Brazilian Journal of Pulmonology

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


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Year 2005 - Volume 31  - Number 6  (November/December)


1 - The soul of the business!

A alma do negócio!

José Antônio Baddini Martinez

J Bras Pneumol.2005;31(6):

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Original Article

4 - Determining the score and cut-off point that would identify asthmatic adults in epidemiological studies using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire

Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos

Elayne de Fátima Maçãira, Eduardo Algranti, Rafael Stelmach, Marcos Ribeiro, Maria do Patrocínio Tenório Nunes, Elizabete Medina Coeli Mendonça, Marco Antônio Bussacos

J Bras Pneumol.2005;31(6):477-485

Abstract PDF PT PDF EN Portuguese Text

Objective: To validate, for use in asthma prevalence studies, the asthma module of the standardized written questionnaire developed for use in the International Study of Asthma and Allergies in Childhood, establishing the score and cut-off point that would identify asthmatic adults. Methods: We interviewed 78 adult outpatients (40 adult asthmatics and 38 age-matched and gender-matched controls) using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire, which is composed of questions related to eight dichotomous features of asthma. We determined the score and cut-off point required to accurately identify asthmatic adults, calculating sensitivity, specificity and Youden index. The method was validated against the clinical and functional diagnosis of asthma. The reproducibility of individual questions was evaluated by conducting second interviews with half of the patients some weeks later. Results: The score ranged from 0 to 14 points. A score = 5 allowed patients with asthma to be distinguished from those without (sensitivity = 93%; specificity = 100%; Youden index = 0.93). Most questions presented satisfactory reproducibility in the second interviews conducted after 48.2 ± 11.1 days (kappa and weighted kappa ranging from 0.43 to 1.00 for individual questions). Conclusion: For studies of adult asthma prevalence, the determination/validation of a cut-off point allows an alternative interpretation of the information gathered through the application of the asthma module of the International Study of Asthma and Allergies in Childhood, taking into account the totality of the data rather than responses to individual questions.


Keywords: Asthma/diagnosis; Asthma/epidemiology; International cooperation; Questionnaires


5 - Prevalence of bronchial asthma and related symptoms in schoolchildren in the Federal District of Brazil: correlations with socioeconomic levels

Prevalência de asma brônquica e de sintomas a ela relacionados em escolares do Distrito Federal e sua relação com o nível socioeconômico

Maria Luisa Brangeli Maia Felizola, Carlos Alberto de Assis Viegas, Marcelo Almeida, Fernando Ferreira, Martinho Candido A. Santos

J Bras Pneumol.2005;31(6):486-491

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Objective: To evaluate the asthma prevalence in the Federal District of Brazil, using the questionnaire developed for the International Study of Asthma and Allergies in Childhood to look for correlations with socioeconomic levels. Methods: A total of 6437 children (3183 from six to seven years old and 3254 from thirteen to fourteen years old), attending public or private schools, were evaluated. The data were analyzed by gender and socioeconomic status (chi-square test). Results: The prevalence of asthma in the Federal District was 12.1% among the six- and seven-year-olds and 13.8% among the thirteen- and fourteen-year-olds (p < 0.04). In the six-to-seven age bracket, asthma prevalence was significantly greater, and asthma-related symptoms were more frequent, among males (p < 0.001). In contrast, asthma-related symptoms were more frequent among females in the thirteen-to-fourteen age bracket (p < 0.05). Children belonging to the lowest socioeconomic class, as determined by the responses given on the questionnaire completed by the parents, presented the highest prevalence of asthma, regardless of age bracket (p < 0.001). Among such children, asthma-related symptoms were also more frequent (p < 0.05). In the thirteen-to-fourteen age bracket, the prevalence of asthma was greater among those belonging to the highest socioeconomic class (p = 0.001). Conclusions: Overall, economically disadvantaged children more frequently presented asthma-related symptoms and experienced asthma attacks that were of greater severity. In addition, the prevalence of suspected asthma was higher than that of diagnosed asthma in this group, suggesting that asthma is underdiagnosed in children belonging to the lowest socioeconomic class.


Keywords: Asthma/epidemiology; Asthma/diagnosis; Socioeconomic factors; School health; Questionnaires


6 - Climate variations and health services use for the treatment of asthmatic children under five years of age: an ecological study

Variações climáticas e uso de serviços de saúde em crianças asmáticas menores de cinco anos de idade: um estudo ecológico

Celso Taques Saldanha, Ageo Mário Cândido da Silva, Clovis Botelho

J Bras Pneumol.2005;31(6):492-498

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Objective: To study variations in climate (dry or rainy periods) and health services use for the treatment of asthma in children under five years of age. Methods: An ecological study was conducted and involved analysis of the medical charts of all children under the age of five that were diagnosed with asthma and treated in the Municipal Emergency Room of the city of Cuiabá, located in the state of Mato Grosso, Brazil. In accordance with the geographic location of Cuiabá, two climatic periods were identified: a dry season (from May to October) and a rainy season (from November to April). Results: The percentage of children treated that were diagnosed with asthma was 12.2% (3140/25,802), with no gender-based difference. Children from 3 to 5 years of age were most often affected. The overall asthma hospitalization rate was 1.3% (336/25,802), rising to 10.7% (336/3140) among the asthmatic children treated in the emergency room. In the rainy season, the percentage of outpatients seeking treatment for asthma was higher than in the dry season: 39.1% (1228/3140) versus 60.9% (1912/3140). However, during the dry season, a greater proportion of such patients were hospitalized: 52.3% (176/336) versus 47.7% (160/336). These differences were statistically significant (p < 0.05). Conclusions: The dry season, which was correlated with higher asthma hospitalization rates, seems to be related to more severe cases of asthma in children under five years of age.


Keywords: Asthma/prevention & control; Allergens/adverse effects; Respiratory hypersensitivity; Environmental monitoring;


7 - The effect of psychotherapy provided as part of a pulmonary rehabilitation program for the treatment of patients with chronic obstructive pulmonary disease

O efeito da assistência psicológica em um programa de reabilitação pulmonar para pacientes com doença pulmonar obstrutiva crônica

Dagoberto Vanoni de Godoy, Rossane Frizzo de Godoy, Benno Becker Júnior, Paula Fernanda Vaccari, Maurício Michelli, Paulo José Zimermann Teixeira, Bruno Carlos Palombini

J Bras Pneumol.2005;31(6):499-505

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Objective: To assess the effect of psychotherapy on levels of anxiety and depression, as well as on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program. Methods: A randomized, controlled, blind clinical trial was conducted involving 49 chronic obstructive pulmonary disease patients. Patients were randomized into three groups: those submitted to the complete pulmonary rehabilitation program, which included psychotherapy and an exercise regimen (group 1); those submitted to the program minus physical exercise (group 2); and those submitted to the program minus psychotherapy (group 3). The three groups underwent a 12-week treatment program. All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program through four instruments: The Beck Anxiety Inventory, Beck Depression Inventory and St. George's Respiratory Questionnaire were applied. The distance walked-weight product was also calculated. Results: Statistically significant absolute improvements in exercise capacity were found for groups 1 and 2, although not for group 3 (p = 0.007, p = 0.008 and p = 0.06, respectively). In groups 1 and 2, levels of anxiety and depressions were also significantly reduced (group 1: p = 0.0000 and p < 0.0003; group 2: p = 0.0001 and p = 0.0014), and quality of life was significantly improved (p = 0.0007 and p = 0.002, respectively). Anxiety levels were also reduced in group 3 (p = 0.03), although levels of depression were not, and quality of life was unaffected. Conclusion: Psychotherapy sessions provided as part of a pulmonary rehabilitation program assist patients with chronic obstructive pulmonary disease in coping with disease-related limitations by reducing behavioral symptoms, especially depression, thereby influencing exercise capacity and health-related quality of life.


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Pullmonary diseases, chronic obstructive/psychology; Anxiety; Depression; Quality of Life; Exercise therapy


8 - 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

Abstract PDF PT PDF EN Portuguese Text

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


9 - Effect of perillyl alcohol on gene expression of human pulmonary adenocarcinoma cells

Efeito do álcool perílico na expressão gênica de células de adenocarcinoma de pulmão humano

Juliana de Saldanha da Gama Fischer, Marcelo Soares da Mota e Silva, Marcos Eduardo Paschoal, Cerli Rocha Gattass, Paulo Costa Carvalho, Maria da Gloria da Costa Carvalho

J Bras Pneumol.2005;31(6):511-515

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Objective: To study the effect of perillyl alcohol on the gene expression of human pulmonary adenocarcinoma cells. Methods: Pulmonary adenocarcinoma cells were incubated with perillyl alcohol in dilutions ranging from 0.03% to 0.0003% for 48 hours. Alterations were observed in the cell morphology, and cell viability was quantified using [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays. Protein synthesis of samples previously targeted with S35 was analyzed using electrophoresis on a polyacrylamide gel. Expression of the proteins p53 and p44/42 was determined using the Western blot method. Results: After 48 hours of incubation, greater numbers of morphological alterations were observed in cells treated with the 0.03% perillyl alcohol dilution than in those treated with perillyl alcohol diluted to 0.003% or further. Treatment with perillyl alcohol dilutions of 0.03%, 0.003% and 0.0003% inhibited cellular viability by 60.17% (p < 0.001), 15.62% (p < 0.001) and 11.53% (p < 0.05), respectively. The results show that 28-kDa, 42-kDa and 110-kDa proteins were induced. No statistically significant effect on p53 expression was observed. In comparison with the expression of a-tubulin, the 0.003% perillyl alcohol dilution induced an increase in p42 phosphorylation and a marked decrease in p44 phosphorylation. Conclusion: The results suggest that there are other, previously undescribed, metabolic pathways for perillyl alcohol effects in human pulmonary adenocarcinoma cells.


Keywords: Adenocarcinoma; Lung neoplasms; Monoterpenes; Cell culture; Lung/cytology


10 - Smoking among physicians in a specific region of the greater metropolitan area of São Paulo

Tabagismo entre médicos da Região do ABC Paulista

Adriano Cesar Guazzelli, Mário Terra Filho, Elie Fiss

J Bras Pneumol.2005;31(6):516-522

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Objective: To evaluate the prevalence of and describe the methods used to control the smoking habit among a geographically-specific population of physicians. Methods: Questionnaires were distributed to physicians practicing in a region of the greater metropolitan area of São Paulo area known as the "ABC Paulista" (comprising the municipalities of Santo Andre, São Bernardo and São Caetano), and completed questionnaires were received from 678 physicians, all registered with the São Paulo State Regional Council of Medicine. Results: Of the 678 responding physicians, 58 (8.6%) were smokers, 183 (27.0%) were former smokers, and 437 (64.5%) were nonsmokers. No gender-based differences were found. Nor were there any significant differences in prevalence based on medical specialty. Most of the smokers had tried to stop smoking. Among the smokers, cessation methods were used by 7%: nicotine replacement therapy by 4.3%; and acupuncture by 2.7%. Most of the former smokers (88.1%) had successfully quit smoking without using any cessation methods. Conclusion: The prevalence of smoking among physicians in the ABC Paulista region was 8.6%. In this region, the majority of physicians who quit smoking did so without the aid of smoking cessation methods. Among those who did use such methods, nicotine replacement therapy was the method of choice.


Keywords: Prevalence; Smoking; Physicians; Smoking cessation


11 - Spatial and temporal patterns of tuberculosis in the city of Ribeirão Preto, Brazil from 1998 to 2002

Evolução espaço-temporal dos casos de tuberculose em Ribeirão Preto (SP), nos anos de 1998 a 2002

Paula Hino, Claudia Benedita dos Santos, Tereza Cristina Scatena Villa

J Bras Pneumol.2005;31(6):523-527

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Objective: To determine the spatial distribution of tuberculosis in the city of Ribeirão Preto, located in the state of São Paulo, Brazil, between 1998 and 2002, with a focus on the potential spatially-dependent nature of its occurrence. Methods: The secondary Epi-Tb database of the Ribeirão Preto Municipal Secretary of Health. Georeferencing of tuberculosis cases was performed using MapInfo 6.5 software, and the Spring program was used for statistical analysis of spatial data. Results: Through analysis of the existing spatial pattern and those of the previous years analyzed, we found a consistent pattern of spatial distribution of tuberculosis in Ribeirão Preto. Although there are areas that were homogeneous in terms of risk, the highest concentrations of cases were found in one zone, consisting of middle- to lower middle-class neighborhoods, located in the northeast part of the city. Conclusion: These results add to the store of knowledge regarding the spatial distribution of tuberculosis in Ribeirão Preto in various periods, emphasizing the importance of space as a methodological alternative to aid the planning, monitoring and evaluation of health care programs, allowing interventions to be more appropriately directed in order to decrease inequalities in the allocation of health care resources.


Keywords: Tuberculosis/epidemiology; Health status indicators; Residence characteristics; Urban health/ statistics & numerical data; Topography, medical


Review Article

12 - The challenge of diagnosing acute pulmonary thromboembolism in patients with chronic obstructive pulmonary disease

O desafio de diagnosticar tromboembolia pulmonar aguda em pacientes com doença pulmonar obstrutiva crônica

Sérgio Saldanha Menna-Barreto

J Bras Pneumol.2005;31(6):528-539

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Pulmonary thromboembolism and exacerbation of chronic obstructive pulmonary disease are common conditions. Chronic obstructive pulmonary disease is a clinical risk factor for pulmonary thromboembolism. The presentation of acute pulmonary thromboembolism and acute exacerbation of chronic obstructive pulmonary disease often mimic each other so closely that they cannot be distinguished clinically. The structural abnormalities of the lungs in chronic obstructive pulmonary disease make also difficult to interpret the results of noninvasive tests like ventilation-perfusion lung scans. Therefore, diagnosing acute pulmonary thromboembolism in patients with underlying chronic obstructive pulmonary disease is a challenging task. In order to update knowledge of the subject and offer suggestions regarding conduct, we evaluated various studies addressing this theme, including case reports and case series. In addition, we reviewed diagnostic approaches to acute pulmonary thromboembolism, and we reflect upon that topic. The clinical probability of pulmonary thromboembolism concomitant to chronic obstructive pulmonary disease is typically intermediate, as is positivity on the ventilation-perfusion lung scan. Diagnostic algorithms should take that into consideration.


Keywords: Pulmonary disease, chronic obstructive/complications; Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Ventilation-perfusion ratio


13 - Treatment of superior vena cava syndrome

Tratamento da síndrome da veia cava superior

Luís Marcelo Inaco Cirino, Rafael Ferreira Coelho, Ivan Dias da Rocha, Bernardo Pinheiro de Senna Nogueira Batista

J Bras Pneumol.2005;31(6):540-550

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The superior vena cava is formed by the union of the right and left brachiocephalic veins. It is located in the middle mediastinum, to the right of the aorta and anterior to the trachea. Superior vena cava syndrome consists of a group of signs (dilation of the veins in the neck, facial swelling, edema of the upper limbs, and cyanosis) and symptoms (headache, dyspnea, cough, orthopnea and dysphagia) caused by the obstruction of blood flow through the superior vena cava to the right atrium. This obstruction can be caused by extrinsic compression, tumor invasion or thrombosis. Such obstruction may also occur as a result of insufficient venous return secondary to intra-atrial or intraluminal diseases. From 73% to 93% of all cases of superior vena cava syndrome occur during the development of an intrathoracic tumor. Most patients presenting superior vena cava syndrome secondary to malignant neoplasms are treated without surgery, through radiotherapy, chemotherapy or the use of intraluminal stents. When the etiology of superior vena cava syndrome is benign, it can be treated with clinical measures (anticoagulation, raising the head, etc.) or, in refractory cases, with angioplasty, stents or surgery.


Keywords: Superior vena cava syndrome/therapy; Superior vena cava syndrome/surgery; Superior vena cava syndrome/etiology; Superior vena cava syndrome /drug therapy; Superior vena cava syndrome /radiotherapy; Superior vena cava


14 - Respiratory therapy in pleural empyema. A systematic review of the literature

Fisioterapia respiratória no empiema pleural. Revisão sistemática da literatura

Murilo Carlos Amorim de Britto, Maria do Carmo Menezes Bezerra Duarte, Silvia Maria Mendes da Conceição Silvestre

J Bras Pneumol.2005;31(6):551-554

Abstract PDF PT PDF EN Portuguese Text

Some techniques used in respiratory therapy are not based on sound scientific evidence. The misuse of such techniques can be harmful in terms of adverse effects and may not be cost-effective. A systematic review of the literature was performed using the Oldmedline, Medline, Cinahl and Lilacs databases, as well as the registry of clinical trials registered by the Cochrane Library and National Institutes of Health. The focus of the review was on trials addressing the efficacy of respiratory therapy in treating pleural empyema in children, adolescents and adults. No such trials were found. We can conclude that there is a lack of data regarding the efficacy of respiratory therapy in pleural empyema. In order to provide such data, clinical trials are warranted.


Keywords: Empyema pleural/rehabilitation; Evidence-based medicine; Physical therapy techniques; Review [Publication Type]; Randomized controlled trials


Case Report

15 - Endobronchial lipoma

Lipoma endobrônquico

Antônio Mauro Bof, Abrão Rapoport, Luiz Carlos Paier, Yara Lopes Diaz, Luiz Carlos Filgueiras Leiro, Roberto Ruben Pando-Serrano, Márcio Rogério Alcalá Gomes, Emílio Scafura Lomonte

J Bras Pneumol.2005;31(6):555-558

Abstract PDF PT PDF EN Portuguese Text

Lipomas are benign neoplasms composed primarily of adipose tissue and may be located in various parts of the body. The case reported is that of a patient who sought medical assistance complaining of recurring pneumonia. After diagnostic procedures, including chest X-ray and computed tomography scan of the chest, endobronchial lesion with fat density was suspected. The diagnostic hypothesis was endobronchial lipoma. This hypothesis was confirmed after surgical intervention. The aim of this study was to report this case of endobronchial lipoma and to review the available literature on the subject.


Keywords: Pneumonia/complications; Recurrence; Bronchial neoplasms/surgery; Lipoma/surgery; Tomography, X-ray computed; Case reports


16 - Mucoepidermoid carcinoma: a rare cause of recurrent pneumonia

Pneumonia recorrente com uma causa rara: carcinoma mucoepidermóide

José Wellington Alves dos Santos, Maurício Licks da Silveira, Cristiano Tonello, Melissa Falster Daubermann

J Bras Pneumol.2005;31(6):559-562

Abstract PDF PT PDF EN Portuguese Text

Recurrent pneumonia is characterized by frequent infection and infiltrates in one or more lung lobes. The localized form of the disease is caused by intraluminal obstruction, extrinsic compression or structural abnormalities. The pattern, frequency and severity of the infections, together with a thorough review of all chest X-rays, inform the diagnosis. Herein, we report a case of recurrent pneumonia due to endobronchial obstruction by mucoepidermoid carcinoma.


Keywords: Pneumonia; Recurrent; Carcinoma, mucoepidermoid/diagnosis; Tomography, X-ray computed; Case reports


16 - 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

Abstract PDF PT PDF EN Portuguese Text

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


Letters to the Editor

17 - The avian flu pandemic

Pandemia de gripe aviária

Danilo Cortozi Berton, Paulo Jose Zimermann Teixeira

J Bras Pneumol.2005;31(6):570

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Relationship of Reviewers


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