Summary: b-agonists are considered the agents of first choice for the treatment of asthmatic symptoms and are usually available for aerosol administration. Its propellants damage the ozone layer and are often not used properly by the patients. Turbuhaler seems a better alternative since it does not present these inconveniences. In Brazil, it has been recently introduced. Purpose: Compare salbutamol aerosol (SA) to terbutaline turbuhaler (TT) in relation to technical use, bronchodilation and adverse effects in outpatients with mild-obstruction asthma (PFR ³ 60 and < 80% predicted). Material and methods: Open, parallel randomized study performed in each arm of 20 patients (SA: 200 mg and TT: 500 mg). After 30 minutes, a second dose was given if PFR was not 15% or 30 L/min greater than the initial one; a second dose was also delivered if PFR was not greater than 80%. All patients were instructed on how to use both devices. Results: Clinical improvement and increase in PFR were similar in both groups (SA 69.5 vs. TT 58.1 L/min, p > 0.05). A second dose was given to 13 patients (SA 6 and TT 7) with similar results. Errors in the usage were observed in all 20 patients of group SA vs. 11 patients in group TT (p < 0.05). Adverse effects were more frequent with TT - 9 patients - due to its unpleasant taste. Fifteen patients of group TT and with previous experience with SA considered turbuhaler easier. Conclusions: 1) administration by the patient is easier with turbuhaler than with SA; 2) bronchodilation is not different with SA 200 mg and TT 500 mg; 3) unpleasant taste was noted only in group TT (50% of the patients).

Keywords: Asthma. Salbutamol aerosol. Terbutaline Turbuhaler.

Objective: Current debates on the bronchodilator response in COPD patients and whether the variation in FEV1 can be considered as an indicator of complete reversibility in such patients motivated us to conduct this study. The objective of the study was to determine the effect of albuterol on the resistive and reactive properties of the respiratory system in COPD patients. Methods: We evaluated 70 patients with COPD, divided into two groups based on spirometry findings: bronchodilator (BD)-negative (n = 39); and BD-positive (n = 31). We used the forced oscillation technique (FOT) to evaluate the following parameters: resistance at the intercept (R0), associated with the total resistance of the respiratory system; mean resistance (Rm), associated with central airway resistance; dynamic compliance (Cdyn); and the slope of resistance (S) and mean reactance (Xm), both of which are associated with the homogeneity of the respiratory system. Results: The use of albuterol resulted in significant reductions in R0 (p < 0.00002) and Rm (p < 0.0002). There were also significant increases in S (p < 0.0001), Cdyn (p < 0.0001) and Xm (p < 0.00004). These modifications occurred in both groups, the changes in FOT parameters being greater than those observed for spirometric parameters. Conclusions: The use of albuterol improved the resistive and reactive properties of the respiratory system of the COPD patients under study. These changes occurred regardless of the FEV1-based classification, thereby indicating that the use of this parameter in isolation might not suffice to identify the physiological effects involved.

Keywords: Pulmonary disease, chronic obstructive; Bronchodilator agents; Spirometry; Albuterol.

To describe and characterize local adverse effects (in the oral cavity, pharynx, and larynx) associated with the use of inhaled corticosteroids (ICSs) in patients with moderate or severe asthma. Methods: This was a cross-sectional study involving a convenience sample of 200 asthma patients followed in the Department of Pharmaceutical Care of the Bahia State Asthma and Allergic Rhinitis Control Program Referral Center, located in the city of Salvador, Brazil. The patients were ≥ 18 years of age and had been using ICSs regularly for at least 6 months. Local adverse effects (irritation, pain, dry throat, throat clearing, hoarseness, reduced vocal intensity, loss of voice, sensation of thirst, cough during ICS use, altered sense of taste, and presence of oral candidiasis) were assessed using a 30-day recall questionnaire. Results: Of the 200 patients studied, 159 (79.5%) were women. The mean age was 50.7 ± 14.4 years. In this sample, 55 patients (27.5%) were using high doses of ICS, with a median treatment duration of 38 months. Regarding the symptoms, 163 patients (81.5%) reported at least one adverse effect, and 131 (65.5%) had a daily perception of at least one symptom. Vocal and pharyngeal symptoms were identified in 57 (28.5%) and 154 (77.0%) of the patients, respectively. The most commonly reported adverse effects were dry throat, throat clearing, sensation of thirst, and hoarseness. Conclusions: Self-reported adverse effects related to ICS use were common among the asthma patients evaluated here.

Keywords: Asthma; Glucocorticoids; Administration, inhalation; Pharmaceutical services.

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;

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.

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.

Objective: To evaluate whether respiratory therapy followed by the use of inhaled albuterol modifies the pulmonary deposition of inhaled tobramycin in patients with cystic fibrosis (CF) and whether pulmonary deposition correlates with disease severity or genotype. Methods: A prospective study was carried out including patients with CF older than 6 years of age and colonized with Pseudomonas aeruginosa. Exclusion criteria were pulmonary exacerbation, changes in therapy between the study phases and FEV1 < 25%. All patients were submitted to pulmonary scintigraphy by means of a scintillation camera equipped with a low-energy all-purpose collimator in order to evaluate drug penetration following the administration of inhaled 99mTc-tobramycin, as well as to pulmonary perfusion with 99mTc-macroaggregated albumin (phase 1). One month later, the same procedure was performed following respiratory therapy and administration of inhaled albuterol (phase 2). Results: We included 24 patients (12 males) aged 5-27 years (mean ± SD: 12.85 ± 6.64 years). The Shwachman score (SS) was excellent/good in 8 patients, moderate/fair in 16 and poor in 0. Genotyping revealed that 7 patients were ΔF508 homozygotes, 13 were ΔF508 heterozygotes; and 4 presented other mutations. In all patients, lung deposition of tobramycin decreased in phase 2, especially in those with moderate/fair SS (p = 0.017) and in heterozygotes (p = 0.043). Conclusions: The use of a respiratory therapy technique and the administration of inhaled albuterol immediately prior to the use of inhaled tobramycin decreased the pulmonary deposition of the latter in CF patients, and this reduction correlates with disease severity and genotype.

Keywords: Cystic fibrosis; Tobramycin; Respiratory therapy; Albuterol; Radionuclide imaging.

Abstract Objective: To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. Methods: Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen staining, auramine staining, culture on Löwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR). The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. Results: Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture on LJ medium and PCR was 54.2%, 58.4%, 67.6% and 77.5%, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100% specificity. In the identification of mycobacteria, there was high (96.8%) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8% in samples with negative sputum smear microscopy results and 98.8% in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6% and 99.0%, respectively). Conclusions: We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.

Keywords: Tuberculosis, pulmonary/diagnosis; Culture media; Polymerase chain reaction; Sputum/microbiology.

Objective: To describe and analyze clinical symptoms and spirometric alterations of patients with chronic obstructive pulmonary disease (COPD) and history of exposure to wood and tobacco smoke. Methods: We retrospectively evaluated data related to 170 patients distributed into 3 groups: 34 exposed only to wood smoke, 59 patients exposed only to tobacco smoke and 77 patients exposed to both. Results: The groups did not differ significantly in terms of age (p = 0.225) or degree of exposure, considering each type of exposure in isolation or in combination (p = 0.164 and p = 0.220, respectively). Females predominated in the group exposed to wood smoke. There were no differences among the groups regarding respiratory symptoms (p > 0.05), and moderate dyspnea predominated in the three groups (p = 0.141). The group exposed to wood smoke presented higher percentages of forced expiratory volume in one second/forced vital capacity ratio and of forced expiratory volume in one second (p < 0.05). Positive results on bronchodilator testing occurred more frequently in the group exposed to tobacco smoke. The percentage of severe and extremely severe obstruction was significantly higher in the group exposed to tobacco smoke (44.1%) than in that exposed to wood smoke (11.8%; p = 0.006). Conclusions: Respiratory symptoms and pulmonary function alterations consistent with COPD were observed in the groups of patients exposed to wood smoke. However, those alterations were not as significant as the alterations observed in the groups exposed to tobacco smoke. This study emphasizes the importance of prospective studies in evaluating the risk of wood-smoke-related COPD in Brazil, as well as the need for preventive measures in this area.

Keywords: Pulmonary disease, chronic obstructive; Smoking; Air pollution, indoor; Smoke.

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.

Objective: To compare the incidence and intensity of acute adverse effects and the variation in the temperature of facial skin by thermography after the use of noninvasive ventilation (NIV). Methods: We included 20 healthy volunteers receiving NIV via oronasal mask for 1 h. The volunteers were randomly divided into two groups according to the ventilatory mode: bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP). Facial thermography was performed in order to determine the temperature of the face where it was in contact with the mask and of the nasal dorsum at various time points. After removal of the mask, the volunteers completed a questionnaire about adverse effects of NIV. Results: The incidence and intensity of acute adverse effects were higher in the individuals receiving BiPAP than in those receiving CPAP (16.1% vs. 5.6%). Thermographic analysis showed a significant cooling of the facial skin in the two regions of interest immediately after removal of the mask. The more intense acute adverse effects occurred predominantly among the participants in whom the decrease in the mean temperature of the nasal dorsum was lower (14.4% vs. 7.2%). The thermographic visual analysis of the zones of cooling and heating on the face identified areas of hypoperfusion or reactive hyperemia. Conclusions: The use of BiPAP mode was associated with a higher incidence and intensity of NIV-related acute adverse effects. There was an association between acute adverse effects and less cooling of the nasal dorsum immediately after removal of the mask. Cutaneous thermography can be an additional tool to detect adverse effects that the use of NIV has on facial skin.

Keywords: Masks; Noninvasive ventilation; Thermography.

Objective: To compare the resistance of manual suture with that of mechanical suture immediately after the suture of the left bronchial stump of dogs submitted to pneumonectomy. Methods: A total of 15 mixed-breed dogs of both genders, each weighing between 8 and 23 kg, were randomly divided into 2 groups. In group I (n = 7), the bronchial stump was sutured manually (the Sweet method) and, in group II (n = 8), it was stapled. Immediately after the closure of the bronchial stump, the intratracheal pressure was progressively increased in a controlled manner. Results: The mean rupture pressure of the bronchial stump suture line was 33.71 mmHg in group I and 89.87 mmHg in group II (p < 0.01). Conclusion: These data allowed us to conclude that mechanical suture of the bronchial stump, submitted to pressure immediately after closure, is more resistant than is manual suture in dogs submitted to pneumonectomy.

Keywords: Comparative study; Suture techniques; Bronchial fistula; Pneumonectomy.

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.

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.

Introduction: Spirometry and analysis of blood gases data have been extensively used to assess ventilatory limitation and prognosis of COPD patients. However, functional physical tests, such as the six-minute walk test (6wt) have been used for the dynamic assessment of COPD patients. Objective: To determine correlations between respiratory function test data and the six-minute walk test in COPD patients. Patients and methods: 45 patients were submitted to clinical history survey and complete physical examination performed by the medical staff of the Pneumology Department of the Brasilia University Hospital, followed by spirometry, analysis of arterial blood gases, maximal respiratory pressures data, and the six-minute walk test. Results: Concerning the spirometric, analysis of blood gases and maximal respiratory pressures data, statistically significant positive correlations (p < 0.05) between FEV1, PaO2, SpO2, MEP and the six-minute walk test were obtained. Conclusions: For the studied group, the six minute walk test has significant correlation with FEV1, PaO2, SpO2 and MEP, and can be used as an alternative functional assessment of COPD patients.

Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients.

Keywords: Administration, inhalation; Aerosols/administration & dosage; Asthma/prevention & control.

Background: Spirometry is widely used in the diagnosis and quantification of respiratory disorders such as asthma. A microspirometer is a portable and easily used apparatus that can substitute for a regular spirometer, although there is little evidence of its accuracy. Objective: To compare the microspirometer to a regular spirometer for use in asthmatic children and adolescents. Methods: The instruments used were a Micro Spirometer, manufactured by Micro Medical, and a conventional Cosmed Pony Graphic 3.5 spirometer, both with turbinometers (flow sensors). The study sample consisted of 62 children and adolescents, of both genders, clinically diagnosed with asthma and under treatment at a pulmonology clinic. Ages ranged from 5 and 16 years. All spirometric tests were carried out according to the guidelines established by the American Thoracic Society and by the Associacão Brasileira de Normas Técnicas (Brazilian Technical Standards Association). For each patient, microspirometry was performed first, followed by conventional spirometry. The parameters analyzed in both devices were forced vital capacity, forced expiratory volume in one second and peak expiratory flow. Data were analyzed using the Student's t-test and Pearson's correlation test. Results: Strong correlations were found between the two devices in the parameters analyzed: forced expiratory volume in one second: r = 0.97; forced vital capacity: r = 0.97; and peak expiratory flow: r = 0.91. Conclusion: These results demonstrate that the microspirometer is a useful diagnostic tool that can be used when a conventional spirometer is unavailable.

Keywords: Key words: Asthma. Spirometry. Micro spirometer. Puomonary ventilation.

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

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.

Objective: To compare the bronchodilatory effect of salbutamol delivered by metered-dose inhaler connected to spacers with and without previous antistatic treatment. Design: Prospective, randomized, open, crossover study. Setting: Outpatients from The Pulmonary Clinic of Hospital Júlia Kubitschek-FHEMIG, Belo Horizonte, Minas Gerais, Brazil. Patients and methods: Eleven patients, with stable mild to moderate asthma were randomized to four inhalation tests of 100 mg of salbutamol: (A) open mouth, (B) non antistatic small volume spacer (50 ml), (C) antistatic small volume spacer (50 ml) and (D) antistatic Fisonair® (750 ml). The antistatic treatment consisted in soaking the spacer in a solution of water and detergent for ten minutes and letting it to drip dry without rinsing. Main outcome measure: The peak expiratory flow (PEF) variation 15 minutes after each test in absolute, % of predicted and % of baseline values. Results: The median (Min-Max) PEF absolute variation was 25 (5-85), 40 (0-70), 70 (25-83) and 60 (15-90) l/min for tests A, B, C and D, respectively. The median PEF % baseline variation was 7.6, 11.0, 15.0, 13.3, and median PFE % predicted variation was 6.0, 8.7, 12.7 and 10.7 for tests A, B, C and D, respectively. The results of tests C and D were significantly superior to those of tests A and B (p < 0.01) based on the three methods evaluated. There was no significant difference between the results of tests C and D. Conclusion: The antistatic treatment of a small volume spacer device using a solution of water and detergent can improve the antiasthmatic effect of inhaled drugs delivered by metered-dose inhaler, as occurred with the salbutamol in this study. This fact can be more relevant concerning the treatment with inhaled steroids for asthma.

Keywords: Asthma. Respiratory therapy. Aerosols. Albuterol.