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© The Author(s) 2019, The lung is a complex ecosystem of host cells and microbes often disrupted in pathological conditions. Although bacteria have been hypothesized as agents of carcinogenesis, little is known about microbiota profile of the most prevalent cancer subtypes: adenocarcinoma (ADC) and squamous cell carcinoma (SCC). To characterize lung cancer (LC) microbiota a first a screening was performed through a pooled sequencing approach of 16S ribosomal RNA gene (V3-V6) using a total of 103 bronchoalveaolar lavage fluid samples. Then, identified taxa were used to inspect 1009 cases from The Cancer Genome Atlas and to annotate tumor unmapped RNAseq reads. Microbial diversity was analyzed per cancer subtype, history of cigarette smoking and airflow obstruction, among other clinical data. We show that LC microbiota is enriched in Proteobacteria and more diverse in SCC than ADC, particularly in males and heavier smokers. High frequencies of Proteobacteria were found to discriminate a major cluster, further subdivided into well-defined communities' associated with either ADC or SCC. Here, a SCC subcluster differing from other cases by a worse survival was correlated with several Enterobacteriaceae. Overall, this study provides first evidence for a correlation between lung microbiota and cancer subtype and for its influence on patient life expectancy., IPATIMUP integrates the i3S Research Unit, which is partially supported by the Portuguese Foundation for Science and Technology (FCT). Tis work was supported by the Portuguese Foundation for Science and Technology (FCT), fnanced by the European Social Funds (COMPETE-FEDER) and National Funds through the FCT (projects PEstC/SAU/LA0003/2013 and POCI-01-0145-FEDER-007274, fellowships SFRH/BPD/77646/2011 and SFRH/ BPD/120777/2016 to S.G. and P.I.M., respectively, grant PTDC/BEXGMG/0242/2012 to S.S. and by Programa Operacional Regional do Norte (ON.2 – O Novo Norte and Norte 2020), through FEDER funds under the Quadro de Referência Estratégico Nacional (QREN; projects NORTE-07-0162-FEDER-00018 and NORTE070162-FEDER-000067, and NORTE-01-0145-FEDER-000029)

If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios.We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23.A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure.Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience. Keywords: Pleuroscopy, Pleural effusion, Pleural biopsies, Interventional pulmonology

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/., The lung is inhabited by a diverse microbiome that originates from the oropharynx by a mechanism of micro-aspiration. Its bacterial biomass is usually low; however, this condition shifts in lung cancer (LC), chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). These chronic lung disorders (CLD) may coexist in the same patient as comorbidities and share common risk factors, among which the microbiome is included. We characterized the microbiome of 106 bronchoalveolar lavages. Samples were initially subdivided into cancer and non-cancer and high-throughput sequenced for the 16S rRNA gene. Additionally, we used a cohort of 25 CLD patients where crossed comorbidities were excluded. Firmicutes, Proteobacteria and Bacteroidetes were the most prevalent phyla independently of the analyzed group. Streptococcus and Prevotella were associated with LC and Haemophilus was enhanced in COPD versus ILD. Although no significant discrepancies in microbial diversity were observed between cancer and non-cancer samples, statistical tests suggested a gradient across CLD where COPD and ILD displayed the highest and lowest alpha diversities, respectively. Moreover, COPD and ILD were separated in two clusters by the unweighted UniFrac distance (P value = 0.0068). Our results support the association of Streptoccocus and Prevotella with LC and of Haemophilus with COPD, and advocate for specific CLD signatures., This work was supported by Norte Portugal Regional Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)—project NORTE-01-0145-FEDER-000029. This work was also financed by FEDER funds through COMPETE 2020 (Operacional Programme for Competitiveness and Internationalization— POCI) and by private funds through the Young Investigator Prize Francisco Augusto da Fonseca Dias and Maria José Melenas da Fonseca Dias to P.I.M. FCT supports P.I.M. through a post-doctoral fellowship (SFRH/BPD/120777/2016), financed by the Portuguese State Budget of the Ministry for Science, Technology and High Education and from the European Social Fund (Programa Operacional do Capital Humano—POCH). M.P-L was partially supported by FCT under the Programa Operacional Potencial Humano—Quadro de Referência Estratégico Nacional funds from the European Social Fund and Portuguese State Budget of the Ministry for Science, Technology and High Education (IF/00764/2013; RX: IF/00359/2015).

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© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)., Acellular bronchoalveolar lavage (BAL) proteomics can partially separate lung cancer from non-lung cancer patients based on principal component analysis and multivariate analysis. Furthermore, the variance in the proteomics data sets is correlated mainly with lung cancer status and, to a lesser extent, smoking status and gender. Despite these advances BAL small and large extracellular vehicles (EVs) proteomes reveal aberrant protein expression in paracrine signaling mechanisms in cancer initiation and progression. We consequently present a case-control study of 24 bronchoalveolar lavage extracellular vesicle samples which were analyzed by state-of-the-art liquid chromatography-mass spectrometry (LC-MS). We obtained evidence that BAL EVs proteome complexity correlated with lung cancer stage 4 and mortality within two years´ follow-up (p value = 0.006). The potential therapeutic target DNMT3B complex is significantly up-regulated in tumor tissue and BAL EVs. The computational analysis of the immune and fibroblast cell markers in EVs suggests that patients who deceased within the follow-up period display higher marker expression indicative of innate immune and fibroblast cells (four out of five cases). This study provides insights into the proteome content of BAL EVs and their correlation to clinical outcomes., R.M. is supported by Fundação para a Ciência e a Tecnologia (CEEC position, 2019–2025 investigator).This article is a result of the projects (iNOVA4Health—UID/Multi/04462/2013), supported by Lisboa PortugalRegional Operational Programme (Lisboa2020), under the PORTUGAL 2020 Partnership Agreement, through theEuropean Regional Development Fund (ERDF). This work is also funded by FEDER funds through the COMPETE2020 Programme and National Funds through FCT—Portuguese Foundation for Science and Technology underthe projects number PTDC/BTM-TEC/30087/2017 and PTDC/BTM-TEC/30088/2017. This work was supported bythe Wellcome Trust/DBT India Alliance Margdarshi Fellowship (grant number IA/M/15/1/502023) awarded to A.P.B.C.-S., M.C.S.C. and C.B. are supported by the Champalimaud Foundation and the EMBO Installation Grant 3921

Introduction: Combining adenosine deaminase (ADA) and lymphocyte-neutrophil ratio (LNR) in pleural fluid (PF) has been shown to help differentiate exudates of tuberculous origin from others, in countries with a high prevelance of tuberculosis (TB). Since 2016 the incidence of TB in Portugal has decreased to less than 20/100.000 inhabitants, which may alter the cut-off value of these 2 markers and the usefulness of both. Aims: To ascertain the best possible cut-off value for PF ADA and LNR in pleural TB and the value of combining both markers. Methods: We conducted a cross sectional retrospective study based on the consultation of the clinical records of all patients who performed PF ADA (November 2016 to December 2018). Transudative and repeated samples were excluded. ROC curve was calculated considering a significance of 5%, and test characteristics: sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Results: From a total of 200 patients, 136 were included. Patients were mainly male (60.3%); mean age of 70.4 (±15.65) years. Of total, 10 had a final diagnosis of pleural TB; 54 infectious; 45 malignant; 27 other diagnosis. Area under ROC curve was 0.808 for a cut-off value of ADA of ≥ 24.9 U/L [S 70%; E 87% (p 2.85 [S 100%; E 43% (p Conclusions: In our sample a newer and lower cut-off value of PF ADA of 24.9U/L would have a stronger power for diagnosing pleural TB. Combining both markers was only useful to exclude the disease.

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel SARS-CoV-2 pathogen. Its capacity for human-to-human transmission through respiratory droplets, coupled with a high-level of population mobility, has resulted in a rapid dissemination worldwide. Healthcare workers have been particularly exposed to the risk of infection and represent a significant proportion of COVID-19 cases in the worst affected regions of Europe. Like other open airway procedures or aerosol-generating procedures, bronchoscopy poses a significant risk of spreading contaminated droplets, and medical workers must adapt the procedures to ensure safety of both patients and staff. Several recommendation documents were published at the beginning of the pandemic, but as the situation evolves, our thoughts should not only focus on the present, but should also reflect on how we are going to deal with the presence of the virus in the community until there is a vaccine or specific treatment available. It is in this sense that this document aims to guide interventional pulmonology throughout this period, providing a set of recommendations on how to perform bronchoscopy or pleural procedures safely and efficiently. info:eu-repo/semantics/publishedVersion

Introduction: Pneumococcal vaccination (PV) is generally recommended for chronic respiratory patients (CRP). Data on real life compliance is scarce and heterogeneous, but usually unveils an overall low adherence to PV1. Aims: To ascertain whether PV is beneficial in the occurrence and severity of respiratory infections (RI) in CRP. Methods: We conducted a prospective cohort study of CRP that attended our pulmonary outpatient clinic from October 2017 to February 2018 and had previously participated in our survey1. A 12-month follow up of this cohort was made to evaluate the presence of RI. From those infected, Fisher’s test was used to compare the percentage of vaccinated and unvaccinated patients in the outcomes of hospitalization, use of antibiotics (AB) and death. Results: From the total of 201 in the survey, 199 patients were included in this cohort. Mainly men (59.8%), 65.4 (SD=15.2) years, 8% current smokers and 37% former smokers, 82% with low educational status. Major diagnosis were asthma (31.7%) and COPD (29.1%). PV coverage increased 15.4% in a year, currently 57·8%. Globally, 34.2% (n=68) of this cohort had any kind of RI occurring more frequently in vaccinated (41.8% v (27.5%, p=0,042) patients. Comparing both groups we found that a similar use of AB (100% v 97.8%, p=1.00), but lesser hospitalizations (37.0% v 50.0%, p=0.307) and lesser deaths (4.3% v 18.2%, p=0.081) were reported in vaccinated as opposed to unvaccinated CRP. Conclusions: In this year follow up, PV had already a beneficial impact in decreasing the severity of RI in CRP. Reference: 1. Martins RN, Vaz LR. Influenza and Pneumococcal Vaccination in Chronic Respiratory Patients-Are We in the Right Path?. Arch bronconeumol. 2019 Jan

Introduction: Pulmonary rehabilitation (PR) is regarded as a standard of care for most chronic respiratory patients (CRP). Differences in PR programs (PRP) specifications and outcomes for both Interstitial Lung Disease (ILD) and chronic obstructive pulmonary disease (COPD) are still under investigation. Aim: To ascertain the differences in the operational characteristics and the outcomes obtained with PRP in ILD and COPD patients. Material and methods: Observational retrospective study of CRP who completed PRP in our unit (Jan2017-Feb2019). PRP was hospital based and combined supervised exercise training and educational intervention, twice weekly for ≥ 8 weeks. Patients were grouped (ILD or COPD) and comparison of baseline characteristics, PRP overall duration and final outcomes were made, using Chi-square and non-parametric (Mann-Whitney and Wilcoxon) tests for a level of significance of 5%. Results: A total of 22 patients were included (13 COPD v 9 ILD). Both groups had similar characteristics: male sex (76.9% v 100%); median age of 64 [35-74] and 66 [51-75] years, baseline dyspnea (mMRC 3 v 2.5) and quality of life (SGRQ 64.20 v 44.96) scores; functional capacity (mean 6 minute Walk Test distance 372.7 v 416.8 meters); anxiety (median 8 v 9) and depression (both median 9) symptoms. ILD patients completed an overall higher number of sessions (mean 15.3 v 19.4). Final outcomes were similar in both groups but ILD surpassed COPD patients in final Borg dyspnea scale assessment (p=0.040) and improvement in anxiety symptoms (p=0.012). Conclusion: In our sample PRP was equally beneficial for COPD and ILD patients, though ILD patients had benefited in symptoms from longer programs.

The lung is a complex ecosystem of host cells and microbes often disrupted in airway disorders, such as chronic obstructive pulmonary disease (COPD). Although bacteria have been hypothesized as agents of carcinogenesis, little is known about the microbiota profile of NSCLC and common histological subtypes: adenocarcinoma (ADC) and squamous cell carcinoma (SCC); or the impact of COPD comorbidity in its composition. To fill this gap, we performed a wide characterization of lung microbiota using a pooled sequencing approach of 16S ribosomal RNA gene, covering a total of 103 bronchoalveaolar lavage samples. Next, identified taxa were used to guide the surveying of 509 ADC and 500 SCC tumor samples from The Cancer Genome Atlas and the annotation of unmapped RNAseq reads. In the analysis of microbial data several clinical variables were considered along with cancer subtype, namely history of cigarette smoking and airflow obstruction, affected lung region and gender. Globally, we showed that NSCLC microbiota is enriched in Proteobacteria and more diverse in SCC than ADC, particularly in males and heavier smokers. Tumor localization and cancer stage had no effect in microbiota diversity. High frequencies of Proteobacteria were found to discriminate a major cluster of NSCLC cases, which could be further subdivided into two well-defined bacterial communities associated with either ADC or SCC (Fig.1). Here, the SCC group was found to diverge from other cases by a worse patient survival and to be defined by Enterobacteriaceae and Achromobacter, correlated also with COPD. This study provides evidence for a link between lung microbiota and NSCLC subtypes and for its influence on patient life expectancy.

Introduction: Exertional dyspnea (ED) is a common symptom throughout the course of interstitial lung diseases (ILD). The pathophysiology behind this symptom can pertain to impairments in cardiovascular, peripheral muscle or respiratory systems. Aim: To evaluate the clinical utility of cardiopulmonary exercise testing (CPET) in the assessment of ED in ILD patients. Material and Methods: Retrospective study conducted within our ILD outpatient clinic. Clinical records (January 2015 - December 2017) were reviewed and data regarding demographics, modified Medical Research Council dyspnea scale scores, pulmonary function tests (PFT) and CPET results were retrieved. Results: From a total of 187 patients we included 19 (10.2%) that underwent CPET for the study of ED. Patients were mainly male (74%) with an average age of 54 years. Silicosis (37%), sarcoidosis (26%) and systemic vasculitis (26%) were the most frequent diagnosis. Baseline PFTs were normal (63%) or revealed only mild obstructive (26%) or restrictive (11%) patterns. DLCO was slightly decreased in 26% of patients. In all cases ED was considered out of proportion to the PFTs results. A cyclo-ergometer incremental protocol CPET was performed and considered normal in 32%; 26% presented respiratory limitation and 32% peripheral muscle deconditioning. On average the VO2 was 82.6%, the mean ventilatory reserve was 35L/min, the anaerobic threshold (AT) was 46.7%, VE/VCO2 at AT was 32.3% and the peak P(A-a)O2 was 20mmHg. Conclusions: CPET proved a valuable tool in detailing the pathophysiology of ED in our ILD patients. Peripheral muscle deconditioning was a frequent finding that would have otherwise remained unaddressed.

© The Author(s) 2017. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/, Lung cancer configures as one of the deadliest types of cancer. The future implementation of early screening methods such as exhaled breath condensate analysis and low dose computed tomography (CT) as an alternative to current chest imaging based screening will lead to an increased burden on bronchoscopy units. New approaches for improvement of diagnosis in bronchoscopy units, regarding patient management, are likely to have clinical impact in the future. Diagnostic approaches to address mortality of lung cancer include improved early detection and stratification of the cancers according to its prognosis and further response to drug treatment. In this study, we performed a detailed mass spectrometry based proteome analysis of acellular bronchoalveolar lavage (BAL) fluid samples on an observational prospective cohort consisting of 90 suspected lung cancer cases which were followed during two years. The thirteen new lung cancer cases diagnosed during the follow up time period clustered, based on liquid chromatography-mass spectrometry (LC-MS) data, with lung cancer cases at the time of BAL collection. Hundred and thirty-tree potential biomarkers were identified showing significantly differential expression when comparing lung cancer versus non-lung cancer. The regulated biomarkers showed a large overlap with biomarkers detected in tissue samples., All experiments including MS analysis were supported by Fundação para a Ciência e Tecnologia project EXPL/DTP-PIC/0616/2013. RM is supported by FCT investigator program 2012 (IF/01002/2012). ASC is supported by grant SFRH/BPD/85569/2012 funded by Fundação para a Ciência e Tecnologia.

Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal lymphoma arising in a number of epithelial tissues, including stomach, salivary gland and the lung. Pulmonary MALT lymphoma originates in the parenchyma and/or bronchi and is a rare disease, representing 0.5-1% of primary pulmonary malignancies. Although the time to diagnosis can be delayed because most patients are asymptomatic and investigations are usually driven by the accidental finding of abnormal lung imaging studies, it has an indolent course and a good prognosis. Here we report the case of an asymptomatic female patient with a nodular lung opacity that was found to persist five months after an episode of community-acquired pneumonia. A final diagnosis of pulmonary MALT lymphoma was obtained after an extensive diagnostic work-up. RESUMO: O linfoma do tecido linfóide associado à mucosa (MALT) é um linfoma extranodal que surge em vários tecidos epiteliais, incluindo o estômago, as glândulas salivares e o pulmão. O linfoma MALT pulmonar tem origem no parênquima e/ou brônquios e é raro, representando 0.5-1% dos tumors primários do pulmão. Pode haver um atraso no tempo até ao diagnóstico porque a maioria dos pacientes é assintomática, sendo as investigações geralmente conduzidas pelo achado acidental de exames de imagem pulmonares alterados. Este linfoma tem um curso indolente e um bom prognóstico. Aqui expomos o caso de uma paciente assintomática com uma opacidade nodular que persistiu 5 meses após um episódio de pneumonia adquirida na comunidade. O diagnóstico final de linfoma MALT pulmonar foi obtido após uma investigação diagnóstica extensa.

EnglishIntroduction: The triad of symptoms: dyspnea, cough and wheezing directs the clinician to the diagnosis of asthma. The same set of symptoms can be observed in a wide range of other disease entities. Case report: Authors report the case of a 65 years old female with dyspnea, wheezing and cough over the last 6 months. Physical exam, aside from bilateral wheezing, was normal. Chest X-ray revealed bilateral increased interstitial markings. Pulmonary function testing showed obstructive syndrome with positive bronchodilator test. Asthma diagnosis was ascertained and treatment was started with inhaled budesonide/formoterol. At three month follow-up, the patient was still referring daily respiratory symptoms. Chest computed tomography revealed an endobronchial mass at the entrance of the left main bronchus near the carina, confirmed by fiberoptic bronchoscopic. Biopsy of this lesion showed an adenoid cystic carcinoma (ACC). Discussion: ACC is a variant of adenocarcinoma with rare pulmonary occurrence, probably originated from tracheobronchial mucosa. Symptoms usually include dyspnoea with wheezing and cough, leading to the equivocal diagnosis of asthma. The preferred therapeutic option is surgical resection. Lesions have slow growth and infiltrative behavior, with frequent local recurrence. Nevertheless, prognosis is good. portuguesIntroducao: A triade de sintomas dispneia, tosse e pieira direcciona o clinico para o diagnostico de asma. O mesmo conjunto de sintomas pode observar-se num amplo espectro de outras entidades nosologicas. Caso clinico: Os autores descrevem o caso de uma doente de 65 anos, com dispneia, pieira e tosse com 6 meses de evolucao. O exame fisico,exceptuando sibilos dispersos, era normal. A radiografia de torax mostrava reforco peribroncovascular bilateral e o estudo funcional respiratorio padrao obstrutivo com prova de broncodilatacao positiva. Estabelecido o diagnostico de asma e iniciada terapeutica com associacao de budesonido/ formoterol inalado. Apos tres meses mantinha dispneia, pieira e tosse diaria. Na TC toracica identificou-se lesao endobronquica na carina/ bronquio principal esquerdo, confirmada por broncofibroscopia. O exame histologico revelou tratar-se de carcinoma adenoide quistico (CAQ). Discussao: O CAQ e uma variante do adenocarcinoma de ocorrencia pulmonar rara, com origem na mucosa traqueobronquica e localizacao frequentemente central. O sintoma de apresentacao mais comum e a dispneia associada a sibilância, pieira e tosse, frequentemente interpretados como asma. A terapeutica de eleicao e a exerese total. Tem um comportamento infiltrativo e crescimento lento, com recidivas locais frequentes, mas habitualmente com bom prognostico.

Introduction: The 6-minute walk test9s (6MWT) is widely used in patients with chronic respiratory disorders (CRD) referred to Pulmonary Rehabilitation Programs (PRP). Recent recommendations (Holland, A.E. et al . Eur Respir J 2014; 44: 1428–1446) address the need to perform two consecutive measures to avoid the bias of learning effect (LE). Aims: To evaluate the LE in a population of patients with CRD referred to our PRP. Methods: Prospective study conducted over one year, including patients with CRD referred to PRP. Each patient performed two 6MWT separated by 30 minutes at the beginning of PRP. Output measures included: walked distance (WD), respiratory frequency (RF), heart rate (HR), peripheral oxygen saturation (SpO2) and perception of muscle fatigue and dyspnea by Borg modified scale (BMS). Results: 21 patients were included, all male, with mean age of 67 years, mainly with diagnosis of CPOD (19 patients). 9 patients had taken the 6MWT previously (with a time gap higher than 6 months from this study). Comparing the first to the second test: WD was 422,52m VS 427,10m (p=0,657). The lower SpO2 was 82,33% VS 83,48% (p=0,299). The higher HR was 105,95bpm VS 102,62bpm (p=0,177). Final BMS for dyspnea was 4 VS 3 (p=0,666); final BMS for muscle fatigue was 3 VS 4 (p=0,266). Only 9 patients improved their WD between the two measures (34 m +- 39). Conclusions: Despite the small sample size, our results are contradictory to those previously published. The heterogeneity of our sample and the fact that most patients had performed the test previously may provide some explanations. Though preliminary these results raise the question whether it is necessary to repeat the test in this setting.

Introduction: COPD and asthma affect almost 300 million individuals worldwide. Inhaled therapy is often associated with technical errors reducing efficacy and compliance. Objective: To assess the impact of teaching the inhalation technique in clinical and functional control of Asthma and COPD. Methods: Inhalation was evaluated in 4 steps: previous expiration, device activation, forced inspiration and end inspiratory pause. Clinical control was measured through Asthma Control Test (ACT), Control of Allergic Rhinitis and Asthma Test (CARAT), modified Medical Research Council and COPD Assessment Test. Pulmonary function tests were performed in all patients. After the first visit patients were educated on correct use of their devices using repeated placebo devices manipulation and visual support material. They were reevaluated 6 to 8 months later. Results: 44 participants were included. Overall there was a significant decrease in the number of performed errors (average 0.7) (p Conclusions: Inhalation technique education improves its performance, leading to an improvement in clinical and functional control in Asthma. These findings were not reproduced in the COPD group, which may reflect its physiopathological hallmark of irreversible obstruction.

Chronic obstructive pulmonary disease and asthma affect almost 300 million individuals. Inhaled therapy is often associated with technical errors reducing efficacy and compliance.To evaluate the inhalation technique and its relation with clinical and functional control in asthma and chronic obstructive pulmonary disease.Analytical cross-sectional study including patients with asthma and chronic obstructive pulmonary disease treated with any type of inhaler device. Demographic data and inquiry about previous teaching of inhalation technique were collected in all participants. Inhalation technique was evaluated in: Step 1 - device activation; Step 2 - previous expiration; Step 3 - inspiration; Step 4 - end inspiratory pause. Clinical control was assessed from the questionnaires Asthma Control Test, Control of Allergic Rhinitis and Asthma Test, modified Medical Research Council and Chronic Obstructive Pulmonary Disease Assessment Test. Spirometric evaluation was performed in all participants.From a total of 62 subjects, 74.19% made at least one error, mainly during step 2 (53.2%). Previous education on inhalation technique was associated with lower number of errors (p = 0.014). There was no association between number of errors and age (p = 0.321), years of diagnosis (p = 0.119) or spirometric evaluation (p0.05). In asthma an association was found between number of errors and Asthma Control Test (p = 0.032) and Control of Allergic Rhinitis and Asthma Test (p = 0.008).Teaching inhalation technique has a positive impact on its future performance. Most patients make mistakes, affecting clinical control in asthma, although in chronic obstructive pulmonary disease no relation was found. This is an ongoing work that aims to reevaluate inhalation technique after patients' education and its further impact.Introdução: A doença pulmonar obstrutiva crónica e a asma afectam quase 300 milhões de indivíduos em todo o mundo. A terapêutica inalatória associa-se frequentemente a erros na técnica realizada reduzindo a eficácia e adesão.Objectivo: Avaliar a técnica inalatória e sua relação com o controlo clínico e funcional em asma e doença pulmonar obstrutiva crónica. Material e Métodos: Estudo transversal analítico incluindo doentes com asma e doença pulmonar obstrutiva crónica medicados com dispositivos inalatórios. Recolheram-se dados demográficos e existência de ensino prévio da técnica. Avaliou-se a técnica inalatória em: Passo 1 - expiração prévia; Passo 2 - activação do dispositivo; Passo 3 - inspiração; Passo 4 - apneia final. O controlo clínico avaliou-se com os questionários Asthma Control Test, Control of Allergic Rhinitis and Asthma Test, modified Medical Research Council e Chronic Obstructive Pulmonary Disease Assessment Test. Todos os participantes realizaram avaliação espirométrica. Resultados: Obtiveram-se 62 participantes, dos quais 74,19% cometeram pelo menos um erro na inalação, principalmente na expiração prévia (53,2%). A existência prévia de ensino da técnica associou-se a menor n'º de erros (p = 0,014). Não houve associação entre n'º de erros e idade (p = 0,321), n'º de anos de diagnóstico (p = 0,119) ou avaliação espirométrica (p0,05). Na asma encontrou-se associação entre menor número de erros e Asthma Control Test (p = 0,032) e Control of Allergic Rhinitis and Asthma Test (p = 0,008). Discussão e Conclusão: O ensino da técnica inalatória melhora o seu desempenho futuro. A maioria dos doentes comete erros afectando o controlo clínico na asma, apesar de na doença pulmonar obstrutiva crónica não se verificar nenhuma associação. Este trabalho encontra-se a decorrer procurando reavaliar os doentes após o ensino da técnica e verificar o seu impacto subsequente.