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Introduction: Transbronchial lung cryobiopsy (TBC) has emerged as a diagnostic alternative to surgical lung biopsy in interstitial lung disease (ILD). Despite its less invasive nature, some associated complications have been described., Objective: To evaluate complications of TBC and associated factors., Methods: Prospective evaluation of all patients with ILD submitted to TBC in our centre. Clinicodemographic variables and factors associated to TBC complications were analyzed. The effect of the variables on the complication risk was evaluated by a logistic regression model., Results: Ninety patients were included (mean age 60±13 years; 58.9% male). Twenty-two patients presented pneumothorax, 18 (81.8%) of which were treated with chest tube drainage [median air leak time: 1 day (IQR=2)]. Grade 2 and 3 bleeding was observed in 13 (14.4%) cases. Presence of visceral pleura in the sample accounted for almost more than 10 times the odds of pneumothorax (OR=9.59, 95% CI 2.95-31.17, p<0.001). Increased body mass index (BMI) was associated with bleeding (16% additional odds for each BMI unit increase (OR=1.16, 95% CI 1.01-1.34, p=0.049)., Conclusion: The most frequent complication of TBC was pneumothorax, although rapidly reversible. There was a positive association between pneumothorax and the presence of pleura in the biopsy samples as well as between bleeding and increased BMI. More studies about TBC complications are needed to improve the selection of the candidates for this procedure., (Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Lung cancer staging has recently evolved to include endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for nodal assessment., Aim: Evaluate the performance and safety of EBUS-TBNA as a key component of a staging algorithm for non-small cell lung carcinoma (NSCLC) and as a single investigation technique for diagnosis and staging of NSCLC., Methods: Patients undergoing EBUS-TBNA for NSCLC staging at our institution between April 1, 2010 and December 31, 2014 were consecutively included with prospective data collection. EBUS-TBNA was performed under general anesthesia through a rigid scope., Results: A total of 122 patients, 84.4% males, mean age 64.2 years. Histological type: 78 (63.9%) adenocarcinoma, 33 (27.0%) squamous cell carcinoma, 11 (8.9%) undifferentiated/other NSCLC. A total of 435 lymph node stations were punctured. Median number of nodes per patient was 4. EBUS-TBNA nodal staging: 63 (51.6%) N0; 8 (6.5%) N1; 34 (27.9%) N2, and 17 (13.9%) N3. EBUS-TBNA was the primary diagnostic procedure in 27 (22.1%) patients. EBUS-TBNA NSCLC staging had a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy rate of 83.3, 100, 100, 86.1, and 91.8%, respectively. No complications were attributable to the procedure., Conclusion: A comprehensive lung cancer staging strategy that includes EBUS-TBNA seems to be safe and effective. Our EBUS-TBNA performance and safety in this particular setting was in line with previously published reports. Additionally, our study showed that, in selected patients, lung cancer diagnosis and staging are achievable with a single endoscopic technique., (Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Post-intubation tracheal stenosis (PITS) continues to be challenging in terms of diagnosis, management and prevention. Recurrence is common because of excessive granulation tissue formation and an insidious process of scar contracture. Topical application of mitomycin-C (MMC) as an adjuvant treatment for endoscopic management of stenosis has shown good results. The authors aimed to evaluate the results of MMC topical application following bronchoscopic dilatation as an adjuvant in PITS treatment., Methods: Retrospectively selected patients with PITS who had had rigid bronchoscopy (RB) dilatation followed by MMC application as adjuvant to endoscopic treatment. MMC in a concentration of 0.4 mg/ml was applied with a cotton stiletto around the stenotic lesion and granulation tissue for 3 minutes., Results: Eleven patients with PITS, with a median initial tracheal stenosis of 75% of the lumen, underwent RB/MMC treatment. Mean MMC sessions performed/patient was 3.5, with good response and prolonged decrease in granulation tissue formation in 55% of cases, moderate in 18% and relapse in 27%. Mean stenosis improvement was 34%., Conclusions: Topical MMC application at 0.4 mg/ml concentration seems to be associated with good results as adjuvant in PITS management with decrease in granulation tissue and sustained improvement in lumen diameter., (Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.)

Background: There is a great heterogeneity in the prevalence of Chronic Obstructive Pulmonary Disease (COPD) demonstrates a great heterogeneity across the world. The Burden of Obstructive Lung Disease (BOLD) initiative was started to measure the prevalence of COPD in a standardized way. We aimed to estimate the prevalence of COPD in Portuguese adults aged 40 years or older of a target population of 2,700 000 in the Lisbon region, in accordance with BOLD protocol., Methods: A stratified, multi-stage random sampling procedure was used which included 12 districts. The survey included a questionnaire with information on risk factors for COPD and reported respiratory disease and a post-bronchodilator spirometry performed at survey centres., Results: For the 710 participants with questionnaires and acceptable spirometry, the overall weighted prevalence of GOLD stage I+ COPD was 14.2% (95% C.I. 11.1, 18.1), and stage II+ was 7.3% (95% C.I. 4.7, 11.3). Unweighted prevalence was 20.2% (95% C.I.17.4, 23.3) for stage I+ and 9.5% (95% C.I. 7.6, 11.9) for stage II+. Prevalence of COPD in GOLD stage II+ increased with age and was higher in men. The prevalence of GOLD stage I+ COPD was 9.2% (95% C.I. 5.9, 14.0) in never smokers versus 27.4% (95% C.I. 18.5, 38.5) in those who had smoked >20 pack-years. The agreement between previous doctor diagnosis and spirometric diagnosis was low, with 86.8% of underdiagnosed individuals., Conclusions: The 14.2% of COPD estimated prevalence indicates that COPD is a common disease in the Lisbon region. In addition, a large proportion of underdiagnosed disease was detected. The high prevalence of COPD with a high level of underdiagnosis, points to the need of raising awareness of COPD among health professionals, and requires more use of spirometry in the primary care setting., (Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.)

Background: Chronic Obstructive Pulmonary Disease (COPD) has been a leading cause of morbidity and mortality worldwide, over the years. In 1995, the implementation of a respiratory function survey seemed to be an adequate way to draw attention to neglected respiratory symptoms and increase the awareness of spirometry surveys. By 2002 there were new consensual guidelines in place and the awareness that prevalence of COPD depended on the criteria used for airway obstruction definition. The purpose of this study is to revisit the two studies and to turn public some of the data and respective methodologies., Methods: From Pneumobil study database of 12,684 subjects, only the individuals with 40+ years old (n = 9.061) were selected. The 2002 study included a randomized representative sample of 1,384 individuals with 35-69 years old., Results: The prevalence of COPD was 8.96% in Pneumobil and 5.34% in the 2002 study. In both studies, presence of COPD was greater in males and there was a positive association between presence of COPD and older age groups. Smokers and ex-smokers showed a higher proportion of cases of COPD., Conclusions: Prevalence in Portugal is lower than in other European countries. This may be related to lower smokers' prevalence. Globally, the most important risk factors associated with COPD were age over 60 years, male gender and smoking exposure. All aspects and limitations regarding different recruitment methodologies and different criteria for defining COPD cases highlight the need of a standardized method to evaluate COPD prevalence and associated risks factors, whose results can be compared across countries, as it is the case of BOLD project., (Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.)

Introduction: New-onset insomnia (NOI) associated with nocturnal ventilatory support (NVS) is becoming a reality in clinical practice; however there is a lack of data about its prevalence. Our aim was to determine the prevalence of NOI in patients with obstructive sleep apnoea syndrome (OSAS) under NVS and its associated risk factors., Material and Methods: Descriptive cross-sectional study of 80 patients with OSAS under NVS. We compared two groups, with and without NOI, considering demographic characteristics, disease features, and personality. Patients under anxiolytic and/or antidepressant medication, with a weight loss of 10% or greater, and with restless legs symptoms were excluded., Results: Median age of patients was 60.0 (interquartile range (IQR) 10.0) years; 82.5% were male. Median initial Epworth Sleepiness Scale (ESS) and apnoea-hypopnoea index (AHI) were 12.5 (IQR 9.0) and 44.1 (IQR 22.4)/hr, respectively. The majority of patients (91.3%) were under auto-adjusting positive airway pressure (APAP). Insomnia at baseline was present in 30% of patients (n=24). Prevalence of NOI was 21.4% (12/56). Initial and/or intermediate insomnia were the most frequent subtypes (n=11). We found a statistically significant negative relation between NOI and pressure on 90% night-time (P(90)) (p=0.040)., Conclusions: OSAS patients under NVS presented a high prevalence of NOI. Patients with NOI presented lower levels of pressure using NVS, compared to the others., (Copyright © 2010 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.)

Aims: To determine patterns of ambulatory oxygen (AO) use among patients with chronic obstructive pulmonary disease (COPD) and interstitial lung diseases, and analyze the effects of this therapy on daily activities and quality of life (QoL)., Patients and Methods: We included 37 consecutive adult patients on AO by liquid O(2) for more than three months prescribed by hospital pulmonologists. The acute response to O(2) was evaluated through the standardized 6-minutes walk test (6MWT) and the Borg dyspnea scale during the O(2) pre-intervention trial. Time spent away from home, compliance, side effects and QoL (SF-36 v1 questionnaire) were evaluated by a telephone interview during the follow-up period. Time spent away from home and QoL comparisons after and before the intervention were assessed retrospectively., Results: COPD was the most frequent diagnosis (54%), and 29 (78%) patients were already on long-term oxygen therapy. In relation to the acute response to O(2) evaluated through the 6MWT, there were significant improvements in the distance walked (p<0.001), in resting SatO(2) (p<0.001), in minimal SatO(2) (p<0.001), and in percentage of desaturation (p=0.002), independently of the diagnosis. No differences were observed in Borg dyspnea scale. AO was used for a mean of 4.1h/day. Patients spent fewer hours per day away from home after AO treatment (3.5h vs. 5.0h, p<0.025). Six patients (16%) were not compliant to the prescription, and 54% mentioned side effects. We verified low scores in almost all of the sub-domains of SF-36 QoL questionnaire, with a significant improvement noted only in role emotional (p=0.032). Improvement in health global state was described by 49% of patients., Conclusions: Acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities and QoL with AO. More detailed studies are needed to achieve evidence based AO benefits., (Copyright © 2011. Published by Elsevier España.)

Background: Berlin Questionnaire (BQ), an English language screening tool for obstructive sleep apnea (OSA) in primary care, has been applied in tertiary settings, with variable results., Aims: Development of BQ Portuguese version and evaluation of its utility in a sleep disordered breathing clinic (SDBC)., Material and Methods: BQ was translated using back translation methodology and prospectively applied, previously to cardiorespiratory sleep study, to 95 consecutive subjects, referred to a SDBC, with OSA suspicion. OSA risk assessment was based on responses in 10 items, organized in 3 categories: snoring and witnessed apneas (category 1), daytime sleepiness (category 2), high blood pressure (HBP)/obesity (category 3)., Results: In the studied sample, 67.4 % were males, with a mean age of 51 ± 13 years. Categories 1, 2 and 3 were positive in 91.6, 24.2 and 66.3 %, respectively. BQ identified 68.4 % of the patients as being in the high risk group for OSA and the remaining 31.6 % in the low risk. BQ sensitivity and specificity were 72.1 and 50 %, respectively, for an apnea-hipopnea index (AHI) > 5, 82.6 and 44.8 % for AHI > 15, 88.4 and 39.1 % for AHI > 30. Being in the high risk group for OSA did not influence significantly the probability of having the disease (positive likelihood ratio [LR] between 1.44-1.49). Only the items related to snoring loudness, witnessed apneas and HBP/obesity presented a statistically positive association with AHI, with the model constituted by their association presenting a greater discrimination capability, especially for an AHI > 5 (sensitivity 65.2 %, specificity 80 %, positive LR 3.26)., Conclusions: The BQ is not an appropriate screening tool for OSA in a SDBC, although snoring loudness, witnessed apneas, HBP/obesity have demonstrated being significant questionnaire elements in this population.

Introduction: Obstructive Sleep Apnoea Syndrome (OSAS) patients may develop hypertension and Positive Airway Pressure (PAP) is an effective treatment in blood pressure (BP) control., Objectives: Analyse a hypertensive OSAS population with unexpected BP rise after PAP usage and verify correlations between BP rise, either with OSAS severity index or nocturnal ventilatory support compliance., Methods: Descriptive, retrospective analysis of 30 patients with PAP treated OSA, for one year, on average, and with previous controlled hypertension, who developed a rise in BP, defined as augmentation of > 5 mmHg in systolic (SBP) and/or diastolic BP (DBP), after PAP usage. Co-relational analysis of BP increase, with OSAS severity indexes and therapy compliance, using Pearson coefficient., Results: Of 508 consecutive patients followed in our Department, treated with nocturnal ventilatory support, 30 evolved with BP rise after initiating treatment (age 58 ± 10.8 years; Apnoea-Hypopnoea Index [AHI], 46.1 ± 18.68). After PAP usage, mean blood pressure (MBP), Systolic BP (SBP) and Diastolic BP (DBP) variation was 16 ± 15 mmHg, 20 ± 25 mmHg and 6 ± 19.4 mmHg, respectively. No patient showed significant BMI increase. Epworth Sleepiness Scale (ESS) value decreased 8.9 ± 5.48 points. MBP, SBP and DBP variations were not correlated with P90/P95, residual AHI, leaks or PAP compliance., Conclusions: No specific characteristics were identified in the group who developed a rise in BP with PAP usage. No correlations were found between rises in BP and OSAS severity indexes or PAP compliance. Neither BMI nor variation in wakefulness status explained the rise in BP. Studies relate polymorphisms of β1-adrenoreceptors with different BP responses to ventilatory support. More studies are needed to clarify the cause of this paradoxical response.

Hemoptysis is a common and alarming clinical problem. Acute massive hemoptysis is a life threatening condition. Different therapeutic strategies such as surgery, endovascular treatment and/or bronchoscopy have been applied. We report two cases of patients with severe hemoptysis who were treated by bronchoscopy guided topical hemostatic tamponade therapy with oxidized regenerated cellulose.

Tracheal stenosis follows any injury to the airway mucosa, such as ischaemic, traumatic and other injuries. The treatment of tracheal stenosis remains a challenging problem despite all the advances in endoscopic and surgical techniques. Scar formation and reestenosis are the main causes of treatment failure. The authors present two cases of successful treatment of a tracheal stenosis after tracheal injury from prolonged oro -tracheal intubation / tracheostomy following dilatation with rigid broncoscope and laser therapy, associated with topical application of mitomycin C as an adjuvant treatment.

There is a 10 -36% rate of obstructive sleep apnoea syndrome (OSAS) associated with rapid eye movement (REM) in the OSAS population. Prior studies have suggested an increased prevalence of psychiatric disorders and an effect of gender and age on these patients. Our aim was to study the clinical and polysomnograph (PSG) characteristics of our patients with REM- -related sleep disordered breathing (REM SDB). Inclusion criteria was the identification of REM SDB detected by PSG defined as apnea -hypopnea index (AHI) in REM sleep > or = 5h, AHI in non -REM sleep (NREM) < or = 15h and REM/NREM AHI > or = 2. Several Sleep Disorders Questionnaire (SDQ) version 1.02 parameters were analysed. The study comprised 19 patients with a mean age of 54.0 (SD+/-13.97), a mean BMI of 29.01 (SD +/- 4.10) and a 0.58 female / male ratio. The mean Epworth Sleepiness Scale score was 12.74 (SD +/-4.86). Mean AHI was 9.16/h (SD 4.09); mean AHI in REM sleep 37.08/h (SD 25.87) and mean REM -AHI/NREM- -AHI 8.86 (SD 8.63). The anxiety disorder rate was 33.3%; 44.4% in females, 16.7% in males. The average deep sleep was 20.7% (SD 10.42) and REM sleep 15.45% (SD 9.96), with a sleep efficiency of 85.3 (SD 8.70). No significant statistical correlation was found between the REM/NREM AHI index and anxiety symptoms, daytime sleepiness and sleep quality (REM and deep sleep percentages). These patients differ from the general OSAS population: on average, they are not obese, there are a greater number of females affected and they do not present a very significant diurnal hypersomnia. Reduced deep sleep and increased REM sleep were also present versus general population data, and sleep efficiency was just below the normal limit. Anxiety disorders were more prevalent in this group than described for the general population (3%) and OSAS patients.

The use of spirometry is not yet widespread enough in chronic respiratory or at -risk patients whose diagnosis is incomplete. There is scarce knowledge and inadequate management of the burden of these diseases, particularly chronic obstructive pulmonary disease (COPD). Pneumobil, an initiative aimed at raising awareness among smokers and ex -smokers, was reactivated 10 years after its launch in Portugal. It found a large prevalence of bronchial obstruction as measured by spirometry (30% and 25% in men and women respectively) in a sample of 5324 smoke -exposed individuals, 50% current smokers, screened at state or business (private company group) health institutions. This risk is neither mainly attributable to occupational exposure nor mainly related to respiratory symptoms, which were very common in our population. Only dyspnoea (OR=1.28; p=0.02) and frequent episodes of sputum production (OR=1.21; p=0.008) or acute bronchitis (OR=1.31; p=0.05) were somewhat related to bronchial obstruction. Prior knowledge of COPD is rare and bronchial obstruction is not correlated (p=0.204) to a possible diagnosis of COPD.

Constrictive bronchiolitis is characterized by alterations in the walls of membranous and respiratory bronchioles. These changes lead to concentric narrowing or complete obliteration of the airway lumen. Suspicion of possible bronchiolar disorders may arise from clinical, functional, and radiologic findings. However, constrictive bronchiolitis may be present even with normal physical, functional and image findings, which turns the diagnosis difficult. A high index of suspicion is necessary to justify invasive tests that lead to pulmonary biopsy. In this report, we describe a patient with cough and dyspnoea, with normal physical, functional and image findings, whose work-up leaded to the diagnosis of constrictive bronchiolitis.

Bronchial fracture is a rare, life -threatening injury usually associated with blunt chest trauma. It represents a great task in diagnosis, as its manifestations are various and nonspecific. Bronchoscopy has a primordial role to diagnose and, in selective cases, to treat bronchial fractures. The authors present the case report of a patient with a thoracic trauma after an accident in the workplace. The bronchoscopy revealed a fracture of the left main bronchus. Conservative treatment was per- formed with endobronchial stenting and balloon dilatation. In conclusion, a review of the literature on bronchial fracture and the role of bronchoscopy is presented.

The authors report a case of a rare pulmonary neoplasm - epithelioid hemangioendothelioma, in a 39 year-old woman, asymptomatic until December 2003, when she developed pleuritic and right-sided chest pain. The patient presented a previous chest radiograph, performed 13 years before, which showed multiple small bilateral pulmonary nodules attributed to tuberculous sequelae. The definitive histological diagnosis was made by lung biopsy through thoracotomy. The patient developed a clinical and imagiological worsening and then therapy with interferon alpha-2a was started. Even with imagiological stability of pulmonary lesions the patient remained symptomatic and died nine months after the diagnosis had been established. The authors emphasise the rarity of this type of pulmonary neoplasm and discuss its clinical presentation, histological features, treatment and prognosis.

Background: In recent years non-invasive ventilation (NIV) as become a valuable therapeutic option in exacerbations of patients with chronic pulmonary obstructive disease. Although widely used there is a paucity of information on weaning from NIV., Objectives: We aimed to describe the performance of a weaning protocol based on progressive periods of NIV withdraw., Methods: During a one year period we performed NIV in 78 patients with acute exacerbation of chronic respiratory failure. Weaning was considered in patients with 24 hours without acidosis and respiratory rate less than 25 cycles per minute. Weaning was performed as following: during the first 24 hours in each 3 hours, one hour without NIV (except during night period), in the second day in each 3 hours, two hours without NIV (except during night period) and in the third day NIV was used during the night period., Results: Sixty five patients began the weaning protocol. Mean NIV time was 120,9 hours (17 to 192 hours). No adverse effects were recorded in patients who began the weaning protocol. All patients completed the weaning protocol with no re-institution of NIV or invasive ventilation during hospitalization., Conclusions: We report an excellent weaning success rate of NIV in patients with acute severe exacerbation of CRF. Although our weaning protocol required 72 hours, our results suggest that strategies based on periods with and with-out NIV are effective. Weather similar less time consuming weaning strategies are effective, merits investigation.

Hamartomas are benign neoplasms often located in lung and frequently asymptomatic. They are typically discovered incidentally with thorax radiographic stu- dies. About 1.4-20% of hamartomas have endobronchial location and can be symptomatic due to airway obstruction. Traditionally, surgical resection has been considered the standard of care for endobronchial hamartoma. However, there is increasing experience using endoscopic treatment and a paucity of reported complications. Endoscopic resection has comparable therapeutic efficacy with surgical resection but spares a major operation. We report two cases of endobronchial hamartomas, each diagnosed and definitively treated with bronchoscopic techniques. Persistent symptoms and abnormal radiological features were the impetus for initial diagnostic bronchoscopy. Endobronchial treatment was performed using electrosurgery by Argon plasma (APC) and Nd:YAG la- ser. This approach resulted in complete resolution of both patients' symptoms. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

Wheezing is a major symptom of asthma although it may be present in other pathologies. Foreign body aspiration a situation that often remains hidden for long periods of time. The authors present a case report of an asthmatic victim of workplace accident with aspiration of foreign body that was only suspected after some time.

The lung is a unique interface between the antigen and the circulating blood volume. It is submitted to extrinsic/intrinsic challenges and is particularly vulnerable to circulating insulting agents. It is a site of intense immune surveillance, allowing antigen sampling to expand the immunologic repertoire through lymphocyte recirculation. In addition, local inflammatory reactions to antigens are generated. Imaging has an important role in diagnosis of patients with immunologic lung diseases. This group includes autoimmune lung diseases. There are many advantages of plain chest radiography but also significant limitations. It was a revolution in imaging of lung diseases with Computed Tomography (CT), being high resolution an important help in pulmonary interstitium study. This technique has a higher diagnostic accuracy than the conventional chest X-ray both in the detection and the diagnosis of lung diseases, such as autoimmune lung diseases.

Granular cell tumor is a mesenchymal neoplasm almost always benign, with tendency to recurrence. Although it is more frequent in in the head and neck it has been described in almost all areas of the body. Its occurrence in the lung is extremely rare. The authors describe two cases of endobronchial granular cell tumours, discuss the particularities of this pathology as well as the treatment options, with particular attention to the use of endobronchial excision and criotherapy.

Pulmonary arteriovenous malformations are a rare disorder associated to hereditary hemorrhagic telangiectasia in over 50 % of the cases. Clinical presentation, diagnostic work-up, therapeutic options and prognosis are reviewed by the authors. Pulmonary arteriovenous malformations are known to have considerable morbidity and mortality, their treatment being advisable as well as their screening among family members, especially if the index case is diagnosed with both pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia. To this moment prospective studies establishing the best diagnostic work-up for the patients and their families are lacking. The authors report two pulmonary arteriovenous malformations cases in a family with hereditary hemorrhagic telangiectasia. Patient's diagnosis led to family screening which resulted in the identification of pulmonary arteriovenous malformations in two family members and pulmonary disease exclusion in four patients previously known to have hereditary hemorrhagic telangiectasia.

Tracheal rupture after endotracheal intubation requires immediate intervention. There have been an increasing number of reports that describe nonsurgical management of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Bronchoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate treatment are very important in managing this potentially fatal situation. The final decision should be based on clinical, radiologic and bronchoscopic findings.

Introduction: Foreign body aspiration (FBA) is frequent in children but uncommon in adults it's and often remains hidden for long periods of time. A high index of suspicion is essential for the correct diagnosis of this condition. Early extraction of FB avoids sequelae and complications., Methods: Retrospective study of FBA cases in adults that occurred in a 20 year period (1985-2005). The authors reviewed of the clinical records of all patients admitted with the diagnosis of foreign body in the airway in that time period., Results: In that period of time 77 FB were extracted. Male:female ratio was 68:32%, mean age was 51.4 years and mean delay between FB aspiration and removal 401 days (min: 3 h, max: 21 years). Most common clinical presentations: acute asphyxia in 28%, persistent cough 22%. Nature of FB: bone fragments 33%, vegetable matter 31%. The majority of FBs (61%) was lodged in the right bronchial tree; 26% were radiopaque. Rigid bronchoscopy was performed in 75 cases and fiberoptic bronchoscopy in only two. Two patients needed two bronchoscopies for FB removal. There were no complications, need for surgery or relevant sequelae., Conclusions: FBA may happen at any age. In adults the clinical presentation is variable and the FBA episode is often missed, delaying the diagnosis. Rigid bronchoscopy proved to be an efficient and safe procedure. FBA must be a diagnostic hypothesis when studying an adult with long standing respiratory complaints.

Introduction: Asthma, similarly to other chronic conditions, is strongly influenced by psychological factors. Previous studies have not established the personality characteristics of adult asthma patients as compared to non-patients., Objectives: To study the psychological characteristics of adult asthma patients in comparison to a pattern drawn up for the Portuguese population. To study the relationships between the personality and the severity and duration of the disease., Methods: Outpatients of the Immunallergology and Pulmonology units of the São João Hospital suffering from asthma responded to the Revised NEO Personality Inventory (NEO-PI-R). Patients with co-morbidity factors were not excluded. The doctor who attended them classified the severity of the asthma according to the Global Initiative for Asthma (GINA). Relationships between the personality and the severity/duration of the disease were analysed using the ANOVA models., Results: 300 asthma patients aged between 17 and 79 were studied. Of these, 75% were female; the great majority had intermittent/light persistent asthma (71%); 17% had moderate persistent asthma and 12% had severe persistent asthma. The duration of the disease was less than 10 years in 34% and over 23 years in 35%. The asthma patients had higher Neuroticism scores (p < 0.001), with the other facets (except impulsiveness) equally high. All the remaining domains--Extroversion, Openness to Experience, Conscientiousness and Agreeableness--had lower scores than the control group (p < 0.001). Both Extroversion and Openness to Experience decrease with growth in the severity (p = 0.003; p = 0.009) and the duration of the disease (p = 0.006; p = 0.013). Neuroticism increases in tandem with the severity of the disease., Conclusion: This study shows the predominance of Neurotic characteristics and lowered Extroversion, Openness to Experience, Agreeableness and Conscientiousness characteristics in asthmatics as compared to the general Portuguese population. Decreased Extroversion and Openness to Experience are observed as the severity and duration of the disease increase. Further studies are necessary to clarify the relationships between personality and the severity and duration of the disease.

Childhood obstructive sleep apnea syndrome is a common condition and can result in serious complications. The nocturnal polysomnography remains the gold standard in the diagnosis of this pathology. Given the scarcity of sleep laboratories, namely with paediatric profile, screening techniques have been commonly used. It was our aim to study the yield of the home cardiorespiratory sleep studies carried out in children. Since January of 1999 until June of 2003, 33 home cardiorespiratory sleep studies were performed in children. We studied 31 children (21 male) with a median age of 10.6+/-3.4 years. Five children had craniofacial malformations, 2 neuromuscular diseases and 10 were obese. The signals of nasal flow and saturation were good/acceptable in 67.7% and 96.8% of the cases, respectively. In 2 cases the register was null. Average of apnea-hypopnea index was of 10.7+/-12.3/hour, average saturation of 95.6%+/-3.0 %, minimum saturation of 82.2 %+/-9.2% and dessaturation index of 12.5+/-10.7/hour. Childhood obstructive sleep apnea syndrome was confirmed/suggested in 30 children. The apnea-hypopnea index and the dessaturation index were significantly higher in the group of children with craniofacial malformations and neuromuscular disorders comparatively to children with obesity (26.3 versus 10.5 and 21.5 versus 11.3, respectively) but without statistical significance. In our experience, home cardiorespiratory sleep studies is a diagnostic method easily used in children. This method gives more information comparatively to other screening techniques so that it can evaluate with more accuracy the existence of sleep disordered breathing and may be a possible alternative to polysomnography.

Obstructive sleep apnea syndrome and diffuse idiopathic skeletal hyperostosis are frequent diseases in the elderly, however its association has rarely been described. The authors describe a case of obstructive sleep apnea syndrome in a patient with diffuse idiopathic skeletal hyperostosis, with a giant osteophyt of the cervical column, which leads to obstruction of the pharynx and they discuss the association between both entities.

Introduction: Obstructive Sleep Apnea (OSA) is associated with adverse effects in cardiovascular physiology. Some studies have connected this pathology with Cardiovascular Disease (CVD)., Aim: Determine the prevalence of CVD in patients with OSA of different severity and verify the association between CVD and OSA., Material and Methods: Retrospective study based on data from 155 consecutive patients with OSA referred to a Sleep Disordered Breathing Clinic in an University Hospital during the year of 2001., Results: The majority of patients were male (83,2%), the mean age was 53,6 +/- 11,9 years. Severe OSA was observed in 52,9% patients, moderate in 20% and mild in 27,1% patients (mean Apnea Hypopnea Index of 35,2 +/- 23,8/hour). Among the studied individuals 52,3% showed CVD, being Arterial Hypertension (AH) the most common disease (45,8%). Acute Myocardial Infarction appeared in 6,5% and Angina in 3,9% cases. The majority of the patients (67,1%) were obese (Body Mass Index - BMI>30). The mean BMI was 33,1 +/- 6,34. A significant (31%) number of patients reported Lipid Disorders and 11% reported Diabetes mellitus. The majority (51,3%) of patients referred smoking habits. Severity of OSA (evaluated by AHI) was significantly higher in women with AH (p= 0,033) and significantly lower in patients who developed Cerebrovascular Disease (CeVD) (p = 0,036)., Conclusions: The studied population presented a high prevalence of CVD, being the severity of OSA significantly higher in women with AH. The increased prevalence of CVD in patients with OSA has been documented in recent epidemiologic studies. The physiopathologic mechanisms underlying this association, certainly, deserve further investigation.