere disease. The median FVC and DLCO, as percentages of the predicted values, were 64.9% (range, 48.8-105.7%) and 38.9% (range, 16.0-60.0%), respectively. Nine patients had reduced DLCO despite having normal spirometry results. Regarding HRCT, patterns typical of usual interstitial pneumonia were found in 6 patients (17.1%). In 25 cases (71.5%), the HRCT features were consistent with a diagnosis other than idiopathic pulmonary fibrosis. In 11 cases (31.4%), the radiological patterns were uncharacteristic of interstitial lung disease. Of the six lung tissue samples analyzed, four showed interstitial pneumonia with bronchiolocentric accentuation, and, on the basis of the clinical and radiological data, the corresponding patients were diagnosed with hypersensitivity pneumonitis. Conclusions: Patients with FPF can present with a wide variety of clinical features. Most HRCT scans of these patients exhibit patterns not typical of usual interstitial pneumonia. The family history of fibrotic lung diseases should be investigated in all patients under suspicion, regardless of their age.


Keywords: Idiopathic pulmonary fibrosis; Respiratory function tests; Tomography, X-ray computed.


Idiopathic pulmonary fibrosis can be a transient diagnosis

Fibrose pulmonar idiopática pode ser um diagnóstico transitório

Martina Rodrigues de Oliveira1, Daniel Antunes Silva Pereira1, Olívia Meira Dias1, Ronaldo Adib Kairalla1, Carlos Roberto Ribeiro Carvalho1, Bruno Guedes Baldi1

J Bras Pneumol.2016;42(1):74-75

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Idiopathic pulmonary fibrosis and emphysema in smokers

Fibrose pulmonar idiopática simultânea a enfisema em pacientes tabagistas

Denise Rossato Silva, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto, Marli Maria Knorst

J Bras Pneumol.2008;34(10):779-786

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Objective: To describe the clinical and functional findings recently reported in the medical literature for patients diagnosed with emphysema involving the upper lobes and idiopathic pulmonary fibrosis (IPF) involving the lower lobes. Methods: Eleven patients with emphysema and IPF were identified retrospectively. All of the patients underwent high-resolution computed tomography of the lung and pulmonary function tests. Results: Of the 11 patients, 8 were male and 3 were female. The mean age was 70.7 ± 7.2 years (range, 61-86 years). All of the patients were smokers (mean smoking history, 61.5 ± 43.5 pack-years). The mean values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC were 72.1 ± 12.7%, 68.2 ± 11.9% and 74.4 ± 10.8, respectively. Lung volumes were normal in 7 patients. A restrictive pattern was observed in 3 patients, and hyperinflation was present in one. The diffusing capacity was moderatelyto- severely reduced in all of the patients (mean, 27.7% ± 12.9% of predicted). Ten of the 11 patients performed the six-minute walk test. The mean distance covered was 358.4 ± 143.1 m, and 9 of the 10 patients presented desaturation ≥ 4%. Echocardiographic findings suggestive of pulmonary hypertension were present in 4 patients (mean systolic pulmonary artery pressure, 61.8 mmHg; range, 36-84 mmHg). Conclusions: The concomitant presence of emphysema and IPF causes characteristic changes on pulmonary function tests. The most significant finding is a discrepancy between diffusing capacity and spirometry results.


Keywords: Pulmonary emphysema; Pulmonary fibrosis; Lung Diseases, interstitial; Anoxia; Hypertension, pulmonary.


Pulmonary idiopathic fibrosis: clinical findings and survival in 132 histologically-proven patients

Fibrose pulmonar idiopática: características clínicas e sobrevida em 132 pacientes com comprovação histológica

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Scheidt

J Bras Pneumol.2000;26(2):61-68

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In order to evaluate the clinical findings and survival of pulmonary idiopathic fibrosis patients, 132 cases with histologically-proven biopsy were studied, coming from Pavilhão Pereira Filho Hospital, from 1970 to 1996. The diagnosis was made in 120 patients by open lung biopsy and in 12 cases by transbronchial lung biopsy. The average age was 56 years; 78 were male and only 6 were black. Smoking was observed in 61 cases. Mean duration of symptoms before diagnosis was 22.7 months. Digital clubbing was present in 75 patients and teleinspiratory crackles in 100. Dyspnea was observed in all but two patients and cough was present in 89 cases. Lung function test values were: FVC, 62%; FEV1, 70%; DLCO, 43.4%; TLC, 76.7%; PaO2, 67.3 mmHg; PaCO2, 39.1 mmHg and SaO2, 92.3%. Bronchoalveolar cellularity values were: macrophages, 83.8%; neutrophils, 9.1%; lymphocytes, 6.1% and eosinophils, 0.6%. In X-ray, honeycombing was present in 79 cases, reduced total lung capacity in 107 and intrathoracic tracheal widening in 50. In CT, the mean reticular pattern profusion was 42.3% and the mean granular pattern profusion was 43.6%. The usual histologic pattern was found in 128 cases, and the descamative pattern in only 4. Information about survival was found in 121 cases until December 1997. The mean survival rate of all patients was 28 months and for dead patients was 24 months. Patient characteristics in this study were associated with advanced stage of disease, which was confirmed by small survival rates of those cases. The strong predominance of usual pattern and better patient selection may have contributed to these results.


Keywords: Pulmonary fibrosis, interstitial lung disease, clinical symptoms; Survival analysis.


Idiopathic pulmonary fibrosis: a decade of progress

Fibrose pulmonar idiopática: uma década de progressos

Jeffrey J. Swigris, Kevin K. Brown

J Bras Pneumol.2006;32(3):249-260

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Although idiopathic pulmonary fibrosis remains a devastating diagnosis, recent advances have improved our understanding of many facets of this disease. These breakthroughs, combined with the increased general availability of therapeutic trials, hold the promise of a brighter future for idiopathic pulmonary fibrosis patients. For example, we now have a more comprehensive understanding of the diagnostic criteria and natural history of the disease. Several studies have shown that simple measurement of pulmonary physiology or gas exchange can be used to predict patient survival. By identifying several molecular pathways that play significant roles in the pathogenesis of idiopathic pulmonary fibrosis, investigators have produced a growing list of novel potential therapeutic targets for the disease. Several prospective, controlled therapeutic trials have been conducted. Others are ongoing or are still in the planning stages. These efforts have advanced our current knowledge of idiopathic pulmonary fibrosis and have raised new important questions, as well as having generated the interest and momentum needed to gain additional ground in the fight against this challenging disease. This article offers the reader a view of the recent advances in idiopathic pulmonary fibrosis research, with a focus on natural history, pathogenesis and treatment.


Keywords: Pulmonary fibrosis/diagnosis; Pulmonary fibrosis/drug therapy; Fibroblasts; Transforming growth factor beta; Lung/pathology, Anti-inflammatory agents/therapeutic use


Physiopathology and clinical management of one-lung ventilation

Fisiopatologia e manejo clínico da ventilação seletiva

Halina Cidrini Ferreira, Walter Araújo Zin, Patrícia Rieken Macedo Rocco

J Bras Pneumol.2004;30(6):566-573

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During one-lung ventilation, the nonventilated lung is excluded from the ventilation, with all tidal volume directed into the ventilated lung. This technique facilitates viewing of intrathoracic structures, thereby providing optimal surgical conditions. However, this procedure has been associated with reduced arterial oxygen tension, principally in patients with a previous history of lung disease, since it reduces the surface area available for gas exchange and causes a loss of normal autonomic respiratory regulation. Therefore, maintaining sufficient oxygenation and elimination of carbon dioxide is the greatest challenge in the management of the one-lung ventilation. It is recommend that the tidal volume administrated to the ventilated lung be similar to that used during conventional mechanical ventilation and that high fractions of inspired oxygen be used. However, several alternative methods have been proposed in order to minimize hypoxemia during one-lung ventilation, including the correct positioning of the double-lumen tube, the use of positive end-expiratory pressure or continuous positive airway pressure, nitric oxide administration, and alveolar recruitment. The management of one-lung ventilation continues to be a challenge in clinical practice.


Keywords: tidal volume, hypoxemia, ventilatory management, mechanical ventilation


Accelerated form of interstitial pulmonary fibrosis in the native lung after single lung transplantation

Forma acelerada da fibrose pulmonar idiopática no pulmão nativo após transplante pulmonar unilateral

Rogério Rufino, Kalil Madi, Omar Mourad, Angelo Judice, Giovanni Marsico, Carlos Henrique Boasquevisque

J Bras Pneumol.2007;33(6):733-737

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 56-year-old patient who underwent left single lung transplantation for idiopathic pulmonary fibrosis (IPF). Despite the high level of immunosuppression after the surgery, there was rapid progression to IPF in the native (right) lung as demonstrated by thoracoscopic lung biopsy. After 104 days on mechanical ventilation, the patient underwent right lung transplant and was discharged from the hospital on postoperative day 26.


Keywords: Idiopathic pulmonary fibrosis; Lung transplantation; Case reports [publication type].


Formation of multiple pulmonary nodules during treatment with leflunomide

Formação de múltiplos nódulos pulmonares durante tratamento com leflunomida

Gilberto Toshikawa Yoshikawa1, George Alberto da Silva Dias1, Satomi Fujihara1, Luigi Ferreira e Silva2, Lorena de Britto Pereira Cruz3, Hellen Thais Fuzii4, Roberta Vilela Lopes Koyama1

J Bras Pneumol.2015;41(3):281-284

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Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis and can be due to the disease itself or secondary to the medications used in order to treat it. We report the case of a 60-year-old woman who had been diagnosed with rheumatoid arthritis and developed multiple pulmonary nodules during treatment with leflunomide.


Keywords: Arthritis, rheumatoid; Immunosuppressive agents; Rheumatoid nodule; Lung.


Aspergilloma formation in cavitary sarcoidosis

Formação de uma aspergilloma em sarcoidose com cavitação

Chandramani Panjabi, Sandeep Sahay, Ashok Shah

J Bras Pneumol.2009;35(5):480-483

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Pulmonary cavitation is rather uncommon in patients with sarcoidosis, and aspergilloma is even more uncommon in such cases. Here, we present the case of a 63-year-old female patient with cavitary lung disease who had been under treatment for TB for 9 months. A diagnosis of pulmonary sarcoidosis was established based on the fiberoptic bronchoscopy finding of noncaseating granuloma. Treatment with corticosteroids led to a dramatic improvement in symptoms. While under treatment for sarcoidosis, the patient developed an aspergilloma. She presented immediate skin test reactivity to Aspergillus fumigatus, as well as positivity for A. fumigatus serum precipitins. This is the first reported case of aspergilloma formation in a patient with cavitary sarcoidosis in India.


Keywords: Sarcoidosis, pulmonary; Aspergillosis; Medical records.


Frequency of COPD in health care workers who smoke

Frequência de DPOC em profissionais de saúde que fumam

Ivan Kopitovic1,2, Aleksandar Bokan1,2, Ilija Andrijevic1,2, Miroslav Ilic1,2, Sanja Marinkovic3, Dragana Milicic1,2, Marija Vukoja1,2

J Bras Pneumol.2017;43(5):351-356

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Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.


Keywords: Pulmonary disease, chronic obstructive/prevention & control; Smoking; Health personnel.


Incidence of asthma symptoms and decreased pulmonary function in young amateur swimmers

Frequência de sintomas de asma e de redução da função pulmonar entre crianças e adolescentes nadadores amadores

Iara Nely Fiks, Leonardo Carlos Araujo Santos, Telma Antunes, Raquel Calvo Gonçalves, Celso Ricardo Fernandes de Carvalho, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2009;35(3):206-212

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Objective: To investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil. Methods: The study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest. Results: The overall incidence of asthma symptoms (ISAAC score ≥ 6) among the swimmers was 16.8%. Of the 119 swimmers submitted to spirometry, 39 (32.7%) presented spirometric alterations (FEV1/FVC < 0.75). Among those with an ISAAC score ≥ 6, there were 10 (31.2%) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24% made use of bronchodilators but not of corticosteroids. Conclusions: The incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.


Keywords: Asthma/therapy; Asthma/diagnosis; Child; Swimming; Exercise.


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):-

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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


Pulmonary function and respiratory muscle strength in chronic renal failure patients on hemodialysis

Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

Demetria Kovelis, Fábio Pitta, Vanessa Suziane Probst, Celeide Pinto Aguiar Peres, Vinicius Daher Alvares Delfino, Altair Jacob Mocelin, Antônio Fernando Brunetto

J Bras Pneumol.2008;34(11):907-912

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Objective: To evaluate pulmonary function and respiratory muscle strength in chronic renal failure patients, correlating these variables with hemodialysis-related weight fluctuation; to study the correlation between the duration of hemodialysis and potential respiratory alterations. Methods: Seventeen patients (median age, 47 years; interquartile range, 41-52 years), submitted to three weekly hemodialysis sessions for a median of 27 months (interquartile range, 14-55) were evaluated. Twelve of the patients were male. The patients underwent spirometry. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured prior to and after the first hemodialysis session of the week. Body weight was quantified prior to and after each of the three weekly sessions. Results: Before the first hemodialysis session of the week, 8 patients presented mild restrictive defect, which normalized after the session in 2 of those patients. After dialysis, there was a significant increase in forced vital capacity (p = 0.02) and a significant decrease in body weight (p = 0.0001). Weight fluctuation over 3 days without hemodialysis tended to correlate with the variation in forced vital capacity in the first weekly session (r = 0.47; p = 0.055). Duration of hemodialysis correlated with predialysis MIP (r = −0.3; p = 0.03) and MEP (r = −0.63; p = 0.006). Conclusions: More pronounced weight gain in the interdialytic period is associated with worsening of lung function, which is almost fully reversible by hemodialysis. In addition, longer duration of hemodialysis is associated with decreased respiratory muscle strength.


Keywords: Spirometry; Respiratory muscles/physiopathology; Kidney failure, chronic; Renal dialysis.


Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

Função pulmonar em crianças e adolescentes com doença falciforme: temos dado atenção adequada a esse problema?

Ana Karine Vieira1, Cristina Gonçalves Alvim2, Maria Cristina Marquez Carneiro3, Cássio da Cunha Ibiapina4

J Bras Pneumol.2016;42(6):409-415

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. Methods: This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. Results: Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. Conclusions: In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter.


Keywords: Anemia, sickle cell; Respiratory function tests; Exercise test.


Case management of the patient/family with tuberculosis: a strategy of systematizing home care

Gerenciamento de caso ao doente/família com tuberculose: uma estratégia de sistematização do cuidado no domicílio

Aline Aparecida Monroe, Roxana Isabel Cardozo Gonzales, Cinthia Midori Sassaki, Antônio Ruffino Netto, Tereza Cristina Scatena Villa

J Bras Pneumol.2005;31(1):-

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Global TB Network: working together to eliminate tuberculosis

Global TB Network: trabalhando juntos para eliminar a tuberculose

Denise Rossato Silva1,a, Adrian Rendon2,b, Jan-Willem Alffenaar3,c, Jeremiah Muhwa Chakaya4,5,d, Giovanni Sotgiu6,e, Susanna Esposito7,f, Giovanni Battista Migliori8,g

J Bras Pneumol.2018;44(5):347-349

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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

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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.


Pulmonary foreign body granulomatosis in a chronic user of powder cocaine

Granulomatose pulmonar de corpo estranho em um usuário crônico de cocaína em pó

Shruti Khurana1, Ankit Chhoda2, Sandeep Sahay3, Priyanka Pathania4

J Bras Pneumol.2017;43(4):320-321

Abstract PDF PT PDF EN Portuguese Text

We describe the case of a 33-year-old man, a chronic user of powder cocaine, who presented with dyspnea, fever, night sweats, and significant weight loss. Chest HRCT revealed centrilobular nodules, giving an initial impression of miliary tuberculosis. Therefore, he was started on an empirical, four-drug antituberculosis treatment regimen. Four weeks later, despite the tuberculosis treatment, he continued to have the same symptoms. We then performed transbronchial lung biopsy. Histopathological analysis of the biopsy sample revealed birefringent foreign body granuloma. A corroborative history of cocaine snorting, the presence of centrilobular nodules, and the foreign body-related histopathological findings led to a diagnosis of pulmonary foreign body granulomatosis. This report underscores the fact that pulmonary foreign body granulomatosis should be included in the differential diagnosis of clinical profiles resembling tuberculosis.


Keywords: Lung; Granuloma, foreign-body; Cocaine-related disorders.


Pulmonary hamartoma as a differential diagnosis of breast cancer metastasis: case report

Hamartoma pulmonar como diagnóstico diferencial de metástase de carcinoma de mama: relato de caso

Vanessa Assis da Silva, Paula Kataguiri, Damila Cristina Trufelli, Leandro Luongo de Matos, João Carlos das Neves-Pereira, José Ribas Milanez de Campos

J Bras Pneumol.2007;33(6):738-742

Abstract PDF PT PDF EN Portuguese Text

We present the case of a 60-year-old female patient who had been in menopause for 14 years and presented a pulmonary nodule on chest X-ray diagnosed in the postoperative follow-up evaluation of breast cancer. The patient had a history of mastectomy and ipsilateral axillary lymphadenectomy for invasive ductal breast carcinoma, as well as of hormone therapy, chemotherapy, and adjuvant radiotherapy. After thoracoscopic nodulectomy, the frozen section analysis revealed a pulmonary hamartoma. Recent studies show that 75% of patients who undergo surgery for pulmonary nodules after a curative mastectomy for breast cancer present lung metastases, 11.5% present primary lung cancer, and 13.5% present benign lesions, including hamartoma.


Keywords: Hamartoma; Breast neoplasms; Lung neoplasms; Neoplasm metastasis.


Malignant pulmonary hemangiopericytoma: report of a case

Hemangiopericitoma pulmonar maligno: relato de caso

Mônica Flores Rick, Sonia Catarina de Abreu Figueiredo

J Bras Pneumol.1999;25(1):50-52

Abstract PDF PT

The hemangiopericytoma is a rare malignant neoplasia that involves the lungs in about 10% of the cases. It usually presents as a great encapsulated mass in asymptomatic patients. The treatment of choice is surgical resection. The authors present a case of malignant lung hemangiopericytoma in a 62 year-old woman, followed by discussion and review of literature.


Keywords: Hemangiopericytoma. Lung neoplasms.


Extramedullary hematopoiesis: findings on computed tomography scans of the chest in 6 patients

Hematopoese extramedular: achados em tomografia computadorizada do tórax de 6 pacientes

Edson Marchiori, Dante Luiz Escuissato, Klaus Loureiro Irion, Gláucia Zanetti, Rosana Souza Rodrigues, Gustavo de Souza Portes Meirelles, Bruno Hochhegger

J Bras Pneumol.2008;34(10):812-816

Abstract PDF PT PDF EN Portuguese Text

Objective: To present findings on computed tomography scans of the chest indicative of extramedullary hematopoiesis in six patients. Methods: We retrospectively analyzed computed tomography scans of six adult patients-five males and one female-with a mean age of 36.5 years. Two radiologists independently reviewed the scans, and a consensus was reached in discrepant cases. Results: The most common finding in the scans was lower paravertebral masses with heterogeneous content (four patients). The scans of two patients showed a solitary parietal and pleural mass. Conclusions: There are findings in computed tomography scans that are highly suggestive of extramedullary hematopoiesis, especially when those findings correlate with underlying blood diseases. Such findings, in most of the cases, allow physicians to dispense with histopathological confirmation.


Keywords: Tomography, X-ray computed; Hematopoiesis, extramedullary; Mediastinum/physiopathology; Anemia, sickle cell.


Alveolar hemorrhage associated with lupus nephritis

Hemorragia alveolar associada a nefrite lúpica

Ricardo Henrique de Oliveira Braga Teixeira, Marcel Hiratsuka, Flávia Calderini Rosa, Rogério Souza, Carlos Roberto Ribeiro de Carvalho

J Bras Pneumol.2003;29(6):401-404

Abstract PDF PT

Alveolar hemorrhage leading to respiratory failure is uncommon. Various etiologies have been reported, including systemic lupus erythematosus, which generally presents as pulmonary-renal syndrome. It is believed that the pathogenesis of microangiopathy is related to deposits of immune complexes that lead to activation of cellular apoptosis. The authors report two cases of alveolar hemorrhage and respiratory failure, both requiring mechanical ventilation. The two cases had opposite outcomes after pharmacological therapy. The presence of anti-glomerular basement membrane antibodies in one of the cases demonstrates the multiplicity of physiopathological mechanisms that may be involved. This multiplicity of mechanisms provides a possible explanation for the heterogeneous responses to the available treatments.


Keywords: Lupus erythematosus systemic/etiology. Lupus nephritis/etiology. Respiratory insufficiency/complications.


Transdiaphragmatic intercostal hernia: imaging aspects in three cases

Hérnia intercostal transdiafragmática: aspectos de imagem em três casos

Ana Carolina Sandoval Macedo, Fernando Uliana Kay, Ricardo Mingarini Terra, José Ribas Milanez de Campos, André Galante Alencar Aranha, Marcelo Buarque de Gusmão Funari

J Bras Pneumol.2013;39(4):-

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Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.


Keywords: Hernia, diaphragmatic; Radiography; Ultrasonography; Tomography; Magnetic resonance imaging.


Sternal and pectoral musculature hydatidosis

Hidatidose do esterno e musculatura peitoral


J Bras Pneumol.2001;27(4):223-226

Abstract PDF PT

Hydatidosis is a cyclezoonotic infection caused by taenia Echinococcus granulosus, whose larval form accidentally affects men by forming hydatic cysts preferably in the lungs and liver. Osseous hydatidosis is a rare event characterized by slow growth and few symptoms. It is reported on a 36-year-old man who had presented nodes in the anterior thorax for nine years. Imaging diagnostic examinations revealed thick, loculated, expansive masses in the pectoral muscles and sternal lytic lesions. The diagnosis of hydatidosis was established by exploratory surgery. The patient showed good clinical-surgical evolution and was discharged receiving albendazole, 2,400 mg/day, for 28 days.


Keywords: Diagnostic techniques and procedures. Pulmonary echinococcosis. Surgery.


Hypercoagulability and lung cancer

Hipercoagulabilidade e câncer de pulmão

Felipe Costa de Andrade Marinho, Teresa Yae Takagaki

J Bras Pneumol.2008;34(5):312-322

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The relationship between cancer and coagulopathy was suggested by Trousseau nearly 150 years ago. Later, it became more evident that oncologic patients are at a higher risk of experiencing thromboembolic events. This can be due to activation of the coagulation system either by neoplastic cells or by prescribed therapies (chemotherapy or surgical procedures). In fact, these events can constitute the first manifestation of cancer, and their recurrence, despite efficient anticoagulation, has been described. The coagulation system is normally activated in order to provide healing. In the presence of neoplasms, this complex system is activated as a response to multiple stimuli and seems to contribute to cancer progression. Activation of the coagulation system has a greater effect on metastatic foci than on the primary tumor. However, most cancer victims die from complications caused by metastasis, which underscores the importance of this theme. In this area, various mechanisms have been described, creating promising perspectives for future treatments. The current success in using low-molecular-weight heparins against small cell lung cancer is encouraging. Although the knowledge of those mechanisms is relatively incipient, many basic research and clinical studies are underway.


Keywords: Lung neoplasms; Thrombophilia.


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.


Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia accompanied by airflow obstruction

Hiperplasia de células neuroendócrinas pulmonares difusas com obstrução ao fluxo aéreo

Ester Nei Aparecida Martins Coletta, Larissa Rêgo Voss, Mariana Silva Lima, Jaquelina Sonoe Ota Arakaki, Juvêncio Câmara, Carlos D'Andretta Neto, Carlos Alberto de Castro Pereira

J Bras Pneumol.2009;35(5):489-494

Abstract PDF PT PDF EN Portuguese Text

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia with airflow obstruction is a rare form of lung injury. All of the reported cases have been diagnosed by surgical lung biopsy. Only three of the reported cases presented with diffuse interstitial lung opacities on HRCT scans. We report three additional cases of this entity. All of the patients were female and presented with mild-to-moderate airflow obstruction. In the first case, transbronchial biopsy and imaging data were sufficient to make the diagnosis. Although the HRCT scans of all three cases revealed a mosaic pattern, that of the third patient also revealed diffuse interstitial infiltrate. In extremely rare cases, HRCT findings can simulate those seen in other interstitial lung diseases.


Keywords: Neuroendocrine cells; Carcinoid tumor; Bronchiolitis obliterans.


Chronic intermittent hypoxia increases encoding pigment epithelium-derived factor gene expression, although not that of the protein itself, in the temporal cortex of rats

Hipóxia intermitente crônica aumenta a expressão gênica, mas não proteica, de pigment epithelium-derived factor no córtex temporal de ratos

Guilherme Silva Julian, Renato Watanabe de Oliveira, Vanessa Manchim Favaro, Maria Gabriela Menezes de Oliveira, Juliana Cini Perry, Sergio Tufik, Jair Ribeiro Chagas

J Bras Pneumol.2015;41(1):39-47

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Objective: Obstructive sleep apnea syndrome is mainly characterized by intermittent hypoxia (IH) during sleep, being associated with several complications. Exposure to IH is the most widely used animal model of sleep apnea, short-term IH exposure resulting in cognitive and neuronal impairment. Pigment epithelium-derived factor (PEDF) is a hypoxia-sensitive factor acting as a neurotrophic, neuroprotective, and antiangiogenic agent. Our study analyzed performance on learning and cognitive tasks, as well as PEDF gene expression and PEDF protein expression in specific brain structures, in rats exposed to long-term IH. Methods: Male Wistar rats were exposed to IH (oxygen concentrations of 21-5%) for 6 weeks-the chronic IH (CIH) group-or normoxia for 6 weeks-the control group. After CIH exposure, a group of rats were allowed to recover under normoxic conditions for 2 weeks (the CIH+N group). All rats underwent the Morris water maze test for learning and memory, PEDF gene expression and PEDF protein expression in the hippocampus, frontal cortex, and temporal cortex being subsequently assessed. Results: The CIH and CIH+N groups showed increased PEDF gene expression in the temporal cortex, PEDF protein expression remaining unaltered. PEDF gene expression and PEDF protein expression remained unaltered in the frontal cortex and hippocampus. Long-term exposure to IH did not affect cognitive function. Conclusions: Long-term exposure to IH selectively increases PEDF gene expression at the transcriptional level, although only in the temporal cortex. This increase is probably a protective mechanism against IH-induced injury.


Keywords: Sleep apnea, central; Disease models, animal; Cognition; Sleep; Sleep apnea, obstructive.


Langerhans-cell histiocytosis: rapid resolution after smoking cessation

Histiocitose de células de Langerhans: rápida resolução após cessação do tabagismo

José Miguel Chatkin, Vinicius D. Silva, Carlos C. Fritscher, Jussara Fiterman, Cláudia Reck

J Bras Pneumol.2005;31(2):173-176

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We describe a case of pulmonary Langerhans cell histiocytosis with a close temporal relationship between smoking cessation and radiological improvement. High-resolution computed tomography revealed multiple small nodules located in the upper and middle lobes of both lungs. Microscopy of these lesions showed histiocytic infiltration that reacted strongly to staining for S100 protein. The histiocytes resembling Langerhans cells showed strong reactivity for S100 protein. Smoking cessation was recommended and the patient complied. Chest X-ray and computed tomography performed 6 and 24 months later revealed almost complete resolution of the radiographic abnormalities. Despite the possibility that this evolution was attributable to spontaneous remission, in this case, the lesions did, in fact, disappear rapidly after smoking cessation.


Keywords: Key words: Histiocytosis. Langerhans-Cell. Tabaco use cessation.


Acute disseminated histoplasmosis in an immunocompetent patient

Histoplasmose disseminada aguda em indivíduo imunocompetente

Simone Castelo Branco Fortaleza, Silvia Karine de Albuquerque Lopes, Tereza de Jesus Bandeira, Teresa Neuma Albuquerque Gomes Nogueira, Marcelo Alcântata Holanda

J Bras Pneumol.2004;30(3):270-273

Abstract PDF PT

Histoplasmosis is a fungal disease caused by inhalation of Histoplasma capsulatum fungus. The disease does not normally affect immunocompetent individuals after a single, transient inhalation exposure. However, longer exposure may cause chronic or disseminated acute pulmonary infection. In immunocompromised patients, the infection is disseminated and severe. We report the case of a 13-year-old immunocompetent patient, presenting with fever, cough and dyspnea for one month. The chest X-ray and computed tomography scan revealed interstitial infiltrate and diffuse micronodules. The patient reported having had close and prolonged contact with birds. He was submitted to an open lung biopsy and the tissue culture was positive for Histoplasma capsulatum sp. He was treated with amphotericin B for 28 days, followed by treatment with itraconazole for 6 months, and there was complete resolution of the disease.


Keywords: Histoplasmosis, Immunocompetence, Birds.


Chronic cavitary pulmonary histoplasmosis

Histoplasmose pulmonar cavitária crônica

José Wellington Alves dos Santos, Gustavo Trindade Michel, Mônica Lazzarotto, Juliana Kaczmareck Figaro, Daniel Spilmann, Gustavo Köhler Homrich

J Bras Pneumol.2009;35(11):1161-1164

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Histoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.


Keywords: Histoplasmosis; Cavitation; Pulmonary emphysema.


Pulmonary histoplasmosis presenting with a halo sign on CT in an immunocompetent patient

Histoplasmose pulmonar presente com sinal do halo em TC em um paciente imunocompetente

Graziella Hanna Pereira, Liliane Yuri Almeida, Rosa Shizuda Okubo, Edson Marchiori

J Bras Pneumol.2013;39(4):-

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III Brazilian Thoracic Association Guidelines on TB

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia

BTA Committee on Tuberculosis1, BTA Guidelines on Tuberculosis Work Group2

J Bras Pneumol.2009;35(10):1018-1048

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New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.


Keywords: Tuberculosis; Mycobacterium infections; Diagnosis; Tuberculosis, multidrug-resistant.


Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year

Impacto da adesão à oxigenoterapia de longa duração em pacientes com DPOC e hipoxemia decorrente do esforço acompanhados durante um ano

Carolina Bonfanti Mesquita1,a, Caroline Knaut1,b, Laura Miranda de Oliveira Caram1,c, Renata Ferrari1,d, Silmeia Garcia Zanati Bazan2,e, Irma Godoy1,f, Suzana Erico Tanni3,g

J Bras Pneumol.2018;44(5):390-397

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Objective: To determine the impact of adherence to long-term oxygen therapy (LTOT) on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia followed for one year. Methods: Patients experiencing severe hypoxemia during a six-minute walk test (6MWT) performed while breathing room air but not at rest were included in the study. At baseline and after one year of follow-up, all patients were assessed for comorbidities, body composition, SpO2, and dyspnea, as well as for anxiety and depression, having also undergone spirometry, arterial blood gas analysis, and the 6MWT with supplemental oxygen. The Saint George's Respiratory Questionnaire (SGRQ) was used in order to assess quality of life, and the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index was calculated. The frequency of exacerbations and the mortality rate were noted. Treatment nonadherence was defined as LTOT use for < 12 h per day or no LTOT use during exercise. Results: A total of 60 patients with COPD and exertional hypoxemia were included in the study. Of those, 10 died and 11 experienced severe hypoxemia during follow-up, 39 patients therefore being included in the final analysis. Of those, only 18 (46.1%) were adherent to LTOT, showing better SGRQ scores, higher SpO2 values, and lower PaCO2 values than did nonadherent patients. In all patients, SaO2, the six-minute walk distance, and the BODE index worsened after one year. There were no differences between the proportions of adherence to LTOT at 3 and 12 months of follow-up. Conclusions: Quality of life appears to be lower in patients with COPD and exertional hypoxemia who do not adhere to LTOT than in those who do. In addition, LTOT appears to have a beneficial effect on COPD symptoms (as assessed by SGRQ scores). (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR‑9b4v63 [])


Keywords: Respiratory insufficiency; Pulmonary disease, chronic obstructive; Patient compliance; Hypoxia; Oxygen inhalation therapy.


Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water

Impacto da pressão positiva contínua nas vias aéreas sobre as alterações pulmonares promovidas pela imersão em água

Danize Aparecida Rizzetti1, Janayna Rodembuch Borba Quadros1, Bruna Esmerio Ribeiro1, Letícia Callegaro1, Aline Arebalo Veppo2, Giulia Alessandra Wiggers1, Franck Maciel Peçanha1

J Bras Pneumol.2017;43(6):409-415

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Objective: To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. Methods: This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. Results: We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. Conclusions: When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.


Keywords: Physical therapy modalities; Noninvasive ventilation; Continuous positive airway pressure.


Impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer

Impacto da radioterapia torácica na função respiratória e capacidade de exercício em pacientes com câncer de mama

Milena Mako Suesada1,a, Heloisa de Andrade Carvalho2,b, André Luis Pereira de Albuquerque1,c, João Marcos Salge1,d, Silvia Radwanski Stuart2,e, Teresa Yae Takagaki1,f

J Bras Pneumol.2018;44(6):469-476

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Objective: To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. Methods: Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose. Results: The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis. Conclusions: In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.


Keywords: Breast neoplasms; Radiotherapy; Radiation pneumonitis; Respiratory function tests; Exercise test.


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.


Impact of open lung biopsy on refractory acute respiratory failure

Impacto de biópsia pulmonar a céu aberto na insuficiência respiratória aguda refratária

Carmen Silvia Valente Barbas, Vera Luiza Capelozzi, Cristiane Hoelz, Ricardo Borges Magaldi, Rogério de Souza, Maria Laura Sandeville, José Ribas Milanez de Campos, Eduardo Werebe, Laerte O. Andrade Filho, Elias Knobel

J Bras Pneumol.2006;32(5):418-423

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Objective: To determine the impact that open lung biopsy findings have on decisions regarding changes in the treatment strategies employed for critically ill patients presenting diffuse pulmonary infiltrates and suffering from refractory acute respiratory failure, as well as on their clinical improvement. Methods: This study involved 12 mechanically ventilated patients with acute respiratory failure who were subjected to open lung biopsy (by thoracotomy) after not presenting a clinical response to standard treatment. Results: The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40%). The pre-operative evaluation of the cause of respiratory failure was modified in 11 patients (91.6%), and a specific diagnosis was made in 100% of the cases. Regardless of changes in treatment regimen, the mortality rate was 50%. Six patients (50%) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50% among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days. Conclusion: We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.


Keywords: Respiratory distress syndrome, adult; Lung/pathology; Biposy; Acute respiratory syndrome


Impact of a mechanical ventilation weaning protocol on the extubation failure rate in difficult-to-wean patients

Impacto de um protocolo de desmame de ventilação mecânica na taxa de falha de extubação em pacientes de difícil desmame

Cassiano Teixeira, Juçara Gasparetto Maccari, Silvia Regina Rios Vieira, Roselaine Pinheiro Oliveira, Augusto Savi, André Sant'Ana Machado, Túlio Frederico Tonietto, Ricardo Viegas Cremonese, Ricardo Wickert, Kamile Borba Pinto, Fernanda Callefe, Fernanda Gehm, Luis Guilherme Borges, Eubrando Silvestre Oliveira

J Bras Pneumol.2012;38(3):364-371

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Objective: To determine whether the predictive accuracy of clinical judgment alone can be improved by supplementing it with an objective weaning protocol as a decision support tool. Methods: This was a multicenter prospective cohort study carried out at three medical/surgical ICUs. The study involved all consecutive difficult-to-wean ICU patients (failure in the first spontaneous breathing trial [SBT]), on mechanical ventilation (MV) for more than 48 h, admitted between January of 2002 and December of 2005. The patients in the protocol group (PG) were extubated after a T-piece weaning trial and were compared with patients who were otherwise extubated (non-protocol group, NPG). The primary outcome measure was reintubation within 48 h after extubation. Results: We included 731 patients-533 (72.9%) and 198 (27.1%) in the PG and NPG, respectively. The overall reintubation rate was 17.9%. The extubation success rates in the PG and NPG were 86.7% and 69.6%, respectively (p < 0.001). There were no significant differences between the groups in terms of age, gender, severity score, or pre-inclusion time on MV. However, COPD was more common in the NPG than in the PG (44.4% vs. 17.6%; p < 0.001), whereas sepsis and being a post-operative patient were more common in the PG (23.8% vs. 11.6% and 42.4% vs. 26.4%, respectively; p < 0.001 for both). The time on MV after the failure in the first SBT was higher in the PG than in the NPG (9 ± 5 days vs. 7 ± 2 days; p < 0.001). Conclusions: In this sample of difficult-to-wean patients, the use of a weaning protocol improved the decision-making process, decreasing the possibility of extubation failure.


Keywords: Ventilator weaning; Ventilation; Ventilators, mechanical.


Impact of a short-term educational intervention on adherence to asthma treatment and on asthma control

Impacto de uma intervenção educacional de curta duração sobre a adesão ao tratamento e controle da asma

Paulo de Tarso Roth Dalcin, Denis Maltz Grutcki, Paola Paganella Laporte, Paula Borges de Lima, Vinícius Pellegrini Viana, Glauco Luís Konzen, Samuel Millán Menegotto, Mariana Alves Fonseca, Rosemary Petrik Pereira

J Bras Pneumol.2011;37(1):19-27

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Objective: To evaluate the effect of a short-term individualized education program on adherence to asthma treatment, inhalation techniques, and asthma control. Methods: A prospective study involving patients aged 14 years or older, with a confirmed diagnosis of asthma and recruited from the asthma outpatient clinic of a university hospital in the city of Porto Alegre, Brazil. The study was conducted in two phases (before and after the educational intervention). At a routine medical visit, the participants completed a general questionnaire in order to assess the level of asthma control and inhalation techniques. The participants also underwent pulmonary function testing. Subsequently, they participated in an asthma education program, which consisted of one individualized session. The participants were reevaluated after three months. Results: Of the 174 patients recruited, 115 completed the study. Between the first and second evaluations, there was a significant improvement in the effective use of inhaled corticosteroids (90.4% vs. 93.3%; p = 0.003), the effective use of long-acting β2 agonists (57.4% vs. 63.5%; p < 0.0001), the effective use of a combined regimen with these two medications (57.4% vs. 62.6%; p < 0.0001), and the self-reported adherence to corticosteroid therapy (p = 0.001). There was a significant decrease in the proportion of patients visiting ERs (30.4% vs. 23.5%; p = 0.012). However, the level of asthma control and the inhalation technique did not improve significantly (p = 0.095 and p = 0.512, respectively). Conclusions: This short-term asthma education program resulted in an improvement in the use of medications for asthma control and a decrease in the number of ER visits, although it had no significant effect on the inhalation technique.


Keywords: Ambulatory care; Patient education as topic; Respiratory therapy; Metered dose inhalers.


Immunophenotyping and gene rearrangement analysis in lymphoid/lymphoproliferative disorders of the lungs

Imunofenotipagem e rearranjo gênico em doenças pulmonares linfocíticas e linfoproliferativas

Camila Cristina Ishikawa, Alexandre Muxfeldt Ab'Saber, Edwin Roger Parra, Chin Jia Lin, Carmen Silvia Valente Barbas, Vera Luiza Capelozzi

J Bras Pneumol.2007;33(6):625-634

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Immunophenotyping and extracellular matrix remodeling in pulmonary and extrapulmonary sarcoidosis

Imunofenotipagem e remodelamento da matriz extracelular na sarcoidose pulmonar e extrapulmonar

Pedro Henrique Ramos Quintino da Silva, Edwin Roger Parra, William Sanches Zocolaro, Ivy Narde, Fabíola Rodrigues, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro de Carvalho, Vera Luiza Capelozzi

J Bras Pneumol.2012;38(3):321-330

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Objective: To investigate the significance of cellular immune markers, as well as that of collagen and elastic components of the extracellular matrix, within granulomatous structures in biopsies of patients with pulmonary or extrapulmonary sarcoidosis. Methods: We carried out qualitative and quantitative evaluations of inflammatory cells, collagen fibers, and elastic fibers in granulomatous structures in surgical biopsies of 40 patients with pulmonary and extrapulmonary sarcoidosis using histomorphometry, immunohistochemistry, picrosirius red staining, and Weigert's resorcin-fuchsin staining. Results: The extrapulmonary tissue biopsies presented significantly higher densities of lymphocytes, macrophages, and neutrophils than did the lung tissue biopsies. Pulmonary granulomas showed a significantly higher number of collagen fibers and a lower density of elastic fibers than did extrapulmonary granulomas. The amount of macrophages in the lung samples correlated with FVC (p < 0.05), whereas the amount of CD3+, CD4+, and CD8+ lymphocytes correlated with the FEV1/FVC ratio and VC. There were inverse correlations between TLC and the CD1a+ cell count (p < 0.05), as well as between DLCO and collagen/elastic fiber density (r = −0.90; p = 0.04). Conclusions: Immunophenotyping and remodeling both showed differences between pulmonary and extrapulmonary sarcoidosis in terms of the characteristics of the biopsy samples. These differences correlated with the clinical and spirometric data obtained for the patients, suggesting that two different pathways are involved in the mechanism of antigen clearance, which was more effective in the lungs and lymph nodes.


Keywords: Sarcoidosis; Granulomatous disease, chronic; Extracellular matrix; Immunophenotyping; Respiratory function tests.


Incidence of pulmonary embolism during COPD exacerbation

Incidência de embolia pulmonar durante exacerbação da DPOC

Eylem Akpinar, Derya Hoşgün, Serdar Akpinar, Gökçe Kaan Ataç, Beyza, Doğanay, Meral Gülhan

J Bras Pneumol.2014;40(1):38-45

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Objective: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE. Methods: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels. Results: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively). Conclusions: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese.


Keywords: Pulmonary disease, chronic obstructive; Pulmonary embolism; Risk factors.


Incidence of pulmonary embolism during COPD exacerbation

Incidência de embolia pulmonar durante exacerbação da DPOC

Shailendra Kapoor, Mauricio González-García

J Bras Pneumol.2014;40(1):96-97

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Incidence of viral infection of the respiratory tract in acute asthma patients treated in the emergency room

Incidência de infecção viral do trato respiratório em asma aguda atendida em sala de emergência

Ivete Terezinha Machado da Rocha, Diego Menegotto, Cristine Feliciati Hoffmann, Sergio Saldanha Menna-Barreto, Paulo de Tarso Roth Dalcin, Selir Maria Straliotto, Suzie Hyona Kang, Lilian Rech Pasin, Josiane Fischer, Fabiane Nieto

J Bras Pneumol.2005;31(5):382-389

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Objective: To evaluate the incidence of viral infection in patients with acute asthma treated in the emergency room. Methods: We conducted a cohort study of patients aged 12 and older presenting to the emergency room of the Hospital de Clínicas de Porto Alegre with acute asthma. Nasopharyngeal aspirate was collected, and antigens were detected through indirect immunofluorescence staining for respiratory syncytial virus, adenovirus and influenza, as well as for parainfluenza types 1, 2, 3 and 4. Data were collected regarding demographic characteristics, medical history, the attack that led to the current emergency room visit, and clinical outcomes. Results: From March to July of 2004, 49 patients were examined for viral infection of the respiratory tract. Respiratory viruses were identified in 6 patients (3 with adenovirus, 2 with influenza A, 1 with parainfluenza type 1). The mean age of the patients with viral infection of the respiratory tract was 61.7 ± 11.5 years, compared with 41.7 ± 20.9 years for the patients without such infection (p = 0.027). There were no other significant differences in clinical characteristics or outcomes. Conclusion: The incidence of viral infection of the respiratory tract in acute asthma patients 12 years and older treated in an emergency room was 12.2%, which confirms that viral infection is a significant precipitant of acute asthma for patients in this age bracket.


Keywords: Emergency Service, Hospital; Vírus diseases/prevention & control; Asthma; Respiratory tract infections; Influenza A virus, human


Incidence of TB diagnosed in the emergency room of a teaching hospital in southeastern Brazil

Incidência de TB diagnosticada no pronto-atendimento de um hospital escola na região sudeste do Brasil

Silvana Spíndola de Miranda, Ana Rita de Paiva Toledo, Simone Rodrigues Ribeiro, Izabela Magalhães Campos, Petra Maria de Oliveira Duarte Sthur, Afrânio Lineu Kritski

J Bras Pneumol.2009;35(2):174-178

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In this study, we analyzed the number of TB cases in an emergency room (ER) and the susceptibility profile of Mycobacterium tuberculosis strains. Patients were selected from among those treated at the Hospital das Clínicas, in the city of Belo Horizonte, Brazil. Between 2002 and 2005, 240 TB patients were identified. Of those, 117 patients (48.7%) were diagnosed in the ER, 72 (61.5%) presenting positive sputum smear microscopy. Drug susceptibility testing was carried out in 90 strains, of which 80 (89%) were sensitive, 9 (10%) were resistant, and 1 (1%) was multidrug resistant. The incidence of positive smear sputum microscopy and resistant TB strains was high, which calls for the immediate adoption of TB control measures in the ER.


Keywords: Tuberculosis; Disease transmission, infectious; Drug resistance.


Incidence of fatal venous thromboembolism in antineutrophil cytoplasmic antibody-associated vasculitis

Incidência de tromboembolismo venoso fatal em vasculite associada a anticorpo anticitoplasma de neutrófilos

Alfredo Nicodemos Cruz Santana, Teresa Yae Takagaki, Carmen Silvia Valente Barbas

J Bras Pneumol.2011;37(3):409-411

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Participation of researchers from the Brazilian Network of Tuberculosis Research in the activities of the Brazilian Journal of Pulmonology, official publication of the Brazilian Society of Pulmonology and Phthisiology

Incorporação de atores da Rede Brasileira de Pesquisa em TB nas atividades do Jornal Brasileiro de Pneumologia da Sociedade Brasileira de Pneumologia e Tisiologia

Afrânio Lineu Kritski

J Bras Pneumol.2004;30(4):394-397

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Indicators related to delays in diagnosis and in implementation of measures to control airborne infection among patients with pulmonary tuberculosis in a tertiary-care hospital

Indicadores relacionados ao retardo no diagnóstico e na instituição das precauções para aerossóis entre pacientes com tuberculose pulmonar bacilífera em um hospital terciário

Mariângela Ribeiro Resende, Verônica Maria Sinkoc, Márcia Teixeira Garcia, Eliane Oliveira de Moraes, Afrânio Lineu Kritski, Priscila Maria de Oliveira Papaiordanou

J Bras Pneumol.2005;31(3):225-230

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Background: The risk for nosocomial transmission of tuberculosis exists in health care institutions. Objective: To evaluate indicators of transmission risk among patients with pulmonary tuberculosis treated at a university hospital. Method: A retrospective study covering the January 1997 to September of 1999 period and evaluating patients admitted to the Hospital de Clínicas of the Universidade Estadual de Campinas with pulmonary tuberculosis. Three intervals were determined: from admission to collection of sputum for acid-fast bacilli microscopy; from admission to implementation of airborne infection control measures; from sputum collection to the initiation of treatment. Results: The final sample included 63 cases. Concomitant human immunodeficiency virus-positivity was found in 31.7%. Forty patients (63.5%) were admitted through the emergency room. In 42 (66.7%) patients, TB was suspected at admission. The interval between admission and sputum collection exceeded 12 hours in 27.5% of cases admitted through the emergency room and in 30.4% of those admitted directly to wards (p = 0.803). Delayed respiratory isolation occurred in 31 cases (49.2%). The delay in isolation was correlated to no diagnosis of tuberculosis at admission (p < 0.000) and lower bacillary load in the sputum (p = 0.032). Co-infection with human immunodeficiency virus (p = 0.530), hospitalization ward (p = 0.284) and underlying diseases (p = 0.541) were not correlated with delayed isolation. The interval between sputum collection and initiation of treatment was greater than 24 hours in 15.9% of the cases. Conclusion: Delayed isolation was observed in many cases. Policies of continuing education are called for, especially in high-risk areas.


Keywords: Tuberculosis. Infection Control. Brazil. Delay. Diagnosis.


Emphysema index in a cohort of patients with no recognizable lung disease: influence of age

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

Bruno Hochhegger, Giordano Rafael Tronco Alves, Klaus Loureiro Irion, José da Silva Moreira, Edson dos Santos Marchiori

J Bras Pneumol.2012;38(4):494-502

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Objective: To investigate the effects of age on pulmonary emphysema, based on the values of the emphysema index (EI) in a cohort of patients who had never smoked and who had no recognizable lung disease. Methods: We reviewed the CT scans, reported as normal, of 315 patients. Exclusion criteria were a history of smoking, cardiorespiratory disease, and exposure to drugs that could cause lung disease. From this cohort, we selected 32 patients (16 men and 16 women), matched for gender and body mass index, who were divided equally into two groups by age (< 50 years and  50 years). We quantified emphysema using a computer program specific to that task. The EI was calculated with a threshold of −950 HU. We also evaluated total lung volume (TLV) and mean lung density (MLD). Results: The overall means for TLV, MLD, and EI were 5,027 mL, −827 HU, and 2.54%, respectively. Mean values in the older and younger groups, respectively, were as follows: for TLV, 5,229 mL vs. 4,824 mL (p > 0.05); for MLD, −846 HU vs. −813 HU (p < 0.04); and for EI, 3.30% vs. 1.28% (p < 0.001). Significant correlations were found between EI and age (r = 0.66; p = 0.001), EI and TLV (r = 0.58; p = 0.001), and EI and MLD (r = −0.67; p < 0.001). The predicted EI per age was defined by the regression equation (r2 = 0.43): p50(EI) = 0.049 × age − 0.5353. Conclusions: It is important to consider the influence of age when quantifying emphysema in patients over 50 years of age. Based on the regression analysis, EI values of 2.6%, 3.5%, and 4.5% can be considered normal for patients 30, 50, and 70 years of age, respectively.


Keywords: Pulmonary emphysema; Tomography, spiral computed; Aging; Pulmonary disease, chronic obstructive.


Body mass index, asthma, and respiratory symptoms: a population-based study

Índice de massa corpórea, asma e sintomas respiratórios: um estudo de base populacional

Elaine Cristina Caon de Souza1,2,a, Marcia Margaret Menezes Pizzichini1,2,b, Mirella Dias1,2,c, Maíra Junkes Cunha1,2,d, Darlan Lauricio Matte1,2,e, Manuela Karloh1,2,f, Rosemeri Maurici1,2,g, Emilio Pizzichini1,2,h

J Bras Pneumol.2020;46(1):e20190006-e20190006

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Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.


Keywords: Obesity; Dyspnea; Cough; Asthma; Smoking.


Experimental myocardial infarction and increased oxidative stress in the rat diaphragm

Infarto do miocárdio experimental e aumento do estresse oxidativo em diafragma de ratos

Fabiano Leichsering Silva, Nicolle Gollo Mazzotti, Marcus Picoral, Daniella Meirelles Nascimento, Maria Isabel Morgan Martins, Adriane Belló Klein

J Bras Pneumol.2005;31(6):506-510

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Objective: To use an experimental model to evaluate the effect of heart failure on oxidative stress in the rat diaphragm. Methods: The model of myocardial infarction was developed through left coronary artery ligation. On day 42 after coronary artery ligation, the animals were killed, after which the diaphragms were collected and homogenized. Oxidative stress was evaluated in diaphragm homogenates through measurement of lipid peroxidation and assays of the activity of antioxidant enzymes, including catalase and glutathione peroxidase (enzymes that reduce hydrogen peroxide to water), as well as superoxide dismutase (an antioxidant enzyme that reduces superoxide anions to hydrogen peroxide). Results: The coronary artery ligation model was found to be effective in causing heart failure. In the animals submitted to coronary artery ligation, the mean infarcted area of the left ventricle was 39%. Lipid peroxidation was 217% greater in the diaphragms of ligated animals than in those of controls. The activity of catalase and glutathione peroxidase was 77% and 20% lower, respectively, in study rats than in control rats. Infarction did not modify superoxide dismutase activity. Conclusion: The results suggest that left coronary artery ligation results in oxidative stress in the diaphragm.


Keywords: Myocardial infarction; Oxidative stress; Congestive heart failure; Antioxidants; Diaphragm; Rats


Mycobacterium tuberculosis infection among community health workers involved in TB control

Infecção por Mycobacterium tuberculosis entre agentes comunitários de saúde que atuam no controle da TB

Patrícia Marques Rodrigues, Tiago Ricardo Moreira, Andressa Karla Luz de Moraes, Rafael da Cruz Araújo Vieira, Reynaldo Dietze, Rita de Cassia Duarte Lima, Ethel Leonor Noia Maciel

J Bras Pneumol.2009;35(4):351-358

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Objective: To evaluate the incidence of Mycobacterium tuberculosis infection, using tuberculin skin test, among community health agents (CHAs) monitoring TB patients in the city of Cachoeiro de Itapemirim, Brazil. Methods: We included 30 CHAs acting in the Family Health Program and 30 of their family members residing in the same household. The tuberculin skin test results of each CHA were compared with those of the corresponding family member. Results: Of the 30 CHAs, 27 (90.0%) were female, compared with 23 (76.7%) of the 30 family members (p = 0.299). The mean age of the CHA group and of the family member group was, respectively, 36.8 and 39.7 years. No statistically significant difference was found between the groups regarding the level of education. Regarding M. tuberculosis exposure, the same number of participants in the two groups reported having known or had contact with a TB patient (17 individuals; 56.7%). There was a statistically significant difference regarding positive tuberculin skin test results (26.7% in the CHA group and 3.3% in the family member group; p = 0.011). Conclusions: M. tuberculosis infection was significantly higher among CHAs than among their family members, fueling the debate on the occupational risk involved in the activities of these professionals.


Keywords: Community health aides; Tuberculosis; Tuberculin test.


Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact, diagnosis, and treatment

Infecção por Pseudomonas aeruginosa em pacientes com fibrose cística: evidências científicas sobre o impacto clínico, diagnóstico e tratamento

Luiz Vicente Ribeiro Ferreira da Silva Filho, Flavia de Aguiar Ferreira, Francisco José Caldeira Reis, Murilo Carlos Amorim de Britto, Carlos Emilio Levy, Otavio Clark, José Dirceu Ribeiro

J Bras Pneumol.2013;39(4):-

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Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO-an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group.


Keywords: Cystic fibrosis/diagnosis; Cystic fibrosis/drug therapy; Pseudomonas aeruginosa; Evidence-based medicine.


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

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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.


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

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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.


The influence of leptin on Th1/Th2 balance in obese children with asthma

Influência da leptina no equilíbrio Th1/Th2 em crianças asmáticas obesas

Doaa Mohammed Youssef, Rabab Mohamed Elbehidy, Dina Mahamoud Shokry, Eman Mohamed Elbehidy

J Bras Pneumol.2013;39(5):562-568

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Objective: In individuals with asthma, obesity induces the production of leptin and is associated with disease severity. Our objective was to evaluate the levels of serum leptin and their effect on Th1/Th2 balance in obese and non-obese children with asthma, as well as to investigate the association between serum leptin levels and clinical outcomes. Methods: We evaluated 50 atopic children with physician-diagnosed moderate-to-severe persistent asthma and 20 controls. The children with asthma were divided into two groups, by body mass index percentile: obese (n = 25) and non-obese (n = 25). From all subjects, we collected peripheral blood samples in order to determine the levels of leptin, IFN-, and IL-4. Asthma severity was assessed by an asthma symptom score, and the results were correlated with the parameters studied. Results: Serum leptin levels were significantly higher in the obese asthma group than in the non-obese asthma group, as well as being significantly higher in the children with asthma than in the controls, whereas IFN- levels were significantly higher and IL-4 levels were significantly lower in the obese asthma group than in the non-obese asthma group. In addition, the obese asthma group showed higher asthma symptom scores and significantly lower FEV1 (% of predicted) than did the non-obese asthma group. There was a significant positive correlation between leptin and IFN- levels only in the obese asthma group. Conclusions: Although leptin is involved in the pathogenesis of asthma in obese and non-obese children, its effect is more pronounced in the former. In the presence of high leptin levels, only obese children with asthma exhibited Th1 polarization, with higher IFN- levels and greater asthma severity.


Influence of oscillating positive expiratory pressure and the forced expiratory technique on sputum cell counts and quantity of induced sputum in patients with asthma or chronic obstructive pulmonary disease.

Influência da técnica de pressão expiratória positiva oscilante e da técnica de expiração forçada na contagem de células e quantidade do escarro induzido em portadores de asma ou doença pulmonar obstrutiva crônica

Ana Lúcia Bernardo de Carvalho Morsch, Maria Marta Amorim, Andréa Barbieri, llka Lopes Santoro, Ana Luisa Godoy Fernandes

J Bras Pneumol.2008;34(12):1026-1032

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Abstract Objective: To evaluate whether respiratory therapy techniques influence the number of cells within and quantity of induced sputum in patients with asthma or chronic obstructive pulmonary disease (COPD). Methods: Randomized clinical trial, in which patients with asthma or COPD under intervention (n = 16 and 10, respectively) were compared with control groups (n = 16 and 10). Patients in the asthma/intervention (A/I) and COPD/intervention (C/I) groups were submitted to oscillating positive expiratory pressure maneuvers for 5 min, followed by 10 forced expiratory technique sequences. These patients were also submitted to an induced sputum protocol with inhaled hypertonic saline (3%, 4% or 5%; A/I group) or inhaled isotonic saline (C/I group). The asthma/control (A/C) and COPD/control (C/C) groups were submitted only to the standard induced sputum protocol. Results: The final mean weight of the sputum samples was significantly greater in the A/I group than in the A/C group (2,767.25 ± 998.08 mg vs. 1,689.17 ± 1,189.96 mg; p = 0.03). The mean/median total cell counts (×106/mL) were higher in the A/I and C/I groups than in the A/C and C/C groups (4.06/0.95 and 0.63/0.39, p = 0.05, vs. 5.08/1.77 and 0.64/0.40, p = 0.02). There were no statistically significant differences among the groups in terms of cell viability. Conclusions: The use of respiratory therapy techniques can increase sputum sample weight in asthma patients, as well as increasing total cell counts in patients with asthma or COPD.


Keywords: Asthma; Pulmonary disease, obstructive chronic; Sputum; Physical therapy modalities.


Influence that oscillating positive expiratory pressure using predetermined expiratory pressures has on the viscosity and transportability of sputum in patients with bronchiectasis

Influência da técnica de pressão expiratória positiva oscilante utilizando pressões expiratórias pré-determinadas na viscosidade e na transportabilidade do escarro em pacientes com bronquiectasia

Ercy Mara Cipulo Ramos, Dionei Ramos, Daniela Mizusaki Iyomasa, Graciane Laender Moreira, Kátia Cristina Teixeira Melegati, Luiz Carlos Marques Vanderlei, José Roberto Jardim, Adriana Siqueira de Oliveira

J Bras Pneumol.2009;35(12):-

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Objective: To determine the effectiveness of oscillating positive expiratory pressure (OPEP) using predetermined expiratory pressures on the viscosity and transportability of sputum in patients with bronchiectasis. Methods: The study involved 15 stable patients with bronchiectasis (7 males; mean age = 53 ± 16 years), submitted to two consecutive OPEP interventions, with a 24-h interval between the two, using positive expiratory pressures set at 15 cmH2O (P15) and 25 cmH2O (P25). The protocol consisted of a voluntary cough; another voluntary cough 20 min later, designated time zero (T0); a 10-min rest period; and two 10-min series (S1 and S2, using OPEP at P15 and P25 in both), with a 10-min interval between the two. The viscosity and transportability of sputum were evaluated by viscometry, relative transport velocity on frog palate, transport in a simulated cough machine and contact angle. Sputum samples were collected at T0, after S1 and after S2. Specific statistical tests were performed depending on the type of data distribution. Results: In comparison with the values obtained at T0, sputum viscosity decreased significantly after S1 at P15 and after S2 at P25. There were no significant differences among all of the samples in terms of transportability. Conclusions: The fact that sputum viscosity decreased whether OPEP was performed at P15 or at P25 suggests that there is no need to generate high expiratory pressure to achieve the desired result.


Keywords: Viscosity; Bronchiectasis; Physical therapy (specialty); Sputum.


Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

Influência das máscaras facial total, facial e nasal nos efeitos adversos agudos durante ventilação não-invasiva

Marcelo Alcantara Holanda, Ricardo Coelho Reis, Georgia Freire Paiva Winkeler, Simone Castelo Branco Fortaleza, José Wellington de Oliveira Lima, Eanes Delgado Barros Pereira

J Bras Pneumol.2009;35(2):164-173

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Objective: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. Methods: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. Results: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO2 entering the ventilator circuit was zero for the TFM. Conclusions: The short-term adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO2 from the circuit is less likely to occur when a TFM is used.


Keywords: Intermittent positive-pressure ventilation; Masks/adverse effects; Respiratory insufficiency;Equipment failure analysis.


Influence of the technique of re-educating thoracic and abdominal muscles on respiratory muscle strength in patients with cystic fibrosis

Influência do método Reequilíbrio Toracoabdominal sobre a força muscular respiratória de pacientes com fibrose cística

Renata Claudia Zanchet, Aline Mayara Azevedo Chagas, Juliana Sarmento Melo, Patricia Yuki Watanabe, Augusto Simões-Barbosa, Gilvânia Feijó

J Bras Pneumol.2006;32(2):123-129

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Objective: To determine the effect that re-education of the thoracic and abdominal muscles has on the respiratory muscle strength of patients with cystic fibrosis evaluated over time at the Cystic Fibrosis Outpatient Clinic of the Universidade Católica de Brasília (Catholic University of Brasília). Methods: The sample consisted of 29 cystic fibrosis patients, characterized based on anthropometric, genetic and bacterial colonization data. The patients were submitted to physical therapy sessions, involving re-education of the respiratory muscles, twice a week for four months. Spirometry, pressure manometry and anthropometry were performed before and after each session. Results: Comparing baselines values to those obtained after physical therapy, increases in maximum inspiratory pressure and maximum expiratory pressure were observed in all patients, those without any obstructive respiratory disease and those with mild obstructive respiratory disease (p < 0.05). A positive correlation between age and maximum expiratory pressure was observed for most of the patients. Maximum inspiratory pressure correlated positively with age only in the group with mild obstructive respiratory disease (p = 0.012; r = 0.817). In female patients and in the group of patients without obstructive respiratory disease, a negative correlation was observed between maximum expiratory pressure and colonization with Pseudomonas aeruginosa (p = 0.036; r = -0.585). Conclusion: Use of the thoracic and abdominal muscle re-education technique increased respiratory muscle strength in the cystic fibrosis patients studied, a finding that underscores the importance of including physical therapy in the treatment of these patients.


Keywords: Cystic fibrosis/rehabilitation; Physical therapy technique; Respiratory muscles; Forced expiratory volume; Inspiratory capacity; Vital capacity


Influence of the oxygen delivery system on the quality of life of patients with chronic hypoxemia

Influência do sistema de fornecimento de oxigênio na qualidade de vida de pacientes com hipoxemia crônica

Suzana Erico Tanni, Simone Alves Vale, Paula S Lopes, Marcelo M Guiotoko, Ilda Godoy, Irma Godoy

J Bras Pneumol.2007;33(2):161-167

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Objective: To evaluate the health-related quality of life of patients with chronic obstructive pulmonary disease receiving long-term oxygen therapy (LTOT) at home through oxygen cylinders and compare these results with those obtained six months after the transition from oxygen cylinders to oxygen concentrators. Methods: A total of 45 patients were evaluated. Of those, 24 had chronic hypoxemia and 21 presented no evidence of hypoxemia. The patients with chronic hypoxemia had been regularly receiving LTOT for at least the last six months and were evaluated at baseline, while using cylinders, and six months after the transition from cylinders to concentrators. The non-hypoxemic patients were evaluated at the same time points as were the hypoxemic patients. In order to evaluate quality of life, a version of the Saint George's Respiratory Questionnaire (SGRQ), translated and validated for use in Brazil, was administered. Results: At baseline, quality of life, as evaluated using the total score and the symptom and impact domain scores of the SGRQ, was more impaired in the hypoxemic patients than in the non-hypoxemic patients. After six months of using the concentrators, the hypoxemic patients presented a significant improvement in the quality of life, and, at that time, no difference was found between the patients with and without hypoxemia. Conclusion: Our findings show that quality of life is impaired in patients with chronic obstructive pulmonary disease and chronic hypoxemia, that their quality of life can be improved through regular use of LTOT, and that the oxygen delivery system has an influence on this improvement.


Keywords: Pulmonary disease, Chronic obstructive; Anoxemia; Oxygen inhalation therapy; Quality of life.


Influence of vial size on the results of the tuberculin test

Influência do tamanho do frasco de tuberculina nos resultados da prova tuberculínica

Antonio Ruffino-Netto, Afranio Lineu Kritski, Eleny Guimarães Teixeira, Carla Conceição dos Santos Loredo, Danielle Novelo de Souza, Anete Trajman

J Bras Pneumol.2005;31(2):144-148

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Background: Tuberculin purified protein derivative is stored in vials of various sizes. Its adsorption to the vial can influence the results of tuberculin tests. Objective: To evaluate the effect of vial size on the results obtained in tuberculin tests. Methods: Sixty-four inpatients with active tuberculosis were submitted to two simultaneous tuberculin tests using the Mantoux technique. Patients were randomly allocated to receive two 0.1-ml injections, either one in the right forearm from a 1.5-ml vial and one in the left forearm from a 5-ml vial or vice versa. Induration was determined in a blinded fashion by a single, previously trained observer. Right arm-left arm differences of 2 mm or less were considered concordant results. Results: Twenty-one patients presented no induration and were excluded from analysis. Among the 42 remaining patients, mean induration diameters obtained in tuberculin tests using the larger vials were greater than those obtained in tests using the smaller vials. Concordance was achieved in 40.5% (17/42). The difference was negative (large-vial indurations smaller than small-vial indurations) in 16.7% (7/42) and positive in 42.9% (18/42). Conclusions: The size of the vial may influence tuberculin test results. Adsorption to the sides of the vial may explain this phenomenon. The authors caution others to be aware of the impact of these variations in epidemiological and operational studies.


Keywords: Key words: Tuberculin Skin Test. Tuberculin. Adsorption. PPD. Mantoux.


Sport-specific influences on respiratory patterns in elite athletes.

Influências específicas do esporte nos padrões respiratórios em atletas de elite

Tijana Durmic1,2, Biljana Lazovic2,3, Marina Djelic2,4, Jelena Suzic Lazic5, Dejan Zikic2,6, Vladimir Zugic2,7, Milica Dekleva2,8, Sanja Mazic2,4

J Bras Pneumol.2015;41(6):516-522

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Objective: To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows. Methods: This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21 ± 4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry). Results: Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV1, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV1 (r = −0.386; p < 0.001). Conclusions: Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.


Keywords: Athletes; Sports; Spirometry; Respiratory function tests.


Pandemic influenza A (H1N1) 2009: risk factors for hospitalization

Influenza pandêmica A (H1N1) 2009: fatores de risco para o internamento

Luana Lenzi, Ângela Maron de Mello, Lineu Roberto da Silva, Mônica Holtz Cavichiolo Grochocki, Roberto Pontarolo

J Bras Pneumol.2012;38(1):57-65

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Objective: To evaluate pandemic influenza A (H1N1) 2009 in hospitalized patients in order to identify risk factors for hospitalization and, consequently, for the worsening of the disease. Methods: This retrospective observational study was conducted between March and December of 2010. The data were collected from the Brazilian Ministry of Health National Case Registry Database. We included only patients (inpatients and outpatients) in whom H1N1 infection was confirmed (via laboratory testing) during the study period. The variables regarding demographic and clinical characteristics were statistically evaluated in order to compare the hospitalization rates in the presence or absence of these factors. Risk factors were identified by logistic regression analysis. Results: We included 4,740 patients with laboratory confirmation of H1N1 infection. Of these, 1,911 individuals were hospitalized, and 258 (13.5%) died. The risk factors for hospitalization were age (20-29 years), African or Indigenous ethnicity, presence of specific comorbidities (heart disease, lung disease, kidney disease, hemoglobinopathy, immunosuppression, diabetes, obesity, puerperium, and smoking), a high number of comorbidities, and specific symptoms (dyspnea, diarrhea, vomiting, chest pain, hemoptysis, pneumonia, and wheezing). Higher levels of education and early use of oseltamivir were found to be protective factors. Hospitalization contributed to an increase in survival. Conclusions: Knowledge of the epidemiological characteristics that can be associated with hospitalization, disease severity, and mortality can be helpful in the adoption of preventive measures, as well as in the early diagnosis and treatment of disease, which might contribute to the reduction in the numbers of hospitalizations and deaths.


Keywords: Influenza A virus, H1N1 subtype; Hospitalization; Risk factors; Oseltamivir.


Acute respiratory failure after occupational exposure to food preservatives

Insuficiência respiratória aguda após exposição a conservantes de alimentos

Maria Auxiliadora Carmo Moreira, Luiz Carlos da Cunha, Tereza Yoshie Ikegami, José Laerte Rodrigues da Silva Junior

J Bras Pneumol.2005;31(5):464-469

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Herein, we report an instance of occupational exposure to food preservatives and resultant acute respiratory failure in three workers. The toxicological analysis revealed that mixing the particular food preservatives involved, a procedure that was performed by the three workers involved, produced NO2, the inhalation of which caused the pulmonary edema and respiratory failure. With time, the pulmonary damage was completely reversed in all three individuals. Accompanying this case report is a brief review of the literature regarding acute pulmonary injury resulting from occupational exposure to chemicals. We emphasize the importance of training, as well as of the use of protective gear, for workers who handle chemical substances.


Keywords: Respiratory insufficiency; Occupational exposure; Occupational diseases; Case report


Interfaces for noninvasive ventilation: Does it matter?

Interfaces para ventilação não-invasiva: Faz diferença?

Sean P. Keenan, Brent Winston

J Bras Pneumol.2009;35(2):103-105

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Interference of nail polish colors and time on pulse oximetry in healthy volunteers

Interferência da coloração de esmaltes de unha e do tempo na oximetria de pulso em voluntários sadios

Mara Harumi Miyake, Solange Diccini, Ana Rita de Cássia Bettencourt

J Bras Pneumol.2003;29(6):386-390

Abstract PDF PT

Background: Pulse oximetry is a noninvasive method to measure the saturation of peripheral oxyhaemoglobin (SpO2). It's usually used in emergency, intensive care and operating room units. Pulse oximeter readings have limited accuracy in the presence of methemoglobin, carboxyhemoglobin, anaemia, peripheral vasoconstriction, nail polish, fluorescent light, and motion. Objectives: To evaluate the interferences of the color of nail polishes and time on SpO2 in healthy individuals. Methods: Sixty-one healthy female volunteers, ages ranging from 18 to 32 years. The nail polish colors used to evaluate SpO2 were: base coat on the little finger, light pink on the ring finger, sparkling light pink on the medium finger and red on the thumb. The index finger was used as control and thus, did not receive nail polish. The time for each color was evaluated every minute until 5 minutes were completed. Results: When the SpO2 measurement was compared with the control, the base coat (p = 0.56), light pink (p = 0.56) and sparkling light pink (p = 0.37) colors didn't present statistically significant differences. Only the red presented a significant variation (p < 0,001), however it was within normal parameters. SpO2 didn't vary significantly with time. Conclusion: Despite the difference found with the red color, all the SpO2 values achieved were inside the normal range for a healthy individual. Pulse oximeter readings are not significantly affected by the color of nail polish in relation to time.


Keywords: Nail polish. Oxygen saturation. Pulse oximetry.


Interpretation of autoantibody positivity in interstitial lung disease and lung-dominant connective tissue disease

Interpretação da positividade de autoanticorpos na doença pulmonar intersticial e colagenose pulmão dominante

Daniel Antunes Silva Pereira, Alexandre de Melo Kawassaki, Bruno Guedes Baldi

J Bras Pneumol.2013;39(6):728-741

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The initial evaluation of patients with interstitial lung disease (ILD) primarily involves a comprehensive, active search for the cause. Autoantibody assays, which can suggest the presence of a rheumatic disease, are routinely performed at various referral centers. When interstitial lung involvement is the condition that allows the definitive diagnosis of connective tissue disease and the classical criteria are met, there is little debate. However, there is still debate regarding the significance, relevance, specificity, and pathophysiological role of autoimmunity in patients with predominant pulmonary involvement and only mild or benign symptoms of connective tissue disease. The purpose of this article was to review the current knowledge of autoantibody positivity and to discuss its possible interpretations in patients with ILD and without clear etiologic associations, as well as to enhance the understanding of the natural history of an allegedly new disease and to describe the possible prognostic implications. We also discuss the proposition of a new term to be used in the classification of ILDs: lung-dominant connective tissue disease.


Keywords: Idiopathic interstitial pneumonias; Autoantibodies; Connective tissue diseases; Autoimmune diseases; Diagnosis, differential.


Nontuberculous mycobacteria isolated in São José do Rio Preto, Brazil between 1996 and 2005

Isolamento de micobactérias não-tuberculosas em São José do Rio Preto entre 1996 e 2005

Heloisa da Silveira Paro Pedro, Maria Izabel Ferreira Pereira, Maria do Rosário Assad Goloni, Suely Yoko Mizuka Ueki, Erica Chimara

J Bras Pneumol.2008;34(11):950-955

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Objective: To study the incidence of nontuberculous mycobacteria and the range of species isolated between 1996 and 2005 at a regional branch of the Adolfo Lutz Institute-located in the city of São José do Rio Preto, Brazil-and to show the importance of laboratory testing. Methods: Mycobacteria were isolated from pulmonary and extrapulmonary specimens and identified through phenotyping and molecular methods (polymerase chain reaction-restriction enzyme analysis). Results: We isolated 317 nontuberculous mycobacterium strains: ­Mycobacterium avium complex, 182 (57.4%); M. gordonae, 33 (10.4%); M. fortuitum, 25 (7.9%); M. chelonae, 8 (2.5%); M. terrae complex, 8 (2.5%); M. kansasii, 7 (2.2%); and less frequent species, 54 (17%). During this period, 72 cases (33.3%) were characterized as mycobacteriosis, according to bacteriological criteria established by the American Thoracic Society in 2007. Of those 72 cases, 56 were attributed to M. avium complex. Of those 56, 29 (51.8%) were characterized as disseminated disease. Six cases were attributed to M. fortuitum, 3 to M. gordonae, 2 to M. chelonae, 1 to M. abscessus, 1 to M. kansasii, 1 to M. intracellulare, 1 to M. malmoense and 1 to ­Mycobacterium ssp. Conclusions: These results show the importance of the bacteriological diagnosis, since identification of the species enables early and appropriate treatment.


Keywords: Mycobacteria, atypical/isolation & purification; Mycobacteria, atypical/classification; Diagnostic techniques and procedures.


Jornal Brasileiro de Pneumologia and Sociedade Brasileira de Pneumologia e Tisiologia: perspectives for the next four years

Jornal Brasileiro de Pneumologia e Sociedade Brasileira de Pneumologia e Tisiologia: perspectivas para os próximos quatro anos

Bruno Guedes Baldi1,2,a, José Miguel Chatkin3,4,b

J Bras Pneumol.2019;45(1):e20190028-e20190028

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Solitary benign metastasizing leiomyoma: imaging features and pathological findings

Leiomioma metastático benigno solitário: aspectos de imagem e achados anatomopatológicos

Bernardo Corrêa de Almeida Teixeira, Kássia Mahfouz, Dante Luiz Escuissato, Ana Flávia Cardoso Buarque Costa, Lúcia de Noronha

J Bras Pneumol.2014;40(2):-

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Inflammatory lung injury in rabbits: effects of high-frequency oscillatory ventilation in the prone position

Lesão inflamatória pulmonar em coelhos: efeitos da ventilação oscilatória de alta frequência em posição prona

Jose Roberto Fioretto1,a, Rafaelle Batistella Pires2,b, Susiane Oliveira Klefens1,c, Cilmery Suemi Kurokawa1,d, Mario Ferreira Carpi1,e, Rossano César Bonatto1,f, Marcos Aurélio Moraes1,g, Carlos Fernando Ronchi1,3,h

J Bras Pneumol.2019;45(5):e20180067-e20180067

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Objective: To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI). Methods: Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue. Results: After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores. Conclusions: Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.


Keywords: Respiration, artificial/adverse effects; Prone position; Lung/physiopathology; Pneumonia; Respiratory distress syndrome, adult; Acute lung injury; Disease models, animal; Rabbits.


Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations

Limiares auditivos em pacientes com tuberculose resistente: configurações do audiograma basal e associações

Olusola Ayodele Sogebi1, Muse Olatunbosun Fadeyi2, Bolanle Olufunlola Adefuye3, Festus Olukayode Soyinka4

J Bras Pneumol.2017;43(3):195-201

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Objective: To use baseline audiogram parameters in order to ascertain whether drug-resistant tuberculosis (DR-TB) has effects on hearing, as well as to describe the configurations of the audiograms and to determine whether there are parameters that can be associated with those configurations. Methods: This was a prospective study involving patients diagnosed with DR-TB at a tuberculosis treatment center in the state of Ogun, in Nigeria. The patients included in the study were submitted to pure tone audiometry at baseline (within two weeks after treatment initiation). For comparative analyses, data regarding demographic and clinical characteristics were collected from the medical records of the patients. Results: The final sample comprised 132 patients. The mean age of the patients was 34.5 ± 12.6 years (range, 8-82 years), and the male:female ratio was 2:1. Of the 132 patients, 103 (78.0%) resided in neighboring states, 125 (94.7%) had previously experienced antituberculosis treatment failure, and 18 (13.6%) were retroviral-positive. Normal audiograms were found in 12 patients (9.1%), whereas sensorineural hearing loss was identified in 104 (78.8%), the two most common configurations being ascending, in 54 (40.9%), and sloping, in 26 (19.7%). Pure-tone averages at low frequencies (0.25-1.0 kHz) and high frequencies (2.0-8.0 kHz) were 33.0 dB and 40.0 dB, respectively. Regarding the degree of hearing loss in the better ear, 36 patients (27.3%) were classified as having normal hearing and 67 (50.8%) were classified as having mild hearing loss (26-40 dB), whereas 29 (21.9%) showed moderate or severe hearing loss. Among the variables studied (age, gender, retroviral status, previous treatment outcome, and weight at admission), only male gender was associated with audiometric configurations. Conclusions: In this sample of patients with DR-TB, most presented with bilateral, mild, suboptimal sensorineural hearing loss, and ascending/sloping audiometric configurations were associated with male gender.


Keywords: Audiometry, pure-tone; Hearing loss, high-frequency; Drug-related side effects and adverse reactions; Tuberculosis, multidrug-resistant.


Lymphadenopathy and fever in a chef during a stay in Europe

Linfadenomegalia e febre em chefe de cozinha durante viagem à Europa

Letícia Kawano-Dourado, Daniel Antunes Silva Peirera, Alexandre de Melo Kawassaki, Marisa Dolhnikoff, Marcos Vinicius da Silva, Ronaldo Adib Kairalla

J Bras Pneumol.2015;41(2):191-195

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This case illustrates a rare presentation (as lymphadenopathy and fever) of one of the most common zoonotic diseases worldwide-brucellosis-in a 22-year-old Brazilian male (a chef) who had recently returned to Brazil after having lived in and traveled around Europe for one year. The histopathology, clinical history, and response to treatment were all consistent with a diagnosis of brucellosis, which was confirmed by PCR in a urine sample. We also review some aspects of brucellosis, such as the clinical features, diagnosis, and management.


Keywords: Brucellosis; Fever; Lymph nodes; Brucella; Mononuclear phagocyte system; Granuloma.


Primary effusion lymphoma in an immunocompetent patient

Linfoma primário de cavidade pleural em paciente imunocompetente

Leila Antonangelo, Francisco S Vargas, Lisete Ribeiro Teixeira, Marcelo A C Vaz, Maria Mirtes Sales, Luis C Moreira, Roberta Karla Barbosa de Sales

J Bras Pneumol.2005;31(6):563-566

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Primary effusion lymphoma is an unusual non-Hodgkin's lymphoma rarely seen in immunocompetent patients. Herein, we present clinical and biochemical data obtained from an immunocompetent patient diagnosed with primary effusion lymphoma.


Keywords: Pleural effusion; Lymphoma, non-Hodgkin; HIV seronegativity; Case reports


Intrapulmonary lymph node: a common and underrecognized tomography finding

Linfonodo intrapulmonar: um achado tomográfico comum e pouco reconhecido

Bruno Hochhegger, Daniela Quinto dos Reis Hochhegger, Klaus Irion, Ana Paula Sartori, Fernando Ferreira Gazzoni, Edson Marchiori

J Bras Pneumol.2013;39(6):757-758

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Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality

Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória

Pablo Gerardo Sánchez, Giovani Schirmer Vendrame, Gabriel Ribeiro Madke, Eduardo Sperb Pilla, José de Jesus Peixoto Camargo, Cristiano Feijó Andrade, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2006;32(6):495-504

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Objective: To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma. Methods: A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death. Results: The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%. Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 ± 4.4), forced expiratory volume in one second (74.1 ± 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 ± 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01). Conclusion: Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.


Keywords: Lung neoplasms/surgery; Postoperative complications; Pneumonectomy; Morbidity


Location of lung carcinoma in relation to the smoking habit and gender

Localização do carcinoma pulmonar em relação ao vício tabágico e ao sexo

Sérgio Jamnik, César Uehara, Vilmer Vieira da Silva

J Bras Pneumol.2006;32(6):510-514

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Objective: To analyze the locations of lung carcinomas in relation to patient gender and smoking status. Methods: In order to test the hypothesis that lung carcinoma location (upper or lower lobe; left or right side) is correlated with smoking status and gender, we conducted a retrospective study of 697 patients with bronchogenic carcinoma treated at the Pulmonology-Oncology Outpatient Clinic of the Federal University of São Paulo. Results: We found that the bronchogenic carcinomas occurring in smokers were more frequently located in the upper lobes, whereas those occurring in nonsmokers were more frequently located in the lower lobes. In women, the neoplasms were more often seen in the lower lobes, especially in nonsmokers. Based on the available data, there were no differences in terms of the side affected (left or right). Conclusion: Overall, bronchogenic carcinomas are predominantly found in the upper lobes. However, in nonsmokers, they occur more frequently in the lower lobes. In females, bronchogenic carcinomas present a tendency to occur more often in the lower lobes.


Keywords: Lung neoplasms; Sex factors; Smoking


Plasmodium falciparum malaria: another infection of interest to pulmonologists

Malária por Plasmodium falciparum: outra infecção de interesse para o pneumologista

Edson Marchiori, Gláucia Zanetti, Bruno Hochhegger, Clarissa Canella, Klaus Loureiro Irion

J Bras Pneumol.2013;39(6):750-752

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Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report

Manejo da estenose traqueal distal recidivada por meio de endoprótese: relato de caso

André Germano Leite, Douglas Kussler

J Bras Pneumol.2008;34(2):121-125

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The authors report the case of a patient with recurrent distal tracheal stenosis after several tracheal resections. A T-Y tracheobronchial stent was inserted for the management of distal airway obstruction. The prosthesis was adapted based on the specifications obtained through a computed tomography scan of the chest with three-dimensional reconstruction.


Keywords: Tracheal stenosis; Prostheses and implants; Trachea/surgery; Case reports [publication type].


Clinical, radiological, and laboratory characteristics in pulmonary tuberculosis patients: comparative study of HIV&#8209;positive and HIV-negative inpatients at a referral hospital

Manifestações clínicas, radiológicas e laboratoriais em indivíduos com tuberculose pulmonar: estudo comparativo entre indivíduos HIV positivos e HIV negativos internados em um hospital de referência

Aline Besen, Guilherme Jönck Staub, Rosemeri Maurici da Silva

J Bras Pneumol.2011;37(6):768-775

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Objective: To compare clinical, radiological, and laboratory characteristics of individuals with pulmonary tuberculosis co-infected or not with HIV. Methods: A cross-sectional study, in which signs and symptoms were assessed by anamnesis and physical examination in patients hospitalized with pulmonary tuberculosis. The results of sputum smear microscopy and culture for Mycobacterium tuberculosis, as well as hemoglobin levels and CD4+ T-cell counts, were obtained from medical records, and chest X-ray reports were consulted. Results: We included 50 pulmonary tuberculosis patients, who were divided into two groups (HIV-positive and HIV-negative; n = 25 per group). The mean age of the participants was 38.4 ± 10.5 years; 46 (92%) were males; and 27 (54%) were White. Expectoration was presented by 21 (84%) and 13 (52%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016). Radiological findings of cavitation were present in 10 (43%) and 2 (10%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016), whereas an interstitial pattern was observed in 18 (78%) and 8 (40%), respectively (p = 0.012). The mean hemoglobin level was 11.1 ± 2.9 g/dL and 9.3 ± 2.2 g/dL in the HIV-negative and HIV-positive groups, respectively (p = 0.015). Conclusions: In our sample of tuberculosis patients, expectoration was less prevalent, hemoglobin levels were lower, and cavitation was less common, as was an interstitial pattern, among those co-infected with HIV than among those without HIV co-infection.


Keywords: HIV; Tuberculosis; Acquired immunodeficiency syndrome.


Extraesophageal manifestations of gastroesophageal reflux disease

Manifestações extra-esofágicas da doença do refluxo gastroesofágico

Richard Ricachenevski Gurski, André Ricardo Pereira da Rosa, Enio do Valle, Marcelo Antonio de Borba, André Alves Valiati

J Bras Pneumol.2006;32(2):150-160

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Gastroesophageal reflux disease often presents as heartburn and acid reflux, the so-called "typical" symptoms. However, a subgroup of patients presents a collection of signs and symptoms that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of gastroesophageal reflux disease. Principal among such manifestations are bronchospasm, chronic cough and laryngitis, which are classified as atypical symptoms. These manifestations comprise a heterogeneous group. However, some generalizations can be made regarding all of the subgroups. First, although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been well established, a cause-and-effect relationship has yet to be definitively elucidated. In addition, the main proposed pathogenic mechanisms of extraesophageal reflux are direct injury of the extraesophageal tissue (caused by contact with gastric acid) and the esophagobronchial reflex, which is mediated by the vagus nerve. Furthermore, gastroesophageal reflux disease might not be considered in the differential diagnosis of patients presenting only the atypical symptoms. In this article, we review the extraesophageal manifestations of gastroesophageal reflux disease, discussing its epidemiology, pathogenesis, diagnosis and treatment. We focus on the most extensively studied and well-established presentations.


Keywords: Gastroesophageal reflux/complications; Asthma; Laryngitis; Cough; Fundoplication; Respiration disorders/etiology


Manoel de Abreu

Rubens Bedrikow

J Bras Pneumol.2001;27(1):56-58


Inflammatory and immunogenetic markers in correlation with pulmonary tuberculosis

Marcadores inflamatórios e imunogenéticos e sua relação com tuberculose pulmonar

Beatriz Lima Alezio Muller, Daniela Maria de Paula Ramalho, Paula Fernanda Gonçalves dos Santos, Eliene Denites Duarte Mesquita, Afranio Lineu Kritski, Martha Maria Oliveira

J Bras Pneumol.2013;39(6):719-727

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Objective: To describe serum levels of the cytokines IL-10, TNF-, and IFN-, as well as polymorphisms in the genes involved in their transcription, and their association with markers of the acute inflammatory response in patients with pulmonary tuberculosis. Methods: This was a descriptive, longitudinal study involving 81 patients with pulmonary tuberculosis treated at two referral hospitals. We collected data on sociodemographic variables and evaluated bacteriological conversion at the eighth week of antituberculosis treatment, gene polymorphisms related to the cytokines studied, and serum levels of those cytokines, as well as those of C-reactive protein (CRP). We also determined the ESR and CD4+ counts. Results: The median age of the patients was 43 years; 67 patients (82.7%) were male; and 8 patients (9.9%) were infected with HIV. The ESR was highest in the patients with high IFN- levels and low IL-10 levels. IFN- and TNF- gene polymorphisms at positions +874 and −238, respectively, showed no correlations with the corresponding cytokine serum levels. Low IL-10 levels were associated with IL-10 gene polymorphisms at positions −592 and −819 (but not −1082). There was a negative association between bacteriological conversion at the eighth week of treatment and CRP levels. Conclusions: Our results suggest that genetic markers and markers of acute inflammatory response are useful in predicting the response to antituberculosis treatment


Keywords: Tuberculosis; Cytokines; Immune system; Polymorphism, single nucleotide.


Morphological aspects as prognostic factors in malignant mesothelioma: a study of 58 cases

Marcadores morfológicos de prognóstico no mesotelioma maligno: um estudo de 58 casos

Alexandre Bottrel Motta, Germânia Pinheiro, Leila Antonângelo, Edwin Roger Parra, Maria Margarida Monteiro, José Carlos das Neves Pereira, Tereza Takagaki, Mario Terra Filho, Sandro Martins, Vera Luiza Capelozzi

J Bras Pneumol.2006;32(4):322-332

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Objective: Various markers have shown promise as diagnostic markers and prognostic predictors in malignant mesothelioma (MM). Methods: Through morphometric and immunological studies of markers in stromal components (calretinin, CEA, Leu-M1 and thrombomodulin) and nuclear components (p53 and Ki-67), we evaluated post-diagnosis survival in 58 patients with MM. Results: The histologic pattern of the MM was typical in 50 cases and atypical in 8. Through immunohistochemistry, we confirmed 40 cases of mesothelioma and 11 cases of adenocarcinoma, although we were unable to classify 7 of the 8 cases presenting atypical histologic patterns. Cox multivariate analysis revealed that the risk factor for death was higher (476.2) among patients of advanced age, presenting the biphasic subtype and testing positive for components expressed at the nuclear level. Conclusion: The most useful immunohistochemical markers were was calretinin (for mesothelioma) and CEA (for adenocarcinoma). Immunohistochemical quantification of thrombomodulin facilitated the diagnosis of mesothelioma in patients testing positive for both calretinin and CEA. The most useful prognostic information was that provided by the routine histopathological analysis of the tumor type. It is of note that the combination of a mean age of 55 years and 30.5% immunohistochemical markers in nuclear components created a natural dividing point between patients in which survival was shorter than expected and those in which it was longer than expected. Therefore, histopathological analysis offers a powerful weapon with great potential to inform decisions regarding the use of adjuvant chemotherapy after surgical excision of a mesothelioma.


Keywords: Pleural neoplasms; Mesothelioma; Tumor markers, Biological; Carcinoembryonic antigen; Prognosis.


Diaphragmatic pacing: unusual indication with successful application

Marca-passo diafragmático: indicação incomum, aplicação bem-sucedida

Rodrigo Afonso da Silva Sardenberg, Liliana Bahia Pereira Secaf, Adriana Cordeiro Pinotti, Mário Augusto Taricco, Roger Schmidt Brock, Riad Naim Younes

J Bras Pneumol.2011;37(5):697-699

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Sclerosing mediastinitis in the differential diagnosis of mediastinal tumors

Mediastinite esclerosante no diagnóstico diferencial de tumores mediastinais

Davi Wen Wei Kang, Mauro Canzian, Ricardo Beyruti, Fábio Biscegli Jatene

J Bras Pneumol.2006;32(1):78-83

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Sclerosing mediastinitis is a rare disorder characterized by an extensive fibrotic reaction involving the mediastinum. Due to the compression or invasion of mediastinal structures, the disorder mimics neoplasia. We present three cases of superior vena cava syndrome in which sclerosing mediastinitis was confirmed. The pathophysiological process is related to enlarged mediastinal lymph nodes, fibroblast proliferation and collagen deposition. The main causes of sclerosing mediastinitis are histoplasmosis and tuberculosis, both of which are prevalent in Brazil. It is difficult to make an accurate histopathological diagnosis using minimally invasive methods, and there is no effective treatment for this condition. In order to make a definitive diagnosis and resolve the aerodigestive tract obstruction, exploratory surgery is indicated.


Keywords: Mediastinitis/physiopathology; Mediastinum; Pulmonary fibrosis; Mediastinal neoplasms; Diagnosis, differential; Case reports [Publication type].


Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation

Melhora funcional em portadores de fibrose pulmonar idiopática submetidos a transplante pulmonar unilateral

Adalberto Sperb Rubin1,2, Douglas Zaione Nascimento1, Letícia Sanchez1, Guilherme Watte2, Arthur Rodrigo Ronconi Holand1, Derrick Alexandre Fassbind1, José Jesus Camargo1,2

J Bras Pneumol.2015;41(4):299-304

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Objective: To evaluate the changes in lung function in the first year after single lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). Methods: We retrospectively evaluated patients with IPF who underwent single lung transplantation between January of 2006 and December of 2012, reviewing the changes in the lung function occurring during the first year after the procedure. Results: Of the 218 patients undergoing lung transplantation during the study period, 79 (36.2%) had IPF. Of those 79 patients, 24 (30%) died, and 11 (14%) did not undergo spirometry at the end of the first year. Of the 44 patients included in the study, 29 (66%) were men. The mean age of the patients was 57 years. Before transplantation, mean FVC, FEV1, and FEV1/FVC ratio were 1.78 L (50% of predicted), 1.48 L (52% of predicted), and 83%, respectively. In the first month after transplantation, there was a mean increase of 12% in FVC (400 mL) and FEV1 (350 mL). In the third month after transplantation, there were additional increases, of 5% (170 mL) in FVC and 1% (50 mL) in FEV1. At the end of the first year, the functional improvement persisted, with a mean gain of 19% (620 mL) in FVC and 16% (430 mL) in FEV1. Conclusions: Single lung transplantation in IPF patients who survive for at least one year provides significant and progressive benefits in lung function during the first year. This procedure is an important therapeutic alternative in the management of IPF.


Keywords: Pulmonary fibrosis; Respiratory function tests; Lung transplantation.


Malignant pleural mesothelioma: multidisciplinary experience in a public tertiary hospital

Mesotelioma pleural maligno: experiência multidisciplinar em hospital público terciário

Ricardo Mingarini Terra, Lisete Ribeiro Teixeira, Ricardo Beyruti, Teresa Yae Takagaki, Francisco Suso Vargas, Fabio Biscegli Jatene

J Bras Pneumol.2008;34(1):12-20

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Objective: To evaluate the experience in diagnosing and treating malignant pleural mesothelioma (MPM) accumulated over 5 years in a tertiary public hospital. Methods: The medical charts of the patients diagnosed with MPM between January of 2000 and February of 2005 were evaluated retrospectively. Results: Of the 17 patients analyzed, 14 were male and 3 were female. The mean age was 54.1 years (range, 13-75 years). The biopsy specimens for histopathological examination were obtained through thoracoscopy in 9 patients (53%), Cope needle in 5 (29.5%), and open pleural biopsy in 3 (17.5%). The following histological types were identified: epithelial, in 14 patients (82%); sarcomatoid, in 1 (6%); and biphasic, in 2 (12%). The therapeutic approaches used were as follows: multimodal (pleuropneumonectomy and adjuvant radiotherapy and chemotherapy) in 6 patients (35%); chemotherapy and radiotherapy in 6 (35%); radiotherapy alone in 3 (17.5%); and chemotherapy alone in 2 (12%). The mean survival was 11 months (range, 1-26 months). Conclusions: In the cases studied, an integrated multidisciplinary approach was used, and a highly complex hospital infrastructure was available for the diagnosis and treatment of MPM, as recommended in the literature. However, the mean survival was only 11 months, reflecting the aggressiveness of the disease.


Keywords: Mesothelioma; Pleura; Surgery; Diagnosis.


Pulmonary metastases in men: primary tumor in an unusual location

Metástases pulmonares em homem: localização incomum do tumor primário

Daniel Brito de Araújo, Nilton Haertel Gomes, Décio Valente Renck, Ricardo Bertolino Silva, Danise Senna Oliveira, Fábio Eduardo Nunes Vieira

J Bras Pneumol.2007;33(2):234-237

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We report a case of breast cancer identified in a 72-year-old male as an accidental finding during the course of the investigation of a primary tumor and the search for pulmonary metastases. We address aspects related to the epidemiology, diagnosis, treatment and prognosis of this condition in males.


Keywords: Neoplasm metastasis/lung; Breast neoplasms; Male.


Metformin synergistically enhances antiproliferative effects of cisplatin and etoposide in NCI-H460 human lung cancer cells

Metformina sinergicamente potencializa os efeitos antiproliferativos de cisplatina e etoposídeo em linhagem de células de câncer humano de pulmão NCI-H460

Sarah Fernandes Teixeira, Isabella dos Santos Guimarães, Klesia Pirola Madeira, Renata Dalmaschio Daltoé, Ian Victor Silva, Leticia Batista Azevedo Rangel

J Bras Pneumol.2013;39(6):644-649

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Objective: To test the effectiveness of combining conventional antineoplastic drugs (cisplatin and etoposide) with metformin in the treatment of non-small cell lung cancer in the NCI-H460 cell line, in order to develop new therapeutic options with high efficacy and low toxicity. Methods: We used the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and calculated the combination index for the drugs studied. Results: We found that the use of metformin as monotherapy reduced the metabolic viability of the cell line studied. Combining metformin with cisplatin or etoposide produced a synergistic effect and was more effective than was the use of cisplatin or etoposide as monotherapy. Conclusions: Metformin, due to its independent effects on liver kinase B1, had antiproliferative effects on the NCI-H460 cell line. When metformin was combined with cisplatin or etoposide, the cell death rate was even higher.


Keywords: Carcinoma, non-small-cell lung; Drug therapy, combination; Metformin.


The pulmonary microbiome: challenges of a new paradigm

Microbioma pulmonar: desafios de um novo paradigma

André Nathan Costa1,a, Felipe Marques da Costa1,b, Silvia Vidal Campos1,c, Roberta Karla Salles1,d, Rodrigo Abensur Athanazio1,e

J Bras Pneumol.2018;44(5):424-432

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The study of the human microbiome-and, more recently, that of the respiratory system-by means of sophisticated molecular biology techniques, has revealed the immense diversity of microbial colonization in humans, in human health, and in various diseases. Apparently, contrary to what has been believed, there can be nonpathogenic colonization of the lungs by microorganisms such as bacteria, fungi, and viruses. Although this physiological lung microbiome presents low colony density, it presents high diversity. However, some pathological conditions lead to a loss of that diversity, with increasing concentrations of some bacterial genera, to the detriment of others. Although we possess qualitative knowledge of the bacteria present in the lungs in different states of health or disease, that knowledge has advanced to an understanding of the interaction of this microbiota with the local and systemic immune systems, through which it modulates the immune response. Given this intrinsic relationship between the microbiota and the lungs, studies have put forth new concepts about the pathophysiological mechanisms of homeostasis in the respiratory system and the potential dysbiosis in some diseases, such as cystic fibrosis, COPD, asthma, and interstitial lung disease. This departure from the paradigm regarding knowledge of the lung microbiota has made it imperative to improve understanding of the role of the microbiome, in order to identify possible therapeutic targets and to develop innovative clinical approaches. Through this new leap of knowledge, the results of preliminary studies could translate to benefits for our patients.


Keywords: Microbiota; Microbiology; Immune system.


Pulmonary alveolar microlithiasis: high-resolution computed tomography findings in 10 patients

Microlitíase alveolar pulmonar: achados na tomografia computadorizada de alta resolução do tórax em 10 pacientes

Edson Marchiori, Carolina Marinho Gonçalves, Dante Luiz Escuissato, Kim-Ir-Sen Santos Teixeira, Rosana Rodrigues, Miriam Menna Barreto, Mauro Esteves

J Bras Pneumol.2007;33(5):552-557

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Objective: To present the high-resolution computed tomography (HRCT) findings of pulmonary alveolar microlithiasis. Methods: The HRCT scans of 10 adult patients (seven females and three males; mean age, 38.7 years) were retrospectively analyzed. The films were studied independently by two radiologists. Results: The most common tomographic findings were ground-glass attenuation and linear subpleural calcifications, which were seen in 90% of the patients. Other relevant findings were small parenchymal nodules, calcification along the interlobular septa, nodular cissures, subpleural nodules, subpleural cysts, dense consolidations, and a mosaic pattern of attenuation. Conclusions: The HRCT findings presented by individuals with pulmonary alveolar microlithiasis are distinct. In most cases, such findings can form the basis of the diagnosis, eliminating the need to perform a lung biopsy.


Keywords: Tomography, X-Ray Computed; Lithiasis/lung; Lung diseases.


Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features

Mitos populares e características do tratamento da asma em crianças e adolescentes de zona urbana do sul do Brasil

Cristian Roncada1, Suelen Goecks de Oliveira1, Simone Falcão Cidade1, Joseane Guimarães Rafael1, Beatriz Sebben Ojeda1, Beatriz Regina Lara dos Santos1, Andréia da Silva Gustavo1, Paulo Márcio Pitrez1

J Bras Pneumol.2016;42(2):136-142

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Objective: To describe the frequency of popular myths about and features of asthma treatment in children and adolescents in an urban area in southern Brazil. Methods: The parents or legal guardians of public school students (8-16 years of age) completed a specific questionnaire regarding their understanding of asthma, asthma control, and treatment characteristics. The sample included parents or legal guardians of students with asthma (n = 127) and healthy controls (n = 124). Results: The study involved 251 parents or legal guardians, of whom 127 (68.5%) were the mothers and 130 (51.8%) were White. The mean age of these participants was 38.47 ± 12.07 years. Of the participants in the asthma and control groups, 37 (29.1%) and 26 (21.0%), respectively, reported being afraid of using asthma medications, whereas 61 (48%) and 56 (45.2%), respectively, believed that using a metered dose inhaler can lead to drug dependence. However, only 17 (13.4%) and 17 (13.7%) of the participants in the asthma and control groups, respectively, reported being afraid of using oral corticosteroids. In the asthma group, 55 students (43.3%) were diagnosed with uncontrolled asthma, only 41 (32.3%) had a prescription or written treatment plan, and 38 (29.9%) used asthma medications regularly. Conclusions: Popular myths about asthma treatment were common in our sample, as were uncontrolled asthma and inappropriate asthma management. Further studies in this field should be conducted in other developing countries, as should evaluations of pediatric asthma treatment programs in public health systems.


Keywords: Asthma/therapy; Asthma/prevention & control; Child health.


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

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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.


An experimental rat model of ex vivo lung perfusion for the assessment of lungs after prostacyclin administration: inhaled versus parenteral routes

Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação de desempenho de pulmões submetidos à administração de prostaciclina inalada versus parenteral

Paulo Francisco Guerreiro Cardoso, Rogério Pazetti, Henrique Takachi Moriya, Paulo Manuel Pêgo-Fernandes, Francine Maria de Almeida, Aristides Tadeu Correia, Karina Fechini, Fabio Biscegli Jatene

J Bras Pneumol.2011;37(5):589-597

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Objective: To present a model of prostaglandin I2 (PGI2) administration (inhaled vs. parenteral) and to assess the functional performance of the lungs in an ex vivo lung perfusion system. Methods: Forty Wistar rats were anesthetized and placed on mechanical ventilation followed by median sterno-laparotomy and anticoagulation. The main pulmonary artery was cannulated. All animals were maintained on mechanical ventilation and were randomized into four groups (10 rats/group): inhaled saline (IS); parenteral saline (PS); inhaled PGI2 (IPGI2); and parenteral PGI2 (PPGI2). The dose of PGI2 used in the IPGI2 and PPGI2 groups was 20 and 10 µg/kg, respectively. The heart-lung blocks were submitted to antegrade perfusion with a low potassium and dextran solution via the pulmonary artery, followed by en bloc extraction and storage at 4°C for 6 h. The heart-lung blocks were then ventilated and perfused in an ex vivo lung perfusion system for 50 min. Respiratory mechanics, hemodynamics, and gas exchange were assessed. Results: Mean pulmonary artery pressure following nebulization decreased in all groups (p < 0.001), with no significant differences among the groups. During the ex vivo perfusion, respiratory mechanics did not differ among the groups, although relative oxygenation capacity decreased significantly in the IS and PS groups (p = 0.04), whereas mean pulmonary artery pressure increased significantly in the IS group. Conclusions: The experimental model of inhaled PGI2 administration during lung extraction is feasible and reliable. During reperfusion, hemodynamics and gas exchange trended toward better performance with the use of PGI2 than that with the use of saline.


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


An experimental rat model of ex vivo lung perfusion for the assessment of lungs regarding histopathological findings and apoptosis: low-potassium dextran vs. histidine-tryptophan-ketoglutarate

Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação histopatológica e de apoptose celular em pulmões preservados com solução de baixo potássio dextrana vs. solução histidina-triptofano-cetoglutarato

Edson Azevedo Simões, Paulo Francisco Guerreiro Cardoso, Paulo Manuel Pêgo-Fernandes, Mauro Canzian, Rogério Pazetti, Karina Andriguetti de Oliveira Braga, Natalia Aparecida Nepomuceno, Fabio Biscegli Jatene

J Bras Pneumol.2012;38(4):461-469

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Objective: To compare histopathological findings and the degree of apoptosis among rat lungs preserved with low-potassium dextran (LPD) solution, histidine-tryptophan-ketoglutarate (HTK) solution, or normal saline (NS) at two ischemia periods (6 h and 12 h) using an experimental rat model of ex vivo lung perfusion. Methods: Sixty Wistar rats were anesthetized, randomized, and submitted to antegrade perfusion via pulmonary artery with one of the preservation solutions. Following en bloc extraction, the heart-lung blocks were preserved for 6 h or 12 h at 4°C and then reperfused with homologous blood for 60 min in an ex vivo lung perfusion system. At the end of the reperfusion, fragments of the middle lobe were extracted and processed for histopathological examination. The parameters evaluated were congestion, alveolar edema, alveolar hemorrhage, inflammatory infiltrate, and interstitial infiltrate. The degree of apoptosis was assessed using the TdT-mediated dUTP nick end labeling method. Results: The histopathological examination showed that all of the lungs preserved with NS presented alveolar edema after 12 h of ischemia. There were no statistically significant differences among the groups in terms of the degree of apoptosis. Conclusions: In this study, the histopathological and apoptosis findings were similar with the use of either LPD or HTK solutions, whereas the occurrence of edema was significantly more common with the use of NS.


Keywords: : Organ preservation; Organ preservation solutions; Lung transplantation; Reperfusion injury; Apoptosis.


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):-

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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.


A murine model of elastase- and cigarette smoke-induced emphysema

Modelo murino de enfisema induzido por instilação de elastase e exposição a fumaça de cigarro

Rubia Rodrigues1, Clarice Rosa Olivo1, Juliana Dias Lourenço1, Alyne Riane1, Daniela Aparecida de Brito Cervilha1, Juliana Tiyaki Ito1, Milton de Arruda Martins1, Fernanda Degobbi Tenório Quirino dos Santos Lopes1

J Bras Pneumol.2017;43(2):95-100

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Objective: To describe a murine model of emphysema induced by a combination of exposure to cigarette smoke (CS) and instillation of porcine pancreatic elastase (PPE). Methods: A total of 38 C57BL/6 mice were randomly divided into four groups: control (one intranasal instillation of 0.9% saline solution); PPE (two intranasal instillations of PPE); CS (CS exposure for 60 days); and CS + PPE (two intranasal instillations of PPE + CS exposure for 60 days). At the end of the experimental protocol, all animals were anesthetized and tracheostomized for calculation of respiratory mechanics parameters. Subsequently, all animals were euthanized and their lungs were removed for measurement of the mean linear intercept (Lm) and determination of the numbers of cells that were immunoreactive to macrophage (MAC)-2 antigen, matrix metalloproteinase (MMP)-12, and glycosylated 91-kDa glycoprotein (gp91phox) in the distal lung parenchyma and peribronchial region. Results: Although there were no differences among the four groups regarding the respiratory mechanics parameters assessed, there was an increase in the Lm in the CS + PPE group. The numbers of MAC-2-positive cells in the peribronchial region and distal lung parenchyma were higher in the CS + PPE group than in the other groups, as were the numbers of cells that were positive for MMP-12 and gp91phox, although only in the distal lung parenchyma. Conclusions: Our model of emphysema induced by a combination of PPE instillation and CS exposure results in a significant degree of parenchymal destruction in a shorter time frame than that employed in other models of CS-induced emphysema, reinforcing the importance of protease-antiprotease imbalance and oxidant-antioxidant imbalance in the pathogenesis of emphysema.


Keywords: Tobacco; Models, animal; Emphysema; Respiratory physiological phenomena; Lung injury.


Technical modification of unilateral lung transplantation in rats

Modificação da técnica de alotransplante pulmonar unilateral em ratos

Pablo Gerardo Sánchez, Lucas Krieger Martins, Frederico Krieger Martins, Ricardo Schimer, Paulo Francisco Guerreiro Cardoso, Cristiano Feijó Andrade

J Bras Pneumol.2007;33(4):443-447

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The increasing demand in transplantation research requires efficient and less expensive animal models in order to obtain reliable results that are reproducible in larger animal models and, ultimately, applied clinically. The model of unilateral left lung transplantation in rats has proven to be a useful alternative for those purposes. We demonstrate a technical modification of this model, which consists of the isolation and ligation of the contralateral (right) pulmonary artery, allowing blood circulation exclusively in the transplanted lung. This model is feasible and reproducible. However, the short survival time restricts the assessment of the transplanted lung to a maximum period of three hours.


Monitoração da inflamação das vias aéreas na asma

Mark D. Inman

J Bras Pneumol.2003;29(4):176-


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):-

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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.


Mortality and costs of pneumococcal pneumonia in adults: a cross-sectional study

Mortalidade e custos da pneumonia pneumocócica em adultos: um estudo transversal

Lessandra Michelin1,a, Fernanda M. Weber1,b, Bruna W. Scolari2,c, Bruna K. Menezes1,d, Maria Carolina Gullo3,e

J Bras Pneumol.2019;45(6):e20180374-e20180374

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Objective: Pneumococcal pneumonia is a significant cause of morbidity and mortality among adults. The study's main aim was to evaluate the in-hospital mortality and related costs of community-acquired pneumococcal pneumonia in adults. Methods: This cross‑sectional study used medical records of adult patients with pneumococcal pneumonia hospitalized in a university hospital in Brazil from October 2009 to April 2017. All patients aged ≥ 18 years diagnosed with pneumococcal pneumonia were included. Risk factors, intensive care unit admission, length of hospital stay, in-hospital mortality, and direct and indirect costs were analyzed. Results: In total, 186 patients were selected. The mean in-hospital mortality rate was 18% for adults aged < 65 years and 23% for the elderly (≥ 65 years). Bacteremic pneumococcal pneumonia affected 20% of patients in both groups, mainly through chronic respiratory disease (adjusted OR: 3.07, 95% CI: 1.23-7.65, p < 0.01). Over 7 years, annual total direct and indirect costs were USD 28,188 for adults < 65 years (USD 1,746 per capita) and USD 16,350 for the elderly (USD 2,119 per capita). Conclusion: Pneumococcal pneumonia remains an important cause of morbidity and mortality among adults, significantly affecting direct and indirect costs. These results suggest the need for prevention strategies for all adults, especially for patients with chronic respiratory diseases.


Keywords: Pneumococcus; Pneumococcal disease; Pneumonia; Hospital costs; Mortality.


Mortality and associated factors in a thoracic surgery ICU

Mortalidade e fatores associados em uma UTI de cirurgia torácica

Ekrem Senturk, Zehra Senturk, Serdar Sen, Mevlut Ture, Nursen Avkan

J Bras Pneumol.2011;37(3):367-374

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Objective: To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. Methods: We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. Results: Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). Conclusions: Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.


Keywords: Intensive care units; Thoracic surgery/mortality; Hospital mortality; Risk factors.


Mortality due to respiratory diseases in the elderly after influenza vaccination campaigns in theFederal District, Brazil, 1996-2009

Mortalidade por doenças respiratórias em idosos após campanhas vacinais contrainfluenza no Distrito Federal, Brasil, 1996-2009

Francisca Magalhães Scoralick, Luciana Paganini Piazzolla, Liana Laura Pires, Cleudsom Neri,Wladimir Kummer de Paula

J Bras Pneumol.2013;39(2):198-204

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Objective: To compare mortality rates due to respiratory diseases among elderly individuals residing in the Federal District of BrasÝlia, Brazil, prior to and after the implementation of a national influenza vaccination campaign. Methods: This was an ecological time series analysis. Data regarding the population of individuals who were over 60 years of age between 1996 and 2009 were obtained from official databases. The variables of interest were the crude mortality rate (CMR), the mortality rate due to the respiratory disease (MRRD), and the proportional mortality ratio (PMR) for respiratory diseases. We performed a qualitative analysis of the data for the period prior to and after the implementation of the vaccination campaign (1996-1999 and 2000-2009, respectively). Results: The CMR increased with advancing age. Over the course of the study period, we observed reductions in the CMR in all of the age brackets studied, particularly among those aged 80 years or older. Reductions in the MRRD were also found in all of the age groups, especially in those aged 80 years or older. In addition, there was a decrease in the PMR for respiratory diseases in all age groups throughout the study period. The most pronounced decrease in the PMR for respiratory diseases in the ≥ 70 year age bracket occurred in 2000 (immediately following the implementation of the national vaccination campaign); in 2001, that rate increased in all age groups, despite the greater adherence to the vaccination campaign in comparison with that recorded for 2000. Conclusions: Influenza vaccination appears to have a positive impact on the prevention of mortality due to respiratory diseases, particularly in the population aged 70 or over.


Palavras-chave: Influenza humana/mortalidade; Influenza humana/epidemiologia; Vacinas contra influenza.


Mortality from idiopathic pulmonary fibrosis: a temporal trend analysis in Brazil, 1979-2014

Mortalidade por fibrose pulmonar idiopática: análise temporal no Brasil, 1979-2014

Eduardo Algranti, Cézar Akiyoshi Saito, Diego Rodrigues Mendonça e Silva, Ana Paula Scalia Carneiro, Marco Antonio Bussacos

J Bras Pneumol.2017;43(6):445-450

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Objective: To analyze mortality from idiopathic pulmonary fibrosis (IPF) in Brazil over the period 1979-2014. Methods: Microdata were extracted from the Brazilian National Ministry of Health Mortality Database. Only deaths for which the underlying cause was coded as International Classification of Diseases version 9 (ICD-9) 515 or 516.3 (until 1995) or as ICD version 10 (ICD-10) J84.1 (from 1996 onward) were included in our analysis. Standardized mortality rates were calculated for the 2010 Brazilian population. The annual trend in mortality rates was analyzed by joinpoint regression. We calculated risk ratios (RRs) by age group, time period of death, and gender, using a person-years denominator. Results: A total of 32,092 deaths were recorded in the study period. Standardized mortality rates trended upward, rising from 0.24/100,000 population in 1979 to 1.10/100,000 population in 2014. The annual upward trend in mortality rates had two inflection points, in 1992 and 2008, separating three distinct time segments with an annual growth of 2.2%, 6.8%, and 2.4%, respectively. The comparison of RRs for the age groups, using the 50- to 54-year age group as a reference, and for the study period, using 1979-1984 as a reference, were 16.14 (14.44-16.36) and 6.71 (6.34-7.12), respectively. Men compared with women had higher standardized mortality rates (per 100,000 person-years) in all age groups. Conclusion: Brazilian IPF mortality rates are lower than those of other countries, suggesting underdiagnosis or underreporting. The temporal trend is similar to those reported in the literature and is not explained solely by population aging.


Keywords: Idiopathic pulmonary fibrosis/epidemiology; Idiopathic pulmonary fibrosis/mortality; Population dynamics.


Mortality due to pneumoconioses in macro regions of Brazil in the 1979-1998 period

Mortalidade por pneumoconioses nas macrorregiões do Brasil no período de 1979-1998

Hermano Albuquerque de Castro, Genésio Vicentin, Kellen Cristina Xavier Pereira

J Bras Pneumol.2003;29(2):82-88

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Pneumoconioses make up a group of lung diseases related to exposure to mineral dusts in work environments. This is a public health problem as such diseases could have already been eradicated in Brazil with the use of control measures in such environments. The aim in this paper was to map the distribution of deaths due to pneumoconioses in the different Brazilian geographical areas and states through an ecological survey carried out among the working population older than 15 years. The preliminary results of this investigation in the Brazilian macro regions in the period from 1979 to 1998 are presented. This study used mortality data from the Mortality Information System of Datasus - Data Processing Department of the Unified Health System, including codes from International Classification of Diseases (ICD) 9 and ICD 10. The results showed an increase of the coefficient of deaths due to pneumoconioses per 1 million inhabitants per year throughout this period. The shift from ICD 9 to ICD 10 showed an increase in the frequency of deaths, which was twice as high. As a conclusion, the coefficients of deaths due to pneumoconiosis does not describe this problem adequately, thus obscuring the transcendence and magnitude of the disease. To obtain more representative indicators it is necessary to know the population really exposed and the territorial distribution of the disease.


Change in asthma mortality trends in children and adolescents in Rio Grande do Sul: 1970-1998

Mudança da tendência da mortalidade por asma em crianças e adolescentes no Rio Grande do Sul: 1970-1998

José Miguel Chatkin, Jussara Fiterman, Nivalvo Almeida Fonseca, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(2):89-93

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Introduction: During the period from 1970 to 1992, mortality from asthma in children and young adults increased in Rio Grande do Sul. The present study aimed at assessing this phenomenon in patients of the same age group, now extending the time period to 1998. Methods: The death certificates of 157 patients aged between 5 and 19 years in which asthma was reported to be the cause of death during 1970-80 were reviewed. Testing for trends was conducted using the log-linear, S-curve, and quadratic models. Results: Asthma mortality rate ranged from 0.04 to 0.399/100,000. Among the tested models, S curve trend model showed the best accuracy for the adjusted time series: r2=0.59; mean absolute percentage error (MAPE) = 23.48; mean absolute deviation (MAD) = 0.035; mean square deviation (MSD) = 0.0021. These results suggest that a plateau has probably been reached. The quadratic model also showed good accuracy values suggesting that a decrease in the coefficients probably started to occur. In this model, the estimated maximal point value was found in the 25th year (1994). Conclusions: Stabilization of asthma death rates is starting to occur in Rio Grande do Sul and it is likely that a decrease will take place.


Keywords: Asthma. Mortality. Brazil.


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

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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 thre