Background: Lung volume reduction surgery is an alternative treatment for advanced pulmonary emphysema. Radiological evaluation of the type and distribution of emphysema, together with the results of pulmonary function testing, seem to be the main criteria used in deciding whether or not the procedure is indicated. Objective: To determine the extent of scientific evidence available regarding the radiological profile of the ideal candidate for lung volume reduction surgery. Method: A systematic review of the literature from January 1994 to January 2004 using the following databases: MEDLINE, EMbase, LILACS, The Cochrane Library and EBM Reviews. Results: Of 208 articles identified, 16 met the study criteria. Two were randomized (one multicentric, named the 'National Emphysema Treatment Trial' and including 1218 patients, and the other including only 30 patients). The other 14 articles were observational studies. The National Emphysema Treatment Trial identified a subgroup of patients with favorable prognoses when submitted to lung volume reduction surgery. This group consisted of patients with advanced heterogeneous pulmonary emphysema with upper lobe predominance, diffuse pulmonary distention and low exercise capacity. The pattern of the results obtained in the remainder of the studies was consistent with the individual analyses, despite their heterogeneity. In the observational studies, surgical benefit, mortality rates and quality of life were assessed. Conclusion: The radiological pattern, characterized by the type, heterogeneity, distribution and diffuse distention, together with the degree of emphysema severity, represents the main predictor of a positive surgical outcome. Due to the paucity of studies in the literature, this is a grade B recommendation.

Keywords: Pulmonary emphysema. Lung surgery. Tomography X-ray computed. Review.

A review of the literature published from 1992 to 2002 was performed in order to evaluate educational interventions for asthmatics from 0 to 18 years of age and to identify characteristics related to the efficacy of such interventions. Various databases were used, and a manual search of the references found in the studies selected was conducted. Thirty-nine studies (including 27 controlled studies) were selected, and, although presenting varying results, these studies provided valuable insights into the validity of education in the control of pediatric asthma. The studies evaluated the following parameters: morbidity, use of health care services, quality of life, pulmonary function, knowledge of the disease and self-care abilities. In 32 studies (82%), a beneficial effect was attributed to one or more of the variables. Among the 27 controlled studies, 85.7% presented evidence of improvement in self-care abilities, 83.3% demonstrated increased knowledge, 80% showed a reduction in diurnal and nocturnal asthma symptoms, 71.4% demonstrated fewer unscheduled medical visits, 66.6% showed that the capacity for physical activity increased, 54.5% reported fewer hospital admissions, 50% demonstrated fewer emergency room visits, 50% presented evidence of improved pulmonary function, 22,2% showed fewer school absences, and 20% found an improvement in quality of life. Among the educational programs reviewed, the number of topics was the only characteristic that was found to correlate with the degree of efficacy. The use of sophisticated educational techniques did not lead to better results. Although asthma education programs for children and adolescents has beneficial effects, further studies with better control of confounding variables are needed in order to evaluate the efficacy of such programs with greater precision.

Keywords: Asthma/prevention & control; Health education; Health knowledge, attitudes, practice; Child; Questionnaires