Year 2004 - Volume 30 - Issue 3 (May/June)

Editorial

1 - Biomass burning and its effects on health

Biomass burning and its effects on health

C. Arden Pope III

J Bras Pneumol.2004;30(3):193-

2 - Smoking in health professionals

Smoking in health professionals

J Bras Pneumol.2004;30(3):194-

Original Article

3 - Effects of salbutamol delivered by dry-powder inhaler on methacholine-induced bronchoconstriction

Efeito do salbutamol liberado através de inalador de pó seco sobre o broncoespasmo induzido por metacolina

Adalberto Sperb Rubin, Liliana G Pelegrin,Christiano Perin, Maurício Roux Leite, Luiz Carlos Corrêa da Silva

J Bras Pneumol.2004;30(3):195-200

Background: Short-acting b2 agonists delivered by metered-dose inhaler (MDIs) are the drugs usually used for the reversal of methacholine-induced bronchoconstriction. The b2 agonists that are delivered by dry-powder inhaler (DPI) can be an efficacious option. Objective: To evaluate the effectiveness and speed of action of salbutamol delivered by DPI (Pulvinal; Butoventâ), in comparison to salbutamol delivered by MDI, in reversing methacholine-induced bronchoconstriction. Method: Sixty successive methacholine-induced bronchoconstriction patients who presented a decrease of at least 20% in forced expiratory volume (FEV1) were evaluated prospectively. Of these 60 patients, we randomized 30 (first group) to receive 200 mcg of salbutamol by MDI and 30 (second group) to receive 200 mcg of salbutamol by DPI (Pulvinal). Both drugs were administered with the objective of reversing bronchoconstriction during the final phase of a bronchoprovocation test. The FEV1 values obtained at 1 and 5 minutes after bronchodilator administration were evaluated. Results: The groups were comparable in gender distribution, age, weight, dose level provoking a 20% drop in FEV1 (first group: 1.3 mg; second group: 1.19 mg; p = 0.79) and post-methacholine FEV1 (first group: 2.03 l; second group: 1.99 l; p = 0.87), with no statistically significant differences between the two groups. In the first group (MDI), the mean increase in FEV1 was 16.2% (at 1 minute) and 22.2% (at 5 minutes), and in the second group (DPI) it was 17% (at 1 minute) and 23.6% (at 5 minutes). There was no statistically significant difference between the groups (p = 0.8). Conclusion: The b2-agonists delivered by DPI (Pulvinal) present the same bronchodilator efficacy and speed of action as do those delivered by the more traditional MDI method.

Keywords: Asthma. Bronchodilator agents/administration & dosage. Albuterol/administration & dosage. Methacholine chloride/administration & dosage. Respiratory therapy/methods. Administration, inhalation/methods. Prospective studies.

4 - Immunoglobulins, complements and autoantibodies in 58 workers exposed to silica

Estudo de imunoglobulinas, complementos e auto-anticorpos em 58 trabalhadores expostos à sílica

Hermano Albuquerque de Castro, Carolina Gimenes da Silva, Alfred Lemle

J Bras Pneumol.2004;30(3):201-206

5 - Influence of general clinical parameters on the quality of life of chronic obstructive pulmonary disease patients

Influência de características gerais na qualidade de vida de pacientes com doença pulmonar obstrutiva crônica

Victor Zuniga Dourado, Letícia Cláudia de Oliveira Antunes, Lídia Raquel de Carvalho, Irma Godoy

J Bras Pneumol.2004;30(3):207-214

Background: There is currently no consensus regarding which factors influence the quality of life of patients suffering from chronic obstructive pulmonary disease (COPD). However, identifying such factors could orient approaches to improving the quality of the lives of these patients. Objective: To evaluate factors that can interfere with quality of life in COPD patients selected for pulmonary rehabilitation. Methods: Twenty-one patients with moderate to severe COPD were evaluated. Maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), body mass index (BMI), pulmonary function, blood gases, grip strength (measured with a dynamometer), quadriceps strength and St. George's Respiratory Questionnaire (SGRQ) scores were assessed. Results: Statistically significant negative correlations with quality of life were found for the following factors: "impact" scores of: forced expiratory volume in one second (FEV1) (r = -0.68; p = 0.004), FEV1 to forced vital capacity ratio (FEV1/FVC) (r = -0.61; p = 0.014), peak expiratory flow (PEF) (r = -0.53 (p = 0.015), 6MWT (r = -0.63; p = 0.001) and BMI (r = -0.64; p = 0.002); "activity" scores for: MIP (r = -0.57; p = 0.007), baseline arterial oxygen saturation by pulse oximetry (SpO2) (r = -0.52; p = 0.018) and 6MWT (r = -0.58; p = 0.007); "symptom" score for: BMI (r = -0.60; p = 0.005); and "total" scores for: FEV1 (r = -0.64; p = 0.01), PEF (r = -0.47; p = 0.033) and BMI (r = -0.57; p = 0.009). Multiple linear regression revealed the primary factors influencing quality of life to be: BMI, which presented a significant influence on "symptom", "impact" and "total" scores (p = 0.002, p = 0.009 and p = 0.024, respectively); and 6MWT, which had a significant influence on "activity" and "impact" scores (p = 0.048 and p = 0.010, respectively). Conclusions: The BMI and 6MWT were shown to have an influence on quality of life in the COPD patients studied. Therefore, therapeutic approaches to improving the quality of life of COPD patients should take these indices into consideration.

Keywords: Lung diseases, obstructive/rehabilitation. Quality of life

6 - Treatment of empyema using thoracentesis with irrigation and intrapleural application of an antimicrobial agent

Toracocentese esvaziadora com irrigação e uso de antimicrobiano intrapleural no tratamento do empiema

Liana Peres Duailibe, Maria Ilizabeti Donatti, Paulo de Tarso Müller, Pedro Nango Dobashi

J Bras Pneumol.2004;30(3):215-222

7 - Smoking among medical students: temporal trends and related variables

Tabagismo em estudantes de Medicina: tendências temporais e fatores associados

Ana Maria Baptista Menezes, Pedro Curi Hallal, Fernando Silva, Marcos Souza, Luciene Paiva, Aline D'Ávila, Bianca Weber, Viviane Vaz, Fernando Marques, Bernardo L. Horta

J Bras Pneumol.2004;30(3):223-228

8 - Community-acquired pneumonia in elderly patients: adherence to Brazilian guidelines for the treatment of pneumonia

Pneumonias adquiridas na comunidade em pacientes idosos: aderência ao Consenso Brasileiro sobre Pneumonias

José Roberto de Almeida, Olavo Franco Ferreira Filho

J Bras Pneumol.2004;30(3):229-236

Background: Pneumonia is a common disease with a high mortality rate, being the sixth leading cause of death among elderly people in the USA and the fifth among those in Brazil. Initial treatment of pneumonia is usually empirical since the ethiological agent is identified in only approximately 50% of cases. Therefore, several scientific societies have defined some guidelines for initial antimicrobial therapies. Objectives: This study evaluated adherence to the guidelines set forth by the Consenso Brasileiro sobre Pneumonias (Brazilian Consensus on Pneumonia) for treatment of community-acquired pneumonia in hospitalized elderly patients. Method: Fifty-four patients, aged 60 or over, hospitalized at Londrina University Hospital with community-acquired pneumonia between 2 August 1999 and 2 August 2000 were evaluated. Whether their treatment adhered or did not adhere to guidelines, the patients were compared in terms of 30-day mortality, average time for clinical stabilization, average length of hospital stay, cost of treatment and severity score. Results: The average age was 74.1, and 61.1% of the patients were treated in accordance with the Brazilian guidelines for treatment of community-acquired pneumonia. There were no differences in length of hospital stays, cost of treatment, time to clinical stability and severity score between the two groups (adherent and non-adherent). However, there was a difference in mortality. The rate of mortality was higher in patients with pneumonia severity index (PSI) scores of IV or V who were treated according to the guidelines than in those with the same score whose treatment was non-adherent (p = 0.04). In general, PSI score was related to mortality. The mortality rate among patients with scores of II and III was 9.5%, compared with 30.3% in patients with scores of IV and V. Conclusion: Adherence to the Brazilian guidelines for treatment of community-acquired pneumonia in elderly patients was satisfactory, and there was no difference in results between both groups, except for the higher mortality rate found for patients with higher PSI scores who were treated according to the guidelines. A positive correlation was found between PSI score and mortality.

Keywords: Pneumonia. Health Planning Guidelines. Community-Acquired Infections. Health Services for the Aged.

9 - Percutaneous Tracheostomy in Critically-ill Patients: The Experience of a Medical Intensive Care Unit

Traqueostomia percutânea no doente crítico: a experiência de uma unidade de terapia intensiva clínica

Marcelo Park, Leonardo Brauer, Ricardo Reis Sanga, André Carlos Kajdacsy-Balla Amaral, José Paulo Ladeira, Luciano Cesar Pontes de Azevedo, Leandro Utino Taniguchi, Luiz Monteiro da Cruz-Neto

J Bras Pneumol.2004;30(3):237-242

10 - Clinical and epidemiological characteristics of contagious adult of tuberculosis in children

Características clínicas e epidemiológicas do adulto contagiante da criança com tuberculose

João Ab Lima, Edgar Enrique Sarria Icaza, Beatriz G. Menegotto, Gilberto Bueno Fischer, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2004;30(3):243-252

Background: Tuberculosis in children generally occurs as a direct result of cohabitation with a contagious adult. Objective: To create a profile of a typical adult with contagious tuberculosis (as identified through the public health system) living with a child who has been diagnosed with tuberculosis. Method: Case study. Children younger than 14 years of age who were diagnosed with tuberculosis were included. Parents were interviewed using structured questionnaires. Means and standard deviations were analyzed using the Student's t-test. Fisher's exact test or the Ç² test was used for comparisons. Results: Fifty children, representing 96% of those diagnosed with tuberculosis in the Porto Alegre health care system between July 20, 2001 and August 10, 2002, were included. The mean age was 76 months, and 60% were girls. The classic forms of pulmonary presentation (consolidation or cavitation) were seen in 38%. The majority of the children were diagnosed in the hospital and came from homes in which there were (a mean of) 6 cohabitants and a total family income less than 2 times the local minimum wage. Using ELISA, HIV co-infection was identified in 25% (although not all were tested). The children regularly visited places other than their homes. In 78% of cases, the contagious adult was identified. These contagious adults were mostly males (56%), and the mean age was 32. In most cases (79%), the contagious adult was a relative, usually a parent. Within this group of adults with contagious tuberculosis, HIV co-infection was identified in 43% of those tested. Conclusions: Adults with contagious tuberculosis living in the home continue to be the most likely source of tuberculosis infection in children. Co-infection with HIV in these pediatric patients, as well as in the cohabiting adults with contagious tuberculosis, is a significant finding. It must be emphasized that the possibility of contact with contagious individuals in the home should be explored in every diagnosed case of pediatric tuberculosis.

Keywords: Tuberculosis/epidemiology. Children. Communicable diseases/etiology.

Upgrading

11 - Pulmonary Medicine residency in Brazil

A residência médica em Pneumologia no Brasil

Evandro Guimarães de Sousa

J Bras Pneumol.2004;30(3):253-259

Case Report

12 - Shrinking lung syndrome in systemic lupus erythematosus

Síndrome do pulmão encolhido no lúpus eritematoso sistêmico

Cíntia Andrade Costa, Dálvaro Oliveira de Castro Jr., Sérgio Jezler, Mettermayer Santiago

J Bras Pneumol.2004;30(3):260-263

13 - Severe form of hantavirus cardiopulmonary syndrome managed with continuous positive airway plessure through facial mask

Forma grave da síndrome pulmonar e cardiovascular por hantavírus tratada com pressurização positiva através de máscara facial

Mariangela Pimentel Pincelli, Carlos Roberto Ribeiro de Carvalho, Luis Tadeu Moraes Figueiredo, Antônio Delfino de Oliveira Júnior, Ana Lúcia Bernardo Soares, Carmen Sílvia Valente Barbas

J Bras Pneumol.2004;30(3):264-269

14 - Acute disseminated histoplasmosis in an immunocompetent patient

Histoplasmose disseminada aguda em indivíduo imunocompetente

Simone Castelo Branco Fortaleza, Silvia Karine de Albuquerque Lopes, Tereza de Jesus Bandeira, Teresa Neuma Albuquerque Gomes Nogueira, Marcelo Alcântata Holanda

J Bras Pneumol.2004;30(3):270-273

Review Article

15 - Economic evaluation of the impact of chronic obstructive pulmonary disease and its acute exacerbations on Latin America

Avaliação econômica da doença pulmonar obstrutiva crônica e de suas agudizações. Aplicação na América Latina

Marc Miravitlles

J Bras Pneumol.2004;30(3):274-285

16 - Critical analysis of scoring systems used in the assessment of Cystic Fibrosis severity: State of the art

Análise crítica dos escores de avaliação de gravidade da fibrose cística: Estado da arte

Camila Isabel da Silva Santos, José Dirceu Ribeiro, Antônio Fernando Ribeiro, Gabriel Hessel

J Bras Pneumol.2004;30(3):286-

Previous Issue

Next Issue

Year 2004 - Volume 30 - Issue 3 (May/June)

Editorial

Original Article

Upgrading

Case Report

Review Article

Indexes

Official publication

Newsletters