Objectives: To report the results obtained in six-minute walk tests (6 MWT) performed in a group of patients under a pulmonary rehabilitation program (PRP) as a contribution to a better interpretation and the proper use of this test. Some factors that interfere with physical training during pulmonary rehabilitation were also studied. Methods: Retrospective data on 18 males and 5 females under a PRP were evaluated. During 3 months, the patients had 3 weekly training sessions to exercise the muscles of the lower extremities. The following parameters were analyzed before and after training: the distance walked during the 6 MWT and its relationship with the reference values calculated by the equations of Enright and Sherril; forced expiratory volume in one second, training load, heart rate (HR), respiratory rate (RR), oxygen saturation by pulse oxymeter (SpO2) and body mass index (BMI). Results: The values obtained during pre-training 6 MWT did not differ from the reference values calculated by Enright and Sherril equations (P = 0.777). After training, these values differed significantly (P = 0.001). The mean 6 MWT distance increase was 76 m. However, 3 patients did not reach the minimally significant increase of 54 m. Post-training 6 MWT correlated positively with pre-training FEV1 (P = 0.012), but not with load increase during training (P = 0.693). No significant difference in RR and SpO2 was observed before and after training. HR increased significantly at the end of post-training 6 MWT (P = 0.035). In 9 patients BMI was lower than the inferior limit. Six of them (66%) presented post-training distance increased in 54 m or more. Conclusions: The use of standardized methods for 6 MWT performance is recommended, even when reference values are targeted. The equations of Enright and Sherril for healthy subjects tended to yield underestimated values, with no statistical differences in training values in COPD patients. Differences in the encouragement technique employed could explain these conflicting results. Physical gain after rehabilitation was confirmed regardless of the patient's initial functional status, justifying the indication of rehabilitation even to those with severe respiratory limitations. The heterogeneous responses to load increase suggest the analysis of the predictive factors of the best response to training is necessary to customize load increase and thus obtain the best performance possible.

Keywords: Exercise test. Obstructive lung diseases. Rehabilitation. Respiratory function tests. Exercise.

Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV1 and FEV1/FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions: The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.

Keywords: Pulmonary disease, chronic obstructive/diagnosis; Primary health care; Spirometry.

Objective: To evaluate cases of tuberculosis occurring in the Entorno region of the state of Goiás but reported in the Federal District (FD) and to analyze the influence that this has on the effectiveness of the local tuberculosis control program, as well as on the socioeconomic and demographic data related to tuberculosis incidence rates. Methods: Rates of tuberculosis incidence, cure, noncompliance, treatment failure, mortality and referral, as well as socioeconomic and demographic data, were reviewed for patients from ten cities in Goiás. Results: From 2000 to 2004 in the cities under study, 714 new cases of tuberculosis were reported, 436 (61.0%) of which were treated in the FD, and therefore, were not included in the Goiás database. Among patients treated only in Goiás, the mean incidence of tuberculosis ranged from 4.40 to 10.02/100,000 inhabitants. When those treated in the FD were included, the incidence significantly increased, ranging from 15.16 to 20.54/100,000 inhabitants (p < 0.001). The rate at which contacts of tuberculosis patients were investigated was low, and treatment outcomes were unsatisfactory in Goiás and in the DF. Socioeconomic and demographic data were consistent with the tuberculosis incidence. Conclusion: The number of tuberculosis patients treated in the city in which they reside was lower than expected. Treatment in another city might compromise tuberculosis control. The recalculated tuberculosis incidence is consistent with the socioeconomic and demographic profile of the region. A federal surveillance system can be efficiently optimized, improving the control of this disease.

Keywords: Tuberculosis/epidemiology; Epidemiologic studies; Government programs.

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

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.

Hard metal pneumoconiosis, first described in 1964, is a diffuse disease caused by the inhalation of cobalt particles. The disease can manifest as occupational asthma, interstitial disease or allergic alveolitis. We report the case of a young male, working as a tool sharpener, who presented with dry cough and progressive dyspnea for one year, as well as with spontaneous bilateral pneumothorax at admission. The diagnosis was confirmed by open lung biopsy.

Keywords: Lung diseases, interstitial; Pneumoconiosis; Pneumothorax.

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.