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To determine the differences between sexes in perceptions of asthma symptoms, asthma control, daily activities, and symptom exacerbation in Latin American countries.This cross-sectional study was performed using data from the Latin America Asthma Insight and Management (LA-AIM) study (Of the 2167 participants, 762 (35.2%) were males and 1405 (64.8%) were females. Male participants smoked more than females, but history of rhinitis and allergies was more common in females (In Latin America, females report more asthma symptoms, poorer asthma control, more impact on their daily activities, and more visits with health professionals than males.

Pulmonary rehabilitation (PR) is a mandatory component of a comprehensive treatment of patients with chronic respiratory disease. However, there is no officially published data about PR Centers in Latin America. The objetive is to identify Latin American Pulmonary Rehabilitation Centers and evaluate their characteristics and organizational aspects. A cross-sectional study with the Pulmonary Rehabilitation Centers indicated by the Latin American Respiratory and Physiotherapy Societies and by our own personal survey among physicians and physiotherapists. An eletronic transmission questionnaire with 20 questions was sent to the Coordinator of each one of the Centers. 217 Pulmonary Rehabilitation Centers were found throughout Latin America and a total of 160 (73.7%) Centers answered the questionnaire. Of these, 65.8% had private administration; 68.8% had an associated program for patients with heart disease; programs lasted an average of 24 sessions; the rehabilitation team consisted mainly of physiotherapists, physicians and dietitians; 90.6% of the centers evaluated the patients with different questionnaires; 91.9% used treadmill and 90.6% bicycle for exercises of lower limbs and 80.1% proprioceptive neuromuscular facilitation technique with weights to train the upper limbs of their patients; 55.6% had an educational program and 36.9% presented a home-based program. There has been a great increase in the number of Latin American Pulmonary Rehabilitation Centers, presenting diversity in organizational aspects.

SARS coronavirus-2 (SARS-CoV-2) detection in different clinical specimens has raised important insights about its pathogenesis, but some details remain to be understood. In that respect, disrupt viral control seen in solid organ transplant patients on chronic immunosuppression can help unveil pathogenic mechanisms and characterize new coronavirus disease-19 (COVID-19) immunological and clinical aspects, as well as secondary complications. We herein report a case of SARS-CoV-2 detection in ascitic fluid from a kidney transplant patient with decompensated cirrhosis and COVID-19 and then discuss about immune, cellular, and virological aspects of such clinical presentation of the disease, which also included a disseminated infection, demonstrated by viral detection in his blood sample. We subsequently discuss about the fatal outcome caused by a secondary bloodstream infection by Cryptococcus neoformans. This unprecedented case report presents ascitic fluid as a novel specimen in which SARS-CoV-2 can be detected. Immune dysregulation and cumulative risk factors may lead to secondary infections by opportunistic agents, including Cryptococcus neoformans.

SARS Coronavirus-2 detection in different clinical specimens, including serum and stool, has raised important insights about its dynamics and pathogenesis, but some details remain to be understood.In that respect, disrupt viral control seen in immunocompromising conditions can help unveil pathogenetic mechanisms and characterize new Coronavirus Disease-19 immunological and clinical aspects in general.We herein report a case of cirrhosis decompensation with ascites due to COVID-19 and unprecedented detection of SARS-CoV-2 in ascitic fluid, hence a possible acute viral peritonitis, as well as in serum, leading to a fatal disseminated infection.

Background Asthma is a chronic airway inflammatory condition of the airway and is classified as controlled, partially controlled, and uncontrolled. Patients with uncontrolled asthma are at greater risk for hospitalizations and visits to emergencies, and the condition has greater impact on their daily lives. The aim of this study was to evaluate asthma control, the use of health resources, and asthma's impact on the activities of daily living of patients with different age groups in 5 Latin American countries. Methods This was a retrospective analysis of The Latin America Asthma Insights and Management (LA AIM) study carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Asthmatics were splited into 3 age groups: 12–17, >17–40 and > 40 years old. An interview face to face was carried out and patients answered a questionnaire of 53 questions related to 5 main domains of asthma: symptoms, impact of asthma on daily living activities, patients' perceptions of asthma control, exacerbations, and treatment/medication. Results A total of 2167 asthmatics were interviewed. There was a low percentage of controlled patients (mean 9%) in all 3 groups with no particular difference among the five countries, but Venezuelan patients had a 71% chance of having uncontrolled asthma (p Conclusion In the 3 age groups, patients experienced poor asthma control, with no significant differences among the countries. Patients who used control medication had a greater chance of controlling their asthma, and those who had emergency health care visits had a greater chance of having uncontrolled asthma.

Gastroesophageal reflux disease (GERD) is associated with different pulmonary diseases, including chronic obstructive pulmonary disease (COPD). Whether GERD is contributory to COPD severity remains unclear. This study aims to evaluate the contribution of GERD to the clinical manifestation of COPD based on ventilatory parameters and yearly clinical exacerbations. We studied 48 patients (56% females, age 66 years) with COPD. All patients underwent high-resolution manometry and esophageal pH monitoring. The patients were separated into two groups according to the presence of GERD. GERD was present in 21 (44%) patients. GERD + and GERD – groups did not differ in regard to gender, age, and body mass index. Pulmonary parameters were not different in the absence or presence of GERD. The number of yearly exacerbations was higher in patients GERD1. The severity of GERD (as measured by DeMeester score) correlated with the number of exacerbations. Our results show the following: 1) GERD does not influence pulmonary parameters and 2) GERD is associated with a higher number of annual clinical exacerbations. We believe GERD must be objectively tested in patients with COPD because the prevalence of GERD in these patients is underestimated when only symptoms are considered. GERD treatment might decrease the frequency of episodes of exacerbation.

BACKGROUND: The Glittre activities of daily living (ADL) test is supposed to evaluate the functional capacity of COPD patients. The physiological requirements of the test and the time taken to perform it by COPD patients in different disease stages are not well known. The objective of this work was to compare the metabolic, ventilatory, and cardiac requirements and the time taken to carry out the Glittre ADL test by COPD subjects with mild, moderate, and severe disease. METHODS: Spirometry, Medical Research Council questionnaire, cardiopulmonary exercise test, and 2 Glittre ADL tests were evaluated in 62 COPD subjects. Oxygen uptake (VO2), carbon dioxide production, pulmonary ventilation, breathing frequency, heart rate, SpO2, and dyspnea were analyzed before and at the end of the tests. Maximum voluntary ventilation, Glittre peak VO2/cardiopulmonary exercise test (CPET) peak VO2, Glittre VE/maximum voluntary ventilation, and Glittre peak heart rate/CPET peak heart rate ratios were calculated to analyze their reserves. RESULTS: Subjects carried out the Glittre ADL test with similar absolute metabolic, ventilatory, and cardiac requirements. Ventilatory reserve decreased progressively from mild to severe COPD subjects (P CONCLUSIONS: As the degree of air-flow obstruction progresses, the COPD subjects present significant lower ventilatory reserve to perform the Glittre ADL test. In addition, metabolic and cardiac reserves may differentiate the severe subjects. These variables may be better measures to differentiate functional performance than Glittre ADL time.

Purpose Patients with chronic obstructive pulmonary disease (COPD) have body balance deficits, with consequent fall risk. It is possible that body sway in patients with COPD affects their ability to perform daily activities. The purpose of this study was to determine whether body balance is similar in patients with COPD and healthy persons when performing static and dynamic activities. In addition, we wanted to assess whether impairment of balance is related to the presence of falls in patients with COPD. Methods This is a cross-sectional study, in which every spirometric classification in patients with COPD (mild, moderate, severe, and very severe degrees) and age-matched healthy subjects was assessed. Subjects who were current smokers and patients who underwent physical training in the last 6 months prior to the start of the study were excluded. Static balance was assessed by computerized posturography and dynamic body balance using the Berg Balance Scale. Results Ninety-three patients with COPD and 39 healthy persons were evaluated. Mean age was 67.3 (10.8) and 65.1 (9.7) years and mean forced expiratory volume in 1 second (FEV1) was 50.4 (19.0) and 89.2 (23.6) for patients with COPD and healthy individuals, respectively. The impairment of body balance was higher for the group of patients with COPD (P = .0005). Patients with greater impairment in body balance had greater incidence of falls, and body balance was more affected with age in patients with COPD than in healthy persons. Conclusion Impairment of body balance is more frequent in patients with COPD than in healthy persons while performing dynamic activities, and a greater incidence of falls activities was also found for this group.

The Glittre ADL-test is based on important and common activities of daily living (ADLs), and it is an useful test to objectively distinguish patients with and without self-reported functional limitations. This study aims to analyze if difficulty to perform ADLs, as self-reported by patients with COPD, would reflect a worse Glittre ADL-test performance. In the first visit, patients were evaluated for clinical and nutritional status, spirometry, maximal cardiopulmonary exercise test on a treadmill. One week later, the patients performed two Glittre ADL-tests. Maximal voluntary ventilation (MVV) and the VE

Oxygen therapy is essential in clinical practice and should be correctly adjusted to avoid deleterious effects resulting from lack or excess of gas. Objective: To evaluate the accuracy and precision of neonatal and pediatric oxygen flowmeters. Methods: 160 oxygen flowmeters from six different countries were divided into two groups: 100 neonatal flowmeters (range from 0 to 1L/min and from 0 to 3.5 L/min), tested on following flows 0.1, 0.3, 0.5, 1L/min and 0.5, 1, 1.5, 2 L/min respectively and 60 pediatric flowmeters (range from 0 to 5 L/min and from 0 to 8L/min), tested on following flows 0.5, 1, 3 and 5 L/min. Flowmeters were evaluated from one single oxygen system outlet containing a reduction valve and connected to it, a flow analyzer. All measures were set to zero before the oxygen flow starts and the flowmeter central metal sphere was positioned at corresponding mark of preset flow value. After 30 seconds the measured flow was read on the flow analyzer. Three measurements were performed in each flow. Flowmeter was considered accurate when the variation among three measures was not exceed 10% variation and it was considered precise with no more than 10% difference among the three repeated measures (1stvs2nd, 1stvs3rd, 2ndvs3rd). Results: There was a significant difference among the measurements from different flowmeters (p Conclusion: Flowmeters from different countries presented low accuracy and high precision.

Oxygen flowmeter is an equipment used to control oxygen flow delivery in patients undergoing oxygen therapy. Objective: To evaluate accuracy and precision of oxygen flowmeters used in adult care. Methods:In vitro experimental study that evaluated 160 oxygen flowmeters (Flow range 0 to 15L/min), without previous use, manufactured in eight different countries (Australia, Brazil, Canada, China, England, France, Italy and United States of America). Flowmeters were tested at four flow rates, 1, 3, 5 and 10 L/min, with three repeated measurements in each flow. During the tests, the flowmeters were connected to the gas system through a reduction valve and a flow analyzer (FlowAnalyzer™ PF-302; Imtmedical Ag. Buchs Switzerland). The float (metal sphere) of the flowmeter was set to zero and then was kept at the corresponding mark of the flow to be tested. Was considered accurate flowmeter that maintained the three measurements within a ±10% variation, and precise, flowmeter that present no difference greater than 10% among repeated measurements (1st vs 2nd, 1st vs 3rd, 2nd vs 3rd). Results: The accuracy percentage in the low-flows (1 and 3L/min) was significantly lower than in the high-flows (5 and 10L/min). Flowmeters samples showed high precision in all tested flows (65 to 100%), specially at flows rate 5 and 10L/min (100%). None of the set of the flowmeters met the ideal expectation of 100% combined of accuracy and precision flows in all four tested. Conclusion: None of the eight different countries samples presented accurate and precision for all four tested flows. The flowmeters precision percentage was high despite their low accuracy.

Introduction: Chronic thromboembolic hypertension (CTEPH) patients present decreased aerobic capacity during cardiopulmonary exercise test (CPET) with lower limbs (LL). It is not known if CTEPH patients present the same decreased aerobic capacity during upper limbs (UL) test. Objective: To investigate the response of a UL maximal test on cycloergometer in CTEPH patients and control group and compare to a CPET. Methods: The cross-sectional study including 33 CTEPH patients (54.5% male, 46.5 ± 14.2 years, 33% NYHA FC III and IV) and 22 controls (40.9% male, 39.8 ± 10.9 years). All patients underwent a UL and LL CPET cycloergometer measuring ventilation and gas exchange at peak exercise. Results: The oxygen consuption (VO2) of a UL maximal test of CTEPH patients (815.9 ± 212.7 mL/min) was lower than controls (1066.8 ± 340.2 mL/min) (p=0.004) and corresponded to 76% of the control group. The UL VO2 of CTEPH patients corresponded to 86% of their VO2max in a CPET and to 68% in the control group (p Conclusion: The aerobic capacity of UL in CTEPH patients is lower than a matched sex and age control group and worse physiological responses were observed in the CTEPH patients.

Fractures are common in individuals with COPD and occur at higher bone mass values than expected. COPD appears to be an important risk factor for bone fragility. Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis and fractures, but screening and prophylactic measures to prevent both disorders are often neglected in this population. This case-control study assessed the prevalence of osteopenia, osteoporosis, and fractures in patients with COPD, and identified potential risk factors for fractures in this population. Overall, 91 patients with COPD (COPD group; COPDG) and 81 age- and sex-matched controls (control group; CG) were assessed with bone mineral density (BMD), thoracic/lumbar spine radiographs, and serum PTH and 25-hydroxyvitamin D (25[OH]D) levels. The occurrence of prior fractures was retrieved from clinical history. The prevalence of total fractures in the COPDG was 57.1% (odds of fracture 4.7 times greater compared with the CG), and the femoral neck T-score emerged as the best predictor of fractures. Compared with the CG, the COPDG had lower spine and femoral BMD (p ≤ 0.01) and 25(OH)D levels (p = 0.01) and 2.6 times greater odds of osteoporosis. Among men, vertebral fractures were more prevalent in the COPDG versus CG (25.9% vs. 6.5%, respectively, p = 0.01). The odds of fracture increased with femoral neck T-scores ≤ − 2.7 in the CG and ≤ − 0.6 in the COPDG. These results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder.

Although the internet is an important tool for entertainment, work, learning, shopping, and communication, it is also a possible source for information on health and disease. The aim of this study was to evaluate the proportion of subjects with COPD in São Paulo, Brazil, who use the internet to obtain information about their disease.Subjects (N = 382) with COPD answered a 17-question survey, including information regarding computer use, internet access, and searching for sites on COPD. Our sample was distributed according to the socioeconomic levels of the Brazilian population (low, 17.8%; medium, 66.5%; and high, 15.7%).Most of the subjects in the sample were male (62.6%), with a mean age of 67.0 ± 9.9 y. According to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, 74.3% of the subjects were in stage II or III. In addition, 51.6% of the subjects had a computer, 49.7% accessed the internet, and 13.9% used it to search for information about COPD. The internet was predominantly accessed by male (70.3%) and younger (64.6 ± 9.5 y of age) subjects compared with female (29.7%, P = .04) and older (67.5 ± 9.6 y of age, P.007) subjects. Searching for information about COPD on the internet was associated with having a computer (5.9-fold), Medical Research Council dyspnea level 1 (5.3-fold), and high social class (8.4-fold). The search for information on COPD was not influenced by GOLD staging.A low percentage of subjects with COPD in São Paulo use the internet as a tool to obtain information about their disease. This search is associated with having a computer, low dyspnea score, and high socioeconomic level.

Resumen Introduccion Evaluar si la asociacion entre el indice BODE y el deterioro de la calidad relacionada con la salud de la vida es lineal para determinar las posibles asociaciones entre el indice BODE y el estado de salud evaluadas por el Saint George's Respiratory Questionnaire (SGRQ) en todos los niveles de gravedad de la enfermedad en la EPOC. Metodos Un estudio transversal se llevo a cabo en 253 pacientes de 2 centros latinoamericanos respiratorias (Brasil y Chile) con un diagnostico clinico de la EPOC, con base en criterios GOLD. La evaluacion incluyo el indice BODE y el cuestionario SGRQ. Resultados Los pacientes tenian un indice BODE de 3,1 ± 2,0; FEV1 (%) de 49 ± 19,2; IMC (kg/m2) de 24,7 ± 5,1; 6MWT distancia (metros) de 444 ± 96. Se encontraron correlaciones significativas entre las puntuaciones del indice BODE y SGRQ total (r = 0,5; Conclusion Existe una asociacion entre la calidad relacionada con la salud de la vida, segun la evaluacion del SGRQ y el indice BODE dentro de todo el espectro de gravedad de la EPOC. Incluso en bajos estadios de la enfermedad y con el indice BODE en cero, la calidad relacionada con la salud de la vida ya se ha deteriorado.

Patients with chronic obstructive pulmonary disease (COPD) usually complain of symptoms such as cough, sputum, wheezing, and dyspnea. Little is known about clinical symptoms in individuals with restrictive ventilatory impairment. The aim of this study was to compare the prevalence and type of respiratory symptoms in patients with COPD to those reported by individuals with restrictive ventilatory impairment in the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study. Between 2002 and 2004, individuals ≥40 years of age from five cities in Latin America performed pre and post-bronchodilator spirometry and had their respiratory symptoms recorded in a standardized questionnaire. Among the 5315 individuals evaluated, 260 (5.1%) had a restrictive spirometric diagnosis (forced vital capacity (FVC) < lower limit of normal (LLN) with forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≥ LLN; American Thoracic Society (ATS)/European Respiratory Society (ERS) 2005) and 610 (11.9%) were diagnosed with an obstructive pattern (FEV1/FVC < LLN; ATS/ERS 2005). Patients with mild restriction wheezed more ((30.8%) vs. (17.8%); p < 0.028). No difference was seen in dyspnea, cough, and sputum between the two groups after adjusting for severity stage. The health status scores for the short form 12 questionnaire were similar in restricted and obstructed patients for both physical (48.4 ± 9.4 vs. 48.3 ± 9.8) and mental (50.8 ± 10.6 vs. 50.0 ± 11.5) domains. Overall, respiratory symptoms are not frequently reported by patients with restricted and obstructed patterns as defined by spirometry. Wheezing was more frequent in patients with restricted pattern compared with those with obstructive ventilatory defect. However, the prevalence of cough, sputum production, and dyspnea are not different between the two groups when adjusted by the same severity stage.

Objective: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). Methods: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. Results: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p < 0.001); "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). Conclusions: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance. Objetivo: Avaliar o impacto da asma em pacientes segundo as faixas etárias de 12-17 anos, 18-40 anos e ≥ 41 anos no Brasil. Métodos: Os dados de 400 pacientes com asma diagnosticada por um médico e residentes de quatro capitais estaduais brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) foram obtidos em um inquérito realizado em países da América Latina em 2011. Os dados foram coletados por meio de um questionário padronizado em entrevista presencial com os pacientes ou com os pais/responsáveis daqueles < 18 anos. As questões abordavam controle da asma, número de hospitalizações, número de consultas de urgência, absenteísmo na escola/trabalho e impactos da asma na qualidade de vida, sono e lazer. Os dados foram estratificados pelas faixas etárias selecionadas. Resultados: Em comparação com os grupos de pacientes adultos, houve uma proporção significativamente maior no grupo 12-17 anos em relação a ter ao menos um episódio de asma grave que impediu o paciente a continuar a jogar ou a se exercitar nos últimos 12 meses (p = 0,012), absenteísmo escolar/trabalho nos últimos 12 meses (p < 0,001), e interrupção de medicação para controle ou prevenção da asma nos últimos 12 meses (p = 0,008). Além disso, 30,2% dos pacientes na faixa etária 12-17 anos relataram que esforços físicos normais eram atividades muito limitantes (p = 0,010 vs. outros grupos), enquanto 14% dos pacientes do grupo ≥ 41 anos descreveram as atividades sociais como muito limitantes (p = 0,011 vs. outros grupos). Conclusões: Nessa amostra, o impacto da asma foi maior nos pacientes com idade entre 12 e 17 anos do que nos adultos, e isso pode ser atribuído à baixa aderência ao tratamento.

OBJECTIVE: To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil. METHODS: We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication. RESULTS: Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men. CONCLUSIONS: Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life. OBJETIVO: Avaliar o impacto da asma em relação ao sexo em uma amostra populacional de pacientes asmáticos no Brasil. MÉTODOS: Foram entrevistados pessoalmente 400 pacientes asmáticos com idade > 12 anos de uma amostra probabilística nacional por contato telefônico nas cidades de São Paulo, Rio de Janeiro, Curitiba e Salvador. Os indivíduos responderam um questionário de 53 questões relacionadas com cinco domínios da asma: sintomas; impacto da asma na vida; percepção do controle da asma; exacerbações; tratamento e medicação. RESULTADOS: Dos 400 pacientes entrevistados, 272 (68%) eram do sexo feminino. Em relação aos sintomas respiratórios, uma maior proporção de mulheres relatou se sentir extremamente incomodada com seus sintomas (tosse com secreção, sensação de aperto no peito, tosse/falta de ar/sensação de aperto no peito durante exercícios, falta de ar noturna e tosse noturna) do que os homens. Sintomas diurnos, como tosse, falta de ar, chiado e sensação de aperto no peito, foram mais comuns nas mulheres que nos homens. Além disso, a asma interferiu mais frequentemente nos esforços físicos normais, atividades sociais, durante o sono e na vida em geral nas mulheres. Sobre o impacto da asma na qualidade de vida, as mulheres relataram mais frequentemente que os homens que a asma causava uma sensação de falta de controle sobre a própria vida e que eram afetadas na forma como se sentiam em relação a si mesmas. CONCLUSÕES: As mulheres asmáticas apresentam mais sintomas e são mais afetadas em suas atividades diárias e qualidade de vida.

Functional status and quality of life are measures of the chronic obstructive pulmonary disease (COPD) patient’s health status and can demonstrate the impact of the disease on the patient’s ability to perform activities of daily living (ADLs). The Glittre-ADL test was developed to evaluate the functional status of COPD patients and their ability to perform activities of daily life. The objective of this study was to evaluate the cardiac, respiratory, and metabolic adjustments and reproducibility of the Glittre ADL test performed by COPD patients. Twenty-two mild to severe COPD patients (forced expiratory volume in 1 second (FEV1): 56.6 ± 19.9% predicted; mean age: 66.3 ± 9.18 years old) were enrolled in this study. Metabolic (oxygen uptake (VO2), carbon dioxide production (VCO2), pulmonary ventilation (VE)/VCO2, and VE/VO2), ventilatory (tidal volume, respiratory rate, and VE), and cardiovascular (pulse oxygen saturation, VO2/heart rate (HR), and HR) variables, lower limbs fatigue, and dyspnea (Borg score) after each lap of two Glittre ADL test were analyzed. All metabolic, ventilatory, and cardiac variables increased their values up to the third lap and remained stable (plateau) until the end of the test (five laps; multivariate analysis); there was no difference among the time spent to complete each of the five laps in each test and between tests (total time of second test: 4 minutes and 3 seconds); the second test was 17.8 seconds (6.6%) shorter than the first one (NS). All variables were highly reproducible in the two tests (NS). At the end of the test, patients reached 87.7% of the VO2 max, 81% of VE peak, and 88.5% of the HR peak obtained from an incremental maximal test on a treadmill. The Glittre ADL test is easy for COPD patients to perform and is a highly reproducible test in COPD patients with mild to severe stages of the disease. In addition, our results suggest that it is possible to demonstrate the patient’s functional capacity with a single test of only three laps, making it faster and easier to apply and less stressful for some patients.

The aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test.Twenty-nine subjects with COPD (FEV1 = 62.4 ± 10.7% of predicted, 62.4 ± 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. The control group included 15 subjects (FEV1 = 54 ± 26.2% of predicted, 65.3 ± 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. The home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise.The 2 groups were similar regarding age, FEV1, and FVC. The home-based pulmonary rehabilitation group increased by 65 m in the 6MWT (P.05) and 316.6 ± 81.8 m in the endurance test (P.05) and decreased by4 units in all SGRQ domains. The control group showed no difference in any variable.This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.

Salivary osmolality reflects the hydration status of individuals with cerebral palsy necessary for adequate unstimulated salivary flow rate. Aim: To investigate whether oral motor performance is determinant for the hydration status and the effect of a supplemental oral fluid supply on salivary osmolality. Methods: The sample consisted of 99 children with cerebral palsy aged 6 to 13 years old. In this study, children participated in 2-day evaluations: 1st day - baseline: saliva collection, caries experience and oral motor performance evaluations; and 2nd day: saliva collection after supplemental fluid supply. Prior to each evaluation, the participants were trained for saliva collection. Unstimulated whole saliva was collected using cotton roll at baseline, with the amount of fluid usually offered by caregivers, and 48 h after baseline, with as much as twice the normal daily fluid intake previously offered. Salivary osmolality was measured using a freezing point depression osmometer. Caries experience index for decayed, missed and filled teeth (DMFT) was evaluated. According to the Oral Motor Assessment Scale, the children were classified into subfunctional or functional groups. Chi-square, Student’s t test and Pearson’s correlation coefficient were used. Results: The subfunctional group presented a higher percentage of quadriplegic children (p

OBJETIVO:Determinar a taxa de subdiagnóstico em novos casos de DPOC em uma amostra de pacientes após nove anos de seguimento do estudo Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO) e compará-la à taxa de subdiagnóstico obtida na fase inicial do estudo, assim como identificar as características clínicas dos indivíduos subdiagnosticados na fase de seguimento.MÉTODOS:A população desse estudo foi composta por 1.000 residentes na cidade de São Paulo que fizeram parte do estudo PLATINO. Desses, 613 indivíduos participaram da fase de seguimento. Os indivíduos foram avaliados utilizando-se os mesmos instrumentos e equipamentos na fase inicial do estudo. O teste do qui-quadrado ou o teste t para amostras independentes foi utilizado para analisar a taxa de subdiagnóstico e identificar as características dos indivíduos subdiagnosticados durante a fase de seguimento.RESULTADOS:A taxa de subdiagnóstico para novos casos da DPOC após nove anos de acompanhamento foi de 70,0%. A taxa de subdiagnóstico na fase de seguimento foi 17,5% menor que a da fase inicial do estudo. Os indivíduos subdiagnosticados na fase de seguimento apresentavam poucos sintomas respiratórios, função pulmonar mais preservada e menor gravidade da doença do que aqueles previamente diagnosticados com DPOC.CONCLUSÕES:A taxa de subdiagnóstico na fase de seguimento foi menor que a da fase inicial do estudo. Os indivíduos subdiagnosticados na fase de seguimento do estudo PLATINO apresentavam o mesmo perfil clínico daqueles subdiagnosticados na fase inicial. Esses achados reforçam a necessidade da utilização da espirometria para o diagnóstico de DPOC e possibilitar a intervenção precoce. OBJECTIVE:To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase.METHODS:The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase.RESULTS:The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD.CONCLUSIONS:The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention. Federal University of São Paulo Sao Camilo University Center Department of Physical Therapy Federal University of São Paulo Department of Pulmonology Instituto Nacional de Enfermedades Respiratorias Federal University of Pelotas School of Medicine Department of Clinical Medicine UNIFESP, Department of Pulmonology SciELO

Introduction: Compared to IPAH, patients with CTEPH have greater abnormalities in gas exchange and ventilatory responses during maximum exercise test. Thus, it is possible that these patients have a higher limitation to perform activities of daily living (ADL). Objective: To compare energy expenditure and pathophysiological responses during the simulation of activities of daily living in patients with CTEPH and IPAH. Methods: Cross-sectional study including 9 patients with CTEPH (49±11.8yrs, 66.7% male, 55.6% NYHA FC II and III) and 12 with IPAH (37.4±9.4yrs, 38.5% male, 46.2% NYHA FC II and III). All patients underwent simulation of 10 ADLs with use of Oxycom Mobile device. The oxygen consumption (VO 2 ) during ADL was analyzed in absolute value and as a percentage of Peak VO 2 in incremental exercise test. Results: Patients with CTEPH presented higher VO 2 for walking with 2.5 kg in both hands for 5 minutes (100 ± 16.7% vs 83.2 ± 16.8%, p = 0.03) and walking with 5kg in one hand for another 5 minutes (105.9 ± 18.2% vs 89.8 ± 13.9%, p = 0.042). In both groups, many of ADLs were performed above the anaerobic threshold and very close to their peak aerobic capacity. There was a higher degree of dessaturation and increased VE/VCO 2 in patients with CTEPH. Conclusion: Patients with CTEPH have higher desaturation and excessive ventilatory responses while performing ADL, compared to patients with IPAH.

Summary Objective: To evaluate the sponsored centers for clinical trial in the respiratory care setting in Brazil: profile; logistics and structure. Methods: Principal investigators (29) and subinvestigators (30) of 39 research centers completed the questionnaires that addressed personal identification and training of researchers, the centers' facilities and advantages and/or disadvantages of performing sponsored trials. Results: 75.6% of the centers were located in southern and southeastern Brazil. Most principal investigators were men with a mean age of 53.4 years. The clinical trials in the respiratory care setting focus on asthma and chronic obstructive pulmonar disease (COPD). 80% of the researchers cited delay of the Conep and Anvisa as a barrier to performing research. The advantages of participating in clinical trials were updating knowledge of the researcher and the team, and additional income for the team. The main disadvantages mentioned by the researchers included low financial compensation for the performed workload, and time availability. The median number of professionals per research center was six people, predominantly physicians. Conclusion: The number of research centers in the respiratory care setting in Brazil is still relatively small. The teams have good training for performing the clinical trials. Asthma and COPD are the most studied diseases in sponsored clinical trials. The main barrier is delay by the Conep and Anvisa. The factors that lead investigators to participate range from being updated along with the team, to site and staff financial issues; the main disadvantage is the low compensation for the required workload demand. Resumo Objetivo: avaliar nos centros de pesquisas clínicas patrocinadas na área respiratória no Brasil o perfil, a logística e a estrutura. Método: questionários foram respondidos por pesquisadores principais (29) e subinvestigadores (30) de 39 centros de pesquisa relativos a identificação e formação dos pesquisadores, instalações dos centros e vantagens e desvantagens quanto à participação nas pesquisas patrocinadas. Resultados: setenta e cinco por cento (75,6%) dos centros se localizavam nas regiões Sul e Sudeste do Brasil. A maioria dos investigadores principais eram homens com média de idade de 53,4 anos. As pesquisas na área respiratória se concentravam no estudo da asma e da doença pulmonar obstrutiva crônica (DPOC). Oitenta por cento dos pesquisadores citaram a demora na Comissão Nacional de Ética em Pesquisa (Conep) e na Agência Nacional de Vigilância Sanitária (Anvisa) como fator de entrave para a realização das pesquisas. As vantagens em participar das pesquisas clínicas foram a atualização própria ou da equipe envolvida, com rendimento adicional para a equipe. A principal desvantagem apontada pelos pesquisadores foi a baixa compensação financeira em relação ao volume de trabalho e disponibilidade de tempo. A mediana de profissionais por centro de pesquisa foi de seis pessoas, com predominância de médicos. Conclusão: o número de centros na área respiratória no Brasil ainda é relativamente pequeno. As equipes apresentam boa formação para a realização das pesquisas. Asma e DPOC são as doenças mais estudadas pelas pesquisas clínicas patrocinadas. O principal entrave é a demora da Conep e da Anvisa. Os fatores que levam os investigadores a participarem variam desde atualização própria/equipe até questões financeiras para a equipe e o centro; a principal desvantagem relatada é a baixa remuneração diante da demanda de trabalho exigida.

OBJETIVO: Adaptar culturalmente e avaliar a reprodutibilidade da Wisconsin Smoking Withdrawal Scale (WSWS) para o português do Brasil. MÉTODOS: Foi realizada a tradução da versão original em língua inglesa para o português. A versão traduzida foi aplicada em 8 voluntários fumantes para a adaptação cultural. Após ajustes, a versão da WSWS foi submetida à tradução retrógrada do português para o inglês. A versão em português do Brasil foi considerada adequada. Para a avaliação da reprodutibilidade, a escala foi aplicada em 75 fumantes em dois momentos, com intervalo de 30 minutos (reprodutibilidade interobservador) e, num terceiro momento, após 15 dias (reprodutibilidade intraobservador). Utilizou-se o coeficiente de correlação intraclasse (CCI) para testar a concordância entre as respostas. O nível de significância adotado foi p < 0,05. RESULTADOS: Dos 75 voluntários, 43 (57,3%) eram do gênero feminino. A média geral de idade foi 46,3 anos. A reprodutibilidade interobservador e intraobservador foi determinada para cada um dos sete domínios da WSWS, com CCI variando de, respectivamente, 0,87 a 0,94 e de 0,76 a 0,92. O tempo médio de resposta da WSWS foi 6 min e 44 s, e o tempo de resposta para cada questão variou de 4,2 a 12,6 s. CONCLUSÕES: A versão da WSWS para o português do Brasil é reprodutível, de aplicação rápida e simples, podendo ser utilizada como um instrumento de avaliação da gravidade dos sintomas da síndrome da abstinência à nicotina. OBJECTIVE: To cross-culturally adapt the Wisconsin Smoking Withdrawal Scale (WSWS) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. METHODS: The original English version of the WSWS was translated into Brazilian Portuguese. For cross-cultural adaptation, the Brazilian Portuguese-language version of the WSWS was administered to eight volunteers, all of whom were smokers. After adjustments had been made, the WSWS version was back-translated into English. The Brazilian Portuguese-language version was thereby found to be accurate. The final Brazilian Portuguese-language version of the WSWS was applied to 75 smokers at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. Intraclass correlation coefficients (ICCs) were used in order to test the concordance of the answers. The significance level was set at p < 0.05. RESULTS: Of the 75 volunteers, 43 (57.3%) were female. The overall mean age was 46.3 years. Interobserver and intraobserver reproducibility was determined for each of the WSWS seven domains, the ICCs for which ranged from 0.87 to 0.94 and from 0.76 to 0.92, respectively. The mean time to completion of the WSWS was 6 min and 44 s, and the response time per question ranged from 4.2 to 12.6 s. CONCLUSIONS: The Brazilian Portuguese-language version of the WSWS is reproducible, fast, and simple. It can therefore be used as a tool for assessing the severity of the symptoms of nicotine withdrawal syndrome.

Rationale Measures as height, age, and weight influence the six-minute walk test (6MWT). It was shown that children's true leg length (TLL) influence the 6MWT distance but so far it has never been evaluated how much this variable could predict the distance walked related to height. Our hypothesis is that there should not have any significant difference between models including height or TLL. Objective To establish and to compare the predicted walked distance of healthy children in the 6MWT by two distinct models, one including TLL and other including height. Methods Observational cross sectional study. A total of 161 healthy children (84 girls, 52.2%), 6–13 years old from three local primary and secondary schools. Two 6MWT were performed following ATS guidelines. Weight, height, and TLL were measured. The longer walked distance was selected for statistical analysis. Results Anthropometric data were similar for both genders into each group of age. Mean (±SD) walked distances in whole group were: boys 704.4 m (77.7); girls 681.6 m (67.9; P = 0.049). In the univariate regression to predict the distance walked, the adjusted coefficients to TLL and height were in boys: 0.46 and 0.39; and in girls: 0.35 and 0.29, respectively. After adjusting for age and weight, the residuals of the two equations were not significantly different (P = 0.998). Conclusion The model including TLL to predict the walked distance by healthy children explained more of the variation on the walked distance in the 6MWT than the model using the height but without significant difference between the models. Pediatr Pulmonol. 2013; 48:921–926. © 2012 Wiley Periodicals, Inc.

BACKGROUND: Oxygen therapy is an important therapeutic resource for patients with hypoxemia. When changing oxygen flow meters, we have observed that sometimes, even with the same oxygen flow setting as before, a different SpO2 is obtained. OBJECTIVE: To analyze the precision and accuracy of flow meters used in hospital settings. METHODS: An experimental study was performed to test oxygen flow meters from a tertiary hospital, by using a calibrated flow analyzer. Used and new flow meter accuracy was tested by reading in the gas analyzer a single measurement at flow rates of 1, 3, 5, and 10 L/min in 91 flow meters, and they were compared using the Student t test or Mann-Whitney U test. Flow meter precision was tested by reading in the flow analyzer 3 repetitive measurements set at flow rates of 1, 3, 5, and 10 L/min in 11 flow meters, and the reproducibility of these measurements was conducted by using the intraclass correlation coefficient and the Friedman test. RESULTS: The mean measured flow rates were slightly lower than the stipulated flow rate at 1 L/min, very close for 3 L/min, and higher for the 5 and 10 L/min flow rates. There was a large variability among the measurements from different flow meters, mainly at low flow rates (1 and 3 L/min). There was no difference between new and used flow meters at the flow rates measured, except at 10 L/min. Flow meters precision analysis showed a good reproducibility in 3 repetitive measurements for each flow rate (minimum 0.95, maximum 0.99 intraclass correlations). CONCLUSIONS: The flow meters tested showed good precision and poor accuracy.

OBJECTIVE: To translate the Breathing Problems Questionnaire (BPQ) into Portuguese and adapt it to the Brazilian culture, as well as to evaluate its reproducibility in patients with COPD. METHODS: After the BPQ had been translated and adapted to the Brazilian culture, it was administered to a subgroup of 8 patients in order to identify their uncertainties and difficulties. The questionnaire was reviewed by an expert committee, and its final version was arrived at. A second translator back-translated the final version into English, which was sent to the original author in order to verify that the original meaning of the questionnaire had been maintained. After the approval of the original author, the final Portuguese-language version of the questionnaire was administered to 50 patients with COPD, in order to evaluate its reproducibility. RESULTS: The mean response time was 9.5 min. Of the 50 patients, 21 were female and 29 were male. The mean age was 65.8 ± 7.5 years. Most of the patients were classified as having moderate COPD (29.16%) or severe COPD (52%). The intraclass correlation coefficient (ICC) for the total score was 0.94. The ICCs for the eleven BPQ domains and its two subscales were also above 0.70. Moderate correlations were found between the BPQ domains and subscales. CONCLUSIONS: The translation and cultural adaptation of the BPQ for use in Brazil was deemed appropriate, because the patients could easily understand and answer the questions. In addition, the Brazilian version of the BPQ questionnaire was found to be reliable, showing good reproducibility.

Objetivo El objetivo de este estudio fue verificar la reproducibilidad por parte de dos observadores diferentes de un metodo de analisis de las mediciones del desplazamiento del diafragma con el empleo de una visualizacion directa con videofluoroscopia. Pacientes y metodos Se estudio a 29 ninos de ambos sexos y de entre 5 y 12 anos, con respiracion oral. La evaluacion del desplazamiento del diafragma se dividio en tres partes: videofluoroscopia con grabacion mediante VHS en las posiciones de bipedestacion, sedestacion y decubito supino; digitalizacion de las imagenes; y medicion de la distancia entre las cupulas diafragmaticas durante un ciclo de respiracion, con el empleo de los programas informaticos Adobe Photoshop 5.5 y Adobe Premiere PRO 6.5. Resultados Los coeficientes de correlacion intraclase mostraron una excelente reproducibilidad en todas las posturas, con valores de los coeficientes situados siempre por encima de 0,94. La media de las mediciones del desplazamiento de las cupulas diafragmaticas realizadas por dos observadores fue similar (p

Objective The purpose of this study was to verify the reproducibility between two different observers of an analysis method for diaphragmatic displacement measurements using direct visualization with videofluoroscopy. Patients and methods 29 mouth breathing children aged 5–12 years from both genders were analyzed. The diaphragmatic displacement evaluation was divided in three parts: videofluoroscopy with VHS recording in standing, sitting, and dorsal positions; digitalization of the images; and measurement of the distance between diaphragmatic domes during a breathing cycle using Adobe Photoshop 5.5 and Adobe Premiere PRO 6.5 software. Results The intraclass correlation coefficients presented excellent reproducibility in all positions, with coefficients always above 0.94. Mean of the measurements of the diaphagramatic domes displacement done by the two observers were similar (P Conclusion This study demonstrated that the evaluation of diaphragmatic displacement via videofluoroscopy is a reproducible measurement when two trained investigators are compared. This fact indicates that the present technique can be disseminated and performed by other healthcare professionals.

To evaluate the oxidative stress and the C-reactive protein (CRP) in chronic obstructive pulmonary disease (COPD) patients and their correlation between the severity of the disease according to GOLD criteria and multidimensional indexes such as BODE index. A blood sample was collected for thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), catalase, glutathione (GSH), homocysteine (HCY) and CRP analysis from 45 stable COPD patients. Lung function, body nutritional status, dyspnea and 6-min walk test (6MWT) were evaluated. Patients with GOLD stage IV presented a higher value for the TBARS than stage I patients (4.47 + 1.58 versus 2.27 + 1.04 nmol/mL, p < 0.05). CRP was higher for GOLD IV (2.46 + 3.68 mg/dL) than other stages (GOLD I: 0.39 + 0.25, GOLD II: 0.39 + 0.18 and GOLD III: 0.48 + 0.36 mg/dL, p < 0.05). Oxidative stress markers measured as TBARS presented a negative correlation between forced expiratory volume in the first second (FEV1) post bronchodilatador (% predicted; r = -0.39, p = 0.01) and positive correlations with Modified Medical Research Council Scale (MMRC) dyspnea index (r = 0.40, p = 0.01), multidimensional index (r = 0.49, p = 0.001) and BODE index (r = 0.51, p = 0.001).

J Oral Pathol Med (2011) 40: 582–586 Background: Unstimulated whole salivary parameters have been identified as potential markers of hydration status. Reduced salivary flow rate and increased salivary osmolality have been shown to be useful to identify dehydration, even when minimal loss of body water occurs. This study aimed to evaluate whether unstimulated salivary flow rate and salivary osmolality from individuals with cerebral palsy correlate with plasma and urine osmolality. Methods: Thirty-five male and female children, aged 9–13 years old, diagnosed with cerebral palsy were compared to 27 nondisabled children (10–12 years old). Unstimulated whole saliva was collected under slight suction and salivary flow rate (ml/min) was calculated. Plasma without venostasis and urine were also collected. Salivary, plasma and urine osmolality were measured using a freezing point depression osmometer. Results: Cerebral palsy children presented a reduction in salivary flow rate (50%) compared to the control group (P

Resumen Introduccion El tabaquismo constituye un grave problema de salud publica en todo el mundo. Los modelos animales actuan como un paso intermedio entre los estudios de laboratorio y los estudios en seres humanos. Los modelos aplicados son dificiles de reproducir debido al uso de diferentes tipos de camaras inhaladoras y principalmente por la falta de una monitorizacion constante de la concentracion del humo del tabaco. Objetivo Desarrollar una camara inhaladora para ratas (con la exposicion exclusiva del hocico) en la que pueda mantenerse y monitorizarse constantemente la cantidad de monoxido de carbono (CO). Material y metodos Se expusieron ratas Wistar macho, de 250 g de peso, a 50 partes por millon de CO producido por el humo del tabaco de un cigarrillo sin filtro. Los animales se sometieron a una exposicion de 2 h y, acto seguido, fueron sacrificados a las 0, a las 4, a las 24 y a las 48 h. El grupo de control se dejo libre dentro de pequenas camaras perpendiculares y solo recibio 5 l/min de aire comprimido. Resultados El modelo fue capaz de aumentar la concentracion de carboxihemoglobina inmediatamente despues del termino de la exposicion (p Conclusion Concluimos que este sistema de camara inhaladora puede mantener una concentracion controlada de CO en un modelo en el que se expone a pequenos animales a la inhalacion de humo de cigarrillos, lo que permite estudios adecuadamente controlados, al igual que investigaciones sobre otros gases toxicos y contaminantes ambientales.

OBJETIVO: Divulgar os dados de um estudo transversal randomizado, realizado em 2001, pelo Centro Brasileiro de Informações sobre Drogas Psicotrópicas. MÉTODOS: A população pesquisada neste levantamento incluiu indivíduos com 12-65 anos de idade, residentes nos 107 maiores municípios do Brasil (com mais de 200 mil habitantes), o que representou 27,7% da população brasileira na época, estimada em 169.799.170 habitantes. Foram realizadas no total 8.589 entrevistas. Utilizou-se o questionário Substance Abuse and Mental Health Services Administration, que foi traduzido e adaptado para o uso no Brasil. RESULTADOS: Do total, 41,1% dos entrevistados disseram já ter utilizado produtos derivados de tabaco alguma vez na vida. A prevalência de uso diário de tabaco foi de 17,4% da amostra (20,3% entre os homens e 14,8% entre as mulheres). Observou-se que 9% da população (10,1% entre os homens e 7,9% entre as mulheres) são dependentes da nicotina, segundo os critérios do National Household Surveys on Drug Abuse. CONCLUSÕES: A prevalência do uso diário de tabaco, nos maiores municípios brasileiros, é significativamente menor na presente década do que a prevalência nacional ao final do século passado.

The process of discontinuing neurological patients from mechanical ventilation is still controversial. The aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V t ratio. In a cohort prospective study, all consecutive patients who required mechanical ventilation for up to 6 h after elective craniotomy were eligible for inclusion in this study. Patients passing daily screening criteria automatically received a spontaneous breathing trial (SBT). Immediately previous to the extubation, the expired minute volume (VE), breathing frequency (f), and tidal volume (V t) were measured and the breathing frequency-to-tidal volume ratio (f/V t) was calculated; consciousness level based on Glasgow Coma Scale (GCS) was evaluated at the same time. The extubation was considered a failure when patients needed reintubation within 48 h. Ninety-two patients were extubated and failure occurred in 16%. Despite 15 patients failed extubation just one of them presented the f/V t score over 105. The best cutoff value for f/V t observed was 62, but with low specificity (0.53) and negative predictive values (0.29). Area under the ROC curve for the f/V t was 0.69 ± 0.07 (P = 0.02). Patients who failed the extubation process presented higher incidence of pneumonia (80%), higher need for tracheostomy (33%) and mortality rate of 40%. The f/V t ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.

Exercises using the upper limbs hyperinflate COPD patients more than exercises using the lower limbs at the same metabolic demand. E.F. Porto, A.A.M. Castro, M. Velloso, O. Nascimento, F. Dal Maso, J.R. Jardim. Background. Lower and upper body exercise are mandatory constituents of a rehabilitation programme for patients with COPD. However, it is not known how much these exercises may induce pulmonary dynamic hyperin- flation (DH). Objective. To evaluate the DH in patients with COPD exercising the upper and lower parts of the body at the same metabolic demand. Methods. Sixteen patients aged 63 ± 13 years and with a FEV1 of 1.5 ± 0.7 L (41 ± 11% pred) were studied. Pa- tients initially performed a maximal exercise test with the arms using the diagonal movement technique. The lower limbs were exercised on a treadmill at the same metabolic demand. Results. Inspiratory capacity decreased 222 ± 158 ml (9.8%) after the upper body exercise (p < 0.0001) and 148 ± 161 ml (7%) after exercise with the lower body (p = 0.0028) and a difference between the two groups was found (p < 0.05). There was no difference between resting IC before upper and lower limbs exercises (p = 0.8); in- crease in minute ventilation and in pulmonary ventilation in percentage of maximum voluntary ventilation and re- duction of expiratory time were larger in the upper limbs exercise (p < 0.05). Dyspnea as measured by the Borg Scale was higher in the upper body (3.9 ± 2.2) than in the lower body (2.3 ± 1.3) at the end of the exercise (p = 0.033). Pul- monary ventilation and inspiratory capacity were corre- lated (p = 0.0001; r = 0.82). Conclusion. Exercise with the upper part of the body causes more DH and dyspnea than exercise with the lower part of the body at the same metabolic demand. Monaldi Arch Chest Dis 2009; 71: 1, 21-26.

Objetivo Evaluar las propiedades discriminativas y la validez del cuestionario Airways Questionnaire 20 (AQ20) en un grupo de pacientes con cuadros de obstruccion de la via respiratoria, y comparar sus propiedades con las de los cuestionarios St. George's Respiratory Questionnaire (SGRQ) y Short Form 36 (SF-36). Pacientes y metodos De un grupo de 61 pacientes consecutivos, remitidos a una consulta ambulatoria especializada en enfermedades obstructivas de la via respiratoria, se selecciono una muestra de conveniencia constituida por 47 pacientes. Todos los pacientes completaron los cuestionarios AQ20, SGRQ y SF-36. Otros parametros evaluados fueron el indice de disnea basal, la distancia recorrida en la prueba de la marcha de 6 min, los resultados de la gasometria en sangre arterial y el indice de masa corporal. Resultados El cuestionario AQ20 presento una correlacion estrecha con la puntuacion del SGRQ total (ρ = 0,84; p Conclusiones LOS resultados obtenidos en este estudio demuestran que el AQ20 es un cuestionario preciso de salud en los pacientes con obstruccion de la via respiratoria de grado moderado a intenso. Podria constituir una alternativa a los cuestionarios tradicionales mas complejos, como el SGRQ.

Introduction Patients with COPD have decreased exercise capacity and low oxygen consumption ( V ˙ o 2) during formal cardiopulmonary exercise testing, and lower scores on health-related quality of life questionnaires. When isolated, these three variables show different correlations with COPD mortality. The multidimensional BODE (body mass index[BMI], airflow obstruction, dyspnea, and exercise capacity in COPD) index, which comprises four variables including the 6-min walk test (6MWT), predicts survival in COPD. Objectives To evaluate the degree of association between the values of the BODE index using the 6MWT with the BODE index using maximal V ˙ o 2 ( V ˙ o 2max) obtained in a maximal incremental test. Materials and methods Fifty patients with mild-to-severe COPD (average age, 63.5 ± 9.9 years; FEV1, 65.3 ± 23.6% of predicted) [± SD] had BMI, spirometric function (FVC and FEV1), and dyspnea status (Medical Research Council) evaluated. Two BODE index scores were then completed: one with the 6MWT, and one with the V ˙ o 2max obtained during maximal incremental testing on a treadmill. Results Correlation between BODE index and V ˙ o 2 in milliliters per minute per kilogram (r = − 0.41) was weak; the correlation was moderate (r = − 0.64) when V ˙ o 2 percentage of predicted was used. The BODE index modified by replacing the 6MWT with V ˙ o 2 showed excellent correlations with V ˙ o 2 in milliliters per minute per kilogram (r = 0.92) and V ˙ o 2 percentage of predicted (r = 0.95). Conclusion The excellent correlation between the conventional BODE index and the modified BODE index with V ˙ o 2 replacing the 6MWT enables us to reach the conclusion that the original BODE index is very effective in the evaluation of COPD patients.

According to the Brazilian Constitution each and every Brazilian has the right to free healthcare. Approximately 40% of the population have taken out a private or company funded health care program. Brazil is the world’s largest producer of alcohol derived from sugar cane and the burning of the sugar cane leaves produces a large amount of fine and ultrafine particles what increases the relative risk of hospital admissions by children increases 3.5-fold due to respiratory diseases. Chronic obstructive pulmonary disease (COPD) ranks as the sixth greatest cause of death in Brazil, with a prevalence of 15.8% according to the fixed-ratio FEV1/FVC = 0.70 (PLATINO Study). The occurrence of wheezing in 13-14-year old children over the last 12 months was 20%, while asthma diagnosed by a doctor was at around 10% (ISAAC Study). Mortality from asthma has decreased from 2.2/100 000 in 1980 to 1.37 in 1996, with currently 2500 deaths/year. Smoking is decreasing in Brazil; 32.6% of the adult population were smokers in 1989 while in 2002, a randomized survey carried out in over 107 Brazilian cities with a population of 200 thousand or over showed that the smoking population over 35 years of age had decreased to 24% (17% of overall population). Approximately one-third of the Brazilian population has been infected by the tuberculosis bacillus and estimates agree that there are 116 000 new cases per year but that only 90 000 are reported. Furthermore Brazil is ranked 14th in the world in the number of tuberculosis cases and the 22nd in incidence. A Family Health Program was created in 1994 and in 2005 there were 24 600 Family Health Teams functioning in Brazil, covering a total of 4986 cities, corresponding to approximately 45% of the 180 million Brazilian population. In 2005 the total number of health community agents reached 208 000 and the investment in the Health Family Program was US$ 1.4 billion.

Objective: To determine the prevalence of alpha 1-antitrypsin (AAT) deficiency (AATD), as well as allele frequency, in COPD patients in Brazil. Methods: This was a cross-sectional study involving 926 COPD patients 40 years of age or older, from five Brazilian states. All patients underwent determination of AAT levels in dried blood spot (DBS) samples by nephelometry. Those with DBS AAT levels ≤ 2.64 mg/dL underwent determination of serum AAT levels. Those with serum AAT levels of < 113 mg/dL underwent genotyping. In case of conflicting results, SERPINA1 gene sequencing was performed. Results: Of the 926 COPD patients studied, 85 had DBS AAT levels ≤ 2.64 mg/dL, and 24 (2.6% of the study sample) had serum AAT levels of < 113 mg/dL. Genotype distribution in this subset of 24 patients was as follows: PI*MS, in 3 (12.5%); PI*MZ, in 13 (54.2%); PI*SZ, in 1 (4.2%); PI*SS, in 1 (4.2%); and PI*ZZ, in 6 (25.0%). In the sample as a whole, the overall prevalence of AATD was 2.8% and the prevalence of the PI*ZZ genotype (severe AATD) was 0.8% Conclusions: The prevalence of AATD in COPD patients in Brazil is similar to that found in most countries and reinforces the recommendation that AAT levels be measured in all COPD patients. RESUMO Objetivo: Determinar a prevalência da deficiência de alfa 1-antitripsina (AAT), bem como a frequência alélica, em pacientes com DPOC no Brasil. Métodos: Estudo transversal com 926 pacientes com DPOC, com 40 anos ou mais, oriundos de cinco estados brasileiros. Todos os pacientes foram submetidos a dosagem de AAT em amostras de sangue seco por meio de nefelometria. Aqueles em que a concentração de AAT no sangue seco foi ≤ 2,64 mg/dl foram submetidos a dosagem sérica de AAT. Aqueles em que a concentração sérica de AAT foi < 113 mg/dl foram submetidos a genotipagem. Quando os resultados foram discrepantes, foi realizado o sequenciamento do gene SERPINA1. Dos 926 pacientes com DPOC estudados, 85 apresentaram concentração de AAT em sangue seco ≤ 2,64 mg/dl, e 24 (2,6% da amostra) apresentaram concentração sérica de AAT < 113 mg/dl. A distribuição genotípica nesse subgrupo de 24 pacientes foi a seguinte: PI*MS, em 3 (12,5%); PI*MZ, em 13 (54,2%); PI*SZ, em 1 (4,2%); PI*SS, em 1 (4,2%); e PI*ZZ, em 6 (25,0%). Na amostra estudada, a prevalência global da deficiência de AAT foi de 2,8% e a prevalência do genótipo PI*ZZ (deficiência grave de AAT) foi de 0,8%. Conclusões: A prevalência da deficiência de AAT em pacientes com DPOC no Brasil é semelhante àquela encontrada na maioria dos países e reforça a recomendação de que se deve medir a concentração de AAT em todos pacientes com DPOC.

Introduction: Quality of life (QoL) evaluation is an important tool to understand COPD patients well-being and to adequately treat them. However there is no follow up study of QoL in a populational based sample. Objectives: to evaluate the QoL of individuals at Basal and Follow up (FU) of PLATINO Study, 6 to 9 years later, of 3 cities of Latin America (Sao Paulo, Montevideo, Santiago). Methods: All individuals performed a pre and post bronchodilator spirometry and answered the SF-12 QoL questionnaire at their homes. Results: The following percentage of individuals were contacted at the FU: Sao Paulo, 60.7% of Basal, Montevideo, 72.6% and Santiago, 75.7%. The mental domain (MCS) improved in Montevideo and Santiago (p=0.001) and did not change in Sao Paulo; the physical domain (PCS) worsened in Sao Paulo and Montevideo (p=0.001) but kept stable in Santiago. However, most individuals with score under 50 for both PCS and MCS showed a tendency to improve, while the ones with score ≥ 50 tended to keep stable or worsen. The COPD patients in Sao Paulo and Santiago had a low PCS ( Conclusion: Our results show that the PLATINO population tended to worsen the PCS and improve the MSC with no relation to gender. The COPD population showed the same results and there was no relation to disease severity.

Introduction: Not much is known about the contribution of upper limbs mass for the total muscle mass in COPD patients. Objectives: To identify the distribution of muscle mass in both upper (UL) and lower limbs (LL) of patients with COPD by dual energy X-ray absorptiometry (DXA)and correlate muscular strength with lean mass index (LMM). Methods: We evaluated 96 patients with COPD and 85 healthy elderly control group-CG, matched for age and sex. Lung function, body composition by DXA and muscle strength of UL and LL were measured. Results: Mean age of COPD was 66.8 (±9.3) and of CG 64.2 (±8.9) years (p=0.064), with a BMI of 27.2 (±5.1) and 29.4 (±4.5) kg/m 2 , respectively (p = 0.002). There was no difference in LMM between the two groups but fat mass was higher in CG in both UL and LL and trunk (p 2 for men and ≥ 5.45 kg/m 2 for women) was lower in men with COPD (7.8 kg/m 2 ±1.1) than in CG (8.4 kg/m 2 ±0.9) (p > 0.05); and was lower in the severe and more severe than in the milder and moderate COPD patients (7.5 vs 8.0 kg/m 2 for men and 6.1 vs 6.8 kg/m 2 for women, respectively). There was an association between LMM of the UL (r = 0.5) and LL (r = 0.6) with muscle strength. The specific UL strength for COPD was lower (0.012 ± 0.003 kgf/g of muscle)than for CG (0.013 ± 0.004 kgf/g of muscle) (p Conclusions: LMM and ALMI are decreased in patients with COPD as assessed by DXA, and the muscle loss increases with advancing disease. Specific muscle strength is reduced in UL of patients with COPD sarcopenic may exist in a low percentage in COPD patients.

Background: Patients with idiopathic pulmonary arterial hypertension (iPAH) have a poor exercise tolerance and frequently report limitations during domestic activities of daily life (ADLs). We hypothesize that patients with iPAH have a relatively higher task-related oxygen uptake, VE/VCO2 and dyspnoea perception during domestic ADLs than healthy subjects. Methods: Metabolic, ventilatory and cardiovascular responses were evaluated in 15 patients with iPAH and 9 sex and age-matched healthy subjects during 11 ADL. These data were assessed using a Oxycon Mobile device and compared with values obtained by cycle-ergometer incremental cardiopulmonary exercise test of upper and lower limbs and distance walked in six minute walk test. Borg scores were used to assess ADL related dyspnoea and fadigue. Results: iPAH patients used a significantly higher proportion of their peak aerobic capacity to perform ADLs when compared to healthy subjects, accompained by higher Borg dyspnea scores. Many ADLs were performed above the anaerobic threshold. Oxygen pulse was reduced in lower limb ADLs. The VE/VCO2 was higher in all ADLs. Conclusion: Patients with iPAH perform their ADLs above anaerobic threshold and very close to their peak aerobic capacity, accompanied by significantly high symptoms scores.

OBJETIVO: O proposito deste estudo foi validar em portugues as quatro versoes de questionarios de qualidade de vida em fibrose cistica, desenvolvidos para pacientes com fibrose cistica de 6 a 11 anos, de 12 a 13 e mais de 14 anos, e para os pais de pacientes de 6 a 13 anos. MATERIAL E METODOS: A validacao das quatro versoes de questionarios de qualidade de vida em fibrose cistica (de 35 e 50 questoes, abrangendo nove dominios) constou de: versao ingles-portugues, aplicacao-piloto, traducao retrograda e aprovacao da autora da versao inglesa. As quatro versoes foram aplicadas a 90 pacientes estaveis (30 de cada grupo etario) e aos pais de doentes de 6-13 anos (n = 60), em duas entrevistas, com intervalo de 13-17 dias. Foi avaliada a reprodutibilidade pelo coeficiente de correlacao intraclasse (CCI). O estudo foi aprovado pela comissao de etica em pesquisa da instituicao. RESULTADOS: A reprodutibilidade foi boa (CCI = 0,62 a 0,99) para as quatro versoes, em todos os dominios, exceto o digestivo (CCI = 0,59 e CCI = 0,47) para os grupos etarios de 6 a 11 e 12 a 13 anos, respectivamente, e dominio papel social (CCI = -0,19 ) para o grupo acima de 14 anos. CONCLUSAO: A traducao e a adaptacao a lingua e a cultura brasileiras das quatro versoes de questionarios de qualidade de vida em fibrose cistica mostraram-se de facil entendimento e boa reprodutibilidade.