This will be my last editorial as the editor of the Jornal Brasileiro de Pneumologia (JBP, Brazilian Journal of Pulmonology).

Objective: To evaluate the appropriateness of the use of auscultation terminology in Brazilian respiratory disease-related medical journals published between January of 1980 and December of 2003. Methods: A descriptive study was conducted, evaluating three medical journals: the Jornal de Pneumologia (Journal of Pulmonology), Jornal de Pediatria (Journal of Pediatrics) and Revista Brasileira de Medicina (Brazilian Journal of Medicine). Original articles and case reports about respiratory diseases were selected, and auscultation terminology was extracted from these articles. The appropriateness of terms used to describe adventitious sounds was assessed. Results: We found that the inappropriate use of terms was more frequent when intermittent sounds were described than when continuous sounds were described (87.7% versus 44.0%; p = 0.0000). No significant difference was observed between the inappropriate use of terms by pulmonologists and that observed for other specialists (56.5% versus 62.0%; p = 0.26). In addition, there were no significant differences among the various regions of the country or between the periods prior to and after the dissemination of international nomenclature. Conclusion: Inappropriate use of pulmonary auscultation terms describing adventitious sounds remains common and widespread in Brazilian medical publications.

Keywords: Auscultation; Lung/physiopathology; Lung diseases/diagnosis; Respiratory sounds; Terminology

After the invention of the stethoscope by Laënnec in 1816, the nomenclature for lung sounds was spread without following a specific structure, becoming confusing and lacking precision. Since 1985 a great effort has been made to reach a terminology standardization, based on physical patterns such as frequency, duration, and amplitude. The evaluation of the terminology employed by Brazilian pneumologists in reported cases is the object of this study. A retrospective study of reported cases published in Jornal de Pneumologia has been performed between 1985 and 1997, regarding the pulmonary auscultation described. The data were compared to those proposed by the Symposium on Lung Sounds, in 1985. Out of 131 cases, 72 reported altered pulmonary auscultation, presenting 30 distinctive denominations for lung sounds. It is, therefore, easy to notice that pneumologists are not yet familiar with the current nomenclature. It is important to highlight that 31 cases did not report pulmonary auscultation even in a pneumology publication, which serves to show the underestimation of the method. Pulmonary auscultation is a quick, non-invasive, low-cost, and great clinical guiding means which must be recognized among other techniques applied for diagnosis.

Keywords: Auscultation. Stethoscope. Respiratory sounds. Nomenclature.

Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

Keywords: Cystic fibrosis; GRADE approach; Cystic fibrosis/drug treatment; Clinical practice guide.