Brazilian Journal of Pulmonology

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

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Air pollution and the respiratory system

A poluição do ar e o sistema respiratório

Marcos Abdo Arbex, Ubiratan de Paula Santos, Lourdes Conceição Martins, Paulo Hilário Nascimento Saldiva, Luiz Alberto Amador Pereira, Alfésio Luis Ferreira Braga

J Bras Pneumol.2012;38(5):643-655

Abstract PDF PT PDF EN Portuguese Text

Over the past 250 years-since the Industrial Revolution accelerated the process of pollutant emission, which, until then, had been limited to the domestic use of fuels (mineral and vegetal) and intermittent volcanic emissions-air pollution has been present in various scenarios. Today, approximately 50% of the people in the world live in cities and urban areas and are exposed to progressively higher levels of air pollutants. This is a non-systematic review on the different types and sources of air pollutants, as well as on the respiratory effects attributed to exposure to such contaminants. Aggravation of the symptoms of disease, together with increases in the demand for emergency treatment, the number of hospitalizations, and the number of deaths, can be attributed to particulate and gaseous pollutants, emitted by various sources. Chronic exposure to air pollutants not only causes decompensation of pre-existing diseases but also increases the number of new cases of asthma, COPD, and lung cancer, even in rural areas. Air pollutants now rival tobacco smoke as the leading risk factor for these diseases. We hope that we can impress upon pulmonologists and clinicians the relevance of investigating exposure to air pollutants and of recognizing this as a risk factor that should be taken into account in the adoption of best practices for the control of the acute decompensation of respiratory diseases and for maintenance treatment between exacerbations.

 


Keywords: Respiratory System; Air pollution; Pregnancy; Pulmonary disease, chronic obstructive; Asthma; Respiratory tract Infections.

 


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

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

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

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

Abstract PDF PT PDF EN Portuguese Text

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

 


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

 


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

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

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

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

Abstract PDF PT PDF EN Portuguese Text

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

 


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

 


Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs

Fatores de risco para tuberculose: diabetes, tabagismo, álcool e uso de outras drogas

Denise Rossato Silva1,a, Marcela Muñoz-Torrico2,b, Raquel Duarte3,4,c, Tatiana Galvão5,d, Eduardo Henrique Bonini6,7,e, Flávio Ferlin Arbex6,f, Marcos Abdo Arbex6,g, Valéria Maria Augusto8,h, Marcelo Fouad Rabahi9,i, Fernanda Carvalho de Queiroz Mello10,j

J Bras Pneumol.2018;44(2):145-152

Abstract PDF PT PDF EN Portuguese Text

Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.

 


Keywords: Tuberculosis/epidemiology; Tuberculosis/prevention & control; Diabetes mellitus/prevention & control; Smoking/adverse effects; Alcohol drinking/adverse effects; Street drugs/adverse effects.

 


New and repurposed drugs to treat multidrug- and extensively drug-resistant tuberculosis

Novos fármacos e fármacos repropostos para o tratamento da tuberculose multirresistente e extensivamente resistente

Denise Rossato Silva1,a, Margareth Dalcolmo2,b, Simon Tiberi3,c, Marcos Abdo Arbex4,5,d, Marcela Munoz-Torrico6,e, Raquel Duarte7,8,9,f, Lia D'Ambrosio10,11,g, Dina Visca12,h, Adrian Rendon13,i, Mina Gaga14,j, Alimuddin Zumla15,k, Giovanni Battista Migliori10,l

J Bras Pneumol.2018;44(2):153-460

Abstract PDF PT PDF EN Portuguese Text

Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB, respectively) continue to represent a challenge for clinicians and public health authorities. Unfortunately, although there have been encouraging reports of higher success rates, the overall rate of favorable outcomes of M/XDR-TB treatment is only 54%, or much lower when the spectrum of drug resistance is beyond that of XDR-TB. Treating M/XDR-TB continues to be a difficult task, because of the high incidence of adverse events, the long duration of treatment, the high cost of the regimens used, and the drain on health care resources. Various trials and studies have recently been undertaken (some already published and others ongoing), all aimed at improving outcomes of M/XDR-TB treatment by changing the overall approach, shortening treatment duration, and developing a universal regimen. The objective of this review was to summarize what has been achieved to date, as far as new and repurposed drugs are concerned, with a special focus on delamanid, bedaquiline, pretomanid, clofazimine, carbapenems, and linezolid. After more than 40 years of neglect, greater attention has recently been paid to the need for new drugs to fight the "white plague", and promising results are being reported.

 


Keywords: Tuberculosis/therapy; Tuberculosis, multidrug-resistant; Extensively drug-resistant tuberculosis; Antitubercular agents.

 


The challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of São Paulo, Brazil: a report of three cases

O desafio do tratamento da tuberculose extensivamente resistente em um hospital de referência no estado de São Paulo: um relato de três casos

Marcos Abdo Arbex1,2, Hélio Ribeiro de Siqueira3,4, Lia D'Ambrosio5,6, Giovanni Battista Migliori5

J Bras Pneumol.2015;41(6):554-559

Abstract PDF PT PDF EN Portuguese Text Appendix

Here, we report the cases of three patients diagnosed with extensively drug-resistant tuberculosis and admitted to a referral hospital in the state of São Paulo, Brazil, showing the clinical and radiological evolution, as well as laboratory test results, over a one-year period. Treatment was based on the World Health Organization guidelines, with the inclusion of a new proposal for the use of a combination of antituberculosis drugs (imipenem and linezolid). In the cases studied, we show the challenge of creating an acceptable, effective treatment regimen including drugs that are more toxic, are more expensive, and are administered for longer periods. We also show that treatment costs are significantly higher for such patients, which could have an impact on health care systems, even after hospital discharge. We highlight the fact that in extreme cases, such as those reported here, hospitalization at a referral center seems to be the most effective strategy for providing appropriate treatment and increasing the chance of cure. In conclusion, health professionals and governments must make every effort to prevent cases of multidrug-resistant and extensively drug-resistant tuberculosis.

 


Keywords: Tuberculosis, multidrug-resistant; Extensively drug-resistant tuberculosis; Antitubercular agents; Antibiotics, antitubercular.

 


Biomass burning and health effects

Queima de biomassa e efeitos sobre a saúde

Marcos Abdo Arbex, José Eduardo Delfini Cançado, Luiz Alberto Amador Pereira, Alfésio Luís Ferreira Braga, Paulo Hilário do Nascimento Saldiva

J Bras Pneumol.2004;30(2):158-175

Abstract PDF PT

The first thought that comes to mind concerning air pollution is related to urban centers where automotive exhausts and the industrial chimneys are the most important sources of atmospheric pollutants. However a significant portion of the earth's population is exposed to still another source of air pollution, the burning of biomass that primarily affects developing countries. This review article calls the attention of lung specialists, public authorities and the community in general to the health risks entailed in the burning of biomass, be it indoors or outdoors to which the population is exposed. This review describes the main conditions that lead to the burning of biomass and how the literature has recorded its effects on human health discussing the psychopathological mechanisms. Finally two recent studies are presented that emphasize an important type of biomass burning that of the sugar cane straw. This is a common practice in several regions of Brazil changing the respiratory morbidity standards of the population exposed.

 


Keywords: air pollution, biomass, sugar cane, smoke, vegetation fires, respiratory disease.

 


 

 


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